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U.S. insurers planning to sell 2015 Obamacare health plans expect at least 20 percent growth in customers and in some states anticipate more than doubling sign-ups. In interviews with Reuters, half a dozen privately held and non-profit health insurers around the country say they are expecting this growth based on interest from potential customers they are hearing about through their call centers, sales forces and brokers. With the start of enrollment barely two weeks away, their assessment is dramatically different from a year ago, when it was unclear how many Americans would apply for the brand new insurance and income-based subsidies offered under President Barack Obama’s healthcare law. (Humer, 10/30)

Jessica Bravo walks house-to-house in the piercing Southern California heat. Over and over, at doorsteps around Orange County, she asks the same question: 'Are you insured?' Getting an answer isn’t always easy. Doors slam in her face. She gets shooed from porches. And sometimes people cut her off mid-spiel. Bravo is a paid health outreach worker for the Orange County Congregation Community Organization, a faith-based nonprofit. Her job is to inform people about getting health insurance under the nation’s landmark health law, the Affordable Care Act. (de Marco, 10/31)

When the Minnesota Department of Commerce announced rates would increase by 4.5 percent for 2015 open enrollment, they simply averaged the premium rate increase reported by each insurance company selling plans on the exchange. But that number focused only on how much more insurance companies are charging, a figure that is greater than the amount the many MNsure participants getting a subsidy will actually pay. (Richert and Catlin, 10/30)

Blue Cross and Blue Shield, the state’s largest health insurer, said Thursday that about 42,000 customers around the state received insurance renewal letters with incorrect rates, some showing cost increases of more than 100 percent. The Chapel Hill company has been flooded with calls since Wednesday from irate customers who began receiving their renewal notices this week. Blue Cross officials soon realized the insurance rates were incorrectly transferred from the company’s database to the computer-generated renewal notices. The affected customers are on grandfathered Blue Advantage Plan A policies with a $15 co-pay, and all 42,000 customers on that individual health plan were sent the wrong rates for 2015 renewals, said Blue Cross spokeswoman Michelle Douglas. Customers who signed up for those plans before the passage of the Affordable Care Act in March 2010 were allowed to keep them. (Murawski and Helms, 10/30)

Gov. Pat McCrory said Thursday he's weighing whether to expand Medicaid, the health insurance plan for the poor and disabled, adding to signs that state Republican leaders may reconsider their opposition to extending the social program. In addition to shaping a plan for networks of physicians and hospitals to share the risk of rising health care costs, "I'm also trying to figure out what to do with Medicaid and whether to expand that or not, because the feds are offering all this money and yet I've got to be concerned with the bureaucracy that could be grown because of that," McCrory told a gathering of corporate CEOs at a Raleigh country club. "I'm doing that assessment right now." (Dalesio, 10/30).

Jefferson County didn't get about $342 million. Montgomery County left $157 million on the table. Madison County missed out on about $75 million; and Baldwin County, about $26 million. That's the estimated amount of money those counties would have received this year for health care to the poor - Medicaid money - had the state agreed to expand Medicaid under the Affordable Care Act. The state as a whole would have received $1.4 billion. (Oliver, 10/30)

Senate Minority Leader Mitch McConnell is reassuring conservatives that his position on Obamacare has never wavered as Republicans grow increasingly confident that they will take the Senate and install McConnell as the majority leader. McConnell’s comments Tuesday to Neil Cavuto that a standalone repeal vote would require 60 votes and a presidential signature were taken as a change in position from the Kentucky senator’s frequent references to the goal of repealing the health care law “root and branch.” NPR posted a headline that “McConnell Concedes GOP Senate Will Not Mean Obamacare Repeal” while the Senate Conservatives Fund likened it to a “surrender.” (Everett, 10/31)

Republicans have been eerily quiet about the president's health care law on the campaign trail lately. But that's likely to change if the GOP is victorious and wins control of the Senate next week. (Ehley, 10/30)

Here’s a solid prediction about next Tuesday’s elections: They’ll be crucial to the future of universal health care in America — or at least its near-term future. For those who believe universal coverage is a good thing, prospects aren’t good, judging from an analysis of 27 national polls scoured by researchers at the Harvard School of Public Health. (Knox, 10/30)

Reclaiming white, working-class voters is a tall order for Democrats, who have won the popular vote in five of the past six presidential elections with broad support from minorities, single women and younger voters. Democrats have won national elections with the message that government should help people through such programs as subsidized student loans, food stamps and the Affordable Care Act. (Peterson and Chinni, 10/30)

The Congressional Leadership Fund, the Republican group affiliated with House Speaker John Boehner, is wading into the heavily targeted 7th Congressional District, hitting Sacramento-area Democratic Rep. Ami Bera for his support of the federal Affordable Care Act. The ad opens with a video snippet of Bera, a medical doctor, addressing GOP challenger Doug Ose at the pair’s recent debate. (Cadelago, 10/30)

Republican Cory Gardner and Democrat Mark Udall will tell you the economy is issue number one. But their ads tell a different story. (Cordes, 10/30)

Like many of her fellow baby boomers, Rubin was accustomed to solving problems with the help of advanced tech tools. But she believed that a lot of health-care communications still tended to be more phone-and-fax than apps-and-Web. So Rubin adapted office technology to her caregiving needs. She and her brother, John, continually update a shared Google Docs spreadsheet, tracking their mother’s symptoms, physicians, medications and questions. (Yoquinto, 10/31)

Cigna Corp. again raised its guidance as fee and premium revenue grew along with its customer base in the third quarter. The health insurer’s results easily topped analysts’ expectations. The company predicted earnings for the year of $7.25 to $7.45 a share, up from $7.20 to $7.40. Fellow health insurers WellPoint Inc. and Aetna Inc. also raised their guidance this week, showing how the industry is profiting amid changes brought by the Affordable Care Act. (Wilde Mathews and Calia, 10/30)

Cigna Corp. said on Thursday that financial losses from the new Obamacare health insurance eased in the third quarter, becoming the second insurer this week to say that business was improving. Cigna, Aetna Inc and Humana Inc have said since the beginning of the year that they were posting losses on the plans because their patients were older and sicker than what they had anticipated when they set premiums. Others, like WellPoint Inc., are making a profit, a fact WellPoint confirmed this week was the case in the third quarter. Humana reports next week. (Humer, 10/30)

Kindred Healthcare Inc. on Thursday named operating chief Benjamin Breier as the company’s next chief executive, a key step for the long-term care provider as it moves forward with its acquisition of Gentiva Health Services Inc. Mr. Breier, 43 years old, will succeed Paul Diaz, who will become executive vice chairman of Kindred’s board after a decade in the company’s top executive spot. (Dulaney, 10/30)

State and local governments have the legal authority to impose mandatory quarantines. But law experts are debating whether some states' new Ebola quarantine policies may be stepping over the line. (Stein, 10/30)

A U.S. soldier returning from an Ebola response mission in West Africa would have to spend 21 days being monitored, isolated in a military facility away from family and the broader population. A returning civilian doctor or nurse who directly treated Ebola patients? Depends. The Pentagon has put in place the most stringent Ebola security measures yet, going beyond even the toughest measures adopted by states such as New York, New Jersey and Maine and much further than the guidance set by the federal Centers for Disease Control and Prevention for travelers returning from the afflicted region. (10/31)

In Louisiana, Gov. Bobby Jindal, a Republican, issued a stern warning on Thursday to medical experts coming to an international conference on tropical diseases that they should stay away if they had been in Ebola-affected countries in the past 21 days, and that those who defied would be confined to their hotel rooms. But in New York, Gov. Andrew M. Cuomo, a Democrat, who last week called for mandatory quarantines for health care workers returning from West Africa, sounded a more conciliatory note, joining Mayor Bill de Blasio to announce financial incentives to encourage health professionals to go to West Africa to treat Ebola patients. (Bidgood and Zernike, 10/30)

New York officials announced on Thursday that they would offer employee protection and financial guarantees for health care workers joining the fight against the Ebola outbreak in three West African nations. The announcement was an effort to alleviate concerns that the state’s mandatory quarantine policy could deter desperately needed workers from traveling overseas. (Santora and Hartocollis, 10/30)

She has rebelled against the restrictions, saying that her rights are being violated and that she is no threat to others because she has no symptoms. She tested negative last weekend for Ebola, though it can take days for the virus to reach detectable levels. State officials said that they were seeking a court order to require a quarantine through Nov. 10, the end of the 21-day incubation period for the Ebola virus. But it was unclear Thursday whether the state had gone to court or whether there had been any progress in negotiations aimed at a compromise. (10/31)

Brown’s tenure as lieutenant governor was bookended by two projects, both of which offered opportunities for Maryland to stand out from other states: Preparing for an influx of jobs at military posts because of a congressionally ordered base realignment, and leading the implementation of the Affordable Care Act. ... The health-care effort was marred by the failed launch of the state’s online insurance marketplace, which Brown has said was not his direct responsibility. (Johnson, 10/29)

Haven't been keeping up with the gubernatorial campaigns? We've got you covered. (10/31)

A once-obscure effort by a group of states to get out from under federal health care regulations has become an issue in the final days of the Kansas governor’s race. On Wednesday, Democratic lieutenant governor candidate Jill Docking teamed with Republican Insurance Commissioner Sandy Praeger at a Wichita news conference to criticize Republican Gov. Sam Brownback for signing a bill authorizing Kansas’ membership in a multi-state health care compact. Docking, Democrat Paul Davis’ running mate, said the compact could put the “Medicare benefits of Kansas seniors at risk.” If the compact is approved by Congress, its nine member states could suspend federal health care regulations within their borders and take over several programs now administered by the federal government. (McLean, 10/30)

With four days before the statewide election, California voters remain supportive of a $7.5 billion water bond, but sentiment toward two health-related ballot measures have shifted sharply downward, according to a Field Poll released Friday. (Gutierrez, 10/31)

A TV political ad opposing Proposition 46 in California opens with black silhouettes of plaintiff lawyers shaking hands. In a later frame, a worried older woman opens a medical bill. A doctor in an empty hallway shakes his head. Opponents of Proposition 46, who backed the ad, say it accurately portrays what will happen if Californians vote Tuesday in favor of the ballot initiative supported by plaintiff lawyers and patient advocacy groups. Among other things, the measure would raise the cap on non-economic damages in medical malpractice suits from $250,000 to $1.1 million and index the cap to inflation. They argue that raising that cap—which hasn't been increased since it was approved in 1975—would cause doctors' medical liability insurance premiums to rise. Those costs, they say, would then be passed on to consumers. (Schencker, 10/30)

A long running lawsuit alleging deficiencies in the way Florida handles Medicaid for children has been delayed again after the state filed two motions days before a federal judge was supposed to issue a final ruling on the case. The class-action suit, filed by the Florida Pediatric Society in 2005, accused Florida health officials of failing to provide essential medical and dental services to children on Medicaid. A trial ended in 2012. In motions filed last week, lawyers for Florida’s Office of the Attorney General argued that recent changes to the state’s Medicaid system required by the federal Affordable Care Act, as well as the state’s move to a managed-care system, had addressed the plaintiffs’ complaints. The state asked Judge Adalberto Jordan, who had planned to rule at the end of October, to allow it to present new evidence in the case. (Nehamas, 10/30)

A lawsuit alleging that one of the for-profit companies running KanCare ordered employees to shift KanCare members away from high-cost providers has put a renewed spotlight on the program, one of the Brownback administration’s signature achievements. In the lawsuit filed this week in federal court in Kansas City, Kan., a former official of the company, Sunflower State Health Plan Inc., claimed she was fired after she objected to the directive, saying it was unethical and possibly illegal. (Margolies, 10/30)

The [Louisiana] state health agency has entered into a settlement in a federal lawsuit over the inadequacy of notices denying Medicaid recipients access to services. U.S. District Judge Jim Brady, of Baton Rouge, approved the settlement, in which the state agrees to do a better job of providing specific information about the reasons for the service denials. He will oversee state compliance for the next five years. The settlement came in a class-action lawsuit, Wells v. the Department of Health and Hospitals. The lawsuit alleged that the notices were so lacking that an individual would not know on what basis to appeal the denial and what kind of information would be needed to reverse the decision. (10/30)

Alaskans lined up Wednesday to tell Gov. Sean Parnell's advisory committee on Medicaid that it would be a bad idea to limit payments for therapy services. More than 150 people attended the meeting that lasted more than five hours. Elann "Lennie" Moren, 62, testified that she was told she might not walk or talk again after she was slashed in 2007 by a machete wielded by her finance's son. Seven years later, she walked to a microphone and told the Medicaid Reform Advisory Group that through occupational, physical and speech therapy, "much is possible." The advisory group has recommended trimming therapeutic service to cut Medicaid costs. "If this is an example of Parnell care ... then it's no care at all," Moren said. (10/30)

Georgia’s insurance commissioner, in a rare regulatory action, has told the state’s largest health insurer to rescind newly added amendments to contracts with thousands of physicians. Physicians had complained that the Blue Cross and Blue Shield of Georgia contract revisions lacked clarity on the insurer’s payment rates for medical services. (Miller, 10/30)

The California Department of Public Health has failed to effectively investigate nursing home complaints, a state audit released Thursday found, with a total of 11,000 unresolved complaints in its system. The department, which is responsible for monitoring more than 2,500 nursing homes, classified more than 40% of these complaints and incidents as having caused or being likely to cause harm to a resident. Yet the state auditor’s office found that the average number of days these complaints were open ranged from 14 to 1,042 days. (Flores, 10/30)

Stockton had asked the court to approve its plan, which calls for budget cuts, haircuts for bondholders and even a sales tax increase, which city residents approved in a referendum last year. But it did not touch pensions, not even the benefits that current workers hope to earn in future years. Prospective pension cuts are routine when companies go bankrupt under Chapter 11 and even outside of bankruptcy. But Judge Christopher Klein of the United States Bankruptcy Court for the Eastern District of California in Sacramento said he found Stockton’s proposed plan acceptable, noting that it eliminated the retirees’ health benefits. (Walsh, 10/30)

A judge is siding with Highmark Inc. in a dispute with state regulators over an insurance plan that doesn't cover doctors working for the University of Pittsburgh Medical Center. Commonwealth Court Judge Dan Pellegrini ruled Thursday that Highmark hadn't violated terms of a consent agreement meant to alleviate tensions between the healthcare competitors. The judge rejected calls from the state attorney general's office and the health and insurance departments to hold Pittsburgh-based Highmark in contempt. (10/30)

A Glendive veteran says his confidential medical diagnosis, birth date, address and Social Security information were compromised when the VA Montana Health Care System mishandled his request for medical services. Kip Braden, a U.S. Army, Air Force and National Guard veteran, was waiting for authorization papers from the VA for outpatient services, but when his paperwork arrived, it was for a Bozeman veteran. The authorization papers included the Bozeman veteran’s name, address, date of birth, Social Security information and his medical condition. VA officials have characterized the mix-up as a “mishandling” of correspondence. (Uken, 10/30)

Randy Hodges, the hospital’s administrator, has asked the Putnam County Development Authority to buy the hospital’s only two smoking areas — for one dollar — while the hospital continues to maintain the areas and assume legal liability for them. ... An accreditation company that determines whether the hospital can continue getting paid to serve Medicare and Medicaid patients — representing more than half of its total patient volume — requires CAMC Teays Valley to move toward being a “smoke-free campus.” (Quinn, 10/30)

Two civil rights groups called for a federal investigation into a Jindal administration program that they allege is failing to deliver on promised services to keep at-risk youth with mental health problems out of detention centers and hospitals. In response, the state health chief acknowledged Wednesday that there are “challenges” in getting providers to meet the specialized needs of the youth and their families, but said the administration remains committed to the program. The Southern Poverty Law Center and the Advocacy Center complained to the federal Centers for Medicare and Medicaid Services, called CMS, about shortcomings of the program that attorneys claim violate federal law. (Shuler, 10/30)

[W]e compared experiences of care reported by Medicare beneficiaries served by provider organizations entering the [accountable care organization] programs in 2012 with the experiences reported by beneficiaries served by other providers, before versus after the start of ACO contracts. ... incentives for participating provider organizations to limit health care utilization and improve quality of care were associated with meaningful improvements in some measures of patients' experiences and with unchanged performance in others. ... patients served by ACOs reported improvements in domains more easily affected by organizations (access to care and care coordination) but not in domains in which changes in physicians' interpersonal skills may be required to achieve gains .... In addition, medically complex patients ... reported significantly better overall care after the start of ACO contracts. (McWilliams, Landon, Chernew and Zaslavsky, 10/30)

For many physicians, the prospect of being sued for medical malpractice is a singularly disturbing aspect of modern clinical practice. State legislatures have enacted tort reforms, such as caps on damages, in an effort to reduce the volume and costs of malpractice litigation. ... In this Special Communication, we review recent national trends in medical liability claims and costs, which indicate a sharp reduction in the rate of paid claims and flat or declining levels in compensation payments and liability insurance costs over the last 7 to 10 years. ... Rates of paid claims against physicians have decreased since the early 2000s. For MDs, the rate decreased from 18.6 to 9.9 paid claims per 1000 physicians between 2002 and 2013. Regression analyses estimate an annual average decrease of 6.3% for MDs and 5.3% for DOs over this 12-year period. (Mello, Studdert and Kachalia, 10/30)

We found that between 2002 and 2010, 237 US hospitals switched from nonprofit to for-profit status. This conversion was associated with better subsequent financial health but had no relationship to the quality of care delivered or to mortality rates at the converting hospitals. We also found no evidence that for-profit conversion was associated with any increase in Medicare payments or annual Medicare case volume or decrease in the provision of care to poor patients or to racial or ethnic minorities. Prior to conversion, we found that hospitals that would eventually become for-profit institutions were struggling financially, with negative total margins; this is in keeping with prior research2 and is likely why these hospitals were targeted for conversion. (Joynt, Orav and Jha, 10/22)

Less competition among physician practices is statistically significantly associated with substantially higher prices paid by private PPOs to physicians in 10 large specialties for office visits. ... Examining changes in prices between 2003 and 2010, we found that prices increased more rapidly in areas where practices were initially less competitive than in other areas. In some specialties, declining competition was also associated with larger increases in prices in areas that were initially more competitive. This pattern suggests the possibility that the results we observe in 2010 may be related to the ability of practices in low-competition areas to negotiate larger price increases over time as well as related to changes in competition over time. (Baker et al., 10/22)

Objective: To examine the ACA’s initial effects on young adults’ receipt of preventive care. ... After ACA, young adults had significantly higher rates of receiving a routine examination (47.8% vs 44.1%), blood pressure screening (68.3% vs 65.2%), cholesterol screening (29.1% vs 24.3%), and annual dental visit (60.9% vs 55.2%) but not an influenza vaccination (22.1% vs 21.5%). Full-year private insurance coverage increased (50.1% vs 43.4%), and rates of lacking insurance decreased (partial-year uninsured, 18.4% vs 20.7%; and full-year uninsured, 22.2% vs 27.1%). Full-year public insurance rates remained stable (9.4% vs 8.8%; P = .53). Insurance status fully accounted for the pre- and post-ACA differences in routine examination and blood pressure screening and partially accounted for year differences for cholesterol screening and annual dental visits. Covariate adjustment did not affect year differences. (Lau et al., 10/27)

Hospital readmission after colorectal surgery is common, with reported 30-day readmission rates ranging from 10% to 14%. ... but it is unclear whether there is much difference in readmission among hospitals after appropriate risk adjustment. ... We studied 44 822 patients who underwent colorectal resection for cancer at 1401 US hospitals from January 1, 1997, through December 31, 2002. ... Looking at hospitals that performed at least 5 operations annually, we found marked variation in raw readmission rates, with a range of 0% to 41.2% (IQR, 9.5%-14.8%). However, after adjusting for patient characteristics, comorbidities, and operation types in a hierarchical model, no significant variability was found in readmission rates among hospitals (Lucas et al., 10/22)

Before the Affordable Care Act (ACA), some state regulatory approaches created powerful incentives for health insurers to sell through associations to individuals and small employers, largely because they were exempt from key state consumer protections and requirements .... Some experts suggested these regulatory differences allowed for insurers to segment the market by separating healthier individuals and small groups from the less healthy .... Though many believed that the newly level playing field created by the ACA would effectively eliminate the incentive to market and sell health insurance through associations, this paper finds that associations in Oregon offering health insurance are claiming single large-group health plan status under ERISA, thus sidestepping the requirements under the ACA for the small-group market. (Lucia, Ahn and Corlette, 10/28)

To increase support for physicians providing primary care for Medicaid beneficiaries, and to improve access to primary care as Medicaid coverage expands, the Affordable Care Act (ACA) increased Medicaid payment rates for many primary care services to Medicare fee levels in 2013 and 2014. ... Fifteen states indicated that they will continue the primary care fee increase in 2015, at least in part. The 100% federal funding for rate increase ends on December 31, 2014, so these states will continue the increase at their regular federal matching rate. For states that were paying primary care physicians close to 100% of Medicare rates even before the ACA (such as Alaska, whose rates were 124% of Medicare rates), extending the ACA increase does not impose significant new costs. However, most states noted a sizable increase in state funds required to continue the primary care increase. (Snyder, Paradise and Rudowitz, 10/28)

A key provision of the Affordable Care Act (ACA) is the requirement that private insurance plans cover recommended preventive services without any patient cost-sharing. ... However, costs do prevent some individuals from obtaining preventive services. ... While the number of individuals who have gained coverage for no-cost preventive services is large, public awareness of the preventive services requirement is relatively low. In March 2014, three and half years after the rule took effect, less than half the population (43%) reported they were aware that the ACA eliminated out-of-pocket expenses for preventive services. (10/28)

In this report, we analyze recent trends in the employer health insurance market and the anticipated effects of the Affordable Care Act on employers, with a particular focus on small firms with fewer than 50 workers. ... we find the following: Employers have a strong economic incentive to offer health insurance .... Before the Affordable Care Act, most of the nonelderly population had health coverage through an employer, but rates of employer-sponsored insurance (ESI) decreased nearly every year since 2000. The decline in ESI was even more drastic among small-firm workers .... While nearly all larger firms offered ESI in 2012—99.5 percent of employers with 1,000 or more employees and 94.1 percent of those with 100–999 employees—only 35 percent of small firms with fewer than 50 workers offered coverage to their employees. Small firms have lower offer rates than larger firms because of the additional costs and challenges they face. (Blavin et al., 10/23)

The purpose of [the Sunshine Act] is to increase the transparency in the health care market by requiring doctors, hospitals, pharmaceutical companies, and medical device manufacturers to disclose their financial relationships. ... Teaching hospitals and physicians together received $669,561,563 in general payments from 949 different medical manufacturers. Interestingly, close to 70 percent ($460,369,403) of this amount was paid to individual physicians and the rest was paid to teaching hospitals. More than half of the total general payments were made by only 20 companies led by Genentech .... Two hundred and ninety-four manufacturers awarded 23,225 research grants to teaching hospitals and physicians. The total value of these grants was $155,815,828. About 70 percent ($107,969,961) of these grants were awarded to teaching hospitals and the rest were awarded to physicians (Yaraghi, 10/23)

A simple trigger reminder to oncologists at key times during the course of care of a seriously ill cancer patient may prompt earlier discussions regarding advance care planning (ACP) for the end-of-life phase, according to preliminary research presented at the inaugural Palliative Care in Oncology Symposium, held in Boston, Massachusetts, October 24-25. (Hand, 10/28)

People who search and compare the prices of common healthcare services tend to spend a bit less than people who don’t, according to a new study. The overall amount of money people and their employers spent on office visits, laboratory services and imaging tests was between $1 and $125 less than normal when they looked up the prices ahead of time, researchers found. (Seaman, 10/23)

Putting in place noneconomic damage caps appears to reduce payouts more than not having caps, but when caps increased to $500,000, the effect on payments was neutralized, new research shows. Specifically, any cap trimmed average payments by 15% ($42,980) compared with no cap, and a $250,000 cap reduced average payments by 20% ($59,331), researchers report in an article published online October 22 in Health Affairs. However, when caps reached $500,000, they no longer had a significant effect, compared with no cap. (Frellick, 10/24)

A narrow network plan isn’t the only way to get lower premiums yet still have access to highly ranked hospitals, according to a study released Thursday. Research from the Urban Institute found that the relationship between network size and cost does not always hold. In the six cities examined, some broad networks have low premiums and some narrow networks have high premiums — an inverse relationship that runs counter to most people’s assumptions in picking a health plan. (Villacorta, 10/30)

The battle to contain Ebola has not been pretty. The developed world let the disease fester in West Africa until it became a global threat, and when — inevitably — the first case arrived in the United States, it was greeted with a disturbing mix of incompetence and panic. ... The whole train of events is embarrassing. But there is another way to look at it as well. Pretty much everything that could go wrong did go wrong; the virus was given every chance to spread. Yet it has not. (10/30)

We've learned from the Ebola outbreak of 2014 that to stop pandemics, we must regulate the transport of host and virus alike. Public transmission and cellular invasion depend on the unimpeded traffic of people across borders and viruses across cell membranes. Barring the traffic of people across the Atlantic from Liberia would certainly have prevented the first three cases of Ebola in the United States. Blocking the traffic of virus in human cells would have prevented thousands of cases worldwide. (Gerald Weissmann, 10/30)

Public fury is building as Maine authorities try to maintain quarantine for an asymptomatic nurse returning from caring for Ebola patients in West Africa. While the nurse, Kaci Hickox, insists she poses no risk to others, since even Ebola-infected persons are not contagious prior to developing symptoms — a position that is supported by the CDC, the NIH, the WHO, and many of the world's leading Ebola experts —others believe that she is expressing willful disregard for the health of the general public. (Elizabeth Oelsner, 10/30)

In a rare fit of realism on Tuesday, Senator Mitch McConnell, the Republican leader, admitted he would be unable to repeal the Affordable Care Act if Republicans win the Senate next week and he becomes majority leader. That would take 60 votes, he said, and no one thinks Republicans will get that many. But conservatives reacted with anger to what they considered a demonstration of weakness, and on Thursday Mr. McConnell was forced to backtrack. Yes, his spokesman told The Washington Examiner, Mr. McConnell remains “committed to the full repeal of Obamacare” with only a simple majority, through a parliamentary procedure known as reconciliation. (10/30)

For the activist far right — already brimming with fear, anxiety and ire to spare — GOP candidates promise to obliterate Obama’s most significant achievement, the Affordable Care Act. This pledge has always been shamefully dishonest. Even if Republicans capture the Senate and manage to pass one of the umpteen House bills repealing all or part of Obamacare, the president will simply veto the measure. ... Republicans talk about “repeal and replace” but feel no obligation to elaborate on the “replace” part. If they were being honest, they would admit that the need to keep the consumer-friendly parts of Obamacare. (Eugene Robinson, 10/30)

The GOP is amending its pro-life policy constructs to ensure that no woman who doesn’t want to be pregnant ends up so–adding practical and empathetic policies likely to reframe women’s views of Republicans in ways that could be consequential next week and in 2016. (Juleanna Glover, 10/31)

California last considered right-to-die legislation in 2007. But now, the case of Brittany Maynard, a Californian who moved to Oregon so that she could painlessly end her life, may help persuade the Legislature to try again. (10/30)

Six state propositions are on the ballot and none are sexy. All are snoozers. But each is significant. Some, in fact, are game-changers. Why else would the medical profession and insurance companies be spending well over $100 million to beat back Propositions 45 and 46? (George Skelton, 10/30)

The federal government is pushing two initiatives that will radically change how mental health services are delivered. Both are long overdue. So why, as the father of an adult son with a mental illness, am I skeptical? ... If the Justice Department is going to force states under Olmstead to empty group homes, the federal government must guarantee that suitable housing is available. We should not repeat the debacle of unplanned deinstitutionalization. If the government pushes a shift to private insurance, it must define acceptable community care. (Pete Earley, 10/30)

What’s the most common chronic childhood disease in the United States? It’s worth remembering on Halloween that the answer is tooth decay, which is five times more common than asthma and 20 times more common than diabetes. Tooth decay affects children from all backgrounds, but it’s concentrated among low-income and rural populations, who have the most difficulty accessing and affording dental care. (David Bornstein, 10/30)

Despite rapid growth, the success of the ACO movement is far from certain. The performance of ACOs to date has been promising but not overwhelming. Although some ACOs have gained a substantial return on their investment in improving the health of their patients, many have not. Furthermore, unless and until a high percentage of their patients — including privately insured patients — are covered by ACO contracts, hospitals and physicians will be in the difficult position of dealing with diametrically opposed sets of payment incentives. ... The ACO movement is unlikely to succeed unless health insurance plans dramatically increase their number of ACO contracts and unless CMS modifies specifications for its ACO programs — a course that the agency is considering. (Lawrence P. Casalino, 10/30)

A growing demand for transparency has brought innovation in many areas of health care. In a video roundtable, three expert panels discuss the benefits and the challenges of these innovations, examining transparency in provider-driven quality data, in pricing, and in medical records. (10/30)