Daily Health Policy Report

Wednesday, November 7, 2012

Last updated: Wed, Nov 7

KHN Original Reporting & Guest Opinion

Campaign 2012

Editorials and Opinions

KHN Original Reporting & Guest Opinion

President's Win Is Reprieve For 'Obamacare'

Kaiser Health News staff writer Jay Hancock writes: "President Barack Obama's victory cements the Affordable Care Act, expanding coverage to millions but leaving weighty questions about how to pay for it and other care to be delivered to an increasingly unhealthy, aging population. … Republican presidential candidate Mitt Romney had promised to repeal the act and replace it with something that would loosen government’s involvement in health care. Conservatives portrayed the law's survival as limiting the freedom of patient and doctor and adding to a federal debt that recently exceeded $16 trillion" (Hancock, 11/7). Read the story.

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Federal Deficit Talks Could Impact Obama’s Moves On Health Law

Kaiser Health News staff writer Mary Agnes Carey reports: "President Barack Obama’s victory preserves the federal health overhaul that he championed. The law, which withstood a challenge at the Supreme Court last summer and was bitterly assailed by Republicans during the campaign, is slated to move forward with Democratic control of the White House and Senate" (Carey, 11/7). Read the story.

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Obama Win Boosts Health Law, But States Still Control Its Destiny

Kaiser Health News staff writer Phil Galewitz reports: "President Barack Obama's re-election ensures the survival of his landmark health care law, but predominantly Republican state officials will get a big say in how it is carried out. State lawmakers will control whether millions of uninsured people get coverage through Medicaid beginning in 2014, as the law envisions. They'll also decide whether to set up online markets where individuals can shop for coverage and seek federal subsidies to lower their costs" (Galewitz, 11/7). Read the story.

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Political Cartoon: 'Ahhhhhhh?'

Kaiser Health News provides a fresh take on health policy developments with 'Ahhhhhhh?' by Joe Heller.

Meanwhile, here is today's health policy haiku:

THE ELECTION IS OVER BUT...

No time for champagne.
The fiscal cliff looms ahead.
Time to get to work! 
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Campaign 2012

Health Law Viewed As A Big Winner On Election Day

President Barack Obama's re-election is viewed as a "reprieve" for the health law, but this development raises questions and issues about some of the implementation challenges that the overhaul will now face.  

Kaiser Health News: President's Win Is Reprieve For 'Obamacare'
President Barack Obama's victory cements the Affordable Care Act, expanding coverage to millions but leaving weighty questions about how to pay for it and other care to be delivered to an increasingly unhealthy, aging population. … Republican presidential candidate Mitt Romney had promised to repeal the act and replace it with something that would loosen government's involvement in health care. Conservatives portrayed the law's survival as limiting the freedom of patient and doctor and adding to a federal debt that recently exceeded $16 trillion (Hancock, 11/7).

Politico: Obamacare Survives -- Now What?
It has now survived two near-death experiences. The Supreme Court could have struck the law down, but it didn't. And with Barack Obama in the White House for another four years, it's not going to get repealed -- or even gutted. Now it has to work. If it does, more Americans might come to accept it -- and even be glad it passed. If it doesn't, Obama's legacy will be tarnished. And Republicans will say "we told you so" for years to come (Nather, 11/7).

Reuters: Obama Win Clears Health Care Reform Hurdle Challenges Remain
President Barack Obama's re-election victory eliminates the possibility of a wholesale repeal for his health care reform law, but still leaves questions about how much of his signature domestic policy achievement will be implemented as the national political focus shifts to the debt and deficit. The 2010 Patient Protection and Affordable Care Act, which represents the biggest overhaul of the $2.8 trillion U.S. health care system since the 1960s, aims to extend health coverage to more than 30 million uninsured Americans beginning in January 2014 (Morgan and Yukhananov, 11/7).

NBC News: One Big Winner In Tuesday's Vote: Health Reform
One of the biggest winners Tuesday night was health reform. Now that President Barack Obama has won a second term and kept a Democratic majority in the Senate to back him up, Republicans have lost any chance at repealing his biggest domestic initiative. "Health reform goes ahead," Timothy Jost, an expert on health law at Washington and Lee University, told NBC news. "It has survived two near-death experiences, with the Supreme Court decision (in June) and now with the election. Now it is time to move forward." Republican analysts agree (Fox, 11/7).

Bloomberg: Obama Win Means Health Overhaul to Move Ahead in States
President Barack Obama’s re-election means his overhaul of the U.S. health-care system, opposed by most Republicans, will move ahead in all 50 states, with or without the cooperation of their governors. State officials who held off implementing some aspects of the 2010 Affordable Care Act now face pressure to make decisions almost immediately. They have nine days to advise the federal government how they plan to manage state-run exchanges created by the law to provide medical coverage to the uninsured, or face a de facto U.S. takeover of their insurance markets (Wayne, 11/7).

NBC News: Now That He's Won, The Six Splitting Headaches Waiting For Obama
As President Barack Obama celebrates his election night victory, he faces a second term that presents both immediate and longer-term challenges, some with deadlines that must be confronted in the seven weeks before New Years' Eve. … The administrative mechanism to carry out "Obamacare" needs to be designed, refined and run. Congressional Republicans are especially hostile to the Independent Payment Advisory Board, an outside body of experts, picked by the president, which is supposed to propose cuts in Medicare spending, with those cuts getting special fast-track consideration in Congress. So far Obama has appointed none of IPAB's 15 members. Those nominees will be subject to Senate confirmation (Curry, 11/7).

Modern Healthcare: Obama Win Seen As Victory For Health Care Reform
President Barack Obama's victory serves as a vindication for the Patient Protection and Affordable Care Act, industry experts said soon after the president won re-election Tuesday. The election also produced a Congress that will continue the existing split in control between the two parties. Democrats were projected by the Associated Press to maintain their Senate majority and the Republicans to maintain control of the House of Representatives. While Republican lawmakers on Capitol Hill might continue trying to chip away at the law in pieces, they won't be successful in overturning the statute in its entirety, said Eric Zimmerman, a partner with McDermott Will and Emery in Washington (Zigmond and Daly, 11/7).

Medscape: Obama Edges Out Romney To Win Reelection
Voters tonight reelected President Barack Obama by a narrow margin, giving the Democrat 4 more years to implement the Affordable Care Act (ACA) in the face of continued opposition by Congressional Republicans. …  A poll conducted by Reuters/Ipsos November 2 showed that 42 percent of probable voters thought Obama had a better plan on health care compared with 39 percent who favored Romney. Likewise, Obama held a 42 percent to 35 percent edge over Romney when it came to public confidence in their plans for Medicare. However, Romney bested Obama on those issues among seniors, who said they preferred the Republican as president. The same patterns on health care issues emerged in a tracking poll conducted last month by the Kaiser Family Foundation, which pointed to an additional Obama advantage: 51 percent of Americans trusted the president to make decisions about women's reproductive health choices and services. Romney's support level on this issue was only 33 percent (Lowes, 11/7).

The Medicare NewsGroup: Obama Wins Second Term, Thanks In Part To Medicare Promise
But make no mistake about it: President Obama has endorsed a slower but steady shift that could indeed change the program dramatically and qualify as Medicare reform in its own right. Another term for Obama means another four years over which key Medicare provisions of the Affordable Care Act (ACA) will be implemented. And many of those provisions pave the way for the current fee-for-service Medicare reimbursement system to be replaced with pay-for-performance. Medicare is at a financial crossroads, and if Obama’s vision for the program can achieve savings dramatic enough, it could put the nation's fastest growing entitlement program on a much more solid road to sustainability. Through the ACA and his fiscal year 2013 budget, Obama has articulated a Medicare reform plan that focuses on getting the biggest bang possible for the government’s buck (Szot, 11/6).

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Big Picture: Obama Claims Victory - But What Comes Next?

Even before President Barack Obama's second term officially begins it is clear that he will be facing significant challenges and a very divided Congress. The challenges ahead include the fiscal cliff and efforts to trim back the nation's entitlement programs.   

The Wall Street Journal: Obama Seizes Another Chance
The Barack Obama who won a second term Tuesday was a different candidate from the one swept into power four years ago on promises of hope and change. Instead, he has envisioned a second term that would bring a handful of solid victories ... He wants to protect and implement laws from his first term, particularly his health-care reform and new financial regulations. Most urgent will be deficit talks that will begin almost immediately in hopes of keeping the nation from going over the so-called fiscal cliff (Meckler, 11/7).

The New York Times: News Analysis: Electorate Reverts To A Partisan Divide As Obama's Support Narrows
With voters worn by hard times yet many of them hopeful of better times ahead, Americans reverted to more traditional lines compared with the broader-based coalition that made Barack Obama president four years ago. He was seen generally as more empathetic and better able to handle Medicare and an international crisis. The two were about even when it came to who was better able to handle the economy and the federal budget deficit. ... Mr. Obama won most voters who named foreign policy or health care as their top concern (Calmes and Thee-Brenan, 11/6).

The New York Times: News Analysis: Question For The Victor: How Far Do You Push?
The champagne bottles from victory celebrations in Chicago will barely be emptied before Mr. Obama has to begin answering that question. The coming end-of-the-year fiscal cliff prompted by trillions of dollars of automatic tax increases and spending cuts could force Mr. Obama to define priorities that will shape the rest of his presidency … Mr. Obama seemed to address this tension in the closing speeches of his campaign. “I want to see more cooperation in Washington,” he said in Mentor, Ohio. “But if the price of peace in Washington” means slashing student aid, reversing his health care program or cutting people from Medicaid, he added, "that’s not a price I’ll pay" (Baker, 11/7).

Los Angeles Times: New Analysis: Maybe Stalemate's Latest Victory Means Voters Will Finally Win
Obama offered mixed signals in his final weeks of campaigning. He voiced support for compromise, but also pledged toughness ... "I'll work with anybody, of any party, to move this country forward," he said in his final campaign speech, Monday night in Des Moines. But, he added, there are "some principles you got to fight for. If the price of peace in Washington is cutting deals to kick students off of financial aid, or get rid of funding for Planned Parenthood, or let insurance companies discriminate against kids with preexisting conditions, or eliminate healthcare for millions on Medicaid who are poor, or elderly, or disabled — I won't pay that price" (Lauter, 11/7).

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With Votes Counted, The 'Fiscal Cliff' Looms Large

News outlets report that with the election in the rear-view mirror, President Barack Obama and congressional lawmakers must pivot to high-stakes negotiations over expiring income tax rates, massive scheduled cuts to Pentagon spending and entitlement reform. Also on the to-do list: the Medicare doc fix.

The Washington Post: Fresh From Reelection, President Finds Himself On Edge Of 'Fiscal Cliff'
The president, who won reelection late Tuesday, must now confront the "fiscal cliff," nearly $500 billion in automatic tax hikes and spending cuts set to take effect in January that could throw the nation back into recession. … Obama has threatened to veto legislation to avert the cliff that extends the Bush tax rates for the wealthy. After a campaign focused heavily on that pledge, Democrats say the president is prepared to draw a firm line in the sand, even if it means letting one of the largest tax hikes in U.S. history take effect on Jan. 1 (Montgomery and Goldfarb, 11/6).

Politico: Up Next: The Fiscal Cliff
Obama's convincing reelection, the Republicans' sustained majority in the House and Democrats' hold on the Senate only further complicate the prospects of cutting any kind of deal on expiring income tax rates, massive pending cuts to Pentagon spending and entitlement reform. A clarifying election this was not. Instead, it's the beginning of a stare-down that will almost certainly last months (Sherman and Raju, 11/7).

Kaiser Health News: Federal Deficit Talks Could Impact Obama's Moves On Health Law
President Barack Obama's victory preserves the federal health overhaul that he championed. The law, which withstood a challenge at the Supreme Court last summer and was bitterly assailed by Republicans during the campaign, is slated to move forward with Democratic control of the White House and Senate.
But some analysts predict the mounting pressures to reduce federal spending will complicate efforts to implement the law, known as the Affordable Care Act (Carey, 11/7).

National Journal: It's B-a-a-ck!
Elections can change everything on Capitol Hill. In the next few weeks, the process of members and their staffs packing up and moving out, or moving into better (or worse) offices, begins. But for all the adjustments ahead, there's one health policy issue that will neither change nor go away easily: the so-called doc fix, a multibillion-dollar Medicare headache that has been around for the past six election cycles. …Thankfully, when it comes to the doc fix, Democrats and Republicans actually agree on something: Congress should get rid of this flawed payment system. If only it were that easy. The challenge? How to pay for it. The 1997 formula was originally intended to constrain health care costs: If spending for a given year exceeded the ceiling, doctors’ reimbursements under Medicare were automatically cut. But Congress regularly overrides the pay reduction. And as doctors get further and further away from the goal each year, it gets more and more expensive to delay the cut (McCarthy, 11/7).

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Exit Polls Find That The Health Law Remains Controversial

Looking beyond the final vote tallies, news outlets delve into exit poll findings in order to gain insights into how voters feel about the health law, the economy and other issues.

The Wall Street Journal: Economy's Fate A Central Concern Of Voters
Fears over the economy and unemployment were the central focus of voters who cast ballots in the presidential election Tuesday, with issues such as health care, the federal budget deficit and foreign policy rated far lower in importance. Exit polls showed that many voters see Mitt Romney as better positioned to fix the economy and President Barack Obama as having a better feel for the middle class and how to handle Medicare (King, 11/6).

Politico: Exit Polls 2012: Split On Obamacare
Voters are deeply divided on whether some or all of the Obama health care law should be repealed, according to early exit polls. Forty-five percent of voters said they think the 2010 law should be either fully or partially repealed, compared with 47 percent who want to see the law remain as-is or see it expanded further (Schultheis, 11/6).

CNN: Exit Polls: Obamacare Remains A Hot-Button Issue
President Obama's health care reform law -- Obamacare -- continues to be very controversial, exit polls indicated Tuesday. In Florida, the exit polls showed 49 percent of voters say the 2010 law should be repealed completely or in part. Forty-three percent said it should be expanded or kept as is. Florida voters also had the opportunity to vote on amending the state constitution to prohibit individuals and businesses from being compelled to participate in any health care system. Exit polls show that vote is very close. Exit polls in Ohio, show 52 percent said they think the president's health care reform law should be repealed completely or in part while 42 percent said it should be expanded or left as is. There's a similar split in other swing states. Iowa: 53 percent for change or repeal and 38 percent for leaving it or expanding it. New Hampshire: 50 percent for change or repeal and 47 percent for leaving it. Colorado: 55 percent-37 percent for repeal. Even in the president's home state of Illinois, 49 percent said they want Obamacare changed or repealed while 47 percent want it expanded or left as is (Kanel, 11/7).

Also in the news, The New York Times notes that the outcome could cause the GOP to revisit the "antigovernment focus" that stemmed from the opposition to the Affordable Care Act --

The New York Times: Republicans Face Struggle Over Party's Direction
The coming debate will be centered on whether the party should keep pursuing the antigovernment focus that grew out of resistance to the health care law and won them the House in 2010, or whether it should focus on a strategy that recognizes the demographic tide running strongly against it. … The first test of whether Republicans see any political need to be more conciliatory will come quickly in the lame duck session of Congress this month, when they will face pressure from the White House, Congressional Democrats and perhaps the Senate Republican leadership to strike a deal to avert the expiration of the Bush tax cuts and the beginning of automatic across-the-board spending cuts (Hulse, 11/7).

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GOP Retains House Despite Democrats' Medicare Attacks

As a result, House Republicans could continue to clash with President Obama and the Senate's Democratic majority.  

The Wall Street Journal: GOP Retains House Control
Republicans retained control of the House Tuesday night, confronting President Barack Obama with a continuing partisan obstacle to his second-term agenda (Hook, 11/7).

The New York Times: Republicans Stand Firm In Controlling The House
Retirements by a large number of Democratic members, and a message on Medicare that more or less fizzled, were additional impediments. Blue Dog Democrats, a group of moderates whose numbers have been dwindling, were particularly endangered as they struggled to defend districts they had long held. ... There appeared to be no single issue that Democrats could turn to their advantage, like the health care debate that so dominated the 2010 Congressional elections and propelled Republicans back into the majority (Steinhauer, 11/7).

The Associated Press: Republicans Renew House Control For Two More Years
Shortly after Obama's re-election was clear, Boehner -- re-elected without opposition -- said voters had conveyed a desire for compromise. That was a departure from the House GOP's general tone over the past two years ... Even so, the prospects of continued gridlock over major issues remained strong, both because of the GOP’s strong conservative bent and because Boehner has sometimes faced challenges shepherding his rank-and-file members to endorse deals he’s wanted to strike. Earlier in the evening, he seemed more combative (Fram, 11/7).

In the meantime, a key Democrat in health care -- chairman of the Ways and Means health subcommittee -- was defeated by another Democrat --

Reuters: California's Longest-Serving Congressman Ouster After 40 Years
Representative Pete Stark, the cantankerous dean of California's congressional delegation, appeared to lose his bid for a 21st straight term after being swept aside by a fellow Democrat 50 years his junior. But he was perhaps best known for his relentless push for nationalized health care, and he played a minor role in writing the Affordable Care Act of 2010 (Shih, 11/7).

Politico: Pete Stark Defeated After 40 Years In Congress
The 20-term Democrat lost to fellow Democrat Eric Swalwell 53.1 percent to 46.9 percent, with 100 percent of the vote calculated in the 15th district in California, according to The Associated Press. Stark built a reputation as a hard-charging advocate for progressive health reform in Washington, but in recent years was bogged down by a record of gaffes and personal insults to his colleagues. Not even the endorsements of President Barack Obama and House Democratic leader Nancy Pelosi could overcome Swalwell’s message to San Francisco Bay voters: that the 80-year-old Stark has been in Washington way too long (Haberkorn, 11/7).

Finally, a Georgia Democrat who stood against the health law won re-election and a New York Democrat, who won last year by opposing Rep. Paul Ryan's Medicare plan, lost --

The Atlanta Journal-Constitution: Democrat Barrow Holds Off Challenge; Other Georgia Incumbents Win Easily
U.S. Rep. John Barrow, the last white Democrat in the House from the Deep South, won re-election Tuesday in one of the more closely watched congressional elections in the nation. … Barrow highlighted how he has often bucked his own party, underscoring his vote against the federal health care legislation and the fact that he often voted with Republican House Majority Leader Eric Cantor (Redmon, 11/6).

The Hill: Rep. Hochul Falls In New York
[Rep. Kathy Hochul, D-N.y.] had taken advantage of the controversial Medicare overhaul that Rep. Paul Ryan (R-Wis.), the GOP vice presidential nominee this year, had included in the House budget. Her victory and campaign had energized Democrats, and fed some speculation that Ryan's inclusion on the ticket this year could make Medicare a central issue of the presidential campaign (Becker, 11/7).

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Dems Retain Control Of The Senate; Rape, Abortion Comments Dash GOP Chances In Indiana, Missouri

Victories in high-profile races -- including those in Virginia, Massachusetts, Wisconsin and New Mexico -- helped Democrats keep control of the upper chamber. At the same time, the GOP maintained its majority in the House.

The Washington Post: Democrats Hold On To Senate Majority; Key Wins For Kaine In Va., Warren In Mass.
Still, a bare majority for Democrats offers them the chance to control the chamber's agenda and committee structure. With that edge comes new leverage in negotiations over the nation's most difficult problems, including fiscal issues that must be addressed even before the next Senate takes office. With the GOP retaining control of the House of Representatives, Democrats needed to hold the Senate as a legislative ally to a reelected President Obama (Helderman, 11/6).

The Wall Street Journal: Democrats Rack Up Wins To Keep Senate Majority
Democrats kept control of the Senate by winning a series of high-profile races, giving them a continued stronghold in Washington and disappointing early Republican hopes of retaking the chamber (Bendavid, 11/7).

NPR: Republicans Keep The House; Democrats To Retain Senate
Republicans have easily maintained their hold on the House, while missteps from Tea Party favorites helped Democrats retain a majority in the Senate. That means the two chambers of Congress remain deeply divided, with prospects for agreement on such big ticket items as deficits, tax rates and climate change unclear (Johnson, 11/6).

Meanwhile, controversial comments by two GOP Senate candidates - Todd Akin and Richard Mourdock - about rape and abortion contributed to victories by incumbent Sen. Claire McCaskill, D-Mo., and Rep. Joe Donnelly, D-Ind. - 

Politico: Abortion, Rape Controversy Shaped Key Races
Two Republicans who made widely criticized remarks about abortion and rape lost their Senate elections Tuesday, the result of a massive backlash by female voters in states where Republicans should have won handily. Rep. Todd Akin in Missouri and Richard Mourdock in Indiana each made deeply controversial remarks about rape that played a significant role in shaping their public image, resulting in losses that make it highly unlikely that the Republicans could win control of the Senate (Haberkorn, 11/6).

The New York Times: Turnaround In Missouri As Incumbent Keeps Seat
Missouri Senator Claire McCaskill won a second term on Tuesday, beating Representative Todd Akin in a remarkable turnaround for a lawmaker once believed to be the Senate's most vulnerable Democratic incumbent. … Ms. McCaskill painted Mr. Akin as an extremist, highlighting statements by him and his votes on things like Social Security, federal school lunch subsidies and the definition of rape. She tried to portray herself as a bipartisan moderate, and vastly outspent Mr. Akin on ads. Mr. Akin sought to link Ms. McCaskill as closely as possible to President Obama, who has been unpopular in Missouri. He highlighted Ms. McCaskill’s early support of Mr. Obama, and her votes in favor of the health care law and the stimulus package (Eligon, 11/7).

Bloomberg: McCaskill Defeats Akin To Keep Missouri Senate Seat
Missouri Democrat Claire McCaskill defeated Republican Representative Todd Akin to win a second U.S. Senate term. The race was turned upside down Aug. 19 when Akin, 65, said in a television interview that "legitimate rape" rarely results in pregnancy. The remark prompted party officials, including Republican presidential candidate Mitt Romney, to urge the six-term congressman to leave the race. It was a political gift to McCaskill, 59, who had been trailing Akin in polls (Hunter, 11/6).

NBC News: Rape Remarks Sink Two Republican Senate Hopefuls
Democrats prevailed against Republicans in two U.S. Senate races in which abortion and controversial remarks about rape played a pivotal role. U.S. Rep. Todd Akin of Missouri — who set off a firestorm after using the phrase "legitimate rape" — and Indiana State Treasurer Richard Mourdock — who said, “even when life begins in that horrible situation of rape, that is something that God intended to happen” — were projected to lose their Senate races, NBC News reported on Tuesday. Their Democratic  rivals, Missouri Sen. Claire McCaskill and Indiana U.S. Rep. Joe Donnelly, are the projected winners (Black, 11/7).

The Washington Post: GOP's Akin, Mourdock Lose Senate Elections
Democrats scored decisive Senate wins in Missouri and Indiana after candidates supported by the tea party and evangelical Christians made controversial remarks on rape, pregnancy and abortion that appeared to cost them the support of more-moderate voters in their party (Jaffe, 11/7).

Other Democratic Senate winners include Elizabeth Warren, Tammy Baldwin and Martin Heinrich -

The New York Times: Warren Defeats Brown In Massachusetts Senate Contest
She cast herself as a fighter for the middle class and a champion of women’s causes. In her closing message to voters, she said Mr. Brown occasionally cast good votes but he was unreliable because he had voted against equal pay for equal work, health insurance coverage for birth control and a Supreme Court nominee who supported abortion rights (Seelye, 11/6).

The Wall Street Journal's Washington Wire: Baldwin Defeats Thompson To Win Wisconsin Senate Seat
Mr. Thompson painted Ms. Baldwin a supporter of tax increases and burdensome environmental regulations. Mr. Thompson also tagged Ms. Baldwin as a big-government liberal, noting she said that she was "for a government takeover of health care." Ms. Baldwin labeled Mr. Thompson an ally of big-money interests who would undermine social programs like Medicare. She pounced on Mr. Thompson for saying at a Tea Party meeting, "Who better than me to come up with programs to do away with Medicaid and Medicare?" Mr. Thompson later explained that he only meant that he wanted to reform Medicare to protect it for current and future senior citizens (Hughes, 11/7).

Milwaukee Journal Sentinel: Baldwin Defeats Thompson In Hard-Fought, Contentious Senate Race
Democrat Tammy Baldwin emerged victorious over Republican Tommy Thompson in a hard-fought and bitter race for U.S. Senate that drew national attention and tens of millions of dollars in outside spending. ... The race centered primarily on health care and the economy, with the clearest difference over the Affordable Care Act. Thompson vowed to work to repeal it and Baldwin supports the law, also known as Obamacare. On Medicare, Thompson gravitated to a plan that would allow retirees to opt into the private health care plan offered to federal employees while Baldwin would keep the system intact, despite projections that it is running out of money (Bergquist, 11/7).

The Wall Street Journal's Washington Wire: Heinrich Wins New Mexico Senate Race
Mr. Heinrich and Ms. Wilson clashed over taxes, regulation, energy, and the role of government, drawing sharp contrasts on almost every issue. Mr. Heinrich called for allowing the Bush tax cuts to expire for individuals making more than $200,000 a year and couples making more than $250,000 a year. He said tax increases had to be part of the answer to reducing the deficit and criticized Ms. Wilson for supporting the Bush tax cuts. Ms. Wilson favored a one-year extension of the Bush tax cuts, giving Congress time for Congress to overhaul the tax system. She said the Bush tax cuts helped the economy. Ms. Wilson called for repealing Mr. Obama's signature healthcare law. Mr. Heinrich voted for the measure, which requires individuals to carry health insurance (Hughes, 11/7).

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Some Key Governors' Races Too Close To Call, Outcome Crucial To Health Law's Future

A Republican wins the gubernatorial election in N.C. while N.H. picks a woman to lead the state. Meanwhile, KHN examines how the state-level results will affect the implementation of the health law.

NPR: Gubernatorial Battles: Republican Takes N.C., Democrat Wins N.H.
Voters in North Carolina put a Republican in their governor's office for the first time in two decades, and New Hampshire elected a new female Democratic governor. ... Eight of the gubernatorial seats up for grabs are now held by Democrats; three are in Republican hands. Republicans currently hold 29 governorships, Democrats have 20, and Rhode Island Gov. Lincoln Chafee is an independent (Halloran, 11/7).

The Seattle Times: Inslee Takes Strong Lead, But McKenna Won't Concede
Buoyed by strong support in King County, Democrat Jay Inslee looked well-positioned to maintain his party's three-decade winning streak for the governor's office. ... [Republican Rob] McKenna, the two-term state attorney general from Bellevue, began the race with an advantage in name familiarity and a reputation as a moderate Republican. But Democrats spent the past two years relentlessly chipping away at that image ... McKenna gave Democrats ammunition for that argument when he joined the national lawsuit attacking the constitutionality of the Affordable Care Act, or Obamacare (Brunner, 11/7).

Kaiser Health News: Obama Win Boosts Health Law, But States Still Control Its Destiny 
President Barack Obama's re-election ensures the survival of his landmark health care law, but predominantly Republican state officials will get a big say in how it is carried out. State lawmakers will control whether millions of uninsured people get coverage through Medicaid beginning in 2014, as the law envisions. They'll also decide whether to set up online markets where individuals can shop for coverage and seek federal subsidies to lower their costs (Galewitz, 11/7).

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Supporters Of Mass. Assisted Suicide Ballot Measure Concede Defeat

Meanwhile, among the many ballot items across the country, Florida voters rejected an effort to block some of the federal health law's requirements and limits on abortion. But voters in Alabama, Missouri and Wyoming approved measures to curb the reach of the health law.

The Associated Press/Boston Globe: Backers Of Mass. Assisted Suicide Measure Concede
Supporters of a ballot question legalizing physician-assisted suicide for the terminally ill in Massachusetts have conceded defeat, even though the vote is too close to call. A spokesman for the Death With Dignity Act campaign said in a statement early Wednesday that "regrettably, we fell short." With 93 percent of precincts reporting early Wednesday, opponents of the measure were ahead by about 38,000 votes (11/7).

Politico Pro: Massachusetts Voters Turn Against Assisted Suicide Measure
Massachusetts voters have delivered a surprising defeat to the so-called Death with Dignity movement, narrowly rejecting a measure that would have allowed doctors to prescribe life-ending medication to certain terminally ill patients. The Associated Press had not officially declared the outcome, but backers of the ballot measure conceded defeat early Wednesday. With 93 percent of precincts reporting, the measure was trailing 51 percent to 49 percent — a 38,000-vote deficit out of more than 2.7 million votes cast (Cheney, 11/7).

USA Today: Voters In 38 States Decide Sweeping Ballot Initiatives
The (Massachusetts) issue had been hotly debated in the heavily Catholic state. Similar laws have passed in Oregon and Washington. Thirty-four states prohibit assisted suicide outright, while Massachusetts and six others ban it through common law. Montana's Supreme Court ruled that state law doesn't prohibit doctors from helping patients die (Weise, 11/7).

The Hill: Florida Voters Reject Measure Limiting Abortion Rights
Voters in Florida defeated a measure that would amend the state constitution to limit abortion rights and bar public funds from supporting the procedure. Forty-four percent of voters backed Amendment 6, according to The Associated Press — far less than the 60 percent needed for its enactment. The measure would have prevented state employees from using their healthcare coverage for abortions except in cases of rape, incest or when the woman's life is threatened (Viebeck, 11/6).

The Wall Street Journal: Florida Rejects Health Law Measure
Voters in Florida threw out a proposal to try to block the federal health law's requirement that people purchase insurance or pay a penalty by amending the state's constitution. … Voters rejected the measure by a slim margin, suggesting that the strength of hostility to the individual mandate had waned slightly. Three other states, Alabama, Montana and Wyoming, were weighing similar provisions (Radnofsky, 11/6).

The Associated Press: Florida Health Care Amendment Goes Down To Defeat
Florida voters have rejected a proposal that would have banned government mandates for obtaining insurance such as required by President Barack Obama's health care overhaul. The proposed state constitutional amendment required 60 percent approval but didn't even have a majority with most of the vote counted Tuesday. It was favored by 48 percent and opposed by 52 percent (11/6).

CNN: Florida Voters Defeat Initiative Against Obamacare
The initiative was brought in opposition to the Affordable Care Act, the federal health care legislation also known as Obamacare. Had it passed, the result would have been mostly symbolic in the aftermath of a Supreme Court ruling earlier this year that upheld the constitutionality of the legislation (Crawford, 11/7).

The Associated Press: Mo. Voters Limit Governor's Power On Health Care
Missouri voters have passed a ballot measure limiting the governor's ability to implement part of President Barack Obama's health care law. Voters approved a law Tuesday prohibiting the governor or his administration from taking any steps toward establishing an online health insurance exchange unless specifically authorized to do so by a state law or vote of the people (11/6).

The Hill: Health Care Law Faces New Road Bump In Missouri
Voters in Missouri approved a measure Tuesday that will hamper its governor's ability to implement President Obama's healthcare law. The law will prohibit the governor from creating an insurance exchange unless the move is authorized by the state legislature or by a ballot initiative. Given the makeup of the statehouse, the measure's approval Tuesday all but ensures that Missouri will have a federally run exchange (Viebeck, 11/7).

CNN: Alabama Voters Send Anti-Obamacare Message
In saying yes to Amendment 6, voters chose to prohibit individuals and businesses from being compelled to participate in any health care system. The initiative is considered largely symbolic since Obamacare would still be available to people anyway (Barnett, 11/7).

CNN: Wyoming Voters Send Anti-Obamacare Message
Wyoming residents voted strongly against Obama's signature health care reform law, commonly referred to as "Obamacare", which requires individuals and businesses to purchase health insurance for themselves or their employees. The ballot initiative will amend the state constitution to declare that citizens of Wyoming have the right to make their own health care decisions and allows the state to act to "preserve these rights from undue government influence" (Rizzo, 11/7).

Meanwhile, an effort to improve wages for home health workers fails in Michigan.

Detroit Free Press: Michigan Unions' Gamble Doesn't Pay Off
It was a bad night for organized labor, which also saw the defeat of Proposal 4, the home health care initiative backed by the Service Employees International Union.It was headed for defeat about 59% to 41%, according to indicator precincts. Proposal 4 would have created a Michigan Quality Home Care Council and required background screening and a registry for home health care workers. But it would also continue what's been described as a "dues skim" by which the SEIU collects about $6 million a year from the pay of home health care workers, many of whom are caring for family members (Egan, 11/7). 

Detroit News: Home Health Care Proposal Fails Without Organized Opposition
Michigan voters rejected a proposed constitutional amendment that would have guaranteed a minimum wage and unionization to tens of thousands of home health care workers. Though nearly $8 million was raised by Citizens for Affordable Quality Home Care in support of the proposal, and there was no real opposition campaign, the measure was opposed by 57 percent of voters (Daniels, 11/7). 

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What Obama's Win Means For Businesses' Approach To Health Care

Stock futures fell late Tuesday and early Wednesday as voters re-elected President Barack Obama, even as some business and labor groups cheered his victory.

The Wall Street Journal: Stock Futures Move Lower As Obama Wins
Stock futures slid late Tuesday and early Wednesday as voters re-elected President Barack Obama, though some investors said they expected the passing of the election to clear the way for further gains in the market. ... "It removes an uncertainty and allows investors to allocate capital with a clearer picture of the environment in mind," said Lawrence Creatura, portfolio manager at Federated Investors. ... Mr. Creatura said that, despite the uncertainty, he made trading decisions based on the presidential race during the campaign. He trimmed his holdings of stocks exposed to Medicaid "some weeks back" as Mitt Romney appeared to be nearing Mr. Obama in the polls (Jarzemsky, 11/7).

NPR: Business, Labor Groups Laud Obama Victory
[I]t didn't take long for labor organizers and business leaders to start offering their thoughts on the re-election of President Obama. Because of White House policies, the U.S. economy is "beginning to pick up steam," AFL-CIO President Richard Trumka said in a statement. He cheered Obama's win and put congressional Republicans on notice that Democrats will focus on "ending the Bush tax cuts for the rich and opposing any cuts to Social Security, Medicare, or Medicaid benefits" (Geewax, 11/7).

The Washington Post: Five Things The Election Results Mean For Business And Entrepreneurs
Obamacare full-steam ahead: Romney won't have the chance to extend waivers to the states, nor will he be able to lead a charge to fully repeal the health care reform law. The president's victory quashes the legislation’s biggest remaining threat, and though regulators must still determine exactly how to implement the changes, the law will take full effect as scheduled in the president's second term in office. Changes will include an employer mandate for businesses with 50 or more employees and a tax credit for business owners' contributions toward their employees' health costs (Harrison, 11/7).

The Associated Press: Small Business Outlook For Obama's 2nd Term 
Many [small business owners] opposed the health care overhaul and complain that they are being squeezed by excess regulations. So now that Obama has won four more years, what can small business owners can expect from Obama on taxes, health care, the economy and regulation? The Associated Press interviewed small business experts and advocates to find out. ... Obama's re-election means the health care overhaul will continue to be implemented, but small businesses still have to wait to find out how much it will eat into their profits. Key provisions of the law go into effect in 2014, including the requirement that businesses with 50 or more employees provide affordable health insurance for their workers (Rosenberg, 11/7).

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Editorials and Opinions

Viewpoints: Newspapers Opine On Obama's Health Care, Fiscal Challenges

The New York Times: President Obama's Success
President Obama’s dramatic re-election victory was not a sign that a fractured nation had finally come together on Election Day. But it was a strong endorsement of economic policies that stress job growth, health care reform, tax increases and balanced deficit reduction — and of moderate policies on immigration, abortion and same-sex marriage. ...  Republicans had to be disappointed in the results of their unrelenting assault on Mr. Obama’s health care reform law. Only around a quarter of Americans said it should be repealed in its entirety (11/6).

The Washington Post: President Obama's Second Term: Now The Hard Work Really Begins
Having inherited a mess, he gets four more years to create a legacy. The accomplishments, as we said in endorsing Mr. Obama for reelection, include the stabilization of the economy and health-care reform. The latter has, for the most part, not taken effect; a second-term task will be to ensure that it achieves the dual goals of extending coverage to millions of uninsured Americans and beginning the difficult, uncertain process of restraining the unsustainable rise of health-care costs (11/7).

USA Today: Obama Wins Big Victory, Bigger Challenge
Obama goes in having already achieved what others, ranging from Harry Truman to Richard Nixon to Bill Clinton, failed at: enacting universal health insurance legislation. In his second term, this new law, which has been so reviled in some quarters, will go into full effect and Americans will judge it for themselves. Our guess is the opposition will fade with time as the benefits become more apparent, although cost-control will remain a challenge (11/7).

USA Today: What The GOP Should Do To Rebuild
[Republicans] may also need to recalibrate their positions on reproductive issues such as birth control and Planned Parenthood that are harming it among women and young voters. Women made up 53% of the vote and broke to Obama by a 10-point margin. Candidates with extreme positions on abortion cost the GOP sure-win Senate seats Tuesday in Indiana and Missouri (11/7).

The Wall Street Journal: Hope Over Experience 
These columns have viewed this election as more consequential than others for a single reason—ObamaCare. Tax rates do economic damage when they rise, but they can be cut again. Regulations can be adapted to or phased out. Spending can be cut. But the Affordable Care Act will spread like termites in the national economy and public fisc. Mr. Obama will no doubt use his second term to consolidate this liberal entitlement dream, with its ultimate goal of single-payer health care. ... The exit polls show the two campaigns fought Medicare essentially to a draw in Florida ... Many seniors seem to understand that ObamaCare poses a far greater threat to the future of Medicare than does opening the rickety program to private insurance options (11/7).

Los Angeles Times: The Tough Road Ahead
The longer-term problem for the president will be coping with the dueling pressures of an economy that's growing too slowly and a federal debt that's growing too fast, largely because of the rising cost of Medicare and Medicaid. ... The current paralysis in Washington demands the kind of leadership that brings lawmakers out of their foxholes. ... Republicans want to cap federal spending at a "traditional" percentage of the economy, despite the fact that retirees collecting government benefits are making up a steadily growing share of the population. And Democrats are adamant that the government maintain its promise of healthcare and Social Security benefits for those retirees (11/7). 

Chicago Tribune: The President's Big Night 
And now we implore you to recognize the mistakes of your first term, mistakes that nearly cost you a second term. Listen, at last, to this nation's employers. They do have a notion of what it will take to put the nation back to work. They have genuine fears about the burden that government places on them, fears about the cost of your signature health care reform, ... [at] the same time, we implore Republicans: Get over your Obama obsession (11/7). 

The Wall Street Journal: Obama Gets A Do-Over
This is a mandate to do what? That is, besides a mandate to keep frightening women about abortion and contraception every time Democrats need to scare up a few votes in close races? ... The Rube Goldbergism of ObamaCare, added to the Rube Goldbergism already extant in our health-care system, in our view never made him the "transformational" president he sought to be. He can still be a consequential president, though (Holman W. Jenkins, 11/7).

Los Angeles Times: Obama Will Get No Rest Before Second-Term Challenges Arise
The most important dickering could involve Social Security, Medicare and Medicaid, those programs dismissed by conservatives as "entitlements." The Romney-Ryan ticket made no secret of its plans to hack away at all three, as if they are equal threats to the federal budget. To supporters of the programs, Obama's counter-argument was never sufficiently forceful (Michael Hiltzik, 11/7). 

The Washington Post: Obamacare Gets Its Vindication
Obama didn’t “have” to do health reform. It wasn’t in his inbox. ... Obama is now certain to leave America a more decent society in ways that business will come to recognize are good for the economy as well. (The fact that Mitt Romney’s health reform inspired its design gives the achievement a kind of tacit bipartisan poetry as well.) (Matt Miller, 11/7). 

The New York Times: Bad Medicine for Women
No one should expect a postelection letup in the continuing courtroom fights over state efforts to restrict women's access to safe and legal abortions. Two important cases — one in the United States Court of Appeals for the Ninth Circuit, in San Francisco, the other in the Court of Appeals for the Sixth Circuit, in Cincinnati — show how intense these battles have become and how important it is for basic women's rights to prevail (11/6).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.