On Monday, the Supreme Court denied certiorari in Coons v. Lew, a constitutional challenge to provisions in the Affordable Care Act (ACA) creating the Independent Payment Advisory Board (IPAB), an independent federal agency charged with responsibility for controlling the growth of health-care costs by constraining the growth of Medicare.

IPAB is controversial, and potentially unconstitutional (as even fervent ACA advocates admit). Nonetheless, the denial of certiorari was to be expected. IPAB is not yet operational, so (as the U.S. Court of Appeals for the Ninth Circuit concluded) a challenge of this sort isn’t ripe. If and when the IPAB is up and running — and begins making changes to Medicare that affect providers or beneficiaries — there will be ample time to consider the constitutionality of Congress’s creation.

Alternatively, Congress could repeal or reform IPAB itself, as some have suggested. Given that the text of the ACA expressly limits Congress’s ability to amend these portions of the law, such legislative action could itself prompt litigation and perhaps even High Court review.

The Court’s denial of certiorari in the Coons case does not mean the justices won’t revisit the ACA next term. Another cert petition is pending in Mayhew v. Burwell, Maine’s challenge to the constitutionality of the ACA’s maintenance of eligibility requirements for Medicaid. According to Maine (and supporting amici), the federal government’s threat to withhold all Medicaid funding should Maine restrict Medicaid eligibility below pre-existing levels is unconstitutionally coercive and violates the Medicaid holding of NFIB v. Sebelius.

If, as oral argument in King v. Burwell suggested, some of the justices are interested in revisiting federalism concerns about the ACA, Mayhew is a potential vehicle. Indeed, although the U.S. Court of Appeals for the First Circuit found Maine’s arguments unconvincing, Maine’s position would get a boost should the the federal government prevail in King on federalism grounds.

Six Democratic senators and one independent have asked the Department of Health and Human Services to a delay a new rule that would likely force small businesses to pay more for employee health insurance under the Affordable Care Act, aka Obamacare. The senators warn that if the administration goes ahead with the change it would be “particularly harmful and disruptive” to small businesses.

Starting in 2016, the Obamacare change will require businesses that employ between 51-100 people to purchase insurance in what the government defines as the “small group market,” rather than the market for large group plans. The senators warn that the change will inflate health care costs for those businesses.

“[T]hey could experience higher premiums, less flexibility, and new barriers to coverage. We therefore encourage you to delay the effective date in the definition change for two years so the market can more smoothly transition to the new rules,” the senators wrote in the March 12 letter to HHS Secretary Sylvia Burwell.

During a 2014 Valentine’s Day meet-up with House Democrats, President Obama thanked them for their unstinting support of the Patient Protection and Affordable Care Act. “I think,” he said, “10 years, five years from now, we’re going to look back and say this was a monumental achievement.”

Well, the president’s health care law marks its fifth anniversary this week. And most Americans are not, in fact, looking back and saying the law enacted in 2010 – with not one Republican vote in either the House or Senate – was a monumental achievement.

Indeed, in an NBC News/Wall Street Journal poll this month, a 44-34 plurality of respondents thought Obamacare a “bad idea.” And a 62-22 percent majority said that what they had seen, read or heard in recent weeks about the Affordable Care Act had made them “less confident” about the law.

Some suggest the public’s misgivings about Obamacare are almost entirely attributable to GOP opposition to the law. In a statement Monday, Democratic National Committee Chairwoman Debbie Wasserman Schultz noted that “Republicans have voted more than 50 times to repeal or undermine this critical law.”

What Were the Top 5 Fails from 5 Years ofACA?

Here are some of the top actual practices of the ACA thatdiverge from what we were promised:

1. PolitiFact “Lie of the Year”: “If you like your health care plan, you can keep it.”

The Obama Administration and many Democratic members of Congress repeatedly assured Americans that “If you like your health care plan, you can keep it.” PolitiFact rated this the “Lie of the Year for 2013” after cancellation notices went out to 4 million people. (PolitiFact)

2. “If you like the doctor you have, you can keep your doctor, too.” Not.

In June 2009, President Obama said, “If you like the doctor you have, you can keep your doctor, too.” But nearly five years later, the president admitted that Americans might lose their doctors after all. (WebMD Exclusive Interview). This is a broken promise that many ObamaCare enrollees will face, given that 70 percent of ObamaCare plans are narrow or ultra-narrow network plans, compared to 23 percent of employer-sponsored plans. (Washington Post)

The Congressional Budget Office’s new report shows updated cost projections for the insurance coverage expansion in the Affordable Care Act. With the debate over the ACA remaining so intensely polarized, advocates moved aggressively to spin this routine update as reflecting favorably on the law. A front-page article in the Washington Post referred to the new findings as showing “savings,” quoting a supporter as saying, “I can’t see how people can continue to say . . . that Obamacare had no cost containment in it.” Such comments in the wake of CBO’s update are flawed interpretations of the new estimates and what they signify. The following explains what CBO has actually projected: basically that the ACA will do less to expand coverage than previously estimated.

For years now, Wall Street has cheered as Obamacare fuelled the stock prices of corporations in the healthcare industry. One of them was eHealth EHTH +0.96%, Inc. (NASDAQ: EHTH), an online health-insurance broker that was founded in 1997.

Obamacare – in case you need reminding – mandates the purchase of private health insurance for working-age Americans above a low income. Last April, The Motley Fool’s Keith Speights speculated that eHealth might have been “Obamacare’s biggest winner”:

Five years ago, President Obama and Congressional Democrats disregarded both the Constitution and the opinion of the American people when they enacted ObamaCare. Since then, Americans have seen the law transition from political to personal. Many have lost access to their longtime doctor. They lost the insurance plan they were happy with. They pay higher premiums or a higher deductible. Maybe it cost them their job, maybe it cost them hours at work, or maybe they’re suffering from all of the above.

As the legislation has been implemented over the last five years, the cracks in the final bill have expanded one by one into full scale crises. President Obama has attempted to patch these problems by writing new rules and regulations on the fly, often with questionable constitutionality. But soon his days of bypassing federal law and the Constitution may catch up to him, and to all of us.

If you like your health insurance plan, you actually might have been able to keep it this year.

Fewer than 1 million Americans had their health insurance plans canceled for 2015 for noncompliance with Obamacare rules, according to a report by the Urban Institute and Robert Wood Johnson Foundation.

The report, which called that number “quite small,” suggests that in the latest enrollment season there was relatively little disruption of either the individual or job-based insurance market due to plans not meeting Affordable Care Act-related regulations.

Those rules set certain minimum standards for coverage, including prescriptions, maternity care and mental health treatment, which were not required in plans prior to the ACA’s enactment.

DENVER – About 190,000 Coloradans will lose access next year to health insurance plans which don’t comply with the Affordable Care Act, the Colorado Division of Insurance (DOI) decided.

In March of 2014, President Barack Obama decided to give states the option of allowing people on noncompliant health plans to be grandfathered in by renewing their old plans early, while problems with insurance exchanges were ironed out.

Colorado insurance commissioner Marguerite Salazar opted to do that for 2015, but told 9NEWS on Friday that the exception is no longer needed for plans in 2016, even though Colorado could have continued them an additional year.

“By delaying it, it doesn’t give us a good pathway into full implementation of the ACA,” Salazar told 9NEWS. “I feel like we gave people that year, we have a great robust market in terms of health insurance in Colorado.”

If the Supreme Court in King v. Burwell strikes down subsidies to the buyers of health insurance on the federal exchange, President Obama will call on Congress to change the law to allow the subsidies. There also will be enormous pressure on elected officials to establish state exchanges in the 34 states that don’t have them. Instead, congressional Republicans should be laying the groundwork for market-friendly health reforms and devolving power to the states, meanwhile helping Americans who have difficulty purchasing coverage…