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The Affordable Care Act survived another challenge before the U.S. Supreme Court this year. But the still-fragile marketplace is showing the strain of rising health care costs. (Horsley, 12/30)

The Treasury Department on Monday gave employers an extension of critical reporting requirements, as it seeks to manage some of the most complicated parts of the federal health care law. Employers had previously faced deadlines in February and March to report 2015 health insurance information to their employees, and also to the IRS. If they need more time, employers can now have until March 31 to get information to their workers and until June 30 in certain cases to get details to the IRS. Treasury said it acted after many employers complained they might not be able to get the information processed in time. Companies that rely on outside vendors were running into a bottleneck. (Alonso-Zaldivar, 12/28)

A growing number of people are turning to health-care ministries to cover their medical expenses instead of buying traditional insurance, a trend that could challenge the stability of the Affordable Care Act. The ministries, which operate outside the insurance system and aren’t regulated by states, provide a health-care cost-sharing arrangement among people with similarly held beliefs. (Armour, 1/3)

President Obama is entering his final year in office having quietly secured significant expansions to the federal government safety net in the face of Republican majorities in Congress and increasingly insistent calls from GOP presidential candidates to rein in “free stuff.” The latest expansions came in the $1.8-trillion budget deal that Congress approved this month, which made permanent hundreds of billions of dollars in tax breaks for low- and moderate-income families -- measures enacted on a temporary basis in Obama’s first year. ... Moreover, although the budget deal delayed three taxes included in the president’s signature Affordable Care Act, it protected the core of the law, which has extended government-subsidized health coverage to millions of poor and working-class Americans in the last two years. Together, the permanent tax breaks and health protections that Obama has managed to lock into place mark the largest growth of government social programs in half a century. (Levey, 12/29)

When she turned 26 in October, Elif Karatas of Chicago was no longer covered under her parents' health plan. She also wasn't eligible for coverage from her employer because she works part time. So she turned to the public marketplace in Illinois created by the Affordable Care Act, President Barack Obama's signature health care law. But picking a plan on healthcare.gov, the online insurance exchange, was more difficult than she expected for a first-timer. (Sachdev, 12/31/15)

Health-plan enrollment season rolls on, and people shopping on healthcare.gov and the other marketplaces have until Jan. 31 to pick a plan. But even people trying to pick from their employers’ options can find the process complicated and difficult to understand. The jargon can be overwhelming, and it can lead people to make to costly mistakes or avoid care all together. (Zdechlik, 1/4)