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The state legislature is now mulling a change to allow trained home care aides to administer medications to Medicaid patients while working under a nurse's supervision. If the proposal becomes law, it could save the state a bundle.

Despite the federal overhaul of health care, people in the pools are left out because of a wrinkle in legal language. The high-risk pools aren't licensed as insurers in most states, so they're not subject to the federal law.

Though the Obama administration says that the nation is entering a new era of lower health care spending, an analysis from the agency that oversees Medicare says probably not. Those economists say that health spending will escalate as the economy improves, as it has in past economic recoveries.

No one knows for sure right now how many of the estimated 14 million people who buy their own coverage are getting cancellation notices, but the numbers appear to be big. Some insurers report discontinuing 20 percent of their individual business, while other insurers have notified up to 80 percent of policyholders that they will have to change plans.

Very few insurers around the country are offering top-of-the-line platinum insurance plans. Policymakers predicted less expensive but more restrictive bronze and silver plans would prove more popular than high-end options, and it looks like insurance companies think so, too.

There was a party atmosphere at Affordable Care Act events both in California, where the law has been embraced by the state government, and in Virginia, where it has been resisted. But consumers will have very different experiences in the two states.

People are looking for answers to complex health insurance problems. The navigators whose job it is to help are going to have their work cut out for them now that that the Affordable Care Act is moving into high gear.

Insurance plans that carry higher premiums may be a bargain for consumers with costly health conditions. Lower out-of-pocket costs for some patients can offset the higher price of the coverage over the long haul.

Many laid-off workers continue the insurance they got on the job by paying for it themselves through an expensive option known as COBRA. The health insurance exchanges that open in October are likely to be a cheaper source for health coverage.

Almost anyone can buy a plan on the health insurance marketplace, sometimes called an exchange. But tax credits that reduce the premium are only available to people who don't have access to other coverage that meets the law's standards for affordability and adequacy.