3 of 4 Americans live in states still flummoxed by how to deliver the health law's promise of affordable care

News outlets report on a variety of health law implementation issues, including an Associated Press report detailing how the overhaul is lagging in the states. Other reports examine questions about ACOs, essential benefits and other specific provisions.

The Associated Press: Health Overhaul Lags In States
Here's a reality check for President Barack Obama's health overhaul: Three out of four uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care. This is the year that will make or break the health care law. States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House claims they're making steady progress (Alonso-Zaldivar, 1/22).

The Wall Street Journal: Can Accountable Care Organizations Improve Health Care While Reducing Costs?
It's often said that the main method of paying health care providers -; with a fee for each service -; results in increased and wasteful spending. Such a system, its critics say, rewards providers just for doing more procedures, rather than for providing efficient and high-quality care. One major effort to fix that system, promoted by the federal health-overhaul law and some private insurers, is to create accountable-care organizations, or ACOs. Medicare's main ACO program is launching this year, while many health plans are already working with providers on ACO-style payment models (Mathews, 1/23).

Kaiser Health News: Capsules: Advocates Demand Clarity About Options For Patients In Financial Need 
Many Americans continue to struggle with the high cost of medical care, unaware that non-profit hospitals are required to provide information about potential financial assistance or relief. But, a provision in the 2010 health law seeks to clarify what help hospitals should offer (Marcy, 1/20). 

CQ HealthBeat: Essential Health Benefits Benchmarks Need Active Government Oversight To Be Successful
Federal and state oversight will be critical to ensuring the plans states choose to represent essential health benefits meet both the requirements of the health overhaul and the needs of patients with chronic disease and disabilities, Marc Boutin of the National Health Council said Friday. Of the 500 potential benchmark plans in the states, "some of them will be excellent, some of them not as excellent and some of them potentially could be disastrous," he said at a National Health Council briefing on Capitol Hill. "Somebody needs to have the oversight to say 'I'm sorry this benchmark is not going to address what was statutorily required by the Accountable Care Act.'" The council is coalition of groups representing people with chronic diseases and disabilities (Bristol, 1/20).

Chicago Tribune: Health Reform Law Has Small Insurers On Edge
Although the government doesn't have authority under the law to order insurers to lower rates, its ability to challenge rate hikes and publicize them provides new transparency and protection for consumers, administration officials said. But critics say the administration's stepped-up reviews and heightened scrutiny are more about showcasing the value of the new health law in the run-up to the 2012 elections, a charge the Department of Health and Human Services denies. Some small insurers and industry observers also complain that the added scrutiny could be harmful for small and midsize carriers. ... Small insurers like United Security don't have the benefit of spreading risk over a large pool of customers, (Robert Laszewski, president of Alexandria, Va.-based Health Policy and Strategy Associates) said. Further, the share of premiums paid out in benefits can vary significantly year to year (Frost, 1/21).