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4368 Federal Register/Vol. 87, No. 18/Thursday, January 27, 2022/Rules and Regulations
<br /> For workers that are also caregivers illness or hospitalization due to COVID— Treasury Response:Treasury agrees
<br /> for children, seniors, or other family 19 had increased the negative economic that loss of health insurance,increased
<br /> members,there may be a similar need impacts of lacking health insurance. financial risk from lacking health
<br /> for—and benefits of—paid family leave. Background:In 2019,prior to the insurance, or excessive out-of-pocket
<br /> For example, some workers may have pandemic,it was estimated that 11 healthcare costs constitute negative
<br /> struggled during the pandemic to percent of nonelderly adults lacked economic impacts of the pandemic.
<br /> balance caring for children,as schools health insurance.166 By mid-2020,job Under the final rule,programs or
<br /> and daycares closed,and working.For loss had resulted in an estimated 3.3 services to expand access to health
<br /> new parents,paid parental leave results million people losing their employer insurance coverage are an enumerated
<br /> in fewer infant hospitalizations, sponsored insurance,resulting in an eligible use as assistance to households,
<br /> lowering parental stress,increasing additional 2 million uninsured for example,subsidies for health
<br /> parental involvement, and improving adults.167 Participation in Medicaid,the insurance premiums or expansion of a
<br /> the overall health of parent and child.160 Children's Health Insurance Program recipient's health insurance plan to
<br /> COVID-19 has also increased the levels (CHIP), and the Affordable Care Act cover additional employees who
<br /> of"caregiving intensity"161 and (ACA)marketplace played an important currently lack coverage.
<br /> "caregiving burden"162 for those role in minimizing the number of 13. Services for the unbanked and
<br /> providing care to seniors or older family people who completely lost health underbanked.
<br /> members.163 164 When surveyed,more insurance during the early phases of the Public Comment:One commenter
<br /> than half of caregivers reported that pandemic;Medicaid and CHIP expressed support for the inclusion of
<br /> COVID-19 increased both the amount of enrollment increased by 9 percent from services to increase banking access as an
<br /> caregiving responsibilities they had as February to September 2020168 and 8.3 allowable expense under SLFRF. The
<br /> well as the negative physical and mental million people enrolled in insurance commenter recommended that states be
<br /> impacts their caregiving responsibilities through the ACA marketplace.169 encouraged to offer opportunities for
<br /> had on themselves.165 Although the ACA,CHIP,and consumers to open safe and affordable
<br /> Treasury Response:Treasury agrees Medicaid have significantly reduced the accounts capable of receiving direct
<br /> that these constitute impacts of the number of uninsured Americans payments. The commenter emphasized
<br /> pandemic,and accordingly,under the through the pandemic and the economic that allowing unbanked and
<br /> final rule, creating, expanding, or downturn,adequate coverage and underbanked households to receive
<br /> financially supporting paid sick, affordability still remains an issue for funds securely through no-fee, direct
<br /> medical,or family leave programs is an many.In 2020, 21 percent of working- deposit will help connect or reconnect
<br /> enumerated eligible use of funds to age adults were inadequately insured, consumers to the mainstream financial
<br /> respond to the negative economic meaning even if they had insurance, system.
<br /> impacts of the pandemic. they incurred a significant amount of Background:Banking inequities can
<br /> 12.Health insurance. out-of-pocket costs. Additionally, 37 make it difficult for unbanked or
<br /> Public Comment:Several commenters percent of adults reported struggling underbanked households to access
<br /> recommended that uses of funds to with medical bills or medical debt and housing,jobs,and other important
<br /> expand access to health insurance be 71 percent of adults who did not economic opportunities. Being
<br /> enumerated eligible uses; commenters purchase insurance cited affordability as unbanked or underbanked can also
<br /> believed that the heightened risk of the main factor.171 make it challenging for households to
<br /> apply for and receive financial
<br /> 159 U.S.Bureau of Labor Statistics,Employee 166 Jennifer Tolbert et al.,Key Facts about the assistance, including services like
<br /> Benefits in the United States(March 2019),https:// Uninsured Population,Kaiser Family Foundation
<br /> www.bls.gov/ncs/ebs/benefits/2019/ownership/ (November 6,2020),https://www.kff.org/uninsured/ pandemic emergency housing
<br /> civilianitable31a.pdf. issue-brief/key facts-about-the-uninsured- assistance.
<br /> 160 Maya Rossin-Slater et al.,Local exposure to population/. Safe, affordable,and accessible
<br /> school use,antidepressant antid youth d an shootings e 167 Joshua Aarons et.al.,As the COVID-19
<br /> g y p financial services play a critical role in
<br /> Proceedings of the National Academy of Sciences, assisting households in the United
<br /> vol 117(38),pages 23484-23489(2020),https:// Than 3 Million Adults Lost Employer-Sponsored g
<br /> www.pnas.org/content/l17138123484;Ariel Marek Health Insurance Coverage and 2 Million Became States in managing income volatility
<br /> Pihl and Gaetano Basso,Did California Paid Family Uninsured,Urban Institute(September 18,2020), and cash flow shortages.172 Currently,
<br /> Leave Impact Infant Health?,Journal of Policy https://www.urban.org/research/publication/covid-
<br /> over 5ercent of families, or 7 million
<br /> Analysis and Management,https://onlinelibrary. 19-recession-extended-summer-2020-more-3- p <<
<br /> wiley.com/doi/abs/l0.1002/pam.2210. million-adults-lost-employer-sponsored-health- households are unbanked, meaning
<br /> 161 J.C.Jacobs,A.Laporte,C.H.Van Houtven,P.C. insurance-coverage-and-2-million-became- they do not have a bank account.173
<br /> Coyte,Caregiving intensity and retirement status in uninsured. Low-income households,non-white
<br /> Canada.Social Science&Medicine,102,74-82 168 Centers for Medicare and Medicaid Services, households,and households with
<br /> (2014),https://www.sciencedirect.com/science/ Medicaid and CHIP Enrollment Trends Snapshot
<br /> article/abs/pii/S0277953613006631. through September 2020(Washington:2021), individuals with disabilities were even
<br /> available at https://www.medicaid.govlsitesl more likely to be unbanked. In 2019 16
<br /> 16z E.Lightfoot,R.P.Moone,caregiving in times default/files/2021-01/september-medicaid-chip- '
<br /> of uncertainty:Helping adult children of aging enrollment-trend-ill spt embf. percent of Native American households,
<br /> parents find support during the COVID-19 169 Centers for Medicare and Medicaid Services, 14 percent of Black households,and 12
<br /> outbreak,Journal of Gerontological Social Work, 2021 Federal Health Insurance Exchange Weekly percent of Hispanic households were
<br /> 63(6-7),542-552(2020),https://www.tandfon Enrollment Snapshot:Final Snapshot(January 12, unbanked, compared to 2.5 percent of
<br /> line.com/doi/abs/10.1080/01634372.2020.1769793. 2021)available at https://WWW.cros.gov/newsroom/
<br /> 163 Note:"caregiving intensity"is defined as the fact-sheets/2021 federal-health-insurance- White households. Additionally,
<br /> amount and type of care provided by informal exchange-weekly-enrollment-snapshot-final-
<br /> caregivers;"Caregiving burden"is defined as the snapshot. 172 Federal Deposit Insurance Corporation,FDIC
<br /> impacts on physical and mental health,and health- 170 Sara R.Collins,Munira Z.Gunja,and National Survey of Unbanked and Underbanked
<br /> related quality of life of informal caregivers. Gabriella N.Aboulafia,U.S.Health Insurance Households(2015),https://www.fdic.gov/household
<br /> 164 SA Cohen,ZJ Kunicki,MM Drohan,ML Coverage in 2020:A Looming Crisis in Affordability survey/2015/2015execsumm.pdf.
<br /> Greaney,Exploring Changes in Caregiver Burden (New York:Commonwealth Fund,2020),available 173 Federal Deposit Insurance Corporation,How
<br /> and Caregiving Intensity due to COVID-19, at https://www.commonwealthfund.orgl America Banks:Household Use of Banking and
<br /> Gerontology and Geriatric Medicine(January 2021), publications/issue-briefsl2020/aug/looming-crisis- Financial Services 2019 FDIC Survey,https://
<br /> doi:10.1177/2333721421999279. health-coverage-2020-biennial. www.fdic.gov/analysis/household-survey/
<br /> 165Id. 171Id. 2019report.pdf.
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