First Edition: October 30, 2014

Kaiser Health News: How Obamacare Went South In Mississippi
In the country’s unhealthiest state, the failure of Obamacare is a group effort. ... The first year of the Affordable Care Act in Mississippi was, by almost every measure, an unmitigated disaster. In a state stricken by diabetes, heart disease, obesity and the highest infant mortality rate in the nation, President Barack Obama’s landmark health care law has barely registered, leaving the country’s poorest and perhaps most segregated state trapped in a severe and intractable health care crisis. (Varney, 10/29)

Kaiser Health News: L.A. County Officials Demand Details On Reduced Nursing Home Penalties
The Los Angeles County Board of Supervisors ordered the public health department this week to provide an update on the nursing home inspection process, responding to a Kaiser Health News report that draft penalties in three patient deaths had been reduced without explanation. The supervisors unanimously approved the motion to have the acting public health director report back with a “detailed description” of procedures for reviewing nursing home penalties recommended by on-site inspectors. The vote followed an article published Saturday in the Los Angeles News Group newspapers, which described three fatal cases in which sources said inspectors’ draft citations had been downgraded. (Gorman, 10/29)

The Wall Street Journal: Small Firms Start to Drop Health Plans
Small companies are starting to turn away from offering health plans as they seek to reduce costs and increasingly view the health law’s marketplaces as an inviting and affordable option for workers. In the latest sign of a possible shift, WellPoint Inc. said Wednesday its small-business-plan membership is shrinking faster than expected and it has lost about 300,000 people since the start of the year, leaving a total of 1.56 million in small-group coverage. (Wilde Mathews, Loten and Weaver, 10/29)

Politico: More Turmoil For House GOP Lawsuit Against Obama
House Speaker John Boehner’s still-unfiled lawsuit against President Barack Obama for exceeding his constitutional power is in more trouble. For the second time in two months, a major law firm has backed out of an agreement to pursue the case, sources say. ... Boehner’s office also suggested the suit, which planned to challenge Obama’s failure to implement aspects of his health care reform law, could be broadened if Obama goes forward, as promised, with plans for executive action on immigration. (Gerstein and Haberman, 10/29)

The Wall Street Journal's Washington Wire: Burwell Picks Treasury Aide Fitzpayne For HHS Chief Of Staff
Alastair “Al” Fitzpayne, a top Treasury Department aide with extensive contacts on Capitol Hill, will be the next chief of staff at the Department of Health and Human Services, working with secretary Sylvia Mathews Burwell. In selecting Mr. Fitzpayne, Ms. Burwell tapped a well-connected administration aide who has worked on some of the most high-stakes fiscal battles in recent years but has relatively little health care experience. (Paletta, 10/ 29)

The Washington Post's Wonkblog: Why Obamacare Still Matters In This Election
Although the politics of Obamacare have cooled down this year — and even with declining interest in this year's midterms — the upcoming election will have a bigger influence on the direction of health care than you may think. That's the major takeaway from a new Harvard University analysis of 27 public opinion polls from 14 organizations on President Obama's signature law. The analysis, published in the New England Journal of Medicine, offers a pretty comprehensive view of how the Affordable Care Act — less than a year into its major coverage expansion — will shape the agenda for the next Congress and potentially the 2016 presidential race. (MIllman, 10/29)

The Associated Press: Groups Book Louisiana Ads After Election Day
More than $24 million in TV advertising already has aired in the state with a week to go before Election Day, according to the nonpartisan Center for Public Integrity, which is tracking ad spending across the country. National conservative group Crossroads GPS, co-founded by GOP operative Karl Rove, aired a new ad Tuesday, hitting Landrieu for her vote for President Barack Obama’s signature health care law. The 30-second TV commercial said the Democratic incumbent’s vote was a betrayal of Louisiana, a continuing theme of GOP advertising that has framed Landrieu as a rubber stamp for the president. Despite the negative ads, Landrieu continued to embrace the health overhaul... (Deslatte and Elliott, 10/20)

The Associated Press: Health Care Overhaul Doubts Ease For Insurers
What a difference a year makes. The nation’s biggest health insurers entered last fall cautious about a major coverage expansion initiated by the health care overhaul, the federal law that aims to cover millions of uninsured people. ... But a year later, these challenges are starting to appear manageable, and investors see much less uncertainty ahead for the sector. Insurers have cut costs and raised prices to help mitigate added expenses from the law. They’ve also added new business. (10/29)

The Wall Street Journal: Cigna Raises Outlook As Results Exceed Expectations
Cigna Corp. again raised its guidance as fee and premium revenue grew along with its customer base. The health insurer’s results easily topped analysts’ expectations. The company again raised its earnings outlook for the year, this time to a range of $7.25 to $7.45 a share, from $7.20 to $7.40. Fellow health insurers WellPoint and Aetna had also raised their guidance this week. (Calia, 10/30)

The Associated Press: Healthcare Overhaul Ramps Up Business At WellPoint
The Indianapolis insurer's big quarter comes after competitors Aetna Inc. and UnitedHealth Group Inc. also topped quarterly expectations and raised their annual forecasts. Insurers began the year cautious about a major coverage expansion initiated by the overhaul, the federal law that aims to cover millions of uninsured people. Late last year, the U.S. introduced state-based public health insurance exchanges that promised to give insurers millions of new customers by making it easier for people to buy coverage, sometimes with help from income-based tax credits. But the overhaul also heaped additional costs onto the balance sheets of insurers, including an industrywide tax that is non-deductible. It trimmed funding for Medicare Advantage plans and altered the manner in which insurers operate by preventing them from excluding high-risk patients. (10/29)

USA Today/Louisville Courier-Journal: Retirees Sue GE Over Health Coverage
Two retirees have sued General Electric in federal court alleging that the company violated federal law by dropping its supplemental health coverage and placing retirees in a health care exchange. In a lawsuit filed in the Eastern District of Wisconsin, the pair allege that GE breached its promise to keep the benefits indefinitely only to announce in September 2012 and last month that the company would drop its Medicare plans and switch non-union retirees to private coverage. (Schneider, 10/29)

The Wall Street Journal: Wellness Program At Honeywell Faces Test
When Honeywell International Inc. recently asked workers to participate in voluntary screenings of their cholesterol, body-mass index and other health measures, it made a persuasive case: Employees who choose not to sit for the screenings—part of the company’s wellness program—could face up to $4,000 in surcharges and lost incentives in 2015. (Weber, 10/29)

The Associated Press: Quarantines Rarely Used, Effectiveness Questioned
The Spanish flu pandemic a century ago prompted the last large-scale quarantines in this country. Now the Ebola outbreak is raising new questions about whether ordering quarantines is an effective way to fight deadly disease in the U.S. (10/30)

The Associated Press: Nurse Defies Ebola Quarantine In Maine
A nurse who vowed to defy Maine's voluntary quarantine for health care workers who treated Ebola patients followed through on her promise Thursday, leaving her home for a bike ride. Kaci Hickox and her boyfriend stepped out of their home Thursday morning and rode away on bicycles, followed by state police who were monitoring her movements and public interactions. Police couldn't detain her without a court order signed by a judge. (Bukaty, 10/30)

Los Angeles Times: State Orders Quarantine For Workers Who Had Contact With Ebola
California's top health officer has ordered a 21-day home quarantine for all returning medical workers or travelers who have had contact with a confirmed case of Ebola in West Africa, and invoked the possibility of imprisonment and fines if the restrictions are disobeyed. The order, issued Wednesday by California Department of Public Health Director Dr. Ron Chapman, is the latest in a series of measures issued by state governments in response to widespread — and some say unwarranted — public fear. (Morin and Flores, 10/29)

The New York Times: Threat Of Lawsuit Could Test Maine’s Quarantine Policy
A nurse who cared for Ebola patients in Sierra Leone was headed for a legal showdown with the State of Maine on Wednesday over whether the state can quarantine her against her will. The dispute is heightening a national debate over how to balance public health and public fears against the rights and freedoms of health care workers, and troops, returning from West Africa. (Zernike and Fitzsimmons, 10/29)

The Washington Post: Election Could Tip Historic Number Of Legislatures Into Republican Hands
If Iowa Democrats can’t hang on to control of the state Senate, Gov. Terry Branstad (R) will be freer to pursue an ambitious agenda. If Arkansas Republicans keep control of the state House and win the governor’s mansion, the future of that state’s unique approach to Medicaid expansion under the Affordable Care Act is at risk. In Kentucky, Sen. Rand Paul (R) could take advantage of a Republican state legislature to change a law that prevents him from running for president and re-election to the U.S. Senate at the same time. (Wilson, 10/29)

The New York Times: California’s Proposition 45 Would Offer Public A Say On Health Insurance Rates
A year after the federal Affordable Care Act took effect, California voters are now considering another major change to health care: a ballot measure that would give state officials the authority to veto health insurance rate increases for individual and small group plans. Proposition 45 would hand broad new control of the individual health insurance market to the state insurance commissioner, who could reject rate increases deemed excessive. The measure is designed to keep costs down for consumers in a state where health care premiums have spiked in recent years, raising public ire. (Lovett, 10/29)

The Wall Street Journal's Washington Wire: States Offer Economic Blueprints And Caution For GOP Congress
If Republicans win control of the Senate next week, they will have a rare opportunity to design a unified congressional economic plan that reworks things like health-care spending, tax policy, labor rules, and adjustments to social-welfare programs. For the past few years, a number of states led by GOP governors have served as incubators for some of these ideas with mixed results. Those experiences could influence which strategy GOP lawmakers adopt. Many of these governors inherited large projected budget deficits and made tax and spending changes to balance the budget (as they are often required to do by law). Sometimes, the changes resonated well with voters. But the jury is still out in a number of states. (Paletta, 10/29)

The Wall Street Journal: Fight Over Abortion Dominates Tennessee Election
An antiabortion referendum is turning into this state’s most contentious campaign this fall, as groups for and against the measure work to get out the vote in an otherwise ho-hum election season. (McWhirter, 10/29)

Los Angeles Times: Police Need More Training To Deal With Mentally Ill, L.A. County Told
A consultant hired to find a way to divert the mentally ill from Los Angeles County's jail system found that not enough law enforcement officers were trained to handle people undergoing a mental health crisis. In a report made public Wednesday, the consultant found that more resources were needed to train police officers, dispatchers and other criminal justice workers on how to deal with people with mental illness, and that law enforcement agencies should expand the use of special teams that respond to people in crisis. (Sewell, 10/29)