"Health & Medical News"

An integral part of some state and local health system reform efforts has hit a major stumbling block. The business community has taken employer mandates to court.

These state and local laws require businesses to spend a certain amount on workers’ health care coverage or put that money into a fund to provide access for the uninsured. U.S. courts in Maryland, New York and California have sided with the business community and ruled that the federal Employee Retirement Income Security Act trumps these efforts.

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Washington — Many states enacted modest health coverage expansions in 2007, but gloomy budget forecasts will continue to make it tough for them to adopt more expensive, comprehensive health reforms.

Three major state reform trends continued or developed in 2007, said Susan Laudicina, one of the authors of a recent BlueCross BlueShield Assn. report on health legislation. States continue to adopt bills expanding access to public health programs and legislation making private insurance more affordable or flexible. Ten states also adopted transparency bills, most of which required hospitals to disclose medical errors and infection rates.

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Emergency departments are finding it increasingly difficult to get specialists to provide on-call coverage, a growing problem that threatens patient access to quality and timely care at hospitals, a new study said.

The study, released in November by the Center for Studying Health System Change, said hospitals have struggled during the past decade to get specialists to be on call at their EDs. But hospital executives and others interviewed for the report said the situation is worsening.

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