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Unless Congress finds a way to repeal the Affordable Care Act over the next 10 months -- after more than 60 failed attempts -- President Barack Obama will leave office with his signature legislation intact, and running pretty smoothly. Obamacare, which turns six today, has reduced the share of Americans without health insurance by half, provided people without job-based coverage access to affordable high-quality options, and prevented people from being denied insurance because of preexisting health conditions. Meanwhile, health-care costs have grown more slowly than they did before the law was passed. (3/23)

The Affordable Care Act generates so much partisan heat and draws so much media attention that many people may have lost perspective on where this law fits in the overall health system. The Affordable Care Act is the most important legislation in health care since the passage of Medicare and Medicaid. The law’s singular achievement is that 20 million people who were previously uninsured have health-care coverage. What sets the ACA apart is not only the progress made in covering the uninsured but also the role the law has played rewriting insurance rules to treat millions of sick people more fairly and its provisions reforming provider payment under Medicare. The latter is getting attention throughout the health system. (Drew Altman, 3/23)

Happy birthday, ObamaCare. If only you were strong enough to blow out six candles. After a difficult gestation, an awkward birth and a few trips to the ER (aka the Supreme Court), the Affordable Care Act turns 6 years old on Wednesday. It made it through nursery school and kindergarten, but it’s still a very troubled child. (Sreedhar Potarazu, 3/23)

What is a “substantial” burden on religious freedom? For four Supreme Court justices, the answer may be: whatever a religious objector says it is. That was the implication of a brief exchange during oral arguments on Wednesday morning, in one of the most significant cases of the court’s current term, involving a religious challenge to women’s access to free birth control. If the justices split 4-4, they would leave the issue unresolved until a new justice is confirmed, which could be a year or more from now. (Jesse Wegman, 3/23)

Millions of Americans are finding Obamacare to be unstable ground. ... Because of fluctuations in income, millions of Americans move back and forth between Medicaid and the Affordable Care Act’s insurance marketplace, leading to significant health and financial costs for individuals, states and insurance companies. This cycling across different forms of insurance is called “churning.” (Dhruv Khullar, 3/23)

On Wednesday, an eight-member Supreme Court heard a challenge to the requirement under Obamacare that employer health insurance plans cover birth control. The case was brought by nonprofit organizations with religious objections to contraception. But questions from the bench suggested that the justices might be evenly split on whether the complicated arrangement worked out by the Obama administration to balance religious freedom and women's health violates the nonprofits' rights under existing law. If so, two outcomes are possible: The justices could hand down a 4-4 ruling that would not establish a binding precedent around the country, leaving the law open for interpretation. Or they could decide to have the case reargued next term in the hope that a successor to the late Justice Antonin Scalia will have been confirmed by the Senate. (3/24)

If the Obama administration had thought long and hard about the meaning of religious freedom, one of the nation’s most fundamental rights, it would not have ended up in the Supreme Court on Wednesday doing battle over free birth control with Little Sisters of the Poor and other religious non-profits. (3/23)

The Obama administration has gone out of its way to accommodate the religious beliefs of employers who don’t want to provide insurance coverage for birth control required by the Affordable Care Act. There is an outright exemption for churches and other houses of worship. Religiously affiliated non-profit organizations can opt out, too. They simply fill out a form stating their objection and send it to their insurance company or the government. Then, the insurance company must provide the non-profits’ employees with the coverage directly, without the employers’ involvement. These employers are exempted, but the women get the essential birth control coverage they need. (Gretchen Borchelt, 3/23)