January 07th, 2014

DID YOU KNOW THAT MARYLAND IS ONE OF THE STATES NOT COVERING AUTISM AND THAT IS THE MOST DIAGNOSED NEUROLOGICAL  DISEASES TODAY BECAUSE OF DAMAGES FROM CHEMICAL EXPOSURES FOR ONE!  THE DEVIL IS IN THE DETAILS!

IN MARYLAND, WHAT DOES THIS SAY ABOUT JOHNS HOPKINS PUBLIC HEALTH? YOU KNOW IT RUNS ALL OF BALTIMORE AND MUCH OF MARYLAND PUBLIC HEALTH----AND IT IS A CORPORATION FOR GOODNESS SAKE!

PLEASE BE AWARE THAT THE FAILURE OF ACA AS A HEALTH REFORM IS NOT BECAUSE OF DEMOCRATS, IT IS BECAUSE OF NEO-LIBERALS.  IT IS A REPUBLICAN PLAN SIMPLY MEANT TO DISMANTLE PUBLIC HEALTH AND MAXIMIZE PROFIT.  SO, DON'T VOTE REPUBLICAN BECAUSE YOU ARE MAD AT NEO-LIBERALS.....RUN AND VOTE FOR LABOR AND JUSTICE!

YOUR POLITICIAN KNEW THIS WOULD BE THE RESULT!


Michael Riseup Stowell
I figured Obamacare was designed as a bailout for the insurance industry, and so I expected it to be disappointing - this journalist explains how: "Poor young people with zero disposable income are being asked to pay monthly premiums of $150 and more, and they’re opting out, inevitably sinking Obamacare in the process.

Those young people who actually do buy Obamacare plans—to avoid the “mandate” fine— will be further enraged when they attempt to actually use their “insurance...

Everyone knows I've been shouting for four years that this would be the result and your political pundit, media, and national labor union/justice leaders knew it too!  Labor no doubt backed this to save union rights but there is a point at which saving the bathwater and throwing out the baby comes into play.  Union members feel betrayed and citizens see the unions as working against their interests. 

CITIZENS HAVE TO COME OUT AND SHOUT AS OUR UNIONS ARE BETWEEN A ROCK AND A HARD PLACE.  STRENGTHEN UNIONS BY FIGHTING FOR THE BENEFITS PROMISED!



YOU CANNOT WAIT TO SHOUT OUT AND DEMAND EXPANDED AND IMPROVED MEDICARE FOR ALL AND DO NOT VOTE FOR ANY POLITICIAN THAT DOES NOT SHOUT THIS!

The article below is harsh on supposed progressive people backing what people in the know knew was bad for Americans.  The process of reform was built on making labor and justice desperate and divided and that is what happened.  I went to a progressive symposium four years ago in Washington with all the leading 'progressive' voices and shouted at that packed symposium that this would be the result and there was silence.  If your incumbent chose silence then

THE SILENCE IS DUPLICITY.

January 06, 2014

Single-Payer is the Only Real Option The Left After the Failure of Obamacare by SHAMUS

COOKE it’s satisfying to watch rats flee a sinking ship.  This is because onlookers knew the ship was doomed long ago, and swimming rats signify that the drawn-out tragedy is nearing an end.  A collective sense of relief is a natural response.

The rats who propped up the broken boat of Obamacare are a collection of liberal and labor groups who frittered away their group’s resources—and integrity— to sell a crappy product to the American people.

Those in the deepest denial went “all in” for Obamacare— such as some unions and groups like Moveon.org— while the more conniving groups and individuals—like Michael Moore— playacted “critical” of Obamacare, while nevertheless declaring it “progressive”, in effect adding crucial political support to a project that deserved none.

But of course Obamacare was always more barrier than progress: we’ve wasted the last several years planning, debating, and reconstructing the national health care system, all the while going in the wrong direction— into the pockets of the insurance mega corporations.    A couple progressive patches on the sails won’t keep her afloat.  It’s shipbuilding time.

It was painful to watch otherwise intelligent people lend support to something that’s such an obviously bad idea.  So it’s with immense relief that liberals like Michael Moore, labor groups, and others are finally distancing themselves from Obamacare’s Titanic failure.   Now these individuals and groups can stop living in denial and the rest of us can proceed towards a rational discussion about a real health care solution.

The inevitable failure of Obamacare is not due to a bad website, but deeper issues.   The hammering of the nails in the coffin has begun:  millions of young people are suddenly realizing that Obamacare does not offer affordable health care.  It’s a lie, and they aren’t buying it, literally.

The system depends on sufficient young people to opt in and purchase plans, in order to offset the costs of the older, higher-needs population.    Poor young people with zero disposable income are being asked to pay monthly premiums of $150 and more, and they’re opting out, inevitably sinking Obamacare in the process.

Those young people who actually do buy Obamacare plans—to avoid the “mandate” fine— will be further enraged when they attempt to actually use their “insurance”.   Many of the cheapest plans—the obvious choice for most young people— have $5,000 deductibles before the insurance will pay for anything.   For poor young people this is no insurance at all, but a form of extortion.

At the same time millions of union members are being punished under Obamacare: those with decent insurance plans will suffer the “Cadillac” tax, which will push up the cost of their healthcare plans, and employers are already demanding concessions from union members in the form of higher health care premiums, co-pays, deductibles, etc.

Lower paid union workers will suffer as well.  Those who are part of the Taft Hartley insurance plans will be pressured to leave the plans and buy their own insurance, since they cannot keep their plans and get the subsidy that the lowest income workers get.   This has the potential to bust the whole Taft Hartley health care system that millions of union members benefit from, which is one of the reasons that labor leaders suddenly became outraged at Obamacare, after having wasted millions of union member’s dollars propping it up.

Ultimately, the American working class will collectively cheer Obamacare’s demise.   They just need labor and other lefties to cheer lead its destruction a little more fiercely.

Surprisingly, most of the rats are still clinging to Obama’s hopeless vessel, frantically bailing water.  Sure they’ve put on their life preservers and anxiously eyeing the lifeboats, but they’re also preaching about how to re-align the deckchairs.

For example, in his “critical” New York Times op-ed piece, Michael Moore called Obamacare “awful”, but also called it a “godsend”, singing his same tired tune.   Part of Moore’s solution for Obamacare—which was cheered on in the Daily Kos— is equally ludicrous, and follows his consistently flawed logic that Obamacare is worth saving, since its “progress” that we can build on.   Moore writes:

“Those who live in red [Republican dominated] states need the benefit of Medicaid expansion [a provision of Obamacare]…. In blue [Democrat dominated] states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer.”

This is Moore at his absolute worst.  He’s neck deep in the flooded hull of the U.S.S Obamacare and giving us advice on how to tread water.

Of course Moore doesn’t criticize the heart of Obamacare, the individual mandate, the most hated component.

Moore also relies on the trump card argument of the pro-Obamacare liberals: there are progressive aspects to the scheme—such as the expansion of Medicaid— and therefore the whole system is worth saving.

Of course it’s untrue that we need Obamacare to expand Medicaid.  In fact, the expansion of Medicaid acted more as a Trojan horse to introduce the pro-corporate heart of the system; a horse that Moore and other liberals nauseatingly continue to ride on.

But Moore’s sneakiest argument is his advice to blue states to  “…lobby for a public option on the insurance exchange…”

Again, Moore implies that it’s ok if we are “mandated” to buy health insurance, so long is there is a public option.  But that aside, the deeper scheme here is that Moore wants us to further waste our energy “reforming” Obamacare, rather than driving it to the bottom of the sea.

Moore surely knows that very few people are going to march in the streets demanding a public option at this point; he therefore knows that even this tiny reform of the system is unachievable. He’s wasting our time.  Real change only happens in politics when there is a surge of energy among large sections of the population, and it’s extremely unlikely that more than a handful of people are going to be active towards “fixing” Obamacare— they want to drown it.

Moore’s attempt to funnel people’s outrage at Obamacare towards a “public option” falls laughably short, and this is likely his intention, since his ongoing piecemeal “criticisms” of the system have only served to salvage a sunken ship.

Instead of wasting energy trying to pry Obamacare out of the grip of the corporations, Moore would be better served to focus exclusive energy towards expanding the movement for Medicare For All, which he claims that he also supports, while maintaining that somehow Obamacare will evolve into Single Payer system. 
IT WILL......MEDICAID FOR ALL!

Most developed nations have achieved universal health care through a single payer system, which in the United States can be easily achieved by expanding Medicare to everybody.  Once the realities of Obamacare directly affect the majority of the population and exacerbates the crisis of U.S. healthcare, people will inevitably choose to support the movement of Medicare for All, the only real option for a sane health care system.

Shamus Cooke is a social service worker, trade unionist, and writer for Workers Action (www.workerscompass.org).  He can be reached at shamuscooke@gmail.com

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Cutting a trillion from Medicare and then allowing health corporations decide how those cuts will be made.....by limiting patient access of course. THAT'S A NEO-LIBERAL FOR YOU!

As the American people are now calling for Expanded and Improved Medicare for All you see neo-liberals and Obama are busy dismantling that as a public health program.  First you make it too expensive to access and then you pass TPP which does not allow policy that prevents private profits in health care!

So, this isn't just the poor and working class losing their access, it is the seniors and disabled as well.  Those upper-middle class still affording to buy private insurance------about 5% of Americans!

Medicare reimbursement cuts threaten access to care

Published on March 29, 2013 at 1:26 PM ·News Medical

Physicians and patients alike are feeling the impact of Medicare reimbursement cuts that went into effect on January 1, 2013. With an additional 2% sequestration cut to roll out on April 1, it's likely that physicians who treat Medicare patients will be faced with difficult decisions as operating margins continue to shrink.

The the 2% cuts may seem modest, but they come on the heels of much larger cuts to reimbursement for nerve conduction studies (NCSs) of 40-70% for Medicare beneficiaries. These cuts were announced November 1, 2012, and went into effect on January 1, 2013, allowing providers little time to prepare.

While all Medicare providers are feeling the squeeze, private practices are likely to experience the most impact. "These cuts may force private practice physicians to choose between seeing Medicare patients and keeping their practice open," said Catherine French, AANEM senior analyst of medical economic affairs. French is concerned that the sequestration cuts will be adopted by private insurers, too. "It is possible that private insurers will follow suit and reduce reimbursement by 2% because most model their payment rates on Medicare."

Cuts Threaten Access to Care
According to Kristi Snihurowych, MD, a spine interventionalist in Salt Lake City, UT, the cuts pose a serious risk to access to care. Snihurowych has decided to discontinue EMG and NCS testing, which previously made up an eighth of her total practice. "Given the cuts, it's no longer feasible to perform these tests in-house. The problem is, I cannot find anyone to do them for me," said Snihurowych. "It seems everyone has had to give them up, and not just for Medicare patients. Providers anticipate that other payers will soon follow suit, so many have stopped offering EMGs all together."

Snihurowych suspects unnecessary and costly procedures will be among the cuts' ripple effects. "I am seeing patients go to surgery without a definitive diagnosis of, for example, carpal tunnel syndrome because the surgeons cannot get confirmation by an EMG or NCS test."

Utah-based physiatrist Faisel M. Zaman, MD, PC, agreed, "People will pay with their health. Of course there will be financial costs associated with unnecessary surgeries, but the biggest cost will be to the patients with scars and pain from procedures they didn't need."

Zaman is a spine specialist who has had several cases where an EMG has prevented patients from undergoing major surgery. In one case, a healthy and active 70-year-old male patient was referred by a vascular surgeon who thought the patient was experiencing symptoms of peripheral vascular disease. But the surgeon wanted to rule out spinal problems before he did a major bypass operation. Following EMG testing, the man was diagnosed with spinal stenosis.

"EMG was critical in this case," said Zaman. "It turns out that he is a great candidate for nonvascular treatments that will improve his condition. Without the lower-extremity EMG, he would have undergone major surgery. It's scary to think of the consequences to patients if the availability of EMG testing becomes more limited. Ultimately, it would hurt patients the most."

Claire Wolfe, MD, AANEM past president, has similar concerns regarding access to care. Nearing retirement and working part-time, she is the only physician performing EDX studies for an office of 23 physicians, as well as some outside referrals. Before the cuts, two other physiatrists in her office performed EMGs.

"There will be greater uncertainty around diagnoses of upper and lower limb pain/numbness; neck surgeries rather than carpal tunnel releases and vice-versa; delayed diagnoses of motor unit diseases; and delayed recognition of folks with metabolic disorders like diabetes if patients don't have access to an electrodiagnostic study that may catch peripheral neuropathy changes before the diagnosis of the underlying disorder is made," Wolfe said.

Unfortunately, the impact of the cuts may be long-lasting. "These cuts will significantly impact Medicare beneficiary access to appropriate management of their disabling neurologic disorders, limit further the number of neurologists who are currently seeing Medicare patients, and discourage budding physicians from the field of neurology," said Mohammed Zafar, MD, in response to an AANEM survey about the Medicare reimbursement cuts for EDX procedures.

Looking Forward
With the cuts to Medicare reimbursement, AANEM members are asking what can be done to protect their practices and to ensure access to care for patients into the future.



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As this article shows big PHARMA drives TPP and it will basically end a nation's ability to lower prices either with restrictions to generic brands or collective purchasing power as is sought in the US in the case of Medicare.  As you hear neo-liberals saying good-bye doughnut hole/co-pays for PHARMA.....they are working to be sure you won't be able to afford it.

Who is PHARMA?  Well, Bill Gates is PHARMA in his funding of research for drugs to prevent disease in Asian and African nations.  Was he really being philanthropic or just getting the jump on global PHARMA markets?  Johns Hopkins is now attached to its BIO-TECH branch that will market its patents coming from taxpayer funded research.  IT IS NOW PHARMA.

WE NEED TO BE ELECTING POLITICIANS SHOUTING FOR EXPANDED AND IMPROVED MEDICARE FOR ALL AND GETTING RID OF THE GLOBAL CORPORATE AFFORDABLE CARE ACT SUPPORTERS!

Notice this article was written in 2011----everyone in power has known this was coming that long-----DO NOT BELIEVE YOUR POL WAS KEPT IN THE DARK!


Conclusion: A New International Agreement on Pharmaceutical Price Regulation?

The TPP chapter may be best seen as a significant step toward the pharmaceutical industry’s ultimate goal, which is a binding international agreement on drug pricing that would restrain the ability of governments to use collective purchasing power to demand prices below “market” levels.


  For immediate release.


By Sean Flynn, sflynn@wcl.american.edu

Lima, Peru. on October 22, 2011

Among the US Trans Pacific Partnership (TPP) proposals leaked today was a proposed chapter on “Transparency and Procedural Fairness for Healthcare Technologies,” more widely known as the Pharmaceutical Pricing Chapter.

All countries negotiating the Trans Pacific Partnership agreement should reject this proposal, the primary goal of which is to regulate pharmaceutical reimbursement programs. This is an extreme proposal that has no place in a trade negotiation, particularly one with some of the poorest countries in the world.



Although the provisions are styled as “transparency” provisions, in fact they regulate the substance of drug pricing programs. The heart of the proposal would require that countries establish new administrative and judicial appeal systems to contest whether public drug reimbursement rates “appropriately recognize the value” of pharmaceutical patents. Similar provisions have led to higher drug prices and more challenges by pharmaceutical companies in the one country to implement similar provisions – Australia.[1]

At the core of this proposal is a false distinction between government reimbursement prices and “market” prices. Government reimbursement prices ARE market prices. Suppliers can refuse to supply to governments, just as they can with any private purchaser demanding a better deal. The fact that governments obtain better prices than atomized consumers does not make their roles as purchasers anti-market. Drug price restraint is a natural, inevitable and beneficial result of public health expenditure or any other form of pooled purchasing. Large purchasers in free markets obtain better prices; governments obtain better prices when they pool consumers and negotiate as a volume purchaser.

Raising drug prices is, of course, the goal of pharmaceutical companies pushing for these provisions. This point was explained by President Bush’s Ambassador to Poland in a recently released cable. He explained:

While pharmaceuticals companies often assert that they would be happy with a transparent process, even if it led to decisions not to fund their drugs, in practice they seem to resent all government measures aimed at cost containment, as these also inevitably limit drug companies’ sales.[2]

This proposal is contrary to the demands of democracy, is bad for the development interests of poorer countries, and represents an affront to best practices in evidence-based health policy, including such practices in the US.

• Pharmaceutical price regulation is an inappropriate subject for closed door trade negotiations. The proposed pharmaceutical chapter regulates public health policy, not trade. This is perhaps most notable in the fact that the provisions apply to policies regardless of any trade distorting or discriminatory effect of the given policy. Using secretive trade negotiation processes to set minimum requirements for domestic health policy like this is democratically illegitimate. Enactment of reimbursement policies to advance public health outcomes lies in the core of domestic sovereignty. These policies do not affect a limited range of companies, justifying closed door processes where only those companies are meaningfully consulted. Public health policies affect all citizens and a wide variety of stakeholders that deserve to be included in policy making processes. Indeed, access to decision making processes that impact public health programs is an internationally recognized human right.
• Pharmaceutical price regulation is an inappropriate subject for agreements with developing countries. This would be the first-ever international agreement regulating the efficacy of pharmaceutical price regulations in developing countries. The ability to regulate the prices of patented products directly is one of the most important TRIPS flexibilities. Without some kind of price control, patents on pharmaceuticals demonstratively and predictably lead to excessive pricing of medicines in developing countries with very high income inequality. This is because the most profitable behavior of an unregulated essential service monopolist in high inequality countries will be to price to the richest tier of the population. [3] All of the developing countries negotiating the TPP (Peru, Malaysia, Vietnam, and Chile) have been identified as having high medicine prices given their development level. [4] The case of Vietnam is particularly egregious – with local prices of patented medicines 46 times higher than international referents.[5]
• The U.S. proposal would require bad public policy contrary to best practices in the US itself. Ironically and ominously, US drug pricing programs do not comply with the standards that the US is proposing. In particular, the operation of preferred drug lists by the Federal Medicaid program would violate the terms of the agreement, including because they do not provide appeals for pharmaceutical companies on whether the prices achieved adequately value patents. Previous FTAs with Australia and Korea carefully exempted all U.S. programs from their coverage, including through a footnote defining the federal Medicaid program as a “regional,” rather than “central,” level government program. That footnote has been removed from the draft TPP proposal. This may indicate that the US has not decided whether to propose exempting Medicaid from the TPP requirements or to give in to demands of other countries for full reciprocity in the agreement.

SECTION BY SECTION ANALYSIS

X.1: Agreed Principles. The agreed principles are verbatim restatements from the KORUS agreement. As in KORUS, they understate the role and importance of promoting affordability through pharmaceutical reimbursement policies. The provisions mainly discuss the promotion of “access” and “availability” of pharmaceuticals. The concept of affordability is mentioned only once. USTR’s recent white paper on TPP and medicines also defines “access” without reference to affordability concerns. One of the key purposes of drug reimbursement programs must be to promote affordable access to pharmaceuticals, not mere availability of the products themselves. This concern applies throughout the proposal.

X.2: Transparency Related to Healthcare Technologies. The provision creates a vague requirement that “all measures” related to pharmaceutical reimbursement be administered in an “objective” manner. This concept of “objective” administration of the law is not a current US legal requirement and is not defined in the agreement. What it means in this context is unclear, which may open opportunities for pharmaceutical companies to attempt to define it through litigation. What is a non-objective administration of the law? Would public interest standards violate the test? What about the choosing of drugs for a formulary based on a multitude of factors including price and availability decisions?

X.3: Procedural Fairness Related to Healthcare Technologies. This is the core section forcing countries to use formal rulemaking processes rather than market negotiations to determine reimbursement prices. International law should not determine this important policy choice. Countries must be free to use reimbursement programs as a player in the market rather than as its regulator.

X.3(a): The term “reasonable period” has no definition in the agreement or in US or international law. It invites litigation.

X.3(b): The requirement to disclose all methodologies used to negotiate drug prices is one of many rules forcing the government to operate as a price regulator rather than market participant. Private companies do not disclose such information to their suppliers.

X.3(c): The requirement to give notice and comment opportunities during reimbursement decisions prevents health authorities from using negotiation rather regulation to set drug prices. Private entities do not invite public comments on their negotiations with suppliers.

X.3(d): This is one of the most worrisome provisions in the text. The provision has two parts:

• The first part encourages countries to abandon any economy of scale benefits from pooled purchasing through government and instead reimburse pharmaceutical companies at rates “consisting of competitive market-driven prices in the Party’s territory.” The restriction to “in the Party’s territory” was not included in previous agreements and is designed to restrict countries from the common practice of using international reference prices to determine reasonable reimbursement rates. This rule is not followed in the US. Medicaid programs receive discounts of up to 50% off the list price for pharmaceuticals due to their increased purchasing power. The provision is also practically unworkable since other large private purchasers in the market will not be under any obligation to disclose their “market-driven” prices.
• The second part of this section, read with paragraph (i), provides that if countries do not set reimbursement prices at the “competitive market-driven” price, then they must provide companies with appeals of whether reimbursement prices “appropriately recognize the value” of patents. There is no objective measure of the “value” of a patent. Economists normally define value as a function of market price. But in a monopoly market for an essential good, particularly in countries with high income inequality, this market price will be excessively high absent government regulation. It is impossible to know how this provision would be implemented. It invites litigation and promotes uncertainty.

X.3(e): This provision mandates that countries allow companies to “apply for an increased amount” in reimbursement based on evidence of “superior safety, efficacy or quality.” This provision is potentially beneficial in embracing the idea that prices should be set based on efficacy rather than market value. Nonetheless, affordability concerns must also be an integral part of reimbursement decisions, but are not mentioned.

X.3(f): This provision mandates that governments allow companies to “apply” for reimbursements for additional medical indications for products. The provision has no requirement that the additional indications applied for first be approved by the government’s medical registration authorities. It rather suggests that the safety and efficacy information would be submitted directly to the reimbursement entity, side stepping regulatory authorities.

X.3(g, h, i): These provisions require that governments provide written reasons for every decision [(g) and (h)] and then provide an “independent appeal” of any reimbursement decision (i), presumably based on the substantive restrictions on reimbursement programs defined in X.2(d). These provisions will likely increase pharmaceutical company negotiating power to exact higher prices from governments through litigation threats.

X.3(k): This provision requires that all members of reimbursement committees be made public, presumably to enable targeted lobbying from pharmaceutical companies. Such lobbying can be detrimental to public decision making, especially when linked to unethical gift giving that has plagued pharmaceutical marketing in the US and elsewhere.

X.4: Dissemination of Information to Health Professionals and Consumers. This provision attempts to set drug marketing policy through trade agreements. It would mandate that countries allow certain kinds of direct-to-consumer and direct-to-physician marketing efforts over the internet. This is a subject currently subject to regulatory investigations in the US and would be contrary to the drug marketing laws of many countries. The provision would appear to make illegal a proposal by Representative Waxman that companies not be allowed to engage in certain kinds of direct to consumer promotion in the first three years of a drug’s time on the market.

X.5: Ethical business practices [no text]. As in other areas of the TPP, provisions protecting corporate concerns are well developed and those potentially protecting consumers are absent. This section should consider standards that would ban gift giving and other pecuniary relationships between pharmaceutical companies and prescribers or government health officials. It should ban off-label marketing of drugs. It should mandate private and public rights of action against fraudulent and misleading marketing practices.

X.6: Cooperation. As in the agreed principles, this provision appears tailored to promote a conception of “availability” that does not include affordability. The key concern of countries in the region, and in particular the US, should be on sharing information on how best to ensure the affordability of medicines in the context of the ongoing economic crisis.

X.7: Definitions. Few of the key terms in the agreement are defined, including “access,” “value,” “reimbursement” and “health care programs” as applied to the scope of coverage, “transparent,” “verifiable,” “objective,” “competitive-market derived,” “independent” as related to “appeal or review.”

X.7 fn 2. (US carve out?). In previous agreements with the US including pharmaceutical chapters, the US has claimed that they have no application to programs in the US. The KORUS agreement included a footnote stating: “For greater certainty, Medicaid is a regional level of government health care program in the United States, not a central level of government program.” This footnote has been criticized in the US for potentially leaving vulnerable other US programs that control prices on drugs in government programs, including through Medicare and the so-called 340b program. TPP removes this footnote form the proposed text and substitutes a bracketed place holder for clarification of the scope of application. This should be concerning to US health advocates and officials. A letter from several senior members of the US Congress, released during the Chicago round of negotiations, instructed that “TPP should not undermine either U.S. or other member countries’ current or prospective, non-discriminatory drug reimbursement policies and programs (e.g. Medicare, Medicaid, the VA, and other programs).” Vermont Governor Peter Shumlin wrote President Obama with respect to a possible TPP pharmaceutical chapter:

Even if a chapter was proposed that did include a Medicaid carve-out, state leaders believe it is inappropriate for U.S. trade policy to advance restrictions on pharmaceutical pricing programs that U.S. programs do not meet but for technical carve outs.[6]

Conclusion: A New International Agreement on Pharmaceutical Price Regulation?

The TPP chapter may be best seen as a significant step toward the pharmaceutical industry’s ultimate goal, which is a binding international agreement on drug pricing that would restrain the ability of governments to use collective purchasing power to demand prices below “market” levels.[7] This is a radical proposal that would move trade agreements completely beyond any pretense to regulate trade and instead directly regulate domestic regulation itself. If such an agreement is desired by countries, it should be negotiated in an open forum where public health experts and advocates are well represented, e..g the World Health Organization. This is a completely inappropriate subject for closed door trade negotiations.





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Selling this policy as helping to insure groups not previously covered is a ploy to hide the real mission and that is to end public health and programs that protect the public on health issues.  Does it matter if you have subsidized insurance coverage if you cannot pay to access it?  Of course not.  The ACA makes it sound as if people will gain access when in fact they are losing it!

Review of U.S. Health Care Law from a Human Rights Perspective

DGH Supports Medicare for All

Many misconceptions exist, both in the U.S. and abroad, about the health care reform law recently passed in the U.S. The Patient Protection and Affordable Care Act (PPACA) implements a series of health care and insurance related provisions to take effect over years -- most by 2014.

A recent report by the National Economic and Social Rights Initiative (NESRI) has published several documents that point out where this law has failed women, immigrants, and people of color.  

To briefly explain, the PPACA will extend health insurance to 32 million more Americans. Many will get insurance through Medicaid, a federal social insurance program for the poor, which will be expanded to cover all citizens and some legal residents up to 133% of the federal poverty level. The PPACA will subsidize insurance premiums for lower income individuals and families, and give financial incentives to businesses to provide health care benefits to employees. It initiates consumer protections from certain insurance company abuses such as being cut off (“rescission”) and discrimination against those with pre-existing conditions.  It will mandate that all legally residing U.S. residents obtain medical insurance, and state-based insurance “exchanges” will be established. It will establish a non-profit Patient-Centered Outcomes Research Institute to assess the relative outcomes, effectiveness and appropriateness of various treatments. Funding for community health centers and payments for primary care services will increase substantially. Cost sharing for preventive care will be eliminated, and it will also eliminate co-pays for prescription drugs for those with Medicare.

Although more people will obtain insurance once the law is fully in effect in 2014, this actually insures that more public and private funds will flow to pharmaceutical, insurance, hospital and other health care industry corporations. An estimated $447 billion in taxpayer money from the new law will go directly to the health insurance industry alone. While the PPACA creates some important consumer protections and will expand health care coverage for millions, it continues to strengthen a profit-driven and fractured approach to health in the U.S. It is far from a comprehensive system of health care for all.

Impact of the PPACA on marginalized and vulnerable groups

Under the new law, an estimated 23 million Americans will remain uninsured.  This translates to 23,000 unnecessary deaths annually, and preventable and unnecessary suffering for those who remain without access to healthcare. In addition, many previously uninsured will be mandated to spend a significant portion of their income on health care from private insurers and still may not have comprehensive coverage. On average, poor people will spend 10% of their income to cover 70% of health care expenses, with co-pays and fees still unaffordable for many  Medicaid expansion will largely be outsourced by the federal government to private insurance companies, raising concerns over for-profit abuse of Medicaaid. Federal payments to hospitals with a large proportion of uninsured and low-income patients will be lowered, limiting much needed services.

Under the new law, the health rights of women have been undermined.  Gender-based higher insurance rates for women will remain legal until at least 2017, and large employer based insurance programs will be exempt from the new PPACA provision on gender rating prohibition. Women’s reproductive rights have been eroded, as the law seriously restricts access to abortion by requiring segregation of federal insurance funds for abortion from all other medical services. This means that government funds to finance insurance programs in the PPACA cannot be used for abortion services except in cases of rape, incest, or if a woman’s life is in danger. Contraception is currently not considered a “preventive” service, so women may continue to pay for this out of pocket, despite the PPACA law that eliminates fees and co-pays for preventive services. 

Under the new law, documented immigrants are subject to the health insurance mandate upon entry to the U.S., but still face waiting periods of 5 or more years to qualify for government social services such as Medicaid. This means the large expansion of Medicaid under the new law excludes all recent immigrants. Undocumented immigrants will be unable to access state exchanges to purchase their own insurance. Nor will Medicaid (except in cases of medical emergency) or other social services be open to them. This continues a dire and inhumane practice for asylum seekers and undocumented immigrants that denies them essential health care. In addition, overly strict verification requirements for the exchanges may lead to an exclusion of many eligible applicants. 

Again, please share this information. The struggle is not over for fair, equitable, and comprehensive health care for all in the U.S.

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As we see below, the ACA was simply a policy preparing the US market for these TPP treaties.....and as you see the US is criss-crossing the world pressuring other nations to shed their public health because, after all, the US now sees health care as purely market driven.....as it does education.  GOOD BYE PUBLIC HEALTH !

If Obama and neo-liberals are working so hard overseas to end public health and create these TPP treaties that super-size corporate control of all public policy especially health care......DO YOU REALLY THINK THEY ARE SITTING ON CAPITOL HILL FIGHTING REPUBLICANS IN OUR BEHALF?????

REALLY?????



Public Health Advocates Must Derail the TranPacific Partnership

December 29, 2013

Kris Alman, Assistant Secretary of Health for Data Privacy

Without public input, fast-track passage of this treaty could jeopardize their important work with the threat of costly lawsuits that put profits over people.

The mainstream media should be ashamed of its minimal attempts at informing the American people about the TranPacific Partnership (TPP). Negotiated in secret, the TPP is NAFTA on steroids. It’s urgent we demand that Congress oppose a “fast track” of this treaty.

You may be muttering, “Why pay attention to this irrelevant issue?” After all, we’re too busy working long hours to buy cheap Nike shoes, iPads and apparel from retailers like Walmart to celebrate the Christmas® holidays.

Indeed, we are so busy buying stuff destined for landfills that we don’t realize we are disposable too. The wizards behind the curtain of the TPP are 600 corporate “advisors” for rich multi-national corporations that don’t care about public health, the environment and human rights. They care about profits—period.

Over the weekend, the New York Times published a front-page story, “Tobacco Firms’ Strategy Limits Poorer Nations’ Smoking Laws.” While the Times pointed out that the U.S. is among twelve Pacific Rim Countries completing talks on a major new trade treaty that will be a “model for the rules of international commerce,” they made no mention of the TPP. “Fast tracking” the TPP requires a complicit mainstream media—one that eliminates enough dots so citizens can’t connect them.

The Oregonian is no different. As a scribe for Nike, the Oregonian reports that the TPP would eliminate tariffs on sneakers (outsourced to manufacturers who pay low wages overseas) and magically, we'll have more high-paying jobs here! Money needs to circulate for a society to thrive. Since the 2008 recession, we’ve learned that money is heading in just one direction: upwards. Global trade agreements will further concentrate money and power when corporate boardrooms reward their executives—including Nike CEO Mark Parker.

A Nixon innovation, fast track limits Congress to a no-amendments, no-filibuster, simple majority vote on complex trade agreements—even though the rare Congressman or Senator has read the TPP. Fast track expired in 2007. A midterm election compels the most do-nothing Congress to make amends to their corporate donors. Passing fast track in early 2014 is a bipartisan agenda.

The TPP is much more than tariffs. There are twenty-nine chapters and only five chapters deal with traditional trade issues. In mid-November, Wikileaks released draft text of the TPP Intelligential Property Rights chapter. This text includes an investor-state protection clause that gives multi-national corporations the right to sue communities, states and nations enacting laws that might compromise future profits.

The TPP singles out tobacco as a health concern, but the Chamber of Commerce says this “would leave the door open for other products, like soda or sugar, to be heavily regulated in other countries.” The Chamber of Commerce sent a letter to U.S. Trade Representative Michael Froman, opposing the “last-minute inclusion of a product-specific reference to tobacco or any other product.” They claimed “the TPP nor any prior U.S. trade agreement prevents American officials from regulating in the public interest—period. Trade agreements only require that such measures be based in sound science…”

Like the “sound science” performed by Monsanto that “proves” GMOs are safe and labeling is a costly regulatory burden?  One of the lobbyists that co-signed the letter is the Grocery Manufacturers Association. The Grocery Manufacturers Association amassed $7.2 million (of over $22 million in the opposition coffers) to successfully oppose GMO labeling in Washington State. PepsiCo, Nestle USA and Coca-Cola each donated over $1 million to that Grocery Manufacturers Association slush fund.

Corporations are tribal when they collectively fight public health campaigns because it’s costly for corporations to also fight “sin taxes.” In 2010, these same corporations helped to raise over $16 million to pass Initiative 1107 which repealed a tax on candy and soda in Washington. This discouraged Upstream Health, a nonprofit in Oregon, to mount a similar campaign to tax sugary sodas in 2013, especially since they couldn’t get a hearing for the same bill in 2011. Yet there is no question that sugar-sweetened beverages promote obesity.

Since the mainstream media protects corporate interests, WikiLeaks came to the rescue in publishing the Intellectual Property chapter of the TPP. If you can't stomach Julian Assange, turn to Joseph Stiglitz, (Columbia professor and winner of the Nobel Prize for Economic Science in 2001), who wrote an open letter to the TPP negotiators. Sadly, we must look to blogs for this publication. Stiglitz concludes, "The investor state dispute resolution mechanisms should not be shrouded in mystery to the general public, while the same provisions are routinely discussed with advisors to big corporations.

The invisible hand of “free” market forces is what Milton Friedman calls “the possibility of cooperation without coercion.” In the current era of mass communication and micro-targeted advertising, corporations have the upper hand when they defend their ability to obfuscate harms, laying blame on people that should take “personal responsibility” for their consumer choices.

More than three-quarters of the world’s smokers now live in the developing world, too poor to fight corporate lawsuits that might arise if they try to place limits on advertising, packaging and sale of tobacco products. With deep pockets, corporations squelch the voice of public health advocates while they belittle consumer protections as the “nanny state.”

The TPP subordinates public health, the environment and human rights to corporate profits. As global citizens, we must take time to learn more about the TPP. Call Congress and demand NO FAST TRACK.

~ Kris Alman serves as Assistant Secretary of Health for Data Privacy in the General Welfare Branch of the Green Shadow Cabinet.



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Here you see an article written last year.  This information was available to all politicians and pundits that pushed the ACA as hard as they could.....knowing it simply prepared US policy for these TPP deals.

Know who shouted loudly and who was silent------silence in these cases is duplicity and in Maryland----all democrats are silent and neo-liberals have to go!

IF YOUR LABOR AND JUSTICE ORGANIZATIONS ARE NOT RUNNING CANDIDATES IN ALL PRIMARIES AGAINST NEO-LIBERALS -----THEY ARE NOT WORKING FOR YOU AND ME!

TPP’s Investment Rules Harm Public Health
27/06/2012
Trade officials from nine Pacific Rim nations—Australia, Brunei, Chile, Malaysia, New Zealand, Peru, Singapore, the U.S. and Vietnam— are in intensive, closed- door negotiations to sign a Trans-Pacific Partnership (TPP) free trade agreement in 2012. Every Pacific Rim nation from China and Russia to Indonesia and Japan could eventually be included. There are draft texts for many of this pact’s 26 chapters, most of which have nothing to do with trade, but rather impose limits on domestic food safety, health, environmental, and other policies. The governments won’t release the texts to the public. But over 600 U.S. corpo rate “trade advisors” have full access. America’s worst job-offshoring corporations, global banks, agribusiness, and pharmaceutical giants want this deal to be another corporate power tool like NAFTA (North American Free Trade Agreement.) Consumer, labor, environmental, and other public interest advocates want transparen- cy in the process and a “Fair Deal or No Deal.”

A major goal of U.S. multinational corporations for the TPP is to impose on more countries a set of extreme foreign investor privileges and rights and their private enforcement through the notorious “investor-state” system. This system allows foreign corporations to challenge before international tribunals national health, consumer safety, environmental, and other laws and regulations that apply to domestic and foreign firms alike. Outrageously, this regime elevates individual corporations and investors to equal standing with each TPP signatory country’s government – and above all of us citizens. This regime would empower corporations to skirt national courts and sue our governments before tribunals of private sector lawyers operating under UN and World Bank rules to demand taxpayer compensation for domestic regulatory policies that investors believe diminish their “expected future profits.” These regulatory policies can be anything from health and environmental protection to financial regulation. Indeed, under this regime, corporations can launch attacks on changes in government regulation surrounding patents and other intellectual property rights – something that can cast a chill on efforts to improve access to safe and affordable generics.

If a corporation “wins”, the taxpayers of the “losing” country must foot the bill. Over $350 million in compensation has already been paid out to corporations in a series of investor-state cases under NAFTA-style deals alone. This includes attacks on toxics bans, natural resource policies, health and safety measures, and more. In fact, of the over $12.5 billion in the 17 claims now pending under NAFTA-style deals, all relate to public health, environmental, and transportation policy – not traditional trade issues. Even when governments win, they waste scarce budgetary resources defending national policies against these corporate attacks.

A review of just some of the outrageous cases brought under this system highlights the extreme peril of these extreme investor privileges and their investor-state private enforcement being included in a TPP: 

Investor-state attack on cigarette plain packaging policies:

In the mid-2000s, countries from around the world signed onto the World Health Organization’s Frame- work Convention on Tobacco Control, which aims “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for tobacco control measures to be implemented by the Parties at the national, regional and international levels in order to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke…”

In 2008, Uruguay began implementing its obligations under this framework, including through legislation to enhance tobacco warning labels and require plain packaging. In 2010, Australia followed suit. But before the ink was even dry on these efforts, Philip Morris launched investor-state attacks against both countries. While the company is widely considered a U.S. company, the U.S.-Australia Free Trade Agreement doesn’t have investor-state arbitration, thanks to the push-back of legislators in both countries at the time of negotiation. So Philip Morris used its Swiss and Hong Kong subsidiaries to launch the attacks, using Bilateral Investment Treaties. The company is requesting investor-state tribunals to block the Uruguayan and Australian legislation from going into effect, and to have taxpayers of these nations compensate the company.  

Justice for children poisoned by smelter imperiled by investor-state:

Citizens in La Oroya, Peru suffer from the toxic emissions from a metal smelter owned by Ira Rennert, one of the richest men in the United States.  

An in-depth scientific study of the site – deemed among the top 10 most polluted worldwide – noted that sulfur dioxide concentrations at La Oroya greatly exceed international standards, noting that the chemical “damages the respiratory system, aggravates existing respiratory illnesses (especially bronchitis), and diminishes the capacity of the lungs to expel foreign particles such as heavy metals. It leads to a higher mortality rate, particularly when combined with the presence of elevated levels of particulate material.” The study found that sulfur dioxide levels doubled in the years after Rennert’s acquisition of the complex. When Rennert’s company bought the smelter, it agreed to construct a sulfur plant by 2006, which  would help with environmental remediation. But the company did not, and requested – and was granted extensions in 2006 and 2009.  That same year, the company presented a proposal to the Peruvian authorities to restart the smelter if the environmental commitments were loosened. The Peruvian government refused, and by the end of the year, Rennert had launched an attack under the U.S.-Peru FTA, claiming at least $800 million in damages. Among other claims, the company argues Peru’s failure to grant additional extensions constitutes an FTA violation. Unfortunately, past tribunals have found that countries can violate FTAs by disappointing investors’ expectations. Rennert’s efforts seem to have succeeded in casting a chill on the Peruvian government, which is slated to loosen the environmental requirements that the company must meet.  

Canada reverses ban on toxic gasoline additive after investor-state attack, pays $13 million.

Ethyl Corporation was a Virginia-based chemical company with a long and controversial history. In the 1950s, Ethyl Corporation developed a new gasoline additive called methylcyclopentadienyl manganese tricarbonyl (MMT). MMT, an anti-knocking agent used to improve engine performance, contains manganese – a known human neurotoxin. MMT was banned from use in unleaded gasoline by California, which has its own clean air law, and by the U.S. Environmental Protection Agency, due to environmental and public health concerns. Against this background, the Canadian Parliament imposed a ban on the import and interprovincial transport of MMT in April 1997. 

Although the potential hazards to human health were not fully-known, Canada acted in a precautionary manner until more information was available, as had the state of California and the U.S. EPA. But on September 10, 1996, while the prospective ban was being debated in the Canadian Parliament, Ethyl Corporation notified the government of Canada that it would sue for compensation under NAFTA’s investment chapter if restrictions were placed on MMT. The Parliament withstood these threats and passed the ban a year later in April 1997. That same month, Ethyl filed a NAFTA investor-state claim against the Canadian government. Initially, Canada objected to the NAFTA suit. On June 24, 1998, however, the NAFTA panel rejected Canada’s claims, clearing the way for the case to move forward. Shortly after this initial ruling, the government of Canada decided to settle with Ethyl.  

On July 20, 1998, Canada reversed its ban on MMT, paid $13 million in legal fees and damages to the Ethyl Corporation, and issued a statement for Ethyl’s use in advertising declaring that “current scientific information” did not demonstrate MMT's toxicity or that MMT impairs functioning of automotive diagnostic systems. This case shows how investor-state rules can cast a chill on public interest regulation. 

Growing resistance.

The investor-state system is so extreme that it is losing whatever small political support it ever had. Australia has said it will not include investor-state in its trade deals, and the Korean opposition parties are promising to derail the pending Korea-U.S. trade deal unless investor-state is removed. Latin American countries are pulling out of various arbitration agreements that provide venues for these private corporate attacks. President Obama even campaigned against this system! But career bureaucrats and big business want to stay the course, no matter the cost.




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Johns Hopkins has used a trillion dollars in public taxpayer money to build its global health corporation.....a few billion in Baltimore alone as the city crumbles from lack of government revenues.  When questioned about paying corporate taxes since it is now a global corporation Hopkins stated 'we will not pay taxes'.  It now controls the entire City of Baltimore development and policies are all neo-con.

This is what the ACA is all about.  It is a mirror of the Clinton banking deregulation and consolidation and is only meant to create global health corporations like these.  Hopkins declared health institutions have never been more profitable as quality of care/access has plummeted. 

8 Health Systems That Created International Partnerships in 2013

Written by Bob Herman  | December 26, 2013 Becker's Hospital Review


Globalization is a major part of the business sector, and several U.S. health systems have also grown their roles internationally.

Several providers expanded their work and ideas into other countries. Here are eight hospitals and health systems that created some of the most significant international partnerships in the past year, starting with the most recent.

1. Irving, Texas-based Christus Health finalized a joint venture with Pontificia Universidad Católica de Chile, a Chilean university in Santiago. Under the agreement, the two will become equity partners in a Santiago, Chile-based health network called Red Salud UC. 

2. Brentwood, Tenn.-based RegionalCare Hospital Partners partnered with Nashville, Tenn.-based nonprofit LiveBeyond to open a hospital in Thomazeau, Haiti.

3. Sioux Falls, S.D.-based Sanford Health partnered with YMCI Calmette Medical Investment & Management Company, a state-owned health system in China's Yunnan province. Sanford launched its World Clinics initiative in 2007 to develop a series of pediatric clinics in the U.S. and around the world in areas lacking sufficient primary care services. It has since expanded the scope of the initiative to provide care for entire families.

4. Baltimore-based Johns Hopkins Medicine International signed an affiliation agreement with Hospital Moinhos de Vento of Porto Alegre in Brazil. 

DOES 'MEDICINE INTERNATIONAL' SOUND LIKE A CORPORATION AND NOT A NON-PROFIT?  YOU BETCHA, BUT THEY ARE STILL CATEGORIZED AS NON-PROFIT AS IS MEDSTAR, A NATIONAL HOSPITAL CHAIN!

5. University of Rochester (N.Y.) Medical Center and Chennai, India-based Apollo Hospitals discussed a potential affiliation. Apollo is one of the largest private hospital networks in its region, with 50 hospitals located across India and eight other countries in South Asia, the Middle East and Africa.

6. A July agreement between Kazakhstan's Nazarbayev University and Pittsburgh-based UPMC's Pitt School of Medicine will help NU open its first medical school

7. Winston-Salem, N.C.-based Wake Forest Baptist Medical Center announced its commercialization arm, Wake Forest Innovations, signed a memorandum of understanding with CHA Health Systems, based in Seoul, South Korea.

8. Cleveland Clinic signed a contract with an academic medical center in Beijing, where Cleveland Clinic physicians will consult on the opening of a new brain health facility.





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I showed recently that 80% of Americans have now been driven to the poverty line so will not be able to afford the premium payments much less the co-pays and deductibles.  THAT IS THE POINT! 

What they are doing is setting up a system of 'preventative care' that fills the entitlement system with the same kinds of health care that most of the health fraud exists.  OK, you get preventative care checkups that find you have HIV....how do you afford the treatment?  YOU DO NOT.  You do get placed in the database as having this illness and these lists will be available to corporations who then will not hire you.  You have no job, no access to basic health care for HIV and you die prematurely.  This same scenario plays for any of the chronic illnesses that require long-term treatment and we know most people will not afford treatment beyond the first level of care.  It systematically kills most Americans.

Why are they doing this?  Because these few decades health industry has been stealing hundreds of billions of dollars each year from Medicare and Medicaid so these Trusts are gutted by fraud.  Then, they dismantled all of the oversight in Medicare agencies and allowed profiteering with super-sized pricing that drained these Trusts----WE PAID FOR THE MEDICAL ADVANCES AND WE WILL HAVE ACCESS TO THEM!

FRAUD AND PROFITEERING IS THE PROBLEM AND OBAMA AND NEO-LIBERALS MADE THE AFFORDABLE CARE ACT ABOUT ELIMINATING ACCESS TO GET RID OF COSTS THAT CUT INTO PROFIT.

Everyone understands that simply having a few health incidents a year will end a family's ability to access more care!

Obamacare: Is a $2,000 deductible 'affordable?'

By Tami Luhby  @Luhby June 13, 2013: 6:23 AM ET

Participants may have different views on whether Obamacare plans are affordable.

NEW YORK (CNNMoney) Until now, much of the debate swirling around Obamacare has focused on the cost of premiums in the state-based health insurance exchanges. But what will enrollees actually get for that monthly charge?

States are starting to roll out details about the exchanges, providing a look at just how affordable coverage under the Affordable Care Act will be. Some potential participants may be surprised at the figures: $2,000 deductibles, $45 primary care visit co-pays, and $250 emergency room tabs.

Those are just some of the charges enrollees will incur in a silver-level plan in California, which recently unveiled an overview of the benefits and charges associated with its exchange. That's on top of the $321 average monthly premium.

For some, this will be great news since it will allow them to see the doctor without breaking the bank. But others may not want to shell out a few thousand bucks in addition to a monthly premium.

"The hardest question is will it be a good deal and will consumers be able to afford it," said Marian Mulkey, director of the health reform initiative at the California Healthcare Foundation. "The jury is still out. It depends on their circumstances."

A quick refresher on Obamacare: People who don't have affordable health insurance through their employers will be able to sign up for coverage through state-based exchanges. Enrollment is set to begin in October, with coverage taking effect in January. You must have some form of coverage next year, or you will face annual penalties of $95 or 1% of family income (whichever is greater) initially and more in subsequent years.

Each state will offer four levels of coverage: platinum, gold, silver and bronze. Platinum plans come with the highest premiums, but lowest out-of-pocket expenses, while bronze plans carry lower monthly charges but require more cost-sharing. Gold and silver fall in the middle.

The federal government will offer premium subsidies to those with incomes of up to four times the federal poverty level. This year, that's $45,960 for an individual or $94,200 for a family of four. There will be additional help to cover out-of-pocket expenses for those earning less than 250% of the poverty line: $28,725 for a single person and $58,875 for a family of four. The subsidies are tied to the cost of the state's silver level plans.


California offers insight into how much participants will actually have to pay under Obamacare. The state, unlike most others, is requiring insurers to offer a standard set of benefits and charges in each plan level. The only variables are monthly premiums, doctor networks and carriers in your area.

For those in need of frequent medical care, the platinum or gold plans would reduce out-of-pocket costs for treatment. These plans have no deductible, and doctors' visits and medication are cheaper. But the trade-off is that they have higher monthly premiums. California has not yet released the premium range for these tiers.

On the flip side, a young man who never visits the doctor and wants to minimize his monthly charge could opt for a bronze plan. A 40-year-old enrolling in this plan could pay as little as $219 a month. But, if he did get sick, he'd get socked with a $5,000 deductible, $60 co-pays for primary care visits and a $300 emergency room charge.

Obamacare provides protection for those who need a lot of care by placing a cap on out-of-pocket expenses. The maximum a person in an individual platinum plan will spend a year is $4,000, while those in the other tiers will shell out no more than $6,400.

"Insurance is expensive. It's hard for anyone who isn't well off to afford it," said Gary Claxton, director of the health care marketplace project at the Kaiser Family Foundation. "But it is good enough that you can afford to get sick without bankrupting yourself."

Whether potential enrollees find these plans affordable will depend on how healthy they are and whether they are currently insured.

Many individual insurance offerings currently available come with much higher deductibles, cover fewer expenses and limits on how much they'll pay out in a year. Plans on the exchange, on the other hand, are required to cover a variety of "essential benefits," including maternity care, mental health services and medication.

"In many cases, depending on the plan, the coverage will be more comprehensive than what the enrollee currently has," said Anne Gonzalez, a spokeswoman with Covered California, which is running the state's exchange.