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.

When is Beggars Night in your city?

Published: Friday, October 14, 2016 @ 11:20 AM
Updated: Thursday, October 12, 2017 @ 8:44 AM

No Tricks, Just Treats: How to Have a Safe Halloween

It's almost time to gets the kids out for this year’s Beggars Nights (aka trick-or-treating).

It's time to plan your perfect costume, grab a bucket for all of those treats and be adorable. 

>> RELATED: Halloween Guide 2017

We've compiled Beggars Night dates and times in communities across the region.

When is Beggars Night in your community?

>>> FOR KIDS: Halloween fun for the kids all month long

>>> FOR ADULTS: More than 10 of the best Halloween events (for adults)

Doctor takes to Facebook in search for new kidney

Published: Monday, October 23, 2017 @ 12:47 PM

Dr. Stuart Himmelstein is searching for a new kidney. Himmelstein has spent five years on dialysis. He is talking to the press and on his Facebook page, "New Kidney for Stu." "I am hopeful my walking angel is out there," he said.

Dr. Stuart Himmelstein has spent every night of the past five years on dialysis. Since learning he had a rare form of kidney disease, the primary care physician with a private practice in Delray Beach has been on the deceased donor transplant list with no success. So he decided to create a Facebook page titled "New Kidney for Stu." 

Himmelstein, who started the page in June 2016, has been getting a surge in likes on his page after a local news station recently ran a segment on his plight. "Since the segment aired, 19 people have reached out to contact me about my quest for a kidney," he said. "I was diagnosed in 2012 with tuberous sclerosis, which is a congenital abnormality. The sooner I get a kidney, the better. My energy levels are definitely down and if I'm healthier, I can continue to help others."

Having to explain to his 90-year-old mother that he needs a kidney is heart-wrenching for Himmelstein, who has been practicing medicine for 30 years and is affiliated with Delray Medical Center. "I have had the sweetest people including an 85-year-old man try to help me find a kidney," he said. "I have to help my own mother understand why she can't give her baby a kidney." 

His sister works in Manhattan, and he said friends and relatives in New York have been trying to share his Facebook page. "Anyone who potentially wants to be a donor has to undergo a screening process," Himmelstein, 58, said. "I've gotten close a few times where a donor was going to give me a kidney but then they had to back out for personal or medical reasons." 

His friend Mary Milchikier is also trying to help him spread the word. Milchikier, an employee at Delray Medical Center, donated a kidney to her brother-in-law. Milchikier said she wishes she was born with three kidneys so she could give one to Himmelstein. 

"My husband had to have a liver transplant so I am very familiar with the donor and recipient process and I learned everything I could about transplants," Milchikier said. "My husband received his liver transplant through a woman who was in a tragic car accident, but my brother-in-law needed a kidney and couldn't find a donor, so I volunteered to give him mine." While a healthy person can live a normal life with just one kidney, she must now make sure she drinks at least of two liters of water a day and monitors her sugar and protein intake. "I have a special place in my heart for those in need of organ transplants and I really hope Stu gets a kidney," Milchikier said. "I wanted to pay it forward after everything I watched my husband go through." Himmelstein said most of the organ transplant donors he's met have a positive outlook on it, as Milchikier does. "Mary is so positive about her donation and has this eternal positivity," he said. "I am hopeful my walking angel is out there."

Embracing Life On Cancer’s Journey

Published: Monday, October 23, 2017 @ 11:50 AM


            Brenda Frey, a breast cancer survivor from Houston in Shelby County. CONTRIBUTED
Brenda Frey, a breast cancer survivor from Houston in Shelby County. CONTRIBUTED

Brenda Frey said her breast cancer journey has been energized by the power of prayer and a positive outlook.

It’s also been enhanced by those with whom she has interacted at Upper Valley Medical Center’s Cancer Care Center, where she received chemotherapy and radiation in 2014.

While discussing her diagnosis and treatment, the resident of the Houston area in Shelby County sported a T-shirt reflecting part of her philosophy. It read: “Life isn’t easy. Life isn’t perfect. Life is good.”

“It is hard. Life is hard,” Frey said. “You have to work at it, just like you have to work at a marriage. You just can’t sit back and let others do everything for you.”

Frey was in recovery from a 2012 stroke, learning how to walk and talk again, when her cancer was diagnosed in late 2013.

“I knew it was breast cancer before I went in. This had been growing in my chest,” she recalled. “I was standing in front of the mirror. I told my husband, ‘I think I had better go in. It is getting worse.’”

After her diagnosis and surgery at St. Rita’s Medical Center in Lima, Frey told her doctor it was too far to drive to Lima for treatments. At the recommendation of a relative, she asked for referral to Upper Valley and oncologist Mohan Nuthakki, M.D.

Among Frey’s first stops was a cancer class in which a nurse addressed four cancer patients as a group and then their specific form of cancer as well as what to expect during treatment. Frey was no stranger to cancer; it had killed her mother and maternal grandparents. Still, she had many questions.

She, like other cancer patients, became a regular at the Cancer Care Center, first receiving chemotherapy and then radiation treatments.

“The longer you go, the more you get to know people,” Frey said. She and husband, Tom, came to know the staff well along with other patents. “I enjoyed watching people and meeting people. Some people loved talking to you. I love to listen,” she said.

Tom, who she called her “biggest cheerleader,” befriended Cancer Care Center janitors, she said.

Frey said her faith gave her strength during treatment, and beyond, along with a positive attitude.

She took advantage of the hospital’s amenities for cancer patients, including the Cancer Care Center’s massage therapy services.

“My body is a thing of pain, but I deal with it. If you tell me what is wrong, I can deal with it,” she said. “People need to know their body. When something’s not right, doesn’t seem right, bring it up to the doctor.”

Self-advocacy also is important, Frey said. “You have to be your own advocate. You have to make sure that your questions, your concerns are addressed,” she said. “A question is not dumb. It is dumb if you don’t ask it. Write the questions down.”

A comfort level with the doctor is key. “At Upper Valley Medical Center, you are more than just a number. You are a person. To me, that makes a difference. They have great oncology, radiology departments,” Frey said.

People also need to be aware of local treatment options and consider them, if they can meet the individual patient’s needs, she said.

Frey would like to see more survivors. “But to see more, people need to have their mammograms, their colonoscopies, their prostate checks,” she said.

Dr. Nuthakki said Frey did well overall with her Stage 2 breast cancer treatment coupled with other health problems. She progressed through treatment, now is on oral medication and has a strong support system through her husband, he said.

“She is doing well. When you see her, your heart thinks, ‘Why do they have so many problems?’ Yet, she is upbeat. She is very positive,” he said. “Sometimes when I get down looking at all the problems, she lifts your spirits up. She is that kind of person.”

Carrie Fisher’s beloved dog wishes her a happy birthday: ‘I sure do miss you’

Published: Sunday, October 22, 2017 @ 2:28 PM
Updated: Sunday, October 22, 2017 @ 8:18 AM

Two weeks after watching his mom in The Last Jedi trailer, Gary Fisher returned to Instagram on Saturday with a sweet message for the late Carrie Fisher.

“Happy birthday mom, I sure do miss you and the cozy days #garyloveshismom #garymisseshismom #garyfisher #garyloveshisfans #happybirthdaymom,” the pup “posted” next to a snuggly shot of the pair. The shot had 14,000 likes and counting, with endless comments about the actress and her pooch.

» Carrie Fisher once sent producer a cow tongue after friend was allegedly assaulted

Fisher’s 25-year-old daughter, Billie Lourd, shared her own throwback photo earlier in the day, captioning it simply, “Happy Birthday Mom.”

The late actress’ longtime companion was adopted from Lourd as a service pet to help Fisher handle her bipolar disorder.

Fisher, who was open about her diagnosis and mental health, said the French bulldog provided vital emotional support and stability in her life.

“Gary is mental also. My mother says Gary is a hooligan. Gary is like my heart,” Fisher told  The Herald Tribune  in 2015. “Gary is very devoted to me and that calms me down. He’s anxious when he’s away from me.”

» New 'Star Wars' trailer released for 'The Last Jedi'

While Fisher had a long, established career in Hollywood, Gary (and his signature protruding tongue) became something of a celebrity himself during the actress’ press tours for Star Wars: The Force Awakens and her recent book,  The Princess Diarist

The brindle-colored canine was a frequent red-carpet guest of Fisher’s, too, and became a hit on social media (his Instagram account boasts more than 156,000 followers).

» Billie Lourd opens up about life after mom Carrie Fisher's death

The dog was by Fisher’s side when she went into cardiac arrest aboard a flight from London to Los Angeles on Dec. 23. He remained with the actress at the hospital, where she died four days later at the age of 60.

These days, the French bulldog is reported to be living with the late actress’ assistant, Corby McCoin. McCoin is said to have a strong connection with the pooch, according to TMZ, which first reported the news.

This article originally appeared on People.com