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6 Ways to Prevent Snoring

Snoring—that loud, hoarse breathing during sleep—is a nuisance, whether it affects you personally or the person you share a bed with. And that's a lot of people, since 37 million people are consistent snorers, according to the National Sleep Foundation. The sound originates in the very back of the mouth, where the soft tissues of many structures meet. When these tissues vibrate together, snoring occurs. This phenomenon is much more common in men than in women, and usually increases with age. Generally, snoring is not a cause for concern, unless it interferes with the sleep of others. But in some cases, it can be a sign of a serious medical condition called sleep apnea. In sleep apnea, people actually stop breathing for about 10 seconds at a time throughout the night, causing dangerous dips in blood-oxygen levels. According to the National Institutes of Health, this disorder may contribute to high blood pressure and even stroke. Anyone who snores on a regular basis should be medically evaluated to rule out this condition. If sleep apnea is not involved in your snoring, then there are lots of techniques to try that may help reduce or even eliminate snoring. Here are six simple suggestions that may help to reduce snoring: 1. Lose weight if you're overweight. Excess weight can contribute to a host of health problems, but it also narrows the airway, increasing the likelihood that those tissues will rub together. 2. Limit or avoid alcohol and other sedatives at bedtime. These substances relax the airway, leading to snoring. Limit yourself to less than one drink daily for women, or less than two drinks daily for men, and consume your last drink at least four hours before bedtime. 3. Avoid sleeping flat on your back. Back-sleepers are more prone to snoring since this position allows the flesh of your throat to relax and block the airway. If you are a habitual back-sleeper, try this method to retrain yourself: Stuff a tennis ball into a sock, and safety-pin the sock to the back of your pajamas. Each time you roll to your back during the night, you'll feel uncomfortable and turn back to your side. 4. Don't smoke. Besides contributing to other respiratory problems, smoking also leads to nasal and lung congestion, which can result in snoring. Take steps to quit today. 5. Avoid secondhand smoke. Secondhand smoke is just as harmful, and causes snoring in the same ways actual smoking does. Encourage your loved ones to quit, and avoid smoky restaurants and bars. 6. Improve your fitness level. When you have poor muscle tone, you're more likely to snore. Exercising tones and strengthens muscles all over the body, while also regulating your sleeping patterns. Aim for at least three cardio sessions and two strength training sessions each week. In most cases, snoring isn't caused by one single factor, but a combination of many. If these suggestions don’t work, see you doctor for more ideas. There are lots of products and procedures designed to reduce snoring, from removable plastic nasal dilators to nasal surgery. If you or your loved ones are suffering from snoring, a good night’s sleep may be just a doctor’s visit away.Article Source: http://www.sparkpeople.com/resource/wellness_articles.asp?id=853

Honest restaurant worker returns patron’s lost diamond

An Alaskan woman is thanking a restaurant worker for returning her diamond ring.

Rachel Saldana was visiting Carlos Mexican Resaturant in Anchorage and went to the bathroom to change her baby’s diaper.

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 A few minutes after returning to her table, she realized the diamond from her ring was missing.

“My heart just sank,” Saldana told KTUU.

Restaurant workers helped a frantic Saldana search for the ring, but they had no luck.

Patricia Christophersen works at the restaurant busing tables. She took Saldana’s phone number and promised she would keep searching.

After finishing her shift, Christophersen went to check the bathroom one last time, in case they had missed the diamond. The bathroom had already been cleaned for the evening, but amazingly, a sparkling rock caught Christophersen’s eye.

>> Need something to lift your spirits? Read more uplifting news 

“And miraculously, it was right behind the door, like, right behind the door on the ground!” said Christophersen.

She called Saldana at 11:00 that night to tell her the good news.

“She could have completely taken that diamond and sold it at a pawn shop, or wherever, to make a little extra cash, to be able to take care of things going on in her life. So the fact that she was so honest, and had so much integrity to contact me back and return it, was really amazing,” said Saldana.

How Being the Weird Kid Helped This Vegan Chef Become Crazy Successful

Welcome to Behind the Confidence, a video series about the real, unfiltered journey to self-belief. We talked to four health and wellness pros who prove true confidence doesn't stem from a "like," nor does it magically happen overnight. It's about finding what makes you feel good physically, mentally, and emotionally.

Confidence isn't a new concept to Jenné Claiborne, the vegan blogger behind Sweet Potato Soul. It's something she's felt since she was a child. And not much has changed—she still stands out in a crowd and radiates self-assuredness. In this video, Claiborne talks about where her inner strength comes from and the moment everything clicked for her.

A Paleo Shopping List for Beginners (So You're Not Tempted to Buy Bread)

So you're trying this whole Paleo diet for the first time. The last thing you need is to step foot into the grocery store with no clue what to buy. If frustration kicks in, so will the bread aisle. Then your (grocery cart) wheels spin off. Stay calm and prepared by taking this Paleo shopping list with you the next time you head to the store. It's not everything on the Paleo-approved list, but it's the perfect start to this high-protein, low-carb, no-junk-food way of eating.

You're gonna eat *lots* of protein.
  • Chicken. A Paleo-er's BFF.
  • Eggs. So. Many. Eggs.
  • Fish. All seafood, really.
  • Pork. Just wait until you try Paleo pulled pork.
  • Red meat. Especially ground, because meatballs.
  • Turkey. Not to be confused with turkey sandwiches.
  • Chicken sausage. A breakfast necessity.

Buy the ones you're actually going to eat (wilted greens are the worst).

  • Acorn squash. Best enjoyed with a drizzle of honey.
  • Beets
  • Bell peppers
  • Broccoli
  • Brussels sprouts. News flash: They go great with bacon.
  • Butternut squash
  • Cabbage. Don't knock it 'til you try it.
  • Carrots
  • Cauliflower
  • Celery
  • Cucumber
  • Mushrooms
  • Leafy greens
  • Onions
  • Spaghetti squash
  • Sweet potatoes. Swoodles, anyone?
  • Zucchini. And zoodles, duh.

We like to think of these as nature's desserts.

  • Apples
  • Avocados. Stock up.
  • Bananas
  • Berries
  • Cantaloupe
  • Dates. Add a little almond butter for a sweet treat.
  • Grapes. Freeze them for a post-dinner snack.
  • Lemons
  • Mango
  • Pears
  • Pineapples
  • Tomatoes
  • Watermelon

Nuts (and seeds) make the best 3 p.m. snack.

  • Almonds
  • Brazil nuts
  • Cashews
  • Hazelnuts
  • Pumpkin seeds
  • Sunflower seeds
  • Walnuts

Wine isn't on the list, but if you ask us, it's not *totally* off-limits.

  • Coffee
  • Coconut water
  • Club soda
  • Kombucha
  • Sparkling water
  • Tea

What would this world be without nut butters and coconut?

  • Almond butter
  • Coconut milk
  • Coconut oil
  • Ghee
  • ​Olive oil

A few staples that add some flavor.

  • Coconut aminos. Tastes like soy sauce.
  • Honey
  • Hot sauce. Makes everything better.
  • Maple syrup. For Paleo pancakes.

The Life-Changing Surprises That Come From Not Drinking for a Year

Party girl meets the bright light of day. / Photograph courtesy of Pat Bourque

My name is Rachel, and I am not an alcoholic. (Hi, Rachel.) But I drank too much, so I decided to take a couple of weeks off. A couple of weeks came and went, and as I neared the end of a month, I still didn’t feel ready to jump back in. I was feeling better—my head felt clear, and I felt more in control than I had in a long time. So I decided to make it a full calendar year, just to see what would happen. Right now, I'm nine months in.

Most people go dry for a resolved month in January (kudos!), but the idea struck me, seemingly without warning, in early May of last year. My anxiety had started chewing away at random parts of my life over the last year or two, and everyday activities had started sending me straight into heart-slamming panic. So one afternoon, I was doing nothing more unusual than driving to PetSmart for cat food when I suddenly experienced crashing waves of anxiety, like a spaceship was going to zoom down at any moment and swoop me up. It shouldn’t be this terrifying to drive 20 minutes away from my house, I thought.

So I considered what, in my day-to-day life, I could change. Contributing to my anxiety that day was my hangover. I'd overdone it a little the night before, which had made me uncomfortable and physically ill, but more than that, it was interrupting my brain function. All those neurons and synapses were firing off fight and flight simultaneously, creating a mental cocktail for panic. In that moment, I realized there was no way to combat my anxiety without cutting out the booze in one hard line.

But my lifestyle was so steeped in cheap beer and sparkling gin and tonics that it was practically impossible to imagine fully separating myself from booze. See, my corporate career of nine years was in sales and marketing with one of those big, fat macro-breweries popular with hipsters, millennials, and celebrities who want to be seen drinking low-brow brew for a dose of street cred.

Jell-O shots, a.k.a. the stuff of nightmares. "We’re all just functioning alcoholics," one red-faced boss said as we walked into a big stadium to negotiate a placement for the season. "Highly functioning alcoholics." His shirt looked like he paid someone to wrinkle it, and he'd wrapped electrical tape around most of his fingertips in a bid to prevent him from biting his cuticles and nails down any more than he already had. He looked puffy and untrustworthy.

When he said those words about us, I felt like I was being force-fed a half-dead rat.

"I’m not like you," I thought. And maybe I wasn’t. But the thought made it hard for me to just blithely go from happy hours to tastings to beer fests. In the beer biz, there was one irrefutable expectation, especially if you're among the rare women: You have to be able to hang.

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One morning, I met with a salesman to ride his route to try to sell his accounts on some new product we were pushing. He said he gets an early start, which I never do, so meeting him at a neighborhood bar in the morning was a stretch in every way. Still, it felt like a kind of adventure. Walking in, I realized that the bar was full from one end to the next—at 7 a.m. When a heavy glass tumbler full of Baltimore’s honey- and cinnamon-laced moonshine, which is called "Evil," came at me first thing with a clink, I thought, "Ugh," but tossed it straight down the hatch. It was just going to be one of those days.

Over the years, these days became less surprising and more and more common. Some salesmen lived this drink-all-day life every day, so it gave me a strange sense of perspective. I could separate my drinking, a whole cut above the rest, and think, "I’m still not like you." Comparatively, my relationship with alcohol was mild.

After I left the industry, I wish I could say I found greener or more holistic pastures, and at times I did, but I still drank. Drinking helps so much with everything from anxiety to stage fright… until it doesn’t. And when it isn’t helping, it’s one hell of a choker. But in the past nine months, I haven't had so much as a sip, drop, shot, or beer since the day I decided to try this on. The closest I’ve come is the odd dream here and there where, for some ungodly reason, I drink a warm, cheap beer out of a plastic cup, or an awful, fruity malt beverage—and immediately regret my actions. I wake up feeling so incredibly relieved that none of it actually happened.

So here are my key takeaways, just in case you’re like one of the many people I encounter whose curiosity about going sober for a time comes from thinking about calling it quits too.

No booze means no hangovers.

I didn’t realize how amazing never, ever getting a hangover would be. Yes, it's even better than the boozed-up confidence that encouraged me to wear that dress and dance at the soul night and talk to a boy. Not being hungover is gorgeous. The utter lack of hangover makes me feel like quitting drinking isn’t actually about cutting something out so much as putting something better in.

People aren’t really that scary.

OK, some people will always be scary, but without the social lube, the scary ones become apparent super quickly, and I can now move away from stranger danger like BAM instead of after half a dozen half-witted hangs in a dark bar, groping at intuition. Otherwise, people in grocery stores and audiences and meetings are just people instead of automatic heart attack prompters.

Sleep is amazing.

I get it now: Sleep is restful. My dreams are cray, but I had missed them so, so much. Pro tip: If I ever want a "sober drunk," I just stay up way past my bedtime and get all the delirious feels that come with a little sleep deprivation. It really works.

Your appreciation for basically everything develops.

I used to get antsy at concerts, and I couldn’t really appreciate a day at the museum, knowing there was a beer to be had at the bar after. "Portrait, portrait, war sucks, portrait, sculpture—got it! Let's go." My attention span for things I cared about was diminished, and so was my capacity to love. Love requires all kinds of stillness, genuine curiosity, and wonder, it turns out.

Your social life will experience ch-ch-ch-changes.

If I kept yammering on about all the amazing benefits of not drinking for a year, you might not believe me, and you’d be right: Some things aren’t easy. A number of my friendships revolved around partying—it’s just what we did and how we spent our time. So some of those connections didn’t hold up without the crutch. Alcohol can really rev up an argument for some people, but it can also cast a spell and make you think a connection is stronger than it is.

Damn, does the mirror become your friend.

In my experience, suddenly ceasing drinking means you’ll lose weight. Your face will look less tired. That stubborn belly fat ceases to be stubborn when you stop feeding it. IMO, you could exercise less and still look better if you quit drinking. But if you’re like me, you’ll end up exercising even more because you feel like it, because it feels good to be physically strong. Before, I often saw exercise as a way to balance alcohol's negative effects. Now it’s a simple matter of power.

My lifestyle was so steeped in cheap beer and sparkling gin and tonics that it was practically impossible to imagine fully separating myself from booze.

My life has been positively affected by quitting drinking in all of these ways and more. Most of all, putting down the bottle has helped me to build confidence, and I believe that a lack of confidence causes all kinds of trouble: It makes Sally anxious, and it makes Jon want to sabotage himself and others around him. It breeds dark, ungainly urges.

When you feel bad about yourself, chances are that negativity and doubt are gonna express themselves one way or another, and whether you throw yourself a pity party or use them to try to make someone else look bad, they’re going through you—making you age prematurely, that surly look on your face stick, your blood spoil. In short, it’s not a good look.

Drinking can ease insecurity and boost a kind of false confidence that starts unnecessary fires and leaves a trail of meanness that burrows a not-so-charming perma-link in your brain. And this kind of damage is not easily undone. If instead, in the clear light of day, you confront whatever monster is living in your head or your heart and telling you, "You aren’t good enough," you’ll be happier and have a more meaningful relationship with yourself and others.

In the end, I honestly can’t think of any good reason to drink anymore. The idea of the year off drinking was to change my behavior around, and relationship with, alcohol. I figured a year would be long enough to hold a variety of experiences—holidays, breakups, hopefully meeting the man of my dreams, rejections, sleepless nights, congratulations, throw-down fights—and that if I could manage all that without the hard stuff, I’d have a pretty good idea of who I really am, what I really want, and how to make it happen. And so far, it's working.

Rachel Anne Warren is a writer and wedding singer based in Baltimore, MD. Her debut memoir is about running away to join a circus when she was 19-years-old. Follow her on Twitter and Instagram.

7 Clean-Eating Recipes That Prove You Can Eat Bread, Dessert, and (Good) Salads

Eating clean might sound like a whole lot of celery sticks and lemon water, but this week's featured foodie, Amie Valpone of The Healthy Apple, proves there's more to (a clean-eating) life. She's sharing her favorite clean-eating recipes, ranging from dinner-worthy salads to homemade, grain-free breads. And don't worry, there's even a chocolate dessert. Hey, looks like we can all get on board with this clean-eating craze if bread and sweets are still in the mix.

1. The Best Kale and Sweet Potato Salad We know what you're thinking... of course boring salads are included in clean-eating recipes. But TBH we're just trying to prove how easy it is to throw together a delicious salad that will fill you up at dinner and clean out your fridge. Use this recipe as a base, because we'll be adding in whatever our fridge has to offer. 2. Roasted Onion Arugula Salad With Creamy Hummus Dressing Don't judge a salad by its simplicity. Roasted Vidalia onions are caramelized to a sweetness that complements savory quinoa, crunchy walnuts, and a homemade hummus dressing tossed with arugula. Pro tip: If you have leftover store-bought hummus, just mix it with balsamic vinegar and lemon juice for a super-fast DIY version. We won't tell. 3. Grain-Free Coconut Shortbread Crackers With coconut flour, cacao powder, and a peach, you might call BS on the fact that these are considered crackers. But if we're comparing to a chocolate chip cookie, these are far less sweet. Mix the ingredients in a large bowl, flatten to a 1/2-inch crust, and bake in the oven for close to an hour. Who cares what you call them? All that matters is they are damn good. 4. Grain-Free Parsnip Focaccia Bread Your Italian grandmother might say WTF at this bread, but we say it's FTW. It may not be as fluffy as standard focaccia, but if you're going grain free or Paleo and you miss bread (who doesn't?), then get out a few parsnips, chickpea flour, and flaxseeds and you're already halfway done. 5. Paleo Sweet Potato Flatbread Sweet potatoes, you just keep getting better. This recipe looks just like the focaccia bread you've already drooled over, but the taters give it a unique (and also drool-worthy) taste. Once you give these no-grain-needed breads a try, you might consider a bread-free life forever. 6. Quinoa Pizza Crust With Carrot Ribbon and Shallots Invite your gluten-free friends over, because you're ready to throw a pizza party. You'll need to be somewhat prepared, because the key to this crust is soaking the quinoa the night before, but then you're just mixing it with veggie broth and flaxseeds before sticking it in the oven. The easy-to-prep toppings give it that gourmet look that will impress guests but keep you stress free. 7. Raw Chocolate Coconut Banana Tart When you think of "clean eating," desserts aren't the first thing to come to mind. But this no-bake, chocolaty recipe is about as squeaky clean as it gets. With a crust made up of almonds and dates and a creamy filling of mostly bananas and coconut milk, we think it's totally OK if you eat this for breakfast.

Amie Valpone, HHC, AADP is the founder of The Healthy Apple and best-selling author of Eating Clean: The 21-Day Plan to Detox, Fight Inflammation, and Reset Your Body. She is a Manhattan celebrity chef, nutrition expert, wellness consultant, and motivational speaker specializing in simple gluten-free, soy-free, and dairy-free clean-eating recipes. Amie lives in New York City, where she cooks for clients with busy lifestyles. Visit Amie on Facebook, Twitter, Instagram, and Pinterest.

How to DIY a Shared Bedroom Space For Two Kids

Making room for two.After finding out that I was unexpectedly pregnant with a third child, creating a combined...

Drowning In A ‘High-Risk Insurance Pool’ — At $18,000 A Year

Some Republicans looking to scrap the Affordable Care Act say monthly health insurance premiums need to be lower for the individuals who have to buy insurance on their own. One way to do that, GOP leaders say, would be to return to the use of what are called high-risk insurance pools, for people who have health problems.

But critics say even some of the most successful high-risk pools that operated before the advent of Obamacare were very expensive for patients enrolled in the plans, and for the people who subsidized them — which included state taxpayers and people with employer-based health insurance.

Craig Britton of Plymouth, Minn., once had a plan through Minnesota’s high-risk pool. It cost him $18,000 a year in premiums.

Britton was forced to buy the expensive coverage because of a pancreatitis diagnosis. He called the idea that high-risk pools are good for consumers “a lot of baloney.”

“That is catastrophic cost,” Britton said. “You have to have a good living just to pay for insurance.”

The argument in favor of high-risk pools goes like this: Separate the healthy people, who don’t cost very much to insure, from people who have preexisting medical conditions, such as a past serious illness or a chronic condition. Under GOP proposals, this second group, which insurers expect to use more medical care, would be encouraged to buy health insurance through high-risk insurance pools that are subsidized by states and the federal government.

Republican Speaker of the House Paul Ryan made the case for high-risk pools on public television’s “Charlie Rose” show in January.

“By having taxpayers, I think, step up and focus on, through risk pools, subsidizing care for people with catastrophic illnesses, those losses don’t have to be covered by everybody else [buying insurance], and we stabilize their plans,” Ryan told the TV host.

Minnesota’s newest congressman, Rep. Jason Lewis, a Republican representing Burnsville and Bloomington, recently endorsed high-risk pools on CNN.

“Minnesota had one of the best … high-risk insurance pools in the country,” Lewis said. “And it was undone by the ACA.”

It’s true that the Affordable Care Act banned states’ use of high-risk pools, including the Minnesota Comprehensive Health Association, or MCHA. But that’s because the MCHA was no longer needed, the association’s website explains; the federal health law requires insurers to sell health plans to everybody, regardless of their health status.

Supporters of the MCHA approach tout a return to it as a smart way to bring down the cost of monthly premiums for most healthy people who need to buy insurance on their own. But MCHA had detractors, too.

“It’s not cheap coverage to the individual, and it’s not cheap coverage to the system,” said Stefan Gildemeister, an economist with Minnesota’s health department.

MCHA’s monthly premiums cost policyholders 25 percent more than conventional coverage, Gildemeister pointed out, and that left many people uninsured in Minnesota.

“There were people out there who had a chronic disease or had a preexisting condition who couldn’t get a policy,” Gildemeister said.

And for the MCHA, even the higher premiums fell far short of covering the full cost of care for the roughly 25,000 people who were insured by the program. It needed more than $173 million in subsidies in its final year of normal operation.

That money came from fees collected from private insurance plans — which essentially shifted a big chunk of the cost of insuring people in the MCHA program to people who get their health insurance through work.

Gildemeister ran the numbers on what a return to MCHA would cost. Annual high-risk pool coverage for a 40-year-old would cost more than $15,000 a year, he says. The policyholder would pay about $6,000 of that, and subsidies would cover the more than $9,000 remaining.

University of Minnesota health policy professor Lynn Blewett said there is a better alternative than a return to high-risk pools. It’s called “reinsurance.” In that approach, insurers pay into a pool that the federal government administers, using the funds to compensate health plans that incur unexpectedly high medical costs. It’s basically an insurance program for insurers.

The big question is whether lawmakers will balk at the cost of keeping premiums down for consumers — whatever the approach, Blewett said.

“The rub is, where that funding is going to come from?” she said. “And is the federal government or the state government willing to put up the funding needed to make some of these fixes?”

The national plan Ryan has proposed would subsidize high-risk pools with $25 billion of federal money over 10 years. The nonpartisan Commonwealth Fund estimates the approach could cost U.S. taxpayers much more than that — almost $178 billion a year.

Researchers at the consulting firm McKinsey & Company say reinsurance would likely cost about a third of what the high-risk pool option would.

This story is part of NPR’s reporting partnership with Minnesota Public Radio and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

To Pay Or Not To Pay – That Is The Question

K.A. Curtis gave up her career in the nonprofit world in 2008 to care for her ailing parents in Fresno, Calif., which also meant giving up her income.

She wasn’t able to afford health insurance as a result, and for each tax year since 2014, Curtis has applied for — and received — an exemption from the Affordable Care Act’s coverage requirement and the related tax penalty, she says.

This year, given President Donald Trump’s promise to repeal the ACA, along with his executive order urging federal officials to weaken parts of the law, Curtis began to wonder whether she’d even have to apply for an exemption for her 2016 taxes.

She also heard that the IRS recently flip-flopped on its previous decision to reject 2016 tax returns that don’t include the taxpayer’s health coverage status.

“I thought, ‘Maybe I won’t have to apply for the exemption again,’” says Curtis, 59. “The public debate about the law makes it confusing.”

Indeed, there’s widespread confusion among consumers about the status of Obamacare, and because of that, they are uncertain how to handle Obamacare-related tax requirements.

Should you still submit your 1095 tax forms that show when you were covered — or, if you purchased a plan from an exchange, the amount of tax credits you received? Should you apply for an exemption from the Obamacare coverage requirement?

If you were uninsured in 2016 and don’t qualify for an exemption, should you pay the Obamacare tax penalty?

“Unfortunately, there are a lot of myths floating around,” says Lawrence Pon, a certified public accountant (CPA) in Redwood City. “Some of my clients ask me, ‘Does the law still exist?’”

It sure does.

As a result, California tax experts have some relatively simple advice for confused taxpayers.

“Until Obamacare is no longer the law of the land, we don’t have much choice other than to continue under the current rules and regulations,” says Janet Krochman, a CPA in Costa Mesa.

Death, Taxes And Obamacare

This year’s tax filing deadline is April 18.

And as many of you learned in the past few years, Obamacare and taxes are inextricably linked.

As part of filing your tax return, you need to prove you had health insurance, or pay a penalty, unless you qualify for one of the law’s exemptions.

If you bought coverage through a health insurance exchange such as Covered California and received federal tax credits, which are based on an estimate of your income, you must report whether your actual income varied from your estimate. Since most of you received tax credits in advance, if there’s a difference you may either owe or be owed money.

Many tax preparers say they’d rather not deal with the law’s arcane and complex requirements. But every single one I spoke with says they will continue doing so as long as former President Barack Obama’s health law exists.

“I tell everybody I want all of their forms. We’re going to document everything,” says Rebecca Neilson, a registered tax preparer in Sheridan, about 40 miles northeast of Sacramento. “I’m not going to change what I’m doing because the law might get changed.”

However, a recent IRS switch has fueled hopes among some consumers that the agency won’t enforce the Obamacare tax penalty for 2016.

On 1040 tax forms, taxpayers must check a box attesting that they had health care coverage, or enter their penalty amount if they didn’t.

For the first two tax years that Obamacare was in effect, the IRS accepted tax returns that didn’t include this information but often followed up with taxpayers to get it. For 2015, about 4.3 million taxpayers did not check the box, claim an exemption from coverage or pay a penalty, according to the IRS.

The IRS had said it would start rejecting those forms outright for the 2016 tax year — until Trump signed his executive order.

Citing the order, the agency now says it will continue to process tax forms that don’t include a taxpayer’s health coverage status. “This is similar to how we handled this in previous years,” says an IRS statement.

At the same time, the agency says it will continue to enforce the health law and may follow up with taxpayers who withhold their coverage information.

“Legislative provisions of the ACA law are still in force until changed by the Congress, and taxpayers remain required to follow the law and pay what they may owe,” the IRS statement says.

Mixed Signals

Andrew Porter, a CPA in Contra Costa County, believes that the agency “has just added to the confusion” with this change but that taxpayers shouldn’t be lulled into complacency.

“They have to enforce the law,” he says. “It’s exactly the same as last year.”

Though Porter doesn’t advise it, if you choose not to report your coverage on your tax return, he urges you to make sure you have your 1095 form so you have proof of coverage.

“If the IRS does come calling and says you owe this penalty, producing that document may be very useful,” he says.

Michael Eisenberg, a CPA in Encino, acknowledges that there may be consumers who owe a penalty and are hoping that a repeal in the coming months would get them off the hook.

They could request a tax-filing extension, allowing them to submit tax forms to the IRS in October, he says.

But that’s not a sure thing and would require any change in the law to be retroactive to the 2016 tax year, he says. If the penalty is not forgiven, they would have to pay it, plus interest.

“Maybe there will be clarity by October, maybe there won’t be,” Eisenberg says. “You can take your chances, but what’s the likelihood the law would be repealed retroactively? I don’t think it’s that great.”

Krochman, the Costa Mesa CPA, has a few clients who owed the penalty in previous years but haven’t paid it.

“They’re kicking the can down the road in the hopes there will be retroactive removal of the penalty once the law is repealed or replaced,” she says. “What happens down that road, we don’t know.”

Given the uncertainty, my biggest piece of advice is, and always has been, to consult with a tax professional. If you can’t afford it, multiple programs offer free tax help, including the Volunteer Income Tax Assistance (VITA) program, run by the IRS (www.irs.gov/VITA) and the AARP Foundation Tax-Aide program (www.aarp.org/findtaxhelp).

In the face of the confusion, Curtis, of Fresno, erred on the side of caution.

“I ended up deciding this year to go ahead and file the exemption paperwork and be safer than sorry,” she says. “It is the law, and we’re stuck navigating our way through it, as difficult as it may be.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Liberal Vermont Tests The Waters On GOP Health Care Overhaul

Tiny — and very blue — Vermont could be at the leading edge of the health reforms envisioned by the Trump administration and a Republican Congress.

The Green Mountain State, population around 626,000, got a broad waiver last October from the federal government to redesign how its health care is delivered and paid for. The statewide experiment aims to test new payment systems, prevent unnecessary treatments, constrain overall growth in the cost of services and drugs, and address public health problems such as opioid abuse.

The six-year initiative — an outgrowth of a failed attempt by Vermont a few years ago to adopt a single-payer plan for all residents — could eventually encompass almost all of its 16 hospitals, 1,933 doctors and 70 percent of its population, including workers insured through their jobs and people covered under Medicare and Medicaid.

The Obama administration approved the experiment, but it fits the Republican mold for one way the Affordable Care Act could be replaced or significantly modified. The Trump administration and lawmakers in Congress have signaled that they want to allow states more flexibility to test ways to do what Vermont is doing — possibly even in the short-term before Republicans come to an agreement about the future of the ACA.

Two Republican senators, Bill Cassidy of Louisiana and Susan Collins of Maine, introduced legislation in January that would permit individual states to design their own health reforms and keep provisions of the health law intact.

Coincidentally, the ACA contains a provision that allows states to launch such experiments starting this year, as long as they meet the ACA’s overall goals for coverage expansions and consumer protections. One possible scenario, then, is that the Trump administration and Congress would agree to retain a version of that provision — modified to make it easier for states to experiment, experts say.

“It’s a very reasonable approach, especially if it looks as if Congress can’t agree on an immediate replacement plan,” said Stuart Butler, a senior fellow in economics and health policy at the Brookings Institution in Washington, D.C. “States have long been the laboratories for social change and policy reform, and I think many governors, Republican and Democrat, would welcome this opportunity.”

Chris Jennings, a longtime health policy adviser to Bill and Hillary Clinton and Barack Obama, said Democratic states also may be amenable. “There’s a long way to go on this and there are downsides — for example, what would state legislatures actually do — but it looks like it will be a meaningful debate.”

‘We Want To Simplify How Things Work’

Al Gobeille, Vermont’s secretary of Human Services and a Republican serving under newly elected Republican Gov. Phil Scott, said the hope is that the Trump administration will preserve the state’s initiative.

“We are doing what [the Republicans] seem to be talking about,” said Gobeille, who owns a restaurant company in the state. “We want to simplify how things work, with both coverage and access to care. We want to enhance competition and we want to lower cost growth even as we improve quality.”

Scott and Gobeille this month announced the formal launch of the program’s pilot phase. In 2017, 30,000 of the state’s roughly 190,000 Medicaid patients will get care, under a set budget, through an organization called OneCare Vermont. OneCare’s network of hospitals and doctors already provide care to about 100,000 Vermonters.

The state will give OneCare $93 million, in monthly payments, for the care of the 30,000 Medicaid patients — $3,100 per person. If OneCare spends more than $93 million, the company will absorb the loss. If OneCare spends less than that amount, the company and the state share the savings.

“This tests the concept of a global budget and streamlined payment which incentivizes better care,” says Todd Moore, OneCare’s CEO. “We may be a small state but we are trying a big thing. If it works, many states are likely to stand up and take notice.”

Moore added that patients will be informed they are part of the program and can seek redress with the state’s Department of Human Services if they feel their care is stinted in any way.

In announcing the pilot program, Scott said that if it’s successful the experiment will be expanded in 2018 and beyond to encompass the rest of the Medicaid population, Medicare beneficiaries and people who have insurance through private employers and on their own, including through Vermont Health Connect, the state’s Obamacare insurance exchange. Additional hospitals, doctors and other providers would become involved, likely under the umbrella of OneCare Vermont.

Medicaid covers almost 30 percent of Vermont residents, Medicare covers 21 percent, and the rest have either private insurance, coverage through the VA or Tricare (military) or are uninsured. About 4 percent of Vermonters were uninsured in 2015, one of the lowest rates in the nation.

Under the terms of Vermont’s contract with the Obama administration, the target for the state’s maximum overall cost increase in health spending would be 3.5 percent per year from 2018 to 2022 — that’s two percentage points lower than the annual 5.6 percent average increase in health care spending nationally the federal government projects between this year and 2025.

Success or failure will also be assessed based on population health and quality of care measures. For example, the plan calls for a reduction of substance abuse deaths by at least 10 percent by 2022. Likewise, the plan sets a target for not more than a 1 percent rise statewide in the number of people with chronic diseases such as diabetes, high blood pressure and COPD (chronic obstructive pulmonary disease). The allowance for the slight increase takes account of the state’s aging population.

The number of people with ready access to a primary care physician will also be evaluated, with a target of 90 percent of residents by 2022.

A Shift From ‘Fee For Service’

To make all this work, almost every doctor and hospital would have to join OneCare Vermont or create their own accountable care organizations, or ACOs. In these organizations, providers agree to work together to improve and coordinate care and reduce spending under a set budget.

ACOs are also set up to allow payers to gradually shift to global per-patient payment, or other simplified forms of payment, and abandon traditional “fee-for-service” payment. Fee-for-service payment in medicine is widely viewed as providing incentives for excessive and wasteful care, as well as fraudulent billing. Both the Affordable Care Act and a 2015 law setting up an incentive-payment system in Medicare for doctors take major steps to test whether ACOs and alternative payment systems improve the efficiency and quality of care.

Vermont’s initiative builds on those efforts.

Some in Vermont are skeptical the experiment will work well, however. Paul Reiss is a family doctor in Williston and chief medical officer for HealthFirst, Vermont’s largest independent practice association. HealthFirst represents (but does not own or operate) 66 doctor groups with 250 doctors, physician assistants and nurses. Reiss said the state’s largest hospital system — the University of Vermont Medical Center — dominates health care in parts of state.

“We are fearful that much of a restricted pot of money will still go mostly to that company, baking in the inefficiencies of a bloated hospital budget, and not be deployed equitably to the front lines of patient care across the state,” Reiss said.

The University of Vermont Medical Center vigorously denied that its budget was bloated. Moore, who is affiliated with the hospital as well as being OneCare Vermont’s CEO, said: “Statewide data do not confirm those assertions. The medical center is, in fact, a strong leader in ushering in a value-based system for Vermont.”

Scott, in announcing the launch of the pilot phase this month, said if it does not work this year, the state would consider terminating the experiment early.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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