Penalty could keep smokers out of health overhaul

WASHINGTON (AP) — Millions of smokers could be priced out of health insurance because of tobacco penalties in President Barack Obama's health care law, according to experts who are just now teasing out the potential impact of a little-noted provision in the massive legislation.

The Affordable Care Act — "Obamacare" to its detractors — allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums starting next Jan. 1.

For a 55-year-old smoker, the penalty could reach nearly $4,250 a year. A 60-year-old could wind up paying nearly $5,100 on top of premiums.

Younger smokers could be charged lower penalties under rules proposed last fall by the Obama administration. But older smokers could face a heavy hit on their household budgets at a time in life when smoking-related illnesses tend to emerge.

Workers covered on the job would be able to avoid tobacco penalties by joining smoking cessation programs, because employer plans operate under different rules. But experts say that option is not guaranteed to smokers trying to purchase coverage individually.

Nearly one of every five U.S. adults smokes. That share is higher among lower-income people, who also are more likely to work in jobs that don't come with health insurance and would therefore depend on the new federal health care law. Smoking increases the risk of developing heart disease, lung problems and cancer, contributing to nearly 450,000 deaths a year.

Insurers won't be allowed to charge more under the overhaul for people who are overweight, or have a health condition like a bad back or a heart that skips beats — but they can charge more if a person smokes.

Starting next Jan. 1, the federal health care law will make it possible for people who can't get coverage now to buy private policies, providing tax credits to keep the premiums affordable. Although the law prohibits insurance companies from turning away the sick, the penalties for smokers could have the same effect in many cases, keeping out potentially costly patients.

"We don't want to create barriers for people to get health care coverage," said California state Assemblyman Richard Pan, who is working on a law in his state that would limit insurers' ability to charge smokers more. The federal law allows states to limit or change the smoking penalty.

"We want people who are smoking to get smoking cessation treatment," added Pan, a pediatrician who represents the Sacramento area.

Obama administration officials declined to be interviewed for this article, but a former consumer protection regulator for the government is raising questions.

"If you are an insurer and there is a group of smokers you don't want in your pool, the ones you really don't want are the ones who have been smoking for 20 or 30 years," said Karen Pollitz, an expert on individual health insurance markets with the nonpartisan Kaiser Family Foundation. "You would have the flexibility to discourage them."

Several provisions in the federal health care law work together to leave older smokers with a bleak set of financial options, said Pollitz, formerly deputy director of the Office of Consumer Support in the federal Health and Human Services Department.

First, the law allows insurers to charge older adults up to three times as much as their youngest customers.

Second, the law allows insurers to levy the full 50 percent penalty on older smokers while charging less to younger ones.

And finally, government tax credits that will be available to help pay premiums cannot be used to offset the cost of penalties for smokers.

Here's how the math would work:

Take a hypothetical 60-year-old smoker making $35,000 a year. Estimated premiums for coverage in the new private health insurance markets under Obama's law would total $10,172. That person would be eligible for a tax credit that brings the cost down to $3,325.

But the smoking penalty could add $5,086 to the cost. And since federal tax credits can't be used to offset the penalty, the smoker's total cost for health insurance would be $8,411, or 24 percent of income. That's considered unaffordable under the federal law. The numbers were estimated using the online Kaiser Health Reform Subsidy Calculator.

"The effect of the smoking (penalty) allowed under the law would be that lower-income smokers could not afford health insurance," said Richard Curtis, president of the Institute for Health Policy Solutions, a nonpartisan research group that called attention to the issue with a study about the potential impact in California.

In today's world, insurers can simply turn down a smoker. Under Obama's overhaul, would they actually charge the full 50 percent? After all, workplace anti-smoking programs that use penalties usually charge far less, maybe $75 or $100 a month.

Robert Laszewski, a consultant who previously worked in the insurance industry, says there's a good reason to charge the maximum.

"If you don't charge the 50 percent, your competitor is going to do it, and you are going to get a disproportionate share of the less-healthy older smokers," said Laszewski. "They are going to have to play defense."

___

Online:

Kaiser Health Reform Subsidy Calculator — http://healthreform.kff.org/subsidycalculator.aspx

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S&P rises for seventh day but 1,500 too steep a climb

NEW YORK (Reuters) - The smallest of gains gave the Standard & Poor's 500 its seventh straight winning day on Thursday, but the index failed to hold above the 1,500 line, restrained by Apple's worst day in more than four years.

Apple Inc slid 12.4 percent to $450.50 a day after it posted revenue that missed Wall Street's forecast as iPhone sales were poorer than expected.

The sharp drop wiped out nearly $60 billion in Apple's market capitalization to less than $423 billion, leaving the company vulnerable to losing its status as the most valuable U.S. company to second-place ExxonMobil , at $416.5 billion.

The S&P 500, however, managed to hit its longest winning streak since October 2006.

"The market has sent the message it is no longer driven by the whims of Apple," said Ken Polcari, director of the NYSE floor division at O'Neil Securities in New York.

The S&P 500 briefly traded above 1,500 for the first time since December 12, 2007, but failed to hold above it, indicating that momentum is waning and a pullback is in the charts.

"If the market had a little bit more excitement to it, momentum players would have jumped after it broke through 1,500. Investors know the market is a little bit ahead of itself," Polcari said.

Economic data helped buoy equities as U.S. factory activity grew the most in nearly two years in January and new claims for jobless benefits dropped to a five-year low last week, giving surprisingly strong signals on the economy's pulse.

At the same time, Chinese manufacturing grew this month at the fastest pace in about two years, while data suggesting German growth picked up boosted hopes for a euro-zone recovery.

"PMI in Asia, Europe, and obviously, here in the United States, is moving in the right direction, and that's stuff people should be excited about," Polcari said.

The Dow Jones industrial average <.dji> rose 46 points or 0.33 percent, to 13,825.33 at the close. The S&P 500 <.spx> inched up just 0.01 of a point, or 0 percent, to finish at 1,494.82. The Nasdaq Composite <.ixic> dropped 23.29 points or 0.74 percent, to end at 3,130.38, with most of that loss on Apple's slide.

The broader Russell 2000 index <.rut> also hit a milestone as it closed above 900 points for the first time.

Video streaming service Netflix Inc surprised Wall Street with a quarterly profit after it added nearly 4 million customers in the United States and abroad. Netflix shares surged 42.2 percent to $146.86, its biggest percentage jump ever.

Earnings have helped drive the stock market's recent rally. Thomson Reuters data through early Thursday showed that of the 133 S&P 500 companies that have reported earnings so far, 66.9 percent have exceeded expectations - above the 65 percent average over the past four quarters.

About 6.8 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, below the daily average during January 2012 of about 6.93 billion shares.

Roughly five issues rose for every four that fell on both the NYSE and Nasdaq.

(Editing by Jan Paschal)

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U.S. Adoptions From Abroad Decline Sharply

WASHINGTON — The number of foreign children adopted by Americans has plunged to its lowest level in more than a decade as some countries have cut back on adoptions to the United States and others have struggled to meet stricter standards intended to combat corruption and child trafficking, government officials said Thursday.

Some prospective parents, nonprofit adoption agencies and members of Congress are raising concerns about the sharp decline in foreign adoptions, which dropped by 62 percent to 8,668 in the 2012 fiscal year from a high of 22,991 in 2004, according to a report released by the State Department on Thursday.

State Department officials attribute the decline over those years primarily to the internal policies of several countries, particularly China, Russia and South Korea, which have sharply limited adoptions to the United States in recent years as they have worked to encourage more domestic adoptions at home.

In the 2012 fiscal year, 2,697 children came to the United States from China, down from 7,038 in 2004, the statistics show. In 2004, 5,862 children from Russia were adopted here as opposed to 748 in the 2012 fiscal year, which ended in September.

The number of international adoptions is expected to fall even further in the current fiscal year as a result of Russia’s decision to curtail all adoptions to the United States. The Russian president, Vladimir V. Putin, approved the ban on adoptions in late December as part of a broader law retaliating against the United States for its efforts to punish Russian officials accused of human rights violations.

“I’m not sure what the future holds for intercountry adoptions from Russia to the United States,” Ambassador Susan Jacobs, the State Department’s special adviser for children’s issues, said in an interview on Thursday.

The number of international adoptions has declined every year since 2004. Homeland Security officials, who process petitions for international adoption, say that stricter standards intended to combat corruption have also played a role in the decline. Some have questioned the State Department’s decision not to permit new adoptions in recent years from countries including Guatemala, Vietnam and Cambodia. They argue that the United States should continue to process adoption cases while working to reform the adoption programs in those countries, which have been dogged in the past by allegations of corruption.

But Ms. Jacobs said, “For us the right number is the number we can process ethically, safely and transparently”

She said the additional scrutiny gives American parents and the American public greater confidence that the children who arrive here have not been stolen or sold or taken from parents under false pretenses. She said the State Department was eager to reopen the pipeline to countries that have improved their programs.

“Vietnam and Cambodia are making great strides and improving,” Ms. Jacobs said. “I think it’s quite likely that we will be doing some adoptions from those countries this year, probably in the second half of the year.”

Homeland Security officials declined to comment on the newly released adoption figures. But a senior official at the department said last year that she believed that the nation’s tough stance had left thousands of vulnerable orphans stranded in institutions overseas.

The official, Whitney Reitz, who was then in charge of children’s affairs and parole policy at the United States Citizenship and Immigration Services agency, said at the time that while some might believe it is best not to allow adoptions from some countries, “when I think personally about the individual children in these countries who need families and who are stuck in institutions, it really doesn’t look like such a great outcome to me.”

State Department officials maintain that ensuring that a transparent, legal process is in place is more important than the number of foreign orphans who are adopted. China, Ethiopia, Russia, South Korea and Ukraine remain the top feeder countries to the United States, according to the report, which is released annually.

Senator Mary L. Landrieu, Democrat of Louisiana, said on Thursday that the government must do more to prevent vulnerable children from growing up in orphanages.

Senator Landrieu, co-chairwoman of the Congressional Coalition on Adoption, described the decline in international adoptions as “tragic.” She said the State Department had “failed to put the resources or personnel in place to help countries” meet the stricter standards required by countries that have signed The Hague convention on intercountry adoption. The treaty, which took effect for the United States in 2008, establishes accreditation requirements for adoption agencies and protections against child trafficking.

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Google dominates the mobile app market, has 5 of the top 6 apps in the U.S.

Wondering why Apple (AAPL) is sinking so much effort into building its own Maps application? Because it doesn’t want Google (GOOG) to gobble up all the revenue from big-name mobile applications. ComScore has published its most recent monthly review of the top iOS and Android apps in the United States ranked by unique visitors and has found that Google captured 5 of the top 6 spots with Google Maps, Google Play, Google Search, Gmail and YouTube. In fact, Facebook (FB) was the only non-Google app to crack the top 6, although it also had the benefit of being the most-visited app in the entire country by a margin of more than 10 million unique visitors. iTunes was the only Apple app to crack the top 10, meanwhile, as it ranked eighth with roughly 46 million unique visitors last month.

[More from BGR: As data gets cheaper for Verizon to transmit, customers are paying more]

This article was originally published on BGR.com

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Women have caught up to men on lung cancer risk

Smoke like a man, die like a man.

U.S. women who smoke today have a much greater risk of dying from lung cancer than they did decades ago, partly because they are starting younger and smoking more — that is, they are lighting up like men, new research shows.

Women also have caught up with men in their risk of dying from smoking-related illnesses. Lung cancer risk leveled off in the 1980s for men but is still rising for women.

"It's a massive failure in prevention," said one study leader, Dr. Michael Thun of the American Cancer Society. And it's likely to repeat itself in places like China and Indonesia where smoking is growing, he said. About 1.3 billion people worldwide smoke.

The research is in Thursday's New England Journal of Medicine. It is one of the most comprehensive looks ever at long-term trends in the effects of smoking and includes the first generation of U.S. women who started early in life and continued for decades, long enough for health effects to show up.

The U.S. has more than 35 million smokers — about 20 percent of men and 18 percent of women. The percentage of people who smoke is far lower than it used to be; rates peaked around 1960 in men and two decades later in women.

Researchers wanted to know if smoking is still as deadly as it was in the 1980s, given that cigarettes have changed (less tar), many smokers have quit, and treatments for many smoking-related diseases have improved.

They also wanted to know more about smoking and women. The famous surgeon general's report in 1964 said smoking could cause lung cancer in men, but evidence was lacking in women at the time since relatively few of them had smoked long enough.

One study, led by Dr. Prabhat Jha of the Center for Global Health Research in Toronto, looked at about 217,000 Americans in federal health surveys between 1997 and 2004.

A second study, led by Thun, tracked smoking-related deaths through three periods — 1959-65, 1982-88 and 2000-10 — using seven large population health surveys covering more than 2.2 million people.

Among the findings:

— The risk of dying of lung cancer was more than 25 times higher for female smokers in recent years than for women who never smoked. In the 1960s, it was only three times higher. One reason: After World War II, women started taking up the habit at a younger age and began smoking more.

—A person who never smoked was about twice as likely as a current smoker to live to age 80. For women, the chances of surviving that long were 70 percent for those who never smoked and 38 percent for smokers. In men, the numbers were 61 percent and 26 percent.

—Smokers in the U.S. are three times more likely to die between ages 25 and 79 than non-smokers are. About 60 percent of those deaths are attributable to smoking.

—Women are far less likely to quit smoking than men are. Among people 65 to 69, the ratio of former to current smokers is 4-to-1 for men and 2-to-1 for women.

—Smoking shaves more than 10 years off the average life span, but quitting at any age buys time. Quitting by age 40 avoids nearly all the excess risk of death from smoking. Men and women who quit when they were 25 to 34 years old gained 10 years; stopping at ages 35 to 44 gained 9 years; at ages 45 to 54, six years; at ages 55 to 64, four years.

—The risk of dying from other lung diseases such as emphysema and chronic bronchitis is rising in men and women, and the rise in men is a surprise because their lung cancer risk leveled off in 1980s.

Changes in cigarettes since the 1960s are a "plausible explanation" for the rise in non-cancer lung deaths, researchers write. Most smokers switched to cigarettes that were lower in tar and nicotine as measured by tests with machines, "but smokers inhaled more deeply to get the nicotine they were used to," Thun said. Deeper inhalation is consistent with the kind of lung damage seen in the illnesses that are rising, he said.

Scientists have made scant progress against lung cancer compared with other forms of the disease, and it remains the leading cause of cancer deaths worldwide. More than 160,000 people die of it in the U.S. each year.

The federal government, the Canadian Institutes of Health Research, the Bill and Melinda Gates Foundation, the cancer society and several universities paid for the new studies. Thun testified against tobacco companies in class-action lawsuits challenging the supposed benefits of cigarettes with reduced tar and nicotine, but he donated his payment to the cancer society.

Smoking needs more attention as a health hazard, Dr. Steven A. Schroeder of the University of California, San Francisco, wrote in a commentary in the journal.

"More women die of lung cancer than of breast cancer. But there is no 'race for the cure' for lung cancer, no brown ribbon" or high-profile advocacy groups for lung cancer, he wrote.

Kathy DeJoseph, 62, of suburban Atlanta, finally quit smoking after 40 years — to qualify for lung cancer surgery last year.

"I tried everything that came along, I just never could do it," even while having chemotherapy, she said.

It's a powerful addiction, she said: "I still every day have to resist wanting to go buy a pack."

___

Online:

American Cancer Society: http://www.cancer.org

National Cancer Institute: http://www.cancer.gov/cancertopics/tobacco/smoking and http://www.cancer.gov/cancertopics/types/lung

Medical journal: http://www.nejm.org

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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S&P up for sixth day, Apple slip could halt rally

NEW YORK (Reuters) - The S&P 500 rose for a sixth day on Wednesday after stronger-than-expected profits from IBM and Google but the rally could be halted as Apple's after-hours miss sent its shares lower.

The S&P was just 4.7 percent from its all-time closing high as IBM's and Google's earnings, released after Tuesday's close, followed on the heels of stronger U.S. economic data.

"People were kind of nervous about earnings coming into this quarter but numbers have shown so far strength in earnings," said King Lip, chief investment officer at Baker Avenue Asset Management in San Francisco.

But Apple , still the largest U.S. publicly traded company, fell 8 percent in extended trading after sales of its flagship iPhone came in below analyst targets and quarterly revenue slightly missed Wall Street expectations.

"One thing that stands out is the company's ballooning balance sheet, where they now have $137 billion dollars in cash and investments," said Michael Sheldon, chief market strategist at RDM Financial in Westport, Connecticut. "You've got to wonder when they're going to put some more of that to work."

Declining issues beat advancers in both the NYSE and Nasdaq during regular market hours, in a sign the market's rally may be overstretched. The broad Russell 2000 index <.rut> closed the day down 0.3 percent after earlier hitting and intraday historic high just below 900 points.

Shares in IBM Corp , the world's largest technology services company, climbed 4.4 percent during regular market hours to $204.72, providing just about all of the Dow's 67-point gain.

Also helping the tech sector was a 5.5 percent jump in Google Inc to $741.50. The Internet search company reported its core business outpaced expectations and revenue was higher than expected.

The S&P technology sector <.splrct> rose 1.2 percent.

The Dow Jones industrial average <.dji> rose 67.12 points or 0.49 percent, to 13,779.33, the S&P 500 <.spx> gained 2.25 points or 0.15 percent, to 1,494.81, and the Nasdaq Composite <.ixic> added 10.49 points or 0.33 percent, to 3,153.67.

The benchmark S&P 500 is a mere 0.35 percent away from hitting 1,500, a level not seen since December 12, 2007.

S&P 500 futures fell 4.1 points, or 0.3 percent, while Nasdaq 100 futures fell 20 points or 0.7 percent.

Netflix shares soared 32 percent, above $136, after the video subscription service said it added subscribers in the United States and abroad and posted a quarterly profit.

LED maker Cree Inc jumped 22 percent to $40.85 after it forecast a higher-than-expected third-quarter profit, and reported results above analysts' estimates.

Upscale leather goods maker Coach Inc plunged 16.4 percent to $50.75 after reporting sales that missed expectations.

Clearing a market hurdle, the U.S. House of Representatives passed a Republican-led plan to extend the country's borrowing authority until mid May. This delays a confrontation in Congress similar to one in 2011, which generated a stalemate that triggered the first-ever U.S. debt rating downgrade.

Thomson Reuters data through Wednesday showed that of the 99 S&P 500 companies that have reported earnings so far, 67.7 percent have topped expectations, above the 65 percent average beat over the past four quarters.

Overall, S&P 500 fourth-quarter earnings rose 2.8 percent, according to Thomson Reuters data. That estimate is above the 1.9 percent forecast at the start of earnings season.

Top U.S. manufacturers sounded a confident note about their expectations for 2013 on Wednesday as fears of the year-end "fiscal cliff" faded into memory.

In the regular session, about 6.1 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, below the 2012 daily average of about 6.45 billion.

On the NYSE, roughly 15 issues fell for every 14 that rose and on Nasdaq seven declined for every five gainers.

(Reporting by Rodrigo Campos, additional reporting by Caroline Valetkevitch; Editing by Nick Zieminski and Diane Craft)

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Florence Cassez Is Freed From Prison in Mexico

MEXICO CITY — A Supreme Court panel in Mexico voted Wednesday to free a French woman serving a 60-year sentence for kidnapping, ending a case that has become emblematic of problems in the country’s opaque justice system and that has strained relations with France.

In voting 3-2 to free the woman, Florence Cassez, 38, the magistrates did not address whether she was guilty or innocent. What was clear, they said, was that her rights had been violated by a televised broadcast of what appeared to be her arrest and the liberation of three kidnapping victims at a ranch outside Mexico City in December 2005.

Authorities later acknowledged that the raid was staged, and that Ms. Cassez and her boyfriend at the time, Israel Vallarta, had been arrested the day before on a highway. They were held while the police set up the supposed raid, which was broadcast on national television.

Three kidnapping victims testified against her. But their testimony was inconsistent and two of them did not identify her at first.

She was released Wednesday night and left directly for the airport. Her lawyer said she hoped to leave for France as soon as possible. Ms. Cassez’s plight had been portrayed by the French news media as the tale of an innocent woman imprisoned in a corrupt legal system.

Visiting French cabinet ministers came to see her in her cell. Carla Bruni, the former first lady of France, and Valérie Trierweiler, the partner of President François Hollande, sent gifts.

After the ruling, Mr. Hollande, in a televised statement, said, “Today we can say that between France and Mexico we have the best relations that can be established,” Reuters reported.

President Enrique Peña Nieto of Mexico said he would respect the Supreme Court’s decision. Mr. Vallarta’s case is still being decided in the courts, according to local news media reports. The episode set off an impassioned debate in Mexico. Reflecting widespread desperation over the authorities’ frequent failure to investigate crimes fully, victims’ rights groups argued that the testimony that convicted Ms. Cassez could not just be thrown out.

“Should a failure in the form leave aside the substance: if a person is guilty or not?” Maria Elena Morera, a respected anticrime activist, wrote in the site Animal Politico this week.

But scholars and civil rights groups said that the case represented the problems with a judicial system where witness testimony, often coerced, frequently substitutes for physical evidence and adequate investigation.

“Today anybody can be the victim of a process that is plagued by bad practices from the start,” Federico Reyes Heroles, an author, wrote in the newspaper Reforma.

After the Supreme Court’s decision, Miguel Carbonell, a constitutional lawyer at the National Autonomous University of Mexico, wrote on Twitter: “One thing is clear to everybody: the Mexican judicial system urgently needs improvement.”

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Google’s fourth quarter results shine after ad rate decline slows

SAN FRANCISCO (Reuters) – Revenue from Google Inc’s core Internet business outpaced many analysts’ expectations during the crucial holiday quarter and advertising rates fell less than in previous periods, pushing its shares up more than 4 percent.

The world’s largest Internet search company introduced new product listings during the fourth quarter – typically its strongest – and also benefited from business growth in international markets, analysts said.

Excluding traffic-acquisition costs, the business generated net revenue of $ 9.83 billion, up from $ 8.13 billion a year earlier, Google reported on Tuesday. That surpassed a $ 9.6 billion average forecast from six analysts polled by Reuters.

“Business looked really strong, especially from a profitability perspective. They really grew their margins in the core business,” said Sameet Sinha, an analyst with B. Riley Caris. “Most of that strength seems to be coming from international markets which grew revenues quite substantially: up 23 percent year over year, versus the 15 percent growth in the third quarter.”

Average cost-per-click, a critical metric that denotes the price advertisers pay Google, declined 6 percent from a year ago, the fifth consecutive quarter of decline.

Google executives told analysts on a conference call that the company had focused on improving the metric – shoring up margins – while lowering the overall growth rate of paid clicks in the holiday quarter.

“Click prices are still declining, but it’s better than expected,” said BGC Partners analyst Colin Gillis.

MOTOROLA MOBILITY “STILL LOSING MONEY”

Consolidated net income in the fourth quarter was $ 2.89 billion or $ 8.62 per share, compared with $ 2.71 billion, or $ 8.22 per share, in the year-ago period when Google had not yet acquired Motorola.

Excluding certain items, Google said it earned $ 10.65 per share in the fourth quarter.

“The core business is a great business and the fourth-quarter is always a time for Google to shine. However, Motorola is still losing money and click rates still declined. They only declined 6 percent, but go back four or five quarters and click prices were improving. So mobile is still pressuring click prices,” Gillis said.

The company posted consolidated revenue – which includes its Motorola Mobility mobile phone business but not the television set-top box business it recently agreed to sell – of $ 14.42 billion on Tuesday.

Motorola Mobility had an operating loss of $ 353 million during the quarter.

Shares of Google were up roughly 4.5 percent at $ 734.46 in after-hours trading on Tuesday.

(Reporting By Alexei Oreskovic; Editing by Bernard Orr)

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PEOPLE's Music Critic: Why We're Upset About Beyoncé's Lip-Synching Drama

By Chuck Arnold

01/22/2013 at 08:40 PM EST

Did she lip-synch or didn't she?

That's the question surrounding Beyoncé after reports surfaced that she didn't sing "The Star-Spangled Banner" live at yesterday's presidential inauguration.

A spokesperson for the U.S. Marine Band, which backed the pop diva at the ceremony, said Tuesday that Mrs. Jay-Z decided to use a previously recorded vocal track before delivering the national anthem, but later on another spokesperson, this one for the Pentagon, said there was no way of knowing whether the 16-time Grammy winner was guilty of lip-synching or not.

Should it matter? Let's remember that Whitney Houston, in what is widely considered one of the best renditions of "The Star-Spangled Banner" of all time, didn't sing it live either at the 1991 Super Bowl.

There are all sorts of technical reasons why it can be challenging to perform a song as difficult as this on such a large scale, and there are many extenuating circumstances that could have played a role in any decision to lip-synch. Certainly no one is questioning whether Beyoncé – who, in removing her earpiece midway through, may have been experiencing audio problems – has the chops to sing it.

Lip-synching – or at least singing over pre-recorded vocal tracks – has long been acceptable for dance-driven artists like Madonna, Janet Jackson and Britney Spears, whose emphasis on intense, intricate choreography makes it hard to execute the moves fans have come to expect while also singing live. Huffing and puffing into the microphone or barely projecting for the sake of keeping it real just isn't gonna cut it. Of course, there have been other instances – such as Ashlee Simpson's 2004 Saturday Night Live debacle – where faking it crossed the line.

Surely there wouldn't be the same controversy about Beyoncé had she been hoofing across the stage performing "Single Ladies (Put a Ring on It)" on one of her tour stops. But this was the presidential inauguration, the national anthem, and there was no choreography involved.

Some things have to remain sacred, and for "the land of the free and the home of the brave," this was one of them.

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Flu season fuels debate over paid sick time laws

NEW YORK (AP) — Sniffling, groggy and afraid she had caught the flu, Diana Zavala dragged herself in to work anyway for a day she felt she couldn't afford to miss.

A school speech therapist who works as an independent contractor, she doesn't have paid sick days. So the mother of two reported to work and hoped for the best — and was aching, shivering and coughing by the end of the day. She stayed home the next day, then loaded up on medicine and returned to work.

"It's a balancing act" between physical health and financial well-being, she said.

An unusually early and vigorous flu season is drawing attention to a cause that has scored victories but also hit roadblocks in recent years: mandatory paid sick leave for a third of civilian workers — more than 40 million people — who don't have it.

Supporters and opponents are particularly watching New York City, where lawmakers are weighing a sick leave proposal amid a competitive mayoral race.

Pointing to a flu outbreak that the governor has called a public health emergency, dozens of doctors, nurses, lawmakers and activists — some in surgical masks — rallied Friday on the City Hall steps to call for passage of the measure, which has awaited a City Council vote for nearly three years. Two likely mayoral contenders have also pressed the point.

The flu spike is making people more aware of the argument for sick pay, said Ellen Bravo, executive director of Family Values at Work, which promotes paid sick time initiatives around the country. "There's people who say, 'OK, I get it — you don't want your server coughing on your food,'" she said.

Advocates have cast paid sick time as both a workforce issue akin to parental leave and "living wage" laws, and a public health priority.

But to some business owners, paid sick leave is an impractical and unfair burden for small operations. Critics also say the timing is bad, given the choppy economy and the hardships inflicted by Superstorm Sandy.

Michael Sinensky, an owner of seven bars and restaurants around the city, was against the sick time proposal before Sandy. And after the storm shut down four of his restaurants for days or weeks, costing hundreds of thousands of dollars that his insurers have yet to pay, "we're in survival mode."

"We're at the point, right now, where we cannot afford additional social initiatives," said Sinensky, whose roughly 500 employees switch shifts if they can't work, an arrangement that some restaurateurs say benefits workers because paid sick time wouldn't include tips.

Employees without sick days are more likely to go to work with a contagious illness, send an ill child to school or day care and use hospital emergency rooms for care, according to a 2010 survey by the University of Chicago's National Opinion Research Center. A 2011 study in the American Journal of Public Health estimated that a lack of sick time helped spread 5 million cases of flu-like illness during the 2009 swine flu outbreak.

To be sure, many employees entitled to sick time go to work ill anyway, out of dedication or at least a desire to project it. But the work-through-it ethic is shifting somewhat amid growing awareness about spreading sickness.

"Right now, where companies' incentives lie is butting right up against this concern over people coming into the workplace, infecting others and bringing productivity of a whole company down," said John A. Challenger, CEO of employer consulting firm Challenger, Gray & Christmas.

Paid sick day requirements are often popular in polls, but only four places have them: San Francisco, Seattle, Washington, D.C., and the state of Connecticut. The specific provisions vary.

Milwaukee voters approved a sick time requirement in 2008, but the state Legislature passed a law blocking it. Philadelphia's mayor vetoed a sick leave measure in 2011; lawmakers have since instituted a sick time requirement for businesses with city contracts. Voters rejected a paid sick day measure in Denver in 2011.

In New York, City Councilwoman Gale Brewer's proposal would require up to five paid sick days a year at businesses with at least five employees. It wouldn't include independent contractors, such as Zavala, who supports the idea nonetheless.

The idea boasts such supporters as feminist Gloria Steinem and "Sex and the City" actress Cynthia Nixon, as well as a majority of City Council members and a coalition of unions, women's groups and public health advocates. But it also faces influential opponents, including business groups, Mayor Michael Bloomberg and City Council Speaker Christine Quinn, who has virtually complete control over what matters come to a vote.

Quinn, who is expected to run for mayor, said she considers paid sick leave a worthy goal but doesn't think it would be wise to implement it in a sluggish economy. Two of her likely opponents, Public Advocate Bill de Blasio and Comptroller John Liu, have reiterated calls for paid sick leave in light of the flu season.

While the debate plays out, Emilio Palaguachi is recovering from the flu and looking for a job. The father of four was abruptly fired without explanation earlier this month from his job at a deli after taking a day off to go to a doctor, he said. His former employer couldn't be reached by telephone.

"I needed work," Palaguachi said after Friday's City Hall rally, but "I needed to see the doctor because I'm sick."

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Associated Press writer Susan Haigh in Hartford, Conn., contributed to this report.

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Follow Jennifer Peltz at http://twitter.com/jennpeltz

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