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Some of the most notable federal policy innovations of the last generation have originated in the states, including school vouchers, energy efficiency standards, welfare reform and the Affordable Care Act. Governors like Bill Clinton and George W. Bush leveraged their state policy successes as springboards to the Oval Office. The problem is, just when we need their innovative energies, the states are looking less and less likely to be fountainheads of new federal policy over the next generation. What has changed? (Aaron Chatterji, 1/11)

If you think Obamacare is bad, just wait until the Supreme Court dismembers it. The Urban Institute has gamed out what would happen if the justices ended health insurance subsidies for people in 34 states, a plausible result from the court’s current term. Urban’s results ... predict a national policy disaster. (Stephen Stromberg, 1/9)

Lawsuits aimed at eviscerating the Affordable Care Act have been lining up in federal courts like airliners on America's taxiways. Most are frivolous or partisan or both, and some have already been tossed. The Supreme Court on Friday will ponder whether to hear one that actually has some merit. Half of it has merit, anyway. Coons v. Lew is a double-barreled attack on Obamacare's individual mandate and its Independent Payment Advisory Board, or IPAB. The latter is a board empowered to hold Medicare spending below an inflation-indexed ceiling, chiefly by imposing cuts on provider reimbursements. The constitutionality of the individual mandate has already been considered and settled by the Supreme Court, so that part of Coons v. Lew is a loser. But IPAB hasn't been examined, and it should be -- and quite possibly eliminated. (Michael Hiltzik, 1/9)

What I am arguing is that weakening the employer mandate is not going to get [Republicans] any closer to repealing Obamacare. Indeed, the reverse is true. If they actually succeeded in getting this bill passed into law, all they would do is further entrench the 2010 health-care bill. After all, a weaker employer mandate will push more people onto the exchanges. Many of those people would be receiving subsidies. The more people who receive subsidies, the harder repeal of the whole law will be. And since the exchanges, and the associated regulations, are the law's most problematic part, it's hard to see why Republicans want to push more people into that part of the system (Megan McArdle, 1/9)

Today, as one of 1.6 million Americans living in Europe, I instead face hard questions about our nation. Wherever I travel, Europeans, Asians and Africans ask expatriates like me to explain everything odd or troubling about the conduct of the United States. ... At the absolute top of the list: "Why would anyone oppose national healthcare?" Many countries have had some form of national healthcare since the 1930s, Germany since 1880. Some versions, as in France and Britain, have devolved into two-tier public and private systems. Yet even the privileged would not begrudge their fellow citizens government-funded comprehensive healthcare. That so many Americans do strikes Europeans as baffling, if not brutal. (Ann Jones, 1/11)

It would be stupidly optimistic to assume [Gov.-elect Greg] Abbott, who has spent the last several years fighting the ACA, is suddenly willing to negotiate with the federal government on Medicaid expansion, particularly with the very conservative Legislature about to convene. But momentum for some kind of solution for covering uninsured Texans seems to be building, and even he can’t avoid being caught up in it. (1/9)

The decision by the state Supreme Court that dissident legislators have standing to contest the constitutionality of Medicaid expansion has put Gov. Doug Ducey in quite a pickle. ... During the campaign, Ducey expressed opposition to the Medicaid expansion. And the two-thirds vote requirement for increases in state revenues is a fiscal conservative totem. So Ducey will be under pressure from the right to stop defending the lawsuit and admit its unconstitutionality. Ducey, however, probably doesn't really want to see the lawsuit go away, at least just yet. For one thing, if the assessment goes away, it will rip another big hole in the state budget, since the assessment pays not only for the Obamacare expansion population but childless adults already covered by Medicaid under a ballot proposition approved by voters. (Robert Robb, 1/9)

The ACA has made it possible for roughly 12 million Americans to gain health coverage. Maddening to Republican critics, it has not exploded the federal deficit as they predicted. That deficit has been declining. Nor has it blown up medical costs. North Carolina’s spending on Medicaid has declined. The insurance industry, which has long opposed any health care reform that might reduce its profits, has benefited from having more people covered with private insurance, which is what Obamacare mandated. But North Carolina, along with some other states controlled by Republicans, has stubbornly refused to do the humanitarian thing by half a million people who need coverage and the financially sensible thing by allowing expansion of Medicaid. (1/10)

The $164.7-billion budget that Gov. Jerry Brown proposed Friday for the coming fiscal year highlights the glass-half-empty nature of California's improving fortunes. ... One consequence of the high poverty rate is that a huge chunk of the state budget — more than 30% — is projected to be spent on safety net programs. The biggest of those is Medi-Cal, the joint federal-state health insurance program for the poor, which covers almost a third of all Californians. Driven in part by increased enrollment in Medi-Cal, the administration expects to spend $1.4 billion more on health and human services in the coming fiscal year than in 2014-15. And that's not even factoring in the cost of extending Medi-Cal, in-home supportive services and other health benefits to low-income immigrants who recently gained temporary legal status through President Obama's executive action. (1/11)

We went from one extreme to the other, and I’ve lived through the whole thing. It’s like I moved from California to Louisiana without moving. Without lifting a finger, I changed states. I was trained as a family physician here in Phoenix. I rotated through Planned Parenthood here in Phoenix, and I liked what I was doing, so I continued training and working there for the first five years until 1999, and then I opened my own office, Camelback Family Planning. At the time, it was a doctors office. And then I started doing abortions in my office. ... Literally I needed a pulse oximeter to monitor their vitals, a vacuum machine and staff and a recovery room, and the knowledge and skills to do it. That could never happen now. You have to be a licensed abortion clinic, and have inspections, and all kinds of things that didn’t exist in the year 2000. (Lydia DePillis, 1/9)