Pauline Bartolone

The leftover prescription drugs you have around your house are at the center of a battle between small government and big pharmaceutical companies.

The immediate aim is to have the pharmaceutical companies take care of disposing of extra drugs. But Alameda County in northern California wants to make manufacturers think about the life cycles of their products — from their creation to what happens when they're no longer needed.

When Diane Shore got a letter that her health policy would be canceled, the small premium increase for the new plan didn't bother her that much.

But the changes in her choices for care really bugged her. "My physicians will no longer be in this network of physicians, or the hospitals," she says.

Shore, 62, owned an IT consulting business in the San Francisco Bay Area and retired when she sold it in 2000. She wants to stick with the health care providers that she's had for years, she says, including the surgeon who cared for her when she had breast cancer in 1998.

Sitting in her San Francisco living room, Kimberly Jeffrey is combing her son Noel's hair. He groans, but she meets his energy with calm — and adoration.

Noel's birth was not an easy time. While Jeffrey was pregnant, she served a six-month sentence for petty theft at a state prison. When it came time to deliver Noel through a caesarean-section, Jeffrey was also confronted with the prospect of sterilization.

As states gear up for the Affordable Care Act, they're trying to figure out if there will be enough providers of health care to meet demand from the newly insured.

California is one of 15 states expected to consider legislation this year that would give advanced practice nurses more authority to care for patients without a doctor's supervision.

Tina Clark is a nurse practitioner at Glide Health Services, a clinic in San Francisco's Tenderloin district, a low-income section of the city.

As states work to comply with the federal health care law, many are designing their insurance exchanges, where people will be able to shop for coverage.

But just the word "exchange" sounds to many like off-putting government-speak, and some states are eager to come up with a more appealing name for these new marketplaces.

Peter Lee directs California's Health Benefit Exchange. It's up for a new name, and Lee says they want it to sound fresh, dynamic and innovative.

Transcript

PAULINE BARTOLONE, BYLINE: I'm Pauline Bartolone in Sacramento.

California, unlike Mississippi, is already on the road to Medicaid expansion under the Affordable Care Act. And after the law passed in 2010, it was the first state to get going to build an exchange.

Peter Lee is in charge of it. He never let uncertainty about the Supreme Court decision come in the way of building the new marketplace.