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Harris wants to forgive medical debt for millions of Americans

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Vice President Kamala Harris addresses the Democratic National Convention at the United Center in Chicago on Aug. 19, 2024.

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Vice President Kamala Harris wants to forgive medical debt for millions of Americans.

The economic plan Harris rolled out last week notes that the Democratic presidential nominee and her running mate, Minnesota Gov. Tim Walz, would work with states to relieve people of their medical debt and “to help them avoid accumulating such debt in the future, because no one should go bankrupt just because they had the misfortune of becoming sick or hurt.”

Some 15 million Americans have medical bills on their credit reports, according to Consumer Financial Protection Bureau research published in April. People in the U.S. owe at least $220 billion in medical debt, a February KFF analysis found.

“Medical debt affects an enormous number of people, so it’s an issue that resonates with voters,” said Larry Levitt, executive vice president for health policy at KFF.

How medical debt became normal in the U.S.

Indeed, 51% of adults say it is extremely or very important for the federal government to forgive medical debt, compared with 39% who said the same about student loan debt, according to a May poll conducted by the University of Chicago Harris School of Public Policy and The Associated Press-NORC Center for Public Affairs Research. The groups surveyed 1,309 adults.

“Vice President Harris may see student loan forgiveness and medical debt forgiveness as both addressing inequities that prevent people from achieving the American dream,” said higher education expert Mark Kantrowitz.

The Harris campaign did not respond to a request for comment.

Former President Donald Trump hasn’t come out with a medical debt cancellation proposal, but as president he pushed for more price transparency for patients and to curb surprise medical bills.

The Trump administration also tried but failed to repeal the Affordable Care Act. Overturning even portions of that law would lead to more Americans becoming uninsured and higher premium costs for policyholders, according to an estimate by the Congressional Budget office.

Harris differentiates herself with focus on medical debt

By coming out with a medical debt forgiveness plan, Harris may be looking to differentiate herself from President Joe Biden and his student debt efforts, said Braxton Brewington, press secretary for the Debt Collective, an organization that advocates for debt cancellation.

Biden has forgiven more student debt than any other president.

“She has the freedom to move into another space,” Brewington said, adding that Harris would likely continue Biden’s work on student debt, as well.

“I’m sure she’ll do both,” he said.

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The American health-care system has long been on Harris’ radar.

As a presidential candidate in 2020, Harris pushed for a version of Medicare For All, a plan she no longer backs as she shifts to the center of her party. But Harris continued to show a concern with health-care costs as vice president, leading a White House effort in June to clear medical bills from Americans’ credit reports.

This focus may come, in part, from her own experience.

In a 2019 interview with late activist Ady Barkan, Harris described the day her mother informed her she had cancer.

“My mother, she said to my sister and me, ‘I want to meet you guys for lunch,’ and she showed up at the restaurant wearing makeup — my mother never wore makeup, and her hair was blow dried,” Harris said, tearing up. “She took our hands, and she’d said she’d been diagnosed with colon cancer.

“That was one of the worst days of my life, truly.”

That families experiencing this “would also have to worry about how to pay the bills,” Harris told Barkan was “just inhumane.”

Harris’s mother, who was a cancer researcher, died in 2009 at 70.

How medical debt could be canceled

Harris’ economic plan didn’t include specific details on how the medical debt jubilee would happen, but experts say an investment by the government would go far.

“Amazingly, medical debt can be bought from collection agencies for a penny on the dollar, a reflection of the fact that so few people can afford to pay their overdue medical bills,” KFF’s Levitt said.

Allison Sesso, president and chief executive officer of Undue Medical Debt, a nonprofit that partners with local governments to cancel people’s medical debts, said the group can usually wipe out around $1,000 of the debt for every $10. It often buys the debt directly from hospitals, Sesso said.

States, counties and cities across the U.S. are already using funds from the American Rescue Plan passed during the Covid pandemic to purchase and eliminate around $7 billion in medical debt for roughly 3 million Americans by the end of 2026. As many as 1 million residents in Arizona could benefit, for example, and 400,000 people in New Jersey, according to the White House.

Medical debt affects an enormous number of people, so it’s an issue that resonates with voters.

Larry Levitt

executive vice president for health policy at the Kaiser Family Foundation

Recent research has raised some doubts about the benefits of forgiving medical debt. The relief has no impact on people’s mental health, credit access or financial distress, according to a National Bureau of Economic Research study published in April.

Experts say this may be due in part to the fact that, beginning last year, the major credit reporting companies cleared most medical collections under $500 from people’s records. Those past-due bills are now less likely to affect people’s credit. Harris is now trying to get even more, if not all, medical debts off people’s credit reports.

However, Sesso said Undue Medical Debt hears from people all the time about how canceling their medical debt improved their lives. In extreme cases, unpaid medical bills can lead to wage garnishments and seized assets, she said.

Frequently, people who still owe a hospital or doctor a bill will avoid necessary treatments, she said.

“People don’t go back to the doctor because they feel they’ll be asked for the bill,” Sesso said. “And then the problem gets worse, and the interventions much more expensive.”

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Here’s how to know if active ETFs are right for your portfolio

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Exchange-traded funds are generally known for passive strategies. But there has been a surge in actively managed ETFs as investors seek lower costs and more precision, experts say.

Active ETFs represented just more than 2% of the U.S. ETF market at the beginning of 2019. But these funds have since grown more than 20% each year, rising to a market share of more than 7% in 2024, according to Morningstar.

Some 328 active ETFs have launched in 2024 through September, compared to 352 in 2023, which has been “kind of remarkable,” said Stephen Welch, a senior manager research analyst for Morningstar, referring to the growth of ETFs this year.

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Here’s a look at other stories offering insight on ETFs for investors.

There are a few reasons for the active ETF growth, experts say.

In 2019, the U.S. Securities and Exchange Commission issued the “ETF rule,” which “streamlined the approval process” and made it easier for portfolio managers to create new ETFs, Welch said.

Meanwhile, investors and advisors have increasingly shifted toward lower-cost funds. Plus, there has been a trend of mutual fund providers converting funds to ETFs.

Still, only a fraction of issuers have been successful in the active ETF market. The top 10 issuers controlled 74% of assets, as of March 31, according to Morningstar. As of October, only 40% of active stock ETFs had more than $100 million in assets.

The “biggest thing” to focus on is the health of an active ETF, explained Welch, warning investors to “stay away from ones that don’t have a lot of assets.”

Active ETFs allow ‘tactical adjustments’

While passive ETFs replicate an index, such as the S&P 500, active managers aim to outperform a specific benchmark. Like passive ETFs, the active version is typically more tax-friendly that similar mutual funds.

“Active ETFs allow managers to make tactical adjustments, which may help navigate market volatility more smoothly than a passive index,” said certified financial planner Jon Ulin, managing principal of Ulin & Co. Wealth Management in Boca Raton, Florida.

These funds can also provide “more unique strategies” compared to the traditional index space, he said.  

The average active ETF fee is 0.65%, which is 36% cheaper than the average mutual fund, according to a Morningstar report released in April. But the asset-weighted average expense ratio for passive funds was 0.11% in 2023.

However, there is the potential for underperformance, as many active managers fail to beat their benchmarks, Ulin said. Plus, some active ETFs are newer, with less performance data to review their performance.

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Ahead of U.S. election, financial advisors say public debt is top concern

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Voters work on their ballot at a polling station at the Elena Bozeman Government Center in Arlington, Virginia, on September 20, 2024.

– | Afp | Getty Images

Many investors worry about how the outcome of the presidential election will impact their investments.

But there’s another risk financial advisors are focused on — public debt, according to a new survey from Natixis Investment Managers.

Most U.S. advisors — 68% — rank public debt as the top economic risk, while 64% of advisors worldwide said the same, according to the survey of 2,700 respondents in 20 countries, including 300 in the U.S.

“No matter who wins the election, they’re convinced public debt is going to continue to go up,” said Dave Goodsell, executive director of the Natixis Center for Investor Insight.

The term public debt is used interchangeably by the U.S. Treasury with national debt and federal debt.

The government has borrowed to pay expenses over time, comparable to how an individual might use a credit card and not pay off the full balance each month. The U.S. national debt is now more than $35 trillion and growing.

The next U.S. president and Congress will inherit that government spending dilemma, as well as looming trust fund depletion dates for Social Security and Medicare.

More individuals now believe they are on their own when it comes to funding their retirements, the Natixis survey have shown, according to Goodsell.

Experts say there are certain moves individual investors can make to limit the financial exposure they have to those broader risks.

“You cannot control what Congress is doing, but you can control how you plan, how you save, invest and react to the news,” said Marguerita Cheng, a certified financial planner and CEO of Blue Ocean Global Wealth in Gaithersburg, Maryland. Cheng is also a member of the CNBC FA Council.

Diversify your portfolio

50% of Americans believe election outcome will directly impact their personal finances, survey finds

Adjust your tax exposure

Higher national debt means taxes may also likely go up.

“We can’t forecast what tax rates will be in the future,” Cheng said.

Having money in a mix of tax-deferred, tax free and taxable accounts can be helpful, because it gives investors flexibility to limit their taxable withdrawals.

Roth individual retirement accounts and 401(k) plans allow savers invest post-tax money toward retirement. Taking advantage of other kinds of accounts — 529 college savings plans or health savings accounts for medical expenses — may provide tax advantages for money spent on qualified expenses.

Pare back personal debts

While the U.S. national debt is high, consumer debts have also been climbing.

“The sheer amount of debt that is outstanding that is charging more than 10% per year is shocking,” Glassman said.

To help keep those balances in check, and how much they cost, it helps to have good credit, Cheng said.

Consumers can help reduce the cost of their debts by paying their bills on time, which then lets them borrow money at better interest rates on everything from cars to homes, and can even help to reduce car insurance costs, she said.

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Why parents will pay $500,000 for Ivy League admissions consulting

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Ivy League architecture at Princeton University.

Loop Images | Getty Images

At the nation’s top schools, including many in the Ivy League, acceptance rates hover near all-time lows.

“College admissions only ever gets more competitive and there’s a lot of stress from families about the stakes and how to get in,” said Thomas Howell, the founder of Forum Education, a New-York based tutoring company.

For some families, getting their child into a top school is an investment, and to that end there is almost no limit to what they will spend on tutors, college counselors and test prep.

‘Top 20% or bust’

Meanwhile, as the sticker price at some private colleges nears six figures a year, some students have opted for less expensive public schools or alternatives to a degree altogether. For those willing to pay for a four-year, private college, it should be worthwhile, the sentiment often goes.

“The value proposition of higher education is splitting,” Howell said, “it’s either a top school or a real value.”

For this crop of college applicants, it’s “top 20% or bust,” he added.

As a result, universities in the so-called “Ivy Plus” are experiencing a record-breaking increase in applications, according to a report by the Common Application.

The “Ivy Plus” is a group that generally includes the eight private colleges that comprise the Ivy League — Brown, Columbia, Cornell, Dartmouth, Harvard, University of Pennsylvania, Princeton and Yale — plus the University of Chicago, Duke, Massachusetts Institute of Technology and Stanford.

To get into this elite group of schools, many families look for outside help to get a leg up.

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“The consensus is it’s only worth going to college if it’s a life changing college,” said Hafeez Lakhani, founder and president of Lakhani Coaching in New York. 

“What hasn’t changed is people with enormous resources willing to invest over $100,000, which is about 20% of our clients,” Lakhani said. “This might be the single largest thing they’ve spent on other than a car.”

Lakhani Coaching’s clients spend an average of $58,000 on counseling, but some have spent as much as $800,000 over the course of several years, according to Lakhani.

At that price point, students receive “essentially a ‘SEAL-team’ level tutor through almost every class,” he said. Lakhani was equating the academic support with the highest level of organization and execution that epitomizes the training of a Navy Seal, the special operation force that stands for sea, air and land teams.

Lakhani charges $1,600 an hour for his services, the top rate at his company, and still, families often choose to work with him over the less senior coaches there, some of whom charge about $290 an hour, he said.

Even if he charged more, that dynamic likely would not change, he added.

Parents often say, “it’s worth the investment,” he added. “That word investment comes up over and over again.”

Christopher Rim, founder and CEO of college consulting firm Command Education.

Courtesy: Christopher Rim

At Command Education in New York, counselors meet with students weekly starting in eight or ninth grade. Families are charged $120,000 per year, not including the Standards Admission Test (SAT) or American College Test (ACT) test prep. By graduation, they’ve spent roughly half a million dollars.

Command caps the clientele at 200 students worldwide, mostly on a first-come, first-served basis, although they will turn students away if they don’t think they can deliver the desired outcome, according to Christopher Rim, the founder and CEO.

“At the end of the day, results are most important,” he said.

‘This is not a neighborhood tutor’

‘An imperfect meritocracy’

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“Higher education is an imperfect meritocracy,” Lakhani said.

However, the wealthiest students hailing form the country’s top private schools are primarily competing amongst themselves as schools look to build a diversified class.

“When you are applying from an affluent family, the people you are competing against are people in a similar bucket,” Lakhani said.

The irony is most don’t want to admit that they’ve received private help, even if they are fortunate enough to get it.

“Every parent wants to say their child does it on their own,” Rim said.

Is an Ivy League degree worth it?

A study by Harvard University-based non-partisan, non-profit research group Opportunity Insights compared the estimated future income of waitlisted students who ultimately attended Ivy League schools with those who went to public universities instead.

In the end, the group of Harvard University- and Brown University-based economists found that attending an Ivy League college has a “statistically insignificant impact” on earnings.

However, there are other advantages beyond income.

For instance, attending a college in the “Ivy-plus” category rather than a highly selective public institution nearly doubles the chances of attending an elite graduate school and triples the chances of working at a prestigious firm, according to Opportunity Insights.

Leadership positions are disproportionately held by graduates of a few highly selective private colleges, the Opportunity Insights report found. 

Further, it increases students’ chances of ultimately reaching the top 1% of the earnings distribution by 60%.

“Highly selective private colleges serve as gateways to the upper echelons of society,” the researchers said.

“Because these colleges currently admit students from high-income families at substantially higher rates than students from lower-income families with comparable academic credentials, they perpetuate privilege,” they added.

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