The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

The Affordable Care Act has proved the need for health reform, but it also has proved the need for significant changes to the law to reflect Americans’ demand for more choices of more affordable health coverage. Despite the president’s claims, most Americans are seeing much higher costs for health insurance. They want secure coverage and access to care that meets their needs and the needs of their families, but they want the law to live up to its name of “affordability.”

Understanding exchange populations — their demographics, biometrics, health risks, and chronic conditions — is at the core of health insurance management. Government, health plan, employer, and provider leaders know that to create product strategies and plan designs without this information is not just futile, it’s bad business.

The aims of the Affordable Care Act (ACA) were to increase health insurance coverage for those under age 65, improve the performance of the health care delivery system, and slow cost growth. Less recognized are the provisions of the law that seek to strengthen the Medicare program.

The ACA addresses gaps in Medicare preventive and prescription drug benefits. It initiates ambitious testing of new payment methods to improve the value of care received by beneficiaries and, indirectly, all Americans. And it substantially extends the solvency of the Medicare Health Insurance Trust Fund by slowing the growth of future Medicare outlays.

Efforts by insurers to boost premiums are the latest evidence that President Barack Obama’s health care law “just doesn’t work” and must be replaced, the Republican chairman of the House Ways and Means Committee said Wednesday.

Rep. Paul Ryan of Wisconsin launched the GOP’s latest attack against the health care overhaul as Health and Human Services Secretary Sylvia Burwell defended it before his committee. Their conflicting views underscored that Obama’s 5-year-old law remains a partisan flashpoint, likely to reverberate through next year’s presidential and congressional elections.

In response to a question at a press conference today following the G7 summit in Germany, President Obama commented on the pending decision in the Competitive Enterprise Institute’s U.S. Supreme Court case King v. Burwell:

“And so this should be an easy case. Frankly, it probably shouldn’t even have been taken up. And since we’re going to get a ruling pretty quick, I think it’s important for us to go ahead and assume that the Supreme Court is going to do what most legal scholars who’ve looked at this would expect them to do.”

Senate Majority Leader Mitch McConnell (R-Ky.) says President Obama will veto any ObamaCare contingency plan Congress sends him, even if the Supreme Court cripples the law.

Congressional Republicans are working on backup plans in case the high court rules later this month in King v. Burwell to invalidate subsidies that help 6.4 million people afford health insurance in 34 states using the federally run exchanges.

Republicans in Congress have repeatedly promised they will have a plan if the Supreme Court rules that an estimated 6.4 million Americans can’t get health insurance subsidies from the federal government.

Though the GOP has not reached a consensus – and few if any details are discussed in public – there is plenty of activity behind the scenes, as disparate groups in the House and Senate work to at least unify around an opening bid.

Public support for Obamacare tied its all-time low in the latest ABC News/Washington Post poll – even as most Americans say the Supreme Court should not block federal subsidies at the heart of the health care law.

With the high court set to rule on the latest challenge to the ACA, the poll reflects the public’s split views of the law – criticism of its insurance mandate, yet support for extended coverage.

Overall, just 39 percent support the law, down 10 percentage points in a little more than a year to match the record low from three years ago as the Supreme Court debated the constitutionality of the individual mandate. A majority, 54 percent, opposes Obamacare, a scant 3 points shy of the high in late 2013 after the botched rollout of

Millions of Americans could lose Obamacare subsidies under a Supreme Court ruling this month, but many in the GOP don’t need their votes anyway.

That’s a major political calculus for Tea Party Republicans, who are likely to resist any efforts to extend the subsidies, even temporarily. They’re much more worried about angering their base by appearing to concede to Obamacare than whether a handful of constituents lose their subsidies.

“Ninety-seven percent of Americans aren’t receiving those subsidies,” Rep. Austin Scott, R-Ga., told reporters Thursday. “I will tell you I’m a ‘no’ on voting to extend those subsidies unless the president is willing to sit down and work with us and fix the problems for that 97 percent.”

At stake are federal subsidies that about 7 million low and moderate-income Americans are using to buy health coverage.

They could lose the assistance if the justices rule the Obama administration is awarding it illegally in the 37 states relying on instead of running their own insurance marketplaces. The dispute, known as King v. Burwell, is over the interpretation of a few sentences in the Affordable Care Act.

Sen. Ted Cruz’s Obamacare hearing in a Senate Judiciary subcommittee Thursday afternoon began rather bizarrely.

To his right sat two Democrats: Sens. Christopher Coons, the ranking member of the oversight subcommittee, and Richard Blumenthal.

Directly in front of Cruz was an empty row of seats, vacant because witnesses from the Obama administration who were asked to fill them didn’t show up. Beyond that was an audience filling almost every seat in the room, drawn by the hearing’s subject: the writing of the Obamacare subsidy rule, a topic that is also in a roundabout way currently under consideration by the Supreme Court.

The Treasury Department had told Cruz last week that it wouldn’t be sending any witnesses, so the Texas Republican wasn’t surprised. The empty table was theater, and Cruz took advantage of the opportunity, railing against the Affordable Care Act and the administration for not sending the requested Treasury officials, a snub which he called “the height of arrogance.”

“It’s a symbol for how little regard the Obama administration has for the American people,” Cruz said. “By their absence, I take it the administration is saying they are not subject to oversight.”