Caring For The Caregivers: How To Help

Providing meaningful support of caregivers is a growing, challenging and essential urgent need for the millions of Americans acting as caregivers elderly, disabled, injured or ill family members or friends.

Caregiving is surprisingly common.  More than 51 million Americans or 31% percent of the adult population age 20 to 75 provide informal care to a family member or friend who is ill or disabled.

These caregivers are the lifelines of the people they care for and the predominant and growing long-term care system in the United States.  They are a lifeline for the people they support and our long-term care system.  A study by AARP reveals that at 350 billion dollars, the economic value of non-compensated caregiving exceeds 2006 Exxon Mobile profits.

The many hats the wear includes the traditional family care giving roles of  companion, personal shopper, financial manager, chauffeur, housekeeper, cook, personal care assistant, advocate, counselor and emotional support provider.  Along side these roles, the shift in health care delivery model to outpatient, home-based care means caregivers-most of which have little or no medical background-increasingly find themselves responsible for a host of medical procedures from medication administration to a host of other medical care activities once considered the province of nurses or other licensed health care providers.

While often undertaken out of love, often unavoidable and often rewarding, caregivers often face many challenges. It comes as no surprise that acting as a caregiver can cause emotional and physical stress.

While the caregiving role can be enormously rewarding, it also means a lot of sacrifice.  It may start with just a few hours a week.  Usually the need expands and with each increase, caregivers give up more of their personal lives.   The average family caregiver provides nearly 18 to 20 hours of care a week in addition to holding down a job and managing a family. Second Opinion TV Caregiver BurnoutThe added costs of caring for their family members tends to create added economic strain.  When the caregiver also is a breadwinner, the caregiver also tends to suffer adverse employment consequences. Studies have shown that caregivers of the chronically ill tend to suffer significant income losses and many are forced to switch jobs.

As individuals providing long-term care for a loved one with illness try to do more than they are able to do, tend to develop “caregiver burnout.”  They become  more vulnerable to sickness, anxiety, medical problems and depression.  The resulting  physical, emotional and mental exhaustion and leaves the caregiver vulnerable to illness and can lead to cardiovascular disease, hypertension, stroke, and a compromised immune system.

Caregiver burnout symptoms are similar to those for anxiety and depression and include:

  • Sleep disturbances and fatigue
  • Lost interest in once-pleasurable things
  • Changes in appetite, weight, or both
  • Getting sick more often
  • Withdrawal from social contacts
  • Persistent feelings of worry, hopelessness and sadness
  • Irritability
  • Low self-esteem
  • Overreacting to minor issues
  • Decreased productivity
  • Alcohol or drug abuse

Always stressful and demanding,  the number of caregivers and their burden just keeps growing.  While Americans might thing that the burgeoning baby boom generation would have sufficient political pull to demand government address some of these challenges, so far government action seems to be adding to, rather than improving the crisis.  The cost-driven push by Medicare and other payers to force patients out of hospitals, skilled nursing facilities into home care environments coupled with the sharp rise in home care costs, economic downturns, the dispersion of the family, the activity-charged, over busy and over-extended lives of American families generally and the longer and more functional, while disabled life span of aging baby boomers, and other chronically aged, ill or disabled individuals are just a few of the drivers that complicate these challenges.

As a result, American families acting as caregivers and the families and communities must recognize the need to help caregivers care not only for their loved ones but also for themselves.

Caregivers and those around them  should keep an eye out for caregiver burnout and take appropriate steps to prevent or address it.  The  Caregiver Self-Assessment Questionnaire (PDF)  may be a useful assessment tool to help monitor for caregiver burnout.  However, the goal is to prevent or minimize it by taking appropriate preventive action when possible.  While no panacea, some steps for helping caregivers cope with their responsibility include:

  • Caregivers should ask for and accept help.  Meanwhile, friends and family need to offer help with the anticipation that the caregiver that needs it the most is the one most likely to decline or resist it.
  • Friends and family need to offer and provide, and caregivers need to seek social support.  Family and friends can help by touching base regularly, providing respite care to allow the caregiver a break to go out for a couple of hours, or visit.
  • Caregivers and their support network need to develop a realistic understanding of what the patient needs and the caregiver realistically can provide.  Rather than the caregiver feeling guilty about their own limits or family or friends commenting on what the caregiver isn’t or cannot do, the parties should work together to look for and to coordinate resources to help fill the gaps.
  • Family, friends and others in the community surrounding patients and their caregivers need to keep in mind that what is needed is HELP, not commentary.  Avoid the tendency of talking to the caregiver about what the caregiver needs to do or criticizing what isn’t getting done and focus instead on what actions you can do to help out.   Offer to sit with the patient, run errands, or do other tasks that ease the burden of the caregiver and help look for and obtain other resources.
  • Look and seek help where available.
  • Remember, caregiving typically is a long-term role.  Family and friends need to avoid falling into  the out-of-sight, out-of-mind syndrome.  Stay in the game for the long haul as caregiver’s burnout and ite associated challenges tend to get more significant as time passes.

The resources caregivers need and finding them can be a challenge and tend to vary by patient and caregiver situation, place, financial situation, and a host of other factors.  The following is a starting list of some resources, which Project COPE invites the reader to supplement by sharing their additions through postings in the PROJECT COPE LinkedIn Group:

  • Local assisted living, nursing home and other care providers
  • Employee Assistance Programs (EAPs) health and disability plans and insurers
  • Employers
  • Family, friends, church and other social networks
  • Health care providers
  • Administration on Aging (AOA)
  • AARP Caring for Those You Care About free online seminars on planning for and managing caregiving and other resources
  • AMA (Public Health) Caregiver Self-Assessment Tool to help caregivers determine how they are coping with the challenges and stresses of giving care to a loved one
  • Eldercare Locator operated by the U.S. Administration on Aging, has a nationwide directory of state and area agencies that deal with services for the aging and atoll-free number – 1-800-677-1116 – which operates Monday through Friday, 9:00 a.m. to 8:00 p.m., Eastern time
  • Family Caregiver Alliance  web site includes information, free publications, and an online caregiver support discussion group
  • National Alliance for Caregiving online publications and resources
  • National Council on the Aging and your State Department of Aging and Disabilities
  • National Family Caregivers Association which has information on federal and state assistance programs for older Americans in each community and a  TAKE CARE! – Self Care for the Family Caregiver quarterly newsletter
  • PBS Caregiver’s Handbook (from the 90-minute program Caring for Your Parents) With Eyes Wide Open (information on caregiving, grief, difficult decisions and what may lie beyond death) Frontline, Living Old
  • Second Opinion episodes lime  Depression (Episode 201) End of Life (Episode 313) Dementia (Episode 101)
  • Well Spouse Foundation support groups and other resources to husbands, wives, and partners of chronically ill or disabled individuals
  • Healthy Women publications and other resources

Know of other resources?  Share your ideas in the  PROJECT COPE: Coalition On Patient Empowerment LinkedIn Group.

About Project COPE: The Coalition On Patient Empowerment &  Coalition on Responsible Health Policy

If you have knowledge, experience or other resources that could help patients, families, communities, or the government better understand or cope with  Asperger’s or other health care conditions, costs of care, or other challenges affecting Americans and the American health care system, we encourage you to get involved and share your insights.

As American leaders continue to struggle to deal with these and other mounting problems impacting the U.S. health care system, the input of individual Americans and businesses and community leaders is more critical than ever.  Get involved in helping to shape improvements and solutions to the U.S. health care system and the Americans it cares for by sharing your ideas and input through the Coalition For Responsible Health Care Policy  and exchanging information and ideas for helping American families deal with their family member’s illnesses, disabilities and other healthcare challenges through PROJECT COPE: Coalition On Patient Empowerment.

Sharing and promoting the use of practical practices, tools, information and ideas that patients and their families, health care providers, employers, health plans, communities and policymakers can share and offer to help patients, their families and others in their care communities to understand and work together to better help the patients, their family and their professional and private care community plan for and manage these  needs is the purpose of PROJECT COPE.

The Coalition and its PROJECT COPE arise and run on the belief that health care reform and policy must be patient centric and patient empowering.  The best opportunity to improve access to quality, affordable health care for all Americans is for every American, and every employer, insurer, and community organization to seize the opportunity to be good Samaritans.  The government, health care providers, insurers and community organizations can help by providing education and resources to make understanding and dealing with the realities of illness, disability or aging easier for a patient and their family, the affected employers and others. At the end of the day, however, caring for people requires the human touch.  Americans can best improve health care by not waiting for someone else to step up:  Step up and help bridge the gap when you or your organization can. Speak up to help communicate and facilitate when you can.  Building health care neighborhoods filled with good neighbors throughout the community is the key.

The outcome of this latest health care reform push is only a small part of a continuing process.  Whether or not the Affordable Care Act makes financing care better or worse, the same challenges exist.  The real meaning of the enacted reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye.  Americans individually and collectively clearly should monitor and continue to provide input through this critical time to help shape constructive rather than obstructive policy. Regardless of how the policy ultimately evolves, however, Americans, American businesses, and American communities still will need to roll up their sleeves and work to deal with the realities of dealing with ill, aging and disabled people and their families.  While the reimbursement and coverage map will change and new government mandates will confine providers, payers and patients, the practical needs and challenges of patients and families will be the same and confusion about the new configuration will create new challenges as patients, providers and payers work through the changes.

We also encourage you and others to help develop real meaningful improvements by joining PROJECT COPE: Coalition On Patient Empowerment and by sharing ideas, tools and other solutions and other resources. The Coalition For Responsible Health Care Policy provides a resource that concerned Americans can use to share, monitor and discuss the Health Care Reform law and other health care, insurance and related laws, regulations, policies and practices and options for promoting access to quality, affordable healthcare through the design, administration and enforcement of these regulations.

You also may be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, and/or our HR & Benefits Update electronic publication available here.

You also can get details about how to arrange for your employees or other communities to participate in training on “Building Your Family’s Health Care Toolkit,”  using the “PlayForLife” resources to organize low-cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here.

For Advice, Training & Other Resources

Should your business need legal advice about the taxability of or other requirements on tips, gratuities or other compensation,  assistance assessing or resolving potential past or existing compliance exposures, or monitoring and responding to these or other workforce, benefits and compensation, performance and risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer may be able to help.

Board Certified in Labor & Employment Law, Past Chair of the ABA RPTE Employee Benefit & Other Compensation Arrangements Group, Co-Chair and Past Chair of the ABA RPTE Welfare Plan Committee, Vice Chair of the ABA TIPS Employee Benefit Plans Committee, an ABA Joint Committee On Employee Benefits Council representative, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a Fellow in the American College of Employee Benefit Counsel, ABA, and State Bar of Texas, Ms. Stamer has more than 25 years’ experience advising health plan and employee benefit, insurance, financial services, employer and health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health plans and insurers about ACA, and a wide range of other plan design, administration, data security and privacy and other compliance risk management policies.  Ms. Stamer also regularly represents clients and works with Congress and state legislatures, EBSA, IRS, EEOC, OCR and other HHS agencies, state insurance and other regulators, and others.   She also publishes and speaks extensively on health and other employee benefit plan and insurance, staffing and human resources, compensation and benefits, technology, public policy, privacy, regulatory and public policy and other operations and risk management concerns. Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.

You can review other recent human resources, employee benefits and internal controls publications and resources and additional information about the employment, employee benefits and other experience of the Cynthia Marcotte Stamer here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at www.cynthiastamer.com or by registering to receive these and other updates here.  Recent examples of these updates include:

NOTE:  This article is provided for educational purposes.  It is does not provide legal advice, establish any attorney-client relationship or provide or serve as a substitute for legal advice to any individual or organization.  Readers must engage properly qualified legal counsel to secure legal advice about the rules discussed in light of specific circumstances.ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, or (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.  ©2015 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press.  All other rights reserved.

Perspective Change May Offer Best Option For Solving Society’s Asperger’s/Autism Puzzel

The growth in the number of Americans diagnosed with  Asperger’s and other Autism spectrum disorders is fueling demands to identify the “cause” and to find  a “cure” that to  “fix” the these “conditions” while individuals labeled with these conditions and their families struggle to cope.

While certain therapeutic interventions often provide some relief for stress, anxiety and other complications experienced by those diagnosed with Asperger’s or other Autism spectrum syndromes, make it easier for schools, employers, families or others encountering them, or both,  the current treatments are not a cure and typically provide only limited relief for some of the symptoms.  As a result, individuals with Asperger’s and other Autism spectrum syndromes and the families, friends, employers, schools, businesses and other elements of the community often struggle to cope.

While the search for a cure continues, the pragmatic tools, strategies and insights shared by two accomplished young men bearing these diagnostic labels at www.aspergerexperts.com prompts the possibility that best hope for a next great discovery in the quest to solve the Asperger’s/Autism puzzle lies in a change in perspective and understanding about Asperger’s and Autism.

While the idea that practical solutions to the Asperger’s/Autism puzzle begins with understanding the experience of those diagnosed with Asperger’s and Autism spectrum conditions from the perspective of those assigned that diagnosis makes sense,  the blogging and other perspective, training and resources shared by Asperger Experts Danny Raede & Hayden Mears, both diagnosed with Asperger’s themselves, suggests that the best way to help people with Asperger’s to achieve their highest potential in life lies with a better understanding of their experience and how this impacts their actions.  Drawing from their insights living in society with Asperger’s, Danny and Hayden share invaluable experiences and insights about the Asperger’s experience and how it can induce defensive or other behavior society considers abnormal then suggest practical strategies for those with Asperger’s cope with the demands and expectations of life in “normal” society and the “normal” people and society cope with individuals with Asperger’s more effectively.

The insights Danny and Hayden share suggest Asperger’s and other autism spectrum challenges may be best understood best as a process for harmonizing the functioning and interaction of two different and distinct human operating systems rather than as a disease to be “fixed.”  The insights and tools Danny and Hayden share reflect their own experiences with what works and does not work in efforts to understand and influence how individuals with Asperger’s behave compared to the expectations and assumptions of others in society.  After debugging common stereotypes about the goals, desires, needs, wants, personalities and emotions of people with Asperger’s, Danny and Hayden provide education drawn from their open experience about how distinct sensory differences in their human operating systems trigger undesirable, defensive behavior when these hypersensitivities are not anticipated and managed properly.  In other words, the tension and disruption that occur in the course of dealings between those with Asperger’s and others arises from improperly anticipated or managed hardwired differences in their human operating systems.

By approaching  the Asperger’s challenge like the integration of Apple Mac and Microsoft operating systems rather than the forced replacement of one operating system with the other,  the pragmatic instructions shared by Danny and Hayden become a troubleshooting toolkit that both parties can use to more effectively deal with each other.  Their tools and insights encourage both those bearing the Asperger’s label and others dealing with them to accept that the operating system and principles of people – including those with Asperger’s-function differently.  Their experience reflects that the pragmatic solutions for helping those with Asperger’s function better in ordinary society lies in abandoning efforts to cure individuals with Asperger’s by forcing the reprogramming of their operating system in favor of all parties working accept these differences and working together to bridge the difference thru mutual understanding, collaboration, compromise and respect.  Approached from this perspective, the Asperger’s solution becomes not a cure, but an integration and communication management process with the goal of effectively integrating and managing the interactions between those with Asperger’s to the maximum benefit of all parties.

The resources shared, while not a panacea, provide valuable functional strategies that help people with Asperger’s cope with those around them and those in the community and family to interact more effectively with individuals with Asperger’s.  While helping to ease today’s challenges, the insights shared of Asperger Experts who know what it is like to live in society with their condition provides equally valuable understanding that challenges all to embrace the notion that people with and without Asperger’s function somewhat differently, they share many commonalities. The shared goal should be to look beyond the labels and stereotypes by understanding these differences and working together to accommodate each other with mutual respect and understanding.

About Project COPE: The Coalition On Patient Empowerment &  Coalition on Responsible Health Policy

If you have knowledge, experience or other resources that could help patients, families, communities, or the government better understand or cope with  Asperger’s or other health care conditions, costs of care, or other challenges affecting Americans and the American health care system, we encourage you to get involved and share your insights.

As American leaders continue to struggle to deal with these and other mounting problems impacting the U.S. health care system, the input of individual Americans and businesses and community leaders is more critical than ever.  Get involved in helping to shape improvements and solutions to the U.S. health care system and the Americans it cares for by sharing your ideas and input through the Coalition For Responsible Health Care Policy  and exchanging information and ideas for helping American families deal with their family member’s illnesses, disabilities and other healthcare challenges through PROJECT COPE: Coalition On Patient Empowerment.

Sharing and promoting the use of practical practices, tools, information and ideas that patients and their families, health care providers, employers, health plans, communities and policymakers can share and offer to help patients, their families and others in their care communities to understand and work together to better help the patients, their family and their professional and private care community plan for and manage these  needs is the purpose of

The Coalition and its Project COPE arise and run on the belief that health care reform and policy must be patient centric and patient empowering.  The best opportunity to improve access to quality, affordable health care for all Americans is for every American, and every employer, insurer, and community organization to seize the opportunity to be good Samaritans.  The government, health care providers, insurers and community organizations can help by providing education and resources to make understanding and dealing with the realities of illness, disability or aging easier for a patient and their family, the affected employers and others. At the end of the day, however, caring for people requires the human touch.  Americans can best improve health care by not waiting for someone else to step up:  Step up and help bridge the gap when you or your organization can. Speak up to help communicate and facilitate when you can.  Building health care neighborhoods filled with good neighbors throughout the community is the key.

The outcome of this latest health care reform push is only a small part of a continuing process.  Whether or not the Affordable Care Act makes financing care better or worse, the same challenges exist.  The real meaning of the enacted reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye.  Americans individually and collectively clearly should monitor and continue to provide input through this critical time to help shape constructive rather than obstructive policy. Regardless of how the policy ultimately evolves, however, Americans, American businesses, and American communities still will need to roll up their sleeves and work to deal with the realities of dealing with ill, aging and disabled people and their families.  While the reimbursement and coverage map will change and new government mandates will confine providers, payers and patients, the practical needs and challenges of patients and families will be the same and confusion about the new configuration will create new challenges as patients, providers and payers work through the changes.

We also encourage you and others to help develop real meaningful improvements by joining PROJECT COPE: Coalition On Patient Empowerment and by sharing ideas, tools and other solutions and other resources. The Coalition For Responsible Health Care Policy provides a resource that concerned Americans can use to share, monitor and discuss the Health Care Reform law and other health care, insurance and related laws, regulations, policies and practices and options for promoting access to quality, affordable healthcare through the design, administration and enforcement of these regulations.

You also may be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, and/or our HR & Benefits Update electronic publication available here.

You also can get details about how to arrange for your employees or other communities to participate in training on “Building Your Family’s Health Care Toolkit,”  using the “PlayForLife” resources to organize low-cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here.

For Advice, Training & Other Resources

Should your business need legal advice about the taxability of or other requirements on tips, gratuities or other compensation,  assistance assessing or resolving potential past or existing compliance exposures, or monitoring and responding to these or other workforce, benefits and compensation, performance and risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer may be able to help.

Board Certified in Labor & Employment Law, Past Chair of the ABA RPTE Employee Benefit & Other Compensation Arrangements Group, Co-Chair and Past Chair of the ABA RPTE Welfare Plan Committee, Vice Chair of the ABA TIPS Employee Benefit Plans Committee, an ABA Joint Committee On Employee Benefits Council representative, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a Fellow in the American College of Employee Benefit Counsel, ABA, and State Bar of Texas, Ms. Stamer has more than 25 years’ experience advising health plan and employee benefit, insurance, financial services, employer and health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health plans and insurers about ACA, and a wide range of other plan design, administration, data security and privacy and other compliance risk management policies.  Ms. Stamer also regularly represents clients and works with Congress and state legislatures, EBSA, IRS, EEOC, OCR and other HHS agencies, state insurance and other regulators, and others.   She also publishes and speaks extensively on health and other employee benefit plan and insurance, staffing and human resources, compensation and benefits, technology, public policy, privacy, regulatory and public policy and other operations and risk management concerns. Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.

You can review other recent human resources, employee benefits and internal controls publications and resources and additional information about the employment, employee benefits and other experience of the Cynthia Marcotte Stamer here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at www.cynthiastamer.com or by registering to receive these and other updates here.  Recent examples of these updates include:

NOTE:  This article is provided for educational purposes.  It is does not provide legal advice, establish any attorney-client relationship or provide or serve as a substitute for legal advice to any individual or organization.  Readers must engage properly qualified legal counsel to secure legal advice about the rules discussed in light of specific circumstances.ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, or (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.  ©2015 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press.  All other rights reserved.

Calculating & Reporting Your ACA Individual Shared Responsibility Payment

The Health Care Law and Taxes: Reporting Coverage, Exemptions and Payments

Beginning January 1, 2014,  the individual coverage mandate rules of the Patient Protection & Affordable Care Act (ACA) generally required most American citizens to maintain health coverage meeting the “minimum essential coverage” mandates of ACA or pay an “individual shared responsibility payment.”  With the deadline for filing 2014 individual tax returns rapidly approaching, Americans now generally will be required to show their fulfillment of  or exemption from this mandate or pay the “individual shared responsibility” payment that ACA imposes as a penalty for failing to meet its individual coverage mandates when filing their 2014 individual tax returns.

Internal Revenue Service (IRS) rules now require individual Americans to report minimum essential coverage meeting ACA’s requirements, report or claim a coverage exemption, or make an individual shared responsibility payment when filing their 2014 federal income tax return. If an individual is not required to and does not want to file a tax return, however, IRS rules stay he does need to file a return solely to report his minimum essential coverage or to claim an exemption.

If a taxpayer and his dependents all had minimum essential coverage  for each month of the tax year, the taxpayer should show this on his 2014 tax return by simply checking a box on Form 1040, 1040A or 1040EZ.

Individuals who obtained a coverage exemption from the Marketplace or who qualify for an exemption must claim the exemption by filing Form 8964 with their tax return.

For any month a taxpayer or his dependents did not have coverage or a coverage exemption, IRS rules will require the individual to make a shared the responsibility payment. The payment will be reported on Form 1040, line 61 in the Other Taxes section and on the corresponding lines on Form 1040A and 1040EZ.

The Internal Revenue Code specifies that the required individual shared responsibility payment generally equals the greater of:

  • 1 percent of the taxpayer’s household income that is above the tax return filing threshold for your filing status, or
  • The taxpayer’s family’s flat dollar amount, which for 2014 is $95 per adult and $47.50 per child, limited to a family maximum of $285,
  • But capped at the cost of the national average premium for a bronze level health plan available through the Marketplace in 2014.

Many taxpayers who elected not to buy the required minimum essential coverage necessary to avoid the individual shared responsibility payment reportedly are experiencing painful surprise about the amount of their required shared responsibility payment when completing their 2014 individual tax returns.

It appears that many Americans were unaware of or did not fully appreciate that their required individual shared responsibility payment could be up to 1 percent of their family income.  Rather, they may have assumed that their family’s required individual shared responsibility payment would be only $95 per adult and $47.40 per child up to a family maximum of $285.

Depending on the income of the individual taxpayer, however, the actual individual shared responsibility is likely to be much higher.

For 2014, the annual national average premium for a bronze level health plan available through the Marketplace is $2,448 per individual ($204 per month per individual), but $12,240 for a family with five or more members ($1,020 per month for a family with five or more members). See Rev. Proc. 2014-46.

Many taxpayers who elected not to buy the required minimum essential coverage necessary to avoid the individual shared responsibility payment reportedly are experiencing painful surprise about the amount of their required shared responsibility payment when completing their 2014 individual tax returns.  It appears that many Americans were unaware of or did not fully appreciate that their required individual shared responsibility payment could be up to 1 percent of their family income.  Rather, they may have assumed that their family’s required individual shared responsibility payment would be only $95 per adult and $47.40 per child up to a family maximum of $285.  Depending on the income of the individual taxpayer, however, the actual individual shared responsibility is likely to be much higher. 

Taxpayers interested in more information about the ACA individual shared responsibility payment, its exemptions and reporting, should check out the information on Claiming and Reporting an Exemption and Individual Shared Responsibility Provision – Reporting and Calculating the Payment pages on IRS.gov for more information about figuring and reporting the payment.

About Project COPE: The Coalition On Patient Empowerment &  Coalition on Responsible Health Policy

As American leaders continue to struggle to deal with these and other mounting problems impacting the U.S. health care system, the input of individual Americans and businesses and community leaders is more critical than ever.  Get involved in helping to shape improvements and solutions to the U.S. health care system and the Americans it cares for by sharing your ideas and input through the Coalition For Responsible Health Care Policy  and exchanging information and ideas for helping American families deal with their family member’s illnesses, disabilities and other healthcare challenges through Project COPE: Coalition for Patient Empowerment here.

Sharing and promoting the use of practical practices, tools, information and ideas that patients and their families, health care providers, employers, health plans, communities and policymakers can share and offer to help patients, their families and others in their care communities to understand and work together to better help the patients, their family and their professional and private care community plan for and manage these  needs is the purpose of

The Coalition and its Project COPE arise and run on the belief that health care reform and policy must be patient focused, patient centric and patient empowering.  The best opportunity to improve access to quality, affordable health care for all Americans is for every American, and every employer, insurer, and community organization to seize the opportunity to be good Samaritans.  The government, health care providers, insurers and community organizations can help by providing education and resources to make understanding and dealing with the realities of illness, disability or aging easier for a patient and their family, the affected employers and others. At the end of the day, however, caring for people requires the human touch.  Americans can best improve health care by not waiting for someone else to step up:  Step up and help bridge the gap when you or your organization can. Speak up to help communicate and facilitate when you can.  Building health care neighborhoods filled with good neighbors throughout the community is the key.

The outcome of this latest health care reform push is only a small part of a continuing process.  Whether or not the Affordable Care Act makes financing care better or worse, the same challenges exist.  The real meaning of the enacted reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye.  Americans individually and collectively clearly should monitor and continue to provide input through this critical time to help shape constructive rather than obstructive policy. Regardless of how the policy ultimately evolves, however, Americans, American businesses, and American communities still will need to roll up their sleeves and work to deal with the realities of dealing with ill, aging and disabled people and their families.  While the reimbursement and coverage map will change and new government mandates will confine providers, payers and patients, the practical needs and challenges of patients and families will be the same and confusion about the new configuration will create new challenges as patients, providers and payers work through the changes.

We also encourage you and others to help develop real meaningful improvements by joining Project COPE: Coalition for Patient Empowerment here by sharing ideas, tools and other solutions and other resources. The Coalition For Responsible Health Care Policy provides a resource that concerned Americans can use to share, monitor and discuss the Health Care Reform law and other health care, insurance and related laws, regulations, policies and practices and options for promoting access to quality, affordable healthcare through the design, administration and enforcement of these regulations.

You also may be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, or our HR & Benefits Update electronic publication available here.

You also can get details about how to arrange for your employees or other communities to participate in training on “Building Your Family’s Health Care Toolkit,”  using the “PlayForLife” resources to organize low-cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here.

For Advice, Training & Other Resources

Should your business need legal advice about the taxability of or other requirements on tips, gratuities or other compensation,  assistance assessing or resolving potential past or existing compliance exposures, or monitoring and responding to these or other workforce, benefits and compensation, performance and risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer may be able to help.

Board Certified in Labor & Employment Law, Past Chair of the ABA RPTE Employee Benefit & Other Compensation Arrangements Group, Co-Chair and Past Chair of the ABA RPTE Welfare Plan Committee, Vice Chair of the ABA TIPS Employee Benefit Plans Committee, an ABA Joint Committee On Employee Benefits Council representative, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a Fellow in the American College of Employee Benefit Counsel, ABA, and State Bar of Texas, Ms. Stamer has more than 25 years’ experience advising health plan and employee benefit, insurance, financial services, employer and health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health plans and insurers about ACA, and a wide range of other plan design, administration, data security and privacy and other compliance risk management policies.  Ms. Stamer also regularly represents clients and works with Congress and state legislatures, EBSA, IRS, EEOC, OCR and other HHS agencies, state insurance and other regulators, and others.   She also publishes and speaks extensively on health and other employee benefit plan and insurance, staffing and human resources, compensation and benefits, technology, public policy, privacy, regulatory and public policy and other operations and risk management concerns. Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.

You can review other recent human resources, employee benefits and internal controls publications and resources and additional information about the employment, employee benefits and other experience of the Cynthia Marcotte Stamer here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at www.cynthiastamer.com or by registering to receive these and other updates here.  Recent examples of these updates include:

NOTE:  This article is provided for educational purposes.  It is does not provide legal advice, establish any attorney-client relationship or provide or serve as a substitute for legal advice to any individual or organization.  Readers must engage properly qualified legal counsel to secure legal advice about the rules discussed in light of specific circumstances.ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, or (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.  ©2015 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press.  All other rights reserved.

Former National Quality Forum Committee Co-Chair Pays $1M, Excluded From Medicare In Fraud Settlement

A former National Quality Forum Committee Safe Practices Co-Chair landed in hot water under the False Claims Act for receiving compensation to use his influence and position to influence safety practices standards.  Patient safety consultant Dr. Charles Denham, will pay $1 million to settle Justice Department allegations that he violated the False Claims Act by soliciting and accepting kickbacks while he co-chaired the Safe Practices Committee 2009 and 2010, according to a Justice Department announcement.   The consulting company Health Care Concepts Inc. and the research organization Texas Medical Institute of Technology, operated by Denham both also are parties to the settlement.

With physicians and other health care organizations increasingly stepping up involvement in credentialing organizations and government advisory and other task forces, the enforcement action highlights another area where health care organizations and their people need to be careful to avoid violations of the False Claims Act or other laws…

View original post 1,931 more words

Mass. Connector & Other State Exchanges Problems Another Sign of Cracks In Obama Care?

While most Americans are familiar with the well-publicized issues and higher than projected premium costs of coverage offered to Americans enrolling in health care coverage through the federal healthcare marketplace Healthcare.gov created under the health care reforms of the Patient Protection & Affordable Care Act (ACA), many Americans are just beginning to recognize the growing problems and concerns emerging with state exchanges in those states that elected to enact their own exchange.  As the Supreme Court prepares to hear arguments in the challenge to the use of ACA subsidies to pay for coverage purchased through the federal healthcare.gov marketplace in King v. Burwell on Wednesday, March 4, 2015, the growing evidence of rapidly emerging funding and other challenges affecting state-run exchanges raise concerns about the solvency and reliability of coverage promised and purchased through those state run exchanges.

During the Congressional debates leading up to the enactment of ACA, for instance, ACA advocates touted the Massachusetts health care mandates and reform law of Massachusetts as part of the model for ACA and evidence of the potential benefits offered by enactment of ACA.  Now Massachusetts officials are blaming ACA for serious underfunding and other problems in their state’s health care connector.

Massachusetts Governor Charlie Baker recently cited the Health Connector and its challenges in enrolling Massachusetts residents in health insurance plans as part of the Affordable Care Act that forced the state to temporarily transition hundreds of thousands of state residents into the commonwealth’s Medicaid program as a primary reason for the state’s projected $1.5 billion budget deficit.  He now has asked for the resignations of four Massachusetts Health Connector board members:  MIT professor Jonathan Gruber,  Covered California actuarial consultant John Bertko; Massachusetts Nonprofit Network CEO Rick Jakious and Spring Insurance Group CEO George Conser.

The Massachusetts experience is not unique.  Other states also are experiencing significant funding and other problems dealing with the ACA mandates and implementation.  See, e.g.,  Funding Woes Imperil Future of State Run Exchanges;  State Insurance Exchanges Face Challenges In Offering Standardized Choices Alongside Innovative Value-Based Insurance.

This mounting evidence of serious cost, financing and other concerns in state-run exchanges creates new reason for concern about the future of ACA’s health care reforms even for those citizens of states whose eligibility for subsidies is not challenged by the King v. Burwell Supreme Court challenge.  These and other budget overruns and operational challenges raise serious questions about the ability of the federal government or the states to fund the promises currently made by ACA in its present form.  Congress and state governments almost certainly will be forced to deal with these broader challenges regardless of the outcome of King v. Burwell.   As American leaders continue to struggle to deal with these and other mounting problems impacting the U.S. health care system, the input of individual Americans and businesses and community leaders is more critical than ever.  Get involved in helping to shape improvements and solutions to the U.S. health care system and the Americans it cares for by sharing your ideas and input through the Coalition For Responsible Health Care Policy  and exchanging information and ideas for helping American families deal with their family member’s illnesses, disabilities and other healthcare challenges through Project COPE: Coalition for Patient Empowerment here.

About Project COPE: The Coalition On Patient Empowerment &  Coalition on Responsible Health Policy

Do you have ideas or experiences to share about medical debit, ACA or other health care challenges?  Have ideas for helping improve ACA and other health care policies impacting the US health care system, helping Americans cope with these and other health care challenges or other health care matters? Know other helpful resources or experiences that you are willing to share?  Are you concerned about health care coverage or other health care and disability issues or policy concerns?  Join the discussion and share your input by joining Project COPE: Coalition for Patient Empowerment here.

Sharing and promoting the use of practical practices, tools, information and ideas that patients and their families, health care providers, employers, health plans, communities and policymakers can share and offer to help patients, their families and others in their care communities to understand and work together to better help the patients, their family and their professional and private care community plan for and manage these  needs is the purpose of

The Coalition and its Project COPE arise and operate on the belief that health care reform and policy must be patient focused, patient centric and patient empowering.  The best opportunity to improve access to quality, affordable health care for all Americans is for every American, and every employer, insurer, and community organization to seize the opportunity to be good Samaritans.  The government, health care providers, insurers and community organizations can help by providing education and resources to make understanding and dealing with the realities of illness, disability or aging easier for a patient and their family, the affected employers and others. At the end of the day, however, caring for people requires the human touch.  Americans can best improve health care by not waiting for someone else to step up:  Step up and help bridge the gap when you or your organization can. Speak up to help communicate and facilitate when you can.  Building health care neighborhoods filled with good neighbors throughout the community is the key.

The outcome of this latest health care reform push is only a small part of a continuing process.  Whether or not the Affordable Care Act makes financing care better or worse, the same challenges exist.  The real meaning of the enacted reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye.  Americans individually and collectively clearly should monitor and continue to provide input through this critical time to help shape constructive rather than obstructive policy. Regardless of how the policy ultimately evolves, however, Americans, American businesses, and American communities still will need to roll up their sleeves and work to deal with the realities of dealing with ill, aging and disabled people and their families.  While the reimbursement and coverage map will change and new government mandates will confine providers, payers and patients, the practical needs and challenges of patients and families will be the same and confusion about the new configuration will create new challenges as patients, providers and payers work through the changes.

We also encourage you and others to help develop real meaningful improvements by joining Project COPE: Coalition for Patient Empowerment here by sharing ideas, tools and other solutions and other resources. The Coalition For Responsible Health Care Policy provides a resource that concerned Americans can use to share, monitor and discuss the Health Care Reform law and other health care, insurance and related laws, regulations, policies and practices and options for promoting access to quality, affordable healthcare through the design, administration and enforcement of these regulations.

Other Helpful Resources & Other Information

We hope that this information is useful to you.   If you found these updates of interest, you also be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, or our HR & Benefits Update electronic publication available hereYou also can get access to information about how you can arrange for training on “Building Your Family’s Health Care Toolkit,”  using the “PlayForLife” resources to organize low-cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail by creating or updating your profile here. You can reach other recent updates and other informative publications and resources.

Examples of some of these publications include:

For important information about this communication click here.

©2015 Cynthia Marcotte Stamer.  Limited non-exclusive license to republish granted to Solutions Law Press, Inc.  All rights reserved.

 

New Opportunity To Share Your Input With HHS About How To Improve Healthcare

Health care providers, health plans and insurers, employers, providers, patients, states, consumer groups, individual Americans and others concerned about health care in the United States should sign up and participate in the new Health Care Payment Learning and Action Network (“Network”) the Department of Health and Human Services (HHS) is creating to help shape the transformation of the nation’s health care delivery system to promote better care, smarter spending, and healthier people through the expansion of new health care payment models and other reforms.  HHS is inviting private payers, employers, providers, patients, states, consumer groups, consumers, and other partners within the health care community to register here to participate in the Network activities including  kickoff event scheduled for Wednesday, March 25, 2015.

HHS hopes cooperation through the Network will help the entire U.S. health care system match and exceed the following HHS goals for Medicare:

  • Tying 30 percent of payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and
  • Tying 50 percent of payments to alternative payment models by the end of 2018. The Network will also support the broader goal of tying the vast majority of payments in the health care system to quality or value.

As HHS moves forward to promote ACOs and other reforms, it is particularly important that providers and patients provide feedback and input about the goals and ideas HHS is promoting as solutions for “improving” health care.  While HHS often touts consolidation of care into ACOs and other reimbursement strategies using government generated standards of quality as the best means of improving quality and cost-effectiveness, many patients, providers and others worry that HHS ACO and other reimbursement reforms as presently implemented or contemplated by HHS cut costs at the expense of patients by denying reimbursement or other access for effective care options based on cost or ignore other patient needs in the name of cost savings.  Active, consistent participation in these and other opportunities for input is critical for those concerned about these and other issues to question and shape the goals, assumptions and actions HHS, Congress and others take to change the U.S. health care system.

HHS says most Network meetings will occur virtually by teleconference or webinar. In-person meetings will occur in the Washington D.C. area. HHS plans to hold the first live streaming of the kickoff event on Wednesday, March 25, 2015. HHS will share details through e-mails to those registered online to participate in the network.  Individuals and organizations concerned about ACO and other HHS-lead health care reforms are urged to register and participate in the Network as one of the ways to help monitor and shape health care reform as lead by HHS.

About Project COPE: The Coalition On Patient Empowerment &  Coalition on Responsible Health Policy

Do you have feedback or other experiences to share about medical debit, ACA or other health care challenges?  Have ideas for helping improve our system, helping Americans cope with these and other health care challenges or other health care matters? Know other helpful resources or experiences that you are willing to share?  Are you concerned about health care coverage or other health care and disability issues or policy concerns?  Join the discussion and share your input by joining Project COPE: Coalition for Patient Empowerment here.

Sharing and promoting the use of practical practices, tools, information and ideas that patients and their families, health care providers, employers, health plans, communities and policymakers can share and offer to help patients, their families and others in their care communities to understand and work together to better help the patients, their family and their professional and private care community plan for and manage these  needs is the purpose of

The Coalition and its Project COPE are founded and operate based on the belief that health care reform and policy must be patient focused, patient centric and patient empowering.  The best opportunity to improve access to quality, affordable health care for all Americans is for every American, and every employer, insurer, and community organization to seize the opportunity to be good Samaritans.  The government, health care providers, insurers and community organizations can help by providing education and resources to make understanding and dealing with the realities of illness, disability or aging easier for a patient and their family, the affected employers and others. At the end of the day, however, caring for people requires the human touch.  Americans can best improve health care by not waiting for someone else to step up:  Step up and help bridge the gap when you or your organization can. Speak up to help communicate and facilitate when you can.  Building health care neighborhoods filled with good neighbors throughout the community is the key.

The outcome of this latest health care reform push is only a small part of a continuing process.  Whether or not the Affordable Care Act makes financing care better or worse, the same challenges exist.  The real meaning of the enacted reforms will be determined largely by the shaping and implementation of regulations and enforcement actions which generally are conducted outside the public eye.  Americans individually and collectively clearly should monitor and continue to provide input through this critical time to help shape constructive rather than obstructive policy. Regardless of how the policy ultimately evolves, however, Americans, American businesses, and American communities still will need to roll up their sleeves and work to deal with the realities of dealing with ill, aging and disabled people and their families.  While the reimbursement and coverage map will change and new government mandates will confine providers, payers and patients, the practical needs and challenges of patients and families will be the same and confusion about the new configuration will create new challenges as patients, providers and payers work through the changes.

We also encourage you and others to help develop real meaningful improvements by joining Project COPE: Coalition for Patient Empowerment here by sharing ideas, tools and other solutions and other resources. The Coalition For Responsible Health Care Policy provides a resource that concerned Americans can use to share, monitor and discuss the Health Care Reform law and other health care, insurance and related laws, regulations, policies and practices and options for promoting access to quality, affordable healthcare through the design, administration and enforcement of these regulations.

Other Helpful Resources & Other Information

We hope that this information is useful to you.   If you found these updates of interest, you also be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, or our HR & Benefits Update electronic publication available hereYou also can get access to information about how you can arrange for training on “Building Your Family’s Health Care Toolkit,”  using the “PlayForLife” resources to organize low-cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail by creating or updating your profile here. You can reach other recent updates and other informative publications and resources.

Examples of some of these publications include:

For important information about this communication click here.

©2015 Cynthia Marcotte Stamer.  Limited non-exclusive license to republish granted to Solutions Law Press, Inc.  All rights reserved.