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The Democratic Party has prospered for decades by promising voters entitlements in return for Election Day loyalty. It worked with Social Security and Medicare, and so it was supposed to work for ObamaCare: Pass it and they will come. Instead the Affordable Care Act has become a recurring political catastrophe for Democrats, most recently on Tuesday in Kentucky. (11/4)

Matt Bevin, the newly elected Republican governor of Kentucky, says his state can't afford to keep covering the people who have gained health insurance through Medicaid expansion. If money really is the issue, Bevin may find Kentucky can't afford not to. (11/5)

Thirty states have expanded Medicaid under the Affordable Care Act since the Supreme Court made it a state option in 2012. Ten of them have Republican governors, two of whom are presidential candidates, John Kasich and Chris Christie. If, however, you follow campaign commentary on cable TV you would think expanding Medicaid is a political black mark in the eyes of all Republicans. To be sure, the most activated elements of the GOP base–conservative campaign contributors, super PACs, and conservative legislators–oppose Medicaid expansion, primarily because they see it more as embracing Obamacare than providing federal funding to states to help them expand coverage for low-income residents. But the limited polling the Kaiser Family Foundation has done on the issue has found that most Republicans do not oppose Medicaid expansion. In fact, they favor it. (Drew Altman, 11/4)

Opponents of the Affordable Care Act keep trying to chip away in court and at the state level at pieces of the whole -- Kentucky's governor-elect, Matt Bevin, has pledged to roll back the state's Medicaid expansion. But a slew of recent attacks has taken aim at what one would think is the law's most sacrosanct provision. That's the protection of insurance customers with preexisting medical conditions, otherwise known as "guaranteed issue." (Michael Hiltzik, 11/4)

“Everyday people with good health insurance and ready access to medical care die of preventable diseases,” my friend John, a retired surgeon, wrote me recently. My friend was lamenting a recent article appearing in many Idaho newspapers about the tragic death of a woman with asthma. Her death was blamed on lawmakers who have refused to expand government-run programs like Medicaid to include able-bodied, childless adults. The article is but the first, I’m sure, of many that will claim that someone’s death is connected to the unwillingness of lawmakers to put more people on government assistance. That legislators are to blame for people dying is a lie, but it’s one advocates for Medicaid expansion figure will move lawmakers to act. (Wayne Hoffman, 11/4)

Yet another attack on the ACA is making its way through the courts. Frustrated that dozens of votes to repeal the ACA have gone nowhere, the House of Representatives voted along party lines in 2014 to file a lawsuit challenging the administration's implementation of two provisions of the law. First, the House claimed that the decision of the Obama administration to delay the employer mandate violated the ACA. Second, it claimed that the administration was illegally reimbursing insurers for reducing cost sharing for enrollees under the ACA's cost-sharing reductionprogram, asserting that Congress had not specifically appropriated funds for the program. ... Although the technical legal issue in House v. Burwell is whether funding for the cost-sharing reductions has been properly appropriated, the really significant issue in the case is whether the House can bring the lawsuit at all. (Timothy Stoltzfus Jost, 11/4)

It’s been well over a year since the deception and negligence at the U.S. Department of Veterans Affairs shocked the American people. Even though the headlines have faded, the situation continues to worsen. Whereas 40 veterans died in the wait-list scandal first uncovered at the Phoenix VA, a September VA inspector general’s report found as many as 307,000 veterans nationwide died before their applications were processed. How can veterans trust this failing agency with their health and well-being? A federal agency is only as good as the people working in it, and although the vast majority of VA employees deserve our thanks, it is undeniable that a small minority has contributed to a culture of deception and disregard for veterans’ well-being. (Pete Hegseth, 11/4)

Clinton made her views known in an Oct. 23 interview with MSNBC. She declared that last year’s wait-list scandal in Phoenix was little more than an anomaly: “It’s not been as widespread as it has been made out to be.” She also claimed that “veterans who do get treated are satisfied with their treatment,” while arguing that Republicans manufactured a non-existent crisis to serve their political ends. These are astounding comments from someone who wants to command America’s men and women in uniform. They betray a shocking ignorance of the facts on the ground. Time and again, the VA has let down the veterans who fought and bled for their country. Simply look at the reams of evidence released since the wait-list scandal was first uncovered in Phoenix in April 2014. (Thomas McInerney, 11/5)

George was 18 when he was diagnosed with acute myeloid leukemia, a blood cancer that is fatal but curable with effective therapy. He was treated and went into remission. This was 24 years ago .... Unfortunately, in May 2015, at age 42, his leukemia came back. ... we recommended a clinical trial in our department at MD Anderson in the hope of controlling his leukemia. ... Our expert opinion was that the clinical trial was his best option. It is approved by the Food and Drug Administration .... However, George's insurance company denied coverage for the clinical trial. Unfortunately, this is a common scenario. We routinely encounter situations where insurance companies deny clinical trial coverage for patients with cancer using a variety of excuses. The only motive is to save money. (Nitin Jain and Hagop Kantarjian, 11/4)

Two Princeton economists startled other Americans — and themselves — when they uncovered a trend that had escaped the medical and scientific world: Between 1999 and 2013, white middle-aged men and women in the United States, especially those with only a high school education, began dying at a sharply increased rate, largely a result of problems with legal and illegal drugs, alcohol-related liver disease and suicide. The health and financial implications are disturbing for the country, and for what the two economists called a “lost generation.” (11/5)

That’s the story that Steven Francesco, a longtime pharmaceutical industry executive and consultant, tells in “Overmedicated and Undertreated,” his harrowing memoir of raising Andrew, his son. He makes clear that the larger problem — even from his view as an industry insider — is a sector that sometimes puts profits above public well-being. Here’s the central issue: Children with emotional or mental disorders have become a gold mine for the drug industry. Psychiatric medicines for children account for billions of dollars in sales annually, and the market has boomed. (Nicholas Kristof, 11/5)

The public outcry and political scrutiny over the pricing policies of drug companies Valeant and Turing has amplified the national debate over high specialty drug costs. To address the problem in a way that might actually improve things, it is important to recognize that not all high-priced drugs are created equal. Some are novel agents that enter relatively large markets at high prices, such as the Hepatitis C medication Sovaldi. Their prices are likely to remain high. Others, however, reflect older off-patent medications that were sold for years at low prices and have recently experienced large and sudden price increases, such as Daraprim. Both kinds of drugs cause distress for insurers and consumers, but they have very different implications for overall health care spending, and they require different policy solutions. (Joshua M. Liao and Mark V. Pauly, 11/4)

Ohio voters did the right thing on Tuesday by overwhelmingly rejecting a deeply flawed marijuana legalization ballot initiative. The proposal would have amended the state’s constitution to grant a monopoly on commercial cultivation of cannabis to a small group of investors, which is a terrible idea. By a margin of 64 percent to 36 percent, voters rejected the measure, called Issue 3, which was backed by a group of business interests that spent about $25 million on their campaign. Ohioans narrowly approved another measure that was meant to undo a yes vote on the legalization proposal. (Vikas Bajaj, 11/4)

It's a mistake to make a federal case out of a single outbreak of food poisoning. It's worth pointing out, however, the utter failure of Congress to do more to prevent foodborne illness, which costs Americans some $15 billion in treatment and lost work days every year. (11/4)

Between 2002 and 2014, a total of 16 new allopathic and 15 new osteopathic medical schools opened in the United States and many existing schools increased their class sizes, for an estimated 49% increase in first-year enrollment nationwide. This explosion in the number of medical students after a long period of level numbers of graduates has raised concerns about the adequacy of the U.S. system of graduate medical education (GME) to provide residency positions for all U.S. medical school graduates. ... Traditionally, there have been many more entry-level positions available than there have been U.S. medical graduates (M.D. and D.O.) to fill them. ... The GME system is proving responsive to the increased output of U.S. medical schools. The country would be best served if academic medicine focused its considerable intellect and energies on the task of transforming GME to respond to our rapidly evolving health care system. (Fitzhugh Mullan, Edward Salsberg and Katie Weider, 11/4)

Tattoos are becoming increasingly common worldwide. In the United States, at least 21% of all Americans have 1 or more tattoos. Despite this, tattooing is minimally regulated. In the United States, tattoo inks are considered cosmetic products and are not subject to monitoring by the US Food and Drug Administration. ... Instead, regulation occurs at the state or local level. ... This lack of oversight extends to the provision of aftercare instructions. Aftercare instructions are the guidelines that describe how to care for a new tattoo. ... Providing written and verbal aftercare instructions may minimize rates of postplacement tattoo infections and complications. (Walter Liszewski, Jared Jagdeo and Anne E. Laumann, 11/4)