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Adding to the onslaught has been a seemingly endless barrage of bad news — about Ebola, Russian hegemony, hostages beheaded in the Middle East — and a series of Washington missteps, including the botched rollout of the healthcare program and scandals at the Internal Revenue Service, the Secret Service and the Department of Veterans Affairs. The result is a surly electorate, and it goes beyond Colorado. Those not skipping the election in disgust are ready to lash out at lawmakers of both parties. (Barabak, 11/3)

Republican candidates and a few Democrats toughened their stands on illegal immigration. The GOP hardened its vows to repeal the Affordable Care Act. Minimum-wage increases championed by Democrats drew some GOP support. In a midterm campaign generally short on detailed policy debates, a small set of issues broke through. The question now is whether the campaign rhetoric will make it harder or easier for the two parties to find common ground after Tuesday’s voting. (Meckler, 11/3)

Republican Senate candidate Joni Ernst says that Iowa can be "the healthiest state in the country" with the repeal of the Affordable Care Act. (Russert, 11/3)

Late in the ad war, Democrats are going to an old standby attack: scaring seniors about Medicare. ... The attacks in the DSCC ad are based on Gardner's support of budget plans from Rep. Paul Ryan, who chairs the House Budget Committee. Each version of the Ryan plan focused on curbing federal spending, though a lot of the specifics would have been left up to Congress to decide, making some of the specifics in this ad questionable. (Rittman, 11/3)

Moving to close what many see as a major loophole in Affordable Care Act rules, the Obama administration will ban large-employer medical plans from qualifying under the law if they don’t offer hospitalization coverage. The administration intends to disallow plans that “fail to provide substantial coverage for in-patient hospitalization services or for physician services,” the Treasury Department said in a notice Tuesday morning. It will issue final regulations banning such insurance next year, it said. (Hancock, 11/4)

The Obama administration plans to close a loophole in the Affordable Care Act that allows large companies to refuse to cover in-patient hospital stays in any of their health insurance plans, according to an official involved in the internal discussions. The official requested anonymity until the announcement is made because "the guidance that will be issued is not finalized." (O'Donnell, 11/3)

Just after the election, insurers will send letters to millions of consumers spelling out changes in premiums for coverage under the health care law. Why not before? Under the health law, the federal government is responsible for approving premiums for health plans in 36 states where it is running some or all of the online insurance exchanges through the HealthCare.gov website. The Department of Health and Human Services told insurers in early September they should notify consumers who hold policies with them of their new premiums for 2015 only after HHS approved the rates. HHS can’t reject the new rates, only criticize them. (Radnofsky, 11/3)

When Obamacare patients learn their deductible is so high they’re unlikely to get any reimbursement, they often wind up in places like the Denton, Texas Community Care Center. (Angle, 11/4)

Todd Hawkins is a Virginia home builder who insists that the big plans he has for his business are not so big that they will put him in the path of the Affordable Care Act. That, anyway, is what he told You’re the Boss readers when he commented on a recent post about determining whether a company is subject to the law’s employer mandate. “I can promise we won’t go over 49 employees, so A.C.A. will affect employment, at least by one company,” he wrote. “Mine.” But Mr. Hawkins told a different story when I contacted him a few days later to talk about his comment. “Next year,” he said, if he and his partner’s new idea works out, “that’s when we’ll run into the A.C.A.” He has 21 employees now. (Mandelbaum, 11/3)

The Obama administration is defending its health care law in court, arguing that the text of the law and Congress' intent allow Americans to receive insurance subsidies regardless of whether they're enrolled through insurance markets run by the states or by the federal government. In a federal appeals court filing, the Justice Department on Monday disputed opponents' contention that the law limits tax credits for low- and moderate-income consumers only to those who live in states that have set up their own insurance markets, or exchanges. (11/3)

You won't find Obamacare listed on any state ballots this year, but the future of its coverage expansion will hinge on the outcome of gubernatorial races across the country. Voters in 15 of the 23 states that haven't expanded their Medicaid programs under the Affordable Care Act will go to the polls on Tuesday, and the outcome of those elections will play a major role in determining the reach of President Obama's health-care law. (Millman, 11/3)

Georgia health advocates were long hopeful that Republican Gov. Nathan Deal would expand the state’s Medicaid program after winning reelection. But on the eve of the vote, they know he has likely closed the door. (Wheaton, 11/3)

An extra 3 million people would have gained health insurance if the Supreme Court had ruled in favor of the Obama administration's Medicaid plans two years ago, according to new data. If all states had expanded their eligibility for the low-income insurance program, the percent of people without insurance nationwide would have fallen by two percentage points, according to a model created by the nonprofit group Enroll America and a data analytics group called Civis. The data was analyzed and published by the New York Times on Monday. (Ferris, 11/3)

The second time around, open enrollment on the state health-insurance exchange site will be a friendlier, simpler process, officials promise, yet skeptics and questions remain. Connect for Health Colorado's website will include a streamlined single-application format, helpful consumer tools and even an avatar/guide named "Kyla." The website, a shared system with Medicaid, goes live Nov. 10, a few days ahead of the national Nov. 15-Feb. 15 dates for open enrollment under the Affordable Care Act. While applications for insurance won't be submitted to carriers until Nov. 15, consumers can get an early start doing everything they need to enroll, said Marcia Benshoof, the exchange's chief strategy and sales officer. (Draper, 11/3)

A "small subset" of applicants to Covered California has been deluged with multiple notices, as many as 20 different letters -- some of them with conflicting eligibility information, exchange officials said. (Gorn, 11/3)

A recruiting project at the California State University system -- billed as the nation's largest and possibly most diverse college system -- has shown promising results and could be used as a model for other university systems, according to organizers. (Lauer, 11/3)

Aetna Inc. said it has reached a deal to buy a privately held provider of technology that helps people shop on health-insurance exchanges, which have grown in prominence under the federal Affordable Care Act. Aetna said the deal for the company, bswift, carries a price tag of about $400 million, and is expected to close before the end of this year. (Calia, 11/3)

Health insurer Aetna will spend $400 million on a technology company that could strengthen its push into a relatively small but growing area of employer-sponsored coverage: private exchanges that let workers choose their own plans. Aetna said Monday it is acquiring privately held Bswift, a Chicago-based company that provides technology for benefits administration and insurance purchases on private exchanges. More employers have been considering private insurance exchanges in recent years as a way to improve control over health care costs that consistently rise faster than inflation and consumer bigger portions of their budgets. Under this approach, businesses generally give their workers a set amount of money to purchase health insurance and then send them to a private exchange, where they pick from a number of plans. (11/3)

Laboratory Corp. of America Holdings, one of the largest U.S. medical testing companies, is entering the drug-development business by agreeing to buy Covance Inc. in a cash-and-stock deal worth about $6.1 billion, the companies said on Monday. (Walker, 11/3)

Tenet Healthcare Corp. said its third-quarter revenue soared and admissions continued to improve with a boost from the U.S. health-care policy overhaul. For the year, the hospital operator raised the lower end of its projection for adjusted earnings before interest, taxes, depreciation and amortization by $50 million and now expects to a range of $1.90 billion to $1.95 billion. (Stynes, 11/3)

Tenet Healthcare Corp. reported earnings that beat analysts estimates as the hospital company saw increased revenue from higher admissions and fewer uninsured patients under Obamacare. The hospital chain benefited from the Patient Protection and Affordable Care Act, spending less on charity care for uninsured patients in states that have expanded Medicaid, the joint state-federal health program for the poor. About a quarter of Tenet’s patient beds are in states that have expanded Medicaid. (Pettypiece, 11/3)

For stocks, it’s just what the doctor ordered. Health care companies are leading the market’s rebound from a sharp sell-off two weeks ago, helping push the Dow Jones industrial average and Standard & Poor’s 500 index back to record levels. (11/3)

Honeywell International Inc. (HON) defeated the Equal Employment Opportunity Commission’s bid for a court order preventing it from penalizing workers who don’t participate in a corporate wellness program. After hearing arguments today, U.S. District Judge Ann Montgomery in Minneapolis denied the agency’s request to block the company from assessing the health insurance-related surcharges. Montgomery was asked to decide whether the wellness program, which Honeywell said was enacted in furtherance of President Barack Obama’s Affordable Care Act, conflicts with other federal laws. Saying she wasn’t ready to make even a preliminary determination, she allowed the company’s practices to continue. (Hawkins and Harris, 11/3)

A U.S. district judge in Minneapolis is allowing Honeywell to begin penalizing workers who refuse to submit to biometric or medical tests. A federal agency had asked the judge to block the program. (Collins, 11/3)

Two years ago, Inova Health System recruited a top executive who was not a physician, had never worked in hospital administration and barely knew the difference between Medicare and Medicaid. What Paul Westbrook specialized in was customer service. His background is in the hotel business – Marriott and The Ritz-Carlton, to be precise. He is one of dozens of hospital executives around the country with a new charge. Called chief patient experience officers, their focus is on the service side of hospital care: improving communication with patients and making sure staff are attentive to their needs, whether that’s more face time with nurses or quieter hallways so they can sleep. (Rabin, 11/4)

The Obama administration’s $30 billion effort to encourage hospitals to digitize their health records and modernize the health care system seems to be failing--with half the participating health providers threatening to bail out of the program. (Ehley, 11/3)

North Dakota and Colorado will weigh “personhood” amendments to their state constitutions. Each would enshrine and expand rights to the unborn, with opponents suggesting the measures would have unintended consequences, such as putting an end to in vitro fertilization, banning some forms of birth control and restricting access to abortion providers. Tennessee’s Amendment 1 would lay the foundation for future abortion restrictions by amending the state constitution to explicitly make clear that nothing in it “secures or protects right to abortion or requires the funding of an abortion.” ... California is home to what are among the most expensive ballot fights in the nation. A pair of health care-related measures — propositions 45 and 46 — have generated at least $130 million in combined contributions, largely from insurers, doctors and lawyers. (Chokshi, 11/3)

Mr. Walker campaigned on the sometimes controversial polices enacted during his four years in office, which included income and property tax cuts, overhauling health care for the poor and eliminating most collective-bargaining rights for government employees. He promised to push similar policies in a second term, including placing new limits on public assistance. ... Ms. Burke, 55, has staked out positions as a business-friendly Democrat whose professional career began while working for Wisconsin-based bicycle maker Trek Bicycle Corp., which her father started. She opposes school vouchers and restrictions on same-sex marriage, while criticizing Mr. Walker for refusing to accept federal money from the Affordable Care Act aimed at expanding health care to more low-income residents. (Kesling and Peters, 11/4)

Yes, it’s looking like the Massachusetts ballot measure on earned sick time will pass on Election Day, but no, that doesn’t mean you should plan to call in sick on Wednesday. First of all, even if it does become law, “Question 4″ won’t take effect until July 1, 2015. And second, it has a few nuances. (Goldberg, 11/3)

Voters in Oregon and Colorado will face ballot initiatives on Election Day that call for labeling food containing genetically modified ingredients, potentially joining New England states that have passed similar measures – and, win or lose, focusing more attention on state-by-state battles over the issue. Voters in Oregon will decide on Measure 92, and Colorado voters will vote on Proposition 105, both of which require labels on most retail food that contains genetically modified, or GMO, ingredients. Polling in both states over the past week was mixed, but seems to indicate that support for the measures is trailing. (11/3)

The state's Medicaid cost-reduction program saved $31 million on medical services during the 2013-2014 fiscal year, officials said Monday. The Department of Health Care Policy and Financing, which administers Medicaid and Child Health Plan Plus, said the Accountable Care Collaborative grossed $100 million, more than double the costs cut last fiscal year. After accounting for payments to providers and regional care collaborative organizations, the program's net savings were about $31 million. (Draper, 11/3)

Medicaid enrollment in Kansas grew by a historically low rate in 2013, and it isn’t entirely clear why. An analysis by Kansas Health Institute found the number of children and families enrolled in Medicaid grew by 0.1 percent from 2012 to 2013. Scott Brunner, senior analyst and strategy team leader for coverage and access at KHI, said the normal rate of growth for Medicaid has been about 3 percent. That reflects population growth and the normal “churn” of families moving above and below the income cut-off for Medicaid, he said. (Hart, 11/3)

The Missouri Department of Health's Facilities Review Committee granted a certificate of need for a three-bed urgent care hospital that's part of developer Paul McKee's master plan for the overall project. No one spoke in opposition to granting McKee a certificate of need during the committee's meeting, and the vote in favor was 7-0. The facility is to be built at 25th Street and Maiden Lane. McKee also said he hopes to break ground on the health-care facility by late spring next year. (Griffin, 11/3)

The principal owner of Bauder's Pharmacy is transferring his stake to his sister so the business will remain in their family after he pleads guilty to federal drug charges, his lawyer said Monday. Mark Graziano is expected to plead guilty Thursday to two federal criminal charges related to the disappearance of about 700,000 narcotic painkilling pills from the Des Moines pharmacy. The Ingersoll Avenue store has been in Graziano's family for decades. Its state license was in jeopardy from the Iowa Board of Pharmacy because of allegations related to the diversion of the hydrocodone pills and other alleged problems. But the board voted last week to settle its pending administrative charges against the store if Graziano relinquishes any ownership interest in it within 30 days. (Leys, 11/3)

West Virginia is getting nearly $1.2 million to protect and improve the health of women, children and families across the state. U.S. Sens. Joe Manchin and Jay Rockefeller say the funding is being awarded to the West Virginia State Department of Health and Human Resource's Office of Maternal, Child and Family Health. (11/3)

After six years of railing against Obamacare, here’s the sum total of what Republicans are likely to do if they win control of the Senate: Little, if anything. Obamacare has been Republicans’ favorite whipping boy even before it became law in 2010. They’ve used it time and again on the campaign trail to fire up voters against the White House and Democrats in Congress. But now that they seem poised to begin doing something about it, they will have to face a new reality: The Affordable Care Act is here to stay and Republicans will be political losers if they mess with it too much. (Richard Kirsch, 11/3)

Some Republican governors and U.S. senators are going to have a major Obamacare dilemma on their hands if they wake up Wednesday morning and find that their party controls Congress. Congressional Republicans repeatedly have vowed to repeal the Patient Protection and Affordable Care Act. Sen. Mitch McConnell, (R-Ky.), who the polls show is likely to be re-elected and become the next Senate majority leader, was forced by conservatives last week to retract his statement that a Republican Congress would not be able to repeal the law. (Harris Meyer, 11/3)

Republicans and Democrats have little occasion to agree on anything in these toxic times. Nowhere are their differences more acute than on health-care policy. ... Yet it is still possible to make progress on changes that will improve the health-care system. Disagreements about the future of Obamacare need not stop us from agreement in other areas. And it starts with emphasizing the role that states can and should play in slowing the increase in health-care costs. (Lanhee Chen and Topher Spiro, 11/3)

Let’s be clear. The American health care system has plenty of flaws. Regrettably, Obamacare will do little to correct those ills (and any impact it has on life expectancy will be vanishingly small). Indeed, in many respects this misguided law has simply lengthened the laundry list of problems needing fixing. But we surely cannot find a sensible solution until and unless both sides of the aisle are willing and able to soberly confront the reality of our current system’s performance without resorting to statistics that severely bend reality in a favored direction. For unless we can clearly see what our problems are, it is a safe bet we will never find sensible solutions. (Chris Conover, 10/30)

A lot of attention has been paid to what a shift in control of the Senate in the midterms might mean for the Affordable Care Act and other big policy issues. As ACA implementation has shifted to the states, governor’s races may be just as important, particularly when it comes to whether states expand Medicaid. (Drew Altman, 11/3)

Technically, the Medicaid expansion is not on the ballot in any state. But it is effectively on the ballot through gubernatorial races around the country. In Maine, if Democrat Mike Michaud defeats Governor Paul LePage—a Republican committed to blocking the expansion—70,000 low-income Maine residents will receive Medicaid. The same scenario could play out in Wisconsin, where Governor Scott Walker has opposed the expansion. ... In Florida, Alaska, Kansas and Georgia, the election of Democratic or independent governors could bring those states closer to accepting the expansion. (Danny Vinik, 11/4)

Voters are usually inclined to vote their pocketbooks. But that's become more difficult with every election, as the pocketbooks that carry the most weight aren't those of the individual voter, but corporations and plutocrats. ... The analogous cases on this year's ballot involve Propositions 45 and 46, which would both strengthen state regulations in healthcare. Accordingly, they've attracted stupendous contributions from corporate interests. Proposition 45 would give the state insurance commissioner much-needed authority to approve or reject health insurance rates in advance. The No on 45 war chest is nearly $57 million, the vast majority of which has come from insurers operating in the state such as Kaiser, Blue Shield and WellPoint. (Michael Hiltzik, 11/3)

Tuesday’s voting will not only determine control of the Senate, but the fate of important ballot initiatives in several states. ... Ballot initiative aimed at ending or severely curtailing womens’ access to safe and legal abortion care will be contributing to the election night drama in three states: Colorado, North Dakota and Tennessee. (11/3)

[C]ivil liberties and rationality do not seem to count for much to politicians and public authorities who refuse to believe medical science or simply want to enhance their own public standing. California congressman Darell Issa, the Republican chair of the House Oversight and Government Reform Committee, opened hearings into the Ebola problem by repeatedly mispronouncing the name of one of the countries most affected by the disease – he kept saying “Guayana,” a nation in South America, instead of Guinea, a center of the outbreak in West Africa. He also mispronounced the name of the disease, calling it “eboli,” perhaps confusing it with E-coli. Despite those errors, he spoke as if he knew what he was talking about when he asserted that a person can get Ebola from sitting next to someone on a bus. ... the disease is not spread until it reaches an acute level. That fact did not preclude New York Republican Rep. Peter King from going on talk radio to speculate that Ebola was somehow becoming airborne or Kentucky’s junior Republican senator, Rand Paul, from alleging the disease could be served up at cocktail parties with the martinis and cosmopolitans. (David Horsey, 11/3)

Hundreds of government and civilian workers of all stripes, and thousands of military personnel, have braved the terrifying prospect of infection to respond to the Ebola emergency in West Africa. And thousands more will be needed for an effort that is expected to go well into 2015. But will they go? Beyond the obvious dangers to health care workers — more than 270, mostly African, have died so far this year — a host of obstacles stand in the way of anyone who may want to help stem a catastrophe.(Lawrence K. Altman M.D., 11/3)

Mike Weisser is my favorite gun dealer. ... There’s something else about Weisser: He strongly believes that the country needs a new approach to guns and gun violence — an approach that is more data-driven, less hyperbolic, and that emphasizes the public health aspect of gun violence. Using the pen name Mike the Gun Guy, Weisser writes a blog at The Huffington Post that encapsulates his approach. He is one of the few who has focused on suicides, which make up nearly two-thirds of all gun deaths. He has called out gun control advocates from time to time; he mainly thinks they are too often passive when confronted with the tactics of the National Rifle Association. (Joe Nocera, 11/3)

Among the many ideas that have been tossed around for decades on how to bring down health care spending, none may be as well known as malpractice reform. Many people believe that it’s the key to removing waste from the health care system and making the practice of medicine better. But a growing body of evidence shows that belief is most likely mistaken. (Aaron E. Carroll, 11/3)

Veterans Day we salute and honor the men and women who have served in the United States armed forces. It's a day we reflect on the contributions and sacrifices of service members and their families and demonstrate that our gratitude toward veterans is more than mere words. On Veterans Day, ceremonies are held across the country as we pause to honor those patriots who have safeguarded our liberty. From Bunker Hill to Baghdad, we are the beneficiaries of their vigilance and determination to uphold the democratic beliefs on which our nation was founded. What better way to thank veterans than to make sure they receive the care and support they need when they need it? (Dennis H. Smith, 11/3)