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The last decade began with the narrow passage of the Affordable Care Act — President Barack Obama’s signature health-care legislation — over the strenuous objections of Republicans. It ended with most of the 2020 Democratic presidential field pushing for even more substantial change to a system the ACA only began to fix, and with Republicans once again in opposition. The debate continues. Under Obamacare, more than 20 million previously uninsured Americans now have health coverage, and many more have robust consumer protections. That has helped turn what was a controversial electoral weakness for Democrats in 2010 into a strength — so much so that failed Republican efforts to repeal the law helped Democrats take back the House majority in the most recent midterm elections. (Max Nisen, 1/5)

As the calendar flips to 2020, we’re coming up on a decade since the passage of ObamaCare. But Democrats aren't celebrating 10 years of the Affordable Care Act, signed into law March 23, 2010. That's largely because President Obama’s signature legislative achievement hasn’t yielded the affordable care Democrats promised. (Sally Pipes, 1/6)

With legislation in Congress likely to be blocked by partisan division and interest group opposition, much of the real action in health care this year will be in the states. The big picture: States don’t have the money or purchasing power the federal government does, but their decisions nevertheless affect millions of people, and they could signal the future of federal reform. What to watch: Colorado and Washington are implementing public insurance options that could be a model for Democrats at the federal level. (Drew Altman, 1/6)

Surprise medical bills have become the bane of many Americans who are seen in emergency departments. These bills arise because hospital-based physicians, who are mostly employed by private equity-owned staffing firms, decline to join insurers’ provider networks. These doctors double dip by getting paid by insurers and then collecting a balance from patients. They also use their ability to bill out of network to negotiate higher fees when they do sign contracts. Business and consumer advocates have focused on legislative solutions to this problem, but efforts in Congress have stalled. (Jackson Williams, 1/6)

President Trump has used his executive authority to make positive reforms that are bringing affordable health insurance to consumers and small businesses. However, for many people, access remains a challenge. More than half of all Americans routinely delay getting proper care because of worries about costs. Through additional executive actions, President Trump can resolve to make three crucial health care changes in 2020 — changes that will lower costs and improve efficiency. Should the president fulfill them, these New Year’s resolutions would bring excellent benefits to the American people.  (Roger D. Klein, 1/3)

Spending on U.S. health care is out of control, expanding steadily from 5% of GDP in 1960 to 18% in 2018. There are, however, ways to curb the explosion in costs from both the demand and the supply side.Health care costs per capita in the U.S. are almost double those of other developed countries, but life expectancy is lower than many, even South Korea, according to the CIA and Eurostat. Without restraint, costs will accelerate as more and more postwar babies age. The nonpartisan Congressional Budget Office projects Medicare spending alone will leap from 3% of GDP to 8% by 2090. (A. Gary Shilling, 1/3)

My pager emits the same urgent beep no matter the occasion. That afternoon, it was the local preoperative clinic to say my 80-something patient, Lily, had been given an electrocardiogram (EKG) “just to be safe” before a minor office procedure. The EKG was a little off, the page went on. Could I take a look? Lily (I’m identifying her by only her first name at her request) felt fine. No chest pain. No trouble breathing. But now that the irregularity was out there, the procedure would be delayed until we had answers. (Ishani Ganguli, 1/5)

Young and old people are struggling to take care of themselves and increasingly each other at a time when blame and resentment flows both ways. But winner-take-all, generational warfare neglects our shared interests and challenges. We need to work together to forge policies that simultaneously improve the fortunes of all generations. As “Ok, Boomer” becomes the latest cultural putdown, growing conflict between younger and older people reflects dwindling resources and misunderstanding across the generational spectrum. (Stacy Torres, 1/3)

A U.S. appeals court last month declined to invalidate the Affordable Care Act, which has already been wounded by a decade of Republican undermining. By keeping what’s left of Obamacare alive, the court has granted a reprieve for the patients who rely on it. But make no mistake: Millions of Americans with preexisting medical conditions are still threatened by the GOP’s continued campaign of destruction. (1/5)

The subtitle of this editorial could be “Please look past Cuyahoga County government’s clumsy nonsense and vote to help those in our community who are hurting.” Yes, we are frustrated by how regularly County Executive Armond Budish’s administration screws up. Yes, we are disappointed by the administration’s inexcusably bad messaging in rolling out a proposal to raise our taxes. But, yes, we wholeheartedly endorse this tax increase. It will help so many troubled people – the mentally ill, senior citizens, people battling addiction, babies, the hungry and more. It is worthy of your approval March 17. (1/5)

In an important sense, the political new year won’t start in North Carolina until November. The General Assembly’s Republican majority can’t be expected to turn over a new leaf. It’ll follow the now tattered and discredited plan it has executed since taking control in 2011 — pushing tax cuts that favor the wealthy and big corporations, resisting Medicaid expansion, reducing environmental protections and business regulations and conducting public education on the cheap. But, as North Carolina is becoming painfully aware, ignoring needs doesn’t make them go away. Despite the tunnel-vision of the legislature’s leaders, it’s worth taking a broader look at what North Carolina should do in 2020. No. 1: Expand Medicaid. (1/5)