Emergency room usage has spiked sharply in recent years. That’s the depressing finding from a new survey by the American College of Emergency Physicians – and it’s putting those who need emergency care at grave risk. The survey concluded that three in four emergency room doctors have experienced a surge of new patients since the Affordable Care Act became law.

That isn’t a coincidence.

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If you thought the legal fight over the health care overhaul was finally over, think again. At least four issues related to the Affordable Care Act still are being sorted out in the courts, although none seems to pose the same threat to the law as the challenge to nationwide subsidies that the court rejected on Thursday, or the constitutional case that the justices decided in favor of the law in 2012.

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Obamacare is dead. Long live Robertscare.

With Thursday’s U.S. Supreme Court decision in King v. Burwell, Chief Justice John Roberts, writing for the majority, cemented the Affordable Care Act as the law of the land. Oh, there will still be plenty of legal challenges to it, and there will be an attempt to replace it should a Republican occupy 1600 Pennsylvania Ave. in 2017; but for all intents and purposes, the individual and employer mandates, and now the subsidized federal health insurance exchange, are now in concrete.

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Last year, 95 American hospitals merged or were acquired — a 40 percent increase from 2010. Over roughly the same period, the percentage of physician practices owned by hospitals doubled — from about 30 percent to nearly 60 percent.

This rapid consolidation among U.S. healthcare providers is dizzying to behold, even for those who have spent careers in healthcare. Its effects are only starting to be felt, but could be profound.

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It’s an established fact of social science, replicated in surveys dating to the Nixon administration, that conservatives are happier than liberals. It stands to reason, then, that liberals whine more than their counterparts on the right. The litany of liberal complaints includes Republicans, Fox News, global warming “deniers,” conservatives’ silly fixation with religious freedom, and the United States Supreme Court.

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King v. Burwell is in the history books. Subsidies on federal exchanges will continue to flow and supporters of the ACA will (correctly) see this as a big win for the president. But to pretend that this means smooth sailing for Obamacare from here on out would be disingenuous at best.

Obamacare subsidies are just one important leg of a three-legged stool. And two of them may start wobbling after 2016.

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The GOP’s best chance of knocking down the Affordable Care Act disappeared Thursday when the Supreme Court sided with the administration in King v. Burwell. With the case decided, the Senate could start holding the anti-Obamacare votes leadership said they wanted to attempt when they took the chamber this year.

But with a crowded floor schedule, the prospect of tough amendment votes under regular order and disagreement over what budget reconciliation should be used for, it’s unclear how Republicans will go about taking those votes.

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The Affordable Care Act narrowly escaped a judicial decision that would have shrunk its reach Thursday when the Supreme Court ruled the IRS could continue distributing insurance subsidies nationwide. Now, with the law no longer under an immediate meaningful threat of repeal, some are looking to stretch Obamacare further.

Specifically, governors in several states are renewing their push to expand Medicaid, hoping to bring the federal low-income health insurance program to more of their state’s residents.

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Despite the Supreme Court decision to uphold the subsidies for private insurance in King v. Burwell, the fundamental problems with the Affordable Care Act remain. Ironically, it is the growing government centralization of health insurance at the expense of private insurance that must be addressed.

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Republican leaders vowed to continue their effort to dismantle Obamacare after the Supreme Court ruled for the Obama administration in King v. Burwell, while acknowledging that repealing and replacing the law is extremely unlikely while President Obama is in office.

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