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When President Barack Obama signed the Affordable Care Act, six years ago this week, he addressed the rancor the health-care debate had inspired with a call to resist cynicism. “We are not a nation that does what’s easy," he said. "We are a nation that does what is hard. What is necessary. What is right. Here, in this country, we shape our own destiny.” (Sylvia M. Burwell, 3/22)

Court on Wednesday will again consider the Affordable Care Act’s requirement that all insurance plans provide free access to contraceptives. Some religiously affiliated nonprofit groups object — not to the requirement per se, but to the work-around the government devised to accommodate their theological opposition to contraception. The nonprofits do not have a strong case. ... All the nonprofits have to do is fill out a simple form. They claim it is sinful for them to sign the form, which enables a process whereby someone else takes the time and expense of distributing contraception to employees who want it. The nonprofits argue that the government is not simply asking them to “raise their hand” in objection. They would have to give the government the names of their insurers, which the government would use to arrange for separate contraception coverage. The government “is forcing them to hand over the keys” to their health plans. (3/22)

The Supreme Court will hear a second challenge to the Affordable Care Act’s contraceptive mandate on Wednesday in a case called Zubik v. Burwell. The plaintiffs want to extend the 2014 ruling in Burwell v. Hobby Lobby Stores, which recognized the right of certain for-profit companies to a religious exemption from the act’s requirement that employers’ health plans provide contraceptive coverage. This time, the objection comes from a handful of religious nonprofits that argue that the government’s religious exemption itself infringes on their religious freedom. (Elizabeth Deutsch, 3/23)

On Wednesday, the Supreme Court will hear arguments in yet another challenge to the implementation of the 2010 Patient Protection and Affordable Care Act, better known as Obamacare. Although the legal issues are complex, the case of Zubik vs. Burwell can be summed up in an old saying: “No good deed goes unpunished.” The good deed in this case is the Obama administration's decision to accommodate religiously affiliated employers who believe birth control to be immoral. (3/22)

My religion has always been a big part of my life. I was raised Catholic, received a Catholic education and taught at a religious school for years. My daughter is in Catholic school now. But the church’s attempts to block my access to health care have made me feel disillusioned. Frankly, I’ve lost a great deal of faith in its teachings. As a teacher at a religiously affiliated school between 2007 and 2015, my health insurance was managed by the archdiocese. It didn’t cover contraception. We were told that the plan was in line with the beliefs of the church. (Sonia Guizar, 3/22)

As a doctor and a researcher, I spend my days working with women in St. Louis as they navigate some of the most important decisions of their lives, including their reproductive decisions. I see the impact of political decisions — decisions that are disconnected from the lived experiences of women — in my daily work as I talk to women about finding the best contraceptive method for them. That is why I am so concerned about the Zubik v. Burwell case currently at the Supreme Court. (3/22)

Money always ranks high among the reasons for divorce. In the failing marriage between Anthem Blue Cross and Express Scripts, it's reasons one through 15 billion. That's how many dollars the party of the first part thinks its been cheated by the party of the second part. For those who missed the wedding announcement back in 2009, the first is the nation's second-largest health insurance company and his (or her) partner is the nation's biggest pharmacy benefits management firm, or PBM. They seemed to be in a marriage made in heaven, until household finances strained the relationship to the breaking point. (Michael Hiltzik, 3/22)

The contrast with Republicans is obvious. The House GOP released a budget that cuts domestic spending to levels lower than they were eight years ago, with the bulk of the cuts coming from programs for the most vulnerable. They would promote fracking, cut funding for renewable energy, end support for Amtrak and urban mass transit, shut down the Consumer Financial Protection Bureau, repeal the Affordable Care Act without a plan to replace it and turn Medicaid and food stamps into block grants for the states to savage. They would increase military spending. The Congressional Budget Office warned that under the House proposal, “economic output would be lower . . . because differences in federal spending and revenues would reduce total demand for goods and services.” Over the past decades, conservatives in both parties have failed the vast majority in this country. The CPC People’s Budget, like the Sanders platform, shows there is an alternative. Bold, big reforms can make our lives better. (Katrina vanden Heuvel, 3/22)

A scuffle last week over whether independent Vermont Sen. Bernie Sanders adequately supported former Secretary of State Hillary Clinton’s 1993-1994 health care reform efforts highlighted how the question of moving beyond the Affordable Care Act has emerged as a defining difference between the two candidates. The most recent dispute seems to have been resolved. But the larger issue remains. Just as we saw with President Lyndon B. Johnson's fight for Medicare in 1965, both candidates are presenting plans that while politically expedient, fail to adequately control costs. (Tony Lucadamo and Guian McKee, 3/22)

Fewer than half of Iowans polled approve of how Gov. Terry Branstad is handling his job, according to a February Des Moines Register/Mediacom Iowa Poll. His 42 percent disapproval rating reflects a level of dissatisfaction in this governor not seen since 1993. It would be no surprise if this is an indication of the frustration felt as he rams through his pet project of privatizing management of Medicaid health insurance. The move is creating uncertainty and disruption for hundreds of thousands of patients and providers. The majority of Iowans trust the state, not private companies, to operate the program, according to the same poll. But Branstad doesn’t care about what constituents want, or what makes sense, on this issue. In one week, Iowa will abandon a state-run Medicaid model that has worked well for decades. Managed care companies will take over the $4.2 billion government program. (3/22)

A few moments of inattentiveness can end in tragedy if patients with serious mental issues aren’t properly monitored. In 2014, for example, a patient left unattended at Universal Health Services’ Timberlawn Mental Health System in Dallas hanged herself from a closet doorknob with a bedsheet. The mental health unit’s policy required staff to check on patients every 15 minutes. In their investigation of the death, regulators found no evidence that this procedure was followed, even though staffers knew the woman posed a danger to herself. (3/22)

Two recent patient-safety initiatives—one designed to curb opioid overprescribing and the other a heart-device recall—reveal the limits of voluntary action when it comes to avoiding harm from drugs and medical devices. The Centers for Disease Control and Prevention issued voluntary guidelines last week for how physicians and hospitals should prescribe opioids for long-term pain relief. The CDC recommended starting with over-the-counter pills such as ibuprofen before switching to low-dose opioids if the initial treatment is ineffective. (Merrill Goozner, 3/19)

Calling all techies: The Substance Abuse and Mental Health Services Administration plans to award a total of $30,000 in prizes for apps that can be worked into recovery plans for opioid addiction. A number of digital health developers have turned their attention to the behavioral health space, which has traditionally existed in its own silo. But as new regulations have pushed for payment parity with physical health conditions, more investment is flowing into the sector. There's also growing awareness among health systems that they'll need to tackle mental health if they want to succeed with risk-based payment contracts that reward them for outcomes. (Beth Kutscher, 3/21)

Despite expanding primary prevention efforts, the majority of individuals will develop cardiovascular disease (CVD) during their lifetime.1,2 The discordance between short-term (10-year) and long-term (30-year to lifetime) cardiovascular risk is well established and is now reflected in the most recent clinical practice guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) on lipid-lowering treatment for primary prevention of atherosclerotic CVD (ASCVD).3,4 Specifically, these guidelines recommend that lifetime risk estimation can be used as a communication strategy for adults younger than 60 years who are free of ASCVD and not candidates for lipid-lowering therapy. Although a high lifetime ASCVD risk has not been recommended as a class I indication for lipid-lowering treatment, the acknowledgment of lifetime risk in the guidelines indicates a more comprehensive awareness of the importance of prevention of ASCVD over a life span. Risk estimation remains an imperfect science. However, by focusing on the key elements of risk prediction over a lifetime—the treatment thresholds, risk factor trajectories, and predicted outcome—advances can be made to more accurately identify individuals at an increased lifetime ASCVD risk to tailor optimal primary prevention strategies. (Maarten J.G. Leening, Jarrett D. Berry, and Norrina B. Allen, 3/21)