KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Don’t Fence Me In?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Don’t Fence Me In?'" by Nick Anderson, Houston Chronicle.

Here's today's health policy haiku:

THE CHALLENGES OF FEDERALISM

States and feds lock horns.
Whose quarantine plan is best?
Hard to know, for sure...

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.

Capitol Hill Watch

As Election Nears, Polls Tighten And GOP Plans For Senate Control Take Shape

Also in the news, Sen. Mary Landrieu, D-La., who is locked in a tight challenge for her Senate seat, is sticking to her support for the health law despite attack ads.

Fox News: Poll: Race For Congress Tightens, Confidence In Obama Low
Enthusiasm in the midterm elections remains in the Republicans’ favor -- but the spread has significantly narrowed, according to a new Fox News national poll. Among likely voters, 45 percent of Republicans are “extremely” interested compared to 41 percent of Democrats. Two weeks ago, the GOP was up 15 points on that question. ...Still, voters say the economy is the most important issue facing the country (43 percent). Less than one in five say the top issue is illegal immigration (17 percent), health care (16 percent) or foreign policy (15 percent). And majorities disapprove of Obama’s performance on each of these issues: 56 percent disapprove on the economy, 60 percent on immigration, 57 percent on health care and 57 percent disapprove of how he’s handling foreign policy. (Blanton, 10/28)

Politico: Conservatives Ready To Give Leaders Hell
Conservatives in Congress are drawing up their wish list for a Republican Senate, including “pure” bills, like a full repeal of Obamacare, border security and approval of the Keystone XL pipeline — unlikely to win over many Democrats and sure to torment GOP leaders looking to prove they can govern. (French and Palmor, 10/29)

Aside from mid-term election politics, some senators are also focusing on the Obama administration's new Veterans Affairs secretary -

Politico: GOP Unhappy With New VA Chief
Republican senators are having some buyer’s remorse when it comes to new Secretary of Veterans Affairs Robert McDonald, who was confirmed unanimously this summer. Three GOP senators publicly blasted McDonald on Tuesday for not moving to dismiss Phoenix VA Health Care System Director Sharon Helman, who, along with two other staffers, was put on paid leave in May when revelations about patient backlogs, records falsification and long wait times for appointments swamped former VA Secretary Eric Shinseki. (Everett, 10/28)

Marketplace

Medicaid Directors Urge Congress To Intervene On Specialty Drug Costs

In an eight-page letter to key congressional leaders, state Medicaid directors said the high-cost of pharmaceuticals like the Hepatitis C treatment Sovaldi and other new drugs require "an immediate federal solution." Meanwhile, Sanofi and Gilead Sciences Inc., the maker of Sovaldi, reported lower-than-expected sales in the third quarter.

The Associated Press: States Ask Congress To Intervene On Drug Prices
Medicaid chiefs from red and blue states are urging Congress to stem the cost of revolutionary new drugs for hepatitis C, cancer, and other diseases. In a letter Tuesday to key congressional committees, the National Association of Medicaid Directors said lawmakers should consider everything from outright price controls on manufacturers to federal help for states trying to pay for the new medications. (10/28)

CQ Healthbeat: Medicaid Directors Warn Congress On Cost Of Specialty Drugs
The National Association of Medicaid Directors, in its eight-page letter to the Democratic and Republican leaders of four congressional committees with jurisdiction over health care issues, said that prescription drug spending for hepatitis C treatments has doubled or tripled in several states in the first quarter of 2014 compared to the amount the states spent during the entire year of 2013. Sovaldi costs roughly $84,000 per treatment course. (Adams, 10/28)

The Wall Street Journal: Sales Of Gilead’s Pricey Hepatitis Drug Slow
Gilead Sciences Inc. said sales of its blockbuster hepatitis C treatment Sovaldi fell 20% in the third quarter from the June period, a drop that was expected as physicians and patients waited for the arrival of the company’s newest drug. Sovaldi is believed to be the biggest new drug launch ever, thanks to demand driven by its 90% hepatitis C cure rate and diminished side effects. (Stynes and Rockoff, 10/28)

WellPoint, Aetna Raise 2014 Forecasts

There is a downside for Aetna. Even as the insurer posted higher membership and revenue, its medical costs also increased. Meanwhile, HCA's third-quarter earnings rose as the hospital operator continued to experience a rebound in admissions and other positives generated by the health law.

The Wall Street Journal: WellPoint’s Profit Prompts Higher View
WellPoint Inc. on Wednesday morning became the latest health insurer to raise its outlook after posting higher-than-expected quarterly earnings. The company, which touted its growing membership base, said it now expects to post earnings of $8.75 to $8.85 a share this year, up from its prior call of more than $8.60 a share. (Calia, 10/28)

The Wall Street Journal: Rising Medical Costs Weigh On Aetna
The insurer has posted higher membership and revenue of late. But medical costs also have increased, although it has categorized that trend as moderate. New treatments for hepatitis C have been among the biggest pressures on results, along with the company’s individual book of business. (Wilde Mathews and Calia, 10/28)

The Associated Press: Aetna Tops Street In 3Q, Raises 2014 Forecast
Aetna became the latest major health insurer to thump third-quarter expectations and raise its 2014 forecast, but the company’s shares slipped Tuesday after it also said expenses climbed more than expected for part of its enrollment. The nation’s third-largest health insurer said that medical costs for some of its small-business coverage came in higher than projected, and benefit and network changes that it had made to help control those expenses hadn’t worked as expected. (10/28)

The Wall Street Journal: HCA Profit Rises 42% On Admissions Growth
HCA Holdings Inc. said its third-quarter earnings rose 42% as the hospital operator continued to benefit from a rebound in admissions and benefits from the U.S. health-care policy overhaul. The company’s board authorized the repurchase of as much as $1 billion of HCA’s shares. (Stynes, 10/28)

Health Law Issues And Implementation

MNsure Audit Finds Shortcomings In Controls For Spending, Premium Collections

Elsewhere, Colorado Health News reports on why some consumers will get less tax help in purchasing their coverage through the state's online insurance marketplace, and a small business exchange is launched in Illinois.

The Associated Press: Audit Finds MNsure Missteps With Marketing Work
Minnesota’s health insurance exchange failed to properly authorize over $925,000 in marketing work and didn’t update its contract with its vendor to cover it until after the job was done, Legislative Auditor James Nobles reported Tuesday. He also found that MNsure lacked adequate internal controls over premiums collected from insurance applicants and didn’t maintain proper inventories of equipment purchased with federal funds. (Karnowski, 10/28)

Health News Colorado: Consumers Squeezed As Tax Credits, Insurance Rates Drop
Even though health insurance rates dropped in Colorado for 2015, many consumers might have to pay a bigger share of the bill. Aggressive cost cuts from the Colorado HealthOP, which is the low-cost carrier in every county but one in the state, helped reduce insurance rates overall. But because tax subsidies are tied to the lowest rates for mid-level “silver” plans, tax help for consumers is also declining. (Kerwin McCrimmon, 10/28)

The Chicago Tribune: Small Business Health Exchange Launches In Illinois
The Affordable Care Act's online health insurance marketplaces for small businesses launched Monday in Illinois and four other states, according to the Department of Health and Human Services. Small businesses in Illinois — as well as Delaware, Missouri, New Jersey and Ohio — will get a chance to pre-enroll in the Small Business Health Options Program, or SHOP, but won't be able to see or select plans until the Affordable Care Act begins open enrollment Nov. 15. (Hirst, 10/28)

In other news, the House Science Committee has issued a subpoena to Todd Park, the Obama administration's former chief technology officer, to testify about his role in the oversight of healthcare.gov -

The Hill: House Subpoenas Former HealthCare.gov Official
The House Science Committee has issued a subpoena for former U.S. Chief Technology Officer Todd Park over his role in developing HealthCare.gov. Chairman Lamar Smith (R-Texas) issued the subpoena for the Obama administration’s former top tech advisor, demanding that he testify about his oversight of the ObamaCare website, including its security protocols. (Hattem, 10/28)

And on the Medicaid expansion front -

The Tennessean: Gov. Haslam: Little Progress In Medicaid Expansion Plans
Plans to find a way to expand Medicaid eligibility for Tennessee residents aren’t moving as quickly as expected, Gov. Bill Haslam said Tuesday morning. ... In August Haslam announced he wanted to find a plan to expand Medicaid coverage in some form, working with U.S. Health and Human Services Secretary Sylvia Mathews Burwell. The governor told reporters then that he hoped to submit a plan to federal health officials sometime in the fall. On Tuesday he said it’s been more difficult working with those officials than he originally anticipated. “It sounds simple, but it really is hard to find something that we can get approved in Washington and pass in the legislature ...,” Haslam said. (Boucher, 10/28)

Public Health And Education

Obama Rejects Needs For Health Care Worker Quarantines

The president says quarantines like that imposed by New Jersey could undermine efforts to get health care workers to volunteer to help in Africa.

The Washington Post: Obama Assails Ebola Quarantines, Saying They Are Based On Fear, Not Facts
President Obama on Tuesday forcefully rejected the idea of a quarantine for medical­ workers returning from Ebola-affected­ countries, arguing that such an approach would undermine the broader effort to eliminate the epidemic . Politicians in the United States, including the president, have come under increasing pressure to curtail the movements of medical personnel returning from Ebola-affected regions after Craig Spencer — a doctor who had been treating Ebola patients in Guinea — was diagnosed with the virus 10 days after he returned home to New York City. (Eilperin, Dennis and Achenbach, 10/28)

Politico: Obama: Don't Put Barriers On U.S. Help To Ebola Zones
President Barack Obama offered an implicit rebuke Tuesday of New Jersey Gov. Chris Christie and others who have demanded mandatory quarantines for public health workers returning from Ebola-ravaged West African countries, stressing that policies should be based on fact and not fear. “We don’t want to do things that aren’t based on science and best practices because if we do, we’re just putting another barrier on somebody who’s already doing important work on our behalf. And that’s not something that I think any of us should want to see happen,” Obama said from the South Lawn of the White House before boarding Marine One for a trip to Wisconsin, where he’ll be campaigning for Democratic gubernatorial candidate Mary Burke. (Epstein, 10/28)

Reuters: Obama Sees Different Ebola Rules For U.S. Military Than For Civilians
President Barack Obama on Tuesday appeared to back more rigorous procedures for dealing with soldiers returning from missions to Ebola-hit West African countries, even as he criticized moves by some U.S. states to quarantine returning civilian health workers. Obama said that American military personnel were in a "different situation" compared with healthcare workers. (Alexander and Holland, 10/28)

The Associated Press: Where's Czar? Ebola Raises Management Questions
President Barack Obama's commander in the fight against Ebola was expected to operate below the public radar. But did that mean invisible? Ron Klain has barely been seen, and a week before midterm elections, Obama is pressing to dispel criticism that the government can't manage the Ebola crisis. The White House's behind-the-scenes coordination of the Ebola response is being severely tested, while the Pentagon and states like New York and New Jersey take public steps that are far firmer than federal guidelines. That's creating the appearance of a crazy quilt of Ebola measures. (Kuhnhenn, 10/28)

Politico: Jeb: Obama ‘Incompetent’ On Ebola
Former Florida Gov. Jeb Bush is calling President Barack Obama’s initial response to Ebola “incompetent.” “It looked very incompetent to begin with, and that fueled fears that may not be justified,” Bush said during a discussion at Vanderbilt University, according to the Tennessean. “And now you have states that are legitimately acting on their concerns, creating a lot more confusion than is necessary.” (Breitman, 10/29)

The Wall Street Journal: Maine Willing To Enforce Ebola Quarantine, Official Says
Maine’s health director asserted Tuesday that the state can impose a quarantine on someone potentially exposed to the Ebola virus amid continued pushback from a local nurse who is fighting such restrictions. Kaci Hickox, a 33-year-old from northern Maine, flew back to the U.S. on Friday after a five-week stint with Doctors Without Borders in West Africa. After she raised complaints about her forced quarantine in New Jersey, where she landed, she returned to Maine on Monday to a state request she voluntarily self-quarantine there. (Kamp and Levitz, 10/28)

The New York Times: New York’s Rules To Let Travelers Pick Site For Isolation
Offering the first detailed account of how New York State’s quarantine order for travelers returning from West Africa will be put into effect, Gov. Andrew M. Cuomo’s administration has issued guidelines that go beyond federal recommendations but seek to allow people to choose where to spend their enforced isolation. The state protocols show an effort by the administration to portray the quarantine, which has been criticized as excessive by some experts and doctors’ organizations, in a humane manner. (Santora and Kaplan, 10/28)

Medicare

Medicare Agency Gets Scrutiny In Insider-Trading Investigation

Elsewhere, a whistleblower lawsuit alleges some false diagnoses were created to bilk the government of $1 billion or more.

The Wall Street Journal: Insider-Trading Probe Focuses On Medicare Agency
The day Medicare officials began discussing whether to set new coverage limits on a costly new prostate-cancer treatment, the official in charge emailed three colleagues to put a “close hold” on the process. That meant: Keep quiet until an announcement later that month. Yet by the end of that same day, June 7, 2010, shares of the company that made the treatment, Dendreon Corp. , had plunged 10%. Before long, federal investigators took notice. (Mullins, Pulliam and Weaver, 10/28)

Center for Public Integrity: Another Whistleblower Suit Alleges Medicare Advantage Fraud
A new whistleblower lawsuit accuses a California health care firm of diagnosing “false and fraudulent” medical conditions that several Medicare Advantage plans allegedly used to overcharge the federal government by $1 billion or more. The suit was filed by Anita Silingo, a former compliance officer for Mobile Medical Examination Services, Inc., or MedXM. The Santa Ana, California-based firm sends medical professionals to the homes of Medicare Advantage members to assess their health. (Schulte, 10/29)

Also, news on Medicare's enrollment season, and how what Medicare decides to cover could mean less treatment for ALS patients -

Kaiser Health News: Medicare Changes Could Limit Patient Access To ALS Communication Tools
Starting Dec. 1, people with ALS – a disease that impairs motor function so people often can’t talk or even move – could lose access to technological advances that allow them to better communicate, thanks to a federal review of what Medicare is allowed to cover. ALS, which stands for amyotrophic lateral sclerosis, hit the national spotlight this summer with the viral “Ice Bucket Challenge.” But while public awareness about the disease soared, Medicare changes that could curtail coverage of communication tools were – by “sheer dumb luck” – already in the works, said Kathleen Holt, associate director at the Center for Medicare Advocacy. (Luthra, 10/29)

Medicaid

CMS: New Medicaid Managed Care Regulations On Track For January 2015 Release

Modern Healthcare reports that the rules are intended to address beneficiaries' access to care, among other things. Additionally, CQ Healthbeat reports on news related to the federal matching rate for Medicaid technology upgrades to enrollment and eligibility systems.

Modern Healthcare: Coming Medicaid Plan Rules Will Set New Access Standards
CMS officials say they're on track for a January 2015 release of sweeping new Medicaid managed-care regulations intended to ensure that beneficiaries get timely access to care and better integration of services. HHS' inspector general's office, meanwhile, is preparing a follow-up to a September report that criticized the CMS and the states for not doing enough to make sure Medicaid plans offer adequate provider networks, according to CMS officials who addressed members of the Medicaid Health Plans of America at a conference Tuesday. (Dickson, 10/28)

CQ Healthbeat: Medicaid Officials Provide Extension Of Higher Matching Funds
Federal Medicaid officials will permanently pay 90 percent of the costs for technological upgrades to enrollment and eligibility systems, according to a letter from the Centers for Medicare and Medicaid Services on Tuesday. The share of funding, which every state in the country has taken advantage of, had been expected to drop to 50 percent of states’ costs on Jan. 1, 2016. The money was available through a 2011 rule that also increased the federal matching rate for maintaining or operating the electronic enrollment and eligibility systems from 50 percent to 75 percent of costs. (Adams, 10/28)

Health IT

Nation's Largest Digital Medical Records Company Wants To 'Correct' Perceptions

In addition, Modern Healthcare reports that, although electronic health records can lead to reduced costs and greater efficiency, if used incorrectly they become a liability issue for health care providers.

Politico: Big Health Records Firm Epic Raises DC Profile
The U.S. government is spending $30 billion to encourage the health care system to go digital. Now, the founder and chief executive of the country’s largest vendor of digital medical records is fighting back against what she calls incorrect perceptions that her company is creating obstacles to creating a national system where health records can be shared. The sharing of health records is a critical but elusive goal, one that’s getting the attention of policymakers and K Street, as well as the health care industry. Some critics say industry giant Epic Systems is part of the problem. (Pittman and Allen, 10/28)

Modern Healthcare: Malpractice Suits Often Tap Electronic Health Records
Electronic health records can save money and improve medical outcomes, but using them incorrectly can create significant liability problems for healthcare providers, defense attorneys say. In the overwhelming majority of cases, health records are the “single-most important piece of evidence” in medical malpractice lawsuits, said Craig R. Merkle, a partner at Goodell, Devries, Leech & Dann in Baltimore. (Greenwald, 10/28)

State Watch

State Highlights: Support For Calif. Rate Regulation Grows; Minn. Employee Wellness Lawsuit

A selection of health policy stories from California, Kansas, Minnesota, South Carolina and Florida.

Los Angeles Times: Hoover Poll Shows Support For Health Insurance Rate Regulation
Proposition 45, a ballot measure that would regulate health insurance rates, is ahead, according to a new Internet poll by the Hoover Institution at Stanford University. The survey of self-reported, registered voters who said they planned to vote in the Nov. 4 election, had Proposition 45 leading with 41.6% of those queried and opposed by 29.9%. Undecideds were 28.5%. The poll was taken between Oct. 3 and Oct. 17 and had a margin of error of 3.65%. (Lifsher, 10/28)

Topeka Capital-Journal: Former Executive Alleges Misconduct By Kansas Medicaid Contractor
A former insurance company executive involved in Kansas’ privatized Medicaid program filed a wrongful-termination lawsuit alleging retaliation by management for objecting to potentially unethical or illegal maneuvers to improve company revenue, documents said Tuesday. The lawsuit filed in U.S. District Court by Overland Park resident Jacqueline Leary named as defendants Centene Corp., Centene subsidiary Sunflower State Health Plan in Kansas and two executives of the corporate entities. (Carpenter, 10/28)

The Associated Press: Lawsuit Alleges Problems With Medicaid In Kansas
A former executive with a private company managing part of the Kansas Medicaid program has alleged in a federal lawsuit that she was wrongly fired for protesting potentially improper cost-saving measures. Jacqueline Leary filed the suit this week. Leary was fired in January from her position as vice president for the Sunflower State Health Plan, a subsidiary of St. Louis-based Centene Corp. The lawsuit contends that in 2013, the Sunflower State Health Plan stopped assigning some Medicaid participants to doctors who worked for health care providers who were paid a higher-than-standard rate for their services. The state's $3 billion-a-year Medicaid program provides health coverage for the needy and disabled. (10/28)

Kaiser Health News: Soda Makers Battle Proposed Taxes In Berkeley, San Francisco
Again and again in the United States, anti-obesity crusaders have been stymied wherever they’ve tried to impose new laws on soda sales: in New York, ex-Mayor Michael Bloomberg’s plan to limit soda size was tossed out by the state’s highest court, proposed taxes in the northern California cities of El Monte and Richmond were voted down and the Washington, D.C. city council failed to pass an excise tax on soda. (Varney, 10/29)

Stateline: 'Social Impact Bonds' Tap Private Money For Public Health
South Carolina is turning to an unusual source to finance a new program intended to reduce the state’s high rate of premature births: private investors. If the program succeeds in slicing that rate among Medicaid beneficiaries and reduces state spending as a result, South Carolina will repay the principal plus a healthy, yet-to-be determined rate of return. If the program doesn’t meet expectations, the state will owe the investors less or even nothing at all. The state sees the plan as a way to launch a promising health program without having to bear the costs for years to come, if ever. (Ollove, 10/29)

Health News Florida: Most Florida Plans Shine In Star Ratings
Just a handful of Florida Medicare Advantage plans offered for 2015 received below average scores in a federal quality rating system, a breakdown of data by Avalere Health shows. Not a single one of the 125 plans offered by 24 different insurers earned the poorest rating for 2015, according to the data released this month by the Centers for Medicare and Medicaid Services. (Shedden, 10/28)

Los Angeles Times: L.A. City Workers Rally Over Bank Deals As Bargaining Continues
Currently, L.A.’s civilian workers can choose health plans that don’t require them to pay anything toward the premium cost. If employees had to chip in 10% -- as city lawmakers assumed in their budget for this year -- the added annual expense for family coverage could exceed $1,690, according to the Coalition of L.A. City Unions. But those at the Tuesday march and rally mostly argued that city lawmakers needed to recoup taxpayer revenue from Wall Street banks to restore city services and create jobs. Union officials say their bargaining is deeply tied to those concerns. (Reyes and Karlamangla, 10/28)

Boston Globe: Partners Chief Met A Trail Of Resistance
Speaking to investors early this year, Partners HealthCare chief executive Gary L. Gottlieb said his organization’s hospitals and doctors were creating a “new medical model” in a bid to “control our own destiny.” But within months, parts of the plan started to fray. (Weisman and McCluskey, 10/29)

Editorials And Opinions

Viewpoints: States Move On Ebola Because Obama Didn't; Copper Plans' Hidden Costs

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

The Wall Street Journal: Why No Ebola Travel Ban? Politics
New York and New Jersey shouldn’t be making Ebola policy, but if Washington leaves a vacuum, it will be filled. And leaving vacuums is becoming an Obama administration specialty. The decisions by Andrew Cuomo and Chris Christie were not as awful as some make them out to be: Any medical worker returning from West Africa can just bypass JFK and Newark. The “mandatory quarantines” simply divert traffic to other airports, making it less likely a newly symptomatic person will step off a plane onto the New York subway (even so, a worker can fly into Dulles, jump on Amtrak and be throwing up on the C train in a few hours). (Holman W. Jenkins Jr., 10/28)

Los Angeles Times: Does An Ebola Quarantine Make Sense?
The safest, most conservative step obviously would be to require volunteers returning from the front lines to stay at home for 21 days, the incubation period of the disease. But look at the reality: Of the hundreds who have worked with Doctors Without Borders and other groups and have returned to their home countries over the last six months, there is not a single known instance in which any of them has infected others. Health officials in New York City are acting with an abundance of caution to track down people who might have been exposed to Craig Spencer, the doctor who was diagnosed after his return (and after he traveled around the city and went bowling). His case prompted New York and New Jersey to tighten their quarantine rules, but the chances that anyone is in real danger are extremely low. (10/28)

Los Angeles Times: America's Epidemic Of Fear Over Ebola
Beware of epidemics in election years. It's unfashionable to express sympathy for politicians these days, but spare an ounce of charity for all those officeholders trying to come up with reassuring responses to the terrifying — but so far, exaggerated — problem of Ebola in the United States. (Doyle McManus, 10/28)

The Washington Post: Shifting Policies, Uncertain Rules: Ebola, New York And New Jersey
The end result, though, is that there are still different guidelines governing different states and people around the country. The CDC has its guidelines, New York and New Jersey have settled on some form of quarantines that are stricter than these rulings, and states from Illinois to Virginia have their own rules. In effect, a person flying back to the United States from West Africa could encounter very different rules depending on what airport they choose. It is unclear if this will be sorted out, as the push and pull between politics and science persists here while an outbreak rages in West Africa. Additional cases are likely coming to the United States, and with them fears, a desire for swift action and the possibility of yet another new policy somewhere. (Mark Berman, 10/28)

Bloomberg: What Science Can't Tell You About Ebola
Does it make sense to quarantine health workers returning from West Africa, as the governors of New York and New Jersey proposed? The science doesn't support it, experts on the disease have said; we're acting out of an abundance of caution, say the governors. Are the governors just plain wrong? Is this really a battle between reason and fear? No. It's more complicated than that -- and pretending it's simple doesn't help. To begin with -- how shall I put this? -- the science on Ebola isn't settled. (Clive Crook, 10/28)

The New York Times' The Upshot: Obamacare: 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)

The Wall Street Journal: The Senate Referendum
Then there’s Jeanne Shaheen, the New Hampshire Democrat who won in 2008 by opposing the war in Iraq and embracing all things Obama. She too was the decisive vote for ObamaCare. Now she too claims to want to fix it, not that she has succeeded in getting a vote to do so. Amid the health-care rollout in February, Ms. Shaheen said “I think we need to fix the things that are not working, and that’s what I am committed to.” But by Oct. 22 she had backtracked to proposing merely “an independent CEO and advisory committee that would oversee the health-care website, because we saw some issues with the rollout of the website.” Translation: If she wins, she’ll do whatever Mr. Obama asks. (10/28)

Los Angeles Times: What Prop. 46 Would Fix
For haters of junk mail, Proposition 46 may be this election season's biggest nuisance. Groups supporting and opposing 46 have spared no expense in stuffing voters' mailboxes. Among other provisions, the measure would reset California's cap on noneconomic damages recoverable in medical malpractice cases based on inflation, meaning that the $250,000 cap, imposed in 1975, would become a cap of $1.1 million. Rarely, if ever, has the commonplace idea of a regular inflation adjustment provoked such bitter controversy. (Nora Engstrom, Robert L. Rabin and Michelle M. Mello, 10/28)