No Letup in the Health-Law Debate If the Obama administration does not clarify the details of the Affordable Care Act - clearly, simply, graphically and chronologically, so that every American can understand them - we risk losing the most important legislative achievement of President Obama's first term. One key vulnerability of the legislation remains the continuing confusion about what it includes, what changes will occur when, and who is affected. As detractors" talk of repealing the legislation grows, there is no time to waste. One pamphlet, with a simple visual summary and timeline, would eradicate confusion and reassure millions of Americans with the indisputable facts, once and for all. To see the Affordable Care Act repealed - or to deprive it of the broad support it deserves - simply because its contents were never plainly illustrated for every American would be a terrible shame, and a potentially irreversible blow to the future of health care in this country. Re "Reluctance in Some States Over Medicaid Expansion" (front page, June 30): The now very real possibility that many states will reject the Medicaid expansion has costly implications for the nation's uninsured poor. Medicaid expansion is supposed to be our guarantor that millions of vulnerable patients won't be denied care for ability to pay. Keeping patients uninsured increases total health care costs through their heavy reliance on acute episodic care (avoidable emergency room visits and hospital admissions). It also results in higher rates of missed diagnoses, preventable complications of disease, and, of course, poor quality of life. Physicians and health care workers ought to make these ramifications clear to the public and to their state legislators. Only then will state leaders acknowledge the political costs in rejecting billions of federal dollars for the much needed expansion of public insurance. The writer, a medical student, is a Maryland state leader of Doctors for America. In the wake of the Supreme Court decision establishing the constitutionality of the Affordable Care Act, many Republicans are focusing their opposition on states" rights. They argue that rather than a "one size fits all" national plan, each state should be able to choose a policy that suits its own conditions. Mitt Romney defends his having championed a similar law in Massachusetts when he was governor in similar terms. Let's not forget an important reality: many states, even if their governors wanted to enact health care reform to provide insurance to 98 percent of the population, as Massachusetts did, cannot afford to do so. And not just because of the recent recession. Some states are much poorer than others. Moreover, those states also tend to have larger numbers of people without insurance and would need to spend more to provide coverage for them. One result of a state-based health care reform plan, therefore, would be that some citizens would be denied coverage that similar residents of other states would have - simply because of where they happened to live. The writer is a professor at the Boston University School of Management and the author of "Still Broken: Understanding the U.S. Health Care System." Richard A. Epstein, in "A Confused Opinion" (Op-Ed, June 29), bases his critique of Chief Justice John G. Roberts Jr."s opinion on the alleged inseparability of federal taxation and federal regulation. But the federal government routinely taxes things that it chooses not to regulate directly by law, and that the Supreme Court could possibly deem unconstitutional to so regulate, such as cigarettes and alcohol. Using taxation to discourage potentially harmful activity, instead of passing laws to forbid it, is a firmly established practice in America. Whether you want to call these payments penalties or taxes is ultimately meaningless. Although I agree with your editorial decrying the heedless politicization of the Supreme Court by right-wing justices ("The Radical Supreme Court," July 1), your statement that the justices are not "articulating a new social consensus" is highly debatable. The excerpts from the Supreme Court hearing on the Affordable Care Act and Chief Justice John G. Roberts Jr."s majority opinion make abundantly clear that the conservative justices believe they are upholding a new social consensus of the primacy of the marketplace in just about all facets of society. Their obstinate refusal to concede that health care is a necessity and not a mere commodity like broccoli can only be rationally explained by the fact that such an admission would shatter the glass menagerie of their ideology. This is pathetic at best and dishonorable at worst. Yet, before judging the justices, we must also consider that this ideology is arguably the prevailing social consensus, demonstrated by the high ratings of right-wing news media and the 2010 election results. Those of us who differ with this ideology can argue its merits, but its current pervasiveness is undeniable.