“If the courts were to accept Adler’s and Cannon’s argument, that could effectively enable states to kill federal exchanges by empowering them to cut off the subsidies. Without subsidies, the federal exchanges would not be economically viable because they couldn’t get as many people to sign up for coverage.”

“Much attention has been given to the argument that without the individual purchase mandate, other parts of the health care law would become unworkable. Much less attention has been given to the fact that without the states forced to be on board with the Medicaid expansion, the law’s health exchange subsidies might be fiscally unworkable. The Supreme Court may have just set in motion of chain of events that could lead to the law’s being found as busting the budget, even under the highly favorable scoring methods used last time.”

“The Supreme Court has spoken, but problems built into the Affordable Care Act (ACA) have not been resolved by the decision and may have worsened. Even accepting the law’s assumptions about how the health system should be reformed, actually putting all the pieces in place is exceptionally expensive and difficult. If President Obama wins a second term, fiscal pressures and practical challenges will force him to scale back the unaffordable spending and slow down the unrealistic implementation timeline.”

“With Thursday’s Supreme Court ruling upholding President Obama’s landmark health-care law, debate has shifted to whether deadlines key to the law’s goal of expanding coverage to tens of millions of Americans will be pushed back. Some say states and the federal government are facing such complex technical and political realities that some deadlines need to be relaxed, including the Jan. 1, 2014, opening of online marketplaces where individuals and small businesses will be able to shop for coverage. And there may be pressure in Congress to delay some spending on the law to help reduce the federal budget deficit.”

“Republican governors are planning to ignore the Supreme Court’s decision Thursday to uphold Obamacare hoping that the issue will drive voters to dump President Obama in favor of Mitt Romney who has vowed to kill the Affordable Care Act.
After the decision, the Republican Governors Association said that nothing should be done by the states until after the election, a clear signal that they believe a GOP president, House and Senate will kill the health care reform pushed through by Democrats and opposed by Republicans.”

“If the health law withstands the Supreme Court challenge, two physician legislators in Congress want to make sure the Obama administration doesn’t get away with its attempt to rewrite the law to fit its larger agenda.”

“Even if the Affordable Care Act survives its first Supreme Court test— a ruling is due as early as today — the lawsuits won’t end. Citizens have already filed challenges to what critics call the law’s ‘death panel’ and its impact on privacy rights, religious liberty and physician-owned hospitals. Still another potential lawsuit poses as great a threat to the law as the case now before the high court.”

“States and the federal government will have to work hard to make sure that new insurance exchanges in President Obama’s healthcare law actually create more competition, a new study says… The Health Affairs study says people in those areas generally pay higher out-of-pocket costs than people in more populated areas with greater competition. ‘If experience with the federal benefits program is an indication of how much competition can be expected in the exchanges, then people obtaining coverage from exchanges will not benefit much from competition unless the exchanges are at least modestly assertive in setting conditions of participation for qualifying health plans,’ the authors wrote.”

“The purpose of this paper is to describe why the health insurance exchanges defined in PPACA won’t
work, won’t increase access to affordable health care, and won’t do anything to improve health
outcomes or increase value. The solution to affordable coverage isn’t to be found in these new
bureaucracies, but rather in reducing barriers to competition and consumer choice and removing
regulations that make coverage unaffordable today.”

“If state health care exchanges survive the Supreme Court challenge to health care reform, the election and state tea party activists, health policy experts are worried they could still be brought down by a much more mundane problem: information technology. Even states that are solidly committed to pursuing an exchange are facing major logistical challenges in building the computer systems that will be able to handle enrollment when exchanges open for business in 2014.”