Administration officials touted a report that found 49 states are implementing at least some parts of healthcare reform, though many Republican-led states have said they’ll hold back on their exchanges until the Supreme Court decides whether the law is constitutional. And they called out “unreasonable” insurance company rate hikes in nine states using new powers granted by the law.

House Minority Leader Nancy Pelosi (D-Calif.) was bullish on the law’s legal outlook Thursday, telling reporters the law is “iron-clad constitutionally.” The Supreme Court will begin hearing oral arguments over the law Monday. The Hill has more on Pelosi’s confidence.

Air wars: So, why haven’t the law’s supporters been able to make bigger gains with the public? It probably doesn’t help that they’ve been outspent by more than 3 to 1 by their opponents. Over the past two years, critics have spent roughly $204 million on TV ads attacking the healthcare law, compared with only about $58 million in ads from supporters, according to a report released Thursday. Opponents have also targeted their ads to swing states, while supporters have spent most of their money on national spots. The Hill has more.

Small businesses, big doubts: Small-business owners are afraid of the healthcare law, House Small Business Committee Chairman Sam GravesSamuel (Sam) Bruce GravesThe Hill Interview: Missouri Republican has gavel on his radar Trump promises to unveil infrastructure plan after tax reform Trump admin launches program to help veterans become commercial pilots MORE (R-Mo.) said Thursday. Graves has been asking business owners to share their biggest concerns, and he used the healthcare law’s second anniversary to highlight comments from small-business owners who say the new law is an obstacle to hiring new employees. Their testimonials are online here.

Gone-PAB: As expected, legislation to repeal the healthcare law’s cost-cutting board sailed through the House on a mostly partisan vote after Republicans attached medical-malpractice caps. The Hill has the low-down on the vote here. As soon as the vote was over, Democrats assailed Republicans for endangering Medicare’s solvency; Healthwatch’s Julian Pecquet has that story here.

Before voting on repeal, Republicans stripped language that said the U.S. healthcare industry affects interstate commerce — something they feared could undermine their argument before the Supreme Court next week that the healthcare reform law abuses the Commerce Clause of the Constitution. The Hill has more on that quandary here.

Friends against benefits: Alabama Attorney General Luther Strange (R) on Thursday joined the Becket Fund for Religious Liberty’s lawsuit against the Obama administration’s mandate that religiously affiliated hospitals and universities offer contraception coverage without co-pays for their employees and students. 

“We welcome Alabama as a crucial ally in this fight,” said Kyle Duncan, the Becket Fund’s general counsel. “Their participation reveals another glaring problem with the mandate: Not only does the mandate threaten religious freedom, but it also impairs Alabama’s ability to protect its own citizens’ rights.”

510 “pray”: Rep. Edward MarkeyEdward (Ed) John MarkeyNet neutrality supporters predict tough court battle over FCC's repeal plan Avalanche of Democratic senators say Franken should resign Driverless car bill hits Senate speed bump MORE (D-Mass.) released a report that claims a loophole in the Food and Drug Administration approval process for medical devices has enabled a number of defective products to enter the market and cause serious harm or even death. The report bolsters Markey’s legislation changing the 510(k) approval process for medical devices that demonstrate their similarity to an earlier model, which he wants to attach to user-fee legislation that’s up for renewal this year.

Friday’s agenda

The “Stand Up for Religious Freedom” coalition is holding a rally outside the Health and Human Services building to protest the health law’s individual mandate ahead of Supreme Court oral arguments on Monday. The rally is co-sponsored by the Becket Fund for Religious Liberty — other attendees include Star Parker, director of the Coalition on Urban Renewal and Education; Lila Rose, president of Live Action; Kristen Hawkins, director of Students for Life; Johnny Hunter, president of LEARN; and the Rev. Patrick Mahoney, director of the Christian Defense Coalition.

State by state

The New Hampshire Senate shelved legislation creating insurance mandates for midwives, autism services, hearing aids and bariatric surgery.

Utah Gov. Gary Herbert (R) was in Washington this week to tout states’ ability to find their own healthcare solutions on the federal law’s second anniversary. 

State sovereignty is at stake in next week’s Supreme Court case, says the Christian Science Monitor.

Bill tracker

Rep. Bill Pascrell (D-N.J.), co-founder and co-chairman of the Congressional Brain Injury Task Force, introduced legislation to reauthorize and broaden the Traumatic Brain Injury Act (H.R. 4238). Here’s his news release.

Lobbying registrations

Thorn Run Partners/Beverly Oncology & Imaging Centers (cancer treatment medical group lobbying on issues related to the U.S. Immigration and Customs Service)

Reading list

Health Affairs has a handy policy brief on House Budget Committee Chairman Paul RyanPaul Davis RyanMcConnell names Senate GOP tax conferees House Republican: 'I worry about both sides' of the aisle on DACA Overnight Health Care: 3.6M signed up for ObamaCare in first month | Ryan pledges 'entitlement reform' next year | Dems push for more money to fight opioids MORE’s Medicare proposal.

Sales of electronic medical records, propelled by federal incentives, reached $17.9 billion in 2011 — up 14.2 percent from the previous year, reports HealthcareFinanceNews.com.

What you might have missed on Healthwatch

Obama: Romney ‘pretending’ he came up with different healthcare plan

Texas GOP Sen. Hutchison defends Planned Parenthood, rips Rick Perry

Comments/complaints/suggestions? Please let us know:

Julian Pecquet: jpecquet@thehill.com / (202) 628-8527

Sam Baker: sbaker@thehill.com / (202) 628-8351

Follow us on Twitter @hillhealthwatch