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Student Highlights - Nathaniel Wildes
Nathaniel Wildes
Political Science major
Innovation Engineering minor
Honors College
Cumberland, Maine
How did you get into Innovation Engineering?
The Foster Center for Student Innovation is one of the reasons I chose to come to UMaine. I was looking for a place that had a liberal arts foundation so I could get into the theory and science of political science. But I also wanted to have that grounding of real-world research — something that was real now — so I was focusing on schools that offered an engineering major, and when I found the innovation center, it was the best of both worlds for me.
For the uninitiated, what's Innovation Engineering all about?
Its purpose is to bring together people from across the academic spectrum and help them make their ideas real, whatever those ideas may be. It's about taking the principles of engineering — it's a system and a process — and applying it to innovation, to creativity.
Innovation Engineering is not like anything I had experienced before. It's open and accepting of everyone in such a way that it allows every student to excel. The diversity in the classroom is enormous — you have engineers, English majors, philosophy majors, microbiology majors — and that diversity is what makes it so great. It's what drives innovation in the classroom. The more diverse thinking skills you have in a room, the better the ideas.
How does it apply to your own course of study?
With political science, I'm learning how to best create, communicate and make political ideas, whether it be law, convincing people to vote for you, to make legislation real, or to make it more effective. Government exists to make our lives better; from security to encouraging economic growth, using a process like Innovation Engineering can help make government work more effectively.
How has UMaine shaped your plans for the future?
At the University of Maine, you develop a huge tool kit, a huge set of skills, resources and knowledge. When you graduate, you may have a certain profession as a goal, but really, you'll enter the real world knowing you have the skills to go anywhere. I think college is more about developing a tool kit for life. If you do what you love, the money will come.
You were a summer intern at Eureka! Ranch, the Ohio-based innovation think tank run by UMaine alumnus and faculty member Doug Hall. What was that like?
There were four of us. We had all been in Innovation Engineering classes, and the Innovation Engineering curriculum at UMaine is essentially the business model behind Eureka! Ranch. It helps companies, nonprofits and government come up with new ideas that create a positive impact on people's lives. The internship gave me the motivation and courage to take risks in the classroom that I might not normally have taken. Doug Hall's philosophy is "fail fast, fail cheap," which frees you up to take small, incremental risks without sinking the ship. For me, that has meant challenging my professors. It has meant approaching my education in the classroom as a much more dynamic entity — of trying to find out what the courses I'm taking mean to me and to the world.
What was a typical week like?
On any typical project, 120 hours of work had to be done in 48. Everyone at Eureka! Ranch treated us like real employees. They gave us the responsibility of real employees and we were expected to perform like real employees.
What about the networking opportunities?
I met hundreds of leaders from the private sector, nonprofits and the U.S. government that I never would've met on my own. It was a great learning opportunity, and opened a lot of doors. Especially in politics, who you know is very important to making valuable connections for the future.
Who are your mentors?
Doug Hall is an inspirational leader, a visionary, and he has endless energy for doing what's right and doing what you love. Renee Kelly and Jesse Moriarity of the Foster Center for Student Innovation are clearly focused on the students and very supportive of your dreams.
How are the professors?
Innovation Engineering professors are here because they want to be here and they believe in the impact of what they're doing. That sets them apart, adds to the value of the classes, and in that regard, the professors are clearly people to look up to.
How has UMaine shaped your outlook?
To have a day when you don't learn something new? That doesn't exist here. You'll have experiences that alter what you value in the world. You'll have experiences that change your perspective, your perception and your outlook. I have peers here from all different disciplines from all over the world. When you have that much diversity in one location, that sheer volume of resources, you can't not grow.
How would you describe UMaine students?
There is no such thing as a 'typical' UMaine student, but a love for hockey, the outdoors, and the color blue are definite trends.
What surprised you about UMaine?
I was pretty intimidated by the fact that there are 12,000 students here, but the reality is, it becomes a small world pretty quickly. It's a tight community of students. Now, it's impossible for me to walk anywhere without seeing someone I know on a first-name basis, but at the same time, it's impossible for me to go a day without meeting someone new.
Tell us about a memorable UMaine moment
There was a time at a hockey game when I was sitting in the bleachers and I realized the people sitting next to me were two professors who co-taught the first class I took as a freshman. They were all riled up. Everyone was yelling and screaming and having a great time on a Friday night. When one of those professors turned to me, jabbed me in the shoulder and said, 'Good game, huh, Nate?' that really clarified how close-knit of a community this is.
What is your favorite UMaine tradition?
It's not a formal tradition, but the fact that everyone holds the door open for someone else speaks volumes about the people here. In my experience, UMaine is the only place where if you don't hold the door open for someone, even if they're 50 feet away, it's considered rude. Black Bear courtesy is something that defines the community very well.
What do you think of the location?
It's the perfect distance from everything. It's just far enough away from downtown Orono and Bangor that we have a real community on campus, but we're still within a few hours' drive of the tallest mountain in Maine, ski resorts, Acadia National Park and some of the most beautiful places to get outdoors. You can see the first sunrise in the United States. The opportunities to go places are boundless. We're not here to have our college experience defined by a campus boundary. We're here to have our college experience defined by the entire state of Maine.


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FINDLAY, OH (Toledo News Now) – One school district is operating with $900,000 less in its budget. Now leaders are forced to use the chopping block.
It is the same amount of cuts Findlay faced last year, but the district treasurer says he has a plan to lessen the blow.
On Monday night, the Findlay School Board announced it will face a $900,000 reduction in revenue for the next school year. Treasurer Mike Barnhart says he has been reviewing numbers.
"We expected it. We do a five-year forecast and we keep track of what's happening and we plan accordingly," explained Barnhart.
Since it was no surprise, the district has been working to pinch pennies wherever they can. Last year, teachers received no increase on their base salary and no pay for an additional year of working. School staff also negotiated a new health care plan saving $800,000.
The plan to close a middle school and build two new ones, as well as opening the millstream career center, are also decreasing costs.
"We save on staff, we don't have to have three different custodians, three different secretaries," said Barnhart.
The treasurer does not expect students to see any changes.
"These cuts have not affected any programming, any academic offerings" said Barnhart.
The next budget has not been approved yet, but Barnhart plans to continue looking for ways to cut costs with little to no effect on education.
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A college library without books? Yep, it's a thing
IN THIS STORY: Florida Polytechnic University, University of Chicago, North Carolina State University
Top 10 U.S. colleges for an accounting degree
Bentley University, University of Notre Dame and Bryant University are the top three accounting colleges in the U.S.
The 3 things you really missed about your college roommate
You might not realize how much you miss your roommate until they come barging through your apartment door.
Emory & Henry College aims to put 'fun' in funding
Students will see an additional $100 charge on fall and spring accounts, which will be given to three student-run organizations.
Blackboard awards $25,000 in #PayMyTuitionChallenge
College students are calling on everyone from the government, celebrities and corporations to help them pay for their tuition.
Georgia students study Kendrick Lamar for class
Students are juxtaposing Lamar's music with literary works from James Joyce and James Baldwin, among others.
College Problems Podcast: Awkward first classes & naive freshmen
The College Problems Podcast is a regular series of spirited chats attempting to make sense of college life.


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"Luck" is the creation of world renowned writer/producer David Milch, who is also a prominent Thoroughbred horse owner and as such, has won two Breeders' Cup races.
The pilot for "Luck," which is due to air on HBO late next year, was shot primarily at Santa Anita this past March and April. Milch enlisted the services of highly coveted director Michael Mann, whose credits include "Miami Vice," "Ali" and "Public Enemies," and Mann will remain in an advisory capacity for the upcoming series. Milch also procured the services of A-list actors Dustin Hoffman, Nick Nolte, Dennis Farina and John Ortiz.
Retired Hall of Fame jockey Gary Stevens, who made his big screen debut in 2003's blockbuster hit "Seabiscuit," has also been engaged and will have a prominent role in the series' pilot.
Although they will not all remain series regulars, it is believed those actors who contributed to the pilot will maintain a presence as "Luck" develops in seasonal episodic form.
"It's hard to quantify how much we feel this could mean to Santa Anita and horseracing in general," said Santa Anita Community and Events Coordinator Pete Siberell. "Anyone who's watched 'Hill Street Blues,' 'NYPD Blue' or 'Deadwood' knows what David Milch is capable of. He has a heart-felt passion for racing and although he'll be delving into to some dark areas on occasion, we feel strongly that "Luck" has the potential to have a similar impact to that of 'The Sopranos,' which also aired on HBO.
"This is great news and it couldn't have come at a better time. Horseracing is experiencing many challenges right now and now, more than ever, we need to be reaching out to new people in a creative and innovative way. 'Luck' is going to generate a lot of buzz and it is going to get people talking about racing and about Santa Anita—which is fantastic.
"From what we understand, the people at HBO are absolutely thrilled with what Michael Mann has been able to put together thus far and we feel that people are going to view horseracing as they've never seen or imagined it before, with a compelling plot line, dynamic acting and film production that Mann is famous for."
Live racing will return to Santa Anita Park with the beginning of the Oak Tree meeting on Sept. 29.


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KNIGHTDALE — Police are investigating the suspected murder of 55-year-old Seanne Winters Barnette after she was found dead in her Legacy Oaks apartment Saturday afternoon.
Virginia State Police found Barnette's vehicle, driven by her brother, John Wesley Winters Jr., in Prince William County, in northern Virginia later on Saturday night. Winters lived in the apartment with his sister.
Winters was taken to Sentara Hospital in Woodbridge, Va. and is being held in the Prince William County Adult Detention Center.
Barnette's family asked police to conduct a well-being check on her, and her body was found in her apartment.
Knightdale police have not said how Barnette died and they have not directly connected Winters to her death.
As of press time, Knightdale police were seeking a search warrant to further investigate any role Winters might have had in his sister's death.
Knightdale police have charged Winters in connection with the vehicle's theft and he was scheduled to appear in court Tuesday, Oct. 15 in Prince William County. Winters will appear in court there because Virginia police served the arrest warrant for the theft charge.
Knightdale police are still working with Virginia authorities to determine whether Winters had any connection with Barnette's death.
If police pursue the case as a murder, it will be the second murder in Knightdale's history. The first happened in 2010 when Travis Sherman of Raleigh bludgeoned Knightdale Domino's manager Kenneth Ring to death.
Sherman received a life sentence for that murder.
Hankerson: 919-829-4826; Twitter: @easternwakenews


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Baseball falls to #5 Florida State, 11-10, in 13 innings
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After five hours, another epic battle eventually came to an end when Mike McGee hit an RBI single in the bottom of the 13th as the JU baseball team fell to No. 5 Florida State, 11-10, Tuesday evening at Dick Howser Stadium.
JU (20-19), which tallied 10 runs in back-to-back games in Tallahassee for the first time in program history, could not overcome 20 walks, three wild pitches and a hit batsman by the pitching staff.
FSU (34-11), which left a game-high 19 batters on base, rallied from a three-run deficit in the 12th inning by taking advantage of two costly fielding errors by the Dolphins.
"There is not anything you can say with a loss like this," said Alexander. "It hurts to go through it after all of that effort but it happens. Our job now is to forget and lace them up again tomorrow."
Freshaman Matthew Gaine (0-1) was tagged with the loss after allowing a run on one hit with two walks in the 13th. Sophomore Clay Kollenbaum kept the Dolphins in the contest with 3.1 innings of scoreless relief. Senior Glenn Witkowski got the no-decision after allowing one run on two hits with a walk in two innings of work.
Robert Benincasa (2-0) got the win after despite allowing three runs on four hits with two walks and two strikeouts. Hunter Scantling also got the no-decision after allowing three runs on seven hits with five strikeouts in four innings.
Freshman designated hitter Adam Brett Walker led the Dolphin onslaught by going 4-for-7 with a double, a home run and a career-high five RBI. Freshman center fielder Dan Gulbransen added three hits while junior catcher Alex Swenson, senior first baseman Alex Martinez and sophomore left fielder Jonathan Murphy also finished with multiple hits.
Jayce Boyd led the Seminoles by going 3-for-6 with a double while McGee finished 2-for-6 with three RBI.
The Seminoles took a 1-0 lead in the first when Stuart Tapley drove in a run with a fielder's choice to third.
The Dolphins opened up a 3-1 advantage in the fourth when Walker hit an RBI single and Swenson hit a two-run double.
Martinez led off the inning with a single up the middle and then advanced to second on a single to left center by Gulbransen. In the next at-bat, Walker pulled a ball through the left side to score Martinez. After senior second baseman Chuck Opachich advanced both runners with a sacrifice bunt, Swenson followed with a double down the third base line.
FSU cut the deficit to 3-2 in the fifth whe McGee hit a sacrifice fly to deep center. The Seminoles appeared to tie the game with a shot off the bat of Tapley with a runner on third but the ball went directly at sophomore Baker Chapman and knocked his glove on the ground. The ball popped out of the glove when it hit the ground and Chapman was able to throw to first to end the inning.
The Seminoles took a 6-3 lead in the sixth after scoring four runs on only one hit while talking advantage of four walks, a hit batsmen and two sacrifice flies.
The Dolphins cut the margin to 6-4 in the seventh when Murphy hit an RBI grounder to second.
FSU made it 7-4 in the bottom of the seventh when James Ramsey hit a sacrifice fly to right.
JU evened the contest, 7-7, in the eighth when Walker hit a three-run homer.
Martinez and Gulbransen led off the inning with back-to-back singles before Walker hit his team-leading 13th round tripper over the right field wall.
The Seminoles threatened with runners on second and third with no outs in the bottom of the ninth but Kollenbaum got two strikeouts and fly to right by Stephen Cardullo to end the inning unscathed.
FSU had another bases loaded threat in the 10th but Kollenbaum got a grounder to junior third baseman Glen Johnson who snared it and forced the runner at second to end the threat.
With the contest tied, 7-7, in the 12th, Walker gave JU the lead with a double to right center. Swenson plated another run with a sacrifice fly to right before Murphy dropped in an RBI single to right.
The Seminoles evened the game, 10-10, in the bottom of the 12th when pinch-hitter Sean Gilmartin hit a two-run single to right and a run scored from third on a wild pitch.
The Dolphins will conclude their trip through Tallahassee against Florida A&M on Wednesday at 4 p.m. The contest can be followed through live stats by logging onto JUDolphins.com.


text: What organizes these rings so well? With chaotic formation of ring+moon systems, one would think that rings would be at some angle to the equator, and be "thick", shaped more like a donut than a plate. Yet they are over the equator and thin layered to within a part per million, IIRC. What makes them so "perfect"?


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Festivals have changed dramatically in this time - when the first T in the Park took place in 1994 the only other UK festivals were Glastonbury, Reading and WOMAD - now there are literally hundreds all over the country and they have gone from just being a place where you watch bands outdoors, to an entire four day experience or a long weekend away.
It's a Wednesday night in early January and as George Frakes takes to the stage of this cosy north London boozer, clad in a mishmash of tweed and velvet, there's an air of the English Gent to him. While the crowd at The Wheelbarrow may be rather thin on the ground, those who have turned out are reverent in their hushed appreciation.


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FOR IMMEDIATE RELEASE: July 4, 2012
Boil Water Advisory Rescinded limits
A Boil Water Advisory issued by the KCMO Water Services Department on July 3, 2012 has been cancelled at 2:45 p.m. on July 4, 2012.
The affected area is south of I-70 to 87th Street, and Blue Ridge Cutoff east to the city limits.
Customers no longer need to boil water prior to drinking or cooking.
Tests on the water show it meets requirements for public drinking water and is safe to drink without boiling.
This precautionary Boil Water Advisory was issued due to low water pressure as a result of electrical power issues at a pump station.
For more information about the boil advisory contact Water Services Dispatch Office at 816-513-0416.
For media inquiries, contact Colleen Doctorian, public information officer for the Water Services, at 816-513-0232.
Kansas City, Mo., Water Services maintains and operates water collection, processing and distribution systems, stormwater management and control systems, and waste water collection and processing systems for residential and business customers in Kansas City and for wholesale customers in the Kansas City region. Operation is funded entirely by fees charged to customers based on their use of products and services, not by taxes.
Follow Kansas City Water Services on Facebook under Kansas City Water Services and on Twitter at www.twitter.com/kcmowater.


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Del. John Cosgrove will join Old Dominion University students, faculty and staff in celebrating Veterans Day with a ceremony on Kaufman Mall at 12:20 p.m. Thursday, Nov. 11.
Cosgrove, a 1985 graduate of Old Dominion and a Naval Reserve officer, will deliver remarks at the ceremony. Capt. Erich Fellenz, a senior Army ROTC instructor at Old Dominion, and Maj. Robert Strong, a Marine Corps instructor, will also offer their personal experiences and reflections. Fellenz served as a special operations commander for seven months in northern Iraq and Strong, a helicopter pilot, has served mulitple tours in both Afghanistan and Iraq.
John Towell '50, a World War II and Korean War Veteran, will participate in a celebratory flag raising and The Faithful Men, under the direction of Nancy Klein, will provide music.
The event is open to the public. A rain site has been set in Webb University Center.
This article was posted on: November 8, 2004
Old Dominion University
Office of University Relations
Room 100 Koch Hall Norfolk, Virginia 23529-0018
Telephone: 757-683-3114
Old Dominion University is an equal opportunity, affirmative action institution.


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In this Sept. 1, 1994 file photo, George W. Bush looks to the sky during a dove hunt in Hockley, Texas during his first Texas gubernatorial campaign. Anticipating some dove hunting on a 100-plus degree day during Sept. 2000, Bush explained that the birds could be marinated, but "I'm probably just going to throw them right on the grill."
Credit: AP Photo/File, David J. Phillip


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Check Wikipedia
by Trey Rentz, Thu Oct 28, 2010 at 01:00:33 PM EDT
Check Wikipedia, and you might find something interesting. I have noticed that the record of several congressmen, in my state, is being actively distorted and misrepresented in their wikipedia article.
Case in point, my Local Congressman. He voted for healthcare reform, from a heavily republican district. At a town hall meeting, the GOP sent a bunch of people to stack and disrupt the meeting. He calls them out on it, and it gets reported in the newspaper. But the way it gets written into his Wikipedia article is that he was angry at everyone who showed up, and wouldn't let anyone provide any feedback on the issue. This is not the case. I wrote to the guy several times, and he sent I and my wife several replies. He took in all of his constituency, in his vote for Healthcare Reform. I remember him thinking about it carefully. He finally voted for it.
The fun part is, that if you read his Wikipedia article (at least, the draft that was there before I just finished correcting it) - it does not mention anything else about healthcare reform except a meeting in which most of the people from the meeting that attenended, weren't even from his own constituency. It was a stacked meeting, that was made just to eff with him. Later on, apparently, they painted a swastika on his office. Y'all just don't get that kind of fun up in New England. But this is just the kind of dog and pony show that GOP activists love to play. They did this when they tried to put Nixon in power. This guy really sat down with people in his district, I remember his vote was cast very carefully. The article seems to suggest he just bulldozed everyone in his district. Not so.
I'm not completely happy with my congressman, but we should remember that the reason the House of Representatives is getting so much heat this election cycle is that the Big Pharma lobbyists, that are feeling the pull of their now-very-easy-to-hide corporate lobbyist power (thanks to the supreme court decision that opened the floodgates) - really hated the concept that there was a public option in healthcare reform. The money is flowing into the GOP bigtime. 85% of all lobbyist money is now flowing into the GOP and they want desperately to control the house.
My rationale for asking you to check wikipedia is pretty simple. I rely on it. It is usually a decent source of information. If the activists who want to distort the record of congress - need to screw with it, my advice is screw it right back until it's factual. And honest. Don't do it just for kicks, do it because it's the right thing to do.
After all, on the issue of Healtcare Reform - I am reminded of a sign that I saw in the Great Bush Election of 2000...
The one that said. "Number of children uninsured, by country"
England 0
Germany 0
France 0
Spain 0
Canada 0
America 11,000,000
Tension was running high then, on the subject of healthcare reform - and it is even today. But if the vote were accurately counted in 2000, instead of distorted... what would our country look like today?
So. My advice is. Check Wikipedia. See if it's wrong. And if so, correct it. Most people are going to try to fact check their candidate. The number one thing you can do is make sure the facts are correct.
Do this, and you'll probably be ok. People haven't forgotten that they are in charge. But they don't count on factual distortion.
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The Takeaway: Helen Mirren's Best Body; The Aging Well Edition
Posted on 08/3/2011 by Tina Johnson-Marcel |The Takeaway | Comments
Bulletin TodayHelen Mirren takes the crown again. The sexiest woman over 50 has a new title: Best body. According to an L.A. Fitness poll, the 66-year-old was named female celebrity with the best body – beating Elle "The Body" MacPherson, Jennifer Lopez, Kate Winslet and Pippa Middleton. But we already knew this.


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Health Care Reform Memo: September 10, 2012
Deloitte Center for Health Solutions publication
The health care reform memos are issued on a weekly basis, highlighting news from the previous week's activities in the administration and implications for the C-suite and various stakeholder groups.
My take: 10 myths of health reforms
From Paul Keckley, Executive Director, Deloitte Center for Health Solutions
The Charlotte and Tampa conventions are now in the books and the closing stretch of the Campaign 2012 season ahead. In 57 days, we will elect 435 members of the House of Representatives, 33 senators, 11 governors and the president and vice president of the United States.
Walking down Tryon Street Wednesday in Charlotte amidst the banners, campaign paraphernalia, and protesters, I found myself reflecting on the complexity of our elective system: our democracy assures citizens a right to vote if older than 18. It leaves it to states to determine how prisoners and those on probation are to be included, and how the voting processes are to be conducted, but by and large, it's a nationalized process reinforced thru a variety of follow-on laws (e.g., Voting Rights Act of 1965) and amendments (e.g., 15th Amendment) intended to secure the right to vote. It's that simple. More than $11 billion will be spent in this election cycle to sway voters, and the stakes for the health care industry are high.
As I listen to speeches and watch the campaigns unfold, I am often frustrated that complex health care issues are disposed of in slogans, pundit talking points, and sound bites. Health care is complex: its issues are complicated and solutions in some cases are not clear. And I bristle at how frequently candidates opine on these issues harkening to what "the American people want…" though no two seem to have the same read on exactly who they are or what they want. To that end, here are my "Top 10 Myths of the Health Reform Debate" as a listener guide for the final run in the Campaign 2012 season:
Myth: Most Americans like our current system. They want the current system protected at all costs.
Fact: The majority of Americans think the current system is inefficient, expensive, and wasteful, and the most satisfied constituents are seniors and those enrolled in the military health system. Our polls say the public wants to see the system fixed, using technologies that reduce paperwork, redundancy, and error, and expand the roles for pharmacists and nurses in the delivery of care.1 And the public is increasingly concerned about its costs.
Myth: Most Americans understand the U.S. system and think it's better than others.
Fact: Most Americans do not understand our system. They understand the doctors, hospitals, insurance plans, and constellation of public and private health programs they use in their local communities. And only a handful has direct knowledge of systems in other countries. Notably, our polls of consumers in countries like France, Germany, Switzerland, and others reveal their constituents understand their systems more and rate their system more highly than U.S. citizens rate ours.2
Myth: There's not enough money in the U.S. health system.
Fact: There's plenty of money in the U.S. system: almost $9,000 per capita.3 But it's spent in the places where our incentives direct: ours is a high-tech system built around cures and fixes to complicated problems. Incentives to prevent disease are modest; incentives to fix problems later are attractive. And it costs more to fix a problem than to prevent it. Little surprise only 1 in 10 students entering medical school envisions a career in primary care, and developed systems of the world have better preventive health outcomes than the U.S., especially when comparing lower income cohorts across countries. And, ours is not an organized system: it's a complicated array of highly regulated, capital intense, labor intense sectors—each setting its own rules virtually independent of others. Administrative waste is rampant because integration and coordination across silos is minimal. There's plenty of money to go around; there's no agreement on who should get the money or how to re-set the allocations.
Myth: Government health care programs—Medicare and Medicaid—are poorly managed and need overhaul.
Fact: The administrative costs of these programs are less than the administrative costs paid by employers for commercial coverage: 5-6 percent versus 7 percent, respectively.4 That said, the costs of these programs are soaring due to increased enrollments and rising costs for the health services they use. Their overhaul is necessary because the costs are not sustainable due not to the ineptitude of administrators but the realities of demand and medical inflation.
Myth: There is a shortage of primary care physicians.
Fact: If the presumption is that ONLY MDs/DOs are capable of providing primary care to patients and current incentives to treat continue to be based on visits, not results, then the statement's accurate. But if new incentives for managing health, technologies to enable self-care, and practitioners including nurses, nutritionists, pharmacists, and counselors were allowed to practice to the full extent of their training, there would be no shortage. The myth presumes a reformed system where sick-care and well-care are not appropriately balanced and funded.5
Myth: The major driver of health costs is unhealthy lifestyles, and the Affordable Care Act (ACA) doesn't address this at all.
Fact: Costs associated with chronic diseases like obesity, diabetes, asthma, and lifestyle choices like drug abuse, smoking, and hang gliding contribute, but other root causes also contribute: incentives to do more tests and procedures instead of only when necessary per the evidence, underlying costs of technologies and facilities that in many cases are driven by financial or competitive opportunities rather than clinical need, and regulatory compliance costs add to the cost spiral.6 It's not one of these; it's all of them in tandem. And the ACA has a number of provisions that address lifestyle and chronic challenges—essential health benefits must include programs to address them, the National Quality Strategy for Quality Improvement in Health Care, released by the U.S. Department of Health and Human Services (HHS), must advance innovation in finding new solutions like medical homes and accountable care, and expansion of access to primary care services are three among many new solutions. But the major presumption of ACA relative to lifestyle issues is this: access to health insurance for 32 million newly insured Americans will put a dent in unhealthy lifestyles by taking down a barrier to the system's providers and programs.
Myth: The ACA does nothing to lower costs.
Fact: The ACA includes a complicated set of demonstrations and pilots that "might" bend the curve—avoidable readmission penalties to hospitals, limitations on physician self-referrals and private inurement, increased transparency to equip consumers to understand treatment options and underlying evidence, and others. But its major tenet for cost reduction is often missed: by increasing access to insurance coverage for 32 million, changing incentives from fee-for-service to performance and value, and requiring use of information technologies to improve diagnostic accuracy and reduce error, it fundamentally alters the center of gravity from a paternalistic system in which patients are told what to do, to a consumer-directed system in which individuals bear more responsibility for their own decisions. Therein, cost reduction might be achieved most significantly.7
Myth: Most of the care that's recommended is necessary. And most of what the system spends is therefore appropriate and unavoidable.
Fact: To be fair, no one knows for sure. The evidence supporting most of what medical professionals do is scant, and as they develop powerful tools for mining clinical data, they're finding that the more they learn about the intersection of signs, symptoms, risk factors, co-morbidities, and genotypic predictors, the more complicated it gets.
Here's what we know: where one lives is a determinant of the quality of care received with widespread differences in standards of care comparing communities. Per the Institute of Medicine (IOM), adherence to evidence-based practices by clinicians is highly variable, with as much as 30 percent to be saved if evidence was consistently applied to treatment recommendations and patient management.8 The issue is not defending waste due to unnecessary care, it's about providing tools—data and information technologies—to clinicians and consumers that are useful in making decisions, and creating an environment based on tools, not rules, where information-driven health is foundational to diagnosis and treatment. It's about medication adherence—by clinicians that appropriately prescribe and dose, and consumers who take meds as directed. And along the way, liability reform will help. So for accuracy, most of the care is probably necessary but a substantial amount isn't, and knowing the differences between the two is essential to better health and lower costs.
Myth: The health insurance industry is the problem, and its fate uncertain.
Fact: The health insurance industry is a convenient punching bag for policymakers and campaigns. Its role as protagonist for evidence-based care, narrower high performing networks of providers, transparency about costs and quality, and healthy living would seemingly get accolades, but criticism is more the rule than exception. So amidst the banter, there are two reasons insurance as an industry will thrive in coming years: (1) employers and consumers value financial security resulting from insurance coverage: they want to keep coverage; (2) enrollment in managed care will increase: it's ironic to "beat up" on insurance when virtually every state is implementing managed Medicaid via private plans and Medicare Part D is wildly popular, and state and federal programs like Medicare and Medicaid will increasingly embrace managed care in their program designs to lower costs and coordinate care better.9 The demise of the industry is a myth. The transformation of the insurance industry is certain. The problem with the health system is not one sector; it is structurally flawed, fragmented, and expensive. It's not one sector's fault.
Myth: Health reform is about the future of the ACA.
Fact: The compelling issue about health care is cost. Regardless of the election outcome, policymakers and the industry must grapple with the system's costs as a priority. At 17.6 percent of the U.S. gross domestic product (GDP), 25 percent of the federal budget, 23 percent of the average state budget, and 19 percent of household discretionary spending, it's the elephant in the room. The big question in health reform is this: is our system performing at a level that's commensurate with the value it adds in communities, companies, and households, and if not, how can the value gap be bridged? It's about cost versus results, perception versus reality, platitude versus pragmatics, theory versus practice, and wants versus needs. It's not about physician income, offshoring the health care workforce, or political posturing to delay decision-making to get through election cycles. It's the national discussion we have to have regardless of the ACA.10
So with the conventions behind us and 57 days until elections, no doubt health care will be front and center in advertising and campaign rhetoric. I hope the discussion is fact-based; and I pray our elected officials steer clear of mythology that might cloud meaningful discussion about health reform and the future of the U.S. health system.
Paul Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutions
1 Deloitte 2012 Survey of U.S. Health Care Consumers: The performance of the health care system and health care reform, Deloitte Center for Health Solutions, June 2012
2 2011 U.S. and Global Survey of Health Care Consumers, Deloitte Center for Health Solutions, June 2011
3 National Health Expenditure Projections: 2010-2020, U.S. Department of Health and Human; Center study of discretionary spend ; Robert Wood Johnson Foundation, "High and rising health care costs: Demystifying U.S. health care spending", Oct. 2008; Journal of the American Medical Association
4 "Eliminating Waste in U.S. Healthcare", March 2012; Congressional Budget Office; "Medicaid Works: A Review of How Public Insurance Protects the Health and Finances of Children and Other Vulnerable Populations, Leighton Ku and Christine Ferguson, June 2011
5 The new health care workforce: Looking around the corner to future talent management, Deloitte Center for Health Solutions with the Bipartisan Policy Center, October 2011
6 Robert Wood Johnson Foundation, "High and rising health care costs: Demystifying U.S. health care spending", Oct. 2008; Journal of the American Medical Association, "Eliminating Waste in U.S. Healthcare", Mar. 2012; Congressional Budget Office, "Technological Change and the Growth of Health Care Spending", Jan. 2008; Centers for Disease Control and Prevention, "Chronic diseases: the power to prevent, the call to control", 2009; Medicaid Works: A Review of How Public Insurance Protects the Health and Finances of Children and Other Vulnerable Populations, Leighton Ku and Christine Ferguson, June 2011
7 CBO and JCT, Baseline Budget Projections for 2011 and 2012, Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the Recent Supreme Court Decision
8 Institute of Medicine, The Healthcare Imperative: Lowering Costs and Improving Outcomes, 2010; Philip Ellis, et al, Health Affairs, "Wide Variation In Episode Costs Within A Commercially Insured Population Highlights Potential To Improve The Efficiency Of Care," September 2012 ; Institute of Medicine, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America," September 6, 2012
9 Patient Protection and Affordable Care Act; CBO, Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act , March 2012 and, Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the Recent Supreme Court Decision July 2012; KRC Research, "Seniors' Opinions About Medicare Rx: Sixth Year Update," October 2011
10 2012 Deloitte Survey of U.S. Employers, Deloitte Center for Health Solutions, July 2012; Bending the Cost Curve, Deloitte Center for Health Solutions; Deloitte Survey of U.S. Health Consumers
Special feature
Health care platforms coming out of the national conventions
The platforms of the two parties reinforced prominent themes in the campaigns:
- The Democratic National Committee (DNC) platform follows the ACA closely with added emphasis on women's and children's health issues and increased funding to increase access to health insurance and providers for those without.
- The Republican National Committee (RNC) platform reinforced the role of private health insurance plans as options in a Medicare premium support program (similar to Part C and Part D already implemented) and state flexibility in managing Medicaid and dual eligible populations.
|DNC Health care platform
|RNC Health care platform
|Access to health services or insurance
|Reduce costs
|Quality and safety
Source: 2012 Republican National Convention Platform, 2012 Democratic National Convention Platform
Implementation update
IRS provides guidance to employers on shared responsibility requirement
Last week, the U.S. Internal Revenue Service (IRS) issued a notice describing safe harbor methods employers may use to determine which employees are treated as full-time employees for purpose of the shared employer responsibility provisions per Section 4980H of the Internal Revenue Code amended by Section 1513 of the ACA. In its notice, the IRS:
- Expands the safe harbor method described in a previous notice to provide employers the option to use a look-back measurement period of up to 12 months to determine whether new variable hour employees or seasonal employees are full-time employees, without being subject to a payment under Section 4980H.
- Provides employers the option to use specified administrative periods for ongoing employees.
- Facilitates a transition for new employees from the determination method the employer chooses to use for them to the determination method the employer chooses to use for ongoing employees.
- Permits employers of ongoing employees to use measurement and stability periods of up to 12 months.
- Clarifies that an employer that maintains a group health plan that meets certain requirements will not be subject to an assessable payment for failing to offer coverage to the employee for the initial three months of employment for new employees who are reasonably expected to work full-time.
- Clarifies that for all employees, an employer will not be subject to an assessable payment for an employee if the coverage offered to that employee was affordable based on the employee's Form W-2 wages reported in Box 1 (often referred to as the affordability safe harbor).
Guidance on 90-day waiting period limitation for employee health coverage issued
Last week, the Center for Consumer Information and Insurance Oversight (CCIIO), in coordination with HHS, the U.S. Department of Labor, and the U.S. Department of the Treasury, issued guidance to group health plans and insurance issuers offering group health insurance coverage. The guidance includes several examples to illustrate how the "design to avoid compliance with the 90-day waiting period limitation" standard applies to various plan eligibility conditions. Comments on the guidance will be accepted until September 30, 2012. Also noted in the guidance:
- Eligibility based solely on the lapse of a time period cannot exceed 90 days
- A plan issuer will not be penalized if an employee opts to take more than 90 days to decide to enroll in the plan offered
Background: per Section 2708 of the Public Health Service Act, amended by Section 1201 of the ACA, for plan years beginning on or after January 1, 2014, "a group health plan or health insurance issuer offering group health insurance coverage shall not apply any waiting period that exceeds 90 days."
ACA civil rights protections apply to individuals who are transgender
The HHS Office of Civil Rights responded to a letter of inquiry from the National Center for Lesbian Rights affirming that Section 1557 of the ACA sex discrimination prohibition also applies to gender identity, including protection for individuals who do not conform to stereotypical notions of masculinity or femininity.
Background: Section 1557 prohibits the discrimination, the denial of benefits, or the exclusion of participation in any health program or activity, any part of which is receiving federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an executive agency or any entity established under Title I of the ACA or its amendments based on sex, race, color, national origin, age, or disability. It does not require health plans to adopt additional services or coverage; however, more and more employers are beginning to cover procedures to meet the needs of individuals who are transgender.
Legislative update
Expanded mental health services for veterans and service members authorized by Executive Order
Last week, President Obama issued an Executive Order to expand mental health services for service members, veterans, and their families to address increasing rates of suicide and post-traumatic distress disorder (PTSD) in the military. The Executive Order encourages the U.S. Department of Veterans Affairs (VA), HHS, and the U.S. Department of Defense to collaborate to expand capacity for mental health programs and services. Specifically, the order calls for:
- Increased capacity of the Veterans Crisis Line by 50 percent by December 2012 to ensure that veterans have timely access—including by telephone, text, or online chat, to qualified—caring responders who can help address immediate crises and direct veterans to appropriate care
- Development and implementation of a 12-month national suicide prevention campaign focused on connecting veterans and service members to mental health services
- Evaluation of all existing mental health and substance abuse prevention, education, and outreach programs across the military services and the Defense Health Program to identify the key program areas that produce the greatest impact on quality and outcomes, and rank programs within each of these program areas using metrics that assess their effectiveness
- Enhanced partnerships between the VA and community providers
- Increased use of peer-to-peer counselors—by December 2013, the Secretary of the VA must hire and train 800 peer-to-peer counselors to empower veterans to support other veterans and help meet mental health care needs
- Improved research and development
- Establishment of a Military and Veterans Mental Health Interagency
State update
HHS collaborating with states in education about health exchanges
Last week HHS began hosting conference calls by region to discuss "strategies to educate the uninsured, under-insured and small businesses about expanded coverage options" and to update stakeholders on the latest implementation information regarding health insurance exchanges (HIXs).
State round-up
- Tuesday, Standard and Poor's (S&P) announced that Massachusetts's latest health reform legislation could harm providers' credit ratings. The press release stated that ratings will likely remain stable for the next year and half, but over a longer period providers could be at a disadvantage if they are unable to cut costs deeply or quickly enough to meet the law's requirements. S&P believes the law may compress the operating margins of the state's health care providers, although not all possible effects are clear.
Background: on August 6, 2012, Governor Deval Patrick (D-MA) signed a cost containment bill into law requiring health care providers across Massachusetts to limit spending increases to a rate no greater than the gross state product (GSP) through 2017 and at half a percentage point below the GSP for the following years or face a $500,000 penalty.
- Georgia launched a telemedicine initiative to increase access to health care providers in rural provider shortage areas. Ware County, a rural community in Georgia, has installed videoconferencing equipment in all of its schools so approximately 5,800 students may have access to physicians remotely. While rural communities have been using telemedicine for some time, with the ACA's impending expansion of health insurance coverage in 2014, Georgia is one of a few states pro-actively exploring teleconferencing technology to help ensure newly insured individuals have access to health care.
- California legislators endorsed a Kaiser small group health maintenance organization (HMO) plan as the state's essential health benefit benchmark.
- The District of Columbia submitted to HHS a letter of declaration stating its intention to operate its health exchange. The exchange board also met last week to discuss proposals to consolidate the District's small business and individual markets into one exchange.
- The California Health Care Foundation released a report examining the state's transition of Medicaid beneficiaries from FFS models to managed care. The report recommended that states allow more than seven months to implement the transition, develop outreach, engagement, and care management strategies for specific populations, and conduct extensive outreach to high-volume providers. Findings from the report include:
- Beneficiaries "experienced anxiety due to confusion and concern over whether or not they would still be able to see their current primary care physician, specialists and mental health providers" as well as those who provided their prescriptions and medical equipment, according to providers, advocates and others who had contact with them."
- Many had trouble understanding the complex written materials they received, and fewer than half of the health plans offered individual counseling or support to beneficiaries by telephone.
- Health plans reported out-of-date contact information for many beneficiaries and said they had difficulty recruiting FFS providers to their networks.
- While most health plans reported they trained staff to work with beneficiaries to provide "information, support and care coordination," stakeholders said this service should have been offered earlier in the transition period to managed care, rather than once beneficiaries were enrolled in a plan and needed medical care.
Background: on November 1, 2010 the Centers for Medicare & Medicaid Services (CMS) approved the state's "Bridge to Reform" Social Security Administration Section 1115 waiver, authorizing the state to expand mandatory managed care for seniors and people with disabilities. Per Section 2602 of ACA, the Federal Coordinated Health Care Office was created to oversee demonstration projects to find better care models. Twenty-six states—including California—have submitted proposals.
- The state attorney general of Maine, on behalf of Governor Paul LePage (R), filed a motion for the First Circuit Court of Appeals to review "the failure" of (CMS) to act upon the state's request for a Medicaid amendment.
Background: on August 1, 2012, Maine filed the amendment and requested that CMS expedite its review and approve the plan by September 1, 2012. On August 31, CMS issued a letter to the state indicating that it would not provide an expedited response to the amendment plan. The proposed program cuts are projected to cut almost $20 billion from the state's Medicaid expenses.
Industry update
Study: hospital-acquired urinary tract infection data inaccurate
A study by University of Michigan researchers found that most hospital reported data used by Medicare to determine non-payment of catheter-associated hospital-acquired urinary tract infections (CAUTIs) was inaccurate. A statewide analysis found that for all adult hospital stays in Michigan in 2009, eliminating payment for this infection decreased hospital pay for 25 hospital stays (0.003 percent of all stays). In 2009, 2.6 percent of hospital-acquired UTIs were described as CAUTIs, and hospitals requested payment for non-CAUTIs as secondary diagnoses for 10.3 percent of all discharges. According to researchers, the findings suggest that billing data is inaccurate for comparing hospitals by their catheter-associated UTI rates, and hospitals that report accurately in claims data will be unfairly penalized because their reported rates will be higher.
Background: the Deficit Reduction Act of 2005 requires a quality adjustment in Medicare Severity Diagnosis Related Group payments for certain hospital-acquired conditions. For discharges occurring on or after October 1, 2008, hospitals do not receive the higher payment for cases when one of the selected conditions is acquired during hospitalization—including UTIs in patients after bladder catheters are placed.
(Source: Jennifer Meddings, et al, Annals of Internal Medicine, "Effect of Nonpayment for Hospital-Acquired, Catheter-Associated Urinary Tract Infection: A Statewide Analysis," September 2012)
FDA approves new orphan drug for cancer patients
Last week, the U.S. Food and Drug Administration (FDA) approved a Pfizer manufactured drug, Bosulif, to treat chronic myelogenous leukemia (CML)—a disease that is most prevalent among older adults. In 2012, it is estimated 5,430 men and women will be diagnosed with CML. Bosulif is recommended for use in patients with chronic, accelerated, or blast phase Philadelphia chromosome-positive CML who have not responded well to other therapies.
Study: silent heart attacks common, may predict risk of death
Silent heart attacks are more frequent than previous studies have reported, especially in older adults with diabetes according to a study conducted by the National Heart, Lung, and Blood Institute, the National Institute on Aging, and the Icelandic Heart Association. Of 1,000 study participants between the ages of 67 and 93, 21 percent with diabetes and 14 percent without diabetes were found to have had silent heart attacks, compared to 11 percent with diabetes and 9 percent without diabetes who had recognized heart attacks. Researchers also found that magnetic resonance imaging (MRI) is more effective than electrocardiography (ECG) at identifying "silent" heart attacks. Those identified by cardiac MRI were associated with a higher risk of mortality than those identified by ECG; however, participants who had either form of heart attack were significantly more likely to die than those who had neither. The study also found that even though people with silent heart attacks displayed many cardiovascular risk factors associated with recognized heart attacks (i.e., high blood pressure and evidence of atherosclerosis) 36 percent who had a silent heart attack were taking medications such as statins or aspirin compared with 73 percent of survivors of recognized heart attacks.
Note: according to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for both men and women. Heart disease caused almost 25 percent of deaths—almost one in every four—in the U.S. in 2008. More than half of the deaths due to heart disease in 2008 were in men.
(Source: Andrew Arai, National Institutes of Health, "Silent heart attacks are common and predict risk of death, MRI diagnosis shows," September 2012)
Study: consumer satisfaction slightly higher among enrollees with traditional plans compared to high deductible plans
A survey released last week indicates that traditional plan enrollees were more likely than those with a consumer-directed health plan (CDHP), or high deductible health plan (HDHP) to be extremely or very satisfied with their overall plan from 2006 to 2011. In 2011, 57 percent of traditional plan enrollees were extremely or very satisfied with their overall health plan (down from 60 percent in 2010), compared with 46 percent (up from 43 percent in 2010) of CDHP enrollees and 37 percent of HDHP enrollees (up from 34 percent in 2010). Other notable findings include:
- 41 percent of traditional plan respondents were more likely to be either extremely or very satisfied with out-of-pocket costs for health care services other than for prescription drugs, while 16 percent of HDHP enrollees and 24 percent of CDHP participants were extremely or very satisfied
- 13 percent of CDHP enrollees were extremely or very satisfied with their ability to get doctor appointments, compared with 68 percent among traditional plan enrollees
- 49 percent of traditional plan enrollees were extremely or very likely to recommend to recommend their health plan to friends or co-workers and to stay with their current health plans if they had the opportunity to switch plans their plan compared with 41 percent of CDHP enrollees, and 29 percent of HDHP enrollees
(Source: Employee Benefit Research Institute, "Satisfaction With Health Coverage and Care: Findings from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey", August 2012)
Study: wide variation across markets in quality, costs
A recent analysis of nearly 250,000 U.S. physicians serving commercially insured patients nationwide concluded that episode costs for selected set of common chronic conditions varied at a far greater rate than major medical procedures (15-fold vs. 2.5-fold) across markets. Researchers also reviewed data on quality and efficiency patterns and found that among physicians meeting quality and efficiency benchmarks costs for episodes of care were on average 14 percent lower than among others. Although some markets experienced a much higher variation in episode costs than others, there was no correlation between average episode costs and measured quality across markets. The study concluded that "changing incentives through payment reforms could help to improve performance, but providers are at different stages of readiness for such reforms and thus will often need support in order to succeed". Notable findings:
- Median costs for treatment generally fell in the range of $350–$650, but median costs for diabetes were substantially higher ($1,103)
- For major procedures, the variation in episode costs across markets was somewhat larger in percentage terms and much larger in dollar terms than the variation for chronic conditions
- Arthroscopic knee surgery with ligament repair was $2,990 in low-variation areas compared to $8,163 in high-variation areas, or nearly three times more variable
- For common chronic conditions across different geographical regions average costs in low-cost markets were typically 15–20 percent below the median, while average costs in high-cost markets were about 15–20 percent above the median
(Source: Philip Ellis, et al, Health Affairs, "Wide Variation In Episode Costs Within A Commercially Insured Population Highlights Potential To Improve The Efficiency Of Care," September 2012)
IOM: better use of technology needed to reduce cost
Last week, the IOM Committee on the Learning Health Care System in America released a report exploring the challenges to health care today, providing recommendations for creating a continuously learning healthcare system. The committee identified three major imperatives for change: the rising complexity of modern health care, unsustainable cost increases, and outcomes below the system's potential. According to the report around 30 percent of health spending in 2009—roughly $750 billion—was wasted on unnecessary services, excessive administrative costs, fraud, and other problems, and costs of the system's current inefficiency underscore the urgent need for a system wide transformation. The committee recommendations include:
- Improve the capacity to capture clinical, care delivery process, and financial data for better care, system improvement, and the generation of new knowledge
- Accelerate integration of the best clinical knowledge into care decisions
- Involve patients and families in decisions regarding health and health care, tailored to fit their preferences
- Promote community-clinical partnerships and services aimed at managing and improving health at the community level
- Continuously improve health care operations to reduce waste, streamline care delivery, and focus on activities that improve patient health
- Improve coordination and communication within and across organizations
- Structure payment to reward continuous learning and improvement in the provision of best care at lower cost
- Increase transparency on health care system performance
- Expand commitment to the goals of a continuously learning health care system
(Source: Institute of Medicine, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America," September 6, 2012)
"If a party is saying they're not going to touch Medicare, what they're saying is, they're going to allow it to go broke."
—Senator John Kyl (R-AZ), August 30, 2012
"Ladies and gentleman, it's just that simple: We are for Medicare; they are for Vouchercare."
—Vice President Joe Biden, September 3, 2012
"The president's approach to Medicare, which was supported by AARP—extended Medicare solvency for eight years. The savings all came from waste and fraud and subsidies that shouldn't have been going to the insurance companies, not a dime came from Medicare beneficiaries. The Romney/Ryan approach is voucherized Medicare. So when you run out of vouchers, seniors are going to be on their own… So I think on the question, in Florida and Ohio and other states of who do you trust to protect Medicare and who do you trust as we reduce our deficit to get the savings from the system, not putting it on the backs of Medicare beneficiaries, we think that's a debate we're well positioned to have, to execute and to win."
—David Plouffe, Senior Advisor to President Obama, ABC, "This Week," September 2, 2012
"A voucher system would do little to control the growth of health care costs, but it would shift their burden onto Medicare beneficiaries in the form of higher premiums and reduced care. Cost-shifting should not be confused with cost containment…the evidence has confirmed that competition among private insurance plans would not yield Medicare savings without harming beneficiaries. To achieve this goal, enforceable payment and cost-containment reforms like those in the Affordable Care Act are necessary."
—Laura D'Andrea Tyson, New York Times, "Evidence vs. Ideology in the Medicare Debate," August 24, 2012
Fact file
Funding sources in the ACA:
|10-year revenue estimate
|Effective date
|Individual mandate (Section 1501)
|Penalty of the greater of $695 or 2.5% of income per adult in the household for individuals who fail to obtain adequate coverage. Tax phases in beginning at the greater of $95 or 1% of income in 2014, reaching $695 or 2.5% of income in 2016 (indexed for inflation thereafter)
Exclusion for employer-provided health care for adult children up to age 26
|$27 billion
|Tax years beginning after Dec. 31, 2013
|Employer mandate (Section 1401, 1402)
Employers with at least 50 full-time employees are subject to nondeductible fees if they:
|$52 billion
|Tax years beginning after Dec. 31, 2013
|Medicare tax increases (Earned income, Section 9015)
|Additional 0.9% hospital insurance tax on wages over $200,000 ($250,000 for joint filers)
|$86.8 billion
|Tax years beginning after Dec. 31, 2012
|Medicare tax increases (Unearned income, Section 1402 Budget Reconciliation Act)
|3.8% Medicare contribution levied on certain unearned income of individuals with AGI over $200,000 ($250,000 for joint filers)
|$123.4 billion
|Tax years beginning after Dec. 31, 2012
|Excise tax on 'Cadillac' group health plans (Section 4980I)
|40% nondeductible excise tax for insurer on employer-sponsored insurance in excess of $10,200 for individuals ($27,500 for families), indexed for inflation
Premium thresholds for retirees and high-risk professions are increased by $1,650 for individuals ($3,450 for families)
|$32 billion
|Tax years beginning after Dec. 31, 2017
|Fee on health insurance providers (Section 9010)
|$8 billion for 2014, $11.3 billion for 2015 and 2016, $13.9 billion for 2017, and $14.3 billion for 2018; allocated to taxpayers based on net premiums for U.S. health risks
|$60.1 billion
|Calendar years beginning after Dec. 31, 2013
|Fee on branded drug manufacturers and importers (Section 9008)
|$2.5 billion for 2011, $2.8 billion for 2012 and 2013, $3 billion for 2014 through 2016, $4 billion for 2017, $4.1 billion for 2018, and $2.8 billion for 2019 and thereafter; Includes joint and several liability
|$27 billion
|Calendar years beginning after Dec. 31, 2010
|Excise tax on medical devices (Section 9009)
|2.3% excise tax on manufacturers and importers of certain medical devices
|$20 billion
|Calendar years beginning after Dec. 31, 2012
|Itemized deduction for medical expenses (Section 9013)
|Raise floor for itemized deduction for medical expenses to 10% of modified adjusted gross income (AGI) (from 7.5%); retain 7.5% floor for individuals (and their spouses) over age 65
|$15.2 billion
|Tax years beginning after Dec. 31, 2012; provision for individuals over age 65 expires Dec. 31, 2016
|Health flexible spending accounts (FSA, Section 9005)
|Limit annual salary-reduction contributions to health flexible spending arrangements in cafeteria plans to $2,500, indexed for inflation after 2013
|$13 billion
|Tax years beginning after Dec. 31, 2012
|Excise tax on indoor tanning services (Section 10907)
|Impose 10% excise tax on indoor tanning services
|$2.7 billion
|Services provided on or after July 1, 2010
|Definition of 'medical expenses' for employer-provided health coverage (Section 1302)
|Conform definition of medical expenses for purposes of health flexible spending arrangements, health reimbursements, health savings accounts, and Archer Medical Savings Accounts to the definition for the itemized deduction
|$5.0 billion
|Expenses incurred after Dec. 31, 2010
|Comparative Effectiveness Research Trust Fund (Section 9511)
|Impose fee on insured and self-insured health plans to finance patient-centered outcomes research trust fund
|$2.6 billion
|Effective for policies and plans for portion of policies or plan years beginning on or after Oct. 1, 2012
|Medicare Part D subsidy (Section 9010)
|Eliminate deduction for expenses allocable to Part D subsidy
|$4.5 billion
|Tax years beginning after Dec. 31, 2012
|Health savings account distribution (Section 9004)
|Increase penalty for nonqualified distributions from health savings accounts to 20%
|$1.4 billion
|Distributions made during tax years beginning after Dec. 31, 2010
|Executive compensation limits for health insurance Providers (Section 9014)
|Limit deduction on taxable year remuneration to officers, employees, directors, and service providers of covered health insurance providers to $500,000
|$600 million
|Remuneration paid in taxable years beginning after 2012, for services performed after 2009
|Special deduction for Blue Cross Blue Shield Organizations (Section 9016)
|Limit special deduction for organizations under section 833 in the case of organizations with a low medical loss ratio
|$400 million
|Tax years beginning after Dec. 31, 2009
|Tax treatment of 'black liquor' (Section 40(b)(6) IRS Code)
|Make 'black liquor' ineligible for the cellulosic biofuel producer credit
|$23.6 billion
|Fuel sold or used after Dec. 31, 2009
|Information reporting (Section 9006)
|Mandatory Form 1099 reporting for payments made to a corporation totaling $600 or more in a calendar year
|$17.1 billion
|Payments made after Dec. 31, 2011
|Economic substance (Section 1409 Budget Reconciliation Act)
|40% liability penalty on tax understatements attributable to undisclosed noneconomic substance transactions (20% if adequately disclosed)
|$4.5 billion
|Transactions entered into after date of enactment
|Charitable (Nonprofit) hospitals (Section 9007)
|Additional compliance and reporting requirements on section 501(c)(3) hospitals
|Taxable years beginning after date of enactment
|Veterans health care (Section 9011)
|Study and report on effect of the bill on veterans' health care
|Study and report on effect of the bill on veterans' health care
|Indian health benefits (Section 9021)
|Provide income exclusion for specified Indian health benefits
|Loss of less than $50 million
|For health benefits and coverage provided after date of enactment
|Cafeteria plan nondiscrimination safe harbor (Section 9005)
|Simplify cafeteria plan nondiscrimination safe harbor for certain small employers
|Tax years beginning after Dec. 31, 2010
|Qualifying therapeutic discovery credit (Section 9023)
|50% credit for qualified investment in a qualifying therapeutic discovery project of an eligible taxpayer
|Loss of $900 million
|For amounts paid or incurred after Dec. 31, 2008 to Dec. 31, 2010
|State loan repayment tax relief for health professionals (Section 10909)
|Provide exclusion from gross income for assistance provided to participants in state student loan repayment programs for certain health professionals
|Loss of $100 million
|For taxable years beginning after Dec. 31, 2008
|Modifications to adoption credit (Section 10909)
|Make adoption credit refundable, increase credit amount, and extend through 2011
|Loss of $1.2 billion
|For taxable years beginning after Dec. 31, 2009
Sources: Deloitte, "Prescription for change 'filled' Tax provisions in the Patient Protection and Affordable Care Act", March 2010, Patient Protection and Affordable Care Act; CBO, Joint Committee on Taxation, 'Estimated Revenue Effects of the "Reconciliation Act of 2010," As amended in Combination with the Revenue Effects of H.R. 3590, The "Patient Protection and Affordable Care Act (PPACA), March 2012.
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text:
You are a general manager. You desperately need starting pitching. Your owner keeps sending you passive-aggressive text messages on the subject. The injuries are piling up. You think you saw Matt Clement in the clubhouse. You need to act fast.
Your options:
Pitcher A used to be on the Royals, but he was traded to the Brewers for a substantial package of young players. For a while, things were great. They reached the NLCS together, and it looked like a good fit all around. But the pitcher is scheduled to be a free agent after the season, and the Brewers are currently terrible. If an extension can't be worked out, he'll almost certainly be shopped.
Stats over the last three years
621 innings, 126 ERA+, 3.33 ERA, 624 strikeouts, 151 walks, 48 home runs allowed
Cost to acquire
High. Even though he's a pending free agent, the Brewers' apparent willingness to extend him gives them a little leverage. It would likely take a team's top prospect and additional filler to swing a trade, especially this early in the season.
Pitcher B is another pending free agent, this time with the Phillies. He led them to their first World Series championship in over two decades, and even though he was pushed down in the rotation by two of the best pitchers in baseball, he's still considered a true ace. He carries a dog in a backpack, but there's probably a very good reason for that.
Stats over the last three years
618 innings, 120 ERA+, 3.36 ERA, 573 strikeouts, 148 walks, 69 home runs allowed
Cost to acquire
Look, forget it. The Phillies are over .500 and just four games out of first. They aren't sellers right now, not even close. Get away, you jackals. /swings large stick found on the side of the road
Pitcher C was a free agent over the offseason. You could have had him. You chose not to pursue him. He signed with the Marlins for four years and $58 million.
Stats over the last three years
629 innings, 113 ERA+, 3.91 ERA, 313 strikeouts, 139 walks, 65 home runs allowed
Cost to acquire
Four years, $58 million, and a Delorean with a flux capacitor. You missed it, pal. Move on.
Pitcher D is David Price. He's good.
Stats over the last three years
561 innings, 115 ERA+, 3.42 ERA, 508 strikeouts, 196 walks, 54 home runs allowed
Cost to acquire
Why would you think you can trade for David Price? You're annoying.
Well, why did you include him?
I don't know. Just listing pitchers to make a point, I guess. Because it turns out there's one more pitcher that's worth bringing up. I mean, he's alright. Doesn't hurt to give you the option, at least.
Pitcher E is scaring teams away because of his contract. He's due a prorated portion of $10 million this year, $12 million next year, and a $12 million option that becomes a player option if he's traded. So about $30 million over the next three seasons.
Stats over the last three years
591 innings, 118 ERA+, 3.36 ERA, 537 strikeouts, 200 walks, 62 home runs allowed
Cost to acquire
Well, if you take the rest of the contract, it shouldn't be too prohibitive. They're not going to say "no backsies" and just give him to you like he was Alex Rios, but we're not talking about giving up your top prospect. But if you're worried about losing prospects for a rental, remember that you have the pitcher for at least another year. And if he declines his player option, it's probably because he had a hell of a year.
What's the catch?
What do you mean?
Well, why aren't teams fighting over him? Is he hurt? Is he having a miserable season?
Oh, no, no. Quite the contrary.
I don't get it
Neither do I. Pitcher E is Wandy Rodriguez, and he's good. Better than you think. Those other pitchers up there were Zack Greinke, Cole Hamels, Mark Buehrle, and David Price. Wandy might not be as good as those pitchers, but he doesn't stand out as a ridiculous comparison. He's been quite valuable. He's been consistent. He's been one of the better pitchers in the National League this year.
But the difference is that he'll have teams on the hook for (potentially) $30 million. That's the cost of the gold leaf used to wrap the manservant who will fulfill the personal-services part of Cole Hamels's contract. That's almost half of what the Marlins had to commit to Buehrle, both in years and money. It's less than the Dodgers had to spend to secure Randy Wolf, who wasn't quite as productive and had larger injury concerns. But for some reason, it's making teams balk right now.
There are a lot of teams who need pitching. The Phillies, Dodgers, Red Sox, and Tigers were all rumored to be interested in Roy Oswalt. And that made sense. But for a solution that can help in 2012 and 2013, Rodriguez would be a fine choice. Maybe I'm underestimating what the Astros are asking, but the early rumors suggest teams are scared by the contract.
There aren't going to be a lot of premium options in July. Considering prospects and salary, Wandy Rodriguez might be your best bet. Hop on the bandwagon now because it's going to be awfully crowded in two months.


text:
She was born June 20, 1942, in Iowa City, Iowa, to Marion and Mary Ilene Evans. Dallas was a homemaker and also helped her husband in business as a local bread distributor for Flowers Bakery.
Visitation will be Friday, Jan. 31, 2014, from 6 to 8 p.m. at the Cullman Heritage Funeral Home in Cullman. Funeral services for will be at noon Friday in the Cullman Heritage Funeral Home Chapel with Charles Hannah officiating. Interment will be in the Cullman Heritage Cemetery.
Survivors include her husband, Raymond Dallas; a daughter, Vicky (Clinton) Crane; a son, Ken (Danielle) Dallas; grandchildren, Emmy Crane, Mikel (Rachel) Dallas, Kevin (Krista) Dallas and Kenny Mike Dallas; sisters, Carol Evans and Wanda Goddard; a sister-in-law, Nadine Reynolds; nephews, Jason Reynolds, Nolen Reynolds and Gene Goddard, Jr.; and a niece, Susie Hill.
Cullman Heritage Funeral Home, Cullman; 256-734-0208


text:
Robert Bayer, director of UMaine's Lobster Institute, was interviewed for a story in the coastal Free Press newspaper about a half yellow and half blue lobster recently caught off North Haven in the Gulf of Maine. Bayer said such oddly colored lobsters are extraordinarily rare and often hermaphroditic.
Contact: Jessica Bloch, (207) 581-3777


text:
Two fire hydrant-shaped middleweights duked it out last night (Dec. 14, 2012) as Hector Lombard battled Rousimar Palhares in the opening bout of the UFC on FX 6 main card in Gold Coast, Australia.
Lombard was embarrassed in his UFC debut, looking lackluster en route to losing a close decision to Tim Boetsch after being hyped up as a serious title contender. The former Bellator middleweight champion blamed his performance on an injury and promised to come back stronger.
Did he ever.
From the opening seconds of the fight, Lombard looked a man possessed stepping forward aggressively throwing kicks and heavy punches. Palhares tried to keep him at bay with low leg kicks but Lombard was far to aggressive for that, lunging forward with heavy looping hooks trying to knock Palhares' block off.
Palhares could not circle away fast enough and the first signs of trouble appeared when he backed up straight instead of circling, eating a right and then left hook from Lombard and dropping to the canvas. Lombard tried to finish it then and there, but Palhares recovered and he backed off, knowing he could finish it on the feet.
After the reset, Lombard stalked Palhares, looking for that killshot. A lead right hand got things started and when Palhares didn't circle away quick enough, Lombard went in for the kill, throwing heavy shots against the Brazilian as Palhares could only cover up. The blows were so powerful that despite being blocked, Palhares dropped to the canvas and after two shots on the ground, "Toquinho" was out cold.
Lombard was ecstatic in his post-fight celebration, even calling out Michael Bisping due to "The Count's" disparaging remarks about his UFC debut.
For Rousimar Palhares, his inability to get the fight to the ground was his undoing. The leg kicks were a nice addition to his striking game, but when you've got a suspect chin and a lack of serious striking technique or defense against one of the scariest strikers in the division, you're going to have a bad time. Palhares' inability to continue circling cost him as Lombard was able to connect whenever he stopped moving to his right. When Lombard finally cornered him against the fence and unloaded, it was all she wrote. "Toquinho" never even got to attempt a leg lock.
With his second straight loss, Palhares will likely move back down to destroying mid level 185-ers. Fights against Tom Lawlor, Tom DeBlass or Alessio Sakara make sense.
For Hector Lombard, he looked so much more aggressive and explosive than in his UFC debut. He did a great job of moving forward, not following Palhares but working to cut him off in the cage and he was setting up his huge left hand with every punch he threw. It was either going to be a lead right hook to position Palhares for the left hand or a lead kick to the body to do the same. When he finally hurt the Brazilian, he wisely realized he couldn't finish and backed off, knowing he could do it again. When he did, he didn't let "Toquinho" off the hook, massacring him with heavy blows until he was out. This was the Hector Lombard that the UFC paid big bucks for.
Lombard called out Bisping, but he likely won't be getting that fight. An opponent which would make more sense would be the upcoming winner of Alan Belcher vs. Yushin Okami. Other potential foes include Costa Philippou should he get past Tim Boetsch or perhaps Chris Leben if he beats Karlos Vemola.
So what did you think, Maniacs?
Were you impressed with Lombard's performance? How much stronger did he look last night compared to his UFC debut? Do you think he can still make a run?
Sound off!
For complete UFC on FX 6 results, including blow-by-blow, fight-by-fight coverage of the entire event as well as immediate post-fight reaction click here, here and here.


text:
Karma Pendant
Karma pendant is composed of clear pyrex exterior glass along with amber interior glass. Transformer is supplied in the canopy. It comes with nineteen 10 watt 12 volt JC G4 halogen bulbs included. Each shade is 5.75" high. Overall width is 12 inches. Adjustable cable length from 65 to 75 inches. The overall height of this lighting fixture is 30 inches.
|Dimensions: 30"H x 12"W
|Lamp Source: Halogen
|Bulb: 19 x JC/G4 (bipin)/10W/12V Halogen
Bulb included
|Dimmer: Incandescent
About Nuevo Living
The Nuevo Living brand has developed over time from a home accent and furnishings company to a major supplier with over 700 items, including contemporary and mid-century modern lighting fixtures. With a focus on high design and premium quality at an affordable price, Nuevo Living has developed an impressive contemporary lighting selection of floor lamps, table lamps and chandeliers.


text:
EAST PEORIA, Ill. -- Residents in the heart of Illinois looking for a job will have a new opportunity next week.
That's because Target is hosting a hiring fair for its newest store in East Peoria.
It begins next Thursday, January 10 at 11 a.m. at Illinois Central College.
The event continues through Saturday, January 12.
Target says it could hire as many as 200 people for the new store, which is set to open in March.
Job fair dates and times:
Thursday, Jan. 10 to Saturday, Jan. 12
* 11 a.m. to 6:30 p.m., Thursday
* 9 a.m. to 6 p.m., Friday
* 8 a.m. to 2:30 p.m., Saturday


text:
Definition: This entry provides the total expenditure on health as a percentage of GDP. Health expenditures are broadly defined as activities performed either by institutions or individuals through the application of medical, paramedical, and/or nursing knowledge and technology, the primary purpose of which is to promote, restore, or maintain health.
Source: CIA World Factbook - Unless otherwise noted, information in this page is accurate as of January 1, 2012See also: Health expenditures map
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text:
DURHAM — Entering the game against Ohio State, freshman Rasheed Sulaimon had taken the second-most shots of any Duke player.
But he took just two in the first half. And neither went in.
He was a little down on himself, Ryan Kelly said. Obviously, when youre a freshman, its even harder to get out of that hole, even if its a little hole.
I just told him, Youre a heck of a player. Youve shown it all year against great teams, so go show it in the second half. And he did.
Sulaimon went 7-of-10 in the second half, scoring 17 points. His contribution was a key part of No. 2 Dukes 73-68 win over No. 4 Ohio State.
For a freshmen, I thought he got knocked back, coach Mike Krzyzewski said. At halftime, he responded. He had 17 points in the second half and gave us a verve. He gave us a real verve.
Sulaimon did, indeed, show vigor and spirit, or enthusiasm, in the second half. And hes shown that all year. Sulaimon took Seth Currys spot in the starting lineup during the preseason, when Currys right shin kept him off the court completely. But when Curry was ready to return, Sulaimon didnt leave the lineup. Duke opted to sacrifice a few inches (the 6-foot-8 Alex Murphy went to the bench while 6-foot-4 Sulaimon stayed) and instead kept Sulaimons offensive and defensive verve on the floor.
Through seven games, Sulaimon is averaging 12.7 points per game, third-most on the team behind Curry and Mason Plumlee. At this point in the year, Sulaimons scoring pace is actually not far from where another Duke freshman Austin Rivers was at the same time last season (14.4 points per game).
Sulaimon does more than just score, though, and, personality-wise, is nothing like Rivers. Sulaimons 4.3 rebounds per game also rank third on the team, as do his six total steals. And he has the ability to impact the game defensively with his reach in ways that arent quantifiable.
Rasheed is really as good of freshman as there is in the country, Krzyzewski said. This kid is playing well.
And Wednesday night, Sulaimon showed he can respond quickly after not meeting the high standard he has set. Kelly wasnt the only one who talked to him at halftime--Krzyzewski did, too.
The message: be more aggressive.
In the first half especially, I was very passive, Sulaimon said. In the second half, I just wanted to look more for my shot. My teammates gave me great passes, set great screens to set me up, and I was very fortunate that some of those shots did fall in the second half.
Part of Sulaimons surge resulted from tweaks to Dukes offense. Throughout the first half, Duke struggled to generate any open looks. In the second half, the team set fewer ball screens and instead tried to push the pace and open space to drive. As a result, Sulaimon found more space to shoot on the elbows.
Sulaimon connected for his first basket within two minutes of the second halfs opening. His jump shot was an immediate response to Ohio State taking a 10-point lead at 33-23, the largest Buckeyes advantage of the night. From there, his shots started to fall, and he ended his night with Dukes last field goal, an emphatic, one-handed dunk to put Duke up 66-58 with 1:04 remaining in the game.
I dont know if a kid is going to respond, Krzyzewski said of his halftime challenge to Sulaimon. For a freshman to respond that way is superb. It just doesnt happen very often.
This kid at halftime said, youre right, Ive got to do something, and he was sensational.
Keeley 919-829-4556; Twitter @laurakeeley