KHN On Call: Answers To Questions On Tax Credits, Penalties And Age Ratings

Published: Monday, March 20, 2017 @ 2:36 PM

For years, Republicans in Congress have promised to repeal and replace the Affordable Care Act, claiming that its requirement for nearly everyone to buy insurance or pay a fine is burdensome and costly, and that it doesn’t give people enough flexibility to get the coverage they need.

Now that they’re in charge, the bill they’ve released as an alternative (the American Health Care Act) would effectively eliminate the requirement to buy coverage and might open up more health care choices. It’s also under fire because it may cause millions of people to lose their coverage. According to the nonpartisan Congressional Budget Office, up to 24 million more people could be without insurance by 2026 if it passes.

So what are the differences between the ACA and the GOP alternative, and what does it all mean to you and your health care? We put some of your questions from our Twitter chat (#ACAchat) earlier this month to Alison Kodjak, NPR health policy correspondent, and Julie Rovner, chief Washington correspondent for Kaiser Health News.

Many questions came in about the elimination of the requirement to buy insurance, known as “the mandate,” and how the lack of one might affect the health insurance market.

Is the mandate in the GOP bill? It won’t work if people sign up only when they are sick.

.@sjp3121 I read mandate still there, just no fine. Is this accurate? #ACACHAT Won't work without mandate if only sign up when sick.

— ILPoliticalPug (@BarbinIL52) March 9, 2017

Kodjak: The mandate is technically still written into the law, but since no one will enforce it under this new bill, it’s unlikely to have any impact. In fact, the Internal Revenue Service has already issued some guidance that suggests it may not enforce the mandate very actively even now, before this bill becomes law. The result? People who think insurance is too expensive and don’t expect to need it are unlikely to sign up for a health plan.

Rovner: It’s true that the GOP bill technically preserves the mandate, but it eliminates the penalties. Instead, the bill would require those with a lapse in insurance of more than 63 days to pay an insurance premium that’s 30 percent higher for one year. Analysts say that could actually serve as a disincentive for healthy people to purchase insurance if they’ve had a break.

Can someone wait until they are sick to buy insurance, knowing that they would have to pay a 30 percent fine?

Thanks for doing #ACAchat. Can someone wait till they are sick to get insurance under cont cov rule even if they pay 30% more?

— AtoZ (@InOneFortyRLess) March 9, 2017

Rovner: Not exactly. There will still be standardized open enrollment periods once a year, and you will only be able to buy insurance outside of those windows if you have a life change, like moving or losing a job. But if you’re willing to wait as long as 11 months, then, yes, you can wait and buy insurance after you get sick.

Kodjak: It’s not without risk. The Department of Health and Human Services has already proposed regulations that would reduce that open enrollment period to six weeks from the current three months. So a patient may incur some health care costs while awaiting the open enrollment, and then face the 30 percent penalty when they do buy a health plan. However, if the individual has a health issue where treatment can wait, then they certainly can enroll at the correct time and then seek medical care.

We also got a lot of questions about the GOP bill’s new tax credits to help people buy insurance, and how different they would be from the structure of purchasing help in the ACA.

Explain the difference between tax credits and subsidies, and will tax credits be distributed quarterly or at the end of the year?

@NPRHealth Please explain the difference between tax credits and subsidies. Will there be quarterly tax credits or just year end? #ACACHAT

— songbirder74 (@songbirder74) March 9, 2017

Kodjak: Both the ACA and the AHCA use advanceable, refundable tax credits. That means the government each month sends the tax credit amount to your insurance company.

We refer to the Obamacare financial assistance as a “subsidy” in part because the amount fluctuates and is based on your income — the idea is to limit your health costs to a specific percentage of your income. In addition, under the ACA, there are payments to insurers to help cover the copayments and deductibles of lower-income people.

Rovner: The tax credits differ in how large they are and how they are calculated. The ACA tax credits are based on income and how much insurance costs in a given area. The GOP credits, by contrast, are based primarily on age and do not vary according to the cost of insurance in an area, so in low-cost parts of the country they will go further than in very high-cost areas.

In addition, the ACA has a series of subsidies that help those with low incomes (under 250 percent of poverty; about $50,000 for a family of three) pay their deductibles and other out-of-pocket expenses in addition to the tax credits to help pay for premiums.

Why does the GOP bill provide age-based tax credits instead of income-based ones?

#ACAchat @NPRHealth what's the policy behind providing age-based tax credits as opposed to income-based?

— molliegel (@molliegel) March 9, 2017

Kodjak: The basis for age-based tax credits is that people who are younger tend to have fewer health costs, so insurance policies are likely to be lower-priced for them than for older people.

Republicans prefer the fixed credits in part because they are cheaper, and more predictable, than the income-based credits under the Affordable Care Act. That’s because those ACA credits rise as premiums rise, giving insurers little incentive to keep their premiums low. Republicans hope that by restraining the government’s financial help to patients, insurance companies will offer cheaper policies that better match the cost of the tax credits.

Rovner: Younger adults, on average, need less health care than older adults. The ACA limited the differential in premiums for older adults to three times more than the amount charged to younger adults. The GOP bill would change that so older adults could be charged five times more. The change would make insurance less expensive for younger people, likely enticing more of them to enroll, and lowering premiums for all, at least marginally, according to the Congressional Budget Office. But it would dramatically increase premiums for older adults, particularly those aged 55-64, just under the age to qualify for Medicare.

Which brings us to this question, which represents several we received about how the AHCA appears to disproportionately penalize people ages 55-64.

Do I face a penalty for waiting to buy health insurance until I’m eligible for Medicare in three years? I’m concerned that I’ll be stuck with an expensive plan.

@SabrinaCorlette If I'm 62 and I decide 5:1 health insurance is too expensive and I wait for Medicare, no penalty for me, right? #ACAchat

— Anne Paulson (@KrampusSnail) March 9, 2017

Kodjak: No 30 percent penalty if you wait for Medicare, but remember, if you get sick while you’re waiting, you could be in financial trouble.

Rovner: That is correct. Also, remember, if you fail to sign up for Medicare when you first become eligible at age 65, you would also pay a premium penalty. It’s 10 percent per year, forever.

Got more questions? We’ll keep answering them as the GOP bill moves through Congress. Send them to us via Twitter at #ACAchat or via email at KHNHelp@kff.org.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Elephant ranch lets visitors bathe, feed, ride elephants

Published: Sunday, March 26, 2017 @ 12:47 PM

Elephant ranch lets visitors bathe, feed, ride elephants

A private central Florida elephant preserve offers a unique, hands-on experience to visitors. The Elephant Ranch allows tourists to get up close and personal with the majestic animals.

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The Two Tails Ranch located near Gainesville lets people feed, bathe and even ride the eight elephants living at the ranch.

The nonprofit group All About Elephants, Inc. owns and runs the ranch with an objective of teaching people about pachyderms.

It was founded in 2008 “to start educational programs for private sectors and professionals to learn about elephants.”

The organizations said it has helped more than 250 elephants over the years. “Some stayed temporarily while their own exhibits were being remodeled or built. Others stayed for retirement, medical needs, behavior problems or even emergencies after hurricanes destroyed their zoos,” the company said on its website.

The ranch focuses on elephants, but it houses other exotic animals, as well, including a pair of zebras, African spurthighed tortoises, red foot tortoises, an ostrich, emu and a camel.

Shelby Lin Erdman contributed to this report.

Idaho woman blames car crash on deer-chasing Bigfoot

Published: Sunday, March 26, 2017 @ 11:35 AM

Idaho woman blames car crash on deer-chasing Bigfoot

A northern Idaho woman blamed a car crash with a deer on a Sasquatch sighting last week.

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The woman told police she collided with the deer after spotting a Bigfoot on a highway near Potlatch near the Washington border, according to NBC Montana.

The woman said the Sasquatch was chasing the deer Wednesday night along the side of the road, and as she watched the creature in her rear-view mirror, the deer veered onto the road in front of her car.

The Benewah County Sheriff’s Office issued the report on the accident, but did not report any evidence of a Sasquatch, NBC Montana reported. 

4-year-old with brain tumor gets star treatment as honorary police officer

Published: Sunday, March 26, 2017 @ 8:32 AM

4-year-old with brain tumor gets star treatment as honorary police officer

A 4-year-old was smiling ear to ear Saturday while he got to be an honorary Boston police officer for the day and member of their basketball team at a cancer research fundraiser in Massachusetts. 

>> On Fox25Boston.com: See more photos from Declan's day

"We won't know where we'll be a year from now, but today my son's as happy as he can be," said dad David Higgins. 

Declan Higgins, a huge BPD fan, and is being treated for a stage 3 brain tumor. He's had surgery and radiation at the Dana-Farber Cancer Institute for the tumor. 

"It's one day at a time," David said. 

>> Need something to lift your spirits? Read more uplifting news

On Saturday, complete with a hat and mini badge, Declan was picked up from his Medfield home and escorted to West Roxbury for a day of fun and basketball. 

Boston police officers were playing in the annual A Shot For Life: Battle of the Badges to raise money and awareness for brain cancer research at the Stephen E. and Catherine Pappas Center for Neuro-Oncology at the Massachusetts General Hospital Cancer Center. Declan got the chance to be part of their team as an honorary player.

"I'm honored that he's here. He's my favorite player today," said nonprofit leader Mike Slonina.

>> Read more trending news

Slonina started the nonprofit following his mother's brain cancer diagnosis in 2010. 

"It's supposed to united people through basketball," he said. 

And that it did. A large crowd of people were in West Roxbury to cheer Declan on as he arrived before the game. There were posters, cheerleaders and plenty of police officers giving the 4-year-old the basketball star treatment. 

"We open up our hearts; that's we do," said Sgt. Detective Joe Sullivan with the BPD, who helped organize the day. 

Declan walked into the gym and changed into his BPD jersey. He shot some hoops and even got into the game with the officers as they played in the Battle of the Badges. 

via GIPHY

In support of the fundraiser, the Leonard P. Zakim Bunker Hill Bridge, TD Garden and Prudential Tower were lit in red and blue Saturday night.

Baby born with 'parasitic twin' undergoes risky surgery, makes remarkable recovery

Published: Sunday, March 26, 2017 @ 3:29 AM

Baby born with 'parasitic twin' undergoes risky surgery, makes remarkable recovery

A baby girl is beginning her new life after a successful but risky surgery to remove extra body parts from what doctors call a “parasitic conjoined twin.”

>> Need something to lift your spirits? Read more uplifting news

Baby Dominique was born in the Ivory Coast in Africa with four legs and two spines. According to Advocate Health Care, the extra body parts were from an undeveloped parasitic conjoined twin.

Dominique was flown to the U.S. to undergo a life-changing surgery to remove the extra body parts at Children’s Hospital in Park Ridge, Illinois.

>> Read more trending news

On March 8, doctors performed the complicated surgery after weeks of preparation. Six hours later, they successfully removed the parasitic twin.

WGN-TV reports that Baby Dominique is recovering with her foster family in Chicago and will return home to her family in Africa soon.

>> Watch a video about Baby Dominique here