Employers Must Offer Family Health Care, Affordable or Not, Administration Says

WASHINGTON — In a long-awaited interpretation of the new health care law, the Obama administration said Monday that employers must offer health insurance to employees and their children, but will not be subject to any penalties if family coverage is unaffordable to workers.

The requirement for employers to provide health benefits to employees is a cornerstone of the new law, but the new rules proposed by the Internal Revenue Service said that employers’ obligation was to provide affordable insurance to cover their full-time employees. The rules offer no guarantee of affordable insurance for a worker’s children or spouse. To avoid a possible tax penalty, the government said, employers with 50 or more full-time employees must offer affordable coverage to those employees. But, it said, the meaning of “affordable” depends entirely on the cost of individual coverage for the employee, what the worker would pay for “self-only coverage.”

The new rules, to be published in the Federal Register, create a strong incentive for employers to put money into insurance for their employees rather than dependents. It is unclear whether the spouse and children of an employee will be able to obtain federal subsidies to help them buy coverage — separate from the employee — through insurance exchanges being established in every state. The administration explicitly reserved judgment on that question, which could affect millions of people in families with low and moderate incomes.

Many employers provide family coverage to full-time employees, but many do not. Family coverage is much more expensive, and the employee’s share of the premium is typically much larger.

In 2012, according to an annual survey by the Kaiser Family Foundation, premiums for employer-sponsored health insurance averaged $5,615 a year for single coverage and $15,745 for family coverage. The employee’s share of the premium averaged $951 for individual coverage and more than four times as much, $4,316, for family coverage.

Starting in 2014, most Americans will be required to have health insurance. Low- and middle-income people can get tax credits to help pay their premiums, unless they have access to affordable coverage from an employer.

In its proposal, the Internal Revenue Service said, “Coverage for an employee under an employer-sponsored plan is affordable if the employee’s required contribution for self-only coverage does not exceed 9.5 percent of the employee’s household income.”

The rules, though labeled a proposal, are more significant than most proposed regulations. The Internal Revenue Service said employers could rely on them in making plans for 2014.

In writing the law, members of Congress often conjured up a picture of employees working year-round at full-time jobs. But in drafting the rules, the I.R.S. wrestled with the complex reality of part-time, seasonal and temporary workers.

In addition, the administration expressed concern that some employers might try to evade the new requirements by firing and rehiring employees, manipulating their work hours or using temporary staffing agencies. The rules include several provisions to prevent such abuse.

The law says an employer with 50 or more full-time employees may be subject to a tax penalty if it fails to offer coverage to “its full-time employees (and their dependents).”

Employers asked for guidance, and the Obama administration provided it, saying that a dependent is an employee’s child under the age of 26.

“Dependent does not include the spouse of an employee,” the proposed rules say.

Thus, employers must offer coverage to children of an employee, but do not have to make it affordable. And they do not have to offer coverage at all to the spouse of an employee.

The administration said that the rules — which apply to private businesses, nonprofit organizations and state and local government agencies — would require changes at many work sites.

“A number of employers currently offer coverage only to their employees, and not to dependents,” the I.R.S. said. “For these employers, expanding their health plans to add dependent coverage will require substantial revisions to their plans.”

In view of this challenge, the agency said it would grant a one-time reprieve to employers who fail to offer coverage to dependents of full-time employees, provided they take steps in 2014 to come into compliance. Under the rules, employers must offer coverage to employees in 2014 and must offer coverage to dependents as well, starting in 2015.

The new rules apply to employers that have at least 50 full-time employees or an equivalent combination of full-time and part-time employees. A full-time employee is a person employed on average at least 30 hours a week. And 100 half-time employees are considered equivalent to 50 full-time employees.

Thus, the government said, an employer will be subject to the new requirement if it has 40 full-time employees working 30 hours a week and 20 half-time employees working 15 hours a week.

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Hollywood keeps its tax break in 'fiscal cliff' deal

Middle-class taxpayers aren't the only ones who stand to benefit from the last-ditch deal to avert the so-called fiscal cliff.

The agreement in Congress also includes something for Hollywood -- the extension of a tax break for movies and TV shows that shoot mainly in the U.S.

The provision, Section 181 of the federal tax code, allows qualifying productions to write down the first $15 million of expenses from their corporate tax bill. 

The program will cost an estimated $430 million in deductions in the next year, according to estimates by the Joint Committee on Taxation.

Congress implemented the federal tax incentive in 2004 to encourage productions to stay home rather than flee to Canada, Britain and other foreign countries.

It's not clear how effective the incentive has been. Film and television production continues to migrate to foreign cities, including Vancouver, Canada, and London, because of the stronger film tax breaks available there.  And while production in the U.S. has increased dramatically in the last decade, most of that has been attributed to various state tax incentive programs.

Nonetheless, the federal credit extension was strongly backed by the Motion Picture Assn of America, the chief lobbying arm for the studios. MPAA Chief Executive Chris Dodd has been a strong proponent of tax breaks for the industry.

"The combination of the state production incentives and the federal incentive over the past decade have been a successful counter to very aggressive incentives in foreign countries," said Kate Bedingfield, a spokeswoman for the MPAA. "The accompanying growth of production in the United States over that same time is great evidence of that.''

The film and television industry employs 2.1 million people and is responsible for $137 billion in total wages to American workers, according to the MPAA.

"The film and television industry is a vital component of the nation's overall economy, has a positive balance of trade with virtually every country in the world, and has been a significant contributor to growth in our economy," Bedingfield added.

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Ruling over bumper-car injury supports amusement park

SAN FRANCISCO — The California Supreme Court, protecting providers of risky recreational activities from lawsuits, decided Monday that bumper car riders may not sue amusement parks over injuries stemming from the inherent nature of the attraction.

The 6-1 decision may be cited to curb liability for a wide variety of activities — such as jet skiing, ice skating and even participating in a fitness class, lawyers in the case said.

"This is a victory for anyone who likes fun and risk activities," said Jeffrey M. Lenkov, an attorney for Great America, which won the case.

But Mark D. Rosenberg, who represented a woman injured in a bumper car at the Bay Area amusement park, said the decision was bad for consumers.

"Patrons are less safe today than they were yesterday," Rosenberg said.

The ruling came in a lawsuit by Smriti Nalwa, who fractured her wrist in 2005 while riding in a bumper car with her 9-year-old son and being involved in a head-on collision. Rosenberg said Great America had told ride operators not to allow head-on collisions, but failed to ask patrons to avoid them.

The court said Nalwa's injury was caused by a collision with another bumper car, a normal part of the ride. To reduce all risk of injury, the ride would have to be scrapped or completely reconfigured, the court said.

"A small degree of risk inevitably accompanies the thrill of speeding through curves and loops, defying gravity or, in bumper cars, engaging in the mock violence of low-speed collisions," Justice Kathryn Mickle Werdegar wrote for the majority. "Those who voluntarily join in these activities also voluntarily take on their minor inherent risks."

Monday's decision extended a legal doctrine that has limited liability for risky sports, such as football, to now include recreational activities.

"Where the doctrine applies to a recreational activity," Werdegar wrote, "operators, instructors and participants …owe other participants only the duty not to act so as to increase the risk of injury over that inherent in the activity."

Amusement parks will continue to be required to use the utmost care on thrill rides such as roller coasters, where riders surrender control to the operator. But on attractions where riders have some control, the parks can be held liable only if their conduct unreasonably raised the dangers.

"Low-speed collisions between the padded, independently operated cars are inherent in — are the whole point of — a bumper car ride," Werdegar wrote.

Parks that fail to provide routine safety measures such as seat belts, adequate bumpers and speed controls might be held liable for an injury, but operators should not be expected to restrict where a bumper car is bumped, the court said.

The justices noted that the state inspected the Great America rides annually, and the maintenance and safety staff checked on the bumper cars the day Nalwa broke her wrist. The ride was functioning normally.

Reports showed that bumper car riders at the park suffered 55 injuries — including bruises, cuts, scrapes and strains — in 2004 and 2005, but Nalwa's injury was the only fracture. Nalwa said her wrist snapped when she tried to brace herself by putting her hand on the dashboard.

Rosenberg said the injury stemmed from the head-on collision. He said the company had configured bumper rides in other parks to avoid such collisions and made the Santa Clara ride uni-directional after the lawsuit was filed.

Justice Joyce L. Kennard dissented, complaining that the decision would saddle trial judges "with the unenviable task of determining the risks of harm that are inherent in a particular recreational activity."

"Whether the plaintiff knowingly assumed the risk of injury no longer matters," Kennard said.

maura.dolan@latimes.com

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Four Android productivity apps you should use in 2013

Happy New Year! Like most folks, I am working on some resolutions for 2013. One resolution I have is to be more productive. One way I am going to do this is by using my Android phone better. Now there are apps that I have, but really have not used to their fullest. As I work on this resolution, I might discover even better apps. For now I will focus on these impressive apps that can make anyone more productive.

I use Hootsuite on the computer, but rarely find myself engaging with it on my smartphone. With Hootsuite, you can manage Twitter, Facebook, LinkedIn, and Foursquare accounts. The free version allows for up to five accounts and one member of your team to access the account. There is a pro version with a monthly fee, in which you can have more accounts and team members and helpful analytics tools.

The design of the app is very good. If you sync the web version to mobile, you will have everything automatically downloaded to the phone. When viewing content, you swipe left or right to change columns or streams. If you are in the middle of a stream, simply tap the top menu bar to automatically return to the top. The app allows for multiple profiles and scheduled tweets. My goal is to keep up with my feeds and tweets in real-time rather than waiting until I get to a computer.

Another web service that I started to use, but find myself not using it to the fullest. Producteev is a web-based task management service. With Producteev you can work as an individual or in a team by setting up workspaces and then organize tasks by labels. For each task you can assign a priority, due date, and share with team members, if you have any. Overall, this is a great service, since I like making lists, even though I rarely remember having made them.

The Producteev app is available for all platforms. The app has a very clean interface and is easy to find tasks. Probably the best way to keep up with tasks is to use the different widget for the home screen. Seeing the widgets will help keep those key tasks in the forefront of your mind. The app will work offline and syncs in the background.

I read blogs every single day, especially those related to new apps, Android, or mobile news. The only way I can do that is via my Google Reader. I find myself trying to catch up each day on the computer (just like with Twitter activity) when I would be better off reading a little bit over time during the day. NewsRob is a Google Reader that I have had for years. The interface is very clean and easy to use. The developer created a bunch of customizations options, which really make this reader stand out.

With NewsRob you can set up a notification of new articles, how you synchronize with Google and when, how many articles to keep in your cache, and more. If you set up folders within Google Reader, NewsRob will download the folders, too. This enables you to read the posts by blog or folder. The app provides a very clean blogpost display optimized for smaller screens. With each post you can zoom in or out, mark a post read or unread, view in the browser, and share the link to email or services such as Evernote. There is a free version of the app.

The last task I need to work on to be more productive is to keep up with the calendar. I find myself checking on the computer, after the fact, finding out that I am either late or forgot about a meeting or appointment. Using Google calendar is a good place to start, but I have not found the standard calendar app on my Droid was all that helpful.

Business Calendar is a very capable calendar app that has a ton of features. The app lets you view your calendar in a number of different views, and has search and favorite-calendar features, to name a few. The option of viewing different calendars, color coding and being able to easily add, delete, and edit events is helpful. The ability to use widgets for reminders is important. The pro version has over 10 different sizes and allows for the import or export of calendar files in the iCalendar format. Business Calendar also has a free version.

So my top goal or resolution for 2013 is to be more productive. I think using these apps more will help me accomplish that goal. Are there any apps you have but not using to their fullest? What resolutions do you have for 2013?

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Playboy Hugh Hefner marries his 'runaway bride'

LOS ANGELES (AP) — Hugh Hefner's celebrating the new year as a married man once again.

The 86-year-old Playboy magazine founder exchanged vows with his "runaway bride," Crystal Harris, at a private Playboy Mansion ceremony on New Year's Eve. Harris, a 26-year-old "Playmate of the Month" in 2009, broke off a previous engagement to Hefner just before they were to be married in 2011.

Playboy said on Tuesday that the couple celebrated at a New Year's Eve party at the mansion with guests that included comic Jon Lovitz, Gene Simmons of KISS and baseball star Evan Longoria.

The bride wore a strapless gown in soft pink, Hefner a black tux. Hefner's been married twice before but lived the single life between 1959 and 1989.

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Study Suggests Lower Death Risk for the Overweight

A century ago, Elsie Scheel was the perfect woman. So said a 1912 article in The New York Times about how Miss Scheel, 24, was chosen by the “medical examiner of the 400 'co-eds'” at Cornell University as a woman “whose very presence bespeaks perfect health.”

Miss Scheel, however, was hardly model-thin. At 5-foot-7 and 171 pounds, she would, by today's medical standards, be clearly overweight. (Her body mass index was 27; 25 to 29.9 is overweight.)

But a new report suggests that Miss Scheel may have been onto something. The report on nearly three million people found that those whose B.M.I. ranked them as overweight had less risk of dying than people of normal weight. And while obese people had a greater mortality risk over all, those at the lowest obesity level (B.M.I. of 30 to 34.9) were not more likely to die than normal-weight people.

The report, although not the first to suggest this relationship between B.M.I. and mortality, is by far the largest and most carefully done, analyzing nearly 100 studies, experts said.

But don’t scrap those New Year’s weight-loss resolutions and start gorging on fried Belgian waffles or triple cheeseburgers.

Experts not involved in the research said it suggested that overweight people need not panic unless they have other indicators of poor health and that depending on where fat is in the body, it might be protective or even nutritional for older or sicker people. But over all, piling on pounds and becoming more than slightly obese remains dangerous.

“We wouldn’t want people to think, ‘Well, I can take a pass and gain more weight,'” said Dr. George Blackburn, associate director of Harvard Medical School’s nutrition division.

Rather, he and others said, the report, in The Journal of the American Medical Association, suggests that B.M.I., a ratio of height to weight, should not be the only indicator of healthy weight.

“Body mass index is an imperfect measure of the risk of mortality,” and factors like blood pressure, cholesterol and blood sugar must be considered, said Dr. Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis.

Dr. Steven Heymsfield, executive director of the Pennington Biomedical Research Center in Louisiana, who wrote an editorial accompanying the study, said that for overweight people, if indicators like cholesterol “are in the abnormal range, then that weight is affecting you,” but that if indicators are normal, there’s no reason to “go on a crash diet.”

Experts also said the data suggested that the definition of "normal" B.M.I., 18.5 to 24.9, should be revised, excluding its lowest weights, which might be too thin.

The study did show that the two highest obesity categories (B.M.I. of 35 and up) are at high risk. “Once you have higher obesity, the fat’s in the fire,” Dr. Blackburn said.

But experts also suggested that concepts of fat be refined.

"Fat per se is not as bad as we thought," said Dr. Kamyar Kalantar-Zadeh, professor of Medicine and Public Health at the University of California, Irvine. "What is bad is a type of fat that is inside your belly. Non-belly fat, underneath your skin in your thigh and your butt area — these are not necessarily bad." He added that, to a point, extra fat is accompanied by extra muscle, which can be healthy.

Still, it is possible that overweight or somewhat obese people are less likely to die because they, or their doctors, have identified other conditions associated with weight gain, like high cholesterol or diabetes.

“You’re more likely to be in your doctor’s office and more likely to be treated,” said Dr. Robert Eckel, a past president of the American Heart Association and a professor at University of Colorado.

Some experts said fat could be protective in some cases, although that is unproven and debated. The study did find that people 65 and over had no greater mortality risk even at high obesity.

“There’s something about extra body fat when you’re older that is providing some reserve,” Dr. Eckel said.

And studies on specific illnesses, like heart and kidney disease, have found an “obesity paradox,” that heavier patients are less likely to die.

Still, death is not everything. Even if "being overweight doesn't increase your risk of dying," Dr. Klein said, it "does increase your risk of having diabetes" or other conditions.

Ultimately, said the study’s lead author, Katherine Flegal, a senior scientist at the Centers for Disease Control and Prevention, “the best weight might depend on the situation you’re in.”

Take the perfect woman, Elsie Scheel, in whose "physical makeup there is not a single defect," the Times article said. This woman who "has never been ill and doesn't know what fear is" loved sports and didn't consume candy, coffee or tea. But she also ate only three meals every two days, and loved beefsteak.

Maybe such seeming contradictions made sense against the societal inconsistencies of that time. After all, her post-college plans involved tilling her father’s farm, but “if she were a man, she would study mechanical engineering.”

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Optimistic stock investors reaped rewards worldwide in 2012

Wall Street closed out the year with a surge in the final trading session, betting on a last-minute resolution of the so-called fiscal cliff.

The market may have jumped the gun, but investors' hopefulness fit the pattern of 2012: It was a year of solid stock price gains worldwide, as various predictions of Armageddon fell flat.

That has reinforced many market pros' conventional cautious optimism as the new year begins. Bears can still find plenty to be dour about, but the bulls have called it right in three of the last four years since the 2008 financial-system crash.

On Monday, the Dow Jones industrial average jumped 166 points, or 1.3%, to end the year at 13,104. Stocks rallied late in the session as rumors spread that Congress would approve a deal to limit the tax increases and spending cuts otherwise set to kick in Tuesday.

But after the closing bell, a deal to avert the fiscal cliff appeared uncertain — raising fears of a blistering market sell-off Wednesday.

Still, investors who had expected a sustained slump in stocks in 2012 found themselves left behind as most world markets posted double-digit percentage gains, underpinned by a resilient U.S. economy and by central banks' efforts to keep interest rates at rock bottom.

Wall Street optimism about 2013 remains rooted in expectations that the U.S. economy will continue to expand, albeit slowly, and with it corporate earnings.

"Absent a complete failure from Washington, growth should remain positive," said Russ Koesterich, global chief investment strategist at money management giant BlackRock Inc. in New York.

That bet paid off in 2012: The Standard & Poor's 500 index, a popular benchmark for many Americans' retirement accounts, rose 1.7% to 1,426 on Monday and was up 13.4% for the year.

That was the biggest advance since the index rose 23.4% in 2009. Stocks' gains last year also beat returns on most kinds of bonds and on low-yielding short-term cash accounts.

The S&P index now has rebounded 111% from its decade low in March 2009, restoring most of the wealth lost by investors in the Great Recession — if they held on.

In Europe, the Stoxx index of 600 big-name shares rose 14.4% for the year, also the biggest rally since 2009. Japan's main market index soared 22.9%. Most so-called emerging markets also were up sharply, including those in India, Mexico and Turkey.

The 30-stock Dow index was a relative laggard, rising 7.3% for the year. It was hurt by weakness in major energy stocks as crude oil prices fell and by a collapse of shares of troubled tech giant Hewlett-Packard Co.

Markets worldwide had rallied in the first few months of 2012, then dived in spring as doubts multiplied about the global economy.

Europe, gripped for a third year by its government-debt crisis, was the epicenter of those fears: Many investors expected the Eurozone to finally break up under its debt strains, consigning Greece, Spain, Portugal and perhaps other nations to economic death spirals.

But the doomsday predictions were thwarted by the European Central Bank. In late July, ECB President Mario Draghi shocked markets by declaring that the central bank would do whatever was necessary to preserve the Eurozone. "And believe me, it will be enough," Draghi said.

The ECB followed that pledge with a commitment to buy unlimited sums of Eurozone governments' bonds, if necessary, to pull down countries' borrowing costs — similar to the U.S. Federal Reserve's ongoing program of buying Treasury debt.

The ECB's move sparked a sharp rally in the euro that buoyed confidence in European stocks as well, despite deep recessions in the Continent's hardest-hit economies.

The U.S. economy, meanwhile, confounded expectations that it would slide back into recession. The economy grew at a 3.1% annualized rate in the third quarter after slowing to a 1.3% rate in the second quarter. Growth was supported in part by the housing market's continuing rebound.

"Housing got us into this mess. Now it's one of the sectors to get us out," said Sam Stovall, chief investment strategist at S&P Capital IQ in New York.

Housing-related stocks were some of the year's biggest winners, with builder PulteGroup Inc. up 188%, appliance maker Whirlpool Corp. rising 114% and paint producer Sherwin-Williams Co. up 72%.

Worldwide, investors' confidence also benefited as worries dissipated about a war between Israel and Iran. And late in the year, hopes rose that China's slowing economy would avoid a so-called hard landing — which could have put it in a recession — and instead would help drive global growth in the new year. The Shanghai stock market rocketed nearly 15% in December alone.

Emerging markets such as China could be a big lure for global investors in 2013, some experts said. Many governments in those markets have more leeway than developed economies to bolster growth with fiscal stimulus measures and with lower interest rates, said Jack Ablin, chief investment officer at BMO Private Bank in Chicago.

By contrast, Ablin worries that U.S. economic growth and corporate earnings growth will be much slower than many investors are anticipating in the new year.

Whatever the ultimate workout of the fiscal cliff, Ablin said, "We are going to see taxes go up incrementally and spending go down incrementally," weighing on the economy.

Market pessimists believe that stock markets since 2009 have been driven largely by cheap credit supplied by central banks, particularly the Federal Reserve. Critics say the Fed's latest decision to ramp up purchases of Treasury bonds, aimed at pumping more money into the economy, smacks of desperation.

Fed Chairman Ben S. Bernanke, however, has insisted that the Fed still has plenty of tools left to help the U.S. recovery gain speed. Wall Street, by and large, believes Bernanke.

"If they can print money," Stovall said, "are the central banks ever really out of bullets?"

business@latimes.com

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Body of Connecticut shooter Adam Lanza quietly claimed by his father

Newtown, Conn. shooter Adam Lanza's body has been claimed by his father.

The body of Newtown, Conn., shooter Adam Lanza was claimed by his father last week, a family spokesman said Monday. 

Peter Lanza claimed his son's body from the Connecticut medical examiner last Thursday, said family spokesman Errol Cockfield.

“Private arrangements took place over the weekend," Cockfield said. He declined to elaborate further about the nature of the arrangements.

Connecticut Chief State Medical Examiner H. Wayne Carver, confirmed that Lanza's body is "finally gone."

Adam Lanza, 20, killed 20 first-graders and six adults at Sandy Hook Elementary School on Dec. 14 and then committed suicide. He also killed his mother in their Newtown home before the rampag.

PHOTOS: Connecticut school shooting

A private funeral was held earlier this month in New Hampshire for his mother, Nancy Lanza, who was divorced from Peter Lanza.

Authorities have not offered a motive for the killings. State police say they have been exploring all aspects of Adam Lanza's life, including his education, family history and medical treatment for clues.

"Our family is grieving along with all those who have been affected by this enormous tragedy," Peter Lanza said in a statement in the days after the shooting. "No words can truly express how heartbroken we are. We are in a state of disbelief and trying to find whatever answers we can. We too are asking why."

Peter Lanza lives in Stamford, Conn., and is an executive with GE Energy Financial Services. 

Adam Lanza, who was known to be very shy, had a tight relationship with his mother but was estranged from his father after the couple's 2001 separation was finalized in a 2009 divorce.

FULL COVERAGE: Shooting at Connecticut school

Peter Lanza had seen his son weekly after the separation, according to a family acquaintance. But Adam Lanza began refusing to see him after Peter began seeing another woman whom he later married, according to Shelley Cudiner, an employee at the library at the University of Connecticut.

Adam Lanza also began refusing to see his brother, Ryan, an accountant in Manhattan, after their parents' 2009 divorce.

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Armstrong better, Green Day to resume tour in 2013

LOS ANGELES (AP) — Green Day is going back on the road.

The Grammy-winning punk band announced new tour dates Monday.

The band canceled the rest of its 2012 club schedule and postponed the start of a 2013 arena tour after singer-guitarist Billie Joe Armstrong's substance abuse problems emerged publicly in September when he had a profane meltdown on the stage of the iHeartRadio Music Festival in Las Vegas. The band's rep announced later that Armstrong was headed to treatment for substance abuse.

"I just want to thank you all for the love and support you've shown for the past few months," Armstrong told fans in a statement Monday. "Believe me, it hasn't gone unnoticed and I'm eternally grateful to have such an amazing set of friends and family. I'm getting better every day. So now, without further ado, the show must go on."

The tour is scheduled to begin March 28 at the Allstate Arena in the Chicago area. Tickets for postponed shows will be honored on the new dates, and refunds will be available for canceled shows.

"We want to thank everyone for hanging in with us for the last few months," the band said. "We are very excited to hit the road and see all of you again, though we regret having to cancel more shows."

The band released their most recent album, "Tre," on Dec. 11, more than a month ahead of schedule.

___

Online:

http://www.greenday.com/

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Well: Managing Diabetes, Then Told of Cancer

Nine years ago, Brenda Gray, a former schoolteacher in North Carolina, discovered she had Type 2 diabetes.

Since then, she has learned to manage the disease, diligently taking her medicine and keeping tabs on her blood sugar. But in September, she was told she had skin cancer, and her diabetes spun out of control.

Ms. Gray started an aggressive course of treatment that included radiation therapy. But the treatments weakened her and destroyed her appetite. Unable to eat, she developed dangerously low blood-sugar levels, and about two months ago, Ms. Gray’s daughter had to rush her to a hospital.

“She found me in bed shaking and sweating,” said Ms. Gray, who is 62 and lives in Durham. “When I got to the hospital, they couldn’t understand how I was still standing.”

Cancer and diabetes are two of the leading killers in America. Each can be a devastating diagnosis in its own right, but researchers are finding that the two often occur together. By some estimates, as many as one in five cancer patients also has diabetes.

In a recent joint report, the American Cancer Society and the American Diabetes Association noted that people with Type 2 diabetes have an increased risk of developing cancers of the liver, pancreas, colon and bladder. Researchers with the National Cancer Institute released a similar report last year, which found greater rates of cancer among diabetics, as well as an elevated risk of dying from cancer.

Experts say it is clear from accumulating clinical data that the two share some biological links. The problem results from simple demographics as well: with the rapid rise in Type 2 diabetes and a growing population of cancer survivors, the two diseases are coinciding more frequently in older patients.

“We are going to see a lot greater numbers of people with both diseases,” said Edward Giovannucci, a professor of nutrition and epidemiology at the Harvard School of Public Health and an author of the joint report. “By some estimates, the link between diabetes and cancer may quantitatively become even more important than the link between smoking and cancer.”

Already, oncologists say, it is not uncommon to encounter patients struggling to balance cancer treatments with insulin shots and diabetes drugs. Because cancer is generally seen as the more lethal of the two diseases, patients often make it the priority.

“Although cancer is no longer generally a death sentence, for many patients, they see it as that no matter what you say,” said Dr. June McKoy, a geriatric oncologist at the Northwestern University Feinberg School of Medicine. “Suddenly, they put their diabetes on the back burner, and they focus on the cancer.” But high blood sugar can damage kidneys and blood vessels, strain the immune system and worsen cancer prognosis.

Researchers say that the link between the two diseases is complex and driven by many factors. Typically, though, it is diabetes that sets the stage for cancer. “Most cancers don’t cause diabetes,” said Dr. Pankaj Shah, an endocrinologist at the Mayo Clinic in Rochester, Minn. “Mostly diabetes increases the risk of cancer.”

Type 2 diabetes is often preceded by chronically high insulin levels and high blood sugar, fertile conditions for cancer. Insulin is known to fuel cell growth, and cancer cells consume glucose out of proportion to other nutrients. The two diseases share many risk factors as well, including obesity, poor diet, physical inactivity, smoking and advanced age.

Another factor that complicates the relationship are the treatments given to patients. Diabetes drugs can have an impact on cancer prognosis and vice versa. Type 2 diabetics treated with the drug metformin, for example, develop cancer less frequently than diabetics given other medications. A number of clinical trials are now under way to see how well the drug performs as a cancer treatment.

Drugs used against cancer, on the other hand, tend to worsen diabetes. Chemotherapy can wreak havoc on blood sugar levels, and glucocorticoids, which are widely prescribed to alleviate nausea in cancer patients, promote insulin resistance, said Dr. Lorraine L. Lipscombe of Women’s College Hospital in Toronto.

Dr. Lipscombe was the lead author of a large study last month that found that breast cancer survivors were 20 percent more likely to receive a diabetes diagnosis than other women. The study found evidence that glucocorticoids and chemotherapy may hasten the onset of diabetes.

“They don’t cause diabetes in everyone, but they can bring out or unmask it in people who might already be vulnerable,” she said.

For diabetics who are used to tightly monitoring their blood sugar levels, the impact of cancer drugs can be alarming. Rigoberto Cortes, 71, a former metal worker in Chicago, has had Type 2 diabetes for over two decades. A year ago, he was told he had Stage 3 colon cancer.

“When I started chemotherapy, my sugar level was going way up and way down like never before,” he said. “I kept asking my oncologist what I should do.”

Mr. Cortes said his oncologist was not very concerned by the blood sugar swings. He eventually got a second opinion and switched doctors. He also lost weight and changed his eating habits, which helped minimize his blood sugar swings.

Although every case is different, the general strategy in treating such patients should be to get the cancer under control first, said Dr. Shah at the Mayo Clinic.

“Diabetes treatment essentially is given to prevent long-term complications,” he added.

At some hospitals, oncologists may take responsibility for managing blood sugar and other diabetes concerns in their cancer patients. But ideally, treatments should be coordinated by a team that includes a certified diabetes educator.

“They go over diet with the patient, review their medication, review their insulin,” said Dr. McKoy of Northwestern. “They can play a big role.”

For a diabetic trying to navigate the world of cancer, or a cancer patient navigating the world of diabetes, such interventions can be crucial. In a study published in October, Dr. McKoy and her colleagues looked at several years of health records for over 200,000 people with Type II diabetes who developed cancer.

Those who underwent a diabetes counseling session after their cancer diagnosis — consisting of two sessions a week for four to six weeks — were more likely to receives tests of hemoglobin A1c levels, a barometer of how well blood sugar has been controlled over time, and to take care of their blood sugar levels. As a result, they had fewer emergency room visits, fewer hospital admissions and lower health care costs.

Ms. Gray, the former schoolteacher in Durham, learned this firsthand. After her recent emergency, she worked with a diabetes educator at Duke University Hospital. Ms. Gray learned tips and strategies to balance the two diseases, including ways to keep her blood sugar normal when cancer treatments ruin her appetite.

“I came into the hospital and they got me back on track,” she said. “I was just so focused on the cancer. It changed everything. But I’ve learned how to face this.”

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