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The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say. The theory behind the policies is that patients should bear more financial risk so they will be more conscious and cautious about health care spending. But some experts say the new policies have also left many Americans scrambling to track expenses from a multitude of sources. (Rosenthal, 2/7)

One of the biggest targets of health reform was the uninsured "super-user" who sought out care for everything and anything under the bright lights of America's chaotic emergency rooms. But emergency rooms at Detroit's two largest hospital systems, as well as emergency rooms at several other hospitals, are as busy — or even busier — than they've been in recent years, according to hospital officials. (Erb, 2/7)

Small businesses (50 or fewer employees) who voluntarily offer health insurance to their employees face no deadline for signing up through the federal government's online portal. But Healthcare.gov's small-business offering in Michigan, called the Small Business Health Options Program (SHOP), will lack full functionality for at least one more year. That's why most businesses in this category have been skipping this one-stop-shop and instead working through their regular agent or broker to obtain coverage. (Reindl, 2/7)

Some of the nation's most prominent healthcare groups are telling the Obama administration that its proposals to soften the financial risk involved in Medicare accountable care contracts won't be enough to make sure U.S. hospitals and doctors keep signing up. The central concession would be to give participants more time in the program before they have to accept the risk of penalties along with the opportunity to earn bonuses based on the quality and efficiency of the care they provide. (Evans, 2/8)

When the Affordable Care Act was launched a little over a year ago, there was some confusion about how the law would apply to U.S. territories like Puerto Rico, which is part of the U.S. but isn't a state. In July, the federal Department of Health and Human Services declared that U.S. territories aren't required to follow most of the rules of the ACA. That means four of the five U.S. territories — Guam, American Samoa, Northern Marianas, and U.S. Virgin Islands — have essentially been untouched by the bill. But Puerto Rico's government passed its own series of bills, adopting the ACA rules. (Kelto, 2/7)

North Carolina’s elected officials have steadfastly shunned the Affordable Care Act by refusing to create a state health insurance exchange and by blocking expansion of the Medicaid program for the poor. But this month the N.C. Department of Health and Human Services endorsed the federal health care law, albeit in a small way: North Carolina is paying for drug coverage for HIV-positive residents who have purchased health coverage through the federal insurance exchange. (Murawski, 2/7)