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There's a long list of issues on which the Trump administration, and Republicans generally, are out of step with most Americans, yet on few of them is the chasm so broad or so deep as on health care. On Tuesday, voters made that clear in a pair of purple states, Virginia and Maine, while for the past week Americans across the country have been surging to sign up for health-care coverage under the Affordable Care Act, which the White House and congressional Republicans have tried to repeal and, failing that, sabotage. (11/8)

Less than a day after voters in Maine voted to expand Medicaid in their state, Gov. Paul LePage (R) moved quickly to subvert their democratic will, announcing Wednesday that he will not implement the expansion until it is “fully funded by the Legislature.” (Josh Silver, 11/8)

Democrats won pretty much everywhere in Tuesday’s election, but there is a reason beyond the effect President Trump has on their fortunes for Republicans to be unnerved by the results. It has to do with both politics and policy, and it could mean trouble for them in 2018. I’m talking about Medicaid. As you might have seen, voters in Maine approved a ballot initiative Tuesday to accept the Affordable Care Act’s expansion of Medicaid by a margin of 59 percent to 41 percent. The expansion has been resisted by Paul LePage (R), to whom I fondly refer as America’s Worst Governor™. (Paul Waldman, 11/8)

Republicans who think the American public is clamoring to repeal or roll back the Affordable Care Act have another think coming. Voters in Maine overwhelmingly enacted Medicaid expansion for their state Tuesday, overturning a string of five successive vetoes by their right-wing governor, Paul LePage. The vote was roughly 60%-40%. Maine thus becomes the 33rd state (including the District of Columbia) to expand Medicaid under the Affordable Care Act, the first to do so during the Trump administration, and the first to do so by ballot initiative. (Michael Hiltzik, 11/8)

On Tuesday, the state’s voters approved Medicaid expansion by an enormous 18-point margin. The proposal was placed before the state’s voters by a petition drive, bypassing recalcitrant GOP legislators and controversial Gov. Paul LePage. Regrettably, Page said Wednesday he would not implement the expansion if it is not funded. (11/8)

In this issue of JAMA, Dieleman and colleagues1 report findings from their study in which they examined trends in US health care spending from 1996 to 2013. The authors evaluated the association between 5 factors—population growth, population aging, disease prevalence or incidence, service utilization, and service price and intensity of services—and health care spending over time and also analyzed trends overall and across major conditions. This report is a significant contribution to the literature because trends in health care spending over time, by major categories of spending, accounting for prevalence of disease, and across conditions have not been previously reported. (Patrick H. Conway, 11/7)

The US health system is so mired in politics, with positions hardened by rigid ideologies, that we can’t even seem to talk with one another civilly about difficult tradeoffs. If the polity could agree on core ethical values to guide discourse, we would make hard health system choices based on which values we prefer and why. Herein, I offer 5 critical values for health system reform—universal access, equitable access, affordable access (cost), quality, and choice—explain the tradeoffs, and provide reasons why certain values should take priority. There will be disagreement across the political spectrum, but alternative visions should be justified by reasoned argument. (Lawrence Gostin, 11/8)

IRS Commissioner John Koskinen has made no secret of his contempt for Republicans who tried to hold his agency to account for Tea Party targeting. His payback as he walks out the door is a major hit on employers. The IRS confirmed Tuesday that it is now for the first time beginning to enforce the Obama Care employer mandate, issuing thousands of penalty letters to noncompliant companies. The letters are on the way to firms with more than 50 employees that have failed to provide what ObamaCare defines as qualifying coverage to its workers. The letters reach back to 2015, setting up companies for years of penalties. (11/7)

Is Missouri operating a new stealth prescription drug monitoring program, or has Gov. Eric Greitens simply failed to get his promised program up and running? After saying in July that the program could be operational within weeks, the state Department of Health and Senior Services and the state Office of Administration wouldn’t say Tuesday whether it is. (11/8)

The United States is experiencing a serious epidemic of opioid-related drug addiction that includes a 200% increase in the number of opioid-related overdose deaths from 2000 to 2014. In 2015, there were 52 404 drug overdose deaths in the United States with 33 091 (63.1%) involving an opioid. An important contributor to this epidemic is semisynthetic prescription opioid pain medications (eg, oxycodone and hydrocodone) that are frequently used for nonmedical purposes and are implicated in many opioid overdose deaths. (Demetrios N. Kyriacou, 11/7)