Toes

So, I have this habit where I do fingernails every Monday for teh girls and myself. I personally don't put any polish on my fingernails. I just don't like color there and it seems to chip off faster than I can keep up with it. However, toes are a difffernt matter. i bought teal color of polish. I would never dream of putting it on my fingernails, but I must admit that on my toes I love it! It makes me think of summer days and going to the beach. Not that I ever go to the beach, but the color belongs on the beach. Then I had to ask the question of why? Why can toes look so good in colors that the fingers could never wear? I certainly wouldn't paint a room in my house the same colors as I paint my toes. Toes are just meant to be painted bright fun colors. Well, at least for girls. I've seen guys with painted toes and I'm not sure it is the same, however, they can still pull it off better on their toes rather than their finger nails. Thus, I wonder if toes, in addition to helping you keep your balance, are put there so that girls can paint them pretty colors. Because no matter how bad my day is, I can look down and think, "Well, at least I have cute toes."

Cute Girls

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Easter Breakfast

So, yesterday was the annual breakfast and egg hunt at our church. Both girls were very excited about it. However, I feel like the meanest mom ever. They had a lot of kids there, so i told McKayla she could only have 2 eggs. I wanted her to learn that we are nice to others and that everyone has to get some eggs. In the end I felt sad because other kids had 20 eggs or less, but others, couldn't find even 1. McKayla was a little sad at only having two, but she tried to understand. I felt really bed. How do you teach your kids not to push and fight when other kids do? I decided that I would take her to the store and let her pick out a bag of candy for the family. then, a really wonderful thing happened. A little girl that knows McKayla well gave her 5 eggs because she felt bad that McKayla only had 2. I was so impressed with this little girl. What a wonderful friend for McKayla to have. I am grateful for the love that little children have and how sweet they can be. Ariana was in a different group and Chad let her get about 5 before he stopped her. She was pretty happy about the whole thing. I think next year we might say a total of 5 each. I'm not sure yet. Here are some pictures from it.

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Game Night

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Such A Long Way To Go

Everyone has a story. Everyone has experiences that define them. I have several and I don't share a lot of them. While I lacked for little physically growing up, I did have a lot of emotional challenges at home and at school. Something that I have been working on is forgiving others and seeing the best in them. I doubt my classmates care or even know what was going on and how they treated me. Quite frankly I was an odd duck and it showed. I have worked hard on overcoming my dislike for my hometown and the bad memories there. I have made great strides in that area. After 10 years I can honestly say I am well acquainted with a girl I thought despised me and I have been able to associate with most of my classmates via facebook and not feel too much hurt. I even went to the class of 99's 10 year reunion which was the class I grew up with, but I left a year early due to the need to escape. Home is another matter. I have tried to make strides to accept the things of the past and realize harm was never done intentionally. I have invested time and patience to becoming the lady that Heavenly Father would like me to be. I am grateful for my wonderful brothers and sister-in-laws, they always make me laugh and no matter how often or not often we talk, I know we are there for another no matter what. Yet, things will happen with my mother that cause a lot of strife. I feel so guilty when I become angry with her. Yet, when I think I am the master of my emotions and in control, something will happen that sends my temper flaring and words will be exchanged. I will always love my mother and I will never cease to focus on the good in her, yet I realize I have so far to go in forgiveness and Christ like love. Sometimes it is hardest to forgive those whom we love because we are family. I am humbled when I am forced to look at my true nature and I feel like I have to start all over in the process of being a better person. I wonder if that is normal? Do we all struggle with shortcomings and feel we are overcoming them only to get a glimpse of where we are and notice the mountain seems higher? I will keep trying, but I must admit that I feel upset today because I know I have so far to go and I worry if I will ever make it.

Eureeka

I have been pondering something lately. I work with the youth at my church and I have noticed that they are telling me some hard things. I am sure every member of every religion is facing the same thing. The youth complain that things are becoming more polarized. There are the nerds or the party crowd. I guess there is very little middle ground for the youth that want to have fun, but don't wish to engage in drugs, alcohol, or breaking the law. They want to experience life, but still hold true to their personal values. One very awesome girl told me that she was frustrated because she wanted to try new things, but felt restrained because of her religion. When I asked her what these things might be, she said she didn't want to stay home on Friday and Saturday nights anymore because she was bored. In her mind, there are only two options 1-stay home 2-party. I told her that living life is not about the drugs or alcohol that you consume, but about the experiences you make. I told her that living life was making memories that she would never feel embarrassed to share. I told her that if she wanted to learn to scuba dive and go off the coast of Florida, there was nothing stopping her. If she wanted to see the world, climb mountains, white water raft, or anything like that, she did not have to compromise her values. Then I started fretting that the youth would feel this way. Why do they feel that there is no middle ground and how can the community as a whole offer wholesome activities to the youth regardless of religion? Then I understood something that I had not thought of before. Maybe I am hearing this now, not only to try to council the youth, but to prepare myself and change my parenting now. I admit that sometimes I just get down right mad at my kids and I yell at them or swat their behinds. Maybe I need to remember my training and skills and learn to discipline without yelling. Stop and listen to my kids so that they can come to me without worrying about me freaking out. I need to provide wholesome activities in my home now, so that my kids are more comfortable choosing to stay home rather than finding trouble. No, I'm not going to be instantly perfect, but I received a tiny glimpse from current youth as to how much my kids need me and how hard they may have it. My children will make their own choices and I have to allow them to do that, but I also need to foster a home environment that produces trust, love, and fun. I think back to my high school years and note that I had very different challenges, and those challenges still exists for youth, but what if my home environment were different, what then? However, this is futile because you can't change the past, however, I can change how I react and parent and that is what I need to focus on. I also need to let go of the worry and enjoy my job as a parent. I need to enjoy the sticky hugs and barbies everywhere because at some point, they won't be there anymore.

Etiqutte Dinner

Last night we had an etiquette dinner for the youth of our ward. We gave them about 30 minutes of instruction and then we had them pair off and go to dinner. We tried to break up the clicks and have the boys practice opening the doors and holding out the chairs. At first, there were so many red faces and it was awkward, but then they loosened up and realized these are the same kids from church every Sunday. I think it was a great lesson and the kids really had fun. They had the chance to ask some of the older couples questions about dating. I started laughing because I realized that I didn't have answers to those questions, but thankfully they never asked me. They asked what was our favorite movie when you were dating each other? I don't think Chad and I watched too many movies together. We did listen to a lot of music, so I would have to say Harry Conick Junior was our music. Then they asked what our most memorable date was, and I could think of going down to SLC and seeing the Christmas lights on Temple Square. Then I had to confess one of my most fun dates was not with my husband, but in high school a boy took me paint balling and I loved it. I haven't done it since, but I did buy Chad a paintball gun for Christmas. Maybe I will get one and we can go paint balling one of these days. Then it was asked what impressed the girls the most about their husbands when they were dating. I had to chuckle because mine was the fact that my husband was and still is a gentleman. He held open the door for me, he offered his arm when we walked, he had no problem meeting my family, and (don't laugh) when he was done using the bathroom, he always put the seat down. I was impressed by those things because I knew he did them to show respect. I am grateful for my mother and father in law that taught my husband such great manners. I know that manners have fallen by the wayside lately, but they are so important. I try to work on manners with my girls and I will continue to do so. When my girls get older, Chad wants to take them out on daddy daughter dates so that he can show them what a young man should treat them like. He wants to show them that the gentleman will open the car door, the door into a building, he will make a girl feel like she is the most important person in the world, and he will treat her with the up most respect. We value these ideas because manners never become old fashioned.

Health Care

I was and still uncertain about the new health care system, but i do believe that change is needed. The CEO of EIRMC sent this e-mail to all employees yesterday and Chad shared it with me. I thought it was interesting to read what a CEO had to say about the changes. I have pasted it below. I know there is a lot of controversy and confusion. I am sifting through all of the information as I am sure most of you are. Here is another take on the changes. It is long, but I found it well written.

From: Crabtree Doug
Sent: Monday, March 22, 2010 18:20
To: EIDAHO.DL Everyone
Subject: Monday Message


Dear Colleagues,

Last night, Congress passed a historic piece of legislation that will in many ways remap how American healthcare is accessed, delivered, regulated and paid for in our country. The final legislation is not perfect. It is not simple. And exactly how it will all unfold is still far from clear.

All that said, compared to the “system” we have now, if you could call it that, there is a lot more good than bad in the proposals being enacted.

The process to this point has not been without significant political grandstanding. But hospitals are in a unique position. We can look at it from a politically agnostic point of view. That’s because we see first-hand the suffering that lack of insurance places on families. It’s our doors, after all, where they turn for care. We also know the stifling effect the high cost of care has had on American business, with businesses subsidizing not only the uninsured, but also back-filling the gap between our break-even and what government sources (Medicare and Medicaid) actually pay us. We also see impact in our own EIRMC workforce, as employees make painful choices between gas in the car or insurance premiums; food on the table or prescriptions in the medicine cabinet; clothes on the kids or co-pays and deductibles.

We can do better. And we must. That is why HCA and our hospital joined Idaho Hospital Association, American Hospital Association, American Medical Association, and hospitals across the country in supporting the health reform bill passed by the Congress. I wanted you to know that our company supports this development and that we have been active participants in trying to help shape it over the past year.

This health reform legislation builds a framework for comprehensive reform that increases coverage, improves efficiency, reduces costs and enhances health. It also works toward establishing a more transparent and competitive marketplace of insurance coverage options, which has particular meaning in a state like Idaho, where just a few insurance companies hold a stranglehold on the marketplace.

In quick summary, the benefits of reform, according to several sources, will be:
32 million uninsured Americans will be newly covered;
The bill will reduce the federal deficit; and
It will keep Medicare from going broke in the near future, as would otherwise have been the case.

At the bottom of this email, I include an implementation timeline that walks through how and when these reforms will be deployed. Not everything will happen overnight. Some changes won’t phase in for 7, 8 and even 9 years. And some reforms will first be trialed and piloted, to test what works before widespread adoption. So this is only a first step. But whatever direction this process now takes, we will continue to support reform that increases health care access, affordability, and most of all, great patient care.

You should know that hospitals across our state and country, including ours, have already demonstrated our commitment to lasting, effective reform with expanded coverage by shouldering some of the sacrifice. We collectively agreed to give up $155 billion over 10 years in Medicare and Medicaid programs. Why would we do that? Two reasons: 1) belief that our sacrifice will be offset when our patients who are currently uninsured get covered under the bill; and 2) knowing that the status quo was simply unsustainable and unacceptable any longer.

In September, Cindy and I hosted employee forums where we discussed these issues in greater depth. There was great discussion, lively dialogue, and it was clear then, as now, that simply being a doctor or a nurse doesn’t mean we all think the same about this problem, or its solutions. Anyone, including me, who says they can perfectly predict how this will all work out – good or bad – is mistaken.

But an apt analogy might be that no matter your political persuasion, we’ve all been travelling together on this same, huge, leaky ship, and we’ve been pointed straight toward the rocks. More and more people kept getting thrown overboard just to keep the ship afloat. But even still, it was clear we were going to hit the rocks anyway. Those are the facts. And they are undisputed. Reform is about not just patching up the leaking holes, but turning the whole ship away from the rocks.

Below is the implementation timeline, which may clarify what’s on deck, and in what order.

I hope this information is helpful, thanks for reading, and have a great week.

Doug

H.R. 4872, THE HEALTH CARE & EDUCATION AFFORDABILITY RECONCILIATION ACT of 2010
IMPLEMENTATION TIMELINE
2010
Immediate Access to Insurance for Uninsured Individuals with a Pre‐Existing Condition. Provides eligible individuals access to coverage that does not impose any coverage exclusions for pre‐existing health conditions. This provision ends when Exchanges are operational.
Small Business Tax Credit. Initiates the first phase of the small business tax credit for qualified small employers for contributions to purchase health insurance for employees. The credit is up to 35 percent of the employer’s contribution to provide health insurance for employees. There is also up to a 25 percent credit for small nonprofit organizations.
Eliminating Pre‐Existing Condition Exclusions for Children. Bars health insurance companies from imposing pre‐existing condition exclusions on children’s coverage.
Prohibiting Rescissions. Prohibits abusive practices whereby health insurance companies rescind existing health insurance policies when a person gets sick as a way of avoiding covering the costs of enrollees’ health care needs.
Eliminating Lifetime Limits and Restricting Use of Annual Limits. Prohibits lifetime limits on benefits in all group health plans and in the individual market and prohibits the use of restrictive annual limits.
Covering Preventive Health Services. All new group health plans and plans in the individual market must provide first dollar coverage for preventive services.
Extending Dependent Coverage. Requires any group health plan or plan in the individual market that provides dependent coverage for children to continue to make that coverage available up to age 26.
Bringing Down the Cost of Health Care Coverage. Health plans, including grandfathered plans, must annually report on the share of premium dollars spent on medical care and provide consumer rebates for excessive medical loss ratios.
Reducing the Cost of Covering Early Retirees. Creates a new temporary reinsurance program to help companies that provide early retiree health benefits for those ages 55‐64 offset the expensive cost of that coverage.
Strengthening Community Health Centers and the Primary Care Workforce. Provides funds to build new and expand existing community health centers, and expands funding for scholarships and loan repayments for primary care practitioners working in underserved areas.
Ban on Development or Expansion of Physician-Owned Hospitals. Prohibits construction of or physician investment in new projects, and prohibits expansion of existing facilities that are grandfathered.
Improving Consumer Assistance. Requires that any new group health plan or new plan in the individual market implement an effective appeals process for coverage determinations and claims.
Improving Consumer Information through the Web. Requires the Secretary of HHS to establish an Internet website through which residents of any State may identify affordable health insurance coverage options in that State. The website will also include information for small businesses about available coverage options, reinsurance for early retirees, small business tax credits, and other information of interest to small businesses. So‐called “mini‐med” or limited‐benefit plans will be precluded from listing their policies on this website.
Cracking Down on Health Care Fraud. Requires enhanced screening procedures for health care providers to eliminate fraud and waste in the health care system.
Rebates for the Part D “Donut Hole”. Provides a $250 rebate for all Part D enrollees who enter the donut hole. Currently, the coverage gap falls between $2,700 and $6,154 in total drug costs.
Improving Public Health Prevention Efforts. Creates an interagency council to promote healthy policies at the federal level and establishes a prevention and public health investment fund to provide an expanded and sustained national investment in prevention and public health programs.
Strengthening the Quality Infrastructure. Additional resources provided to HHS to develop a national quality strategy and support quality measure development and endorsement for the Medicare, Medicaid and CHIP quality improvement programs.
Extending Payment Protections for Rural Providers. Extends Medicare payment protections for small rural hospitals, including hospital outpatient services, lab services, and facilities that have a low‐volume of Medicare patients, but play an important role in their communities.
Establishing a Patient‐Centered Outcomes Research Institute. Establish a private, non‐profit institute to identify national priorities and provide for research to compare the effectiveness of health treatments and strategies.
Ensuring Medicaid Flexibility for States. A new option allowing States to cover parents and childless adults up to 133 percent of the Federal Poverty Level (FPL) and receive current law Federal Medical Assistance Percentage (FMAP) will take effect.
Non‐Profit Hospitals. Establishes new requirements applicable to nonprofit hospitals beginning in 2010, including periodic community needs assessments.
Expanding the Adoption Credit and Adoption Assistance Program. Increases the adoption tax credit and adoption assistance exclusion by $1,000, makes the credit refundable, and extends the credit through 2011. The enhancements are effective for tax years beginning after December 31, 2009.
Encouraging Investment in New Therapies. A two‐year temporary credit subject to an overall cap of $1 billion to encourage investments in new therapies to prevent, diagnose, and treat acute and chronic diseases. The credit would be available for qualifying investments made in 2009 and 2010.
Tax Relief for Health Professionals with State Loan Repayment. Excludes from gross income payments made under any State loan repayment or loan forgiveness program that is intended to provide for the increased availability of health care services in underserved or health professional shortage areas. This provision is effective for amounts received by an individual in taxable years beginning after December 31, 2008.
Excluding from Income Health Benefits Provided by Indian Tribal Governments. Excludes from gross income the value of specified Indian tribal health benefits. The provision is effective for benefits and coverage provided after the date of enactment.
Establishing a National Health Care Workforce Commission. Establishes an independent National Commission to provide comprehensive, nonbiased information and recommendations to Congress and the Administration for aligning federal health care workforce resources with national needs.
Strengthening the Health Care Workforce. Expands and improves low‐interest student loan programs, scholarships, and loan repayments for health students and professionals to increase and enhance the capacity of the workforce to meet patients’ health care needs.
Special Deduction for Blue Cross Blue Shield (BCBS). Requires that non‐profit BCBS organizations have a medical loss ratio of 85 percent or higher in order to take advantage of the special tax benefits provided to them under Internal Revenue Code (IRC) Section 833, including the deduction for 25 percent of claims and expenses and the 100 percent deduction for unearned premium reserves.
Indoor Tanning Services Tax. Imposes a ten percent tax on amounts paid for indoor tanning services in lieu of the tax on cosmetic surgery. Indoor tanning services are services that use an electronic product with one or more ultraviolet lamps to induce skin tanning. The tax would be effective for services on or after July 1, 2010.
2011
Increasing Reimbursement for Primary Care. Provides a 10 percent Medicare bonus payment for primary care physicians and general surgeons.
Increasing Training Support for Primary Care. Establishes a Graduate Medical Education policy allowing unused training slots to be re‐distributed for purposes of increasing primary care training at other sites.
Improving Health Care Quality and Efficiency. Establishes a new Center for Medicare & Medicaid Innovation to test innovative payment and service delivery models to reduce health care costs and enhance the quality of care provided to individuals.
Improving Preventive Health Coverage. Provides a free, annual wellness visit and personalized prevention plan services for Medicare beneficiaries and requires new plans to cover preventive services with little to no cost sharing. Creates incentives for State Medicaid programs to cover evidence‐based preventive services with no cost‐sharing, and requires coverage of tobacco cessation services for pregnant women.
Improving Consumer Assistance. Requires the Secretary of Health and Human Services (HHS) to award grants to States to establish health insurance consumer assistance or ombudsman programs to receive and respond to inquiries and complaints concerning health insurance coverage.
Improving Transitional Care for Medicare Beneficiaries. Establishes the Community Care Transitions Program to provide transition services to high‐risk Medicare beneficiaries.
Expanding Primary Care, Nursing, and Public Health Workforce. Increases access to primary care by adjusting the Medicare Graduate Medical Education program. Primary care and nurse training programs are also expanded to increase the size of the primary care and nursing workforce. Ensures that public health challenges are adequately addressed.
Increasing Access to Home and Community Based Services. The new Community First Choice Option, which allows States to offer home and community based services to disabled individuals through Medicaid rather than institutional care, takes effect on October 1, 2011.
Transitioning to Reformed Payments in Medicare Advantage. Freezes 2011 Medicare Advantage payment benchmarks at 2010 levels to begin transition. Continues to reduce Medicare Advantage benchmarks in subsequent years relative to current levels. Benchmarks will vary from 95% of Medicare spending in high‐cost areas to 115% of Medicare spending in low‐cost areas. Changes are phased‐in over 3, 5 or 7 years, depending on the level of payment reductions.
Discounts in the Part D “Donut Hole”: Provides a 50 percent discount on all brand‐name drugs in the donut hole and begins phasing in additional discounts on brand‐name and generic drugs to completely close the donut hole by 2020 for all Part D enrollees.
Reporting Health Coverage Costs on Form W‐2: Requires employers to disclose the value of the benefit provided by the employer for each employee’s health insurance coverage on the employee’s annual Form W‐2.
Standardizing the Definition of Qualified Medical Expenses. Conforms the definition of qualified medical expenses for HSAs, FSAs, and HRAs to the definition used for the itemized deduction. An exception to this rule is included so that amounts paid for over‐the‐counter medicine with a prescription still qualify as medical expenses.
Increased Additional Tax for Withdrawals from Health Savings Accounts and Archer Medical Savings Account Funds for Non‐Qualified Medical Expenses. Increases the additional tax for HSA withdrawals prior to age 65 that are not used for qualified medical expenses from 10 to 20 percent. The additional tax for Archer MSA withdrawals not used for qualified medical expenses would increase from 15 to 20 percent.
Cafeteria Plan Changes. Creates a Simple Cafeteria Plan to provide a vehicle through which small businesses can provide tax‐free benefits to their employees. This would ease the small employer’s administrative burden of sponsoring a cafeteria plan. The provision also exempts employers who make contributions for employees under a simple cafeteria plan from nondiscrimination requirements applicable to highly compensated and key employees.
Pharmaceutical Manufacturers Fee. Imposes an annual, non‐deductible fee on the pharmaceutical manufacturing industry allocated according to market share and not applying to companies with sales of branded pharmaceuticals of $5 million or less.
2012
Encouraging Integrated Health Systems. Implements physician payment reforms that enhance payment for primary care services and encourage physicians to join together to form “accountable care organizations” to gain efficiencies and improve quality.
Linking Payment to Quality Outcomes. Establishes a hospital value‐based purchasing program to incentivize enhanced quality outcomes for acute care hospitals. Also, requires the Secretary to submit a plan to Congress by 2012 on how to move home health and nursing home providers into a value‐based purchasing payment system.
Reducing Avoidable Hospital Readmissions. Directs CMS to track hospital readmission rates for certain high‐volume or high‐cost conditions and uses new financial incentives to encourage hospitals to undertake reforms needed to reduce preventable readmissions, which will improve care for beneficiaries and rein in unnecessary health care spending.
2013
Administrative Simplification. Health plans must adopt and implement uniform standards and business rules for the electronic exchange of health information to reduce paperwork and administrative burdens and costs.
Encouraging Provider Collaboration. Establishes a national pilot program on payment bundling to encourage hospitals, doctors, and post‐acute care providers to work together to achieve savings for Medicare through increased collaboration and improved coordination of patient care.
Limiting Health Flexible Savings Account Contributions. Limits the amount of contributions to health FSAs to $2,500 per year, indexed by CPI for subsequent years.
Eliminating Deduction for Employer Part D Subsidy. Eliminates the deduction for the subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees.
Increased Threshold for Claiming Itemized Deduction for Medical Expenses. Increases the income threshold for claiming the itemized deduction for medical expenses from 7.5 to 10 percent. Individuals over 65 would be able to claim the itemized deduction for medical expenses at 7.5 percent of adjusted gross income through 2016.
Additional Hospital Insurance Tax for High Wage Workers. Increases the hospital insurance tax rate by 0.9 percentage points on an individual taxpayer earning over $200,000 ($250,000 for married filing jointly). Expands the taxable base to include net investment income in the case of taxpayers earning over $200,000 ($250,000 for joint returns).
Medical device excise tax. Establishes a 2.9 percent excise tax on the first sale for use of a medical device. Excepted from the tax are class I devices, eye glasses, contact lenses, hearing aids, and any device of a type that is generally purchased by the public at retail for individual use.
Limiting Executive Compensation. Limits the deductibility of executive compensation under Section 162(m) for insurance providers if at least 25 percent of the insurance provider’s gross premium income from health business is derived from health insurance plans that meet the minimum creditable coverage requirements. The deduction is limited to $500,000 per taxable year and applies to all officers, employees, directors, and other workers or service providers performing services, for or on behalf of, a covered health insurance provider. This provision is effective beginning in 2013 with respect to services performed after 2009.
Fee for patient centered outcomes research. Annual fee becomes effective on insured and self‐insured plans to fund the patient centered outcomes research trust fund.
2014
Reforming Health Insurance Regulations. Implements strong health insurance reforms that prohibit insurance companies from engaging in discriminatory practices that enable them to refuse to sell or renew policies due to an individual’s health status. Health plans can no longer exclude coverage for treatments based on pre‐existing health conditions. It also limits the ability of insurance companies to charge higher rates due to heath status, gender, or other factors. Premiums can vary only on age (no more than 3:1), geography, family size, and tobacco use.
Eliminating Annual Limits. Prohibits health plans from imposing annual limits on the amount of coverage an individual may receive.
Ensuring Coverage for Individuals Participating in Clinical Trials. Prohibits new health plans from dropping coverage because an individual chooses to participate in a clinical trial and from denying coverage for routine care that they would otherwise provide just because an individual is enrolled in a clinical trial. Applies to all clinical trials that treat cancer or other life‐threatening diseases.
Establishing Health Insurance Exchanges. Opens health insurance Exchanges in each State to individuals and small employers. This new venue will enable people to comparison shop for standardized health packages. It facilitates enrollment and administers tax credits so that people of all incomes can obtain affordable coverage.
Ensuring Choice through a Multi‐State Option. Provides a choice of coverage through a multi‐State plan, available from nationwide health plans under the supervision of the Office of Personnel Management.
Providing Health Care Tax Credits. Makes premium tax credits available through the Exchange to ensure people can obtain affordable coverage. Credits are available for people with incomes above Medicaid eligibility and below 400 percent of poverty who are not eligible for or offered other acceptable coverage. They apply to both premiums and cost‐sharing to ensure that no family faces bankruptcy due to medical expenses again.
Ensuring Choice through Free Choice Vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an Exchange plan.
Promoting Individual Responsibility. Requires most individuals to obtain acceptable health insurance coverage or pay a penalty of $95 for 2014, $325 for 2015, $695 for 2016 (or, up to 2.5 percent of income in 2016), up to a cap of the national average bronze plan premium. Families will pay half the amount for children, up to a cap of up to a cap of $2,250 per family. After 2016, dollar amounts are indexed. If affordable coverage is not available to an individual, they will not be penalized.
Promoting Employer Responsibility. Requires employers with 50 or more employees who do not offer coverage to their employees to pay $2,000 annually for each full‐time employee over the first 30 as long as one of their employees receives a tax credit. Precludes waiting periods over 90 days. Requires employers who offer coverage but whose employees receive tax credits to pay $3,000 for each worker receiving a tax credit up to an aggregate cap of $2000 per full‐time employee.
Increasing Access to Medicaid. Medicaid eligibility will increase to 133 percent of poverty for all non‐elderly individuals to ensure that people obtain affordable health care in the most efficient and appropriate manner. States will receive increased federal funding to cover these new populations.
Small Business Tax Credit. Continues the second phase of the small business tax credit for qualified small employers.
Quality Reporting for Certain Providers. Places certain providers – including ambulatory surgical centers, long‐term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, PPS‐exempt cancer hospitals and hospice providers – on a path toward value‐based purchasing by requiring the Secretary to implement quality measure reporting programs in these areas and also pilot test value‐based purchasing for each of these providers in subsequent years.
Health Insurance Provider Fee. Imposes an annual, non‐deductible fee on the health insurance sector allocated across the industry according to market share. The fee does not apply to companies whose net premiums written are $25 million or less.
2015
Continuing Innovation and Lower Health Costs. Establishes an Independent Payment Advisory Board to develop and submit proposals to Congress and the private sector aimed at extending the solvency of Medicare, lowering health care costs, improving health outcomes for patients, promoting quality and efficiency, and expanding access to evidence‐based care.
Paying Physicians Based on Value Not Volume. Creates a physician value‐based payment program to promote increased quality of care for Medicare beneficiaries.
2018
Excise tax on high cost employer‐provided health plans becomes effective. Tax is on the cost of coverage in excess of $27,500 (family coverage) and $10,200 (single coverage), increased to $30,950 (family) and $11,850 (single) for retirees and employees in high risk professions. The dollar thresholds are indexed with inflation, and employers with higher costs on account of the age or gender demographics of their employees may value their coverage using the age and gender demographics of a national risk pool.

Why Guys Run The BBQ

So, I requested to my beloved that I wanted BBQ chicken tonight for dinner. Then we started bantering why guys are the ones that BBQ. I think it is hilarious that men are the guardians of the BBQ domain. So, I decided to list out the reasons I feel it is this way.
1. Guys, flames, and explosive gases go together.
2. They can pull off the "one eyebrow" look.
3. When they singe the hair off their hands, it looks manly.
4. They look good standing over the grill.
5. Meat-need I say more?
6. When it comes to cleaning up after BBQing they just have to turn off the grill.
7. And lastly, it stems from their genes past down that the man must stand over the fire as the latest kill is roasting over the fire.

Do you have any others to add?

Field Trip

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I Worry About My 4 Year Old

I try to explain things to my four year as best that I can. I try to give her enough information without going over board. Last night we were talking about Christ and his atonement. I was trying explain how when we make bad choices we become unclean and then when we believe in Christ and repent we can be made clean. I tried to shower her this by drawing on a page protector with a dry eraser and then wiping it clean. I'm not sure how much she understood. I then talked about how Christ was resurrected and how we will be too. She comment that Jesus will make us a new body because when we die and go in the ground our blood and bones fall apart. She was quite graphic about this part. In fact she repeated it over and over. I tried to make sure that she knew our spirits weren't in our bodies when they were in the ground. I am not sure how much of this she understands, but then at other times she seems to display a greater understanding. I'm not sure how the talk went from Christ cleaning us from our sins to getting a new body when we are resurrected, but it did. Does anyone else have crazy talks like this with their kids? At least we made oreo shakes to help digest these heavy topics.

Toys

I am beginning to think that all toys are a conspiracy against parents. You buy these cute little dolls and then the nightmare begins. For example, the purple shoes gets lost and your child request that you spend all of your time helping her find it. Or you just get the doll dressed and your child decides that the tea party is over and now dolly needs to get ready to go to the ball. The outfits are such a pain to get on and off too. It takes awhile to change cloths. The last problem is the modesty issue. The dolls never have cloths on them. The kids can get the dresses off, but have a hard time getting another one back one and so the dolls are not clothed. I have considered spray painting some clothing on the dolls, but my kids might get upset. Maybe what the toys need are snap on cloths. No, not cloths with lots of snaps, they have those, but rather some that snap onto the doll very easy. Plus, when you have more than one child, you could easily get roped into dress up time forever. Perhaps I could stretch this a little by saying that it is teaching my daughters way too much about accessorizing. Really, you do not need to have that many cloths, shoes, and accessories. Then again maybe every child goes through this and some day I will remember searching high and low for that one shoe.

It Will Get Easier

I had a couple a nice ladies from my church invite me to do a couch potato to 5k program with them. I decided to try. I have never been good at running. Even when I was in high school I stank at running. Anyway, we started and have been doing really good. At first we met at about 4:30 in the afternoon, but that didn't always work out because of schedules. We decided to start meeting at 5:30 in the morning. The first week I thought I was going to die getting up that early, but then it started getting easier. This week is throwing me for a loop. I have been able to get up but then I run out of ambition at noon. I'm not sure why, but I just feel like I hit a brick wall. This morning I completely overslept and didn't get up to go running. I thought I had set my alarm but obviously I didn't. I woke up at 5:45 and decided to go back to bed since I was running late. I didn't move again until the kids woke me up at 8:oo. I thought exercising gave you more energy and it got easier, but I am doubting that. Then I remembered that the time is changing on Sunday. I'm not sure how I will do facing the day a whole hour earlier. I will keep plugging away, but I need some encouragement. Maybe if the weight would magically melt away, I would feel better, but that's not happening either. I must like food way too much. Oh well! I will be a fit, round person. Since I am short, maybe I can pass myself off as an elf.

I Got It

So, way back when I was a little girl (yes, a long time ago) I had these awesome Fisher Price roller skates. They were orange and yellow. They were made so that you simply slipped your foot inside and away you went. Not only that, but they were adjustable so that I was able to wear them for a long time. McKayla has been begging to go roller skating and ice skating. I have calmly ignored her because the suggestion brought up visions of the emergency room. Maybe she is not as accident prone as I am, but I still worried. Then yesterday while I was at Walmart looking for some musical instruments (long story) a light shone shone down and there was singing as I noticed a pair of "My First Skates" They are made by matell and have barbie all over them, so Mckayla will like them. Like them because they have three stages of skating. You can lock the wheels so that the child can get used to having skates on, you can lock them so the child can't roll backward, and then stage three is a free for all. It says for ages over 2 and up to 44 pounds. So, while I wasn't planning on buying anything for her birthday until next month I snatched them up because I knew that if I waited I would never find them again. Then I started pondering about the information. Good for children over 2? Well, McKayla is turning 5 this April. While she doesn't weigh anywhere near 44 pounds, I worried that they were too youngish for her. Then logic hit! Really, someone would put roller skates on a two year old? Who would do that? Maybe they don't have visions of the ER, but I would. I'm scared enough allowing my 5 year old to wear skates. Plus, Ariana would figure out how to move the buttons and try to roller skate as fast as she could down the driveway and shoot out onto our street between the hours of 8:30 and 9:00 or 3:00 and 3:30. (We have a school down the street, so it gets very busy at that time). Anyway, I am excited to give McKayla the skates. I think she will like them. I have no idea what we are doing for Easter or Ariana's birthday, which fall before McKayla's birthday, but I found skates. And I did find a "Band in a Bucket" at Toy r Us, so that worked out as well.

Ariana

So, I have noticed I have posted often about McKayla and Ariana has been left out as of late. I decided to show you the new little game I play with Ariana. This always brings a smile to my face.


Isn't that so cute?

Play Unplugged

I found a great book at the library. It's called "Play Unplugged". It has games and activities that require no batteries, electrical cords, or flashing lights. It also has selcions that are based on age groups. I have been using it to help brake up he boredom and to help all of us get away from the tv more. I love that the activities use things that are found in the home rather than having to buy anything. I think sometimes we forget how to play without something prompting us. Even simple toys have lights and buttons. Today is cooking at our house, so I won't be using it, but tomorrow is music day and I plan on using some the ideas to incorporate music into our play. Try to find this book or one similar, it helps you come up with ideas and it helps you spend quality time with your kids.

To Krista, From Chad

This is Chad. Krista wrote a lovely blog post about me a few days ago and I wanted to sneak on here and do the same for her. I want to celebrate our marriage and the person who makes it all possible; My wife, Krista. She is so talented and amazing. She cares for me and our daughters like no other. She works so hard and I appreciate her so much.

To Krista I’d like to say:

I want to celebrate my love for you. I want to celebrate you and all you mean to me. I need you. I celebrate your strength, love, and compassion. I celebrate the fact that you are a part of my life! I cherish the day I met you. I cherish the day I married you. I cherish the day we were sealed for time and all eternity. I cherish the days we had our children together. I cherish and am ever so grateful for the effort you are making in this marriage and for our family. I love you! I am grateful you are my wife. I hope to keep you as my wife for the rest of our lives and through all eternity. Please accept my public expression of love and my hope and commitment to a wonderful marriage. Thanks for being my sweetheart and for your kind words in your previous blog post. Thank you for toughing out the hard times like Grad school with me. Thank you for putting up with my weakness and shortcomings. Thank you for loving me despite my faults.

Love,
Your humble and devoted Husband,
Chad

Kindergarten

Today i am registering McKayla for Kindergarten. She is very excited, but would like to start tomorrow. She is my oldest child and I worry about her entering the public school system during a time when cuts are being made right and left. The teachers have to be discouraged, there are no supplies, and parents can't really do lot to help the situation. I know that the teachers are doing their best not to let this affect their teaching, but can they do it? I worry that McKayla will end up in a classroom with a teacher that is frustrated and doesn't want to deal with it any more. Having good teachers is so important. I had a couple of bad teachers in elementary and it was not a good thing. Somehow I figured I was stupid and a C average was all I could achieve. Then I had some great teachers during my jr high/ high school years that made me believe that I could do better than that. Oddly enough I did. I am grateful for the teachers that believed in me. Due to their belief I went on and received a degree and will some day earn a masters. However, back to McKayla. What is in store for her? How long will the Idaho government keep cutting? How will the school districts manage? I feel sad because my kids will have a less fulfilling education. Extra art or humanities will be cut, no field trips, no science experiments, no extra incentives. I have been worried about this for a while and Chad and I are going to make an extra effort to try to supplement their education. We want to be able to take them on field trips to help them further what they are learning at school. We want to try and make education exciting in any possible. I am also going to try and help out in the classroom if it is at all possible. I pray that our economy will recover soon and that education will once again be pushed to the front of the line.

Dance, Dance, Dance

McKayla had her first grand dance experience. It was an all day event that included 9other dance companies. Thankfully McKayla was in the first 2 hours. We stayed longer to watch my nieces dance and then we left. McKayla did so great. She wasn't the best dancer, but she was the most enthusiastic. I told Chad that I simply wanted her to have fun. There is no way that I am going to make her practice and practice and then yell if she gets it wrong. (Not that I know what that is like). Instead I told her to dance because she loves to dance. I loved watching her. Her dance teacher set up a daddy/daughter dance called "Cinderella" It was so cute. Chad practiced really hard so that he wouldn't mess up. I am grateful that he worked hard for McKayla and I am glad she had so much fun. In May, she will have a dance recital that only her dance company will be at, so that will be nice because it won't take all day. I wonder how long she will want to dance until she finds something else to entertain her.

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Hair Cut

McKayla was able to go to her first hair appointment. She has been very excited to do this and it really needed to be done. We have never really done anything with her hair except for cutting some bangs. Her hair is naturally curly so I never noticed how uneven and nasty the ends were. Then one day I decided to straighten it. Wow! He hair was so uneven and needed some real help. I hoped she wouldn't be too upset when she saw how much hair needed to be trimmed away. It does look shorter, but more healthy and full. I couldn't take her to the appointment due to an unexpected change of plans, so Chad took her and took all of the pictures. I am happy that she is so excited, yet I feel sad because she is getting so big. So here is a slide show of the pictures that Chad took of McKayla's first hair appointment!

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Chad

I have a great husband. We have both been under a lot of stress lately. He has a lot of school work that needs to be done, plus homework, plus church callings, plus a wife that needs help, plus two little girls that adore their father and won't let him out of their site when he first gets home. I have do run the household often alone which involves all of the cleaning, cooking, scheduling of appointments, remembering birthdays, planning, shopping, budget/bills, and taking care of our kids. Our burdens are pretty heavy right now. I had one of those, this is not working for me days lately. I was frustrated because sometimes my husband has a gad tie keeping up with all of the information I throw at him. I have a family calendar that he can check, I bought him a planner, and I try to have a family planning meeting on Sundays to outline the week, but he still has a hard time remembering all of the different obligations that we have going on. I took a preliminary test and may have sleep apnea. We need to have him really tested and if he needs help breathing at night, get it going. I knew sleep apnea could account for his lack of energy and always seeming so tired. What I didn't know is that it could be why he has a difficult time processing information, remembering things, and slower work performance. I feel so bad for him because he is trying his best, yet his body is not cooperating. So, today I wanted to list 10 reasons why i love him and what makes him a great guy. I think he needs to see this:)

1. He is always soft spoken. he rarely speaks in anger and really follows the "a soft answer turns away wrath".
2. He is willing to do anything to help out, I just have to remind him often.
3. He leads our family in scriptures and prayer morning and night.
4. He always gives the kids a bath and gets them ready for bed at night.
5. He will go to the craft store with me and be interested in what I am looking at because it is important to me.
6. He will arrange with his boss to come in late or leave early if he needs to.
7. He is the best father ever! I have never found him lacking in the area of involvement, love, or providing care when it comes to our girls.
8. He does his best to provide for us and make sure we have what we need.
9. He likes to spoil me.
10. Last, I love him because he loves me. I have many faults. I am grumpy and demanding. I run at a super pace and often stress myself out. I have crazy ideas and he goes along with it. I have a terrible temper and it takes time for me to cool down. Yet, he chooses to love me. He stays by my side when I am at my worst and helps me to be my best.

There are so many other things that make him a great guy. Really, I could write pages and pages. These are not in order of importance, they are written as they came to my brain. I just wanted to let him know I love him and appreciate him.

Camp

I found out on Sunday that I will be doing most of the work for girls camp. We had a camp director and then she got released. Somewhere along the way they didn't call a new one. However, I was called as assistant camp director and now I am trying to wade through a lot of stuff figuring out what to do. In all fairness, the YW president is the camp director, but she has a lot going on right now and needs help. I am feeling overwhelmed, yet I can see how I could really grow from this experience. I think that this trial is like many others. Once you find a place to start, you can start to plan on how to reach your goal. We should be further along in some areas, but I think we can catch up. I just need to pray often and work on doing the best job as I can. However, I still have this nagging fear that some one planning girls camp should have more experience than I do. The one time I went to girls camp, I had not been baptized yet, and while it helped me choose to be baptized, I still don't recall a lot of the specifics. Although I did find a certificate that said I passed off the lever two requirements, so that should mean something right? Please pray for me and pray that the girls don't suffer for my inadequacy.

Why I Laugh at Random Moments

My kids crack me up. They are so funny. I wanted to share a conversation that I had with McKayla today.
McKayla: No one has a birthday in July huh?
Me: Well, Grandma Porter and I both have birthdays in July.
McKayla: You didn't last year.
Me: I'm pretty sure I had a birthday last year.
McKayla: What did we do?
Me: I don't remember what we did on the exact day. Your day paid for me to have my hair done and a little spa day. I'm sure he took me out for dinner on my birthday.
McKayla: Why?
Me: Because he likes to do that.
McKayla: Because he is awesome huh?
Me (laughing): Yup, he sure is.

Chad came in and have McKayla a high five for that. We both chuckled about her comment.

A conversation between Chad and Ariana last night.

Ariana: Dad I want princesses. (She wants a princess movie to watch)
Chad: Well, guess what?
Ariana: What dad?
Chad (very excited): It's time for bed!
Ariana (with a very grumpy face): NO!

I love when they start talking and saying funny things. Ariana is very smart and can say a lot of things. It's great when our conversations with her make sense.

Monday Morning

I have been up since before 5:30. I have been very productive. The first of every month I sit down and pay bills and budget for the entire month. It works out well for the most part. I dislike having to do it all at once, but it makes it easier to plan for things. As i was doing bills this morning, I couldn't help but think of my many blessing. I am so grateful for all that I have. Then my thoughts turned to Chile. How crazy that 2 large earthquakes have hit so close together. It makes me wonder if the plates in the US are going to shift soon. I am not fearful, but rather I am taking inventory of our emergency kits, food, and water. We have some food stored away, but I know we could use more. Maybe I will have to start stocking up again. I will have to re-assess what we have and look at what we need to buy. We need to work on being more prepared physically and spiritually.