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The Supreme Court’s decision to hear arguments in King v. Burwell next year poses an enormous danger to Obamacare, but it also presents an urgent challenge to the law’s opponents. The outcome might result in many thousands of residents in more than half the states being unable to afford health insurance. The next Congress must be ready to respond with a consumer-oriented health reform. That means preparing now. (Yuval Levin and James C. Capretta, 12/17)

The New York Democrat noted that the Affordable Care Act “was aimed at the 36 million Americans who are not covered” and asserted that “to aim a huge change in mandate at such a small percentage of the electorate made no political sense.” Schumer says he was surprised that nine paragraphs in a 6,600-word speech got all the attention. He shouldn’t have been. (E.J. Dionne Jr., 12/17)

About 10 million people have gained coverage in 2014, and notably, that’s not just the finding from this data source but from various other coverage surveys as well. Now, since trends in economic variables, including the share of those without health insurance coverage, by definition have some persistence, when you see a shift in a trend of this magnitude, your strong suspicion is that an “exogenous” change has occurred, i.e., something new entered the system that had a large impact on the variable in question. (Jared Bernstein, 12/17)

In the struggle between pragmatism and ideology over Medicaid expansion in red states, pragmatism may slowly be winning. Gov. Bill Haslam‘s announcement Monday of his plans to expand Medicaid under the Affordable Care Act makes Tennessee the 10th state with a Republican governor to expand the program (if the state legislature approves the plan). ... The governors of Indiana, Wyoming and Utah have also announced plans to expand. Many of these states are or will be negotiating with the Obama administration to expand Medicaid coverage for adults in ways that match their more conservative policy preferences and allow elected officials who opposed the health-care law to continue to distance themselves from Obamacare. (Drew Altman, 12/18)

Put differently, Democrats and Republicans have done precious little to resolve their basic differences over how large government should be, what it should do and who should pay for it. Both have benefited politically from outside events. They have claimed success while evading the hardest choices. In a letter with the report, outgoing Budget Committee Chairman Patty Murray (D-Wash.) urges Republicans to abandon their “partisan, cuts-only approach” and to accept tax increases. But the advice works both ways. Though Republicans have resisted new taxes (an exception: higher rates on the wealthy enacted in 2013), Democrats have been as adamant in resisting benefit cuts to Social Security and other “entitlements,” including Medicare. Not surprisingly, Murray’s letter does not mention benefit cuts. (Robert J. Samuelson, 12/17)

The Massachusetts Health Connector has 99 problems, but Jonathan Gruber isn’t one. The four GOP state senators who have called for the respected MIT economist to resign from the connector’s board are aiming at the wrong target. Last year’s bungled rollout of the state’s health website, which is intended to connect citizens with health insurance plans, cost taxpayers still-uncounted millions. Legislators would be better off demanding auditor Suzanne Bump and Governor-elect Charlie Baker get to the bottom of what happened, rather than joining a frivolous right-wing vendetta against Gruber. (12/17)

Last week the regional transportation authority in this area, SEPTA, filed suit against pharmaceutical company Gilead for its “exorbitant pricing” of Sovaldi, a product to treat hepatitis C. SEPTA is a self-funded organization that covers the health benefits for its employees and their families, so Gilead's $84,000 per person price tag for a course of treatment represents a jolt to the agency's health care costs. SEPTA's lawsuit raises the question of why there has been no consortium of large, self-funded companies to act in unison and haul pharma to the woodshed for its pricing? (Daniel R. Hoffman, 12/17)

The Ebola epidemic is testing virtually every aspect of the public health and healthcare systems in the U.S., including healthcare institutions’ public service commitments. Although the number of cases in the U.S. remains very small, an extraordinary amount of public and hospital resources have been devoted to preparing for new cases domestically. In contrast, although US hospital and medical professional organizations have called for an “enhanced focus” on containing Ebola in West Africa, there is a striking absence of public commitments on the part of US healthcare institutions to contribute to the containment effort. (Michelle Mello, Maria Merritt and Scott Halpern, 12/17)