Healthcare law will have new California Legislature scrambling

SACRAMENTO — When state lawmakers are sworn in Monday for the new legislative session, they will have little time to enjoy the pomp and circumstance.

Facing a federal deadline, the Legislature must move quickly to pass measures to implement President Obama's healthcare law and revamp the state's insurance market. New legislation will help extend coverage to millions of uninsured Californians and solidify the state's reputation as a key laboratory for the federal law.

Legislative leaders have said they also want to overhaul environmental regulations, curb soaring tuition at public colleges, and tweak the state's tax structure and ballot-initiative system.

But healthcare remains one of the largest and most immediate challenges.

The federal Affordable Care Act takes effect in January 2014, when most Americans face the requirement to buy health insurance or pay a penalty. State lawmakers must pass a series of rules to clear the way for enrollment in a new state-run insurance market next fall, including a requirement for insurers to cover consumers who have preexisting medical conditions and limits on how much they can charge based on age.

Gov. Jerry Brown is expected to call a special session of the Legislature next month — concurrent with the regular session — so healthcare bills that he signs can take effect within 90 days rather than the next year.

"It's a very, very big undertaking to make the promise of the Affordable Care Act a reality," said state Health and Human Services Secretary Diana Dooley. "We are working as hard and as fast as we can in a very complex area with a lot of conflicting information."

As an early adopter of the Affordable Care Act, California has already laid much of the groundwork.

It was the first state to establish an insurance exchange after Congress passed the legislation in 2010. More than 30 other states have since sought federal help in enacting their own. Millions of Californians will be able to purchase coverage, with federal subsidies earmarked for families earning about $92,000 or less annually.

One of the most significant proposals will be an expansion of Medi-Cal, the state's health insurance program for the poor. About 2 million low-income Californians would be newly eligible under the expansion, with the federal government subsidizing costs for the first three years. The state would then shoulder a portion of the bill.

According to a Kaiser Family Foundation study, the expansion could cost the state $6.3 billion over a decade, meaning a 1.7% increase in the amount California spends on Medi-Cal.

California got a head start on the effort by signing up more than 550,000 low-income people in a temporary program. They are expected to automatically move into Medi-Cal in 2014.

Lawmakers will also consider legislation that would create a health plan for people who cannot afford insurance on the open market but make too much money to qualify for Medi-Cal. The option, known as the Basic Health Plan, would provide coverage for individuals with incomes between 133% and 200% of the federal poverty level, or between $15,000 and $21,800 a year.

State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and author of the proposal, said the plan was needed to help California's working poor. "I don't think they should be choosing between putting food on the table and buying health insurance," he said.

Insurers urged lawmakers to resist requirements that could make policies offered through the exchange unaffordable.

"We think the Affordable Care Act does much to get millions of people coverage, but new insurance taxes, costly benefit requirements and age pricing restrictions all have the potential of driving up costs," said Nicole Evans, a spokeswoman for the California Assn. of Health Plans.

Healthcare advocates said it was critical for the Legislature to promote policies that would ensure a mix of healthy and sick policyholders to keep premiums affordable.

"It should be a goal of the state to have millions of people enrolled on Day 1," said Anthony Wright, executive director of the consumer group Health Access California, "to bring in those federal dollars and make healthcare cheaper for everybody."

michael.mishak@latimes.com

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Amid Egypt’s Duel on Democracy, Morsi Calls for Vote

Tara Todras-Whitehill for The New York Times

A Cairo rally for President Mohamed Morsi, who wants expanded powers, drew a crowd of hundreds of thousands on Saturday.

CAIRO — President Mohamed Morsi speaks darkly of imminent threats from a conspiracy of unnamed foreign enemies and corrupt businessmen. He vows to uncover counterrevolutionaries hiding under judicial robes. His advisers charge that loyalists of the former dictator have infiltrated the opposition, saying it would gladly sacrifice democracy to defeat the Islamists.

Amr Abdallah Dalsh/Reuters

A large Cairo rally on Saturday added to a debate over President Mohamed Morsi’s commitment to democracy.

In a one-week blitz, Mr. Morsi and his allies in the Muslim Brotherhood cast aside two years of cautious pragmatism in an effort to seize full control of Egypt’s political transition. Mr. Morsi decreed himself above the reach of the courts until completion of a new constitution. He went around the laws to install his own public prosecutor in a stated drive to go after those who abused power or reaped profits under the old government. And his Islamist allies in the constitutional assembly rammed through a charter over the objections of their secular opposition and the Coptic Christian Church.

On Saturday, Mr. Morsi pushed forward with plans for the new constitution, setting a national referendum on it for Dec. 15.

“I pray to God and hope that it will be a new day of democracy in Egypt,” he said in a nationally televised speech, calling for a “national dialogue.”

But his recent tone and actions reminded critics of the autocratic ways of his predecessor, and have aroused a new debate here about his commitment to democracy and pluralism at a time when he and his Islamist allies dominate political life.

Mr. Morsi’s advisers call the tactics a regrettable but necessary response to genuine threats to the political transition from what they call the deep state — the vestiges of the autocracy of former President Hosni Mubarak, especially in the news media and the judiciary.

But his critics say they hear a familiar paranoia in Mr. Morsi’s new tone that reminds them of talk of the “hidden hands” and foreign plots that Mr. Mubarak once used to justify his authoritarianism.

“I have sent warnings to many people who know who they are, who may be committing crimes against the homeland,” Mr. Morsi declared in an interview with state television on Thursday night, referring repeatedly to secret information about a “conspiracy” and “real and imminent threats” that he would not disclose. “If anybody tries to derail the transition, I will not allow them.”

In a speech to supporters that unveiled his new push to seize control of the transition’s end, Mr. Morsi was even more zealous. “To the corrupters who hide under respectable cover, I say, ‘Never imagine that I can’t see you,”’ he declared. “I’m on the lookout for them and will never let them go.”

The Muslim Brotherhood mobilized hundreds of thousands of supporters to rally on his behalf on Saturday at Cairo University. They chanted for legal action against the Mubarak-appointed judge who led the call for a judicial strike to protest Mr. Morsi’s attempts to limit judicial power over the transition, and against the Mubarak-appointed public prosecutor Mr. Morsi sought to remove.

The demonstrators denounced both men as remnants of the old government in disguise.

Across town, several thousand of Mr. Morsi’s opponents rallied in Tahrir Square to oppose the draft constitution and what they describe as Mr. Morsi’s power grab. In response to the referendum announcement, Mohamed ElBaradei, an opposition leader and former United Nations diplomat, sent a Twitter message that the draft constitution “undermines basic freedoms and violates universal values.”

“The struggle will continue,” he added.

The Brotherhood has adopted a tone of “open threats and intimidation,” said Hossam Bahgat, executive director of the Egyptian Initiative for Personal Rights. Liberal critics note that the Brotherhood has already broken its pledges not to take more than a third of the parliamentary seats, run a presidential candidate or monopolize power.

Mayy El Sheikh contributed reporting.

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6 Futuristic Fireplaces to Keep You Warm This Winter

Who would have guessed — the futuristic-looking luxury fireplace industry is booming. Surprisingly, if you can dream it, it can be built. But, most of the time, it’ll cost you.

It seems we’re no longer just content to view the crackling Yule Log on our TVs. These fireplaces even move past the traditional stone and brick models commonly seen today. They run on gas and have controllers to turn them on or off. Some can even be operated from smartphone apps.

[More from Mashable: For Sale: Space Shuttle Xing Sign]

Check out the gallery and tell us which one is most appealing to you.

Uni Flame

The Uni Flame indoor or outdoor fireplace comes from modern home goods company Radius.

[More from Mashable: Portland Toymakers Create Ten-Legged Bamboo Companion [VIDEO]]

Click here to view this gallery.

Photo courtesy of iStockphoto, dszc

This story originally published on Mashable here.

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Ashley Hebert and J.P. Rosenbaum Are Married

People Exclusive

By Monica Rizzo

12/01/2012 at 06:15 PM EST

J.P. Rosenbaum and Ashley Hebert

Victor Chavez/Getty

It’s official: Bachelorette star Ashley Hebert and her fiancé J.P. Rosenbaum tied the knot Saturday afternoon in Pasadena, Calif.

Surrounded by family, friends and fellow Bachelor and Bachelorette alumni like Ali Fedotowsky, Emily Maynard, and Jason and Molly Mesnick, the couple said "I do" in an outdoor ceremony officiated by franchise host Chris Harrison.

"Today is all about our friends and family," Hebert, whose nuptials will air Dec. 16 on a two-hour special on ABC, tells PEOPLE. "It's about standing with J.P., looking around at all the people we love in the same room there to celebrate our love."

The 28-year-old dentist from Madawaska, Maine, met New York construction manager Rosenbaum, 35, on season 7 of The Bachelorette. The couple became engaged on the season finale.

Hebert and Rosenbaum are the second couple in the franchise's 24 seasons to make it from their show finale to the altar, following in the footsteps of Bachelorette Trista Rehn, who married Vail, Colo., firefighter Ryan Sutter in 2003.

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Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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Army sergeant killed in Afghanistan

A self-described "meat and potatoes" conservative, Tony Ruiz often argued politics with his son.

They clashed over perceptions of Islam after the U.S. Embassy in Benghazi was overrun. But Tony said his son, Clinton, made some good points.

"He drew a very clear distinction between Muslim radicals and the Islam religion," Tony said. "It actually did convince me."

He is still convinced, a month after his son, Sgt. Clinton K. Ruiz, was killed by small-arms fire in Afghanistan, serving a tour as a psychological operations specialist with the 9th Military Information Support Battalion, 8th Military Information Support Group.

"It was one man pulling the trigger," the elder Ruiz said firmly. "Harboring ill will is not going to serve my son's memory."

Born in Poway and raised in Murrieta, Clinton was the type of kid who could always find a reason to be in a good mood, Ruiz said. In junior soccer leagues he defended the ball like a "bulldog with a pork chop," but he always had a kind word for anyone who scored a goal, said his mother, Carla Trease.

When he lost at board games, he'd heap accolades on the victor until they started to laugh. He lavished praise on his mother's cooking, sang along to the radio in the car and never minded if his younger siblings followed him around.

"I don't know how he did it." Trease said. "I was never a good cook. but he just made you feel good just by being in the room."

At school, Clinton was confident and athletic, but never a prom king candidate. He was quiet, but his smile won him friends. He tested well, but homework bored him, said Trease, an elementary school teacher. He felt most at home on a four-wheeler, conquering the hills near their Riverside County home at top speed.

"He just always wanted to be going somewhere and doing something," Trease said.

After graduating in 2008, Ruiz enrolled in summer college classes because he knew Trease wanted him to try. But even then, the only class that excited him was a course on emergency medical triage, Trease said. Before the summer was out, he had joined the Army.

Kira Ruiz, Clinton's wife, first met him in training camp as they stood shoulder to shoulder in formation for morning drills. Clinton was wearing Rayban glasses with the logo blacked out in Sharpie because regulations prohibited recruits to wear brand names.

"I looked up at him and said 'nice glasses,' and he started laughing," said Kira, who was also a psychological operations specialist.

When Kira became a squad leader during drills, Clinton took a position at road guard to be a few paces closer. Soon, he asked her out. She refused. He asked again, every day, for three weeks.

"I wasn't sure I liked him as more than a friend," Kira said. "But he was pretty sure."

Won over by Clinton's persistence, she started dating him, sneaking moments between language classes at their base, Ft. Bragg. One morning Clinton appeared in Kira's bedroom and shook her awake. In his right hand, he was carrying a caramel macchiato; in his left hand, a ring.

They got married in the county courthouse, after Kira's deployment was moved up. Clinton's father got a text the day of the wedding.

"It said, 'I got married lol,'" Tony Ruiz said. "Not a big planner, that one."

Late last year, soon after Kira gave birth to their son, Caleb, Clinton reenlisted with the Army. The decision sent him to Afghanistan and put him face to face with the small-arms fire that claimed his life.

Trease fought his decision and recalls a strong sense of foreboding. She called, texted and emailed until she feared she was "sounding like a broken record," Trease said.

"But he would always call back. He'd always say, 'I know, Mom, I know,' " Trease said.

Clinton was killed in the Oruzgan province in mountainous central Afghanistan. His awards include the Bronze Star Medal, Purple Heart and the National Defense Service Medal. He was buried at the Fort Rosecrans National Cemetery in San Diego.

One of the last times Trease saw her son, they were driving home from a dinner with her two sons.

She remembers it because the Ruizes are a family that sings in the car during road trips, Trease said. The song doesn't matter as much as singing loudly and remembering as many words as you can. The singer Adele came on the radio and someone turned up the volume. They all belted the song at the top of their lungs until the car pulled into the driveway.

"I just remember thinking, oh, I hope this song never ends," Trease said. "It was a good, long one."

frank.shyong@latimes.com

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Facebook Powerball frenzy: Purported winner offers to ‘share’ $1 million

His name is Nolan Daniels, and he’s just about to give some random dude or dudette $ 1 million. Or so he claims.

Purporting to be the second Powerball winner in Wednesday’s $ 588 million payout, Mr. Daniels posted a Facebook photo late Thursday of himself holding a ticket showing the winning numbers. The photo is the only one visible on Daniels’s account, which dates to 2008.

“Looks like I’m not going to work … EVER!!!” the smiling purported winner exclaimed. The numbers on his ticket – 5-23-16-22-29-Powerball 6 – correspond to the winning combination, but the ticket has not been publicly verified.

To make the Facebook announcement that much more bizarre, Daniels vowed to give $ 1 million of his winnings to a “random” person who “shares” his photo.

That set off a frenzy Friday as thousands of Facebook users got in on the action, with the photo being shared over 1,000 times a minute, with over 100,000 shares as of 3:30 p.m.

On his Facebook page, Daniels chastised skeptics and suggested, “Anyone who doubts the legitimacy of this photo will not be included in the 1 million dollar drawing.”

There were two winners in the drawing. The only winners confirmed so far are Cindy and Mark Hill of Dearborn, Mo., who decided to take a lump sum payment. Lottery authorities have not revealed the name of the other winner, who bought a ticket in Arizona. Earlier on Friday, some guessed that a video of a man celebrating in Maryland might show the winner.

The payout is the second largest in US history after three ticket buyers shared a $ 656 million jackpot in March. As the amount grew this week, tickets were selling at a rate of 130,000 a minute.

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Dennis Quaid Files for Divorce, Seeks Joint Custody

By Mike Fleeman

11/30/2012 at 09:20 PM EST

Kimberly Buffington-Quaid and Dennis Quaid

Casey Rodgers/NBC/AP

Dennis Quaid is ready to end his marriage for good.

After his wife of eight years, Kimberly Buffington-Quaid, sought legal separation in October, the Vegas star filed Friday for divorce in Los Angeles Superior Court.

The actor requests joint physical and legal custody of their 4-year-old twins, Thomas and Zoe, and offers to pay spousal support, according to the petition.

This will be the third divorce for Quaid, 58, who was previously married to Meg Ryan and P.J. Soles.

Kimberly, a former real estate agent, initially filed for divorce in March. She
put the divorce on hold a month later, pulling the papers so they could work on their marriage, before then filing for separation.

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South L.A. frustrated by delays in building new King hospital

Earlier this year, Joane Austin rushed her elderly mother to the emergency room for fear she was having a heart attack.

Austin normally would have made the short trip to Martin Luther King Jr./Drew Medical Center, the landmark hospital in South Los Angeles. But King/Drew has been closed for five years, so Austin drove several miles to the emergency room at Centinela Hospital Medical Center in Inglewood.

"I prayed all the lights would stay green," she said. "It was scary."

Once they arrived, doctors determined that Austin's mother needed emergency surgery to remove scar tissue around her intestines.

For years, King/Drew provided emergency, trauma and inpatient care to residents from throughout South Los Angeles. After a series of medical errors resulted in patient deaths, Los Angeles County closed it in 2007. County officials promised the community a better, safer new medical center in a few years.

But the opening has been repeatedly delayed, and the community is still waiting. Originally, officials hoped to have the new facility ready by 2010. Then it was pushed to 2012. Now, officials say they plan to have construction completed next year and the hospital opening its doors in 2014.

Without a nearby hospital, patients have had to travel to such places as Bellflower, Inglewood and Long Beach for emergency room and inpatient care.

Several local hospitals — California Hospital Medical Center, L.A. County/USC Medical Center and Harbor-UCLA Medical Center — received an influx of former King patients after the closure. The closest hospital, St. Francis Medical Center in Lynwood, reported an increase of 20% to 30% in emergency room visits since King/Drew closed, though other factors also may have contributed to the rise.

Getting to other hospitals has presented a challenge for many in the low-income neighborhood, said William Hobson, president and chief executive of the Watts Healthcare Corp. "Just the fact that it is a long way away may discourage them from going," he said.

The closure of King/Drew, which was born out of the Watts riots and opened in 1972, created a healthcare gap in a community where rates of chronic disease are high and vast swaths of the population lack insurance, said David Carlisle, president of the adjacent Charles R. Drew University of Medicine and Science. South Los Angeles has a shortage of doctors, inpatient beds and outpatient services, according to both experts and research.

Despite King/Drew's many medical lapses, which earned it the nickname "Killer King," many in the community remained fiercely loyal to the hospital and the services it provided.

Studies examining the impact of King/Drew's closure found that it led to delays in care for elderly blacks and Latinos and a dramatic increase in patient admissions at other trauma centers. Physicians throughout the county also reported more overcrowding in other emergency rooms and said they saw sicker patients who didn't know where to go or couldn't afford transportation elsewhere.

"It is fearful to think about how many lives may have been saved had this thing been opened by now," said Lark Galloway-Gilliam, executive director of the advocacy group Community Health Councils. "It shouldn't take five years to build a facility."

Patrick Wooten, 49, went to St. Francis when he had a dislocated kneecap a few years ago. Wooten, who is uninsured, said he received good care at the private hospital but then got a $3,200 bill. Wooten said he is frustrated that the new King hospital still hasn't opened and won't until 2014. "What you do until then, God only knows," he said. "Hopefully we can wait it out."

Last year, Sandira Gonzalez, 29, took her 5-year-old son to the Martin Luther King urgent care center when he had a fever. But when the center closed for the night, her son had to be taken by ambulance to Harbor-UCLA near Torrance, where he was treated for an infection.

Community members and advocates said they are disappointed by the long wait, caused by a combination of bureaucratic delays and the complexity of the project. But when it does open, they said, they are hopeful that it will be a better, and safer, hospital.

The county is building the hospital and will help support it financially but will not be responsible for day-to-day operations. Instead, an independent, nonprofit organization will run the facility, to be known as Martin Luther King Jr. Community Hospital, and the University of California will help staff it and ensure the quality of patient care. Construction is progressing, but the grand opening may still be nearly two years away.

"It will be a significantly different kind of institution, with the right kind of accountability," said Robert K. Ross, president and chief executive of the California Endowment. "Now we just need the institution to open up on budget and on time."

Los Angeles County Supervisor Mark Ridley-Thomas said it takes time to create a state-of-the-art hospital — and a whole medical complex — that could become a model for others around the nation. "A lot of eyes are on this," he said. "We want to do this well and we want to do it right.... Nothing else is acceptable."

The nonprofit's board recognizes how critical the facility is to the area, said board President Manny Abascal. "Every day this hospital is not open, people are suffering," he said. At the same time, he added, the board is committed to ensuring that the new hospital is a high-quality institution. "If you open it … and there are some of the same problems you had before, then it's going to be devastating," he said.

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U.S. Moves Toward Recognizing Syria Opposition

Bryan Denton for The New York Times

Rebels in Aleppo, Syria’s largest city, in August. The opposition to the Syrian government is developing a political structure.

WASHINGTON — The United States is moving toward recognizing the Syrian opposition as the legitimate representative of the Syrian people as soon as it fully develops its political structure, American officials said Thursday.

A decision to recognize the group could be announced at a so-called Friends of Syria meeting that Secretary of State Hillary Rodham Clinton is expected to attend in Morocco on Dec. 12. It is the most immediate decision facing the Obama administration as it considers how to end the government of Bashar al-Assad and stop the violence that has consumed Syria.

President Obama has not signed off on the move, and the meetings to decide the issue have yet to be held. Debates within the administration concern legal issues about the implications of diplomatic recognition, how such a move might affect efforts to enlist Russian support for a political transition in Syria and, most importantly, the state of the opposition.

Britain, France, Turkey and the Gulf Cooperation Council have already recognized the opposition, which was enlarged and overhauled at a meeting in Doha, Qatar, last month at the insistence of the United States and other nations. It is formally known as the National Coalition of Syrian Revolutionary and Opposition Forces.

“They are a legitimate representative of the Syrian people’s aspirations,” Robert Ford, the American ambassador to Syria, said Thursday at a conference on the Syrian humanitarian crisis. “They are making real progress and I expect that our position will evolve as they themselves develop,” he added.

American officials who favor the move are hoping to use formal recognition as a reward to the opposition for uniting opponents of the Assad government inside and outside Syria and fleshing out its political structure so that it can play a credible role if Mr. Assad is ousted.

The National Coalition of Syrian Revolutionary and Opposition Forces is in the process of developing a series of committees on humanitarian assistance, education, health, judicial and security issues. If opposition leaders are able to present their group at the Morocco meeting as a functioning organization, one senior American official said, recognition by the United States might follow at the gathering, a conference of more than 70 nations that is to be held in Marrakesh.

“We’ve been looking for them to establish a leadership structure that’s clear to everybody, but also discrete committees that can deal with the various issues that they are assuming responsibility for,” Victoria Nuland, the State Department spokeswoman, said Thursday. “We don’t want to get ahead of the game here.”

At an appearance here on Thursday, Mrs. Clinton expanded on Ms. Nuland’s remarks. “We have been deeply involved in helping stand them up, and we’re going to carefully consider what more we can do,” she said at a conference co-hosted by the publisher of the magazine Foreign Policy. “It appears as though the opposition in Syria is now capable of holding ground, that they are able to bring the fight to the government forces.”

Mr. Ford and other experts attending a conference organized by the Middle East Institute and International Relief and Development, two nongovernment organizations, described a deepening humanitarian crisis because of the Syrian conflict. The number of internally displaced people in Syria has soared to about 2.5 million, according to Kelly Clements, a deputy assistant secretary in the State Department’s Bureau of Population, Refugees and Migration.

The number of refugees has also climbed. About 140,000 Syrians have registered for assistance as refugees in Jordan, some 25,000 of whom are in refugee camps. There are also believed to be more than 100,000 additional Syrian refugees who have not registered. In Turkey, there are 125,000 Syrian refugees in camps and another 75,000 who are not residing in camps, she said. In Lebanon, there are an estimated 135,000 Syrian refugees, none of whom live in refugee camps.

In Iraq, some 60,000 Syrians have registered as refugees, half of whom live in camps. More than 35,000 additional Iraqis who fled the conflict in Iraq for Syria have since returned to Iraq.

The Assad government, Mr. Ford said, has often interfered with the delivery of humanitarian assistance. He also said that Iran had helped the Assad government track down opposition figures who are voicing their view on the Internet.

Mr. Ford indicated that the subject of providing arms to opposition fighters was also being reviewed, but said that any discussion of arms needed to be part of a broader strategy for a political transition if Mr. Assad leaves power. “Arms are not a strategy; arms are a tactic,” he said.

He suggested that the government was still able militarily. “There is no sign of any kind of political deal to be worked out between the opposition groups and the regime,” he said. “The fighting is going to go on.”

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