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The Obama administration has discovered a number of defects in the online marketplace that will offer health insurance to millions of small-business employees, but federal officials said the problems could probably be fixed before the website goes live on Nov. 15. The website, for businesses with 50 or fewer employees, was created by the Affordable Care Act and was supposed to open Oct. 1, 2013, but officials could not meet that deadline. Since then, they have been trying to build the site. (Pear, 11/1)

When the Affordable Care Act marketplace opens on Nov. 15, consumers can expect healthcare.gov to have robust technology, amped-up functions, and a shorter application form for individual plans. What they won't see - and likely won't know about - are the ongoing communication problems that many on the insurance industry say continue to plague the "back-end" transfer of consumer files between the website and insurance companies. (Calandra, 11/2)

More than half the people who enrolled in Obamacare last year don’t plan to sign up again—and that’s bad news for the President’s controversial health care law. A new Bankrate survey reveals that 53 percent of current Obamacare enrollees who signed up through the exchanges said they would not be enrolling for 2015. Their reason --“much higher prices for health plans.” (Ehley, 11/3)

When HealthCare.gov debuted a little more than a year ago, many insurance brokers accused the federal government of putting them on the sidelines and trying to cast them into professional obscurity. But many brokers are now celebrating what they call a dramatic attitude shift by President Barack Obama’s administration as the second enrollment period under his signature health law approaches. Brokers’ descriptions of the administration’s attitude toward their profession during the first round of health plan enrollment ranged from confident to hostile. And although problems persist, many now say federal health officials have given them a much-needed seat at the table. (Shapiro, 10/31)

As the start of the second open enrollment period for health insurance under the federal Affordable Care Act nears, Oregon officials say this time the state will avoid an enrollment disaster. When Oregon launched its insurance exchange portal last October, it turned into a technology fiasco. Cover Oregon was the only exchange in the nation that never fully launched and didn't let the public enroll in coverage in one sitting. Instead, residents had to use a time-consuming hybrid paper-online application process to get health insurance. Six top officials connected to the Cover Oregon debacle resigned. (Wozniacka, 11/2)

Health insurers increasingly are building and staffing brick-and-mortar retail centers to expand their membership base and enhance their brand image with the public. Blue Cross and Blue Shield of Minnesota is opening a mall store in Edina on Nov. 8, a week before the start of the 2015 Obamacare open-enrollment period. Eight employees will staff the store. (Herman, 11/1)

The Supreme Court is expected to announce this week whether or not it will hear the latest challenge to the Affordable Care Act—the King versus Burwell case. That case asks whether the Affordable Care Act should be taken literally. (Marshall-Genzer, 11/3)

Right now, the U.S. Supreme Court is deciding whether to hear a case that could have devastating implications for Obamacare and hundreds of thousands of people currently receiving health insurance through its exchanges. The case, King v. Burwell, is one of several challenges based on language in the Affordable Care Act that authorizes the government to offer subsidies to people who enroll in policies sold on the health exchanges. (Ehley, 10/31)

The survey found plentiful evidence that Election Day will draw an electorate that thinks the nation is on the wrong track and dislikes the direction in which President Barack Obama has led the country. With eight or more Senate races considered close, even a slight advantage for Republicans could produce enough victories to give the party the six seats it needs to gain control of the chamber. (O'Connor, 11/2)

ObamaCare has fizzled as a midterm election issue, with views on the law hardening into a partisan split that leaves little opportunity to win over new voters. While Democrats predicted that the public would come to love ObamaCare, the law’s unpopularity remains high as it enters its second enrollment year. And while GOP candidates have attacked the law in their campaigns, it has not been the silver bullet that many expected when HealthCare.gov was melting down last year. The result could be a wash for both sides (Viebeck and Ferris, 11/1)

In interviews, GOP senators talked at times of an ambitious conservative push for fewer regulations, lower taxes and other long-held priorities. But they also outlined more pragmatic, modest agendas that might avoid Obama's veto .... There was virtually no talk of balancing the budget, repealing Obama's health care law or achieving similar GOP campaign pledges that prove politically impossible in Washington.... Sen. Lindsey Graham, R-S.C., says leaders of both parties must be willing to defy key supporters, and even risk their political careers, to end government gridlock. With his re-election virtually assured, Graham has told business leaders he wants Congress to improve roads and bridges and to shore up entitlement programs such as Social Security and Medicare, among other things. That will require ending some tax breaks and finding new sources of revenue, which is anathema to many Republicans, he said. (Babington, 11/2)

A GOP Congress would almost certainly pick a quick fight with the White House over Obamacare, immigration and what Republicans see as the administration's anti-coal policies. Problem is, even if Republicans take the Senate, their majority would likely fall short of the 60 votes needed to break a Democratic filibuster, or the 67 votes needed to overcome a presidential veto. ... Party officials, including Kentucky's Sen. Mitch McConnell, who would become Senate majority leader, are already trying to temper expectations. Last week McConnell warned that repealing Obamacare in its entirety may be unrealistic. "Remember who's in the White House for two more years," he cautioned. But tea party activists immediately forced him to backtrack, and he vowed to do his best for full repeal, perhaps by using the upcoming budget process. ... Critics note that despite GOP demands to repeal the Affordable Care Act, they have yet to offer a viable alternative. (Memoli and Mascaro, 10/31)

Four days before Election Day, conservatives are attacking Mitch McConnell, potentially the next Senate majority leader and in a tight race himself, as insufficiently committed to repealing Obamacare. (Everett and Palmer, 10/31)

Republican attacks on the health care law dominated the early months of the campaign, but now have largely receded from view. The focus instead has been more on tethering Democratic candidates to Mr. Obama with a broad-brush condemnation of his policies. And even though some Republican candidates still vow to repeal the law, almost none have offered an alternative. Mr. Gillespie and Mike McFadden, the Republican challenger to Senator Al Franken in Minnesota, stand as exceptions, to little effect. Like Mr. Gillespie in his race against Senator Mark Warner, Mr. McFadden holds little chance of defeating the incumbent on Tuesday. (Weisman, 10/31)

Rate filings indicate some of the 85,000 people who bought private health insurance through Kentucky's exchange could have to pay more for those plans in 2015. The exchange, established under President Barack Obama's federal health law, has been a key piece of Kentucky's heated campaign for the U.S. Senate. Republican Sen. Mitch McConnell says the law must be repealed and blames it for rising health care costs. Democrat Alison Lundergan Grimes says she would fix it, not wanting to take away people's coverage. However, she's refused to say how she would have voted for the law if she were in office. (Beam, 10/31)

There’s an element of nostalgia in campaign ads targeted at seniors. Both parties are talking about Medicare like it’s 2012. The ads are new, but the arguments are old: Republicans accuse Democratic incumbents of cutting $716 billion from Medicare as part of the health reform law in 2010. Democrats say the GOP lawmakers have been trying to “end Medicare as we know it” since 2011 by turning it into a voucher program as part of Rep Paul Ryan’s House budget plan. Neither attack is strictly true, but the vintage 2012 attacks just keep coming. (Wheaton, 11/2)

Democratic Rep. Ami Bera of Elk Grove, in another television ad, depicts Republican challenger Doug Ose as opposing access to birth control and being against abortion rights, showing the former congressman backpedaling in black-and-white footage. (Cadelago, 11/2)

U.S. hospitals are grappling with whether to withhold aggressive treatments from Ebola patients to avoid further exposing doctors and nurses to the virus. Some facilities have decided they will forgo cardiopulmonary resuscitation or may opt not to pursue invasive surgical procedures on deteriorating Ebola patients. Such procedures can expose health workers to bodily fluids that transmit the disease, and hospitals say in many cases have little chance of saving a patient. The decisions are sparking a thorny debate at hospitals across the country and calls for national guidelines. (Armour, 10/31)

Top medical experts studying the spread of Ebola say the public should expect more cases to emerge in the United States by year's end as infected people arrive here from West Africa, including American doctors and nurses returning from the hot zone and people fleeing from the deadly disease. But how many cases? ... This week, several top infectious disease experts ran simulations for The Associated Press that predicted as few as one or two additional infections by the end of 2014 to a worst-case scenario of 130. (Mendoza, 11/1)

When public health leaders and government officials make the case against isolating more people returning from the Ebola hot zones in West Africa, or against imposing more travel restrictions from that region, time and again they cite science and experts. It isn’t working very well. ... Even defenders of the Centers for Disease Control and Prevention say the agency has hurt the case for trusting scientists, by making overly broad assurances early on, or changing guidelines on handling the disease, indicating that the earlier ones were not strict enough. This comes on top of a broader mistrust of elites. (Perez-Pena, 10/31)

Sen. Rand Paul says the libertarian in him is "horrified" at the forced quarantine of a nurse who returned to the United States after treating Ebola patients in Africa. "The libertarian in me is horrified at indefinitely detaining or detaining anyone without a trial," the Kentucky Republican said Sunday on CNN's "State of the Union." ... "We have to be very careful of people’s civil liberties, but I’m also not saying government doesn’t have a role in trying to prevent contagion," Paul said, adding he believes the federal government should have instituted some travel restrictions. (Gold, 11/2)

Gov. Chris Christie provided a more detailed explanation of his quarantine policy, which has been criticized by public-health experts but appears to be broadly popular with the general public. New Jersey officials on Friday saiid travelers coming through Newark Liberty International Airport would be categorized into three tiers: high risk, some risk and low risk. Travelers from three Ebola-stricken countries who have fevers will be transported to a hospital for monitoring and tests, as state officials did with nurse Kaci Hickox. Travelers who have been to Sierra Leone, Guinea and Liberia but haven't been in contact with Ebola patients and don't show symptoms wouldn’t be subject to quarantine, but would face 21-day monitoring by local health officials. (Dawsey, 10/31)

But Rubinson, who is director of the critical care resuscitation unit at the University of Maryland’s Shock Trauma Center, had just spent three weeks working for the World Health Organization at the Kenema Government Hospital, and he knew that a fever was usually the first signal that a person harboring the deadly virus has become infectious. Now, he thought, the moonsuited doctors and nurses looking after him seemed surprised by how sick he was. The needle had provided the virus with an ideal route to invade his body. And if that needle hadn’t infected him, Rubinson found himself wondering, could he have had an earlier exposure that he hadn’t even known about? (Stead Sellers, 11/3)

Democratic victories in gubernatorial races in Florida and Georgia would help hospital chains as Medicaid is expanded, according to Bloomberg Intelligence. If Democrats take executive offices from Republicans in those toss-up states as well as in Kansas and Alaska, they may enlarge the program, which would increase hospital admissions and reduce free care, said analysts Gerard Campagna and Jason McGorman. HCA Holdings Inc., the largest U.S. hospital operator, and Tenet Healthcare Corp. are among companies that may benefit the most. (Braun, 10/31)

Voters will pick who they’re sending to Congress and to their statehouses on Tuesday, but many will also get to weigh in on issues like abortion, gun control, marijuana and the minimum wage. In more than 40 states, voters’ ballots will include statewide measures on important issues. (O'Connor, 11/1)

Radical elements in the anti-abortion movement keep coming up short in their effort to define an embryo as a “person” with constitutional rights. It’s failed on the ballot in conservative strongholds like Mississippi and in Republican-dominated legislatures around the country. (Haberkorn, 11/3)

On Tuesday, voters here will decide the fate of a proposed amendment to the state constitution that has provoked excitement and fear among the combatants in the country's never-ending abortion wars. The ballot initiative known as Measure 1 — which would enshrine "the inalienable right to life of every human being at any stage of development" — has attracted millions of dollars in contributions, as well as the involvement of one of the nation's best-known conservative strategists. From the start, Measure 1 was aimed squarely at ending abortion. "I'm hoping it will be a direct challenge to Roe v. Wade," the amendment's chief sponsor in the North Dakota legislature declared last year. Leaders of the burgeoning personhood movement — who believe that establishing legal rights for the unborn is the key to overturning that 1973 decision — have made Measure 1's passage a national priority. (Martin, 10/31)

Amendment 67 would allow prosecutors to bring charges against someone who commits a crime against a fetus. Proponents are going out of their way to insist that the measure has nothing to do with abortion, and Alderman, vice president of public affairs for Planned Parenthood of the Rocky Mountains, is worried that voters won't recognize its similarity to other "personhood" initiatives they've rejected in the past. (Zezima, 11/2)

Voters strongly back a ballot measure to soften penalties for certain drug and theft crimes, but two healthcare initiatives face much stiffer opposition, a new USC Dornsife/Los Angeles Times poll shows. The healthcare-related measures, Propositions 45 and 46, have faced an onslaught of negative advertising from well-financed opposition campaigns, damaging their prospects at the ballot box Tuesday. (Mason, 11/2)

[State Rep. Andy] Tobin, who's in a tight race with [Rep. Ann] Kirkpatrick to represent the northern Arizona district, is repeating a common criticism levied at Democrats who supported the health care law proposed by President Barack Obama. Democrats in Congress, including Kirkpatrick, narrowly passed the law commonly referred to as "Obamacare" in March 2010. The law included changes in funding for parts of Medicare. (Shumway, 10/31)

There are few health care providers slated to be in this year’s crop of state legislators. In one district, two providers are running against each other. (Hoban, 10/31)

Voters in McPherson County will decide Tuesday whether to raise their sales tax by a half-cent, with proceeds going to three hospitals in the county. If the ballot measure passes, 75 percent of the tax revenue would go to McPherson Hospital, and the remaining 25 percent would be split evenly between Lindsborg Hospital and Moundridge's Mercy Hospital. The increase would take effect in April and expire after 10 years. The money generated could be used for capital improvements or operating budgets. McPherson Hospital would get about $1.65 million per year if the measure passes. The facility has one wing built in 1921 and another built in 1971. It is in the midst of a multi-phase renovation project. (Marso, 10/31)

The Patrick administration early Friday evening announced a five-year health care deal with the federal government worth $41.4 billion, which will succeed a three-year $26.75 billion waiver agreement that expired June 30. (Norton, 11/1)

California State Auditor Elaine M. Howle found that the complaints had been open for a year on average – a time frame she called unreasonable and “very concerning.” Nearly 370 open complaints arose from situations that put patients in “immediate jeopardy,” meaning they caused or were likely to cause serious injury or death, according to the review, which looked at cases open as of April 2014. In the Los Angeles County district, 65 immediate jeopardy complaints were open an average of 514 days. (Gorman, 10/31)

Holly Dawson believes her job is a calling. She is one of about 2 million home care workers in the country. The jobs come with long hours and low pay. Each workday, Dawson drives through the Cleveland suburbs to help people take their medicines, bathe and do the dishes. She also takes time to lend a sympathetic ear. George Grellinger, a former client of hers, has dementia. He recently fell down the back steps of his home. Dawson remains friends and regularly stops in to check on him. To remain living at home, Grellinger had to switch to an aide who is covered by his veterans’ benefits. (Tribble, 11/3)

The operator of some Oklahoma dental clinics has agreed to pay more than $5 million to settle allegations that it submitted false Medicaid claims. Federal and state prosecutors said Friday they had alleged that Ocean Dental, which operates clinics throughout the state, submitted false Medicaid claims for work that was either never performed or billed at higher rates than allowed. Officials alleged former Ocean Dental employee Dr. Robin Lockwood submitted claims for dental restorations between 2005 and 2010 that were either billed for more surfaces than actually performed or not performed at all. (11/1)

Arizona doesn't have enough primary care physicians to meet the need in many areas, particularly in rural and underserved parts of the state. According to a study by the Henry J. Kaiser Family Foundation that also considered dentists and mental-health professionals, only 53 percent of Arizona's primary health care needs are being met. To combat the problem, [University of Arizona] medical students held a Primary Care Week recently, offering speakers and events to promote the specialty of primary health care and address reservations students may have about entering the field. (Armstrong, 11/2)

A year after leaders in northern Kentucky formed a task force to battle the growing heroin problem, they are setting their sights on the next phase. The Northern Kentucky Heroin Impact Response Task Force gathered in Covington earlier this week to reflect on the year's successes. But the business leaders, law enforcement officers and health care workers who make up the group know they have a long way to go. The group's efforts have inspired 17 free overdose-prevention clinics, providing 129 free kits containing a life-saving drug, naloxone, The Kentucky Enquirer reported. The group has recorded five rescues, including a 15-year-old boy who overdosed on heroin on his birthday. (11/2)

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)