�鶹Ů��

They are only four words in a 900-page law: “established by the state.” But it is in the ambiguity of those four words in the Affordable Care Act that opponents found a path to challenge the law, all the way to the Supreme Court. How those words became the most contentious part of President Obama’s signature domestic accomplishment has been a mystery. Who wrote them, and why? Were they really intended, as the plaintiffs in King v. Burwell claim, to make the tax subsidies in the law available only in states that established their own health insurance marketplaces, and not in the three dozen states with federal exchanges? The answer, from interviews with more than two dozen Democrats and Republicans involved in writing the law, is that the words were a product of shifting politics and a sloppy merging of different versions. (Pear, 5/25)

A Supreme Court ruling due in a few weeks could wipe out health insurance for millions of people covered by President Barack Obama's health care law. But it's Republicans — not White House officials — who have been talking about damage control. A likely reason: Twenty-six of the 34 states that would be most affected by the ruling have Republican governors, and 22 of the 24 GOP Senate seats up in 2016 are in those states. (Alonso-Zaldivar, 5/26)

Preparing for a Supreme Court decision that could strike down Obamacare’s subsidies for nearly 7.5 million people this summer, Senate Republicans are coalescing around a plan to resurrect them — at a steep price for the White House. With several Senate Republicans facing tough reelections, and control of the chamber up for grabs, 31 senators have signed on to a bill written by Sen. Ron Johnson (R-Wis.) that would restore the subsidies for current Obamacare enrollees through September 2017. But the administration would have to pay a heavy price — the bill would also repeal Obamacare’s individual and employer mandates and insurance coverage requirements. ... But even if Johnson could somehow persuade Obama and Senate Democrats to accept his plan — a herculean task — the bigger problem will be his Republican colleagues in the House. (Haberkorn and Bade, 5/26)

The court is expected by the end of June to rule on a lawsuit seeking to invalidate subsidies to more than 7.5 million people who bought plans on the federal exchange. If the court upholds the lawsuit, those people will land in the same boat as their more well-heeled compatriots. People with individual coverage in 2010 and 2012 who bought silver and bronze plans on the exchange after the law took effect saw total premiums and out-of-pocket payments rise an estimated 14% to 28%, according to a study last year by the National Bureau of Economic Research. (Armour, 5/25)

A different health care issue has emerged for Democrats, in sync with the party's pitch to workers and middle-class voters ahead of next year's elections. It's not the uninsured, but rather the problem of high out-of-pocket costs for people already covered. Democrats call it "underinsurance." After paying premiums, many low- and middle-income patients still face high costs when trying to use their coverage. There's growing concern that the value of a health insurance card is being eaten away by rising deductibles, the amount of actual medical costs that patients pay each year before coverage kicks in. (Alonso-Zaldivar, 5/23)