�鶹Ů��

In King vs. Burwell, the Supreme Court ruled that the Affordable Care Act permits individuals who purchase insurance on the federal exchange to receive taxpayer subsidies. Though the King decision pleases the ACA’s ardent supporters, it undermines the rule of law, particularly the Constitution’s separation of powers. ... When judges take it upon themselves to “fix” a law — or to bless an executive “fix” — they diminish political accountability by encouraging Congress to be sloppy. And they bypass the political process established by the Constitution’s separation of powers, arrogating to itself — and the executive — the power to amend legislation. This leads to bad laws, bad policy outcomes and fosters the cynical belief that “law is politics.” (David B. Rivkin Jr. and Elizabeth Price Foley, 6/29)

When the Supreme Court last week swatted down a legal challenge that could have crippled a centerpiece of President Barack Obama's health-care law, it merely kicked the debate back from the legal to the political arena. Conservatives are still determined to fight Obamacare. But now, they're fighting over how to fight it. The latest plan, floated by a couple of top-tier Republican presidential hopefuls, is already facing pushback from the right. In recent days, former Florida Governor Jeb Bush, officially a candidate for president, and Wisconsin Governor Scott Walker, who appears likely to make his campaign official in July, have both hit on the same idea for getting rid of Obamacare. But it would involve killing a Washington sacred cow that is, if anything, more beloved of conservatives than it is of liberals. Namely, the Senate filibuster. (Sahil Kapur, 6/30)

The Supreme Court's decisive 6-3 vote confirming the right of all Americans to federally supported health-care insurance should end the Republican Party's losing war on Obamacare — but it probably won't. The party tried and failed in 2012 to win back the White House behind Mitt Romney and a pledge to "repeal and replace" the president's signature Affordable Care Act. Now it seems determined to continue the fight, to the point that most of its 2016 presidential aspirants have signaled their willingness to walk the same plank right through the next election. (Jules Whitcover, 6/29)

As happy as the president is with the result, though, Republicans may be even happier. If the court's decision had gone the other way, the GOP governors in those 33 states would have had a crisis on their hands and the Republican Congress would have been expected to come up with a very quick remedy or risk facing the wrath of millions of voters suddenly dumped from the healthcare system. Now Republicans in the House and Senate can continue to rail against Obamacare, hone their talking points and make vague assertions that they have a better idea without having to do anything -- and congressional Republicans have proven pretty convincingly that doing nothing is what they do best. (David Horsey, 6/26)

Last week the U.S. Supreme Court upheld the Affordable Care Act — again. The 6-3 decision maintains a cornerstone of the law, which provides federal subsidies to Americans purchasing private health insurance. The ruling has been characterized as a relief for people who rely on those subsidies and health providers compensated by insurers for care. Perhaps most relieved are anti-Obamacare politicians who had no feasible plan in place if the court issued a decision that resulted in millions of Americans losing their coverage. These politicians knew they could be held responsible. The lesson opponents should learn from all this: Move on. (6/29)

As a conservative, I think it serves the country best if elected officials, not judges, repair what's wrong in Obamacare. Former Texas Gov. Rick Perry, a 2016 GOP presidential hopeful, hit the right note when he said he did not agree with the ruling. "It never was up to the Supreme Court to save us from Obamacare," he said in a statement issued Thursday. Because the Democratic Congress wrote a heavy-handed provision, which the Obama White House determined it was best to ignore, the Supreme Court got handed a live grenade. With all the Democratic justices on board, Roberts jumped on the grenade - leading with a bogus argument. The real casualty is any notion that the U.S. Supreme Court remains an honest broker. (Debra J. Saunders, 6/29)

State laws and procedures, especially in the South, are rife with political and economic discrimination, subtle and otherwise. Even if some of these policies can be defended as not overtly racially motivated, their racially discriminatory effect is plain. The region is the epicenter of opposition to the Affordable Care Act; among Southern states, only Arkansas has expanded Medicaid, the provision of Obamacare most specifically directed at low-income Americans, a group in which black residents are overrepresented. (Michael Hiltzik, 6/29)

Gov. Jerry Brown has been among the world’s leaders when it comes to recognizing and responding to the science of climate change. Now the question is whether he’ll do the same with what science says about vaccinations. (Karin Klein, 6/29)

Despite all the noise around mandating vaccinations for schoolchildren, most California adults -- some 67%, according to a recent poll -- think it’s a good idea. We will soon know whether Gov. Jerry Brown agrees. On Monday, the Legislature sent him a bill that would end the personal belief exemption, a routinely abused loophole that has seriously eroded the immunization rates in many of California’s school districts. Children who cannot be vaccinated for medical reasons would be allowed to attend school. (Robin Abcarian, 6/29)

The best moment of my first spinal tap came after it ended. I was not supposed to move, so I lay still and watched the lab technician deftly drip my cerebrospinal fluid into 50 tubes, one drop at a time. “You have just created 50 samples for Alzheimer’s research,” he said. Fifty samples. From a couple of tablespoons of fluid. Fifty samples, in exchange for allowing myself to be numbed with one needle and then delicately poked with another while I lay curled on my side. It felt like the most useful thing I’d ever done. Certainly, it was the most useful thing I’d ever done to fight Alzheimer’s disease. (Ann Hedreen, 6/28)

Two recent studies of Medicare’s new way to pay for health care show that it’s reducing spending and improving quality. The problem is, health care organizations don’t always stick with the program. Both studies examined Medicare’s 32 Pioneer Accountable Care Organizations. This program, and a related, similar one with a larger number of participants, offers health care organizations the opportunity to earn bonuses in exchange for accepting some financial risk, provided they meet a set of quality targets. (Austin Frakt, 6/29)

The logic of US federalism ensures that states will experiment with various approaches to organizing their health insurance marketplaces. Before rushing to reinvent their current marketplace models, legislators should proceed with caution. The performance of ACA insurance marketplaces varies widely; no single organizational structure predicts better outcomes. Indeed, [state partnership marketplaces] and [federally facilitated marketplaces] models often outperform [state based marketplaces] in terms of cost-effectiveness, enrollment growth, and effects on health insurance premiums. (Robert B. Hackey and Erika L. May, 6/29)

Health care disparities in neurological conditions have become increasingly apparent during the past decade, principally focusing on racial and ethnic disparities. However, disparities involving the lesbian, gay, bisexual, and transgender (LGBT) community continue to be understudied in medicine, including neurology. Although the significance of an LGBT identity frequently goes unrecognized in neurological care, this community faces unique challenges and potential disparities that are vital for neurologists to understand to provide thorough and culturally competent care. (Nicole Rosendale and S. Andrew Josephson, 6/29)