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The U.S. Supreme Court is expected to decide by late June whether millions of Americans in three dozen states are benefiting from illegal health insurance subsidies. If the justices invalidate those subsidies, Republicans must have a free-market alternative waiting in the wings. Otherwise, there will be tremendous pressure on Congress to pass a “fix” allowing existing benefits to continue. Obamacare will be entrenched before Republicans even get a chance to retake the White House. The time to stop that is now. (Philip Klein, 1/13)

Justice Antonin Scalia was missing from the bench this morning when the U.S. Supreme Court handed down two statutory interpretation cases -- apparently he was stuck in traffic. But even in his physical absence, Scalia’s presence was looming. It’s not only that he wrote both of the opinions, each decided by a unanimous court. It's that both opinions reflect his approach of “textualism” -- a form of literal legal interpretation that has become his most distinctive contribution to U.S. law. And that in turn provides a strong indication that the Supreme Court will use the same technique later this year to reach a ruling that effectively puts an end to the Affordable Care Act. (Noah Feldman, 1/13)

How much money does Arkansas save by offering stingier Medicaid than Vermont? It looks like a straightforward calculation. Arkansas makes it tougher for children to qualify for Medicaid than Vermont does, and it spends much less on each beneficiary. ... But there is a price to pay for such parsimony. Children in Arkansas get fewer regular checkups at the doctor and dentist. More adults forgo care because of the expense. More Arkansans are overweight and have diabetes. More are disabled. They die younger. (Eduardo Porter, 1/13)

Among the Affordable Care Act’s many economic and political disruptions, the law has unintentionally encouraged employers to convert full-time jobs into part-time jobs. ObamaCare mandates that employers offer health insurance to employees who work more than 30 hours a week, or pay a penalty up to $3,000 an employee. But employers have no such obligation for employees who work less than 30 hours a week, making part-time employment less costly. (Andy Puzder, 1/13)

EHRs [electronic health records] are supposed to simultaneously reduce costs, increase efficiency, and improve quality. Unfortunately, such predictions have not played out as well as many individuals have hoped. ... Just recently, the American Medical Association called for an overhaul of EHRs, arguing that the meaningful-use requirements set by the government require EHRs to do too many things adequately, making them perhaps unable to do too few things well. The American Medical Association argued for a new framework that would focus on making EHRs more usable and more likely to achieve better patient care. Given what we know about physician satisfaction, this seems aligned with what physicians want: EHRs to be more functional, more user friendly, and less of an impediment to workflow. (Dr. Aaron E. Carroll, 1/12)

[T]he effect that unprecedented budget pressures are having on biomedical research cannot be ignored. Due to inflation, the NIH budget has lost almost 25% of its purchasing power over the last decade. The decline has had important consequences; the NIH once funded 1 in 3 research proposals, but now only has enough resources to support 1 in 6. As a result, a great deal of excellent science is being left unfunded. These challenging fiscal times are also impeding the ability of the NIH and NIH-funded institutions to recruit and retain the brightest minds in science. ... If the United States wants talented, young scientists—especially physician-scientists—to pursue high-risk research that will improve human health over the long term, timely and stable funding for biomedical research is needed. (Francis Collins, 1/13)