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Health Insurance is Rigged & Controlled by the Big Companies w/ Donvan Ryckis of Ethos Benefits - AZ TRT S06 EP10 (272) 6-15-2025 What We Learned This Week Health Insurance is primarily run by the Big 4 - BUCA: Blue Cross United Healthcare, CIGNA, Aetna To Insurance Co's – Premium = Revenue, and they are not going lower profits, so no incentive to lower costs Health insurance employer group plans can be broken down into 4 Parts Network PPO is what people typically think of when they think of health insurance There have been revisions to the Healthcare Act passed in 2021 Guest: Donovan Ryckis, Ethos Benefits https://ethosbenefits.com/ https://ethosbenefits.com/documentary/ https://businessofbenefitspodcast.com/ Our Ethos is Simple: Fiduciary First. Act in the best interest of those we serve—no matter the cost. ‘Ethos' represents the guiding principle, character, or spirit of a person or organization. It's the ‘why' that drives decision-making and fuel's purpose. Our Ethos is deeply rooted in the story of our Founder, Donovan Ryckis. Over a decade ago, Donovan, a fiduciary Series 65 securities advisor specializing in retirement and pension planning, was approached by a client facing a dire situation. The client's publicly traded broker claimed there was no solution for a staggering 37.5% health insurance renewal increase—a cost that threatened the business and its employees. With no prior experience in health insurance markets but guided by his unwavering fiduciary principles, Donovan took on the challenge. The result? He mitigated the risk entirely, delivering a solution 12% below the current rate. This allowed the business to thrive and ensured hundreds of employees wouldn't have to choose between basic necessities and skyrocketing health premiums. That moment sparked a revelation. The fraud, waste, and abuse Donovan had fought in retirement planning paled in comparison to the challenges in healthcare. He saw an opportunity to bring transparency and fiduciary principles to an industry in desperate need of change. Donovan pivoted his career, becoming one of the first fee-based health insurance advisors in the nation. By removing all conflicts of interest in broker compensation, he laid the foundation for what is now the leading innovative employee benefits agency in the country, delivering higher quality care at a significantly lower cost to employers nationwide. Notes: Ethos Benefits deals with employee benefits, with a primary focus on group health insurance Per Donovan ‘Employee benefits are rigged' Insurance company premium equals revenue. There is no incentive to lower cost, as it would lower profits. ACA Obamacare passed in 2010, and it capped profits for insurance companies at 20% Insurance Co's are working to expand their pool to make more profit Health Insurance guarantees inflation keeps going up, so family of 4 could spend 35K a year For a business, healthcare cost and employee benefits are a top 3 P&L expense Ethos strategies can create a 30 to 40% reduction on premium impact to lower costs for a business The HQ is in Florida, but they are a virtual office with agents and clients nationwide Healthcare finance and delivery + Improving employee benefits Seg 1 Donovan's bio, he was a financial advisor with a Series 65 license before he got into health insurance. Around 2014 he moved into health insurance seeing an opportunity for better service. Typically you see agents who are working for the health insurance company and not really working for the employer companies they are selling to. Health insurance is primarily run by the Big 4 – BUCA: Blue Cross United Healthcare, CIGNA, Aetna. Health insurance employer group plans can be broken down into 4 Parts: 1. TPA or third-party administrator 2. Network PPO or HMO 3. Pharmacy benefit RX 4. Insurance that covers the caps the limits on the stop loss PPO is your primary network and open on using referrals HMO is a non-preferred network typically has less offerings and tight on referrals Ethos Benefits helps employers to break up the four parts of a group plan and customize Network PPO is what people typically think of when they think of health insurance. Network and the Big 4 health companies have a tighter deal with doctors and contract prices. A lot is pre-negotiated with a set of rates, which is the point of a PPO. This is where you get larger claims and they run in the system of healthcare. Seg 2 Pay more for healthcare in the U.S. than the rest of the world The biggest pharmaceutical companies are in the US Pharmaceutical companies in flight prices, and also set the prices They make money through spread pricing Employers can actually pick up their own Pharma benefit and get the rebates that the big health insurance companies are not giving them Healthcare system is a rigged game The fraud waste and abuse extremely high in health 401(k) and retirement benefit industry is actually tighter with more disclosure than the healthcare industry Regulated better since the creation of the Securities Act in the 1930s and updates that ran through the 1970s and beyond with things like ERISA There have been revisions to the healthcare act passed in 2021 - started in Jan.2022 Actions had 3 disclosures: · Brokers comp and bonus · Data with gag, clauses, and full access to data upon request · Benchmarking for drug cost Further Notes via Google: The revisions you are likely referring to are part of the Consolidated Appropriations Act of 2021 (CAA). While the CAA was passed in late 2020, many of its provisions, including those related to transparency in healthcare, became effective on January 1, 2022. The three key areas of disclosure you mentioned are directly addressed within these regulations: 1. Broker's Compensation and Bonuses: The CAA amends ERISA Section 408(b)(2) and requires service providers, including brokers, to disclose specific information to group health plan fiduciaries. 2. Data Transparency (Gag Clauses and Full Access to Data): The CAA prohibits gag clauses, which prevent plans from providing access to their data. It also requires health insurance carriers to attest annually to their compliance with this prohibition. Moreover, the Health DATA Act, a proposed bill, would further reinforce the right of employers to access their data and hold service providers accountable for non-compliance. 3. Benchmarking for Drug Costs: The CAA includes provisions regarding pharmacy benefit and drug cost reporting, which aims to provide greater transparency and potentially lead to better benchmarking of drug costs. The Build Back Better Act, a separate piece of legislation, also included provisions for Medicare to negotiate drug prices, further impacting drug costs and potential benchmarking. These revisions aim to increase transparency in healthcare pricing and empower consumers and employers to make more informed decisions about their healthcare coverage. Seg 3 Ethos works with Employers to create business plans usually with a 3 to 5 year time horizon. The goal is long-term to lower healthcare cost. Example would be a company with 100 employees with 50 to 80% of them on the health plan (does not include dependents). Ethos wants to keep the demands of a company low, easy transition. Ethos handles employee Qs and healthcare navigation. Ethos is full service. Risk handled 1 of 4 ways - Reduce, avoid, retain, transfer - Transfer to insurance Broker wants to transfer risk Company can control costs Careful not to have too much disruption with a switch to a new company Ex - start with pharmacy part NDC National Drug Code Run report vs costs Pharmacy benefit mgr Pre packaged health plan Gets co approved pharmacy benefit Save 5 - 15% on costs (30%) Separate - parts of group plan Seg 4 Brokers comp - incentives from big insurance companies Opening move - edit pharmacy benefit piece State by state - regulators and rules Employers / employees Know the network and PPO Nationwide covers insurance part – Stop-loss Insurance 30-40 major stop loss companies Ex: Allstate Met Life Sun Life Stop-loss insurance for group health plans acts as a financial safety net for self-funded employers, protecting them from large, unpredictable medical claims. It is a form of additional insurance. Healthcare risk is incredibly predictable on group basis Overall predictable w stats, actuarial analysis Gag clauses look at dataset from current carrier Prescription database sets 3rd party admin are less of a concern, lots of claims Average of 18 claims per employee per year, includes dependents Data - review AI Claims analytics software AI claims analytics software is transforming how insurance companies handle claims by leveraging artificial intelligence and machine learning to analyze data, automate tasks, and improve decision-making. 30 - 40% reduction in premium w Ethos Further Notes via Google: Group Medical Plans Breakdown of the common components of a comprehensive employer group health plan, particularly within the context of a self-funded model. Here's a more detailed explanation of each part: 1. TPA (Third-Party Administrator): A TPA is a company that provides administrative services for self-funded health plans. This includes processing claims, handling enrollment, and managing other administrative tasks that would typically be done by an insurance company. 2. Network (PPO or HMO): This refers to the group of doctors, hospitals, and other healthcare providers that the health plan contracts with to provide services to its members. The network defines where employees can go to receive care and often dictates the level of coverage they will receive (e.g., in-network vs. out-of-network benefits). · PPO (Preferred Provider Organization): Offers more flexibility, allowing members to see out-of-network providers, though with higher out-of-pocket costs. · HMO (Health Maintenance Organization): Typically requires members to stay within the network for covered services, except in emergencies. Pharmacy Benefit (RX): This component manages the prescription drug coverage for the plan. It includes negotiating drug prices, processing claims for prescriptions, and managing the plan's formulary (list of covered drugs). Stop-Loss Insurance: This is a crucial element for self-funded employers. It protects the employer from catastrophic claim costs. If an individual employee or the entire group's claims exceed a certain threshold (the "attachment point"), the stop-loss insurance kicks in to cover the excess costs, limiting the employer's financial liability. Additional Considerations: · Data Access: Self-funded plans often provide employers with greater access to claims data, which can be used to analyze healthcare costs, identify trends, and implement strategies to improve employee health and manage costs. · Benchmarking: Employers can use claims data and industry benchmarks to compare their plan's performance to similar organizations and negotiate better rates with providers and other vendors. · Wellness Programs: Some employers offer wellness programs to encourage employees to adopt healthy behaviors and potentially reduce healthcare costs. · Essential Health Benefits (ACA Compliance): Group health plans must comply with the Affordable Care Act (ACA), which requires them to cover a list of essential health benefits, such as outpatient care, emergency services, hospitalization, and prescription drugs. · Other Benefits: Group plans can also include other benefits, such as dental, vision, life insurance, and long- and short-term disability insurance. Understanding these different parts is essential for employers to effectively manage their group health plan, control costs, and provide valuable benefits to their employees. Investing Shows: https://brt-show.libsyn.com/category/Investing-Stocks-Bonds-Retirement ‘Best Of' Topic: https://brt-show.libsyn.com/category/Best+of+BRT Thanks for Listening. Please Subscribe to the AZ TRT Podcast. AZ Tech Roundtable 2.0 with Matt Battaglia The show where Entrepreneurs, Top Executives, Founders, and Investors come to share insights about the future of business. AZ TRT 2.0 looks at the new trends in business, & how classic industries are evolving. Common Topics Discussed: Startups, Founders, Funds & Venture Capital, Business, Entrepreneurship, Biotech, Blockchain / Crypto, Executive Comp, Investing, Stocks, Real Estate + Alternative Investments, and more… AZ TRT Podcast Home Page: http://aztrtshow.com/ ‘Best Of' AZ TRT Podcast: Click Here Podcast on Google: Click Here Podcast on Spotify: Click Here More Info: https://www.economicknight.com/azpodcast/ KFNX Info: https://1100kfnx.com/weekend-featured-shows/ Disclaimer: The views and opinions expressed in this program are those of the Hosts, Guests and Speakers, and do not necessarily reflect the views or positions of any entities they represent (or affiliates, members, managers, employees or partners), or any Station, Podcast Platform, Website or Social Media that this show may air on. All information provided is for educational and entertainment purposes. Nothing said on this program should be considered advice or recommendations in: business, legal, real estate, crypto, tax accounting, investment, etc. Always seek the advice of a professional in all business ventures, including but not limited to: investments, tax, loans, legal, accounting, real estate, crypto, contracts, sales, marketing, other business arrangements, etc.
In this episode of Friday Fiduciary Five, Eric Dyson discusses the implications of the Cunningham v Cornell Supreme Court decision for health plans, emphasizing the need for 408(b)(2) disclosures under the Consolidated Appropriations Act. He explains that health plans subject to ERISA must now disclose fees and services provided by vendors, such as third-party administrators and pharmacy benefit managers. Eric advises plan committee members to establish a process similar to retirement plans, including fiduciary committees and charters, to ensure compliance.Connect with Eric Dyson: Website: https://90northllc.com/Phone: 940-248-4800Email: contact@90northllc.com LinkedIn: https://www.linkedin.com/in/401kguy/ The information contained herein is general in nature and is provided solely for educational and informational purposes.It is not intended to provide a specific recommendation of any type of product or service discussed in this presentation or to provide any warranties, financial advice, or legal advice.The specific facts and circumstances of all qualified plans can vary, and the information contained in this podcast may or may not apply to your individual circumstances or to your plan or client plan specific circumstances.
In this episode, host Stacey Richter speaks with Ann Lewandowski about whistleblowing in the healthcare industry, focusing on a significant case involving a whistleblower at an employee benefit consultant (EBC) firm. This EBC allegedly pocketed their clients' pharma rebates, violating the Consolidated Appropriations Act of 2021. The discussion highlights the nuances of being a whistleblower, the ethical dilemmas faced, compliance challenges, and the significant financial implications for companies and individuals involved in illegal activities. Ann Lewandowski provides insights into documenting and protecting oneself legally and discusses the broader context of trust and transparency in the healthcare sector. Click through to the show notes below to access all of the mentioned links and prior episodes mentioned. === LINKS ===
In this episode of Friday Fiduciary Five, Eric Dyson talks about the Cunningham vs. Cornell Supreme Court decision and its implications for ERISA plans and the potential implications for Health Plans based on the Consolidated Appropriations Act (“CAA”). He emphasizes that the decision does not change how fiduciaries should operate but highlights guidance that is already in place. Eric explains prohibited transactions in ERISA plans, the necessity of ERISA 408(b)(2) disclosures, and the importance of reasonable fees. He also extends these requirements to health plans under the Consolidated Appropriations Act, advising plan sponsors to ensure proper fee disclosures and fiduciary processes for both retirement and health plans.Use the keyword “90north”: https://www.fiduciaryinabox.com/ Connect with Eric Dyson: Website: https://90northllc.com/Phone: 940-248-4800Email: contact@90northllc.com LinkedIn: https://www.linkedin.com/in/401kguy/ The information contained herein is general in nature and is provided solely for educational and informational purposes.It is not intended to provide a specific recommendation of any type of product or service discussed in this presentation or to provide any warranties, financial advice, or legal advice.The specific facts and circumstances of all qualified plans can vary, and the information contained in this podcast may or may not apply to your individual circumstances or to your plan or client plan specific circumstances.
In this episode of Relentless Health Value, host Stacey Richter sits down with Peter Hayes to discuss the major forces driving change in the healthcare industry. Hayes outlines three critical factors: changing public opinion, heightened transparency, and new regulations such as the Consolidated Appropriations Act. He emphasizes the unprecedented convergence of these elements, creating a pivotal moment for healthcare transformation. The discussion delves into the erosion of trust within the healthcare system and the growing public unrest over high costs and inefficiencies. Hayes also highlights the role of state-level initiatives as experimental laboratories for potential national solutions. The episode concludes with a call to focus on root causes and collaborative approaches to restore trust and improve healthcare affordability and quality. === LINKS ===
In this episode of the Astonishing Healthcare podcast, Spencer Kramer, Director, Client Services at Capital Rx, joins us in the studio to discuss an important aspect of plan sponsors' annual reporting requirements: Prescription Drug Data Collection - aka RxDC. We review key dates and where plan fiduciaries can find important data and updates, and Spencer shares his experience working with Capital Rx's clients and some suggestions to a) yield a smooth RxDC submission process and b) make use of the detailed data that plan sponsors are entitled to!As a requirement of the Consolidated Appropriations Act of 2021, RxDC demands detailed annual data submissions by plan issuers, TPAs, and others. Spencer explains the importance of starting early, understanding the data submission components, tackling coordination complexities, and ensuring accuracy. You'll want to be working with a partner here, not "just a vendor." Spencer emphasizes the importance of cooperation and maintaining detailed records to avoid friction and streamline the reporting process.Related ContentAH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff HoganThe Consolidated Appropriations Act & Prescription Drug Data Collection (RxDC): New Rules & Regulations Equal New ResponsibilitiesAH048 - High-Cost Orphan Drugs, Securing Claims Data, and More, with Dr. Eric BrickerVisit CMS.gov for RxDC-Related Resourceshttps://www.cms.gov/marketplace/about/oversight/other-insurance-protections/prescription-drug-data-collection-rxdcFor more information about Capital Rx and this episode, please visit Capital Rx Insights.
On Episode 57 of the Astonishing Healthcare podcast, host Justin Venneri welcomes Jeff Hogan, President of Upside Health Advisors, back to the show to discuss the major trends he observed in healthcare procurement and plan management in 2024 and areas of focus in 2025. Jeff highlights the evolving role of employer fiduciaries under the Consolidated Appropriations Act of 2021 (CAA), building on Episode 30 and re-emphasizing the necessity of real-time data access and process-driven strategic decision-making. He explains how employers must take greater accountability for healthcare spending, moving beyond reliance on traditional insurance networks (BUCAHs) and considering alternative care delivery models; and adds that provider organizations must adapt to align care delivery with consumer needs or risk obsolescence.The discussion also covers the increasing use of analytics - including platforms like HOMA Health - or outside resources, like Nick Welle explained on Episode 52, to help plan employer plan sponsors manage costs and their vendor contracts, PBM reform, and point solution fatigue. Finally, Jeff outlines key priorities for 2025, including fiduciary compliance, confirming the removal of gag clauses from contracts, and greater transparency in broker compensation to ensure better alignment between healthcare purchasers and providers.Related ContentReplay - Strategic Well-Being: Rethinking Health Benefits to Empower Employees and Drive ImpactAH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff HoganBest of '24! AH041 - ERISA Litigation Outlook and Meeting CAA Requirements, What Can Plan Fiduciaries Do?Signs it is time to change your PBM vendor, and how to overcome common hesitationsTo learn more about Upside Health Advisors, click here, or you can find Jeff on LinkedIn.Resources MentionedVizient - 2025 Trends Report: Strategy is (finally) back in the driver's seatPeterson Health Tech Institute - Virtual Musculoskeletal Solutions (June 2024)ICER - Peterson Health Tech Institute: Assessment Framework for Digital Health Technologies (Sept. 2023)Peterson Health Tech Institute - Digital Diabetes Management Solutions (March 2024)For more information about Capital Rx and this episode, please visit Capital Rx Insights.
Patrick Williams has over 39 years of experience in retirement and employee benefits consulting. As the co-founder of Fiduciary in a Box®, he has created a cloud-based solution to help employers manage their fiduciary responsibilities effectively. With his deep understanding of the Consolidated Appropriations Act of 2021, Patrick offers invaluable insights to ensure compliance with evolving regulations for ERISA health plans.Patrick earned a Bachelor of Arts in Finance from the University of Minnesota and holds the Accredited Investment Fiduciary® (AIF®) designation. He has served as president of the Minnesota Association of Health Underwriters and is a founding member of the Minnesota and Florida Fiduciary Roundtables.A dynamic speaker, Patrick simplifies complex topics for his audience, making his presentations both educational and impactful. He is dedicated to guiding organizations toward achieving fiduciary excellence.In this episode, Eric and Patrick Williams discuss:Comprehensive solution for fiduciary responsibilitiesCritical coverage areas for health plans and retirement plansWho can benefit from Fiduciary in a Box? Establishing repeatable processes as a managerKey Takeaways:Fiduciary in a Box is a comprehensive solution that helps you manage fiduciary responsibilities for both retirement and healthcare plans, providing a repeatable process and documentation.The platform covers critical areas such as governance, risk management, vendor relationships, and compliance with regulations like the Consolidated Appropriations Act (CAA).Fiduciary in a Box can be leveraged by various professionals, including employee benefits consultants, retirement plan consultants, and organizations focused on addressing healthcare cost and transparency challenges.As a young benefit manager, you can use Fiduciary in a Box to establish a repeatable process, evaluate vendor relationships, and communicate your organization's commitment to managing costs and compliance to participants and committees.“We've created a solution that you can manage both of those responsibilities: retirement plan, and health care, with one product, which is fiduciary in a box.” - Patrick WilliamsConnect with Patrick Williams:Website: https://www.fiduciaryinabox.com LinkedIn: https://www.linkedin.com/in/corporatefiduciary/ | https://www.linkedin.com/company/fiduciaryinabox/?viewAsMember=true Connect with Eric Dyson: Website: https://90northllc.com/Phone: 940-248-4800Email: contact@90northllc.com LinkedIn: https://www.linkedin.com/in/401kguy/ The information and content of this podcast is general in nature and is provided solely for educational and informational purposes. It is believed to be accurate and reliable as of the posting date but may be subject to changeIt is not intended to provide a specific recommendation for any type of product or service discussed in this presentation or to provide any warranties, investment advice, financial advice, tax, plan design or legal advice (unless otherwise specifically indicated). Please consult your own independent advisor as to any investment, tax, or legal statements made.The specific facts and circumstances of all qualified plans can vary and the information contained in this podcast may or may not apply to your individual circumstances or to your plan or client plan-specific circumstances.
On this final encore episode of the Astonishing Healthcare podcast this year, we're replaying Episode 41, which featured three experts weighing in on rising litigation against employers and pharmacy benefit managers (PBMs) and was one of our most popular. We also want to take the opportunity to say, "Happy Holidays and New Year!" and thank our listeners and guests this year, including current and former colleagues; we couldn't have done it without you!In Episode 41, we discussed what employers sponsoring ERISA-covered health and welfare plans can do to show they are making an effort to establish processes and assess how "reasonable" the fees they pay are. Chris Deacon, Founder of VerSan Consulting; Jonathan Levitt, trial attorney and Co-Founding Partner at Frier Levitt; and Julie Selesnick, Senior Counsel in the employee benefits and ERISA Group at Berger Montague, joined host Justin Venneri for the discussion covering relevant provisions of the Consolidated Appropriations Act of 2021 (CAA), the recent lawsuits against Johnson & Johnson and Wells Fargo, and how plan sponsors can approach things like getting their data to make informed decisions.This episode built on previous conversations, including AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan.Chris, Jon, and Julie share their opinions about the similarities - or lack thereof - of the health plan lawsuits to the 401(k) and pension litigation of the early 2000s, why we will likely see more litigation, the reality and frustration of relying on traditional PBMs and carriers for data (and what to do about it), conflicts of interest in and around PBM procurement and broker/consultant relationships, and why Julie has a "fainting couch!"Related ContentAH004 - Data, Fiduciary Responsibility, and Reversing Trend with Jeff HoganThe Consolidated Appropriations Act & Prescription Drug Data Collection (RxDC): New Rules & Regulations Equal New ResponsibilitiesSelf-funded plans ignore the Consolidated Appropriations Act at their perilFor more information about Capital Rx and this episode, please visit Capital Rx Insights.
Are you struggling to navigate the complex world of gag clause attestation requirements? In this must-watch episode of Shift Shapers, Jennifer Berman, JD, CEO of MZQ Consulting, provides a comprehensive breakdown of everything plan sponsors and advisors need to know about these critical compliance requirements.From the Consolidated Appropriations Act of 2021 to today's implementation challenges, discover how these regulations are reshaping healthcare plan transparency. Jennifer explains why many contracts still contain illegal gag clauses in 2024 and what this means for your organization. Learn about the crucial differences between fully-insured and self-funded plans, and how these differences impact your compliance obligations.Key topics covered:Detailed explanation of gag clauses and their impact on healthcare plansStep-by-step guide to annual CMS attestation requirementsUnderstanding potential penalties and enforcement mechanismsNavigation of the HIOS system reporting processCritical differences between fully-insured vs. self-funded plan requirementsPractical strategies for verifying gag clause complianceTips for accessing and utilizing plan data effectivelyReal-world challenges in contract review and complianceThis episode delivers essential insights for anyone involved in healthcare plan administration and compliance. Whether you're managing benefits for your organization, advising clients on their healthcare plans, or ensuring regulatory compliance, you'll gain valuable knowledge about navigating these complex requirements. Jennifer's expertise provides actionable guidance for insurance professionals, consultants, and organizational leaders who need to understand and implement these critical transparency regulations.In This Episode00:00 Introduction to Gag Clause Attestation00:45 Understanding Gag Clauses01:39 Legal Requirements and Compliance03:00 Challenges and Real-World Implications04:58 Access to Plan Data and Its Importance07:11 Reporting and Documentation07:33 Understanding Certification and Penalties10:02 Annual Reporting Requirements10:18 Advisor's Role in Compliance10:40 Self-Funded vs Fully Insured Plans13:03 Ensuring No Gag Clauses13:20 Final Thoughts and Key Takeaways14:39 Conclusion and Farewell
On this episode of the Astonishing Healthcare podcast, three experts weigh in on rising litigation against employers and pharmacy benefit managers (PBMs) and what employers sponsoring ERISA-covered health and welfare plans can do to show they are making an effort to establish processes and assess how "reasonable" the fees they pay are. Chris Deacon, Founder of VerSan Consulting; Jonathan Levitt, trial attorney and Co-Founding Partner at Frier Levitt; and Julie Selesnick, Senior Counsel in the employee benefits and ERISA Group at Berger Montague, joined host Justin Venneri for the discussion covering relevant provisions of the Consolidated Appropriations Act of 2021 (CAA), the recent lawsuits against Johnson & Johnson and Wells Fargo, and how plan sponsors can approach things like getting their data to make informed decisions.This episode builds nicely on previous conversations, including AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan.Chris, Jon, and Julie share their opinions about the similarities - or lack thereof - of the health plan lawsuits to the 401(k) and pension litigation of the early 2000s, why we will likely see more litigation, the reality and frustration of relying on traditional PBMs and carriers for data (and what to do about it), conflicts of interest in and around PBM procurement and broker/consultant relationships, and why Julie has a "fainting couch!"Stay tuned for more, and we'll add some new resources (scripts and checklists, for example) to the links as they become available!Related ContentAH004 - Data, Fiduciary Responsibility, and Reversing Trend with Jeff HoganThe Consolidated Appropriations Act & Prescription Drug Data Collection (RxDC): New Rules & Regulations Equal New ResponsibilitiesSelf-funded plans ignore the Consolidated Appropriations Act at their perilFor more information about Capital Rx and this episode, please visit Capital Rx Insights.
Last time Cora Opsahl was on the show, Michelle Bernabe, RN, KAT, wrote a comment on LinkedIn I thought encapsulated the gist of it all so well. She wrote, “[Cora] first became a mentor/ally through Relentless Health Value episode 372. … It opened a doorway to a whole group of very relentless people.” For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. I want to start there because it's a nice comment, but it's also a call to action. Think about this and think about it not in the context of being a “stakeholder” and not in the context of being an organization but in the context of humans who work at these various organizations who, combined, comprise the bucket of companies that we lumped together using the old stakeholder word. All of these individuals are making choices every day, and all of these choices, they could be made with integrity and with the patient or member in mind … or not. In real life, right now, the overwhelming majority of members/patients in this country get their clinical care and the pleasure of paying for that care or drugs within the current ecosystem we have here in the USA. For any of us, or all of us who work within that traditional ecosystem, it is up to us to choose our own legacy here. It's probably why you listen to this show in the first place, actually. There are so many RHV (Relentless Health Value) listeners who are pushing for patients against the riptide that is the profit motives of the organization that they work for. It's hard. But yeah, it's all about finding our people and supporting each other. Okay, so let's get to the “between a rock and a hard place” portion of this discussion. Hospitals and ASOs (administrative services organizations)/carriers/TPAs (third-party administrators) often enter into or sometimes enter into what amounts to anticompetitive contracts with each other. Listen to episode 395 with Brennan Bilberry for the rundown on that one. But meanwhile, the CAA, the Consolidated Appropriations Act from 2021, holds employer plan sponsors accountable and responsible to ensure that plan assets are spent prudently, that costs paid are reasonable, and that there's no conflict of interest (COI). This is the definition of what a fiduciary is supposed to do, by the way—prudent, reasonable, and no COI. Anticompetitive contracts between a carrier and a hospital are the very definition of COI. And when that COI results in higher, maybe unreasonable, prices and non-prudent spend, well, plan sponsors are put between a rock and a hard place if they stick with their existing vendors. Rosa Novo from Miami-Dade County Public Schools put this really succinctly on a panel at a 32BJ event recently. She said what amounts to, I have no choice but to actually do the right thing here, for many reasons, but one of them is I do not look good in orange. She said, my personal butt is on the line here. And furthermore, who do class action lawsuits make look bad when their company or CEO or CFO are personally sued over conflicted benefits? See the Wells Fargo lawsuit, J&J lawsuit, etc. It sucks that employers or plan sponsors get put into this pickle by their own vendors. And that's what we're talking about today. This is a conversation that starts out talking about rates (ie, prices), edges into rights (ie, plan sponsor rights), and ends up all about power. And by the way, if you're a plan sponsor, especially in New York City, maybe doing the right thing here means hatching a plan to steer and tier in your benefit design, figuring out how to, for reals, help support the efforts of 32BJ to advantage pretty much every patient near and far. The pushback I often hear to doing something like this often involves the perception that plan members are too rich to care about reasonable prices, prudent plan spending, and COI. And yeah, to state the obvious, these same people are also sophisticated enough to smell a fine opportunity for a class action lawsuit; and also, they probably do care, as more and more studies suggest. Sorry if I just stumbled onto a sacred cow. Cora Opsahl, my guest today, is the director of the 32BJ Health Fund, serving over 200,000 folks. Their ability to kick NewYork-Presbyterian, a big, consolidated, very expensive hospital, out of their network in 2018 enabled them to offer maternity benefits for $40 in total out-of-pocket for members. And also, employees got their biggest raise ever; employers got a premium holiday and a 3% rate increase for a bunch of years after that; and yeah … this is where we start the conversation today. And yeah, it's a freakin' tangled web we weave; and this tale is a perfect case study of it. It makes me even more invested in remembering my own manifesto (that was episode 400) to ensure that I can feel good about what I personally have accomplished and what I have been a part of and the net impact of my own personal actions, since I, too, very often work in the belly of the beast. Furthermore, you will find links to a template health savings calculator for plan sponsors and also a template contract (again for plan sponsors) that 32BJ has made available. More on that in the show that follows. Also mentioned in this episode are 32BJ Benefit Funds; Michelle Bernabe, RN, KAT; Brennan Bilberry; Rosa Novo; Marilyn Bartlett; Cynthia Fisher; Zack Cooper, PhD; Claire Brockbank; Andreas Mang; Chris Deacon; Elizabeth Mitchell; and Purchaser Business Group on Health. You can learn more at health.32bjfunds.org and by following Cora on LinkedIn. Cora Opsahl is the director of the 32BJ Health Fund, a self-insured Taft-Hartley benefit fund that sets comprehensive design parameters to ensure the 200,000 members and families of Service Employees International Union 32BJ have easy and sustained access to affordable, high-quality healthcare. Since becoming director of the Health Fund in 2021, Cora has prioritized a data-driven approach to healthcare, focusing on reducing trend; solving the affordability challenge on behalf of union members; and most important, keeping members at the center of every decision. Under her leadership, the 32BJ Health Fund has saved more than $35 million annually—which it has reinvested in new and better benefits, including the first fertility benefit for members—by removing NewYork-Presbyterian hospitals and physicians from its network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and establishing an expanded Centers of Excellence program. Most recently, Cora conducted an innovative medical request for proposal (RFP), stipulating that all finalists must have a signature-ready contract drafted by the Health Fund prior to award. By including the Health Fund–drafted contract in the RFP process, the Fund was able to negotiate an agreement that brought unprecedented visibility and increased accountability to the 32BJ Health Fund benefit. Cora is regarded as an expert in pharmacy benefit management and previously worked at Express Scripts, where she held a variety of roles, ranging from Medicare Part D to operations to strategy and acquisitions. She earned an MBA from Saint Louis University. 06:16 Why is it imperative for employers to do something differently when it comes to being plan sponsors? 09:22 How analyzing claims data allowed 32BJ Health Fund to reshape their benefit design. 12:09 What anticompetitive rights did 32BJ run into that limited 32BJ Health Fund from managing their benefit design? 14:12 How do these anticompetitive rights have quality implications as well as cost implications? 18:43 How did 32BJ Health Fund remove NewYork-Presbyterian from their network, and how much did it save 32BJ Health Fund per year? 19:46 What did the healthcare savings allow the unions and employers to do? 20:46 Study by Zack Cooper, PhD. 21:26 Why rising healthcare costs has pushed 32BJ Health Fund to move beyond benefit design to manage healthcare spend. 24:15 Why 32BJ Health Fund wants to control the contracting process. 26:00 EP419 with Andreas Mang. 27:18 What are 32BJ Health Fund's four non-negotiables? 33:17 Wall Street Journal article on health insurance contract. 35:30 Upcoming episode with Claire Brockbank. 36:14 What is the challenge that exists in our current healthcare environment? 37:43 Cora's advice on how to get high-quality healthcare at an affordable price. You can learn more at health.32bjfunds.org and by following Cora on LinkedIn. @CoraOpsahl discusses #fiduciaryresponsibility in #healthcare on our #healthcarepodcast. #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Dan Nardi, Dr Spencer Dorn (EP451), Marilyn Bartlett, Dr Marty Makary, Shawn Gremminger (Part 2), Shawn Gremminger (Part 1), Elizabeth Mitchell (Summer Shorts 9), Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402), Ashleigh Gunter, Dr Spencer Dorn (EP446)
Courtenay joined Harrison Smith on Infowars to issue an urgent call to action, in regards to the USDA soliciting public input involving the implications of the land-grabbing SUSTAINS Act. The USDA is preparing policy to implement the SUSTAINS Act, determining who will own “environmental services,” which include the air we breathe, photosynthesis, pollination, and the health benefits of open space. This step is critical for proponents of the United Nations' sustainable development agenda to achieve, as it will provide the path to transfer America's real assets from private citizens to federal and international interests. The earlier attempt to accomplish this was stopped when the Natural Asset Company scam was soundly defeated in January. Biden-Harris Administration is preparing to determine ownership of natural processes on private lands as it implements the Sustains Act authorized through the Consolidated Appropriations Act of 2023. This will have catastrophic consequences on our economy, and on individual property rights resulting in loss of liberties and sovereignty! While the official public comment period has since passed, your input is still instrumental to the resistance. Contact your congressmen, senators & policy makers, educate yourself and community, support your local farmers & independent media, etc. Local action is how we win the info war! ____________________________________________________________________ ▶ GET On-Demand Access for Courtenay's Cognitive Liberty Conference: https://cognitivelibertyconference.com ▶ Come meet Courtenay LIVE @ ✩ Freedom Fest in Knoxville, TN on September 28th https://tcgc1776.org ✩ MAGA Fest in New Orleans, LA on October 5 & 6 (Promo: Turner) https://www.magafest24.live ✩ Red Pill Expo in Tulsa, OK on Nov 16 & 17 (Promo Code: COURTZ) https://bit.ly/RedPillExpo ----------------------------------------- ▶ Follow & Connect with Courtenay: https://www.courtenayturner.com ✩ Linktree: https://linktr.ee/courtenayturner ▶ Support my work & Affiliate links: ✩Buy Me A Coffee! https://www.buymeacoffee.com/courtzt ✩GiveSendGo: https://www.givesendgo.com/courtenayturnerpodcast ✩Venmo: https://account.venmo.com/u/Courtenay-Turner ✩Cash App: https://cash.app/$CourtzJT ✩ Gold Gate Capital (Secure Your Wealth!) https://bit.ly/COURTZGoldSilver ✩ SatPhone123 (Claim Your Free Satellite Phone!) https://bit.ly/COURTZ123 Promo Code: COURTZ ✩ Richardson Nutritional Center: (B-17!) https://rncstore.com/courtz ✩ Relax Far Infrared Saunas: (Warm Up!) https://relaxsaunas.com/COURTZ Discount Code: COURTZ ✩ IronHawk Financial (Become Your Own Bank!) Receive Free Books On How: Send email, subject: "Free Books" and Mention Promo Code "COURTZ" to: Joe@IronHawkFinancial.com ✩Discover The Magic of MagicDichol: https://iwantmyhealthback.com/COURTZ ✩Defy The Grid With Real Currency.....Goldbacks!: https://bit.ly/Courtenay-Turner-Goldbacks Promo Code: COURTZ ✩Honey Colony "Where The Hive Decides What's Healthy": https://bit.ly/HoneyColony-COURTZ Promo Code: COURTZ ✩Full Moon Parasite Protocol: https://bravetv.store/COURTZ Promo Code: COURTZ ▶ Follow Courtenay on Social Media: ✩Twitter: https://twitter.com/KineticCourtz ✩TruthSocial: https://truthsocial.com/@CourtenayTurner ✩Instagram: https://instagram.com/kineticcourtz ✩Telegram: https://t.me/courtenayturnerpodcastcommunity ▶ Listen to &/or watch the podcast here! https://linktr.ee/courtenayturner ————————————————— ▶ Disclaimer: this is intended to be inspiration & entertainment. We aim to inform, inspire & empower. Guest opinions/ statements are not a reflection of the host or podcast. Please note these are conversational dialogues. All statements and opinions are not necessarily meant to be taken as fact. Please do your own research. Thanks for watching! ————————————————— ©2024 All Rights Reserved Learn more about your ad choices. Visit megaphone.fm/adchoices
In this episode of the Astonishing Healthcare podcast, Jeffrey Hogan, President of Upside Health Advisors, returns to the show for a timely discussion with Justin Venneri about why the timing is perfect for health plan sponsors and fiduciaries to engage their partners to secure necessary disclosure requirements and access to their data: it's renewal season! The Consolidated Appropriations Act (CAA) placed additional responsibilities on plan fiduciaries, including the need to make attestations. With gag clauses removed from contracts, the door is open. Jeff stresses the importance of analyzing the plan's data to make informed decisions and meet the fiduciary obligations. "The industry is craving trust," and fiduciaries need a trusted source of data and analytics to help them identify areas of waste and make changes that will benefit their plans. Whether it's pharmacy benefits, hospital spend, or the commissions paid to brokers/consultants, there's a unique opportunity to gain the insight needed and avoid the rising risk of liability right now.To learn more about Upside Health Advisors, click here, or you can find Jeff on LinkedIn.Related ContentAH004 - Data, Fiduciary Responsibility, and Reversing Trend with Jeff HoganThe Consolidated Appropriations Act & Prescription Drug Data Collection (RxDC): New Rules & Regulations Equal New ResponsibilitiesSelf-funded plans ignore the Consolidated Appropriations Act at their perilFor more information about Capital Rx and this episode, please visit Capital Rx Insights.
After being in effect for over three years, the COVID-19 public health emergency (PHE) expired in May 2023. From the start of the PHE, state Medicaid programs applied continuous coverage (or non-termination) requirements to access additional federal matching funds provided through the Families First Coronavirus Response Act (FFCRA). The Consolidated Appropriations Act of 2023 ended the Medicaid continuous coverage requirements in March 2023, disconnecting the federal match requirements from the PHE. This change was projected to result in millions of individuals losing their Medicaid coverage, raising questions about significant short-term and long-term impacts on state Medicaid programs and other health insurance markets. During this podcast, our guests discuss where we are over a year into the unwinding of the continuous coverage requirements, as well as the projected effects on health coverage for the Medicaid population. Presenters also shared considerations for addressing the unwinding in Medicaid managed care capitation rate-setting.
Today is an encore because I am going on vacation next week. It always feels a little bit like a time warp because by the time this show will air, I will be back from vacation. This show with Paul Holmes was one of the most popular episodes of 2023 and definitely is just as relevant now. A lot of the things that Paul talks about are worth repeating or listening to again. For a full transcript of this episode, click here. Before we kick in, though, I'm gonna repeat something that Ge Bai, PhD, CPA, says a lot: There's no angels and there's no devils in the healthcare industry. But we are talking about for-profit entities. And if there's one thing that's generally true about a for-profit entity, especially one that is publicly traded, it's gonna do whatever it can get away with. It becomes up to the customer to set expectations and using the purchasing discipline that they probably use everywhere else in the business because it basically is good business to have purchasing discipline. Before we kick into the episode, just a couple of things. Thing one, if you haven't, do subscribe to the weekly email that goes out describing the show. Here's just one reason to do so. It's really efficient because what is transcribed in that email is the whole beginning half (usually) of the introduction. So, if later on you are trying to remember which episode you heard something in, you can just search your email and find the show. How you subscribe is go to relentlesshealthvalue.com, hang out for probably 15 seconds, and there will be a pop-up. And while you're on the Web site, here's something else you could do. Go to the lower right-hand corner of the Web site. You will notice a little button. It's an orange button. There's a microphone. Click on that; say something like your name, your company name, maybe a word or two about Relentless Health Value; and then encourage others to subscribe to the weekly email that goes out, similarly to what I just did. Then what our team will do is take that recording and potentially use it at the end of some of the shows so we can hear somebody else talk besides myself. So, please do go over to the Web site, click on that little microphone, and record something that you might want to share with the other members of the Relentless Tribe. And with that, here's your encore. If this were a video show, I would stare into the camera with steely eyeballs right now and say that I have a special message for employer CFOs. If you aren't a CFO, pretend that you are so that you get the full effect here. So, now that we're all CFOs, let's pull up the company P&L (Profit and Loss) statement. This is what keeps us all up at night, right? Making sure that the net profit line at the bottom looks good. We could decide to lay off a few people. Reorg something or other. Beat up a vendor. We also could go over and have a strident conversation with sales leadership about what they can do to jack up their sales revenue. Top line begets bottom line and all that. Or, here's another idea: In this healthcare podcast, I am speaking with Paul Holmes, who is an ERISA (Employee Retirement Income Security Act) attorney with a specialty in PBM (pharmacy benefit manager) contracts, especially the PBM contracts from the big PBMs that get jammed in employer plan sponsor faces by whomever and which they are told look fine and that the employer plan sponsor should just go ahead and sign. Now, if we, meaning all of us CFOs, sign that paper, or someone on our benefits team signs the paper … fun fact, our company just spent 30% to 40% over market for our pharmacy benefits. That contract we just signed contains all kinds of expensive little buried treasures—treasures accruing to the PBM and other parties, to be clear, and coming at our expense. There's 17-ish very common treasures in your typical PBM contract, and none of us will ever spot them unless we know what we are looking for. But let's dig into this for a sec, especially for all of us newly minted CFOs because the real ones already did this math. Say our company spends whatever—we're a bigger company, and we spend $100 million a year on our drugs. That's a minimum of $30 million that we got taken for … $30 million a year. Because of the huge dollars at stake (30% to 40% of drug spend), it's certainly the advice of almost anybody that you talk to who's an expert in PBM contracts to have a third party—not your EBC (employee benefit consultant), which we'll get into in a sec, but somebody else (a third party)—review every PBM contract. I mean, what's the worst that can happen for anybody considering having an independent third party review their PBM contract? It costs a couple grand in lawyer fees, and they give it a stamp of approval. Knowledge is power, and now we know. But let's just say this third-party review doesn't happen. We all go with a “devil may care” about this whole PBM overcharging us by 30% to 40% possibility. And let's say the PBM contract is, in fact, a ride on the Hot Mess Express but we don't know it. Here's two pretty bad downsides, especially now, this year, since the passage of the CAA (the Consolidated Appropriations Act). Number one bad thing: Plan sponsors may get sued as per the CAA for ERISA violations. It's not just the company paying that extra $30 million, or 30% to 40%, right? It's also employees. This is risk exposure, bigly. Just like it was on the 401(k) side of the house, which Paul Holmes, my guest today, mentions later on in the interview. He talks about just how much those lawsuits cost and, yeah, exposure. As I mentioned three times already, today I am speaking with Paul Holmes about PBM contracts in all their stealthy glory. The one thing I came to appreciate is that these things are works of art … if you're into those paintings of pretty flowers where, if you look hard enough, you spot a skull tucked in the greenery (memento mori). Paul is a longtime ERISA attorney. He has dedicated his career to helping plan sponsors in their negotiations with PBMs and trying to help them reduce drug spend, especially drug spend that isn't actually paying for drugs. Here's a link to an article we discuss about how a school district in Florida is suing their longtime EBC for taking $2 million a year in alleged secret payments. We also mention an episode with AJ Loiacono (EP379). And along similar lines, Jeff Hogan mentioned on LinkedIn the other day, “It's pretty amazing that just in the course of the [past few] weeks, I'm reading, seeing, and hearing about big new CAA breach of fiduciary duty cases.” So, Paul Holmes says this more eloquently, but if you're a plan sponsor, definitely get your PBM contract reviewed and maybe consider working with an EBC who's happy to sign the disclosure statement that your lawyer has provided without disclaimers. Also mentioned in this episode are Ge Bai, PhD, CPA; AJ Loiacono; and Jeffrey Hogan. You can learn more by emailing Paul at pbh@williamsbarbermorel.com. Paul B. Holmes, JD, is a seasoned ERISA lawyer with nearly 40 years of specialization in that field. Paul joined Williams Barber & Morel Ltd. recently, after 31 years with Nixon Peabody LLP and Ungaretti & Harris LLP. Paul is one of the few ERISA lawyers in the United States, concentrating his practice on PBM contracting and oversight. Paul represents large employers, Taft-Hartley welfare funds, and governmental units in their selection, contracting, auditing, and disputes with large pharmacy benefit managers (PBMs). This work includes active oversight of the request for proposal (RFP) process for selecting a PBM, the negotiation and customization of PBM contracts, and legal audits of PBM compliance with their contracts. Paul provides insightful guidance on the prudent selection of independent pharmacy benefit consulting firms (who do not receive indirect compensation from PBMs), which independence is expressly required under Section 202 of the Consolidated Appropriations Act of 2021 (CAA). Recent efforts have focused on reducing wasteful drug spend promulgated by large PBMs in dozens of categories. These include the preference of Humira® biosimilars, reducing off-label utilization of GLP-1s, reducing huge markups on certain specialty generics, and customizing PBM formularies and clinical protocols to better control spend. He was selected, through a peer-review survey, for inclusion in The Best Lawyers in America® (2020 and 2021) in the field of Employee Benefits (ERISA) Law. Paul received his bachelor's degree from Bradley University and his Juris Doctor degree from the University of Illinois College of Law. 07:41 What are Paul's usual observations when a PBM contract crosses his desk? 08:34 “If you just sign … one of their model contracts …, you're probably gonna pay 30% to 40% above market on your drug spend.” 12:11 What is a PBM lawyer? And why is it important to find an ERISA PBM lawyer? 17:12 EP379 with AJ Loiacono. 17:40 Who is on the hook for the cost of the PBM contracts? 21:05 What's the problem with most ERISA lawyers today? 22:56 Lawsuit about PBM contract. 27:43 What's Paul's advice for benefits consultants? 31:40 How much might a plan sponsor be paying their consultant versus what a consultant might be making from a PBM? You can learn more by emailing Paul at pbh@williamsbarbermorel.com. Paul Holmes discusses #PBMContracts on our #healthcarepodcast. #healthcare #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Ann Kempski, Marshall Allen (tribute), Andreas Mang, Abby Burns and Stacey Richter, David Muhlestein, Luke Slindee, Dr John Lee, Brian Klepper, Elizabeth Mitchell, David Scheinker (Encore! EP363)
The incumbent administration made the strategic decision to offload a massive one million barrels of gasoline from our critical emergency reserves to reduce gas prices just before the long-awaited holiday weekend. The Department of Energy, the body tasked with overseeing our country's energy resources, has revealed that five contracts were awarded to several energy firms. These companies have been granted permission to purchase barrels that the Biden-led team is now liberating from the Northeast Gasoline Supply Reserve; this reserve is a component of the much larger federal Strategic Petroleum Reserve system. The primary motivation behind these well-timed releases is an attempt to bring down gas prices right before the Fourth of July festive break. Our leaders are certainly trying to appease the consumers with lowered prices as the summer driving season picks up. Under the leadership of Energy Secretary Jennifer Granholm, the Department has strategized the release of these reserve supplies specifically before the nation celebrates Independence Day. Its pure intent is to ensure an adequate flow of gas supply for the hardworking Northeast citizens at a crucial, high-demand time. Following the announcement of the intention to trigger releases from the Northeast Gasoline Supply Reserve, the DOE was met with active responses from the business front. A total of five firms put forth 19 proposals to the energy authority after learning about this lucrative opportunity, and it seems each of them got favorable responses; indeed, all five were awarded contracts. The strategic decision to release gas reserves has significant implications for the general public. The Department mentions that the barrels are being sold at an impressively average price of $2.34 per gallon, giving the consumer a clear monetary benefit ahead of the holidays. According to a DOE representative, it was Congress, through the 2024 Consolidated Appropriations Act, that necessitated the complete sale and subsequent closure of such a reserve. This step may be seen as part of broader administrative responses to price management, especially in the energy sector. See omnystudio.com/listener for privacy information.
In this episode of ShiftShapers, host David Saltzman discusses the recent Supreme Court decision to overturn the 40-year Chevron Deferment precedent and its implications for advisors and their clients. Joined by Jennifer Berman, ERISA attorney Jennifer Berman, the NABIP (National Association of Benefit Insurance Professionals) Legislative Vice Chair and CEO of MZQ Consulting, the discussion explores the decision's potential long-term effects on federal regulations and compliance in the healthcare sector. They delve into how this ruling shifts the responsibility from federal agencies to the judiciary in interpreting ambiguous statutes and assess the impact on specific regulations like compensation disclosures under the Consolidated Appropriations Act. Berman emphasizes to advisors and employers the importance of maintaining fiduciary duties and regulatory compliance while staying informed about future changes.More from MZQ ConsultingKey Takeaways:SCOTUS Decision Impact: The Supreme Court recently overturned the Chevron Deferment, shifting the power of interpreting ambiguous federal statutes from federal agencies to the judiciary. This major change may lead to increased challenges to existing regulations.Immediate Effects on Law: Currently, the ruling doesn't change existing laws or regulations. However, advisors should anticipate more court challenges to federal regulations based on ambiguities in the underlying statutes.Advisors' Immediate Actions: Advisors should communicate to their clients that no immediate changes are necessary. They should continue to follow current laws and regulations and focus on fulfilling their fiduciary duties.Potential Healthcare Changes: Specific areas in healthcare, such as compensation disclosures and mental health parity, may become more contentious and face judicial challenges. However, statutory requirements like HIPAA, COBRA, and ACA reporting remain intact.Need for Robust Fiduciary Processes: Advisors should emphasize the importance of maintaining documented fiduciary processes, including setting up committees, meeting regularly, and properly documenting actions to demonstrate compliance and best efforts.
In this episode, we look at the intentional financial collapse of the United States, that will usher in Universal Basic Income. Website: thefacthunter.comEmail: thefacthunter@mail.comSnail Mail: George Hobbs PO Box 109 Goldsboro, MD 21636Show notes Will Trump chicken out of the presidential debate? Probably. He's a Grade-A coward. https://www.usatoday.com/story/opinion/columnist/2024/06/25/trump-biden-presidential-debate-cnn-rigged/74195698007/ Over 1,700 Ukrainian forces killed in 24 hours: Russia https://www.presstv.ir/Detail/2024/06/24/728059/Over-1,700-Ukrainian-forces-killed Covid-19 pandemic will ‘bring socialism to US' and transform the world – Nassim Taleb to RT https://www.rt.com/news/497465-nassim-taleb-pandemic-socialism/?ysclid=lxt46t5fjz706201515 Americans Must Now Accept The Hard, Cold Reality That The Coronavirus Outbreak Is Intentionally Being Used To Collapse The U.S. Economy https://www.nowtheendbegins.com/coronavirus-crisis-being-used-to-crash-american-economy-cloward-piven-strategy/ Cloward–Piven strategy https://en.wikipedia.org/wiki/Cloward–Piven_strategy Richard Cloward https://en.wikipedia.org/wiki/Richard_Cloward Democratic Socialists of America https://en.wikipedia.org/wiki/Democratic_Socialists_of_America Guaranteed minimum income https://en.wikipedia.org/wiki/Guaranteed_minimum_income Why you need to know about the Cloward-Piven strategy for destroying America https://www.naturalnews.com/052296_Cloward-Piven_strategy_liberals_destruction_of_America.html CARES Act https://en.wikipedia.org/wiki/CARES_Act Consolidated Appropriations Act https://en.wikipedia.org/wiki/Consolidated_Appropriations_Act,_2021 Rudy Davis Website https://yearofjubile.com Jeremy Brown https://www.jeremybrowndefense.com USSG Firearm Violence Pamphlet https://www.hhs.gov/sites/default/files/firearm-violence-advisory.pdf Orioles Pride Night https://www.thefacthunter.com/post/mlb-pushing-pride-agenda-on-our-youth
For a full transcript of this episode, . The episode today is somewhat of a follow-on to the show with Lauren Vela, which was about employer inertia. If we're talking about inertia, though, we'd be remiss not to get a little circumspect about the whole affair and subject some other stakeholders to our microscope. One of these stakeholders is EBCs (employee benefit consultants), practice leads, and brokers, which AJ Loiacono talked about in to some extent; so we can check that box at least for now. That leaves TPAs (third-party administrators), ASOs (administrative services onlys), and health plans. And this hotbed of inertia is what I talk about today with Elizabeth Mitchell from PBGH, the Purchaser Business Group on Health. Similar to earlier shows, one disclaimer is that I am using the TPA and ASO terms sort of interchangeably here. Again, TPA is third-party administrator, and ASO is administrative services only, which is generally the term used when an insurance carrier offers services to a plan sponsor, like a self-insured employer. And these services don't include insurance, because … self-insured. So, the services are administrative only. One point to make clear before we dive in, this conversation is not about these carriers/payers/health plans in general and what they may or may not be doing. This conversation is very specifically focused on how well are those entities helping jumbo employers deploy their health benefits. And first we talk about the role of a TPA or ASO, both in terms of what a jumbo employer might want them to be doing versus what they are often actually doing. Spoiler alert: What they are often actually doing is acting like a full-on health plan and charging as such, even if the health plan part is not what the self-insured employer wants or needs, especially when somebody figures out exactly how much additional is getting charged for those ancillary health plan services. Listen to the show with Justin Leader () for a bead on just a piece of the how much additional that gets baked into the weekly claims wires many self-insured employers get. Bottom line, right now, there's a gap in the market. What is needed are indie TPAs who are effective and efficient and not owned by a health plan because, if history is any predictor of the future, the second the TPA gets owned by a health plan, the TPA sort of ceases to be a TPA and becomes a health plan—with all the attendant bells and whistles that, a lot of times, an employer can't opt out of. And also, the whole not sharing data becomes a thing, both cost data and also quality data. Now, just because there's a gap in the market, does that mean all jumbo employers are paralyzed into inertia? Well, it makes it harder, for sure. But it's also a reason to start figuring out how to solve for a problem when it has as many zeros at the end of it as this problem has. Have you seen these lawsuits popping up all over the place and just the numbers that are involved? Aramark's lawsuit against Aetna is just one example. Not to single out just this one, but in the interest of time, let's talk about this one. Aramark, a big employer, alleged that since 2018, Aetna has taken more than $200 million from it to pay for medical services that should not have been paid out and retains millions of dollars in undisclosed fees. Mark Flores about this one the other day. Also, there was that Cigna lawsuit where an electrician's union health plan was surprised to learn that the fees charged by Cigna had risen from around $550,000 in 2016 to $2.6 million in 2019. That was from a New York Times . For more on stuff like this, follow Doug Aldeen and/or Chris Deacon on LinkedIn. They're a great resource. I'd also listen to the “Who's Suing Who?” episode with Chris Deacon, which was . Because of all of this, the conversation today with Elizabeth Mitchell pretty quickly gets into the shift toward direct contracting between employers and providers to improve access quality and outcomes. If you can't beat them, get ruthlessly practical is my takeaway. I have to say, I truly admire some of these HR folks and their leadership willing to do what it takes on behalf of protecting the people that work for them. Now, important side note: There are certainly some health plans at least trying here, so I don't want to imply otherwise. There are some interesting initiatives that are afoot at, I'm gonna say, usually regional health plans. Elizabeth Mitchell has talked about some of these and made this clear also elsewhere. Lastly, if you aren't familiar with the CAA, which comes up in the episode today, there's a show () on the Consolidated Appropriations Act, which is what CAA stands for. Elizabeth Mitchell, my guest today, currently serves as the president and CEO of the Purchaser Business Group on Health. PBGH members are really focused on innovating and implementing change. We talk about some of this innovation and implementation on the show today, and it is very inspiring. Stay tuned on this topic, given just the absolute need for TPA services like we discuss in the show that follows, and given the smart, innovative, action-oriented people who are affected—1 plus 1 equals … yeah. Stay tuned. Very, very lastly, I just want to give a shout-out and thanks to Brad Brockbank for posing some great questions, which I pretty much turned around and asked Elizabeth Mitchell in this healthcare podcast. Also mentioned in this episode are ; ; ; ; ; ; ; ; ; ; ; ; ; ; and . You can learn more at and by connecting with Elizabeth on . You can also watch a on success with direct contracting. Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH), supports the implementation of PBGH's mission of high-quality, affordable, and equitable healthcare. She leads PBGH in mobilizing healthcare purchasers, elevating the role and impact of primary care, and creating functional healthcare markets to support high-quality affordable care, achieving measurable impacts. Elizabeth leverages her extensive experience in working with healthcare purchasers, providers, policymakers, and payers to improve healthcare quality and cost. She previously served as senior vice president for healthcare and community health transformation at Blue Shield of California, during which time she designed Blue Shield's strategy for transforming practice, payment, and community health. Elizabeth also served as the president and CEO of the Network for Regional Healthcare Improvement (NRHI), a network of regional quality improvement and measurement organizations. She also served as CEO of Maine's business coalition on health, worked within an integrated delivery system, and was elected to the Maine State Legislature, serving as a state representative and chair of the Health and Human Services Committee. Elizabeth served as vice chairperson of the US Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee, board and executive committee member of the National Quality Forum (NQF), member of the National Academy of Medicine's “Vital Signs” Study Committee on core metrics, and a Guiding Committee member for the Health Care Payment Learning & Action Network. She now serves as a board member of California's Office of Healthcare Affordability. Elizabeth holds a degree in religion from Reed College and studied social policy at the London School of Economics. 06:48 What is the overarching context for health plans in healthcare purchasing? 09:00 with Olivia Webb. 11:44 Why is it important to reestablish a connection between the people paying for care and people providing care? 14:07 What are the needs of a self-insured employer when managing employee benefits? 19:41 Is it doable for employers to set their own contracts? 22:11 Is transparency presumed? 23:25 Will the new transparency upon us actually expose wasted expense? 27:45 “This is not about individual bad actors. … The systems … that is not aligned.” 29:32 Are there providers who want to work directly with employers? 32:46 Why is it important that incentives need to be aligned? 34:25 Why is the quality of care even more important than transparency? 36:29 with Rik Renard. 38:08 What's missing from the conversation on changing health plans? You can learn more at and by connecting with Elizabeth on . You can also watch a on success with direct contracting. @lizzymitch2 of @PBGHealth discusses #TPA and #healthplan inertia on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! , , , , , , , , ,
Welcome to a riveting episode of our podcast, with Jim Connors (JC) and Wendy Sellers. In this episode, Chelsea Ryckis, President of Ethos Benefits, demystifies the difference between a 'benefits broker' and a 'benefits advisor', an essential understanding for HR professionals in an industry forecasted to be worth $44.53 billion in 2024. Chelsea underscores the importance of transparency in broker compensation and the critical need for brokers to ensure compliance with the Consolidated Appropriations Act of 2021. With startling examples of giant commissions and broker malpractices, which ultimately impact the client's bottom line, this episode sheds light on the hidden crevices of the industry. She doesn't only highlight problems but also offers robust solutions to tackle healthcare issues without sending insurance premiums skyrocketing. She elaborates on a fascinating case study involving a finger skin graft, which underscored the potential for healthcare costs to be curtailed, improving the work and financial conditions for all employees. This episode is a must-listen for those who wish to gain a deeper understanding of the employee benefits brokerage sector. This eye-opening episode spotlights the need to question the status quo, provides insights into the broker vs. advisor dilemma, and throws light on the demand for transparency in the healthcare industry. Regardless of whether you are a broker, an advisor, work in HR, or are impacted by the healthcare industry in any capacity, this episode is sure to leave you with much to ponder and act upon. Chelsea M. Ryckis Employee Benefits Consultant, President (407) 494-4227 https://ethosbenefits.com/ https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Liz and Andrew break Justice Merchan's contempt ruling that paves the way for Trump to spend time in lockup, then discuss the witnesses and how they did, or did not, help the prosecution build its case. Plus, Tennessee banned contrails and maybe … spray bottles? Links: Second Contempt Order https://www.nycourts.gov/LegacyPDFS/press/PDFs/DOcontempt_5-6-24FINAL.pdf Consolidated Appropriations Act of 2022 https://www.congress.gov/117/plaws/publ103/PLAW-117publ103.pdf 2023 OSTP Geoengineering Report https://www.whitehouse.gov/wp-content/uploads/2023/06/Congressionally-Mandated-Report-on-Solar-Radiation-Modification.pdf Tennessee HB 2063 https://legiscan.com/TN/text/HB2063/id/2983097 Florida SB 1084 https://www.flsenate.gov/Session/Bill/2024/1084 DeSantis Statement re SB 1084 https://www.flgov.com/2024/05/01/governor-desantis-signs-legislation-to-keep-lab-grown-meat-out-of-florida/ Show Links: https://www.lawandchaospod.com/ BlueSky: @LawAndChaosPod Threads: @LawAndChaosPod Twitter: @LawAndChaosPod Patreon: patreon.com/LawAndChaosPod
In this episode of ShiftShapers, host David Saltzman invites David Mordo, Senior Compliance Officer at MZQ Consulting, to discuss the intricacies of prescription drug reporting (RxDC) as mandated by the Consolidated Appropriations Act of 2021. The conversation delves into the transparency requirements for employers regarding their prescription drug plans, encompassing the scope of reporting, deadlines, submission processes, and implications of non-compliance. With a focus on the pivotal role of employers, insurance carriers, third-party administrators (TPAs), and Pharmacy Benefit Managers (PBMs) in this process, the talk highlights the collaborative effort needed to ensure compliance. Mordo offers valuable insights are offered on how brokers and advisors can assist their clients in navigating the complexities of RxDC reporting, the selection of vendors for report preparation, and the importance of timely action to meet regulatory deadlines.Key Takeaways From This Episode:RxDC is part of the Consolidated Appropriations Act of 2021, requiring employers to provide prescription drug plan information.Employers have to comply with multiple reporting requirements related to prescription drug plans annually.Reports for 2024 regarding prescription drug plans are due on June 3rd.Employers are responsible for ensuring compliance with prescription reporting, even if they use TPAs or PBMs for assistance.Brokers need to ensure vendors for reporting have experience, are reasonably priced, and can deliver timely and accurate data.
GDP Script/ Top Stories for April 3rd Publish Date: April 3rd From the Ingles Studio Welcome to the Gwinnett Daily Post Podcast. Today is Wednesday, April 3rd, and Happy heavenly Birthday to actor Marlon Brando. ***04.03.24 – BIRTHDAY – MARLON BRANDO*** I'm Bruce Jenkins and here are your top stories presented by Tom Wages Funeral Home. Lawrenceville Police say Hyundai and Kia thefts are on the rise Gwinnett County Public Schools Launches AI Policy Lab Lilburn Secures Federal Funding to Enhance Police Operations and Camp Creek Projects Plus, my conversation with Leah McGrath from Ingles Markets about the best breakfast choices. All of this and more is coming up on the Gwinnett Daily Post podcast, and if you are looking for community news, we encourage you to listen daily and subscribe! Break 1: TOM WAGES STORY 1: Lawrenceville Police say Hyundai and Kia thefts are up Lawrenceville police have issued a warning to owners of certain Hyundai and Kia models, urging increased vigilance due to a surge in thefts. The vulnerability, tied to an absent security feature in the ignition switch, affects vehicles manufactured between 2011 and 2021 that use traditional turnkey ignition systems instead of push-button starts. In response, Kia has supplied steering wheel locks to the police department for distribution to local residents. Vehicle owners from the specified years can obtain a lock by reaching out to Capt. Salvador Ortega via email. To further safeguard their vehicles, police suggest implementing additional security measures such as installing kill switches, battery disconnects, alarms, and GPS tracking devices, and ensuring cars are parked in well-lit, secure areas. STORY 2: Gwinnett County Public Schools Launches AI Policy Lab Gwinnett County Public Schools, in collaboration with the EdSAFE AI Alliance, has announced the creation of an AI Policy Lab. This initiative is dedicated to fostering the safe and ethical implementation of artificial intelligence within educational settings. The lab will provide comprehensive policy recommendations alongside educational materials aimed at teachers, students, and parents, emphasizing practical applications of AI. Dr. Calvin J. Watts, Superintendent of GCPS, highlighted the critical importance of instilling responsible AI practices among students to equip them adequately for future professional environments. This endeavor enhances GCPS's ongoing commitment to AI education, building on the foundation set by the AI-Future Ready pilot initiated in 2019. It also contributes to broader national discussions focused on establishing guidelines that ensure AI is used in ways that are safe, responsible, inclusive, and beneficial within the educational sphere. STORY 3: Lilburn gets federal funds for police, Camp Creek efforts Lilburn has successfully obtained federal funding amounting to $1.8 million through the 2024 Consolidated Appropriations Act, earmarked for two pivotal projects. The allocation will be divided equally between enhancing public safety and environmental preservation efforts. The first half of the funding supports the Tri-City Connect Program, a collaborative effort with Lawrenceville and Snellville. This initiative aims to bolster public safety by creating a video and data sharing platform. It encourages residents and businesses to voluntarily register their security cameras, facilitating quicker resolution of criminal activities by law enforcement agencies. The remaining funds are allocated to the stabilization of Camp Creek. This project is vital for maintaining the integrity of the 4.2-mile Camp Creek Greenway Trail, a cherished community asset for recreation and nature engagement. U.S. Representative Lucy McBath has been instrumental in securing these funds, demonstrating her dedication to advancing the welfare and safety of the community. We have opportunities for sponsors to get great engagement on these shows. Call 770.874.3200 for more info. We'll be right back. Break 2: INGLES 2 STORY 4: Gwinnett Clean & Beautiful Recognized with State And National Awards In March, Gwinnett Clean & Beautiful was distinguished for its dedication to the objectives of Keep America Beautiful. The organization received the prestigious Governor's Circle Award at the state level and was further recognized with the President's Circle Recognition Award on a national scale. Executive Director Schelly Marlatt expressed profound appreciation for these honors and reiterated the organization's commitment to environmental stewardship. Among the highlighted initiatives were the Earth Day recycling event and the Great Gwinnett Wetlands Cleanup, both emblematic of the organization's efforts to uphold Gwinnett County as an exemplar of cleanliness, sustainability, and natural beauty. For individuals seeking further information on the organization's activities or wishing to participate in future events, visit www.GwinnettCB.org. STORY 5: Gwinnett students will compete in national career education competition Twenty-six students from Gwinnett County Public Schools have earned the opportunity to participate in the national SkillsUSA leadership and skills competition, scheduled for June in Atlanta. These individuals achieved this distinction by securing either 1st or 2nd place at the SkillsUSA State Leadership Conference. The national competition is expected to attract over 6,500 students nationwide, showcasing their talents and leadership. A significant number of these students are from Maxwell High School of Technology, with additional participants from the Grayson Technical Education Program. SkillsUSA plays a crucial role in bridging students, educators, and industry experts, aiming to develop a highly skilled workforce ready to meet the demands of the future. STORY 6: LEAH MCGRATH And now here is my conversation with Leah McGrath about the best breakfast choices. STORY 7: LEAH MCGRATH ***LEAH MCGRATH INERVIEW*** We'll have final thoughts after this. Break 4: GCPS DISCOVERY Signoff – Thanks again for hanging out with us on today's Gwinnett Daily Post podcast. If you enjoy these shows, we encourage you to check out our other offerings, like the Cherokee Tribune Ledger Podcast, the Marietta Daily Journal, the Community Podcast for Rockdale Newton and Morgan Counties, or the Paulding County News Podcast. Read more about all our stories and get other great content at Gwinnettdailypost.com. Did you know over 50% of Americans listen to podcasts weekly? Giving you important news about our community and telling great stories are what we do. Make sure you join us for our next episode and be sure to share this podcast on social media with your friends and family. Add us to your Alexa Flash Briefing or your Google Home Briefing and be sure to like, follow, and subscribe wherever you get your podcasts. Produced by the BG Podcast Network Show Sponsors: ingles-markets.com wagesfuneralhome.com gcpsk12.org/about-us/careers #NewsPodcast #CurrentEvents #TopHeadlines #BreakingNews #PodcastDiscussion #PodcastNews #InDepthAnalysis #NewsAnalysis #PodcastTrending #WorldNews #LocalNews #GlobalNews #PodcastInsights #NewsBrief #PodcastUpdate #NewsRoundup #WeeklyNews #DailyNews #PodcastInterviews #HotTopics #PodcastOpinions #InvestigativeJournalism #BehindTheHeadlines #PodcastMedia #NewsStories #PodcastReports #JournalismMatters #PodcastPerspectives #NewsCommentary #PodcastListeners #NewsPodcastCommunity #NewsSource #PodcastCuration #WorldAffairs #PodcastUpdates #AudioNews #PodcastJournalism #EmergingStories #NewsFlash #PodcastConversationsSee omnystudio.com/listener for privacy information.
In this episode of the ShiftShapers podcast, we explore the complex world of Pharmacy Benefit Managers (PBMs) and their impact on healthcare costs, sparked by the Johnson & Johnson lawsuit. Our guest, USRxCare President Renzo Luzzatti, with a 30-year healthcare background, discusses the Consolidated Appropriations Act of 2021, which is aimed at shifting power back to payers from vendors by enhancing transparency and fiduciary responsibilities. The episode sheds light on the lawsuit against J&J for excessive pharmaceutical payments through their PBM, Express Scripts, highlighting the issue of overpayment in the industry. Luzzatti emphasizes the necessity of fiduciary PBMs, devoid of conflicts of interest, and the importance of transparency and beneficiary interests. We also discuss how employers can strategically manage their pharmacy benefits to avoid overpayment and ensure compliance with fiduciary duties, emphasizing the role of advisers in navigating this complex territory. The conversation also touches on current trends and future outlooks for managing pharmacy benefits more effectively and ethically. Each of these insights are critical to business owners and other organizational leaders who must manage healthcare benefits to be cost-effective while providing for employee health needs. USRxCare: https://usrxcare.com/
Three projects impacting Henrico County will receive funding as part of the Consolidated Appropriations Act of 2024, which recently passed the U.S. House of Representatives by a vote of 339 to 85. The act included money to fund all 15 of the Community Project Funding requests (formerly known as earmarks) made by U.S. Representative Jennifer McClellan (VA-4th District), which included: • 5,000 for Henrico County's Universal Broadband Deployment Project to extend fiber-to-the-home infrastructure to 412 serviceable units in the County. • 0,000 for the Richmond International Airport's Aircraft Apron Project to allow for the construction of a new aircraft apron...Article LinkSupport the show
“The CAA was the most significant piece of healthcare legislation that we've had since the ACA.” - Sarah Borders Healthcare compliance, especially post-CAA, can be a complex thing for employers to navigate. There's an increased level of scrutiny on employers, with heavy fees for those who don't comply. This week on Self-Funded with Spencer I'm joined by Sarah Borders, co-founder of Benefits Compliance Solutions. Here are a few key takeaways for consultants: Understanding compliance: Navigating the complex regulations and avoid costly mistakes. Turning compliance into an advantage: Discover how you as a consultant can leverage compliance as a prospecting tool, saving clients from lawsuits, penalties, and headaches. Embracing the benefits of regulation: Understand the purpose of the CAA and how it exposes bad practices, ultimately improving healthcare for everyone. Join us this week on Self-Funded with Spencer to learn how to not get sued. Chapters: 0:00 - Meet Sarah Borders 6:37 - Sarah's Journey To Compliance Expertise 14:05 - The Shift Towards Data-Driven Compliance 17:33 - Remote Work As An Entrepreneur 27:01 - Effective Communication = Effective Information 34:57 - Legal Repercussions Of Cobra Compliance 41:34 - Group Health Plan Compliance 46:20 - Yearly Attestation 54:04 - The Impact Of Regulations On Transparency 1:01:21 - Empowering Clients and Consultants 1:04:38 - The Impact Of CAA On Group Health Plans Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/ Key Words: #insurance #compliance #industrytrends #ACA #caa #levelfundedplans #Cobra #CobraCompliance #grouphealthplan #ConsolidatedAppropriationsAct #attestation #regulations #consulting #futureofcompliance #healthcarecompliance #selffunded #selffunding #podcast Insurance, Compliance, Industry Trends, ACA, CAA, Cobra, Cobra Compliance, Group Health Plan, Consolidated Appropriations Act, Attestation, Regulations, Consulting, Future Of Compliance, Healthcare Compliance, Self Funded, Self Funding, Podcast --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support
“The CAA was the most significant piece of healthcare legislation that we've had since the ACA.” - Sarah Borders Healthcare compliance, especially post-CAA, can be a complex thing for employers to navigate. There's an increased level of scrutiny on employers, with heavy fees for those who don't comply. This week on Self-Funded with Spencer I'm joined by Sarah Borders, co-founder of Benefits Compliance Solutions. Here are a few key takeaways for consultants: Understanding compliance: Navigating the complex regulations and avoid costly mistakes. Turning compliance into an advantage: Discover how you as a consultant can leverage compliance as a prospecting tool, saving clients from lawsuits, penalties, and headaches. Embracing the benefits of regulation: Understand the purpose of the CAA and how it exposes bad practices, ultimately improving healthcare for everyone. Join us this week on Self-Funded with Spencer to learn how to not get sued. Chapters: 0:00 - Meet Sarah Borders 6:37 - Sarah's Journey To Compliance Expertise 14:05 - The Shift Towards Data-Driven Compliance 17:33 - Remote Work As An Entrepreneur 27:01 - Effective Communication = Effective Information 34:57 - Legal Repercussions Of Cobra Compliance 41:34 - Group Health Plan Compliance 46:20 - Yearly Attestation 54:04 - The Impact Of Regulations On Transparency 1:01:21 - Empowering Clients and Consultants 1:04:38 - The Impact Of CAA On Group Health Plans Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/ Key Words: #insurance #compliance #industrytrends #ACA #caa #levelfundedplans #Cobra #CobraCompliance #grouphealthplan #ConsolidatedAppropriationsAct #attestation #regulations #consulting #futureofcompliance #healthcarecompliance #selffunded #selffunding #podcast Insurance, Compliance, Industry Trends, ACA, CAA, Cobra, Cobra Compliance, Group Health Plan, Consolidated Appropriations Act, Attestation, Regulations, Consulting, Future Of Compliance, Healthcare Compliance, Self Funded, Self Funding, Podcast --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support
In this episode, Greg and Rob continue their review of items from the HRSA audit data request list (DRL). They'll cover DRL #4, the provider list, as well as DRL #6, contract pharmacy documentation. Don't worry – they'll come back to DRL #5 (purchasing documentation) in an upcoming episode! In the intro, Rob shares a few insights from the recent 340B Coalition Winter Meeting in San Diego, and then the guys catch up on some 340B related news. They'll share a quick reminder on grantee 340B annual recertification (starting now through 2/26/2024) and describe communication HRSA has been sending to hospitals that were granted eligibility extensions last year under the Consolidated Appropriations Act. Finally, they'll discuss some developments from the Senate “Gang of 6” and their newly released 340B legislative draft and request for information on 340B Program reform.
In this episode of the Astonishing Healthcare Podcast, Jeffrey Hogan, President of Upside Health Advisors, shares his insights on the current state of healthcare and the challenges plan sponsors, including employers and other payers, face. He discusses the importance of aligning supply and demand in the healthcare system in the post-COVID era, the significance of the Consolidated Appropriations Act (CAA), and why establishing a process to evaluate plan data is a must. Jeff explains short-term steps plan fiduciaries can take to learn about their new responsibilities, gain access to their data, evaluate cost categories like pharmacy (which has been a primary driver of inflation, often compounding at 10%+ per year), and why advanced primary care models are worth a look, too. Finally, Jeff shares the most astonishing thing he's seen over his 35+ years in the business (hint: it's not exactly how you'd want to get out of a tough presentation to a client)! Related Content: Self-funded plans ignore the Consolidated Appropriations Act at their peril To learn more about Upside Health Advisors, click here, or you can find Jeff on LinkedIn. For more information about Capital Rx and this episode, please visit Capital Rx Insights.
For a full transcript of this episode, click here. Here's a quote from Ann M. Richardson, MBA. She wrote it on LinkedIn, and I love it: Quiet the noise that doesn't add value. Surround yourself with intelligent and respectful people who can deliver endless opportunities. Celebrate brilliance and new beginnings. Together, we've got this. Thanks for this beautifully stated call to action (I wish I would have written it myself) because it is also precisely the goal of Relentless Health Value and my hope for the Relentless Health Value Tribe—those of you who have connected with each other by way of this podcast vis-à-vis LinkedIn, or maybe you've met each other at an online or live event. For sure, subscribe to the weekly email to get notified of such goings-on. Now, this aspirational vision doesn't mean putting the onus on just any given individual to fix the systemic failings that get talked about on the podcast, but we can start somewhere. We can sit with ourselves; we can ask ourselves some big questions. We can decide the legacies we want to leave and what we want our life's work to add up to. That is what this show should, I hope, help you accomplish. And, yeah … together, we've got this. In this healthcare podcast, I am speaking with Peter Hayes; and we talk about five realities of 2024 for hospital chains, integrated delivery networks, health systems. Now, to make one thing very clear, as I have said many times on many Relentless Health Value shows: Not all hospital chains or hospitals are the same. There are large, consolidated, extremely rich, extremely politically and economically powerful organizations who are called health systems. And then there are rural or urban institutions that are barely scraping by and serving huge vulnerable patient populations. And despite the many aforementioned names for hospital chains and their associated outpatient facilities and owned physician groups and urgent care centers, all these names for these big care delivery entities are flabbergastingly meaningless because they do not separate the consolidated rich ones from the very desperately not rich ones. Today on the show, we're talking about the first kind of health systems: the big rich consolidated ones which are taking over every geography where there's money to be made. These are the ones where you read about their bad behavior in the New York Times or hear about them in YouTube videos like this one. Peter Hayes talks about the five things that these behemoth entities may really need to start thinking hard about, even in the face of their fierce and often-unrelenting market power and the political hold that they have over many local communities and all the regulatory capture that goes along with that. So, here's Peter's list in a nutshell—the five things to get real about: 1. Health systems need to get real about the CAA (Consolidated Appropriations Act) and its implications that plan sponsors only pay “fair and reasonable” prices for medical services. Now, before I dig in on this, jargon alert: When we say plan sponsors, that means entities such as self-insured employers—sponsors of health plans, if you will (the purchasers, the ones who are actually paying the bills). Peter explains the quick version of what the Consolidated Appropriations Act is in the show that follows, so do listen. But for more info on this really, really meaningful bit of legislation that is the law as of 2021, go back and listen to the episodes with Chris Deacon (EP342 and EP408) or check out the myriad of LinkedIn posts from Jeff Hogan. Also, others like Darren Fogarty, Justin Leader, Jamie Greenleaf, and others have some great words of wisdom that you will be able to find that really explain what the point is of the CAA, the Consolidated Appropriations Act, and its sprawling implications. 2. To survive on reduced commercial reimbursements, health systems need to get real about becoming ruthlessly aggressive in driving administrative and technology efficiencies. 3. They need to get real about pivoting from fee-for-service reimbursement to episode-based care based on taking real downside risks for good clinical outcomes. They need to pivot from a mindset of maximizing patient revenue to maximizing patient health. They need to move from a sick care reimbursement model to a healthcare reimbursement model based on health. 4. They need to get real about being completely transparent and accountable in reporting how they are using the value of their tax-exempt status. Similarly, they need to account for and report how they're using the estimated $55 billion in net margins that they're realizing off the 340B drug program. 5. They need to get real about quality and patient safety. We still have about 46% of our hospitals that have a C or lower Leapfrog rating. And, by the way, the chance of having a fatality on an avoidable error is 90% higher at a C or lower-rated Leapfrog entity versus a Leapfrog entity that has an A or a B. Now, some of you—and by some of you, I mean practically everybody listening—are thinking of reasons why any one of these “get real about” things is arguable or how one of the above is not holding up in some market. I think Peter would tell you the same thing that I would: You're not wrong. But trying to predict a zeitgeist or the next pet rock never works well because it's always a confluence of right time/right place where the whole is way more than the sum of its parts. Think about Malcolm Gladwell's The Tipping Point. It's about how small changes can have enormous effects if the context is right. So, now contemplate these five things that Peter brings up. All these forces are pushing in the same direction. Put it all into a stew where 48% of Americans have delayed or forgone care due to cost. Listen to the show with Wayne Jenkins, MD (EP358) for more on that. Or, you have the article John Tozzi just wrote in Bloomberg. Here's a quote: “In one California community, teachers have to pay an extra $10,000 a year to upgrade to insurance that covers the local hospitals. Teachers who can't afford it … give birth outside the county.” Meanwhile, insurers are making record profits, along with hospital CEOs and C-suites. At the same time, you know who I think is the third-biggest group with medical debt in this country? Yeah, it's people who work in hospitals—nurses, others. There's this frothing lack of trust for hospitals and what goes on there: 30% of physicians do not trust the leadership of their health system. And no wonder. There are examples of healthcare executives sitting up there in their palatial offices acting more like mobsters than the nuns they took over the hospital from. So, to orient your context, you are here. Peter Hayes is the newly retired former president and CEO at the Healthcare Purchaser Alliance of Maine. He is a national presence in healthcare strategy, innovation, and a keynote speaker. For more on the wild-ass problems with hospital pricing, check out this list of shows. But, spoiler alert, some of these are hair-raising. Encore! EP249: The War on Financial Toxicity in North Carolina as a Case Study Everybody Should Be Keeping Their Eye On, With Dale Folwell, North Carolina State Treasurer EP395: Consolidated Hospital Systems and Cunning Anticompetitive Contracts, With Brennan Bilberry EP390: What Legislators Need to Know About Hospital Prices, With Gloria Sachdev, PharmD, and Chris Skisak, PhD EP389: The Clapback When Hospitals Cannot Constrain Their Own Prices, With Mike Thompson EP346: How Did Health Systems Get Addicted to the Inflated Prices They Charge Employers and Some Patients? 2021 Update, With Peter Hayes, President and CEO of the Healthcare Purchaser Alliance of Maine EP394: Spoiler Alert: It Is Counterintuitive Which Hospitals Offer the Most Charity Care, With Vikas Saini, MD, and Judith Garber, MPP Also mentioned in this episode are Ann M. Richardson, MBA; Chris Deacon; Jeffrey Hogan; Darren Fogarty; Justin Leader; Jamie Greenleaf, AIF, CBFA, C(k)P; Wayne Jenkins, MD; John Tozzi; NASHP (National Academy for State Health Policy); Gloria Sachdev, PharmD; Chris Skisak, PhD; Leon Wisniewski; Cora Opsahl; Rik Renard; John Rodis, MD; Rob Andrews; Al Lewis; Eric Bricker, MD; Vikas Saini, MD; Judith Garber, MPP; Lown Institute; RAND Corporation; Dale Folwell; Brennan Bilberry; and Mike Thompson. You can learn more by following Peter on LinkedIn. Peter Hayes recently retired as the president and CEO of the Healthcare Purchaser Alliance of Maine and formerly a principal of Healthcare Solutions and director of associate health and wellness at Hannaford Supermarkets. He has been recognized as a thought leader in innovative, strategic benefit design for the past 25+ years. He has received numerous national awards in recognition of his commitment to working collaboratively with healthcare providers and vendors in delivering health benefits that are focused on value (high-quality efficient care). He has been successful in this arena by focusing on innovative solutions for patient advocacy, chronic disease management, and health promotion programs. Peter has also been involved in healthcare reform leadership roles on both the national and regional levels with organizations like Center for Health Innovation, Care Focused Purchasing, and Leapfrog. He's also co-founder of the Maine Health Management Coalition and has been appointed by two different Maine Governors to serve on Health Care Reform Commissions to recommend public policies to improve the access and affordability of healthcare for Maine citizens. 08:04 Why do hospitals need to get real about the implications of the Consolidated Appropriations Act? 10:09 What is considered fair pricing for hospitals? 13:00 EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD. 15:59 The medical transparency tool, Billy. 16:34 How does lowering prices become more challenging with consolidated hospital systems? 18:07 What is one of the solutions available to combatting this now? 19:31 Why do hospital systems need to get real about administrative and technology efficiencies? 22:27 EP373 with Cora Opsahl. 26:51 Why do hospitals need to get real about pivoting from fee-for-service reimbursement to episode-based care? 30:16 EP415 with Rob Andrews. 30:53 Why do hospitals need to get real about the 340B program and their tax-exempt status? 35:38 EP394 with Vikas Saini, MD, and Judith Garber, MPP. 38:19 What are the ethical and moral issues that are coming to a head with healthcare costs? 39:03 Why do hospitals need to reexamine their care quality and patient safety? 40:05 “We just need to make sure that the health industry is as accountable as some of our other industries.” 42:53 Why does Peter think it's going to take regulation to move the dial? You can learn more by following Peter on LinkedIn. @pefhayes discusses #hospitalsystems and what their executives need to do on our #healthcarepodcast. #healthcare #podcast #pharma #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Joey Dizenhouse, Benjamin Jolley, Emily Kagan Trenchard (Encore! EP392), Cora Opsahl (Encore! EP372), Jodilyn Owen, Ge Bai, Andreas Mang, Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385)
December 31, 2023 is the deadline for submission of the inaugural Section 201 Gag Clause Prohibition Compliance Attestation to the Departments of Labor, Health and Human Services, and the Treasury. The federal government passed the Consolidated Appropriations Act in 2020 (CAA) with the goal of improving price and quality transparency in healthcare. Specifically, Section 201 of the CAA prohibits employers/plan sponsors from entering into contractual arrangements that contain “gag clauses.” To ensure compliance, Section 201 requires that plans submit an annual attestation that the plan did not enter any agreements that contain gag clauses. Jennifer Malik, Shareholder at Babst Calland, provides practical insight to ensure that your company is compliant. Malik's healthcare benefits administration practice includes counseling firm clients on a wide array of federal and state health laws and regulations, including compliance under HIPAA, the Affordable Care Act, the Consolidated Appropriations Act, and the Public Health Services Act. She also assists Firm clients in providing comprehensive coverage analyses under commercial liability, property, professional liability, and fiduciary policies.
On today's episode, Madison is joined once more by NHPCO's VP of Policy and Government Relations, Logan Hoover plus a new addition to the NHPCO team, Patrick Harrison, Senior Director of Regulatory and Compliance, to discuss one of the most pressing issues facing the hospice community in 2024: the U.S. Centers for Medicare & Medicaid Services' Special Focus Program (SFP). Enacted under the Consolidated Appropriations Act, 2021, the SFP aims to increase oversight of hospices which have substantially failed to meet Medicare program requirements. However, despite concerns raised by key stakeholders including members of Congress, technical expert panel participants, and hospice community leaders, CMS is moving forward with a program based on a flawed methodology which may not accurately identify poor performing hospices. Tune in to learn more about what's being done to attempt to change the current SFP algorithm and how providers can advocate for change.
We are joined again by Dr. Neal Christopher, who is currently the Vice Chair and Associate Medical Director of Arrowhead Regional Medical Center and the Psychiatry and Addiction Consultant for the San Bernardino County Department of Public Health. Dr. Christopher has previously appeared on the Psychiatry and Psychotherapy Podcast in episode 063, “Interviewing Well For Psychiatry Residency & Beyond,” and episode 103, “Acceptance and Commitment Therapy with Dr. Steven Hayes.” In this week's episode, Dr. Puder and Dr. Christopher discuss the recent elimination of the X-Waiver and what it means for providers, the mechanism and efficacy of buprenorphine, and practical tips for prescribing buprenorphine and supporting patients on their road to recovery from opioid use disorder. This episode continues our podcast series on addiction, designed to meet the one-time, 8-hour training requirement introduced by the Consolidated Appropriations Act of 2023. This mandate applies to all providers registered with the Drug Enforcement Administration (DEA), and our series primarily focuses on the treatment and management of patients with substance use disorders.
I am thrilled to continue our podcast series on addiction, designed to meet the one-time, 8-hour training requirement introduced by the Consolidated Appropriations Act of 2023. This mandate applies to all practitioners registered with the Drug Enforcement Administration (DEA), and our series primarily focuses on the treatment and management of patients with substance use disorders. Link to blog here.
The "Consolidated Appropriations Act of 2023" (more commonly referred to as the Omnibus Act) was passed and signed into law on December 29th, 2022. This amendment to the Food and Drug Cosmetic Act has expanded the scope of the FDA beyond just "safety and efficacy" to include the cybersecurity of medical devices. This amendment resembles a watered-down version of the PATCH Act, which failed to pass in late 2022.As a result, on March 29, 2023, the FDA gained the legal authority to define and enforce medical device cybersecurity. So for today's episode, we got THE leading minds in MedTech cybersecurity together to discuss what we need to do next. Chris Gates, Director of Product Security at Velentium, Chris Reed, Vice President of Product Security at Medtronic, and Ken Hoyme, CEO of Dark Star Consulting, join the podcast today to discuss the new guidelines, what the FDA can and can't say about it, and what kinds of deficiencies you'll be seeing in the future because of the new legislation.Some of the highlights of this episode include:How the FDA tried to clear a path for routine patches and updatesThe minimum that the omnibus bill is talking aboutNo longer needing to make the link between cybersecurity and safety and effectivenessWhen they have the legal authority to enforce cybersecurityWhy the document took so long to go throughSecurity architecture analysisWhy you should be referencing the April 2022 draftUnpatched vulnerabilities at the time of submissionThe effort needed to understand the FDA's intentionsMemorable quotes from this episode:“Literally, if you're not aware of this already, you're already behind the 8-ball right now and there's things you've got to do.”“Basically, if you think it might be a cyber device, it is a cyber device.”“Don't sit there and try to be pedantic about this and say “I don't need to do this because there's a comma here.” It ain't gonna work for you.”“A synonym for threat modeling really is security architecture analysis.”Links:Christopher GatesChris ReedKen HoymeVelentiumMedtronicDarkStar ConsultingMedical Device Cybersecurity in 2023 and Beyond SlidesEtienne Nichols LinkedInGreenlight Guru
In this episode, Rob and Greg discuss an interesting piece of 340B history – the Morford letter (25:31). Rob shares his understanding of the origins of the letter and contemporary application of the letter as it relates to the recent debate around the 340B-eligible patient definition. But first, the guys catch up on 340B news, including: -A reminder of 340B protections offered under the 2022 Consolidated Appropriations Act (i.e., DSH attestation) -Legislative updates from the House E&C health subcommittee bill mark-up session -Updated manufacturer restrictions for contract pharmacies To access a copy of the Morford Letter: http://content.spendmend.com/assets/Morford-Letter-1.26.01.pdf
Taiwan's status in the world has never been clear and neither has the United States' position on the issue. In this Congressional Dish, via footage from the C-SPAN archive dating back into the 1960s, we examine the history of Taiwan since World War II in order to see the dramatic shift in Taiwan policy that is happening in Congress - and in law - right now. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via PayPal Support Congressional Dish via Patreon (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank's online bill pay function to mail contributions to: 5753 Hwy 85 North, Number 4576, Crestview, FL 32536. Please make checks payable to Congressional Dish Thank you for supporting truly independent media! View the show notes on our website at https://congressionaldish.com/cd272-what-is-taiwan Background Sources Recommended Congressional Dish Episodes CD259: CHIPS: A State Subsidization of Industry CD187: Combating China Taiwan History and Background “In Focus: Taiwan: Political and Security Issues” [IF10275]. Susan V. Lawrence and Caitlin Campbell. Updated Mar 31, 2023. Congressional Research Service. “Taiwan taps on United Nations' door, 50 years after departure.” Erin Hale. Oct 25, 2021. Aljazeera. “China must 'face reality' of Taiwan's independence: Taiwanese President Tsai Ing-wen.” Stacy Chen. Jan 16, 2020. ABC News. “Taiwan weighs options after diplomatic allies switch allegiance.” Randy Mulyanto. Sep 26, 2019. Aljazeera. U.S.-Taiwan Relationship Past “The Taiwan Relations Act” [Pub. L. 96–8, § 2, Apr. 10, 1979, 93 Stat. 14.] “22 U.S. Code § 3301 - Congressional findings and declaration of policy.” Cornell Law School Legal Information Institute. Current “China moves warships after US hosts Taiwan's Tsai.” Rupert Wingfield-Hayes. Apr 6, 2023. BBC News. “Speaker Pelosi's Taiwan Visit: Implications for the Indo-Pacific.” Jude Blanchette et al. Aug 15, 2022. Center for Strategic and International Studies. "Pelosi in Taiwan: Signal or historic mistake?” Aug 4, 2022. DW News. “China threatens 'targeted military operations' as Pelosi arrives in Taiwan.” News Wires. Feb 8, 2022. France 24. “Nancy Pelosi's visit to Taiwan would be 'ill-conceived' and 'reckless.'” Dheepthika Laurent. Feb 8, 2022. France 24. Presidential Drawdown Authority “Use of Presidential Drawdown Authority for Military Assistance for Ukraine.” Apr 19, 2023. U.S. Department of State Bureau of Political-Military Affairs. U.S. China Relationship “America, China and a Crisis of Trust.” Thomas L. Friedman. Apr 14, 2023. The New York Times. Laws H.R.7776: James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 Full Text Outline of Taiwan Provisions TITLE X - GENERAL PROVISIONS Subtitle G - Other Matters Sec. 1088: National Tabletop Exercise By the end of 2023, the Secretary of Defense is to assess the viability of our domestic critical infrastructure to identify chokepoints and the ability of our armed forces to respond to a contingency involving Taiwan, including our armed forces' ability to respond to attacks on our infrastructure. TITLE XII - MATTERS RELATING TO FOREIGN NATIONS Subtitle E - Matters Relating to the Indo-Pacific Region Sec. 1263: Statement of Policy on Taiwan “It shall be the policy of the United States to maintain the capacity of the United States to resist a fait accompli that would jeopardize the security of thepeople of Taiwan.” Fait accompli is defined as, “the resort to force by the People's Republic of China to invade and seize control of Taiwan before the United States can respond effectively.” Sec. 1264: Sense of Congress on Joint Exercises with Taiwan Congress wants the Commander of the United States Indo-Pacific Command to carry out joint military exercises with Taiwan in “multiple warfare domains” and practice using “secure communications between the forces of the United States, Taiwan, and other foreign partners” Taiwan should be invited to participate in the Rim of the Pacific (RIMPAC) exercise in 2024. RIMPAC is a multinational maritime exercise, now the world's largest, that has happened 28 times since 1971. The last one took place in and around Hawaii and Southern California in the summer of 2022. 26 countries, including the US, participated. TITLE LV - FOREIGN AFFAIRS MATTERS Subtitle A - Taiwan Enhanced Resilience Act PART 1 - IMPLEMENTATION OF AN ENHANCED DEFENSE PARTNERSHIP BETWEEN THE UNITED STATES AND TAIWAN Sec. 5502: Modernizing Taiwan's Security Capabilities to Deter and, if necessary, Defeat Aggression by the People's Republic of China Grants: Expands the purpose of the State Department's Foreign Military Financing Program to “provide assistance including equipment, training, and other support, to build the civilian and defensive military capabilities of Taiwan” Authorizes the State Department to spend up to $100 million per year for 10 years to maintain a stockpile of munitions and other weapons (authorized by Sec. 5503). Any amounts that are not obligated and used in one year can be carried over into the next year (which essentially makes this a $1 billion authorization that expires in 2032). The stockpile money is only authorized if the State Department certifies every year that Taiwan has increased its defense spending (requirement is easily waived by the Secretary of State). Authorizes $2 billion per year for the Foreign Military Financing grants each year for the next 5 years (total $10 billion in grants). The money is expressly allowed to be used to purchase weapons and “defense services” that are “not sold by the United States Government” (= sold by the private sector). No more than 15% of the weapons for Taiwan purchased via the Foreign Military Financing Program can be purchased from within Taiwan Loans: Also authorizes the Secretary of State to directly loan Taiwan up to $2 billion. The loans must be paid back within 12 years and must include interest. The Secretary of State is also authorized to guarantee commercial loans up to$2 billion each (which can not be used to pay off other debts). Loans guaranteed by the US must be paid back in 12 years. Sec. 5504: International Military Education and Training Cooperation with Taiwan Requires the Secretary of State and Secretary of Defense to create a military training program with Taiwan by authorizing the Secretary of State to train Taiwan through the International Military Education and Training Program. The purposes of the training include enhancements of interoperability between the US and Taiwan and the training of “future leaders of Taiwan”. The training itself can include “full scale military exercises” and “an enduring rotational United States military presence” Sec. 5505: Additional Authorities to Support Taiwan Authorizes the President to drawdown weapons from the stocks of the Defense Department, use Defense Department services, and provide military education and training to Taiwan, the value of which will be capped at $1 billion per year The President is also given the “emergency authority” to transfer weapons and services in “immediate assistance” to Taiwan specifically valued at up to $25 million per fiscal year. Sec. 5512: Sense of Congress on Taiwan Defense Relations “The Taiwan Relations Act and the Six Assurances provided by the United States to Taiwan in July 1982 are the foundation for United States-Taiwan relations.” “The increasingly coercive and aggressive behavior of the People's Republic of China toward Taiwan is contrary to the expectation of the peaceful resolution of the future of Taiwan” “As set forth in the Taiwan Relations Act, the capacity to resist any resort to force or other forms of coercion that would jeopardize the security, or the social or economic system, of the people on Taiwan should be maintained.” The US should continue to support Taiwanese defense forces by “supporting acquisition by Taiwan of defense articles and services through foreign military sales, direct commercial sales, and industrial cooperation, with an emphasis on capabilities that support an asymmetric strategy.” Support should also include “Exchanges between defense officials and officers of the US and Taiwan at the strategic, policy, and functional levels, consistent with the Taiwan Travel Act.” PART 3 - INCLUSION OF TAIWAN IN INTERNATIONAL ORGANIZATIONS Sec. 5516: Findings “Since 2016, the Gambia, Sao Tome and Principe, Panama, the Dominican Republic, Burkina Faso, El Salvador, the Solomon Islands, and Kiribati, have severed diplomatic relations with Taiwan in favor of diplomatic relations with China” “Taiwan was invited to participate in the World Health Assembly, the decision making body of the World Health Organization, as an observer annually between 2009 and 2016. Since the 2016 election of President Tsai, the PRC has increasingly resisted Taiwan's participation in the WHA. Taiwan was not invited to attend the WHA in 2017, 2018, 2019, 2020, or 2021.” “United Nations General Assembly Resolution 2758 does not address the issue of representation of Taiwan and its people at the United Nations, nor does it give the PRC the right to represent the people of Taiwan.” Sec. 5518: Strategy to Support Taiwan's Meaningful Participation in International Organizations By the end of Summer 2023, the Secretary of State must create a classified strategy for getting Taiwan included in 20 international organizations. The strategy will be a response to “growing pressure from the PRC on foreign governments, international organizations, commercial actors, and civil society organizations to comply with its ‘One-China Principle' with respect to Taiwan.” PART 4 - MISCELLANEOUS PROVISIONS Sec. 5525: Sense of Congress on Expanding United States Economic Relations with Taiwan “Taiwan is now the United States 10th largest goods trading partner, 13th largest export market, 13th largest source of imports, and a key destination for United States agricultural exports.” Audio Sources Evaluating U.S.-China Policy in the Era of Strategic Competition February 9, 2023 Senate Foreign Relations Committee Witnesses: Wendy Sherman, Deputy Secretary of State, U.S. Department of State Ely Ratner, Assistant Secretary of Defense for Indo-Pacific Security Affairs, U.S. Department of Defense Clips 17:40 Wendy Sherman: We remain committed to our long standing One China Policy and oppose any unilateral changes to the cross-strait status quo. Our policy has not changed. What has changed is Beijing's growing coercion. So we will keep assisting Taiwan in maintaining a sufficient self-defense capability. 41:30 Sen. Marco Rubio (R-FL): I want to get a little broader because I think it's important to understand sort of the strategic vision behind our tactics on everything that we do. So if we go back to the late 80s, early 90s, end of the Cold War, and the gamble at the time was, if we created this international economic order, led by the US and the West, built on this global commitment to free trade, that this notion of that this trade and commerce would bind nations together via trade, via commerce and international interest and economic interest, that it would lead to more wealth and prosperity, that it would lead to democracy and freedom, basically domestic changes in many countries, and that it would ultimately ensure peace. The famous saying now seems silly, that no two countries with McDonald's have ever gone to war. That's obviously no longer the case. But the point being is that was the notion behind it. It was what the then Director General of the WTO called a "world without walls," rules-based international order. Others call it globalization. And basically, our foreign policy has been built around that, even though it's an economic theory it basically, is what we have built our foreign policy on. I think it's now fair to say that we admitted China to the World Trade Organization, Russia as well, I think it's now fair to say that while wealth certainly increased, particularly in China through its export driven economy, massive, historic, unprecedented amount of economic growth in that regard, I don't think we can say either China or Russia are more democratic. In fact, they're more autocratic. I don't think we can say that they're more peaceful. Russia has invaded Ukraine now twice, and the Chinese are conducting live fire drills off the coast of Taiwan. So I think it's fair to say that gamble failed. And we have now to enter -- and I think the President actually hinted at some of that in his speech the other night -- we're now entering a new era. What is that new era? What is our vision now for that world, in which not just the global international order and World Without Walls did not pacify or buy nations, but in fact, have now placed us into situations where autocracies, through a joint communique, are openly signaling that we need to reject Western visions of democracy and the like. So, before we can talk about what we're going to do, we have to understand what our strategic vision is. What is the strategic vision of this administration on what the new order of the world is? The Future of War: Is the Pentagon Prepared to Deter and Defeat America's Adversaries? February 7, 2023 House Armed Services Committee, Subcommittee on Cyber, Information Technologies, and Innovation Watch on YouTube Witnesses: Chris Brose, Author Rear Admiral Upper Half Mark Montgomery (Ret.), Senior Director, Center on Cyber and Technology Innovation, Foundation for Defense of Democracies Peter Singer, Strategist at New America and Managing Partner of Useful Fiction LLC Clips 1:16:30 Rear Adm. Mark Montgomery: We don't have weapons stowed in Taiwan. In the last National Defense Authorization Act you authorized up to $300 million a year to be appropriated for Taiwan-specific munitions. The appropriators, which happened about seven days later, appropriated $0. In fact, almost all of the Taiwan Enhanced Resilience Act, which you all pushed through the NDAA, ended up not being appropriated in the Consolidated Appropriations Act that passed eight days later. 30:10 Chris Brose: Nothing you do in this Congress will make larger numbers of traditional ships, aircraft and other platforms materialized over the next several years. It is possible, however, to generate an arsenal of alternative military capabilities that could be delivered to U.S. forces in large enough quantities within the next few years to make a decisive difference. Those decisions could all be taken by this Congress. The goal would be to rapidly field what I have referred to as a "moneyball military," one that is achievable, affordable and capable of winning. Such a military would be composed not of small quantities of large, exquisite, expensive things, but rather by large quantities of smaller, lower cost, more autonomous consumable things, and most importantly, the digital means of integrating them. These kinds of alternative capabilities exist now, or could be rapidly matured and fielded in massive quantities within the window of maximum danger. You could set this in motion in the next two years. The goal would be more about defense than offense, more about countering power projection than projecting power ourselves. It would be to demonstrate that the United States, together with our allies and partners, could do to a Chinese invasion or a Chinese offensive what the Ukrainians, with our support, have thus far been able to do to their Russian invaders: degrade and deny the ability of a great power to accomplish its objectives through violence, and in so doing to prevent that future war from ever happening. After all, this is all about deterrence. All of this is possible. We have sufficient money, technology, authorities, and we still have enough time. If we are serious, if we make better decisions now, we can push this looming period of vulnerability further into the future. The Pressing Threat of the Chinese Communist Party to U.S. National Defense February 7, 2023 House Armed Services Committee Watch on YouTube Witnesses: Admiral Harry B. Harris Jr., USN (Ret.), Former Commander, U.S. Pacific Command Dr. Melanie W. Sisson, Foreign Policy Fellow, Strobe Talbott Center for Security, Strategy, and Technology Clips 28:15 Rep. Mike Rogers (R-AL): China is the most challenging national security threat America has faced in 30 years. If we fail to acknowledge that and take immediate action to deter it, the next 30 years could be devastating for our nation. Under President Xi, the Chinese Communist Party has nearly tripled its defense spending in the last decade alone. The PLA has gone from an obsolete force barely capable of defending its borders to a modern fighting force capable of winning regional conflicts. The CCP now controls the largest army and navy in the world, with a goal of having them fully integrated and modernized by 2027. The CCP is rapidly expanding its nuclear capability; they have doubled their number of warheads in two years. We estimated it would take them a decade to do that. We also were just informed by the DOD [that] the CCP now has more ICBM launchers than the United States. The CCP is starting to outpace us on new battlefields as well. They have leapfrogged us on hypersonic technology, they are fielding what we are still developing. They are making advances in AI and quantum computing that we struggle to keep pace with. Finally, their rapid advances in space were one of the primary motivations for us establishing a Space Force. The CCP is not building these new and advanced military capabilities for self defense. In recent years, the CCP has used its military to push out its borders, to threaten our allies in the region, and to gain footholds on new continents. In violation of international law, the CCP has built new and commandeered existing islands in the South China Sea, where it has deployed stealth fighters, bombers and missiles. It continues to intimidate and coerce Taiwan, most recently by surrounding the island with naval forces and launching endless fighter sorties across its centerline. In recent years, the CCP has also established a space tracking facility in South America to monitor U.S, satellites, as well as an overseas naval base miles from our own on the strategically vital Horn of Africa. These are just a few destabilizing actions taken by the CCP. They speak nothing of the CCPs Belt and Road debt trap diplomacy, it's illegal harvesting of personal data and intellectual property, it's ongoing human rights abuses, and its advanced espionage efforts, the latter of which came into full focus for all Americans last week when the Biden administration allowed a CCP spy balloon to traverse some of our nation's most sensitive military sites. Make no mistake, that balloon was intentionally lost as a calculated show of force. 44:15 Dr. Melanie W. Sisson: Since 1979, the United States has adopted a constellation of official positions, together known as the One China policy, that allow us to acknowledge but not to accept China's perspective that there is one China and that Taiwan is part of China. Under the One China policy, the United States has developed robust unofficial relations with the government and people of Taiwan consistent with our interest in preserving peace and stability in the Taiwan Strait. US policy is guided by an interest in ensuring cross-strait disputes are resolved peacefully and in a manner that reflects the will of Taiwan's people. This has required the United States to deter Taiwan from declaring independence, and also to deter the CCP from attempting unification by force. The 40 year success of the strategy of dual deterrence rests upon the unwillingness of the United States to provide either an unconditional commitment to Taipei that it will come to its defense militarily, or an unconditional commitment to Beijing that we will not. The U.S. national security interest in the status of Taiwan remains that the CCP and the people of Taiwan resolve the island's political status peacefully. Dual deterrence therefore remains U.S. strategy, reinforced by U.S. declaratory policy which is to oppose unilateral changes to the status quo by either side. 45:28 Dr. Melanie W. Sisson: The modernization of the PLA has changed the regional military balance and significantly enough that the United States no longer can be confident that we would decisively defeat every type of PLA use of force in the Taiwan Strait. This fact, however, does not necessitate that the US abandon the strategy of dual deterrence and it doesn't mean that the United States should seek to reconstitute its prior degree of dominance. Posturing the U.S. military to convince the CCP that the PLA could not succeed in any and every contingency over Taiwan is infeasible in the near term and likely beyond. The PLA is advances are considerable and ongoing, geography works in its favor, and history demonstrates that it's far easier to arrive at an overconfident assessment of relative capability than it is to arrive at an accurate one. Attempting to demonstrate superiority for all contingencies would require a commitment of forces that would inhibit the United States from behaving like the global power that it is with global interests to which its military must also attend. This posture, moreover, is not necessary for dual deterrence to extend its 40 year record of success. We can instead encourage the government of Taiwan to adopt a defense concept that forces the PLA into sub-optimal strategies and increases the battle damage Beijing would have to anticipate and accept. 46:45 Dr. Melanie W. Sisson: U.S. military superiority in the Persian Gulf and Indian Ocean allows us to threaten the maritime shipping upon which China depends for access to energy, global markets, and supply chains. The inevitable damage a use of force would cause to the global economy and the imposition of sanctions and restricted access to critical inputs needed to sustain China's economic development and the quality of life of its people, moreover, would certainly compound China's losses. 1:04:50 Adm. Harry B. Harris: We're going to share the crown jewel of America's military technology, the nuclear submarine and the nuclear reactors, with another country and that's Australia. We have not done that with any other country, except for the UK, back in the late 50s, and into the 60s. So here we have the two countries with with that capability, the United States and the UK, and we're going to share that with Australia. It's significant. But it's only going to going to be significant over the long term if we follow through. So it's a decade long process. You know, some people the CNO, Chief of Naval Operations, has said it could be 30 years before we see an Australian nuclear submarine underway in the Indian Ocean. I said that if we put our hearts and minds to it, and our resources to it, and by ours, I mean the United States', the UK's and Australia's, we can do this faster than that. I mean we put a man on the moon and eight years, and we developed a COVID vaccine in one year. We can do this, but we're going to have to put our shoulders to the task for Australia, which has a tremendous military. For them to have the long reach of a nuclear submarine force would be dramatic. It would help us dramatically. It would change the balance of power in the Indian Ocean, and it will make Australia a Bluewater navy. They are our key ally in that part of the world and I'm all for it. 1:32:05 Adm. Harry B. Harris: I think this issue of strategic clarity versus strategic ambiguity is critical, and we have been well served, I'll be the first to say that, by the policy of strategic ambiguity with Taiwan over the past 44 years, but I think the time for ambiguity is over. I think we have to be as clear about our intent with regard to what would happen if the PRC invades Taiwan as the PRC is clear in its intent that it's ultimately going to seize Taiwan if need. 1:41:25 Adm. Harry B. Harris: I used to talk about during the Cold War with the Soviet Union, almost every branch of the U.S. government understood that the Soviet Union was the threat. You know, I used to joke even a park ranger, Smokey Bear, would tell you that the Soviets were the bad guys. We didn't have that comprehensive unified view of the PRC. You know, State Department looked at as in negotiation, DOD look at it as a military operation, Commerce looked at it as a trading partner, and Treasury looked at it as a lender. So we didn't have this unified view across the government. But I think now we are getting to that unified view and I think the Congress has done a lot to get us in that position. 1:49:45 Rep. Matt Gaetz (R-FL): We have the capability to block the transmission of information from the balloon back to China, don't we? Adm. Harry B. Harris Jr.: We do. Rep. Matt Gaetz (R-FL): And in this type of an environment do you think it's probably likely that we did that? Adm. Harry B. Harris Jr.: I would only guess, but I think General van Herk said that -- Rep. Matt Gaetz (R-FL): Well you can't see any reason why we wouldn't do that, right? U.S.-Taiwan Relations March 14, 2014 House Foreign Affairs Committee Witnesses: Kin Moy, [Former] Deputy Assistant Secretary for East Asian and Pacific Affairs, U.S. Department of State Clips 7:20 [Former] Rep. Eliot Engel (D-NY): Taiwan is a flourishing multiparty democracy of over 20 million people with a vibrant free market economy. It is a leading trade partner of the United States alongside much bigger countries like Brazil and India. Over the past 60 years, the U.S.-Taiwan relationship has undergone dramatic changes, but Taiwan's development into a robust and lively democracy underpins the strong U.S.-Taiwan friendship we enjoy today. 14:00 Rep. Brad Sherman (D-CA): I think that it's important that we provide Taiwan the tools to defend itself, but Taiwan needs to act as well. Taiwan spends less than $11 billion on its defense, less than 1/5 per capita what we in America do, and God blessed us with the Pacific Ocean separating us from China. Taiwan has only the Taiwan Strait. On a percentage of GDP basis, Taiwan spends roughly half what we do. So we should be willing to sell them the tools and they should be willing to spend the money to buy those tools. 1:11:50 Rep. Randy Weber (R-TX): I think Chris Smith raised the issue of a One China policy. Does it not bother you that that exists, that there are statements that people have made, high level officials, that said they they agreed on one China policy? Does the administration not view that as a problem? Kin Moy: Our one China policy is one that has existed for several decades now. Rep. Randy Weber (R-TX): Okay. Well, I take that as a no, but let me follow up with what Jerry Connolly said. So you haven't sold submarines yet, you don't take Beijing into account. People around the world watch us. Words and actions have consequences. Would you agree that y'all would be okay with a one Russia policy when it comes to Crimea and the Ukraine? Is that akin to the same kind of ideology? Kin Moy: Well, I can't speak to those issues. But again, we are obligated to provide those defense materials and services to Taiwan and we have been through several administrations, I think very vigilant in terms of providing that. U.S.-China Relations May 15, 2008 Senate Foreign Relations Committee Witnesses: Richard N. Haass, President, Council on Foreign Relations Harry Harding, Professor of International Affairs, George Washington University, 1995-2009 Clips 1:46:42 Richard N. Haass: The bottom line is China is not yet a military competitor, much less a military peer. Interestingly, I think Chinese leaders understand this. And they understand just how much their country requires decades of external stability so that they can continue to focus their energies and their attention on economic growth and political evolution. China is an emerging country, but in no way is it a revolutionary threat to world order as we know it. 1:47:20 Richard N. Haass: We alone cannot bring about a successful us Chinese relationship. What the Chinese do and say will count just as much. They will need to begin to exercise restraint and patience on Taiwan. There can be no shortcuts, no use of force. We, at the same time, must meet our obligations to assist Taiwan with its defense. We can also help by discouraging statements and actions by Taiwan's leaders that would be viewed as provocative or worse. 2:03:47 Harry Harding: Now with the support and encouragement of the United States, China has now become a member of virtually all the international regimes for which it is qualified. And therefore the process of integration is basically over, not entirely, but it's largely completed. And so the issue, as Bob Zoellick rightly suggested, is no longer securing China's membership, but encouraging it to be something more, what he called a "responsible stakeholder." So this means not only honoring the rules and norms of the system, but also enforcing them when others violate them, and assisting those who wish to join the system but who lack the capacity to do so. It means, in other words, not simply passive membership, but active participation. It means accepting the burdens and responsibilities of being a major power with a stake in international peace and stability, rather than simply being a free rider on the efforts of others. Now, China's reacted to the concept of responsible stakeholding with some ambivalence. On the one hand, it appreciates that the United States is thereby seeking a positive relationship with China. It suggests that we can accept and even welcome the rise of Chinese power and Beijing's growing role in the world. It certainly is seen by the Chinese as preferable to the Bush administration's earlier idea that China would be a strategic competitor of the United States, as was expressed during the campaign of 2000 and in the early months of 2001. However, Beijing also perceives, largely correctly, that America's more accommodative posture as expressed in this concept is conditional. China will be expected to honor international norms and respect international organizations that it did not create and it may sometimes question. And even more worrying from Beijing's perspective is the prospect that it's the United States that is reserving the right to be the judge as to whether Chinese behavior on particular issues is sufficiently responsible or not. Taiwanese Security August 4, 1999 Senate Foreign Relations Committee Witnesses: David “Mike” M. Lampton, Founding Director, Chinese Studies Program, Nixon Center Stanley Roth, Assistant Secretary, East Asian and Pacific Affairs, U.S. Department of State Caspar W. Weinberger, Former Secretary, Department of Defense James Woolsey, Former Director, CIA Clips 9:00 Sen. Joe Biden (D-DE): Taiwan security, in my view, flows from its democratic form of government's growing economic, cultural and political contacts with the mainland and, ultimately, the United States' abiding commitment to a peaceful resolution of the Taiwan question. In my opinion, we should concentrate on strengthening those areas rather than spend time pre-authorizing the sales of weapon systems, some of which don't even exist yet. 20:10 Stanley Roth: There are three pillars of the [Clinton] administration's policy. First, the administration's commitment to a One China policy is unchanged. Regardless of the position of the parties, we have not changed our policy. The President has said that both publicly and privately. Second, we believe that the best means to resolve these issues is by direct dialogue between the parties themselves. We have taken every opportunity, including on my own trip to Beijing last week with Ken Lieberthal from the NSC, to urge the PRC to continue this dialogue. It strikes us that it's precisely when times are difficult that you need to dialogue, and to cancel it because of disagreements would be a mistake. China has not yet indicated whether or not these talks will continue in the Fall, as had been previously anticipated, but they put out a lot of hints suggesting that it wouldn't take place, and we are urging them to continue with this dialogue. Third point that is integral to our position. We have stressed again, at every opportunity, the importance of a peaceful resolution of this issue and the President has made that absolutely clear, as did Secretary Albright in her meeting with Chinese Foreign Minister Tong in Singapore last week, as did Ken Leiberthal and I in our meetings in Beijing. But China can have no doubts about what the United States' position is, with respect to peaceful resolution of this issue. 1:29:15 Caspar Weinberger: So I don't think that we should be hampered by or felt that we are in any way bound by what is said by the communique, nor should we accept the argument that the communique sets the policy of the United States. 1:32:50 Caspar Weinberger: There are two separate states now, with a state-to-state relationship, and that the unification which was before emphasized, they repeated again in the statement of Mr. Koo, the head of their Trans- Strait Negotiating Committee, that the unification might come when China itself, the mainland, changes, but that that has not been the case and it is not now the case. 1:41:15 David “Mike” Lampton: Once both the mainland and Taiwan are in the WTO, each will have obligations to conduct its economic relations with the other according to international norms and in more efficient ways than now possible. 1:45:20 James Woolsey: The disestablishment of large, state-owned enterprises in China over the long run will bring some economic freedoms, I believe, that will quite possibly help change China and Chinese society and make it more conducive over time to political freedoms as well. But in the short run, the unemployment from the disestablishment of those enterprises can lead to substantial instability. U.S.-Taiwan Relations February 7, 1996 Senate Foreign Relations Committee, Subcommittee on East Asian and Pacific Affairs Witness: Winston Lord, Assistant Secretary of East Asian and Pacific Affairs, U.S. Department of State Clips 16:45 Winston Lord: The Taiwan Relations Act of 1979 forms the basis of US policy regarding the security of Taiwan. Its premise is that an adequate defense in Taiwan is conducive to maintaining peace and security while differences remain between Taiwan and the PRC. I'm going to quote a few sections here because this is a very important statement of our policy. Section two B states, "It is the policy of the United States to consider any effort to determine the future of Taiwan by other than peaceful means, including by boycotts or embargoes, a threat to the peace and security of the Western Pacific area, and of grave concern to the United States. To provide Taiwan with arms of a defensive character, and to maintain the capacity of the United States to resist any resort to force or other forms of coercion that would jeopardize the security or the socioeconomic system of the people on Taiwan." Section three of the TRA also provides that the "United States will make available to Taiwan such defense articles and defense services in such quantity as may be necessary to enable Taiwan to maintain a sufficient self defense capability." 18:00 Winston Lord: The key elements of the US policy toward the Taiwan question are expressed in the three joint communiques with the PRC as follows. The United States recognizes the government of the PRC as the sole legal government of China. The US acknowledges the Chinese position that there is but one China and Taiwan as part of China. In 1982, the US assured the PRC that it has no intention of pursuing a policy of two Chinas, or one China, one Taiwan. Within this context, the people the US will maintain cultural, commercial and other unofficial relations with the people of Taiwan. The US has consistently held that the resolution of the Taiwan issue is a matter to be worked out peacefully by the Chinese themselves. A sole and abiding concern is that any resolution be peaceful. 19:30 Winston Lord: The U.S. government made reciprocal statements concerning our intentions with respect to arms sales to Taiwan, that we did not intend to increase the quantity or quality of arms supplied, and in fact intended gradually to reduce the sales. At the time the joint communique was signed, we made it clear to all parties concerned that our tensions were premised on the PRC's continued adherence to a policy of striving for peaceful reunification with Taiwan. 21:30 Winston Lord: The basic inventory of equipment which Taiwan has or will have in its possession will, in our view, be sufficient to deter any major military action against Taiwan. While arms sales policy aims to enhance the self defense capability of Taiwan, it also seeks to reinforce stability in the region. We will not provide Taiwan with capabilities that might provoke an arms race with the PRC or other countries in the region. 21:55 Winston Lord: Decisions on the release of arms made without proper consideration of the long term impact. both on the situation in the Taiwan Strait and on the region as a whole, would be dangerous and irresponsible. If armed conflict were actually breakout in the Taiwan Strait, the impact on Taiwan, the PRC, and indeed the region, would be extremely serious. The peaceful, stable environment that has prevailed in the Taiwan Strait since the establishment of our current policy in 1979 has promoted progress and prosperity on both sides of the Taiwan Strait. The benefits to Taiwan and the PRC have been obvious and I outline these in my statement. All of these achievements would be immediately put at risk in the event of conflict in the Strait. Conflict would also be costly to the United States and to our friends and allies in the region. Any confrontation between the PRC and Taiwan, however limited in scale or scope, would destabilize the military balance in East Asia and constrict the commerce and shipping, which is the economic lifeblood of the region. It would force other countries in the region to reevaluate their own defense policies, possibly fueling an arms race with unforeseeable consequences. It would seriously affect the tens of thousands of Americans who live and work in Taiwan and the PRC. Relations between the US and the PRC would suffer damage regardless of the specific action chosen by the President, in consultation with Congress. For all these reasons, we are firmly determined to maintain a balanced policy, which is best designed to avoid conflict in the area. Music Presented in This Episode Intro & Exit: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)
Tina and Hillary cover former Missouri State Representative Patricia Derges and former Governor of Louisiana Edwin Edwards. Tina's Story Patricia Derges served as a Missouri state rep beginning in November 2020. BUT when she sold fake cures for Covid she swindled herself out of a job and into jail. Hillary's Story Edwin Edwards served as Louisiana's governor on and off for nearly 25 years. BUT his unscrupulous wheelings and dealings took him from the bayou to a prison cell. Sources Tina's Story KCUR Missouri Rep. Patricia Derges convicted of multiple counts of health care fraud (https://www.kcur.org/news/2022-06-28/missouri-rep-patricia-derges-convicted-of-multiple-counts-of-health-care-fraud)--by Dan Margolies KSMU Former MO lawmaker Tricia Derges is sentenced to 75 months in prison (https://www.ksmu.org/news/2023-03-01/former-mo-lawmaker-tricia-derges-is-sentenced-to-75-months-in-prison)--by Michele Skalicky Med Page Today HCP Busted for Selling Fake Stem Cell Therapy (https://www.medpagetoday.com/special-reports/exclusives/91053)--by Kristina Fiore The New York Post Missouri Rep. Tricia Derges resigns after $900K COVID clinic fraud scheme conviction (https://nypost.com/2022/07/05/rep-tricia-derges-resigns-after-900k-covid-clinic-fraud-scheme-conviction/)--by Danielle Wallace St. Louis Dispatch Sentencing set for ex-Missouri lawmaker in medical fraud case (https://www.stltoday.com/news/local/crime-and-courts/sentencing-set-for-ex-missouri-lawmaker-in-medical-fraud-case/article_576e8761-54b5-5f9c-a860-4660ce17ff46.html)--by Kurt Erickson US Attorney's Office (Western District of Missouri) Jury Convicts State Lawmaker of COVID-19 Fraud Scheme at Springfield Health Care Charity (https://www.justice.gov/usao-wdmo/pr/jury-convicts-state-lawmaker-covid-19-fraud-scheme-springfield-health-care-charity) US Treasury About the CARES Act and the Consolidated Appropriations Act (https://home.treasury.gov/policy-issues/coronavirus/about-the-cares-act#:~:text=The%20Coronavirus%20Aid%2C%20Relief%2C%20and,%2C%20small%20businesses%2C%20and%20industries.) Photos Patricia Derges (https://npr.brightspotcdn.com/dims4/default/86fe407/2147483647/strip/true/crop/1013x1025+0+0/resize/1760x1780!/format/webp/quality/90/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Fed%2F69%2Fa51418d94d1985c31a04eda11b54%2F032621-mo-triciaderges.png)--from Missouri House of Representatives via KCUR/NPR Derges Ozark Valley Medical Clinic (https://nypost.com/wp-content/uploads/sites/2/2022/07/missouri-republican-fraud-covid-02.jpg?quality=75&strip=all)--from Google Maps via The New York Post Hillary's Story The Advocate 93-year-old Edwin Edwards left all of his assets to his 8-year-old son, according to handwritten will (https://www.theadvocate.com/baton_rouge/news/politics/93-year-old-edwin-edwards-left-all-of-his-assets-to-his-8-year-old/article_6add3c70-7bce-11ec-ae43-47d05790c544.html)--by Tyler Bridges and Mark Ballard Associated Press Ex-Louisiana Gov. Edwin Edwards dies; knew power and prison (https://apnews.com/article/louisiana-edwin-edwards-17a25131ac1a24988e71e60cf701f7f8)--by Kevin McGill Louisiana Secretary of State Edwin Edwards (https://www.sos.la.gov/HistoricalResources/AboutLouisiana/LouisianaGovernors1877-Present/Pages/EdwinWEdwards.aspx) The New York Times Edwin Edwards, Flamboyant Louisiana Governor, Is Dead at 93 (https://www.nytimes.com/2021/07/12/us/politics/edwin-edwards-dead.html)--by Robert D. McFadden nola.com The rise and fall of Gov. Edwin Edwards (https://www.nola.com/300/the-rise-and-fall-of-gov-edwin-edwards/article_25f29b72-8af3-5e68-9c42-37da19577950.html) NPR Edwin Edwards, Ex-Louisiana Guv, Leaves Prison For Halfway House (https://www.npr.org/sections/itsallpolitics/2011/01/13/132908525/edwin-edwards-ex-louisiana-guv-leaves-prison-for-halfway-house)--by Frank James Edwin Edwards: Governor, Convict, Reality TV Star — Congressman? (https://www.npr.org/sections/itsallpolitics/2014/02/20/280234613/edwin-edwards-governor-convict-reality-tv-star-congressman)--by Liz Halloran Ex-Con, Future Congressman? Former Gov. Edwin Edwards Campaigns Again (https://www.npr.org/2014/09/26/351438036/ex-con-future-congressman-former-gov-edwin-edwards-campaigns-again)--by Debbie Elliot (Morning Edition) Louisiana's Edwin Edwards May Be On His Last Political Stand (https://www.npr.org/2014/12/04/368529482/louisianas-edwin-edwards-may-be-on-his-last-political-stand)--by Debbie Elliot (All Things Considered WLRN) Photos Edwin W. Edwards (https://upload.wikimedia.org/wikipedia/commons/7/78/Edwin_Edwards_%281986%29.png)--from 1986 Northwestern State University Potpourri Yearbook via Wikipedia (CC0) 1991 Governor Race Bumper Sticker (https://bloximages.newyork1.vip.townnews.com/theadvocate.com/content/tncms/assets/v3/editorial/e/1a/e1af33c3-7f00-512a-a2fa-ec78f7647c05/60ecb92f731a5.image.jpg?resize=1333%2C888)--photo by Chris Granger via The Advocate Edwards, his wife Trina, and baby (https://www.klfy.com/local/trina-edwards-says-his-last-words-were-to-eli/)--screenshot via KLFY
By Adam Turteltaub Telehealth is here to stay, but that doesn't mean the rules will all be staying the same, reports Holly Hester, Senior Director, Strategic Client Partnerships for Net Health and Yolunda Dockett (LinkedIn), Chief Compliance Officer at Anne Arundel Dermatology. While the Public Health Emergency is set to end on May 11, 2023, the Consolidated Appropriations Act of 2023 extended many telehealth flexibilities through the end of December 2024. These include the ability to provide telehealth to patients in their homes, in both rural and urban settings, and the ability of physical and occupational therapists, along with speech pathologists, to provide telehealth. Yet, there are inconsistencies, with some CPT codes used by rehab therapists set to expire at the end of 2023. Plus, some are being continued only for 151 days after the end of the emergency. One other change to expect centers on privacy requirements. While many platforms have been used to provide telehealth, soon only HIPAA-compliant platforms will be allowed. It's a change that makes the provision of care less flexible and perhaps less friendly. Regardless, if your organization has not yet done a risk assessment about telehealth, now is the time. Leverage the relationships established in rolling out the service and then look collaboratively at the risks and start thinking about remediation techniques. Some other things to consider: Understanding how to decide if a patient has the physical and mental capacity for telehealth Business and operational risks Privacy considerations, on both the provider and patient sides Reimbursement and billing Documentation requirements. It's a lot of work, but it helps to ensure that telehealth can be delivered in a complaint manner. Finally, don't miss learning more at their session “Incorporating Telehealth into Your Compliance Workplan” at the 2023 HCCA Compliance Institute.
Under Section 204 of the Consolidated Appropriations Act of 2021, employer-based health plans must submit certain information about prescription drugs and healthcare spending. This data submission is known as RxDC reporting. During yesterday's Compliance Corner webinar, NABIP Compliance Corner members Barb Gerken and Samantha Malovrh discussed RxDC reporting, who is responsible for this reporting, and how to maintain compliance. On this week's episode of the Healthcare Happy Hour, we are providing a snippet of the 60-minute webinar! But RxDC reporting is not the only topic that the compliance gurus covered - we are just a couple of short months away from the official end of the public health emergency that was prompted by the pandemic. What happens when the emergency period ends? Watch the rest of the webinar to find out at www.nabip.org!
Under Section 204 of the Consolidated Appropriations Act of 2021, employer-based health plans must submit certain information about prescription drugs and healthcare spending. This data submission is known as RxDC reporting. During yesterday's Compliance Corner webinar, NABIP Compliance Corner members Barb Gerken and Samantha Malovrh discussed RxDC reporting, who is responsible for this reporting, and how to maintain compliance. On this week's episode of the Healthcare Happy Hour, we are providing a snippet of the 60-minute webinar! But RxDC reporting is not the only topic that the compliance gurus covered - we are just a couple of short months away from the official end of the public health emergency that was prompted by the pandemic. What happens when the emergency period ends? Watch the rest of the webinar to find out at www.nabip.org!
If this were a video show, I would stare into the camera with steely eyeballs right now and say that I have a special message for employer CFOs. If you aren't a CFO, pretend that you are so that you get the full effect here. So, now that we're all CFOs, let's pull up the company P&L (Profit and Loss) statement. This is what keeps us all up at night, right? Making sure that the net profit line at the bottom looks good. We could decide to lay off a few people. Reorg something or other. Beat up a vendor. Stop buying the gold paper clips. We also could go over and have a strident conversation with sales leadership about what they can do to jack up their sales revenue. Top line begets bottom line, after all. Or, here's another idea: In this healthcare podcast, I am speaking with Paul Holmes, who is an ERISA (Employee Retirement Income Security Act) attorney with a specialty in PBM (pharmacy benefit manager) contracts, especially the PBM contracts from the big PBMs that get jammed in employer plan sponsor faces by whomever and which they are told look fine and that the employer plan sponsor should just go ahead and sign. Now, if we, meaning all of us CFOs, sign that paper, or someone on our benefits team signs the paper … fun fact, our company just spent 30% to 40% over market for our pharmacy benefits. That contract we just signed contains all kinds of expensive little buried treasures—treasures accruing to the PBM and other parties, to be clear, and coming at our expense. There's 17-ish very common treasures in your typical PBM contract, and none of us will ever spot them unless we know what we are looking for. But let's dig into this for a sec, especially for all of us newly minted CFOs because the real ones already did this math. Say our company spends whatever—we're a bigger company, and we spend $100 million a year on our drugs. That's a minimum of $30 million that we got taken for … $30 million a year. That's a metric load of our cold hard cash that got dumped out back and burned. Because of the huge dollars at stake (30% to 40% of drug spend), it's certainly the advice of almost anybody that you talk to who's an expert in PBM contracts to have a third party—not your EBC (employee benefit consultant), which we'll get into in a sec, but somebody else (a third party)—review every PBM contract. I mean, what's the worst that can happen for anybody considering having an independent third party review their PBM contract? It costs a couple grand in lawyer fees, and they give it a stamp of approval. Knowledge is power, and now we know. But let's just say this third-party review doesn't happen. We all go with a “devil may care” about this whole PBM overcharging us by 30% to 40% possibility. And let's say the PBM contract is, in fact, a ride on the Hot Mess Express, but we don't know it. Here's two pretty bad downsides, especially now, this year, since the passage of the CAA (the Consolidated Appropriations Act) at the beginning of 2022. Number one bad thing: Plan sponsors may get sued as per the CAA for ERISA violations. It's not just the company paying that extra $30 million, or 30% to 40%, right? It's also employees. This is risk exposure, bigly. Just like it was on the 401(k) side of the house, which Paul Holmes, my guest today, mentions later on in the interview. He talks about just how much those lawsuits cost and, yeah, exposure. As I mentioned three times already, today I am speaking with Paul Holmes about PBM contracts in all their stealthy glory. The one thing I came to appreciate is that these things are works of art … if you're into those paintings of pretty flowers where, if you look hard enough, you spot a skull tucked in the greenery (memento mori). Paul is a longtime ERISA attorney. He has dedicated his career to helping plan sponsors in their negotiations with PBMs and trying to help them reduce drug spend, especially drug spend that isn't actually paying for drugs. Here's a link to an article we discuss about how a school district in Florida is suing their longtime EBC for taking $2 million a year in alleged secret payments. We also mention an episode with AJ Loiacono (EP379). And along similar lines, Jeff Hogan mentioned on LinkedIn the other day, “It's pretty amazing that just in the course of the [past few] weeks, I'm reading, seeing, and hearing about big new CAA breach of fiduciary duty cases.” So, Paul Holmes says this more eloquently, but if you're a plan sponsor, definitely get your PBM contract reviewed and maybe consider working with an EBC who's happy to sign the disclosure statement that your lawyer has provided without disclaimers. Oh, hey … one last thing and new topic. Here's a cool goings-on: Right now, the March Healthcare Classic is in full swing. Each spring, Josh Berlin's rule of three team collaborates with other experts to predict which major trend will find itself at the top of the healthcare agenda over the next 12 months. This year, their selection committee includes Anisha Sood; Danny Brywczynski; David Carmouche, MD; Shaheed Koury, MD; and Stephanie Mercado. Check it out and weigh in yourself should you choose to do so. You can learn more by emailing Paul at pbh@williamsbarbermorel.com. Paul B. Holmes, JD, is a seasoned ERISA lawyer with nearly 40 years of specialization in that field. Paul joined Williams Barber Morel recently, after 31 years with Nixon Peabody LLP and Ungaretti & Harris LLP. Paul has extensive and unique experience in representing large employers and Taft-Hartley welfare funds in their selection, contracting, auditing, and litigation with large pharmacy benefit managers (PBMs). Paul has logged over 8000 hours during the past four to five years, advising large employers and Taft-Hartley welfare funds managing their prescription drug benefit plans. This work includes active oversight of the request for proposal (RFP) process for selecting a PBM, the negotiation of final PBM contracts (including pricing, rebates, and audit rights), and regular audits of PBM compliance with their contracts. He was selected, through a peer-review survey, for inclusion in The Best Lawyers in America (2020 and 2021) in the field of Employee Benefits (ERISA) Law. Paul received his bachelor's degree from Bradley University and his Juris Doctor degree from the University of Illinois College of Law. 06:06 What are Paul's usual observations when a PBM contract crosses his desk? 06:57 “If you just sign … one of their model contracts …, you're probably gonna pay 30% to 40% above market on your drug spend.” 10:35 What is a PBM lawyer? And why is it important to find an ERISA PBM lawyer? 15:37 EP379 with AJ Loiacono. 16:05 Who is on the hook for the cost of the PBM contracts? 20:36 What's the problem with most ERISA lawyers today? 22:28 Lawsuit about PBM contract. 27:15 What's Paul's advice for benefits consultants? 31:11 How much might a plan sponsor be paying their consultant versus what a consultant might be making from a PBM? You can learn more by emailing Paul at pbh@williamsbarbermorel.com. Paul Holmes discusses #PBMContracts on our #healthcarepodcast. #healthcare #podcast Recent past interviews: Click a guest's name for their latest RHV episode! Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry, Dr Vikas Saini and Judith Garber, David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson
This is part two of our two-part series focusing on 340B grantee-covered entities. The team talks about the importance of maintaining auditable records (15:34) and the challenges that many grantees face in meeting this 340B eligibility requirement. Also, they cover important billing considerations related to Medicaid Duplicate Discount prevention (31:20). Finally, the group debates future developments that 340B grantee-covered entities should keep on their radar through 2023 (45:52). But first, Greg and Rob catch up on 340B implications from the Consolidated Appropriations Act of 2023 and share insights from a recent publication (J Manag Care Spec Pharm. 2023;29(3):229-35) that predicts which drugs will be subject to Medicare price negotiations starting in 2026 and beyond.
The annual war authorization (NDAA) is an excellent opportunity to examine our military's roles and goals in the world. In this episode, learn about how much of our tax money Congress provided the Defense Department, including how much of that money is classified, how much more money was dedicated to war than was requested, and what they are authorized to use the money for. This episode also examines our Foreign Military Financing programs with a deep dive into a new partner country: Ecuador. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via PayPal Support Congressional Dish via Patreon (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank's online bill pay function to mail contributions to: 5753 Hwy 85 North, Number 4576, Crestview, FL 32536. Please make checks payable to Congressional Dish Thank you for supporting truly independent media! View the shownotes on our website at https://congressionaldish.com/cd269-ndaa-2023-plan-ecuador Background Sources Recommended Congressional Dish Episodes CD244: Keeping Ukraine CD243: Target Nicaragua CD230: Pacific Deterrence Initiative CD229: Target Belarus CD218: Minerals are the New Oil CD191: The “Democracies” Of Elliott Abrams CD187: Combating China CD176: Target Venezuela: Regime Change in Progress CD172: The Illegal Bombing of Syria CD147: Controlling Puerto Rico CD128: Crisis in Puerto Rico CD108: Regime Change CD102: The World Trade Organization: COOL? World Trade System “IMF vs. WTO vs. World Bank: What's the Difference?” James McWhinney. Oct 10, 2021. Investopedia. The Profiteers: Bechtel and the Men Who Built the World. Sally Denton. Simon and Schuster: 2017. Littoral Combat Ships “The Pentagon Saw a Warship Boondoggle. Congress Saw Jobs.” Eric Lipton. Feb 4, 2023. 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Reuters. “On the Ecuador-China Debt Deal: Q&A with Augusto de la Torre.” Sep 23, 2022. The Dialogue. “Ecuador sees trade deal with China at end of year, debt talks to begin.” Alexandra Valencia. Feb 5, 2022. Reuters. Business Reforms “Will Ecuador's Business Reforms Attract Investment?” Ramiro Crespo. Mar 3, 2022. Latin American Advisor. U.S. Ecuador Partnership “Why Ecuador's president announced his re-election plans in Washington.” Isabel Chriboga. Dec 22, 2022. The Atlantic Council. “USMCA as a Framework: New Talks Between U.S., Ecuador, Uruguay.” Jim Wiesemeyer. Dec 21, 2022. AgWeb. “US seeks to bolster Ecuador ties as China expands regional role.” Dec 19, 2022. Al Jazeera. “As China's influence grows, Biden needs to supercharge trade with Ecuador.” Isabel Chiriboga. Dec 19, 2022. The Atlantic Council. “The United States and Ecuador to Explore Expanding the Protocol on Trade Rules and Transparency under the Trade and Investment Council (TIC).” Nov 1, 2022. Office of the United States Trade Representative. “A delegation of U.S. senators visits Ecuador.” Oct 19, 2022. U.S. Embassy & Consulate in Ecuador. Referendum “Guillermo Lasso Searches for a Breakthrough.” Sebastián Hurtado. Dec 19, 2022. Americas Quarterly. State Enterprise Resignation “Ecuador President Guillermo Lasso asks heads of all state firms to resign.” Jan 18, 2023. Buenos Aires Times. Lithium Triangle “Why the U.S. Inflation Reduction Act Could Benefit Both Mining and Energy in Latin America.” John Price. Aug 22, 2022. Americas Market Intelligence. Colombia “Latin America's New Left Meets Davos.” Catherine Osborn. Jan 20, 2023. Foreign Policy. “How Colombia plans to keep its oil and coal in the ground.” María Paula Rubiano A. Nov 16, 2022. BBC. “Colombia: Background and U.S. Relations.” June S. Beittel. Updated December 16, 2021. Congressional Research Service. Tax Reform “In Colombia, Passing Tax Reform Was the Easy Part.” Ricardo Ávila. Nov 23, 2022. Americas Quarterly. “U.S. Government Must Take Urgent Action on Colombia's Tax Reform Bill.” Cesar Vence and Megan Bridges. Oct 26, 2022. U.S. Chamber of Commerce. “Letter from ACT et. al. to Sec. Janet Yellen, Sec. Gina Raimondo, and Hon. Katherine Tai.” U.S. Chamber of Commerce. Relationship with U.S. “Does glyphosate cause cancer?” Cancer Treatment Centers of America. Jul 8, 2021. City of Hope. “Colombian Intelligence Unit Used U.S. Equipment to Spy on Politicians, Journalists.” Kejal Vyas. May 4, 2020. The Wall Street Journal. “Exposure to glyphosate-based herbicides and risk for non-Hodgkin lymphoma: A meta-analysis and supporting evidence.” Luoping Zhang et al. Mutation Research/Reviews in Mutation Research Vol. 781, July–September 2019, pp. 186-206. “Colombia to use drones to fumigate coca leaf with herbicide.” Jun 26, 2018. Syria “Everyone Is Denouncing the Syrian Rebels Now Slaughtering Kurds. But Didn't the U.S. Once Support Some of Them?” Mehdi Hasan. Oct 26, 2019. The Intercept. “U.S. Relations With Syria: Bilateral Relations Fact Sheet.” Jan 20, 2021. U.S. Department of State, Bureau of Near Eastern Affairs. “Behind the Sudden Death of a $1 Billion Secret C.I.A. War in Syria.” Mark Mazzetti et al. Aug 2, 2017. The New York Times. “Arms Airlift to Syria Rebels Expands, With Aid From C.I.A.” C. J. Chivers and Eric Schmitt. Mar 24, 2013. The New York Times. Government Funding “House Passes 2023 Government Funding Legislation.” Dec 23, 2022. House Appropriations Committee Democrats. “Division C - Department of Defense Appropriations Act, 2023.” Senate Appropriations Committee. Jen's highlighted version “Division K - Department of State, Foreign Operations, and Related Programs Appropriations Act, 2023.” Senate Appropriations Committee. Laws H.R.2617 - Consolidated Appropriations Act, 2023 H.R.7776 - James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 Jen's highlighted version Bills H.R. 8711 - United States-Ecuador Partnership Act of 2022 S. 3591 - United States-Ecuador Partnership Act of 2022 Audio Sources A conversation with General Laura J. Richardson on security across the Americas January 19, 2023 The Atlantic Council Clips 17:51 Gen. Laura Richardson: The Belt and Road Initiative (BRI) that has been ongoing for the last over a decade in this region, 21 of 31 countries have signed on to this Belt and Road Initiative. I could take Argentina last January, the most recent signatory on to the Belt and Road Initiative, and $23 billion in infrastructure projects that signatory and signing on to that. But again, 21 of 31 countries. There are 25 countries that actually have infrastructure projects by the PRC. Four that aren't signatories of the BRI, but they do actually have projects within their countries. But not just that. Deepwater ports in 17 countries. I mean, this is critical infrastructure that's being invested in. I have the most space enabling infrastructure in the Western Hemisphere in Latin America and the Caribbean. And I just caused question, you know, why? Why is all of this critical infrastructure being invested in so heavily? In terms of telecommunications, 5G, I've got five countries with the 5G backbone in this region. I've got 24 countries with the PRC Huawei 3G-4G. Five countries have the Huawei backbone infrastructure. If I had to guess, they'll probably be offered a discount to upgrade and stay within the same PRC network. And so very, very concerning as we work with our countries. 20:00 Gen. Laura Richardson: What I'm starting to see as well is that this economy...the economy impacts to these partner nations is affecting their ability to buy equipment. And you know, as I work with our partner nations, and they invest in U.S. equipment, which is the best equipment, I must say I am a little biased, but it is the best equipment, they also buy into the supply chain of spare parts, and all those kinds of things that help to sustain this piece of equipment over many, many years. So in terms of the investment that they're getting, and that equipment to be able to stay operational, and the readiness of it, is very, very important. But now these partner nations, due to the impacts of their economy, are starting to look at the financing that goes along with it. Not necessarily the quality of the equipment, but who has the best finance deal because they can't afford it so much up front. 24:15 Gen. Laura Richardson: This region, why this region matters, with all of its rich resources and rare earth elements. You've got the lithium triangle which is needed for technology today. 60% of the world's lithium is in the lithium triangle: Argentina Bolivia, Chile. You just have the largest oil reserves -- light, sweet, crude -- discovered off of Guyana over a year ago. You have Venezuela's resources as well with oil, copper, gold. China gets 36% of its food source from this region. We have the Amazon, lungs of the world. We have 31% of the world's freshwater in this region too. I mean, it's just off the chart. 28:10 Gen. Laura Richardson: You know, you gotta question, why are they investing so heavily everywhere else across the planet? I worry about these dual-use state-owned enterprises that pop up from the PRC, and I worry about the dual use capability being able to flip them around and use them for military use. 33:30 Interviewer: Russia can't have the ability to provide many of these countries with resupply or new weapons. I mean, they're struggling to supply themselves, in many cases, for Ukraine. So is that presenting an opportunity for maybe the US to slide in? Gen. Laura Richardson: It is, absolutely and we're taking advantage of that, I'd like to say. So, we are working with those countries that have the Russian equipment to either donate or switch it out for United States equipment. or you Interviewer: Are countries taking the....? Gen. Laura Richardson: They are, yeah. 45:25 Gen. Laura Richardson: National Guard State Partnership Program is huge. We have the largest National Guard State Partnership Program. It has come up a couple of times with Ukraine. Ukraine has the State Partnership Program with California. How do we initially start our great coordination with Ukraine? It was leveraged to the National Guard State Partnership Program that California had. But I have the largest out of any of the CoCOMMs. I have 24 state partnership programs utilize those to the nth degree in terms of another lever. 48:25 Gen. Laura Richardson: Just yesterday I had a zoom call with the U.S. Ambassadors from Argentina and Chile and then also the strategy officer from Levant and then also the VP for Global Operations from Albermarle for lithium, to talk about the lithium triangle in Argentina, Bolivia and Chile and the companies, how they're doing and what they see in terms of challenges and things like that in the lithium business and then the aggressiveness or the influence and coercion from the PRC. House Session June 15, 2022 Clips Rep. Jackie Speier (D-CA): The GAO found that the LCS had experienced engine failure in 10 of the 11 deployments reviewed. Rep. Jackie Speier (D-CA): One major reason for the excessive costs of LCS: contractors. Unlike other ships where sailors do the maintenance, LCS relies almost exclusively on contractors who own and control the technical data needed to maintain and repair. Rep. Jackie Speier (D-CA): Our top priority and national defense strategy is China and Russia. We can't waste scarce funds on costly LCS when there are more capable platforms like destroyers, attack submarines, and the new constellation class frigate. A review of the President's Fiscal Year 2023 funding request and budget justification for the Navy and Marine Corps May 25, 2022 Senate Appropriations Committee, Subcommittee on Defense Watch full hearing on YouTube Witnesses: Carlos Del Toro, Secretary, United States Navy Admiral Michael M. Gilday, Chief of Naval Operations General David H. Berger, Commandant of the Marine Corps Clips Sen. Jerry Moran (R-KS): I think the christening was just a few years ago...maybe three or so. So the fact that we christened the ship one year and a few years later we're decommissioning troubles me. Sen. Jerry Moran (R-KS): Are there not other uses, if there's something missing from this class of ships, that we would avoid decommissioning? Adm. Michael Gilday: We need a capable, lethal, ready Navy more than we need a larger Navy that's less capable, less lethal, and less ready. And so, unfortunately the Littoral combat ships that we have, while the mechanical issues were a factor, a bigger factor was was the lack of sufficient warfighting capability against a peer competitor in China. Adm. Michael Gilday: And so we refuse to put an additional dollar against that system that wouldn't match the Chinese undersea threat. Adm. Michael Gilday: In terms of what are the options going forward with these ships, I would offer to the subcommittee that we should consider offering these ships to other countries that would be able to use them effectively. There are countries in South America, as an example, as you pointed out, that would be able to use these ships that have small crews. Secretary of State Antony J. Blinken and Secretary ofDefense Lloyd J. Austin III Remarks to Traveling Press April 25, 2022 China's Role in Latin America and the Caribbean March 31, 2022 Senate Foreign Relations Committee Watch full hearing on YouTube Witnesses: Kerri Hannan, Deputy Assistant Secretary for Public Diplomacy, Policy, Planning, and Coordination, Bureau of Western Hemisphere Affairs, U.S. Department of State Peter Natiello, Senior Deputy Assistant Administrator, Latin America and Caribbean Bureau, U.S. Agency for International Development Andrew M. Herscowitz, Chief Development Officer, U.S. International Development Finance Corporation Margaret Myers, Director of the Asia & Latin America Program, Inter-American Dialogue Evan Ellis, Senior Associate, Center for Strategic and International Studies Clips 24:20 Sen. Tim Kaine (D-VA): Ecuador for example, nearly 20 years ago, former President Rafael Correa promised modernization for Ecuador, embracing Chinese loans and infrastructure projects in exchange for its oil. Fast forward to today. Ecuador now lives with the Chinese financed and built dam that's not fully operational despite being opened in 2016. The Coca Codo Sinclair Dam required over 7000 repairs, it sits right next to an active volcano, and erosion continues to damage the dam. The dam also caused an oil spill in 2020 that has impacted indigenous communities living downstream. And all that's on top of the billions of dollars that Ecuador still owes China. 56:40 Peter Natiello: One example that I could provide is work that we've done in Ecuador, with Ecuadorian journalists, to investigate, to analyze and to report on the issue of illegal and unregulated fishing off Ecuador's coast. And we do that because we want to ensure that Ecuadorian citizens have fact-based information upon which they can make decisions about China and countries like China, and whether they want their country working with them. 1:23:45 Sen. Ed Markey (D-MA): There are 86 million tons of identified lithium resources on the planet. On the planet. 49 million of the 86 million are in the Golden Triangle. That's Argentina, Bolivia, Chile. So what's our plan? 1:54:10 Evan Ellis: In security engagement, the PRC is a significant provider of military goods to the region including fighters, transport aircraft, and radars for Venezuela; helicopters and armored vehicles for Bolivia; and military trucks for Ecuador. 2:00:00 Margaret Myers: Ecuador is perhaps the best example here of a country that has begun to come to terms with the challenges associated with doing business with or interacting from a financial or investment perspective with China. And one need only travel the road from the airport to Quito where every day there are a lot of accidents because of challenges with the actual engineering of that road to know why many Ecuadorians feel this way. Examining U.S. Security Cooperation and Assistance March 10, 2022 Senate Committee on Foreign Relations Watch Full Hearing on YouTube Witnesses: Jessica Lewis, Assistant Secretary of State for Political-Military Affairs, U.S. Department of State Mara Elizabeth Karlin, Assistant Secretary of Defense for Strategy, Plans and Capabilities, U.S. Department of Defense Clips 1:23:17 Sen. Chris Murphy (D-CT): According to one study, the DoD manages 48 of the 50 new security assistance programs that were created after the 9/11 attacks and out of the 170 existing security assistance programs today, DOD manages 87, a whopping 81% of those programs. That is a fundamental transition from the way in which we used to manage security assistance. And my worry is that it takes out of the equation the people who have the clearest and most important visibility on the ground as to the impact of that security assistance and those transfers. Sen. Chris Murphy: We just spent $87 billion in military assistance over 20 years in Afghanistan. And the army that we supported went up in smoke overnight. That is an extraordinary waste of U.S. taxpayer dollars, and it mirrors a smaller but similar investment we made from 2003 to 2014 in the Iraqi military, who disintegrated when they faced the prospect of a fight against ISIS. Clearly, there is something very wrong with the way in which we are flowing military assistance to partner countries, especially in complicated war zones. You've got a minute and 10 seconds, so maybe you can just preview some lessons that we have learned, or the process by which we are going to learn lessons from all of the money that we have wasted in Iraq and Afghanistan. Jessica Lewis: Senator, I'll be brief so that Dr. Karlin can jump in as well. I think we do need to learn lessons. We need to make sure, as I was just saying to Senator Cardin, that when we provide security assistance, we also look not just at train and equip, but we look at other things like how the Ministries of Defense operate? Is their security sector governant? Are we creating an infrastructure that's going to actually work? Mara Elizabeth Karlin: Thank you for raising this issue, Senator. And I can assure you that the Department of Defense is in the process of commissioning a study on this exact issue. I will just say in line with Assistant Secretary Lewis, it is really important that when we look at these efforts, we spend time assessing political will and we do not take an Excel spreadsheet approach to building partner militaries that misses the higher order issues that are deeply relevant to security sector governance, that will fundamentally show us the extent to which we can ultimately be successful or not with a partner. Thank you. Sen. Chris Murphy (D-CT): You know, in Iraq, last time I was there, we were spending four times as much money on security assistance as we were on non-security assistance. And what Afghanistan taught us amongst many things, is that if you have a fundamentally corrupt government, then all the money you're flowing into the military is likely wasted in the end because that government can't stand and thus the military can't stand. So it also speaks to rebalancing the way in which we put money into conflict zones, to not think that military assistance alone does the job. You got to be building sustainable governments that serve the public interests in order to make your security assistance matter and be effective. Thank you, Mr. Chairman. National Security Challenges and U.S. Military Activity in North and South America March 8, 2022 House Armed Services Committee Watch full hearing on YouTube Witnesses: Melissa G. Dalton, Assistant Secretary of Defense for Homeland Defense and Hemispheric Affairs Office of the Secretary of Defense General Laura Richardson, USA, Commander, U.S. Southern Command General Glen D. VanHerck, USAF, Commander, U.S. Northern Command and North American Aerospace Defense Command Clips 17:30 General Laura Richardson: Colombia, for example, our strongest partner in the region, exports security by training other Latin American militaries to counter transnational threats. 1:20:00 General Laura Richardson: If I look at what PRC (People's Republic of China) is investing in the [SOUTHCOM] AOR (Area of Responsibility), over a five year period of 2017 to 2021: $72 billion. It's off the charts. And I can read a couple of the projects. The most concerning projects that I have are the $6 billion in projects specifically near the Panama Canal. And I look at the strategic lines of communication: Panama Canal and the Strait of Magellan. But just to highlight a couple of the projects. The nuclear power plant in Argentina: $7.9 billion. The highway in Jamaica: $5.6 billion. The energy refinery in Cuba, $5 billion. The highway in Peru: $4 billion. Energy dam in Argentina: $4 billion, the Metro in Colombia: $3.9 billion. The freight railway in Argentina: $3 billion. These are not small projects that they're putting in this region. This region is rich in resources, and the Chinese don't go there to invest, they go there to extract. All of these projects are done with Chinese labor with host nation countries'. U.S. Policy on Democracy in Latin America and the Caribbean November 30, 2021 Senate Foreign Affairs Committee Watch full hearing on YouTube Witnesses: Brian A. Nichols, Assistant Secretary of State for Western Hemisphere Affairs, U.S. Department of State Todd D. Robinson, Assistant Secretary of State for International Narcotics and Law Enforcement Affairs, U.S. Department of State Clips 1:47:15 Sen. Ted Cruz (R-TX): I'd like to start with Mexico. I am increasingly concerned that the Mexican government is engaged in a systematic campaign to undermine American companies, and especially American energy companies that have invested in our shared prosperity and in the future of the Mexican people and economy. Over the past five months, Mexican regulators have shut down three privately owned fuel storage terminals. Among those they shut down a fuel terminal and Tuxpan, which is run by an American company based in Texas, and which transports fuel on ships owned by American companies. This is a pattern of sustained discrimination against American companies. And I worry that the Mexican government's ultimate aim is to roll back the country's historic 2013 energy sector liberalisation reforms in favor of Mexico's mismanaged and failing state-owned energy companies. The only way the Mexican government is going to slow and reverse their campaign is if the United States Government conveys clearly and candidly that their efforts pose a serious threat to our relationship and to our shared economic interests. 2:01:50 Sen. Cory Booker (D-NJ): Mr. Nichols, can you can you just be a little more specific about the tactics of the GEC? What are some of the specific activities they're doing? And what more would you like to see them do? Brian A. Nichols: The Global Engagement Center both measures public opinion and social media trends throughout the world. They actively work to counter false messages from our strategic competitors. And they prepare media products or talking points that our embassies and consulates around the hemisphere can use to combat disinformation. I think they do a great job. Obviously, it's a huge task. So the the resources that they have to bring to bear to this limit, somewhat, the ability to accomplish those goals, but I think they're doing vital, vital work. 2:13:30 Todd D. Robinson: We are, INL (International Narcotics and Law Enforcement) are working very closely with the Haitian National Police, the new Director General, we are going to send in advisors. When I was there two weeks ago, I arrived with -- they'd asked for greater ability to get police around the city -- I showed up with 19 new vehicles, 200 new protective vests for the police. The 19 was the first installment of a total of 60 that we're going to deliver to the Haitian National Police. We're gonna get advisors down there to work with the new SWAT team to start taking back the areas that have been taken from ordinary Haitians. But it's going to be a process and it's going to take some time. Sen. Bob Menendez: Well, first of all, is the Haitian National Police actually an institution capable of delivering the type of security that Hatians deserve? Todd D. Robinson: We believe it is. It's an institution that we have worked with in the past. There was a small brief moment where Haitians actually acknowledged that the Haitian National Police had gotten better and was more professional. Our goal, our long term goal is to try to bring it back to that Sen. Bob Menendez: How much time before we get security on the ground? Todd D. Robinson: I can't say exactly but we are working as fast as we can. Sen. Bob Menendez: Months, years? Todd D. Robinson: Well, I would hope we could do it in less than months. But we're working as fast as we can. Global Challenges and U.S. National Security Strategy January 25, 2018 Senate Committee on Armed Services Watch the full hearing on YouTube Witnesses: Dr. Henry A. Kissinger, Chairman of Kissinger Associates and Former Secretary of State Dr. George P. Shultz, Thomas W. and Susan B. Ford Distinguished Fellow, Hoover Institution, Stanford University and Former Secretary of State Richard L. Armitage, President, Armitage International and Former Deputy Secretary of State Clips Dr. George Shultz: Small platforms will carry a very destructive power. Then you can put these small platforms on drones. And drones can be manufactured easily, and you can have a great many of them inexpensively. So then you can have a swarm armed with lethal equipment. Any fixed target is a real target. So an airfield where our Air Force stores planes is a very vulnerable target. A ship at anchor is a vulnerable target. So you've got to think about that in terms of how you deploy. And in terms of the drones, while such a system cannot be jammed, it would only serve to get a drone—talking about getting a drone to the area of where its target is, but that sure could hit a specific target. At that point, the optical systems guided by artificial intelligence could use on-board, multi-spectral imaging to find a target and guide the weapons. It is exactly that autonomy that makes the technologic convergence a threat today. Because such drones will require no external input other than the signature of the designed target, they will not be vulnerable to jamming. Not requiring human intervention, the autonomous platforms will also be able to operate in very large numbers. Dr. George Shultz: I think there's a great lesson here for what we do in NATO to contain Russia because you can deploy these things in boxes so you don't even know what they are and on trucks and train people to unload quickly and fire. So it's a huge deterrent capability that is available, and it's inexpensive enough so that we can expect our allies to pitch in and get them for themselves. Dr. George Shultz: The creative use of swarms of autonomous drones to augment current forces would strongly and relatively cheaply reinforce NATO, as I said, that deterrence. If NATO assists frontline states in fielding large numbers of inexpensive autonomous drones that are pre-packaged in standard 20-foot containers, the weapons can be stored in sites across the countries under the control of reserve forces. If the weapons are pre-packaged and stored, the national forces can quickly deploy the weapons to delay a Russian advance. So what's happening is you have small, cheap, and highly lethal replacing large, expensive platforms. And this change is coming about with great rapidity, and it is massively important to take it into account in anything that you are thinking about doing. Foreign Military Sales: Process and Policy June 15, 2017 House Foreign Affairs Subcommittee on Terrorism, Nonproliferation, and Trade Watch the full hearing on YouTube Witnesses: Tina Kaidanow, Acting Assistant Secretary, Bureau of Political-Military Affairs, U.S. Department of State Vice Admiral Joseph Rixey, Director, U.S. Defense Security Cooperation Agency Clips 14:40 Tina Kaidanow: Arms Transfers constitute an element of foreign policy. We therefore take into account foreign policy considerations as we contemplate each arms transfer or sale, including specifically, the appropriateness of the transfer in responding to U.S and recipient security needs; the degree to which the transfer supports U.S. strategic foreign policy and defense interests through increased access and influence; allied burden sharing and interoperability; consistency with U.S. interests regarding regional stability; the degree of protection afforded by the recipient company to our sensitive technology; the risk that significant change in the political or security situation of the recipient country could lead to inappropriate end use or transfer; and the likelihood that the recipient would use the arms to commit human rights abuses or serious violations of international humanitarian law, or retransfer the arms to those who would commit such abuses. As a second key point, arms transfers support the U.S. Defense industrial base and they reduce the cost of procurement for our own U.S. military. Purchases made through the Foreign Military Sales, known as the FMS, system often can be combined with our Defense Department orders to reduce unit costs. Beyond this, the US defense industry directly employs over 1.7 million people across our nation. 20:20 Vice Admiral Joseph Rixey: FMS is the government-to-government process through which the U.S. government purchases defense articles, training, and services on behalf of foreign governments, authorized in the Arms Export Control Act. FMS is a long standing security cooperation program that supports partner and regional security, enhances military-to-military cooperation, enables interoperability and develops and maintains international relationships. Through the FMS process, the US government determines whether or not the sale is of mutual benefit to us and the partner, whether the technology can and will be protected, and whether the transfer is consistent with U.S. conventional arms transfer policy. The FMS system is actually a set of systems in which the Department of State, Department of Defense, and Congress play critical roles. The Department of Defense in particular executes a number of different processes including the management of the FMS case lifecycle which is overseen by DSCA (Defense Security Cooperation Agency). Technology transfer reviews, overseen by the Defense Technology Security Administration, and the management of the Defense Acquisition and Logistics Systems, overseen by the Office of the Undersecretary of Defense for Acquisition, Technology and Logistics, and the military departments. This process, or a version of it, also serves us well, in the DoD Title X Building Partnership Capacity arena, where the process of building a case, validating a requirement and exercising our U.S. acquisition system to deliver capability is modeled on the FMS system. I want to say clearly that overall the system is performing very well. The United States continues to remain the provider of choice for our international partners, with 1,700 new cases implemented in Fiscal Year 2016 alone. These new cases, combined with adjustments to existing programs, equated to more than $33 billion in sales last year. This included over $25 billion in cases funded by our partner nations' own funds and approximately $8 billion in cases funded by DOD Title X program or Department of State's Appropriations. Most FMS cases move through the process relatively quickly. But some may move more slowly as we engage in deliberate review to ensure that the necessary arms transfer criteria are met. Cover Art Design by Only Child Imaginations Music Presented in This Episode Intro & Exit: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)
Are you a real estate broker, building owner, or CPA? Do you want to reduce your tax liability through cost segregation? Joining us in this episode is Erik Oliver, a graduate with a Bachelor's Science Degree in Applied Science in Accounting, previously an operations manager for a landscaping design firm at Long Island, and is currently the Vice President of Business Development at Cost Segregation Authority. Erik's here to help out with understanding what “Cost Segregation” is and why it's so beneficial. Take a listen and see for yourself how cost segregation could be beneficial for you, depreciation, the process of cost segregation, and more. What You'll Learn From This Episode: Introduction to Erik Oliver Cost Segregation breakdown Discussing depreciation What the Consolidated Appropriations Act is Erik's advice for beginning investors Factoring in tax benefits of property So what are you waiting for? It's time to get out there and start crushing it in the real estate investing world now! Connect with Erik Oliver@: Email:erik@costsegauthority.com Website: https://costsegauthority.com/ Connect with Corwyn @: Contact Number: 843-619-3005 Instagram: https://www.instagram.com/exitstrategiesradioshow/ FB Page: https://www.facebook.com/exitstrategiessc/ Youtube: https://www.youtube.com/channel/UCxoSuynJd5c4qQ_eDXLJaZA Website: https://www.exitstrategiesradioshow.com Linkedin: https://www.linkedin.com/in/cmelette/ Email @: corwyn@corwynmelette.com --- Support this podcast: https://anchor.fm/corwyn-j-melette/support
On December 29, 2022, President Biden signed the Consolidated Appropriations Act, 2023 into law. This omnibus law is over 4,100 pages, and, like many omnibus bills, affects a broad range of issues.According to Dr. Joel M. Zinberg, physician and health care expert, one such issue is the practice of medicine, as a nineteen-line section relating to the authority of the Food & Drug Administration (FDA) may fundamentally change the future viability of off-label prescriptions. Dr. Zinberg joins us in this podcast to explain the Act's provisions concerning the FDA, the possible implications on the practice of medicine, and possible solutions to the potential pitfalls posed by these new health care provisions.Featuring: Joel Zinberg, Senior Fellow, Competitive Enterprise InstituteVisit our website – www.RegProject.org – to learn more, view all of our content, and connect with us on social media.*******As always, the Federalist Society takes no position on particular legal or public policy issues; all expressions of opinion are those of the speaker.
Host Bret Keisling gives a brief overview of important new federal legislation that should move employee ownership to new levels. Part of the Consolidated Appropriations Act, passed in December 2022, the SECURE Act and WORK Act call for the Department of Labor to provide guidance on ESOP valuations and determining fair market value, allow for deferred capital gains tax on S-Corp ESOP transactions, provide funding for state and local governments and non-profit entities to encourage EO, as well as implement technical changes to mandatory disbursements and to self-correcting and reporting inadvertent errors in ESOP administration. The show notes and full transcript of this episode, which includes links to all of the topics mentioned, is available on our website at https://www.theesoppodcast.com/post/mini-cast-213-the-secure-and-work-acts-move-eo-forward
Flight #48: New 401k, IRA Limits New SECURE ACT 2.0 A Airline News: New IRA, 401k 401(a)17 and 415 Limits Secure Act 2.0 Highlights: Setting Every Community Up for Retirement Enhancement (SECURE) Act...originally passed in December 2019. December 23, 2022, passed the Consolidated Appropriations Act of 2023, an omnibus spending bill that includes the much anticipated and long-awaited retirement bill known as SECURE Act 2.0. RMD 73,75...plus reduced penalty 73-1951-1959 / 1960+ RMD 75 ▪ What does this do...Roth Conversions??? Plus 10-year rule from Secure Act 1.0 Beware of higher RMD at 73/75 - jump tax brackets??? QCD no effect – still 70 and a half years old. No Roth 401k RMD (2024) Roth style SEP and SIMPLE IRA 529 plans to Roth IRA transfers up to $35,000. Subject to annual Roth limits and 529 accounts in existence for 15 years. Student loan payments count and qualify the employee for 401k matching. I.e., you'll get matched in your 401k for student loan payments. Base matching contributions on student loan repayments. Catch up contributions: 2025 – 60-63 – catch up contribution of 10,000 or 50% more than the standard catch-up contribution that year. Catch up contributions are now linked with inflation 2024 - $145k – catch-up contributions must be made in Roth Roth basis if permitted by the plan sponsor SECURE Act 2.0 provides that all catch-up contributions to qualified retirement plans are subject to Roth tax treatment, effective for taxable years beginning after December 31, 2023, An exception is provided for employees with compensation of $145,000 or less (indexed) https://www.kitces.com/blog/secure-act-2-omnibus-2022-hr-2954-rmd-75-529-roth-rollover-increase-qcd-student-loan-match/?utm_source=social&utm_medium=linkedin&utm_campaign=tagged_author https://www.youtube.com/watch?v=i-PXuU_2wnA
Over the past few weeks, Congress has slowly brought two of its biggest pieces of annual omnibus legislation to the finish line: the National Defense Authorization Act, or NDAA, and the Consolidated Appropriations Act. Both annual endeavors play central complementary roles in our political system and often become vehicles for an array of otherwise unrelated provisions, including many related to national security. And even by the usual standards of Congress, this year's process has been a chaotic one.To discuss, Lawfare senior editor Scott R. Anderson sat down with fellow Lawfare senior editor and Brookings Institution colleague Molly Reynolds. They talked about the process that led to this year's bills and highlighted some notable items that are in them— and some notable items that aren't.Support this show http://supporter.acast.com/lawfare. Hosted on Acast. See acast.com/privacy for more information.
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