THE PROGNOSIS

The Democrats' strategy to focus on health care in the midterm elections has helped crack open opportunities in states they wouldn't have dreamed of winning two years ago, bolstering their chances  of retaking the Senate majority.

Democrats running for the open Senate seats in Arizona and Tennessee are currently leading their Republican opponents, according to a CNN poll released this week.

In Arizona, Rep. Kyrsten Sinema (D) leads Rep. Martha McSally (R) by 7 points, 50 percent to 43 percent among likely voters. In Tennessee, former governor Phil Bredesen (D) is up by 5 points over Rep. Marsha Blackburn (R), 50 percent to 45 percent.

In these traditionally red states where Republicans have held the seats for several decades, health care tops the list of issues that concern voters most. The voters who named health care as their most important issue overwhelmingly supported the Democratic candidate 75 percent to 14 percent in Arizona and 71 percent to 21 percent in Tennessee. 

Heading into the 2018 midterms, the Senate map for Democrats was as tough as it gets. Many of their incumbents are defending seats in states won by President Trump while only one Republican is running for reelection in a state won by Hillary Clinton. In other words, they had only one potential seat to pick off and a significant number to lose. 

This election is by and large a referendum on President Trump, but Democrats nationwide have seized on health care -- and Republican attempts to take it away -- as a central part of their campaign messaging. They have flipped the script from previous campaigns, when the GOP motivated voters by vowing it would repeal and replace Obamacare -- which the Republicans  tried to do in 2017, without success.

In some cases Democrats have tacked to left, unafraid to adopt progressive ideas like universal health care or "Medicare for all." Others playing it safer are focused on saving the most popular parts of the Affordable Care Act, namely protections for people with preexisting conditions

The latter is true of the two candidates in Arizona and Tennessee. Let's break down each example. 

Sinema is a progressive turned centrist in a state that has grown accustomed to representation from independently minded thinkers (the late-Sen. John McCain and retiring Sen. Jeff Flake). She's been critical of the ACA and has dismissed "Medicare for All" as unrealistic. Still, health care has been center stage in her campaign and her TV ads.

Here's one about protecting preexisting conditions:

And here's another that speaks generally about the need for affordable health care:

Meanwhile in Tennessee, Bredesen has traveled the state holding roundtables about health care. Like Sinema, he's taken a moderate approach to the issue — he told voters he'd be "shot, tarred, feathered, and driven out of town" if he supported universal health care.

Bredesen's record on health care is complicated. In his first years as governor he made drastic cuts to the state's ballooning Medicaid program, causing hundreds of thousands to lose coverage.  He's since called it "an extraordinarily difficult and painful decision," but defended it, saying he inherited a program that was bankrupting the state.

He's even got a campaign ad arguing that he saved the program: 

“Democratic campaigns in these states – and across the Senate map – are talking about health care because it’s the defining issue of this election," David Bergstein, the spokesman for the Democratic Senatorial Campaign Committee, told me. "For voters it’s an issue deeply tied to their personal economy, it’s driving their electoral decision making, and they’re going to punish every GOP Senate candidate for their party’s agenda that spikes health care costs and cuts coverage for preexisting conditions.”

Arizona and Tennessee aren't the only states where Democrats are showcasing their health-care message.

Democrats defending seats in red states, like West Virginia Sen. Joe Manchin and Missouri Sen. Claire McCaskill, are laser-focused on the threat of a pending lawsuit taking down the ACA and with it protections for preexisting conditions. Notably, those two senators are running against their state's attorneys general who are part of the Texas-led lawsuit to bring down the ACA. 

Manchin, now famously, is airing a TV ad where he literally shoots the Texas lawsuit. McCaskill is producing 30 videos over 30 days each telling the story of a constituent with a preexisting health condition. 

Even in Texas, a state suddenly within reach for Democrats, Senate candidate Beto O'Rourke (D) is running on affordable health care, which is slightly ironic given his opponent Sen. Ted Cruz (R) sailed to victory in 2012 on a promise to repeal the ACA. Now O'Rourke is telling Texans the law doesn't go far enough. Unlike Sinema and Bredensen, O'Rourke has unabashedly promoted universal health care. 

The Democrats' health-care push has put Republicans on their heels. The GOP has tried to convince voters they also want to save protections for people with preexisting conditions, but the pending lawsuit and past repeal efforts have made it difficult for Republicans to argue their position. 

As Politico's Adam Cancryn wrote in a piece that ran last night, Republicans are "grasping to find a new health care message less than two months before midterm elections. Their inability to neutralize the pre-existing condition issue is hurting their efforts in tight races that could determine control of Congress."

The ACA is not the only health-care related topic playing a role in these midterms. Candidates are also making ads about the opioid crisis. 

The Wall Street Journal, using television advertising data from Kantar Media/CMAG, reported Thursday that in the 2014 midterms there was only one campaign ad in Kentucky that mentioned opioids and it aired 70 times. This year, candidates across the country have aired opioid-related ads a collective 50,000 times. 

The ads promise "more funds for treatment and stopping the inflow of opioids from elsewhere," the Journal reports, and while the issue is showing up more frequently in Republican ads, both parties are using it. 

If lawmakers are spending precious campaign dollars on addressing the crisis it's no wonder there's such a mad dash to complete the opioid package before November to make good on their promises. 

AHH, OOF and OUCH

AHH: The effort to rapidly confirm Brett M. Kavanaugh continues, even as Christine Blasey Ford, who has accused the Supreme Court nominee of sexually assaulting her when they were teenagers, criticizes the rush for a public hearing on Monday.

Republican senators are pushing for a vote as it appears Ford may decline to testify before the Senate Judiciary Committee, our Post colleagues Seung Min Kim, Josh Dawsey and John Wagner report. “Trump is more convinced he should stand by Kavanaugh than he was two days ago, people close to the White House say,” they write. “Publicly, Trump has become more vocal in defending Kavanaugh, telling ‘reporters on Wednesday that it was ‘very hard for me to imagine anything happened.’”

But Our Post colleague Robert Costa notes that “privately, discussions about the political fallout gripped the party, with Republican lawmakers and strategists unnerved by the charged, gender-infused debates that have upended this campaign season.

“Already burdened by an unpopular president and an energized Democratic electorate, the male-dominated GOP is now facing a torrent of scrutiny about how it is handling Kavanaugh’s accuser and whether the party’s push to install him on the high court by next week could come at a steep political cost with women and the independent voters who are the keystone for congressional majorities,” he adds.

Meanwhile, Ford has through her lawyers requested the FBI look into the alleged incident before she were to speak to the Senate panel, as Republicans continue to insist the FBI does not need to et involved.

“Meanwhile, White House aides have begun asking lawyers and others whether other women are likely to come out and make accusations,” our colleagues report.

“Sen. Susan Collins (R-Maine), a pivotal swing vote on Kavanaugh’s confirmation, and Sen. Jeff Flake (R-Ariz.), a member of the Judiciary Committee, both urged Ford to speak to senators,” they add. “And Sen. Bob Corker (R-Tenn.), who like Flake also pushed the Senate to hit pause on Kavanaugh’s nomination until lawmakers heard from the professor, said: 'If we don’t hear from both sides on Monday, let’s vote.’”

OOF: It appears the Trump administration has lost track of more than a thousand migrant children. According to congressional findings released this week, the administration is unable to account for about 1,500 migrant children who entered the country illegally and alone this year and later were placed with sponsors, the New York Times’s Ron Nixon reports.

Senate investigators note the Department of Health and Human Services “could not determine with certainty the whereabouts of 1,488 out of 11,254 children the agency had placed with sponsors in 2018, based on follow-up calls from April 1 to June 30.” The findings also follow an acknowledgment from the department in April that it had lost track of 1,475 migrant children that had been moved out of shelters last year, Ron writes.

“The inability to track the whereabouts of migrant children after they have been released to sponsors has raised concerns that they could end up with human traffickers or be used as laborers by people posing as relatives,” he wrote. “Since 2016, officials at the Department of Health and Human Services have called sponsors to check on children 30 days after they were placed there. But the department has also said it was not legally responsible for children after they were released from the custody of its office of refugee resettlement.”

OUCH: Two mental-health patients who were in the back of a sheriff’s van drowned when deputies drove down a South Carolina road flooded by Florence. The deputies were transporting the women to a hospital. 

The sheriff’s van "picked up Wendy Newton, 45, and Nicolette Green, 43, at a hospital in Loris — a small town north of Myrtle Beach that lacked a mental-health ward," The Post's Avi Selk reports. "The van was bound for Florence, about an hour’s drive northwest in good conditions. But that afternoon, in the storm’s aftermath, it wound through a treacherous maze of closed roads and floodwaters pouring off the Pee Dee River and its tributaries."

When the van encountered a flooded road, it "ran off the road," according to coroner Jerry Richardson. "In a statement, the sheriff’s office said two deputies escaped from the cab and tried to get the women out of the back," Avi writes, but they were unable to open the doors.

The New York Times’s Tyler Pager, Campbell Robertson and Chris Dixon report the two deputies involved in the incident have been put on administrative leave.

“The women were not being evacuated from floodwaters,” they write. “They were both being taken from hospitals, where they had come voluntarily, to mental health facilities, where they had been committed. At the news conference, Sheriff Thompson said that his department had been responding to a court order to transport the women.”

They add the women’s families had not heard about any court orders.

AGENCY ALERT

— HHS announced $1 billion in grants to states and communities to address the opioid crisis.

“Addressing the opioid crisis with all the resources possible and the best science we have is a top priority for President Trump and for everyone at HHS,” Health and Human Services Secretary Alex Azar said in a statement. “The more than $1 billion in additional funding that we provided this week will build on progress we have seen in tackling this epidemic through empowering communities and families on the frontlines.”

Included in the funding doled out by the department is $930 million from the Substance Abuse and Mental Health Services Administration for state efforts to support treatment and recovery support services for opioid abuse. The Health Resources and Services Administration awarded $352 million  to increase services at 1,232 community health centers. The CDC also awarded $194 million to support state efforts on preventing opioid-related overdoses and deaths, according to a news release.

HEALTH ON THE HILL

— A bipartisan group of senators has introduced a bill that would allow hospitals to increase the number of addiction patients it can take in at a time.

Under current Medicaid rules, the so-called “IMD exclusion” limits payments for substance abuse treatment at facilities with more than 16 beds. A provision increasing that number was dropped from the sweeping opioids package the Senate passed earlier this week.

Sens. Rob Portman (R-Ohio), Richard J. Durbin (D-Ill.), Benjamin L. Cardin (D-Md.) and Sherrod Brown (D-Ohio) introduced Tuesday the Improving Coverage for Addiction Recovery Expansion Act that would lift the long-standing ban, the Washington Examiner’s Kimberly Leonard reports.

“The ban has created long lines for medical care at a time when more than 40,000 people a year are dying from opioid overdoses,” Kimberly writes. “The exclusion would apply not only to treatment for an opioid addiction, but to all types of addictions. This differs from the bill passed by the House, which would have allowed hospitals to bill Medicaid only for treating addictions to cocaine and to opioids. The Senate bill would make the repeal on the ban permanent, while the House legislation applies for five years. The Senate bill also allows patients to stay in the hospital for up to 90 days, rather than its current 30-day limit.”

STATE SCAN

— Maine Equal Justice Partners, an advocacy group that is pushing for Medicaid expansion, is calling on the Trump administration to approve the state’s request to expand the program. In a letter to the Centers for Medicare and Medicaid Services sent this week, the group also calls on CMS to dismiss Republican Gov. Paul LePage’s request to reject the expansion plan.

“Expanding the Medicaid program is by federal law a step that Maine is entitled to take, and the choice to take that step is now the established law of the state of Maine,” wrote Charles Dingman, an attorney representing the group in a letter dated Sept. 14.

“Despite the vote last year enacting Medicaid expansion, [LePage] has refused to implement it. LePage submitted an application for Medicaid expansion earlier this month after a court ordered him to do so, but he also sent a letter to the Trump administration urging it to reject the application,” The Hill’s Peter Sullivan reports. “The showdown sets up a decision for the administration on what it will do in the face of an application for expansion that supporters say is legally required, but that is opposed by a fellow Republican in LePage.”

— The pharmaceutical industry has spent half a million dollars on a California policy fight with no explicit health-care connection. PhRMA, the pharmaceutical industry's biggest lobbying group, has contributed $500,000 to support an effort from landlords, developers and real-estate investors who are opposing a ballot measure in the state that would expand rent-control protections, Stat’s Lev Facher and Rebecca Robbins report.

“The group says that it’s getting involved in the ballot measure at stake, called Proposition 10, because it fears passage could make housing harder to find for the nearly 900,000 employees who work in biopharma in the state,” Lev and Rebecca report. “Some economists have expressed concern that it could discourage the construction of new housing and make life harder for low-income renters in the long-term.

“But some people here suspect that PhRMA is using its financial clout to settle an old political score with Michael Weinstein, a longtime HIV/AIDS activist who has repeatedly tangled with the drug industry, most recently by bankrolling a set of state-level ballot measures aimed at capping drug prices.” Weinstein, who leads the AIDS Healthcare Foundation that has provided a bulk of the financial backing for the ballot measure, told Stat he believes PhRMA’s spending is payback, Lev and Rebecca write. “They consider us an enemy, and they have unlimited money to spend on anything they want,” Weinstein said. “It’s preposterous for them to say they have an interest in this issue.”

— And here are a few more good reads: 

TRUMP TEMPERATURE
President Trump said Wednesday that he believed differences on healthcare between Republicans and Democrats could help bolster the party into a "red wave" for the midterm elections.
Washington Examiner
Lower-price drugs would hit the market faster under a bipartisan bill awaiting a vote in the Senate, according to a score released Wednesday by the Congressional Budget Office and the Joint Committee on Taxation.
Washington Examiner
MEDICAL MISSIVES
African-Americans are widely underrepresented in clinical trials for cancer drugs, even when the type of cancer disproportionately affects them.
Stat
INDUSTRY RX
GENEVA (AP) — The latest Ebola outbreak in Congo presents complex challenges as the virus spreads for the first time in an area where long-running conflict is hampering aid efforts, the regional Africa chief for the International Federation of the Red Cross said Wednesday.
Associated Press
A rogue pharmaceutical company ramped up the cost of a common antibiotic by 400 percent. While the medical community is irate, could high prices make antibiotics worth investing in?
WIRED
DAYBOOK

Today

  • The FDA holds a meeting of the Pharmaceutical Science and Clinical Pharmacology Advisory Committee.
SUGAR RUSH

The Post’s Nicole Ellis breaks down the cost of egg freezing:

From the Fact Checker: Brett Kavanaugh’s unlikely story about Democrats’ stolen emails| Fact Checker