KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Disability Advocates Fight Assisted Suicide Measures

Disability rights advocates are speaking up in opposition to a bill currently being considered by California legislators that would allow terminally ill patients to get prescriptions to end their lives. Their opposition stems from worries that if it becomes law, depression and incorrect prognoses may lead people with serious disabilities to end their lives prematurely. (Anna Gorman, 6/29)

Coverage And Access

Same-Sex Marriage Ruling Likely To Impact Employer-Provided Health Benefits

Last week's ruling is expected to boost employer-sponsored health coverage for same-sex partners, but could also lead to new questions.

The New York Times: Fate Of Domestic Partner Benefits In Question After Marriage Ruling
Sandra Haggard, a 71-year-old professor, has been in a committed relationship with her partner, Lynne Lamstein, for more than two decades. They never had plans to marry — nor do they now — even though same-sex marriage has been declared a constitutional right. But ever since same-sex marriage became legalized two years ago in Maine, where the couple lives part of the year, Ms. Haggard said she has had a niggling worry that her employer, the University of Maine, might eliminate domestic partner health coverage for Ms. Lamstein, 66, a freelance writer. Ms. Lamstein uses Ms. Haggard’s plan because Medicare does not cover a medication that she needs. (Bernard, 6/28)

Modern Healthcare: Same-Sex Marriage Ruling Puts Health Benefits In Spotlight
The landmark U.S. Supreme Court 5-4 decision Friday granting all same-sex couples the right to marry throughout the country is significant for civil rights, but it also will likely change the health insurance landscape. Now that same-sex marriage is legal in every state, more employees will add their same-sex partners to their health plans. But it's also likely that a number of employers will soon drop their domestic partnership benefits and instead require employees to marry if they want to extend coverage to their partners. (Schencker and Herman, 6/26)

Politico Pro: Gay Marriage Ruling Has Health Coverage Implications
The Supreme Court’s decision to legalize gay marriage nationwide will force major changes in states’ Medicaid programs as well as affect the Obamacare exchanges. With the court’s landmark 5-4 ruling on Friday, a state’s Medicaid program must now recognize same-sex couples who are married when they apply for eligibility, regardless of where they got married. (Pradhan, 6/26)

Texas Tribune: Benefits Should Follow Same-Sex Marriages
Public employers including Texas agencies, universities and schools may now be required to extend benefits to spouses of married gay employees in light of the U.S. Supreme Court's ruling Friday that same-sex couples have a constitutional right to marry. (Ura, 6/26)

The Detroit Free Press: Gay Marriage Ruling Will Impact Michigan Employers
From family leave policies to survivor benefits, legalized same-sex marriage will affect how Michigan employers offer health care and workplace benefits to workers. Yet the full financial and legal ramifications of Friday's U.S. Supreme Court decision on businesses are not yet known. (Reindl and Witsil, 6/27)

Health Law Issues And Implementation

In Wake Of Supreme Court's Health Law Decision, Burwell Says There's Still 'Work To Do'

Health and Human Services Secretary Sylvia Mathews Burwell said that the ruling was an emotional one, but also that it's time to look ahead and build on the ACA momentum.

The Washington Post: Top Obamacare Official Says She Wept For Joy After Supreme Court Victory
Burwell also knew that the initial media reports could be wrong, recalling what happened the last time the court ruled on a challenge to the law. “Are we sure?” she asked her staff. She took a moment to lean over a staff member’s shoulder to read the decision on a laptop as staff members double-checked the opinion, according to an official in the room. The mood in the room was joyful but also relieved. Some staff members cried. (Sun, 6/27)

The Wall Street Journal's Washington Wire: Burwell Describes ‘Emotional’ Moment Awaiting Supreme Court Health Ruling
Health and Human Services Secretary Sylvia Mathews Burwell said she had had a “very emotional” Thursday morning awaiting a decision in the case brought against her over the Obama administration’s implementation of the Affordable Care Act health law. Ms. Burwell — the Burwell of King v. Burwell — said she was one of the tens of thousands who had tuned in to the SCOTUSBlog website to see if a decision would come down on her case Thursday, and was, at the same time, reading a memo from staff — distractedly, she confessed. (Radnofsky, 6/26)

Reuters: Top Obamacare Official Looks Ahead After Supreme Court Ruling
The U.S. official overseeing Obamacare said on Friday she has not seen any indication that states will back away from running their own health insurance marketplaces now that the Supreme Court has validated the federal insurance exchange. Sylvia Burwell, secretary of Health and Human Services, also said she expected enrollment in both the state and federal health insurance exchanges established under the 2010 Affordable Care Act -- called Obamacare -- to decline from 10.2 million currently to 9.1 million by the end of 2015. That was the number her department had originally set as a goal for 2015. (Cornwell, 6/26)

Politico Pro: After Court Ruling, Burwell Looks To Build ACA Momentum
Like much of Washington’s health policy scene, HHS Secretary Sylvia Mathews Burwell was logged into SCOTUSBlog on Thursday morning. Sitting in her office in HHS’s mammoth headquarters, she was trying to multitask: reviewing a memo while following the live blog of Supreme Court opinions, just in case the King v. Burwell decision came down. (Haberkorn, 6/26)

High Court Ruling May Encourage More States To Join

Many of the dozen states operating exchanges under the Affordable Care Act are encountering financial strains and, in some cases, technical problems, which might make the federal exchange or creating regional operations more attractive.

The Wall Street Journal: States Eye Health Exchange Options
The Supreme Court ruling upholding subsidies on the federal health-insurance exchange may prompt state-run exchanges to forge regional networks or use the federal marketplace. Many of the dozen states operating exchanges under the Affordable Care Act are encountering financial strains, and could join the three dozen states already using the federal marketplace, Some policy experts say it’s possible most of those states will eventually do just that, creating a largely national exchange program. (Armour, 6/26)

Marketplace: What Will Happen To State-Run Insurance Exchanges?
The Supreme Court upheld a key part of the Affordable Care Act on Thursday, enabling health insurance subsidies to all qualifying Americans. The ruling firmly establishes the legality of Obamacare, but quite a few states had already moved forward in creating their own insurance exchanges. ... Levitt says now that the health care law is here to stay, those states may want to think about letting take over. (Allington, 6/26)

The Philadelphia Inquirer: Health Insurance Customers Are Holding On To Their ACA Plans
Many people opposed to the ACA foresaw situations like [M.L.] Simone's leading to the law's eventual downfall. Anti-ACA pundits predicted people would enroll and never even make their first payments or would stop paying when they found the premiums unaffordable. But that is not what appears to be happening - either to Simone or to marketplace enrollees nationwide. (Calandra, 6/28)

Critics Of Obamacare Recalibrate After High Court Decision

The Supreme Court has proven a dead end for those using legal arguments to blow up the law, despite pending lawsuits focused on smaller-bore issues. But political efforts to repeal the law through Congress continue -- although those are unlikely to surmount a presidential veto unless Republicans win the White House.

The Wall Street Journal: Health-Law Foes Recalibrate Approach
Many opponents of the health law are putting away their legal wrecking balls and reaching for chisels. Thomas Miller, one of the strategists behind the Supreme Court case that aimed to strike down subsidies on the federal exchange, said he thought he would be celebrating now. But after Thursday’s decision upholding the subsidies, he is setting up meetings to discuss narrower attacks on the Affordable Care Act. (Armour, 6/26)

The Associated Press: High Court Ruling Offers Chance To Alter Health Law Debate
The country finally has an opportunity to change the subject on health care, after the Supreme Court again upheld President Barack Obama's law. There's no shortage of pressing issues, including prescription drug prices, high insurance deductibles and long-term care. But moving on will take time, partly because many Republicans want another chance to repeal the Affordable Care Act if they win the White House and both chambers of Congress next year. (6/29)

The Hill: Politics Shift On Obamacare
The politics of ObamaCare are shifting. A law that helped Republicans sweep into the House majority in 2010 and that contributed to Democrats losing the Senate four years later may be becoming a bigger political problem for the GOP than it is a liability for Democrats. The Supreme Court’s ruling on Thursday virtually guarantees that the law will remain in place for the rest of President Obama’s tenure, further entrenching ObamaCare as a new entitlement to stand alongside Medicare and Social Security. (Sullivan and Ferris, 6/29)

Politico Pro: Bipartisan Agreement By Ex-HHS Leaders: Move Ahead With ACA
Five former HHS secretaries — including three Republicans — praised the Affordable Care Act and said it’s time for the country to stop fighting over the law and start making it work better. The secretaries, from the Ford, Clinton, Obama and both Bush administrations, didn’t embrace Obamacare with equal enthusiasm, but all applauded the coverage expansion and said it created opportunities to improve Americans’ health. (Kenen, 6/28)

The Nashville Tennessean: King v. Burwell In Rearview, Employer Mandate To Dominate
The next bit of scrutiny on SCOTUScare — to borrow a new name for the federal health reform act coined by U.S. Supreme Court Justice Antonin Scalia — ... is all about the workplace now that health insurance tax credits are securely in place. The jeopardy of tax credits overshadowed that employers have big changes ahead under the employer mandate of the Affordable Care Act. The Supreme Court affirmed in King vs. Burwell Thursday the federal government's position that tax credits, which help many people afford monthly insurance premiums, are available on both federally and state-run exchanges. (Fletcher, 6/28)

NBC News: More Lawsuits Remain Against Obamacare
If you thought the legal fight over the health care overhaul was finally over, think again. At least four issues related to the Affordable Care Act still are being sorted out in the courts, although none seems to pose the same threat to the law as the challenge to nationwide subsidies that the court rejected on Thursday, or the constitutional case that the justices decided in favor of the law in 2012. (6/26)

Fox News: ObamaCare Battle Not Over, Despite Court Ruling
President Obama declared Thursday that "the Affordable Care Act is here to stay," after winning yet another round in the Supreme Court. But the battle's not over -- a host of legal and political challenges remain, and if anything, Republicans say they are more emboldened than ever to repeal the law. (Beaucar Vlahos, 6/26)

Following Supreme Court Ruling, Alaska State Senator Urges Governor To Expand Medicaid

The senator presses Gov. Bill Walker to expand the program for low-income residents without approval from the legislature. Also, Politico Pro surveys the responses in some other states that have been on the fence about Medicaid expansion.

Alaska Public Media: Senator Calls On Governor To Expand Medicaid
A prominent Democrat in the state Senate is calling on Governor Bill Walker to expand Medicaid in Alaska without approval from the legislature. Anchorage Senator Bill Wielechowski says now that the U.S. Supreme Court has upheld insurance subsidies in Alaska there is no reason for the governor not to expand Medicaid. (Feidt, 6/26)

Campaign 2016

Kasich, Christie Poised To Announce Presidential Bids

News outlets also examine how the Supreme Court's decision in the health law challenge, King v. Burwell, could make the high court a central issue in the 2016 campaign. Meanwhile, the Los Angeles Times notes "the lack of a clear front-runner" among the GOP's presidential hopefuls.

The Associated Press: Kasich Plans To Announce GOP 2016 Presidential Bid July 21
Ohio Gov. John Kasich, who's spent the year testing his scrappy political style and pragmatic policy positions around the country, plans to formally enter the 2016 presidential race July 21. ... He also is known for going off script and for pulling no punches about political positions he sees as practical though they might anger fellow Republicans. Kasich advocated income-tax cuts and expanded Medicaid under the federal health care law and has taken on oil-and-gas producers while supporting Common Core education standards. (6/29)

The Associated Press: As He Launches 2016 Bid, Christie Embraces Underdog Role
When New Jersey Gov. Chris Christie enters the race for president this week, he’ll do so as an underdog. ... With a new slogan — “Telling it like it is” — Christie will also play up his brash persona, presenting himself as someone unafraid to take on unpopular issues such as overhauling Social Security and Medicare. (Colvin, 6/29)

Reuters: Obamacare Ruling Puts Supreme Court On Hot Seat In Presidential Race
Infuriated by a U.S. Supreme Court ruling that kept President Barack Obama’s healthcare program intact, conservative activists and Republican presidential candidates vowed on Thursday to make the role of the high court a central issue in the 2016 presidential election. Conservative ire was trained particularly on Chief Justice John Roberts, who wrote the majority opinion that preserved the subsidy regime underpinning the Affordable Care Act, even though another Republican appointee, Justice Anthony Kennedy, also voted with the majority. (Oliphant, 6/26)

Los Angeles Times: Lack Of Clear Front-Runner In Huge 2016 Field Highlights Fractures Within GOP
What the party lacks is a clear leader in the 2016 field — or anyone, for that matter, who can plausibly claim a meaningful advantage — producing what is arguably the most wide-open Republican race in more than 50 years. ... No GOP candidates have gone as far as Clinton in taking on their own party. But several have nudged fellow Republicans in different ways: Bush, a former Florida governor, by urging the party to soften its tone on immigration; Kentucky Sen. Rand Paul by advocating a less assertive military policy; Ohio Gov. John Kasich by embracing the expansion of Medicare under the Affordable Care Act, which is loathed by many Republicans. (Barabak, 6/29)

Also in the news, a Democratic White House hopeful advances his position on the health law -

CNN: Bernie Sanders: Obamacare Not Enough
Bernie Sanders isn't satisfied with the Supreme Court's affirmation last week of President Barack Obama's health care law. Instead, the Democratic presidential hopeful said on Sunday he wants the United States to adopt a "Medicare-for-all" single-payer health care plan. (Bradner, 6/28)


Justice Department Looking At Anti-Trust Issues In Insurance Mergers

Many of the health insurance company mergers under discussion have the potential to raise antitrust concerns, a Justice Department official tells The Wall Street Journal.

The Wall Street Journal: DOJ Girds For Strict Review Of Any Health-Insurer Mergers
The Justice Department is gearing up for an exacting look at any proposed mergers among the nation’s top health-insurance companies, amid questions inside and outside the department about whether industry consolidation could suppress competition. The five biggest health insurers have been circling one another for potential deals. Anthem Inc. has made public a $47.5 billion bid for Cigna Corp., which Cigna has so far rejected. Aetna Inc., meanwhile, has made a takeover proposal for Humana Inc. (Kendall and Wilde Mathews, 6/28)

The Wall Street Journal: Fear Of Losing Out Drives Deal Boom
In industries ranging from health care to technology to media, chief executives are rushing to make acquisitions, often either in anticipation of takeover moves by rivals or in response to them. The resulting corporate realignments affect executives, employees, customers and suppliers. (Mattioli and Cimilluca, 6/26)

Health IT

IBM Trains Watson As A Cancer Specialist

The idea is to use the supercomputer to find personalized treatments for every cancer patient within minutes. Meanwhile, patient advocates are pushing consumers to learn how to take charge of their medical records. And provider-run insurance plans face challenges to acquire the right health technology tools.

The Washington Post: Watson’s Next Feat? Taking On Cancer
IBM is now training Watson to be a cancer specialist. The idea is to use Watson’s increasingly sophisticated artificial intelligence to find personalized treatments for every cancer patient by comparing disease and treatment histories, genetic data, scans and symptoms against the vast universe of medical knowledge. Such precision targeting is possible to a limited extent, but it can take weeks of dedicated sleuthing by a team of researchers. Watson would be able to make this type of treatment recommendation in mere minutes. (Cha, 6/27)

The Wall Street Journal: How To Take Charge Of Your Medical Records
It’s your health. So it’s time you took control of all the information about it. That’s the message that a growing number of patient advocates are trying to spread to American health-care consumers. For most people, of course, it’s all too easy to simply leave their health records in the hands of doctors and hospitals. But that’s a big mistake, the advocates argue. First, it gives doctors too much power over information that is vital to patients, and it creates opportunities for errors. Perhaps more important, it keeps patients from using the information themselves for their own benefit. (Beck, 6/29)

Modern Healthcare: Health IT A Key Challenge For Provider-Owned Plans
There's a boomlet underway in health information technology buying, triggered by provider organizations considering or launching their own Medicare Advantage or commercial health plans. Provider-run plans without long experience in the insurance business face a challenge in shopping for and setting up an IT system that will meet their needs. Hospitals, health systems and medical groups already are in the market for data analytics and care-management software. Those tools augment their electronic health-record systems, aiding in population health risk assessments and managing high-cost patients with chronic conditions. But they need even more technology tools to operate as an insurer. (Conn, 6/27)

Public Health And Education

CDC Panel Urges Expanding Pool Of Young People Who Receive Meningitis B Shot

An advisory committee for the Centers for Disease Control and Prevention is recommending that all 16- to 23-year-olds to consider the vaccine. Previous guidance was limited to those at high risk of exposure to the disease, like lab workers and students at colleges with outbreaks.

NPR: Vaccine Against Meningitis B Gets A Boost From CDC
Parents, take note! The Centers for Disease Control and Prevention's vaccine committee has expanded its recommendation for immunization against meningitis B, a rare but potentially deadly strain of meningitis. The committee's revised guidance, issued late last week, broadens the group of young people that the CDC thinks should consider getting the shot, and increases the likelihood that health insurance policies will pay for the injection. (Neighmond, 6/29)

Several other news stories focus on developments related to autism -

USA Today/Federal Times: Where Federal Health Insurance Fails Autistic Children
When Matt Crockett's 2-year-old son, Mark, was diagnosed with autism, the Air Force Reserve technician assumed his government insurance would help cover the cost of the treatment. He discovered the Federal Employee Health Benefits Program encourages — but does not require — insurance carriers to cover the cost of the leading treatment for autism. In fact, only 23 states offer federal health insurance plans that cover Applied Behavior Analysis therapy, which leaves federal employees trapped in a patchwork of coverage that costs tens of thousands of dollars a year. (Medici, 6/28)

The Washington Post: Anti-Vaccine Doctor Behind ‘Dangerous’ Autism Therapy Found Dead, Family Cries Foul
Dr. James Jeffrey Bradstreet’s life was full of controversy. To thousands of supporters, he was a savior: a physician who claimed vaccines caused autism and promoted radical procedures to treat those afflicted, including his own son. To many others, however, he was a crackpot: a man who, despite his medical license, ignored science and championed dangerous, discredited and occasionally deadly treatments. (Miller, 6/29)

State Watch

State Highlights: Calif. Will Hire More L.A. Nursing Home Inspectors; Mo. To Spell-Out Eating Disorder Coverage

News outlets report on health care developments in California, North Carolina, Missouri, Maryland, Iowa, Alabama and Texas.

Kaiser Health News: State, L.A. Near Deal To Boost Nursing Home Inspections
The Los Angeles County Department of Public Health could receive nearly $15 million in additional state funds and about 70 more staff members under a proposed new contract with the state to expand and increase oversight of nursing homes. But a yearlong training and certification process for new staff members means that the longstanding backlog of nursing home investigations could get worse before it gets better. (Gorman, 6/29)

Los Angeles Times: 35 California Counties Grant Healthcare To Immigrants In U.S. Illegally
In the latest wave of such decisions, a group of 35 mostly rural counties in California agreed this week to grant healthcare to immigrants in the country illegally. For several years, just 11 of the state's 58 counties provided some form of low-cost medical care to these uninsured immigrants. But as of this month, 47 of the state's counties have promised to do so. (Karlamangla, 6/26)

Kaiser Health News: Disability Advocates Fight Assisted Suicide Measures
As California legislators consider a bill that would allow terminally ill patients to get prescriptions to end their lives, disability rights advocates are speaking up in opposition. They worry that if it becomes law, depression and incorrect prognoses may lead people with serious disabilities to end their lives prematurely. (Gorman, 6/29)

The Baltimore Sun: Medical Marijuana Moves Closer To Reality In Maryland
With the state publishing draft regulations for medical marijuana and an infrastructure for growing and distributing it coming into view, Marylanders who suffer from chronic pain or debilitating disease could gain access to the drug by the middle of next year. The rules developed by the Maryland Medical Cannabis Commission, which cover doctor registration, licensing, fees and other concerns, were published last week. The state is accepting public comment on the rules through July 27. (Cohn, 6/28)

Des Moines Register: Grieving Father: Stop Jailing People For Mental Illness
No one believes Jeff Cornick was thinking straight when he drunkenly carried up to a dozen gas cans into his Des Moines house, stalked around rooms with a lit candle and ranted to police that he was going to blow himself up. "Shoot me!" he yelled to an officer, a police report shows. The question is: Did this bizarre behavior make him a serious criminal? Or just a person who needed serious psychiatric treatment? (Leys, 6/27)

Montgomery (Ala.) Advertiser: Pediatricians: Medicaid Cuts Could Hurt All Patients
Kiara Spencer's 6-month-old daughter, Londyn, looked eagerly around the examination room. ... Londyn is one of roughly 548,000 Alabama children, including 40,000 babies, eligible for Medicaid. ... Linda Lee, executive director of the Alabama chapter of the American Academy of Pediatrics, said that pediatric practices in the state get between 30 to 50 percent of their funding from Medicaid. ... The General Fund passed by the Alabama Legislature earlier this month — and vetoed by Gov. Robert Bentley — would have cut Medicaid by about 5 percent. Percentage-wise, it was one of the lowest cuts in the budget. But due to the byzantine structure of Alabama's Medicaid funding, some programs and services faced greater danger. Medicaid's $6 billion budget — the federal government provides a two-to-one match of state dollars — has many untouchable areas, such as hospitals, nursing homes, and behavioral health. (Lyman, 6/27)

Montgomery (Ala.) Advertiser: In Nursing Home, Medicaid And A Family's Struggle
According to the Alabama Medicaid Agency, three of every four individuals in the state's nursing homes receive coverage. Medicaid's nursing home funding is not an area that can be cut should legislators decide to reduce Medicaid funding in a special session, said Dr. Don Williamson, overseeing a transition of the Medicaid delivery system. But Medicaid's importance to nursing homes underlines its major role in Alabama's health system, where 20 percent of state residents are covered by the program. (Lyman, 6/28)

Editorials And Opinions

Viewpoints: Health Law Assaults Not Finished; Time To Double Down On Medicaid Expansion

A selection of opinions on health care from around the country.

The New York Times: The Fight For Health Care Isn’t Over
The Supreme Court’s decision upholding health insurance subsidies for low-income Americans in every state will almost certainly not stop attempts by Republicans to destroy or impede the Affordable Care Act piece by piece. ... there are myriad ways the current Republican Congress, future Congresses or a future Republican president could subvert important elements of the law or render it inoperative. (6/27)

The Wall Street Journal: Repairing The ObamaCare Wreckage
Despite the Supreme Court decision to uphold the subsidies for private insurance in King v. Burwell, the fundamental problems with the Affordable Care Act remain. Ironically, it is the growing government centralization of health insurance at the expense of private insurance that must be addressed. (Scott W. Atlas, 6/28)

The Washington Post: When Change Stops Waiting
Sometimes history speeds up. Rarely in our nation’s 239 years of life has a single week brought such a surge of social change and such a sweeping set of challenges to past assumptions. ... On Thursday, the Supreme Court decided, 6 to 3, to keep the Affordable Care Act whole. To go the other way, as Chief Justice John G. Roberts Jr. rightly argued, would have violated any plausible understanding of what Congress had intended. ... Yet if the King v. Burwell case was about a textual dispute, its implications were much broader. (E.J. Dionne Jr., 6/28)

The Washington Post's Monkey Cage: Conservatives Worry That Obamacare Is A ‘Super-Statute.’ It Isn’t Quite One Yet.
The Supreme Court’s decision in King v. Burwell is an enormous victory for the Obama administration and the Affordable Care Act. By upholding the provision of subsidies in the 34 states that rely on the federal insurance exchange, the court ensured that 6.4 million Americans would not lose access to affordable coverage. Instead of dealing a devastating blow to Americans with ACA insurance plans, the court handed Obamacare opponents a crushing defeat. The last serious legal challenge to Obamacare is over. ... Yet the ACA in 2015 is not where health-reform supporters envisioned it would be in 2010. Obamacare is a limited law, full of compromises that were necessary to secure its enactment. (Jonathan Oberlander and Eric Patashnik, 6/28)

Reuters: Justice Scalia Is The Supreme Court's Real Loser In Obamacare Ruling
Chief Justice John Roberts' majority opinion upholding subsidies on the Affordable Care Act's federal exchange is a big gift to Republicans. Though he was ruling against the expressed desire of every Republican presidential candidate -- that the subsidies should be eliminated even if that meant the nation's healthcare system would enter a death spiral -- the chief justice greatly simplified the lives of Republican politicians. In the process, he made a powerful argument for deference to the legislature and the critical need to consider the goals of Congress and real-world consequences when interpreting statutes. By mustering five votes in support of his position, Roberts made a bitter loser of Justice Antonin Scalia and his rigid textualist approach to statutory interpretation. (William Yeomans, 6/26)

Des Moines Register: Roberts Court Divines What’s In Obamacare
Obamacare is dead. Long live Robertscare. With Thursday’s U.S. Supreme Court decision in King v. Burwell, Chief Justice John Roberts, writing for the majority, cemented the Affordable Care Act as the law of the land. Oh, there will still be plenty of legal challenges to it, and there will be an attempt to replace it should a Republican occupy 1600 Pennsylvania Ave. in 2017; but for all intents and purposes, the individual and employer mandates, and now the subsidized federal health insurance exchange, are now in concrete. (Christopher Rants, 6/27)

San Antonio Press Express: Obamacare Is Not Going Away
Many Texas lawmakers have doggedly opposed all aspects of Obamacare since its passage five years ago, perhaps hoping the law would simply go away. But now it is time for the law’s opponents to take a more pragmatic approach and embrace those parts of the law that can help ordinary Texans afford needed medical care. In particular, Texas should take advantage of generous federal matching funds available to states that expand their Medicaid programs to cover people earning up to 138 percent of the federal poverty level, or $33,465 for a family of four. (Sam Richardson, 6/26)

Forbes: Pay No Attention To GOP Efforts To Repeal Obamacare Through The Budget
I first posted last January about how the Republicans’ hopes (“plans” would be too strong a term) to repeal Obamacare through reconciliation were, to be polite, highly unlikely to be successful. But events over the past two weeks have made any attempt to use the congressional budget process to repeal or make substantial changes in Obamacare a complete waste of time. (Stan Collender, 6/29)

Cincinnati Enquirer: How King v. Burwell Ruling Affects Kentucky
While many have been awaiting this important decision, we must remember that much remains to be done to assure that all Kentuckians – and all Americans – have timely access to safe, effective and affordable quality care. ... In Kentucky, where more than a half million people have gained insurance through the Affordable Care Act, the work to assure access and improve health continues. Diverse groups of individuals and organizations from across Kentucky continue to work with the state to find ways to continue to improve and protect Kentuckians' health and well-being. Reforming the way we pay for care and making cost and pricing more transparent are under discussion. The state has expanded scope of practice for Advance Practice Registered Nurses. (Susan G. Zepeda, 6/28)

Orange County Register: ACA Medicaid Expansion Drives Up Health Care Costs
By design, Obamacare relies on Medicaid – the federal health insurance program for the poor – to expand health coverage. Since 2013, more than 11 million people have gained insurance through the federal program, which supports those earning below 133 percent of the federal poverty level. At the same time, there hasn’t been a surge of new or current primary care physicians taking on Medicaid patients. As a result, millions of enrollees can’t access a doctor and have turned to the ER for basic care. The best way to reverse this trend is to redesign how Medicaid is financed. (Sally C. Pipes, 6/28)