VMA Awards, rising 'Big Brother' top week's ratings

CBS' "Big Brother" had its best week of the summer and claimed the top three series spots in the weekly demo rankings, but it was no match for MTV's "Video Music Awards."

Though it was down from last year, the Sunday awards show remains a popular draw among adults under 50 -- attracting about as many as the Primetime Emmys one night later on NBC.

It was another transitional week overall, with lots of coming and goings in primetime, including the final episode of HBO's "True Blood," the season-ender of hot rookie drama "The Last Ship" on TNT and a record-setting season premiere for BBC America's "Doctor Who."

It was also a big week for pro football -- the first of many over the next five months -- as three NFL preseason games cracked the top 15 in adults 18-49. In a surprise, it was ESPN's Monday matchup between Cleveland and Washington drawing the most young adults of the three (2.3 rating/9 share in the demo) as audiences tuned in to see Browns rookie quarterback Johnny Manziel; in total viewers (6.90 million), it was the biggest tune-in for a preseason game on the cabler in five years.

Of note outside of primetime, the U.S. Championship game of the Little League World Series on ABC (Chicago vs. Las Vegas) drew a 12-year-high with 5.19 million viewers on Saturday afternoon.

And over at FXX, the first few days of its "The Simpsons" marathon helped the nascent net stand as the 21st most popular cable network in total-day averages for the week -- a huge jump from its 65th place finish one week earlier.

According to "live plus same-day" estimates from Nielsen for the week of Aug. 18-24, Univision finished on top in adults 18-49 for a third straight week with a 1.3 rating/5 share in adults 18-49, followed by CBS and NBC (1.2/4), ABC (0.9/3) and Fox (0.8/3).

CBS edged past NBC to win in adults 25-54 (1.7 to 1.6) while the Eye won comfortably in total viewers (5.8 million to 5.1 million for NBC).

The standout on broadcast last week was "Big Brother," whose Sunday telecast (2.5/8 in 18-49, 7.24 million viewers overall) set season highs -- and also matched the top demo score for any night last season. The Wednesday and Thursday editions both did 2.3 demo ratings, tying for third among all primetime shows for the week.

At NBC, "America's Got Talent" continued its sluggish late-summer performance in 18-49 (2.0/7 on Tuesday, 1.9/6 on Wednesday) but remains a powerhouse in total viewers -- and was actually up vs. the comparable nights a year ago.

Monday newbie "Running Wild with Bear Grylls" (1.1/4 in 18-49, 5.83 million viewers overall) came down from its high of the previous week but remains one of the top summer newcomers on any net. Meanwhile, the Peacock's new Thursday comedy "Welcome to Sweden" bounced up a couple of tenths from its prior outing (0.7 vs. 0.5).

ABC's singing competition "Rising Star" ended its modestly rated run with an uptick Sunday (1.0/3 in 18-49, 3.57 million viewers overall), and "Rookie Blue" (1.0/3 in 18-49, 5.31 million viewers overall) was on the rise Thursday as it closed its season. The cop drama matched its year-ago finale demo score while delivering its largest closing-night audience to date.

With "So You Think You Can Dance" hitting lows on Wednesday (0.9/3 in 18-49, 3.45 million viewers overall), Fox's only night with a pulse was Monday with "MasterChef" (2.0/7 in 18-49, 5.83 million viewers overall) and "Hotel Hell" (1.5/4 in 18-49, 3.99 million viewers overall), with both shows rising week to week.

At CW, "Whose Line Is It Anyway" remained hot leading off Monday (0.6/2 in 18-49, 1.66 million viewers overall), and then hit a summer high with its repeat episode behind it (0.7/2 in 18-49, 1.91 million viewers overall). It was followed by the 21st-cycle premiere of "America's Next Top Model" (0.4/1 in 18-49, 1.11 million viewers overall), which was down two tenths from its Friday 8 p.m. premiere of last summer -- though it faced much tougher reality competition this time.

On Wednesday, the net's "Penn & Teller: Fool Us" (0.5/2 in 18-49, 1.69 million viewers overall) held at the same solid demo number of its first three weeks.

TNT's "The Last Ship" (1.0/2 in 18-49, 4.38 million viewers overall) ended its strong first season steady in the demo and up in total viewers, finishing as cable's top new show of the summer in adults 25-54 and total viewers. "Rizzoli & Isles" (0.83 rating in 18-49, 5.21 million viewers overall) was No. 2 behind "Ship" last week in the demo while standing as the most-watched cable series overall for the frame.

At VH1, "Love and Hip Hop Atlanta" wrapped its season with strong numbers (2.1/7 in 18-49, 3.90 million viewers overall), down a bit from last year's finale but big enough for a No. 2 finish among all series on television for the week -- behind only CBS' "Big Brother" -- in 18-49.

At HBO, "True Blood" (2.1/6 in 18-49, 4.04 million viewers overall) didn't see a big finale bounce, but gained about 500,000 viewers week-to-week to end its run with a season high. And behind it, rookie "The Leftovers" drew its largest audience to date (1.85 million).

BBC America's season premiere of "Doctor Who," with the debut of Peter Capaldi as the 12th Doctor, set a network record with 2.2 million viewers and was cable's top show for the night in 18-49 (0.85 rating).

Discovery's "Fast N' Loud" kicked off its season well Monday (1.0/4 in 18-49, 2.34 million viewers overall), ruling as cable's No. 1 non-sports program of the night in key male demos.

New Starz drama "Outlander" is picking up steam, drawing a best-yet 1.003 million for its regular-timeslot telecast on Saturday and 1.7 million in total for the night. The show continues to skew more female than previous series on the premium cabler, with femmes comprising 62% of Saturday's audience.

WEEKLY NETWORK PRIMETIME AVERAGES
(Live plus same-day)

Adults 18-49 (rating/share)
UNI 1.3/5
CBS 1.2/4
NBC 1.2/4
ABC 0.9/3
Fox 0.8/3
MTV 0.7/3
ESPN 0.7/2
TBS 0.7/2
USA 0.6/2
TEL 0.5/2

Total Viewers
CBS 5.82 million
NBC 5.10 million
ABC 4.02 million
UNI 3.33 million
ESPN 2.59 million
Fox 2.55 million
Fox News 1.91 million
USA 1.89 million
TNT 1.81 million
Disney 1.79 million

WEEK'S TOP PRIMETIME PROGRAMS
(Live plus same-day)

Adults 18-49
1. MTV Video Music Awards (MTV), 4.2/15
2. Big Brother-Sunday (CBS), 2.5/8
3. Big Brother-Wednesday (CBS), 2.3/9
3. NFL Preseason-Monday: Cleveland-Washington (ESPN), 2.3/9
3. Big Brother-Thursday (CBS), 2.3/8
6. Love & Hip-Hop Atlanta (VH1), 2.1/7
6. NFL Preseason-Sunday: Cincinnati-Arizona (NBC), 2.1/6
6. True Blood (HBO)*, 2.1/6
9. America's Got Talent-Tuesday (NBC), 2.0/7
9. MasterChef (Fox), 2.0/7
11. America's Got Talent-Wednesday (NBC), 1.9/6
11. MTV Video Music Awards Pre-Show (MTV), 1.9/6
13. American Ninja Warrior (NBC), 1.8/6
14. The Big Bang Theory-r (CBS), 1.6/7
15. NFL Preseason-Friday: Oakland-Green Bay (CBS), 1.5/6
15. Under the Dome (CBS), 1.5/5
15. Hotel Hell (Fox), 1.5/4
18. Mom, Thursday-r (CBS), 1.4/5
19. Bachelor in Paradise (ABC), 1.3/4

Total Viewers (in millions)
1. America's Got Talent-Tuesday (NBC), 9.48
2. America's Got Talent-Wednesday (NBC), 9.43
3. NCIS-r (CBS), 9.11
4. 60 Minutes (CBS), 8.50
5. MTV Video Music Awards (MTV), 8.26
6. The Big Bang Theory-r (CBS), 7.45
7. Under the Dome (CBS), 7.30
8. Big Brother-Sunday (CBS), 7.24
9. NFL Preseason-Sunday: Cincinnati-Arizona (NBC), 6.98
10. NCIS: Los Angeles-r (CBS), 6.97
11. NFL Preseason-Monday: Cleveland-Washington (ESPN), 6.90
12. Big Brother-Wednesday (CBS), 6.64
13. Big Brother-Thursday (CBS), 6.60
14. Unforgettable (CBS), 6.39
15. MasterChef (Fox), 5.83
16. Mom, Thursday-r (CBS), 5.78
17. American Ninja Warrior (NBC), 5.74
18. America's Got Talent, Wednesday-r (NBC), 5.68
19. Extant (CBS), 5.57
20. NFL Preseason-Friday: Oakland-Green Bay (CBS), 5.46

Source: Nielsen (English-language programs only)
Each 18-49 ratings point represents roughly 1.3 million viewers

*not supported by advertising

© 2014 Variety Media, LLC, a subsidiary of Penske Business Media; Distributed by Tribune Content Agency, LLC

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Spiders force Suzuki to recall midsize cars

DETROIT — Spiders have forced Suzuki to recall more than 19,000 midsize cars.

The automaker says spider webs can clog a fuel vapor vent hose in some 2010 to 2013 Kizashi cars, cutting off air flow. If that happens, it can cause the gas tank to deform, causing cracks, fuel leaks and possible fires.

The recall was prompted by seven reports of the problem. Service centers will replace the vent line with one that has a filter on the end. They'll also replace gas tanks if necessary.

The problem hasn't caused any accidents or injuries in the U.S., Suzuki said in documents posted Wednesday by the National Highway Traffic Safety Administration.

Owners will be notified this month. Those with questions can call Suzuki customer service at (800) 934-0934.

American Suzuki Motor Corp. filed for Chapter 11 bankruptcy protection in November of 2012 and stopped selling automobiles in the U.S.

The recall is the second caused by spiders this year. In April Mazda recalled 42,000 Mazda6 midsize cars in the U.S. with 2.5-liter engines for a similar problem. The recalled cars were from the 2010 through 2012 model years.

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Stocks edge higher in early trade; Tiffany gains

U.S. stocks are opening slightly higher, a day after the Standard & Poor's 500 index had its first close above 2,000 points.

Tiffany & Co. rose 4 percent after the jewelry company reported earnings that were well ahead of what analysts were expecting.

The S&P 500 edged up a point to 2,001 as of 9:35 a.m. Wednesday.

The Dow Jones industrial average rose 20 points, or 0.1 percent, to 17,127. The Nasdaq composite index rose four points, or 0.1 percent, to 4,574.

European markets were also slightly higher. Germany's DAX gained 0.1 percent and France's CAC-40 rose 0.2 percent.

Bond prices rose. The yield on the 10-year Treasury note fell to 2.37 percent.

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Sales at gun maker Smith & Wesson down

SPRINGFIELD, Mass. — Smith & Wesson is reporting lower sales for the most recent quarter due mostly to falling demand for rifles.

The Springfield-based gun maker announced that sales for the quarter were $131.9 million, a decrease of $39.2 million from the same quarter time last year.

Long guns, including modern sporting rifles, drove 87 percent of the first quarter decline.

Smith & Wesson also announced net income for the quarter was $14.56 million, down from $26.4 million in the year-ago quarter.

Gun sales increased in 2012 and early 2013 after high-profile shootings that raised fears of increased gun control regulations, which for the most part, never materialized.

CEO James Debney said high inventories of guns across the industry result from dealers restocking after that earlier surge in buying.

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Scottish businesses: no case for independence

LONDON — A group of 130 business leaders in Scotland have signed an open letter arguing that the case for independence from Britain has not been made.

The leaders say much is at stake but uncertainties surround a number of key issues should Scotland vote to break away from Britain on Sept. 18.

The leaders say vital issues such as what currency the country would use remain unresolved. Questions also remain on taxes, pensions and the country's membership in the European Union.

Signatories include top executives in HSBC Holdings, the Co-operative Bank and Cairn Energy as well as the heads of the largest producers of whisky, including brands Famous Grouse, Cutty Sark and Glenfiddich.

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Journalist killing highlights role of freelancers

WASHINGTON — Journalists James Foley, Steven Sotloff and Peter Theo Curtis all had one thing in common when they were captured by Islamic militants in Syria, the title "freelance journalist."

The role of freelancers, who make a living by selling individual stories, photos and video to multiple outlets, has expanded across conflict zones in recent years with the spread of technology and social media, which provides a ready canvas for their work. Some are cautious and well-trained; Others take major risks. And they often lack the institutional support staff journalists receive if they get into trouble in a conflict zone.

"There is no question that people with less experience and less support are venturing out into conflict zones and seeking to make their name as journalists," said Joel Simon, the executive director of the New York-based Committee to Protect Journalists.

While freelance journalists make important contributions, those who go into danger without a contract and the support of an established organization can face immense challenges, said Simon, who worked as a freelancer himself in Latin America. If freelancers are injured or detained, for example, it can take longer for word to get out because no one is monitoring their whereabouts — and early intervention can be crucial to their survival, he said.

According to the committee's data, just under half of the 70 journalists killed in Syria since the conflict began in 2011 have been freelancers. Foley, who was beheaded by Islamic militants in a grisly video released last week, is one of them, and militants threatened to make Sotloff their next victim. Other militants freed Curtis on Sunday.

Ellen Shearer, the Co-Director of Northwestern University's National Security Journalism Initiative and one of Foley's former professors said that when Foley went missing in 2012, the Boston-based media company GlobalPost, one of the organizations he freelanced for, went "above and beyond" in supporting him and working behind the scenes to try to get him freed. But other freelancers may not get that kind of backing or have access to the infrastructure that a staff journalist would, she said. For major news organizations, that might mean a risk assessment team determining whether a place is safe, hostile environment training, health insurance, life insurance, kidnap and ransom insurance and expensive protective equipment including helmets and fitted body armor.

Reporters Without Borders tries to fill the gap by loaning freelancers protective gear and GPS personal distress beacons, and providing safety training sessions and insurance, said Delphine Halgand, the U.S. director of the Paris-based group.

Francesca Borri, an Italian journalist who left her job as a human rights worker to become a freelancer in Syria two years ago, said low pay can also put freelancers in more danger. Borri, 34, said many freelancers go without protective gear, "the first thing they save money on," and rely on less experienced guides instead of people like the driver and "fixer" she used in Syria, who cost her $1,000 per day. Writing a piece on freelancing for the Columbia Journalism Review last year she called freelancers "second-class journalists," but she said Tuesday in a telephone interview from Gaza that it's more honest to call freelancers "exploited journalists."

Some organizations try to discourage risk-taking by refusing to take non-commissioned work from particularly dangerous places — or from journalists without insurance — even though it might be compelling. In 2013, the British newspaper The Sunday Times made news when it rejected pictures from a British freelancer who went to Syria.

But there is no standard policy. When border crossings in northern Syria fell to the rebels fighting to topple President Bashar Assad in early 2012, many journalists went in because they could get in without a visa. When a surge in militant groups and a wave of kidnappings made it increasingly dangerous, many news organizations suspended reporting trips to opposition-held northern and eastern Syria.

Some media organizations still bought material from freelancers in the danger zone, however, creating an incentive for some to still make trips to the area. Many relied on "fixers" they barely knew, local Syrians who arranged for their transportation and acted as translators and escorts within the country. Several freed hostages reported being sold out or betrayed by their "fixers."

James Brabazon, a British documentary filmmaker and freelance journalist who has reported from conflict zones including Liberia, cautioned against thinking of all freelancers as young, inexperienced and untrained. Brabazon, a trustee at the Rory Peck Trust, a London-based organization helping freelancers and their families, acknowledged that when he was younger he "broke every single rule that I urge people to adhere to now" including thinking about their motivations before going into a conflict zone. But Brabazon, 42, said it's true that journalists starting out can make a name for themselves with "spectacular and unique coverage" and that some young journalists may see conflict journalism as "a shortcut" to getting a good job in the profession.

New York City-based freelancer Michael Luongo, 46, who has reported from Iraq, Afghanistan and some 80 other countries, though not from the front lines, said even when media organizations say no to a story because of the danger, that may not be the last word. Luongo said once when he was in Iraq he was told: "We want work from you but we won't officially commission it" because we don't want to be connected with you if something happens. The editor knew he'd go anyway, he said.

___

Associated Press reporter Zeina Karam contributed to this report from Beirut.

___

Follow Jessica Gresko at http://twitter.com/jessicagresko .

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Time Warner Cable says outages largely resolved

NEW YORK — Time Warner Cable said Wednesday service was largely restored after a problem that occurred during routine maintenance caused a nationwide outage of its Internet service for hours.

The company says it is still investigating the cause of the problem, which occurred with its Internet backbone, the paths that local or regional networks connect to in order to carry data long distances.

The company says the problem affected all of its markets and started at 4:30 a.m. and was largely restored by 6 a.m., and updates continue to bring all customers back online. The outage sparked widespread complaints on social networks.

Tim Farrar, an analyst at TMF Associates said there are major outages of at least one telecom provider every year, although typically they aren't fully national.

"AT&T had a major outage back in April, Comcast had one last October. Verizon Wireless had several national outages on its 4G network back in 2012," he said. "Usually it is related to bugs in new technology, and occasionally to routine maintenance where someone did something wrong."

Time Warner Cable, which is in the process of being bought by rival Comcast Corp. for $45 billion, has about 11.4 million high-speed data subscribers in 29 states nationwide. The Federal Communications Commission is reviewing the deal.

Separately, on Tuesday, the FCC said Time Warner Cable, based in New York, would pay $1.1 million to resolve outage reporting violations. The FCC found that Time Warner Cable did not report disruptions in service to its networks to the FCC in a timely enough manner. In addition to the payment, the company is submitting a three-year compliance plan to make sure it will comply with the reporting rules.

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US indexes drift higher; Tiffany gains

Major U.S. stock indexes edged higher in morning trading Wednesday, drifting slightly from the record highs the day before. Trading was light ahead of the Labor Day holiday weekend as investors sifted through company earnings and deal news.

KEEPING SCORE: The S&P 500 rose a point to 2,000 as of 11:15 a.m. Eastern. The Dow Jones industrial average added 16 points, or 0.1 percent, to 17,122. The Nasdaq composite gained one point, or 0.03 percent, to 4,572.

THE QUOTE: Lawrence Creatura, portfolio manager at Federated Investors, said trading volumes were "extraordinarily light," as many people in the financial sector traditionally take time off the last week of August.

"Highs made on lower volumes should be viewed suspiciously," he said. "It will be important that next week, when everyone has returned to their desks, that these levels are maintained and confirmed."

SECTOR VIEW: Six of the 10 sectors in the S&P 500 index rose, led by telecommunications stocks. Analog Devices declined most among companies in the S&P 500. The company, which reported third-quarter earnings on Tuesday, fell $1.88, or 3.6 percent, to $50.33.

LACKLUSTER FORECAST: The Congressional Budget Office said Wednesday it predicts the U.S. economy will grow by just 1.5 percent this year. The forecast reflects the severe winter weather that hurt growth in the first-quarter.

ELEGANT RESULTS: Tiffany rose $1.88, or 1.9 percent, to $102.65 in morning trading. The jewelry company's latest quarterly earnings beat Wall Street's forecasts.

EARNINGS BEAT: Express reported lower income and sales in its fiscal second quarter, but the clothing retailer's results trumped financial analysts' expectations. Its shares surged $1.73, or 11.8 percent, to $16.32.

OVERSEAS ACTION: In Europe, stocks and bonds have been rising since last week on hopes of more central bank stimulus, but that rally lost steam Wednesday. Germany's DAX slipped 0.2 percent and France's CAC-40 was little changed. Britain's FTSE 100 gained 0.7 percent. In Asia, Japan's Nikkei 225 closed 0.1 percent higher, while Hong Kong's Hang Seng fell 0.6 percent. South Korea's Kospi added 0.3 percent and Australia's S&P/ASX 200 rose 0.2 percent.

BONDS AND COMMODITIES: Bond prices rose. The yield on the 10-year Treasury note fell to 2.37 percent. Benchmark U.S. crude rose 6 cents to $93.92 a barrel in New York. Gold fell $1.60 to $1,283.60 an ounce.

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AP Business Writer Elaine Kurtenbach in Tokyo contributed to this report.

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Correction: Dwindling Bathhouses story

LOS ANGELES — In a story Aug. 23 about the declining number of gay bathhouses The Associated Press reported erroneously that Todd Saporito, the CEO of Ohio-based Flex Spas, ran the Gay Games that were held in Cleveland. Saporito held events at his bathhouse and nightclub in conjunction with the games but was not involved in running the event.

A corrected version of the story is below:

Gay bathhouses nationwide face uncertain future

As gay acceptance rises and hooking up goes online, US bathhouses adapt to stay in business

By MATT HAMILTON

Associated Press

LOS ANGELES (AP) — Gay bathhouses that once remained in the shadows to stay in business are now seeking attention to keep their doors open.

Some are doing aggressive online advertising and community outreach. Others tout their upscale amenities like plush towels and marble baths. A bathhouse in Ohio has even added hotel rooms and a nightclub.

Gone are the days when bathhouses drew crowds just by offering a discreet place for gays to meet, share saunas and, often, have sex.

"The acceptance of gays has changed the whole world. It's taken away the need to sneak into back-alley places," said Dennis Holding, 75, who owns a Miami-based bathhouse.

In the heyday of bathhouses in the late 1970s, there were nearly 200 gay bathhouses in cities across the U.S., but by 1990, the total had dropped to approximately 90, according to Damron, the publisher of an annual gay travel guide. In the last decade, bathhouses, including ones in San Diego, Syracuse, Seattle and San Antonio, have shut down and the total nationwide is less than 70. Most patrons are older.

Hollywood Spa — one of the largest bathhouses in Los Angeles, a city regarded as the country's bathhouse capital — closed in April. Owner Peter D. Sykes said fewer customers and rising rent put an end to four decades in business.

"Bathhouses were like dirty bookstores and parks: a venue to meet people," said Sykes, who still owns the smaller North Hollywood Spa. "Today, you can go to the supermarket."

Bathhouses date to the Roman Empire. In the 19th and early 20th centuries, American bathhouses were built in many cities to maintain public hygiene among poor and immigrant communities. Chicago and Manhattan each had about 20 public bathhouses.

But the need for public places to wash up declined and by the 1950s and '60s, bathhouses largely had become rendezvous spots for gays, prompting occasional raids because sodomy was still criminalized.

Privately run, gay-owned bathhouses proliferated in the 1970s, offering a haven for gay and bisexual men to meet. Clubs like New York City's Continental bathhouse and Los Angeles' 8709 Club saw a steady stream of patrons.

Each venue was operated like a speakeasy: a nondescript building often located in the urban fringe. In-house entertainment was common, from DJs to live performers. Bette Midler even launched her career from the stage of the Continental.

Amid the AIDS epidemic in the early 1980s, bathhouses were vilified for enabling promiscuity and helping spread the disease, and many either closed voluntarily or by legal pressure. Those that remained were stigmatized, and now many younger gays see them as anachronisms.

"The younger generation's main fear is that it's some dark, seedy place," said T.J. Nibbio, the executive director of the North American Bathhouse Association. NABA formed two years ago for bathhouse owners to pool best practices for marketing and operations.

To attract younger patrons, some bathhouses offer steep discounts, cutting admission by as much as 60 percent. At the three-story Midtowne Spa in downtown Los Angeles, 18- to 20-year-olds get in for $5 any time. On Tuesdays, Los Angeles' Melrose Spa lets those 18 to 25 in for free, a deal that brought 22-year-old Brett Sparks on a recent midweek visit.

"You're either hooking up online or you are here, or you go to bars in West Hollywood, get drunk and hook up," said Sparks, acknowledging that although the bathhouse crowd skews older, it's not as risky as going home with a stranger. "Here it's a safer environment — there's condoms and other protection."

The CEO of Ohio-based Flex Spas, Todd Saporito, has positioned his bathhouse chain as a pillar of the gay community. Saporito uses the chain's Cleveland-based flagship spa, whose 50,000 square feet include luxury hotel rooms and a nightclub, to run the city's annual pride parade. He also held events there for this year's Gay Games, an international LGBT athletic competition.

Flex Spas also has sponsored the White Party, an annual electronic music festival in Palm Springs, and partnered with the AIDS Healthcare Foundation, part of an effort to frame the bathhouse as an opportunity for preventing risky behavior.

Flex Spas has had mixed success over the past few years. Its location in Atlanta has seen "exponential" growth, but clubs in New Orleans and Columbus, Ohio, have closed, Saporito said.

Saporito said more progressive views on homosexuality aren't evenly spread across the country, underscoring the need for modern bathhouses in some areas. Still, he takes nothing for granted, regardless of the location.

"Bathhouses at some level will go extinct if you don't offer something more than a towel," Saporito said.

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3 ways insurers can discourage sick from enrolling

Insurers can no longer reject customers with expensive medical conditions thanks to the health care overhaul, but there's still wiggle room for them to discourage the sickest and costliest patients from enrolling.

Insurance companies can exclude some well-known cancer hospitals or certain individual specialists who treat pricey conditions from the list of providers they cover under a plan. They can dissuade HIV patients from signing up for coverage by requiring heavy initial payments of the bill for their prescriptions. They also might simply wait for competitors to jump into a market first and take all the risky patients who were hungry for coverage.

Consumer advocates and industry insiders warn that insurers are using tactics like these to limit their coverage of the sick, which can make it difficult for the people who need insurance the most to find the right plan. Narrow provider networks, in particular, have become more common, especially in coverage sold on new public health insurance exchanges created by the overhaul.

"It's the same insurance companies that are up to the same strategies: Take in as much premium as possible and pay out as little as possible," said Jerry Flanagan, an attorney with the advocacy group Consumer Watchdog.

Insurers acknowledge that people may see changes in coverage, driven in part by how the overhaul affects insurance. But they say prudent business practices, not discrimination against the sick, are the key factors behind the trends that have raised concerns. They also point out that if customers find a plan they don't like, they generally have plenty of additional options to choose from both on and off the exchanges.

They also note that the overhaul takes several steps to discourage them from avoiding costly patients. The law prevents them from marketing or designing a plan that would discourage someone from applying based on their health. It also calls for insurers to chip into a pool that compensates competitors who wind up with a more expensive patient population. That lowers their incentive for discouraging the sick from enrolling.

"Health plans now guarantee coverage for individuals and families regardless of health status," said Clare Krusing, a spokeswoman for the trade association America's Health Insurance Plans, or AHIP.

There are three major ways insurers still might steer sick or expensive patients away from their coverage:

— FORM NARROW NETWORKS

Insurers can lower their chances for covering patients with expensive medical conditions like cancer and autism simply by limiting the number of doctors and hospitals in a coverage network. That would send those patients searching for coverage elsewhere because they don't want to pay expensive, out-of-network rates.

Narrow insurer networks might include only 30 percent or less of a market's hospitals, as opposed to 70 percent or more for a broader network, according to the consulting firm McKinsey & Co.

An Associated Press survey of the nation's top cancer centers this spring found that patients covered under the health care law could encounter barriers to access in many cases. For instance, MD Anderson Cancer Center said it is included in the networks of less than half of the plans sold on the Houston area's public insurance exchange.

Aside from excluding patients, narrow networks also can help insurers form a healthy customer base by lowering the cost of coverage. A narrow provider network gives insurers leverage to squeeze better rates out of doctors who want to be included in that network in order to get the insurer's business.

Better rates lead to lower premiums, and young and healthy people generally shop for insurance based on price.

"They're the ones that don't check the provider directory," said Bob Laszewski, a former insurance executive turned industry consultant.

Insurers say plans with narrow networks are among many coverage choices consumers can make when they shop for insurance, and they are not an attempt to dodge the sick.

Narrow provider networks help maximize value by grouping providers "who have a track record of delivering high-quality, cost-effective care," said Krusing, the AHIP spokeswoman.

She added that insurers who sell coverage on the overhaul's public insurance exchanges have to offer more than one plan. It would make little sense for them to steer patients away from one plan when that person could just choose another option from the same insurer with broader benefits.

The overhaul sets some standards for provider networks, and a Centers for Medicare and Medicaid Services spokesman said regulators plan to increase their review of these networks for 2015 to figure out whether they need to strengthen requirements.

— CAUSE PRESCRIPTION STICKER SHOCK

Some plans are requiring patients to initially pay 30 percent or more of the bill for drugs that can cost several thousand dollars a month. HIV drugs and multiple sclerosis medications are among them.

The overhaul caps the annual amounts patients are required to pay for these so-called out-of-pocket expenses. Still, some say the higher cost-sharing requirements can steer patients that need these medications away from enrolling.

"It's another way to send a message to sicker patients that says, 'If you're taking these medications, we'd rather not sell insurance to you," Flanagan said.

The AIDS Institute filed a complaint with U.S. Health and Human Services department earlier this summer against four Florida insurance companies over the issue.

Insurers say their plans follow HHS guidelines and cover all medically necessary HIV drugs. They also note that the price patients pay reflects, to some degree, what drugmakers charge for their medications.

Insurers also say customers have options if they find a prescription plan they dislike. In some markets, a customer may more than a dozen choices, some of which might offer better coverage or a lower-cost alternative for their prescriptions.

But AIDS Institute Deputy Executive Director Carl Schmid said he worries that patient choices will dissolve over time if the high prescription payments spread to other insurers in a market, and "the good plans will become the bad plans."

— ENTER MARKETS CAUTIOUSLY

Another way insurers might land a healthier population is by playing the waiting game.

The nation's largest health insurer, UnitedHealth Group Inc., will dive into the overhaul's public insurance exchanges with plans to sell 2015 individual coverage in 24 exchanges. That's up from only four in 2014.

These exchanges debuted last fall and offer shoppers a chance to compare and buy policies, often with help from an income-based tax credit.

UnitedHealth's delayed growth could be a savvy way to avoid some of the sickest patients who likely rushed to sign up for insurance in the initial year of the exchanges, said Laszewski, the industry consultant.

That could free UnitedHealth to enter markets and sign up healthier patients after other insurers, most likely nonprofits with deep community roots, have "taken the bullet" the first year, he said.

Health insurers are still figuring out plan options for 2015, so there are no signs yet that other insurers are following UnitedHealth's example.

UnitedHealth said it had always planned a measured approach. It needed a year to set up provider networks and see how the exchanges worked in their debut before deciding whether to plunge in deeper. Spokesman Tyler Mason said the insurer wasn't waiting for those competitors to sign up all the sick patients first.

"Philosophically, we've always said the marketplaces would evolve over time and that they would be good markets and that reform is needed," he said.

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Associated Press writer Ricardo Alonso-Zaldivar contributed to this report from Washington, D.C.

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