“We kind of have a typical board listing all of the decedents for the day,” Gill said, pointing to the list of names on a dry erase board. “Overdose, overdose, overdose, overdose overdose. That’s just for today.”

Gill is the for the state of Connecticut, and of the nine bodies in his custody that day, four were the remains of the people who likely died from an accidental drug overdose. A fifth was a probable suicide involving drugs. It was a sad, but typical day, he explained, with a practical consequence for the state’s morgue: Gill is running out of room to store bodies.

“We’ve had to buy some extra racks and things so we can store more,” he told me. “But we really probably need more cooler space. We’re kind of outgrowing the storage space here.”

“I found that the doctors here, a lot of them were certifying the deaths as acute or multi-drug intoxication,” Gill told me. “And I said, ‘No, we need to spell out what the drugs are that are causing the death.’ So, it would be ‘acute intoxication due to the combined effects of heroin, diazepam and alcohol’ — and that’s how we certify the deaths now. We’re very specific about what we’re finding in the toxicology.”

In 2014 , the most recent year that data are available, only Rhode Island did better than Connecticut in getting and passing along these sorts of comprehensive details. Conversely, only about half of deaths in some other states — including Pennsylvania, Indiana, Mississippi and Louisiana — have specific information on the death certificates.

There are a lot of contributing factors that could explain the variation from state to state, Gill said.

First, not all people who certify deaths have the same training.

Second, when lots of drugs are involved, some people may not be comfortable singling out one or two as the cause of death. Custom could play a role, too — the “We’ve always done it this way” factor. So might size. Connecticut is small and centralized in the way it handles these cases.

“All of the deaths are examined here by the same group of medical examiners, the same investigators,” Gill said. “So we can kind of establish that common technique and certification ability. Whereas, in a lot of jurisdictions — New York, for example — it varies by county.”

, an injury epidemiologist with the Centers for Disease Control and Prevention, focuses on monitoring trends in mortality, using death certificate data, and she agrees that lots of variables contribute to Connecticut’s success in gathering better data. But one of them is pretty basic: clear communication with the people who determine and report the cause of death.

“The thing that’s different between 2012 and the current year,” Warner told me, “is that Dr. Gill — who knows that we want those specific drugs written down on the death certificate — is now writing them down. So some of it’s about reaching out to the certifiers to make sure that they know we want the specific drugs involved.”

The CDC is actively working on that, Warner said.

But, in Gill’s experience, not everyone wants all that information documented.

“I remember one call from a family member who was upset that we put heroin on the death certificate,” he said. “Their son had died of heroin, and they didn’t want it on the death certificate because they were afraid that the public was going to hear about it and know that that person died of heroin. And I said, ‘I’m sorry, but this is a public health issue.’ ”

And, judging , it may be a big public health issue for a long time to come.

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Rossi works in the neonatal intensive care unit (NICU) at the Hospital of Central Connecticut near Hartford. Like many hospitals across the country, it has seen the number of babies born with go up dramatically in recent years. The National Institute of Drug Abuse reports more than in the U.S. were born in withdrawal from opioids in 2012, the most recent year for which data are available. The hospital says each baby costs roughly $50,000 to treat.

These fragile and fitful babies present new challenges for hospitals. There’s research that suggests they may do best when they can be held for hours, by their mothers, in a quiet, private room as they go through the process of being weaned off the drugs. But delivering that care means changing hospital systems and attitudes about addiction among doctors and nurses.

“It was a lot about taking babies away from moms,” Rossi said, describing the way she first learned to care for babies in withdrawal. The nurses saw their role, she said, as “trying to protect the baby from the mother, basically. Like we were going to cure the baby but not cure the mother and the family.”

It wasn’t the best strategy. The babies can often be soothed best by their mothers. But mothers are struggling, too.

This story is the second in our four-part series, “Treating the Tiniest Opioid Patients,” a collaboration produced by Kaiser Health News, NPR and local NPR member stations.

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The battles lines are clear. Gov. Dannel Malloy, a Democrat, says the hospitals are getting rich off taxpayers, making more money than in past years — thanks, in part, to the Affordable Care Act. So he thinks hospitals can afford to give some money back.

“If you make almost a billion dollars a year, how bad are things?” Malloy asks. “If you’re having the best results in recent history in hospital performance, why do you need the citizens of Connecticut to give you an additional $500 million?”

Malloy is making his argument personal — taking aim at the high salaries of hospital CEOs. Many of the executives of the state’s nonprofit medical institutions make at least a million dollars a year, he points out.

“If you look at, how much money did you really make — operating income? If that’s the number,” Murphy says, “and it’s a pure accounting number, we lost tens of millions of dollars last year.” As for 2015, he says, “I’m sure it’s worse.”

The governor’s staff sees the hospital’s balance sheet differently. If lower-paid hospital employees and small programs are taking a hit because of the state cuts, Malloy’s office argues the blame should be on hospital boardrooms — not the state government. It’s the board members who are prioritizing executive salaries over other financial needs.

This public fight between the state and its medical institutions is playing out largely because of what the hospitals say is a broken promise.

In 2012, the state of Connecticut implemented a new hospital tax. The hospitals would pay around $350 million a year to the state, and all of that money — if not more — was supposed to be returned to them as Medicaid payments.

But that was then. Until Tuesday, the state budget was out of balance. To help fix it, Malloy wanted to cut another $63 million to hospitals; lawmakers put about half of that back. But the numbers still seem out of whack to , the CEO at Griffin Hospital, an independent nonprofit in Derby, Conn.

“So, now we’re talking over half a billion dollars,” Charmel says. “That’s what hospitals are paying in terms of the tax. And, essentially, we’re not getting any of that back.”

He thinks hospitals have cut all they can, despite what Malloy thinks.

“When there’s a cut in state payments to hospitals or federal payments to hospitals, it’s got to come out of care delivery,” Charmel says. “There’s nobody else to shift it to.”

Medicaid is lurking in the of the discussion. The state says more people than ever are getting Medicaid, and Medicaid payments to hospitals have more than doubled in 10 years.

But don’t tell that to Murphy. Hospitals lose about 60 cents on every dollar of Medicaid service, the hospital CEO says. “The fact that we’re getting more Medicaid patients to take care of, and on every one of them we have financial challenges associated with that care — it really isn’t a windfall for us,” Murphy says. “In fact, it’s a greater economic burden.”

While this year’s budget may be back in balance, the hospitals are gearing up for a long-term fight. They want the tax ruled invalid — a move that could take the fight from the capitol to the courtroom.

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The failure of Colorado’s co-op has hit Rick and Letha Heitman hard. They are currently customers of the Colorado HealthOP, which is closing up shop at the end of the year. The couple, who own a contracting business, say the co-op proved to be a life-saver when Rick was diagnosed with aggressive prostate cancer last spring.

“I owe them for taking care of me. They helped me at a time when I needed it a lot,” he says.

“We were really blindsided by that,” she says. “We felt like we’d done our part in helping serve individuals who really need insurance and now we’re the one left holding the bag.”

And, she insists the co-op was on track to be profitable. Colorado HealthOp is one of in 22 states that opened after Obamacare was enacted. The startups were supposed to shake up the traditional marketplace by being member-owned and nonprofit, but it was tough to figure out how much to charge. They needed to estimate how much medical care their customers would use, and they had to do that without data from previous years and without the cushion of a reserve fund. Established insurers can use reserves and experience to recover if they underestimate premium prices in a given year.

Many co-op plans were priced low, and . But these new customers had high health costs, so the co-ops had to start paying a lot of bills. The math didn’t add up. On top of that, they were counting on a variety of funding streams from the federal government, and not all of them materialized.

Linda Gorman, with the , a conservative-leaning Colorado think tank, says the new co-ops were in over their heads.

“You shouldn’t go into business counting on federal subsidies,” she says. “The notion that you should beat up on for-profit entities and then form these nonprofits and everything will be magically OK is unfortunate to begin with. We’ve wasted a lot of taxpayer money on that.”

But the HealthOP’s senior IT manager Helen Hadji, a Republican, blames conservatives in Congress for to keep the cooperatives afloat.

“This is a federal failure,” she says. “This is all a political battle to dismantle Obamacare.”

Colorado’s co-op captured 40 percent of the individual market on the state’s exchange. Now as customers, like the Heitmans, hunt for new insurance, they are finding higher prices: They paid about $500 a month last year. Next year, it could be double or triple that.

“You know, that’s a big ‘owee!’” says Letha Heitman.

But it’s the price they’ll pay to keep Rick with the doctors who are treating his cancer.

In Connecticut, the opposite story is playing out. If Colorado saw an early surge in membership because of low prices, Connecticut’s co-op nearly priced itself out of the market in its first year. With rates much higher than its competitors, HealthyCT only got 3 percent of the state’s business under the Affordable Care Act.

“In that first year, the reason we had such low market share was that consumers — new to the industry, new to insurance — most of those individuals bought on price,” says Ken Lalime, who runs the co-op.

And, he says, starting it was hard.

“Nobody’s built a new insurance company in the state of Connecticut in 30 years,” he says. “There’s no book that you pull off the shelf and say, ‘Let’s go do this.’”

Lalime faced the same problem as insurers across the country: He didn’t know who his customers would be, he didn’t know whether they’d be sick or healthy, and he didn’t know how much to charge. It turns out he ended up charging too much.

But even though that meant relatively few signups in year one, the slow ramp-up actually helped. He didn’t have a huge number of claims to pay right out of the gate, and the ones he did pay didn’t break the bank.

“Hindsight, yes, that didn’t hurt us. To be able to take it slowly,” he says.

In year two, he had more competitive average premiums — and his company went from 3 percent market share to 18 percent. For 2016, HealthyCT and the state — after some back and forth — settled on a 7 percent premium hike for customers.

Paul Lombardo is an actuary for the state. He says that bouncing around is an indicator that setting premiums under the Affordable Care Act is still a bit of a gamble. That’s in part because there’s still no good data. So few people signed up with HealthyCT in the beginning that they didn’t have enough information to help set 2016 premiums.

“There wasn’t a lot of data to say, OK, we can use 2014 experience to project forward,” Lombardo says.

For now, at least, Lombardo says HealthyCT is holding its own.

“They’re in good standing,” he says. “The premium we think that we’re setting for 2016 — albeit a little bit higher than they wanted it to be on the revision — is appropriate.”

Enrollment for health insurance in the co-ops runs through Jan. 31 with just 11 of the original 23 co-ops still in business.

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Nevertheless, about signed up for health insurance under the law and almost all of them got help from the federal government to pay their premiums.

The U.S. Supreme Court could soon rule illegal the insurance subsidies in Louisiana and more than 30 other states that use the federal website healthcare.gov. If the subsidies are eliminated, the number of uninsured people in the affected states would rise by 8.2 million in 2016, according to recent  by Linda Blumberg, a senior fellow at the Urban Institute.

She worries the Supreme Court justices could take away that peace and asked what she would tell the justices if she could, she says: “Think about your kids, your family. If they could not afford to pay for health insurance. Wouldn’t you want someone to help them?”

Jimmy See

At a coffee shop in Zachary, half an hour north of Bazille’s home in Baton Rouge, Jimmy See says he never felt like he needed health insurance – until he did. He’s 54, a self-employed housing and maintenance worker, and he’d always felt like health insurance was too expensive. But then he started having trouble breathing and he went to the hospital: “They said, ‘Well do you have any insurance? And I said, ‘No.’”

Rather than pay a lump sum up front, he went home and got worse.  Eventually, he collapsed and had to be hospitalized for close to two weeks for pneumonia. His remembers his bill being between $8,000 and $9,000. See negotiated with the hospital and received financial assistance to settle the bill.

“If I hadn’t gotten that, I’d be looking for bill collectors after me,” See says. “And bill collectors don’t play. They come after you.”

See’s Obamacare subsidy covers all of his premium, and he says having insurance is a relief.

“If I had a big operation or whatever, you can’t afford no $70,000, $80,000, $90,000,” he says. “So, through the Affordable Care Act, the government’s going to help you out with all that.”

If the Supreme Court rules against subsidies, See says, for him it would be, “Back to square one. No insurance.”

James Marks

James Marks lives four hours north of Baton Rouge in Shreveport. He doesn’t want to go back to square one, either.

Marks is 36 and works as a freelance computer technician and an afterschool art teacher. Neither job provides insurance and being uninsured has been a blow to his self-esteem.

“It made me feel lousy,” Marks says. “It made me feel like I was sponging off my parents. It made me feel like I wasn’t able to take care of myself.”

Marks lives with a mental health issue – and, for the better part of 10 years, his parents paid for both his psychiatrist and his expensive medications. Now, he pays about $180 a month for a subsidized insurance policy, and he says it makes him feel like an adult.

Asked what he would tell the justices, Marks says: “I know the Supreme Court tries to decide stuff based on the law and not based on the impact that it has on America.  But it’ll wind up making a lot of people who were insured, who had insurance, who were able to go to the doctor and pay for their pills, not be able to anymore. And that’s just pretty lousy.”

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In just a couple of months, the Supreme Court will rule in a major case concerning those subsidies. The question is whether the law allowed for them across the country or just in the minority of states that set up their own insurance exchanges. A decision to take away those subsidies could without insurance.

Attorney Tom Goldstein, who runs , has been following the case and says the law is ambiguous. “This is a real, serious question,” he says. “The law doesn’t tell you whether Congress wanted to limit the subsidies only to those states where the state itself went to the trouble of setting up the exchange or whether Congress wanted everybody who needed the help to be able to get the subsidies.”

Louisiana is a state where a lot of people could be affected. It runs healthcare.gov and about there have used the site to buy health insurance. Nearly 90 percent of them in Louisiana get subsidies.

We traveled to the state to interview many of these people who could lose subsidies if the Supreme Court rules against them. Here are our first three profiles:

Carlton Scott

Carlton Scott is 63. Sitting at his kitchen table at the house he owns in Prairieville, near Baton Rouge, he says he worked at a chemical plant for 30 years before he retired. He found out last fall that his company was scaling back his retiree benefits.

“’Round October they wrote me a letter saying, in December we’ll no longer be covered,” he says.

That included his health insurance, which he was really counting on.

“I thought they would take me to my grave. I really thought the company would take me to my grave,” he says. When it went away, “That pissed me off. Because, god——, I been through 30 years and you come with this bullsh–? That pissed me off.”

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Sue Ellen Smith manages an H&R Block office in San Francisco, and she is expecting things to get busy soon.

“This year taxes and health care intersect in a brand new way,” Smith says.

For most people, who get insurance through work, the change will be simple: checking a box on the tax form that says, “yes, I had health insurance all year.”

But it will be for an estimated 25 million to 30 million people who didn’t have health insurance or who bought subsidized coverage through the exchanges. To get ready, Smith and her team have been training for months, running through a range of hypothetical scenarios. One features “Ray” and “Vicky,” a fictional couple from an H&R Block flyer. Together they earn $65,000 a year, and neither has health insurance.

“The biggest misconception I hear people say is, ‘Oh the penalty’s only $95, that’s easy,’” says Smith, but the Rays and Vickys of the world are in for a surprise that will hit their refund. “In this situation, it’s almost $450.”

That’s because the penalty for being uninsured in 2014 is $95 or 1 percent of income, whichever is greater. Next year, it’s 2 percent. Smith says the smartest move for people to avoid those penalties is to sign up for insurance before Feb. 15, the end of the health law’s open enrollment period.

But a lot of people may not think about this until they file their taxes in April. For them, it will be too late to sign up for health insurance and too late to do anything about next year’s penalty too, says Mark Steber, chief tax officer for.

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“The big takeaway for us last year was that the uninsured were really pocketed in a couple of key, large cities,” says , the chief marketing officer of , in Connecticut. In light of that, he says, the exchange has changed its ad strategy.

“We’ve dialed up some of the more locally-focused efforts while we’ve dialed down some of the broader efforts,” he says.

The uninsured people Madrak’s trying to reach tend to be young, male, urban and Hispanic or African American. They also “aren’t really consumers of traditional media,” he says.

They don’t necessarily read the big daily newspapers and they don’t watch mainstream TV, so they can be harder to reach. So Madrak is spending his media money on ads in community newspapers and on local television and radio.

Reaching potential customers is the first half of the job. The second half is figuring out what to tell them. One emphasis is on money, like in this TV ad with a barber asking his customer if he has health insurance. When the customer says, “No, I can’t afford it,” the barber says, “Now, you can, with Access Health CT, since you may qualify for help to pay for your coverage.”

Madrak says the messages of ads that appear later in the open enrollment period, as people are starting to think harder about choices, will be more specific about the cost of the insurance.

“If I say ‘affordable,’ nobody really knows what that means,” he says. “If I say, ‘I can get you a plan for 20 bucks a month with tax credits,’ that means something to somebody at that point.”

California health officials are also deploying a new and (they hope) improved campaign to woo Latinos. Last year, made a series of missteps. First, the exchange had only a handful of Spanish-speaking counselors at the call centers. And the Spanish advertising campaign was riddled with .

Among the worst gaffes: Some Latinos who worried that signing up would get undocumented relatives in trouble were shown a written promise from President Obama to the contrary – a note that, unfortunately, was printed on letterhead of U.S. Immigration and Customs Enforcement.

Covered California says it has learned from those mistakes. , the executive director, says this year, the agency is doubling down on making sure Latinos get the right messages.

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Dr. Jack Ross is used to seeing potentially lethal viruses, and he is used to putting patients into isolation. Still, Ebola is different.

“I think, for any hospital today, Ebola represents one step higher than anything else, if we had to do it,” says Ross, who is the director of infection control for Hartford Healthcare’s five hospitals in Connecticut.

On a tour of one of them, Hartford Hospital, Ross explains how the layout of the building is one of the important factors in his Ebola control plan.

“This would be an area that we would close off with plastic sheeting,” Ross says. His plan  includes the emergency room, intensive care unit and patient floors. “Right here, we’d have a security officer, because you want to restrict visitors. You want to have a log of who goes in, who goes out.”

In Connecticut, the idea of taking care of an Ebola patient is still just theoretical. However,Ìýone of the reasons that public health officials in the U.S. are confident that American hospitals could contain an outbreak is because they can accommodate the isolation and sanitation needed to keep the virus from spreading.

The best place to put someone who falls ill, for instance, is ideally at the end of a hall in a room with its own bathroom, anteroom, and entrance. “The rest of the floor is safe,” Ross says. “I limit the amount of traffic. I’m able to do the care there.”

Ross and his team are preparing in other ways, too. With the Centers for Disease Control and Prevention’s help, he’s made a specific list of questions doctors and nurses will ask incoming patients about symptoms and travel. He’s inventoried the supplies they would need to treat an Ebola patient.

Ross says he understands the concern of the general public when it comes to Ebola — the symptoms and severity of the illness are frightening. But he also says this — Ebola might frighten the general public, but the virus doesn’t threaten the American public.

“This is not something that will become established in the local general American population,” Ross says. In the United States, the medical infrastructure is strong enough to detect and diagnose the infection relatively quickly, trace contacts, isolate patients with symptoms and offer them supportive treatment. And, in comparison to flu or measles, for example, the Ebola virus is not spread through the air, and is not very contagious. The people at risk of catching Ebola are those who have been in close, unprotected contact with someone who is sick and has active symptoms of the disease.

Indeed, the only known case of Ebola that has been transmitted outside of a West African country is a  who fell ill after caring for two missionaries who contracted the disease in Africa, came to Spain for treatment and eventually died. While anyone in close physical contact with a symptomatic patient is at some risk, the evidence suggests that the people most likely to be exposed to these isolated cases are health care workers.

For that reason, even if the chances of running into Ebola in the U.S. are relatively small,ÌýRoss says hospital workers have to be painstakingly vigilant. That begins with the triage questions nurses and doctors ask incoming patients get when they arrive at the emergency room, and at various other times throughout their treatment.

If a patient is diagnosed, health care workers treating an Ebola patient need to wear a face mask or goggles, and they also need a buddy with them as they put on and take off their protective clothing. All of that is to make sure that they don’t come into any contact with bodily fluids.

The gear used to care for an Ebola patient — the goggles, the clothing, the bed linens — then becomes contaminated waste that has to be treated and sterilized in much the same way as tools being prepared for use in the operating room. Just how that’s accomplished will be done on a case-by-case basis, governed by the CDC and the federal department of transportation.

Ross’s decades of work in infectious disease make him feel prepared. Still, he says he expects to be nervous if and when he treats a person with Ebola.

“My heart may be pounding, my palms may be sweating,” he says. “I think it’s only a natural human response that we would have heightened awareness and some nervousness as we go through this.”

Ross says he’d be concerned about any caregiver treating Ebola who wasn’t nervous, too.

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Department of Health and Human Services Secretary Sylvia Burwell tapped Counihan to lead the site as part of a that aims to have the second year of Obamacare run more smoothly than the first.

Access Health CT, under Counihan’s leadership, is one of the more successful state-run exchanges. About 257,000 people got coverage, according to the state, including  for private insurance. Surveys show that about in the state were previously uninsured.

“One of the most important things we did is we showed that government can work,” Counihan said at a press conference in Hartford Tuesday. “It can take on a highly complex social program and succeed.”

But taking the reins of healthcare.gov will be a much tougher job. Connecticut has a Democratic governor and legislature, and it embraced the law early, including the expansion of Medicaid. Healthcare.gov serves states that are actively hostile to the law in the Deep South, states that are embracing the law to some minimal degree and states that are active partners in running the exchange.

At the press conference, Connecticut Gov. Dannel Malloy said Burwell had called him to discuss Counihan. The governor joked that Counihan should have his head examined for agreeing to go to Washington.

Burwell, in a press release, said that Counihan “will be a clear, single point of contact for streamlined decision-making.” The announced several other hires as well.

Obamacare year 2 starts with enrollment opening on Nov. 15, and the challenges are many. In addition to making sure the technical glitches stay in the rearview mirror, Counihan will be responsible for keeping people who are already signed up satisfied, as well as reaching out to the millions of Americans who are eligible for coverage but not yet insured.

Counihan said he’s optimistic that it can be done. “People understand intuitively that having people uninsured is not right for them or right for the country,” he said. “Now, how we go about doing it — people can debate and there can be solid policy differences.  But I’m fundamentally very optimistic that, even though there are some big ideological schisms, that those can be bridged.”

Counihan’s exchange excelled at marketing Obamacare insurance — taking the pitch to , jazz festivals and a storefront on a city street. And he credits some of that success to the pool of executive talent he was able to draw on in Hartford, an insurance capital.

Counihan has several decades of experience in health care, including launching complex new coverage programs. After a career in the private insurance industry (Tufts Health Plan, Cigna), he helped launch Massachusetts’ successful health exchange starting in 2006. He also helped launch a private insurance exchange in California.

Counihan is the second high-profile addition to the healthcare.gov second year team. Earlier this summer HHS brought on Andy Slavitt, who helped fix the site’s initial problems as an executive with contractor Optum.

Counihan may have caught the president’s attention a year or so ago during a conference call with the leaders of the state-based exchanges. Counihan recalls talking to the president about the marketing event at the Lil Wayne concert: “And he said, ‘Lil Wayne.  I’ve never been to a Lil Wayne concert.’  And I said, ‘Well, Mr. President, neither [had] I, and I don’t think I’m exactly in the target demographic.'”

Later in the meeting, another exchange official from a different state talked about advertising their state’s exchange on coasters at bars. “My counterpart in that state had said that she felt too old or embarrassed to actually go into bars to see if it’s working,” Counihan said. “At which point the president said, ‘Well, if Kevin can go to a Lil Wayne concert, you certainly should be able to go to a bar.'”

Julie Rovner contributed.

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