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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.

7 things to know about the human plague, symptoms and how to protect yourself

Published: Tuesday, June 27, 2017 @ 3:39 PM

Two new cases of the human plague have been confirmed in New Mexico Tuesday, according to health officials.

» RELATED: Possible plague case in Georgia 

This year, New Mexico has seen three cases of the plague, the first of which was reported in early June.

>> Read more trending news 

All three cases required hospitalization, according to the New Mexico Department of Health.

Here are seven things to know about the plague:

What is it?

According to Atlanta-based Centers for Disease Control and Prevention, plague is a disease caused by the bacterium Yersinia pestis that affects humans and other mammals.

» RELATED: Stray cat's plague death prompts 'fever watch' 

What is the history of plague?

Historians and scientists have recorded three major plague pandemics, according to the CDC.

The first, called the Justinian Plague (after 6th century Byzantine emperor Justinian I), began in A.D. 541 in central Africa and spread to Egypt and the Mediterranean.

The “Great Plague” or “Black Death” originated in China in 1334 and eventually spread to Europe, where approximately 60 percent of the population died of the disease.

» RELATED: The 'Black Death': Are gerbils, not rats, to blame for plague? 

Lastly, the 1860s “Modern Plague,” which also began in China, spread to port cities around the world by rats on steamships, according to the CDC.

In 1894, French bacteriologist Alexandre Yersin discovered the causative bacterium, Yersinia pestis.

Ten million deaths resulted from the last pandemic, which eventually affected mammals in the Americas, Africa and Asia.

It was during this last pandemic that scientists identified infectious flea bites as the culprit in the spread of the disease.

More about the history of plague.

Where in the U.S. is human plague most common?

Human plague usually occurs after an outbreak in which several susceptible rodents die, infected fleas leave the dead rodents and seek blood from other hosts.

These outbreaks usually occur in southwestern states, particularly in Arizona, California, Colorado and New Mexico, according to the CDC.

» RELATED: Lyme disease risks could increase after mouse plague, experts warn 

According to the World Health Organization, an average of five to 15 cases occur annually in the U.S.

Since 1900, more than 80 percent of those cases have been in the bubonic form.

Worldwide, there are approximately 1,000-3,000 cases of naturally occurring plague reported every year.

More about plague in the U.S.

How do humans and other animals get plague?

Usually, humans get plague after a bite from a rodent flea carrying the bacterium.

Humans can also get plague after handling (touching or skinning) an animal (like squirrels, prairie dogs, rats or rabbits) infected with plague.

According to the CDC, inhaling droplets from the cough of an infected human or mammal (sick cats, in particular) can also lead to plague.

» RELATED: Rare tick-borne illness worries some medical professionals 

What are the types of plague and their symptoms?

Bubonic plague (most common)

  • Tender, warm and swollen nymph nodes in the groin, armpit or neck usually develop within a week after an infected flea bite.
  • Signs and symptoms include sudden fever and chills, headache, fatigue, muscle aches.
  • If bubonic plague is not treated, it can spread to other areas of body and lead to septicemic or pneumonic plague.

Septicemic plague

  • Occurs when bacteria multiply in the bloodstream.
  • Signs and symptoms include fever and chills; abdominal pain; diarrhea; vomiting; extreme fatigue and light-headedness; bleeding from mouth, nose, rectum, under skin; shock; gangrene (blackening, tissue death) in fingers, toes and nose.
  • Septicemic plague can quickly lead to organ failure.

Pneumonic plague (least common)

  • Pneumonic plague, which affects the lungs, is the most dangerous plague and is easily spread person-to-person through cough droplets.
  • Signs and symptoms (within a few hours after infection) include bloody cough, difficulty breathing, high fever, nausea, vomiting, headache, weakness.
  • If it is not treated quickly, pneumonic plague is almost always fatal.

» RELATED: What is Lyme disease and how to avoid it 

How is plague treated?

Immediately see a doctor if you develop symptoms of plague and have been in an area where the disease is known to occur.
Your doctor will likely give you strong antibiotics (streptomycin, gentamicin or others) to combat the disease.

If there are serious complications like organ failure or bleeding abnormalities, doctors will administer intravenous fluids, respiratory support and give patients oxygen.

How to protect yourself, your family and your pets against plague

You and your family

The CDC warns against picking up or touching dead animals and letting pets sleep in the bed with you.

Experts also recommend eliminating any nesting places for rodents such as sheds, garages or rock piles, brush, trash and excess firewood.

Other ways to protect yourself and your family include wearing gloves if handling dead or sick animals, using an insect repellent with DEET to prevent flea bites and reporting sick or dead animals to your local health department or to law enforcement officials.

» RELATED: Ticks the season: How to prevent, find and get rid of ticks this summer 

Pets

Flea medicine should be administered regular for both dogs and cats.

Keep your pet’s food in rodent-proof containers and don’t let them hunt or roam in rodent habitats.

If your pet becomes ill, see a veterinarian as soon as possible.

More about plague at CDC.gov.

Related

These states have most overweight pets, research reveals

Published: Tuesday, June 27, 2017 @ 9:06 PM

Overweight cat on a bed.
Andrei Spirache/Getty Images

Dogs and cats in America are becoming increasingly overweight, according to a report from Banfield Pet Hospital.

Time reported that research from Banfield Pet Hospital released Tuesday shows that the number of overweight or obese pets in America is growing, and two states have the most hefty cats and dogs.

>> Read more trending news

The company, which operates close to 1,000 veterinary clinics in the U.S. and Puerto Rico, used information from 2.5 million dogs and 505,000 cats seen at Banfield Hospitals in 2016.

People reported that the ranking for the states with the most cats and dogs diagnosed as overweight both have Minnesota and Nebraska in the No. 1 and No. 2 spots. See the top 10 states in each category below.

Overweight and Obesity in  dogs per 100 cases:

  1. Minnesota: 41 of 100 dogs diagnosed as overweight
  2. Nebraska: 39 of 100 dogs diagnosed as overweight
  3. Michigan: 38 of 100 dogs diagnosed as overweight
  4. Idaho: 38 of 100 dogs diagnosed as overweight
  5. Nevada: 36 of 100 dogs diagnosed as overweight
  6. New Mexico: 34 of 100 dogs diagnosed as overweight
  7. Washington: 34 of 100 dogs diagnosed as overweight
  8. Utah: 34 of 100 dogs diagnosed as overweight
  9. Indiana: 34 of 100 dogs diagnosed as overweight
  10. Oregon: 34 of 100 dogs diagnosed as overweight

Overweight and Obesity in cats per 100 cases:

  1. Minnesota: 46 of 100 cats diagnosed as overweight
  2. Nebraska: 43 of 100 cats diagnosed as overweight
  3. Iowa: 42 of 100 cats diagnosed as overweight
  4. Idaho: 40 of 100 cats diagnosed as overweight
  5. Delaware: 39 of 100 cats diagnosed as overweight
  6. Michigan: 39 of 100 cats diagnosed as overweight
  7. Nevada: 38 of 100 cats diagnosed as overweight
  8. Kansas: 38 of 100 cats diagnosed as overweight
  9. Utah: 37 of 100 cats diagnosed as overweight
  10. New Mexico: 37 of 100 cats diagnosed as overweight

The hospital’s research found that lack of exercise, overfeeding, breed and genetics and the commonality of obesity in pets are some factors that contribute to how so many pets became overweight. 

Pet owners can manage the weight of their cats and dogs by coming up with a weight loss plan with their veterinarian, having more playtime with their pets and giving out less treats, particularly limiting human food.

More information can be found at Banfield.com.

Kitten rescued after getting stuck on the Golden Gate Bridge

Published: Tuesday, June 27, 2017 @ 5:10 PM

Officer Smith with Bridges the kitten.
CHP - Marin

If cats have nine lives, how many lives do kittens have?

An orange and white kitten is very fortunate to be alive after dodging traffic on the Golden Gate Bridge last weekend.

>> Read more trending news

California Highway Patrol received a call Sunday about a kitten running loose on the Golden Gate Bridge, according to the report on its Facebook page. Officers took one pass over the bridge and were unable to find the kitten; on a second pass, officers noticed a furry head popping out of a movable median barrier and blocked traffic to conduct a rescue operation.

The kitten was quickly freed and transported to an animal hospital for an exam and bath. The kitten had no collar or microchip, so it is unknown if he has an owner.

While a search for an owner continues, Officer Smith, one of the kitten's rescuers, offered to foster him.

The kitten has been tentatively named Bridges.

Some call Costco’s new burger ‘Shake Shack copycat’

Published: Tuesday, June 27, 2017 @ 4:35 PM

LOS ANGELES, CA - MARCH 12: A Costco sign is displayed on March 12, 2013 in Los Angeles, California. (Photo by Kevork Djansezian/Getty Images)

Some Costco locations are serving up a new burger -- and it’s causing chatter beyond the food court. 

>> Read more trending news

Observations of the new burger have circulated for weeks, and it’s making headlines because food critics are comparing it to a Shake Shack burger.

Shake Shack, a popular chain that hasn’t made it to the northwest U.S., builds its burger with all-natural Angus beef, a “Chicago-style” potato bun, the Shack's sauce, which is made up of mayo, dijon mustard and dill pickle brine.

>> Related: Dick's Drive-In makes ‘25 Best Cheeseburgers' national list

“The final product looks nearly identical to Shack's beloved burger, though the ingredients are slightly different,” wrote Delish.com's Rheanna O’Neil Bellomo, who simply called it a “Shake Shack copycat.”

Ingredients in the 1/3 pound Costco burger are reported to be an organic beef patty, topped with romaine lettuce, and smoke Thousand Island dressing.

>> Related: This essay about Costco got a high school senior into 5 Ivy League schools

When the Seattle Times checked in with Costco Corporate about Seattle as a test market, it wouldn’t confirm the cheeseburger. But a reporter found one for sale at the Costco location in SoDo, costing a modest $4.99 and not-so-modest 1,140 calories.

According to Eater, the burger is in a localized testing phase.