The Affordable Care Act opened the door for millions of young adults to stay on their parents’ health insurance until they turn 26.

But there’s a downside to remaining on the family plan.

Chances are that Mom or Dad, as policyholder, will get a notice from the insurer every time the grown-up kid gets medical care, a breach of privacy that many young people may find unwelcome.

With this in mind, in recent years a handful of states have adopted laws or regulations that make it easier for dependents to keep medical communications confidential.

The privacy issue has long been recognized as important, particularly in the case of a woman who might fear reprisal if, for example, her husband learned she was using birth control against his wishes. But now the needs of adult children are also getting attention.

“There’s a longstanding awareness that disclosures by insurers could create dangers for individuals,” said Abigail English, director of the advocacy group Center for Adolescent Health and the Law, who has examined these laws. “But there was an added impetus to concerns about the confidentiality of insurance information with the dramatic increase in the number of young adults staying on their parents’ plan until age 26” under the health law.

Federal law does offer some protections, but they are incomplete, privacy advocates say. The Health Insurance Portability and Accountability Act of 1996 is a key federal privacy law that established rules for when insurers, doctors, hospitals and others may disclose individuals’ personal health information. HIPAA contains a privacy rule that allows people to request that their providers or health plan restrict the disclosure of information about their health or treatment. People can ask that their insurer not send to their parents the ubiquitous “explanation of benefits” form describing care received or denied, for example. But an insurer isn’t obligated to honor that request.

In addition, HIPAA’s privacy rule says that people can ask that their health plan communicate with them at an alternate location or by using a method other than the one it usually employs. Someone might ask that EOBs be sent by email rather than by mail, for example, or to a different address than that of the policyholder. The insurer has to accommodate those requests if the person says that disclosing the information would endanger them.

A number of states, including California, Colorado, Washington, Oregon and Maryland, have taken steps to clarify and strengthen the health insurance confidentiality protections in HIPAA or ensure their implementation.

In California, for example, all insurers have to honor a request by members that their information not be shared with a policyholder if they are receiving sensitive services such as reproductive health or drug treatment or if the patient believes that sharing the health information could lead to harm or harassment.

“There was concern that the lack of detail in HIPAA inhibited its use,” said Rebecca Gudeman, senior attorney at the National Center for Youth Law, a California nonprofit group that helps provide resources to attorneys and groups representing the legal interests of poor children. She noted that HIPAA doesn’t define endangerment, for example, and doesn’t include details about how to implement confidentiality requests.

Concerns by young people that their parents may find out about their medical care leads some to forgo the care altogether, while others go to free or low-cost clinics for reproductive and sexual health services, for example, and skip using their insurance. In 2014, 14 percent of people who received family planning services funded under the federal government’s Title X program for low-income individuals had private health insurance coverage, according to the National Family Planning and Reproductive Health Association.

Even though most states don’t require it, some insurers may accommodate confidentiality requests, said Dania Palanker, senior counsel for health and reproductive rights at the National Women’s Law Center, a research and advocacy group.

“Inquire whether there will be information sent and whether there’s a way to have it sent elsewhere,” Palanker said. “It may be possible that the insurer has a process even if the state doesn’t have a law.”

Insurers’ perspective on these types of rules vary. In California, after some initial concerns about how the law would be administered, insurers in the state worked with advocates on the bill, Gudeman said. “I give them a lot of credit,” she said.

Restricting access to EOBs can be challenging to administer, said Clare Krusing, a spokesperson for America’s Health Insurance Plans, a trade group. A health plan may mask or filter out a diagnosis or service code on the EOB, but provider credentials or pharmacy information may still hint at the services provided.

There’s also good reason in many instances for insurers and policyholders to know the details about when a policy is used, experts say. Policyholders also may have difficulty tracking cost-sharing details such as how much remains on the deductible for their plan.

In addition, “if a consumer receives a filtered or masked EOB, he or she has no way of knowing whether their account has been compromised or used as part of fraudulent activity,” Krusing said.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter:@mandrews110.

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The Supreme Court’s decision striking down Texas laws limiting abortion access could have significant impacts in other states.

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People in Texas react to the Supreme Court’s decision Monday overturning a state law cutting the number of health clinics that perform abortions.

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The Supreme Court ruled Monday on a case out of Texas with major implications for access to abortion services.

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When Greg Burel tells people he’s in charge of some secret government warehouses, he often gets asked if they’re like the one at the end of the Raiders of the Lost Ark, when the Ark of the Covenant gets packed away in a crate and hidden forever.

“Well, no, not really,” says Burel, director of a program called the Strategic National Stockpile at the Centers for Disease Control and Prevention.

Thousands of lives might someday depend on this stockpile, which holds all kinds of medical supplies that the officials would need in the wake of a terrorist attack with a chemical, biological or nuclear weapon.

The location of these warehouses is secret. How many there are is secret. (Although a former government official recently said at a public meeting that there are six.) And exactly what’s in them is secret.

“If everybody knows exactly what we have, then you know exactly what you can do to us that we can’t fix,” says Burel. “And we just don’t want that to happen.”

What he will reveal is how much the stockpile is worth: “We currently value the inventory at a little over $7 billion.”

But some public health specialists worry about how all this would actually be deployed in an emergency.

“The warehouse is fine in terms of the management of stuff in there. What gets in the warehouse and where does it go after the warehouse, and how fast does it go to people, is where we have questions,” says Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University.

I recently asked to go take a look at one of the warehouses, and was surprised when the answer was yes. I was told I was the first reporter ever to visit a stockpile storage site.

Since I had to sign a confidentiality agreement, I can’t describe the outside. But the inside is huge.

“If you envision, say, a Super Walmart and stick two of those side by side and take out all the drop ceiling, that’s about the same kind of space that we would occupy in one of these storage locations,” Burel says.

A big American flag hangs from the ceiling, and shelves packed with stuff stand so tall that looking up makes me dizzy.

“We have the capability if something bad happens that we can intervene in a positive way, but then we don’t ever want to have to do that. So it’s kind of a strange place,” says Burel. “But we would be foolish not to prepare for those events that we could predict might happen.”

The Strategic National Stockpile got its start back in 1999, with a budget of about $50 million. Since then, even though the details aren’t public, it’s clear that it has amassed an incredible array of countermeasures against possible security threats.

The inventory includes millions of doses of vaccines against bioterror agents like smallpox, antivirals in case of a deadly flu pandemic, medicines used to treat radiation sickness and burns, chemical agent antidotes, wound care supplies, IV fluids and antibiotics.

I notice that one section of the warehouse is caged off and locked. Shirley Mabry, the logistics chief for the stockpile, says that’s for medicines like painkillers that could be addictive, “so that there’s no pilferage of those items.”

As we walk, I hear a loud hum. It’s a giant freezer packed with products that have to be kept cold.

Just outside it, there are rows upon rows of ventilators that could keep sick or injured people breathing. Mabry explains that they’re kept in a constant state of readiness. “If you look down to the side you’ll see there’s electrical outlets so they can be charged once a month,” she says. Not only that—the ventilators get sent out for yearly maintenance.

In fact, everything here has to be inventoried once a year, and expiration dates have to be checked. Just tending to this vast stash costs a bundle — the stockpile program’s budget is more than half a billion dollars a year.

And figuring out what to buy and put in the stockpile is no easy task. The government first has to decide which threats are realistic and then decide what can be done to prepare. “That’s where we have a huge, complex bureaucracy trying to sort through that,” says Redlener.

The process goes by the clunky acronym PHEMCE and involves agencies from the Department of Defense to the Food and Drug Administration. They’re looking to acquire or develop products that can meet the threats.

“A lot of under-the-hood, background work goes into identifying what the size, the scope, the special needs are, and what medical countermeasures exist or need to be made,” says George Korch, senior advisor to the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services. “That then drives the rest of the process for research, development, procurement, stockpiling, etcetera.”

There often debate, he says, but at the end of the day they have to reach a consensus and move forward.

“We could start stockpiling cobra antivenom if we really wanted to, but should we?” says Rocco Casagrande, who runs a consulting firm called Gryphon Scientific.

The government recently hired Gryphon to do an analysis of how well the stockpile was positioned to respond to a range of scenarios based on intelligence information. “The studies that were done before have all been one-off. They’ve all been looking at a single type of attack at a time, or a single type of weapon of mass destruction,” says Casagrande. “They haven’t looked across all threats to make decisions about whether you should buy A versus B.”

The results can’t be discussed publicly, says Casagrande, but “one thing we can say is that across the variety of threats that we examined, the strategic national stockpile has the adequate amount of materials in it and by and large the right type of thing.”

The trouble is, increasingly the new medicines chosen for the stockpile have some real limitations.

“These are often very powerful, very exciting and useful new medicines but they are also very expensive and they expire after a couple years,” says Dr. Tara O’Toole a former homeland security official who is now at In-Q-Tel, a nonprofit that helps bring technological innovation to the U. S. intelligence community.

O’Toole chairs a recently formed committee at the National Academies of Sciences, Engineering and Medicine, which the government asked to study the stockpile program and offer advice. She says as the inventory of the stockpile goes up and up, the budget to maintain that inventory is staying flat.

“This is an unsustainable plan,” she says. “And we don’t think there’s enough money to do what the stockpile says it must do, already.”

That’s because getting stuff out of the stockpile to the people who would need is a major challenge. Imagine if there’s a major anthrax attack, and there’s just 48 hours to get prophylactic antibiotics to more than a million people

“It is not going to be easy or simple to put medicines in the hand of everybody who wants it,” says O’Toole.

Back at the warehouse, Mabry and Burel show me all the ways they’re set up to expedite delivery. For example, one of the first things you see when you walk into the warehouse is rows of 130 shipping containers. “This is the 12 hour push package, approximately 50 tons of material,” says Mabry.

This collection of stuff could help after a variety of disasters, and it’s designed to be delivered to a city or town within hours. Mabry shows me how the outside of each container is a pouch. “That has the information that anyone would need if they were to receive this, so they could very easily identify what is in this,” she explains.

The people who would receive this container—or anything else from the stockpile—-are state and local public health workers. They’re the ones who have to figure out how get pills into mouths and shots into arms.

But local public health officials have had budget cuts and are drastically under-funded, says Paul Petersen, director of emergency preparedness for Tennessee.

“Many jurisdictions across the U. S. have less staff and less resources available to them to surge up in large-scale events,” says Petersen. “I mean, that’s a risk.”

While they do have plans for emergencies, and lists of volunteers, he says, “they’re volunteers. And they’re not guaranteed to show up in the time of need.”

Over and over, I heard worries about this part of the stockpile system.

“We have drastically decreased the level of state public health resources in the last decade. We’ve lost fifty thousand state and local health officials. That’s a huge hit,” says O’Toole, who wishes local officials would get more money for things like emergency drills. “The notion that this is all going to be top down, that the feds are in charge and the feds will deliver is wrong.”

She’d also like to see more interest from Congress in all this—because it’s a national security issue. “These will be do or die days for America, should they ever come upon us,” O’Toole points out.

And having a stockpile in a warehouse will be just the beginning.

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Blue Cross and Blue Shield of Minnesota will retreat from the sale of health plans to individuals and families in the state starting next year. The insurer, Minnesota’s largest, said extraordinary financial losses drove the decision.

“Based on current medical claim trends, Blue Cross is projecting a total loss of more than $500 million in the individual [health plan] segment over three years,” the insurer said in an emailed statement.

The Blues reported a loss of $265 million on insurance operations from individual market plans in 2015. The insurer said claims for medical care far exceeded premium revenue for those plans.

“The individual market remains in transition and we look forward to working toward a more stable path with policy leaders here in Minnesota and at the national level,” the company stated. “Shifts and changes in health plan participation and market segments have contributed to a volatile individual market, where costs and prices have been escalating at unprecedented levels.”

The decision will have far-reaching implications.

Blue Cross Blue Shield says the change will affect about “103,000 Minnesotans [who] have purchased Blue Cross coverage on their own, through an agent or broker, or on MNsure,” the state’s insurance exchange.

“We understand and regret the difficulty we know this causes for some of our members,” the insurer wrote. “We will be notifying all of our members individually and work with them to assess and transition to alternative coverage options in 2017.”

Cynthia Cox of the Kaiser Family Foundation, who analyzes individual health insurance markets around the country, says what the Blues are doing in Minnesota is similar to a walk back by UnitedHealth Group, the nation’s largest health insurance company.

“Right now what it seems like is that insurance companies are really trying to reset their strategy,” Cox said. “So they may be pulling out selectively in certain markets to re-evaluate their strategy and participation in the exchanges.”

She said the individual markets just aren’t turning out as expected. “The hope was that these markets would encourage exchange competition and [get] more insurers to come in. … I don’t know if we’re at a point where it’s completely worrisome, but I think it does raise some red flags in pointing out that insurance companies need to be able to make a profit or at least cover their costs.”

In response to the development in Minnesota, Gov. Mark Dayton, a Democrat, highlighted gains in enrolling more Minnesotans in health insurance plans since the implementation of the Affordable Care Act. But he also acknowledged the insurer’s departure reflects the instability in the market for individual and family coverage.

“This creates a serious and unintended challenge for the individual market: the Minnesotans who seek coverage there tend to have greater, more expensive health care needs than the general population,” said Dayton. “Blue Cross Blue Shield’s decision to leave the individual market is symptomatic of conditions in the national health insurance marketplace.

University of Minnesota health economist Roger Feldman called the Blues’ departure a major blow to Minnesota’s already troubled individual market.
“What this says about the individual market is that it is very unstable and it has been disrupted by a number of events, and we still don’t know whether it will recover or not from those disruptions,” he said.

Feldman said lawmakers would be wise to pay attention to the unstable individual markets and to shore them up with a carrot and stick approach.

“To get people to sign up in the exchange we need one or both of those,” he said. “The stick could be to raise the penalties on people who don’t buy insurance, and the carrot could be to increase the subsidies for people that do. I think that’s the only way that we’re going to get a decent mix of risks to buy into that exchange.”

Although the main Blue Cross Blue Shield unit is leaving Minnesota’s individual market, its much smaller subsidiary, Blue Plus, will continue to offer plans on the individual market, according to the company statement. Blue Plus has only about 13,000 members, according to his message.

Kaiser’s Cox says that’s typical and leaves insurers a re-entrance option.

MNsure spokesman Shane Delaney said about 20,000 Minnesotans purchased Blue Cross and Blue Shield of Minnesota plans through MNsure. He said the vast majority of them qualified for tax credits to help pay premiums. Delaney said all of the Blue Cross and Blue Shield customers losing their coverage next year should look for other options on MNsure, the only place eligible applicants can secure federal tax credits.

This story is part of a reporting partnership with NPR, Minnesota Public Radio and Kaiser Health News. You can follow Mark Zdechlik on Twitter: @MarkZdechlik.

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It’s a predictable passage in life: Hit 50, get lots of birthday cards with old-age jokes, a mailbox full of AARP solicitations — and a colonoscopy.

But millions of Americans — about one-third of those in the recommended age range for colon cancer screening — haven’t been tested. Some avoid it because they are squeamish about the procedure, or worried about the rare, but potentially serious, complications that can occur during colonoscopies.

Now, an influential panel has added some new choices, aiming to get more Americans screened for colorectal cancer, which is the second leading cause of cancer death in the U.S.

Here are five things to know now:

1) Getting tested — in any of a variety of ways — is a good thing.

Following its review of all the available medical evidence, the U.S. Preventive Services Task Force — an independent blue-ribbon panel of medical experts — updated its colorectal cancer screening guidelines. The panel gave an A rating to screening all adults between ages 50 and 75 years at average risk of the disease, saying the benefits are “substantial.” People with a family history or other risk factors might want to start earlier — and those older than 75 should talk with their doctors about whether to continue screening.

Noting that not enough Americans are getting screened, the panel essentially said the best test is the one that patients will take: “The goal is to maximize the total number of persons who are screened because that will have the largest effect on reducing colorectal cancer deaths.”

2) Two less-invasive tests may qualify for free preventive screening.

The biggest change from prior guidelines is the panel’s inclusion of two more ways to screen for the disease, including virtual colonoscopies, like the one President Obama had in 2010. Also called computed tomography (CT) colonography, the test uses special X-ray machines to examine the colon. The panel also added a $650 home test called Cologuard, which checks stool for elevated levels of altered DNA that could indicate cancer. Those tests join several others that were part of the panel’s previous recommendations: the full colon exam called colonoscopy; sigmoidoscopy, which uses a lighted tube and camera to examine just the lower portion of the colon; and two other types of home stool tests, fecal occult-blood tests and fecal immunochemical tests. Because of the task force’s A rating for colon cancer preventive screening, these tests generally must be offered to insured patients without a copayment or deductible under the rules put in place by the Affordable Care Act.

3) Don’t expect all insurers to drop copays on the new tests right away.

While Medicare already covers Cologuard as a preventive screening tool, many private insurers don’t. Of people with private insurance who are in the target age range, about 1 in 4 currently has coverage for the test, said Kevin Conroy, president and CEO of Exact Sciences, which makes the test. “That’s going to change,” he said, “because health plans have told us that they will follow the task force’s guidelines.”

When it comes to virtual colonoscopies, some insurers — including Cigna — cover them, but Medicare doesn’t. In 2009, Medicare said there was insufficient medical evidence to determine whether such tests should be covered nationally.

Now Medicare will likely be asked by proponents of virtual colonoscopy to revisit that decision.

Under Obamacare, insurers have up to a year to incorporate A- or B-rated screening tests into their benefit packages without a copayment. But there is some ambiguity in this case because the screening itself — not the individual tests — was given the A rating. While many experts believe insurers must offer all the types of tests, that isn’t entirely clear. Insurers and patient advocate groups both say they will seek additional clarity from the Obama administration.

4) The task force didn’t pick favorites.

The panel did not rank the tests, noting a lack of head-to-head comparisons showing any one method has the most net benefit. All tests have pros and cons. For example, getting a colonoscopy every 10 years has the advantage that, if potentially cancerous polyps are detected, they can be removed during the procedure. But it also carries a small risk of harmful complications, such as anesthesia-related cardiac problems, bowel perforations or abdominal pain. Sigmoidoscopy at five-year intervals has a lower rate of complications, but can miss some cancers because it doesn’t reach the entire colon. Annual stool tests, which don’t themselves carry any risk, reduce colorectal cancer deaths, the panel noted. The newer FIT immunochemical stool tests are a bit better at spotting cancers than FOBT, which studies show can correctly identify cancers 62 percent to 79 percent of the time. Cologuard — recommended every one to three years — detects existing cancers 92 percent of the time, but has a higher false-positive rate than FIT. Virtual colonoscopies, which expose patients to X-ray radiation, spot existing cancers of 10 millimeters or larger 67 percent to 94 percent of the time. The exam can also lead to additional, sometimes unnecessary testing because it flags potential problems outside the colon 40 percent to 70 percent of the time, with only about 3 percent of those concerns ultimately needing some form of treatment, the panel noted.

5) You might still get hit with a copayment.

Although preventive screening is covered without copayments or deductibles, some patients still end up with a bill. Medicare, most notably, requires a 20 percent copay if a polyp is found during a screening colonoscopy and removed. That payment averages $272, although advocates say they have seen far higher bills. Most private insurers do not charge patients if a polyp is found during a preventive screening, following Obama administration clarifications on the topic.

Two bills in Congress aim to apply those same rules to Medicare.

Another way consumers can get hit with a copayment is if a stool test, sigmoidoscopy or other exam indicates cancer might exist. A colonoscopy is then performed and some insurers consider that test a diagnostic exam, rather than a preventive screening. The American Cancer Society Cancer Action Network says it has asked the administration to clarify what happens in such a case. “If a patient has a positive test, the next step is colonoscopy, and therefore should be covered without cost-sharing,” said Caroline Powers, director of federal relations with ACSCAN. “We’re trying to get more people screened.”

Kaiser Health News is a service of the nonprofit Kaiser Family Foundation. Neither one is affiliated with the health insurer Kaiser Permanente. Follow Julie Appleby on Twitter: @Julie_appleby.

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When you hear the phrase “digital health,” you might think about a Fitbit, the healthy eating app on your smartphone, or maybe a new way to email the doctor.

But Fitbits aren’t particularly useful if you’re homeless, and the nutrition app won’t mean much to someone who struggles to pay for groceries. Same for emailing your doctor if you don’t have a doctor or reliable Internet access.

“There is a disconnect between the problems of those who need the most help and the tech solutions they are being offered,” said Veenu Aulakh, executive director of the Center for Care Innovations, an Oakland, Calif.-based nonprofit that works to improve health care for underserved patients.

At most digital health “pitchfests,” it’s pretty much white millennials hawking their technology to potential investors. “It’s about the shiny new object that really is targeted at solving problems for wealthy individuals, the ‘quantified-self’ people who already track their health,” Aulakh said. “Yet ….What if we could harness the energy of the larger innovation sector for some of these really critical issues facing vulnerable populations in this country?”

A small but growing effort is underway to do just that. It’s aimed at using digital technologies – particularly cellphones – to improve the health of Americans who live on the margins. They may be poor, homeless or have trouble getting or paying for medical care even when they have insurance.

The initiatives are gaining traction partly because of the growing use of mobile phones, particularly by lower-income people who may have little other access to the Internet.

The Affordable Care Act and the expansion of Medicaid have added millions of previously uninsured people to the nation’s health care system, including community health clinics that serve poor and largely minority populations, according to a California Health Care Foundation report. (California Healthline is an editorially independent publication of the California Health Care Foundation.)

In California alone, the number of people on Medi-Cal, the state’s version of the Medicaid program for the poor, rose from 7.5 million in 2010 to 12.4 million by early 2015. Many Americans remain uninsured, however, because they live in states that have declined to expand Medicaid eligibility.

Health advocates say it’s important to tailor digital health technologies to lower-income people not only to be fair, but because they’re more likely to have chronic illnesses, like diabetes, that are expensive to treat.

Health-care providers have incentives as well. They are being rewarded financially under the Affordable Care Act, Medicare and Medicaid for keeping patients healthy, and this goes beyond simply performing medical procedures and prescribing drugs.

For now, experiments targeting low-income people are a tiny part of the digital health industry, which racked up an estimated $4.5 billion in venture funding in 2015 alone. Entrepreneurs are still trying to figure out how they’re going to get paid by serving this population, and government health programs like Medicaid and Medicare are taking a while to figure out how they’re going to pay providers for approaches that don’t involve a doctors’ visit.

But Jane Sarasohn-Kahn, author of the California Health Care Foundation report, says investors are getting more interested in digital health initiatives for low-income patients simply because there are so many of them.

Investors are eyeing the “fortune at the bottom of the pyramid,” she said, much as Walmart profits from selling low-priced items to millions.

“It’s now sexy to scale,” she says. “If you can have impact [on many people], inexpensively, you can make a lot of money. If we get it right, we can do well and do good.”

Some initiatives are simple and cheap, like Text4Baby. The free text-messaging service for pregnant women and new moms offers information in English and Spanish about prenatal care, labor and delivery, breastfeeding, developmental milestones, and immunizations. The specific texts are timed to the baby’s due date.

Operated by the nonprofit ZERO TO THREE and the mobile health company Voxiva, Inc., Text4Baby has reached nearly 1 million women since starting in 2010. In one survey, more than half of them reported yearly incomes of less than $16,000.

Other experiments are far more elaborate. In California and Washington state, San Francisco-based Omada Health is testing a version of Prevent, a diabetes and heart disease prevention program that’s been modified for “underserved” populations – basically people on Medicaid or who are uninsured. The free program offers patients a digital scale as well as behavior counseling and education, access to a personal health coach and an online peer network.

To adapt the program, the company made it available in Spanish and English and lowered its reading level from ninth grade to fifth grade. Bilingual health coaches were hired, and the educational materials now acknowledge potential food access, neighborhood safety and economic issues that participants may face, said Eliza Gibson, Omada’s director of Medicaid and safety-net commercial development.

The scale doesn’t require a wireless connection, and the patient just needs to be able to access the Internet for one hour each week, Gibson said.

Omada is enrolling 300 community clinic patients in Southern California and rural Washington in a year-long clinical trial of Prevent, in hopes that the program can demonstrably slow the progress of diabetes.

Patients at other community clinics in California will try out the program but won’t be included in the clinical trial, Gibson said. Omada Health is also offering a version called Prevent for Underserved Populations that specifically targets low-income community clinic patients.

Among the people trying out the program is Susy Navarro, an elementary school substitute teacher who lives in the Spring Valley community east of San Diego. After being diagnosed with prediabetes, Navarro, 28, set an ambitious goal to lose 100 pounds. In the meantime, she is taking medication to stave off Type 2 diabetes.

“You name it, I’ve probably tried it – Weight Watchers, low-fat, low carb, pills, injections, acupuncture,” Navarro said. “The first time I try things it goes very well, I feel like I’m very successful, then I wean off and I’m not successful. This program focuses more on life choices that are going to help us out long-term, not just for a little bit.”

Navarro described the scale she was given as “sophisticated looking – all black, flat, digital.” It has been programmed to her weight profile (she is considered obese), and transmits her weight every morning to the program’s counselors.

The program, with its daily weigh-ins, helps her pay attention to what she eats, and her blood sugar levels are declining, Navarro said. She also appreciates the ability to connect online with fellow patients on her “team.” “It’s very awesome – you get to know the other members and feel like it’s a team effort.”

As they continue to explore digital health possibilities for underserved patients, developers are learning more about what works and what doesn’t, says Sarasohn-Kahn. For example, apps chew up a lot of cellphone data, so many community clinic patients prefer lower-cost text messaging.

At the Petaluma Health Center, a network of community clinics in Sonoma County, Calif., staffers offered free, simplified “loaner” digital devices to patients after a hospital stay to help them avoid complications that could land them back in the hospital.

They first offered an Android tablet to allow for a video visit with a health professional, but patients were reluctant to take it, saying it was hard to hide and could be stolen, said Dr. Danielle Oryn, the network’s chief medical information officer.

Then they tried iPhones, in which everything was locked down except the ability to call 911 and a single button triggering the video visit. Those were more acceptable. Still, there were challenges. Would patients, some recuperating at homeless shelters, have access to electricity to charge their phones? Oryn said they had to learn by trial and error. She was surprised and pleased to see seniors accepting the technology. Every loaner iPhone was returned to the clinic.

Oryn’s advice to the captains of the digital health industry?

They should “not necessarily come in with too many assumptions. They should come with an open mind and a willingness to listen,” Oryn said. “Safety-net people are very excited to have these companies interested in them and to share their experiences.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation. Follow Barbara Feder Ostrov on Twitter: @barbfederostrov.

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House Speaker Paul Ryan unveiled the health care component of congressional Republicans’ policy agenda Wednesday, a long-awaited alternative to the Affordable Care Act.

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Bridgton, Maine, is the kind of place people like to go to get away. It’s got a small main street with shops and restaurants, a pair of scenic lakes, a ski resort and plenty of hiking trails.

But about 10 years ago, Bridgton, a town of just 5,000 residents, began showing signs of a serious drug problem.

“I had a lot of young people calling the agency to come into treatment,” says Catherine Bell, director of Crooked River Counseling, a substance abuse treatment center in Bridgton. “They were using needles. They were shooting heroin and it was like, really bombarded.”

Like so many states, Maine is facing a chronic shortage of treatment for opioid addiction. The problem is especially acute in rural parts of the state where there are no addiction doctors and the nearest methadone clinic is at least an hour’s drive away.

Bell says she thought that if treatment was going to be successful, patients would need the option of methadone or buprenorphine, commonly known as Suboxone, in addition to counseling. Both medications reduce withdrawal symptoms and cravings for opioids. For a while, getting patients access to medication-assisted treatment seemed hopeless. And then Bell met Dr. Craig Smith, a physician at North Bridgton Family Practice.

Over lunch with Smith one day, Bell blurted out an idea. “I said, ‘I’ll tell you what. You prescribe. I’ll do the counseling for you.’ “

Under federal law, doctors have to be trained and certified by the Substance Abuse and Mental Health Services Administration to prescribe Suboxone, and they are limited to treating no more than 100 patients. The Department of Health and Human Services has proposed increasing the number of patients to 200.

But beyond that hurdle, many physicians are reluctant to treat opioid addiction because of how they think it will affect their regular practice. Smith told Bell he’d have to think about it.

“And in the month of August of that year, I had four or five patients that had overdosed and died,” Smith says. “One was a 34-year-old mother, two kids. I had no idea. I still feel guilty about that.”

So in 2009, with the support of his hospital and Bell’s assistance, Craig Smith started prescribing Suboxone. At the time, few primary care doctors in the area were doing it. Pretty soon Smith’s wife, who works in the same family practice, had joined him in providing medication-assisted treatment, but not without some misgivings.

“My initial feeling was — you know, I don’t want those people in my office,” says Dr. Jennifer Smith. “I run a family practice. I see a lot of kids. I don’t want them here.”

Smith says she finally realized it wasn’t new patients who needed help; it was patients she was already treating, including pregnant women. She just didn’t know they were using drugs. So now the practice offers medication as well as intensive outpatient counseling and group therapy.

Both Smiths say offering the service has opened a window on their patients’ lives, and both say they would recommend that other primary care doctors take on the same work.

“The key for us was involving the counseling group, Crooked River,” Craig Smith says, “having them screen patients and figure out who are the best candidates for treatment.”

It’s the kind of experience policymakers are hoping catches on as a way to address the shortage of drug treatment around the country.

Catherine Bell of Crooked River Counseling says offering the service and making it work financially is “really, really hard.” Because her practice doesn’t get grant money and isn’t affiliated with a larger hospital, she can’t offer treatment to people who don’t have insurance unless they can afford to pay cash for a few sessions at a time.

On the other hand, the doctors who prescribe medications have more flexibility, Bell says, because their practice is owned by Bridgton Hospital, which does offer some charity care. About 90 percent of patients are covered under the state’s Medicaid program.

At the women’s support group that meets twice a month at North Bridgton Family Practice, the women say they like the convenience of having their medical care and counseling under one roof. It’s easier to schedule appointments. There’s better coordination of their treatment. More importantly, the patients say they now know they can be upfront about their addiction.

Jennifer Smith says offering drug treatment has made her a better doctor, and she says she can see that what she’s doing is making a difference.

“I mean, you see people going back to school, going back to work, staying out of jail, taking care of their kids, getting DHS out of their life,” she says.

Not everyone who enters treatment at the family practice is successful. Counseling is mandatory. So is drug screening. And those patients who can’t or won’t comply are dropped from the program.

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