HealthCare.gov and the state-based public health insurance supermarkets look as if they are operating normally.

The Golden State is trying to protect its standards for vaccines and birth control from any changes that might come out of Washington.

Not unlike many issues affecting public health, socio-economic factors play an important role in improved health.

“Understanding the characteristics and health burdens of high-cost claimants is essential for employers, insurers and policymakers aiming to design targeted strategies for care management, cost containment and improved health outcomes," said the report.