How Health-Care Ruling Will Impact Business

Business strategistCarol Roth weighs in on the potential impact on businesses from todays health-care ruling.

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Massachusetts health-care reform tests impact of employer 'tax' on jobs

The US Supreme Court calls it a tax. The Obama administration says it’s a penalty. In Massachusetts, where health-care mandates have been in effect for six years, they call the money a person pays for not having health insurance a “tax penalty." As far as small-business owners like Diane Giblin are concerned, it doesn’t make a difference one way or another.

“To me it’s the same no matter what you want to call it. It’s just another way to get into my pocket,” says Ms. Giblin, co-owner of a nine-employee metal fabrication company located just south of Boston. “Whether it’s a tax or a penalty, it’s the cost that you have to pay, it’s the money you to have to pay out."

But with the Supreme Court's historic ruling last week upholding the federal health-care reform law, the Massachusetts program faces increased scrutiny for how its plan, especially the mandate for small businesses, has played out in practice.

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The upside of the Bay State's pioneering reform is clear: The state now has the country’s highest rate of people with health insurance, due in no small part to the requirement that businesses over a certain size help provide it. The downside is less clear: the longer-term impact on business hiring and employment.

Under the 2006 law, Massachusetts businesses with more than 11 employees or their equivalent must offer a “fair and reasonable contribution” toward coverage or pay the state a “Fair Share Assessment” of $295 per full-time employee. The law also requires businesses to help employees pay for premiums using pretax dollars.

Under the federal law, by contrast, businesses with more than 50 employees will face penalties (called a “shared responsibility payment”) equal to $2,000 per full-time employee, with some exclusions. Tax credits are intended to help smaller businesses get coverage for workers.

Almost 79 percent of nonelderly insured Massachusetts residents now receive health insurance through their employers. In 2010, under the most recent data, Massachusetts had about 188,000 employers, 22,324 of which had 11 or more full-time equivalent employees and were potentially subject to the tax penalty, according to the state Division of Health Care Finance and Policy. Of that figure, 1,017 employers faced penalties, with restaurants making up the vast majority. Between 2006 and 2010, the penalties brought in an average of $15.7 million per year to the state, which helped offset costs for the entire law.

Businesses that rely on part-time or seasonal workers have reported the most problems in trying to comply. In the Cape Cod town of Wellfleet, where the local economy is tied to summer tourism, John Vincent Jr. says he’s struggled to keep his drive-in movie theater, mini-golf, and snack bar business in compliance.

Of the 50 people on payroll, the majority are college- or high-school-aged students doing summer work, he says. He also has four year-round employees, whose health benefits are paid 100 percent. That is down from 10 year-round employees a decade ago, a drop he blames on rising health-care costs, including double-digit premium increases, he says.

“If I had to all of sudden put 50 employees on the payroll, boy, we wouldn’t be in business, plain and simple,” Mr. Vincent says. “We’d have to charge $15 a ticket to meet all the cost expectations. We’d have to price ourselves out of the market.”

Ms. Giblin, who owns Draper Metal Fabrication in Holbrook, Mass., along with her husband, says they’ve provided health care for their employees since before then-Gov. MItt Romney signed the state's health-care reform into law. Employees pay 40 percent of their coverage, while the company picks up the rest. Health-care costs have increased by double digits for years now, she says, dating back to before the state law went into effect. Two years ago, the company dropped down a tier in coverage, forcing employees to pay more out of pocket and higher deductibles.

With sales steady at about $1.5 million to $2 million annually, the company kept pace with orders at its current payroll, Giblin says. The company has yet to consider dropping coverage, but for other small businesses, she says the 11-employee threshold is an obstacle to hiring.

“It’s definitely not an incentive, and with all the horrible economic factors out there, you don’t need a nonincentive,” she says.

So far, evidence that the Massachusetts law has depressed hiring is largely anecdotal. A Boston-based think tank, the Beacon Hill Institute, estimates that the law has depressed hiring by at least 18,000 jobs, though some experts dispute that conclusion. Unemployment in Massachusetts has consistently been lower than the national average; as of May, the rate stood at 6.0 percent, the lowest since October 2008.

“Employers here don’t like a lot of government intervention, but I think they have adapted,” says Sandy Reynolds, executive vice president with Associated Industries of Massachusetts, which represents 6,000 employers across the state.

State legislators are trying to hammer out changes to try to slow the growth of health-care costs, says Bill Vernon, state director for the National Federation of Independent Businesses. They are also trying to make it easier for employers to meet the threshold for “fair and reasonable” coverage by allowing them to include employees who get insurance, for example, through a spouse or a government program.

“When we passed the law, we never addressed the cost of health insurance," Mr. Vernon says of the Massachusetts statute. "We addressed access, we accessed coverage, and here we are six years later, trying to control the costs."

Despite grumblings, polls show that the Massachusetts law remains popular with residents. Jonathan Gruber, an MIT economist who was instrumental in crafting the state law, says that for President Obama to win reelection, he’ll have to convince Americans of the federal law’s benefits.

“If the American public understands this law, they’ll feel about it like we do in Massachusetts, where there’s, what, two-thirds support for it,” Mr. Gruber says. “It’s not that we’re all crazy lefties here, OK? It’s that it’s a good law and people understand it here.”

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Dignity Health is First Health System in the Nation to Switch to Dye-Free Products to Reduce Environmental Impact

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Health impact studies taking hold, with challenges

ALBANY, N.Y. (AP) — While New York regulators have spent four years mulling the environmental impacts of shale gas development, the potential human health impacts have been given short shrift, according to health advocates.

Whether gas drilling impacts health has led to heated debates. Environmentalists and people living near drilling sites say the risks include contaminated water wells and air pollution. The industry says those fears are exaggerated and that the process been used safely on tens of thousands of wells.

The Medical Society of the State of New York has called for a moratorium on natural gas extraction using hydraulic fracturing until scientific information on health impacts is available.

In a letter last fall to Gov. Andrew Cuomo, more than 250 doctors and other health care professionals cited studies in Alaska and Colorado as examples of what New York should do as regulators consider allowing hydraulic fracturing to begin.

"The purpose of a health impact assessment is to take what's known and make reasoned professional judgments about what kind of health impacts could occur, and provide recommendations to mitigate those impacts before they happen," said Roxana Witter of the Colorado School of Public Health, who led what's called the Battlement Mesa study.

The Colorado study, the nation's first health impact assessment related to natural gas development, was completed last year.

Gina Solomon, a physician with the Natural Resources Defense Council, said health concerns include air pollution; potential contamination of ground or surface water with methane or chemicals used in fracturing fluids; fires or explosions; heavy truck traffic; and altered social conditions.

In Pennsylvania, medical professionals have complained that they have no studies to guide them in handling medical issues; with none to reference, they don't know what to look for, much less how to treat it.

Philanthropies including the Heinz Endowment are funding several new shale-related health projects, such as the Southwestern Pennsylvania Environmental Health Project near Pittsburgh. It's a medical outreach program for people near gas wells.

Some residents in the Pennsylvania town of Dimock have complained that fracking polluted their wells and a toxic response team from the federal Centers for Disease Control and Prevention has investigated. The Environmental Protection Agency said this month that well water tests failed to show health-threatening levels of contamination.

The National Research Council of the National Academies of Science recommends greater use of health impact assessments for major policies and projects. The goal is not to determine if a project is approved, but to ensure that adverse health effects are minimized.

Alaska, under pressure from doctors and community activists, has begun requiring a formal health impact assessment for permitting all large developments, according to Ed Fogels, Alaska's deputy commissioner of natural resources.

While thousands of shale gas wells have brought an economic boom over the last four years to communities in Pennsylvania, drilling in New York's part of the rich Marcellus Shale has been under a de facto moratorium since the Department of Environmental Conservation's review began in 2008. That review is expected to be completed in several months.

DEC has proposed rules for permitting gas-drilling companies to pump water, chemicals and sand into deep, horizontally drilled wells at high pressure to release natural gas from shale, a process known as hydraulic fracturing or "fracking."

DEC spokeswoman Emily DeSantis said the environmental study and proposed regulations thoroughly review potential adverse health impacts and put requirements in place to prevent them. The state Health Department has declined to do an assessment, saying it wouldn't provide significant new information.

A budget amendment proposed in the state Assembly would have commissioned a health impact assessment by a state university, but it was dropped during budget negotiations this week. A bill in the Senate would ban fracking until a health study is completed.

Brad Gill, executive director of the Independent Oil and Gas Association of New York, said the call for a health study was "part of a calculated campaign designed to frighten New Yorkers."

"There are no demonstrated cases of negative health impacts associated with natural gas development in the United States," Gill said. "In fact, a $1 million study, completed last August in Fort Worth, Texas, concluded natural gas development in the Barnett Shale did not lead to adverse health effects."

That study looked only at air quality. Although it found no significant health threats beyond setback distances, it recommended additional emission-control equipment and enhanced inspection and monitoring at natural gas sites.

In Alaska, native communities opposed expansion of oil development into sensitive areas of the North Slope in 2007. Collaboration on a health impact study led to compromises, said Aaron Wernham, director of the Health Impact Project, which assists in such studies.

Studies can become mired in controversy. That's what happened to one by the University of Colorado's School of Public Health for the 3,200-acre community of Battlement Mesa on the western slope of the Rocky Mountains.

County officials who commissioned the study halted it before it was final, saying it was hopelessly bogged down because residents and driller Antero Resources disagreed over its conclusions and recommendations.

The Battlement Mesa study made 70 recommendations for officials to consider before permitting Antero Resources to drill 200 wells. Antero called the recommendations baseless because there's not sufficient data to quantify potential health impacts

The Colorado School of Public Health reported this month that potentially toxic levels of airborne chemicals, including benzene, were detected near wells in the Battlement Mesa area during three years of monitoring.

The oil and gas industry-funded group Energy In Depth has disputed that study's findings, saying it exaggerates emissions from gas well development by at least 10 times and fails to take into account exhaust fumes from a nearby interstate highway.

Earlier this month, Alaska published a draft of its health impact assessment for the Wishbone Hill coal mine 50 miles north of Anchorage.

"In any study of such sensitive issues there are always going to be disagreements," said Katherine Nadeau of Environmental Advocates of New York. "But if we don't even try to get an assessment of what's going on in other states and what New York is doing to prevent similar problems here, it's a missed opportunity."

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Health impact studies taking hold, with challenges

ALBANY, N.Y. (AP) — While New York regulators have spent four years mulling the environmental impacts of shale gas development, the potential human health impacts have been given short shrift, according to health advocates.

Whether gas drilling impacts health has led to heated debates. Environmentalists and people living near drilling sites say the risks include contaminated water wells and air pollution. The industry says those fears are exaggerated and that the process been used safely on tens of thousands of wells.

The Medical Society of the State of New York has called for a moratorium on natural gas extraction using hydraulic fracturing until scientific information on health impacts is available.

In a letter last fall to Gov. Andrew Cuomo, more than 250 doctors and other health care professionals cited studies in Alaska and Colorado as examples of what New York should do as regulators consider allowing hydraulic fracturing to begin.

"The purpose of a health impact assessment is to take what's known and make reasoned professional judgments about what kind of health impacts could occur, and provide recommendations to mitigate those impacts before they happen," said Roxana Witter of the Colorado School of Public Health, who led what's called the Battlement Mesa study.

The Colorado study, the nation's first health impact assessment related to natural gas development, was completed last year.

Gina Solomon, a physician with the Natural Resources Defense Council, said health concerns include air pollution; potential contamination of ground or surface water with methane or chemicals used in fracturing fluids; fires or explosions; heavy truck traffic; and altered social conditions.

In Pennsylvania, medical professionals have complained that they have no studies to guide them in handling medical issues; with none to reference, they don't know what to look for, much less how to treat it.

Philanthropies including the Heinz Endowment are funding several new shale-related health projects, such as the Southwestern Pennsylvania Environmental Health Project near Pittsburgh. It's a medical outreach program for people near gas wells.

Some residents in the Pennsylvania town of Dimock have complained that fracking polluted their wells and a toxic response team from the federal Centers for Disease Control and Prevention has investigated. The Environmental Protection Agency said this month that well water tests failed to show health-threatening levels of contamination.

The National Research Council of the National Academies of Science recommends greater use of health impact assessments for major policies and projects. The goal is not to determine if a project is approved, but to ensure that adverse health effects are minimized.

Alaska, under pressure from doctors and community activists, has begun requiring a formal health impact assessment for permitting all large developments, according to Ed Fogels, Alaska's deputy commissioner of natural resources.

While thousands of shale gas wells have brought an economic boom over the last four years to communities in Pennsylvania, drilling in New York's part of the rich Marcellus Shale has been under a de facto moratorium since the Department of Environmental Conservation's review began in 2008. That review is expected to be completed in several months.

DEC has proposed rules for permitting gas-drilling companies to pump water, chemicals and sand into deep, horizontally drilled wells at high pressure to release natural gas from shale, a process known as hydraulic fracturing or "fracking."

DEC spokeswoman Emily DeSantis said the environmental study and proposed regulations thoroughly review potential adverse health impacts and put requirements in place to prevent them. The state Health Department has declined to do an assessment, saying it wouldn't provide significant new information.

A budget amendment proposed in the state Assembly would have commissioned a health impact assessment by a state university, but it was dropped during budget negotiations this week. A bill in the Senate would ban fracking until a health study is completed.

Brad Gill, executive director of the Independent Oil and Gas Association of New York, said the call for a health study was "part of a calculated campaign designed to frighten New Yorkers."

"There are no demonstrated cases of negative health impacts associated with natural gas development in the United States," Gill said. "In fact, a $1 million study, completed last August in Fort Worth, Texas, concluded natural gas development in the Barnett Shale did not lead to adverse health effects."

That study looked only at air quality. Although it found no significant health threats beyond setback distances, it recommended additional emission-control equipment and enhanced inspection and monitoring at natural gas sites.

In Alaska, native communities opposed expansion of oil development into sensitive areas of the North Slope in 2007. Collaboration on a health impact study led to compromises, said Aaron Wernham, director of the Health Impact Project, which assists in such studies.

Studies can become mired in controversy. That's what happened to one by the University of Colorado's School of Public Health for the 3,200-acre community of Battlement Mesa on the western slope of the Rocky Mountains.

County officials who commissioned the study halted it before it was final, saying it was hopelessly bogged down because residents and driller Antero Resources disagreed over its conclusions and recommendations.

The Battlement Mesa study made 70 recommendations for officials to consider before permitting Antero Resources to drill 200 wells. Antero called the recommendations baseless because there's not sufficient data to quantify potential health impacts

The Colorado School of Public Health reported this month that potentially toxic levels of airborne chemicals, including benzene, were detected near wells in the Battlement Mesa area during three years of monitoring.

Earlier this month, Alaska published a draft of its health impact assessment for the Wishbone Hill coal mine 50 miles north of Anchorage.

"In any study of such sensitive issues there are always going to be disagreements," said Katherine Nadeau of Environmental Advocates of New York. "But if we don't even try to get an assessment of what's going on in other states and what New York is doing to prevent similar problems here, it's a missed opportunity."

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FAIR Health Launches Online “Medicare Compare” Tool to Help Consumers Understand Impact of Medicare-Based out-of ...

FAIR Health, the independent not-for-profit corporation dedicated to bringing transparency to healthcare costs and out-of-network reimbursement, today launched FH Medicare Compare, a free, web-based tool that will help consumers better understand their out-of-pocket medical costs if their insurers base out-of-network reimbursement on the Medicare fee schedule. The tool is available on the FH Medical Cost Lookup on the FAIR Health consumer website (www.fairhealthconsumer.org/medicalcostlookup).

A number of private health plans base out-of-network reimbursement rates on a percentage of Medicare fees. The Medicare-based reimbursement formulas, generally 110% to 140% of the fee set by Medicare, often result in reimbursement amounts that are much lower than those calculated under the traditional usual, customary, and reasonable (UCR) standards that reflect actual provider charges. The switch to Medicare-based rates confuses many consumers who are unaware of the financial implications of this method. Using a Medicare-based reimbursement method often means that consumers will have to pay a larger portion of their medical bills out of pocket when they seek out-of-network services.

“Medicare is a government-based fee schedule that was developed for specific populations such as the elderly and the disabled. It was not designed to serve as a benchmark for the general population in the private out-of-network context FAIR Health President Robin Gelburd said. ”Many consumers are not aware of the differences between Medicare and UCR payment schedules and the cost impact on patients when their plans switch to a Medicare-based formula. Consumers can now use the Medicare Compare feature on the popular Medical Cost Lookup to understand their cost exposure if their plans use a Medicare-based reimbursement method.”

Previously, the free FH Medical Cost Lookup estimated costs for the UCR-based reimbursement method for a queried procedure. The UCR-based method remains the default, but with FH Medicare Compare, consumers can select the “Medicare-based” button to view Medicare-based reimbursement for a specific procedure and “Compare” to see Medicare- and UCR-based amounts side-by-side.

Medicare-based reimbursement:

Insurance plans using Medicare as the basis for out-of-network reimbursement multiply the fee set by Medicare for a specific medical procedure by a specified percentage to determine the maximum amount that they will reimburse for the procedure.

For example, assume that a patient visits an out-of-network doctor in Chicago, Illinois, who charges $1,700.03 for a colonoscopy with a biopsy. The patient’s insurance plan reimburses the visit based on 140% of what Medicare would normally pay for someone covered by Medicare. If the Medicare fee is $297.48 for that office visit, the plan would agree to pay up to $416.47, and the patient would be responsible for the remaining $1,283.56.

UCR-based reimbursement:

Using the same fact pattern, assume instead that the patient’s insurance plan reimburses at the 80th percentile of what the insurance company determines as UCR and the charge at such percentile is $1,700.03. If the insurer reimburses based on 70% of UCR, or $1,190.02 in this case, then the patient would be responsible for only the remaining $510.01 for that visit.

In these two examples, although the percentage of reimbursement for UCR (70%) was lower than that of Medicare (140%), the patient was responsible for a smaller portion of the $1,700.03 bill when the plan based reimbursement on a percentage of UCR, than on the Medicare fee. The new feature will allow consumers to estimate their out-of-pocket costs based on options that better reflect their specific plan provisions.

For a fuller description of the use of the Medicare fee schedule in out-of-network reimbursement, please visit www.fairhealthconsumer.org/reimbursementseries/medicare.aspx.

To use FH Medicare Compare to calculate the difference between Medicare-based and UCR-based reimbursement, visit www.fairhealthconsumer.org/medicalcostlookup.

About FAIR Health:

FAIR Health is a national independent, not-for-profit corporation whose mission is to bring transparency to healthcare costs and health insurance information through comprehensive data products and consumer resources. FAIR Health uses its database of billions of billed medical and dental services to power a free website (fairhealthconsumer.org) that enables consumers to estimate and plan their medical and dental expenditures. The website also offers clear, unbiased educational articles and videos about the healthcare insurance reimbursement system. In addition to its consumer offerings, FAIR Health licenses data products to businesses, governmental agencies, healthcare providers and researchers. With its professional staff of experts in healthcare, statistics, technology and communications, FAIR Health strives to offer accurate, consistent and timely information to all stakeholders in the healthcare system.

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CBS Evening News with Scott Pelley - Health care law's impact - 2 years later

President Obama signed his health insurance reform plan into law two years ago. Some of the provisions of the law have already gone into effect. Chip Reid reports on how the law is working so far.

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NY Assembly calls for fracking health impact study

ALBANY, N.Y. (AP) — Environmental and health groups are praising the New York State Assembly for including an independent health impact study of hydraulic fracturing for natural gas in its budget proposal on Monday.

Numerous physicians, health organizations and environmental groups have criticized the Department of Environmental Conservation for not including a comprehensive health impact study in its environmental review of gas drilling using high-volume hydraulic fracturing, or fracking.

Gas drilling in New York's part of the Marcellus Shale has been on hold since the DEC review began in 2008. Gov. Andrew Cuomo and DEC Commissioner Joe Martens have said the review and new regulations are expected to be completed within a few months.

The Assembly bill would set aside $100,000 for a study by a school of public health within the state university system following a model recommended by the Centers for Disease Control and Prevention. Before the study, the school would have to prepare a document outlining its plans, and the public would have the opportunity to comment and suggest changes.

The study would include research into other states' experiences with fracking; estimated costs of any health impacts to the state, insurers, employers and the health care system; and a long-term plan for monitoring and mitigating health impacts.

"This study will go a long way to answer the many questions New Yorkers have about what fracking would mean for their health if this goes forward," Assemblywoman Barbara Lifton, who proposed the study, said in a prepared statement. Lifton is a Democrat from Ithaca.

There is no companion bill in the Senate.

The Medical Society of the State of New York has called for a moratorium on natural gas extraction using hydraulic fracturing until scientific information on health impacts is available. Fracking stimulates gas production by injecting a well with millions of gallons of chemically treated water at high pressure to fracture surrounding shale, releasing trapped gas. There are concerns about health impacts of chemicals used in the process, handling of large volumes of highly contaminated wastewater, air pollution, and other issues.

"We have county medical societies throughout upstate and downstate that are very concerned that the health impacts have not been studied," said Pat Clancy, the medical society's vice president for public health and education.

In October, 250 physicians and medical professionals signed a letter to Cuomo calling for a comprehensive public health impact assessment.

"DEC has fully considered the impact high-volume hydraulic fracturing could potentially have on public health and our communities if it goes forward in New York," the environmental agency said in a statement. The agency said it looked at ways the public could be exposed to hazards from gas drilling and proposed guidelines and regulations to prevent that exposure.

"DEC's approach is to address the potential causes of exposure to prevent them from happening in New York state. If there are no pathways of exposure in the first place, adverse health impacts cannot occur."

A formal health impact assessment such as the one described in the Assembly bill would be far more extensive and detailed than what DEC has done. In comments to DEC on its environmental review, the Natural Resources Defense Council said DEC looked at some health issues but ignored others.

NRDC noted that there are numerous reports of health complaints among people who live near natural gas drilling and fracking operations in other states and some have been investigated by researchers or governmental agencies. Reported health issues include eye irritation, dizziness, nasal and throat irritation, respiratory symptoms, nausea, fatigue, headaches, anxiety and other ailments.

"New York State has to date failed to take a hard look at the health impacts of fracking," said Katherine Nadeau of NRDC. "By calling for an independent study of fracking's health impacts, the Assembly is leading the charge to provide state leaders with the science necessary to make informed decisions."

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Health Care Reform: The Unintended Impact on Children

When health care reform was passed in 2010, many applauded the provision that children could no longer be denied health insurance coverage due to pre-existing conditions, but there’s decidedly less clapping now.

“As an unintended consequence of health reform, a lot of insurers stopped offering individual coverage for children. That put parents in a bind, and children in danger. How would you feel if you were told that you children could no longer be declined for health insurance, but then you found that no plans were actually available?” asks Carrie McLean, a consumer health insurance expert with eHealthInsurance.com.

The situation is severe. There are an estimated 6 million children in the U.S. without health insurance. “While more insurers and states are stepping up the plate this year, in over 20 states today, there is no child-only health insurance on the market. Even when child-only plans are available, their availability may be limited to a single insurer or to specific once-a-year enrollment periods,” says McLean.

They may also be expensive. “Two years later, the unintended consequence of this new regulation is that many parents now wait to purchase a policy for their child until after they are already sick and have expensive medical bills looming. This drives the cost of child-only health insurance up so high that premiums in many states are unaffordable,” explains Joel Ohman, founder of InsuranceProviders.com.

When children don’t receive proper health care from the start, the fallout can last a lifetime. The big question is, what can parents do?

Check to see if health insurers are still offering child-only policies in your state. You can find out from your State Insurance Department. Ask too, if the state is holding a child-only open enrollment period. Many states have two enrollment periods a year.

Another alternative, says Erinn Springer, media specialist with GoHealthInsurance.com an online portal for finding health insurance coverage, is try to add a child to an individual or group health policy as a dependent. “Children will not be turned down coverage when added to an adult’s individual plan or when added as a dependent to a group plan,” says Springer.

Review your state’s eligibility requirements for the Children’s Health Insurance Program (CHIP), also known as Medicaid. Many states have expanded CHIP coverage in the past few years.

Do investigate your state’s Pre-Existing Condition Insurance (PCIP) Program to see if you child is eligible. This plan provides coverage for individuals with pre-existing conditions with funds from health care reform. “While it’s a great and affordable option, children cannot have health insurance coverage for six months prior to enrolling in the plan,” says Springer. You can learn more about PCIP here.

You can also call health insurance companies directly to ask about their child-only coverage, because in some states, health insurance companies may not sell child-only plans through agents.

Know too, that just because you miss the enrollment period, there may be some wiggle room and you may be able to apply. However, you could face potentially higher premiums as a result, says Phil Lebherz, executive director of the Foundation for Health Coverage Education. If you qualify, you may be able to find coverage for your child through government programs depending on your income by going to www.CoverageForAll.org

Image by Getty Images via @daylife

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No big Fukushima health impact seen: U.N. body chairman

VIENNA (Reuters) - The health impact of last year's Fukushima nuclear disaster in Japan appears relatively small thanks partly to prompt evacuations, the chairman of a U.N. scientific body investigating the effects of radiation said on Tuesday.

The fact that some radioactive releases spread over the ocean instead of populated areas also contributed to limiting the consequences, said Wolfgang Weiss of the U.N. Scientific Committee on the effects of Atomic Radiation (UNSCEAR).

"As far as the doses we have seen from the screening of the population ... they are very low," Weiss told Reuters. This was partly "due to the rapid evacuation and this worked very well."

Weiss was speaking on the sidelines of a week-long meeting of 60 international experts in Vienna to assess for the United Nations the radiation exposures and health effects of the world's worst nuclear accident in 25 years.

The March 11 disaster caused by a 9.0 magnitude earthquake and tsunami wrecked the Fukushima plant on the coast north of Tokyo, triggering a radiation crisis and widespread contamination. About 80,000 residents fled a 20-km (12-mile) exclusion zone.

Weiss said Japanese experts attending the meeting had told him that they were not aware of any acute health effects, in contrast to the 1986 Chernobyl disaster in Ukraine.

"What we have seen in Chernobyl - people were dying from huge, high exposures, some of the workers were dying very soon - nothing along these lines has been reported so far (in Japan)," he said. "Up to now there were no acute immediate effects observed."

Several thousand children developed thyroid cancer due to radiation exposure after the Chernobyl disaster in the then Soviet Union, when a reactor exploded and caught fire and radiation was sent billowing across Europe.

Weiss said a few workers at Fukushima had received high radioactive doses, but "so far the initial medical follow-up of these workers who had high doses, as far as the Japanese colleagues told us, was OK."

A preliminary report on the radiation effects of Fukushima will be presented at UNSCEAR's annual meeting in May and a final document will be submitted to the United Nations General Assembly in 2013.

"We are putting together a jigsaw puzzle, evaluating the exposures of the general public, of workers, and radiation effects, and looking for the missing pieces," Weiss said.

The U.N. committee, which has published reports about Chernobyl, groups scientists from 27 countries.

Asked whether he was optimistic that the overall health effects would be quite small, Weiss said: "If we find out that what we know now is representing the situation, then the answer would be yes ... the health impact would be low."

(Reporting by Fredrik Dahl; editing by David Stamp)

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AP IMPACT: Health overhaul lags in states

WASHINGTON (AP) — Here's a reality check for President Barack Obama's health overhaul: Three out of four uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care.

This is the year that will make or break the health care law. States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House claims they're making steady progress.

But an analysis by The Associated Press shows that states are moving in fits and starts. Combined with new insurance coverage estimates from the nonpartisan Urban Institute, it reveals a patchwork nation.

Such uneven progress could have real consequences.

If it continues, it will mean disparities and delays from state to state in carrying out an immense expansion of health insurance scheduled in the law for 2014. That could happen even if the Supreme Court upholds Obama's law, called the Patient Protection and Affordable Care Act.

"There will be something there, but if it doesn't mesh with the state's culture and if the state is not really supporting it, that certainly won't help it succeed," said Urban Institute senior researcher Matthew Buettgens.

The 13 states that have adopted a plan are home to only 1 in 4 of the uninsured. An additional 17 states are making headway, but it's not clear all will succeed. The 20 states lagging behind account for the biggest share of the uninsured, 42 percent.

Among the lagging states are four with arguably the most to gain. Texas, Florida, Georgia and Ohio together would add more than 7 million people to the insurance rolls, according to Urban Institute estimates, reducing the annual burden of charity care by $10.7 billion.

"It's not that we want something for free, but we want something we can afford," said Vicki McCuistion of Driftwood, Texas, who works two part-time jobs and is uninsured. With the nation's highest uninsured rate, her state has made little progress.

The Obama administration says McCuistion and others in the same predicament have nothing to fear. "The fact of states moving at different rates does not create disparities for a particular state's uninsured population," said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the federal Department of Health and Human Services.

That's because the law says that if a state isn't ready, the federal government will step in. Larsen insists the government will be ready, but it's not as easy as handing out insurance cards.

Someone has to set up health insurance exchanges, new one-stop supermarkets with online and landline capabilities for those who buy coverage individually.

A secure infrastructure must be created to verify income, legal residency and other personal information, and smooth enrollment in private insurance plans or Medicaid. Many middle-class households will be eligible for tax credits to help pay premiums for private coverage. Separate exchanges must be created for small businesses.

"It's a very heavy lift," said California's health secretary, Diana Dooley, whose state was one of the first to approve a plan. "Coverage is certainly important, but it's not the only part. It is very complex."

California has nearly 7.5 million residents without coverage, more than half of the 12.7 million uninsured in the states with a plan. An estimated 2.9 million Californians would gain coverage, according to the Urban Institute's research, funded by the nonpartisan Robert Wood Johnson Foundation.

Democrats who wrote the overhaul law had hoped that most states would be willing partners, putting aside partisan differences to build the exchanges and help cover more than 30 million uninsured nationally. It's not turning out that way.

Some states, mainly those led by Democrats, are far along. Others, usually led by Republicans, have done little. Separately, about half the states are suing to overturn the law.

Time is running out for states, which must have their plans ready for a federal approval deadline of Jan. 1, 2013. Those not ready risk triggering the default requirement that Washington run their exchange.

Yet in states where Republican repudiation of the health care law has blocked exchanges, there's little incentive to advance before the Supreme Court rules. A decision is expected this summer, and many state legislatures aren't scheduled to meet past late spring.

The result if the law is upheld could be greater federal sway over health care in the states, the very outcome conservatives say they want to prevent.

"If you give states the opportunity to decide their own destiny, and some choose to ignore it for partisan reasons, they almost make the case against themselves for more federal intervention," said Sen. Ben Nelson, D-Neb.

A conservative, Nelson was on the winning side of a heated argument among Democrats over who should run exchanges, the feds or the states. Liberals lost their demand for a federal exchange, insulated from state politics.

"It's pretty hard to take care of the states when they don't take care of themselves," said Nelson, who regrets that the concession he fought for has been dismissed by so many states.

The AP's analysis divided states into four broad groups: those that have adopted a plan for exchanges, those that made substantial progress, those where the outlook is unclear, and those with no significant progress. AP statehouse reporters were consulted in cases of conflicting information.

Thirteen states, plus the District of Columbia, have adopted a plan.

By contrast, in 20 states either the outlook is unclear or there has been no significant progress. Those states include more than 21 million of the 50 million uninsured Americans.

Four have made no significant progress. They are Arkansas, Florida, Louisiana and New Hampshire. The last three returned planning money to the federal government. In Arkansas, Democratic Gov. Mike Beebe ran into immovable GOP opposition in the Legislature. Beebe acknowledges that the federal government will have to run the exchange, but is exploring a fallback option.

In the other 16 states, the outlook is unclear because of failure to advance legislation or paralyzing political disputes that often pit Republicans fervently trying to stop what they deride as "Obamacare" against fellow Republicans who are more pragmatic.

In Kansas, for example, Insurance Commissioner Sandy Praeger is pushing hard for a state exchange, but Gov. Sam Brownback returned a $31 million federal grant, saying the state would not act before the Supreme Court rules. Both officials are Republicans.

"It's just presidential politics," said Praeger, discussing the situation nationally. "It's less about whether exchanges make sense and more about trying to repeal the whole law." As a result, outlook is unclear for a state with 361,000 uninsured residents.

There is a bright spot for Obama and backers of the law.

An additional 17 states have made substantial progress, although that's no guarantee of success. Last week in Wisconsin, GOP Gov. Scott Walker abruptly halted planning and announced he will return $38 million in federal money.

AP defined states making substantial progress as ones where governors or legislatures have made a significant commitment to set up exchanges. Another important factor was state acceptance of a federal exchange establishment grant.

That group accounts for just under one-third of the uninsured, about 16 million people.

It includes populous states such as New York, Illinois, North Carolina and New Jersey, which combined would add more than 3 million people to the insurance rolls.

Several are led by Republican governors, including Virginia and Indiana, which have declared their intent to establish insurance exchanges under certain conditions. Other states that have advanced under Republican governors include Arizona and New Mexico.

For uninsured people living in states that have done little, the situation is demoralizing.

Gov. Rick Perry's opposition to the law scuttled plans to advance an exchange bill in the Texas Legislature last year, when Perry was contemplating his presidential run. The Legislature doesn't meet this year, so the situation is unclear.

McCuistion and her husband, Dan, are among the nearly 6.7 million Texans who lack coverage. Dan is self-employed as the owner of a specialty tree service. Vicki works part time for two nonprofit organizations. The McCuistions have been uninsured throughout their 17-year marriage, although their three daughters now have coverage through the Children's Health Insurance Program. Dan McCuistion has been nursing a bad back for years, and it only seems to get worse.

"For me it almost feels like a ticking time bomb," his wife said.

Dan McCuistion says he doesn't believe Americans have a constitutional right to health care, but he would take advantage of affordable coverage if it was offered to him. He's exasperated with Perry and other Texas politicians. "They give a lot of rhetoric toward families, but their actions don't meet up with what they are saying," he said.

Perry's office says it's principle, not lack of compassion.

"Gov. Perry believes 'Obamacare' is unconstitutional, misguided and unsustainable, and Texas, along with other states, is taking legal action to end this massive government overreach," said spokeswoman Lucy Nashed. "There are no plans to implement an exchange."

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Online:

AP interactive: http://hosted.ap.org/interactives/2011/healthcare

Urban Institute estimates: http://tinyurl.com/86py8nd

Center for Consumer Information and Insurance Oversight: http://cciio.cms.gov

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