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A key portion of President Barack Obama's health-care policy could fall at the U.S. Supreme Court this week. Just when Republicans are close to achieving one of their top goals, however, the party is in disarray. As a result, I'd bet that Obamacare is going to survive this challenge -- whatever the court decides -- pretty much unscathed. ... Republicans should have been prepared to respond. Ideally, they'd be ready to advance a bill that would ensure that Obamacare's regulations -- such as its required package of essential benefits -- no longer apply in the affected states while offering tax credits to people who could lose their insurance and who lack access to employer coverage. Then Congress would pass the bill and Obama would sign it. But after months of observing and talking to Republicans, I don't expect this to happen. Instead, I expect Obama to get most of what he wants. (Ramesh Ponnuru, 6/24)

I guess people with strong political preferences have always had a hard time accepting facts that are at odds with those prejudices; but I do also think that it has gotten worse in modern America thanks to the closed information loop of movement conservatism and the incestuous amplification it brings. You see it in things like the rise of inflation trutherism; you also see it in the inability of many on the right to accept the reality that Obamacare really has covered a lot of previously uninsured Americans. (Paul Krugman, 6/24)

With only three decision days still scheduled for this Supreme Court Term (Thursday, Friday, and Monday), the waiting for the Court’s decision in King v. Burwell will soon be over. Can there still be something new to say or think about at this point? Remarkably, the answer is yes. Lost in these discussions – especially those that have focused on the potential for immediate disarray in state insurance markets – has been the procedural posture of the litigation now pending before the Supreme Court. Sometimes, and this is one of those times, analysts have to view the courts as, well, courts – governed by procedural rules that normally apply to courts and that govern their behavior and outcomes. (James Blumstein, 6/24)

It's a little awkward to defend something that doesn't yet exist. But the Independent Payment Advisory Board is in danger of being killed before it's born, thanks to a vote in the House Tuesday, and that would be a mistake -- an extremely costly one both for Medicare, the program it's meant to support, and for the entire federal budget. The payment board is meant to apply a brake on rising Medicare spending. If costs grow beyond a certain level, the IPAB is to come up with cuts to bring them down. (6/24)

In 1990, federal spending equaled about 21 percent of the economy, gross domestic product (GDP). Social Security and major health programs (mainly Medicare and Medicaid) represented a little less than one-third of all spending. The rest was defense, domestic “discretionary” programs (homeland security, environment regulation, law enforcement and the like) and non-elderly “entitlements” (unemployment insurance, welfare). In 2015, the federal government is still spending 21 percent of GDP, but now Social Security and major health programs consume about half the budget, according to the CBO report. Most health spending goes to the elderly. (Robert J. Samuelson, 6/24)

Health insurance companies in Maryland are asking the state for premium increases that are way out of line with the actual cost of providing health care and it's the people who pay for that care whose wallets would be hit hardest.... The state's largest insurer, CareFirst, is asking for rate hikes that would raise by more than 30 percent the cost of a policy for people purchasing health plans at the state's health benefit exchange, Maryland Health Connection. This contrasts with much smaller increases — even decreases — proposed by other insurers. If CareFirst's rates are approved, a 40-year-old Baltimore-area non-smoker would pay $134 more each month for the lowest-cost preferred provider silver plan from CareFirst compared to Kaiser's comparable plan. (Leni Preston and Carmela Coyle, 6/24)

I'd suggest that the best model is exactly the one I suggested when health-care reform was being debated: Get rid of all of our government's existing health insurance programs and make the government the insurer of last resort for all medical expenses above 15-20 percent of adjusted gross income. Allow very generous tax-free savings in health savings accounts that can be passed on to heirs, but spent only on medical expenses. Make the deductible percentage lower, or provide some sort of subsidized gap insurance, for people with very low incomes. (Megan McArdle, 6/24)

While the federal government stalls on immigration reform, some states have begun acting on their own. Much attention in the last decade has focused on Republican-dominated areas that have tightened enforcement. Meanwhile, more quietly, California moved in the opposite direction, encouraging integration rather than deportation. California has passed more than a dozen laws on immigrant integration between 2001 and the present. In mid-June, the state expanded healthcare access to all undocumented children and boosted spending for naturalization assistance. These various laws collectively produce a kind of state-level citizenship — call it "the California Package." (Karthick Ramakrishnan and Allan Colbern, 6/24)

At last, there’s a growing recognition that the long-term sustainability of the US health care system depends on improving the health of populations. Unfortunately, this recognition is not yet accompanied by sustainable sources of funding to achieve this goal, such as support for such initiatives as community-based tobacco control, antiviolence programs, comprehensive home visiting programs, and environmental changes that help improve diet and promote exercise. These efforts can have benefits for health at far lower cost than medical interventions. Although many take credit for investing in “population health,” the vast majority of such spending is directed to traditional quality improvement and care coordination efforts within the health care system. Many people running successful public health programs are losing sleep thinking about options to keep the doors open after grant funding has gone away. (Joshua Sharfstein, 6/24)