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."

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Online:

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

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Blame flies as Bell trial begins

The Bell corruption trial began Thursday with prosecutors depicting six former council members as greedy operators who schemed to collect outsized salaries by serving on various government boards that did nothing.

But attorneys for the former officials portrayed them as helpless pawns. They claim former City Administrator Robert Rizzo controlled the city and was the mastermind of the alleged corruption.

Ronald Kaye, attorney for former Councilman George Cole, went as far as to say the council members were "in a cocoon" and that Rizzo "didn't let them know what was going on in the city."

The opening statements offer a preview to the much-anticipated trial in Los Angeles County Superior Court. Prosecutors insist the six council members were active participants in draining the city's treasury by giving themselves salaries that topped $100,000 a year.

The defendants have blamed Rizzo, who faces trial later this year along with his former assistant.

Deputy Dist. Atty. Edward Miller walked jurors through a PowerPoint presentation describing the tactics by which the former council members allegedly bilked taxpayers.

He said the defendants collected more than $1.3 million by serving on phantom boards that convened for as little as two minutes a year, sometimes gaveling in just to further increase their pay.

The commissions had important-sounding titles: Solid Waste and Recycling, Public Finance, Surplus Property, Community Housing.

For the accused city leaders, a place on the boards boosted pay to $100,000 a year for their part-time jobs, not counting retirement and medical benefits.

What work did they perform on the boards? Almost none, the prosecutor said, pointing out that between 2006 and 2007, the total meeting time for all of the boards was 34 minutes.

"The evidence will show that they worked less minutes than my opening statement will take this morning," Miller said.

The four boards each had just one item on their agenda at a June 30, 2008, meeting, the prosecutor said — pay raises that passed unanimously. They didn't meet again for the rest of the year.

He said that through all of 2006, the solid waste board, which did not even have a staff, met for two minutes — and then just to vote on members' pay.

"This was a sham from the beginning," he told the jury of eight women and four men.

At one point, the surplus property board had not met for nearly two years.

"Three of these boards went years where they didn't do any work," Miller told jurors. "They didn't meet. Did zero work. But that didn't stop the defendants from taking full salaries for those authorities."

The corruption case in Bell exploded more than two years ago when The Times revealed Rizzo's $800,000 salary and the lavish compensation package he and council members enjoyed. Authorities said the city's leaders also lent city money improperly and imposed illegal taxes on their largely poor constituents.

On Thursday, Miller described Rizzo as a "crook."

"So how did they get away with it?" the prosecutor asked jurors. "Well, unfortunately, participation by the community in Bell city politics wasn't very good."

The council pay was kept quiet even from one of its new members, Lorenzo Velez, a heavy-equipment operator who joined the council because "he wanted to help his community," the prosecutor said.

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At War Blog: Women Have Always Served in Combat Roles

8:51 p.m. | Updated Defense Secretary Leon E. Panetta is lifting the military’s ban on women in combat, a groundbreaking decision that overturns a 1994 Pentagon rule that restricts women from artillery, armor, infantry and other such roles.

As Elisabeth Bumiller and Thom Shanker of The Times report, the move means that hundreds of thousands of frontline jobs will now be open to women. Yet women have long been serving in combat, just not officially.

“I respect and support Secretary Panetta’s decision to lift the ban on women serving in combat,” Senator John McCain said in a statement. “The fact is that American women are already serving in harm’s way today all over the world and in every branch of our armed forces. Many have made the ultimate sacrifice, and our nation owes them a deep debt of gratitude.”

Carey Lohrenz, a former Navy lieutenant, told NPR: “People are trying to make it an argument about whether or not women should be in combat. But women are in combat, and they’ve always been in combat, since the American Revolutionary War – the entire history of our country.”

Representative Niki Tsongas, Democrat of Massachusetts, said Panetta’s announcement would “finally acknowledge the reality of the current nature of war, where the lines between combat and support personnel are not clearly drawn.”

More than 20,000 women have served in Iraq and Afghanistan, many of them in combat. As of last year, more than 800 women had been wounded in the two wars and more than 130 had died.

Share your thoughts about Mr. Panetta’s announcement in the comments.

Related Coverage

Pentagon Lifts Ban on Women Serving in Combat Roles

Marines Moving Women Toward the Front Lines

Women at Arms: How the Wars in Iraq and Afghanistan Have Profoundly Redefined the Role of Women

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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

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

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Glendale council takes first step toward banning gun show

The Glendale City Council took the first step toward banning a decades-old gun show at the Civic Auditorium, directing the city attorney to draft an ordinance that would permanently bar the sale of guns on city-owned property.

Despite their desire for the ban, however, the majority of City Council members also agreed to allow a gun show already on the calendar for March, saying that they didn't want to create an immediate financial problem for the event's organizer.

The decision angered more than 100 gun advocates who packed City Hall on Tuesday night to oppose any measure that would hinder the gun show, which has historically paid to use the Civic Auditorium across from Glendale Community College as its venue.

Councilman Ara Najarian firmly opposed the ban. Councilman Dave Weaver approved moving forward with the draft ordinance, but left open the possibility that he may change his mind when it returns for review in February or March.

Representatives of the National Rifle Assn. threatened legal action if the city banned the event, but several gun control advocates said the City Council should not be swayed.

"This is not the time to be driven by fear of lawsuits," said resident Zanku Armenian. "It's time to stand up for principles."

The gun show discussion comes as state and federal lawmakers consider tightening gun regulations after the Sandy Hook Elementary shooting last month in Newtown, Conn., which killed 26 people, including 20 first-graders.

Gun show supporters said it was unfair to lump that tragedy and the Glendale Gun Show into the same category, describing the triannual event as a family affair.

"The Glendale Gun Show is not a threat to the city of Glendale," said Steve Friesen, the event's promoter.

Councilman Rafi Manoukian, who suggested the ban in December, said gun shows don't belong on city property, especially because the Civic Auditorium is across the street from a school.

"It's time to be proactive," Manoukian said, adding that the gun show could still operate at a private facility in the city, such as the Hilton Hotel.

In 2006, Manoukian unsuccessfully pushed a similar ban for gun shows on civic property, which also attracted widespread criticism from pro-gun groups.

In 2012, three gun shows in Glendale generated about $55,000 in rental and parking revenue, or 13% of the Civic Auditorium's total income that year.

The show was expected to bring in $57,000 in 2013, according to a city report.

brittany.levine@latimes.com

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Worker at Algerian Gas Facility Describes Escape

BERGEN, Norway — After militants stormed his remote desert workplace last week, Liviu Floria, a Romanian gas worker, locked the door and sought refuge under a desk. For five hours, as he stayed hidden, he communicated by text message with a Romanian co-worker in another part of the sprawling In Amenas gas facility.

Then an ominous final message flashed on his cellphone from the colleague. “I am a hostage,” it said.

That colleague would later be found dead, Mr. Floria said, along with at least 36 other foreigners whom the Algerian government has identified as victims of the attack. But Mr. Floria’s story is one of both terror and salvation as he and seven others managed to scale the fence surrounding the compound, trek through the desert and escape death.

Mr. Floria saw the attack as it began last Wednesday. He and a colleague, George Iachim, were making their morning coffee when an alarm sounded. They rushed to the window and saw what looked like an action movie unfolding before them. Four men with assault rifles had gotten out of a car and were shooting at the guards stationed at the entrance.

“Out of a peaceful place, a normal place to work, in a few seconds it was transformed into a cemetery,” Mr. Iachim later told Romanian television.

After nearly two days of hiding from the hostage-takers, Mr. Floria and seven others decided their only chance at survival would come from climbing the fence and running away. They left around 2 a.m. for what became a harrowing desert trek, guided only by the flickering flame atop a gas well in the distance and a compass application on Mr. Floria’s iPhone.

Algerian officials said Tuesday that they were searching the Sahara for five missing foreigners, in the hopes that others might have escaped into the desert as Mr. Floria and the others did. “It’s ongoing,” said a senior Algerian official. “They’ve disappeared. We’re not going to just abandon them like that.”

Helge Lund, chief executive of Statoil, the Norwegian company that is one of the operators of the In Amenas plant, said Monday in a televised news conference that 12 of Statoil’s 17 employees had returned home, while “extensive searches in and around the plant at In Amenas and at hospitals in Algeria are taking place” for the other five. It was unclear whether the Algerians were referring to the Norwegians, who as of late Tuesday were still classified as missing rather than dead.

Mr. Floria recounted his experiences from back home in Romania on Tuesday. He was clearly still shaken by the experience and traumatized about the deaths of his colleagues, including two Romanians, and on Monday he had gone to a monastery to pray.

Mr. Floria, 45, said that he was no wildcat cowboy, no thrill seeker or adventurer, just a hard-working man hoping to provide a better life for his family. He had been employed in the oil and gas industry in Pitesti, Romania, for nearly 20 years when he was contacted through the job-networking Web site LinkedIn by an international recruiting agency.

The new job in Algeria as a mechanical foreman paid five times as much as he was making in Romania, where the industry was struggling and the future looked uncertain. With the money he earned, Mr. Floria hoped that he could send his teenage daughter to Britain for college and eventually buy himself a little house in the mountains. Safety was not a concern, he said.

He began work in 2010 and before long was used to the routine, one month in the Sahara working 12-hour days and one month back home.

The night before the attack, Mr. Floria went to bed early. It was a decision he said he believed might have saved his life. He woke up early, at 5:15 a.m., and he and Mr. Iachim drove in a Toyota Land Cruiser from the living area to the central processing facility a few miles away. They drove through the very gate that the militants would storm minutes later.

The two Romanians stayed all day and all night in the office, trying to keep quiet, subsisting on water and a few cookies they had with them. Long periods of silence were interrupted by minutes of gunfire and explosions. Mr. Floria tried to suppress his emotions and remain focused on staying alive.

“In my mind, the fate was we should escape from here,” Mr. Floria said. “I must stay calm, manage my feelings and we see what happens next.”

On Thursday afternoon, after more than 24 hours in hiding, they heard someone calling: “Anybody here? Anybody here?”

It was Lou Fear, one of the Britons. “When we heard his voice, we were very happy,” Mr. Floria said, relieved to have been found by others who had eluded capture.

Mihai Radu contributed reporting from Bucharest, Romania; Henrik Pryser Libell from Bergen; and Adam Nossiter from Algiers.

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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."

___

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

___

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