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.

Facebook founder Mark Zuckerberg visits Dayton to talk opioid epidemic

Published: Saturday, April 29, 2017 @ 6:23 PM

One of the most powerful men in the world was in Dayton to talk to local people about an issue devastating Dayton families. 

Facebook CEO  Mark Zuckerberg is touring the midwest and stopped in Dayton today, April 29.

Dayton has been hit hard by the heroin crisis. 

>> MORE: Dayton No. 1 in nation for drug overdose

>> MORE: Heroin's Impact: A special report

>>MORE: Why Hollywood star Peter Sarsgaard was in Dayton 

Zuckerberg said in January that he was challenging himself to visit people in all 50 states.

He posted the following to his official  Facebook page about his Dayton stop:  

I just sat down with people recovering from opioid addiction and people helping them get treatment in Dayton, Ohio.

The opioid epidemic is one of the worst public health crises we've faced. More people die from it today than died from AIDS at its peak, or that die from car accidents and gun violence. The rate is still growing quickly.

The pull from opioids is incredibly powerful. A man I met said that when he saw someone overdose, his first thought was who that person's dealer was so he could get better stuff. Another woman who was forced to give up her kids said it wasn't because she didn't love them. She just needed the feeling from getting high more.

Everyone in Dayton is affected by this. One woman told me her daughter, who is a recovering heroin addict, got promoted to hostess at the restaurant where she works because the last hostess overdosed in the bathroom. Another woman whose husband is a police officer said her family hears overdose calls coming over the radio every night. The Dayton police department once responded to 29 overdose calls in a single day. She's worried it's all going to seem normal to her young daughter.

Treating an epidemic like this is complicated and the people I met say it's years from even peaking. But they also came back to the importance of connection and relationships.

A big part of recovery is surrounding yourself with people who are a positive influence and will help you avoid situations where you might relapse. You can't get dragged back down. One woman told me she'll talk someone down who is about to use, but she won't go out to a drug house to find them. She has to look out for herself first.

Purpose is also really important. One man who has been in recovery for seven years told me, "Most addicts have destroyed personal relationships, stolen from their family members, sold their cars for drugs, and they have to rebuild all of that. We have to help them develop a sense that they have a goal in life, and we have to do it one addict at a time."

The people I met also talked about how important it is to reduce the stigma that comes from being a recovering addict. One woman who has been clean for a year told me, "If we're in active addiction it doesn't mean we're not human. Even if we're not living our potential at this moment we have a chance to do something with this life." Another told me, "It's important that addicts don't end up as 'those people.' It's not 'those people,' it's your neighbor, and you need to be there to support them."

This touches everyone. People I work closely with have had family members and high school friends die of overdoses. Ohio and communities all across the country have a long road ahead, but as someone told me at the end, "I'm hopeful because we're talking about it." Me too.

>>MORE: 14-year-old mowing grass finds body from apparent overdose

>> MORE: Centerville wife found dead with husband ‘hooked on drugs’ for years, reports say

>> MORE: Robert Redford, Casey Affleck movie to be filmed in downtown Dayton

Dayton to celebrate $4 million River Run with music, community bash

Published: Saturday, April 29, 2017 @ 10:00 AM

After two years of construction and nearly 20 years of plans in the making, Five Rivers MetroParks is ready to debut its newest regional recreation destination on the Great Miami River— a smooth-water passageway and a rippling, whitewater play chute for kayaking enthusiasts.

The $4 million RiverScape River Run project will celebrate the completion of the first water chute with an afternoon of outdoor celebration on Friday, May 5, at 4:30 p.m.

Five Rivers MetroParks, which boasts 3.3 million visitors annually at its parks, is expecting to draw even more crowds of water enthusiasts and spectators for the low-dam attraction.

“RiverScape River Run is one of the most impactful projects in our region,” said Carrie Scarff, Five Rivers MetroParks chief of planning and projects. “River Run was identified as a high-priority project in the Greater Downtown Dayton Plan because of its potential to improve economic vitality and help regional businesses attract and retain top talent.”

» WATCH: The completed Riverscape River Run project opens May 5

The first completed river chute, located in the park on East Monument Avenue near the Dayton Art Institute, includes two features: one smooth-water passageway for novice paddlers and a whitewater chute for those daredevil kayakers.

The free grand opening event starts at 4:30 p.m. with official remarks from community leaders. Project partners include leaders from the park district, the Downtown Dayton Partnership, Miami Conservancy District, city of Dayton and Montgomery County.

» WHAT ELSE IS COMING? 19 projects that are changing downtown Dayton

Those celebrating can also expect:

• The ceremonial first paddle starts at 5 p.m., when demonstration paddlers will show off what the new river run is capable of doing.

• The Five Rivers MetroParks music series Pickin’ in the Park will kick off at 6 p.m. after the official opening. The night will feature live tunes by progressive bluegrass musicians Casey Campbell, Restless Leg String Band and The Tillers.

• Local craft beer providers and food trucks will also be available to enjoy at the park.

» RELATED: 5 things to know about downtown Dayton housing market

The $4 million project was funded by private sector companies, community partners and grants. The James M. Cox Foundation issued a $1 million challenge grant in July 2011 to jump start the project.

Mike Ervin, co-chair of the Downtown Dayton Partnership board, said he expects the attraction to be a “gathering space” for more than just kayakers. He envisions an outdoor space where live music will play often, bikers and runners will pass by while residents hang out on the rock structures near the river.

“This is not just for kayakers,” he said. “It’s a place-making opportunity. You create this great vibrant space … And it becomes a destination.”


• Kroger to create 600 jobs with new Dayton-area stores

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Police want to know who's shaving other people's cats

Published: Saturday, April 29, 2017 @ 10:48 AM

John Lund/Getty Images

The fur is flying in a Virginia town, and police are trying to solve the mystery.

Someone in Waynesboro is shaving other people's cats, police said.

>> Read more trending news

Since December, seven cats have been taken, have had their underbellies or legs precisely shaved, and then are returned to their owners.

Police Capt. Kelly Walker told The Associated Press Friday all the cats appear otherwise unharmed, though act a bit bothered. He said police aren't sure what crime has been committed, but they do want to find the perpetrator.

Concerned cat owners contacted police to put a stop to the disturbing activity.

The Associated Press contributed to this report.

‘Hey there, Mr. Mickey Mouse, my name is Mr. White’

Published: Friday, April 28, 2017 @ 5:34 PM

            Greg Cobb of Washington Twp. took this photo in his backyard on April 13. A curious albino squirrel inspects one of the garden figurines in the yard. Cobb imagines a dialog that goes something like, “Looks like you need some color.”

Share your photos of life in the Miami Valley by season.

Dayton Daily News reader Greg Cobb of Washington Twp. sent in this accompanying photo.

We invite Dayton Daily News readers to submit favorite photos capturing everyday life and special moments related to the season, to be considered for publication in Neighbors; timely nature scenes, family fun, hikes in the park and more. Photos should be from within the past few months.

Please send a high-resolution image to the following address:

Important: Use the email subject line “Seasons photo” (without the quote marks). Submissions should include the date the photo was taken, the location the photo was taken and a brief description of the photo. The photographer should include his/her first and last name and specific town of residence for a photo credit.