• Maine OKs Medicaid Expansion in First-of-Its-Kind Referendum Associated Press by Patrick Wittle — Residents in this rural state grappling with a heroin epidemic and an aging population voted Tuesday to deliver a rebuke to Republican Gov. Paul LePage and join 31 other states that have expanded Medicaid under former President Barack Obama's health care law. The referendum represents the first time since the law took effect that the question of expansion had been put in front of U.S. voters. Some 11 million people in the country have gotten coverage through the expansion of Medicaid, a health insurance program for low income people....Passage of the proposal means an estimated 70,000 people in Maine can gain health coverage. About 268,000 people currently receive Medicaid in the state.
  
  
• Election Results Invigorate Medicaid Expansion Hopes New York Times by Abby Goodnough and Margot Sanger-Katz — The election results in Maine and Virginia have energized supporters of expanding Medicaid under the Affordable Care Act in several holdout states. After months of battling Republican efforts to repeal the law, they now see political consensus shifting in their direction. Groups in Idaho and Utah are already working through the process of getting Medicaid expansion initiatives on next year's ballots, hoping to follow Maine's path after failing through the legislative route. And the outlook for legislative approval has brightened in Virginia after Democrats picked up at least 15 seats in the Republican-controlled House of Delegates and could potentially control the chamber once all the votes are counted. Advocacy groups are also hoping the decisive victory in Maine, and exit polls suggesting health care was the top issue in Virginia, will add momentum to efforts in Kansas and North Carolina.
  
  
• Trump Administration Will Support Work Requirements for Medicaid New York Times by Robert Pear — The Trump administration announced on Tuesday what it called "a new day for Medicaid," telling state health officials that the federal government would be more receptive to work requirements and other conservative policy ideas to reshape the main government health program for low-income people. Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said the administration would approve proposals from states to require work or community engagement for people who want to receive Medicaid. "These are individuals who are physically capable of being actively engaged in their communities, whether it be through working, volunteering, going to school or obtaining job training," Ms. Verma said. "Let me be clear to everyone in this room: We will approve proposals that promote community engagement activities."

• CBO: Obamacare Mandate Repeal Would Cut Deficit by $338 Billion Politico by Jennifer Haberkorn — Repealing Obamacare's individual mandate would save the government $338 billion over a decade and result in 13 million more uninsured Americans in 2027, according to a new Congressional Budget Office (CBO) score. Congressional Republicans are considering axing Obamacare's requirement that most Americans obtain health coverage as part of a tax reform package, although there is resistance from GOP leaders who fear the provision would be rejected in the Senate because it would also mean millions in coverage losses and revive the partisan debate on the rest of the Affordable Care Act.
  
  
• Revenue Hole May Bring GOP Back to Repeal of Obamacare Mandate Bloomberg by Alexis Leondis — The impact of House Ways and Means Chairman Kevin Brady's amendment to revise one of the GOP tax bill's offshore provisions emerged late Tuesday — an estimated $74 billion revenue hole, which is sending tax writers scrambling to find additional revenue. They may pursue a risky strategy to make up the shortfall: repealing the 2010 Affordable Care Act's individual mandate. House Republicans are edging closer to accepting President Donald Trump's suggestion to combine their tax legislation with a repeal of the mandate that all individuals purchase health insurance, according to a person who's helping to draft the tax bill. While the move would give House tax writers an estimated $416 billion in sorely needed offsets for the deep rate cuts they want, it risks alienating GOP senators, who voted down a measure that would have repealed the so-called individual mandate last summer.
  
  
• Trump Preparing Executive Order to Scale Back Obamacare's Individual Mandate: The Hill by Nathaniel Weixel — The White House is reportedly preparing an executive order to weaken Obamacare's individual mandate in the event congressional Republicans don't include the measure in the tax-reform bill. According to the Washington Examiner and The Washington Post, the draft executive order would seek to broaden the "hardship exemptions" to the requirement that taxpayers must demonstrate proof of insurance or pay a fine. Repealing the mandate would save about $400 billion, which could be used to help pay for tax cuts, but the Congressional Budget Office also says 15 million more people would be uninsured and premiums would rise 20 percent.

• Ohio Voters Reject Measure to Rein in Drug Costs Stat by Casey Ross — A ballot proposal to rein in drug costs was soundly defeated in Ohio Tuesday after an expensive ballot fight that drew tens of millions of dollars from the pharmaceutical industry. The ballot proposal, known as the Drug Price Relief Act, was rejected by nearly 80 percent of voters in final results. It would have required that state agencies pay no more for medicine than the U.S. Department of Veterans Affairs, which gets a 24 percent discount off average manufacturers' prices. Tuesday's vote was the second defeat for the proposal, which was also voted down in California last year. Many voters said they were confused about its impacts on consumers and didn't feel comfortable supporting it.
  
  
• Over-the-Counter Painkillers Treated Painful Injuries Just as Well as Opioids in New Study Los Angeles Times by Melissa Healy — In an opioid epidemic that currently claims an average of 91 lives per day, there have been many paths to addiction. For some, it started with a fall or a sports injury, a trip to a nearby emergency room and a prescription for a narcotic pain reliever that seemed to work well in the ER. New research underscores how tragically risky — and unnecessary — such prescribing choices have been.  In a new study of patients who showed up to an emergency department with acute pain in their shoulders, arms, hips, or legs, researchers found that a cocktail of two non-addictive, over-the-counter drugs relieved pain just as well as — and maybe just a little better than — a trio of opioid pain medications widely prescribed under such circumstances.
  
  
• Trump Talks Tough but Little Action Seen on Drug Prices The Hill by Nathaniel Weixel — President Trump blasted the pharmaceutical industry for "getting away with murder" with steep drug prices during the campaign and since, but his administration has done little to force the industry to change its ways. As recently as Oct. 16, the president repeated the "getting away with murder" line and promised to bring prices "way down." But despite the rhetoric, Trump has not acted on most of the drug pricing promises he made during the election. Activists said they are disappointed.  "I actually believe the president understands that people are hurting and he correctly IDs the problem — but the processes in his administration have been captured by the drug companies," said David Mitchell, president and founder of Patients for Affordable Drugs.

• Battered by Trump, Obamacare Triumphs at the Polls  Politico by Rachana Pradhan — The 2010 health law survived a GOP repeal onslaught and buoyed Democrats on Tuesday — Obamacare made a comeback in Tuesday's elections, its strongest show of support since President Donald Trump was elected and the GOP spent months on a futile effort to repeal it. In the governor's race in Virginia and a ballot initiative in Maine, the Affordable Care Act buoyed Democrats, a remarkable reversal from how Trump and congressional Republicans won elections excoriating the "failed" and "doomed" law.  A remarkable 4 out of 10 Virginians in early exit polls said health care was their top issue in a race that saw Democrat Ralph Northam, the current lieutenant governor, handily defeat Republican Ed Gillespie to become Virginia's next governor. And in Maine, voters in a landslide backed Obamacare Medicaid expansion, which their governor had vetoed on five separate occasions.
  
  
• Health Care, for Years a Political Winner for GOP, Now Powers Democratic Wins Los Angeles Times by Noam Levey — The polarizing issue of health care, which has dragged down Democrats since passage of the Affordable Care Act in 2010, emerged from Tuesday's state elections as a potentially formidable new force in the party's efforts to regain power in next year's congressional elections.

Trump Health Agency Challenges Consensus on Reducing Costs New York Times by Abby Goodnough and Kate Zernike — For several decades, a consensus has grown that reining in the United States' $3.2 trillion annual medical bill begins with changing the way doctors are paid: Instead of compensating them for every appointment, service and procedure, they should be paid based on the quality of their care. The Obama administration used the authority of the Affordable Care Act to aggressively advance this idea, but many doctors chafed at the scope and speed of its experiments to change the way Medicare pays for everything from primary care to cancer treatment. Now, the Trump administration is siding with doctors — making a series of regulatory changes that slow or shrink some of these initiatives and let many doctors delay adopting the new system. The efforts to chip away at mandatory payment programs have attracted far less attention than attempts by President Trump and congressional Republicans to dismantle the Affordable Care Act, but they have the potential to affect far more people, because private insurers tend to follow what Medicare does. That in turn affects the country’s ability to deal with soaring health care costs that have pushed up insurance premiums and deductibles.

Editor: Peter Van Vranken