‘Doc Fix’…for Medicaid?: Under a provision required by the ACA, states are slated to receive $11 billion from the federal government to increase payments to physicians treating Medicaid patients beginning next year through 2014, bringing family medicine, general internal medicine, pediatric medicine, and related sub specialists up to the same pay rates they would receive for treating Medicare patients.  This leaves some wondering what happens to the raise after that.

No Plan B: Despite assertions earlier this year from House Republicans that they would have an alternative to the sweeping health care reform law teed up by next month’s anticipated Supreme Court ruling, it now appears that some members are urging a more cautious way forward.  And, while their general opposition to the ACA hasn’t changed, how they intend to find and build consensus within their own party has evolved.



From: The Health Action Network

Medicaid on the Rise: As the effects of the recent economic downturn continue to make ripples across the social landscape, a new study by the Kaiser Family Foundation on Medicaid illustrates just how pervasive the fallout has been.  According to the analysis, spending on the critical low-income health program between 2007 and 2009 increased by an average of 6.6 percent each year, far above the 1.3 percent increase seen from 2005 to 2006.  When combined with the drastic revenue shortfalls plaguing so many of their balance sheets, Medicaid spending has grown to account for as much as one third of the overall budget in some states.

Cost of Care: A recent Commonwealth Fund study examining the cost of care in 13 industrialized nations ranks the U.S. at the top of the list with nearly $8000 spent per person for health care services in 2009.  However, when drilling into the reasons behind the high cost of care in this country, the study concluded that a number of factors were responsible, namely, U.S. patients paying more to doctors, drug companies, and hospitals than patients in other countries.


From: Health Action Network

Have you ever wondered why health insurance is purchased by the employer? Our car insurance or homeowner’s insurance isn’t provided by employers. Employer-provided health insurance often traps people in jobs they don’t want, because if they leave the job they are not allowed to take their coverage with them.

The reason we purchase health insurance through employers is that it is much cheaper for the employer to pay for it than the individual, since the employer gets a tax deduction on the purchase of health insurance.  If an individual purchases health insurance, they are still paying taxes on that money.

This obviously can make a huge difference in how expensive the coverage is to buy.

Let’s look at how this came to be.    During World War II, there were price and wage freezes were put in place.  Since employers could not legally use higher wages to attract better employees, they found a loophole and started offering benefits, such as health insurance, that were tax-free.

Unfortunately, most people today have several different jobs and even different careers, throughout their lifetime.  This means that their employer-sponsored health insurance is always temporary coverage, going away whenever they leave that employer.

Posted: 03 May 2012 02:01 PM PDT

From:  Real Health Care Reform

State of the Mandate: As the country anxiously awaits next month’s Supreme Court ruling, some states find themselves caught in a bit of a holding pattern.  Should the Court rule against the individual mandate, the viability of the exchange marketplace would be severely undermined as, absent the requirement that individuals purchase coverage, healthier people could elect to avoid paying into the system, causing premiums to soar.




From: Health Action Network

CQ (5/1, Bristol, Subscription Publication) reports, "Anywhere from 20 to 66 percent of American adults have a pre-existing condition that could preclude them from insurance coverage or make their premiums escalate, particularly in the individual market, the Government Accountability Office said in a new report." The GAO said that "the wide range in the percentages stems from the variations in the way insurers classify what is a pre-existing condition for their underwriting procedures."

The Los Angeles Times (5/1, Terhune) reports, "Several high-profile business names, such as San Francisco hedge-fund manager Thomas Steyer and agribusiness magnate Stewart Resnick, have contributed to a proposed ballot measure seeking tighter regulation of health insurance rates, according to campaign finance records." The $1.5 million in donations stands in contrast to the $367,200 in donations raised by groups opposing the measure, including Anthem Blue Cross, Kaiser Foundation Health Plan, Health Net, Blue Shield of California and United Healthcare. Consumer Watchdog has "collected about 550,000 signatures thus far and needs to collect an additional 200,000 in the next two weeks" to qualify the measure for the Nov. 6 election

Overview of the benefits:

IMPORTANT:  YOU MUST HAVE COVERAGE PRIOR TO BECOMING PREGNANT.

Many students are having complications with their student loans due to an obscure provision of ObamaCare that prevents private firms from participating in the student loan program.

Department of Education has been transferring large batches of federal student loans to new loan-servicing companies 2014 leaving in the lurch some borrowers who are suddenly encountering problems with their loans, such as payments that are mysteriously adjusted up or down.

The switch, which has been going on for months and will ultimately include millions of loans, is mandated by a little-known provision tucked into the 2010 healthcare overhaul. Pushed by a consortium of nonprofit student loan companies, the provision forces the DOE to use nonprofit loan servicers. But at least in the short run, the switch has caused problems.

Borrower Isabelle Baeck said that after a new servicer, Mohela, took over her loans in December, she received a letter saying that her monthly payments had been reduced to $50 2014 roughly a quarter of what they had been. The change meant Baeck would ultimately pay more in interest over a longer period of time. Concerned, she said she has made repeated calls to get the problem fixed, only to have the payments repeatedly readjusted.

A Mohela representative declined to comment on specific borrower situations but said that the company is working hard to minimize disruption and to resolve issues as they arise.

Baeck is not alone. Since last fall, one million borrowers have had their federal student loans randomly assigned to one of the new companies, all nonprofits or subsidiaries of nonprofit organizations. It is not known what proportion of borrowers has had problems during the switch.

Like their for-profit counterparts, many of these nonprofit student loan companies traditionally originated, bought and insured student loans, with the day-to-day servicing making up only a portion of their business. Several 2014 including at least six that the department has transferred or is planning to transfer loans to 2014 have been touched by scandal in those other capacities, with accusations ranging from bad lending practices to violating state law to overbilling the Education Department.

In all, the Department of Education expects to add more than a dozen new servicers to the mix, roughly tripling the total number of companies that were handling direct federal loans this time last year. The move would also mean that borrowers with such loans would eventually be using about a dozen separate servicer websites, whereas before there was a single website for all direct loans.

Some worry the addition of so many new servicers could make standardization and oversight more challenging.

“It’s hard to know if having more servicers will help or hurt because it’s so bad with just a few right now,” said Deanne Loonin, director of the National Consumer Law Center’s Student Loan Borrower Assistance Project. “Our fear is that the more you have, the less ability you have to oversee them.”

Ultimately, borrowers having their loans moved over to these new servicers have Congress to thank for it. Coupled with the passage of the health care reconciliation bill was an overhaul of federal student lending, which shifted the government away from backing loans by private lenders 2014 what were known as federally guaranteed student loans 2014 and toward loaning directly to students.

For-profit and nonprofit student loan companies alike lobbied over the change and shifted their business models accordingly. In particular, the nonprofit student loan companies won a carve-out to ensure they’d get in on the business of servicing the direct federal loans. The carve-out was crafted and lobbied for by the Education Finance Council, a trade group representing nonprofit student loan companies that spent more than $200,000 on lobbying that year. (The Education Finance Council did not respond to a request for comment.)

Now, two years later, borrowers are experiencing the effect of the law.

Borrower Karen Mahnk said she logged into the Department of Education’s student loan website in October and saw that her loan balance 2014 which typically hovered around $100,000 2014 was suddenly zero. When she called around, her servicer told her that she had been put in an administrative forbearance.

That didn’t sit well with Mahnk, who said she didn’t want to put off her payments and certainly didn’t want to rack up additional interest. She said she called again and talked to someone else, who assured her the opposite 2014 there was no record of forbearance.

While still confused about many details, Mahnk said she learned that her loan is being handled by a new servicer, a company called EdFinancial, which shows she’s not due for a payment until June. Taking no chances, Mahnk said she has been forcing through monthly payments.

“I wanted to continue making payments regardless of what their problem was,” Mahnk explained. But she’s still concerned about how things will shake out. “I’m only taking their word on it that my payment is fine, and that EdFinancial is going to do everything they’re supposed to do.”

EdFinancial did not respond to a request for comment.

Some borrowers were notified of the switch only after the fact. “There was really no prior warning,” said Scott Trudeau, a borrower whose loans were transferred to Mohela in late January. Trudeau, who said he’s never fallen behind on his loans, has had recurring problems since the switchover trying to correct his bank account information with Mohela.

“I get delinquency notices regularly, I get letters in the mail, but every time I try to give them money, the system breaks down,” he said. “I’ve had no trouble with the Department of Education all these years, but it’s been nothing but confusion with Mohela.”

“Anytime you change a servicing relationship, it can cause concern,” said Will Shaffner, Mohela’s director of business development and government relations. “They need to pick up the phone and call us. If they’re not satisfied with our service or aren’t getting answers, they should ask to speak with a supervisor. They can even get in touch with our CEO if they need to.”

The Department of Education’s own implementation schedule shows that the transition is still a work in progress and the phasing in of new servicers is being pushed back.

“FSA has been working aggressively to implement the new not-for-profit servicers,” the document reads. “Our original schedule did not fully accommodate the level of effort required to bring up servicers in a way that minimizes risks for borrowers, FSA, and the not-for-profits themselves.”

by Marian Wang ProPublica, April 23, 2012, 2 p.m.

The Hill (4/27, Baker) reports that a new report from the Government Accountability Office notes that "somewhere between 36 million and 112 million adults have pre-existing conditions." As the article explains, "President Obama's healthcare law requires insurance companies to cover people with pre-existing conditions," which marked a change from when insurance companies would be able to deny coverage to those with pre-existing conditions or offer plans not covering those conditions. According to the GAO, "hypertension, mental health disorders and diabetes are the most common ailments that could lead insurers to deny coverage

Reuters (4/27, (Morgan) reports on Republicans' release of a report about the healthcare overhaul titled "Higher Costs, More Confusion, Less Coverage." The report quotes President Obama's corporate advisers, who predicted the law would raise the cost of care.

GOP Alternative: As stakeholders on both sides of the aisle await June's Supreme Court decision on the fate of the ACA, Republican lawmakers have begun work on a prospective agenda that focuses on controlling costs, while allowing individuals to retain coverage between jobs. Should the high court strike down the entirety of the law, Republicans hope to have in place a legislative blueprint that will provide stopgap measures in the immediate term, while they work to salvage provisions of the law that have shown themselves to be effective.

Subsidy Recoup: Last week, the House Ways & Means Committee took up legislation that would require individuals to pay back excessive subsidies received under the health care law, potentially saving the government $43.9 billion over the next decade. Under the proposal, people would be required to refund any insurance subsidies they had received should the government determine that they had received too much based on income thresholds.


From:  Health Action Network

April 18, 2012

Beginning July 1, 2012, your client’s plan or policy is being updated to comply with a recently passed California bill (CA 2011 SB946). This bill requires that all health plans and policies provide coverage for behavioral health treatment for pervasive developmental disorder or autism.

SMALL GROUP (2-50)

We’re mailing letters to both employer groups and Cal-COBRA members . The letters will also include an amendment (for each employee and Cal-COBRA member) and an endorsement (for the employer). Go to “Quick Links” - located on the left hand side - for copies of the amendments and endorsements.

The letters are scheduled to mail at the end of April. If you have any questions, please contact your Regional Sales Manager or Broker Services at 800-678-4466.

LARGE GROUP (51+)

We’re mailing letters to employer groups .  The letter will also include an amendment (for each employee). Go to “Quick Links” - located on the left hand side - for copies of the amendments.

The letters are scheduled to mail at the end of April. If you have any questions please contact your Anthem Large Group representative.

From:  Anthem Blue Cross Blue Shield

Affordable is Relative: An unresolved tax dispute could drive the ACA’s price tag even higher than originally feared.  At issue, tax credits given to millions of low- to moderate-income employees who opt out of their employer-sponsored coverage and instead receive subsidies to purchase insurance through the newly-established state exchanges.  Specifically, who qualifies for these subsidies is up for debate, as determinations of eligibility are based on how much employees would pay to cover themselves rather than the cost of covering their entire family.


From: Health Action Network

Ley de atención no lo asequible: Un estudio publicado el martes por el síndico de Medicare Charles Blahous desafía los supuestos ahorros utilizados para lograr la aprobación de la ley Care asequible (ACA).  A pesar de su posición larga alegada como un mecanismo de ahorro de costos, de acuerdo con el estudio, la ACA en realidad podría añadir 530 millones de dólares el déficit federal en los próximos diez años.

Pago: Mientras tanto, la administración es desviar 500 millones de dólares al IRS para ayudar a implementar la ACA.  La mitad mil millones de dólares en financiación representa sólo una parte de lo que la Agencia debe proporcionar apoyo a la ejecución y está siendo asignada fuera del proceso normal de créditos.


Desde el: red de acción de salud

Not-So-Affordable Care Act: A study released Tuesday by Medicare trustee Charles Blahous challenges the purported savings used to bring about passage of the Affordable Care Act (ACA).  Despite its long asserted position as a cost-savings mechanism, according to the study, the ACA could in fact add as much as $530 billion to the federal deficit over the next ten years.

Down Payment: Meanwhile, the administration is diverting $500 million to the IRS to help implement the ACA.  The half a billion dollars in funding represents merely a portion of what the agency needs to provide implementation support and is being allocated outside the normal appropriations process.

From the: Health Action Network

El New York Times, por Roni Caryn Rabin –

04 de abril de 2012: en un movimiento que pueda modificar las normas de tratamiento en los hospitales y consultorios de los médicos a nivel nacional, un grupo de nueve especialidad médica placas planes de recomendar el miércoles que médicos realizan 45 pruebas comunes y procedimientos con menos frecuencia y a instar a los pacientes a cuestionar estos servicios si se les ofrece. Ocho otros consejos de especialidad se preparan para seguirle con listas adicionales de procedimientos que deben realizar mucho menos a menudo sus miembros.

Las recomendaciones representan un inusualmente Franco reconocimiento por médicos que muchas pruebas rentables y procedimientos se llevan a cabo innecesariamente y puedan perjudicar a los pacientes. Según algunas estimaciones, el tratamiento innecesario constituye un tercio de los gastos médicos en los Estados Unidos.

"Uso excesivo es una de las más graves crisis en la medicina estadounidense", dijo el Dr. Lawrence Smith, médico en jefe en el sistema de salud de North Shore LIJ y decano de la Facultad de Medicina de Hofstra North Shore LIJ, quien no estuvo involucrado en la iniciativa. "Muchas personas han pensado que las organizaciones más resistentes a esta idea sería las organizaciones de la especialidad, por lo que este es un mensaje muy poderoso".

Muchos intentos anteriores para frenar a cuidados innecesarios han vaciló, pero orientación provenientes de grupos respetado médico es probable que ejercer más influencia que las directivas de otros sectores. Pero su cambio de corazón también refleja los cambios recientes en el mercado de la salud.

Aseguradores y otros contribuyentes intentan desplazar más de su dolor financiero a los proveedores como los hospitales y las prácticas de médico, y se están haciendo esfuerzos para reducir los incentivos financieros a los médicos a realizar más pruebas.

Los grupos de especialidad están anunciando la iniciativa educativa denominada elegir sabiamente, dirigido a pacientes y médicos, bajo los auspicios de la Junta estadounidense de la Fundación de medicina interna y en asociación con Consumer Reports.

La lista de pruebas y procedimientos aconsejan contra incluye electrocardiogramas realizados rutinariamente en física, incluso cuando no hay ningún signo de problemas cardíacos, M.R.I. ordenó cuando un paciente se queja de dolor de espalda y antibióticos prescriben para la sinusitis leve — todo bastante común.

American College of Cardiology está instando a especialistas de corazón no realizar imágenes de rutinario estrés cardíaco en pacientes asintomáticos, y el Colegio Americano de radiología está diciendo radiólogos no para ejecutar análisis de imágenes en los pacientes que sufren dolores de cabeza simples. La Asociación Americana de Gastroenterología está instando a sus médicos a prescribir las menores dosis de medicamentos necesarios para controlar la enfermedad de reflujo ácido.

Incluso oncólogos están siendo instó a recortar el análisis para pacientes con mama de etapa temprana y cánceres de próstata que no están probables que se extendió, y se insta a médicos de la enfermedad de riñón no se inicie la diálisis crónica antes de tener una discusión seria con el paciente y la familia.

Otros esfuerzos para limitar pruebas para pacientes han provocado reacciones. En noviembre de 2009, Nueva mamografía directrices emitidas por la fuerza tarea del servicios de preventivos de Estados Unidos aconsejó a las mujeres a someterse a menor frecuencia de cáncer de mama, alimentando el temor entre los pacientes sobre el creciente control del Gobierno sobre las decisiones personales de atención de la salud y el racionamiento de tratamiento.

"Cualquier información que puede ayudar a informar las decisiones médicas es buena, la preocupación es cuando la información comienza a utilizarse no sólo para informar las decisiones, sino por los contribuyentes para limitar las decisiones que puede hacer que un paciente," dijo Kathryn Nix, analista de políticas de salud de la Fundación Heritage, un grupo de investigación conservador. "Con la reforma sanitaria, cambios en Medicare y la aparición de organizaciones de cuidado responsable, ha habido un fuerte impulso para el uso de esta información para limitar la capacidad de los pacientes a tomar decisiones propias."

Dr. Christine K. Cassel, Presidente y Director Ejecutivo de la Junta estadounidense de medicina interna Fundación, estuvo en desacuerdo, diciendo que Estados Unidos puede pagar por necesidades de cuidado de la salud de todos los estadounidenses como atención es apropiada: "de hecho, el racionamiento no es necesario si sólo no haces las cosas que no ayudan a."

Algunos expertos estiman que hasta un tercio de los 2 billones de dólares de costos anuales de atención de la salud en los Estados Unidos cada año se gasta en hospitalizaciones innecesarias y pruebas, probados tratamientos ineficaces nuevos medicamentos y dispositivos médicos y atención inútil al final de la vida.

Algunas de las pruebas se desaconseja — como tomografías computarizadas para alguien que se desmayó, pero no tiene otros problemas neurológicas — son en gran parte motivado por preocupaciones sobre un juicios de mala praxis, expertos dijeron. Directrices claras, basadas en pruebas como las que se publicará el miércoles irá mucho tanto a tranquilizar a los médicos y a protegerlos de litigios.

Aún, muchos especialistas y defensores de la pacientes expresan cautela, advirtiendo que las directivas podrían mal interpretadas y aplicadas demasiado amplia a expensas de los pacientes.

"Estas todo suenan razonables, pero no olviden que cada persona que esté buscando después es única," dijo el Dr. Eric Topol, director académico de salud Scripps, un sistema de salud basado en San Diego, agregando que preocupa que consejos del grupo serían dificultar sastrería de cuidado para pacientes individuales. "Este tipo de enfoque donde puede ser un perjuicio real a buen cuidado".

Los pacientes con cáncer también expresó su preocupación que desalienta el uso de tratamientos experimentales podría disminuir sus posibilidades de encontrar el medicamento adecuado para aplastar su enfermedad.

"Fui diagnosticada con cáncer de mama etapa IV derecho a la puerta, y lo hice muy bien, era lo que ellos llaman un contestador de' súper', y ahora no tengo ninguna evidencia de la enfermedad," dijo Kristy Larix, una madre de 44 años de edad de dos de Seattle, que fue tratada con Avastin, un medicamento que la FDA no aprueba para el tratamiento de cáncer de mama. "Médicos no pueden practicar medicina buena si nos atan las manos".

Muchos elogiaron a los grupos de especialidad de su audaz acción, diciendo que la iniciativa podría alienar a sus propios miembros, desde hacer menos pruebas de diagnóstico y procedimientos pueden cortar la renta de un médico bajo esquemas de pago de la tarifa-por-servicio que pagan por cada paciente encuentro por separado.

"Es valiente que están intensificando estas sociedades,", dijo el Dr. John Santa, director del centro de salud de calificaciones de Consumer Reports. "Yo mismo soy un internista de atención primaria, y estoy anticipándose a la ejecución de algunos de mis colegas que se dicen, 'Y' sé, John, que todos saben que has hecho electrocardiogramas que no eran necesarias y pruebas de densidad que no eran necesarias los huesos, pero, saben que fue un poco de dinero extra para nosotros." "

The New York Times, By Roni Caryn Rabin -

April 4, 2012: In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often.

The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.

“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the initiative. “Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message.”

Many previous attempts to rein in unnecessary care have faltered, but guidance coming from respected physician groups is likely to exert more influence than directives from other quarters. But their change of heart also reflects recent changes in the health care marketplace.

Insurers and other payers are seeking to shift more of their financial pain to providers like hospitals and physician practices, and efforts are being made to reduce financial incentives for doctors to run more tests.

The specialty groups are announcing the educational initiative called Choosing Wisely, directed at both patients and physicians, under the auspices of the American Board of Internal Medicine Foundation and in partnership with Consumer Reports.

The list of tests and procedures they advise against includes EKGs done routinely during a physical, even when there is no sign of heart trouble, M.R.I.’s ordered whenever a patient complains of back pain, and antibiotics prescribed for mild sinusitis — all quite common.

The American College of Cardiology is urging heart specialists not to perform routine stress cardiac imaging in asymptomatic patients, and the American College of Radiology is telling radiologists not to run imaging scans on patients suffering from simple headaches. The American Gastroenterological Association is urging its physicians to prescribe the lowest doses of medication needed to control acid reflux disease.

Even oncologists are being urged to cut back on scans for patients with early stage breast and prostate cancers that are not likely to spread, and kidney disease doctors are urged not to start chronic dialysis before having a serious discussion with the patient and family.

Other efforts to limit testing for patients have provoked backlashes. In November 2009, new mammography guidelines issued by the U.S. Preventive Services Task Force advised women to be screened less frequently for breast cancer, stoking fear among patients about increasing government control over personal health care decisions and the rationing of treatment.

“Any information that can help inform medical decisions is good — the concern is when the information starts to be used not just to inform decisions, but by payers to limit decisions that a patient can make,” said Kathryn Nix, health care policy analyst for the Heritage Foundation a conservative research group. “With health care reform, changes in Medicare and the advent of accountable care organizations, there has been a strong push for using this information to limit patients’ ability to make decisions themselves.”

Dr. Christine K. Cassel, president and chief executive officer of the American Board of Internal Medicine Foundation, disagreed, saying the United States can pay for all Americans’ health care needs as long as care is appropriate: “In fact, rationing is not necessary if you just don’t do the things that don’t help.”

Some experts estimate that up to one-third of the $2 trillion of annual health care costs in the United States each year is spent on unnecessary hospitalizations and tests, unproven treatments, ineffective new drugs and medical devices, and futile care at the end of life.

Some of the tests being discouraged — like CT scans for someone who fainted but has no other neurological problems — are largely motivated by concerns over a malpractice lawsuits, experts said. Clear, evidence-based guidelines like the ones to be issued Wednesday will go far both to reassure physicians and to shield them from litigation.

Still, many specialists and patient advocates expressed caution, warning that the directives could be misinterpreted and applied too broadly at the expense of patients.

“These all sound reasonable, but don’t forget that every person you’re looking after is unique,” said Dr. Eric Topol, chief academic officer of Scripps Health, a health system based in San Diego, adding that he worried that the group’s advice would make tailoring care to individual patients harder. “This kind of one-size-fits-all approach can be a real detriment to good care.”

Cancer patients also expressed concern that discouraging the use of experimental treatments could diminish their chances at finding the right drug to quash their disease.

“I was diagnosed with Stage IV breast cancer right out the gate, and I did very well — I was what they call a ‘super responder,’ and now I have no evidence of disease,” said Kristy Larch, a 44-year-old mother of two from Seattle, who was treated with Avastin, a drug that the F.D.A. no longer approves for breast cancer treatment. “Doctors can’t practice good medicine if we tie their hands.”

Many commended the specialty groups for their bold action, saying the initiative could alienate their own members, since doing fewer diagnostic tests and procedures can cut into a physician’s income under fee-for-service payment schemes that pay for each patient encounter separately.

“It’s courageous that these societies are stepping up,” said Dr. John Santa, director of the health ratings center of Consumer Reports. “I am a primary care internist myself, and I’m anticipating running into some of my colleagues who will say, ‘Y’ know, John, we all know we’ve done EKGs that weren’t necessary and bone density tests that weren’t necessary, but, you know, that was a little bit of extra money for us.’ ”

La colina, por Sam Baker –

09 de abril de 2012: Obama la administración tranquilamente desvía aproximadamente 500 millones de dólares al IRS para ayudar a implementar la ley de salud del Presidente.

El dinero es sólo una parte de la aplicación total del IRS el gasto, y se presta fuera del proceso normal de créditos. La Agencia tributaria es responsable de varias disposiciones claves de la nueva ley, incluyendo el impopular mandato individual.

Los legisladores republicanos han intentado cortar fondos para implementar la ley de salud, al menos hasta después de que el Tribunal Supremo decide si huelga hacia abajo. Que sentencia se espera para junio y argumentos orales la semana pasada indican a los jueces bien podrían derribar al menos el mandato individual, si no la ley toda.

"Mientras que el Presidente Obama y sus aliados del Senado seguir gastando más dinero de los impuestos implementando una ley impopular y inviable que puede muy bien ser golpeada abajo como inconstitucional en cuestión de meses, continuaré con el pueblo estadounidense que quieren derogar esta ley y reemplazarlo con algo que realmente se ocupará de los gastos de salud," dijo la legisladora Denny Rehberg (R -Montana), quien preside el Subcomité de casa créditos para el sector sanitario y está en una carrera muy controvertida del Senado este año.

La administración Obama ha surcaron adelante pese a las dificultades jurídicas y políticas.

Ha movido agresivamente conseguir políticas importantes en el lugar. Y, de acuerdo con una revisión de los documentos de presupuesto y las cifras proporcionadas por el personal del Congreso, la administración también se quema mediante aplicación de financiación previsto en la ley de salud.
La ley contiene docenas de créditos dirigidos a aplicar disposiciones específicas. También dio el departamento de salud y servicios humanos (HHS) un fondo de aplicación de 1.000 millones de dólares, para utilizar como lo considere oportuno. Los republicanos lo han llamado un "Fondo para sobornos".

HHS planea drenar el fondo completo de septiembre — antes de las elecciones presidenciales y más de un año antes de la mayoría de los efectos de la toma de derecho sanitario. Aproximadamente la mitad de ese dinero irá finalmente al IRS.

HHS ha transferido casi 200 millones de dólares al IRS en los últimos dos años y planea transferir más de 300 millones de dólares este año, según cifras proporcionadas por un ayudante del Congreso.
La Oficina de rendición de cuentas del Gobierno ha dicho que las transferencias son perfectamente legales y conforme a qué agencias han utilizado fondos de aplicación general en el pasado. El fondo de 1.000 millones de dólares se reservó para las actividades de ejecución "federal", dijo la GAO y por lo tanto, puede ser utilizada por cualquier agencia — no sólo de HHS, donde se encuentra el dinero.

Todavía, transferencias significativas para el IRS y otros organismos dejan menos dinero para HHS y el departamento necesita dibujar sobre el fondo de 1.000 millones de dólares para algunas de sus tareas más grandes.

El derecho sanitario dirige HHS para establecer un intercambio seguro federal: un nuevo mercado para particulares y pequeñas empresas a comprar cobertura — en cualquier Estado que no establezca su propio. Pero no proporciona ningún dinero para el intercambio federal, obligando a HHS que busca financiación juntos utilizando algunos de los fondo de mil millones de dólares y dinero de otras cuentas de la dirección.

Las transferencias también permiten que el IRS hacer la ley sanitaria una pequeña parte de sus cifras de presupuesto público. Por ejemplo, la Agencia tributaria pidió 8 millones de dólares el año próximo para cumplir el mandato individual y dijo que no iba a pagar el dinero para los nuevos empleados.
Una portavoz del IRS no diría cuánto dinero se ha gastado hasta ahora aplicar el mandato individual.
Los republicanos cargada durante el debate legislativo sobre cuidado de la salud que el IRS sería contratar a cientos de nuevos agentes para hacer cumplir el mandato y lanzando gente en la cárcel porque no tienen seguro.
Sin embargo, el mandato es solo una parte de las responsabilidades del IRS.

El derecho sanitario incluye una serie de nuevos impuestos y tasas, algunos de los cuales ya están en efecto. La Agencia tributaria quiere contratar a más de 300 nuevos empleados el año que viene para cubrir esos cambios fiscales, tales como las nuevas tasas sobre las compañías farmacéuticas y las pólizas de seguros.

El IRS también administrará la pieza más cara de la nueva ley: subvenciones para ayudar a personas de bajos ingresos a pagar seguros, que están estructuradas como créditos fiscales. La Agencia Pide Congreso a financiar a otro 537 nuevos empleados dedicados a la administración de los nuevos subsidios.

La casa republicano llevó el año pasado aprobó una enmienda, 246-182, patrocinada por la legisladora Jo Ann Emerson (R -Mo) que habría impedido que el IRS de contratar a personal nuevo o iniciar cualquier otra medida al mandato que la gente compra seguro de salud. La medida, se opone firmemente a la administración de Obama, posteriormente cayó desde un proyecto de ley más amplio que evitó un cierre del Gobierno.

The Hill, By Sam Baker -

April 9, 2012: The Obama administration is quietly diverting roughly $500 million to the IRS to help implement the president’s healthcare law.

The money is only part of the IRS’s total implementation spending, and it is being provided outside the normal appropriations process. The tax agency is responsible for several key provisions of the new law, including the unpopular individual mandate.

Republican lawmakers have tried to cut off funding to implement the healthcare law, at least until after the Supreme Court decides whether to strike it down. That ruling is expected by June, and oral arguments last week indicated the justices might well overturn at least the individual mandate, if not the whole law.

“While President Obama and his Senate allies continue to spend more tax dollars implementing an unpopular and unworkable law that may very well be struck down as unconstitutional in a matter of months, I’ll continue to stand with the American people who want to repeal this law and replace it with something that will actually address the cost of healthcare,” said Rep. Denny Rehberg (R-Mont.), who chairs the House Appropriations subcommittee for healthcare and is in a closely contested Senate race this year.

The Obama administration has plowed ahead despite the legal and political challenges.

It has moved aggressively to get important policies in place. And, according to a review of budget documents and figures provided by congressional staff, the administration is also burning through implementation funding provided in the healthcare law.

The law contains dozens of targeted appropriations to implement specific provisions. It also gave the Department of Health and Human Services (HHS) a $1 billion implementation fund, to use as it sees fit. Republicans have called it a “slush fund.”

HHS plans to drain the entire fund by September — before the presidential election, and more than a year before most of the healthcare law takes effect. Roughly half of that money will ultimately go to the IRS.

HHS has transferred almost $200 million to the IRS over the past two years and plans to transfer more than $300 million this year, according to figures provided by a congressional aide.

The Government Accountability Office has said the transfers are perfectly legal and consistent with how agencies have used general implementation funds in the past. The $1 billion fund was set aside for “federal” implementation activities, the GAO said, and can therefore be used by any agency — not just HHS, where the money is housed.

Still, significant transfers to the IRS and other agencies leave less money for HHS, and the department needs to draw on the $1 billion fund for some of its biggest tasks.

The healthcare law directs HHS to set up a federal insurance exchange — a new marketplace for individuals and small businesses to buy coverage — in any state that doesn’t establish its own. But it didn’t provide any money for the federal exchange, forcing HHS to cobble together funding by using some of the $1 billion fund and steering money away from other accounts.

The transfers also allow the IRS to make the healthcare law a smaller part of its public budget figures. For example, the tax agency requested $8 million next year to implement the individual mandate, and said the money would not pay for any new employees.

An IRS spokeswoman would not say how much money has been spent so far implementing the individual mandate.

Republicans charged during the legislative debate over healthcare that the IRS would be hiring hundreds of new agents to enforce the mandate and throwing people in jail because they don’t have insurance.

However, the mandate is just one part of the IRS’s responsibilities.

The healthcare law includes a slew of new taxes and fees, some of which are already in effect. The tax agency wants to hire more than 300 new employees next year to cover those tax changes, such as the new fees on drug companies and insurance policies.

The IRS will also administer the most expensive piece of the new law — subsidies to help low-income people pay for insurance, which are structured as tax credits. The agency asked Congress to fund another 537 new employees dedicated to administering the new subsidies.

The Republican-led House last year passed an amendment, 246-182, sponsored by Rep. Jo Ann Emerson (R-Mo.) that would have prevented the IRS from hiring new personnel or initiating any other measures to mandate that people purchase health insurance. The measure, strongly opposed by the Obama administration, was subsequently dropped from a larger bill that averted a government shutdown.

Según un nuevo informe, cuesta para algunos exámenes preventivos "varían 700%," USA Today (4\/6, Kennedy) informes, agregando que "como la ley federal de salud aumenta la demanda de esos procedimientos, puede significar un aumento en las primas si los empleados no prestan atención a esos gastos." USA Today agrega, "El departamento de salud y humanos servicios estadounidenses predijo un aumento de 1,5% en primas debido a los nuevos requisitos de examen".

According to a new report, costs for some preventive examinations "vary as much as 700%," USA Today (4/6, Kennedy) reports, adding that "as the federal health care law increases demand for those procedures, it can mean an increase in premiums if employees don't pay attention to those costs." USA Today adds, "The US Department of Health and Human Services predicted a 1.5% increase in premiums because of the new exam requirements."

El Los Angeles Times (4 5, Gorman) informes, "California está empezando el proceso de cambio 1,1 millones de los pacientes más enfermos y más pobres del Estado en la atención médica administrada, que dicen los funcionarios de salud será reducir costos y mejorar el tratamiento," pero "provocando preocupaciones entre los críticos". Ayer, "los funcionarios del Estado anunciaron... que Los Angeles, Orange, San Diego y San Mateo será los primeros condados para proporcionar atención médica administrada a los pacientes, que están matriculados en la ejecución por el Gobierno federal Medicare y el programa de Medi-Cal de estado federal." El cambio a "atención médica administrada se proyecta para guardar el estado de 679 millones de dólares en el próximo año fiscal y 1.000 millones de dólares al año siguiente." El estado será "iniciar el proyecto de tres años en enero".

The Los Angeles Times    (4/5, Gorman) reports, "California is beginning the process of shifting 1.1 million of the state's sickest and poorest patients into managed care, which healthcare officials say will cut costs and improve treatment," but "prompting concerns among critics." Yesterday, "state officials announced...that Los Angeles, Orange, San Diego and San Mateo will be the first counties to provide managed care to the patients, who are enrolled in both the federally run Medicare and the state-federal Medi-Cal program." The shift to "managed care is projected to save the state $679 million in the next fiscal year and $1 billion the following year." The state will "start the three-year project in January."

Estado de los Estados: con el resultado de la ACA envuelto en tanta incertidumbre, los Estados han adoptado diferentes estrategias en la aplicación de las disposiciones de la ley de reforma radical.  Mientras que algunos han adoptado un enfoque de esperar y ver, otros han surcaron lleno de vapor por delante, con diversos grados de éxito.



De: Red de acción de salud

State of the States: With the outcome of the ACA wrapped in so much uncertainly, states have adopted different strategies in implementing provisions of the sweeping reform law.  While some have taken a wait-and-see approach, others have plowed full-steam ahead, with varying levels of success.




From: Health Action Network

El San Francisco Chronicle informó (3\/31, D1, Colliver), "dueños de pequeñas empresas de California más de un millón y cara de asegurados individuales una ola de prima de seguro de salud aumenta en los próximos meses que van desde única dígitos a tan alto como 20 por ciento." A partir de "El domingo, acerca de 101.000 himno Blue Cross pequeños grupos de clientes verán a sus primas a subir un promedio de 13.8 por ciento, pero tan alto como el 20,5 por ciento", mientras que "más de 16.000 empresas pequeñas cubiertas por Aetna recibirán aumentos promedio de 3.7 por ciento. Mientras que algunos verán disminuye, otros obtener golpeará con aumentos de más del 20 por ciento." La pieza salió a explicar que a pesar de que algunos consumidores no se enfrentan a un aumento de las primas, puede todavía encuentran mayor deducibles, copagos más pronunciadas y algunas reducciones de beneficios.

The San Francisco Chronicle    (3/31, D1, Colliver) reported, "More than a million California small-business owners and individual policyholders face a wave of health insurance premium increases in the coming months that range from single digits to as high as 20 percent." Beginning "Sunday, about 101,000 Anthem Blue Cross small-group customers will see their premiums go up an average of 13.8 percent but as high as 20.5 percent," while "more than 16,000 small businesses covered by Aetna will receive hikes averaging 3.7 percent. While a few will see decreases, others will get hit with increases of more than 20 percent." The piece went on to explain that even though some consumers are not facing increased premiums, they may still encounter higher deductibles, steeper co-pays, and some benefit reductions.

El Courant de Hartford (CT) (3\/31, Sturdevant) informó, "Los empleados de la ciudad de Manchester, N.H., pueden recibir hasta $150 si eligen proveedores médicos de bajo costo para colonoscopias, tomografías computarizadas y otros procedimientos," que es "un programa piloto ofrecido por uno de Cruz Azul de WellPoint y Blue Shield planes para la ciudad autoasegurada". Aseguradores "se upending las formas pacientes elegir proveedores médicos con la esperanza de reducir los costos, usando un punch uno-dos: dar a los clientes una imagen clara de los precios de diversos y, a continuación, ofrecer incentivos para hacer más atractivo la opción menos cara." Las compañías de seguros "están instando los clientes utilizar programas en línea y aplicaciones móviles que hacen tan fácil de comparar los precios de los servicios médicos, ya que es buscar billetes de avión en Priceline.com."

The Hartford (CT) Courant (3/31, Sturdevant) reported, "Employees of the city of Manchester, N.H., can receive up to $150 if they choose low-cost medical providers for colonoscopies, CT scans and other procedures," which is "a pilot program offered by one of WellPoint's Blue Cross and Blue Shield plans for the self-insured city." Insurers "are upending the ways patients pick medical providers in hopes of lowering costs, using a one-two punch: give customers a clear picture of the varying prices, then offer incentives to make the less expensive choice more enticing." Insurance companies "are urging customers to use online programs and mobile applications that make it as easy to compare prices of medical services as it is to search for plane tickets on Priceline.com."

El Chicago Tribune (3\/28, Beals) informes que de acuerdo con la segunda encuesta "Peso de la Unión" en cualquier momento de Fitness, recibió "casi 4 millones de dólares en reembolsos de seguros de salud para trabajar 12 o más veces al mes en 2011," hasta 1 millón de dólares en 2010. Consultor de salud gimnasio Heidi Holiday dijo, "Estamos viendo un aumento por ambos proveedores de seguros de salud ofrece este beneficio a empleados y tomando ventaja de estos programas que les pagan a ejercer". Tales esfuerzos preventivos tienen beneficios de costo para todas las partes del sistema de salud. Un estudio de la CDC en colaboración con la Johns Hopkins Bloomberg School of Public Health reveló que, sin los incentivos, "alrededor del 86 por ciento de los estadounidenses podría ser sobrepeso u obesidad en 2030. Eso significa $1 de cada 6 $ en los costes sanitarios será debido a los pesados estadounidenses."

The Chicago Tribune (3/28, Beals) reports that according to Anytime Fitness' second "Weight of the Union" survey, it received "nearly $4 million in health insurance reimbursements for working out 12 or more times per month in 2011," up $1 million from 2010. Fitness health consultant Heidi Holiday said, "We are seeing an increase by both health insurance providers offering this benefit to employees and employees taking advantage of these programs that pay them to exercise." Such preventive efforts have cost benefits for all sides of the healthcare system. A CDC study in conjunction with the Johns Hopkins Bloomberg School of Public Health found that, without the incentives, "some 86 percent of Americans could be overweight or obese by 2030. That means $1 out of every $6 in healthcare costs will be due to heavy Americans."

Líder en un discurso en una Conferencia de Las Vegas el mes pasado, Presidente de Aetna, Mark Bertolini, hablar de la ACA, establecidos por qué él cree que la polémica ley salud representa el comienzo del fin de los seguros privados de salud en América. Y, si bien algunos pueden decir que es desde hace tiempo, otros precaución que cambia el barrido de las impuestas por la ley de cuidados asequibles representan el último clavo en el ataúd para la elección de los consumidores.



Que era entonces: uno de los argumentos claves relucir por los defensores de la ACA condujo a su paso en 2010 fue la afirmación de que jóvenes acabaría ahorrando dinero bajo la ley de salud masiva. Adelantar dos años más tarde y uno de los principales arquitectos de proyectos de ahora argumento que las primas en realidad aumentará en virtud de la ACA.


De: Red de acción de salud

Bellwether In a speech at a Las Vegas conference last month, Aetna president, Mark Bertolini, in speaking about the ACA, laid out why he believes the contentious health care law represents the beginning of the end for private health insurance in America. And, while some may say it's long overdue, others caution that the sweeping changes imposed by the Affordable Care Act represent the final nail in the coffin for consumer choice.

That was Then: One of the key arguments trotted out by proponents of the ACA leading up to its passage in 2010 was the assertion that young people would end up saving money under the massive health care law. Fast-forward two years later and one of the key architects of that argument now projects that premiums will actually increase under the ACA.




From: The Health Action Network

El Los Angeles Times (3 23, Terhune) informes, "Sintiendo una fresca amenaza al Estado y a las reformas de salud federales, agentes de seguros de California están buscando nuevos límites en forma controvertida de la cobertura de salud, aseguradores están vendiendo a los pequeños empresarios." Algunos críticos argumentan que "aseguradores como Cigna Corp. están utilizando estos nuevos planes para juego el sistema y escoger las empresas con trabajadores saludables."

The Los Angeles Times (3/23, Terhune) reports, "Sensing a fresh threat to state and federal healthcare reforms, California insurance officials are seeking new limits on a controversial form of health coverage insurers are selling to small employers." Some critics argue that "insurers such as Cigna Corp. are using these new plans to game the system and cherry-pick companies with healthier workers."

El Tribune de Salt Lake (UT) (3\/22, Stewart) informes, "dos compañías de seguros de salud de Utah han llegado para los aumentos de precio fuerte - uno tan alto como el 19 por ciento de escrutinio". Específicamente, "Marca de confianza Life Insurance Company quiere aumentar las primas en un 18,9 por ciento", y "United Healthcare está mirando a bofetada una suba de 14 por ciento en dos de sus planes de empleador pequeño". De acuerdo a una explicación al Estado, "marca de confianza dice golpear las tasas en Utah es 'necesario para garantizar la solidez financiera continua' de la compañía," y "United Healthcare predice perder dinero como reclamaciones crecen alrededor del 12 por ciento; aumentó 7 por ciento el año pasado."

The Salt Lake (UT) Tribune (3/22, Stewart) reports, "Two Utah health insurance companies have come under scrutiny for sharp price increases - one as high as 19 percent." Specifically, "Trustmark Life Insurance Company wants to raise premiums by 18.9 percent," and "United Healthcare is looking to slap a 14 percent rate hike on two of its small employer plans." According to an explanation given to the state, "Trustmark says bumping rates in Utah is 'necessary to ensure the continued financial soundness' of the company," and "United Healthcare predicts losing money as claims grow about 12 percent; they rose 7 percent last year."

Los Angeles Times (3\/22, Terhune) informes, "himno Blue Cross acordó recortar su tasa aumenta a casi 600.000 clientes en California en respuesta a la presión de los funcionarios del Estado, pero muchas familias todavía podían ver las primas suben 20% a partir de mayo." El "asegurador de salud elevará tarifas 8.2% en promedio, abajo de su anterior solicitud de 10,4%," y según la California departamento de seguros, "la subida de la tasa máxima será un 20% en lugar del 30%." El Estado funcionarios dijeron estimaciones del himno para futuros gastos médicos fueron injustificados y presionaron a la compañía para reducir las primas."

The Los Angeles Times (3/22, Terhune) reports, "Anthem Blue Cross agreed to trim its rate increases for nearly 600,000 customers in California in response to pressure from state officials, but many families still could see premiums rise 20% starting in May." The "health insurer will raise rates 8.2% on average, down from its earlier request of 10.4%," and according to the California Department of Insurance, "the maximum rate hike will be 20% instead of 30%." The state's "officials said Anthem's estimates for future medical expenses were unjustified and they pressed the company to lower premiums."

La AP (3\/18) examina ampliamente "la sabiduría de la atención de la salud del Presidente Barack Obama revisión," Observando que "tener un plan médico o bien pagando una multa es a punto de convertirse en otra certeza de la vida estadounidense, a menos que la Corte Suprema dice que no". En cuestión es si el Gobierno puede "realmente nos dicen qué comprar", y "los jueces federales han bajado a ambos lados de la cuestión, dejando a la Corte Suprema para ordenar," comenzando el 26 de marzo durante tres días llegar a una sentencia que "se perfila como un momento histórico en el siglo de búsqueda por los reformistas para proporcionar atención de salud asequible a todos."

The AP (3/18) broadly examines "the wisdom of President Barack Obama's health care overhaul," noting that "having a medical plan or else paying a fine is about to become another certainty of American life, unless the Supreme Court says no." At issue is whether the government can "really tell us what to buy," and "federal judges have come down on both sides of the question, leaving it to the Supreme Court to sort out," beginning on March 26 over three days to reach a ruling that "is shaping up as a historic moment in the century-long quest by reformers to provide affordable health care for all."

El Wall Street Journal (3\/15, Greene) informa que the2012 nacionales a largo plazo la atención seguros índice ha observado que los precios de la cobertura de atención a largo plazo han aumentado entre 6% y 17% desde hace un año.

The Wall Street Journal (3/15, Greene) reports that the2012 National Long-Term Care Insurance Index has observed that prices for long-term care coverage have increased between 6% and 17% from a year ago.

En el Washington Post (parte 3 de 14) "Wonkblog," Ezra Klein escribe que una investigación publicada en los anales de medicina familiar sugiere que "que, incluso si la ley de reforma de salud logran bajar los costos de atención de la salud, estamos todavía en la pista para las primas de seguros superar ingresos promedio por 2037."
       
HealthDay (3\/14, Goodwin) informa que los investigadores utilizaron datos de la encuesta de Panel de gastos médicos y la Oficina de censo, y que "calculan las primas pagan por los norteamericanos desde 2000 a 2009 y frente a los ingresos". De acuerdo con el artículo, en virtud de las tendencias actuales, "el costo promedio de una prima de seguro de salud familiar se golpeó la mitad de los ingresos para el 2021 y superar por 2033, el estudio encontró".
       
El Huffington Post (parte 3 de 14) informes que según el estudio, la razón de este desarrollo es que "los salarios de los trabajadores nos están estancando y los costos de atención de la salud están creciendo tan rápidamente que incluso si promulgó la ley de reforma de salud por Obama Presidente hace dos años trabaja como publicidad, primas de seguro de salud superará ingresos para muchos estadounidenses en las próximas décadas".

In the Washington Post (3/14) "Wonkblog," Ezra Klein writes that research published in the Annals Of Family Medicine suggests that "that, even if the health reform law does succeed in bringing down health-care costs, we're still on track for insurance premiums to surpass average household income by 2037."

HealthDay (3/14, Goodwin) reports that the researchers used data from the Medical Expenditure Panel Survey and the US Census Bureau, and they "calculated the premiums paid by Americans from 2000 to 2009 and compared them to incomes." According to the article, under current trends, "the average cost of a family health-insurance premium will hit half of median household income by 2021 and surpass it by 2033, the study found."

The Huffington Post (3/14) reports that according to the study, the reason for this development is that "wages for US workers are stagnating and health care costs are rising so quickly that even if the health reform law enacted two years ago by President Obama works as advertised, health insurance premiums will surpass income for many Americans in the coming decades."

The release of new rules for states regarding the implementation of health insurance exchanges sparked moderate coverage. Sources noted mixed reaction to the rules among state leaders and consumer advocates. The Washington Times (3/13, Cunningham) reports, "The Obama administration released more than 600 pages of guidance on Monday outlining a flexible framework for how states should go about enrolling uninsured Americans in new insurance exchanges under the president's health-care overhaul." HHS Secretary Kathleen Sebelius remarked, "These policies give states the flexibility they need to design an exchange that works for them." Reaction from state officials was "mixed," as "some complained that the administration is leaving too many questions unanswered...while others applauded the agency's approach."

        The Washington Post /Kaiser Health News (3/13, Appleby) reports, "Responding to thousands of comments on earlier proposals, the administration made some changes, including setting a requirement that governing boards have at least one voting consumer representative." In addition, the announcement "included some 'interim' rules, which could be tweaked after a 45-day public-comment period," covering "issues such as how quickly states must determine whether an applicant is eligible for Medicaid or the Children's Health Insurance Program, and the role insurance brokers will play in helping low- and middle-income people apply for federal subsidies to buy coverage."

        CQ (3/13, Reichard, Subscription Publication) reports that Sebelius emphasized in a news release "that the regulation provides states 'the guidance and certainty they need' to structure exchanges in two key areas. One is 'establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.' The other is the standards for establishing the exchanges, including exchanges for small business, and certifying plan participation."

        In story carried by more than 310 news sources, the AP (3/13) calls the rules "ambitious," and notes that "experts say it's anybody's guess how the national roll out will go." The piece continues, "For things to go smoothly, state and federal officials must work together to verify private personal and financial details for millions of people, make sure that consumers are enrolled in the right health plan, and accurately calculate how much government aid, if any, each household is entitled to." According to Sebelius, "she expects the court to uphold Obama's Affordable Care Act and thinks states will move quickly once the court has ruled."

El Milwaukee Journal Sentinel (3\/13, Gilbert) informes en su blog "Política" que el senador Ron Johnson (R -WI) ha argumentado que la administración de Obama es subestimar los costos de su nueva ley de salud y que muchas personas podrían perder su salud basado en el empleador bajo la ley actual. El diario Centinela observa que Secretario de salud y servicios humanos Kathleen Sebelius respondió a los argumentos de Johnson sobre el aumento de los costos diciendo que el aumento de los costes sanitarios es "la razón que necesitamos desesperadamente un nuevo mercado de seguro. El mercado de seguros privado es básicamente en una espiral de la muerte, donde... no hacer nada no es realmente una opción. "

The Milwaukee Journal Sentinel (3/13, Gilbert) reports in its "All Politics" blog that Sen. Ron Johnson (R-WI) has argued that the Obama Administration is underestimating the costs of its new healthcare law and that many people could lose their employer-based healthcare under the current law. The Journal Sentinel notes that Secretary of Health and Human Services Kathleen Sebelius responded to Johnson's arguments about rising costs by saying that the rise in healthcare costs is "the very reason that we desperately need a new insurance market. The private insurance market is basically on a death spiral, where ... doing nothing is really not an option."

El Los Angeles Times (3 13, Terhune) informes, doctores, hospitales y compañías de seguros de California lanzaron a su campaña el lunes contra una medida de votación propuesta buscando una reglamentación más estricta de las tasas de seguro de salud y los proponentes rápidamente devolvió el fuego. La iniciativa de voto propuesto pretende dar al departamento de seguros de California la misma autoridad de ajuste de la tasa sobre seguros de salud que ya posee sobre las políticas de auto y propiedad." Mientras "Comisionado de seguros de California Dave Jones dijo que los consumidores quieren alivio de alzas excesivas del tipo", los opositores argumentan que "esta medida equivocada causará mayores tasas y disminuir el acceso a la atención." Además, "Duane C. Dauner, Director Ejecutivo de la Assn. Hospital de California," culpó "crónica bajo financiación de Medicare y Medi-Cal" por aumento de las primas, diciendo que tal "los costos se desplazan a planes privados de salud."

The Los Angeles Times (3/13, Terhune) reports, "California's doctors, hospitals and insurance companies launched their campaign Monday against a proposed ballot measure seeking tighter regulation of health insurance rates and proponents quickly returned fire. The proposed ballot initiative seeks to give the California Department of Insurance the same rate-setting authority over health insurance that it already holds over auto and property policies." While "California Insurance Commissioner Dave Jones said consumers want relief from excessive rate hikes," opponents argue that "this misguided measure will cause higher rates and lessen access to care." In addition, "C. Duane Dauner, chief executive of the California Hospital Assn.," blamed "chronic under-funding of Medicare and Medi-Cal" for rising premiums, saying that such "costs are shifted to private health plans."