THE PROGNOSIS

Senate Democrats used their truncated August recess to talk to their constituents about one key issue: Health care. 

And though they are returning to Washington tonight, they have no plans to stop talking about it. 

That's a remarkable turnaround for Democrats who have been on the defensive about health care for the better part of a decade. Obamacare played a major role in their loss of control of the House in the first midterm election of President Obama's presidency in 2010. But now, they're hoping to take back the House and retain their seats in the Senate largely by running on the merits of the Affordable Care Act.

Over their 10-day mini break, Sen. Joe Donnelly (D-Ind.) held a roundtable discussion with voters about health care, as did Sen. Joe Manchin (D-W.Va.), who held his third roundtable this year focused specifically on pre-existing conditions. And Sen. Claire McCaskill (D-Mo.) also met with voters with pre-existing conditions on Tuesday. 

“Cutting people off from insurance and making it harder for people to get insurance, we’re all still gonna pay the bill because in America we’re not going to stop people at the door at the emergency room and I’m sorry you don’t have health insurance, we’re gonna let you die," she said, according to Missourinet.

In Nevada, Democratic Rep. Jacky Rosen, who is hoping to unseat GOP Sen. Dean Heller, also held a public meeting with voters with pre-existing conditions.  Sen. Bob Casey (D-Pa.) met with health care providers and patients to talk pre-existing conditions, and Rep. Kyrsten Sinema (D-Ariz.), who is vying for the open Senate seat there, also met with constituent groups to discuss health care.

“It doesn’t matter which community you are in, health care is the number-one issue that Arizonans are talking about,” Sinema told the Arizona Daily Star. “It is not just Arizonans who don’t have health-care coverage, many of those who are expressing concerns and fear are Arizonans who do have coverage but cannot afford it.”

As campaign cycles go, it's still early in this one. And the deluge of ads will really heat up come fall. Republicans still see an opening to talk about rising costs of health care and President Trump continues to declare that the ACA is dead. But unlike years past when the GOP could run on an anti-Obamacare message, this year the party is more likely to focus on other issues like tax cuts and job creation. 

It's harder for GOP candidates to make their case that health care policy is failing in the first election where they are in control of both houses in Congress and the White House. And recent scuttlebutt that Republicans would consider another repeal effort if they held Congress may not be helpful this cycle.

And so Democrats, if August activity is the precursor to the fall campaign, are going all in on health care. 

Earlier this month, the New York Times' Margot Sanger-Katz had a great anecdote from an event with McCaskill. The senator, who may be in the toughest fight of her career, asked voters to stand if they have a pre-existing condition. There were reportedly few people left in their seats. 

The Democrats and the groups who support them have homed in specifically on the warning that if the ACA is struck down, people with pre-existing conditions would lose protection. Notably, McCaskill and Manchin, two of the Democrats' most vulnerable members, are running against state attorneys general who joined a lawsuit arguing the ACA should be deemed unconstitutional. If the law were struck down, it would take with it protections for people with past and current health conditions.

Before the Senate left, Minority Leader Chuck Schumer (N.Y.)  pledged to keep health care front and center this month in Congress, which is in keeping with Democrats' election strategy this year.  Schumer's office declined to show its hand, but on the floor he detailed exactly what the Democrats would be pushing for, including votes to protect people with pre-existing conditions and a Medicare buy-in program. They're unlikely to get those votes, but that's all part of the game plan to keep the attention on health care.

"The number one thing Americans want is health care, and we Democrats will spend August recess focusing on that issue, and forcing Republicans to cast votes or deny votes on those important issues," Schumer said. "It’s a great opportunity, not just for Democrats, not just for Republicans, but for America. We are going to do it."

The first television ad the campaign arm for the Democrats released in 2017 was about health care. It showed a man selling his car and a woman pawning her engagement ring. Then it cuts to them sitting at the hospital bedside of a sick child.

Most of the heavy ad buys are still to come, but an independent analysis of political ads so far this cycle found pro-Democrat ads have been overwhelmingly about health care.  According to Kantar Media/CMAG data by the Wesleyan Media Project, "An astounding 63 percent of pro-Democratic ads for U.S. House discuss healthcare, and 16 percent contain an explicit statement about being in favor of the Affordable Care Act. U.S. Senate contests are less likely to feature health care, but it is still the top issue, appearing in over a quarter (28 percent) of all ad airings."

Take Rosen, the congresswoman running against Heller. She has a television ad that shows her talking to voters about their anxieties over the ACA being repealed. She says in the ad that ACA has "real problems," but repealing it isn't the answer. 

It's a strategy divergent from previous years when Democrats were defensive of their support for Obamacare. They'd make macro arguments about the millions of people who would lose coverage without it. But now, with the focus on pre-existing conditions, they've found a way to make it personal and accessible for voters. 

"What we’re seeing on the trail is that health care remaining the defining issue of the election and voters are aware and concerned that GOP policies will increase their costs and jeopardize their coverage and voters are preparing to hold GOP candidates accountable on this issue," said David Bergstein, a spokesman for the Democratic Senatorial Campaign Committee.

When asked, most Republicans will say they support keeping protections for pre-existing conditions. For example, when asked, McCaskill's opponent, Missouri Attorney General Josh Hawley, said he thinks "insurance companies should be forced to cover pre-existing conditions." 

For his part, Hawley's first television ad of the campaign was about his work as a clerk on the Supreme Court and accused McCaskill of supporting "liberal activist judges."

In a press release in response to the ad, McCaskill's campaign said, "Josh Hawley is suing to strip protections for nearly 2.5 million Missourians with pre-existing conditions."

AHH, OOF and OUCH

AHH:  A new lawsuit filed yesterday aims to block the Trump administration's Medicaid work requirements in Arkansas, which the state began phasing in during the month of June. The suit was filed on behalf of three poor residents of the state who have significant medical problems and want to stop the implementation of the requirements, which say Medicaid recipients must work at least 80 hours a month, look for a job or otherwise engage in the community to start or keep receiving the benefits, our Post colleague Amy Goldstein reports.

The lawsuit charges that the administration’s approval of the state’s plan is unconstitutional and “violates Congress’s power and undermines the basic purpose of the safety-net program created in the 1960s as part of President Lyndon B. Johnson’s War on Poverty,” Amy writes.

The suit alleges the Trump administration is “overturning a half century of administrative practice, and threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country,” which is language similar to a lawsuit that was successfully brought forth in Kentucky.

Amy writes that the case highlights the divide over how people view the relationship between the government and the poor. “Conservatives, including the administration’s senior health officials, say that Medicaid recipients should be required to fulfill certain obligations, such as work requirements, and that such activities would lift people out of poverty and government reliance,” she writes. “Liberals regard the health-care program as a right for anyone who is eligible, and they maintain that access to care is an underpinning for poor people to improve their lives.”

OOF: The latest Ebola outbreak in the Democratic Republic of Congo has spread to the province of North Kivu, and has now entered an active conflict zone and increased the possibility of a wider outbreak, the Wall Street Journal’s Nicholas Bariyo reports.

The new outbreak’s location is tricky for response efforts as it lies in a war zone.

Five new cases were confirmed yesterday in Ituri province, which borders North Kivu, as well as the town of Mangina, Nicholas reports. The total number of confirmed cases is now 27 and probable cases to 30.

“The World Health Organization’s director-general, Tedros Adhanom Ghebreyesus, visited North Kivu last week, where he urged free and secure access for health officials,” Nicholas writes, adding officials have “put in safeguards” for the safety of health officials. 

OUCH: New research published in the Journal of the American Medical Association suggests traumatic brain injuries may increase the risk of suicide. The study found of the 7.5 million people in Denmark, there were more than 34,500 suicide deaths between 1980 and 2014 and about 10 percent of those who took their own lives also had medically documented traumatic brain injuries, our Post colleague Amy Ellis Nutt reports.

“Individuals with mild TBI, with concussion, had an elevated suicide risk by 81 percent,” study author Trine Madsen of the Danish Research Institute of Suicide Prevention told Amy. “But individuals with severe TBI had a higher suicide risk that was more than double [the risk of someone with no TBI].”

The severity of the TBI, a first occurrence of a TBI in young adulthood and a hospital discharge —following a TBI were three factors that most strongly predicted suicide risk.

AGENCY ALERT

— The Food and Drug Administration last week approved what is the first government-approved app designed to prevent pregnancy.

The Natural Cycles app is marketed as a “natural method of contraception that is powered by a smart algorithm,” our Post colleague Rachel Siegel reports. It calculates and identifies women’s fertility based on information about menstrual cycles and basal body temperature.  Rachel notes that gynecologists and women who have used the app say it’s only as good as the information women enter in it, and that unexpected pregnancies have occurred.

The app had a failure rate of 1.8 percent during clinical studies among the women who used the app exactly as directed, with a “typical use” failure rate of 6.5 percent, which included women who had unprotected sex on fertile days.

“For comparison, the CDC’s failure rate of birth control pills is roughly 9 percent,” Rachel reports. “Hormonal IUDs have failure rates of less than 1 percent, and condoms roughly 18 percent. And in fact, the only fool-proof way to avoid pregnancy is to not have sex.”

OPIOID OPTICS

— Authorities in Nebraska yesterday carried out an execution using fentanyl, the potent synthetic opioid that has been at the center of the ongoing opioid crisis. The execution was one of a series of firsts for the state, including the first execution in 21 years, its very first lethal injection and the first death sentence carried out with fentanyl. Even more notable was that the execution represented  a remarkable reversal to carry out a death sentence after the state briefly abolished capital punishment just three years ago, our Post colleague Mark Berman reports.

Carey Dean Moore, a 60-year-old inmate who was sentenced to death for killing two Omaha taxi drivers, was executed yesterday after spending more than half of his life on death row. 

"The execution drew an unusual amount of attention, in large part because authorities chose to utilize fentanyl even as law enforcement officials are aggressively trying to get the potent drug off of the streets and highlighting its role in the ongoing opioid crisis," Mark writes. "The state’s plan called for it to use four drugs in total, two of which prompted a recent lawsuit from a drug company arguing Nebraska was going to use its products and unsuccessfully trying to block Nebraska from using them."

Mark reports that drug companies, in an effort to block their drugs from being involved in death sentences at all, have “imposed strict limits on who can buy the drugs used for lethal injections, asked states to return some chemicals and, in one case, completely stopped making a drug to keep it out of the nation’s death chambers.”

INDUSTRY RX

— Billionaire activist investor Carl Icahn is backing down from his plan to convince stakeholders in Cigna Corp. not to vote on a $54 billion merger with Express Scripts, the nation’s largest pharmacy benefit manager. Icahn had penned an open letter to stakeholders warning of “existential risks” if the deal went forward.  But Icahn halted his plan "after two proxy-advisory firms recommended shareholders support the deal" the Wall Street Journal’s Cara Lombardo reports. "Significant shareholder overlap between the two companies, which he initially hoped had decreased since the deal was announced, was also a factor in his decision,”

STATE SCAN

— Proponents of legalizing recreational marijuana in North Dakota have acquired enough petition signatures to get the issue on the November ballot, the secretary of state announced this week. Supporters submitted 17,695 ballots, which was tallied as 14,637 valid signatures, up from the 13,452 needed to get on the ballot.

A previous petition drive failed in 2016, the Associated Press’s Blake Nicholson reports.

“The North Dakota Sheriff’s and Deputies Association believes legalizing recreational marijuana would create more problems for law enforcement in the state, where more than half of drug arrests already involve marijuana,” Blake writes. “The association in May passed a resolution opposing the ballot measure. Officers worry about potential problems such as more impaired drivers and fatalities, and more domestic disputes. Mental health and addiction treatment facilities also could feel a strain, said Billings County Sheriff Pat Rummel, president of the association."

— And here are a few more good reads from The Post and beyond:

The nation’s largest legal marijuana market is struggling.
Associated Press
National
Marijuana packaging and other waste is putting the state’s environmentalist credentials to the test.
Kristen Millares Young
REPRODUCTIVE WARS
Politics
The Supreme Court nominee will sit down with several Democrats this month, but the White House says his time is limited because he needs to prepare for confirmation hearings.
Seung Min Kim
Will a new Supreme Court with two Trump-appointed justices overrule Roe v. Wade? It's possible, but not the most likely outcome. Adam Liptak, a New York Times reporter, explains.
The New York Times
TRUMP TEMPERATURE
Virginia Politics
Gov. Ralph Northam had ordered the investigation of the center, which is still the subject of a lawsuit.
Laura Vozzella
MEDICAL MISSIVES
Mario Schlosser, the CEO of Oscar Health, wants technology to cure what ails the health care industry. And now Alphabet, Google's parent company, is betting $375 million on this digital panacea.
Wired
Express Scripts Holding Co built a multi-billion enterprise pressuring drug companies to lower their prices for U.S. patients. Now it is quietly building a side business: getting paid to help drug companies dispense a new generation of high-priced drugs.
Reuters
DAYBOOK

Coming Up

  • The House Financial Services Committee holds a hearing on “The Role of Federal Housing and Community Development Programs to Support Opioid and Substance Use Disorder Treatment and Recovery” on Thursday.
  • The Senate Homeland Security and Government Affairs Permanent Subcommittee on Investigations holds a hearing on “Oversight of Efforts to Protect Unaccompanied Alien Children from Human Trafficking and Abuse” on Thursday.
  • The Senate Homeland Security and Government Affairs Committee holds a hearing to examine “Centers for Medicare and Medicaid Services efforts to fight Medicaid fraud and overpayments” on Aug. 21.
SUGAR RUSH

Trump's tension with Omarosa Manigault Newman, from the boardroom to the White House:

Tiffany Trump remains publicly apolitical at Georgetown Law: