Corrected at 6:00 p.m. to reflect that 11 insurers, rather than 17 have submitted policies to sell in the state’s new online health insurance marketplace.  The larger number includes those proposing to sell both inside and outside the online marketplace.

Colorado became the latest state Wednesday to post proposed health insurance plans for its new online marketplace, which is slated begin enrolling people in coverage Oct. 1.

What stands out is the number of plans being proposed.  A total of 11 insurers are seeking approval to market about 250 health plans to individuals and small groups  in the state’s online marketplace under the federal health care overhaul.

While Colorado regulators said they are encouraged by the number of carriers who want to participate—hoping competition will help keep down premium costs—it worries agents.

“I would say that number has to come down or people are going to be overwhelmed by the choices they have,” said Marie DeWolf, who runs an insurance agency in Greeley, Colo.

The online marketplaces are one of the key ways the health law expands coverage to millions of people not offered coverage by their employers. Consumers will be able to compare plans on the websites and find out whether they might be eligible for government subsidies to help defray the cost of premiums.

The Colorado marketplace called Connect for Colorado has not limited how many plans carriers can offer for each category of standardized coverage. Some other states, including California, Connecticut, Massachusetts, Maryland, Nevada, New York and Oregon, are limiting the number of plans each insurer can offer, according to Avalere Health, a consulting firm.

A few years after the federal government started the Medicare prescription drug program, it also limited the number of plans each carrier could offer in an effort to reduce consumer confusion.

Colorado Insurance Commissioner Jim Riesberg said a preliminary review shows that monthly proposed premiums for the new plans “vary widely,” depending on what portion of medical expenses the plan will pay and what portion consumers will be responsible for through co-pays and other out-of-pocket costs.

He also noted that some of the proposals do not meet the  requirements of the law.

“We are very encouraged by the number of health insurance carriers that want to participate in Colorado,” Riesberg said in a statement. “As the regulatory agency charged with ensuring a competitive marketplace for health insurance companies in Colorado, we believe that a greater number of carriers means more choice for Colorado residents.”

In the next two months,  he said his staff will examine the plans to make sure they meet new requirements for essential health benefits, such as hospitalization, maternity, newborn care and wellness services.  Plans must be certified as complying  with the law before they can be sold.

But they haven’t become more accurate, a top Food and Drug Administration official said Tuesday at a meeting of researchers analyzing studies that show wide variation in the performance of the machines used to measure blood glucose levels.

Katherine Serrano, diabetes branch chief in the FDA division of chemistry and toxicology devices, said the federal government is aware of accuracy problems with meters on the market. But she said the FDA is limited in its response because some manufacturers are in Asia, and the agency must rely on the manufacturers’ own studies related to accuracy.

Health experts say if a blood glucose meter provides a false reading, it puts a patient at risk of dosing with too much or too little insulin. If too much insulin is given, it can bring blood glucose levels down to dangerously low levels, putting the patient at risk of severe hypoglycemia and possible hospitalization.

Typically, a person with diabetes tests his or her blood sugar before eating or exercising to find out if he or she is within normal range. The patient then uses insulin or diet to restore blood glucose to a healthy level. About 24 million people have diabetes in the Unted States,  and nearly a third of that number rely on insulin to regulate their blood sugar.

Researchers at the Diabetes Technology Society meeting in Arlington, Va., presented several studies done in the United States and Germany showing it is common for many devices to fall short of the 95 percent accuracy standard required by the FDA. Consumers often buy the devices based on which is cheapest, or which is covered by their insurance policy without realizing that not all meters offer same accuracy, they said.

Serrano said several factors can reduce a meter’s accuracy, such as storing it in a hot or cold area, or failing to wash your hands before using them. She said studies done by manufacturers seeking approval are done in labs by trained personnel.

“There have been a lot of advances in the technology of the meters but we have not seen great strides in accuracy,” Serrano said.

She noted manufacturers don’t have much incentive to improve accuracy because federal law requires  only that they prove they are “substantially equivalent” to another meter already on the market. The FDA relies on the manufacturer’s own studies to analyze accuracy and does not require any independent testing, she said. Here are some tips to help improve accuracy.

But despite the law’s unpopularity, its expansion of Medicaid is supported by almost two-thirds of adults in these states, according to a survey by the Joint Center for Political and Economic Studies, a left-leaning think tank.

The survey found only 33 percent of adults in the five states have a favorable opinion of the 2010 health law — ranging from a low of 31 percent in Louisiana to a high of 35 percent in Alabama. Yet 62 percent say they support expanding Medicaid to cover more low-income, uninsured adults — ranging from a low of 59 percent in Mississippi to a high of 64 percent in Alabama.

By comparison, an April poll by the Kaiser Family Foundation found that Americans overall support the Medicaid expansion by only a 50 percent to 41 percent margin. (KHN is an editorially independent program of the foundation.)

The Supreme Court ruled last year that the federal government cannot force states to expand their joint federal-state Medicaid programs for the poor. According to health care consultant group Avalere Health, none of the five states in this survey plans to expand its Medicaid program under the health law.

The survey found even stronger support for the law’s creation of health insurance marketplaces — also called exchanges — for small businesses and individuals. Three-quarters of respondents expressed a favorable opinion of the marketplaces, ranging from 73 percent in Louisiana and Georgia to 77 percent in Mississippi. All five of these states have chosen not to build their own online insurance marketplaces, so the federal government will be running the marketplaces in these states.

Not all provisions of the law were regarded favorably, however. By a 65 percent to 31 percent margin, respondents had an unfavorable opinion of the law’s individual mandate that will require all Americans as of 2014 to either sign up for health insurance or pay a penalty.

The Joint Center’s poll surveyed 500 people in each of the five states for a total sample of 2,500 adults.  It was conducted between March 5 and April 8 and has a margin of error of +/- 2 percentage points for the full sample and +/- 4.4 percentage points for each of the state samples.

Not so, says the Department of Health and Human Services. “The Affordable Care Act maintains strict privacy controls to safeguard personal information.  The IRS will not have access to personal health information,” said agency spokeswoman Erin Shields Britt.

Republicans have pounced on news reports that the IRS unfairly targeted conservative groups for greater scrutiny when the groups sought tax-exempt status. Rep. Michele Bachmann, R-Minn., said the health law “will allow bureaucrats access to our most intimate, personal health care information.”  Sen. Rand Paul, R-Ky., a physician, said he was “quite worried about the privacy of medical records. I’m quite worried now that your medical records will be evaluated by the IRS.”

The IRS does play a key role in implementing the 2010 health care law. Those duties include enforcing the law’s requirement that most individuals have health insurance or pay a fine and helping determine whether individuals are eligible for a tax credit to help afford health insurance premiums.

During a House Ways and Means Committee hearing Friday into the IRS scandal, Rep. Jim McDermott, D-Wash., also a physician, asked Steven Miller, who recently resigned from his post as acting IRS commissioner, if the agency had access to individuals’ medical information. Here are the key points:

McDermott: “We need to find some truth here…. And I’ve heard members of this committee now talk about it. The IRS can’t access your medical files. Is that true, Mr. Miller?”

Miller: “Correct, sir.”

McDermott: “They cannot find out your private medical information?”

Miller: “That’s correct, sir.”

McDermott: “Their job in Obamacare is simply to collect financial information on which a determination is made as to whether somebody can get a subsidy for their premium. Is that correct?”

Miller: “Were you covered and over what period is what we would be getting.”

Non-government analysts offer a similar assessment. Joanna Kerpen, a partner at the law firm McDermott Will & Emery, advises clients on compliance with the 2010 health care law. She says that as part of the health law’s implementation the IRS “should not have access to an individual’s medical record, but they will have access to an individual’s coverage status.”

A new poll from the Kaiser Family Foundation says 42 percent of Americans don’t know that the Affordable Care Act actually still stands. (Kaiser Health News is an editorially independent program of the Foundation.) Mary Agnes Carey joined NPR’s “Tell Me More” Friday afternoon to discuss the state of the health law and other health policy issues.

Press play above to listen to the conversation.

The total annual cost of the illnesses? About $247 billion a year.

The study, published as part of the CDC’s weekly journal MMWR, is the first time that federal researchers have sought to compile estimates of how many children have specific mental disorders and describe federal efforts for monitoring the issue.

The prevalence of mental disorders in kids seems to have increased over the past 15 years as well (though the growth could reflect better monitoring and awareness, rather than more kids actually being sick). And they seem to be sicker: inpatient hospital admissions for mental health and substance abuse issues increased by nearly a quarter from 2007-2010. Suicide was the second leading cause of death for kids aged 12-17.

The CDC put together this handy infographic to chart the prevalence of various illnesses. ADHD is the most common diagnosis, followed by behavioral and conduct problems.

This story comes from our partner ‘s Shots blog.

The news that U.S. scientists have successfully cloned a human embryo seems almost certain to rekindle a political fight that has raged, on and off, since the announcement of the creation of Dolly the sheep in 1997.

Photo by gonzales2010 via Flickr

“The issue of legislation on human cloning is about to get hot again,” says Hank Greely, director of the Center for Law and the Biosciences at Stanford Law School.

But it’s a fight that has, over the past decade and a half, produced a lot of heat and light and not a lot of policy.

Human Cloning

In fact, for all the arguing about the issue that’s happened in Washington over the years, human cloning is still technically legal, at least in much of the country.

“There are already 60 countries in the world that have laws on their books banning human reproductive cloning, and this prohibition is also in a number of international agreements” says Marcy Darnovsky, executive director of the Center for Genetics and Society, which is devoted to the responsible use of new genetic and reproductive technologies. “But in the U.S., we have not managed to put such a law on the books at the federal level.”

At least 15 states ban cloning, either for reproductive purposes or research or, in come cases, both, according to the National Conference of State Legislatures.

But Congress has mostly fought issues of both stem cell research and cloning to a draw.

“What we saw the last time cloning was in the headlines was that the discussion really got mired in the abortion controversy,” Darnovsky said.

The House passed bills banning all forms of cloning in 2001 and 2003; the Senate failed to act in both cases.

“All the other issues got completely swamped,” she said. “And I really hope that doesn’t happen this time.”

But both the issues of cloning — for research and reproduction — and embryonic stem cell research have been mired in the abortion controversy from the start.

Stem Cell Research

About the only law that has been able to pass is language that gets added to the funding bill for the Department of Health and Human Services every year since the mid-1990s — the so-called Dickey-Wicker Amendment, named for its original House sponsors, Reps. Jay Dickey, R-Ark., and Roger Wicker, R-Miss. It bars the use of federal funds for research that could destroy or harm a human embryo.

The Clinton administration decided that federal funding of embryonic stem cell research using cell lines derived from embryos destroyed with private funds did not violate that law.

President Bush put that policy into force but severely limited the cell lines available to researchers.

“I have concluded that we should allow federal funds to be used for research on these existing stem cell lines, where the life-and-death decision has already been made,” he said in a televised address to the nation.

Meanwhile, over the years Congress debated several bills to expand federal funding of embryonic stem cell research, under specific ethical guidelines, as well as legislation to ban cloning intended to make a baby. None, however, was able to pass both the House and Senate and get the president’s signature.

When he came into office in 2009, President Obama used his executive authority to expand federal funding for embryonic stem cell research, while maintaining guidelines such as not paying women for their eggs.

“The majority of Americans, from across the political spectrum, and from all backgrounds and beliefs, have come to a consensus that we should pursue this research,” he said.

FDA Rules

But Congress remains deadlocked over the bioethical issues — which is not to say that there is no federal regulation.

Jonathan Moreno, a bioethicist at theUniversity of Pennsylvania , points out that the Food and Drug Administration has, from the start, said it would closely regulate anything it deemed to be human cloning, whether reproductive or therapeutic.

“Once you start talking about putting many of the products of these cells into people, then you get into an area where the FDA is very interested,” he said.

Meanwhile, Darnovsky of the Center on Genetics and Society says she hopes this new development might break the legislative logjam.

“This development, if it turns out to be replicable, will mean that there will be cloned human embryos in labs around the country,” she said. “And we really need to make sure that no unscrupulous person would ever try to use those to produce a cloned human being.”

Congress, however, has been unable to pass much of anything this year. It’s unclear yet if this will rise to the level of must-pass.

The study found the two groups overwhelmingly agreed that nurse practitioners should be able to practice to the full extent of their schooling and training. But doctors were less likely to concur that advanced practice nurses should lead medical homes, which deliver team-based, coordinated care to patients. Only 17 percent of the 505 primary care physicians  surveyed agreed with that notion, compared to 82 percent of the 467 nurse practitioners surveyed.

The two groups also disagreed about whether nurse practitioners should be paid equally for providing the same health services. More than 64 percent of nurse practitioners agreed with the idea of equal pay, as opposed to less than 4 percent of doctors.

The debate over the role of nurse practitioners has intensified as a result of concerns over a shortage of doctors as an estimated 25 million people gain insurance under the health care law.  Nurse practitioners argue they can fill some of those needs if they are granted greater scope of practice.

That debate is reflected in the study’s finding about the groups’ conflicting views about the quality of care provided by doctors versus nurse practitioners. When researchers asked whether they felt the quality of care provided by physicians in exams and consultations was higher than that provided by nurse practitioners, more than 66 percent of doctors agreed, while 75 percent of nurses disagreed.

“We’ve done a lot of comparative surveys with health professionals but we’ve just never found gaps this big,” said Dr. Karen Donelan, an assistant professor of medicine at the Harvard School of Medicine and the study’s lead author. “When we get on the ground and we survey the people actually doing the work and working together, we see some of those professionals come closer together. We didn’t observe that here.”

Donelan pointed out that most nurse practitioners in the study — approximately 75 percent — said they are already practicing to the full extent of their training. Survey respondents who did not have this opportunity blamed their limited practice on state restrictions, hospital regulations and work setting.

During an interview, Donelan also said she was surprised by the level of disagreement in regards to the quality of care, since previous research findings have suggested little variation in the work done by  nurse practitioners and primary care doctors.

During a February 2013 interview, David Hebert, the CEO of the American Association of Nurse Practitioners, described the safety concerns raised by physicians as a “total red herring,” and added that “nurse practitioners have been practicing safely and providing great outcomes for decades.”

In March, the president-elect of the American Academy of Family Physicians, Reid Blackwelder, emphasized his support for a more collaborative approach between the two clinician groups, noting their roles are not interchangeable.

Differences aside, Donelan’s study shows that the majority of practitioners in both groups agreed that increasing the number of nurse practitioners would improve timeliness of care. However, less than a third of doctors said such an increase would boost safety or effectiveness of care.

Nurse practitioners, on the other hand, overwhelmingly felt such an increase would improve care. Close to 81 percent, for example, thought the growth would improve access to health care for the uninsured and 77 percent said it would result in lower health care costs.

“As a team, this kind of inter-professional disagreement is not a good thing when we’re trying to achieve better teamwork,” Donelan said. “The conflict over roles has got to be worked out so that it’s clear for patients when they get their care.”

Moving forward, she said she hopes that both doctors and nurse practitioners will acknowledge their differences and bridge the gaps that keep them from working together.

Photo by Karl Eisenhower/KHN

Senate GOP leaders Tuesday took issue with Department of Health and Human Services Secretary Kathleen Sebelius for soliciting money from private groups to implement the law.  Noting the Internal Revenue Service scrutiny of conservative political organizations,  the Republicans also said the IRS can’t be trusted to implement the health law.

“The secretary is out raising money from the private sector, people who are dependent on the government’s regulations, to help the government convince the public that Obamacare is a good measure,” said Senate Minority Leader Mitch McConnell, R-Ky.

A Sebelius spokesman said her actions were legal and that she had not solicited pharmaceutical and insurance companies regulated by the agency.

Sen. Lamar Alexander, R-Tenn., compared the secretary’s actions to the Iran-Contra scandal during the Reagan administration. Alexander is the ranking Republican on the Senate committee overseeing health policy.

Sen. John Barrasso, R-Wyo., dubbed Sebelius’ actions to implement the health care the “Sebelius Shakedown.”

“What I want to know is what she is promising those businesses that she talks to, and what is she threatening them with,” said Barrasso, chairman of the Senate Republican Policy Committee.

Barrasso also cast doubt on the ability of the IRS to implement the health law in a fair-handed manner. Among its duties are determining which Americans qualify for subsidies to help them purchase coverage and whether an individual should be fined for not having insurance.

Republicans have been fighting implementation of the law since it passed Congress on a strictly partisan vote three years ago. The House has voted more than 30 times to repeal all or part of the law, but those bills have never been acted on by the Democratically controlled Senate.

Sen. Dean Heller, R-Nev., also raised concerns about the IRS’ role in the health overhaul in a letter to Sebelius and said he would try to apply more scrutiny for the IRS’ funding to conduct health law duties. “I believe we need to address IRS funding in the health care law now, which may mean calling for a temporary suspension until it is clearer where this funding will go,” he wrote.

Barrasso, in his comments to reporters, suggested that the recent accusations will make the public skeptical that the IRS can be trusted to administer its part of the health law.

“These are the folks that are supposed to enforce the health care law,” he said. “If you go to one of the exchanges to get insurance, the form you actually send in goes to the IRS. I can’t imagine the American people are going to be delighted hearing about what misuse of power we’ve seen from the IRS and wanting to entrust them with their own health care.”

Only three states have implemented the pay raise — Nevada, Michigan and Massachusetts, according to the American Academy of Family Physicians.

The two-year pay hike is intended to entice more doctors to treat the millions of residents expected to enroll in Medicaid in 2014 when the federal health law expands eligibility. Critics have said the expansion of the federal-state program for the poor would accelerate the shortage of doctors who treat them.

Most states have not started offering the higher pay rates because the Obama administration did not issue the rules until November, and state officials said they didn’t have time to carry out the change and have the federal government approve the new rates.

All states have applied with the federal government to start offering the higher rates, but the Centers for Medicare & Medicaid Services has approved only seven.

“CMS remains confident that the higher payment rates ultimately will help increase access to care for Medicaid beneficiaries,” said a CMS statement.

While Medicaid fees vary by state, they are generally far below those paid by Medicare and private plans. The change means an average 73 percent average pay increase nationally, according to a 2012 study by the Kaiser Family Foundation (Kaiser Health News is an editorially independent program of the foundation.)

Earlier this year,  CMS said doctors will be able to get the higher fees retroactively to Jan. 1, when states do implement the provision. But many states have set deadlines for April and May for doctors to self-attest that they are primary care physicians in order to get the retroactive pay. Those that miss the deadline will only receive the pay raise once they fill out a form showing they are licensed as a family doctor, pediatrician or internist.

Several major physician groups, including the American Medical Association, American Academy of Pediatrics and the American Academy of Family Physicians, wrote to CMS earlier this month about their frustration with the delays. “Our organizations have grown increasingly concerned that the brief time frame which states had to implement this provision has resulted in confusion both by state employees responsible for administering the program and the physician community,” stated the letter to Cindy Mann, who runs the Medicaid program.

One overarching concern shared by our organizations is the lack of a coordinated plan to educate and communicate to eligible providers about the payment increase and steps physicians must take to participate.”

Stephen Zuckerman, senior fellow at the Urban Institute, said doctors were hesitant to sign on as a result of the pay raise given that it expires at the end of 2014, and the implementation problems won’t help.

“Because of the temporary nature of the pay raise, it was always questionable how many doctors would jump at treating Medicaid patients if they had not done in the past,” he said. “If doctors were tentative before, they still have a reason to be.”