Two-thirds of Americans who sign on to buy health insurance using new state marketplaces will actually be getting a federally administered plan, a health consultancy firm projected Thursday.

Only 17 states, plus Washington, D.C, have said they will run their own health insurance exchanges or share responsibility with the federal government.

“These states are expected to enroll 2.8 million individuals out of a total of 8.2 million people nationwide who will buy coverage through exchanges in 2014,” Avaleere said in its report.

The rest have either said they’ll leave it up to the federal government, or are leaning that way.

Friday is the deadline for states to say for sure what they plan to do and just three states – Florida, North Dakota and Indiana – have failed to give an answer so far. But all three have governors who have indicated they won’t be setting up exchanges.

On Wednesday, Pa. Gov. Tom Corbett said his state would leave it up to the federal government.

Republicans who control the House Energy and Commerce Committee’s health subcommittee held a hearing on Thursday to highlight state reluctance to take part in the exchanges, even though they got their deadline extended by a month.

But the Health and Human Services Department said it didn’t matter – people will be able to sign up to buy health insurance on the exchanges as scheduled, in October 2013. Their coverage will start on the first day of 2014 under the 2010 health reform law.

“I am confident that sates and the federal government will be ready in 10 months," Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, which is in charge of the new exchanges, told the hearing.

HHS said earlier this week that six states -- Colorado, Connecticut, Massachusetts, Maryland, Oregon, and Washington – are on track to have their health insurance exchanges approved. California, Hawaii, Vermont, Mississippi, Kentucky, Minnesota, New York and Rhode Island are also on board to run their own, Cohen said. Delaware, Illinois, Iowa and North Carolina want federal-state partnerships.

One of the main goals of the 2010 Affordable Care Act is to get more Americans covered by health insurance. About 15 percent of the population currently goes without, and most experts agree that people without health coverage delay routine medical care until they develop expensive-to-treat conditions. Hospitals and taxpayers often end up footing their bills.

The main way the health care law will get these people covered is on the exchanges. They’re designed to be a kind of online marketplace where people and small businesses can compare different insurance plans available in their states, choose a level of coverage, and find out if they are eligible for federal government subsidies to pay the premiums.

Cohen said HHS is on track to make this as easy as possible. “For example, we are building a website with interactive capabilities and a call center. Consumers will be able to use this to compare qualified health plans, check their eligibility for affordability programs, and enroll in a qualified health plan,” he said at the hearing.

Even if the federal government runs the exchanges, they’ll be subject to state-by-state variation. That’s because state law still determines which insurance companies can sell products within a state’s borders. States also can decide whether to expand Medicaid, the state-federal health insurance plan that now covers mostly the very poor and pregnant women without insurance.

But representatives from several states said the process has been far too confusing and they fear HHS will make an already complicated process even more complex.

“In all my years of public service, I have yet to witness a law so vast with such breathtaking scope, demands on state resources, and lack of federal guidance,” Gary Alexander, Pennsylvania's secretary of public welfare, told the hearing.

“I have hundreds of policy, operational, and technical staffers working to implement this health-care reform law, and yet, we realized early on that we do not have the capacity or the financial resources to address all of the provisions and requirements of this complicated law.”

Bruce Greenstein, Louisiana’s health secretary, echoed this. “We have repeatedly shared our concerns regarding its policy implications, lack of sufficient guidance and unreasonable timelines for implementation,” he said.

Cindy Mann, deputy administrator at the Center for Medicare and Medicaid Services, said HHS had held constant briefings to help guide states. “We are on the phone literally every day with people form the states, helping them, answering their questions,” she told the hearing.

Dr. Joshua Scharfstein, who heads Maryland’s health department, agreed. “We have had a terrific interaction,” he told the hearing, saying he has been “really impressed” with Cohen’s and Mann’s departments.

Democrats on the subcommittee accused Republicans of playing politics and said critics of the health reform law were still trying to undermine it, even though the U.S. Supreme Court ruled it constitutional in June.

“Many of us fear is the purpose of this hearing is to show we can’t move forward,” said California Democrat Henry Waxman. “That’s flat-out wrong. It seems to me it’s just the latest attempt to repeal the Affordable Care Act.”

 Related stories:

• Report: Americans paying more for health insurance
• Who falls through the cracks if states don't expand Medicaid
• States decide future of health reform

Only a quarter of Americans infected with the AIDS virus are getting effective treatment, according to a U.S. government report released Friday -- and the youngest patients are the worst off.  The numbers could worsen if states don’t broaden health care as called for under the 2010 health reform law, scientists worry.

It’s the first comprehensive look by the Centers for Disease Control and Prevention at who is getting effective care, and it doesn’t paint a promising picture. The findings raise even more alarm bells as study after study presented at the International AIDS Conference in Washington this week show that treatment can help stop the spread of HIV.

“The majority of people living with HIV in the United States are not on antiretroviral treatment, not in stable care,” Dr. Kenneth Mayer of The Fenway Institute and Harvard Medical School in Boston told a news conference. “They need to be in care first and then able to get treatment.”

The study finds that just over a third of  HIV patients have steady care -- 34 percent  of African-Americans, 37 percent of Latinos and 38 percent of whites.

Younger patients are the least likely to be getting the cocktails of drugs that can keep them healthy and help keep them from infecting others. Just 15 percent of those aged 25-34 had the virus suppressed to desired levels, compared to 36 percent of those aged 55-64. Only 22 percent of young adults were even getting HIV drugs to treat their infection, the CDC found.

There’s no cure for the human immunodeficiency virus that causes AIDS and no vaccine. HIV has killed 25 million since it first started spreading globally in the early 1980s, and more than 33 million people are infected worldwide. About 1.1 million people in the United States have HIV, and the CDC estimates that 20 percent of them don’t even know it.

“We have to continue to raise the alarm,” CDC’s top AIDS official, Dr. Kevin Fenton, said in an interview. “We have to find that sense of outrage.”

The same factors are driving high transmission and poor treatment rates among some U.S. groups: poverty, a lack of access to medical care, and a lack of education about what causes HIV and what people can do about it. Policymakers need to understand that treating people with HIV saves money, Fenton said. 

“What we now know is that treating HIV is cost-effective. For every dollar spent, you save $2,” Fenton said.

Fenton said the U.S. should pull out the stops on providing condoms, counseling, testing and treatment.

“We need to ensure that states have policies that support routine HIV testing,” Fenton said. “Clearly, this is going to be more challenging in some states than in others.”

Top AIDS experts in the U.S. say no matter what people may think about the moral implications of some of the behavior that leads to HIV infection, it will benefit everyone to get people tested, treated and counseled about controlling their infection.

“Every state really must enact the Affordable Care Act,” said Dr. Judith Aberg, president of the HIV Medicine Association and an AIDS expert at New York University. “States need to fund HIV treatment and prevention. We need to continue this fight.”

Governors of several states have said they will not expand Medicaid, required by the health care law, because they cannot afford it. The U.S. Supreme Court ruled last month that states can decide whether to abide by that provision. States refusing expansion now include Texas, Florida, South Carolina and Louisiana. Medicaid, the state-federal health insurance plan for the poor, currently does not cover most low-income adults with HIV. AIDS activists say it’s essential to controlling the epidemic to get coverage for young adults with HIV, and at risk for HIV.

Related stories:

• Circumcision advocate tackles the cringe factor
• Two patients with HIV now virus-free. Is this a cure?
• The female face of AIDS -- not who might think

By Stephanie Pappas
LiveScience 

With a statement decrying the Obama administration's "blind eye" toward enforcement of federal obscenity laws, Republican presidential candidate Rick Santorum has brought the subject of pornography into the presidential campaign. But some of Santorum's statements about the ills of explicit material may not hold up.

In a statement first posted last week on his campaign website, Santorum cites "a wealth of research" demonstrating that pornography causes "profound brain changes" and widespread negative effects in both adults and children, including violence against women. There's no such evidence of brain changes, researchers say — though the question of pornography's harmfulness is still in some dispute.

"It's very easy if you want to support one side or the other, to pull a particular study," said Paul Wright, an assistant professor of telecommunications at Indiana University, Bloomington, who has studied sex in the media. "Anybody can support one side or another by simply isolating a particular study and talking about it."

Most experimental studies on the effects of pornography have focused on college students, given their easy proximity to the psychology lab. Looked at individually, these studies seem mixed. Some find that exposing young men to porn increases sexist attitudes and even a willingness to inflict pain, often tested by having the men inflict what they believe are real electric shocks on a woman. (The shocks are fake.) Other studies find little to no effect. [Sex Quix: Myths, Taboos & Bizarre Facts]

To pull this disparate research together, psychologists depend on meta-analyses, or studies that analyze data from multiple single studies. Using this technique, Wright said, the effects of pornography are "fairly clear."

"In experimental settings where actual aggressive behavior is measured as the outcome measure among males, both violent pornography and nonviolent pornography increased the probability of subsequent aggression," Wright told LiveScience.

Not all researchers put stock in experimental findings, however.

"The question became do these little tests that we're having these guys do [in the lab], do they really apply to real life?" said Chris Ferguson, a psychologist at Texas A&M University who studies the link between media and violent behavior.

In real life, of course, researchers can't carry out controlled experiments on pornography. One alternative strategy has been to look at sexual violence rates in countries right after pornography is decriminalized. These studies, many done by Milton Diamond, the director of the Pacific Center for Sex and Society at the University of Hawaii at Manoa, usually find that rates of sexual violence go down after pornography becomes more prevalent. Diamond sees this as evidence that pornography actually provides a catharsis for men who have sexually aggressive tendencies. [A Brief History of Porn]

"The majority of the pornography dissipates the arousal by masturbation and I think that works both for males and females," Diamond told LiveScience. "And usually after somebody masturbates and they have their orgasm, they're not as interested in sex as they were 10 minutes before, so I think it dissipates the interest to go out and do anything illegal."

There's no proof of this catharsis effect in the countrywide studies. It's not even possible to firmly link the drop in violence to pornography at all, given the large number of other factors that could play a role. The decriminalization of pornography could go hand-in-hand with other societal changes that influence sexual violence, Ferguson said. Women might even be influenced by a more porn-saturated society to accept violence against themselves and not report sexual aggression, Wright pointed out. Or some other, non-porn-related factor might play a role.

Nonetheless, some researchers see the countrywide correlations as telling.

"When you have people that are making these kinds of claims, that it's a major contributor to men's aggression toward women, it makes sense to look at if that societal data point exists," Ferguson said. [Internet Pornography Statistics]

If the laboratory studies are correct that pornography does increase male violence, it's a small to moderate effect, said Wright, who is quick to point out that he does not advocate censorship in any case.

Researcher Neil Malamuth of the University of California, Los Angeles, has found that exposure to pornography doesn't affect the average man. But for men with other risk factors that predispose them toward sexual violence, "it can add fuel to the fire," Malamuth said.

"It can make a person who perhaps has a certain proclivity, a certain inclination, a certain risk profile even more likely to act out in a sexually aggressive way," Malamuth said.

Risky characteristics include hostility toward women, a narcissistic personality, and a tendency to derive gratification from power and control over women, as well as background characteristics such as growing up in a violent home.

Perhaps different studies are capturing different proportions of men with these characteristics, which would explain the conflicting results, Malamuth said.

The focus on the link between pornography and aggression glosses over other potential pitfalls of porn, including working conditions for the porn actors and the pressure on women to look or act like a porn star. But some researchers are taking a closer look at the potentially positive sign of sexually explicit media. In surveys, pornography users generally see porn as a boon, said Malamuth.

"Pornography may have many beneficial effects for some people in their sexual lives, and many don't see themselves as harmed in any way," Malamuth said.

In one study published this month in the International Journal of Intercultural Relations, University of Hawaii at Manoa researchers compared poses of women in photographs taken from popular pornography websites, magazines and porn-star portfolios, in Norway, the United States and Japan. These three countries were chosen because they fall in different portions of the United Nations' Gender Empowerment Measure, a measure of women's political and economic power in a nation. Norway is No.1 globally on the scale, the U.S. is No. 15, and Japan is No. 54.

The researchers compared "empowering" and "disempowering" poses in the popular pictorial pornography of each nation. An example of a disempowering photograph would be a woman tied up or contorted, with little care given to her own comfort. An empowering photograph would be the opposite, for example an unbound woman facing the camera with confidence.

The researchers found that disempowering photographs were equally common across all three countries. But Norway had the highest number of empowering photographs, followed by the U.S. The findings suggest that pornography may mirror the gender equality or lack thereof of society at large, according to study researcher Dana Arakawa, a doctoral student at the University of Hawaii at Manoa.

"It's a reflection of what our culture produces to show what is sexy about women or what should be considered a sexual ideal," Arakawa told LiveScience. The fact that relatively equal Norway exhibits more examples of "empowering" images of sexual women is heartening, Arakawa said. Most Americans have a vision of porn stars as stereotypically pouting Playboy bunnies, but that view of sexuality is limited in scope, she said.

"There is variety," Arakawa said. "Pornography isn't just what we know of in the U.S."

More from LiveScience:

• 10 Surprising Sex Statistics
• Fight, Fight, Fight: The History of Human Aggression
• 6 (Other) Great Things Sex Can Do For You

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