THE U.S. Supreme Court changed the national discussion with its decision to uphold most of the Affordable Care Act. Time and energy spent debating medical-insurance coverage must now focus not only on providing care but also containing costs.

The latter is urgent because soaring health-care costs are the No. 1 threat to economic prosperity and government treasuries. The law did not address enough substantial reforms to rein them in.

Politicians on both sides of the aisle must accept the decision and move ahead. Republicans should put a lid on the prattle about repeal. President Obama and Democrats get a few scant moments of gloating about their policy triumph, then they must deliver on deeper commitments imposed by their achievement.

Broad medical coverage will benefit tens of millions of Americans. Their access to prenatal care, preventive medicine, discounted drugs and basic access to medical treatment will save money.

At the same time, the Obama administration and the infrastructure being established in states across America must find ways to rein in costs. That overhead takes many forms: the right care delivered at the right time and place, best practices within the medical profession, and the administrative overhead to provide care and deal with insurance providers.

Unchecked, higher medical costs hit taxpayers via public-employee labor and benefit contracts and state Medicaid costs for low-income people. They haunt consumers by way of costs passed on by businesses, small and large.

The court said the federal government could not penalize states for failing to expand Medicaid coverage, as sought by the act. States make the call about expansion. Of course, failure to broaden coverage will leave substantial federal subsidies on the table.

U.S. corporations and manufacturers compete in a global business environment against companies with virtually no health-care overhead. The Affordable Care Act offers some relief.

Knee-jerk threats to dismantle the law need to be challenged with a single question: How will the outraged, arm-waving politician provide health care for 30 million uninsured Americans?

The public quickly adapted to the prospects of continued coverage for young adults on their families health plans, no denials of coverage for pre-existing conditions and no dollar caps on coverage.

Less is made of the boon this plan represents for the insurance industry, which remains the core provider and will see a tidal wave of new business.

The state of Washington is already well under way on planning. A marketplace for insurance, the Health Benefit Exchange, is formed and opens its doors in the fall. The Legislature last session launched projects to control costs in emergency rooms, reduce C-section deliveries and help prevent low-weight births.

These are public-private partnerships, with the purchasers of care and the providers of care being convened by the state. Another ongoing effort is the Puget Sound Health Alliance, a consortium of five counties looking to improve health-care decision-making.

The federal government should be pushing for discounts and rebates on bulk purchases of preferred drugs through Medicare. A basic savings is aggressively resisted by the pharmaceutical industry.

The Affordable Care Act is an extraordinary opportunity for the nation. Maximizing its potential requires a laser focus on managing care and cutting costs.