Monday was the deadline for states to report what their “essential health benefits” packages will look like under Obamacare’s newly-created insurance exchanges, which go into effect in 2014. But dozens of states are either unprepared or are refusing to set up their own exchanges, leaving it up to the federal government to set up the exchanges there.

Some Republican governors are refusing to make a decision about the programs in their states until after the election in case Mitt Romney, who has promised to repeal Obamacare on his first day in office, is elected. If it becomes clear that the health care reform law will not be repealed, those states will have to work quickly after the November election to meet the deadlines:

Some experts believe a larger number of states will eventually set up their own exchanges if President Obama is reelected. Their timetable is short, however, because the exchanges must be operating in time for open enrollment in October 2013.

States must declare their plans to the Department of Health and Human Services by Nov. 16. In addition to the 13 states that have expressed their intent to set up marketplaces, three states have decided to partner with the federal government in forming the exchanges. Eight have opted to leave the task exclusively to federal authorities.

Alabama Gov. Robert Bentley (R) wrote a letter to HHS Secretary Kathleen Sebelius to say that his state will not set up the minimum benefits because Bentley claims “that the law does not make health insurance affordable and negatively affects consumer choice.” For Alabama and the other states that do not set up the required minimum benefits, Kaiser Health News reports that the federal government will step in to set the benchmark at “the largest small group plan in the state.”

A new survey finds that although the majority of parents are talking about sex with their teenage children, they don’t bring it up often enough and they don’t regularly address more complicated topics surrounding sexuality, like birth control.

The survey — conducted through a partnership between Planned Parenthood, the NYU Center for Latino Adolescent and Family Health, and Family Circle magazine — polled parents and teens living in the same households and found significant discrepancies in what each group believed was being conveyed about sex. For instance, parents believe they are having these talks with their kids much more frequently than teens believe their parents are initiating them:

The report finds that while 42 percent of parents say they’ve talked to their teens “many times” about how to say no to sex, only 27 percent of teens agree. In fact, 34 percent of teens say they’ve “never” or “only once” talked with their mom or dad about how to delay sex. Moreover, only small percentages of teens said they plan to discuss these and other sexuality-related topics with their parents in the future. This resistance is likely a result of teens’ discomfort discussing these topics. The results also indicate that parents need to do a better job tackling more-challenging topics, including those involving how teens can act to prevent pregnancy and sexually transmitted diseases.

“This survey shows that parents and teens have very different perceptions about how often they’re talking about sex and what’s being said during those talks,” said Leslie Kantor, vice president of Education for Planned Parenthood Federation of America. “Parents think they’re giving nuanced advice, but their teens are just hearing directives. We’re offering tips that can help parents talk with their teens in a way that resonates and helps them make smart choices about relationships and sex.”

One of the most troubling findings in the survey is the fact that parents are much less likely to address contraception than other issues, like maintaining healthy relationships and navigating consensual sexual experiences. Only about 30 percent of surveyed parents said they have discussed birth control methods many times with their teens, while less than a quarter of teens said they have discussed the topic many times with their parents. On the other hand, a full 93 percent of parents responded that they believe birth control should be covered in high school sex ed programs, while 78 percent believe that information about birth control should also be provided in middle school.

Although opponents of comprehensive sexuality programs in public schools often claim that conversations about sexuality need to happen at home, these conversations are falling short. While parents agree on the importance of conveying accurate information about sexuality — as well as preventative measures like birth control and condoms — they are struggling to break through to their teens in a way that guarantees the information is being received. Integrating medically comprehensive discussions about sexual health in the classroom is one way to help ensure that, no matter what gaps emerge in the conversations between teens and their parents, teenagers are fully equipped with the information they need to make healthy choices.

In the first official guidance about the health care reform law since the Supreme Court ruling that upheld its constitutionality, the Obama Administration is warning states that they will risk losing federal funding if they do not move to expand the Medicaid program under Obamacare. Although Obamacare’s Medicaid expansion would give states federal money to extend health coverage to millions of low-income Americans who cannot currently afford it, Republican governors have resisted accepting the expansion because they say it costs their states too much money.

But Cindy Mann, the federal official in charge of Medicaid, is reminding lawmakers that rejecting the expansion will actually be more costly for states than proceeding with it, because they will lose the federal funding for the expanded populations under their Medicaid programs:

Under the new law, she said, the federal government will pay the entire cost of Medicaid coverage for newly eligible beneficiaries for three years, from 2014 to 2016. The federal share will decline to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent in 2020 and later years.

The federal payment rates “are tied by law to the specific calendar years noted,” Ms. Mann said. So if a state defers the expansion of Medicaid to 2016, the federal government will pay 100 percent of the costs for only one year. After 2016, the federal share will drop to the levels specified by Congress, and states will be responsible for the remainder.

“I am hopeful that state leaders will take advantage of the opportunity provided to insure their poorest families with these unusually generous federal resources,” said Ms. Mann, a deputy administrator of the Centers for Medicare and Medicaid Services.

Studies have estimated that 21 to 45 states would save money by taking the Medicaid expansion, with savings across state budgets potentially reaching into the billions. And if GOP governors don’t heed Mann’s advice and eventually opt to expand Medicaid in their states, they will not only be making an unwise financial choice — they will also be denying millions of the poorest Americans access to essential health services.

One of the myriad things presidential contender Mitt Romney has pledged to do on day one of his presidency is to repeal the Affordable Care Act, President Obama’s signature health care reform legislation, and replace it with “market drive” reforms. But a new study estimates that the effort would actually increase the number of uninsured Americans to 72 million and increase costs across the board.

The Commonwealth Fund report considered Romney’s proposal in full, including his plans to transform Medicare into a “premium support” structure and convert Medicaid into a block grant for the states. Romney would also “equalize the tax treatment of employer-based coverage and plans purchased in the individual insurance market,” allow insurance companies to circumvent state-based consumer protections to sell subprime plans “across state lines,” and push sicker Americans into expensive high-risk pools. The changes will make it harder for the 129 million Americans with pre-existing conditions to find coverage.

As a result, 72 million Americans would be unable to obtain insurance — more than if the Affordable Care Act had not become law in the first place:

Out-of-pocket spending and premiums would also increase, since Americans would lose “the combination of premium tax credits, limits on out-of-pocket spending, and consumer protections” that will reduce “costs for people purchasing coverage through the new insurance exchanges or the individual market”:

Romney’s plan would hit young adults between the ages of 19 and 29 the hardest, with an estimated 41.4 million uninsured (PDF) under his plan. That contrasts sharply to Obama’s health care reform, which will drop the uninsured in that age group down to 16 million, mainly thanks to the provision allowing adults up to 26 years old to remain on their guardians’ insurance.

The Republican candidate’s plan would also be particularly tough for low-income people or people living in poverty, who, under Obamacare, will be eligible for coverage in most states through the expansion of the Medicaid program. With Romney’s cuts to Medicaid, however, the number of uninsured people within 138 percent of the federal poverty line would grow from a baseline of 38.6 million to 43.7 million.

New data from the Census Bureau compares the average number of times that Americans of working age — between 18 and 64 years old — visited a doctor’s office over the first decade of the 21st century. According to the data, the number of visits to medical professionals dropped from an average of 4.8 visits in 2001 to just 3.9 visits in 2010. Census officials could not pinpoint the exact reason for the decline, but speculated that it was largely due to growing rates of uninsured Americans.

According to the report, the rate of working-age Americans without health insurance was 21.8 percent in 2010, up from 17 percent in 2001. Brett O’Hara, one of the study’s co-authors, pointed out that low-income Americans without health insurance are much less likely to be able to afford visits to doctors’ offices — just one factor among significant variations between economic and racial groups:

People lacking insurance were far less likely to go to doctors. Just 24 percent of the uninsured went to a doctor at least once in 2010, compared with 72 percent of the general population of working age adults, the report found. [...]

The report also showed the sharp difference in medical usage by income. Nearly 40 percent of people in poverty did not visit a doctor in 2010, compared with 19 percent of people from higher income levels.

Hispanics were the least likely to seek medical care, with 42 percent reporting not having visited a doctor at all in 2010. Among whites, the share was 23 percent and among blacks it was 30 percent.

Because the Census Bureau used data from before the Affordable Care Act went into effect in 2010, researchers suspect their study reflects a high rate of uninsurance that President Obama’s health care reform law has since helped stem. A September report from the Census Bureau reported that Obamacare significantly lowered the uninsurance rate between 2010 and 2011 by extending coverage to an additional 1.4 million Americans who could not previously afford coverage. And thanks to the Obamacare provision that allows young adults to remain on their parents’ insurance plans until age 26, the heath reform law led to a record drop in uninsured young adults during that time period.