Saturday, March 23, 2013


Health reform turns 3, with the hardest part yet to come

Bumps seen in road to health markets

Win Mcnamee / Getty Images
U.S. President Barack Obama is applauded after signing the Affordable Health Care for America Act during a ceremony with fellow Democrats in the East Room of the White House March 23, 2010 in Washington, DC. The historic bill was passed by the House of Representatives Sunday after a 14-month-long political battle that left the legislation without a single Republican vote.

By Maggie Fox Senior Writer, NBC News
updated 3/23/2013 12:32:24 PM ET
Three years ago this weekend, President Obama signed the Affordable Care Act into law.

Its provisions sound sweeping – get health insurance to 32 million Americans who don’t have it now, stop insurers from cherry-picking their customers, require basic coverage that’s proven to improve health and lower costs, not to mention initiatives to get doctors to work together in teams. But the law’s written to go into effect in stages, and it’ll be years before all the provisions are up and running.

The federal government has barely met each deadline, and the biggest batches of changes are coming up in the next few months.

Don’t expect it to go smoothly, experts predict.

The next big deadline is Oct. 1, when states are supposed to have the new health insurance marketplaces, called exchanges, up and running. This one’s down to the wire for most states, and it’s still impossible to say what they will look like, how many policies people will have to choose from and how much they will cost.

The 55 percent of Americans who are covered by their employers already know it can be confusing at “open enrollment” time, when they often have to choose among several plans. Dental or vision coverage? Which prescription plan? If you choose a high co-pay -- an amount paid every time a patient visits a doctors or other caregiver, or fills a prescription -- does the lower premium balance that out? Or will you end up paying more in co-pays if you end up making a lot of doctor visits, or need surgery?

Expect that to be multiplied, a lot, on one of the new exchanges. And most of the people buying on these exchanges will not have much experience in this area.

Lori Dustin, chief marketing officer for HighRoads, a human resources consulting firm, sees more than a few bumps in the road. “Consumers will be faced with a lack of information to shop for plans,” she predicts. While big states like California and New York are likely to provide many choices, smaller states with a history of limited insurance options may not have much to offer, she says.

“They have to service consumers who are uninsured, who don’t understand what a co-pay is,” she said. “There are going to be a lot of calls into customer service centers.”

Many people will get sticker shock when they see the premiums they will be charged, Dustin predicts. No premiums are yet set – insurers have until April 30 to apply to sell a product on the federally run exchanges.

But the new plans will be comprehensive – the law requires that. So they’ll cost more than some of the bare-bones plans offered in the past. That could scare off younger, healthier customers, Dustin says. “If the premiums are unreasonable, an uninsured person is going to weigh the difference between paying a penalty and paying premiums that may be enormous,” she says.

The whole basis of health insurance is to get a wide variety of people paying premiums, so the insurer can pay for the health care of those who need it, while still covering its administrative costs and staff, not to mention making a profit. If healthier people who don’t yet need insurance don’t buy in, then insurers are stuck with a pool of sick customers.

No coverage cap or ban on those with pre-existing conditions
In the past, many insurers would exclude these sickest people whenever possible, even kicking some off the rolls when they started to cost too much. “Obamacare”, as even the administration now calls it, stops this. Starting in 2014, new policies may not cap coverage and they have to take all comers, even if they are already sick.

But to make this work for the insurers, the new exchanges will have to lure in more healthy payers, too. While the Health and Human Services Department is confident it can, Dustin and some other critics aren’t so sure. In the first year, the fine for not having health insurance will be as low as $95 – not much of a deterrent.

Dustin also sees technological barriers. The websites that form the basis of the new marketplaces are complex. “They don’t even propose to test these websites until late summer and open enrollment is October 1,” she said. “You’d typically want something in place for at least nine months to a year to test quality and usability.”

Jay Angoff of law firm Mehri & Skalet, who oversaw health reform as head of HHS’s Consumer Information and Insurance Oversight office, thinks HHS will meet the deadline and have workable websites.

“It’s a phenomenal accomplishment, when you think about the technology it takes for people to go to the Internet, punch in the answers to a few questions, and get quotes from carriers in their states,” Angoff said in a telephone interview.

The software has to help HHS communicate instantly with other government agencies, for the Internal Revenue Service to the Social Security Administration, to verify what people say and calculate whether they qualify for a federal subsidy to buy the insurance.

But Angoff, an unabashed cheerleader for the effort, admits there may be glitches.

“The administration will be able to say that it has met the deadline. I don’t think everything is going to be elegant in all states,” he said.

Constantly bumping up against deadlines
All along, HHS has met the deadlines set in the law at virtually the last possible moment. “Why always at deadline? For the same reasons that you and I waited until the last minute to do our term papers in college,” Angoff says.

To be fair, there have been distractions. The Supreme Court was asked to rule on whether the Affordable Care Act was even constitutional, and waited until the very last possible day in June to do so. Then Congress went down to deadline after deadline to decide on the “sequester” – the package of mandatory budget cuts imposed in case there was no political deal on the budget. No deal ever came and the sequester’s now in effect, forcing government agencies, including HHS, to scramble almost halfway through the fiscal year to make budget cuts that can include furloughing workers.

HHS has also had to wait for states to decide if they will run their own exchanges, and then approve their plans to do so. HHS will have to do the job for the states that won’t — at last count, 26 of them.

But however they turn out, exchanges are going to shape the future evolution of health insurance coverage, experts agree. And they will eventually be forced to make it an easier process.

“In time I think you’ll see this market evolve,” says Joel Ario, a former Pennsylvania insurance commissioner who helped direct development of the health insurance exchanges for the Obama administration and who now is a managing director at Manatt Health Solutions.

“The winners are the ones who will make it as simple and easy to navigate as possible.”

Although about 7 million people will initially buy insurance on the public exchanges, according to the Congressional Budget Office, Ario says employers will start moving to exchange-style marketplaces as well. And while states and the federal government are the largest forces running exchanges, private groups are already also designing and marketing exchanges – to states, public employers and to companies.

And, by the way, lawmakers are going to get a taste of what the rest of the country is feeling. The law requires that starting in 2014, members of Congress and many of their staffers will have to buy their health insurance on the exchanges, unless they’re over 65 and on Medicare. President Barack Obama is also supposed to buy a plan on an exchange – although he mostly relies on a personal physician at the White House Medical Unit.


Florida governor expands Medicaid

Few may pay for skipping health insurance

Feds set to run most health insurance exchanges

States get more time for health exchange plans

Meteor Spotted Streaking Through Sky Over Region

Breaking: Multiple reports of blue or green light streaking through sky

Meteor Over Manhattan: East Coast Fireball 3-22-2013


Published on Mar 22, 2013
A bright meteor briefly outshined the lights of New York City Friday evening (March 22), according to reports by witnesses who used Twitter and the Internet to report sightings of the fireball streaking over a broad stretch of the U.S. East Coast.
"Strange Friday night ... a meteor passed over my house tonight!" wrote one New Yorker writing as Yanksmom19.
The first fireball sightings came at about 8 p.m. EDT (0000 March 23 GMT) and sparked more than 500 witness reports to the American Meteor Society. Reports of the meteor flooded Twitter from New York, Boston and Washington, D.C.
"The witnesses range from along the Atlantic Coast ranging from Maine to North Carolina," Robert Lunsford, the society's fireball coordinator, wrote in an update. "This object was also seen as far inland as Ohio.
The bright streak of light spotted over the region Friday evening was in fact a meteor, StormTeam 4 Meteorologist Doug Kammerer has confirmed.
Multiple reports began coming in around 8 p.m. People spotted the streak of light in both Maryland and Virginia -- and as far north as New York and Maine. Many said it appeared to be blue or green.

Meteor Streaks Through Sky Over Region
The meteor was traveling about 10 miles per second, much faster than even a speeding bullet, Kammerer said.
While meteors are not rare and come through the Earth's atmosphere every day, this meteor was larger than usual, which is what made it much easier to see, Kammerer said. That's why it had such a dramatic light.
On Twitter, @MisterNeek told us, "[I] definitely witnessed what appeared to be a shooting star around 8 o clock, which then burst into a beaming red/green glow."
Rebecca Hovis told us in an email at 8 p.m. that she saw what appeared to be a meteor. "I was on Van Dorn [Street] going toward seminary road," she wrote.
Karen Watson told us on Twitter: "Yes, yes! Saw the meteor -- bright green -- in the sky over Kingstowne (Alexandria), Va."
Twitter user @brownpau wrote: "Saw it going west to east about 10 degrees up in the northern sky from Dunn Loring area, bright green with a plasma trail."
Jennifer Stymiest told us, "I live in the Croom area of Upper Marlboro and at approximately 7:55 this evening, I saw a rather large bright blue ball with what looked like a bright orange tail go soaring past our house.... It appeared to be just over the treetops."
Thomas Birchall told us, "Meteor spotted streaking across the sky in Germantown, Md. It was greenish blue in color and could be seen disintegrating in the Gaithersburg direction."
Bill Cooke of NASA's Meteoroid Environmental Office told the Associated Press that the flash appeared to be "a single meteor event.'' He also noted that the meteor was widely seen, with more than 350 reports on the website of the American Meteor Society alone.
The sighting comes five weeks after a meteor exploded over Chelyabinsk Oblast, Russia, injuring nearly 1,500 people and blowing out windows across the region.
Also in February, meteors were reported over the Bay Area and in Florida.
While it may seem like there's been an uptick in meteor sightings lately, Kammerer said it's more likely that the growth of social media has made reports of them more widely known.

Reports about East Coast meteor flood in, setting off a media scramble

This security camera footage, from Kim Fox of Thurmont, Md., shows the Friday night flash in the sky. 7:50 PM EDT on March 22 2013.

A Friday night flash of light in the skies over the East Coast sparked a rash of meteor sighting reports, followed by a mad dash to track down photos and videos of the event.
The American Meteor Society logged more than 300 reports from a region ranging from  North Carolina to Washington to New York to New England to Canada. Hundreds more registered their observations on Twitter.  One Twitter user, known as @Married2TheNite, reported from New Jersey that he saw — and heard — the object pass by. "It was making almost a hissing noise as it flew brightly overhead," he wrote. "I saw it around 7:55 p.m. EDT."
That time frame meshed with the many other reports. Some witnesses said they saw flashes of green, red and blue as the object streaked past.
The reports were consistent with a fireball — similar to the one that flashed over Russia on Feb. 15, but much, much smaller.
"It's not an incredibly rare event, but it is very unusual to have that many people observe it, and also it was unusually bright," Ron Dantowitz, director of the Clay Center Observatory, told NBC station WHDH-TV in Boston. "These types of meteors happen once or twice a year. The unusual thing is that it was so well observed not so long after sunset."
Bill Cooke of NASA's Meteoroid Environmental Office told The Associated Press that the flash appeared to be "a fireball that moved roughly toward the southeast, going on visual reports."
"Judging from the brightness, we're dealing with something as bright as the full moon," Cooke said. "The thing is probably a yard across. We basically have (had) a boulder enter the atmosphere over the Northeast."
For a while, Twitter buzzed with tweets and retweets highlighting pictures that falsely purported to show the Friday night light — but eventually, bona fide views surfaced. The paucity of honest-to-goodness meteor shots contrasted with the wealth of dashboard videos that came to light after last month's Russian meteor blast.
"The meteor has taught us one thing tonight," Cara Lynch tweeted, "the East Coast needs more dash cameras."
One of the most widely distributed videos of Friday night's flash came from someone who didn't actually see it when it happened. "I wish I would have seen it for real," said Kim Fox, a first-grade teacher from Thurmont, Md.
Fox told NBC News that she checked her security-camera system after hearing about the meteor. At around the time that news reports said the meteor was widely sighted, she saw a bright flash on one of the camera views. She took out her mobile phone, recorded a video of the video, and posted it to her Facebook page. From there, the video went viral on the Web and on TV newscasts.
"The phones have been ringing all night," Fox said.
Did you see the flash? Add your sighting report to the American Meteor Society's log, and tell me about it in the comment space below. Got pictures? Feel free to post them to the Cosmic Log Facebook page.
Update for 3:44 p.m. ET March 23: In one reference, I mistakenly placed Thurmont in New Jersey rather than Maryland. And it's WHDH, not WDHD. Sorry about that! Also, more video views of the flash have come in. Hopkins Automotive Group posted this flashy security camera video on its Facebook page. There's also this dashcam view from WUSA9 photojournalist Kurt Brooks.

Meteor Antwerp Belgium 22 March 2013. 2:12 AM

More about meteors:

Meteor Seen For Miles Across Maryland

Meteor flash, fireball & debris in the east coast sky & over Manhattan - March 22, 2013

Posted: 03/22/2013
Last Updated: 6 hours and 52 minutes ago

By: Mike Masco
By: Associated Press
By: Jake Pearson
By: Norman Gomlak
Baltimore, MD -

JAKE PEARSON Associated Press

East Coast residents were buzzing on social media sites and elsewhere Friday night after a brief but bright flash of light streaked across the early-evening sky -in what experts say was almost certainly a meteor coming down.

Bill Cooke of NASA's Meteoroid Environmental Office said the flash appears to be "a single meteor event." He said it "looks to be a fireball that moved roughly toward the southeast, going on visual reports."

"Judging from the brightness, we're dealing with something as bright as the full moon," Cooke said. "The thing is probably a yard across. We basically have (had) a boulder enter the atmosphere over the northeast."

"If you have something this bright carry over that heavily populated area, a lot of people are going to see it," he said. "It occurred around 8 tonight, there were a lot of people out, and you've got all those big cities out there."

Matt Moore, a news editor with The Associated Press, said he was standing in line for a concert in downtown Philadelphia around dusk when he saw "a brilliant flash moving across the sky at a very brisk pace... and utterly silent."

"It was clearly high up in the atmosphere," he said. "But from the way it appeared, it looked like a plane preparing to land at the airport."

Moore said the flash was visible to him for about two to three seconds - and then it was gone. He described it as having a "spherical shape and yellowish and you could tell it was burning, with the trail that it left behind."

"Set as it was against a cloudless sky over Philadelphia, it was amazing," he said.

Derrick Pitts, chief astronomer at Philadelphia's Franklin Institute, agreed that the sightings had all the hallmarks of a "fireball." These include lasting 7-10 seconds, being bright and colorful, and seeming to cross much of the sky with a long stream behind it.

He said what people likely saw was one meteor - or "space rock" - that may have been the size of a softball or volleyball and that fell fairly far down into the Earth's atmosphere.

He likened it to a stone skipping across the water - getting "a nice long burn out of it."

Robert Lunsford of the American Meteor Society told USA Today "it basically looked like a super bright shooting star."

Breaking News: Meteor Sighted Over East Coast - 3/22/13 (Raw Footage)

The newspaper reports that the sky flash was spotted as far south as Florida and as far north as New England.

Pitts said meteors of varying sizes fall from the sky all the time, but that this one caught more eyes because it happened on a Friday evening - and because Twitter has provided a way for people to share information on sightings.

He said experts "can't be 100 percent certain of what it was, unless it actually fell to the ground and we could actually track the trajectory." But he said the descriptions by so many people are "absolutely consistent" with those of a meteor.

What is a meteor?

Meteors are most often seen as a very brief streak of light in the night sky. They typically occur and disappear so quickly that you wonder if you actually saw them. These streaks of light are commonly called “shooting stars” or “falling stars”. Although they are most often seen at night, especially bright meteors can be seen during daylight. The photo at right shows a meteor in the sky over Quebec, Canada on an early November morning.

GOP’s latest program for the hungry: Let ‘em eat roadkill!

If you’re poor, the Montana Senate has a new program for you. It voted 28-21, mostly along party lines, to pass a bill Thursday that allows residents (with a permit) to harvest for food big game animals like deer, elk and moose killed by…vehicles.
The roadkill salvage bill cleared the House 95-3 in February and now goes to Governor Steve Bullock, a Democrat, who hasn’t said yet whether he’ll sign it.
Supporters say the bill would provide the needy with a source of food that would otherwise be destroyed.
“It seems like a waste,” said Representative Bill Lavin, the Republican sponsor of the bill, who is also a Montana Highway Patrolman. “This bill … would allow me to legally call the food bank or allow somebody else who requests it to take it and use it,” he said.
No one is in favor of wasted food, but opponents view the idea of feeding the poor possibly rancid meat from the side of the road as potentially dangerous.
“Are highway patrolmen and law enforcement experts in meat inspection?” asked Democratic Senator Kendall Van Dyk. “I have not seen anything in the bill … that indicates to me that the safety parameters are in place to let me know beyond a shadow of a doubt that this is a safe food source for those in need, or anyone else for that matter.”
Van Dyk also said the Montana Food Bank Network sent him a letter opposing the bill and clarifying the network cannot accept roadkill.
But Lavin doesn’t think Big Sky Country needs any “experts in meat inspection” because “we have a lot of common sense…it’s pretty easy to tell when meat is rotten.”
And even the People for the Ethical Treatment of Animals (PETA) doesn’t think the bill’s a bad idea, pointing out that “eating roadkill is healthier for the consumer than meat laden with antibiotics, hormones, and growth stimulants, as most meat is today.”
Bon appetit!