KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Oregon Has A Shortage Of Certified Medical Interpreters

Thirteen years ago, Oregon passed a bill requiring trained translators be available in health care settings for patients who speak little English. But there are still fewer than 100 qualified interpreters in the state. (Kristian Foden-Vencil, Oregon Public Broadcasting, 10/30)

Political Cartoon: 'Proclaimin' Shaman?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Proclaimin' Shaman?'" by John Cole, Scranton Times-Tribune.

Here's today's health policy haiku:

WATCHING THE CALENDAR

Open Enrollment
Starts November the 15th
Ready? Get covered.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Health Law Issues And Implementation

Rural Hospitals In Non-Medicaid Expansion States Face Challenges

Some states with large rural populations opted out of expanding Medicaid even though large numbers of rural residents are uninsured, California Healthline reports. Meanwhile, a second wave of people with unverified immigration status will lose coverage this month, and Fox News reports on the increasing popularity of cheap, one-year insurance policies that are being sold as an alternative to those purchased on government exchanges.

Fox News: Death Spiral? Short-Term Health Plans Grow As Cheap Alternative To Obamacare
A fast-growing, short-term alternative to ObamaCare that allows customers to get cheap, one-year policies could put the government-subsidized plan into a death spiral. The plans ... generally cost less than half of what similar ObamaCare policies cost, and are increasing in popularity as uninsured Americans learn they are required to get health coverage. (Lott, 10/29)

Some Small Firms Drop Coverage Due To Health Law Options

Some employers increasingly view the health law's online marketplaces as an attractive option for their workers, and WellPoint said Wednesday that its small business plan membership is declining more quickly than expected.

The Wall Street Journal: Small Firms Start to Drop Health Plans
Small companies are starting to turn away from offering health plans as they seek to reduce costs and increasingly view the health law’s marketplaces as an inviting and affordable option for workers. In the latest sign of a possible shift, WellPoint Inc. said Wednesday its small-business-plan membership is shrinking faster than expected and it has lost about 300,000 people since the start of the year, leaving a total of 1.56 million in small-group coverage. (Wilde Mathews, Loten and Weaver, 10/29)

Bloomberg: Obamacare’s Success Has Small Business Dropping Coverage
U.S. small businesses are dropping health insurance for their workers, as Obamacare lets them send employees to new marketplaces where they can often get subsidies from the government to buy coverage. WellPoint Inc. (WLP)’s small business insurance products lost 300,000 people this year, the company said today. Business owners are dropping coverage they previously bought through WellPoint and other insurers, and instead sending employees to shop for it on the government exchanges created under the Patient Protection and Affordable Care Act known as Obamacare. (Chen and Gilblom, 10/29)

In related news -

The Seattle Times: Small Businesses Can Enroll In Obamacare Statewide
Small businesses throughout Washington — those with 50 or fewer employees — can now shop for and enroll in health insurance plans through the state’s insurance exchange. The exchange got off to a slow start for businesses this year when only one insurance provider, Kaiser Health Plan of the Northwest, agreed to sell plans in the marketplace and only in Clark and Cowlitz counties. For coverage beginning January 2015, small employers statewide can shop the exchange for coverage from Moda Health, and Kaiser will continue selling in the two southern counties. A total of 23 different plans are available from the two insurance companies. (Stiffler, 10/29)

Supreme Court To Decide If It Will Hear Insurance Subsidies Case

The GOP says language in the health law bars consumers in 36 states from using federal tax subsidies to purchase health coverage on the federal exchange. The justices, who are scheduled to consider the question this week, could announce their decision to take up the case or not as soon as Nov. 3, according to Bloomberg.

Bloomberg: Obamacare Faces New Threat As Supreme Court Weighs Appeal
The fate of President Barack Obama’s health-care law is again in the hands of the U.S. Supreme Court. Two years after upholding the law by a single vote, the justices are weighing whether to hear a Republican-backed appeal that would block people in 36 states from getting tax subsidies to buy insurance. The justices are scheduled to discuss the matter tomorrow, with an announcement coming as soon as Nov. 3. (Stohr, 10/30)

Legal action also continues regarding the overhaul's birth control coverage mandate -

Why Mississippi's Health Law Relationship Failed

News outlets examine how the health law's implementation unfolded in Mississippi and other southern states.

Kaiser Health News: How Obamacare Went South In Mississippi
In the country’s unhealthiest state, the failure of Obamacare is a group effort. ... The first year of the Affordable Care Act in Mississippi was, by almost every measure, an unmitigated disaster. In a state stricken by diabetes, heart disease, obesity and the highest infant mortality rate in the nation, President Barack Obama’s landmark health care law has barely registered, leaving the country’s poorest and perhaps most segregated state trapped in a severe and intractable health care crisis. (Varney, 10/29)

Administration News

HHS Secretary Meets With Insurance Execs Before Open Enrollment Season Begins

Health and Human Services Secretary Sylvia Mathews Burwell met with 12 industry leaders in advance of the Nov. 15 kick-off of the health law's second sign-up period. Also in the news, Burwell taps a top Treasury aide, Alastair Fitzpayne, to be the next HHS chief of staff.

The Hill: Burwell Meets With Insurance Execs Ahead Of O-Care Enrollment
Health and Human Services (HHS) Secretary Sylvia Mathews Burwell met with leading health insurance executives on Wednesday to discuss ObamaCare's second open enrollment period. Twelve executives met with Burwell, including two representatives of the industry's trade association, America's Health Insurance Plans, the department said. The healthcare law's exchanges are scheduled to open for sign-ups in less than three weeks, and the Obama administration is intent on avoiding technical fumbles like those that plagued the system last year. Both sides are hoping to present a united front. (Viebeck, 10/29)

The Wall Street Journal's Washington Wire: Burwell Picks Treasury Aide Fitzpayne For HHS Chief Of Staff
Alastair “Al” Fitzpayne, a top Treasury Department aide with extensive contacts on Capitol Hill, will be the next chief of staff at the Department of Health and Human Services, working with secretary Sylvia Mathews Burwell. In selecting Mr. Fitzpayne, Ms. Burwell tapped a well-connected administration aide who has worked on some of the most high-stakes fiscal battles in recent years but has relatively little health care experience. (Paletta, 10/ 29)

Capitol Hill Watch

McConnell Says Full Health Law Repeal 'Not In The Cards' Even If GOP Controls The Senate

Although there's uncertainty about what would be included on a Republican-controlled Senate's to-do list, The Washington Post notes that the outcome of this election will have a significant impact on the health law's future direction.

The Washington Post's Wonkblog: Why Obamacare Still Matters In This Election
Although the politics of Obamacare have cooled down this year — and even with declining interest in this year's midterms — the upcoming election will have a bigger influence on the direction of health care than you may think. That's the major takeaway from a new Harvard University analysis of 27 public opinion polls from 14 organizations on President Obama's signature law. The analysis, published in the New England Journal of Medicine, offers a pretty comprehensive view of how the Affordable Care Act — less than a year into its major coverage expansion — will shape the agenda for the next Congress and potentially the 2016 presidential race. (MIllman, 10/29)

NBC News: Uncertainty Reigns With Less Than A Week Until Midterms
On Fox News yesterday, Senate Minority Leader Mitch McConnell -- who is hoping to become Majority Leader Mitch McConnell -- admitted that full repeal of the Affordable Care Act isn’t in the cards if the GOP takes control of the Senate. (Todd, Murray and Dann, 10/29)

CQ Healthbeat: McConnell: Obamacare Repeal Not Happening Anytime Soon
Senate Minority Leader Mitch McConnell says Republicans won’t be able to repeal Obamacare anytime soon. Tempering the expectations of conservatives a week before the elections that could install him as the first Republican majority leader in eight years, the Kentucky Republican said in a Fox News interview Tuesday that a repeal of the health care law simply wasn’t in the cards for now. (Lesniewski, 10/29)

And Politico reports that there's more trouble ahead for the Republican legal challenge to President Barack Obama's use of constitutional powers -

Politico: More Turmoil For House GOP Lawsuit Against Obama
House Speaker John Boehner’s still-unfiled lawsuit against President Barack Obama for exceeding his constitutional power is in more trouble. For the second time in two months, a major law firm has backed out of an agreement to pursue the case, sources say. ... Boehner’s office also suggested the suit, which planned to challenge Obama’s failure to implement aspects of his health care reform law, could be broadened if Obama goes forward, as promised, with plans for executive action on immigration. (Gerstein and Haberman, 10/29)

Health Law Weighs Heavily For Some Democratic Candidates

Obamacare has been a buzzword in ads in many key Senate elections, and, in anticipation of an expected run-off, groups are making media buys in Louisiana, that will, among other things, hit Democratic Sen. Mary Landrieu hard for her support of the health law. Meanwhile, other TV advertisements go beyond the campaign and seek to raise awareness about the law itself and to encourage people to sign up for coverage.

Politico: Obamacare Brings Democrats Backlash, Not Benefits
Most Americans don’t want to get rid of Obamacare. They just don’t share its fundamental goal of universal coverage anymore. And not only did the political benefits that Democrats thought the 2010 law would eventually bring them not materialize, opposition has only grown, according to an analysis of multiple polls taken between 2010 and last month. (Wheaton, 10/29)

The Associated Press: Groups Book Louisiana Ads After Election Day
More than $24 million in TV advertising already has aired in the state with a week to go before Election Day, according to the nonpartisan Center for Public Integrity, which is tracking ad spending across the country. National conservative group Crossroads GPS, co-founded by GOP operative Karl Rove, aired a new ad Tuesday, hitting Landrieu for her vote for President Barack Obama’s signature health care law. The 30-second TV commercial said the Democratic incumbent’s vote was a betrayal of Louisiana, a continuing theme of GOP advertising that has framed Landrieu as a rubber stamp for the president. Despite the negative ads, Landrieu continued to embrace the health overhaul... (Deslatte and Elliott, 10/20)

Marketplace

Health Law Boosts Earnings For Many Insurers

Last fall, the nation's biggest health insurers were cautious about the overhaul's coverage expansion and prohibitions against denying coverage to people with pre-existing conditions. But a year later, many have raised earnings expectations, and investors see less uncertainty.

The Associated Press: Health Care Overhaul Doubts Ease For Insurers
What a difference a year makes. The nation’s biggest health insurers entered last fall cautious about a major coverage expansion initiated by the health care overhaul, the federal law that aims to cover millions of uninsured people. ... But a year later, these challenges are starting to appear manageable, and investors see much less uncertainty ahead for the sector. Insurers have cut costs and raised prices to help mitigate added expenses from the law. They’ve also added new business. (10/29)

The Wall Street Journal: Cigna Raises Outlook As Results Exceed Expectations
Cigna Corp. again raised its guidance as fee and premium revenue grew along with its customer base. The health insurer’s results easily topped analysts’ expectations. The company again raised its earnings outlook for the year, this time to a range of $7.25 to $7.45 a share, from $7.20 to $7.40. Fellow health insurers WellPoint and Aetna had also raised their guidance this week. (Calia, 10/30)

The Associated Press: Healthcare Overhaul Ramps Up Business At WellPoint
The Indianapolis insurer's big quarter comes after competitors Aetna Inc. and UnitedHealth Group Inc. also topped quarterly expectations and raised their annual forecasts. Insurers began the year cautious about a major coverage expansion initiated by the overhaul, the federal law that aims to cover millions of uninsured people. Late last year, the U.S. introduced state-based public health insurance exchanges that promised to give insurers millions of new customers by making it easier for people to buy coverage, sometimes with help from income-based tax credits. But the overhaul also heaped additional costs onto the balance sheets of insurers, including an industrywide tax that is non-deductible. It trimmed funding for Medicare Advantage plans and altered the manner in which insurers operate by preventing them from excluding high-risk patients. (10/29)

However, Magellan Health saw more than a 40 percent drop in net income during the third quarter that officials attributed to fees related to the health law -

Modern Healthcare: Magellan Health Attributes Quarterly Earnings Drop To ACA-Related Fee
Magellan Health experienced a more than 40% drop in net income during the third quarter that ended Sept. 30, attributable to a higher tax rate that resulted from the health insurance fee outlined in the Patient Protection and Affordable Care Act, the Avon, Conn.-based healthcare management company reported. Full-year expense related to the fee will be approximately $21 million, the company estimated. (Dickson, 10/29)

Honeywell's Wellness Program Faces Legal Test

Lawyers for the Equal Employment Opportunity Commission filed suit, arguing that a company can ask employees to undergo voluntary testing but can't impose a penalty on those who decline to submit to health screening tests.

The Wall Street Journal: Wellness Program At Honeywell Faces Test
When Honeywell International Inc. recently asked workers to participate in voluntary screenings of their cholesterol, body-mass index and other health measures, it made a persuasive case: Employees who choose not to sit for the screenings—part of the company’s wellness program—could face up to $4,000 in surcharges and lost incentives in 2015. (Weber, 10/29)

Minnesota Public Radio: At Honeywell, Required Biometric And Medical Testing Prompt A Lawsuit
A federal agency is suing Honeywell over new company rules that penalize employees who don't submit to biometric and medical testing. The tests required by the company would measure blood pressure, cholesterol and glucose levels, as well as check for evidence of smoking. Lawyers for the federal agency are asking the court to immediately order the company not to impose any costs on employees who don't take the tests. The Equal Employment Opportunity Commission suit filed this week in Minneapolis argues that Honeywell's new policy violates the Americans with Disabilities Act (ADA). Agency lawyers argue that a company can ask employees to undergo voluntary testing, but it can't impose a penalty on those who decline. (Collins, 10/29)

Meanwhile, the Louisville Journal-Courier reports on a lawsuit by two General Electric retirees regarding the company's decision to drop their health benefits -

USA Today/Louisville Courier-Journal: Retirees Sue GE Over Health Coverage
Two retirees have sued General Electric in federal court alleging that the company violated federal law by dropping its supplemental health coverage and placing retirees in a health care exchange. In a lawsuit filed in the Eastern District of Wisconsin, the pair allege that GE breached its promise to keep the benefits indefinitely only to announce in September 2012 and last month that the company would drop its Medicare plans and switch non-union retirees to private coverage. (Schneider, 10/29)

Public Health And Education

Maine Nurse Defies Quarantine Order, Testing States' Efforts On Ebola

The nurse opts to go for a bike ride Thursday morning against orders from the governor. Meanwhile, California also announces it is setting up a 21-day home quarantine policy for any health care workers returning from West Africa.

The New York Times: Threat Of Lawsuit Could Test Maine’s Quarantine Policy
A nurse who cared for Ebola patients in Sierra Leone was headed for a legal showdown with the State of Maine on Wednesday over whether the state can quarantine her against her will. The dispute is heightening a national debate over how to balance public health and public fears against the rights and freedoms of health care workers, and troops, returning from West Africa. (Zernike and Fitzsimmons, 10/29)

The Associated Press: Nurse Defies Ebola Quarantine In Maine
A nurse who vowed to defy Maine's voluntary quarantine for health care workers who treated Ebola patients followed through on her promise Thursday, leaving her home for a bike ride. Kaci Hickox and her boyfriend stepped out of their home Thursday morning and rode away on bicycles, followed by state police who were monitoring her movements and public interactions. Police couldn't detain her without a court order signed by a judge. (Bukaty, 10/30)

Los Angeles Times: State Orders Quarantine For Workers Who Had Contact With Ebola
California's top health officer has ordered a 21-day home quarantine for all returning medical workers or travelers who have had contact with a confirmed case of Ebola in West Africa, and invoked the possibility of imprisonment and fines if the restrictions are disobeyed. The order, issued Wednesday by California Department of Public Health Director Dr. Ron Chapman, is the latest in a series of measures issued by state governments in response to widespread — and some say unwarranted — public fear. (Morin and Flores, 10/29)

State Watch

State Highlights: GOP Looks For Legislature Control; Abortion Key In Tenn. Election

A selection of health policy stories from Arkansas, California, Tennessee, Michigan, North Carolina and Maryland.

The Washington Post: Election Could Tip Historic Number Of Legislatures Into Republican Hands
If Iowa Democrats can’t hang on to control of the state Senate, Gov. Terry Branstad (R) will be freer to pursue an ambitious agenda. If Arkansas Republicans keep control of the state House and win the governor’s mansion, the future of that state’s unique approach to Medicaid expansion under the Affordable Care Act is at risk. In Kentucky, Sen. Rand Paul (R) could take advantage of a Republican state legislature to change a law that prevents him from running for president and re-election to the U.S. Senate at the same time. (Wilson, 10/29)

The New York Times: California’s Proposition 45 Would Offer Public A Say On Health Insurance Rates
A year after the federal Affordable Care Act took effect, California voters are now considering another major change to health care: a ballot measure that would give state officials the authority to veto health insurance rate increases for individual and small group plans. Proposition 45 would hand broad new control of the individual health insurance market to the state insurance commissioner, who could reject rate increases deemed excessive. The measure is designed to keep costs down for consumers in a state where health care premiums have spiked in recent years, raising public ire. (Lovett, 10/29)

The Detroit Free Press: Fact Check: GOP Ad Hits Schauer On Obamacare
A new ad from the Republican Governors Association attacking Democratic gubernatorial candidate Mark Schauer over the Affordable Care Act is largely factual but includes key statements that are highly misleading. Claim: "Now Michigan seniors are facing higher costs, fewer benefits, and loss of their doctors." Reality: Partly false and highly misleading. Health care costs were rising dramatically prior to the passage of the Affordable Care Act and growth in per capita health care costs has slowed since its passage. Though some seniors on Medicare Advantage plans -- about a third of the total -- have lost access to their doctors, the ad's statement is too sweeping. Many seniors who were in the gap known as the "doughnut hole" are saving on prescription drugs as a result of the ACA. (Egan, 10/29)

The Wall Street Journal's Washington Wire: States Offer Economic Blueprints And Caution For GOP Congress
If Republicans win control of the Senate next week, they will have a rare opportunity to design a unified congressional economic plan that reworks things like health-care spending, tax policy, labor rules, and adjustments to social-welfare programs. For the past few years, a number of states led by GOP governors have served as incubators for some of these ideas with mixed results. Those experiences could influence which strategy GOP lawmakers adopt. Many of these governors inherited large projected budget deficits and made tax and spending changes to balance the budget (as they are often required to do by law). Sometimes, the changes resonated well with voters. But the jury is still out in a number of states. (Paletta, 10/29)

Kaiser Health News: L.A. County Officials Demand Details On Reduced Nursing Home Penalties
The Los Angeles County Board of Supervisors ordered the public health department this week to provide an update on the nursing home inspection process, responding to a Kaiser Health News report that draft penalties in three patient deaths had been reduced without explanation. The supervisors unanimously approved the motion to have the acting public health director report back with a “detailed description” of procedures for reviewing nursing home penalties recommended by on-site inspectors. The vote followed an article published Saturday in the Los Angeles News Group newspapers, which described three fatal cases in which sources said inspectors’ draft citations had been downgraded. (Gorman, 10/29)

The Charlotte Observer: Most Charlotte-Area Hospital's Get A's And B's From Group
Most Charlotte-area hospitals got A’s and B’s on the latest scorecard issued by The Leapfrog Group, a group of large employers that is pressuring hospitals to improve quality and reduce errors. Of area hospitals, only two got C’s. They are Carolinas Medical Center, Charlotte’s largest hospital, and CMC-Lincoln, both owned by Carolinas HealthCare System. Leapfrog released its first safety scores in 2012, grading about 2,500 U.S. hospitals on data that tracks preventable errors and medical complications, such as hospital-acquired infections and medication mix-ups. The group issues overall grades and individual grades in 28 categories. (Garloch, 10/29)

The Baltimore Sun: New Local Research Partnership Will Develop Mental Illness Therapies
There is little doctors can do for those suffering serious brain injuries from car crashes, athletics and battle, other than wait and treat the symptoms, but a unique collaboration between those who study mental illness and those who treat the disorders offers hope for new therapies. The first goal of the new Towson-based institute formed by researchers at the Lieber Institute for Brain Development and doctors at Sheppard Pratt Health System is to reformulate an old Parkinson's drug to soothe aggression and aid memory in people suffering from such brain injuries. Officials expect the new institute, announced Wednesday, to eventually translate discoveries of their own and others in genetics and brain functioning into better treatments for those suffering not just head injuries but schizophrenia, bipolar disorder, autism and other mental illnesses affecting millions of Americans. (Cohn, 10/29)

Los Angeles Times: Police Need More Training To Deal With Mentally Ill, L.A. County Told
A consultant hired to find a way to divert the mentally ill from Los Angeles County's jail system found that not enough law enforcement officers were trained to handle people undergoing a mental health crisis. In a report made public Wednesday, the consultant found that more resources were needed to train police officers, dispatchers and other criminal justice workers on how to deal with people with mental illness, and that law enforcement agencies should expand the use of special teams that respond to people in crisis. (Sewell, 10/29)

Weekend Reading

Longer Looks: How A Quarantine Works; GOP Plan To Sue Obama Hits A Stumbling Block

Every week KHN reporter Shefali Luthra selects interesting reading from around the Web.

Vox: How Ebola Quarantines Actually Work, Explained
As Ebola fears wash over America, some state governors are turning to mandatory quarantines: locking up healthy workers returning from West Africa for 21 days, Ebola's incubation period. The policy in New Jersey made national headlines after it resulted in a nurse who had no Ebola symptoms — and had been fighting the disease in West Africa, no less — being isolated in a poorly heated tent with no running shower or toilet. Public-health experts see the measure as extreme, unnecessary and potentially harmful. But politicians are running ahead with quarantines anyway. (Julia Belluz, 10/28)

The Atlantic: The Anti-Vaccine Movement Is Forgetting The Polio Epidemic
At a time when a single case of Ebola or enterovirus can start a national panic, it’s hard to remember the sheer scale of the polio epidemic. In the peak year of 1952, there were nearly 60,000 cases throughout America; 3,000 were fatal, and 21,000 left their victims paralyzed. In Frankie Flood’s first-grade classroom in Syracuse, New York, eight children out of 24 were hospitalized for polio over the course of a few days. (Jennie Rothenberg Gritz, 10/28)

Washington Monthly: The Congressional Research Service Finds That Boehner’s Lawsuit Has No Legal Basis
When, back in July, Speaker John Boehner secured House authorization to file suit against President Obama for “changing the health care law without a vote of Congress, effectively creating his own law,” cynical Democrats derided the planned litigation as a “political stunt,” a talking point for the fall campaign playbook. But a report by the apolitical Congressional Research Service (CRS), completed on September 4, but never released by the member who sponsored it, nor mentioned in the press, indicates that the Democrats were not cynical enough. (Simon Lazarus and Elisabeth Stein, 10/26)

The New York Times: Atul Gawande: By The Book
The author, most recently, of “Being Mortal: Medicine and What Matters in the End” is a great fan of Dr. Watson: “He is intelligent, observant and faithful, the way we want all doctors to be.” (10/26)

The New York Times: A Perfect Fit For Some, But Not For Others
For the past year, The New York Times has asked readers to share their experiences purchasing and using health insurance under the Affordable Care Act. Here is a selection of their stories, written by Times journalists, from some of those submissions. (Abby Goodnough, Sabrina Tavernise, Robert Pear and Margot Sanger-Katz, 10/26)

MedPage Today: Questioning Medicine: Breast Cancer Screening
We have sold America on the notion that breast cancer screening will reduce the risk of breast cancer death by more than 50%. And it will prevent death in more than 8% of the participants. But according to Biller-Andorno et al., the screening process on its best day can provide a relative risk reduction of 20% and, in absolute terms, one breast cancer death per 1,000 women. (Joe Weatherly, 10/23)

Editorials And Opinions

Viewpoints: Health Law 'Pushing Back Inequality'; Mississippi's 'Shame'; Medicaid Vote In Maine

A selection of opinions on health care from around the country.

The New York Times' The Upshot: Obama’s Health Law: Who Was Helped Most
We know that about 10 million more people have insurance coverage this year as a result of the Affordable Care Act. But until now it has been difficult to say much about who was getting that coverage — where they live, their age, their income and other such details. Now a large set of data — from Enroll America, the group trying to sign up people for the program, and from the data firm Civis Analytics — is allowing a much clearer picture. The data shows that the law has done something rather unusual in the American economy this century: It has pushed back against inequality, essentially redistributing income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades. (Kevin Quealy and Margot Sanger-Katz, 10/29)

Bloomberg: Obamacare Spreads The Wealth Around
The Upshot at the New York Times has a terrific set of graphs and charts on the Affordable Care Act that explains something important: In the real world, Obamacare is more or less doing what it was supposed to do. About 10 million more people have insurance now than a year ago (and this doesn't count young people newly added to their parents’ insurance). The takeaway is just how big a deal Medicaid expansion is -- and what the consequences are of delaying it, thanks to the Supreme Court decision giving states the ability to opt out and the willingness of some Republican governors to do so. (Jonathan Bernstein, 10/29)

Los Angeles Times: The Shame Of Mississippi, Where Racism And Stupidity Killed Obamacare
om Politico and Kaiser Health News comes this jaw-dropping look at Mississippi, the national graveyard of the Affordable Care Act's promise. ... The author, Kaiser Health News correspondent Sarah Varney, ascribes the state's failure to errors, ignorance, racism and tea party-style ideology, among other distasteful qualities. The majority of the 138,000 Mississippians left stranded by the state's refusal to opt in to Medicaid expansion are black. Hospitals, which were counting on the expansion to make up for federal funding they'll be losing as the ACA takes hold, are unable to serve the uninsured even as charity cases. What makes Mississippi typical among Medicaid-refusing states is that its health statistics are dismal. What makes it stand out is that its socio-economic statistics are the worst in the nation. (Michael Hiltzik, 10/29)

New Orleans Times-Picayune: Mississippi Was Working To Provide Poor Folks Health Insurance -- Until Obama
A lengthy piece at Politico.com about Mississippi further highlights the Republican hypocrisy that has characterized the fight against President Barack Obama and the Affordable Care Act. Reporter Sarah Varney says that officials in Mississippi, the sickest state in the nation where a quarter of residents don't have health coverage, began working on a plan to expand healthcare coverage there in 2007, the year before Obama was elected. ... Then came Phil Bryant, ... who proudly proclaims his support from [the tea party]. The end result is that 138,000 Mississippians who would get Medicaid with an expansion won't be getting it. (Jarvis DeBerry, 10/29)

The New York Times: A Political Crystal Ball
By now, I’m sure you’re asking yourself: If the Republicans take control of the Senate in next week’s elections, what would it mean to me? ... Republican voters would have every reason to expect that the first item on [Sen. Mitch] McConnell’s agenda would be repeal of Obamacare. But many Republican senators have positions on the Affordable Care Act that are nuanced in the extreme. Get rid of the program but keep the part about people with pre-existing conditions. Or the bit that lets young adults stay on their parents’ policies. McConnell himself has said that he wants to let his home state of Kentucky keep its extremely popular version of the program, which is known as Kynect. (“The website can continue, but in my view the best interests of the country would be achieved by pulling out Obamacare root and branch.”) We look forward to seeing that legislation. (Gail Collins, 10/29)

USA Today: Attacks Against 'Obamacare' Are Outdated
Even though it's been the law of the land for over four years now, Republicans cannot stop campaigning on the promise that they're somehow going to repeal the Affordable Care Act. Claiming that you're going to repeal "every word" continues to be a major applause line with conservative audiences and many Republican governors are still resisting the Medicaid expansion, at least long enough to get those anti-ACA voters to the polls. But denouncing "Obamacare" is already running out of steam as a political strategy and by 2016, it may be entirely kaput. So Republicans should enjoy riding that horse now, because by the next cycle, it will be too lame to be mounted. (Amanda Marcotte, 10/29)

The New Republic: Think The Midterms Don't Matter? Tell That To 70,000 Poor, Uninsured People In Maine.
Maine’s current governor is Paul LePage, a Republican elected in the 2010 Tea Party wave whose defining legacy ... will be his profound antipathy to the social safety net that so many people rely on in Maine, New England’s poorest state. ... he has vetoed—not once, but thrice—the expansion of Medicaid under the Affordable Care Act, which would cover nearly 70,000 people in the state—that is, more people than live in Portland, the state’s largest city. (Alec MacGillis, 10/29)

news@JAMA: The 2014 Midterm Elections: Is The ACA Still A Political Flashpoint?
As this year’s national elections near, it’s striking how different the rhetoric around the Affordable Care Act (ACA) is from the last election. Even more noticeable is how different things are from 1 year ago. Parsing the way politicians are talking about the ACA and how data describe how it’s working may give us a clue to what to expect in the coming year. Last year at this time, the media were covering the largely catastrophic rollouts of the insurance exchange websites. (Aaron Carroll, 10/29)

The Denver Post: Renew Federal Child Health Insurance Program
Congress should renew funding for the successful Child Health Insurance Program in the coming lame duck session — a year in advance to forestall any possible lapses in the crucial service. Currently, about 60,000 Colorado children and 900 pregnant women rely on CHIP for health coverage, a program that fills a gap for those who earn too much to qualify for Medicaid and not enough for private health plans. Known in Colorado as Child Health Plan Plus, the program has won bipartisan federal support since its creation in 1997. (10/29)

Views On Ebola: Quarantines Will Cripple Fight Against The Disease; Feds, States Must Cooperate

News outlets offer a variety of opinions on the strategy to fight Ebola and on the issue of quarantining health care workers.

Reuters: Recent Mandatory Quarantine Policies Are Unscientific–And Dangerous
The best way to protect the United States against Ebola is to control the epidemic in West Africa. Washington isn’t waiting for Islamic State to attack the United States. It has taken proactive, defensive measures to address these militants in the Middle East. Similarly, the United States can’t wait for the virus to spread beyond Guinea, Sierra Leone and Liberia — as it inevitably will if Americans don’t fight Ebola at its source. The West has to enlist more healthcare workers in this fight, but mandatory quarantines will only discourage doctors from volunteering. (Celine Gounder, 10/28)

The Wall Street Journal's Washington Wire: The Benefit Of A Uniform Response To Ebola In The U.S.
What looks like political wrangling or confusion in federal and state officials’ Ebola responses is a reflection of our complex public health system, which gives certain authorities to the federal government and others to the states. But however explainable as a product of American federalism, officials’ contradictory actions do little to reassure the public in a fast-changing environment where, here in the U.S., fear is as much an enemy as the virus itself. (Drew Altman, 10/29)

Reuters: Why Quarantining Ebola Patients Is A States’ Rights Issue
What remains frustrating about how the United States manages epidemics — as we are rediscovering with the Ebola crisis — are the hazy lines of authority and fierce internecine battles among local, state and federal health agencies, as well as individual hospitals and healthcare systems. Equally discouraging are the distracting criticisms of health officials, doctors and nurses trying to do a complicated job under difficult conditions while subjected to intense media scrutiny. (Howard Markel, 10/30)

The New York Times: The Ebola Hysteria
The absolute hysteria surrounding the Ebola crisis underscores what is wrong with our politics and the policies they spawn. On Ebola, the possible has overtaken the probable, gobbling it up in a high-anxiety, low-information frenzy of frayed nerves and Purell-ed hands. (Charles M. Blow, 10/29)

The Washington Post: Those Who Help Ebola Patients Should Be Honored, Not Punished
The best way to protect Americans from Ebola is by stopping the virus at its source. That’s why President Obama has committed up to 4,000 U.S. military engineers, logistics specialists and public health trainers and $1 billion in funding to help eradicate the virus in West Africa. That’s why philanthropist Paul Allen pledged $100 million in support last week and why Samantha Power, the U.S. ambassador to the United Nations, visited the affected countries this week. (Sen. Christopher Coons, D-Del., 10/29)