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Republican presidential candidates—and members of Congress—are proposing ways to replace or repair the Affordable Care Act. Undoing the damage of ObamaCare may finally become a realistic possibility. For now, Americans are experiencing the law’s natural consequences: rising health-insurance premiums and limitations on individuals’ choice of physicians and hospitals. Further consolidation in the insurance industry and among providers will likely drive health-care costs even higher. To reverse these trends, any replacement for ObamaCare should include two essential elements: high-deductible insurance coverage and health-savings accounts. (Scott W. Atlas and John F. Cogan, 9/1)

In a remarkably incoherent and injudicious opinion favoring the anti-abortion organization March for Life, U.S. District Judge Richard J. Leon of Washington, D.C., ruled Monday that the religious rights of employees of a secular anti-abortion organization are infringed because they're required to buy health insurance that covers contraception, even though nothing forces them to actually acquire contraceptives if they don't wish. (Michael Hiltzik, 9/1)

What’s so special about religion? When it comes to exemptions from general laws, whether regulating gay marriage or contraception, no question is more important -- or more complicated. The federal district court in Washington answered that question Monday by saying religion is nothing special. The court held that the Department of Health and Human Services is obligated to give the same exemption to a nonreligious group that has a principled reason to deny its employees contraceptive health-care coverage that the department already gave to religious groups with analogous views. This conclusion was almost certainly correct as a matter of moral logic. But it’s far from clear that it was correct as a matter of law. (Noah Feldman, 9/1)

The nation's healthcare system is endangering the elderly. But few outside the geriatric medical community seem to notice. I learned about this problem the hard way — when caring for an aging parent. My father, a highly regarded orthopedic surgeon, developed Alzheimer's when he turned 78. As his disease worsened, so did the stress of trying to navigate the healthcare system. (Marcy Cottrell Houle, 9/1)

New drugs to treat hepatitis C are tremendously effective — and tremendously costly — raising fears that the high prices might outstrip the ability of public and private insurers to pay. Fortunately, competitive market forces and hard-nosed bargaining by insurers for big discounts are going a long way toward resolving the problem. (9/2)

Along with the nation’s sharp jump in heroin overdoses has come a startling revelation, often called “the new face of heroin.” It is a white face, mostly middle-class and suburban, “far from the stereotype of the shivering urban junkie,” as the Christian Science Monitor put it this year. (Courtland Milloy, 9/1)

Montana's Medicaid expansion plan, the Health and Economic Livelihood Partnership Act, is a hard-won compromise that promises to offer coverage to as many as 70,000 Montanans. The state says it is on track to launch the program within a matter of months, and could begin providing coverage as soon as Jan. 1, 2016. But first, the plan requires federal approval -- and a waiver -- from the Centers for Medicare and Medicaid Services. And who knows how long that could take? Fortunately, Montanans have one week left to offer public comment telling the feds how important this program is -- and how important it is to get it up and running as soon as possible. (9/1)

In challenging the constitutionality of the hospital assessment paying for Arizona’s Medicaid expansion, it’s clear that the Goldwater Institute bet too much on the argument that the assessment is a tax. ... The Institute needs to retool the relative weight of its argument if it wants to have a chance on appeal. (Robert Robb, 9/1)

On June 1, 2015, the Centers for Medicare & Medicaid Services (CMS) proposed a long-overdue overhaul of Medicaid managed care that, among other provisions, will implement ACA requirements for states to collect a standard set of encounter data—detailed records of services delivered to beneficiaries—from Medicaid managed care organizations (MCOs). Encounter data are the only way to know whether the majority of Medicaid enrollees are receiving the care they need, that the care is of adequate quality, and that it is delivered at the lowest possible cost. ... Although the proposed rule could be finalized as early as 2016, many challenges remain for its implementation. States have been slow to adapt their data collection systems to the growth of managed care. (Philip Rocco, Walid F. Gellad and Julie M. Donohue, 8/31)

In January, Secretary Sylvia Burwell announced that the US Department of Health and Human Services will tie 90% of Medicare payments to quality or value by 2019. ... Paying for value will not work unless it can be measured. The ability to assess health care quality and health outcomes has significantly improved over the past several decades. ... At the same time, national improvement is not occurring fast enough given the resources expended on measurement and reporting. Too much care is of uncertain value, and many opportunities to deliver care of proven value are missed. There continue to be challenges in patient safety, ensuring that health care meets a person’s goals and needs, and providing reliable care that reflects the best evidence. (Christine K. Cassel and Richard Kronick, 9/1)

We are not “healers.” We almost never truly heal a patient of a serious disease, certainly not death. We are “treaters” who should try to help each individual patient deal with his or her problem to the best of our ability. Sometimes, for a dying patient, the option of an easy, assisted death is the most merciful, caring, and, I believe, ethical way to do that. I personally also believe that if a person knows he is dying, he should not be forced to wait until the unpleasantness actually begins. As in Oregon, he should be given the opportunity to die at his own time of choice. I personally choose to die before becoming bedridden or infection sets in, after I have tied up my loose ends and made the transition as easy as possible for my wife and family. (Dr. M. John Rowe III, 9/1)