In his state of the union message in January of 2004, President Bush laid the foundation to require electronic medical records for the following 10 years. In 2009, President Obama signed into law the American Recovery and Reinvestment Act (ARRA) to stimulate the economy. A provision in ARRA was the Health Information Technology for Economic and Clinical Health Act (HITECH), which included $27 billion over 10 years to induce providers to implement electronic medical records. Physicians who met the guidelines received $18,000 in 2011 for a total of $44,000 through 2013. The electronic record must meet certification criteria (meaningful use) through Medicare in order to qualify for the monies. A slight majority (59%) of providers who are eligible and registered for the federal electronic health record (EHR) incentive program achieved meaningful use and of those 50% of Medicare doctors are at risk for penalties next year under the program. In 2015, entities without electronic records will receive a penalty against their Medicare and Medicaid payments. Stage 2 meaningful use contains 126 requirements: meeting the requirement is all or nothing. Meeting 99% of the requirements does not matter (Manos 2014).