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Democratic senators, several of whom are themselves avid traders in healthcare stocks, were right to roast HHS secretary designee Dr. Tom Price for his unseemly plunges into individual healthcare equities.

AS HHS secretary, Dr. Tom Price may be torn between orders to repeal the ACA and pressure from insurers to stabilize the marketplace in order to maintain coverage for 20 million people.

Everyone on the 100 Most Influential People in Healthcare ranking for 2013 plays some part in the massive change roiling the U.S. healthcare system. Providers, payers, regulators, politicians and advocates all grapple daily with how reform is affecting their jobs and organizations. Aetna CEO Mark Bertolini, calls it necessary. "I truly believe we have a once-in-a-lifetime opportunity to improve quality, and control costs and make healthcare work for everyone," says Bertolini, the No. 6 ranked official on this years list.

With the election settled, the Obama administration has forged ahead with a draft rule on essential benefits and other provisions under the Affordable Care Act. Key players are still digesting the proposals, but HHS Secretary Kathleen Sebelius, left, says she's confident that the new rules-and an extended deadline related to exchanges-will give states what they need to implement the law.

As the federal government begins to focus more on wasteful healthcare spending, doctors' relationships with drug companies are coming under scrutiny. Many times, those relationships are legitimate, says Mary Riordan, left, a senior counsel to HHS' inspector general's office. "There are other situations where the relationship between the doctor and the manufacturer is suspect".

In the wake of an IOM report on the criteria HHS should use to determine what benefits will be "essential" under reform, various stakeholders are weighing in. The National Association of Public Hospitals and Health Systems would like "enabling" services--such as language, transportation and case-management services--included, because they help make medical care more effective, says Xiaoyi Huang, left, of the NAPH.

Two new reports had some harsh words for HHS' enforcement of the HIPAA security rule on guarding patient data. A lack of strong enforcement may be hindering providers' efforts in the area. "I continue to hear from folks who work in security, that as long as there is not visible enforcement, it hurts their chances to getting the resources and budgets and employees they need," says Lisa Gallagher.

HHS laid out the framework for its quality-improvement priorities, and providers greeted it with praise. "This is very much in keeping with what we are trying to do for our community as an integrated health system. It helps us partner with patients so there is shared responsibility, and there is also a focus on wellness, which we know is critical to the future of healthcare and controlling costs," says Dr. Nick Turkal, left, of Aurora Health Care.

The final rule for value-based purchasing for hospital services is in, and it contains a few things hospitals didn't want. But some are praising the effort. "We don't have many worries, since we've been working on the core elements of these for some time," says Dr. Charles O'Brien, left, of the Sanford University of South Dakota Medical Center.

HHS has offered a framework on value-based purchasing for ambulatory surgery centers. And ASCs say they're ready. "We are very serious about getting this up and running as soon as possible. I think the only thing I could (negatively) speak to would be further delay," says Dr. David Shapiro, left, of the Ambulatory Surgery Center Association. But delay could be inevitable as the initiative has to make its way through the charged health policy environment in Washington.

HHS has new authority to review proposed insurance premium increases, but no real power to stop them. But at least some states without a rate review process say they welcome any support. "We are borderline at market failure," says Michael McRaith, left, director of the Illinois Department of Insurance. "The expectation is not that rates are going to dramatically or miraculously decline. But that rates will be more stable".

Guided by how weather data from the National Oceanic and Atmospheric Administration fuels all kinds of weather reports, maps and forecasts, HHS officials saw parallels on how to distribute health data so software developers could create tools to be used by patients and providers. "We thought that was inspiring," said Todd Park, left, HHS' chief technology officer.

After many weeks of back-and-forth, Kathleen Sebelius is finally leaving the Sunflower State to take over as HHS secretary. And she isn't headed for a bed of roses as she takes on major healthcare reform and the so-called "swine flu." Her predecessor, Mike Leavitt, right, said he believes she has what it takes to the job. "She has a steep learning curve, but I'm sure she'll do fine," he says.

HHS' new infection-control action plan has some hospital executives arguing that they need a coordination of efforts from HHS, not just guidelines. The federal agenda includes a focus on four hospital-acquired infections. "These are the big four," says HHS' Don Wright, left.

HHS released an updated plan on promoting IT, and it won praise for its broad scope and organization. But there were criticisms--that it wasn't forceful enough in pushing for adoption and didn't do enough to marshal federal resources to meet goals. "The strong points are the emphasis on EHR adoption and interoperability ... on the other hand, the overall adoption goal was low," physician Andrew Ury, left, says.

PatientS delivered a grim assessment last week in survey data, saying only 67% would recommend their hospitals 10 friends or family. But Louis Shapim, left, from the Hospital for Special Surgery says he is concerned about the accuracy of the HCAHPS data because otherwis, "transparency isn't good, it doesn't add any value"

The IOM's call for a national initiative to determine best medical practices has some wondering how such an effort would work. But most everyone agrees that providers and payers are overwhelmed by data about clinical effectiveness. "Once we get an innovation, let's study it right away so we can be sure every person who could benefit gets it, or if it doesn't work, let's do no harm," says WellPoint's Samuel Nussbaum, left.

Healthcare pricing was the focus of discussion in Washington last week, with HHS announcing agencies will be posting the prices paid for common procedures, and industry experts testifying at a hearing on the topic. The debate among lawmakers tends to mask the complexity of shifting healthcare costs, says Paul Ginsburg, left.

HHS' Medicaid Commission presented its first proposal for cutting $10 billion from the Medicaid program while still keeping it viable. Questions remain about how well the recommendations will work and some, like John Goodman, left, of the Washington-based National Center for Policy Analysis, said the proposal is a short-term solution for a program that needs a "complete overhaul."