As the 2013 open enrollment benefit season approaches, consumers say choosing health-care benefits is among the most difficult of life decisions, second only to saving for retirement, according to a recent survey.

According to Aetnas Empowered Health Index Survey, 88% of respondents blamed the information regarding their benefits being too complicated for their difficulty in choosing the right plan. Whats more, 85% say the information is conflicting and 83% of survey participants say it is difficult to know which plan is right for them.

Of the 15% of respondents who did not have health insurance, 36% reported they didnt have enough information to shop for it, and 24% are not confident in their ability to choose the right plan.

Complicated information leads to poor health-care choices which cause costly problems. The survey says many Americans continue to dip into their savings and skip recommended medical treatments to cope with the high cost of health care:

Experts claim these challenges will only become more daunting amid escalating premiums and services as consumers remain uncertain about how the presidential election will impact health-care reform.

According to the survey, slightly more Americans, 43%, have an unfavorable opinion of the Patient Protection and Affordable Care Act, (PPACA) than support it, 41%but 75% of survey respondents believe that all of PPACAs key elements are important for them, individually, and for their families.

The Aetna survey, conducted in July among 1,500 adults, also looked at a wide range of behaviors demonstrating the degree to which consumers use tools and resources to actively make health plan, physician and other medical choices.

Despite the headwinds they are facing, consumers are working to improve the situation.

The Patient Protection and Affordable Care Act requires plans to simplify their summary of benefit choices providing side-by-side comparative information for offered plans, says Mark Cesarano, managing consultant at health-care consulting firm Savitz.

Health plans are responding, and companies like Aetna are taking the lead by continually evolving and enriching their educational materials, interactive tools and resources. For example, Aetnas Plan for Your Health website provides educational articles, cost calculators and checklists. Other health insurers are also improving their websites and customer service to provide detailed, yet understandable information to customers.

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How to Pick a Health Care Plan that Fits Your Lifestyle and Budget

Hospital and nursing home managers are reaching for the aspirin again. No matter who wins on Nov.6, most Democrats and Republicans agree in principle that federal spending on Medicare and Medicaid will need to go under the knife, above and beyond the cuts written into the 2010 health-care overhaul.

Illustration by Andrew Joyce

While history suggests its hardly a sure thing that the two parties will reach a deal, even the possibility of one is a risk for institutional health-care providers. Thats because there arent a lot of other places to find savings. Congress has so far proved unwilling to slice doctors pay. Big Pharma makes for a good populist target, but prescription drugs are less than 10percent of total Medicare and Medicaid spending. That leaves hospitals and nursing homes.

Hospitals will get $450billion next year from Medicare, the program for the elderly, and Medicaid, the program for the poor. Thats almost half their total funding, according to federal projections. Nursing homes will get $89billion, equal to 55percent of their revenue. Losing any of that money will hurt bottom lines and test business models.

Illustration by Andrew Joyce

Brookdale Senior Living (BKD), Kindred Healthcare (KND), and Sun Healthcare Group (SUNH), the three largest operators of nursing and residential-care facilities by revenue, declined to answer questions about their preparations for possible future cuts. So did HCA Healthcare (HCA) and Community Health Systems (CYH), the countrys largest hospital companies. In conversations with investors, however, executives have laid out a number of possible strategies.

Hospitals in particular are about to lose as much as to 2percent of their Medicare revenue under the so-called sequestration bill, passed by Congress in return for raising the debt ceiling in 2011. Those cuts may become a dress rehearsal for dealing with further reductions down the road. At a conference hosted by Morgan Stanley (MS) in September, HCAs president of operations, Samuel Hazen, said his company would try to cope with the cuts to Medicare, which in 2011 contributed almost one-third of revenue, in part by driving harder deals with suppliers, which make up about a quarter of HCAs spending.

Those who have worked to diversify their business, like HCA, will feel less of a blow. There is a lot of activity right now in the consulting side, HCA Chief Financial Officer R. Milton Johnson said at the conference. HCAs Parallon Business Solutions subsidiary handles purchasing, payroll, IT, and other functions for other hospitals. Tenet Healthcare (THC), the third-largest U.S. hospital company, has a consulting arm that offers a similar menu of services. The unit, called Conifer Health Solutions, logged a 45percent jump in revenue in the first half of 2012, compared with the same period last year.

Nursing homes, for their part, are pursuing more options. The chief executive of Brookdale, Bill Sheriff, told investors in the companys most recent earnings call that Brookdales expansion into hospice care and outpatient services such as physical therapy has made an attractive additional contribution to revenue, in spite of governmental rate reductions. Similarly, Richard Lechleiter, chief financial officer at Kindred, said in an August earnings call that his companys home health and hospice services are continuing to grow pretty aggressively. Revenue from those lines of business tripled in the first half of 2012, to $57.3million, from a year ago.

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Hospitals and Nursing Homes Brace for Medicare Cuts

WASHINGTON -- The health insurance industry presented itself as an ally of President Barack Obama's health care law while at the same time making hefty contributions to members of Congress who are trying to get rid of it, according to contribution records.

Between January 2007 and August 2012, the political action committees of the 11 largest health insurance companies and their primary trade group gave $10.2 million to federal politicians. Nearly two-thirds of the total went to Republicans who oppose the law or support its repeal, according to the Center for Public Integrity's analysis of Federal Election Commission filings.

The 11 top companies, according to the Fortune 500 list, controlled 35 percent of the industry in 2011, according to data from the National Association of Insurance Commissioners. The top industry trade group is America's Health Insurance Plans.

Much of the money rolled in as health insurance industry leaders showed support for the Democrats' reform efforts.

"We are ready to be accountable to these (new) rules," Karen Ignagni, AHIP's president and chief executive officer told the Senate Finance Committee in May 2009, roughly a year before Obama's landmark legislation was signed into law. And a month after Obama's Affordable Care Act became law in March 2010, Ignagni said her organization was "strongly committed" to its "successful implementation."

Likewise, Ron Williams, then chairman and chief executive officer of Aetna, the country's

"I believe that President Obama and this Congress have charted a course of change," Williams said in a June 2009 statement. "I want to make clear that we too are committed to expanding access, controlling costs and improving the quality and value of care people receive."

But Williams, who left Aetna in April 2011, this past June penned a Wall Street Journal op-ed calling for health care reform at the state level and criticizing the federal law's mandate.

House Majority Leader Eric Cantor, R-Va., ranks as the top recipient of political action committee money from the top insurers since 2007, according to the center's analysis. Cantor, a tea party favorite and one of the law's most vocal critics, has received about $258,000 from AHIP and the top industry PACs.

In January 2011, Cantor introduced the Repealing the Job-Killing Health Care Law Act, the first of 33 repeal efforts that have reached the House floor.

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Insurers praised Democrats, gave to GOP

Escape Fire: The Fight to Rescue American Healthcare

Documentary. Directed by Matthew Heineman and Susan Froemke. (PG-13. 99 minutes.)

The earnest and well-made documentary "Escape Fire" offers an X-ray of what's ailing the American health care system and prescribes a number of sensible solutions. That the movie largely sidesteps partisan politics will no doubt irk some viewers, but may just be its greatest strength.

The film is surprisingly optimistic, arguing that there are genuine, practical answers to many of the problems afflicting the system, and some are already being adopted.

The issues are familiar to anyone who pays even remote attention to the news: Americans are overly dependent on drugs, lead sedentary lives and often eat poorly; unnecessary tests and treatments are commonplace; primary-care physicians are being squeezed from all sides as dollars flow to specialists and expensive high-tech treatments; the health care industry is under enormous pressure to produce profits and is frighteningly efficient in lobbying against change.

Medical reporter Shannon Brownlee says that tens of thousands of Medicare recipients die each year from unneeded treatments. And Oregon's Dr. Erin Martin offers testimony from the front lines as she struggles with having less and less time to spend with her indigent patients, a situation that's replicated across the system.

The movie gives ample screen time to some familiar advocates for change: Dr. Andrew Weil, who says we need to shift our emphasis from disease intervention to disease prevention; and Dr. Dean Ornish, who urges personal lifestyle changes as a key to any serious reform. As an example of what such changes can achieve, we're given a look at Safeway's employee health program, which has helped the company trim costs.

The film is perhaps at its most compelling in recounting the story of combat veteran Sgt. Robert Yates, who became addicted to drugs prescribed to treat his post-traumatic stress disorder. Through the use of nontraditional treatments including acupuncture and meditation, Yates battles his way out of dependency. "Escape Fire" indicates that the U.S. military is looking seriously at this kind of alternative therapy.

The title, by the way, refers to a blaze set to allow smokejumpers to escape a wildfire, and suggests the kind of unconventional thinking that's needed to alter the health care system.

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'Escape Fire': Diagnosing health care ills

President Barack Obama and Republican presidential candidate and former Massachusetts Gov. Mitt Romney talk at the end of the first presidential debate in Denver, Wednesday, Oct. 3, 2012.

Charles Dharapak, Associated Press

Eric Schulzke seems to perpetuate the notion that Romneycare and Obamacare are roughly the same ("How health care reform came to be," Oct. 2). This notion needs to be challenged as they are not the same. Romneycare is not the same as Obamacare.

First of all, Romneycare has no effect on me whatsoever. It has no effect on the citizens of Utah or any of the other states. The citizens of Massachusetts like it. They voted for it. If they do not like it, they can change it because alternative systems are still available.

When Obamacare gets fully entrenched it will literally destroy all of the alternative health care systems. All of the existing health insurance companies will be put out of business. All of their employees will be laid off; equipment and facilities will be sold or discarded and when they are gone it will be almost impossible to get them back.

Romneycare is more like an experiment in providing health care, is relatively small and run by a local state government. Obamacare will be 50 times bigger than Romneycare and will be run from Washington, D.C. It will not provide affordable health care for the American people. It will be a colossal nightmare.

Blaine R. McCann

Pleasant Grove

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Letter: Health care differences: Romneycare is not the same as Obamacare

Health care was mentioned about six minutes into Wednesday night's presidential debate.

STORY HIGHLIGHTS

(CNN) -- During the first presidential debate Wednesday night, the candidates talked a lot about how they would lower the cost of your medical care.

Heavy on data and large numbers, the debate may not have been the easiest to follow for Americans interested in the subject.

Ken Thorpe, an Emory University economist who specializes in health care costs, may have been one of the few excited by all these numbers.

"It was about as substantive a debate as I think we've ever seen," Thorpe said. "The problem is, even after this debate, I don't think people truly understand the similarities and the differences in what these candidates are proposing for health care."

Here are five things you should know about what the candidates said about health care in last night's debate:

1. You do pay more for health insurance, but Obama's policy isn't totally to blame.

The first mention of health care came about six minutes into the debate. Discussing how "middle-income Americans have been buried" financially under the president's policies, Republican challenger Mitt Romney said health care costs have gone up by $2,500 a family.

Each year, health care costs have gone up during Obama's administration -- that is true. But experts say the increases have not been due to policy, but because of the rising cost of health care. The figure Romney used is not quite right.

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5 things to know about health care post-debate

On health care, Mitt Romney and President Obama sometimes seemed to inhabit parallel universes at their debate on Wednesday night - with separate sets of assumptions, beliefs and even facts - it was on the question of health care, and government's role in providing it.

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On Health Care, Two Visions With Their Own Set of Facts

Published: Thursday, October 4, 2012 at 9:17 p.m. Last Modified: Thursday, October 4, 2012 at 9:17 p.m.

Some of the officials charged with recommending one of the three are already albeit tentatively eyeing favorites.

Munroe's overseers, the Marion County Hospital District trustees, are looking to potentially lease the 421-bed facility. The public, nonprofit hospital is struggling financially and lacks money to expand and remain competitive.

In November, voters will be asked to approve a one-mill property tax measure that would support the hospital. The tax would generate an estimated $65 million over five years. If the referendum passes, the trustees are expected to forgo any new lease agreement for the foreseeable future.

In the meantime, the trustees are considering outside proposals.

On Tuesday, Duke LifePoint Healthcare, a joint venture between Duke University Health System, Inc. and LifePoint Hospitals, made a two-hour pitch.

That was followed by a two-hour presentation from a partnership between Health Management Associates and Shands HealthCare.

On Wednesday, Community Health Systems rounded out the presentations with a pitch as to why it should be allowed to operate the hospital as part of a 40-year lease proposal.

The presentations were made to the trustee-formed, eight-member Strategic Options Workgroup, which will make recommendations to all of the trustees. Some members of the public also attended.

"I don't think anyone provided a knockout," said Randy Klein, a workgroup member. "I'm like the undecided voter."

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Health care suitors make pitches for Munroe