A message to all physicians from AMA President Jeremy A. Lazarus, MD, on the Associations efforts to address unequal care, from access to outcomes.

That cardiovascular disease is the major cause of death in the U.S. is well-known. That minority populations are more at risk than English-speaking white populations at least in part because of disparities in health care is shameful.

We know there are disparities in care not only in cardiovascular disease, but also in asthma, diabetes, flu, infant mortality, cancer, HIV/AIDS, chronic lower respiratory diseases, viral hepatitis, chronic liver diseases and cirrhosis, kidney disease, injury deaths, violence, behavioral health and oral health.

According to the latest National Healthcare Disparities Report, both health care quality and access in the U.S. are suboptimal, especially for racial and ethnic minorities and low-income groups. The report further notes that access to care is not improving for minority groups and that disparities are not diminishing. In fact, there are several areas where disparities are worsening over time between minorities and whites and between poor and high-income populations.

The Affordable Care Act has taken several major steps toward rectifying this disgraceful situation. It expands initiatives to increase diversity in the health care professions and strengthens cultural competency training. It makes improvements in preventive care and care coordination, and increases funding for community health centers. It ends insurance discrimination, and when health insurance exchanges are in place next year, everyone will have access to quality, affordable health insurance. In all, there are more than 60 provisions that could contribute toward ending disparities.

Outside Washington, a number of groups also are involved in trying to bring quality health care to underserved populations.

One of those groups is the Commission to End Health Care Disparities. I am looking forward to welcoming the commission to my hometown of Denver on March 22 and 23. This very significant meeting will focus on disparities in cardiovascular disease care, but it is a part of a much larger effort.

I am proud to be a member of the commissions governing secretariat, but I am also pleased to know that other forces within the AMA are also intent on ending disparities, beginning with the AMA Principles of Medical Ethics.

A year ago, the AMA adopted a three-part strategy that includes a commitment to improving health outcomes and with it, an equal commitment to ending disparities in care.

The AMAs current work toward ending disparities dates to 2000, when the Dept. of Health and Human Services launched a national effort called Healthy People 2010.

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It’s well past time to eliminate health care disparities

As a growing field emerges in the race to fill Edward M. Kennedys US Senate seat, the white-hot debate over the nations health care system is already shaping up to be a defining issue in the Democratic primary campaign.

With three months to make their case to Massachusetts voters, the declared and prospective candidates are staking out varied positions at a time when President Obama is moving aggressively into the final stage of his push for a major health care overhaul - the most pressing issue facing Congress this year.

US Representative Michael Capuano, who plans to announce soon, expresses strong support for liberal priorities, including a so-called public option - a government insurance plan that would compete with the private sector - and a requirement that employers cover their workers.

Attorney General Martha Coakley, the first major contender to formally announce her candidacy for the Democratic primary, is standing behind a government insurance option while appearing to tread more cautiously on the question of an employer requirement, which could force employers over a certain size to offer health insurance to workers or face financial penalties.

The employer mandate has worked well in Massachusetts and I would support its consideration as part of a federal health care reform package, she said in a statement.

And US Representative Stephen Lynch is holding fast to his refusal to announce a position on either of those items, provoking continued anger from labor leaders who shunned him during a key Labor Day breakfast.

Lynchs wait-and-see stance suggests he may seek to position himself as the lone conservative in a crowded Dec. 8 Democratic primary - a move that could separate him from the pack. If he faces three or four contenders who divide the states liberal voters among themselves, Lynch could prevail by garnering most of the states moderate to conservative Democrats, including the so-called Reagan Democrats concentrated in his South Boston neighborhood.

If its a political strategy, thats it - being a little bit more conservative, said Robert J. Haynes, president of the Massachusetts AFL-CIO, which plans to hold a competitive endorsement process in the race. If he holds those positions, hes out of line with his union brothers and sisters.

Lynch, a onetime iron worker who plans to launch a bid for Kennedys seat any day, has had strong labor support in the past, but has often taken a more conservative approach than other members of the states congressional delegation on a variety of issues, including abortion rights, which he opposes, and a 2006 Republican resolution supporting President George W. Bushs policies in Iraq, which he supported. In a Globe interview, Lynch said there is nothing political about his decision to wait for a final health care bill to emerge from five House and Senate committees before taking a stand.

People are trying to get me to sign pledges, but because the situation is so fluid Ive been insisting on the right to see the legislation before I make a commitment, he said. I consider myself a common-sense Democrat and I think issues - especially big ones like this - require measured approaches to find the best solution.

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Health care at center of US Senate race

Health Care in Retirement.mp4

By: R Gardner Sherrill

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Health Care in Retirement.mp4 - Video

RPT: Unions Upset With Health Care Law They Backed - Are Unions Looking For a Health Care Refund?
Unions Didn #39;t Read The Bill You Wanted It Now You Got It!!! RPT: Some Unions Upset With Health Care Law They Backed - Are Unions Looking For a Health Care Refund?

By: Massteaparty

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RPT: Unions Upset With Health Care Law They Backed - Are Unions Looking For a Health Care Refund? - Video

TORONTO, ONTARIO--(Marketwire - Feb 1, 2013) - Accreditation Canada announced this week that it had granted "Accredited with Exemplary Standing" to Preferred Health Care Services (PHCS), a division of Leisureworld Senior Care Corporation. The decision is the highest of four possible accreditation awards following a rigorous survey process conducted in 2012.

"Accreditation is one of the most effective ways for health services organizations to regularly and consistently examine and improve the quality of their services," says Tracy Jones, president of Preferred Health Care Services. "We are exceptionally proud of this recognition of our efforts and performance."

Accreditation Canada is an independent, not-for-profit organization that sets standards for quality and safety in health care and accredits health organizations in Canada and around the world.

Following a comprehensive self-assessment, external peer surveyors conducted an on-site survey during which they assessed leadership, governance, clinical programs and services against Accreditation Canada''s requirements for quality and safety. These included national standards of excellence; required safety practices to reduce potential harm; and questionnaires to assess the work environment, patient safety culture, governance functioning and client experience.

Accreditation Canada commended PHCS for

"Within their exceptional focus on the quality of care, we were very impressed with the long-standing and on-going commitment that Preferred Health Care Services has demonstrated to the community. The home support community based program was created with a focus on the needs of the clients," said Wendy Nicklin, President and CEO, Accreditation Canada. "They did their homework and this was strongly evident during the survey visit."

Preferred Health Care Services has been a trusted partner in Canada for more than 25 years in home and personal care services, as well as health care staffing and education.

About Leisureworld

Leisureworld Senior Care Corporation is Canada''s fifth largest operator of seniors'' housing and the third largest licensed long-term care (LTC) provider in Ontario. Leisureworld owns and operates 27 LTC homes across Ontario with 4,474 beds. The Company also owns and operates six retirement residences and one independent living residence, representing 768 suites, in Ontario and British Columbia. Leisureworld subsidiaries include: Preferred Health Care Services, an accredited provider of professional nursing and personal support services; and Ontario Long Term Care, a provider of purchasing services, and dietary, social work, and other regulated health professional services. For more information, please visit the Company''s website at http://www.leisureworld.ca.

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Accreditation With Exemplary Standing Awarded to Preferred Health Care Services

SEYMOUR - Health professionals are touting a program aimed at bringing health care to farm families in Outagamie County.

The County has formed a partnership with the Rural Health Initiative in the hope of raising the quality of care in the region.

Those behind the program say they're trying their best to attract farm folks who face numerous barriers when it comes to health care.

Rural Seymour residents listened closely as registered nurse Amanda Hatch talked about the Rural Health Initiative.

During a mini-tour of Outagamie County, she explained the effort that brings health care workers into the homes of farm workers.

"We can do testing on them like a blood pressure, we can do a lipid panel, so the total cholesterol, the LDL, the HDL so the bad and the good cholesterol. Triglycerides," said Hatch.

Hatch said farmers work long hours, and have long commute times to their doctors offices, so they're not getting the necessary preventative health and safety screenings. Insurance coverage is also a barrier.

According to the Rural Health Initiative, more than 18 percent of Wisconsin dairy farm families have no health insurance. Another 41 percent have high deductible plans that provide only major medical coverage. And four out of five lack health insurance that covers checkups and preventative care.

"A lot of our farmers, they are either under insured or they have a really high deductible. So $5-$10 thousand deductible. So they're just not going to get that preventative care piece.

The program, which covers Outagamie, Waupaca and Shawano Counties, is funded mostly through donations. The cost each year is $183 thousand dollars. $78 thousand is funneled into Outagamie County.

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Health care program seeks farm families

Readers brought up some good comments about my Thursday column on the provision in the Affordable Care Act that requires most employers to begin reporting the cost of employer-provided health care on their W-2 forms, starting with W-2 forms issued for 2012.

The cost, reported in Box 12 with the code DD, includes both the employer and employee share of health insurance premiums for the year. It might or might not include dental and vision care premiums depending on how the employer packages benefits.

Some employers were exempt from the requirement for 2012 W-2s including those who filed fewer than 250 W-2s in 2011.

The reporting does not create any new tax liability; it's for informational purposes only (although many think Congress might attempt to tax at least some of it). The reporting requirement is supposed to help employees appreciate and understand the value of their health benefits.

In my column, I said the employee pays no income tax on the amount reported in Box 12 and that employees pay their share of premiums with pretax dollars.

While that's true in most cases, there are exceptions.

If employees cover a domestic partner or same-sex spouse, the value of the partner/spouse's coverage (less any after-tax payments made by the employee) is generally added to their income and they pay federal tax on it. The cost of the spouse/partner's coverage is included in the DD amount, but the reporting does not create any additional tax. (Taxation of partner/same-sex spouse benefits at the state level varies.)

And while many employees get to pay their share of health insurance premiums with pretax dollars, many don't.

If an employer sets up a 125 plan, employees can pay for health care premiums with pretax dollars. This plan, also called a cafeteria plan, is named after the section of the tax code that lets employees pay for a variety of benefits with pre-tax dollars if their employer sets one up. Employers can set up a premium-only 125 plan that shelters just health care premiums.

If the employer does not set up a 125 plan, employees pay their premiums with post-tax dollars.

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Health care premiums sometimes taxed

PITTSBURGHGerardo Sciulli was a welder from a small town in the Abruzzi region of Italy. So when he emigrated to America in 1970, he chose this place; its vibrant steel mills assured him plenty of work. He settled with his family in Oakland, a half-square-mile neighborhood east of downtown.

Today, the steel mills are gone, and Oakland is the seat of Pennsylvanias health care industry. It contains a complex of interconnected hospitals, a medical school, doctors offices, and towers of University of Pittsburgh medical labs (which bring in some $450 million in federal grants every year). UPMCthe huge local health care provider, which is expected to pull in $10 billion in revenue this yearowns 16 hospitals in the metro area and is the largest private employer in the state.

All of which made a strong impression on Marc Sciulli, Gerardos 29-year-old son. By the time Marc started college, he knew he wanted a career in health care. Now, after his first few years as a hospital pharmacist, he earns nearly double what his father did (more than $80,000 a year), owns his own home, and plans to make his life in the city. I think just living in Oaklandbeing around the hospitals and the collegespushed me in that direction, he says.

Health carewhich adds thousands of jobs in hospitals, nursing homes, and doctors offices each yearis at the center of this recovery. The sector pulls in federal Medicare dollars to serve the regions aging population and research grants from the National Institutes of Health. It offers middle-class positions to nurses, technicians, accountants, computer programmers, and other professionals. UPMC may not replace the steel industry, but it has taken over the old U.S. Steel building downtown, and its logo looms large atop the citys skyline.

Health care is the leading-edge of a nationwide trend. The number of jobs in this sector is climbing steadily, in contrast to the erosion in so many other areas of the economy. Since the Great Recession began in December 2007, health care jobs are up nationwide by 10.5 percent. Compare that with all other nonfarm jobs, which are still down 4.3 percent, even after recent gains. If the health care economy hadnt grown during that period, the national unemployment rate would be 8.8 percent, a full point higher than it is, according to calculations by the Altarum Institute, which tracks the industry. If health care jobs had plunged like those in other sectors, U.S. unemployment would be a staggering 10.8 percent. Employees like Sciulli kept the country afloat. In the short term, think of the health sector as being a stimulus program: It just keeps generating jobs and money, says Charles Roehrig, director of Altarums Center for Sustainable Health Spending.

But the long term may not be as rosyfor Pittsburgh or for the country. The growth in the health care sector also produces ever-growing costs. Health spending, nearly 18 percent of the U.S. economy, is contributing to personal bankruptcies, driving up the cost of domestic labor, and crowding out other government priorities (infrastructure, say, or education). Thats a problem in Pittsburgh, too, where the city has spent the last nine years in a form of municipal bankruptcy, after retiree pensions and employee health benefit costs crushed the budget.

Its an example, in miniature, of what could happen nationally. Federal health entitlement programs alone are projected to balloon from less than 6 percent of gross domestic product today to more than 10 percent in 2037, according to the Congressional Budget Office, when they will exceed spending on all other government functions except Social Security. About half of that increase can be blamed on our aging population and the expanded benefits under the 2010 Affordable Care Act, but the other half represents what health economists call excess cost growththe annual increases in spending for each persons care. A health system this pricey wont be able to keep adding good jobs like Sciullis without acting like ballast. Its a good thing for now, but as the economy begins to recover and we dont need those health care jobs, were going to be desperate to reduce the growth rate in health spending, Roehrig said. Because we just cant afford it. The health care boom that is propping up the American economy, could eventually come back to haunt us.

Through the mid-70s, Pittsburgh had a vibrant economy. Steel mills in and around the city offered high salaries and plum benefits to workers right out of high school. Then international competition torpedoed steel prices, and the industry collapsed. Nearly all of the regions mills closed within a five-year period. Unemployment rose to more than 18 percent, and union membership fell. Growing up, I didnt know anybody who didnt work in the steel mill, and now I dont know anybody who does, says George Fechter, 66, an entrepreneur who invests in health care start-ups. Working-age people quickly left town. In the early 1980s, they moved out using U-Hauls. Later on, they were moving out due to hearse.

Hospitals moved into the economic vacuum. Allegheny County, which includes Pittsburgh and many of its suburbs, now has the second-highest proportion of seniors of any county in the nation with a population over 1 million (after Floridas Palm Beach). All those Medicare beneficiaries gave local hospitals a solid base of paying customers. A few smaller community hospitals closed, but many survived. UPMC, a nonprofit affiliated with the University of Pittsburgh, began expanding rapidly, buying up hospitals in the region and building up high-revenue specialties such as organ transplantation and oncology.

People in town like to credit the economic recovery to the combination of eds and meds. In addition to the big hospitals, Pittsburgh is home to two major university systemsPitt and Carnegie Mellon Universitywith grant-winning research programs, along with more than a dozen other colleges. The University of Pittsburgh, with its medical school, has been a big breadwinner for the city. It hired a former top NIH official, and Pitt now ranks fifth in the country among universities collecting NIH grantsmore than Yale, Duke, or Stanford.

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Health Care: Great for the Economy Today, Terrible Later

Experts to speak on economic outlook at Feb. 15 seminar

A nurse begins her night shift at Kalispell Regional Medical Center. File photo by Lido Vizzutti | Flathead Beacon

Thats the message from the University of Montanas Bureau of Business and Economic Research, and will be part of the overall 38th Annual Montana Economic Outlook 2013 presentation and seminar at the Hilton Garden Inn on Feb. 15.

This years seminar is titled, The Best Medicine: How Can Montanans Take Charge of Changes in Health Care? and will include a keynote address from Larry White, director of the Western Montana Area Health Education Center at the University of Montana, about the latest developments in health care.

The Economic Outlook seminar travels to Montanas major cities, and will have city-specific information at each event. At Kalispells seminar, Gregg Davis, director of health care research for the BBER, will provide health care information about the Flathead.

Health care is an engine of growth up there, Davis said.

Davis said he compiled information from quarterly census reports, which say the wage growth in the private sector grew at an annualized rate of 2.7 percent from 2005 through 2011.

But wages in the private health care sector grew at an annualized rate of 9 percent in that same time frame, Davis said.

In terms of employment, 2005 to 2011 is a pretty flat time for the Flathead, Davis said, but health care employment grew at 4 percent a year in those years. Other research concluded that in the past decade, Flathead Countys health care growth was the second fastest in the state, behind Gallatin County.

The health care sector is really pulling the economy along, Davis said.

Excerpt from:

Health Care is the Flathead’s ‘Engine of Growth’

Happy about the countrys shrinking unemployment rate? You have the health care industry to thank.

Since the recession hit in late 2007, a huge proportion of the new jobs have been in the health sectorhospitals, doctors offices and nursing homes. All along, those jobs have been rising at a steady clip, while jobs in all other sectors have seen more dismal performance.Take a look at this chart, which shows the wide gulf between health care jobs and everything else:

If health care jobs had just held steady, the unemployment rate would be a full point higher. If they had taken a dive with the rest of the economy, the current unemployment rate would be 10.8 percent, according to an analysis from the Altarum Institute, which track health employment trends.

Friday, the Bureau of Labor Statistics jobs report showed the trend continuing. New health care jobs made up 14.6 percent of the total jobs added, and were among the top contributors to the overall gain in employment.

Health care jobs are across the income spectrum, including low-paid hospital janitors and highly paid doctors and executives. But many are the kind of middle class jobs with benefits and opportunities for advancement that are disappearing from other sectors. Factory work is on the decline, but nursing jobs are on the rise.

The American Hospital Association put out a big report last week, touting its members roles as local economic engines. But theres a limit to how much we can rely on the health sector to prop up our economy.

I examine the tradoffs in this week's National Journal magazine, available for subscribers.

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You Can Thank the Health Care Industry for the Economic Recovery

WASHINGTON The Obama administration on Friday announced a new accommodation for religious nonprofits that object to providing health insurance that covers birth control.

The new regulation attempts to create a barrier between religious groups and contraception coverage, through insurers or a third party, that would still give women free access to contraception. Whether religious groups will accept this new approach depends in part on the technical details of how its paid for.

The new health care law requires most employers, including faith-affiliated hospitals and nonprofits, to provide health insurance that includes artificial contraception, including sterilization, as a free preventive service. The goal, in part, is to help women space out pregnancies to promote health.

Religious groups which primarily employ and serve people of their own faith such as churches were exempt. But other religiously affiliated groups, such as church-affiliated universities and Catholic Charities, were told they had to comply.

Roman Catholic bishops, evangelicals and some religious leaders who have generally been supportive of President Barack Obamas policies lobbied fiercely for a broader exemption. The Catholic Church prohibits the use of artificial contraception. Evangelicals generally permit the use of birth control, but some object to specific methods such as the morning-after contraceptive pill, which they argue is tantamount to abortion.

Obama had promised to change the birth control requirement so insurance companies and not faith-affiliated employers would pay for the coverage, but religious leaders said more changes were needed to make the plan work.

Since then, more than 40 lawsuits have been filed by religious nonprofits and secular for-profit businesses claiming the mandate violates their religious beliefs. As expected, this latest regulation does not provide any accommodation for individual business owners who have religious objections to the rule.

The latest version of the mandate is now subject to a 60-day public comment period. The mandate takes effect for religious nonprofits in August.

Policy analyst Sarah Lipton-Lubet of the American Civil Liberties Union said the group was assessing details of the proposal, but that it appeared to meet the ACLUs goal of providing seamless coverage of birth control for the affected women.

--The Associated Press

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Health care law: Obama administration offers birth control accommodation for religious nonprofits

The leading healthcare analytics and business intelligence solutions provider has unveiled its online Healthcare Rapid Reads to provide insights into how an Enterprise Data Warehouse can solve specific challenges faced by CIOs, CFOs, CMOs and CMIOs.

Columbus, Ohio (PRWEB) February 01, 2013

HCDs new Healthcare Rapid Reads outline the challenges faced by specific executive leaders and examines how an Enterprise Data Warehouse can provide them with opportunities not only to address their challenges, but also to empower their entire organization to make more informed decisions that can impact quality and costs in a positive manner.

The Rapid Reads are available and can be found at the HCD online Healthcare Resource Center, which provides free access to a broad range of educational information related to healthcare business intelligence, Enterprise Data Warehouses, industry issues, trends, challenges and solutions. The resources also include white papers, videos and data sheets for healthcare executives, information technology leaders, administrators, medical providers and other professionals.

The Rapid Reads represent the latest updates to the resources center, which HCD will continue to expand as it develops and provides useful content related to all areas of healthcare analytics in the clinical, financial, administrative, and research functions. The Rapid Reads address the responsibilities, challenges and opportunities facing each C-Suite professional and explain how an EDW can meet their needs. The Rapid Reads include:

The Rapid Reads can be downloaded at http://www.hcdataworks.com/resources/index.htm.

About Health Care DataWorks, Inc.

Health Care DataWorks, Inc., a leading provider of business intelligence solutions, empowers healthcare organizations to improve their quality of care and reduce costs. Through its pioneering KnowledgeEdge product suite, including its enterprise data model, analytic dashboards, applications and reports, Health Care DataWorks delivers an Enterprise Data Warehouse necessary for hospitals and health systems to effectively and efficiently gain deeper insights into their operations. For more information, visit http://www.hcdataworks.com.

Marcy Fleisher Health Care DataWorks 614-397-0032 Email Information

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Health Care DataWorks Expands Healthcare Resource Center To Address Challenges Facing Industry C-Suite Professionals

Bipasha Basu launches free health care centre
Dino Morea the actor who turned producer recently with JISM 2, has gifted Mumbai the fitness mantra with his product DM Fitness. Bipasha Basu launched the first set of machines to help Mumbai control its waistline and regulate the heartbeat. When asked why he asked Bipasha to launch the fitness brand, Dino said: Bipasha is known for her fitness. I wanted someone who has got enough knowledge about it. She is fantastic and she can talk about it. Dino #39;s fitness centre is free for health conscious people. Join Us on Facebook http://www.facebook.com Follow Us on Twitter twitter.com

By: TheBollywoodShow

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Bipasha Basu launches free health care centre - Video

Dr Pam Popper: Commentary on the Health Care System
Think it #39;s a good idea to survey patients about what they think of doctors? You won #39;t believe how this is contributing to more costs, and worse care. And in case you need a little motivation to keep telling others about our alternative view of diet and healthcare -- today #39;s clips should help. Americans are listening, and they are making different choices. Things are changing!

By: drpamsnewschannel

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Dr Pam Popper: Commentary on the Health Care System - Video

ACUPRESSURE HEALTH CARE CENTER KAKINADA
nadipathi for kidney stones

By: Drkrishnam Raju

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ACUPRESSURE HEALTH CARE CENTER KAKINADA - Video

In the year since Community Medical Center joined Geisinger Health System, a dramatically different health care landscape has leaders at the hospital calling Scranton a national "laboratory" for profit and nonprofit competition.

During a Times-Tribune editorial board meeting Wednesday, officials with Geisinger sidestepped the question of whether Scranton can sustain three different hospitals. Instead, GCMC's Anthony Aquilina, D.O., chief medical officer, and Robert Steigmeyer, CEO and president, framed the community in terms of health care systems.

"This area can support two health systems," said Dr. Aquilina.

Geisinger's nonprofit system and Commonwealth Health's for-profit system have absorbed the community's three hospitals, until recently all financially struggling independent nonprofit hospitals.

Tennessee-based Community Health Systems - one of the largest publicly traded hospital companies in the country with 135 hospitals in 29 states - created an umbrella company in 2012, Commonwealth Health, to connect the eight hospitals it has acquired in the region since 1999, including Regional Hospital of Scranton and Moses Taylor Hospital.

Since 2005, Danville-based Geisinger Health System has merged with hospitals in Northeast Pennsylvania, including CMC. While having many hospitals, Geisinger leaders continually stress the need for giving patients the appropriate treatment in the best location at the right time.

Mr. Steigmeyer said Scranton hospitals transitioning to nonprofit and for-profit systems around the same time makes for a unique situation.

"I think Scranton serves as a laboratory for for-profit and nonprofit health care in America," Mr. Steigmeyer said. "It'll be interesting to watch."

Generally, the medical community has lauded improvements in both of the city's hospital systems, which have helped replace and modernize aging equipment and infrastructure and recruited more physicians and staff.

Both hospital systems have added physicians and staff to the area. Since the Geisinger merger, GCMC has added 419 full-time jobs and still has 163 positions to fill, said Mr. Steigmeyer.

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Scranton a health care lab, of sorts

Vincent Garcia clears snow at the Capitol as the state Legislature begins its 2013 session, Monday, Jan. 28, 2013.

Ravell Call, Deseret News

Enlarge photo

SALT LAKE CITY Health care access must be made available to every family before the year is over, and the responsibility for that lies in the hands of state lawmakers.

"Depending on your perspective, it may be the most important issue," said Rep. Jim Dunnigan, R-Taylorsville, of the work facing legislators as they balance health care reforms with the state's other pressing issues.

The Patient Protection and Affordable Care Act, passed in 2010, is intended to decrease the number of uninsured American citizens, as well as drive lower health care costs by enforcing various mechanisms, including mandates, subsidies and tax credits, all controversial measures.

It brings about several deadlines and decisions for states, including for the conditionally approved state-run health insurance exchange and Medicaid expansion, that the Legislature may take into consideration during the 45-day session that began Monday.

"Either we make the decision to run Affordable Care Act programs that will benefit and cover all citizens, or we fail and that role falls to our federal government," Sen. Gene Davis, D-Salt Lake City, told a gathering of stakeholders and citizens at a pre-legislative health reform discussion earlier this month.

Avenue H, Utah's existing health insurance exchange, is only available to small business employers and not individuals. Individuals need to be included in the online insurance marketplace by Oct. 1 in order to meet the federal deadline.

The law, however, contains a mandate that requires that all individuals not covered by insurance through their work place, Medicaid or Medicare, or other public insurance program, to obtain a private health insurance policy or pay a penalty, unless a waiver is secured first. A waiver can only be obtained through application and denial through the law's projected insurance exchange system, which would likely net anyone eligible for Medicaid coverage.

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2013 decisions could be key to your family's health care

Employees have some new information on their W-2 forms for 2012 - the cost of their employer-provided health insurance.

This amount shows up in box 12 with the code DD. It includes what the employer and employee paid in premiums last year. To find out what your employer paid, subtract what you paid (look at your last pay stub for 2012) from the DD amount.

The amount in this box is not taxable, although many fear that could change as Congress looks for ways to raise revenues.

The cost of health coverage paid by your employer is not included in your income, but your employer can deduct it as a business expense. The share you pay is also excluded from your income; it's paid with pre-tax dollars.

The Affordable Care Act (Obamacare) required employers that provide group health coverage to report this cost to employees and the Internal Revenue Services on W-2s starting with 2012 forms. (The military and Indian tribal governments are exempt.)

The requirement is supposed to make employees more aware of health care costs. But it also "establishes the infrastructure for the tax treatment to change on employer-provided health care," says Christopher Renz, a partner with consulting firm Mercer.

The exclusion for group health care is the single biggest tax break. It will cost the government $164.2 billion in fiscal 2014, surpassing the exclusion on employer-provided pensions ($162.7 billion) and the mortgage-interest deduction ($99.8 billion), according to the Congressional Research Service.

Critics say this tax break encourages the over-consumption of health care. Various proposals have called for limiting it or phasing it out.

"I think it is a matter of time before it erodes in some fashion," Renz says. But he doubts that Congress will do away with it entirely. "Policymakers would have some concern that would cause more employers to stop providing health care and that's not what they want to do."

Employers had until Thursday to distribute 2012 W-2 forms.

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W-2 forms now listing health care costs

When its time for your annual physical, you know how you typically think of medical stuff to ask the doctor?

Well, dont do that anymore. Stop thinking. And keep your mouth shut unless you have a serious health concern, such as erectile dysfunction or pending death.

That was the lesson learned by Diane R., a 52-year-old Boylston resident who didnt want her name used, lest her health care provider suddenly decide that hey, those important tests actually arent covered under section R2D2, and she also happens to need a daily colonoscopy.

Diane underwent a physical in November, now called a wellness visit, which is covered under her health insurance plan with no co-pay. During the visit, she happened to mention a minor ankle pain. The doctor looked at it and the ankle appeared normal, so he basically told her she could get an X-ray if the pain didnt subside.

Two months later, Diane and her husband were surprised to receive a doctors bill for a $45 co-pay for the physical. Her husband called UMass Memorial Medical Center and was told that, yes, the exam was free. But the co-pay was charged because Diane had the temerity, during her annual physical, to ask about a medical condition. If you can believe the nerve. So in a nifty sidestep of the space-time continuum, she was charged for a second visit within the same time frame of the original visit.

Dianes husband was understandably baffled. He followed up with a call to Tufts Health Plan, his wifes insurer, and got the same answer. He was also told that Tufts was billed $277 for the physical, and $188 for the casual ankle question, which took her doctor a whopping two minutes to answer. The bills reflected two visits on the same date and time.

According to Einstein, this time-multiplier phenomenon doesnt exist, but I guess it does in the world of medical billing, Dianes husband said.

Clearly, we laypeople lack the advanced medical training needed to understand that a medical exam should not include actual medical questions for the doctor. These days, annual wellness visits are intended for basic maintenance, and youre not supposed to bother the doctor with arcane problems such as back pain, fatigue, your bum knee or the 12-inch machete protruding from your forehead. All of those issues cost extra.

Free annual wellness visits have been offered by Medicare since January 2011 as part of the Affordable Care Act signed into law by President Barack Obama, and Medicares protocol often becomes standard throughout the health care industry. The ACA targets waste, fraud and abuse, and the Department of Health and Human Services has been instructed to impose quality and efficiency measures on hospitals and doctors.

The bottom line is, (wellness visits) are indeed a tricky area, said Dr. David Fairchild, senior vice president for clinical integration at UMass. The annual physical doesnt cover problems. The doctor is obligated legally to bill those as separate complaints because theyre not a health maintenance issue.

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Free wellness visit (Health care extra)

Free health clinics around the Kansas City area, like many across the country, are shedding their free designation and preparing to accept payment from most patients as they adapt to the federal health care law.

The shift will be a big one, especially for the bustling Kansas City Free Health Clinic in midtown. Its one of the largest free clinics in the country, treating upward of 15,000 patients a year with more than 100 staff members and 1,000 volunteers.

In its 42 years, KC Free, as its commonly called, hasnt charged fees or billed patients for care. And it has seen only the uninsured.

Soon, all that will change.

Like several other free clinics across the country, KC Free will soon accept Medicaid and add a sliding fee scale. The dramatic shift in the non-profits business model is necessary under the new law, its leaders say, and will allow the clinic to continue caring for many of Kansas Citys most vulnerable residents.

The face of health care is changing, and we are changing with it. We must, Sheri Wood, the clinics executive director, wrote in a letter to volunteers and supporters in December.

Similarly, the Health Partnership Clinic of Johnson County has shifted its structure; and the Duquesne Clinic in Kansas City, Kan., has changed the definition of whom it serves and may start accepting Medicaid. Other health care providers are moving away from an urgent care approach in an effort to become a primary medical home for patients. Community mental health centers have started offering medical services to some patients, too.

With federal law aiming to expand health coverage, the entire safety net is realigning in preparation for an influx of patients accessing care for the ry first time, or for the first time in a very long time. And yet, parts of the law itself are still unclear, and much of how everything unfolds locally depends on how Missouri and Kansas implement the law.

We are entering a new era, and I think that free clinics are very consciously trying to decide what the best path is, said Julie Darnell, professor of Health Policy at the University of Illinois-Chicago.

A clinic for hippies

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Health care law means free clinics have to accept payments