By Kyle Cheney

With help from Jennifer Haberkorn and Joanne Kenen

MEDICARE IN PLAY AS FISCAL CLIFF APPROACHES – The nation careened closer to the fiscal cliff Wednesday, and Congressional leaders quickly cast themselves as ready to deal with newly reelected President Barack Obama. It’s a convenient post-election posture that could crumble as easily as it holds up, if history is a guide, and leaders were sure to couch their promises with partisan jabs. But the initial indication is that the future of Medicare and Medicaid are central to any efforts to right the national economy. From Pro’s Brett Norman: “Obama already has put major concessions on the table. … Insurers, providers and Medicare advocates are girding to protect their interests as the fiscal cliff negotiations are almost certain to bring these proposals — and possibly more — back into play.”

--THE BASELINE: “Last September Obama offered to cut an additional $248 billion over 10 years from Medicare and $72 billion from Medicaid — as part of a $3 trillion deficit proposal that included substantial revenue increases that Republicans didn’t accept. … And during talks with House Speaker John Boehner in the summer of 2011, Obama indicated he was open to gradually raising the Medicare eligibility age from 65 to 67.” http://politico.pro/RjdYIH

WHAT JOHN BOEHNER SAID – At a news conference Wednesday, the House speaker made clear he’s willing to talk revenue increases — but only in conjunction with spending cuts and “real changes to the structure of entitlement programs.” Although he bolted without taking questions, he repeatedly emphasized that only this comprehensive approach would win enough support in his chamber to pass.

WHAT HARRY REID SAID – The Senate majority leader didn’t say much about entitlements but said he’s ready to be as “conciliatory as possible” in working with Republicans. “I want to work together, but I want everyone to also understand, you can’t push us around if you want to work together,” he said at a Capitol press conference.

Welcome to Thursday PULSE, the back-to-business edition. Amid the traditional post-election navel gazing, observers drubbed pundits who had offered wildly inaccurate predictions of the outcome. Some claimed they underestimated President Obama’s ground game. Others said they misunderstood the permanent change to the electorate that began in 2008. But here’s a novel theory about one of the few pollsters who got it right: http://bit.ly/RGmzGD. Makes you wonder, huh?

“I've made up my mind, PULSE ain't wasting no more time.”

SEBELIUS STICKING AROUND FOR OBAMA 2.0? — POLITICO’s Edward-Isaac Dovere gazes into the crystal ball for insight about Obama’s second-term team. For health care Pros, the main takeaway is that HHS Secretary Kathleen Sebelius looks like she’s staying put: “She’s steeped in Obama’s health care law, and with the amount of work needed to prepare for most of its provisions to take effect in 2014, making a switch now could complicate things. Since confirmation hearings for a new nominee would inevitably become an Obamacare retrial, the argument to keep her gets even stronger.”  http://politi.co/Z1rGDb

ACA MAY GET ITS DAY IN COURT … AGAIN – Legal challenges to Obama’s health care law — most notably, it’s contraceptive coverage requirements — could trip up the law’s implementation now that it seems likely to remain on the books. Pro’s Jennifer Haberkorn and Kathryn Smith report that the likelihood of a prolonged court batter over the law (again) would prove an unwelcome distraction for an Obama administration that’s ready to move on: “These legal challenges pose little threat to the law’s infrastructure, unlike the challenge to the individual mandate, which would have ripped out a significant piece of the law. And it’s too early to judge the ultimate success of this test. But if the Supreme Court case against the individual mandate demonstrated anything, it’s that even an ultimately unsuccessful legal challenge can pose quite a distraction.” http://politico.pro/T7MN3k

--THESAURUS, PLEASE – Looking ahead to 2014, Pro Health decided that health reporters could use a few synonyms for “implementation.” So one of us tweeted a request to colleagues and got many suggestions (enact, adopt, phase in, launch, install, put in place, begin, kick start, carry out, even ACAzation ). Someone suggested “execution” but we figured that might be a synonym for Democrats, but maybe an antonym for Republicans.

** A message from UnitedHealthcare: At UnitedHealthcare, we're using our experience and access to vast health care information to make health care simpler and more responsive. Learn more at www.uhc.com **

REPUBLICAN GOVS NOT CHANGING TUNE ON ACA — The AP reports that Florida Gov. Rick Scott won’t implement the health law just because Obama won reelection. And his neighbor, Georgia Gov. Nathan Deal, has no plans to implement a health insurance exchange. “Deal … confirmed the state stopped planning an exchange once federal agencies wrote regulations that Deal says restrict Georgia's ability to design its own program.” Scott, meanwhile, contended that the health law would still provide too expensive for Florida to implement. The latest on Deal: http://cbsn.ws/TuPCJz. The latest on Scott: http://bit.ly/TwL5IH

STRATEGISTS: LEAVE ENTITLEMENTS ALONE — Democracy Corps, helmed by Democratic strategists James Carville and Stanley Greenberg, has some table-setting insight for Democrats as they approach to fiscal cliff negotiating table: hold the line on entitlements. A sample of 1,700 voters interviewed by the organization suggested that 60 percent want Medicare and Social Security ruled out of any deal. In addition, women rejected Republican presidential contender Mitt Romney’s opposition to Planned Parenthood.

DOCS WAIT ON RESULTS -- The two Democratic physicians hoping to oust California Republicans still don't know if they've been successful. Dr. Ami Bera's (who is running against Rep. Dan Lungren) and Dr. Raul Ruiz's (who is running against Rep. Mary Bono Mack) races are still outstanding. Bera is up by 184 votes.

 --“Although we do not know our race’s final results, we feel confident going into the next several days,” said Bera said in a statement. “The Sacramento County Registrar of Voters is doing an incredible job with the difficult task of counting tens of thousands of provisional and absentee ballots. The top priority right now is to make sure that every vote is fairly counted.”

 --In the Bono Mack-Ruiz race, Ruiz is up as well. But Bono Mack said she’s waiting for the final ballots to be counted.

CHANGES COMING FOR E&C COMMITTEE -- Speaking of Bono Mack, the powerful House Energy and Commerce Committee is in for a shakeup next year after a tumultuous election that left GOP members locked in nail-biters and at least, one — New Hampshire Rep. Charlie Bass — ousted. The committee’s ranking Democrat, Henry Waxman, was nearly defeated. Reps. Mary Bono Mack and Brian Bilbray trailed by narrow margins after the votes were tallied Tuesday. More: http://politico.pro/SuVWSw

MENINGITIS OUTBREAK CLAIMS ANOTHER LIFE – This time in Indiana, where a fourth person died in the national outbreak tied to a drug compounding center in Massachusetts. The CDC reports that the death toll has risen to 31, up one from Monday. Tennessee has seen the most deaths, with 17. The number of cases overall climbed to 424 from 419 since Monday’s count. The latest figures: http://1.usa.gov/QfR6sS

WHAT WE’RE READING, by Kathryn Smith

Kaiser Health News takes a look at the changes Election Day brought to state legislatures and governors, and how it could affect rollout of the health care law. http://bit.ly/XjWfpi

Bloomberg notes hospitals saw shares rise Wednesday after Obama’s reelection, while insurers saw declines. http://bloom.bg/YJBXol

The Wall Street Journal checks in with abortion rights and anti-abortion organizations as they score victories and losses of candidates they supported. http://on.wsj.com/SNDZB9

The Vatican offers President Obama congratulations but reminds him of where he differs with the Catholic Church: abortion and the contraception coverage requirement, Reuters reports. http://reut.rs/VT9dVR

The New York Times highlights the legal complications in two states that passed ballot measures easing restrictions on marijuana use. http://nyti.ms/SDp4Ya

In a letter to GOP colleagues Wednesday, Rep. Eric Cantor (R-Va.) identified IPAB repeal as an area that could find Senate support, The Hill’s Healthwatch reports. http://bit.ly/VFlFgC

** A message from UnitedHealthcare: When it comes to health care, you have questions, concerns and doubts. We believe you deserve thoughtful answers and simpler, more responsive health care. That's where UnitedHealthcare comes in. We see information and data from across the health care system and we are using those numbers to innovate programs and tools. We are more than 78,000 people looking out for more than 70 million Americans. THAT'S HEALTH IN NUMBERS. www.uhc.com **