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A Supreme Court ruling this spring could upend health insurance markets in at least 34 states, eliminating the federal subsidies that make coverage affordable for millions of Americans. State governments, theoretically, have ways to forestall this outcome. But few have taken action. If they wait until the court rules, it may already be too late for a state to get started on an exchange so that it is ready for 2016. (Margot Sanger-Katz, 12/11)

Republicans do not have the votes to repeal the Affordable Care Act in the next Congress. A bill revising the health-care law looks more likely, presuming Senate Republicans can forge a united front and then pick up some doubting Democrats to get the votes necessary to overcome a presidential veto. The prospect of such an outcome could force the president to work out a bipartisan reform package in an effort to head off a showdown that many in his party may not want. (Robert Litan, 12/11)

You may have noticed when you last subscribed to a magazine that the company put you on an automatic renewal plan. ... Auto-renewals are also a key feature of the Affordable Care Act’s insurance marketplaces. ... The same forces that lead people to stick with an expensive cellphone plan or to watch the television program that follows their favorite show come into play with health insurance. But inertia is even stronger when it comes to insurance than many other markets, because people find shopping for a health plan to be so confusing and unpleasant. There are also real trade-offs in changing health insurance — a better premium may come at the cost of your favorite doctor, for example. (Margot Sanger-Katz, 12/11)

It's no secret that Medicaid struggles to attract as many doctors as other health-care plans do. Less clear is what makes that so hard. Everyone assumes it's all because of Medicaid's low payment rates. But a government watchdog suggests it may have more to do with the way states run the program. (12/11)

Two of the most heavily Republican states, Utah and Wyoming, appear to be moving closer to an expansion of Medicaid under the Affordable Care Act. Other GOP-dominated states, like Indiana and Tennessee, are also looking more closely at it, despite the hostility of their party’s leaders toward Obamacare. The reasons are no mystery. Conservative governors and lawmakers in those states are acknowledging that it is profoundly illogical to deny the benefits they would reap — both budgetary and humanitarian — by accepting federal funding to provide health insurance for tens or hundreds of thousands of low-income residents. (12/11)

Vermont's move to a single payer health care system moved a bit closer to reality — or at least a realistic assessment — last week when some people in the know leaked part of the proposed financing mechanism to the media. That part is an 8 percent payroll tax on all Vermont employers. ... Where will the other half come from? The simplest source would be the same 8 percent payroll tax levied on employees. ... Financing Vermont's single payer health care system entirely through payroll taxes would mean a very large payroll tax — more than we now pay in Social Security taxes. That's not acceptable to single payer advocates, who want to get a lot of the funding from wealthy Vermonters, which means using the income tax. (Art Woolf, 12/11)

But the problem for Democrats is that Gruber is not stupid. By all accounts, he is knowledgeable, candid and willing, on occasion, to criticize the Obama administration — an advocate for Obamacare without being a shill. But he is perfectly representative of a certain approach to politics that is common in academic circles, influential in modern liberalism and destructive to the Democratic Party. (Michael Gerson, 12/11)

In my career as a medical doctor and global health policy maker, I have been in the middle of monumental struggles, including fights to make treatment accessible in the developing world for those living with H.I.V./AIDS as well as multi-drug resistant tuberculosis. But the Ebola epidemic is the worst I’ve ever seen. (Jim Yong Kim, 12/11)

This positive development on food, however, is in stark contrast to the United States’ approach to India’s policies on affordable medicines. On Nov. 24, while the food deal was being finalized in Geneva, Michael B. Froman, the United States trade representative, was in India to demand reform of its patent laws. Those laws are friendly to generic medicines and public health, and the United States wants them restructured to favor American pharmaceutical corporations, often called Big Pharma. (David Singh Grewal and Amy Kapczynski, 12/11)