Thursday’s Supreme Court ruling, which preserves federal subsidies for ObamaCare insurance premiums secured through federal exchanges, filled the news cycle with talking heads offering their opinions on the court’s decision and the health care law, also known as the Affordable Care Act — ACA for short.

The court ruling will, at least temporarily, quiet legal challenges to the health care law.

The problem now is that ACA shortcomings persist, and most of them are political and financial. The expansion of coverage to millions of lower-income Americans has been a good thing, but rising health insurance premiums and high-deductible policies are causing headaches across the country.

Despite Republican criticism of the ObamaCare law, no good workable alternative has been proposed by the GOP.

Any progress in making the law work better and/or cost less will require political solutions. And in hyperpartisan Washington, particularly in a presidential election year, politics becomes a stumbling block.

Democrats don’t want to admit the ACA has problems and can be improved. Republicans don’t want to admit the law has improved overall health care by providing more people with health coverage.

Republicans also might resist working to improve the law, hoping instead to make political hay by targeting ACA’s flaws and rising costs faced by many individual Americans and employers that provide health benefits.

President Obama and other ACA defenders say health care costs have risen more slowly than in years before the law’s enactment. But health care officials are warning that big price hikes are coming, and coming soon.

Already New Mexico’s Blue Cross-Blue Shield has proposed a 50-percent price increase. In Maryland and Tennessee, the “Blues” are pressing for increases of 30 percent or more. In Oregon, where the ACA program is described as a success, premiumns are expected to rise by 25 percent.

There are many reasons for rising costs. In the early years of ACA, federal subsidies were offered to insurance companies because they did not know who would sign up for ObamaCare and how much their health care would cost. It also appears that not many young, healthy people signed up for Obama-Care. The idea was that young and healthy people would be compelled to sign up because of penalties levied through the IRS. Their premiums would pay for or subsidize health care for older, sicker Americans. But the penalties for not signing up are quite low. One report estimated penalties, which are scheduled to increase in later years, now amount to just one month’s premium for even the lowest cost ACA plan. So, with such low penalties, young people are staying out of the program and the risk pool.

Another driver of costs comes from drug companies. To gain their support and get Obama- Care passed, the government did not press pharmaceutical companies to reduce prices. It remains a fact that Americans spend far more for the same drugs as patients in other countries pay. In addition, drug companies are developing targeted drug therapies for rare diseases that can cost $50,000 to $100,000 a year. They make lots of profit on these drugs and insurance polices are compelled to pay the prices, without the benefit of a competitive market to drive prices down.

There are many problems with the ACA, with rising costs being the most obvious. Throughout the health care debate that led to ObamaCare there was not enough focus, in Congress or across the country, about the fact that Americans pay about twice as much for health care, on a per person basis, as people in other advanced nations.

Congress and the White House were then, and remain today, too beholden to Big Health Care, meaning drug companies, health insurers, hospital and doctor associations. They needed those groups to accept ACA, so they agreed not to apply pressure to prices so that Americans would no longer pay twice as much for health care as citizens in other advanced countries.

This week’s court ruling should clear the way for discussions about how to improve ObamaCare — and most importantly about how to drive down costs. President Obama often talked about “bending the curve” of health care costs. But the ACA has failed to deliver on that promise. Now that the last court challenge has been rejected, Obama and Congress should focus on reducing costs.

But given the realities of politics and Washington power structures, that is unlikely to happen.