Across the country and around the globe, these healthcare leaders exert their influence

The selection of U.S. Supreme Court Chief Justice John Roberts and President Barack Obama for the top two spots in the 14th annual Modern Healthcare 100 Most Influential People in Healthcare reflects the continuing centrality in healthcare of the Affordable Care Act and the ongoing political battle over its future.

Just behind them in the top 10 are several major health system leaders, along with a prominent physician who has spurred national healthcare conversations through his journalism and book authorship. Finishing out of the top 10 is a veteran CEO who has driven the recent health insurance consolidation trend.

Roberts' written opinion in King v. Burwell in June saving the ACA's premium subsidies in all 50 states made him the obvious choice for the Most Influential title, just as his decision to uphold the constitutionality of the ACA's individual mandate made him the logical choice in 2012. Supreme Court Justice Anthony Kennedy, the other conservative justice who voted to keep the premium subsidies, made the list this year for the first time, at No. 23.

Obama, who promised to veto any Republican bills to repeal or roll back the ACA, took the No. 2 spot on the Most Influential list, after winning the top spot last year—for the third time.

Dr. Atul Gawande, a Boston surgeon, health-services researcher and author, finished in the top 10 for the first time, as his bestselling book, Being Mortal: Medicine and What Matters in the End, helped spark a national discussion about end-of-life decisionmaking and long-term care.

In total, there were 23 people who made the list for the first time, with acting CMS Administrator Andy Slavitt placing the highest at No. 20.

Slavitt, Roberts, Kennedy and HHS Secretary Sylvia Mathews Burwell are among 13 non-elected federal officials on the roster. At No. 6, Burwell placed the highest among the list's 27 women.

Besides Obama, there were four other elected officials. They include House Ways and Chairman Paul Ryan (R-Wis.), who topped the list in 2011 and is No. 30 this year; Senate Majority Leader Mitch McConnell (R-Ky.), who placed at No. 44 and made the list for the first time; Speaker of the House John Boehner (R-Ohio), who made the list for the fourth time, at No. 52; and Kentucky's Democratic governor, Steve Beshear, who made the list for the first time at No. 67. Beshear championed his state's successful Medicaid expansion and the establishment of a state-run insurance exchange.

Along with Beshear and McConnell, a third Kentuckian made the list for the first time: Benjamin Breier, the new CEO of Kindred Healthcare, a Louisville-based post-acute-care provider, with 103,000 employees and $7.2 billion in revenue in 2014. Breier placed No. 71.

Breier said he knows why he made the list. “We find ourselves front and center around the societal debate of what we are going to do to care for (the aging) population that is only going to grow in size,” he said. “Moving from fee-for-service to fee-for-value will be what the next five years in healthcare will be all about. I hope Kindred will be a leader in that.”

Another new CEO making his first appearance on the Most Influential list is Dr. David Torchiana at No. 61. He has led Boston's 12-hospital Partners HealthCare system since the retirement of Dr. Gary Gottlieb, who made the Most Influential list eight times. One area where he hopes to make a difference is in the opioid-addiction problem in his community. “It's a high priority,” Torchiana said, adding that many addictions begin with poor medical management of prescription drugs.

Joseph Swedish, CEO of Indianapolis-based health insurance giant Anthem, is hardly a newcomer to the Most Influential list, having made it 10 times. Coming at No. 11 in this year's rankings, Swedish is a prime mover in the consolidation of the health insurance industry with his company's recently announced $37 billion merger deal with Cigna Corp. That deal, which likely will receive tough antitrust scrutiny, has triggered alarm among hospitals and physicians.

“Our industry is a dynamic one, never more so than now,” Swedish said. “I'm very proud that at Anthem, we haven't been content to just react. We strive to lead the transformation through bold moves, like our recently announced plans to acquire Cigna.”

In her first appearance on the list, Pamela Cipriano, president of the American Nurses Association, placed No. 37. Cipriano said value-based payment reform will increase nurses' influence in healthcare management and policy. To boost nurses' policy role, the ANA has launched an effort to get 10,000 nurses added to healthcare decisionmaking boards by 2020.

Anne Filipic, president of the healthcare-coverage advocacy group Enroll America, made the list for the first time at No. 59. Filipic, a former HHS deputy director, said her influence and the influence of Enroll America “are rooted in the power of the consumer voice.” She said her job is to “help decisionmakers better understand how this sweeping change is really working on the ground.”

One person who has influenced her is Slavitt, who has served as acting CMS administrator since July 2014, and has been nominated by Obama for the permanent position. “We've been impressed by how he's brought real-world experience to government,” Filipic said.

Slavitt succeeded CMS Administrator Marilyn Tavenner, who placed No. 5 in 2014 but fell to No. 55 this year. She recently replaced Karen Ignagni as CEO of America's Health Insurance Plans. This year marks the first time Ignagni did not make the Most Influential list in the 14 years of its existence.

The others who have been on the list every year are Trevor Fetter, CEO of Tenet Healthcare Corp., No. 9; Wayne Smith, chairman and CEO of Community Health Services, No. 18; Chip Kahn, CEO of the Federation of American Hospitals, No. 28; Drew Altman, CEO of the Kaiser Family Foundation, No. 39; and RoseAnn DeMoro, executive director of the California Nurses Association/National Nurses United, No. 96.

“I'm always totally astonished to be on the list,” Altman said. His organization produces healthcare policy analyses, surveys and an independent not-for-profit news service. The foundation was started to “serve as a counterpart to commercial and political interests,” he said, adding that it took awhile for it to establish credibility. “The difference between us and most everyone else is that we're not advancing a particular position,” Altman said. “We go where the data take us.”

A healthcare veteran who is a newcomer to the Most Influential list is Dr. Anthony Fauci, who has directed the National Institute for Allergy and Infectious Diseases for several decades. He placed No. 43. His agency, which has a budget of $4.4 billion, has received increased attention with the recent Ebola and Middle East respiratory syndrome outbreaks, as well as its continuing efforts to address HIV/AIDS and influenza.

Fauci said the lesson from the Ebola outbreak in West Africa is that catastrophes can occur when a region has no public health infrastructure to identify the cause of a disease, to isolate and treat those infected, and to locate those with whom the infected have had contact. “The global community has to make an investment in creating a global health agenda to respond to outbreaks before they get out of hand,” he said.

U.S. Surgeon General Dr. Vivek Murthy made the list for the first time in the No. 38 spot. “As surgeon general, my overarching goal is to create a culture of prevention,” he said. “My dream is that we get as good at preventing disease as we are at treating it,” said Murthy, whose confirmation was held up for many months by Senate Republicans who objected to his previous public statements favoring measures to reduce gun violence. He also wants to create partnerships to bring better food options into communities, and make it safer for people to walk around their communities at night.

Murthy stressed the need to mitigate the public health harms of climate change. “It's important for us to address climate change earlier rather than later, not only to protect the planet, but to protect the health of people in America and around the world,” he said.