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Three years ago, a gruff-sounding Chief Justice John G. Roberts Jr. asked a question during the marathon hearings on the constitutionality of the Affordable Care Act about whether the mandate that individuals buy health insurance was really more like a tax on those who do not. It got a little bit lost in the blizzard of words that accompanied the hearings, but turned out to be the foundation of Roberts’s opinion saving Obamacare. Now, in the analysis of Wednesday’s King v. Burwell hearing, Roberts might be overlooked again. (Barnes, 3/5)

Whether Obamacare survives its latest trip to the Supreme Court surprisingly could come down to a question of the federal government's power over the states. After nearly 90 minutes of oral arguments Wednesday, there's generally agreement the expected ruling in the case -- questioning the legality of subsidies for millions buying health insurance through 34 federal-run exchanges -- is too close to call. Chief Justice John Roberts, the pivotal swing vote upholding the Affordable Care Act three years ago, gave away nothing that would show which way he's leaning. Justice Anthony Kennedy, who voted to strike down the entire law last time, asked tough enough questions of both the plaintiffs and the federal government that indicated his vote could be in play. (MIllman, 3/5)

Chief Justice John G. Roberts Jr. usually displays his supple intellect and competitive nature at Supreme Court arguments, where he makes points and punctures the positions of the lawyers who appear before him. But on Wednesday, hearing one of the most important cases in his almost 10 years on the court, he turned into a sphinx. He asked just a few questions as other justices repeatedly talked over one another during arguments over the fate of President Obama’s health care law. (Liptak, 3/5)

The last time Obamacare faced the Supreme Court, it was Chief Justice John Roberts who made the deciding vote to save the health care law. This time Obamacare’s savior may actually be a man who tried to kill it three years ago and his reason may have nothing to do with health care. (Ehley, 3/6)

Mixed signals from the Supreme Court have states on edge about the future of health insurance subsidies for millions of Americans. And a summer decision from the justices leaves little time for backup planning. Many governors, especially Republicans, want the federal government to craft a contingency plan and at least one governor — in Pennsylvania — is pursuing a state exchange, which would make sure his state was able to receive the subsidy. (Kennedy, 3/5)

Justice Samuel Alito ’s suggestion that the Supreme Court could delay for months the impact of a decision to gut the health law revives the possibility that at least a dozen states could take action to limit the effect of such a ruling. Justice Alito’s remarks came Wednesday during oral arguments in a case that seeks to halt the use of tax credits to offset the cost of insurance premiums for residents in about three dozen states that don’t operate their own insurance exchanges and use the federal HealthCare.gov site instead. Challengers in the case argue the law allows the tax credits only for insurance buyers in states with their own exchanges—currently just 13 states. (Radnofsky and Bravin, 3/5)

During oral arguments before the U.S. Supreme Court Wednesday in King v. Burwell, Justice Samuel Alito suggested that there is a relatively simple fix to the problem of residents in up to 37 states that haven't established their own exchanges potentially losing access to premium subsidies. Alito is correct in the hypothetical sense. ... But realistically, the logistical, financial and—perhaps most crucially—political hurdles would so significant that few states seem capable of overcoming them. (Demko, 3/5)

As the nation awaits a Supreme Court ruling on Obamacare, lawmakers in many states are moving ahead with a range of Affordable Care Act bills, some of which seek to bolster the law and others that are bent on derailing it. The Supreme Court case, King v. Burwell, focuses on subsidies paid to millions of Americans who bought health insurance through exchanges set up under the Affordable Care Act. At issue: whether subsidies issued through exchanges operated by the federal government are legal. By the end of June, the justices are expected to issue a ruling, which could either uphold the law as it now operates or strike down those subsidies for good. (Schulte, 3/5)

Hospitals are just beginning to hash out contingency plans as the waiting begins for the U.S. Supreme Court to decide whether to end insurance subsidies in most of the country. Some of the financial gains that hospitals have experienced from having a greater number of insured patients may be erased if the court rejects the use of subsidies for individuals who purchase health plans from the federal exchange. (Evans and Kutscher, 3/5)

Though Obamacare’s biggest problem right now is a Supreme Court case that threatens the presidents subsidized health care law, federal auditors are calling attention to another problem that could present even more challenges down the road—and that’s the functionality of HealthCare.gov. ... a review of the website and its massive repair effort by the Government Accountability Office released this week, reveal there are still plenty of issues, both tech-related and managerial, that continue to disrupt the massive system that services millions of people living in 34 states that did not create their own exchanges. (Ehley, 3/5)

The Department of Health and Human Services must do more to fix the problems that led to the botched 2013 rollout of its healthcare market website, Healthcare.gov, according to a new federal report. (Pierson, 3/5)

California did a better job of enrolling more minorities and young people for health care coverage during the second year of expansion, but a shortfall in overall enrollment could lead to increased fees in the future, according to new state data released Thursday. Covered California released enrollment figures showing the percentage of Latinos and African-American enrollees increased from last year. The state also reported a younger mix of new enrollees, which ensures a good risk pool for insurers. (Lin, 3/5)

The percentage of Latinos and African Americans who signed up for subsidized health coverage through California’s insurance exchange increased modestly during the second annual open enrollment period, officials announced Thursday. About 37 percent of subsidized enrollees are Latino, up from 31 percent during the first enrollment period ending in March 2014, according to data released by Covered California. About 4 percent are African American, up from 3 percent last year. The numbers, released by Covered California during its monthly board meeting, include only those enrollees eligible for subsidies who responded to questions about their race or ethnicity. (Gorman, 3/6)

The state health insurance exchange said Thursday the forecasted budget for its customer service center in fiscal year 2014-15 has increased to $21.1 million, driven by ongoing online enrollment problems. A previous forecast made in early February by Connect for Health Colorado staff had called for $18.1 million. (Draper, 3/5)

News that Gov. Sam Brownback has softened his position on Medicaid expansion wasn’t exactly racing through the Statehouse on Thursday. But it certainly had some legislators buzzing. In remarks Wednesday to conservative lawmakers in Missouri, Brownback said if the Kansas Legislature presented him with a budget-neutral expansion bill, he would likely sign it. (McLean, 3/5)

Several hundred people gathered at the state capitol Thursday to protest a decision by lawmakers to reject the governor's Medicaid expansion plan. A slate of lawmakers, religious leaders and people with chronic health issues spoke during rally that lasted two hours. The speakers insisted that the plan introduced by Utah Republican Gov. Gary Herbert to help low-income people who don't have access to health insurance go to the House floor for a vote. (Catalfamo, 3/6)

Utah officials are weighing a Medicaid expansion plan that would freeze enrollment under the alternative program championed by Republican Gov. Gary Herbert and allow for a less generous program to be implemented after Healthy Utah runs its initial two-year course. (Pradhan, 3/5)

House Democrats made a bold but unsuccessful move Thursday night to revive Gov. Gary Herbert's "Healthy Utah" plan to expand Medicaid for the poor — and ignited a small war with infuriated House Republicans. While the attempt failed, Democrats did manage to get a recorded vote that put all House members on the record as essentially a friend or foe of Healthy Utah. The attempt died 16-56. Rep. Justin Miller, D-Salt Lake City, made a motion to bring a Senate-passed bill, SB164, promoting the governor's plan, to the House floor even though it had been defeated in committee on Wednesday. (Davidson, 3/5)

The Wyoming House of Representatives this week passed a bill reducing funding for critical access hospitals treating uninsured patients from $5 million — as a Senate bill allocated — to $1 million. The measure comes as Wyoming hospitals are struggling with uncompensated care while lawmakers balk at the idea of Medicaid expansion and other financial options. (Brino, 3/5)

The legal campaign to destroy President Obama’s health care law may be nearing its conclusion, but as the Supreme Court deliberates over the law’s fate, the search for a replacement by Republican lawmakers is finally gaining momentum. Senior Republicans in Congress hope that by June, the Supreme Court will invalidate the subsidies that 7.5 million Americans in 34 states have been given to purchase health insurance through the federal Healthcare.gov website. (Weisman, 3/6)

Freshman Republican Sen. Ben Sasse has introduced a bill designed to get his party out of the political problems that could arise if the Supreme Court rules against the White House over Obamacare subsidies — without having the GOP embrace the health law. (Haberkorn, 3/5)

The Supreme Court heard arguments in King v. Burwell this week, but lawmakers were listening closely too. The issue before the court is whether citizens of states that are using the federal insurance exchange are eligible for subsidies, amid a dispute over wording in the law. If the court finds those people aren’t eligible, more than seven million people in as many as 37 states could lose those supports, making insurance prohibitively expensive. (Chinni, 3/5)

A group of Senate Democrats on Thursday introduced a bill that would provide free birth control to women enrolled in Medicaid, while also expanding access to preventative services nationwide. Sen. Patty Murray (D-Wash.), the top Democrat on the Senate health committee, said the bill would allow more women “to be in the driver’s seat about their own health care.” (Ferris, 3/5)

More than two-thirds of women with unplanned pregnancies rely on public assistance, costing $51 billion each year, according to a new study. Unplanned births are almost twice as likely to require public assistance than planned births, according to new research from the nonprofit Guttmacher Institute. (Ferris, 3/5)

After five suicidal veterans walked out of the emergency room without getting help during a single week in January, Brandon Coleman brought his concerns to his supervisor at the VA Hospital in Phoenix. Coleman, a therapist and decorated veteran, urgently warned that there was a broader problem with how suicidal patients were being handled. Six days after he spoke with his boss, Coleman recalled, he was suspended from his job. He believes it was in retaliation. (Wax-Thibodeaux, 3/5)

Congress says more still needs to be done to reform the Veterans Affairs Department nearly a year after the waiting list scandal was exposed, and despite a bill last summer designed to correct the bureaucratic flaws that led to veterans getting poor care. The House voted earlier this week to let the VA secretary take back bonuses from senior executives who are later found to have manipulated wait-time data, which was a key ingredient of last year’s scandal. (Klimas, 3/5)

Federal officials have initiated investigation into mental health services available for returning soldiers in central Iowa after a veteran was found dead last month in a Des Moines park. The office for U.S. Sen. Joni Ernst announced Wednesday that the U.S. Department of Veterans Affairs Inspector General's office has agreed to review the programs provided at the VA Central Iowa Health Systems. Ernst issued a request on Feb. 23 following the death of 41-year-old Richard Miles, whose body was found frozen at Water Works Park a few days earlier. (3/5)

A significant part of Governor Charlie Baker’s proposal to tame a projected $1.8 billion state budget shortfall involves squeezing savings out of Medicaid, the state-federal health care program for the poor and disabled, which has ballooning costs. (Miller, 3/5)

Gov. Charlie Baker's administration is detailing a proposal to trim $761 million in Medicaid spending, a key part of its overall plan for keeping the state budget in balance. Administration officials said Thursday about 60 percent of the Medicaid savings would be achieved by moving some provider payments due in the next fiscal year to the following year. They said that would give the administration more time to craft long-term solutions for reining in Medicaid. (3/5)

Leaning heavily on the extraction of savings from MassHealth to balance their state budget proposal, top Baker administration health officials on Thursday said that changes to benefits for patients were mostly taken off the table, but the administration may look at co-payments or other commercial market solutions to control cost growth in the future. (Murphy, 3/5)

Legislation that would do away with personal-belief exemptions for childhood vaccines, filed in response to the recent measles outbreak in California, has quickly emerged as one of this year's most polarizing bills. One interest jumping into the fray: chiropractors. (Mason, 3/5)

Tucked into Gov. Scott Walker's proposed budget is a massive overhaul of the system that provides long-term care to more than 50,000 elderly or disabled people in Wisconsin — a dramatic change that blindsided those currently managing the care. (Boulton, 3/6)

Utah lawmakers put on hold Thursday a legislative proposal that would have created a process to allow terminally ill Utahns to obtain prescription medication they could self-administer “for a humane and dignified death.” After hearing emotional testimony on both sides on HB391, the proposed Utah Death with Dignity Act, the House Health and Human Services Committee voted to refer the issue to interim study. (Cortez, 3/5)

The California Supreme Court this year is poised to decide what further limitations -- if any -- should be placed on third-party investigators' access to the state's prescription drug monitoring database. (Infantino, 3/5)

Financial pain has spread across the Georgia hospital industry, from rural facilities to urban systems. Since the beginning of 2013, five hospitals in the state have closed, and four of those were in rural areas, where patients often have no easily accessible alternatives. On the urban side, two Columbus hospitals have announced moves to counter financial pressure. (Miller, 3/5)

Campbell County's need for medical internists is getting worse. Two internists this week notified Campbell County Memorial Hospital that they will be leaving this fall. The departures come as the hospital has already identified a need to recruit one full-time internist. (3/5)

Layoff notices are going out to employees at a state mental health institution in Mount Pleasant that is slated for closure. [Iowa] Department of Human Services spokeswoman Amy McCoy says Thursday that notices had gone out to 36 workers. The layoffs will be effective April 6. There currently are about 74 people working at the facility. (3/5)

The spouses of two West Coast dockworkers and a doctor have sued a union health insurance plan for longshoremen, alleging millions of dollars in legitimate unpaid claims in the last two years. The suit, which seeks class-action status, comes just after shipping companies and dockworkers with the International Longshore and Warehouse Union resolved a long-standing labor dispute that led to severe congestion at West Coast ports in recent months. (Kirkham, 3/5)

Young is among seven patients at UCLA who were infected with a hard-to-treat “superbug” that hospital officials traced to two specialized scopes that they said were contaminated despite being thoroughly cleaned. Two of the patients later died, and scores more were potentially exposed. After the incident became public, the Food and Drug Administration warned that the devices, called duodenoscopes, can be difficult to sanitize and “may facilitate the spread of deadly bacteria.” (Dennis, 3/5)

A popular contraception program in Colorado is receiving criticism from conservative lawmakers who say that the program's use of intrauterine devices, or IUDs, qualify as abortions. More than 30,000 women in Colorado have gotten a device because of the state program, the Colorado Family Planning Initiative. An IUD normally costs between $500 and several thousand dollars. Through the program women could receive one for free. (Verlee, 5/5)

Despite sharp increases in spending on cancer treatment, US cancer mortality rates decreased only modestly .... Our article [compares] the United States to the broad benchmark of all twenty countries in Western Europe between 1982 and 2010. ... Our study has two central findings. First, the number of deaths averted in the United States compared to all of Western Europe from 1982 to 2010 varied substantially by cancer type. The United States averted the largest number of deaths for stomach and colorectal cancer and experienced the largest number of excess deaths for lung cancer and non-Hodgkin’s lymphoma. ... Second, the additional value derived from costlier US cancer care also varied considerably by cancer type. (Soneji and Yang, 3/2)

In 2014, the second year of [Medicare’s value-based purchasing (VBP) program], patient mortality measures were added to the VBP program’s algorithm for assigning penalties and rewards. We examined whether the inclusion ... had a disproportionate impact on safety-net hospitals nationally. We found that safety-net hospitals were more likely than other hospitals to be penalized under the VBP program as a result of their poorer performance on process and patient experience scores. ... However, safety-net hospitals’ performance on mortality measures was comparable to that of other hospitals ... Although safety-net hospitals are still more likely than other hospitals to fare poorly under the VBP program, increasing the weight given to mortality in the VBP payment algorithm would reduce this disadvantage. (Gilman et al., 3/2)

This study analyzes how five state-based marketplaces (SBMs)—those of California, the District of Columbia [D.C.], Kentucky, Minnesota and Washington—addressed and experienced [special enrollment periods] SEPs in 2014. ... We also studied how these five SBMs coordinated with their state Medicaid programs to enroll people losing Medicaid coverage into marketplace plans. Our study finds that marketplace systems and consumer outreach and enrollment efforts are still in progress and do not yet match the significant potential for SEP enrollment in the five study SBMs. ... we identify four themes related to SEP implementation in 2014 that highlight common challenges. Though some challenges flowed from first-year implementation issues, some will likely recur in future years. (Wishner et al., 2/25)

On February 20, 2015, the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services published its massive Notice of Benefit and Payment Parameters (BPP) for 2016 final rule, accompanied by a fact sheet. This rule addresses a host of issues involving the continuing implementation of the Affordable Care Act for 2016. A few provisions, however, affect the 2015 year as well and a number of provisions will not be implemented until 2017. (Timothy Jost, 2/22)

In the past four years the FDA has received nearly 6,000 expanded access applications [for experimental drugs] and denied just 33. However, critics of the program argue that the process is too cumbersome and that it discourages many patients and physicians from applying. Since last year, more than 20 states have introduced laws aimed at making experimental therapies more easily accessible to patients with terminal illnesses, five of which have been signed into law. ... Supporters argue that patients have the right to determine what risks they are willing to undertake to save their own lives ... Opponents argue that such laws may introduce new risks for patients while undermining laws meant to protect public safety. The ultimate effects of these state-level efforts are still unclear, and their constitutionality is open to question. (Richardson, 3/5)

In 2011, the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) published a practice guideline recommending against perioperative antibiotic use for pediatric tonsillectomy. ... [This study sought] to determine the impact of the AAO-HNS guideline ...This was a quasi-experimental study including 9,265 children who underwent routine tonsillectomy from January 2009 through August 2012 ... Immediately after guideline publication, perioperative antibiotic use dropped by 86.5% .... Rates of otolaryngology clinic encounters, emergency department encounters, and hospital admissions did not change significantly over time. There was a small but statistically significant increase in surgical procedures for bleeding. (Milder et al., 2/26)

[Researchers sought to] describe the prevalence of colonoscopy before age 50, when guidelines recommend initiation of colorectal cancer screening for average risk individuals. We assembled administrative health records that captured receipt of colonoscopy between 40 and 49-years of age for a cohort of 204,758 50-year-old members of four US health plans ... We also used self-reported receipt of colonoscopy from 27,157 40- to 49-year-old respondents to the 2010 National Health Interview Survey (NHIS) ... About 5% of the health plan cohort had a record of colonoscopy before age 50. Receipt of early colonoscopy increased significantly from 1999 to 2010, was more likely among women than men and in the east coast health plan compared to west coast and Hawaii plans. (Rutter, 2/24)

The Supreme Court is considering a case – King v. Burwell – that challenges the legality of premium and cost-sharing subsidies for low- and middle-income people buying insurance in states where the federal government rather than the state is operating the marketplace under the Affordable Care Act (ACA). ... People receiving subsidies make up 87% of those who have signed up for coverage for 2015 in states using the federal marketplace. For the vast majority of them, coverage would be unaffordable without the subsidies. The subsidies average $268 monthly per person and cover 72% of the premium ... With the subsidies eliminated, those who had been receiving them would face an increase in their out-of-pocket premiums averaging 256%. (Levitt and Claxton, 2/25)

The King v. Burwell petitioners are challenging the legality of the IRS regulation allowing premium subsidies in states with a Federally-run Marketplace as contrary to the language of the ACA. This issue brief examines the major questions raised by the King case, explains the parties’ legal arguments, and considers the potential effects of a Supreme Court decision. (Musumeci, 2/25)

While a ruling against the Administration would preclude paying those subsidies to individuals who obtain coverage through the federally run exchange, that would merely add one more effect to the ongoing complexity and cascade of adverse effects produced by the law’s complex and flawed design. Congress and the states should therefore seize the opportunity and clear the way for patient-centered, market-based reforms to take root in the states. To start, Congress should devolve the regulatory authority over insurance back to the states. In anticipation of such an exemption, states should use their authority now to put in place their own policies governing insurance. (Owcharenko and Haislmaier, 2/27)

A new study of Medicare and private insurance claims confirms that treatment trends for localized prostate cancer differ by U.S. region, by state and even from county to county. Overall, though, researchers found that newer, less invasive technologies, like laparoscopic prostate removal, have supplanted older treatment methods like open surgery over time. (Doyle, 3/4)

The Medicare prescription-drug benefit introduced in 2006 saved an estimated 19,000 to 27,000 lives in its first year by expanding access to medications that treat cardiovascular killers like strokes and heart disease, according to new research from the Federal Reserve Bank of San Francisco. “While the exact magnitude of the number of lives saved depends on the particular specification, the basic result of a decline in cardiovascular-related deaths is shown to hold up across a multitude of robustness tests,” economists Abe Dunn and Adam Hale Shapiro wrote this month in a working paper, “Does Medicare Part D Save Lives?” The Part D benefit, enacted by Congress in 2003 and introduced in 2006, subsidized drug coverage for elderly and disabled Americans through the Medicare program. (Leubsdorf, 2/20)

Long-acting but reversible methods of birth control are becoming increasingly popular among U.S. women, with IUDs redesigned after safety scares and the development of under-the-skin hormone implants, a government report shows. Birth control pills remain the most popular contraceptive method nationwide, but intrauterine devices and implants are more effective at preventing pregnancy and they last for several years. (2/24)

When women who are family planning experts need to pick a birth control method for themselves, what do they generally choose? Not the same thing the average woman chooses, a new study found. About 42 percent of the family planning experts in the study used long-acting reversible contraceptives (LARCs) – a choice made by only about 12 percent of women in the general population. (Seaman, 2/24)

Regardless of how they frame the discussion, doctors who deliver bad news may be seen as less compassionate by their patients, a new study suggests. Patients who watched videos of fictional interactions between doctors and patients felt the doctors delivering bad news were less compassionate than those giving good news, researchers found. Until recently, doctors and researchers believed that doctors who delivered bad news in an empathetic tone would be seen as sincere, said Dr. Eduardo Bruera, the study’s lead author from the University of Texas MD Anderson Cancer Center in Houston. But it seems the news itself has an impact on the way patients see doctors. (Seaman, 2/27)

A wide majority of pediatricians and family physicians acquiesce to parents who wish to delay vaccinating their children, even though the doctors feel these decisions put children at risk for measles, whooping cough and other ailments, a new survey has found. Physicians who reluctantly agreed said they did so to build trust with families and to avoid losing them as patients. The survey, published Monday in the journal Pediatrics, asked a nationally representative sample of 534 primary care physicians in 2012 how often parents in their practices postponed one or more vaccinations for children younger than age 2. (Saint Louis, 3/2)

States that agreed to expand coverage of Medicaid to more Americans under the Affordable Care Act have created more jobs than other areas of the country, according to a new report. Fitch Ratings said “healthcare and social assistance jobs grew over 30% faster between December 2013 and December 2014 for 24 states that implemented ACA expansion on Jan. 1, 2014 than those that did not.” (Japsen, 2/20)

The health care law may result in roughly 20.3 million additional primary care visits nationally, about a 3.8 percent increase, according to a new state-by-state analysis by the Commonwealth Fund. Primary care visits are expected to grow more than hospital inpatient visits, which are likely to increase by 3.1 percent, or hospital outpatient visits, which may rise roughly 2.6 percent, the study said. (Adams, 2/25)

The number of heroin-related deaths rose by nearly 40 percent in 2013, according to data from the Centers for Disease Control and Prevention. CDC reported that about 8,257 people died in 2013 of causes related to heroin use, including unintentional fatalities and suicides linked to the drug. That's a marked increase from the 5,925 fatalities reported for the previous year. And the 2013 figure also marks a more than doubling in the number of heroin-related deaths from the 3,036 reported for 2010. (Young, 3/3)

At oral arguments before the Supreme Court yesterday, two of the conservative justices — Samuel Alito and Antonin Scalia — both floated versions of the idea that, if the Court does strike down Obamacare subsidies in three dozen states, it might not be that big a deal, because surely lawmakers would then fix the problem and avert disruptions for millions. ... But here’s the thing: It seems likely that it will only get harder later this year — not easier — for Republicans to fulfill any promise of a backup plan, either on the state or federal level. By then the 2016 GOP presidential primary will be in full swing, and continued Total War resistance to Obamacare — in the form of opposition to any fix that Obama and Democrats will be demanding — could very well emerge as a conservative litmus test. (Greg Sargent, 3/5)

Opinions about the big Obamacare case the Supreme Court heard this week are highly polarized. But the court could find a way to split the difference between the conservative and liberal readings of the law -- and that might be the worst of all worlds. ... It could find that the conservative reading of the law -- that states must create exchanges if they want the subsidies -- is right. But it could also say that the federal government has no right to set that kind of condition on states -- that doing so would violate the constitutional principle of federalism. By that logic, the subsidies could be allowed to continue. (Ramesh Ponnuru, 3/5)

One obvious government program that, at least at this point, is still underutilized is the Affordable Care Act. According to a recent survey from the Kaiser Family Foundation, there are still about 30 million adults in the U.S. who are without health insurance—almost half of whom (48%) would qualify for subsidized insurance from the exchange. (Mike Piper, 3/5)

After a century of fierce political debate in the U.S. over national health insurance, the fate of our new, near-universal coverage system almost certainly will be determined by either [Chief Justice John] Roberts or Justice Anthony Kennedy. If both of them vote to strike down premium subsidies in as many as 37 states using the federal insurance exchange, that could be the beginning of the end for the Affordable Care Act. But they could rule in a way that preserves the subsidies for now while putting healthcare reform at the center of the 2016 elections and letting American voters decide the issue. (Harris Meyer, 3/5)

The much-awaited Supreme Court oral argument in King v. Burwell took place Wednesday. A review of the transcript indicates that the lawyers – Solicitor General Donald Verrilli and Petitioners’ Counsel Michael Carvin – brought their A game. And so did the justices. Here are some quick-analysis thoughts. (James Blumstein, 3/5)

As I noted on Wednesday, Justice Anthony Kennedy expressed little sympathy for the federal government’s textual arguments in King v. Burwell, but he did seem concerned about the federalism implications of reading the ACA statute as urged by the plaintiffs. Although there are already several VC posts discussing the federalism issues in King, I thought it was worth exploring the nature of Justice Kennedy’s apparent constitutional concern, and its potential implications, in a bit more depth. (Jonathan H. Adler, 3/5)

If you're going to lose a limb at work, try to avoid doing it in Alabama. That's the gist of a new investigative report by ProPublica, partnered with National Public Radio, which explores the inequities and blatant unfairness within the workers' compensation system (Alabama has the nation's lowest benefits). (Scott Martelle, 3/5)

Jim Makichuk bought a 5-gram tube of Zovirax, a prescription cold-sore cream, a few years ago in Canada for $34.65. That was the over-the-counter price; no insurance involved. He recently purchased a fresh 5-gram tube from a Kaiser Permanente pharmacy in Los Angeles. It cost him $95, or nearly three times as much as the Canadian price — with insurance. But that's not what raised Makichuk's eyebrows. What surprised him was a report Kaiser sent him on prescriptions he filled in January. There was the tube of Zovirax, and there was the $95 payment Makichuk made. And beside that was a listing for what Kaiser paid for the cream: $2,532.80. (David Lazarus, 3/5)

Canada has a well-founded reputation for dangerous exports: Dirty oil. Strong beer. The occasional bad pop song. ... Still, the U.S. pharmaceutical industry's concern about a law that let Maine residents buy prescription drugs from Canada is a little odd. There's no evidence that medicines from Canadian pharmacies pose any greater safety risk than those bought in the U.S. Yet industry trade groups last week persuaded a judge to overturn the law, on the narrow grounds that drug importations are a federal matter. (3/5)

An online program created in collaboration with the UC San Diego School of Medicine faculty aims to help address the nation’s shortage of primary care physicians, a critical health-care issue highlighted by the Association of American Medical Colleges on Tuesday. (Leonard W. Glass, 3/5)

Health care consumers won a significant victory when Massachusetts Suffolk County Superior Court Judge Janet Sanders blocked a settlement that would have allowed Partners HealthCare, the system that dominates the Boston area, to acquire three additional health care providers in eastern Massachusetts. Sanders concluded that the acquisitions “would cement Partners' already strong position in the health care market and give it the ability, because of this market muscle, to exact higher prices from insurers for the services its providers render.” If this decision is not overturned on appeal, consumers will now be spared those projected price increases. But there is an even bigger reason for New Englanders to celebrate the judge's ruling. The danger lay not only in Partners' expanded dominance but also in the degree to which the settlement would have shut out other innovative competitors. (Regina E. Herzlinger, Barak D. Richman and Kevin A. Schulman, 3/4)

I was a harried, green resident busily readying an elderly patient — call her Margaret — for hospital discharge when her face unexpectedly began glowing with pleasure. Looking me intently in the eye, she exclaimed, “I do hope you know Dr. Edgecomb!” But before I could respond, she continued, “Do you know what he told me when I left his office last time? `Now you just be sure to notice the crocuses by the doorway on your way out, Margaret; they're lovely this year.' That's just the kind of person he is . . . and he was so right about the crocuses.” ... As Margaret cheerfully waved goodbye to me, I had to face up to the obvious: she really loved her doctor, and I — the cynical novice — envied him. I hoped my patients might one day think as fondly of me, but I was only beginning to learn how doctors inspired gratitude. Dr. Edgecomb had brought delight to his patient, and I couldn't help wondering: Are doctors supposed to do that? (Dr. Michael W. Kahn, 3/5)

Of all the pressing challenges in the US health care system, lack of innovation in delivery may be the most important. Indeed, as we come upon the 50th anniversary of Medicare, a few facts seem apparent. What we do for patients—whether they have infectious diseases, heart disease, or cancer—has changed dramatically. Yet, how we do those things—the basic structure of our health care delivery system—has changed very little. This lack of innovation in how we do things is a major reason why health care productivity has been so low and high spending has had insufficient benefits for patients. (Ashish K. Jha, 3/4)