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Mr. Mead cited a report by the Institute of Medicine that tallied more than $760 billion in health care “waste” created annually as a result of consumer fraud, unnecessary procedures and excessive administrative costs.

r. Mead said the campaign also stressed the need for health care providers to shift to a model known as “accountable care,” which shifts their reimbursement models for health care professionals from being paid for the volume of services they perform to being paid based on the outcomes of patient care. Accountable care systems are usually linked to technologies that help health care providers measure performance and manage patient data. Aetna has 27 accountable health care agreements with hospitals and other health care providers around the country.

Bertolini said in the video. “If we fix just 20 percent of it, we could pay for the Affordable Care Act. We could insure everyone without increasing taxes.”

making unionized workers less competitive and potentially causing unionized employers to drop the plans that cover more than 20 million people.

To offset the expected rising costs of these "multiemployer" plans, several union groups want their lower-paid members to be able to remain on the plans wh

"will shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class," the union officials wrote.

Operators of employer health-insurance marketplaces say many workers pick cheaper coverage than they previously had and that is one way the exchange approach can save money.

In an exchange run by Liazon Corp. that has around 60,000 people enrolled, about 75% of the workers have chosen less-expensive plans, accepting bigger deductibles and other out-of-pocket charges, as well as smaller choices of health-care providers and restrictions such as primary-care gatekeepers. "They want value for their money," said Alan Cohen, Liazon's chief strategy officer.

Accenture ACN +0.08% PLC projects that around a million Americans will get employer health coverage through such marketplaces next year, and the number will increase to 40 million by 2018.

rkansas has been at the center of the ACA conversation with its game-changing plan for a privatized Medicaid expansion that several Republican-led states considered.

Several hospital chains are driving the boom – including HCA Inc., which will open its seventh ER later this year in Florida, and Wake Med Health and Hospitals, which will add its fourth next month in the Raleigh, N.C., metro area. They regard the facilities as a way to expand into new markets, generate admissions to their hospital and reduce crowding at their hospital-based ERs.

reater Houston has 150 emergency rooms — twice the number as greater Miami -- even though its population is only slightly bigger, according to a KHN analysis.

While the ERs charge insurers double or triple the amount per patient as an urgent care center or doctor's office, patients use them for routine care that could be provided in less costly settings, Ho says. That is the case with standard ERs as well. Yet, insured patients have little incentive to drive past the more expensive, freestanding ERs because their co-payment is only $50 or $100, just modestly more than what it might cost for a visit to an urgent care center or doctor’s office. Their insurers pay the balance generally.

A: That’s true. Or that’s a prediction that I believe will be proven true, I should say. Here’s the explanation. The standard theory on making insurance markets is that you want its competition to be continuous. The way to do that is to see that the risk pool of covered lives is a large, stable and ideally relatively health population. I cannot think of a larger, more stable and relatively healthy population, in proportion to the rest of the exchange population, than the Medicaid expansion population. They are systemically younger than the rest of the population. That’s one of the reasons that they're poorer. Our program design is also going to pull out the highest-risk people from the private option and treat them in the traditional Medicaid program because we would have had to supplement for many of their services. (Editor's note: Federal law requires Medicaid premium assistance to 'wraparound' to make sure recipients get the same amount of coverage through private insurance as they would in Medicaid). That’s very hard to do. It’s both care and administratively burdensome. Those individuals, the highest five to 10 percent costly individuals, would be better served in a single program, and by definition that would have to be the traditional Medicaid program.

Unless trends change significantly in 2013, the key determinants of whether a particular physician will be able to avoid a Medicare pay-for-reporting penalty are his or her specialty and the state in which the doctor practices

Once we understand the rules, we are pretty good at playing by them,” said Lee Hilborne, MD, a professor of pathology and laboratory medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

All health plans offered on a state exchange must provide comprehensive coverage that includes doctors’ visits, lab work, hospital stays, emergency room services, maternity care, prescriptions, mental health services and children’s dental and vision care.

Policies with the most generous benefits will be “platinum” plans; they will have the highest monthly premiums but fewer out-of-pocket costs and lower deductibles. The “gold” and “silver” plans will be somewhat less generous, while those in the “bronze” category will have the cheapest premiums but may require high out-of-pocket costs and deductibles.

Be aware that the plans may have narrow provider networks — your favorite doctor or the hospital down the street may not be a participant. You’ll need to check to see if a certain provider is in the network, advised Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reform.

"Fifteen years ago, pricing was not as important…[but] when the co-pay is coming out of a patient's pocket, they more often want to know what they're paying," said Moshir Jacob, medical director at the Toledo Clinic. The Ohio practice advertises that it offers lower prices than area hospita

Others doubt there has been a structural change. "We haven't done anything in the past three or four years that fundamentally altered the health-care system," said Gerard Anderson of Johns Hopkins University, who was the lead author of the "It's the Prices, Stupid" paper a decade ago. "And everything in Obamacare that tried to control cost was watered down."

The system now offers members a choice: Have your procedure at one of 51 hospitals that agreed to limit what they charge, or have the surgery elsewhere and pay any expenses above $30,000 out of pocket.