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

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

Do you need 8 glasses of water per day? 6 myths and truths about drinking water

Published: Thursday, August 17, 2017 @ 1:49 PM
Updated: Thursday, August 17, 2017 @ 1:49 PM

Here are six of the most prominent myths about drinking water Myth #1: Drinking lots of water will curb your appetite Fact: The only weight-loss benefit of drinking lots of water is that it keeps your mouth too busy to eat Myth #2: You might be thirsty when you think you're hungry Fact: You're probably hungry when you think you're hungry Myth #3: You need to chugalug water constantly or risk imminent dehydration Fact: A healthy diet and drinking when you're thirsty will hydrate you just fine Myth #4: You

Just like the old saying, "water, water everywhere," myths about drinking water are also everywhere. 

Some of them are hype from marketers or overzealous trainers, but most are just misconceptions that have been accepted into the culture. Knowing the truth can help you with healthy hydration and might even save you some anxiety or some hard-earned money.

» RELATED: Considering the water diet? Here’s what you need to know 

Certainly, staying hydrated does contribute to overall health, according to experts like Dr. Angie Eakin, a family medicine physician at Barnard Medical Center in Washington, D.C. 
"Every single cell in your body needs fluid to function properly," she told "That's why even mild dehydration can make you irritable, foggy-headed, and headachy."
But numerous misconceptions have flowed from the basic principle that staying hydrating is a good thing.

Here are six of the most prominent myths about drinking water, followed by the icy cold truths:

6 myths about drinking water, debunked

Myth: Drinking lots of water will curb your appetite.
Fact: The only weight-loss benefit of drinking lots of water is that it keeps your mouth too busy to eat.

As part of coverage on the "Top 10 Fitness Myths," Fitness magazine experts crushed the dieting myth that drinking lots of water makes you less hungry. "Sorry to tell you this," the Fitness editors wrote. "You may eat less, because you're too busy trucking back and forth between the bathroom and dinner table, but that's about it."

Myth: You might be thirsty when you think you're hungry.
Fact: You're probably hungry when you think you're hungry.

While boredom, habit or stress might make you eat when you're not hungry, your body is unlikely to mix up hunger and thirst, Penn State nutrition professor Barbara Rolls, Ph.D., told The sensations aren't even similar. "They feel different and are regulated by separate mechanisms in your body," Rolls said. When you need hydration, cell and blood volumes tank, giving you an unpleasantly dry, tacky-feeling mouth. There's little chance you'll mistake that for the sensation of hunger, which takes cues from gut hormones, nutrients and glucose and is signaled with a rumbling stomach and a sensation of emptiness.

Myth: You need to chugalug water constantly or risk imminent dehydration.
Fact: A healthy diet and drinking when you're thirsty will hydrate you just fine.

There's no need to constantly gulp down water, according to Rolls. As she told, the moisture in food alone provides about 20 percent of the fluid you need. Instead of randomly chugging water throughout the day, Rolls recommended avoiding dry foods like heavily processed crackers and filling up on hydrating produce like cucumbers, which are 97 percent water. Do that and drink water when you're thirsty, and your hydration levels should be fine, Rolls said.

Myth: You can overhydrate easily.
Fact: It's unusual to drink too much water.

People commonly worry about the risk of drinking too much water, but that's low on the list of concerns, said Nicole G. Morgan, a registered dietitian and nutritionist who practices in Atlanta.
She said overhydrating is much more difficult than most people think. "You would have to consume your full water requirement for the day in a short time frame for it to become dangerous." To avoid even this slight danger of drinking too much water, Morgan recommended spreading out an increase in water intake over the course of a day. "That approach to hydration is generally regarded as safe and healthy," she said.

Myth: Bottled water fortified with electrolytes is healthier.
Fact: Most Americans don't need fortified drinks.

In a 2015   evaluation of coconut water and other sports drinks, Consumer Reports concluded that most Americans don't need fortified bottled water. The consumer watchdog noted that the labels on the drinks said they contained added electrolytes, minerals that help regulate muscle function and water balance, which can be lost during long intense workouts. CR then concluded that few people in America exercise so vigorously as to need to replenish electrolytes. 
CR also quoted Leslie Bonci, a dietitian and director of sports nutrition at the University of Pittsburgh Medical Center, who said, "Any liquid is going to be hydrating, even coffee. Do vitamins and minerals add to hydration? No. What's hydrating is the fluid."

Myth: Everyone needs eight 8-ounce glasses of water a day.
Fact: There's no basic rule about how much water you need to stay hydrated.

This is one of the most widespread myths about drinking water, but on closer examination it really doesn't hold up, according to diet and nutrition experts at Consumer Reports on Health in a recent report on "How to Stay Hydrated." They noted that an appropriate amount of water per day can vary "a good bit" from person to person. In general, people who are heavier or taller or more active need to take in more water to cover their losses. In addition, hot or humid weather might increase a person's need for water intake.
 To make sure you get enough water, CR experts recommended taking these steps:

  • Drink before you feel parched. 
  • Sip small amounts throughout the day, instead of worrying about downing a full glass of water all at once.
  • Carry a water bottle with you so you can drink when you're thirsty.
  • Remember that all beverages count towards hydration, except for the ones that contain alcohol.
Even caffeinated drinks count towards hydration, Janet Mentes, Ph.D., a professor at the UCLA School of Nursing, told CR. While coffee and tea and some sodas are mild diuretics that can cause you to urinate more often, they add more to your liquid stores than you'll lose from extra urination, she said.

5 ways you can show love to SICSA

Published: Thursday, August 17, 2017 @ 6:00 AM

Contributed by SICSA Pet Adoption Center
(Contributed by SICSA Pet Adoption Center)

You know the look — those envious, disappointed eyes your pooch throws your way whenever you’re giving another pup a little too much attention. In their mind, you are their human to give all the love and snuggles to, and they’ll let you know that. 

Not to worry, we won’t tell if you stray from your fur-child to give some extra lovin’ to one of SICSA Pet Adoption Center’s 1,700 animals they have in their care. 

>> 5 things to know about SICSA

Whether you’re looking to adopt a pet or lend your support in other ways, here are 5 SICSA programs and events you can lend a paw to: 

1. Cause An Effect Chipotle Fundraiser 

This Dayton-wide Chipotle fundraiser is by far the tastiest and easiest way to help the homeless animals in our community. 50 percent of your purchase at Chipotle locations in the Dayton-area during the event will be donated to SICSA. Be sure to mention you’re supporting the cause to ensure that burrito in your belly is helping the animals! 

When: Thursday, Aug. 17, 10:45 a.m.- 10 p.m.

Where: All Greater Dayton-area Chipotle locations

>> SICSA moves forward with plans to build new facility in Washington Twp.

>> 5 things to know about SICSA and its new facility

2. Yoga With Cats

>> Do yoga with cats every month in Dayton

Every third Saturday of the month, the kittens of SICSA get extra loose and limber to practice their best yoga poses. Cats roam the room, and occasionally claw at a yoga mat or two, as Dayton Yoga Club instructor Matt Turner leads a class into a state of zen relaxation. 

The monthly class, held at the adoption center, fills up fast and your best bet to getting in the door is pre-registering on SICSA’s website.

(Photo by Jessica Valle- SICSA Adoption Center)

When: Every third Saturday of the month

Where: SICSA Adoption Center, 2600 Wilmington Pike, Kettering

3. Furry Film Nights

(Contributed by SICSA)

>> People, pets line up to support SICSA at Lift Your Leg event 

(Contributed by SICSA)

At this monthly event, kiddos ages kindergarten through sixth grade are invited to put on their comfiest PJs and come cuddle with SICSA’s cuddliest animals for a pizza and movie night. 

Pre-registration for this event is required. To register a child and to see dates for upcoming Furry Film Nights, visit

WHEN: Next Furry Film Night: Friday, Aug. 18, 5- 8 p.m.

WHERE: SICSA Adoption Center, 2600 Wilmington Pike, Kettering

4. Splash Your Pup Under Lights

This one-of-a-kind event is taking place Friday, but will continue into Saturday and Sunday, as Splash Your Pup hosts their first UAD/UKC Short Dock competition.

Your pooch is guaranteed to be tuckered out after Friday evening, as there will be “a fun dock dive splash, open swim and ramp races for the dogs who aren't ready to jump off the dock yet! Also a mini agility course, bobbing for hotdogs, and a trick contest,” according to the event’s Facebook page.

Admission for this event is free.

When: Friday, Aug. 25, 7-10 p.m.

Where: Splash Your Pup, 4792 South Dixie Drive, Moraine

5. Volunteer your time and love

(Photo contributed by SICSA Adoption Center)

If you can’t make any of these events, there are still plenty of ways to give your time. SICSA offers many well-organized volunteering programs for both youth and adult. 

You can start your journey volunteering for SICSA at

(Photo by Jessica Valle- SICSA Adoption Center)

Mom shares heartbreaking photo after daughter dies from heroin overdose

Published: Wednesday, August 16, 2017 @ 2:47 AM

What You Need To Know About Heroin

The American opioid epidemic claimed another victim Monday

>> Watch the news report here

The mother of 22-year-old Elaina Towery shared a gut-wrenching photograph of her clutching her daughter just moments before she was taken off life support at a Detroit hospital.

>> See the photo here

Elaina reportedly died due to an overdose of heroin laced with fentanyl. She fell into a coma on Thursday.

Cheryl Towery, 49, told WJBK that her daughter had been battling addiction for seven years.

“She’s my only daughter, my best friend,” Cheryl said. “She was supposed to start her new job today; now she’s on life support.”

>> Doctor saves woman overdosing on flight

She told WJBK that her daughter and a friend had stopped at a Detroit Burger King last week. Elaina went inside to use the restroom. After about 20 to 25 minutes, her friend thought it was odd that she had not returned. Shortly afterward, a Burger King employee found Elaina unconscious on the bathroom floor.

Only moments earlier, Cheryl said, she had received a text message saying her daughter would be home soon.

“By 6 p.m., 6:30, 7, I finally got a message on Facebook,” Cheryl said.

>> How heroin changes our brains and more things to know about the drug

She said her daughter had gone into cardiac arrest.

Elaina had survived five previous overdoses and visits to five different treatment centers, Cheryl said.

“I wasn’t prepared for what I saw in the emergency room,” Cheryl said. “Because that’s the worst I’ve ever seen her.”

She said her daughter’s addiction began in 2010, when she started to abuse prescription drugs to deal with an abusive boyfriend. That boyfriend, who was convicted of domestic abuse and other crimes, is also the father of Elaina’s 5-year-old son, Christopher. She gave up her son due to her addiction, Cheryl said.

What is Fentanyl?

Cheryl believes Elaina giving up her baby contributed to her addiction problems. She was also working as a prostitute, Cheryl told WJBK.

“[She was] beat up, being pimped out, being kept in a hotel room on heroin,” Cheryl said.

>> Read more trending news

Cheryl said she made the decision remove Elaina from life support on Monday after it became clear that her daughter's vital organs were failing and that there was no brain activity.

“I’m going to fight for the rest of my life to make sure the people down here on the street selling this to people need to be locked up,” she said.

Bodybuilding mother of 2 reportedly dies of protein overdose

Published: Tuesday, August 15, 2017 @ 12:38 PM

Bodybuilder With Genetic Disorder Likely Killed By Protein Supplements

A bodybuilding competitor and mom of two reportedly died June 22 from a protein overdose, according to Perth Now.

Meegan Hefford, a 25-year-old from Mandurah, Australia, was discovered to have a urea cycle disorder, which blocks the body from correctly breaking down protein.

Time Inc.(Time)

Hefford was preparing for a bodybuilding competition in September and consuming various protein supplements, her mother, Michelle White, tells Perth Now. Hefford had told her mom in June that she was feeling tired and “weird.”

“I said to her, ‘I think you’re doing too much at the gym, calm down, slow it down,” White said.

Hefford was found unconscious in her apartment on June 19 and rushed to the hospital, where it took doctors two days to diagnose her with urea cycle disorder. By that point, the buildup of ammonia in her blood and fluid in her brain was too much, and she was declared brain dead the next day.

Coroners listed “intake of bodybuilding supplements” as one of Hefford’s causes of death, along with the disorder.

When your girl gets a sneaky little photo of your back while training arms 🙊

A post shared by • MEEGAN HEFFORD • (@meeganheff) on

Her family is now calling for tighter restrictions on protein supplements.

“I know there are people other than Meegan who have ended up in hospital because they’ve overloaded on supplements,” White said. “The sale of these products needs to be more regulated.”

Hefford was studying paramedicine while working part-time at a hospital. She leaves behind her two children, a 7-year-old daughter and a 5-year-old son.