The counterintuitive findings by researchers at Harvard and MIT, from an experiment involving low-income, able-bodied Oregonians, appear in Thursday's New England Journal of Medicine. The study offers a twist for states weighing a major Medicaid expansion under President Barack Obama's health care law, to serve a similar population of adults around the country.

"The study did not generate any evidence that Medicaid coverage translated to measurable improvements in physical health outcomes over a two-year window," said lead researcher Katherine Baicker of the Harvard School of Public Health. "It did generate robust improvements in mental health and enormous reductions in financial strain and hardship."

That leaves policymakers with "a much more nuanced and complex picture" of the potential benefits of expanding Medicaid, said Baicker, an economist.

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The charge, buried in a recent regulation, works out to tens of millions of dollars for the largest companies, employers say. Most of that is likely to be passed on to workers.

Employee benefits lawyer Chantel Sheaks calls it a "sleeper issue" with significant financial consequences, particularly for large employers.

"Especially at a time when we are facing economic uncertainty, (companies will) be hit with a multi-million dollar assessment without getting anything back for it," said Sheaks, a principal at Buck Consultants, a Xerox subsidiary.

Based on figures provided in the regulation, employer and individual health plans covering an estimated 190 million Americans could owe the per-person fee.

The Obama administration says it is a temporary assessment levied for three years starting in 2014, designed to raise $25 billion. It starts at $63 and then declines.

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Republicans from presidential candidate Mitt Romney to lawmakers on Capitol Hill will keep pushing for repeal. But the focus will shift from Washington to the states.

Under the law, states play a key role in delivering new health insurance coverage to millions of lower-income and middle-class people.

But Republican-led states have resisted, and the National Association of Insurance Commissioners expects only about half the states to be ready to set up new health insurance markets, slated to open for business in 2014.

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The requirement is part of a broad expansion of coverage for women's preventive care under President Barack Obama's health care law. Also to be covered without copays are breast pumps for nursing mothers, an annual "well-woman" physical, screening for the virus that causes cervical cancer and for diabetes during pregnancy, counseling on domestic violence, and other services.

"These historic guidelines are based on science and existing (medical) literature and will help ensure women get the preventive health benefits they need," said Health and Human Services Secretary Kathleen Sebelius.

The new requirements will take effect Jan. 1, 2013, in most cases. Tens of millions of women are expected to gain coverage initially, and that number is likely to grow with time. At first, some plans may be exempt due to a complex provision of the health care law known as the "grandfather" clause. But those even plans could face pressure from their members to include the new benefit.

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The new tactic is raising the anxiety level -- and risks -- for corporate honchos at drug companies, medical device manufacturers, nursing home chains and other major health care enterprises that deal with Medicare and Medicaid.

Previously, if a company got caught, its lawyers in many cases would be able to negotiate a financial settlement. The company would write the government a check for a number followed by lots of zeroes and promise not to break the rules again. Often the cost would just get passed on to customers.

Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known. Furthermore, they can also be banned from doing business with government health programs, a career-ending consequence.

Many in industry see the more aggressive strategy as government overkill, meting out radical punishment to individuals whose guilt prosecutors would be hard pressed to prove to a jury.

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House Speaker John Boehner brushed off the Congressional Budget Office analysis as emboldened Republicans, now in the majority, issued their own report arguing that Obama's coverage expansion would cost jobs and increase budget deficits.

But Democrats seized on the CBO analysis, calling it a game changer in the battle for public opinion.

In a letter to Boehner, budget office director Douglas Elmendorf estimated repeal would increase the deficit by $230 billion from 2012 to 2021, the 10-year estimating period for budget projections. Moreover, Elmendorf said about 32 million more people would be uninsured in 2019 as a consequence.

But Boehner told reporters: "I do not believe that repealing the job-killing health care law will increase the deficit."

The budget experts are "entitled to their opinion," added Boehner, R-Ohio, saying that the analysts had to rely on information selectively supplied by Democrats who wrote the legislation. Not so, said the Democrats; adverse rulings by the budget office repeatedly forced them to go back and revise the bill as they were writing it.

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Citing better Medicare prescription coverage and other changes in the new law, Senate Majority Leader Harry Reid and his top lieutenants say the overhaul "is too important to be treated as collateral damage in a partisan mission to repeal health care."

The letter says repeal would have "unintended consequences" for the part of the law that gradually closes the Medicare prescription drug coverage gap, as well as for other popular consumer benefits. Also signing the letter are Sens. Dick Durbin of Illinois, Charles Schumer of New York and Patty Murray of Washington.

A copy of the letter was obtained by The Associated Press.

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And that might not be a bad thing if you're a GOP strategist. It keeps the issue Senate Republican leader Mitch McConnell calls the "tipping point" in the midterm elections alive for 2012, when they'll try to unseat Obama himself.

Republicans will control the House in January, but they don't have the votes to overcome a Senate filibuster, much less Obama's veto on repeal. Plan B, denying funds to carry out the law, could backfire if it escalates to a government shutdown.

Other options call for legislative guerrilla tactics.

Republicans could use the oversight authority of Congress to slow down or block regulations, essentially tying up the instruction manual for the overhaul. Expect flyspeck scrutiny of agencies implementing the law.

GOP lawmakers may be able to pick off unpopular provisions. Obama has already said he's willing to "tweak" an IRS reporting requirement that small businesses find burdensome. Another target is a yet-to-be-named board with the power to make Medicare cuts. And look for a move to tighten restrictions on abortion coverage.

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A new AP poll finds that Americans who think the law should have done more outnumber those who think the government should stay out of health care by 2-to-1.

"I was disappointed that it didn't provide universal coverage," said Bronwyn Bleakley, 35, a biology professor from Easton, Mass.

More than 30 million people would gain coverage in 2019 when the law is fully phased in, but another 20 million or so would remain uninsured. Bleakley, who was uninsured early in her career, views the overhaul as a work in progress.

The poll found that about four in 10 adults think the new law did not go far enough to change the health care system, regardless of whether they support the law, oppose it or remain neutral. On the other side, about one in five say they oppose the law because they think the federal government should not be involved in health care at all.

The AP poll was conducted by Stanford University with the Robert Wood Johnson Foundation. Overall, 30 percent favored the legislation, while 40 percent opposed it, and another 30 percent remained neutral.

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That means no copays, deductibles or coinsurance for people whose health insurance plans are covered by the new requirements.

The Obama administration estimates that 41 million Americans will benefit initially, with the number projected to rise to 88 million by 2013. Many large company plans, which usually offer solid preventive benefits, will be exempt from the requirements for the time being.

Better preventive coverage is one of the goals of President Barack Obama's health care overhaul law, part of a shift to try to catch problems early, before high cholesterol can lead to heart disease.

"Services like these will go a long way in preventing chronic illnesses that consume over 75 percent of the health care spending in this country," said first lady Michelle Obama, announcing the new benefits at a Washington hospital.

Better preventive care may be an investment, but it still carries an upfront cost. Premiums will go up by 1.5 percent on average, as spending for the services is spread broadly across an entire pool of insured people.

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Marking the first 90 days since the bill was signed, the White House rolled out new regulations that explain how several provisions of the law will be carried out, including a ban on insurers denying coverage to children in poor health.

With polls showing Americans split over the health insurance expansion, Obama told an invited audience at the White House that Republicans who seek to reverse such protections do so at their own political peril. "We're not going back," the president emphasized. "I refuse to go back. And so do countless Americans."

The White House called it a "patients' bill of rights," but Republicans dismissed Tuesday's announcement as a public relations effort.

"This shouldn't be called a health care bill of rights, but a bill of goods that the American people aren't buying," said Sen. Orrin Hatch, R-Utah. "There isn't enough slick advertising, politically crafted events or artful sales pitches that will change that."

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The White House later Tuesday will release details of how the patients' provision will be implemented.

The language involving coverage of children with pre-existing conditions will be enforced for most insurance plans renewing on or after Sept. 23.

Under the new federal rules, patients also can still pick their primary doctors or pediatricians, and prior approval requirements for emergency care will be prohibited.

The rules apply to most health plans, except in cases where they are "grandfathered" under the law.

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Online:

http://www.healthreform.gov

THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.

President Barack Obama is revealing details of how the government will enforce the health overhaul law, an announcement expected to focus on how insurance companies must treat consumers.

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Rep. Dennis Kucinich, D-Ohio, long a supporter of Medicare-for-all, voted against the House Democratic bill in November because it did not go far enough in creating a robust government-run plan to compete with private insurance. But Kucinich said Wednesday that the bill coming before the House represents the best chance to expand coverage to the uninsured, even if it does not include a public plan.

At a Capitol Hill news conference, Kucinich said his decision was a combination of pragmatism and concern about the impact that defeat of the health care bill would have on Obama's presidency.

"You do have to be very careful that the potential of President Obama's presidency not be destroyed by this debate," said Kucinich. "Even though I have many differences with him on policy, there's something much bigger at stake here for America."

Kucinich said he'd met with Obama four times to discuss the health overhaul, most recently on Monday when he flew back to Ohio with the president aboard Air Force One.

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At the Capitol during a rare Sunday session of the Senate, Obama delivered a closed-door pep talk to the fractious Democratic caucus that lasted about 45 minutes. Deep divisions remain over abortion coverage, but there was hope for compromise on whether the government should directly offer health insurance in competition with private companies.

"They're going to get it done," Obama said as he left. He avoided specifics in the meeting with senators and took no questions.

The health care legislation -- Obama's signature domestic policy goal -- would provide coverage to more than 30 million additional people over the next decade with a new requirement for nearly everyone to purchase insurance. There would be new marketplaces where people could shop for and compare insurance plans, and lower-income people would get subsidies to help them afford coverage.

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Senators voted 58-42 to reject an amendment by Sen. John McCain, R-Ariz., that would have stripped more than $400 billion in Medicare cuts from the nearly $1 trillion measure. It would have sent the entire 2,074-page bill back to the Senate Finance Committee for a redo.

Republicans said the proposed cuts to health insurance plans and medical providers mean seniors in the popular Medicare Advantage program will lose benefits. And they predicted lawmakers will ultimately back away from the cuts, once seniors start feeling the brunt.

"Medicare is already in trouble. The program needs to be fixed, not raided to create another new government program," said Republican leader Mitch McConnell of Kentucky.

Democrats said seniors will not lose any guaranteed benefits. The cuts -- amounting to a 2 percent slowdown in spending -- will help keep Medicare solvent by making it more efficient, they contended. And they pointed out that the health care overhaul bill improves preventive care and prescription coverage.

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