California coalition's report calls for Overhaul to Rein in Healthcare Costs

California's health industry heavyweights, warning that insurance premiums will soon consume a third of people's incomes, today threw their weight behind a plan to revamp the health care delivery system.

A dozen CEOs from health care providers and insurers spent the past year participating in an unprecedented, collaborative effort with public policymakers and health care researchers, dubbed the Berkeley Forum and based at UC Berkeley School of Public Health.

The result: a report that contains a variety of proposals for changing health care delivery and also stresses the need for Californians to take more responsibility for staying healthy.

"For the first time, the key actors who deliver and pay for our health care have come together to support a road map for fundamental change in how we buy and provide health care services," Stephen Shortell, the forum's chair and dean of the UC Berkeley School of Public Health, said in a prepared statement.

In the report, the forum participants committed to working together and with others to establish new regulations to revamp the health care system.

Without major change, the forum members warned, people who receive coverage through their employers could end up spending a third of their income on premiums within 10 years. Already, a typical Californian spends an average of $23 a day, every day, on health care, factoring in premiums and taxes and unreimbursed expenses, the report said.

One major change the group proposes: a shift from a traditional "fee-for-service" model, under which health providers bill for each test or procedure, to a model in which companies budget a certain amount of money to spend for each patient.

The idea is to eliminate the incentive to treat patients with more tests and procedures than they need, the report said.

"If the insurers spend more than their target, they are at risk for covering that added expense," Shortell said. "That's why we were surprised to the extent that these folks said: 'Bring it on.' "

The report also emphasized the need for more integrated care, a seamless approach to health coverage in which access to primary care doctors and specialists is well coordinated. In California, such an approach is most fully used by Kaiser Permanente.

Together, those two major shifts could save California $110 billion – or $800 per household annually – over the coming 10 years, the report said.

Six added initiatives target populations and conditions that account for a disproportionate share of health care spending. A primary goal: Get Californians to be more active.

Cost-cutting is particularly important given that the Affordable Care Act in 2014 will cover about 2 million more uninsured Californians, adding an estimated 5 percent to the overall cost of providing health care.

"The Affordable Care Act is a tipping point toward this call to action," said Richard Scheffler, vice chair of the Berkeley Forum and a professor at UC Berkeley. "When you add 2 million people, it puts a lot of pressure in the health care system."

Overall, Californians use fewer health care resources than do people in the rest of the country. One reason for this may be the higher cost for an overnight stay in a California hospital – 30 percent more than the national average – as well as the higher general cost of living, which the report said is 34 percent more than the national average.

That higher cost of living, plus low supply of health care workers, accounts for increased costs such as higher wages for nurses, for example, which run about 36 percent more than those elsewhere in the country, the report said.

But if the majority of Californians took steps to take better care of themselves, the need for high-priced care could become less urgent. Taking personal responsibility for one's own health is not far behind cost-cutting in the priorities of health care changes.

The top spenders in the health care system amount to only 5 percent of the population. But that 5 percent accounts for 53 percent of the state's health care expenditures, the report found.

These patients are more likely to be older, to be obese, and to have chronic conditions such as high blood pressure, heart disease, high cholesterol, diabetes, joint pain and arthritis, the report said.

Simply put, participants said Californians should "collectively" create a health culture.

A critical part of this involves creating environments where people are eating healthier foods in smaller portions and getting exercise, especially walking.

"We need to reduce the burden of illness on the health care system," said Shortell. "It's important that we design communities and schools to increase and encourage physical activity."

The participants stressed that the report does not favor any particular model of business, such as HMOs or PPOs. But it does note that California can be a leader for the rest of the nation, in part because the state has seen high enrollment in HMOs, which use budgets and emphasize prevention and wellness.

By Cynthia H. Craft

Read more here: http://www.sacbee.com/2013/02/26/5217193/california-coalitions-report-calls.html#storylink=cpy

When do I need to inform my employees about the CA Healthcare Exchange?

The Affordable Care Act requires employers to provide their employees with a written notice explaining a state’s health insurance exchange and how an employee may access the exchange. 

But federal officials have delayed a March 1, 2013, deadline that requires employers to notify employees about the exchanges until regulations and a model notice with generic language have been issued. The Department of Labor anticipates final regulations will be available in the early fall of 2013

The notice will inform employees about:

• The existence of the state exchange and a description of the services provided
• Eligibility for a premium tax credit or a cost-sharing reduction if their employer's plan does not meet certain requirements and the employee purchases coverage through the state exchange
• The potential loss of any employer contributions to an employer-sponsored health plan and that all or a portion of an employer contribution toward employer-provided coverage may be excludable for federal income tax purposes
• Whom they should contact at the state exchange for assistance
• Their appeal rights

Until further guidance and the model Notice of Exchange have been issued, employers can plan for compliance by summarizing information about their employer-sponsored coverage, including items such as:

• Employer name, EIN, and contact information
• Employee’s name, hours worked per week, and their full or part-time status
• Employee’s enrollment date for employer-sponsored coverage
• Whether health coverage is being provided to the employee
• Employee and employer contribution amounts
• Frequency of contributions
• Name of the lowest cost plan providing minimum value

Insurers Slam New Reform Rules

The health insurance industry is arguing that new health reform regulations just issued by the Obama administration will result in sudden and sharp cost increases for health care.

America’s Health Insurance Plans criticized the Department of Health and Human Services on finalizing the age rating restrictions included in the health care reform law on Friday—a move they say will result in an “overnight increase” in coverage for young people.

“Coverage needs to be affordable for individuals and families in order to achieve broad participation in the health care system,” AHIP President and CEO Karen Ignagni said in a statement. “The new restrictions on age rating will result in an overnight increase in health care costs for people in their 20s, 30s and early 40s. This increases the likelihood that younger, healthier people forgo purchasing insurance until they are sick or injured. When this happens, costs go up for everyone, young and old.”

The new restrictions on age rating take effect at the same time as the reform law’s minimum essential health benefits requirement and the new $100 billion health insurance tax that will further add to the cost of coverage, Ignagni also argued.

In comments previously submitted to HHS, AHIP had urged regulators to delay implementation of the age rating restrictions to avoid significant cost increases for younger people at a time when the broader reforms are taking effect. These concerns were echoed by the National Association of Insurance Commissioners in their comments: “With a transition to the required 3:1 age ratio, younger, healthier individuals will experience more gradual rate increases rather than large one-time rate shocks and will be less likely to drop coverage and further destabilize the market.”

But HHS said in final regulations Friday that it would not delay or phase in that requirement.

Under health reform, insurers are limited to the amount they can charge older people for their health insurance to a maximum of three times the amount younger people pay.

Supporters say the age rating restrictions are necessary to ensure seniors are fairly charged for coverage, but others argue the requirement will raise costs for young adults and lead them to forgo health insurance, which will negatively impact the entire market.

“Higher rates for the younger population combined with low mandate penalties during the first years of the ACA implementation will result in adverse selection because younger individuals are likely to choose not to purchase coverage,” AHIP wrote in comments to HHS. “When these younger individuals do not enroll, destabilization of the individual market will occur, premiums will increase in the individual market for enrollees of all ages, and enrollment will decline.”

By. Kathryn Mayer

California Exchange Promotes Standard Benefits

The California Health Benefit Exchange board is standardizing the co-payment amounts, coinsurance percentages and other plan design features in all new individual and small-group health policies sold in the state.

The federal Patient Protection and Affordable Care Act of 2010 (PPACA) already requires all non-grandfathered, insured individual and small-group plans to cover the services included in a state's standardized "essential health benefits" (EHB) package starting Jan. 1, 2014.

If PPACA works as drafters expect, insurers will have to sell plans at four "metal levels" -- bronze, silver, gold and platinum -- based on the percentage of the actuarial value of the EHB package that the plan covers.

The California exchange board -- which is calling itself "Covered California" -- is going a step further and requiring use of standardized designs.

A chart summarizing the effects of the standardized design approach shows, for example, that a bronze plan could have a $5,000 deductible for medical care and drugs, a silver plan could have a $2,000 deductible, and a gold or platinum plan could not have any deductible.

The co-payment level for a primary care office visit could range $25 at a platinum plan to $60 per visit for three visits per year at a bronze plan.

The emergency room co-payment could range from $150 at a platinum plan to $250 per year at a bronze plan.

The maximum out-of-pocket expenses for one insured would range from $4,000 at a platinum plan to $6,400 at a bronze plan.

Some insurers have chronic condition management programs and value-based insurance design (VBID) programs that encourage patients to get care that seems to have a high probability of reducing overall plan costs by reducing or waiving cost-sharing amounts for patients who get that care.

Some VBID plans might, for example, charge a $5 co-payment or no co-payment for diabetes patients who get regular endocrinologist visits.

It was not immediately clear from Covered California standardized design materials how California will handle chronic condition management program care incentives.

It also was not immediately clear how the state will process the amendments to existing individual and small-group product forms needed to implement the new benefits design requirements.

The design standards program "will allow for innovation as health plans may propose alternative designs that benefit consumers and increase access," officials said in a description of the standards.

Peter Lee, executive director of Covered California, said in a statement that the state will adjust the out-of-pocket costs for lower-income enrollees.

Standardization "lets consumers shop from one insurance provider to the next knowing that the benefits are the same," Lee said.

Originally published on LifeHealthPro. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Obamacare vs. The Young

During his State of the Union address, President Barack Obama contended that "already the Affordable Care Act is helping to slow the growth of health care costs." Yet the costs of health insurance continue to climb, a direct consequence of the Affordable Care Act, and many uninsured Americans are likely to remain that way.

Health insurers are pushing double-digit premium increases, some as high as 26 percent. Next year, when the Affordable Care Act's requirement to have insurance takes effect, premiums are expected to rise further, and many young Americans will have to choose between buying health insurance or paying a penalty. Although proponents of the law argue that subsidies will entice younger people to buy insurance, it actually is expected to have the inverse effect. Subsidies are too small, and out-of-pocket costs for insurance are much higher.For many young Americans, it makes more sense – although it has negative impacts on the overall health care system – to wait until they are very sick to purchase insurance, since they can't be denied coverage due to a pre-existing condition – or to seek to qualify for so-called "free" insurance, such as Medicaid (called Medi-Cal in California).

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And the penalty alternative is so much less expensive than the cost of health insurance that the majority of people purchasing insurance figure to be older and less healthy. Younger Americans won't want – or won't be able to afford – to spend so much on health care. It will be young, healthy Americans, therefore, who will tend to become the losers.

"If young adults can't afford health insurance policies available in 2014 under the health care law, state insurance officials are worried they won't buy them. And that could drive up the cost of insurance for the mostly older, sicker people who do purchase coverage," notes Kaiser Health News, published by a foundation related to the large health insurer Kaiser Permanente.

Higher payroll taxes and taxes on medical devices have now been implemented – yet President Obama wants more "modest" reforms. "Obamacare distorts the marketplace," Joel Hay told us; he's a health economist at the USC Schaeffer Center for Health Policy and Economics. "It takes a broken system and pours gasoline on the fire."

Health expenditures in the United States in 2010 were estimated at $2.6 trillion – more than 10 times the $256 billion spent on health care in 1980. The U.S. spends $7,000 per person, 16 percent of gross domestic product, on health care every year. Yet Americans have a life expectancy slightly below average compared with countries that make up the 30 democracies in the Organization for Economic Cooperation and Development, despite spending more than any other OECD nation.

Ultimately, one of the major root causes of health care inflation is the lack of competition in medical services. Obamacare, looking like another runaway entitlement program, fails to keep those costs down while pushing Americans in the direction of a government-run system, largely due to skyrocketing premiums for private insurance. And many of those who should be buying insurance at affordable rates in the event of an emergency – young and generally healthy Americans – will be unable or unwilling to do so.

by ORANGE COUNTY REGISTER

Health Care Plans Being Assessed

Some local business leaders seem hesitant to say it, as if the federal government could issue a ruling at any moment that puts them back in the soup.

But they’ve studied the Affordable Care Act. They’ve heard presentations by insurance experts, viewed Web seminars and been briefed by their human resources people.

After all of that, they’re thinking that maybe, just maybe, the new law won’t hurt them so badly after all.

As Matthew Simmons, president of the Capital Ale House restaurant chain, put it, “We’re in a really good position for this changeover. We’re pretty much compliant.”

Of course, the law is complicated, and much is still unknown. Individuals and some local business owners have not been spared. They face penalties if they don’t meet its requirements.

“It’s going to have a major effect on our business,” said Karl Karch, owner of Home Instead Senior Care.

Yet two groups of employers—the small ones that employ fewer than 50 people, and the big ones that already offer comprehensive health plans—have escaped the initial fines that are a feature of the act.

SMALL FIRMS EXEMPT

The law encourages businesses to offer health insurance to their workers. And in some cases, it fines those that don’t.

But it exempts those with fewer than 50 workers. (Actually, it uses a formula that combines full- and part-time workers and calls them full-time equivalents.)

Those who employ 50 or more of these full-time equivalents face fines if they don’t offer health coverage. The fines will kick in if their workers qualify for government subsidies to help them buy coverage on the online insurance marketplaces that will open later this year.

Even if they do offer coverage, employer’s plans must be affordable and sufficient, according to rules that the government is still drafting. If not, employers could face fines.

Business owners are trying to make sense of all this.

“That piece of legislation was some 900 pages, and we’re still trying to get our arms around it,” said Kent Farmer, president and chief executive officer of Rappahannock Electric Cooperative.

Affordable, according to the law, means that the employees’ share of their health insurance premium is no more than 9.5 percent of their adjusted gross income.

Sufficient, according to the government, means “bronze-level” coverage, or a comprehensive basket of benefits, such as doctor care, hospital care, outpatient care and medicines. However, the rules have not yet been published.

Many local employers already offer this type of insurance and pay a significant portion of the premiums. So will their plans satisfy the law and spare them the penalties?

“We think we do, but we really don’t know,” said Lloyd Harrison, president and chief operating officer of Virginia Partners Bank.

Added Kevin Dillard, president of LifeCare Medical Transports, “I would hope we meet or exceed it.”

HOW BIG ARE THE FINES?

But the collective sigh of relief coming from some corporate boardrooms is not heard at businesses like Karch’s Home Instead Senior Care or Neda McGuire’s Comfort Keepers.

These and others like them are large-group employers who hire lots of part-time workers and do not offer “bronze-level” health plans. They face hefty fines.

“I think everybody should have access to health care, but I just wish it was done with better thought, with more input from real business owners,” McGuire said.

Karch employs about 190 people, and McGuire has more than 200. Both provide in-home, non-medical care to the sick and elderly.

Both companies have a stable of caregivers who serve the clients. Most of the caregivers are part time since they work less than 40 hours a week.

But, according to the Affordable Care Act, they count as full time if they work more than 30 hours a week.

Both companies offer limited health insurance plans, but those plans won’t meet the government’s requirements. Karch and McGuire said they plan to drop those benefits next year.

“I will then be put in a position of paying a penalty,” Karch said.

The penalty kicks in when one of the workers purchases coverage on a government exchange and qualifies for a subsidy.

Both expect that to happen since their caregivers earn from $8 to $11 per hour.

“I’m bracing myself. It’s just a matter of how big that penalty is,” Karch said.

Subsidies will be available to those who earn from 100 to 400 percent of the federal poverty level. That’s $11,170 to $44,680 per year for an individual.

The employer penalty is set at $2,000 per full-time worker, with an exemption for the first 30 workers.

That means, Karch and McGuire said, that they’ll have to increase rates to their clients, or limit their workers’ hours. Or both.

“It’s the proverbial rock and hard place. I’m squeezed,” Karch said.


SOME BUSINESSES BACK PLAN

The Affordable Care Act has its critics, yet some local business leaders describe themselves as supporters. They include:

Kevin Dillard, president, LifeCare Medical Transports:

“We firmly believe that everybody ought to have access to health care. The line of business that we’re in, we way too often see people who have fallen through the cracks and have not received appropriate care.”

Matthew Simmons, president, Capital Ale House:

“Looking back over the years, we’ve always had large increases in [insurance] rates. The last two years [because of the act] we’ve had the smallest increases ever.”

INSURANCE IS GOLDEN

Government-sponsored online insurance markets will open later this year. Will local businesses drop coverage for their workers and tell them to buy individual plans on these markets? Several said they won’t:

Lloyd Harrison, president and chief operating officer, Virginia Partners Bank:

“We need to be competitive for employees. The other thing is more philosophical. We want to do what we think is the right thing for our employees.”

Kent Farmer, president and chief executive officer, Rappahannock Electric Cooperative:

“Our benefits package is a very important part of our overall compensation program. Our employees are protective of it.”

Paul Scott, president, Scott Insurance & Financial Services:

“Many employers will try to keep their health insurance at all costs.”TOO GOLDEN?

Some local businesses don’t fear the penalties that occur when their employees get relief on a government-sponsored exchange. Instead, they fear the 2018 tax that will be imposed on high-cost health plans, the “Cadillac” plans, valued at more than $10,200 a year for an individual:

Lloyd Harrison, Virginia Partners Bank: “It’s not far-fetched to imagine a point where our existing plan starts pushing up against that $10,200 limit.”

Kent Farmer, VEC: “Unfortunately, we may be in a group that gets defined as a Cadillac plan. It doesn’t take much.”

Paul Scott, Scott Insurance: “It could be a race to the bottom,” with employers offering only the minimum-required coverage.

by Jim Hall

Rising Premiums To Blame For Insurance Cost Jumps

Insurance isn’t getting any cheaper for Americans.

More than a third of Americans spent more on insurance in 2012, mainly due to increasing premiums, according to new research from Bankrate. Significantly fewer spent less on insurance this year.

Research reveals that 37 percent of Americans spent more overall on all kinds of insurance—including  health, life, homeowners, renters and auto—over the past year while only 7 percent spent less. About half (52 percent) said they spent about the same.

Of those who spent more, 62 percent said their spending went up because of rising premiums Other reasons included: the addition of coverage for a new home, vehicle, boat or RV (12 percent); changes in coverage due to family circumstances, such as marriage or addition to the family (9 percent); and a decision by the consumer to boost coverage on an existing policy (4 percent).

San Diego's major healthcare insurance carriers include Anthem, Aetna, Kaiser, Sharp, Health Net, Blue Shield, Cigna, & United Healthcare.  Hear what options will be available to you through the California Exchange at our March 7th, event!

“We continue to view rising expenses and stagnant wages as a key financial hurdle for American households,” says Doug Whiteman, insurance analyst at Bankrate.com. “But consumers shouldn’t accept rising insurance premiums without a fight. Compare quotes from at least three other companies, investigate all possible discounts and don’t be afraid to ask your current insurer for a discount. You may be able to get a better deal.”

by KATHRYN MAYER

CBO lowers estimate of those insured under PPACA

The number of Americans projected to gain insurance from the Patient Protection and Affordable Care Act is eroding, by at least 5 million people, as the Obama administration works to implement the $1.3 trillion health care reform law.

About 27 million people are expected to gain coverage by 2017, according to a report Tuesday from the Congressional Budget Office. The CBO had projected when the law passed in 2010 that 32 million uninsured people would be on a health plan within a decade, and a year later raised its estimate to 34 million. 

Expectations are being pulled back as the expansion relies on governors to build a network of insurance marketplaces and expand Medicaid, the joint federal-state insurance program for the poor. At least 22 Republican governors have said they’ll refuse to participate in the health exchanges and a Supreme Court decision lets them also opt out of the Medicaid expansion. 

There is concern “about a combination of factors, including the readiness of exchanges to provide a broad array of new insurance options, the ability of state Medicaid programs to absorb new beneficiaries, and people’s responses to the availability of the new coverage,” the CBO says. 

Learn about new options available to you in the San Diego marketplace through Sharp Health Plan @ our March 7th Healthcare Reform Event!

In addition, as many as 8 million people will lose health care plans now offered through their employers, the CBO estimates. After the health law was passed, the CBO projected that about 3 million people who would otherwise have employer-sponsored insurance would lose that coverage. 

Some of the losses should be offset by enrollment in plans offered through exchanges, the CBO says. The CBO says that 26 million people will be in exchange plans by 2018, an increase from a maximum of 24 million in an earlier estimate. 

The insurance estimates, which were part of a CBO report on the federal budget, are “a very gentle way of saying there’s a problem” with the implementation of the law, says Douglas Holtz-Eakin, a former CBO director who is now president of the American Action Forum, an advocacy group critical of President Barack Obama’s economic and health policies. 

“They know that everything they do is subject to a lot of uncertainty,” Holtz-Eakin says. “If you see a systematic drift — more uninsured, less employer- sponsored insurance — what they’re saying is, ‘Wow, the bad news outweighs the good news.’” 

The federal government has said it will run exchanges in states that aren’t building their own, and all marketplaces will be ready to begin enrolling people by Oct. 1. The law requires most Americans to carry insurance beginning Jan. 1, 2014. 

A spokesman for the White House, Bradley Carroll, declined to comment on the CBO estimate.

(Employee Benefit News: by Bloomberg news services)

Insurance Still Doesn't Come Cheaply

Buying your own health insurance will never be the same.

This fall, new insurance markets called exchanges will open in each state, marking the long-awaited and much-debated debut of President Barack Obama's health care overhaul.

The goal is quality coverage for millions of uninsured people in the United States. What the reality will look like is anybody's guess — from bureaucracy, confusion and indifference to seamless service and satisfied customers.

Exchanges will offer individuals and their families a choice of private health plans resembling what workers at major companies already get. The government will help many middle-class households pay their premiums, while low-income people will be referred to safety-net programs they might qualify for.

Most people will go online to pick a plan when open enrollment starts Oct. 1. Counselors will be available at call centers and in local communities, too. Some areas will get a storefront operation or kiosks at the mall. Translation to Spanish and other languages spoken by immigrants will be provided.

When you pick a plan, you'll no longer have to worry about getting turned down or charged more because of a medical problem. If you're a woman, you can't be charged a higher premium because of gender. Middle-aged people and those nearing retirement will get a price break: They can't be charged more than three times what younger customers pay, compared with six times or seven times today.

If all this sounds too good to be true, remember that nothing in life is free and change isn't easy.

Starting Jan. 1, 2014, when coverage takes effect in the exchanges, virtually everyone in the country will be required by law to have health insurance or face fines. The mandate is meant to get everybody paying into the insurance pool.

Obama's law is called the Affordable Care Act, but some people in the new markets might experience sticker shock over their premiums. Smokers will face a financial penalty. Younger, well-to-do people who haven't seen the need for health insurance may not be eligible for income-based assistance with their premiums.

Many people, even if they get government help, will find that health insurance still doesn't come cheaply. Monthly premiums will be less than the mortgage or rent, but maybe more than a car loan. The coverage, however, will be more robust than most individual plans currently sold.

Consider a hypothetical family of four making $60,000 and headed by a 40-year-old. They'll be eligible for a government tax credit of $7,193 toward their annual premium of $12,130. But they'd still have to pay $4,937, about 8 percent of their income, or about $410 a month.

A lower-income family would get a better deal from the government's sliding-scale subsidies.

Consider a similar four-person family making $35,000. They'd get a $10,742 tax credit toward the $12,130 annual premium. They'd have to pay $1,388, about 4 percent of their income, or about $115 a month.

The figures come from the nonpartisan Kaiser Family Foundation's online Health Reform Subsidy Calculator. But while the government assistance is called a tax credit and computed through the income tax system, the money doesn't come to you in a refund. It goes directly to insurers.

Obama's law is the biggest thing that's happened to health care since Medicare and Medicaid in the 1960s. But with open enrollment for exchange plans less than 10 months away, there's a dearth of consumer information. It's as if the consumer angle got drowned out by the political world's dispute over "Obamacare," the dismissive label coined by Republican foes.

Yet exchanges are coming to every state, even those led by staunch GOP opponents of the overhaul, such as Govs. Rick Perry of Texas and Nikki Haley of South Carolina. In their states and close to 20 others that are objecting, the exchanges will be operated by the federal government, over state opposition. Health and Human Services Secretary Kathleen Sebelius has pledged that every citizen will have access to an exchange come next Jan. 1, and few doubt her word.

But what's starting to dawn on Obama administration officials, activists, and important players in the health care industry is that the lack of consumer involvement, unless reversed, could turn the big health care launch into a dud. What if Obama cut the ribbon and nobody cared?

"The people who stand to benefit the most are the least aware of the changes that are coming," said Rachel Klein, executive director of Enroll America, a nonprofit that's trying to generate consumer enthusiasm.

"My biggest fear is that we get to Oct. 1 and people haven't heard there is help coming, and they won't benefit from it as soon as they can," she added. "I think it is a realistic fear."

Even the term "exchange" could be a stumbling block. It was invented by policy nerds. Although the law calls them "American Health Benefit Exchanges," Sebelius is starting to use the term "marketplaces" instead.

Polls underscore the concerns. A national survey last October found that only 37 percent of the uninsured said they would personally be better off because of the health care law. Twenty-three percent said they would be worse off in the Kaiser poll, while 31 percent said it would make no difference to them.

Insurers, hospitals, drug companies and other businesses that stand to benefit from the hundreds of billions of dollars the government will pump in to subsidize coverage aren't waiting for Washington to educate the public.

Blue Cross and Blue Shield plans, for example, are trying to carve out a new role for themselves as explainers of the exchanges. Somewhere around 12 million people now purchase coverage individually, but the size of the market could double or triple with the new approach, and taxpayers will underwrite it.

"Consumers are expecting their health insurance provider to be a helpful navigator to them," said Maureen Sullivan, a senior vice president for the Blues' national association. "We see 2013 as a huge year for education."

One goal is to help consumers master the "metals," the four levels of coverage that will be available through exchange plans — bronze, silver, gold, and platinum.

Blue Cross is also working with tax preparer H&R Block, which is offering its customers a health insurance checkup at no additional charge this tax season. Returns filed this year for 2012 will be used by the government to help determine premium subsidies for 2014.

"This tax season is one of historical significance," said Meg Sutton, senior advisor for tax and health care at H&R Block. "The tax return you are filing is going to be key to determining your health care benefits on the exchange."

Only one state, Massachusetts, now has an exchange resembling what the administration wants to see around the country. With six years in business, the Health Connector enrolls about 240,000 Massachusetts residents. It was created under the health overhaul plan passed by former Republican Gov. Mitt Romney and has gotten generally positive reviews.

Connector customer Robert Schultz is a Boston area startup business consultant who got his MBA in 2008, when the economy was tanking. Yet he was able to find coverage when he graduated and hang on to his insurance through job changes since. Schultz says that's freed him to pursue his ambition of becoming a successful entrepreneur — a job creator instead of an employee.

"It's being portrayed by opponents as being socialistic," Schultz said.. "It is only socialistic in the sense of making sure that everybody in society is covered, because the cost of making sure everybody is covered in advance is much less than the cost of putting out fires."

The Connector's executive director, Glen Shor, said his state has proven the concept works and he's confident other states can succeed on their own terms.

"There is no backing away from all the challenges associated with expanding coverage," Shor said. "We are proud in Massachusetts that we overcame what had been years of policy paralysis."

BY RICARDO ALONSO-ZALDIVAR

Religious Nonprofits Won't Pay For Birth Control Under Proposal

After a year of lawsuits and public outcry, the Obama administration proposed Friday a way for women who work at nonprofit religious institutions to get free birth control without requiring their employers to pay for it.

Instead, institutions that insure themselves such as hospitals and universities could use a third party to find a separate health policy that would pay for and provide the coverage. The costs would be offset by the fees insurers will pay to participate in the new online health marketplaces set to open in October under the health law.

“Today, the administration is taking the next step in providing women across the nation with coverage of recommended preventive care at no cost, while respecting religious concerns,” Health and Human Services Secretary Kathleen Sebelius said in a press release.  “We will continue to work with faith-based organizations, women’s organizations, insurers and others to achieve these goals.”

Cardinal Timothy Dolan of New York, president of the U.S. Conference of Catholic Bishops who has spearheaded opposition to the contraceptive mandate, said in a statement that the organization welcomes “the opportunity to study the proposed regulations closely. We look forward to issuing a more detailed statement later.”  A similar statement was issued by the Catholic Health Association, which includes more than 1,000 health groups affiliated with the Roman Catholic Church.

The mandate to cover contraceptive care has inspired at least 44 lawsuits against the government, according to The Becket Fund for Religious Liberty, a legal organization fighting the mandate.

Here’s the way the proposed rule would work:

Religious organizations that self-insure, as well as student health plans, would let their third party administrator know that they object to providing contraceptive coverage on moral grounds. The administrator would then work with a health insurer to provide separate individual contraception coverage at no cost to the enrollees.  The cost would be “offset by adjustments in federally-facilitated exchange user fees that insurers pay.”

If the religious organization offers a group plan, its insurer would provide separate contraception coverage at no cost to participants. The administration argues that such services would be cost-neutral to the insurer since they would result in fewer births.

Ilyse Hogue, president of NARAL Pro-Choice America, praised the proposal.

“Today’s draft regulation affirms yet again the Obama administration’s commitment to fulfilling the full promise of its historic contraception policy,” said Hogue. “Thanks to this commitment, most American women will get birth-control coverage without extra expense.”

Under the health law, employers who insure their workers are required to cover government-recommended preventive services without co-payments. In August 2011, the Obama administration said those would include contraceptive services, such as birth control pills, implants and sterilization procedures.

Religious organizations opposed to birth control sought to be exempt  The Obama administration initially gave them a one-year delay, until August of this year, to comply, while promising further compromise.

by Jenny Gold(KHN)