Podcasts about federal poverty level

In Kewanee, the United Way has rolled out the Shoes for Kids program, aiming to equip local students with new footwear for the upcoming school year. Families within the 2023 Federal Poverty Level guidelines qualify for this initiative, benefiting up to three children per household. Today's registration event is hosted at the Elks Lodge on North Tremont Street. Applicants can receive further assistance directly from the Kewanay Area United Way representatives. The shoes, sourced from Breedloves Sporting Goods, will be distributed in August, ensuring that children step into the new school term on the right foot.

CTL Script/ Top Stories of July 4 Tuesday Publish Date: July 3 Monday   Henssler :15 From the Ingles Studio Welcome to the Award Winning Cherokee Tribune Ledger Podcast    Today is Tuesday, July 4th, and happy 28th birthday to singer Post Malone ***Malone***     I'm Brian Giffin and here are the stories Cherokee is talking about, presented by Credit Union of Georgia Limited Georgia Medicaid expansion launched this past weekend Several state agencies getting new leaders And Cherokee County Educational Foundation raises $70K to help students   Plus, Leah McGrath of Ingles Markets talks with Bruce Jenkins about cutting back on Soda   We'll have all this and more coming up on the Cherokee Tribune-Ledger Podcast      Commercial:  CU of GA   Story 1. medicaid   Georgia Republicans have implemented a limited version of Medicaid expansion called Georgia Pathways, which will provide coverage to low-income individuals between the ages of 19 and 64 with household incomes up to 100% of the Federal Poverty Level. The program excludes low-income elderly Georgians and the disabled. Unlike the federal program, Georgia Pathways includes a work requirement, mandating recipients to participate in at least 80 hours per month of qualifying activities. Critics argue that the program falls short of covering all uninsured Georgians and that the state should adopt full Medicaid expansion, which offers a higher federal match. Supporters of Georgia Pathways argue that it provides a sustainable solution and avoids dependence on federal funding. The debate continues between Democrats and Republicans on the issue..……… Read more on this story at tribuneledgernews.com     STORY 2: agencies   Governor Brian Kemp has announced several changes in key positions within his administration. Rick Dunn, the current director of the Georgia Environmental Protection Division (EPD), will become the new director of the Governor's Office of Planning and Budget (OPB), replacing Kelly Farr. David Dove, the governor's executive counsel, will serve as interim director of the EPD while continuing in his current role. Walter Rabon, currently the deputy commissioner of the Georgia Department of Natural Resources (DNR), will assume the role of commissioner, replacing Mark Williams, who will become the executive director of the Jekyll Island Authority. Russell Carlson, the chief health policy officer for the state Department of Community Health, will become the commissioner of the health agency, succeeding Caylee Noggle. The new appointments will take effect on July 1 and August 1, respectively.   Story 3: 70k   The Cherokee County Educational Foundation held its inaugural Sporting Clays Classic shooting event at Garland Mountain in Waleska, raising $70,000. The event, presented by Batson-Cook Company and Northside Hospital Cherokee, was sold out and aimed to fund Classroom Impact Grants for Cherokee County public schools. Participants enjoyed a breakfast from Chick-fil-A of Canton before competing in a 100-target shooting course. The winners were determined using the Lewis Class Scoring Method. Inglett and Stubbs took first place in Division I, Goshen Valley in Division II, and Newcomb and Boyd in Division III. The foundation expressed gratitude to volunteers, donors, and sponsors for their support. The Cherokee County Educational Foundation is a nonprofit organization focused on supporting the students and staff of the Cherokee County School District.   Back in a moment   Break:  ESOG - Drake   STORY 4: knoll   Kristen Brooks, a technology lab teacher at Indian Knoll Elementary School, received the prestigious ISTE 20 to Watch award from the International Society for Technology in Education. The award recognizes 20 emerging leaders in technology education worldwide who have demonstrated effective use of technology to enhance education and improve teaching practices. Brooks, a Microsoft Innovative Educator Expert and Apple Learning Coach, played a crucial role in earning her school Microsoft Showcase School status for two consecutive years. Indian Knoll Elementary was one of only 43 schools in the United States and one of two in Georgia to receive this recognition. Superintendent Brian Hightower expressed pride in Brooks' accomplishments and her dedication to preparing students for future success.   Story 5: widening   The city of Woodstock has been awarded a $1.5 million loan and an $825,000 grant from the Georgia Transportation Infrastructure Bank to fund a widening project for Towne Lake Parkway. The project aims to provide traffic relief by widening the road between Mill Street and Woodstock Parkway. The funding will be used to widen the travel lanes, including a dedicated right turn lane onto Woodstock Parkway, and extend the sidewalk in the area. Construction is expected to begin in early 2024. Woodstock Mayor Michael Caldwell expressed gratitude for the funding, emphasizing the importance of investing in infrastructure to support the city's growth.   Story 6:  angelakos   Dimitri Angelakos, a standout athlete at Etowah High School, has committed to playing baseball at Georgia Tech. Angelakos played a key role in Etowah's baseball and basketball successes, including reaching the state championship in baseball and the state semifinals in basketball. Despite an arm injury, Angelakos impressed on the mound with his pitching skills. He is also a talented hitter, contributing to Etowah's offense. Angelakos chose baseball over basketball for college and looks forward to competing at a higher level. He expressed excitement about joining Georgia Tech's program and continuing to grow as an athlete.   Back with more after this   Commercial: Elon – Dayco - Ingles 6 Story 7: Leah   And now, Leah McGrath, corporate dietician at Ingles Markets talks with our Bruce Jenkins about cutting back on soda   ****Leah****   Final thoughts after this   Henssler 60   Thanks again for spending time with us listening to today's Cherokee Tribune Ledger podcast. Get more on these stories and other great content at tribune ledger news.com. Giving you important information about our community and telling great stories are who we are. Did you know over 50% of Americans listen to podcasts weekly? 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.   www.ingles-markets.com  www.henssler.com  www.cuofga.org  www.drakerealty.com  www.esogrepair.com  www.elonsalon.com  www.See omnystudio.com/listener for privacy information.

I grew up with a tremendous amount of sexual abuse from a very early age.  I went through a lot of self-destructive behavior, hospitalizations, and an eating disorder early in life. I went into foster care as a teen where the sexual abuse continued.  I became an emancipated minor at the age of 16 and then lived on my own while working full time. I got married when I was 18 and had 3 children right away (3 under the age of 3).We started doing foster care when our youngest was about 4.  At one point we had 8 children 8 and under.  I started nursing school when we had nine children living in our home.  Over the course of the next 25 years we fostered well over 100 children and took permanent legal guardianship of 10 girls.   My husband got cancer and suffered with cancer for 12 years before passing away in 2006.I had 4 girls living at home at that time and took in another one a few months after my husband died.  I completed 3 legal guardianships that first year after he died. I was a single mom and working full time. I started my master's degree 12 days after he passed away.  I remarried in 2010 and by that time was in a doctoral program getting my doctorate degree.I finished it and continued to do medical mission trips all over the world (I have done about 30).  I then went back to school and got my post doctorate degree and am now double boarded as an Advance Practice Nurse (FNP and CNS). My youngest son passed away in 2021 after an 8 year battle with cancer and his story continues to inspire all who knew him.  My biggest encouragement to people is to NEVER give up and never remain a victim.  Use what challenges life has given you and learn to develop a passion to help others overcome theirs.  I have seen in my own life how God turned my sexual abuse into a deep passion to help others who might have had similar experiences.   My second husband and I have recently started a medical clinic in northern India that cares for over 140 girls rescued from sex trafficking and other abuses.  Without having gone through my struggles, I would have never developed the passions I have had to help others. I coauthored a book about my life and how God has used my struggles to develop passion and purpose in my life.   I have a website that shares more about my book, my mission trips, and my life story.  https://phillisdewitt.com   In the past six months, I have been able to share some about my story in Israel, Mexico, India, England, Costa Rica, Romania, and Ukraine.  My husband and I just returned from doing war relief efforts in Romana and Ukraine working with women and children who have lost everything due to their homes being bombed.    I currently teach at 4 colleges in their graduate nursing programs and continue to see patients once a week when I am in Florida (we live there 6 months out of the year) at a free clinic that serves those who are living within 200 % of the Federal Poverty Level. My second husband and I have started 4 endowment scholarships to other students have access to an education that might not otherwise be able to.  I have received many local, state and national awards for my work with families and victims of trauma. Please go to Phillis's website to either seek help or help other people. If you have a life struggle to share, please contact me @ strugglesarehard@gmail.com You may follow me on. Instagram: @lifestrugglespodcast and main page @thechristycollier to purchase Athletic Greens: https://fbuy.io/ag/christycollier --- Send in a voice message: https://podcasters.spotify.com/pod/show/lifestruggles/message Support this podcast: https://podcasters.spotify.com/pod/show/lifestruggles/support

  Come April 1st Medicaid eligibility reviews will commence, and millions of Americans may lose coverage. What does that mean for insurance agents? Find the solutions in this episode!   Read the text version   Get on the Ritter Platform by Registering with Ritter: https://www.ritterim.com/agent-tools/the-ritter-platform/   Meet Your Sales Team: https://www.ritterim.com/meet-your-sales-team/   Follow Us on Social!   Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim Twitter, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ and Instagram, https://www.instagram.com/thesarahjrueppel/ Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/   Resources:   8 Reasons Why Medicare Agents Should Sell ACA Plans: https://agentsurvivalguide.podbean.com/e/8-reasons-why-medicare-agents-should-sell-aca-plans/ ACA 101: Selling Under-65 Health Insurance: https://agentsurvivalguide.podbean.com/e/aca-101-selling-under-65-health-insurance/ ACA's Family Glitch Resolved for 2023 OEP: https://www.ritterim.com/blog/acas-family-glitch-resolved-for-2023-oep/ Guiding Your Clients from the Marketplace to Medicare: https://www.ritterim.com/blog/guiding-your-clients-from-the-marketplace-to-medicare/ How Much Can Agents Make Selling Under-65 Insurance? https://www.ritterim.com/blog/how-much-can-agents-make-selling-under-65-insurance/ How Much Can Insurance Agents Make Selling Medicare? https://agentsurvivalguide.podbean.com/e/how-much-can-insurance-agents-make-selling-medicare-2023/ Knight School: https://www.ritterim.com/knight-school/ Medicare & Medicaid Compared: How Both Programs Benefit Insurance Agents: https://agentsurvivalguide.podbean.com/e/medicare-medicaid-compared-how-both-programs-benefit-insurance-agents/ The Benefits of Selling D-SNPs: https://agentsurvivalguide.podbean.com/e/the-benefits-of-selling-d-snps/ The Beginner's Guide to D-SNPs: https://agentsurvivalguide.podbean.com/e/the-beginner-s-guide-to-d-snps/ The State of the ACA Market in 2022: https://agentsurvivalguide.podbean.com/e/the-state-of-the-aca-market-in-2022/ Sign Up for Your Free Medicareful Site: https://www.ritterim.com/agent-tools/medicareful/ Updated Medicare Enrollment Rules for 2023: https://agentsurvivalguide.podbean.com/e/updated-medicare-enrollment-rules-for-2023/   References:   10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision: https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/ Analysis of Recent National Trends in Medicaid and CHIP Enrollment: https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/ From telehealth to Medicare cuts: Here are the health policies in Congress' $1.7T omnibus: https://www.fiercehealthcare.com/providers/telehealth-medicare-cuts-here-are-health-policies-congress-17t-omnibus Health Insurance Coverage Status and Type by Geography: 2019 and 2021: https://www.census.gov/content/dam/Census/library/publications/2022/acs/acsbr-013.pdf Medicaid Beneficiary Resources: https://www.medicaid.gov/about-us/beneficiary-resources/index.html#when2contactstate Medicaid Income Edibility Limits for Adults as a Percent of the Federal Poverty Level: https://www.kff.org/health-reform/state-indicator/medicaid-income-eligibility-limits-for-adults-as-a-percent-of-the-federal-poverty-level/ Statement of Administration Policy H.R 382 & H.J. Res 7: https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access: https://www.kff.org/coronavirus-covid-19/issue-brief/what-happens-when-covid-19-emergency-declarations-end-implications-for-coverage-costs-and-access/

Retirees often wonder how they are going to afford health insurance if they retire before the age of 65. Thankfully, many Americans qualify for healthcare subsidies through the Affordable Care Act (ACA). On this episode, I'm going to cover the five things you need to know about these subsidies and how you can become eligible for them. You will want to hear this episode if you are interested in... What are ACA tax credit subsidies?[1:24] They are available to many people whose net income is between 100%-400% of the Federal Poverty Level Exploring eligibility for ACA tax credit subsidies [2:17] How does the federal government determine the poverty line? [5:33] The logistics of signing up for healthcare through the Marketplace [6:53] How do ACA tax credit subsidies work? [9:35] What info do I need to get started? [11:32] How do I apply for an ACA tax credit subsidy [14:19] Reducing the cost of healthcare  The years before retirement can be both exciting and nerve-wracking. That's why retirement planning is an essential step! Set yourself up now so that life's third act is enjoyable and stress-free. One major stressor most soon-to-be retirees face is figuring out healthcare coverage. Especially, if it's not currently provided by an employer and they don't yet qualify for Medicare due to age. Never fear, because the Affordable Care Act (ACA) may be the way to go. The ACA, also known as “Obamacare”, provides subsidies to qualifying individuals and families to help make healthcare costs more affordable. This is a great option to gain health insurance at a reasonable cost until you reach age 65 and qualify for Medicare.  These subsidies are available to many people who qualify and the money is put towards significantly reducing your health insurance premium. In some cases, it can even make healthcare free! In 2020, it was estimated that 87% of the roughly 11 million people enrolled in the Healthcare Marketplace received a premium subsidy. If you don't qualify for Medicare and you haven't looked into this yet, what are you waiting for? Do I qualify? While the idea of affordable health insurance is appealing to everyone, some requirements need to be met in order to qualify. ACA tax credit subsidies work on a sliding scale that limits the amount you pay each month for health insurance premiums based on your modified adjusted gross income (MAGI). Most people are eligible for these subsidies if they annually earn between 100% and 400% of the Federal Poverty Level. However, in March of 2021, the American Rescue Plan Act (ARPA) added further relief to those struggling to find affordable health insurance during the COVID pandemic. For 2021 and 2022, many retirees can take advantage of several ARPA provisions that will further reduce their healthcare costs. For example, no citizen or legally present non-citizen without access to other affordable healthcare options will pay more than 8.5% of income for a Marketplace Silver Plan. Additionally, individuals who earn 500% of the Federal Poverty level and don't have access to other affordable healthcare options can take advantage of cost-sharing reductions through low-cost Healthcare Marketplace plans. For more information on reducing your healthcare costs and qualifying for subsidies, listen to this episode! Resources Mentioned Access Health CT  HealthCare.gov Connect With Morrissey Wealth Management  www.MorrisseyWealthManagement.com/contact

On this episode of The Parley in All Blue, Mark is joined by Dr. Ira Murray who is the President and CEO of United Way of the Capital Area in Mississippi to discuss the acronym "ALICE" (Asset limited income constrained & employed), its meaning, who makes up ALICE and what can we do to close some of the gaps in reference to ALICE. Dr. Ira also speaks on the statistics behind ALICE and what the data is telling us from a national perspective, while also discussing what are some of the policies and things we can do to improve the problem. ALICE is a new way of defining and understanding the struggles of households that earn above the Federal Poverty Level, but not enough to afford a bare-bones household budget. For far too many families, the cost of living outpaces what they earn. Dr. Ira Murray is the President and CEO of United Way of the Capital Area. Dr. Murray received his PhD in Administrative and Policy Studies from the University of Pittsburgh and achieved his Masters degree in Community Development from Vanderbilt University which focused on issues of race and equity in urban education, particularly community-based supports for students in urban contexts. Dr. Murray also went to Florida A&M University (FAMU) where he received a Bachelor's degree in Business Administration. Highlights from the episode:Defining ALICELow Income Families and HouseholdsDr. Murray's Journey The ALICE  Essential IndexThe Pandemic & ALICE Connect with Dr. Ira MurrayLinkedIn: @iramurrayResources:United For AliceConnect with Mark Dawson:Instagram: @iammarkdawsonLinkedIN: @mark-a-dawsonWebsite: www.bentonmuse.comTwitter: @Iammarkdawson

About the Show:                           We sat down with Jeff Webster, President, and CEO of Hark Excellerate to learn all about the organization and how they are making a difference in the lives of everyday people here in Northwest Arkansas.  Learn more about Jeff's path to Hark and how all of his previous jobs and roles have set him up for success with the organization. There is even a very cool story of how Jeff, an avid cyclist, worked with Lance Armstrong at the Tour De France.   Learn more about Hark NWA, how they got started, and the solid foundation of care that they have provided and continue to do so with new programs in a variety of areas like housing, cost of living assistance, and financial fitness to name a few.  In addition to their mission hear from Jeff about all of the ways [31:10] that Hark can help out people in Northwest Arkansas. Housing is just the beginning.  All this and more on this episode of I am Northwest Arkansas. Important Links and Mentions on the Show*: https://harknwa.com/ (Hark NWA Website) https://www.facebook.com/harknwa/ (Hark NWA on Facebook) https://www.instagram.com/harknwa/?hl=en (Hark NWA on Instagram) https://twitter.com/harknwa?lang=en (Hark NWA on Twitter) https://catalystfundnwa.com/ (Contribute to Hark NWA) ALICE, Asset Limited, Income Constrained, Employed - is an acronym that stands for Asset Limited, Income Constrained, Employed. ALICE represents the households with income above the Federal Poverty Level but below the basic cost of living. The ALICE Report provides current research-based data that quantifies who in Wisconsin is living on the edge of financial insecurity. United Way will use the ALICE study which contains state, county, and municipal level data to raise awareness in order to create lasting changes implemented to improve lives and strengthen local communities. https://amzn.to/3hc9aqR (Competitive Strategy Book - Michael Porter) https://amzn.to/3jv29nA (Good to Great Book - Jim Collins) This episode is sponsored by*: https://www.signature.bank/ (Signature Bank of Arkansas) -   https://www.signature.bank/ (Signature Bank) was founded here in Northwest Arkansas in 2005. Their focus is personal and community banking. When you bank with a community bank, you're investing in local businesses, local entrepreneurs, local charities, and the causes close to home. Signature Bank has worked hard to earn its tagline, “Community Banking at its Best.” You may ask why bank at Signature?  Because they focus on the customer instead of having a branch on every corner, this means you can have your questions answered by a real person, whether you're reaching out to the call center or your banker's cell phone. You can access any ATM in the country without fear of a fee.  They will refund all of those fees at the end of every month. Finally, they are constantly improving their digital offerings to ensure you can access the best financial tools from your laptop, phone, or tablet 24 hours a day. Signature Bank of Arkansas is a full-service bank offering traditional checking and savings accounts, investment accounts, business and personal loans, and mortgages. Give the folks at Signature Bank a call (479-684-4700) or visit their website https://www.signature.bank/ (Signature.Bank) and let them know you heard about them on the I am Northwest Arkansas Podcast.  https://www.signature.bank/ (Signature Bank of Arkansas) is a Member of the FDIC and an Equal Housing Lender.   http://www.iamnorthwestarkansas.com/canva (Canva) -   Are you looking for ways to build a Digital Marketing Strategy from scratch? Whether you need to design things for your family or personal brand or need a versatile design tool to help you with your social media presence. Canva can...

Julie has been the Executive Director of Food Outreach since 2016. Food Outreach provides nutritional interventions to people living in the St. Louis region diagnosed with HIV/AIDS or cancer whose incomes are at or below 300% of the Federal Poverty Level.  She graduated from FOCUS Leadership St. Louis in 2020 and currently serves on a committee working on building Black individual, household and business capacity in the St. Louis region.  Key Takeaways:You need trust to get anything done - instill a “love bubble” culture in your organization to be more effectiveThink about where each volunteer is coming from, figure out what motivates them and what made them join your organization Empathy and compassion should be dispensed not only to your target group or community, but also inside your organization, towards your volunteers Your organization needs a culture of consistent building of positive morale and mutual trust in each other  “What we bear witness to here is love, the opportunity to give without expecting anything in return - that's really what a volunteer is” - Julie Lock Reach out to Julie at:Twitter: https://twitter.com/FoodOutreachSTLFacebook: https://www.facebook.com/foodoutreach/ Website:https://foodoutreach.org/LinkedIn: https://www.linkedin.com/company/food-outreach/Youtube: bit.ly/YouTubefoodoutreachTo find out how you can volunteer, go to: https://foodoutreach.org/get-involved/volunteer/ Be more confident, credible & convincing to your board & supporters without feeling rejected, ineffective, or pushy.Learn to manage your mindset, lead yourself and others more effectively and have the meaningful conversations that drive your most important work. Get your free starter kit today at  www.theinfluentialnonprofit.com 

Jeffrey Mosher catches up again with Mike Larson, President & CEO, Michigan Association of United Ways, based out of Battle Creek, MI, but serving statewide. They discuss the 2021 ALICE Report for Michigan that shows progress still needed to help working people. Questions covered include; Can you tell us about the main findings from the 2021 ALICE Report? What is the ALICE threshold and how is it different than the Federal Poverty Level? What can you tell us about the 10% on the cusp of the ALICE threshold? The 2021 ALICE Report is representative of 2019 numbers. How do you think the reports will be impacted following the COVID-19 pandemic? What public policy work can be done to lower the percentage of Michiganders living at or below the ALICE threshold?

ChenMed was created with a mission to provide care in such a way that it could alleviate suffering for those seniors in the poorest of communities, recognizing that full-risk primary care can truly be transformative in providing superior health outcomes. This strong sense of purpose is what guides the physicians at ChenMed and serves as a moral compass in caring for patients. It is born out of an idea that ChenMed is a ministry that allows those in the organization to glorify God by spreading more love and promoting better health to those they serve. ChenMed is a family-owned, primary-care physician run organization that serves a challenging population: 75% have five or more chronic diseases, 70% are racial minorities, the average age of patients is 73 years old, 95% of patients within 300% of the Federal Poverty Level. But the success speaks volumes: patients use hospital emergency rooms at a rate 34% below the national average,  have 50% fewer admissions than the average primary care practice, and have close to 30% lower cost. ChenMed's scalable and successful approach has already reached 60 practices, and it is no wonder that they are poised to grow 4 times larger over the next 3 years. Dr. Gordon Chen, CMO, along with his brother Christopher Chen, CEO, and other great leaders throughout the organization are proving that full-risk primary care is a solid and necessary foundation for winning the race to value! Episode Bookmarks: 4:45 ChenMed named to Fortune Magazine's “2020 Change the World List” for measurable social impact, business results, innovation, and corporate integration 5:30 Dr. Chen discusses the spiritual underpinnings of his family-run organization and the Chen family's suffering during his father's cancer misdiagnosis 10:13 The ChenMed ministry in glorifying God, spreading love, and promoting health in underserved communities that are suffering 11:20 A scalable approach that has resulted in 50% fewer hospitals admissions, a 75% reduction in ED visits, and 28% lower per-member costs 13:35 “The traditional, fee-for-service primary care model handcuffs PCPs to see more and more patient volume without being able to optimize outcomes.” 14:14 A Medicare Advantage full-risk business model allows ChenMed to see shrink the PCP panel size so they can focus on cultivating trusting relationships with deeper connectedness 15:50 How a full-risk model enables Primary Care Physician empowerment 16:55 The shift from a reactive approach (e.g. ER and preventable hospitalizations) to a more proactive, preventative model that supports health value 17:45 Having “Stockholm Syndrome” for a broken fee-for-service model that has held PCPs captive from practicing medicine in the way they thought they would when dreaming of becoming a doctor 18:05 COVID-19 as a tipping point for full-risk primary care models, struggling primary care, and PCP moral injury 20:40 Consistency of revenue within a capitated model 21:16 “Fee-for-service primary care is going to end. It is too challenging to make it work, and PCPs don't like a purely transactional model that doesn't value relationships.” 22:45 Dr. Chen discusses the fulfilling purpose of full-risk primary care and how it makes a deep impact in communities 24:55 Supporting high-risk patients through high touch telephonic “love calls” and telehealth 26:11 How ChenMed adjusted its care delivery model during the COVID pandemic (“flipping to 90% virtual in less than a week”) 29:05 Realizing the need for the ChenMed model is far greater than could have ever been imagined during a period of pandemic uncertainty and civil unrest 29:50 Finding the right balance between in-person and virtual visits during the COVID pandemic 30:34 “Telehealth is here to stay.” 31:05 Increased Net Promoter Scores when serving patients during the pandemic 31:30 Health inequities, racial disparities in care, and the plight of racial injustice in our soci...

We pre-recorded today's conversation via Zoom with Elise from United Way Northern Shenandoah Valley and her guest, Pam Murphy, Executive Director for the Shenandoah Community Health Clinic. Pam explained the various services offered by the free medical clinic and also told us about the free dental clinic they also operate under the Shenandoah Community Health Clinic umbrella for Shenandoah County residents. We talked about the impact COVID-19 has had on patients, patient care, as well as fundraising and expenses. She told us how the impact grants they received from United Way NSV were invaluable to help them continue to serve the community. For more information about Shenandoah Community Health Clinic, visit their website: https://shenclinic.org Elise told us about ALICE Awareness week currently happening through the end of October and the fundraising efforts associated with it to help 20 ALICE families in our community. ALICE, an acronym for Asset Limited, Income Constrained, Employed, is a new way of defining and understanding the struggles of households that earn above the Federal Poverty Level, but not enough to afford a bare-bones household budget. To participate in the fundraisers, visit United Way Northern Shenandoah Valley's website for more information: https://www.unitedwaynsv.org/aliceawareness and follow them on Facebook: https://www.facebook.com/UWNSV Elise also asked that everyone in the community take their CIVD-19 impact survey. United Way of the Northern Shenandoah Valley is teaming up with the producers of the ALICE report and the United Way of Harrisonburg-Rockingham County and Warren County Front Royal to collect information about how COVID-19 has impacted households across the region. They hope this survey will provide much needed data in order to continue to serve the needs of the community and assist in the distribution of resources to address those needs. Participants can be of ANY income level and ANY family size, impacted by COVID or not. They need as many unique survey responses as possible in order to make the data as valid as possible. CLICK HERE to access the survey.  

Jeffrey Mosher chats with Mike Larson, President and CEO, Michigan Association of United Ways, Lansing MI. New data points reveal disproportionate financial hardship in Black households across Michigan. The Michigan Association of United Ways released new ALICE data, which shows 63% of Black households statewide are unable to make ends meet, clearly illustrating the inequities that are deeply rooted in our national, state, and local systems and institutions. The ALICE data indicates that 40 percent of all Michigan households did not earn enough to cover basic expenses in 2018, including housing, child care, food, transportation, health care, and a basic smartphone plan. The 63 percent of Black households falling below the ALICE Threshold was almost double that of white households—just 36 percent. The percentage of Black households unable to make ends meet is also almost three times higher than the antiquated Federal Poverty Level. Through the release of this data, the Michigan Association of United Ways hopes to support the many efforts underway to dismantle racism, raise awareness, shift attitudes, and change outcomes as local United Ways across Michigan are reinforcing their commitment to race and equity, both in policy and in action. » Visit MBN website: https://www.michiganbusinessnetwork.com/ » Subscribe to MBN’s YouTube at: https://www.youtube.com/channel/UCqNX… » Like MBN: https://www.facebook.com/mibiznetwork » Follow MBN: https://twitter.com/MIBizNetwork/ » MBN Instagram: https://www.instagram.com/mibiznetwork/

Ji Suk Yi hosts today’s edition of the Wintrust Business Lunch for Monday, February 17th. Segment 1: (At 0:00) Heather Cherone, The Daily Line’s managing editor, and City Hall reporter, discusses Mayor Lori Lightfoot’s pledge to end generational poverty. According to federal guidelines, approximately 22 percent of Chicagoan fall below the Federal Poverty Level, which […]

Identify the socio-economic correlates of sugar sweetened beverage (SSB) consumption among pregnant women and analyze to what extent SSB consumption is associated with diet quality and total energy intake. Additionally, we aim to predict how diet quality scores and totally energy intakes would change if SSB consumption was artificially set to 0. Design: Repeated Cross Sectional Study. Setting: United States. Subjects: SSB consumption was estimated from 1–2 24-hour dietary recalls from 1,154 pregnant women who participated in the 1999–2006 National Health and Nutrition Examination Survey. Methods: Linear regression models were used to identify socioeconomic and demographic factors associated with SSB consumption and to assess the associations between SSB consumption and diet quality and total energy intake. Diet quality was measured with the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P). Results: The mean SSB intake was 1.3 servings per day (sd 1.5). Having a household income ≤100% of the Federal Poverty Level, being born in the United States, and not being married or living with a partner were positively associated with SSB consumption. Every 12 oz. of SSBs consumed was associated with a 2.3 lower AHEI-P score (95% CI: 1.6, 2.9) and the consumption of 124 more calories (95% CI: 85, 163), after adjusting for age, country of birth, race/ethnicity, educational attainment, marital status, household income, survey year and day/s of the week the recall/s were collected. Our predictive models indicated that average AHEI-P would be 6.4 (5.4, 7.6) higher and average total energy intakes would be 203.5 calories (122.2, 284.8) lower if SSB intake was set to 0. Conclusions: SSB consumption is associated with poorer diet quality and higher total energy intake among pregnant women. Gamba RJ, Leung CW, Petito L, Abrams B, Laraia BA. Sugar sweetened beverage consumption during pregnancy is associated with lower diet quality and greater total energy intake. PLoS One. 2019;14(4):e0215686. Published 2019 Apr 25. doi:10.1371/journal.pone.0215686. This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Sections of the Abstract, Introduction, Methods, and Discussion are presented in the Podcast. Access the full-text article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483237/

Today we continue our health insurance series with a discussion of the Premium Tax Credit. The Premium Tax Credit is available for those whose income is between 100% and 400% of the Federal Poverty Level who purchase their health insurance through a government-run marketplace. The dollar amounts involved can be substantial if you're in that range. Pay attention, Joshua IRS Publication 974: Premium Tax Credit Michael Kitces article on the Premium Tax Credit Support RPF on Patreon: www.RadicalPersonalFinance.com/patron Book a consulting phone call with me: www.RadicalPersonalFinance.com/phonecall

I’m not sure about you, but we haven’t met many people that wouldn’t love to lower their tax payments. As we move in to the heart of tax season, do you find yourself wondering every year around this time, what other opportunities you may be missing? Millions of people who file their tax return themselves overlook tax opportunities each year that could save them extra money in April but they hesitate to pay to have a professional prepare them.  The hidden secret is that tax planning should be done year round.  So we put together a list of a few things we see most often missed on tax returns.   Maxing Tax-Deferred Savings One of the easier ways of avoiding tax now, is to save the maximum amount in all your tax-deferred accounts (401k/403b).  Many have a tough time reaching the maximum savings limit ($18k per person in 2016).  This often brings the focus back to your cash flow as overspending keeps many from hitting the maximum amount.  Those over age 50 have an extra benefit where they can save $6,000 more each year until they stop working.   Not Funding HSA accounts This is an excellent retirement account that offers a triple tax saving opportunity.  Problem is many aren’t taking advantage of it. If you have a high-deductible health insurance plan, you have an opportunity to sock away savings tax-free, that can grow tax-free and then be withdrawn tax-free.   Non-deductible IRA contributions & Roth conversions High income earners still have a way to make Roth contributions. It just takes a few extra steps and involves some monitoring to do it successfully.  If you already have nondeductible IRA contributions, this is a great opportunity to get these contributions in to a Roth IRA, assuming you don’t have a larger deductible portion already built up (consider the pro rata rule in this case).  Don’t forget to fill out form 8606 to keep an accurate record of your nondeductible IRA contributions.   Charitable Deduction Opportunities If you have large capital gains from appreciated stock, it may benefit you to donate these shares instead of making cash charitable contributions. Another opportunity for those who are over age 70 ½, is to make a Qualified IRA Charitable Distribution which also qualifies as Required Minimum Distribution.  This benefits you by not increasing Adjusted Gross Income on your tax return which in turn helps with medical expense deductions, social security taxation and Medicare rates to name a few.   Missing Any Deductions? Some of the more common we see left off of Schedule A are car taxes, investment fees, and charitable donations. Go through your potential itemized deductions.  Look at the prior year return for some guidance.  Also, if you made a 2014 estimated payment to the state in January of this year and/or owed when you filed your 2014 state tax return then you can add those payments as a federal tax deduction on this year’s return. If in a low bracket, you may want to delay deductions and accelerate income instead.  When your AGI ends up in the 15% tax bracket, capital gains are taxed at 0%.  So realizing gains could be beneficial here. High tax bracket earners have an opposite focus as they are looking to reduce income. Word of warning: watch the Medicare Surcharge (3.8%) on income over $200k for individuals and $250k for joint filers. If you find yourself in this area, you may want to look for ways to delay income depending on the control you have in your income.   AGI thresholds You Don’t Want to Miss Child tax credit (begins phasing out at $110k).  Can you make a deductible traditional IRA contribution? This could actually reduce your tax bracket from a boosted higher rate as you are not only reducing the ordinary income tax but getting an extra benefit due to the credit. Itemized deduction limitations over $309k (single $258,250) – especially if restricted stock or stock options are vesting and you are selling in that tax year. American Opportunity Tax Credit phases out at $160k AGI ($80k single).  If you pay for the first $4k of college expenses, you can use this credit (mentioned below).   ACA subsidy tax bubble Many retirees who no longer have an employer continued health plan and haven’t yet reached 65 now have a new option – buying medical insurance through the health insurance marketplace.  Depending on the tax diversification in your investment accounts, some early retirees are receiving premium tax credits.  But be careful, if receiving the credit and your income rises above 400% of the Federal Poverty Level for the number of people in your household, you could lose all the credit. In this situation, managing tax brackets become vital.  But to do so, you need to have saved in accounts with tax flexibility.  Tara Signal Benard summarized a breakdown of this strategy in a New York Times article titled, “Devising a Tax Strategy After the Paycheck Is No More.”   Don’t Forget About Other Credits Pay for first $4k of tuition first to get AOTC – 3 million people missed this credit in 2014. Residential energy credit for any HVAC replacement or energy efficient upgrade to house Foreign Tax Credit – you lose this credit with foreign stock in IRA accounts. This is why asset location is important. Vanguard found this can add up to 0.75% per year in performance.  $7,500 for a $1 million portfolio. Dependent care credit – If both spouses are working, don’t forget to include summer camp costs as this is very likely a deduction.   Feeling Like you Missed Something? If you feel a bit lost after reading these examples then look to hire a professional.  Tax return for families can range from $300 to $500 depending on your situation.  Could be money well spent if they find tax savings you overlooked. When digging in to the numbers CNBC found the more you make the more interesting IRS auditors find you.  The IRS begins to get more interested in those earning more than $200k.  According to turbotax – only 1 percent earning less than that are audited.  If you are over the $200k threshold, then 4% of your group will be audited.  It’s not until you begin earning more than a million, to where 12.5% get an audit notification letter. If you feel like you would like a second look, we’d encourage you to find a fee-only financial planner who has knowledge in the tax planning area.  It’s very likely it could be worth it. Other Links Mentioned During the Show Mike’s NerdWallet Article: Are Advisors Worth the Fee? Article: The Best Ways to Pay for College NY Times Article: Devising a Tax Strategy After the Paycheck Is No More

For this episode, I read the entire Patient Protection and Affordable Care Act. The following is a resource for finding information within the Patient Protection and Affordable Care Act. My goal was to highlight the portions of the bill that will most directly affect our lives and put them into plain, understandable English. I'd also like for you to be able to find the text that makes these rules within the bill. The easiest way to search within a bill is by section number. You'll have to read a bit to find exactly what you're looking for, but this outline will tell you which section you can find the different provisions in. Anything "in quotes" is exact text from the bill. There are two versions of the Patient Protection and Affordable Care Act (Public Law 111-148) you can read. This version is 906 pages. This version is 2,409 pages (the margins and the font are bigger). If you are going to attempt to read the Patient Protection and Affordable Care Act, you must know that Title X amends the first nine titles and The Reconciliation Act amended the whole bill. This means that the law is often not what the text says. Here is a section by section summary of the changes made by Title 10 and the Reconciliation Act. This document was provided to the United States Senate for clarification. TITLE I: "QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS Subtitle A: "Immediate Improvements in Health Care Coverage for All Americans" Section 1001: Rules on health insurance minimums that became effective immediately Insurance company can't drop you when you get sick, unless you committed fraud Health insurance plans have to provide - at no extra charge: All of the preventatives services on this list Immunizations Preventative care screenings for kids Kids can stay on their parent's insurance plans until their 26th birthday Insurance companies must cover at least 60% of medical payments The health insurance companies need to provide customers with a summary of benefits, which can only be 4 pages long with a minimum of 12-pt font and must include limitations, co-payments, deductibles, and percentage of medical costs covered by the insurance company. If they fail to provide the summary, the health insurer has to pay $1,000 for each customer who didn't receive it Employers are not allowed to only offer coverage to their high-paid employees Section 1001 as changed by amendment (See Section 10101): No lifetime limits or "unreasonable annual limits" on the value of benefits for any customer They can place limits on things that are not essential health benefits Gun ownership health dangers must be ignored: Prevention programs can not collect information related to the presence of guns or ammunition in someone's home Premium rates can not be affected by the presence of a gun in someone's home Medical Loss Ratio Health insurance companies covering large groups must spend 85% of your premiums on you, or they have to issue a rebate check. Health insurance companies covering people in the individual market or small groups through exchanges have to spend 80% of your premiums on you or issue a rebate check. Hospitals must publish a list of standard charges for their services. Health insurance companies have to let you go to any primary care doctor that you choose and who can accept you The insurance company must have an appeals process for customers and must continue coverage while claims are in appeals If you get treatment in an out-of-network emergency room, your health insurance has to pay for those services. Health insurance companies can't require prior approval for emergency services. Health insurance companies can not require advance approval to go to get gynecological services. Section 1003: Premium Increase Reviews The Federal government and the States will review annual premium increases. States can recommend that a health insurance company be excluded from the exchange for unjustified premium increases. Subtitle B: "Immediate Actions to Preserve and Expand Coverage" Section 1101: Creates the "high risk health insurance pool program" to cover people with pre-existing conditions until January 1, 2014 Could only be run by non-profit private insurers or States Insurer had to cover at least 65% of customer's medical costs Could vary premiums based on age no more than a 4:1 ratio Only open to United States citizens or lawful residents who had no health insurance for the 6 months prior to enrollment Provided $5 billion (this money ran out & the government stopped accepting new applicants on February 15, 2013 - the House Republicans would have added money only if the Public Health fund were defunded, as explained in episode CD026) High risk pool ends on January 1, 2014 and customers will then buy their insurance on the exchanges, when health insurers will not be allowed to deny them coverage anymore Section 1102: Reimbursement for employers who give health coverage to "early retirees" Employers who provide health insurance to people over 55 years old but under 65 (when Medicare kicks in) will be reimbursed for a portion of that expense. Payments will be 80% of the amount over $15,000 up to $90,000. Payments must be used for health care expenses & can not be used as general revenue or count as income. Provided $5 billion for this program Program ends on January 1, 2014, when everyone can buy insurance on the exchanges Section 1104: Orders the Secretary of Health & Human Services to develop "uniform standards" for health information electronic data entry The rules will be for communication between hospitals/doctors and the health insurance companies. Allows for the creation of "machine readable identification cards" Penalty fee will be assessed beginning on April 1, 2014 for health insurance companies that don't comply Fee is $1 per customer covered until they've completed the electronic information requirements. The fee is imposed for each day the plan is not in compliance. The fee is increased annually and capped at $20 per customer or $40 per customer if the insurance company purposely provides false or incomplete information. Penalty fees are paid to the Treasury Department and are due November 1 of each year starting in 2014. Subtitle C: "Quality Health Insurance Coverage for All Americans" Section 1201: Health Insurance Market Reforms Health insurance companies can not exclude someone for having a pre-existing condition This law became effective for children starting six months after the Affordable Care Act was signed Premium rates are allowed to vary based on the following factors only: The number of people covered by the plan (individual or family) Location Age, but the rate can not vary more than a 3:1 ratio for adults Tobacco use, but the rate can not vary more than a 1.5:1 ratio Health insurance companies must accept every employer or individual customer who applies for coverage during their open enrollment periods. Health insurance companies can not deny a customer coverage due to health status, mental or physical illnesses, history of claims, medical history, genetic information, domestic violence history, disability, or any other health-related factor. Health insurance companies also have to renew your insurance policy Health insurance companies can offer rebates or premium discounts as a reward to customers' participation in wellness programs including: Reimbursement for fitness center memberships A disease testing program that does not base the reward on outcomes Waiving co-payments or deductibles for preventative care visits (prenatal care & well-baby visits) Reimbursement for programs that help people quit smoking, regardless of whether or not they can actually quit A reward for attending health education seminars Waiting periods can not be longer than 90 days This does not apply to the individual market  (added by Section 10103) Section 1201 as changed by amendment (See Section 10103) Health insurance companies can't deny coverage for approved clinical trials for treatment of cancer or another life-threatening disease. Section 1251: Grandfathered health care plans Nothing in the Affordable Care Act forces an individual to cancel the coverage they currently have. Grandfathered plans are exempt from the provisions of Subtitle A and Subtitle C, except for the provisions specifically listed below. New employees and their families can be enrolled in health plans that existed before the Affordable Care Act was enacted. Section 1251 as changed by amendment (See Section 10103) Grandfathered plans must provide the easily understood summary of benefits from Section 1001 to their customers. Grandfathered plans must issue rebate checks under the Medical Loss Ratio just like new plans Health insurance companies covering large groups must spend 85% of your premiums on you, or they have to issue a rebate check. Health insurance companies covering people in the individual market or small groups through exchanges have to spend 80% of your premiums on you or issue a rebate check. Section 1251 as changed by the Reconciliation Act (See Public Law 111-152) Grandfathered plans are prohibited from enforcing waiting periods over 30 days. Grandfathered plans are prohibited from enforcing lifetime or annual limits to coverage (group plans only). Grandfathered plans can not drop you when you get sick. Grandfathered plans will also have to cover children until their 26th birthday. Grandfathered plans can not refuse an employee with pre-existing conditions. Subtitle D: "Available Coverage Choices for All Americans" Section 1302: Essential Health Benefits Requirements Essential health benefits to be included in all "qualified health plans": Ambulances Emergency room services Hospitalizations Maternity and newborn care Mental health Substance abuse treatment Behavioral health treatment Prescription drugs Rehabilitation services and devices Laboratory services Preventative care Chronic disease management Pediatric care, including dental and vision Health insurance companies are allowed to cover more than these minimums Coverage for emergency services  can not require prior authorization Health insurance companies can't limit coverage because the ambulance took you to an out-of-network emergency room Out of pocket expense caps In 2014, an individual can not be charged more than $5,000/year for out-of-pocket expenses (not including premiums); after that, it can be increased by the same percentage as premium increases. Deductibles for employer-paid plans are capped at $2,000/year for individuals or $4,000/year for family plans. After 2014, these numbers can be increased by the same percentage as premium increases. Out-of-pocket caps do not include amounts for non-network providers or non-covered services Levels of Coverage Bronze: Covers 60% of medical costs Silver: Covers 70% of medical costs Gold: Covers 80% of medical costs Platinum: Covers 90% of medical costs Catastrophic Coverage available only on the individual market Plan provides no benefits until the person has spent the $5,000/year out-of-pocket limit (or whatever the limit is for that year, adjusted for inflation) Available only to people under 30 years old Available only if a monthly premium would exceed 8% of that person's income Section 1303 as changed by amendment (See Section 10104): Abortion Rules States can prohibit abortions from being offered by health insurance plans offered through the exchange. States must pass a law to do this. Health insurance plans do not need to include abortions. No Federal funds can be used to pay for abortions. No hospital or doctor's office can be discriminated against by insurance companies for not providing abortions. Section 1311: Health Insurance Exchanges States will be given Federal grants to set up their own health insurance exchanges, which are websites where people will compare and purchase their insurance plans. Grants will stop being awarded on January 1, 2015. Exchanges will include an "enrollee" satisfaction system for plans covering more than 500 people. Secretary must determine yearly open enrollment periods Stand-alone dental plans will be allowed on the exchanges. States are allowed to require more benefits than the Federal government requires, but must make up cost to individuals for extra costs if they're eligible for a tax credit. By 2015, exchanges must be self-sustaining and can charge user fees. Exchanges have to publish all payments required by the Exchange & the administrative costs. Interstate and regional exchanges are allowed. Creates "navigator" positions They will inform the public on the health plans, help people enroll, and help people understand their tax credits. Navigators are not allowed be employees of the health insurance industry Section 1311 as changed by amendments (See Section 10104) Health insurance companies need to publicly disclose - in plain language - information on claims payment policies, enrollment, denials, out-of-network charges, and customer rights. Section 1312: Health Insurance Eligibility & Members of Congress All customers in with a company's individual plan will be considered part of a one risk pool. All customers enrolled as employees of small businesses will be considered part of one risk pool. The individual and small business pools may be merged if the State determines it appropriate. Starting in 2017, States can permit large employers (over 101 employees) to offer insurance through the Exchange. Health insurance companies can offer insurance outside of the Exchanges. Only United States citizens and lawfully present foreigners will be allowed to purchase health insurance on the Exchange. Prisoners will not be eligible to buy insurance on Exchanges while they're still incarcerated The Federal Government can only offer health plans to members of Congress that are offered through an Exchange. Section 1312 as changed by amendment (See Section 10104) Agents and brokers are allowed to enroll employers and individuals in health insurance plans and help them apply for tax credits and out-of-pocket reductions. Section 1321: States Must Create Exchanges or Federal Government Will Do It For Them Department of Health and Human Services will provide an exchange for a State if the State will not have it's own operational by January 1, 2014. Section 1322: Grants for Creation of Non-Profit, Member-Run Health Insurance Companies The goal is to have at least one non-profit, member-run health insurance company in each State offer insurance on the individual and small business exchanges. If a State doesn't have a non-profit, member-run option, they will be loaned money to create one or to have one from elsewhere expand into their State. The loan must be repaid within 15 years (added by Section 10104) The non-profit, member-run health insurance companies are not allowed to use Federal funds for marketing. A health insurance company will not count as a non-profit, member-run insurance company unless "any profits made by the organization are required to be used to lower premiums, to improve benefits, or for other programs intended to improve the quality of health care delivered to its members." Non-profit, member-run health insurance companies will be tax exempt. Section 1323: Optional State Public Option (Killed by amendment: See Section 10104) States are allowed to offer a public option, labeled "community health insurance", but they are not required to. Section 1331: States Can Buy Insurance for Low-Income People Who Don't Qualify for Medicaid or Medicare To qualify for this program, if offered by your State: Must be a resident of the offering State Must be under 65 years old Your income needs to be between 133%-200% of the poverty level Section 1332: Waiver for States That Develop A Better System States that develop a system that covers as much and costs the same or less than the Federal system can apply for a waiver. If granted, they can enact their own system. The new system could begin on January 1, 2017. Section 1333: Allows Health Insurance Plans to Be Sold To Multiple States Health insurance companies would have to be licensed in all the States where its plans are sold. Health insurance companies would have to "clearly notify consumers that the policy may not be subject to all the laws and regulations of the State in which the purchaser resides." Plans sold in multiple states - "health care choice compacts"- can begin on January 1, 2016. Section 1334 as added by amendment (See Section 10104): National Health Insurance Plans The Director of the Office of Personnel Management will contract with at least two insurance companies to offer insurance to the individual and small group markets in every state. At least one of these companies must be non-profit. Plans need to be licensed in each State where they offer coverage. States can require health insurance companies to offer additional benefits but must pay the additional cost. The multi-state insurance plans will be nationwide within four years. Section 1341: Insurance Companies Will Have Insurance for "High-Risk" Customers for First 3 Years Subtitle E: "Affordable Coverage Choices for All Americans" Section 1401 as amended by Section 1001 of the Reconciliation Act: Tax Credits Taxpayers Making Between 100% - 400% of the Poverty Level Get Tax Credits To Pay for Premiums The tax credit is for the amount the health insurance plan exceeds a percentage of a person's income, based on the poverty level. The premium used for calculation is the second-lowest silver plan in the individual market where the taxpayer lives. Section 1402: Out-of-Pocket Limits Reduced Only applies to people who have purchased Silver Level coverage on an Exchange The standard out-of-pocket limits ($5,950 for individuals and $11,900 for families) would be reduced for people making under 400% of the poverty level. Reduction Levels: People making 100%-200% of the poverty level will have their limit reduced by 2/3. People making 201%-300% of the poverty level will have their limit reduced by 1/2. People making 301%-400% of the poverty level will have their limit reduced by 1/3. No health insurance company will ever pay more than 94% of medical costs (increased by Section 1001 of the Reconciliation Act). The Federal Government will pay the health insurance companies for the amount they reduce out-of-pocket limits Illegal immigrants are not eligible. *Tax Credit / Premium Calculator Section 1411: How Government Will Determine Eligibility & Grant Individual Exemptions People or employers who disregard regulations and provide false information are subject to a $25,000 fine. People or employers who purposefully provide false information are subject to a $250,000 fine. No property can be taken away if the person or company doesn't pay the penalty. Section 1412: Advance Payment of Tax Credits and Out-of-Pocket Reductions Premium tax credits can be claimed in advance to help pay for premiums. Section 1415: Premium Tax Credits Don't Count As Income Section 1421 as changed by amendment (See Section 10105): Small Business Tax Credit Eligible employers must: Have fewer than 25 employees and Pay average annual wages of less than $50,000/year. Pay at least 50% of total premiums. Eligible employers who purchase coverage through the State exchange can get a tax credit of up to 50% of their health insurance costs. Tax-exempt eligible employers can get a tax credit of up to 35% of their health insurance costs. Subtitle F: "Shared Responsibility for Health Care" Section 1501 as changed by amendment (See Section 10106): The Individual Mandate Individuals must ensure that they and their dependents have health coverage every month starting in 2014. If individuals fail to get themselves and their dependents covered, they will pay a penalty for each month they and their dependents were uncovered. (see Section 1002 of the Reconciliation Act) The penalty in 2014 will be $95 or 1% of income, whichever is higher The penalty in 2015 will be $325 or 2% of income, whichever is higher The penalty in 2016 and after will be $695 or 2.5% of income, whichever is higher. Penalties are capped at the cost of the national average for a bronze plan premium. Exemptions are allowed: For people in an exempt religious sect For members of a health care sharing ministry For Native Americans For people below 100% of the poverty level who can't afford available health insurance options People who have a coverage gap of less than three months (if the gap goes longer than three months, they get no exemption for any of that time) People who have proven to the Department of Health and Human Services that they have an extraordinary hardship. You can not be criminally prosecuted, thrown in jail, or have your property taken away if you fail to pay the penalty. Section 1502: Health Insurance Companies Will Report Your Coverage Status to the Government Every year, the Treasury Department will send notices to people who didn't get coverage telling them what is available to them on their State's exchange. Section 1503: Automatic Enrollment for Workers with Large Employers Companies with over 200 employees will automatically enroll their new full-time employees in one of the health plans they offer. Employees are allowed to opt out of their employer provided coverage. Section 1512: Workers Must Be Informed of Better Options If a company's health insurance plan doesn't cover at least 60% of medical expenses, the worker might be eligible for premium tax credits and out-of-pocket limit reductions. Companies need to inform their workers about the exchanges and provide a description of the exchange's services. Section 1513 as amended by Section 1003 the Reconciliation Act: Employers With Over 50 Employees Starting January 1, 2014, they must offer their employees health insurance. If one or more of their employees received tax credits or an out-of-pocket limit reduction on the exchange, the employer will be fined $2,000 per full-time employee. They will not have to pay the penalty for the first 30 full-time employees. If the employer offers health insurance but the employee claims tax credits and/or out-of-pocket limit reductions on the exchange, the employer will be charged either $3,000 per employee receiving tax credits or $2,000 per full-time employee minus the first 30 employees, whichever is less. Employers can not have waiting periods for health coverage of over 60 days. (Eliminated by the Reconciliation Act) Fines are not tax deductible. Seasonal workers - that work less than 120 days per year -do not count as full-time employees. Section 1514: Large Employers Must Report Your Coverage Status to Government Section 1553: No One Can Discriminate Against Anyone Else For Not Providing Doctor Assisted Suicide Section 1558: Protection For Employees Employers may not fire or discriminate against any worker who reports, testifies, or helps the government prosecute an employer that has violated the Affordable Care Act. Section 1560: Hawaii Can Keep Its Health Care System Section 1563: CBO Estimates The Affordable Care Act Will Reduce Budget Deficits TITLE II: "ROLE OF PUBLIC PROGRAMS" Subtitle A: Improved Access to Medicaid Section 2001 as amended by Section 10201: Medicaid for Poor People Starting in 2014, anyone making under 133% of the Federal Poverty Level will be eligible for Medicaid's health benefits. Medicaid's health benefits will include the essential benefits required of all health insurance plans on exchanges, prescription drugs, and mental health services. The Federal Government will pay States for the new Medicaid expenses at the following rates (changed by Section 1201 of the Reconciliation Act): 100% for 2014-2016 95% for 2017 93% for 2019 90% for ever *The June 28, 2012 Supreme Court ruling effectively made the Medicaid expansion optional for the States. The result is that unfortunate souls making under 133% of the Federal Poverty Level and living in States that have turned down the Federal Government money will not have health care coverage. Via: The Advisory Board Company Section 2004 as amended by Section 10201: Medicaid for Foster Children Beginning in 2014, States must cover former foster children in their Medicaid programs Subtitle B: "Enhanced Support For the Children's Health Insurance Program" Section 2101: Federal Financing of Children's Health Insurance Program (CHIP) Federal Government will increase its contribution to States' CHIP programs by 23%, funding up to 100%. Subtitle C: "Medicaid and CHIP Enrollment Simplification" Section 2201: Electronic Enrollment By January 1, 2014, States must create websites that allow individuals to apply and enroll in Medicaid and CHIP States that fail to create the website will lose their Federal Medicaid money. Section 2202: Hospital Enrollment in Medicaid Allows hospitals to determine whether a person qualifies for Medicaid based on preliminary information in order to provide them with medical assistance. Subtitle D: "Improvements to Medicaid Services" Section 2301: Free-Standing Birth Centers Requires Medicaid cover services from free-standing birth centers. Section 2303: Family Planning Services States can, but don't have to, provide family planning services as part of Medicaid. Subtitle E: "New Options for States to Provide Long-Term Services and Supports" Section 2401: At Home Services Option Allows States to cover at home services - the kind that would usually be offered in an institution - to people under 150% of the poverty level. Subtitle F: "Medicaid Prescription Drug Coverage" Section 2501: Prescription Drug Rebates Increases rebates for prescription drugs up to 100% of the cost of the drug. Section 2502: Additional Drugs Covered Drugs to help quit smoking, barbiturates, and benzodiazepines will be covered by Medicaid starting on January 1, 2014. Subtitle G: "Medicaid Disproportionate Share Hospital (DSH) Payments" Section 2551: Payment Reductions Reduces Federal payments to certain hospitals. Subtitle H: "Improved Coordination for Dual Eligible Beneficiaries" Section 2602: Medicaid and Medicare Coordination Creates a Federal Coordinated Health Care Office to coordinate the benefits of individuals who qualify for both Medicaid and Medicare. Subtitle I: "Improving the Quality of Medicaid for Patients and Providers" Section 2703: Care for Medicaid Patients with Chronic Conditions Gives States the option to create teams of health professionals to manage care for Medicaid patients with chronic conditions. Chronic conditions include: Mental health disorders Substance abuse issues Asthma Diabetes Heart Disease Obesity Subtitle K: "Protections for American Indians and Alaska Natives" Section 2901: No Out-of-Pocket Costs for Certain Indians Indians at or below 300% of the Federal Poverty Level will not have to pay out-of-pocket costs for insurance they get through a state exchange TITLE III: IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE Subtitle A: "Transforming the Health Care Delivery System" Section 3001: Links Hospital Payments to Performance Starting in 2013, a percentage of hospital payments will be tied to performance in treating common high-cost conditions (cardiac issues, surgeries, pneumonia, etc.) Section 3007: New System for Physician Payments Secretary of Health and Human Services must create a new budget-neutral payment system that will adjust Medicare payments to physicians based on the quality of care they deliver. New system will be phased in over two years beginning in 2015. Section 3008: Penalties for Poor Performance Hospitals in the top 25th percentile for rates of diseases caught inside the hospital will have a payment penalty through Medicare. Section 3011: National Strategy Secretary of Health and Human Services has to establish our national strategy to improve health care delivery and overall population health. Section 3025: Readmissions Reduction Ties Medicare payments to hospitals with the hospitals percentage of potentially preventable readmissions to the hospital. The Secretary of Health and Human Services will make readmission rates for certain conditions at every hospital available to the public. Subtitle B: "Improving Medicare for Patients and Providers" Section 3112: Eliminates "Medicare Improvement Fund" Saves over $22 billion Rest of Subtitle creates new systems and changes the way Medicare charges paid for by the government. Subtitle C: "Provisions Related to Part C" Section 3201: Limited Medicare Advantage Payments (Killed by Section 1102 of the Reconciliation Act) Section 3202: Prevents Private Medicare Advantage Plans from Overcharging Prohibits private Medicare Advantage plans from charging more for basic Medicare services than actual Medicare charges. Medicare Advantage plans that offer extra benefits must prioritize reductions in out-of-pocket expenses and preventative care over their extra goodies. Section 3204: Seniors Can Return to Actual Medicare Seniors will be allowed to unenroll in their Medicare Advantage plans and return to real Medicare from January 1-March 15 of every year. Section 3209: Medicare Advantage Plan Denial Allowed Secretary of Health and Human Services now has the authority to prohibit Medicare Advantage plans that significantly increase cost to customers or decrease benefits offered to seniors. Subtitle D: "Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans" Section 3301: Donut Hole Discount Program Medicare Part D private insurance plans pay 75% of drug costs up until $2,970 is spent and then start paying 95% once the senior has spent $4,750. Between $2,960 and $4,750, the insurance company pays nothing. This window is known as the "coverage gap" or "donut hole". This section requires drug manufacturers provide a 50% discount for brand name drugs for seniors while paying out-of-pocket for drugs in the coverage gap. Even though they only pay 50% of cost, the full price of the drug will count as paid so that they get out of the coverage gap sooner. The Secretary of Health and Human Services was put in charge of implementation. Section 1101 of the Health Care and Education Reconciliation Act Provides a $250 rebate to seniors who enter the "coverage gap""donut hole". Closes the Medicare Part D "coverage gap" "donut hole" by 2020. Section 3308: Reduces Medicare Subsidy for High-Income Seniors Section 3311: Medicare Advantage & Medicare Part D Complaint System Secretary of Health and Human Services will create a system so that seniors can submit complaints about the private Medicare Advantage and Medicare Part D drug plans Subtitle E: "Ensuring Medicare Sustainablity" Section 3401: Changes Payment Structures for Medicare Payments Section 3402: Freezes Premiums for High Income Seniors at 2010 Levels until 2019 Section 3403: Independent Payment Advisory Board (IPAB) Creates a 15 member board to propose ways to reduce the growth of Medicare spending. The board's recommendations will not go into effect during years that the Medicare growth rate is under control. The board will make non-binding recommendations during years when the Medicare growth rate is under control (added by Section 10320). The board is not allowed to propose anything that rations care, raises taxes, raises premiums for actual Medicare, increases out-of-pocket expenses for seniors, or reduces benefits. The board's suggestions will take effect unless Congress enacts alternative legislation that achieves the same level of  savings. Subtitle F: "Health Care Quality Improvements" Provides funding for a variety of programs. Subtitle G: "Protecting and Improving Guaranteed Medicare Benefits" Section 3601: Nothing in This Law Can Cut Medicare Benefits Section 3602: Nothing in This Law Can Cut Medicare Advantage Benefits TITLE IV: PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH Subtitle A: "Modernizing Disease Prevention and Public Health Systems" Section 4002: Prevention and Public Health Fund Will provide $2 billion a year (starting in 2015) for public health programs that include research, health screenings, and immunizations. Subtitle B: "Increasing Access to Clinical Preventative Services" Section 4103: Free Wellness Plan for Medicare Seniors Seniors will get a physical their first year on Medicare and risk assessments every year following without having to pay a co-pay or deductible. Section 4107: Help to Quit Smoking for Pregnant Women on Medicaid States must provide counseling and products to help pregnant woman on Medicaid quit smoking with no out-of-pocket costs. Subtitle C: "Creating Healthier Communities" Section 4205: Nutrition Labeling at Chain Restaurants Chain restaurants with 20 or more locations have to provide the number of calories (or a calorie range for combo meals) on menus, boards, and drive-thru boards. Upon request by a customer, they must be able to provide calories from fat, saturated fat, cholesterol, sodium, total carbohydrates, sugars, fiber, and protein. Section 4207: Break Time for Nursing Mothers Employers must allow nursing mothers break time to milk themselves. The employers do not have to pay the mothers for that time. Employers with under 50 employees are exempt. Subtitle D: "Support for Prevention and Public Health Innovation" Funds research and other programs. TITLE V: HEALTH CARE WORKFORCE Subtitle A: "Purpose and Definitions" Subtitle B: "Innovations in the Health Care Workforce" Creates a commission and provides grants. Subtitle C: "Increasing the Supply of the Health Care Workforce" Section 5201: Federally Funded Medical Student Loans Federal government will help pay medical student loans if the student agrees to practice as a primary care physician for 10 years. Decreases the penalty for students who don't comply. Section 5202: Increases Student Loan Amounts for Nursing Students Section 5203: Federal Government Loan Payback for Pediatric Medicine Students If the student agrees to work full-time providing pediatric services, the Federal government will help pay their student loans up to $35,000 a year. Section 5204: Federal Government Service in Return For Loan Repayment If a medical student agrees to work for the government for 3 years or longer, the government will pay up to $35,000 of that student's loans. Subtitle D: "Enhancing Health Care Workforce Education and Training" Subtitle E: "Supporting the Existing Health Care Workforce" Subtitle F: "Strengthening Primary Care and Other Workforce Improvements" Subtitle G: "Improving Access to Health Care Services" Section 5601: Provides Funding for Community Health Centers TITLE VI: TRANSPARENCY AND PROGRAM INTEGRITY Subtitle A: "Physician Ownership and Other Transparency" Section 6001: New For-Profit Doctor-Owned Hospitals Can Not Participate in Medicare Section 6002: Reporting on Industry Payments to Doctors Starting on March 31, 2013, pharmaceutical companies and manufacturers must report any kind of payments that they make to doctors. Manufacturers must report any ownership or investment relationships their doctor customers have with the company. Penalties for not reporting Between $1,000 an $10,000 for each payment that was not reported, capped at $150,000. If the manufacturer knowingly failed to report a payment, the penalty is $10,000-$100,000 for each payment that was not reported, capped at $1,000,000. The payment information reported on by manufacturers must be posted on a searchable website by September 30, 2013 (this has been delayed one year). Section 6004: Reports on Prescription Drug Samples Drug manufacturers and distributors must report the identity and quantity of drug samples requested and distributed every year. Section 6005: Pharmacy Reports Pharmacies need to report on their generic drug dispensing rate, rebates, discounts, and price concessions. Subtitle B: "Nursing Home Transparency and Improvement" Section 6103: Nursing Home Comparison Website The Department of Health and Human Services will operate a website that will allow customers to compare nursing homes by providing staffing data, certifications, complaints, and criminal violations. Section 6105: Creates a Standard Complaint Form Section 6111: Penalties Reduced for Self Reporting Secretary of Health and Human Services will be allowed to reduce penalties by 50% for facilities that report their own violations Subtitle C: "Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long Term Care Facilities and Providers" Section 6201: Background Checks Secretary of Health and Human Services will establish a system for doing background checks that include fingerprints on employees of long term care facilities. Subtitle D: "Patient Centered Outcomes Research" Subtitle E: "Medicare, Medicaid, and CHIP Program Integrity Provisions" Section 6401: Provider Screenings Secretary of Health and Human Services must establish procedures for screening providers and suppliers for Medicare, Medicaid, and CHIP All screening will include license checks Secretary can impose additional screenings including fingerprinting, background checks, and random visits. Providers and suppliers will have to report shady affiliations, suspended payments, if they're excluded from other Federal programs, and/or if they've had their billing privileges revoked. There will be an application fee of $200 for individual doctors and $500 for institutions every five years. Section 6404: Medicare Claims Must be Made Within 12 Months Section 6407: Physicians Must Have Face-to-Face Meeting With Patient Before Certifying Home Services Section 6411: Recovery Audit Contractors Secretary of Health and Human Services will establish contracts with auditors who will identify under and overpayments and collect overpayments for Medicaid services. The Secretary is required to include Medicare Advantage and Medicare Part D. Subtitle F: "Additional Medicaid Program Integrity Provisions" Section 6501: Medicaid Termination States must terminate a Medicaid program if they were kicked out of Medicare or another State's Medicaid program. Section 6502: Medicaid Exclusions Medicaid must exclude an individual or company that owns or manages something that: Has unpaid overpayments Is suspended or excluded from participation Is affiliated with someone who is suspended or excluded from participation Section 6505: No Payments Can Go Outside of the United States Subtitle G: "Additional Program Integrity Provisions" Section 6601: Prohibits False Statements Insurance company employees can be prosecuted and sentenced up to 10 years in prison and fined if they lie about the plan's financial solvency, benefits, or regulatory status. Subtitle H: "Elder Justice Act" TITLE VII: IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES Subtitle A: "Biologics Price Comparison" Subtitle B: "More Affordable Medicines for Children and Underserved Communities" TITLE VIII: "CLASS ACT"(Repealed) TITLE IX: "REVENUE PROVISIONS" Section 9001 as amended by Section 1401 of the Reconciliation Act: Excise Tax on High-Cost Employer Paid Insurance Plans Starting in 2018, there will be a on insurance companies for any health plan that costs more than $10,200 for single coverage and $27,500 for family coverage. The tax is 40% of the amount of the premium above $10,200 and $27,500. The tax begins at $11,850 for individuals and $30,950 for families for plans covering people over 55 and in high risk professions. The tax does not apply to plans sold on the individual market; it only applies to employer paid plans. The tax does not apply to stand alone dental or vision plans. Section 9002: Employer-Paid Health Benefits Will be Included on W-2 Forms Section 9008 as amended by Section 1404 of the Reconciliation Act: Pharmaceutical Industry Fee A fee of at least $2.8 billion a year will be divided by market share and paid by pharmaceutical manufacturers and distributors. Section 9009 as amended by Section 1405 of the Reconciliation Act: The Medical Device Tax There will be a 2.3% deductible tax on the sale of medical devices to be paid by the manufacturer or importer. The tax is not applied to items sold directly to the public such as eyeglasses, contacts, etc. Section 9010 as amended by Section 1406 of the Reconciliation Act: Tax on Health Insurance Companies A non-deductible fee will be divided amongst all health insurance companies based on market share every year. The fee will not apply to insurance companies that make less than $50 million in net premiums. The fee will not apply to government or employers. Non-profits who get more than 80% of their money from government programs are exempt. The fee is: $8 billion in 2014 $11.3 billion in 2015-2016 $13.9 billion in 2017 $14.3 billion in 2018 2019 and beyond: The previous year's fee increased by the rate of premium growth Section 9012: Eliminate Incentives For Employers to Enroll in Medicare Part D Section 9013: Raises Threshold for Medical Expenses Deduction Increases from 7.5% to 10% Individuals over 65 can claim the deduction at 7.5% until 2016 Section 9014 as changed by amendment (See Section 10906): Tax on Wealthy Increases the hospital insurance tax on people earning over $200,000 a year individually or $250,000 married couples filing together by 0.9%. Section 9014 as changed by Section 1402 of the Reconciliation Act: Tax on Wealthy Wall Street Income The hospital insurance tax will include a 3.8% tax on income from interest, dividends, annuities, royalties, and certain rents on people earning over $200,000 a year individually or $250,000 married couples filing together. Section 9017 as changed by amendment (See Section 10907): Tax on Elective Medical Procedures Indoor Tanning There will be a 5% tax on elective cosmetic surgery There will be a 10% tax on indoor tanning services. TITLE X: STRENGTHENING QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS Buried in Section 10104: Dismissal of Fraud Cases Changes Section 3730(e) of title 31, United States Code which determines how we prosecuted people who commit fraud, by eliminating this paragraph: In it's place, they put this: Section 10108: Free Choice Vouchers If a worker's health insurance contribution through their employer will be between 8%-9.8%, their employer has to offer them a voucher that will pay the employee's share if the worker would like to pick their own plan on the exchange. Section 10330: Update Computer Data Systems for Medicare and Medicaid Secretary of Health and Human Services must make a plan and determine the budget for modernizing the computer and data systems for Medicare and Medicaid Additional Provisions from The Health Care and Education Reconciliation Act Section 1103: Stops Medicare Advantage Excessive Profits Medicare Advantage plans must spend 85% of their revenue on medical costs rather than profit and overhead. Additional Information: Intro and Exit Music: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio) Music: Begging for Change - Healthcare Blues by Peter Alexander Is Obamacare Enough? Without Single-Payer, Patchwork US Healthcare Leaves Millions Uninsured, Democracy Now, October 7, 2013. Treasury Department Memo (describes why the large employer reporting requirements are delayed for a year), July 2, 2013. Obamacare Medical Loss Ratio Saved $1.5 Billion in 2011, Insurance Journal, December 5, 2012.