Viewpoints: Daschle says health law still has 4 hurdles; Commentators from states such as Calif., Texas and Florida wrestle with options

Philadelphia Inquirer: GOP Is Refusing Good Medicine
The GOP-controlled U.S. House plans to hold what can only be called symbolic votes on repealing the sweeping reforms they deride as "Obamacare." Meanwhile, at least 15 governors are said to be leaning toward refusing to expand state Medicaid programs -- a key part of the reform's strategy to provide some form of health insurance to the 32 million people now going without coverage. Refusing to expand Medicaid is a bad option that should be rejected by these holdout governors. It certainly isn't the right course for Govs. Corbett or Christie (7/9).

Politico: Obama's 4 Major ACA Hurdles To Go
The Obama administration has cleared a transformational hurdle now that the Supreme Court has ruled the health care individual mandate constitutional. The mandate's importance to meaningful insurance reform and expanded insurance coverage for millions of Americans can't be overstated. ... Yet four major additional hurdles must still be overcome before President Barack Obama and his administration can consider themselves clear of danger. Like the legal hurdle, these too, if not successfully addressed, could substantially undermine the law's future viability (Tom Daschle, 7/8).

Bloomberg: A Penalty Or A Tax?  It's Both
"Penalty" and "tax" are just words. They don't have some kind of essence that can settle any arguments about their meanings if only it can be discovered. … However much a fee may resemble a penalty, it can still be a tax, and vice versa. Arguing about whether it is one or the other is like arguing about how many angels can dance on the head of a pin (7/8).

Boston Globe: When Mitt Romney's Campaign Struggles, Don't Blame The 'Boston Boys'
When it comes to framing a strong rebuttal to the Supreme Court's Obamacare decision, Mitt Romney's biggest problem isn't Eric Fehrnstrom or anyone else in his Boston brain trust. His problem is Romneycare. Under the health care reform law that Romney championed as governor, Bay Staters must have health insurance. If they don't have it, they must pay what Romney mostly characterized, back then, as a penalty. Similarly, under Obamacare, Americans who don't have health insurance also have to pay what President Obama also characterizes as a penalty (Joan Vennochi, 7/8).

Journal of the American Medical Association: The Supreme Court's Medicaid Surprise
Whatever the outcome, Medicaid will continue to be a major part of the nation's system of financing health care, so careful attention must be paid to measuring performance of states and holding them accountable, just as states and private payers hold their health plan partners accountable. This will require states to embrace greater transparency, as Medicare recently has. It will also require more Medicaid participation in multipayer initiatives to analyze data, improve quality, and change the incentives to foster health care that is more longitudinal and less episodic (Dr. Mark D. Smith, 7/6).

Raleigh News & Observer/McClatchy Newspapers: 'Obamacare' And The Voice Of 'The American People'
The GOP strategists are using "Obamacare" as a device to raise money and stir up opposition to the president. The people buying their pitch don't like President Obama, for various reasons. Health care reform seems like a hook on which to hang their feelings against the president. So after the high court ruling, let's take a breather and consider what "Obamacare" doesn't do: It's not a government takeover of health care. The insurance system still is in place, but most everyone will have to have it. Over time that ought to lower the cost for others (Jim Jenkins, 7/6).

iWatch News:  Health Care's Community-Based Beginnings
Back during the debate on the Clinton health care reform proposal, insurance executives tried to convince lawmakers that they were on the same side of health care reform as consumers were, so they embraced the idea of "community rating" in which insurers charge everyone in a given community the same premium regardless of age, gender or health status. ... Fast forward nearly two decades and you'll find that insurance executives have changed their tune, now that they're actually being required to go back to the good old days when community rating was the norm. Today's health insurers want nothing to do with it. There's just not enough profit in it (Wendell Potter, 7/9).

Arizona Republic: Was Justice Roberts' Decision Really Worth Potential Damage?
The so-called individual mandate -- now, officially, a tax -- is not the Affordable Care Act's only unaffordable element. Altogether, the law creates 20 other new taxes intended to raise a half-trillion dollars. That includes a 3.8 percent surtax on investment income, which may come on top of the investment-income hikes created by ending the George W. Bush-era tax cuts. And which, in many states, will come on top of local soak-the-rich tax increases (Doug MacEachern, 7/8).

Los Angeles Times' Capitol Journal: 'Affordable' Care Act? Not So Much For Sacramento
In Washington, it's called the Affordable Care Act. In Sacramento, it could be become known as another budget buster. Obamacare -- as it's pugnaciously tagged by the political right -- may not be affordable at all for California state government (George Skelton, 7/9). 

Sacramento Bee: State Insurance Exchange Can Learn From Big Employers
California leaders have signaled their intention to move full speed ahead with building a state health insurance exchange that has the potential to provide coverage to millions of Californians beginning in 2014. But if the California Health Benefit Exchange simply becomes another website where Californians can go to purchase health insurance, we will have missed a colossal opportunity to improve health care in the Golden State (Bill Kramer and David Chase, 7/8).

The Raleigh News and Observer: The Southern Side Of Health Coverage
As the Supreme Court upheld the health care bill's mandated coverage, seven justices placed ample constraints on the program's massive Medicaid expansion. They ruled that Congress had exceeded its authority by coercing states to participate through the threatened loss of existing federal payments. Accordingly, states can now choose to forgo new dollars, and new strings, without abandoning Medicaid coverage (and funding) altogether -- a prospect none could realistically abide. States have a choice whether to assist in providing additional health care services to their poorest citizens. The resulting political donnybrook may be a daunting one (Gene Nichol, 7/7). 

Spartanburg, S.C., Herald-Journal: We Need To Use S.C. Solutions For S.C. Health Care Issues
South Carolina advocates for better health, lower health care costs and limited government have little to cheer about after the U.S. Supreme Court ruling upheld much of Obamacare. Instead of providing real solutions, the law simply hides our problems from public view by pouring hundreds of billions of government subsidies into a broken health care system, allowing Washington to declare "victory" while continuing to ignore the real health care challenges facing Americans (Gov. Nikki Haley and Anthony Keck, 7/6). 

Des Moines Register: Branstad's Medicaid Stance Is Unreasonable
For decades this nation has left millions of our people without health insurance. One of Congress' main goals with the health reform law was to finally get them coverage. Unfortunately, Gov. Terry Branstad appears to want to make sure they remain uninsured (7/8).

Des Moines Register: State Workers Faced With Tough Decision On Whether To Voluntarily Pay For Health Insurance
More than 20,000 state employees face a decision in the coming days: Should they make a monthly contribution to the state treasury or not? Last week, the Iowa Department of Administrative Services informed them that they would be "good stewards of taxpayer dollars" if they volunteer to pay 20 percent of the cost of their health insurance premiums. The Register's editorial board has repeatedly argued that state workers should pay a portion of the cost of their insurance. ... But such cost-sharing should be sorted out in negotiations between employees' unions and state officials. It should be part of a thoughtful process ensuring that the amount paid is not plucked out of politically-charged thin air and that all workers are paying their fair share, rather than just some (7/6).

Tacoma News Tribune/McClatchy Newspapers: Health Care View Depends On Where You Sit
How you reacted to the pretty darned historic U.S. Supreme Court ruling on the Affordable Care Act might depend upon the lens you look through. Is it a primarily a constitutional issue, a political issue or a public policy issue? (Peter Callaghan, 7/9).

Fort Worth Star-Telegram/McClatchy Newspapers: Health Care Law Will Benefit Small Businesses
In this marketplace, the sharpest dividing line between the haves and have-nots hinges on the size of your employer. Among Texas companies with at least 50 workers, 95 percent offer health insurance to employees. Among smaller companies, 31 percent offer coverage. That means that most small employers don't even try to compete on this benefit. And after the Supreme Court upheld the Affordable Care Act last week, they won't have to. This is one of the great breakthroughs of health reform: By 2014, everyone gets access to health insurance, whether employers are on board or not -- and whether they're sick or healthy (Michael Schnurman, 7/8).

Boston Globe: Obamacare: A Windfall For Massachusetts
Even though the state already has near-universal health coverage, Obamacare -- if all goes well -- will reduce the financial pressure on Massachusetts and give the state some room to make its economy more competitive. The challenge to Beacon Hill is to use this opportunity wisely (Josh Barro, 7/9).

Baltimore Sun: Obamacare: Constitutional But Contemptible
The majority opinion was a win/win for the president; his mandate to purchase health insurance survives. If the costs borne by those now forced to buy insurance are construed as a tax (as I and many others believe they should be), they join with the other 18 (mostly) progressive Obamacare taxes to form the largest tax increase in American history. Lost among most of the analysis was another surprising result: Obamacare's attempt to cover more people under Medicaid was significantly limited; those states that refuse to extend coverage to new beneficiaries will no longer face the prospect of losing their existing federal payments. A small victory for the taxpayers on an otherwise bad day (Robert L. Erlich, Jr., 7/8).

MinnPost:  Why Americans Want To Spend More On Health Care
Last week, the Supreme Court upheld the Affordable Care Act (ACA). Now, the battle moves from the courts to electoral politics, with arguments about whether or not the ACA will reduce health care costs compared to what they would have been without it, or whether repealing the ACA and substituting alternatives such as health care vouchers would encourage increased efficiency and lower costs.  However, such debates are fundamentally flawed. The economic fact is that the amount we spend on health care as a percentage of national income will continue to rise over the next 50 years (Louis D. Johnston, 7/6).

Houston Chronicle: Care Act Will Benefit Children
The U.S. Supreme Court's decision to uphold the Affordable Care Act (ACA) marks a giant step forward for millions of Texas children and families who can now get the health care coverage they need. Because of our state's highest-in-the-nation rates of uninsured, Texas stands to benefit from this decision more than any other state. … Now that the law's legality has been affirmed, our state leaders must get to work on implementing the law effectively for all Texans (Anne Dunkelberg; Eileen Garcia; and Laura Guerra-Cardus, 7/6).

The Seattle Times: Medical Reform, Act II -- How Best To Deliver Care
We should feel great urgency to move forward with our now firmly constitutional health care, while recognizing it is only one piece of a much larger solution still in the making. This solution, which we must shape locally, needs to accomplish three goals. … First is to increase access to health care -- to expand coverage to nearly 200,000 King County residents through the individual mandate and Medicaid-expansion provisions of the act. … Second is to implement payment reform to curtail spending. … And third is to increase our investment in community programs that create health (David Fleming, 7/7).

The Seattle Times: Update From Health Insurer Only Good News, In His View
According to a Rasmussen Reports poll done after the Supreme Court's ruling, 52 percent of Americans still want the entire law repealed, but it's difficult to see which of the above amendments cause such ire. Greater support of preventive care? Increased allowance for essential benefits? Surely not the coverage of pre-existing conditions in children, which UnitedHealth pledged to revoke if the court allowed. I'm grateful that provision stands. As the father of a toddler with type 1 diabetes, I struggle to pay out-of-pocket for preventive care, but for years, I couldn't opt for a better plan -- surely, the best benefit of a free-market system -- without a lapse in coverage  (Dan Newman, 7/6).

Minneapolis Star Tribune: Medicaid Expansion: Good For Minnesota
Many of those newly eligible for Medicaid are already eligible for or are receiving MinnesotaCare, a program that costs state taxpayers more money and offers fewer benefits than Medicaid. The bottom line: Expanding Medicaid is a greater value for Minnesotans at a lower cost to the state, a deal few could pass up (Tony Lourey, 7/8).

Minneapolis Star Tribune: GOP's Unfinished Health Care Work
Now that the U.S. Supreme Court has mostly upheld the Affordable Care Act, it's time for Minnesota's Republican legislative majority to take care of some important unfinished business: passing enabling legislation and working with Gov. Mark Dayton's administration to make the state's online "health exchange" marketplace a reality. … Exchanges will likely be part of the health care landscape no matter which party dominates next fall (7/7).

Detroit Free Press: All Eyes On What Happens Next With Health Care
The U.S. Supreme Court ruling on health care reform does not make adequate health insurance a fait accompli. Serious work remains, particularly at the state level. There are steps at the federal level, too, that could improve the new system even before it gets fully under way, regardless of who holds sway in Washington next year. The most crucial initial decisions will be made in state capitals, and at least some of them need to be made quickly. For Michiganders, that means urging state lawmakers and the governor to take full advantage of the provisions of the Affordable Care Act (7/8).

Kansas City Star: The Sick, Like Me, Should Speak Up
As long as this legislation stands, I do not have to face rejection for health insurance when my COBRA coverage runs out. If it is repealed, my options will be to accept public assistance (something I've resisted despite being irrefutably qualified for disability insurance), deplete my parents' security, or move to one of the nearly 50 countries with universal health coverage. Many people can't wrap their minds around the fact that lots of conditions do not have cures and that diagnostic criteria and treatment guidelines change regularly as more is learned about the body and that which thwarts it. Few understand the feeling of futility and isolation when one is on a quest for an answer or remedy that doesn't yet exist (Brooke Tourtellot, 7/6).

Miami Herald: On Affordable Care Act, Gov. Scott Should Get To Work
Since early 2010, when Congress passed health care reform, Florida Republican leaders have been obsessed with its overthrow. Defeating it was the priority of Gov. Rick Scott. Our last two attorneys general have led the charge in the courts. And the state Legislature did all it could to thwart its implementation. So now that the most conservative Supreme Court in our nation's recent history has ruled that the Affordable Care Act is constitutional, perhaps it is time to redirect a little of that negative energy used to obstruct reform toward implementing the law and solving Florida's healthcare crisis (Dan Gelber, 7/8).

Richmond Times-Dispatch: Reform Is Dependent On An Adequate Work Force
Health care is a service industry and labor represents approximately 65 percent of its costs. Without a sufficient work force, transformation of health care will be unattainable. And yet, health care may be the only industry in America where one business is expected to train the work force for its competitors. Academic health centers like the VCU Health System educate and train the preponderance of health professionals for the nation, while still competing in the marketplace (Dr. Sheldon M. Retchin, 7/8).

Chicago Sun-Times: You Can Cover Long-Term Care With 'Combo' Products
The long-term care insurance industry seems to be throwing in the towel -- deciding it can't afford to give you extensive insurance coverage at a price you can afford. That's a shame because the scariest part of retirement planning is not the possibility of a stock market crash, or even outliving your money. You can adjust your investments and withdrawals for those possibilities. The truly scariest part of retirement is the need for long-term, non-skilled health care -- a cost that can easily wipe out all your retirement savings in a few years (Terry Savage, 7/8).