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Republicans' strong showing in this week’s mid-term elections opens the door to more calls to repeal President Obama’s signature law, the Affordable Care Act. And while that is all but impossible given the balance of power in the U.S. Senate, victories in Washington and at the state level could usher in other healthcare changes. (Gorenstein, 11/6)

In a nod to voter opposition to the Affordable Care Act, Mr. Obama said he is open to making “responsible” changes to his signature legislative achievement. He declined to specify what targeted changes he is willing to accept, saying he preferred to discuss ideas in private with Mr. McConnell and other lawmakers on Friday. Mr. McConnell, who is under pressure from Senate conservatives to fight for a full repeal of the health law, said he’d prefer that course, but acknowledged that such a move might be impossible while Mr. Obama is in office and able to veto any such effort. Mr. McConnell said lawmakers would move to repeal a tax on medical devices and make other targeted changes to the health law. (McCain Nelson and Lee, 11/5)

Sen. Mitch McConnell (R-Ky.) is planning to make ObamaCare a priority in his first weeks as leader of the Senate, vowing a sustained effort to dismantle the law piece-by-piece. Instead of a full repeal, McConnell said the GOP will tackle unpopular aspects of the law such as the individual mandate, the medical device tax and the 30-hour workweek requiring employers to provide insurance. (Ferris, 11/5)

The Republican Party’s drive to repeal the Affordable Care Act will continue to stall despite the Republican takeover of the Senate, prompting party leaders to instead concentrate on peeling back unpopular bits of the law. Republican lawmakers and strategists signaled Wednesday that a simple message of repealing President Barack Obama ’s 2010 health law won’t be enough to appeal to voters. Polls show a majority of Americans oppose the law, but still don’t want it repealed and prefer lawmakers fix it instead. (Radnofsky, Armour and Peterson, 11/5)

Tuesday’s Republican victories in the U.S. Senate are inspiring strong optimism among medical device companies in Minnesota and nationwide for a repeal of the 2.3 percent tax on their products. But repealing the unpopular medical-device tax will not be easy, even with Republican majorities in the House and Senate. Any stand-alone device-tax bill would face a likely veto threat by President Barack Obama, which means repeal is more likely to be a part of a broader bill reforming business taxes or the Affordable Care Act. (Carlson, 11/5)

On immigration, healthcare and global warming, the initial public statements from the two sides, while polite, indicated little flexibility and presaged intense new battles that could begin within weeks. ... McConnell also said the Republican Senate would move to undo at least parts of the 2010 healthcare law, although he also sought to quiet expectations of conservatives that the GOP could achieve total repeal. ... Republicans will, at minimum, try to repeal the law's new tax on certain medical devices, he said, and will try to strike down the requirement that individuals buy health insurance or pay a fine, which "people hate." Obama said he would veto any effort to repeal the insurance requirement, calling it "a line I can't cross" because it would "undermine the structure of the law." (Parsons and Lauter, 11/5)

Within hours of solidifying their control of Congress, Senate Minority Leader Mitch McConnell and House Speaker John A. Boehner were quietly laying plans for a series of quick votes in January aimed at erasing their obstructionist image ahead of the 2016 elections. ... Finally: Aim for the big score. Not repealing President Obama’s Affordable Care Act, though the conservative campaign to undermine the law will proceed in the background. Instead, Republicans dangled the prospect of fast-track trade agreements and sweeping tax reform as potential areas of agreement during Obama’s waning days in office. (Montgomery and Costa, 11/5)

Sen. Jeff Sessions (R., Ala.) is expected to take the gavel at the Senate Budget Committee. GOP control of the budget process in the Senate and House, which remains under Republican control, will give the party greater leverage in budget negotiations with President Barack Obama, particularly over the nation’s borrowing authority and government funding levels. Mr. Sessions, a conservative, could use the position to lead GOP efforts to use the budget process to target the Affordable Care Act and programs such as Social Security or Medicare. (Crittenden, 11/5)

President Barack Obama and the likely new leader of the Senate, Mitch McConnell, pledged Wednesday to work together to govern the nation in a bipartisan way a day after Republicans secured control of both chambers of Congress for the first time since Democrats won the White House in 2008. ... McConnell said Republicans will attempt to roll back the federal health care law known as Obamacare. But Obama said he would draw a line at repeal or significant changes. (Kumar and Cockerham, 11/5)

Obama also made clear that he would resist any efforts by his opponents to undercut his landmark policies on health care and the environment. And McConnell acknowledged that Obama remains “a player” even as Republicans pursue their own initiatives. “The veto pen is a pretty powerful tool,” McConnell said. But he urged Obama to follow the leads of Ronald Reagan and Bill Clinton, “who are good examples of accepting the government you have rather than fantasizing about the government you think you have.” (Nakamura and Eilperin, 11/5)

President Barack Obama reiterated today that he would block Republican efforts to repeal his signature health care law. ... Obama added that while he was open to some changes, he would not sign any “that undermine the structure of the law.” (Wheaton, 11/5)

Obama specifically declared he would not consider doing away with the law's individual mandate, which requires most Americans to obtain health care coverage or face tax penalties. Polls show this to be the most unpopular part of the Affordable Care Act, and it was the subject of a constitutional challenge that went all the way to the Supreme Court, which upheld the policy in 2012. (Young, 11/5)

Obama also mentioned certain amendments to his signature healthcare law that he’d be willing to accept, possible peace offerings in the hours after Republicans swept key congressional races and set themselves up to take over both chambers of Congress early next year. He said he wouldn't consider major changes like a removal of the provision requiring every person to have health insurance. But he said he would be "open and receptive" to ideas for making "responsible changes." (Parsons, 11/5)

Mitch McConnell already has an Obamacare problem. The presumptive incoming Senate majority leader is under rapidly increasing pressure from conservatives to pursue an aggressive path to repealing the landmark health care law, using measures that require only a simply majority. (Haberkorn, 11/5)

Fresh from his own re-election victory and his party’s powerful showing nationwide, Senator Mitch McConnell on Wednesday pledged to break the stalemate in Washington as newly empowered congressional Republicans moved quickly to demonstrate that they can get things done. ... They say they will focus on balancing the budget, restoring an orderly process for spending bills, revising if not repealing the health care law and enacting a major overhaul of the tax code — ambitious goals, given years of stalemate and discord. Before taking up the issue of immigration, Republicans are likely to see what unilateral action President Obama undertakes, and how the country reacts to it. (Hulse, 11/5)

With the states acting as laboratories for legislation that cannot advance in Washington, policy changes are likely on a variety of issues. “What they’re going to do now is move forward a Republican set of policies — lower taxes and a focus on job creation,” Mr. Storey said. “It will be much harder to see expansions of Medicaid. And there may be fewer restrictions for gun owners.” (Nagourney and Davey, 11/5)

Tuesday’s re-election of Republican governors in closely contested races in Florida, Georgia, Wisconsin, Maine and Kansas dims the chances of Medicaid expansion in those states. Advocates hoping for Democratic victories in those states were disappointed by the outcomes, but Alaska, which also has a Republican incumbent, remains in play as an independent challenger holds a narrow lead going into a count of absentee ballots. (Galewitz, 11/5)

The 2014 gubernatorial elections were supposed to sweep in Democrats who would lead the charge for Medicaid expansion in the states. At least that’s how the advocates of expansion saw it. Instead, the Republican incumbents survived, deflating hopes for expansion to cover potentially several million low-income Americans. (Pradhan and Wheaton, 11/5)

The Medicaid expansion won’t gain momentum from the outcome of Tuesday’s midterm elections. None of the gubernatorial candidates in key states who would have shifted policy to support a broadening of Medicaid eligibility won. The state watched most closely was Maine, where GOP Gov. Paul LePage was the projected winner. LePage had with 48 percent of the vote against Democratic Rep. Michael Michaud, who got 44 percent by Wednesday afternoon, with 85 percent of the vote in. Eliot Cutler had complicated the race by running as an independent. The Maine legislature has passed a Medicaid expansion five times, but LePage vetoed each of those bills. (Adams, 11/5)

The Republican surge in Tuesday's U.S. elections carried Arkansas along with it, threatening to sweep away a bipartisan health insurance plan in the state that is also being studied by other states as an alternative to Obamacare. Republicans had a narrow majority in the state's House of Representatives and several in the party campaigned hard to overturn what is known as the "Private Option," a plan cobbled together by centrists in both parties that has enrolled nearly a quarter-million Arkansans previously without medical coverage. (Barnes, 11/5)

State capitols across the country will be more Republican than at any point since the Roaring ‘20s when victorious legislators and governors take office next year. That could result in lower taxes and perhaps fewer dollars flowing to social safety net programs. ... Over the past several years, Republicans already have used those majorities to cut taxes, restrict abortions, expand gun rights and limit the powers of public employee unions. ... The Republican victory in Arkansas was the largest since Reconstruction, with GOP candidates sweeping the statewide offices and building upon its legislative majorities. Republicans will have to decide whether to continue a program enacted under Democratic Gov. Mike Beebe that expanded health coverage to more than 200,000 people by using Medicaid money to buy private insurance. (11/5)

But despite plenty of public talk of more aggressive action — like a rollback of the Affordable Care Act or the Dodd-Frank rules passed after the financial crisis — lobbyists, experts on Wall Street and political veterans say the actual legislative agenda will be much more limited. ... While many of the more conservative Republicans elected on Tuesday made their opposition to the Affordable Care Act a touchstone of their campaigns, there is much less appetite on the part of business leaders for wholesale changes to the health care law. For one thing, many of the insurance exchanges are finally working well, and businesses have adapted to the new landscape. Even more important, added demand from the newly insured is likely to increase profits in sectors like hospitals, pharmaceuticals and medical devices. (Schwartz and Krauss, 11/5)

In interviews in a half-dozen states where a Republican senator replaced a Democrat, voters said they wanted a rollback of the Affordable Care Act, approval of the Keystone XL pipeline and fixes for immigration problems, among other concerns. But beyond any specific policy, Republican voters’ No. 1 wish was for cooperation between the warring tribes of Washington, where gridlock drove much of the voter backlash at the polls this year.(Gabriel, 11/5)

Latinos nationwide remain firmly in the Democratic camp, but a good chunk of them say the party they generally support doesn’t really care about them, according to a new poll. ... In Florida, Latinos ranked the economy and jobs tops; 46 percent ranked it as one of the most important issues, while 39 percent said immigration restructuring was. Health care/Medicaid was third, at 19 percent, and education was right behind, at 18 percent. Respondents were able to select more than one item. (Adams, 11/5)

Health insurers are unleashing a blizzard of ads, letters, live events and other efforts to reach consumers, as the industry ramps up for the reopening of the health law’s marketplaces on Nov. 15. The companies’ outreach task is more complicated than it was last fall, when the exchanges made their debut. Now, insurers are trying to hold on to an estimated 7.3 million existing enrollees, as well as dig out millions of new customers who declined to sign up before. At the same time, they are pushing for a share of an increasingly crowded market, as more competitors have emerged in a number of states. (Wilde Mathews, 11/5)

Small-business owners test-driving the federal government’s new online health-insurance exchange report a mixed experience with the site ahead of its planned opening Nov. 15. The glitches range from business owners being unable to create accounts—a significant potential obstacle—to the lack of easy-to-spot instructions on the site. (Janofsky and Radnofsky, 11/5)

As many as 30,000 customers of the state’s health insurance exchange could lose their coverage or see a drop in the subsidies used to discount their premiums next month because they did not submit information needed to verify their eligibility, acting exchange CEO Jim Wadleigh said. (Levin Becker, 11/6)

Technical flaws persist within the MNsure exchange more than a year after its debut, and state officials said Wednesday that fixes may not be complete before open enrollment begins Nov. 15. (Snowbeck, 11/5)

IT workers on Minnesota's health insurance exchange still are dealing with serious bugs 10 days before the next open enrollment period begins. The MNsure website has been hobbled by dozens of technical problems causing frustration for many users. (Farhang, 11/5)

WellCare Health Plans, a private Medicare and Medicaid managed-care company, beat analysts' adjusted profit estimates in the third quarter. But the insurer revealed it will continue to face challenges next year. Net income declined 70% to $19.3 million, while revenue in the quarter soared 36% to $3.4 billion. New members fueled the top-line growth, as WellCare's enrollment grew 43% to more than 4 million people. Much of that came on the Medicaid side, which represents almost two-thirds of WellCare's business. (Herman, 11/5)

U.S. health insurer WellCare Health Plans Inc (WCG.N) reported a better-than-expected adjusted profit for the third quarter, driven by a 43 percent increase in memberships under Obamacare. Members under the Medicaid health plans increased 28 percent to 2.3 million in the quarter ended Sept. 30, driven by additions in Florida, Kentucky and Georgia under the federal health insurance program for lower-income people, Wellcare said. (Penumudi, 11/5)

Six former WellCare officials are suing the Tampa-based company over health care fraud allegations related to its services in Georgia and other states. The six claim that WellCare improperly kept money that should have been paid to hospitals or been repaid to Medicare or state Medicaid programs in Florida, Georgia, Illinois, New York, Ohio, Kentucky and Missouri. (Miller, 11/5)

President Barack Obama is telling the Veterans Affairs Department it needs to keep working to improve services, health care and accountability for veterans. Obama met on Wednesday with VA Secretary Robert McDonald and his deputy, Sloan Gibson. The White House says Obama urged them to continue strengthening VA management, cutting the backlog of disability claims, speeding up access to health care and ending homelessness for veterans. (11/5)

A proposed rule from the Veterans Affairs Department regarding how providers can take part in a new effort to care for veterans is garnering criticism from the American Hospital Association. President Barack Obama signed a bill this summer that provides the VA $10 billion to contract out care for vets who can't get an appointment in 30 days at VA hospitals or clinics. Also covered are veterans who live more than 40 miles from a VA facility. (Dickson, 11/5)

Some Iowa veterans will soon receive cards they can use to obtain health care at private clinics and hospitals instead of at Veterans Affairs facilities. The "Veterans Choice" cards will be offered to veterans who live more than 40 miles from a VA facility or who have had to wait more than 30 days for an appointment. (Leys, 11/5)

The Affordable Care Act wasn’t directly on the ballot in any state, but voters did decide a host of health-related issues in Tuesday’s elections. And there was no clear theme to what won and lost. For example, voters in two states – North Dakota and Colorado – rejected so-called “personhood” amendments that would have recognized rights for unborn fetuses. (Rovner, 11/5)

Aleady a financial bonanza for health insurers, Obamacare paid off for the industry again at the ballot box as Californians soundly rejected a bid to rein in health insurance rates. Even so, the companies still face heat over their ever-increasing health insurance premiums, and pressure will build on California's Obamacare exchange to hold the line on rates. (Terhune and Lifsher, 11/5)

What's next after Proposition 45? Will the subject surface again in the Legislature? California voters yesterday rejected the proposal to give the state insurance commissioner power to deny health insurance rate increases deemed excessive. (Gorn, 11/5)

A month ago, North Dakota's Measure 1 looked like a winner. The proposal sought to enshrine "the inalienable right to life of every human being at any stage of development" in the state constitution. It was up 17 points in the polls. But on November 4, Measure 1 was crushed, and with it the hopes of both the state's Catholic hierarchy and the national band of activists who make up what has become known as the personhood movement. A proposed Colorado amendment with similar aims also went down to defeat. (Martin, 11/5)

Voters in Berkeley, Calif., have passed the nation’s first soda tax with a resounding 75 percent of the vote. The measure aims to reduce the effects of sugar consumption on health, especially increased rates of obesity and diabetes. Across the bay in San Francisco, however, a similar proposal failed to get the two-thirds supermajority it needed. (Aliferis, 11/5)

Like minimum wage, paid sick leave was among the few midterm bright spots for Democrats, with four ballot measures passing in Massachusetts, Trenton, N.J., Montclair, N.J., and Oakland, Calif. (Levine, 11/5)

The United States is the only developed country without paid sick leave policies for all workers and their families, which increases burdens on the millions balancing work with caregiving for an older family member, according to a new review. In 2009, unpaid caregiving services provided by family members at home added up to an estimated economic value of $450 million, Mei-Lan Chen of the School of Nursing at the University of North Carolina, Greensboro writes in The Gerontologist. There were some 67 million unpaid caregivers in the U.S., and two thirds of adults with disabilities got all their care and assistance from family members. (Doyle, 11/5)

Hawaii could begin cutting some state-funded medical services for Micronesian migrants now that the U.S. Supreme Court has upheld a ruling allowing the state to reduce health care coverage of noncitizens. The state could begin cutting services by the end of the week to nonpregnant, adult noncitizens. The state Department of Health had prepared emergency rules in anticipation of Monday's ruling. (11/5)

Justin Puckett, an osteopathic physician from Kirksville, Mo., will have a major decision to make at the start of 2015 — whether his family medicine practice can continue to treat Medicaid patients. Looming over Puckett and other primary care doctors is a cut to their reimbursement rate that is set to take effect at the end of this year, barring action from a lameduck Congress reeling from Tuesday’s Republican electoral wave. (Shapiro, 11/6)

The Jefferson Center for Mental Health has seen a large increase in the demand for its services and, as a result, will hire approximately 100 new people in the next year. In 2014, the center has seen 13,454 new admissions, which is up from 11,632 last year and 9,858 in 2012. The new employees will increase staff by about 25 percent. (Vaccarelli, 11/6)

A new report on the health of older Missourians says cost and access to health care are key concerns as the state’s population continues to age. “In the next 15 - 20 years Missouri’s population is really going to explode with the Baby Boomers retiring,” explained Ryan Barker, vice president of health policy for Missouri Foundation for Health, the organization that produced the report. “So, we really wanted to look at this population—what are their needs, what are we seeing. And then predicting what are some of those future needs that we really need to start focusing on now so that we aren’t reaching a crisis 10 to 15 years from now.” (Phillips, 11/5)

Americans have entrusted Republicans with control of both the House and Senate. We are humbled by this opportunity to help struggling middle-class Americans .... Looking ahead to the next Congress, we will honor the voters’ trust by focusing, first, on jobs and the economy. Among other things, that means a renewed effort to debate and vote on the many bills that passed the Republican-led House in recent years with bipartisan support, but were never even brought to a vote by the Democratic Senate majority. It also means renewing our commitment to repeal ObamaCare, which is hurting the job market along with Americans’ health care.(Speaker John Boehner, R-Ohio, and Sen. Mitch McConnell, R-Ky., 11/5)

There must be a measure repealing ObamaCare, even though the president’s veto will be sustained. Republicans should respond to a veto with regret, not fury, and with bills that kill some of ObamaCare’s onerous provisions, like those that cause people to lose their plans or doctors. These should be coupled with reforms that push health care toward the patient-centered model Republicans prefer. Some Democrats will support these ideas and there is a limit to how often Mr. Obama can wield his veto without becoming the President of No. (Karl Rove, 11/5)

President Obama refused on Wednesday to submit to the Republican narrative that his presidency effectively ended with the midterm elections. He said he will not agree to the repeal of health care reform, as many Republicans demand. He will not sit around doing nothing while they look for the courage to enact immigration reform. He will continue to demand a higher minimum wage and new spending on public works, and expansion of early education programs. (11/5)

Unlike the dog that chased the car until, to its consternation, he caught it, Republicans know what to do with what they have caught. ... Repeal the Independent Payment Advisory Board. This expression of the progressive mind is an artifact of the Affordable Care Act and may be the most anti-constitutional measure ever enacted. ... Repeal the Affordable Care Act’s tax on medical devices. This $29 billion blow to an industry that provides more than 400,000 jobs is levied not on firms’ profits but on gross revenues, and it comes on top of the federal (the developed world’s highest) corporate income tax, plus state and local taxes. (George F. Will, 11/5)

Will Saletan at Slate puts his finger on a fascinating development in the 2014 election: A slew of Republican Senate and House candidates ran on Democratic themes. These included poverty relief, black unemployment, equal pay for women, dismal middle-class economics, income inequality and the protection of Social Security and Medicare. Saletan's right about that. These themes cropped up in GOP campaigns in the Deep South, the Midwest and on both coasts. (Michael Hiltzik, 11/5)

Tom Wolf made history this week, as the first challenger to defeat an incumbent Pennsylvania Governor seeking a second term. Promising a “fresh start” for Pennsylvania, Wolf picked up 55% of the vote to Corbett’s 45. That means a clear majority of Pennsylvania voters think it’s time to put Governor Corbett’s policies in the past and move forward in a new direction. On health care, we at the Pennsylvania Health Access Network couldn’t agree more. (Antoinette Kraus, 11/5)

It was obvious from the start that the cascade of corporate cash into ballot initiative campaigns in California this year would be overwhelming. The reality did not disappoint. That reality had to please the biggest spenders, notably the insurance companies and agents who defeated propositions 45 and 46, two pro-consumer healthcare measures. The industries spent some $100 million to kill the propositions, and they have a right to consider it well-spent. (Michael Hiltzik, 11/5)

Back in June, more than 60% of Californians supported it. But on Tuesday night, more than 60% of Californians voted against it. What went wrong with Proposition 45, the once popular rate-review ballot initiative? ... Prop. 45 had several high-profile champions. The measure was introduced by Consumer Watchdog and backed by insurance commissioner Dave Jones (D). The commissioner's support was unsurprising, given that Prop. 45 was intended to give Jones the power to veto excessive rate hikes by health insurers. (Currently, the Department of Insurance can review proposed rates but cannot deny them.) (Dan Diamond, 11/5)

October was National Breast Cancer Awareness Month. Football players took to the field in splashes of pink, and women's magazines featured celebrity survivors such as Suzanne Somers and Sheryl Crow, smiling alongside headlines attributing breast cancer survival to an upbeat attitude, personal fortitude and a conscientious shift toward a more healthful lifestyle. You have to applaud the willingness of these survivors to raise awareness of the disease. As a 20-year survivor myself, I recognize that such stories can be empowering. But given current scientific research on the disease, I also know that dispensing knowledge about breast cancer based on individual, anecdotal stories alone isn't nearly enough. (Cynthia Ryan, 11/5)

Historically, the science of epidemiology was directed toward identifying and controlling epidemics of infectious disease. In a study just published in the New England Journal of Medicine, my colleagues and I highlight another important job for epidemiologists: identifying and controlling epidemics of medical care. (H. Gilbert Welch, 11/5)

For those of us who lived through the early days of the U.S. AIDS epidemic, the current national panic over Ebola brings back some very bad memories. The toxic mix of scientific ignorance and paranoia on display in the reaction to the return of health care workers from the front lines of the fight against Ebola in West Africa, the amplification of these reactions by politicians and the media, and the fear-driven suspicion and shunning of whole classes of people are all reminiscent of the response to the emergence of AIDS in the 1980s. (Gregg Gonsalves and Peter Staley, 11/5)