Sure, there’s a deductible with your health insurance. But then what’s the hospital deductible? Your insurer may have multiple deductibles, and it pays to know which apply when. These questions and answers tackle deductibles, whether an ex-spouse has to pay for an adult child’s insurance, and balance billing.

Recently I took my son to see a pediatric gastroenterologist. When I arrived at the office, I saw it was located adjacent to the hospital. My insurance has a large hospitalization deductible so I worried that the visit would not be covered. Nobody in the office could tell me how much an office visit would cost. Why not? Isn’t that something I should be able to expect?

Your plan’s hospital deductible won’t affect how much you pay for the visit to the specialist, whether or not his office is affiliated with the hospital, says Richard Gundling, vice president at the Healthcare Financial Management Association, a professional group.

Here’s how it works. Most health plans have medical deductibles that must be satisfied before the plan starts paying for most services. Preventive care is an important exception; there’s no deductible for that. Some plans like yours also have separate hospital deductibles. But your hospital deductible would generally only come into play if you were admitted as an inpatient.

“Even if the facility is hospital based, her visit would still be an outpatient procedure and wouldn’t affect her hospital deductible,” Gundling says.

Though your hospital deductible wouldn’t be an issue in this case, if your plan has a regular medical deductible and you haven’t yet satisfied it for the year, you may have to pay for the specialist visit anyway.

The doctor’s office should have been able to tell you how much the office visit would cost, Gundling says, but you may be better off checking with your insurer to find out how much you’ll actually owe out of pocket. Your insurer will have information about both how much it has agreed to pay the provider for an office visit and how much you’ll owe based on your health plan deductible and copayment details.

I have insurance coverage through the Affordable Care Act’s marketplace. When I visited a cancer clinic for a routine blood check, I asked upfront three times (first over the phone and again when I was there) if all services would be in-network. The answer was yes each time. Afterward I received a bill from an out-of-network lab for $570. Is there anything I could have done to avoid this charge?

In theory, you could have asked the clinic for the name of the lab that it would use for your blood work and checked with your insurer to make sure that it too was in network, says Kevin Lucia, a senior research fellow at Georgetown University’s Center on Health Insurance Reforms who co-authored a recent study on state efforts to protect consumers from surprise out-of-network bills.

However, “that seems to be a lot of work for the consumer,” Lucia says.

New rules take effect next year for plans sold on the marketplace that will require health plans to maintain up-to-date lists of providers that are easily accessible to consumers.

A CMS official was unable to clarify whether plans must also provide up-to-date listings of labs in addition to other providers.

In the meantime, check with your insurer, Lucia advises. It’s not unusual for providers to bill patients for services that are ultimately covered by their plan.

My ex-husband is responsible for health care premiums for our dependent daughter who will turn 21 in October. Under the Affordable Care Act, children can remain on their parents’ plans until age 26, but my ex is planning to drop our daughter’s coverage when she turns 21. Can he do that?

Yes, he probably can. Although the law requires health plans to offer coverage until adult children turn 26 in most instances, there’s nothing that requires parents to provide it. If your divorce agreement required him to pay for your daughter’s health insurance until she turns 21, his obligation will likely be satisfied at that point.

If your ex-husband chooses to drop your daughter’s coverage and she doesn’t sign up for her own plan, however, he may be on the hook for any financial penalty she owes for not having insurance.

Under the health law, most people have to have insurance or face penalties. In 2015, the penalty is the greater of 2 percent of household income or $325 per person.

If he claims her as his dependent, “When he does his taxes he’ll have to show that everyone in his household has insurance, and then he’ll have to pay the penalty,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation.

Since she’s part of his household, the penalty would be based on his income, not hers.

As for your daughter, if she loses coverage she’ll be eligible for a special enrollment period to sign up on the exchange, or she may be eligible for Medicaid if she lives in one of the roughly two-thirds of states that have expanded coverage to adults with incomes up to 138 percent of the federal poverty level, currently $16,243.

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On the ninth floor of a glassy high rise in downtown Washington, partitions are coming down to make more room for workers handing out billions of dollars in Obamacare-funded research awards.

Business has been brisk at the Patient-Centered Outcomes Research Institute or, PCORI, as it is known. The institute was created by Congress under the Affordable Care Act to figure out which medical treatments work best —measures largely AWOL from the nation’s health care delivery system.

Since 2012, PCORI has committed just over $1 billion to 591 “comparative effectiveness” contracts to find some answers, with much more to come. Money has thus far gone to researchers and medical schools, advocacy groups and even the insurance industry’s lobbying group, which snagged $500,000.

Institute officials say they are reshaping medical research by stressing “patient centered” projects that offer practical guidance to people living with chronic diseases. They cite a $14 million study to settle the debate over how much aspirin people should take daily to help ward off heart disease, or the $30 million project to reduce serious, even deadly, injuries from falls in the elderly.

But like all matters rooted in Obamacare, there are sharp disagreements, both political and scientific, over the core mission of the independent institute. PCORI expects to spend $3.5 billion by the end of the decade. Then it expires.

On both the right and the left, there’s simmering doubt about whether the unusual nonprofit can live up to expectations, or even what those expectations should reasonably be. Others argue these sorts of decisions should have been made prior to committing up to $3.5 billion.

“PCORI seems to have become almost invisible. Maybe they think that’s the best way to stay under the political radar screen,” said Gail Wilensky, a former Medicare chief under President George H.W. Bush. The institute has yet to “offer much value,” she said.

Some Republicans are viscerally hostile. They want to kill off or at the very least hamstring the institute, fearing it will lead to rationing of medical care by interfering with medical decision-making.

The House Appropriations Committee in late June voted to cut PCORI’s funding by $100 million—dubbing it wasteful spending. Earlier this year in the Senate, Kansas Republican Pat Roberts filed a bill to prevent Medicare from using PCORI results to “deny or delay coverage of an item or service.”

“Americans do not want the federal government limiting their treatment options and deciding what is best for them,” Roberts said at the time.

Liberals aren’t singularly thrilled, either. They fault the institute for not evaluating enough drugs and medical devices head-to-head to see which offer the best results – and thus the biggest bang for the health-care buck.

“If it doesn’t prove its worth soon there will be increasing calls for getting rid of it, or reducing its funding,” said Topher Spiro, vice president for health policy at the Center for American Progress, a liberal think tank. “That concerns us.”

PCORI executive director Joe V. Selby, a family physician and researcher, accepts some of the flak. But he argues that Congress directed the institute to explore research topics patients want and need — not to issue edicts on which treatments offer the best bargain.

“We are not in any way a cost effectiveness shop,” Selby said in an interview. “That is not our job and there is a certain wisdom in saying that we shouldn’t get involved.”

Clearly, PCORI’s stated mission means different things to different people.

Five years after setting up shop, PCORI is sponsoring many projects that offer great hope to doctors, patients and their advocates. But the institute also has spent hundreds of millions of dollars on activities only tangentially related to discovering which medical treatments are the most successful, a review by the Center for Public Integrity has found.

Among the findings:

• PCORI has spent only about 28 percent of its contracting budget on projects that assess how best to prevent, diagnose or treat diseases. Selby says more such projects are coming, including head-to-head evaluations of drugs and medical and surgical treatments. He cited a hepatitis C study coming in the fall that will pit the highly costly drug Sovaldi against other options. Much of PCORI’s other spending, though, concerns how to accelerate its research or improve health care systems.
• More than $70 million in PCORI awards cover projects intended to improve methods for conducting research, or to pay for contracts that are essentially public relations gestures to build support and good will in the medical community.

Those figures include nearly $10 million in “engagement” awards and “meeting and conference” subsidies for medical societies and other groups. America’s Health Insurance Plans, the industry trade group, got two engagement awards this year that total $500,000. One physicians’ organization got $250,000 to find out what its members think about PCORI and its work.

Institute officials said these types of awards are necessary to get their work noticed and amount to a mere “rounding error” in terms of total money spent.

PCORI has allocated an additional $61 million to help spread the reach and impact of its activities. But some projects, at least in summaries posted on the institute’s website, are so freighted with academic and scientific language that it’s hard to imagine how they could attract a wide audience. One project, for instance, looks at how doctors can create a “Zone of Openness” with patients.

But the institute faces steep challenges in making its mark on the everyday practice of medicine. The Affordable Care Act states that PCORI’s findings are “not to be construed as mandates for practice guidelines, coverage recommendations, payment or policy recommendations.”

Some critics say that language handcuffs the institute by limiting how its findings can be put to practical use. Others argue that PCORI has plenty of authority to push for more efficient health care spending, but has been too timid in wielding that power.

The health reform law gives PCORI “more flexibility than it is willing to use,” said Nicholas Bagley, who teaches at the University of Michigan Law School.

Oversight Is Minimal At Best

In the world of federally-funded medical research, the mammoth National Institutes of Health in Bethesda, Md., is sometimes viewed as the “discovery” agency, where scientists study the origins of disease and search for breakthroughs and cures. There’s also the much smaller federal Agency for Healthcare Research and Quality, with a budget of about $440 million and a mission to “make health care safer, higher quality, more accessible, equitable and affordable.”

PCORI is a third entrant with a different mission, though it can and does also collaborate with other federal agencies. Congress created it in 2010 as an independent institute that specializes in comparative effectiveness research. Under the ACA, the institute receives a mix of Medicare money, general revenue and funding from a tax on health plans.

PCORI is run by a board whose 21 members are picked by the Government Accountability Office, the watchdog arm of Congress, and it has 191 full-time staff. That’s up from 153 in September 2014.

Oversight is minimal. A GAO audit in March found little to fault, though auditors noted they had heard concerns that PCORI’s research priorities were “too broad and lack specificity.” GAO also noted that the institute won’t undergo an outside critique of its performance until 2020, after it has run through that $3.5 billion.

No Guarantee That Newer And Costlier Is Better

At least in theory, comparative effectiveness is pretty hard to fault. Common sense dictates that doctors need to know which drugs, medical devices and other treatments work best. And it makes little sense for anyone to pay for health care services that are shown conclusively to be ineffective.

But that’s not how things work. New drugs, for instance, come to market based on whether they are “safe and effective,” not if they are clearly superior to the competition. While many people might assume that a new medicine or device that costs much more than what’s already available must be better, there’s no such guarantee. In fact, more than half of medical treatments lack clear evidence of their effectiveness, according to the Institute of Medicine.

Doctors often can’t find persuasive evidence to advise them how best to get sick patients well. While many medical groups strongly back research to find these answers, getting their members to embrace recommended changes isn’t always easy or quick to happen. Some doctors may be slow to pick up on the most current medical information, while others may resent suddenly being told how they should alter their practice.

Dave deBronkart, a kidney cancer survivor, recalled talking to a doctor who derided “cookbook” medicine. “One doctor told me, ‘I want autonomy to practice as I see fit,’ ” deBronkart said. Like many other advocates, he favors a much greater role for patients in their own care.

Manufacturers of drugs, medical devices and other equipment also have a big stake in comparative research. Some companies have noted a worldwide move to restrict payments for health care services and certain types of drugs that can’t clearly demonstrate they are worth the price.

Drafters of the ACA tried to take note of all these competing interests and needs. Despite keen interest in using comparative effectiveness research to cut costs, they yielded to fears that patients could be denied some treatments. As a result, the law appears to restrict use of research findings for cutting costs at the same time that it allows PCORI to consider “the effect on national expenditures associated with a health care treatment” in setting its research priorities.

Testing Whether Nurses Help Reduce Risk Of Falls

Given its mandate, it’s perhaps no surprise that PCORI chose many projects that were seemingly worthwhile, but also unlikely to threaten any powerful health care factions.

Since 2012, PCORI has let $389 million in contracts for accelerating its research agenda or “improving healthcare systems.”

For instance, the $30 million study anchored by medical schools at Harvard, Yale and UCLA, hopes to reduce falls in the elderly.

Falls “represent grievous events for older persons and a major public health problem,” according to the study.

Albert Wu, a health policy professor at Johns Hopkins University who also is involved in the study, said researchers are looking at whether a “specially trained nurse” can work with older people and their relatives to find ways to cut down on these injuries.

“This is a topic that concerns every American who is over 65,” said Wu. “We all live in deathly fear an elderly relative will fall and break a hip. It causes terrible worry and distress and a substantial portion of those people die.”

Though PCORI director Selby wants little to do with health care financing controversies, the falls study appears to be an exception.

“Putting a nurse in every [doctor’s] office doesn’t come cheaply,” he said. “Who pays for that?” Selby said. Confirming unassailable health benefits of hiring the nurses “would be a big step toward getting coverage for that.”

The $14 million aspirin study also has widespread health ramifications because if people take too high a dose they can suffer internal bleeding that may outweigh any heart benefits.

Researchers at Duke University said that every year, 720,000 Americans have a heart attack, and nearly 380,000 die of coronary artery disease. They said that “increasing the use of an inexpensive yet effective therapy, such as aspirin … will save thousands of lives globally.”

“We know that aspirin can be beneficial in preventing heart attacks but surprisingly we haven’t known the appropriate dose,” said Ann Bonham, chief scientific officer for the Association of American Medical Colleges. “That’s an important piece of information…a gap that may not be recognized by a lot of people.”

PCORI has also let 18 contracts worth $44 million for research about rare diseases. Among them is $2.6 million awarded to the Cincinnati Children’s Hospital Medical Center to study which type of diet to give to children with a condition called eosinophilic esophagitis.

Overall, PCORI can point to $279 million in contracts for the “assessment of prevention, diagnosis and treatment options.“ Still, that’s less than a third of total spending and less than one fifth of the total number of contracts issued thus far.

A Boot Camp To Translate Medical Terms

The Center for Public Integrity review found that tens of millions of dollars in other contracts are for studying research methods, or are looking into how to get findings noticed, or are difficult to decipher.

PCORI has directed $64.5 million toward 66 contracts whose purpose is to improve methods for conducting research. In June 2012, PCORI funded more than $30 million in 50 “pilot projects” mostly at universities and medical schools. One was a boot camp at the University of Colorado Denver for $675,000 over 30 months.

The authors said they would “activate personal relationships to bring together community members, clinical practices, patients, providers and researchers to identify the important health issues they each face.” After several meetings, the group would “focus these topics into a priority list for further work.” The goal was to translate medical terms to make them easier for patients to grasp.

Some projects toss around esoteric phrases such as “how to capture stakeholder inputs” or “quality metrics to inform integrated care” that aren’t likely to be clear to the average reader.

Consider the $674,452 project funded at the Palo Alto Medical Foundation Research Institute with the catchy title: “Creating a Zone of Openness to Increase Patient-Centered Care.” The 2012 project explored how medical professionals can foster a climate where patients don’t fear being labeled as difficult “for asserting themselves in clinical decision making.” PCORI officials said the research produced important insights, though they concede they need to make their work sound more compelling.

Jean R. Slutsky, PCORI’s chief engagement and dissemination officer, agreed that heavy use of jargon can be a turnoff, especially for patients the institute is trying to reach.

“We are in the process of putting in lay language to communicate with people who are not scientists,” Slutsky said. “We wish we could change this.”

The 36 “engagement awards” to health care organizations, universities and groups cost more than $8 million. That includes $500,000 to AHIP, the insurance industry trade group, to “build and maintain support from health plan leaders” and to “identify important gaps in availability of health insurance administrative data,” according to summaries of the contracts. AHIP spokeswoman Clare Krusing said sharing health plan data is “complex” and “requires a significant amount of review and expertise from the industry.”

PCORI also has provided “meeting and conference support” to medical organizations that totaled more than $1.8 million in 17 grants.

The Society for Academic Emergency Medicine, for instance, received $50,000 in 2015 to develop and publish “a consensus research agenda.” The year before, the Society of General Internal Medicine, whose 3,000 physician members teach at medical schools, received a $249,960 grant for a two-year program “to help us develop a better understanding of the attitudes and knowledge of our membership … and how they may best be engaged to participate.”

PCORI director Selby said these awards are necessary to get through to busy professionals who “may not answer our phone calls.” Selby said: “Our job is to build relationships and to get on their radar,” adding, “This helps us get their attention.”

Yes, But What Do Patients Want?

Though it may be largely unknown to the public, PCORI has won support from a wide range of parties.

Tony Coelho, a former Democratic congressman from California who chairs the Partnership to Improve Patient Care, said the institute takes pains to “get first-hand views on what questions really matter to patients.”

Coelho’s group, a coalition of patient advocates, drug manufacturers and medical groups, applauds PCORI for conducting research “in a manner that is patient-centered and ultimately useful at the point of health care decision making.”

Other experts said that putting patients first is itself a worthy research legacy.

PCORI “is filling a really important void,” said Justin W. Timbie, a Rand Corporation policy researcher. “This is really practical research to help people make decisions [about their health]. I think that’s a lot of bang for the buck.”

This piece comes from the Center for Public Integrity, a nonpartisan, nonprofit investigative news organization. To follow CPI’s investigations into Medicare and Medicare Advantage waste, fraud and abuse, go here. Or follow the organization on Twitter: @Publici.

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Updated at 6:52 p.m. ET

Republican calls to defund Planned Parenthood over its alleged handling of fetal tissue for research are louder than ever. But they are just the latest in a decades-long drive to halt federal support for the group.

This round aims squarely at the collection of fetal tissue, an issue that had been mostly settled — with broad bipartisan support — in the early 1990s. Among those who voted then to allow federal funding for fetal tissue research was now-Senate Majority Leader Mitch McConnell, R-Ky.

McConnell made no mention of his previous position when he announced that the Senate would take up a bill to cut off Planned Parenthood’s access to federal funds before leaving for its summer break. The Senate blocked the legislation from moving forward Monday night, but the issue may come back with spending bills in the fall.

Videos shot by members of an anti-abortion group posing as fetal tissue middlemen “absolutely shock the conscience,” McConnell said at a news conference last week. Those videos purport to show Planned Parenthood officials discussing the sale of tissue from aborted fetuses in strikingly casual terms. It is illegal to profit from the sale of fetal tissue, though not illegal for expenses involved in its collection to be reimbursed.

Planned Parenthood says the videos are heavily edited and take discussions out of context.

“These videos are hard for anyone to defend and hit at the moral fabric of our society,” said the bill’s lead sponsor, Sen. Joni Ernst, R-Iowa. “Planned Parenthood is harvesting the body parts of unborn babies.”

Ernst’s bill would have not only made Planned Parenthood ineligible for federal grant programs like the federal family planning program, but also would have banned it from receiving reimbursement from Medicaid for other health services it performs for eligible men and women, such as testing and treatment for sexually transmitted diseases.

According to the group’s most recent annual report, 41 percent of the $1.3 billion received by the national group and its affiliates came from government sources. Under a series of laws including the Hyde amendment, none of the federal funds can be used for abortions, which account for 3 percent of the services Planned Parenthood provides.

Yet even though abortion is a small part of what Planned Parenthood does, the group’s enormous size makes it the nation’s largest single provider of the procedure.

The debate is in fact all about abortion, according to Dawn Laguens, executive vice president of Planned Parenthood. “They don’t care about fetal tissue research,” she says of the groups targeting the organization. “It is just an angle to go after safe, legal abortion.”

Asked if the goal was to eliminate funding for Planned Parenthood, fetal tissue research or both, David Daleiden, the head of the Center for Medical Progress, the group that took the videos, said in a statement: “The goal of our investigation is to reveal the truth about Planned Parenthood’s trafficking and sale of aborted baby body parts for profit, which is illegal and unethical. Taxpayers should not be paying for these atrocities against humanity.”

But while the tie to fetal tissue is new, the fight to separate Planned Parenthood from its federal funding is, in fact, older than the 26-year-old Daleiden.

In 1982, when Ronald Reagan was president, his administration issued the so-called squeal rule, which sought to require family planning providers, including Planned Parenthood, to notify parents when providing contraceptives to minors or lose their funding. Planned Parenthood sued and won in federal court, where the rule was found to be a violation of patient privacy.

In 1987, the Reagan administration issued what came to be known as the “gag rule,” which barred recipients of federal family planning funds from counseling or referring patients for abortion, and which required physical and financial separation between contraceptive and abortion services.

Planned Parenthood and others sued again, and the case eventually went to the Supreme Court. This time the government won, but the rules remained mired in lower courts and were never fully implemented. President Bill Clinton erased them on his first day in office in 1993 by executive order.

Planned Parenthood was back on the hot seat in the 2000s, as new “direct action” groups decided to take the fight in a different direction.

In 2011, the anti-abortion group Live Action released a series of videos charging that Planned Parenthood was failing to act in apparent cases of sexual abuse leading to abortion in minors. Republicans in the House helped use those videos (which were later found to have been edited to make them misleading) to pass an amendment to defund Planned Parenthood. The Democratic-led Senate never acted on the measure.

But even those inclined to support Planned Parenthood say the allegations around the sale of fetal tissue may represent a turning point.

“The imagery is terrible,” said Alta Charo, a professor of law and bioethics at the University of Wisconsin.

This is also ironic, she says, because there has been a fairly broad bipartisan consensus in favor of using tissue from aborted fetuses in research for many years.

A panel appointed during the Reagan administration in 1988 voted overwhelmingly that such research was ethical.

“They went through all of the arguments, like ‘Does it make you complicit and evil if you take advantage of what had been a legally aborted fetus and you think that abortion was evil?’ And the answer was, ‘Well no, because we have transplants of organs of homicide victims all the time,’ ” Charo said. “So even if you call it a homicide, we take advantage of it.”

Meanwhile, groups looking for possible cures for devastating diseases, and seeing potential breakthroughs in other countries, urged Congress to cancel a federal funding ban on fetal tissue research imposed by Reagan and continued under President George H.W. Bush.

That support was demonstrated in a bill to update programs at the National Institutes of Health. Among the Republicans who joined the overwhelming support for the measure in 1992 were not only McConnell, but also Sens. Charles Grassley, R-Iowa, and John McCain, R-Ariz.

Bush vetoed that bill, as promised, and while the Senate voted almost as overwhelmingly to override the veto, the House fell 10 votes short of the two-thirds majority needed.

President Bill Clinton overturned the ban by executive order in 1993, and federal funding for fetal tissue research was formally authorized in a similar NIH bill passed later that year.

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Monthly premiums for California’s 1.3 million Covered California customers will rise a modest 4 percent, on average, officials with the agency said Monday. This increase is slightly less than last year’s increase of 4.2 percent for consumers who bought policies on the state’s health insurance marketplace.

Some consumers could even achieve a reduction in their premium, of an average of 4.5 percent, if they choose to shop around.

“This is another year of good news for California’s consumers and further evidence that the Affordable Care Act is working,” said Peter Lee, Covered California’s executive director.

Consumers who live in different parts of the state will see varying rates. In Southern California, consumers who stay in their plan will see an increase of just 1.8 percent, or an average of $296 per month. But in Northern California, where health care costs are typically higher, because of greater consolidation among doctors and hospitals, the increase is an average of 7 percent monthly, or $384.

Lee stressed that shopping around could help consumers save money.

“Health care is also local,” he said. “Where you live frames what your options are. If you live in Los Angeles and you shop around, you could see your premiums go down 11 percent.”

Betsy Imholz, an attorney and advocate with Consumers Union, called the average increase “terrific,” and also encouraged people to shop on price. “Often you can get a lower rate by moving to another carrier,” she said.

Lee said Covered California spent weeks negotiating with insurers.

“We’ve created a market where the consumer drives what’s working in California,” he said. “Throughout our negotiations, consumers in California saved more than $200 million.”

Larry Levitt, senior vice president of the nonpartisan Kaiser Family Foundation, was positive about what he called “modest” increases. “This shows what a stable, competitive individual insurance market can look like,” he said, via email.

In part, Levitt credited the cost-containment to Covered California’s “substantial enrollment so far.” It’s a sign, he said, that the marketplace is likely attracting healthy people to help spread the risk of the sicker people.

Levitt also said the state agency’s active role has helped keep premium increases down. “I think a key element of California’s success is the standardization of insurance policies,” he said, “which simplifies the choices for consumers and focuses competition squarely on premiums.”

Covered California also announced that two new insurers will join the marketplace. UnitedHealthcare, the largest health insurer in the nation, will now offer plans in parts of the state, including the group of counties that start north of Sacramento and stretch to the Oregon and Nevada borders. Where some people had a choice of only one plan, now they will have two or three.

“Covered California did the right thing by targeting the new additions to the places where more choice is needed,” Imholz said.

Under the UnitedHealthcare plan, people who live near the Oregon and Nevada borders will also be able to cross state lines to see a doctor, a practice that was often prohibited in other plans.

“Sometimes people were driving many hours in order to get care,” said Beth Capell, who is with the advocacy group Health Access. People who live in Susanville, for example, were accustomed to getting care in nearby Reno, Nevada. But through Covered California intially, they had to drive several hours to Sacramento.

“They will now have the choice of another carrier that will be offering them coverage beyond the borders of California.”

Parts of Los Angeles County and Orange County will see a new insurer — Oscar Health Plan of California, which currently sells insurance only in the two states of New York and New Jersey.

Lee said that the new additions to the marketplace were chosen because they have good networks and are good for consumers.

“Covered California does not think more plans are always better,” he said. “In 2014 and 2015 we turned plans away. We’re not adding plans just because they knock on our door.”

In addition to the two new plans, all plans from last year were renewed for 2016: Anthem Blue Cross, Blue Shield, Chinese Community Health Plan, Health Net, Kaiser, Molina Healthcare, Sharp Health Plan, Valley Health Plan, LA Care Health Plan and Western Health Advantage.

The rates announced Monday are preliminary and will be reviewed by state regulators over the next 60 days.

This story was produced by State of Health, KQED’s health blog.

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Three terminally ill patients lost a court battle in California Friday over whether they should have the right to request and take lethal medication to hasten their deaths.

San Diego Superior Court Judge Gregory Pollack said he would dismiss the case, adding that the issues were beyond his role as a judge to decide and should instead be put to the California state legislature or voters to establish new law.

Plaintiffs vowed to appeal the ruling.

“This is certainly frustrating, but it’s a temporary setback,” said Elizabeth Wallner, a plaintiff in the case, who has been diagnosed with Stage IV colon cancer. “I am optimistic that we’ll prevail in the end. It’s too big of an issue to leave uncovered.”

Wallner began a series of treatments for her cancer in 2011, including surgeries to remove her colon and parts of her liver, radiation, and numerous rounds of chemotherapy. In the midst of this, when her son was 16, she realized that she wanted to have control over her own death.

“I was throwing up in the bathroom and my son was taking care of me,” she said. “I looked over at his face and I saw him absolutely stricken, watching his mother experience this. I thought, that’s enough — my son doesn’t need to see this. I should have the right to make that decision when it’s time.”

The case she and others brought to the court seeks to challenge current California law (Section 401 of the state penal code), which makes it a crime to deliberately aid or advise another person to commit suicide. Wallner and the other patients say the law prohibits their doctors from discussing or prescribing medications that could end their lives; and that prohibition, they say, violates their rights to privacy, liberty, and free speech under the California Constitution.

Attorneys for the plaintiffs — the three patients and a physician — argue that the option to hasten death is an extension of previously recognized legal rights to make end-of-life decisions, including the right to refuse life-sustaining treatments, like a feeding tube or ventilator.

“When you’re suffering, and you know you’re going to die anyway, it should be up to you to decide when enough is enough,” said Kevin Diaz, an attorney and director of legal affairs for the advocacy group Compassion & Choices, which is representing the plaintiffs. “We’ll keep trying anyway we can to make sure this is an option.”

But California Attorney General Kamala Harris, one of the defendants in the case, argued that there is no right to assisted suicide embedded in California law. Health statutes that protect patients’ rights to withdraw treatment, Harris said, do not include a right to provide proactive assistance to end someone’s life.

“No court has ever extended the right to privacy to encompass an affirmative medical intervention to kill oneself,” Julie Trinh, deputy attorney general, wrote in a legal brief.

She wrote that while the court has sympathized in the past with the plight of the terminally ill, it concluded that the question of allowing physician-assisted suicide is a legislative matter, rather than a judicial one.

The judge in this case agreed. He said he would issue a formal ruling on Monday.

A bill that aims to legalize physician-assisted suicide in California (SB 128) has been tabled for the rest of the year, after stalling in the Assembly Health Committee. Several attempts in other states to pass a similar bill this year have failed.

The practice is legal in five states: The courts authorized the practice in Montana and New Mexico; Vermont passed a law in its legislature; and voters approved ballot measures in Washington and Oregon.

There is one other lawsuit pending in California.

The three patients who are plaintiffs in the case dismissed Friday are worried that the legal process will be too slow to provide relief for them. Christy O’Donnell, a single mother from Santa Clarita, Calif., who is dying from lung cancer, explains her situation in the video below, released earlier this year.

O’Donnell broke down in tears after Friday’s hearing. “I don’t have much time left to live,” she said. “These options are urgent for me.”

This story was produced by State of Health, KQED’s health blog.

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