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Posts Tagged ‘Affordable Care Act’

H-Hour by Christine Doyle

I was going to title this post D-Day but decided that was too harsh since it refers to the day a military attack is unfurled.  Too many people, on both sides of the aisle, view Obamacare in military terms. In fact, the whole fight mentality is part of the problem. It has caused a lot of Americans to tune out exactly when they need to dial in and be informed. We need to be realistic and reasonable in how we approach healthcare reform because everyone agrees costs have spiraled out of control at exactly the time when government resources are strapped. Since we’re talking about healthcare, it seems H-Hour is a more appropriate term for this post.  The hour has arrived when Americans are confronting healthcare reform. Today is the deadline when those without insurance have to sign up or face penalties of either 95 dollars or 1% of their incomes, whichever is greater. I signed up last week, paid my first premium and am now feeling relief that I am protected in a catastrophic event. Having said that, I am far from satisfied with the outcome.

I don’t qualify for assistance (nor would I ask for it) and don’t mind paying a little more for coverage, as long as doing so opens the umbrella to those who have never been able to get it. I was willing to pay a little more but didn’t want to have to give up what was working. I did choose to go through a private insurer who knew me and my health history.

What I got is very different from what I wanted. I am happy that 100 percent of preventive care is covered (yoga isn’t but chiropractic care is) and wanted continuity of care by still having access to my same doctors.  Like many Americans, I have always chosen my doctors based on a variety of factors, including experience, referrals, professional credentials and history. Imagine my concern that I am now paying about the same in premiums but none of my doctors will be participating in my plan. And guess what? I don’t blame them. Why should an excellent doctor accept brokered payments that reduce their compensation while adding additional costs to their practices and mandates over what tests doctors should or should not be ordering? There is a reason we have the best healthcare in the world. Traditionally, we have valued good doctors.

A friend whose husband is an undeniable do-gooder (he works to promote green energy, for goodness sake!) is now paying 15,000 dollars a year to get her family of four covered. Wow. That was unexpected. A young relative, who is a gifted artist and was uninsured, is having to apply for a full-time job to get benefits after his parents got a bill for 60,000 dollars after he was treated for appendicitis.  Here in Missouri, a prominent Republican, formerly an outspoken foe of Obamacare, is now advocating for this state to expand Medicaid. That’s because hospitals, who have no where to turn when dealing with patients who have fallen between the cracks, are overwhelmed by these new costs. Personally, I recognize that the Affordable Care Act means someone like me won’t be denied coverage for run of the mill problems like high blood pressure and the occasional stiff neck and shoulder. But, states should be concerned about taking money to expand Medicaid when funding could run out, when only a 1/4 of the enrollees are young and healthy, when so many Americans, especially Latinos, seem uncomfortable trusting the Federal Government with such personal concerns as their medical histories. And so many small businesses simply can’t afford to comply with the mandate to provide health insurance.

The latest polls show only a 1/4 of Americans are happy with the Affordable Care Act as it stands. The thing that irritates them the most is the mandate or penalty if they don’t sign up. It motivated me because I didn’t want to pay 1% of my income. Most polls show most Americans like that those with pre-existing conditions can no longer be barred from coverage. Americans did soften in their opposition to Obamacare over the last couple of months but only incrementally. And fewer are in favor of an outright appeal. It’s time for Republicans to promote a reasonable response that includes an acknowledgement that something needs to be done. I don’t have the answers but I do hope we can stop short of trying to fix what isn’t broken and just fix what is.

 

 

 

Just the Facts on Healthcare Reform

1) 20 years is too long to figure out that it is time for a different approach. The National Task Force on Healthcare Reform, which Hillary Clinton headed, convened in 1993. The Republicans revolted in 1994. Fast track 20 years to October, 2013 when House Republicans tried to shut down the government in hopes of an outright repeal of Obamacare, now law. If our goal is to improve access and bring down spiraling costs, we need to work together.  

2) According to MSNBC today, HHS just released figures showing 106,000 people have signed up for the Affordable Care Act. For now, 15% or 48 million Americans remain uninsured. 

3) 4.8 million have had their policies cancelled, according to Forbes.com. Many of them are middle class folks who were happy with their plans. They were told they would get to keep their policies if they liked them. But now, the government is talking about offering them a “premium boost” funded by taxpayers. Remember the Harry and Louise ads about that befuddled middle class couple who thought their options under the reworked federal health insurance plan were too complex. Turns out they might be. 

4)  Some states are having more success with their exchanges than others. Connecticut has signed up more customers than any other state. Oregon hasn’t signed up 1. Both were among the 14 states plus Washington, DC that decided to run all aspects of their exchanges. 

5) States have the option to implement the exchanges in ways they see fit. Utah decided to serve small businesses while leaving individual coverage to the Feds. Idaho and New Mexico opted to use the Feds’ information technology infrastructure (navigators, websites and call centers) while managing the actual healthcare coverage themselves.  

6) Experts from Kaiser Family Foundation estimated that Americans would be divided between applying for private health insurance through the exchanges or defaulting to Medicaid. According to news reports, in some places, 9 out of 10 enrollees have opted for Medicaid instead of buying private insurance.

7) The current crisis isn’t over a faulty website. It is where the money is going to come from for all those new Medicaid patients. The Feds offered to pay for it through 2016 but that was based on healthy people signing up for Obamacare to offset the addition of lower income citizens with few options, like uninsured children, those with pre-existing conditions and the disabled.  

 

 

 

Halloween and Obamacare: Trick or Treat?

 

By M.W. Guzy, special to the Beacon

6:34 am on Thu, 10.31.13

When I was a kid, Halloween was the day we gave thanks for attending Catholic school. Because the day after is All Saint’s Day in church liturgy, we were off for a holy day of obligation while our public-school counterparts attended classes as usual after a night of trick or treating. (Suckers.)

Of course, back then Halloween was the province of children. By the time you were old enough for junior high, you were expected to hang up your costume and act your age. You might escort younger siblings around the neighborhood or help your parents hand out candy, but your days of door to door marauding were over.

Today, all that has changed. Reflecting the fashionable “All Mardi Gras – No Lent” approach to life, church attendance has dwindled while Halloween has morphed into a major commercial holiday celebrated by people of all ages. Fewer people worship on All Saints’ but far more party on its eve.

From a societal perspective, the problem with our collective Peter Pan pledge to never grow up is that we’re fast running out of adults to provide the treats. This, I suspect, is the emergent problem with Obamacare.

The disastrous first effort to fully implement the Affordable Care Act — often referred to as the plan’s “roll-out” — was mitigated by a strange miscegenation of Republican stupidity and Democratic incompetence.

The Republicans, you’ll recall, recently decided to shut down the government. The last time they tried that trick, they were treated to the re-election of Bill Clinton. Reluctant to learn from experience, they decided to stick their hand back in the fire to see if it was still hot. Not surprisingly, they again got burnt.

Ironically, the casus belli for the GOP stunt was the effort to de-fund Obamacare. Not only did they fail in that endeavor but the outrage they engendered managed to divert public attention from the shocking ineptitude displayed by the administration during the program’s initiation.

Having spent three years and hundreds of millions of dollars in preparation, Health and Human Services Secretary Kathleen Sebelius unveiled an enrollment website on Oct. 1 that people found difficult to use because it didn’t work. Luckily for the Dems, most people were too busy cursing Republicans to take much notice.

Eventually, of course, the government resumed full operations and public attention shifted to deficiencies in the Obamacare roll-out. The computer problems actually may have provided a hidden benefit for Democrats by delaying access to the plan. It seems the hardy souls who negotiated the hurdles of the website and got to the substance of the program often didn’t like what they found there.

I heard two different case histories reported as examples of the challenges of implementing the new venture. Both are admittedly anecdotal and thus not necessarily representative of the experience of others. Consider them parables illustrating the tricks and treats of health-care reform.

CNN interviewed a woman who’d spent three weeks trying to enroll on-line. She attempted to log in at midnight when she hoped most of her fellow citizens would be asleep; she tried during morning and evening rush hours when she thought most people would be commuting.

It was never explained why she didn’t enroll by phone but she did ultimately succeed in buying health insurance through the website for herself and her daughter. This victory was more than symbolic because both women suffered from pre-existing medical conditions that had previously precluded private insurance and their medical bills had driven their household into bankruptcy. For her, Obamacare — its shortcomings notwithstanding — represented salvation. She advises that, with her worries about medical bills allayed, she can now sleep at night.

CBS reported the story of a 56-year-old Florida woman who had a less happy ending. She currently has health insurance that she feels is adequate to her needs. Her contribution for the coverage is $54 a month.

She thought the president had guaranteed that persons who were happy with their insurance could keep it. Now, she learns that her satisfaction is not enough — the president has to like her policy as well.

Her insurer recently notified her that the current policy doesn’t satisfy the criteria of Obamacare. Among its deficiencies is its failure to provide birth control and maternity benefits. Effective Jan. 1, her monthly premiums will increase to $591 for better coverage.

That’s an annual increase of $6,444 — but the post-menopausal woman will have access to free contraceptives and full pregnancy care. She understands that she may be eligible for some kind of tax credit but states she can’t afford the extra $537 a month to continue coverage in the meantime.

With the control of the Congress at stake, you’ll hear a lot stories like these during the coming off-year election season. It is estimated that about 15 percent of Americans lack adequate health-care coverage without Obamacare. But that leaves 85 percent of the population who are presently fairly comfortable without it.

Most of the insured receive coverage through their employers. Paradoxically, the new law charges employers a head tax for each employee and employee dependant they cover. The government will thus penalize the businesses that provide most of the nation’s health care for doing so. Proceeds from the tax will be used to offset the increased cost of insuring applicants with pre-existing medical conditions.

The employer will then be responsible for insuring himself, his family, his employees, their families and for paying a bonus to insurance companies for selling their product to people they don’t want to cover in the first place.  Sounds fair to me…

Democrats have about a year to convince insured Americans that Obamacare provides better treatment than they receive at present. All things considered, that sales job could be a tricky proposition.

 
 

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Can it be stopped? 8 answers on Obamacare and the shutdown

By Z. Byron Wolf, CNN
Washington (CNN) — Over the next few days, the drama of a potential government shutdown will collide with the promise of a new health insurance system known as Obamacare.

Here are answers to eight of the most pressing questions about both:

1. What happens on October 1 with Obamacare and the government shutdown?

First, the health insurance exchanges established by the Affordable Care Act — or Obamacare — will be open for business. Millions of uninsured Americans will be able to enroll in health plans before the law kicks in on January 1, 2014. Second, the U.S. government might “shut down” if lawmakers can’t agree to pass a funding bill that has attached to it a provision to defund Obamacare. These two events are linked. The reason both houses of Congress may not be able to agree on a funding bill — also known as a continuing resolution — is that some senators and representatives see this as their last chance to stop Obamacare. But that’s really where the link ends.

 2. Does a government shutdown shut down Obamacare?

Not really. Most of the funding for Obamacare comes from new taxes and fees, from cost cuts to other programs like Medicare and other types of funding that carry on even in the event of a government shutdown. Congress’ research arm, the Congressional Research service, prepared a memo for Republican Sen. Tom Coburn, R-Oklahoma, that suggested an effort to use the government shutdown as leverage to force Democrats to delay implementing the law would not really work because the law will continue regardless of a shutdown. Plus, the law would still be in effect, so its many new requirements — everything from forcing insurance companies to cover anyone who wants insurance to forcing everyday Americans to carry health insurance or pay a fine — would still be in effect, too.

Government shutdown: Again? Seriously?

3. Do I have to sign up for a new health insurance plan on October 1 when open enrollment for Obamacare begins?

Maybe — Take this quick survey and we’ll find out:

A. Do you get health insurance from your employer? 
If the answer is yes — and this is by far the No. 1 way Americans get health insurance — go on about your business. Obamacare doesn’t really affect you. At least not yet. A lot of people think that because of Obamacare, fewer companies will offer health insurance, particularly to low-paid workers and retirees. There is some evidence of this. These employers would have to pay a per-worker fine to the government, but it might be cheaper for them in the long run to pay this fine to the government rather than offer insurance. Other companies might cut hours for some workers, making them part-timers working fewer than 30 hours a week in order to avoid helping pay their health insurance. But it will take some years to see if it really comes to pass. However, if you get health insurance at work, you could probably drop that coverage and buy health insurance on the Obamacare exchanges. But you might not want to. You won’t qualify for any government help to buy your insurance and your employer wouldn’t be contributing any of the money it is now.

B. Do you get health insurance from the government? 
If the answer is yes, go on about your business. Obamacare doesn’t really affect you. At least not yet. While Obamacare relies on making Medicare more efficient as a way to pay for some new services for younger people, it is not supposed to change the services offered by Medicare. One big test of this promise is Medicare Advantage. These are privately administered insurance plans that provide Medicare services to seniors. They cost the government more per person to provide Medicare. So, Obamacare seeks to bring their spending back in line with the rest of Medicare. This could lead to changes in Medicare Advantage options, like gym memberships and other items that are offered as enticements. But the same core Medicare services are supposed to remain in effect. The same goes for Medicaid. If you get your insurance from one of the 50 state-run Medicaid programs, Obamacare should not affect you. But you’ll have a lot more company in these programs, which will grow to insure a larger portion of Americans.

 

Zelizer: GOP strategy on shutdown courts doom

4. Do you have an individual health insurance plan?

If yes, Obamacare is going to affect you. It is possible that your insurance plan won’t change, but it’s just as likely that your plan doesn’t meet all the minimum requirements the law imposes. These include new rules for how much profit companies can take for plans, new rules for coverage of women’s services, new rules for how much more insurance companies can charge for women than men, and a lot more. So, you might have to buy a more expensive plan. In this case, your insurance company has probably already let you know. It’s also possible you might want a new plan. Check out your new state health insurance exchange or the one the federal government set up in your state if your state government refused to do so. People who like and dislike Obamacare have something to like about costs of individual plans. Prelminary estimates have come in lower than some government prognosticators expected. So it is fair to say Obamacare might be cheaper than expected for some individuals. But it is also accurate to say that premiums are likely to rise for healthy people on the individual market. Why? They’re going to get more robust insurance plans that cover more things. At the same time, a lot of sick people who get private insurance now pay a ton for it; their costs could decrease.

 

Congress: will it be a government shutdown or budget compromise?

5. Do you have no health insurance?

If so, Obamacare is for you, like it or not. You’re either going to have to enroll in Medicaid or buy health insurance from a private company on an “exchange” organized by either your state government or the federal government. If you’re single and you make less than $15,281.70 ($31,321.50 for a family of four), you’re likely to get Medicaid, although some states have refused to expand their programs. Those income levels for Medicaid — 133% of the federal poverty level — will increase from year to year.

10 ways a government shutdown would affect your daily life

6. How much is Obamacare going to cost me?

It depends. What if you make more than $15,281.70, but not that much more? You don’t get Medcaid. You don’t have employer-sponsored health insurance and you do want coverage. How are you supposed to afford a new health insurance plan?

The government is going to help a lot of people pay for it. If you’re single and you make less than $45,960 ($94,200 for a family of four), you’ll qualify for a government-sponsored subsidy to help you buy insurance. The Kaiser Family Foundation has estimated the average government subsidy for a family will be about $2,700 and the average premium costs will be about $8,250. Those costs will vary depending on the age and number of family members and the level of plan they choose to buy. Try your own scenario here.

Q&A: The lowdown on the shutdown, or why you should care about the CR

7. Is Obamacare health insurance government insurance?

No. Many state Medicaid programs will grow to insure much larger portions of their state populations. But the core of the law is the creation of new health insurance exchanges. These are places — online, mostly — where people who don’t get insurance can buy it from a private company. On the one hand, the government is making people either carry insurance or pay a fine, on the other hand the government is making insurance companies provide insurance to anyone who wants it and they’re controlling how much the insurance companies can charge.

 

8. What happens if I don’t buy health insurance?

You’re young and healthy. You don’t really want health insurance. No sweat. You don’t have to buy it. You can “opt out.” But then you’ll have to pay a fine of between $95 for every adult in your house or 1% of your income after $10,000, whichever is larger. So if you’re single and you make $50,000, you’d have to pay a $400 fine for not having health insurance. The Supreme Court called this fine a tax. You can look at it that way. Or you can view it as an upfront payment for having hospital and ambulance services able to come get you if you need them. Or you can look at it as horrible government overreach. Some people do.

5 strange things about deb

States Experimenting to Lower Health Care Costs / Associated Press

 

As states work on implementing the complex federal health care reforms, some have begun tackling an issue that has vexed employers, individuals and governments at all levels for years — the rapidly rising costs of health care. The success of models that are beginning to emerge across the country will ultimately determine whether the Affordable Care Act can make good on its name.

It’s too early to tell what will work and what won’t, but states, insurers and medical groups are experimenting with a variety of programs to contain costs without undermining care. These test runs come as millions of new patients will gain eligibility for health insurance under the federal law, putting additional pressure on the system.

“Look at any of the long-term projections for the federal budget or for state budgets,” said Alan Weil, executive director of the National Academy for State Health Policy. “If we don’t bring down health care costs, we’re either going to be paying a whole lot more in taxes or we’re going to stop spending money on other things we care about.”

The Affordable Care Act is expected to extend coverage to many of the roughly 50 million Americans who lack insurance by expanding Medicaid, the state-federal health care program for low-income people, and requiring most others to purchase insurance or pay a fine.

Often overlooked are the law’s efforts to stabilize constantly rising costs.

U.S. health care spending reached $2.7 trillion in 2011, or $8,700 per person, according to the Centers for Medicare and Medicaid Services. The agency says those numbers are climbing and predicts spending will reach $14,000 per person by 2021.

The higher costs mean higher premiums for businesses, which are passing on more of those expenses to their employees, and for individuals, who are seeing a rise in out-of-pocket costs.

In the Portland area, spiking costs have forced Steve Ferree to reduce the benefits he offers his 32 employees at the Mr. Rooter Plumbing franchise he owns.

“We feel bad about it,” he said. “We do provide good insurance, and we want to make sure we take care of folks, so that’s a tough decision to make.”

Premiums for employee-only coverage have spiked 65 percent since 2006, Ferree said, and employee and spouse plans rose 90 percent. Workers cover a quarter of the premium.

The struggles of business owners such as Ferree illustrate the difficulty of finding solutions, even in a state that has been held out as a potential national model for savings.

The recession provided what is expected to be a temporary reprieve, with health care costs slowing to 3.9 percent annually between 2009 and 2011, the slowest growth rate since the government began keeping track in 1960, according to data from the Centers for Medicare and Medicaid Services. Over the preceding 18 years, per capita health care costs grew an average of 6.5 percent a year.

Yet despite the recent slowdown, health care costs continue growing faster than both wages and the economy as a whole, accounting for an ever-larger share of spending for employers and workers alike. It now accounts for nearly 18 percent of U.S. economic activity, up from 5 percent in 1960.

Annual premiums for employer-sponsored family coverage jumped nearly 4 percent this year, and single coverage rose almost 5 percent, according to a report released last week by the nonprofit Kaiser Family Foundation. The foundation expects prices will begin rising faster as the economy improves.

many FACTORS

Economists say soaring health care costs are driven primarily by industry consolidation and expensive new medical technologies and prescription drugs.

The Affordable Care Act’s cost-containment section reduces Medicare reimbursements to providers and requires commercial insurance companies to issue refunds if more than 20 percent of their revenue goes to profits, salaries and overhead. Hospitals will face penalties when patients develop conditions while in their care.

The federal law also promotes “accountable care organizations” within Medicare, which are charged with improving coordination to reduce wasteful spending.

But much of the experimentation on reducing costs is driven by state governments and private businesses.

Oregon has tried to tackle rising costs by focusing on Medicaid, which serves 550,000 people in the state and is expected to grow by 200,000 under the Affordable Care Act’s Medicaid expansion that starts next year.

Gov. John Kitzhaber spearheaded last year a new model of delivering services under Medicaid. His initiative led to a state law that set up “coordinated care organizations,” which attempt to integrate mental, physical and dental care as they improve the way chronic conditions are managed. These organizations are required to manage their costs within a fixed rate of growth.

Some coordinated care groups are hiring staff to work intensely with Medicaid patients who frequently visit the emergency room.

“We try to deal with the medical part. But everything they go through, we have to take into account, because if you don’t have money to pay your bills, you’re going to have stress” that complicates medical problems, said Ruby Ibarra, a community health specialist for Multnomah County, which is part of a coordinated care organization in the Portland area.

Elsewhere in the state, Trillium Community Health Plan in Eugene has a program starting this month that gives up to $200 in prepaid debit cards to pregnant mothers who quit smoking.

Oregon’s law also has led to the rapid expansion of “health homes,” supporting a system of primary care that calls for clinics to stay open longer and offer same-day appointments.

The health home model has been successful at improving preventive care in Enterprise, Ore., a town of 2,000 in the remote northeastern corner of the state.

“You don’t feel like you’re just pushing papers around here. You really feel like you have an important part to play in improving people’s health,” said Dr. Elizabeth Powers, one of four physicians at Winding Waters Clinic in Enterprise, an early adopter of the health home model.

The clinic serves all patients, including those with Medicaid, Medicare and private insurance. The federal Affordable Care Act also encourages wider adoption of the health home model.

‘GAINSHARING’

In New Jersey, hospitals have reported success with a Medicare program that paid doctors who saved money for hospitals. Officials said it contributed to lower costs and shorter hospital stays without increasing mortality or readmission rates because doctors began considering the costs of their orders.

The experiment, known as “gainsharing,” is expanding this year to more hospitals, including some outside New Jersey.

In Massachusetts, the first state to enact comprehensive health care reforms, lawmakers supported last year a goal of restraining the rise in health care costs to a level no greater than the state’s overall growth rate. To accomplish this, legislators passed a multi-tiered state law that expands the role of physician assistants and nurse practitioners to act as primary care providers, making it easier for patients to access care outside the emergency room.

The law also requires providers to disclose more information to consumers about costs and quality and allows the state to review proposed consolidations to assess the effect on those factors.

The Massachusetts regulations provide money to accelerate electronic record-keeping and create tax credits for businesses that adopt wellness programs to combat preventable chronic diseases.

Cost-containment efforts are not confined to states that have embraced President Barack Obama’s health care reforms.

Many Southern states are transitioning their Medicaid patients into managed-care programs, which receive a fixed amount of money for each patient, regardless of their costs. Some insurance companies are thinning their networks of doctors to funnel patients to lower-cost options.

South Carolina, for example, is targeting elective early births, trying to keep newborn babies out of the expensive neonatal intensive care unit. The state also trained 18 community health workers who are in clinics that see a large number of Medicaid patients.

There are substantial challenges to copying these experiments nationally. Adopting a technology system to keep medical records electronically, for example, entails substantial upfront costs, as does hiring staff to coordinate patient care. At the same time, providers have to be careful to avoid skimping on needed care to save money.

Most of the experiments are too new to produce reliable data about their success, but health policy experts warn that the rapid rise in costs is unsustainable.

“It has to end eventually,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, “because we can’t have an economy driven entirely by health care.”

Proof that we can’t afford Obamacare as it exists

By Sarah Kliff, May 10 

Health and Human Services Secretary Kathleen Sebelius has gone, hat in hand, to health industry officials, asking them to make large financial donations to help with the effort to implement President Obama’s landmark health-care law, two people familiar with the outreach said.

Her unusual fundraising push comes after Congress repeatedly rejected the Obama administration’s requests for additional funds to set up the Affordable Care Act, leaving HHS to implement the president’s signature legislative accomplishment on what officials have described as a shoestring budget.

Over the past three months, Sebelius has made multiple phone calls to health industry executives, community organizations and church groups and asked that they contribute whatever they can to nonprofit groups that are working to enroll uninsured Americans and increase awareness of the law, according to an HHS official and an industry person familiar with the secretary’s activities. Both spoke on the condition of anonymity to talk openly about private discussions.

An HHS spokesperson said Sebelius was within the bounds of her authority in asking for help.

But Republicans charged that Sebelius’s outreach was improper because it pressured private companies and other groups to support the Affordable Care Act. The latest controversy has emerged as the law faces a string of challenges from GOP lawmakers in Washington and skepticism from many state officials across the country.

“To solicit funds from health-care executives to help pay for the implementation of the President’s $2.6 trillion health spending law is absurd,” Sen. Orrin G. Hatch (R-Utah) said in a statement. “I will be seeking more information from the Administration about these actions to help better understand whether there are conflicts of interest and if it violated federal law.”

Federal regulations do not allow department officials to fundraise in their professional capacity. They do, however, allow Cabinet members to solicit donations as private citizens “if you do not solicit funds from a subordinate or from someone who has or seeks business with the Department, and you do not use your official title,” according to Justice Department regulations.

HHS spokesman Jason Young added that a special section in the Public Health Service Act allows the secretary to support and encourage others to support nonprofit groups working to provide health information and conduct other public-health activities.

Sebelius is working “with a full range of stakeholders who share in the mission of getting Americans the help they need and deserve,” Young said. “Part of our mission is to help uninsured Americans take advantage of new, quality affordable insurance options that are coming thanks to the health law.”

Young said that Sebelius did not solicit for funds directly from industries that HHS regulates, such as insurance companies and hospitals, but rather asked them to contribute in whatever way they can.

But the industry official who had knowledge of the calls but did not participate directly in them said there was a clear insinuation by the administration that the insurers should give financially to the nonprofits.

Meredith McGehee, policy director for the nonpartisan Campaign Legal Center, which researches government ethics issues, said she was troubled by Sebelius’s activities because the secretary seemed to be “using the power of government to compel giving or insinuate that giving is going to be looked at favorably by the government.”

The success of the Affordable Care Act largely hinges on whether enough people sign up for insurance coverage. If only a small number of sick people participate, premiums would spike.

But spreading information about the law to the 30 million uninsured Americans has been a struggle, partly because there isn’t enough money to fund the effort, HHS officials have argued.

The Affordable Care Act included $1 billion to be used in overall implementation of the law. Congressional Budget Office projections, however, estimated that federal agencies will need between $5 billion and $10 billion to get the law up and running over the next decade. And because many states have refused to partner with the federal government in setting up the law, the burden on HHS has grown.

HHS has repeatedly requested additional funds from Congress to assist in the implementing but has been turned down.

After Congress rejected a request in March for nearly $1 billion in additional spending for fiscal 2013, the White House asked for $1.5 billion for fiscal 2015 to set up and run dozens of exchanges that will provide Americans options for health insurance. The new marketplaces will launch in October for open enrollment.

“We requested additional money . . . but we didn’t receive any additional funding for the exchanges,” Ellen Murray, HHS’s assistant secretary for financial resources, said last month at a budget briefing. “So we’ve had to come up with a Plan B. We’ve been working very hard to develop that.”

In 2012, budget documents show that HHS pulled hundreds of millions of dollars from programs not specifically earmarked for the Affordable Care Act’s implementation.

On top of that, the agency announced Thursday that it would use $150 million in Affordable Care Act funds meant to build additional community health centers to train thousands of health-care outreach workers at facilities that already exist.

“Investing in health centers for outreach and enrollment assistance provides one more way the Obama administration is helping consumers understand their options and enroll in affordable coverage,” Secretary Sebelius said in a statement.

Many of Sebelius’s calls have gone to current supporters of Enroll America, the most prominent nonprofit group working on the health care law’s implementation, an HHS official said. Its president, Anne Filipic, joined the group in January after serving as the White House’s deputy director for public engagement.

“We all have a lot of work to do between now and the Marketplace opening in October,” Filipic said in a statement. “That’s why it’s so important that the public, private and non-profit sectors are coming together to educate consumers about the opportunities that will be available to them later this year. Secretary Sebelius recognizes how important the work Enroll America is doing and we’re thrilled to be working with her.”

Health insurers plan to run their own outreach campaigns alongside the work of the Obama administration. They have a vested interest in recruiting Americans to enroll in their specific products rather than those of their competitors.

“As open enrollment gets closer, health plans will be engaged in a variety of innovative outreach activities,” spokesman Robert Zirkelbach, spokesman for the trade association America’s Health Insurance Plans, said.