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Democrats keep saying that opposition to the Affordable Care Act is a spent political force, but not so fast. Senate Republican candidates have run more ads against ObamaCare than on any other issue, according to Kantar Media/CMAG. But perhaps more fascinating this election year are the state referenda that confront rising costs and declining patient choice. The pity is that these states are trying to solve the problems caused by ObamaCare with more ObamaCare-like rules and government control. Leading this challenge from the left as always is California, where on Tuesday voters will consider Proposition 45, which would impose stronger price controls on health insurers. (10/31)

One of the main arguments advanced by the commercials aired and the torrent of mailers sent by the No on 45 campaign is that the measure would place healthcare in the hands of a single corruptible politician. "Who do you trust with your health care," a recent mailer asks, "a politician or your doctor? Prop. 45 gives one Sacramento politician control over medical treatment options." It's as if the No on 45 folks were trying to unleash the same "government takeover of healthcare" demon that Republican strategists employed so effectively in the debate over the 2010 Affordable Care Act. In this case, the attack is misleading, if not flat-out wrong, in at least a couple of significant ways. The first of these is that the measure wouldn't affect most Californians' health insurance, let alone their healthcare. (Jon Healey, 10/31)

Obamacare is back in the news again. Mitch McConnell is now claiming a GOP Senate majority will use the tool known as “reconciliation” to target the health law with simple majority votes. McConnell had previously suggested he wouldn’t go that route, sparking conservative cries of “surrender” that forced him to reverse course. Which makes this a preview of what to expect when conservatives demand maximum confrontation from the new GOP majority. (Greg Sargent, 10/31)

Repealing the Affordable Care Act would take us back to the days when health care was reserved for the healthy and wealthy. In a series of legal challenges, opponents have inaccurately argued that Congress intended to provide financial help only to Americans living in the 14 states that directly run their own health insurance marketplaces, not in the 36 states that delegated administration of their marketplaces to the federal government. This interpretation is wrong. As members of Congress who shaped and debated the legislation, we want to set the record straight. (Sen. Tom Harkin, D-Iowa, Sen. Ron Wyden, D-Ore., Rep. Sander M. Levin, D-Mich., Rep. George Miller, D-Calif., and Rep. Henry A. Waxman, D-Calif., 10/30)

A new data set suggests that more than three million people would have gained health insurance across 24 states if the Supreme Court had ruled differently. (Kevin Quealy and Margot Sanger-Katz, 11/3)

In January of 2013, [Secretary of Health Aldona] Wos, Republican Gov. Pat McCrory and State Auditor Beth Wood, a Democrat, held a news conference at which they somberly announced that North Carolina’s Medicaid program was “broken”. They cited chronic cost overruns and sky-high administrative costs. Therefore, they said, Medicaid could not withstand the stress of being expanded under the Affordable Care Act. ... It was an interesting bit of political jujitsu on McCrory’s part .... the governor said he’s now considering expanding Medicaid. That glimmer of moderation may help state House Speaker Thom Tillis in his U.S. Senate race .... It also may mark McCrory’s first tilt toward 2016 when he will go before voters with a lot of explaining to do about the moderate former Charlotte mayor they thought they elected and the tea party-type executive they got. (Ned Barnett, 11/1)

If you can compute some numerical measure of an economy or society but it will clearly mislead people rather than inform them, don't publish that indicator or cite it as evidence of anything. That's not Ph.D.-level research methodology; it goes back to integrity and common sense. The corollary, of course, is that computing meaningful metrics often is far more complex than people realize. Both those lessons are evident in the recent brouhaha over reported increases in health insurance rates offered through MNsure, our state's exchange established under the federal Affordable Care Act. (Edward Lotterman, 11/2)

We still have a structural mismatch between entitlement promises and revenue. An aging population and rising health-care costs, the basic dynamics that we warned about, remain a threat to fiscal stability. Meanwhile, the passage of time, the failure to take more ambitious actions and the enactment of new obligations have combined to limit our choices and placed the government in a more difficult position to address the challenges than it was in 20 years ago. (Former Sens. J. Robert Kerrey and John C. Danforth, 10/31)

The case of Brittany Maynard, however, may finally signal a shift in this debate. Whereas hastening an inevitable death was once regarded almost exclusively as a medical issue, we are beginning to focus on what patients want, on their right to self-determination. And people are increasingly asking why anyone — the state, the medical profession, religious leaders — would presume to tell someone else that they must continue to die by inches, against their will. (Dr. Marcia Angell, 10/31)

Thank you, Kaci Hickox. You did the world a service in traveling to Sierra Leone to care for Ebola patients. Then you did your country a service in standing up for rationality. It might have been easier to go along with the unnecessary quarantine. ... Instead, Hickox made a brave, and useful, stink. (Ruth Marcus, 10/31)

This is a court ruling that's sure to inflame the anti-immigration crowd. A U.S. District Court judge this week ordered the federal government to begin mental-disability screening for those detained in three states on suspicion of being in the country illegally, and to provide lawyers for those determined unable to represent themselves in removal hearings. It was the right call. (Scott Martelle, 10/31)

The press, politicians and even many veterans’ advocacy groups tend to focus, with legitimate reason, on service members who have returned banged up or who are struggling in their new civilian lives. But this fails to convey the full measure of this generation of veterans. That wouldn’t be a problem if Americans knew their military and understood these stories in context, with the knowledge of veterans who are thriving. But fewer than 1 percent of Americans have participated in our latest wars. Add their direct family members, and it is still only about 5 percent of the population. With so few possessing a direct link to someone who has served, Americans often don’t understand that most of our veterans are not damaged and that many have successfully navigated the transition to life after the military. (Howard Schultz and Rajiv Chandrasekaran, 10/31)