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White House aides say the president isn’t under any illusions that Republicans will drop their objections to the Affordable Care Act just because the administration won the last Supreme Court fight. So while Obama will “discuss how we can move forward and continue building on the progress made under the Affordable Care Act,” according to the trip announcement, he’s not planning to get confrontational, avoiding the more controversial elements, one official said. In particular, the president intends to praise the efforts of Tennessee’s Republican governor, who has embraced key parts of Obamacare and is working to expand Medicaid in his state, a key part of the health care reforms and a top Obama priority. (Wheaton, 7/1)

President Barack Obama is aiming to change the conversation around his health care law from talk about undoing it to talk of how to make it better. Obama was headed to the Nashville, Tennessee-area on Wednesday to discuss ways to improve the Affordable Care Act, including by extending Medicaid coverage to more low-income people. Tennessee is among about 20 states that have rejected Obama's offer of billions of dollars to help pay to expand the federal-state health care program for the poor. (Superville, 7/1)

Obamacare is here to stay. That’s the message from President Barack Obama and other supporters of the Affordable Care Act after their victory at the Supreme Court last week. But dodging a lethal legal bullet is not the same thing as ensuring long-term success. And if health care reform is going to achieve the latter, it’s going to need reforms of its own. “We’ve got more work to do,” Obama acknowledged after the high court ruled in his favor on Thursday. (Young, 6/30)

Healthcare lobbyists across Washington are hoping to win long-sought changes to ObamaCare now that the Supreme Court has affirmed the law is here to stay. Last week’s ruling in King v. Burwell has unfrozen the field for dozens of healthcare groups that have been stymied in their efforts to tweak the law while it was still fighting for survival in the courts. (Ferris, 7/1)

The specific issues, bills or lawmakers might change, but if there's any constant within the Republican caucuses in the Tennessee House and Senate, it's this: They aren't big fans of President Barack Obama. At the same time, Democrats and supporters of Gov. Bill Haslam's controversial Insure Tennessee plan are using the president's visit Wednesday to a Nashville elementary school as their latest rallying cry to push for Haslam's health insurance plan. (Boucher, 6/30)

The stunning series of liberal decisions delivered by the Supreme Court this term was the product of discipline on the left side of the court and disarray on the right. In case after case, including blockbusters on same-sex marriage and President Obama’s health care law, the court’s four-member liberal wing, all appointed by Democratic presidents, managed to pick off one or more votes from the court’s five conservative justices, all appointed by Republicans. ... For example, in King v. Burwell, the case brought by groups hostile to the Affordable Care Act, Chief Justice John G. Roberts Jr. and Justice Anthony M. Kennedy joined the court’s four liberals in rejecting the challenge to health insurance subsidies provided through federal exchanges. Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. dissented. (Liptak, 7/1)

The Supreme Court in the just-completed term passed up a number of opportunities to upend existing law, including the Affordable Care Act. ... The court’s hesitation to strike down existing laws was evident in several cases. ... Justice Kennedy’s votes with the court’s liberals are a major factor in their success. But another conservative justice, Chief Justice Roberts, wrote the majority opinion rejecting a conservative-backed lawsuit that would have gutted the Affordable Care Act. He was joined by the liberal bloc and Justice Kennedy. (Braven, 6/30)

The Supreme Court was no less polarized this term, nor were its opinions any less divided. But its landmark decisions saving the Affordable Care Act and declaring that the Constitution provides a right for same-sex couples to marry create nationwide norms for an increasingly divided country. (Barnes, 6/30)

Now that the ruling has been made, it’s important for Floridians to understand what it means for them. One of the predictions was that after taking advantage of the insurance subsidies to buy coverage, over 1 million Floridians would owe thousands of dollars to the IRS at tax time. With the subsidies upheld, this is an obstacle averted for 1.3 million Floridians who would have collectively owed more than $4 billion for the 2015 tax year. (Naff, 7/1)

While wrangling over benefits is a cornerstone of union negotiations, looming threats facing several big companies—including coping with the requirements of The Affordable Care Act– exacerbate the conflicts, as we reported today in CFO Journal. ... With major tenets of the health law in place for the long haul, labor and management will have to figure out the “subtle, million-and-one smaller points of the bigger package,” he said, such as the excise tax on high-cost plans, or Cadillac tax. Companies could terminate their health care plans, or move employees to higher deductible plans. (Johnson, 6/30)

As courts and regulators increase their scrutiny of the relationship between businesses and independent contractors, employers are turning to a range of tactics to classify workers, taking them off the formal payroll and lowering costs. ... All this is happening against the backdrop of a broader shifting of risk from employers to workers, who shoulder an increasing share of responsibility for everything from health-insurance premiums to retirement income to job security. Alleged misclassification of workers has been one of the primary battlegrounds of this shift. (Weber,6/30)

The home-care sector is keeping an eye out for an expected move by the White House to make up to 5 million more people eligible for overtime pay. Some say it could benefit fee-based employees while others believe it could cause employers to scale back on hiring specialized workers. A new rule from the Labor Department would more than double the threshold at which employers can avoid paying overtime, to $970 a week, by next year. (Sandler, 6/30)

The Supreme Court on Friday ruled that same-sex couples have a constitutional right to marry, meaning that same-sex marriages must be recognized nationwide. The ruling will have vast implications for employers, which until now have been operating under a patchwork of different state and federal laws governing the legal and tax treatment of same-sex unions. ... Companies that offer spousal health benefits and use a separate insurance company to fund their benefits will now be required to cover both gay and straight spouses. ... But companies that are self-insured, which means they assume the insurance risks for their own employees, a common practice among large companies, aren’t under the same legal constraints. (Silverman, 6/30)

As of Wednesday, public employers including Texas agencies, universities and schools will allow current and retired gay and lesbian employees to enroll their same-sex spouses in the same benefit programs and services available to opposite-sex couples. (Ura, 7/1)

The U.S. Supreme Court's decision last week to legalize same-sex marriage across the country will have mixed effects for same-sex couples when it comes to Medicaid. In Obergefell v. Hodges, the court ruled 5-4 that same-sex marriage is a fundamental right guaranteed by the 14th Amendment. Prior to the ruling, same-sex marriage only was allowed in 37 states and the District of Columbia. Experts say the ruling will affect coverage rules for both Medicaid medical and long-term-care benefits. (Dickson, 6/30)

Drug and medical-device makers paid $6.49 billion to U.S. doctors and teaching hospitals during 2014, according to the federal government’s first full-year accounting of the breadth of industry financial ties with medical providers. The tally comprises company payments to more than 600,000 doctors and 1,100 hospitals for services such as consulting, research and promotional speeches about drugs, as well as the value of free meals provided to doctors by sales reps pitching products. (Loftus and Walker, 6/30)

From research dollars to free lunches and junkets, drug and medical device companies paid doctors and leading hospitals nearly $6.5 billion last year, according to government data posted Tuesday. The latest update to the Open Payments database is part of an ongoing effort to highlight potential conflicts of interest in medicine. Unlike last year's initial version of the database, this one is much easier to use for consumers interested in looking up their own doctors. (6/30)

Holly Campbell, a spokeswoman for PhRMA, the nation's top drug lobby, defended the payments, saying they include funding of important clinical trials and facilitate feedback from doctors to companies about their products. “Collaboration between physicians and biopharmaceutical professionals is critical to improving the health and quality of life of patients,” she said in a statement. (Sullivan, 6/30)

Maryland's hospitals and doctors took in more than $7.6 million in payments for research, speeches and other work from drug and device manufacturers in 2014, according to federal authorities who have been releasing payment data periodically. The money is a share of about $6.5 billion in funds paid to U.S. hospitals from 1,444 companies, data supplied by the Centers for Medicare and Medicaid Services shows. (Cohn, 6/30)

The feds argue that Novartis violated the False Claims Act by using different plans, including rebates, to induce specialty pharmacies to boost prescriptions for two drugs: the Myfortic treatment for kidney transplants and Exjade, a medicine used for reducing excess iron in patients who undergo blood transfusions. (Silverman, 6/30)

Around the U.S., people with serious diseases like Agar’s are falling through the cracks, unable to afford the medication they need even if they have good jobs and good insurance. Patients with HIV, cancer, lupus, leukemia, hepatitis C and other serious conditions are paying huge out-of-pocket sums for necessary medication. These costs are putting heavy mental and financial stress on some of America’s most vulnerable people. (Swanson, 6/30)

The battle over drug prices is playing out in states across the country, with at least four states capping consumers’ out-of-pocket costs and others considering transparency requirements to force drug companies to explain their high prices. (Norman, 6/30)

California taxpayers could be on the hook for billions of dollars to treat hepatitis C patients in various state-funded programs, according to a report released Tuesday by an insurers’ trade group. The analysis commissioned by the California Association of Health Plans estimates that paying for the patients’ high-priced hepatitis C medications in prisons and state hospitals, or through Medi-Cal and other state programs, could range from $512 million to $5.1 billion. The wide-ranging estimates depend on how many patients are treated and how much the drugs are discounted by manufacturers. (Gorman, 7/1)

One of his endeavors included serving as a paid director to the hospital company Tenet Healthcare, which backed President Obama’s Affordable Care Act. The position invited questions for Mr. Bush, who as a candidate opposes the health care law. Mr. Bush profited handsomely from his Tenet shares. According to the newly released tax returns, Mr. Bush acquired $441,203 worth of stock in Tenet Healthcare in May 2011. The stock doubled in value by the time he sold it in October 2013, earning him a profit of $462,013 in just 29 months. Like other hospital stocks, Tenet rose sharply from October 2012 through March 2013, when President Obama’s re-election made it likely that the health care law would be carried out. (Eder, 6/30)

Jeb Bush has raked in hundreds of thousands of dollars from health care company stocks since leaving office in 2007, according to tax returns released Tuesday. The former Florida governor, in a transparency effort meant to sharply distinguish himself from Democratic presidential front-runner Hillary Clinton, released 33 years of tax returns that showed an average effective tax rate of 36 percent. The returns, which span 1981 to 2013, indicate he’s had at least $29 million in income after he led the Sunshine State. (Pradhan, 6/30)

The Food and Drug Administration said Tuesday it is responding to an uptick in nicotine poisonings reported by emergency rooms and poison centers nationwide, many involving infants and children. The agency said in an online posting it is considering whether "it would be appropriate for the protection of the public health to warn the public about the dangers or nicotine exposure" and "require that some tobacco products be sold in child-resistant packaging." (6/30)

Anthem, one of the nation’s largest health insurers, wants its members to stop smoking. ... But Anthem’s executive vice president, Wayne S. DeVeydt, serves on the board of the U.S. Chamber of Commerce, which is engaged in a worldwide campaign to block antismoking laws. These include taxes on cigarettes in the Philippines, graphic health warnings on cigarette packs in Jamaica and Nepal, a plan to prohibit the display of cigarettes by retailers in Uruguay and restrictions on smoking in public spaces in Moldova. The chamber’s global opposition to antismoking measures, reported by The New York Times on Tuesday, poses a challenge for many of the members of the organization, particularly hospitals and health insurers. (Hakim, 7/1)

Adopting one of the most far-reaching vaccination laws in the nation, California on Tuesday barred religious and other personal-belief exemptions for schoolchildren, a move that could affect tens of thousands of students and sets up a potential court battle with opponents of immunization. (Willon and Mason, 6/30)

Senate Bill 277 requires almost all California children who attend private or public schools to be fully vaccinated regardless of their parents' personal or religious beliefs. Unvaccinated children can attend schools only if they obtain a medical exemption from a doctor. (Calefati and Seipel, 6/30)

As the bill worked its way through the legislative process, it faced strong, consistent, vocal opposition from some parents, including a small group of protesters who stood vigil outside the Capitol in Sacramento for days before it was clear Brown would sign the bill. (Dembosky, 7/1)

According to California public records, about 90% of kindergarten students had all the required immunizations in the school year 2014-2015. (Porter, 6/30)

While all 50 states require school children to be vaccinated, 48 currently allow exemptions for families with religious objections and 20 exempt children based on parents' personal beliefs, according to the National Conference of State Legislatures. Twelve states this year considered legislation addressing vaccine exemptions. In May, Vermont became the first state to repeal its personal belief exemption, although the law still permits exemptions for religious reasons. (Szabo, 6/30)

Gov. Jerry Brown has signed a hotly contested California bill to impose one of the strictest school vaccination laws in the country in the wake of an outbreak of measles at Disneyland late last year. The following is a look at what the new law signed Tuesday means for the nation's most populous state. (7/1)

A celebrity critic of vaccines and former partner of another star with an autistic child has taken to social media to denounce a new California law requiring most children be vaccinated. Jim Carrey dated Jenny McCarthy for about five years before they split in 2010. In 2005, McCarthy’s son Evan was diagnosed with autism; during their relationship and after their breakup, Carrey and McCarthy were vocal proponents of the discredited theory that vaccines and autism are linked. (Moyer,7/1)

Amid criticism of past oversight efforts, Los Angeles County supervisors approved a new contract Tuesday that redefines state and local responsibilities for inspecting nursing homes and other health facilities and investigating complaints of abuse, neglect or inadequate care of patients. The new contract will give the county more money and scale back its duties. Los Angeles County is the only local government in the state that is contracted to inspect health facilities. Elsewhere, the state handles licensing duties and investigates complaints. (Sewell, 6/30)

If you or someone you are close to has ever tried to get more than a doctor’s appointment for deep depression, alcoholism or a drug addiction, you already know that figuring out where to get care and who will help cover the cost is messy. Now that struggle is spelled out in the first health care cost trends report from Attorney General Maura Healey. (Bebinger, 6/30)

The winners and losers have been announced in a federally mandated program that will redistribute $61 million among the state’s health insurers. The big winner, as expected, is Blue Cross Blue Shield of Massachusetts, the state’s largest insurer, which stands to rake in $51.6 million in payments from smaller rivals. (Freyer, 7/1)

More than 4,000 people who are working to recovery from substance abuse disorders will have some extra help, thanks to a $7.8 million federal grant that’s coming to North Carolina. The Department of Health and Human Services announced late Monday that the grant, from the federal Substance Abuse and Mental Health Services Administration, will be targeted at helping people get sober and back on their feet. (Hoban, 6/30)

The CEOs of four small, rural hospitals announced an agreement Tuesday to form a nonprofit organization known as North Country Healthcare. It all began a year ago in July, when CEOs Russell Keene of Androscoggin Valley Hospital, Warren West of Littleton Regional Healthcare, Peter Gosline of Upper Connecticut Valley Hospital and Scott Howe of Weeks Medical Center gathered at the Omni Mount Washington Hotel, where each said the best way for all to survive was to unite. (Koziol, 6/30)

With time running out before a new Metro Council is elected, a generous but controversial perk for council members is under fire again. Metro Councilman Phil Claiborne, term-limited from his Donelson-area seat, has revived legislation that would reduce Metro government’s financial obligation in covering lifetime health insurance for former two-term council members. (Garrison, 6/30)

Jeb Bush the candidate is not a fan of Obamacare. But Jeb Bush the investor made a big bet on the Affordable Care Act, and it paid off. According to tax returns released by Mr. Bush’s campaign on Tuesday, he sold $1,103,424 worth of stock in Tenet Healthcare in September and October of 2013, yielding a capital gain of $556,283. It hadn’t taken Mr. Bush long to double his money — he was selling shares he had acquired in 2010 and 2011. (Josh Barro, 6/30)

Forget the debate over whether the Supreme Court has taken a liberal turn. It is not a liberal court or a conservative court. It's a Kennedy court. On major constitutional and statutory questions, Justice Anthony M. Kennedy's views matter more than anything else. Liberals do have more to celebrate this term than in the recent past, from the same-sex marriage and Obamacare decisions, to a major housing discrimination case, to a surprising win for minority plaintiffs in a voting rights lawsuit. In all of those cases, Kennedy was in the majority, and all but one — Obamacare — were decided 5-4. (Richard L. Hasen, 6/30)

Americans were perilously close to losing their right to health care when the Supreme Court offered a reprieve. Few were more grateful than the conservative politicians who had been railing against the Affordable Care Act while praying they would not have to face the political consequences of its collapse. (Froma Harrop, 6/30)

Congratulations, California. With Gov. Jerry Brown's swift signature Tuesday on a tough new mandatory vaccination bill, the state has established itself as a national leader on public health. Of course, it will take some years for reality to catch up with the bill's mandates. First there will be the inevitable lawsuits. And even if those don't delay implementation, it will still take a few years before all California students are immunized, because those currently in seventh grade and higher are not required under the law to be vaccinated. (6/30)

Last week, the Supreme Court upheld a core provision of the Affordable Care Act, quashing the Republican Party’s latest attempt to gut the law through the judicial system. At issue in the case, King v. Burwell, was the government’s ability to provide subsidies to help millions of working Americans purchase health insurance through the federal exchange. Yet, as too many middle-class families know, health insurance is only one of the costs associated with getting sick. For more than 40 million workers who currently lack paid sick leave, another pressing concern is how to afford taking time off. (Katrina vanden Heuvel , 6/30)

The SGR was instituted to prevent Medicare fee hikes from exceeding growth of the economy. The effect was to cut Medicare payments to doctors. ... Let me, for a moment, ignore the unpleasant thought that this problem was one Congress itself created — some 17 years ago — and allow me some self-indulgence for having solved a federally imposed conundrum. ... Most congressional offices didn’t even realize SGR was a culprit at that time and, despite the systemic flaw, they weren’t willing to attach their name to a costly repeal vote. To my frustration, Congress opted for one-year funding “patches” to extend the problem rather than confront it. (Rep. Michael Burgess, R-Texas, 6/30)

Approximately 26,000 newly minted doctors across the United States will begin their internships today. For many, this legendarily grueling year will be the most trying time of their professional lives. Most will spend it in a state of perpetual exhaustion, as near ascetics with regard to family, friends and other pleasures. I was an intern nearly 20 years ago, but I still remember it the way soldiers remember war. (Sandeep Jauhar, 7/1)