If House Republicans can make it over the first hurdle in their lawsuit challenging the Affordable Care Act, their arguments might pose a serious threat to the healthcare law, some legal experts say.

U.S. District Judge Rosemary Collyer is now considering whether to allow the lawsuit to proceed or dismiss it for lack of standing on the House’s part. Collyer’s questions during oral arguments in the U.S. District Court for the District of Columbia, along with her subsequent requests, have led some to speculate that she will grant the House standing and let the lawsuit move forward.

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The Obama administration’s top health care official said Wednesday that if the Supreme Court stopped the payment of health insurance subsidies to millions of Americans, it would be up to Congress and state officials to devise a solution.

“The critical decisions will sit with Congress and states and governors,” Sylvia Mathews Burwell, the secretary of health and human services, said at a hearing of the House Ways and Means Committee.

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This week, Hawaii pulled the plug on its state-created Obamacare exchange. Gov. David Ige (D) declared that the Hawaii Health Connector has been “unable to generate sufficient revenues to sustain operations.” The decision to kill the exchange will cost taxpayers $200 million, a relative bargain compared to the political-inspired fiasco that happened with the Oregon version of the Obamacare exchange — Cover Oregon.

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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.”

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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.

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Most Americans have not been paying close attention to King v. Burwell. A majority continue to say that the Affordable Care Act has not had an effect on them or their family, although the proportion that believes it has hurt and, separately, helped has risen. Views of the ACA remain more negative than positive.

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If the Supreme Court rules against the government in King v. Burwell, insurance subsidies available under the Affordable Care Act (ACA) will evaporate in the thirty-four states that have refused to establish their own health-care exchanges. The pain could be felt within weeks. Without subsidies, an estimated eight or nine million people stand to lose their health coverage. Because sicker people will retain coverage at a much higher rate than healthier people, insurance premiums in the individual market will surge by as much as fifty percent.

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President Barack Obama declared Tuesday that his 5-year-old health care law is firmly established as the “reality” of health care in America, even as he awaits a Supreme Court ruling that could undermine it.

“This is now part of the fabric of how we care for one another,” he said.

Obama defended the health care overhaul during an address to the Catholic Health Association Conference in Washington, just days ahead of an anticipated decision by the Supreme Court that could eliminate health care for millions of people.

Obama poked fun at opponents who have issued “unending Chicken Little warnings” about what would happen if the law passed. None of those predictions have come true, Obama argued.

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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.

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President Obama reentered the political battle over healthcare Tuesday, delivering an extended defense of the Affordable Care Act as the Supreme Court prepares to issue its ruling on a case that could strip away health insurance from millions of Americans.

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