Executive Orders related to the PPACA (Patient Protection and Affordable Care Act) began being circulated last Saturday.  More information is due to be released when the Secretary of Health and Human Services (HHS) is confirmed ... but not yet.
No-one yet knows how long the law will remain in effect. However it was made clear in the Executive Order that it is “Imperative for the executive branch to ensure that the law is being efficiently implemented”. It also stated that all executive departments should “take all actions consistent with the law to minimize the unwarranted economic and regulatory burdens of the ACA”. The order then mentions that there should be an effort to afford states more flexibility and control in order to create a more open healthcare market.
After the release of the Executive Order, many are still trying to determine what this all means. What will happen to the individual mandate? What does this mean for insurers? Will employers still have to comply with IRC section 6056? What about the exchanges? Before addressing these things it is imperative to first review some key language from the Executive Order itself.
Sec. 2. To the maximum extent permitted by law, the Secretary of Health and Human Services (Secretary) and the heads of all other executive departments and agencies (agencies) with authorities and responsibilities under the Act shall exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.
Sec. 3. To the maximum extent permitted by law, the Secretary and the heads of all other executive departments and agencies with authorities and responsibilities under the Act, shall exercise all authority and discretion available to them to provide greater flexibility to States and cooperate with them in implementing healthcare programs.
Sec. 4. To the maximum extent permitted by law, the head of each department or agency with responsibilities relating to healthcare or health insurance shall encourage the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers.
Sec. 5. To the extent that carrying out the directives in this order would require revision of regulations issued through notice-and-comment rulemaking, the heads of agencies shall comply with the Administrative Procedure Act and other applicable statutes in considering or promulgating such regulatory revisions.
If any action is to be taken regarding loosening any rules this will most likely require new proposed regulations. This in turn is followed by a review and implementation period. On top of this the Democratic Party is not planning on “playing nice”. To sum it all up any changes will inevitably take some time. These things typically take a while (possibly years) even when they are noncontroversial.Many are wondering what this means for the employer mandate and therefore employer reporting. So far there has been no word specifically on this. One thing is for sure, until the Treasury Department announces something different the current law of the land still stands. This means that all employers should be prepared to furnish 1095Cs to employees by the end of February and also plan to have these filed with the IRS by the March deadlines.

Many errors are being noted as a result of the e-files loaded through the new AIR IRS system. We also expect error reports for paper filers as well. Errors are common it seems as all the TPA's that we have spoken too as well as the IRS confirm that the AIR system's validation has many faults and often the IRS data itself is out of date or just plain wrong.

The "Good Faith Filing Standard" which is the standard for 2015 ACA Reporting means that errors that are noted should be corrected if possible and obvious but NO deadline to do so has been communicated.  If there are errors in the paper or e-file, Source documents need to be reviewed and placed in good order.  Source documents would be the I-9 Form and supporting documents, original insurance enrollment forms completed by the employee ... etc. Again, just because there is an error, does NOT mean that records that were used for reporting are necessarily wrong ... just different from what the AIR system has to match to the record loaded. There is NO guidance on what steps to take IF the information sent to the IRS matches current employer records. "Honest" differences could be incomplete names changes after marriage or divorce, hyphenated last names, dates of birth transposed, name spelling, etc. Problems could occur when employees have provided fake ID's including "bought" Social Security Cards.

Remember one more thing. We are dealing with the IRS and a new area of employment law. Under the theory of American employment law, the employer is considered "guilty" and has the burden of proof for innocence. That is precisely why good documentation is so very important.

Employees that were offered "Affordable Coverage" by their employer were NOT supposed to get subsidized plans from the Marketplace. Many did for the simple economics that the standard for "affordability" for employers was 9.5% for SINGLE coverage and the Marketplace subsidy is for any tier up to and including family coverage ... on the Silver Plan level. Practically speaking, many employees were faced with the cost of Single Coverage that was offered by their employer that was "affordable" costing about the same as Marketplace family premium IF it was subsidized. All the employee had to do was claim that the employer coverage was "not affordable". In these cases, at least initially, the employer is most likely to get a penalty letter from the IRS because an employee listed on the ACA filing as having been offered "affordable coverage" received a subsidy ... and the employer must pay a penalty. Ouch. Employers will have 90 days to appeal and having proof that the Marketplace letters were sent to the employees will be paramount in getting this penalty abated.

Thanks for trusting our staff to assist with your compliance efforts.

The Affordable Care Act has been expensive in so many ways.  Premiums have increased, along with paperwork, reporting, worry, and health insurance awareness.  Just one little tidbit that I think is more representative than we might like to admit.

On a recent CBS Sunday Morning broadcast, it was revealed how much "Med-Flight" helicopters cost and how much patients are charged.  Redundant?  Read on!

The cost with some profit for the service provider averages about $12,000 according to the management representative of a certain med-flight service and that is typically what the insurance pays for ... if the patient has insurance.  You see, the med-flight service actually send out invoices for around $50,000 because so few people can pay the $12,000 they have to "over-charge" everyone.

In a previous post we outlined an out patient hospital procedure that only resulted in the hospital being paid $1,200 ... $600 from the patient and $600 from the insurance carrier and the rest was written off ... right on the EOB (Explanation of Benefits).  So, what is going on here?

A lot.

It seems that those that say that it is always about "money or sex" when trying to root out corruption applies here.  It seems to be money.  Why would a hospital charge $12,000 but then accept $1,200 as full payment when an insurance company is involved?  Let that simmer for a minute.  Then scroll down.












It is about money.  When asked about the procedure's cost, the Doctor quickly responded, $12,000.  The relief is that with insurance, it only cost the insured patient $600.  So who benefits from this arrangement?  Let that simmer for a minute.  The scroll down some more.

















First, consider who does NOT benefit.  The uninsured. Because the uninsured have to pay the $12,000 or seek some agency to pay it on their behalf ... or even finance it with the hospital accounts receivable office.  So, who benefits?  Well, who gets the "deal" on the $12,000 procedure?  Not the patient really because the patient is paying $600 plus their monthly premium.  The insurance company is the big winner here.  They have provided no real service, while claiming to negotiate the costs down actually have driven costs up for all of us because our taxes fund payments for those without insurance who get to pay rates that in this case are higher by a multiple of 10 and the actual cost is hidden in the process so the insured have a false sense of gratitude because they are led to believe that their insurance really saved them.

I remember flashing down the interstate with a co-worker who was driving probably a little too fast.  As we approached a merging lane a car suddenly appeared beside us and my co-worker jerked our car hard to the left lane and overshot it by putting the left 2 wheels on the grass.  Then with a panicked stab on the brakes, we were spinning down the center of the two lanes with all 4 wheels locked (this was before anti-lock brakes).  As our car came to a stop, we were cross ways in the middle of the two lanes with on-coming traffic, which included a tractor trailer, headed directly at my door (this was before air bags too, but I doubt that an airbag would have stopped that truck).  My co-worker quickly backed into the median grass and the traffic whisked past us without a scratch to us or the car.  So, then my co-worker asked for a "thank you" for saving my life.

That is the point of both of these stories.  My co-worker put me in "harm's way" so why should I be grateful?  The apparent collusion between providers, insurance companies and drug companies have contributed significantly to the rising costs of care and insurance ... why should we be thankful?  

Why not just charge $1,200 and move on?  Does it really matter who pays it?  Should it really matter who pays it?

The proponents of the PPACA talked up the facts that underwriting and pre-existing conditions would go away.  They did.  Premiums have rocketed up.  It is NO LONGER insurance but rather a punitive money transfer where those that have insurance pay for those who don't and the poorest people will get fined.

• The requirement that the insurance companies write all "comers" took away the insurance element and now the premiums reflect that.  
• The requirement that everyone have insurance will be, could be, enforced with the 1095 filings and from the thousands that have come across my screen in the past weeks, the poorest will be punished.

The Centers for Medicare and Medicaid Services (CMS) recently announced that they have retired certain qualifying life events for consumers searching for coverage outside of the Affordable Care Act's nationwide open enrollment period. CMS has also made it more difficult to qualify for some of the special enrollment opportunities that are still available (1).

Qualifying Life Events - And How to Prove You Are Eligible
The following describes common qualifying life events that may allow you to enroll in a major medical health insurance plan after open enrollment ends, as well as the paperwork you may need to provide in order to show that you're eligible.

• Loss of qualifying employer coverage: Some insurers require a letter from your former employer that confirms your loss of coverage as well as the date and the reason it occurred. The letter should include the names of the employee and dependents affected. Some insurers will accept a letter showing eligibility for COBRA if it provides the same details listed above.
• Loss of COBRA coverage: If you were previously insured through COBRA, some insurers require you to provide a copy of the letter you should have received stating that your COBRA coverage has now been exhausted.
• Birth or adoption of a child: Some insurers require a copy of the child's birth certificate and/or placement or adoption papers, with a court seal.
• Adding a new dependent: When a child moves in with you for reasons other than birth or adoption, you may need to provide a copy of a court order (in case of a divorce or custody settlement) or school admissions documentation or transcripts.
• A permanent move to a new coverage area: You may be required to show copies of utility bills from both your former and the new residence, dated within sixty days of the date of your move. Mobile phone bills and bank statements are typically insufficient.
• Marriage or divorce: A copy of the marriage license (translated into English, if necessary) or a court-stamped copy of the divorce decree may be required.
• Change of income that alters your eligibility for assistance: You may be required to provide documentation of your eligibility for subsidies. This is generally obtained through the government health insurance exchange serving your state.

What to Expect When Enrolling in Coverage with a Qualifying Life Event
You may have questions about what to expect when enrolling in coverage outside of the nationwide open enrollment period. Here are a few things you should know:

• You have sixty days to enroll. If you experience one of the qualifying life events described above, you will typically have a sixty-day window to enroll in a new health insurance plan.
• Loss of prior coverage due to lack of payment is not a qualifying life event. If your old plan was cancelled because you failed to pay your monthly premiums, this is not considered a qualifying life event and will not allow you to enroll in a new plan outside of the nationwide open enrollment period.
• Not all major life events are considered "qualifying" life events. For example, pregnancy is not considered a qualifying life event, though the birth of a child is. If you were previously uninsured at your old address, moving to a new coverage area is not considered a qualifying life event. Cancelling coverage under your old plan because it is too costly or cancelling your COBRA coverage because it is too costly are not qualifying life events. Loss of coverage under a short-term health insurance plan is not a qualifying life event.
• Having your paperwork handy can speed things up. It can be difficult to obtain the paperwork you may need from former employers or utility companies proving that you have experienced a qualifying life event. Work to obtain these things as quickly as possible after your qualifying life event so that your sixty-day special enrollment window doesn't close before you can sign up for a new plan.
• It can take a few weeks to confirm your eligibility: The time required for an insurance company to confirm your eligibility to enroll may vary from insurer to insurer. It may take 2-3 weeks in some cases, or even longer at busy times of year. Note that your coverage will generally not take effect immediately after approval, but may require 2-6 weeks from the date your application is approved.

Notes:
(1)  Refer to the January 19, 2016 CMS announcement on retired special enrollment periods and to the January 19, 2016 CMS clarification on residency requirements for special enrollment periods.

Ok, you get one guess the "purpose" of the Cadillac Tax.  One Guess.

I could give you a thousand guesses and you will never get this right.  Maybe two thousand.

NPR is a great source for news and has a broad scope of topics that play down the BIG headlines that get pounded on most broadcast news on TV and Radio.  They have segment called Marketplace.

I am writing this before the audio has posted but the host interviewed one of the PPACA Authors regarding the recent two year delay of the Cadillac Tax provision.  Let me say that my current plan is VERY close to invoking the Cadillac Tax as stated in the law.  The HSA contributions AND total Premium count to the calculation of the tax.  Yes, I have a high deductible plan ... $12,000 deductible ... thank you.  And for the record, my total plan costs are only about $1,000 less than the threshold for the tax.  Crazy.

Now, for the "purpose" of the tax, taking my current costs (and probably many of you) into account.  The expressed purpose of the Tax is to punish or try to reduce "excessive spending" in the health care insurance market.  WHAAAAT?

How in the WORLD does that work?  The IRS assesses a 40% TAX to put me (and you) is a plan worse than what I have now.  Wait, pinch me ... no hit me ... no wake me when this is over.  Never have I had a nightmare worse than this.  But, in a government where Tax Cuts are called "spending" and every budget line item gets an annual increase of 10% or it is called a cut, I guess that makes sense.  I just want to know where the line is forming that allows my business to increase prices 10% every year, or I get to scream foul!

Whew!  I feel better.

We need an HONEST discussion about how this works.  What is best.  Not just to grow government but to reduce real costs for care and insurance to protect our assets.

"It has been said the smart people often disagree but only one is right."

Like most people in our industry today, I get a lot of e-mail linked to blog posts and many are focused on the current "hot topic" ... 1095 Filing.

Here are two answers written by two law firms to the same question about how to report COBRA events on the 1095-C.  What am I missing?

This one can be found at this LINK
Q5:  How is COBRA coverage reported?
​A5:  Under recent IRS guidance, for the first full month of COBRA coverage, Code 1H applies (No Offer of Coverage) in Line 14 and Code 2A (Employee not employed during the month) applies in Line 16.  If the plan is self-insured, the same codes apply for the period of COBRA coverage, however, for the applicable months of coverage, Part III is completed showing the months the individuals are covered under the plan – either as employees or COBRA beneficiaries.

This one can be found at this LINK
Now let’s assume that our full-time employee, who previously enrolled in coverage, transfers to a part-time position on July 1, and remains a part-time employee for the balance of the year. The employee would qualify for an offer of COBRA coverage. For January through June, the reporting treatment would be the same as the previous example involving termination. For the balance of the year, Line 14 would continue to be coded 1E (an offer of COBRA coverage to a former employee is ignored, but an offer of COBRA coverage to an ongoing employee counts as an offer of coverage). On Line 15, the employer would report the self-only COBRA coverage rate. If the employee accepted the COBRA coverage, Line 16 would be coded 2C; if declined, Line 16 would be coded 2B (Employee not a full-time employee).


Yes, the second example is for an employee that moves to part-time but they lost eligibility and no offer can be made.  We could fill volumes with the fuzzy nature of these reporting requirements. There are dramatic differences between what the IRS said in July and September.  Our plan remains to process early and file the IRS versions a week or so before the deadlines.  That gives us the best chance of complying with the last version of the interpretations of the codes and filing requirements.

Thank you to all those that have entrusted these filings to our care!

Most of the brokers officially have their collective tongues hanging out as to the national payroll vendors ... but for clearly different reasons.

Brokers have been shackled to the Affordable Care Act ... the Federal "Fix" for the health insurance industry.  "Fix" is a very loose term and if it means the industry is now under the burden of being under the scrutiny of the "masters inside the beltway" then it is very true.  In addition to the 20-50% premium increases that nearly everyone has had to tolerate to pay for all the "free stuff" promised in the rhetoric, now employers that have 50 or more FTE's are stuck with getting gouged by the confusion and costs of the ACA required filing of 1094 and 1095 forms.  It is very very strange that our attorneys are telling us that the IRS is still fluid on how the codes will be interpreted by the IRS but the payroll companies seem to have it all together ... especially charging thousands of dollars setup for giving their clients access to screens where the client is allowed to key in all the information needed for the forms.  

So, the brokers' tongues are hanging out because they are being pushed to the limit every day because of the high volume of December renewals ... thus really working hard just to keep up.  But the national payroll companies are wagging their tongues at the smorgasbord of new fees that get to be piled into January in addition to the W2's.  

Now, reporting is important, and MoneyWise is on the wagon to help with these crazy and in someways stupid requirements.  One example.  If an employee is there for all 12 months, is on an affordable plan and the plan meets the minimum requirements the ONLY additional entry on the entire form for a fully funded plan other than the identification information in Part I is the entry 1A in the first box on Line 14 of the 1095-C.  That's it.  1A  So, for that an employer gets to pay a couple of thousand dollars in setup and they get the forms to distribute with the W2's for a mere $7 each ... Oh yeah, the national payroll companies are also charging a "buck or two" to "track the hours" as well.  Crazy!  

Whew.  I feel better now.

Ignorance can be expensive.  All I am saying is this.  Pay attention and learn what this is all about.  We have already talked to dozens of companies that will do these themselves.  Why not?  The filing standard is "good faith effort" ... so if you make a mistake, and it was based on something that was reasonable, you get the chance to fix it.  So, you fix it and move on ... move on with a few thousand dollars extra in your bank account.

Besides, who thinks these things are here forever?  By next year, it will probably be a new box on the W2 ... and why not?  FLEX, 410(k), HSA and HRA's are already there!

According to the June 26, 2015 Supreme Court decision in Obergefell v. Hodges, 2015 WL 213646, the court held that the 14th Amendment’s Due Process and Equal Protection Clauses prohibit state laws from banning same-gender marriage. Furthermore, it requires that states recognize same-gender marriages performed in other states, as well. That means that same-gender spouses are now entitled to all of the same rights bestowed upon opposite gender spouses under both federal and state law, which opens up a whole new list of potential qualified beneficiaries.

Previous to this decision, the court had ruled in the case U.S. v. Windsor, 133 S. C t. 2675 (2103) to invalidate a portion of the federal Defense of Marriage Act when they required that same-gender marriages must be recognized for federal law purposes. Unlike the recent Supreme Court decision, the Windsor case did not mandate that states allow same-gender marriages, nor did it force states to recognize such marriages performed in other states. However, after the Windsor decision, this did cause the need for federal agencies to clarify how this would impact various laws. For instance, the IRS deemed the word “spouse” would now include both same-gender and opposite- gender people who were legally married – based on the laws in the state where the ceremony was performed. But now with Obergefell case, states must recognize same-gender and opposite gender marriages equally across the board.

As for the ramifications of this ruling in terms of health and welfare benefits, it will still generally depend on whether the benefits are issued under an insured health plan or a self-insured health plan. Since state governments are now required to acknowledge the term “spouse” to include same-gender individuals in regards to their insurance laws, means that employers who sponsor insured plans will need to offer coverage to both types of spouses as well. However, because self-insured plans are not mandated by state laws, the impact is not so clear. Keep in mind, under ERISA, which all self-insured plans must adhere to, does not mandate that employers cover any spouses – whether same gender or opposite gender for that matter. Therefore, currently, it appears that sponsors of self-insured group health plans may continue to exclude coverage for same-gender spouses, however there is much controversy over whether this could result in claims of discrimination.

In terms of COBRA Laws, it appears that this recent ruling will require that group health plans now offer coverage as well as the applicable COBRA rights to an expanded group, namely same-gender spouses. As for an effective date for those insured plans that previously excluded same-gender spouses, the court did not specify an enforcement deadline. However, it is anticipated that federal agencies may issue guidelines as a result of the Obergefell case such as they did after the Windsor case: the date was determined to be effective on the day the decision was handed down, however, employers were allowed to apply this rule prospectively.

Every day e-mails and phone calls come our way with questions about the PPACA as it applies to specific situations.  The ball of confusion is compounded by years of minor and undiscussed changes over the pass 10-15 years in group contracts and broad assumptions based on guesses rather than facts.

Now, everyone is supposed to be covered.  Additional taxes and fees are built into the premium paid to cover all that apply but that may not be enough for lots of reasons.  The additional money is being gobbled up by a bureaucracy that is so vast and unguided it may never be fully understood.  Rules are proposed and published breeding further confusion and more questions about topics that have real gravity in the lives of plan participants. 

Here is one recent example.

A COBRA qualifier who was terminated in May, properly accepts and pays his premium even before his coverage as an active employee ends at the end of that month.  He has claims that are paid in June and naturally assumes that his coverage has been reinstated under his COBRA rights.  Our staff properly notified the broker and the client that he should be reinstated and by the middle of June we received his July payment and August before the end of July ... a model COBRA participant.  So, the first week in July he is refused by the local pharmacy who indicates that his coverage has been cancelled.  Then he gets a letter from the carrier and so does the pharmacy saying that his coverage is cancelled for non-payment.  We have collected and forwarded 3 months of premium to the plan sponsor totaling nearly $6,000 and the carrier has not been paid?  Well, the reason the carrier has not been paid is two fold.  The carrier requires that the monthly invoice be paid as presented ... no changes allowed.  And, the carrier has yet to load the COBRA participant in their billing system and this could easily be the case until the September or even October invoices.  Wow!  How can a Plan Sponsor pay premium if these two circumstances exist?

It is obvious that this system puts the full reconciliation burden on the Plan Sponsors ... thus the pay as presented model ... but pending claim payments or refusing approval of services until the billing system catches up is not a helpful model at all.  This specific participant will have spent nearly $8,000 before the coverage is retro reinstated ... crazy ... and a lot of unnecessary worry, phone calls and math for COBRA participants.

And next we have the "retro rules' that seem to be written in the sand.  The delays in retro enrollments just outlined certainly favors the carrier and punishes those that exercise their rights under COBRA.  But the "retro rules" have other problems as well.  An employee quits in February and accepts a new job in March at an employer that has a waiting period of 60 days.  His wife needs an outpatient procedure that was already scheduled in early March and the carrier issues a pre-authorization which is valued at $16,000.  The Plan Sponsor terms his coverage in the carrier system the first payroll after his final check in mid-March.  The procedure is successful and the now former employee knows of no problems with the claim or the process he has followed.  The employer told him that he would have coverage until the end of the month ... the employer was thinking February and the former employee was thinking March, since he did get a paycheck in March.  Ha!

As it turns out, he refused COBRA and never looked back because the insurance company had authorized the procedure that was done in a month that he thought he had coverage and he even confirmed on the phone that his coverage was active AFTER the procedure was done ... why in the world should he not skip paying for COBRA for April and get on the new employer's plan April 1st.  Enter the "retro rules".  Even though the carrier authorized the procedure, the retro term back to the last day of February was imposed in early April and in June, the hospital has been reversed billed by the carrier and the former employee gets a bill from the hospital (including a nastygram saying that the payment is late) for the full $16,000.  The hospital would have only been paid around $1,600 through the copay and carrier responsibility but that does not seem to matter.  The hospital wants their $16,000 and they want it immediately.  By this time, it is too late to accept and pay for COBRA so the young family is stuck with a $16,000 bill that should have been only $1,600.  They just assumed that the dates on the COBRA letter were wrong because the carrier assured them on the phone that their coverage was active in March when it was later retro cancelled without their knowledge.

There are thousands of stories like these.  I deal with plan sponsors and plan participants every day and the compounding of the gradual drip if change in carrier procedures and the 40,000 pages of new regulations related to the PPACA is making a mess of a system that has worked well since the 1950's.  Sure it has a lot of holes that needed to be plugged, but soon I hope the pendulum starts coming back to a place where fairness and transparency can be the rule.  The ONLY way to do that is to let the market drive the process.  How long could a car dealer, grocery store or even an insurance company survive if their was not a way to do price comparison shopping?  That is the position of the hospital and providers now.  The insurance companies are often their exclusive payors, so there is no way to compare and get the "real price" for procedures.  How can an insurance company get a procedure for $1,600 and charge an uninsured person (who happens to be the same person) $16,000?  I asked this question and the answer will be in our next blog post.  Let me know if you know the answer or if you can figure it out.

Podcasts are probably the easiest way to learn.  Ever since being convinced that successful people are lifelong learners and focused on collaborating I have been committed to both.  The captcha images above tell a simple story of smart people and computer limitations and how learning and collaborating work as exponents to each of us.

Security for online submissions had a simple solution.  Force the entry of characters that ONLY humans can read. Otherwise, a robocall (of sorts) could just fill up a database with corrupt data.  Captcha was born.  In fact, the programer that came up with the idea retired ... for one day.  He thought about the numbers of people that were doing a 10 second task when putting in the captcha code was a total waste.  But, what if that could be turned into a contribution instead.  In short order a way to use these tiny steps of entering a few letters or digits on hundreds of millions of keyboards, hundreds of millions of times each day because a free labor force that could transcribe books and put in number addresses for Google maps and is moving toward translating the entire content of the internet into all the major languages, one keystroke at a time by millions of people ... for free.  So, when you put in the captcha code, you are working and making a contribution to transcribing a classic book or a Google Streets image into a keyed address number.  Amazing.

How can this apply to us?  Think about it.  Henry Ford would be so proud.  He once said that he could train almost anyone to build almost anything because he broke each task into simple repeatable steps that were fully prescribed and measured for completion.  What efforts are being made around you and wasted?

How does this apply to me?  Harvesting all the wasted effort can yield huge rewards.  Little things add up.  Look at what we do each day.  We should ONLY do each thing once and be build something ... probably a database ... in the process.  I need to revisit, well, everything I do with the focus of building something useful with lasting value.