Viewpoints: Pressure on states to move on exchanges; Roberts' decision holds off new calls for public option

A selection of editorials and opinions on health care policy from around the country.

The New York Times: It's Time To Set Up Exchanges
Now that the health care reform law has been ruled constitutional, it is imperative that as many states as possible move aggressively to establish a centerpiece of the reform structure: new insurance policy exchanges for people who lack affordable coverage through an employer. Federal subsidies will be available for those with low or moderate incomes (6/29).

The Atlanta Journal-Constitution: Court Ruled, Now State Should Act
If the state continues to whistle and wait in the hopes that relief from Obamacare will somehow, some way, appear, the risks are real and the downside is significant if the reforms survive future challenges. Standing still may play well politically, but it does nothing to help Georgia's businesses and consumers pragmatically plan their future health care decisions (6/30).

The New York Times: Giving Health Care A Chance To Evolve
It was a complicated case, in part because the reform legislation itself was seriously flawed. The law's drafters could have proposed a simpler and more efficient system -; something more like the single-payer systems that have been adopted by most industrial countries. But that would have meant abandoning the nation's current system of employer-provided health plans. That these plans are a catastrophically bad model for providing health care was beside the point. Forcing voters to abandon a status quo that most of them say they like would have doomed more ambitious proposals from the outset (Robert H. Frank, 6/30).

Kansas City Star: The Remedy For Health Care System Is Universal Medicare
A physician friend recently said to me "Once every 15 years, health care reform comes around. If we do not succeed this time, we will have to wait another 15 years." Unfortunately, he is correct, and that is why it is good for Kansans that Obamacare (the Affordable Care Act) was passed and found constitutional. However flawed, it is better than nothing at all, especially for the 350,000 Kansas residents who are uninsured (according to the Kansas Health Institute) (Jack Bernard, 7/1).

The Chicago Tribune: The Surprising Obamacare Verdict
The irony of the challenge is that if Obamacare had been struck down, supporters of universal health coverage would have been left with no good option but a "single-payer" system, also known as "Medicare for all" -; which is undoubtedly constitutional. Whatever the flaws of Obamacare, it at least builds on the existing system of private insurance. Vermont's self-proclaimed socialist senator, Bernie Sanders, used the court's decision to renew his call for a single-payer system. But for him, the verdict was the worst thing that could have happened (Steve Chapman, 7/1).

The New York Times: Taking One For The Country
It was not surprising to hear liberals extolling the legal creativity and courage of Chief Justice Roberts in finding a way to greenlight Obama's Affordable Care Act. But there is something deeper reflected in that praise, and it even touched some conservatives. It's the feeling that it has been so long since a national leader "surprised" us. It's the feeling that it has been so long since a national leader ripped up the polls and not only acted out of political character but did so truly for the good of the country -; as Chief Justice Roberts seemingly did (Thomas Friedman, 6/30).  

The Wall Street Journal: A Vast New Taxing Power
The commentary on John Roberts's solo walk into the Affordable Care Act wilderness is converging on a common theme: The Chief Justice is a genius. All of a sudden he is a chessmaster, a statesman, a Burkean minimalist, a battle-loser but war-winner, a Daniel Webster for our times. Now that we've had more time to take in Chief Justice Roberts's reasoning, we have a better summary: politician. In fact, his 5-4 ruling validating the constitutional arguments against purchase mandates and 5-4 ruling endorsing them as taxes is far more dangerous, and far more political, even than it first appeared last week.

The Wall Street Journal: A Roberts' Switcheroo?
A number of legal scholars have been poring over the decision since it was announced Thursday, and some of them see signs that Justice Roberts may initially have voted to strike down the law, and only switched sides later (Brian Carney, 6/29).

The Wall Street Journal: ObamaCare-;Upheld And Doomed
The mandate that conservatives now hate was originally a conservative proposal. In upholding it, Chief Justice John Roberts followed President Obama's Rose Garden instructions to the letter: The Court must find an act constitutional if it happens to be the signature act of a president running for re-election. Worse, in doing so, he may have read any constitutional limit on Congress out of the Constitution while pretending to do the opposite. Congress cannot compel you to do anything Congress wishes, but it can impose taxes on you until you finally have no rational alternative but to do whatever Congress wishes (Holman W. Jenkins Jr., 6/29).

Baltimore Sun: Does Roberts Believe What He Wrote?
To reach this decision, Chief Justice Roberts had to embrace a position denied by the White House, Congress and vast swaths of the legal punditocracy: that the mandate is a tax for the purposes of constitutional consideration but not a tax according to the Anti-Injunction Act (which bars lawsuits against taxes until after they're levied). Chief Justice Roberts' effort, wrote Justice Antonin Scalia in dissent, "carries verbal wizardry too far, deep into the forbidden land of the sophists" (Jonah Goldberg, 7/2).

Philadelphia Inquirer: After Obamacare Ruling, Healing
As balm for a divided nation, the historic Supreme Court ruling last week that upheld health-care reform offers the prospect of healing on several fronts -; even if there's no certain cure. The benefits could be felt at the Supreme Court itself in support for the rule of law, in the expanded access of millions to health care, and even perhaps in the fractured political process that hampers Washington's ability to grapple with critical problems (7/1).

Boston Globe: Chief Justice John Roberts Put No Limits On Government Power
[The] Supreme Court decision wasn't about the quality of the legislation -; a point plainly stated by the chief justice in the majority opinion's opening paragraph. Were that the case, the Obama administration would have lost handsomely -; seven of the justices had harsh criticism for the law itself. Instead, the ruling's core addressed a simple, but fundamental constitutional question: How much power should the federal government have to compel an individual's personal behavior? The court's answer: lots (John E. Sununu, 7/2).

Denver Post: A Focus On Improving Americans' Health
As important as this ruling is, work remains to be done to expand access to coverage and to care, to connect financial incentives to high-quality care and to control the cost of care. Opportunities to reform how care is provided in our nation are waiting. More than 75 percent of health care costs in the United States come from services provided to people with chronic conditions -; with 10 percent of all patients needing 80 percent of our total care resources -; and America gets care right for patients with chronic conditions barely 50 percent of the time. The lack of coordination prevalent in the American health care system results in poorer health and higher costs (Donna Lynne, 6/29).

Boston Globe: Mass. Must Remain A Model On Health Care
[If] we are to realize for the nation as a whole the types of gains we have seen in Massachusetts, the state must continue to lead. Part of that leadership means recognizing with some humbleness how we got here. Massachusetts was only able to pass our pioneering law because of enormous federal funding that paid more than half the costs of expanding insurance access. To suggest that other states simply follow our lead, but not to provide them the financial advantage that Massachusetts had in making this move, is simply disingenuous. (I'm talking to you, Governor Romney.) (Jonathan Gruber, 6/29).

And a few opinions not related to the health care decision last week:

The New York Times: Home-Care Workers Aren't Just 'Companions'
Not long after announcing his candidacy in 2007, Barack Obama spent a day working alongside Pauline Beck, a home health care aide in Oakland, Calif. Together, they cooked breakfast and lunch, cleaned house and did the laundry. Last December, the president mentioned his day with Ms. Beck when he proposed placing most home-care employees under the Fair Labor Standards Act, from which many of them have long been excluded (Eileen Boris and Jennifer Klein, 7/1). 

Los Angeles Times: Gov. Brown, Budget Cruncher
Real cuts are needed to close the state's multibillion-dollar shortfall. But cutting welfare programs is counterproductive. For example, eliminating 14,000 children from a state child-care program improves California's immediate fiscal health, but it represents 14,000 parents who may have to leave work to stay at home with their kids, or as many kids who will be left on their own during the day without parental guidance. We need the savings, but it sure feels like we're using them to tear the house down (7/1). 

Arizona Republic: Integrate Arizona's Trauma System
The Valley's trauma system could double in size by the end of next year now that Banner Health is planning to designate each of its hospitals as a trauma center. And, in theory, that's great news for patients. A coordinated web of lower-level trauma centers in the suburbs could help moderately injured patients get the care they need quicker and closer to home. … But the sudden proliferation of trauma centers has some surgeons on edge. They contend that Level 3 and 4 centers are meant for rural areas that don't have ready access to higher-level trauma care, not a major metropolitan area with six Level 1 centers (7/2).