THE PROGNOSIS

Republicans are facing a triple whammy on health care in the midterm campaign.

Here's how:

1. They failed to achieve a pair of coveted goals — namely, repealing Obamacare and slashing entitlement spending — despite controlling both the White House and Congress for two years.

2. That has not stopped Democrats from pummeling them over this unaccomplished GOP to-do list and possibly seizing back control of the House.

3. Just as Republicans are trying to back away from the issue, polls show that health care tops the list of voters’ worries heading into Election Day -- Democrats hold an edge in which party is more trusted to tackle the issue.

As we’ve written extensively at The Health 202, Democrats have spent this election cycle running full-steam ahead on charges that Republicans want to do away with protections for Americans with preexisting conditions. This week, they seized on additional narratives: Republicans will aim to slash Medicare and Social Security if they retain the majority, twin entitlement programs upon which seniors heavily rely.

Senate Majority Leader Mitch McConnell (Ky.) also said Republicans, if still in control in January, will try again to repeal and replace Obamacare.

The Senate leader opened the door to the entitlement attacks by telling Bloomberg News the deficit was disturbingly large, arguing the growing cost of big programs like Medicare and Social Security was to blame despite the estimated $2 trillion price tag of the GOP tax cut overhaul over 10 years. But McConnell also admitted that even if Republicans stay in charge, he would need Democrats to achieve any real overhaul of entitlement spending. The move would be politically risky and the leader would also likely need Democratic votes.

“We all know that there will be no solution to that, short of some kind of bipartisan grand bargain that makes the very, very popular entitlement programs be in a position to be sustained,” he told Reuters.

McConnell is clearly trying to reframe the spending debate, which could be costly (pun intended) for Republicans who have fashioned themselves as guardians of fiscal restraint over the past decade. Under GOP congressional control, deficit spending has ballooned with the Treasury Department reporting on Monday that it has reached its highest level in six years. And Trump doesn't have any desire to curb deficit spending, telling the Associated Press that “I’m not touching Social Security.”

Democrats predictably pounced on McConnell's comments on entitlements:

Sen. Jeff Merkley (D-Ore.):

Rep. Tim Walz (D-Minn.):

Sen. Tammy Baldwin (D-Wis.):

Sen. Joe Manchin III (D-W.Va.):

GOP strategist Lanhee Chen told me he thinks the party has moved away from discussing spending because of President Trump, who expresses little concern about deficits in sharp contrast to the tea party’s emphasis in years past.

“The president has not made it a priority,” he told me. “This is the kind of thing that does require presidential leadership, and the notion of deficit reduction is nowhere in the president’s vocabulary.”

McConnell seems to agree with that analysis. PBS Newshour correspondent Lisa Desjardins:

Even though Republicans didn't succeed in eliminating the ACA, they sure did try -- and they're paying the political price for that. The high-profile effort opened them up to a constant flood of accusations from Democrats that they tried to take away health coverage and preexisting protections from vulnerable Americans.

It’s hard to overstate how pivotal health care seems to be for voters in this year’s election. It’s the No. 1 issue for voters, per polling released this morning by the Kaiser Family Foundation, topping even the economy as the biggest factor affecting who people will vote for. That stands in contrast to every other election since the ACA was passed in 2010, when health care was a top consideration but certainly not voters’ chief worry.

Although there’s a clear partisan divide on the issue — with far more Democratic than Republican voters ranking health care high on their lists — it’s notable that independent voters said health care is their biggest issue. In battleground areas, 28 percent of voters identified it as chief among their worries.

To be clear, voters are not clamoring to protect the ACA, although the landmark bill protects many of the things that they seem to embrace. Far more poll respondents said they're most concerned about the cost of and access to health care — concerns that Democrats are trying to play into with their focus on preexisting condition protections. 

It’s hard to wrap our minds around how much health-care politics have flipped in the past two years. Now it’s Democrats constantly referring to the topic in ads and on the campaign trail, after four elections of Republicans yelling at them about repealing Obamacare.

At least we’ll soon know how well Democrats’ strategy worked.

AHH, OOF and OUCH

AHH: In the interview with Reuters, McConnell also suggested Republicans would take yet another stab at trying to repeal and replace the ACA after midterms.

He called Republicans’ failed attempt to repeal the health-care law “the one disappointment of this Congress from a Republican point of view.”

“If we had the votes to completely start over, we’d do it. But that depends on what happens in a couple weeks,” he said. “We’re not satisfied with the way Obamacare is working.”

“Repealing the Affordable Care Act remains popular with the Republican base, however, and McConnell’s remarks could be aimed at turning out core voters ahead of next month’s election,” our Post colleague Felicia Sonmez writes.

And Democrats, of course, seized on the majority leader’s comments. The Democratic National Committee, the Senate Democratic campaign arm, House Minority Leader Nancy Pelosi (D-Calif.) and Senate Minority Leader Charles E. Schumer (D-N.Y.) all released statements calling McConnell’s remarks a signal of Republicans’ agenda should they win in November.

“Americans should make no mistake about it: If Republicans retain the Senate, they will do everything they can to take away families’ health care and raise their costs, whether it be eliminating protections for pre-existing conditions, repealing the health care law, or cutting Medicare and Medicaid,” Schumer said in a statement. “Americans should take Senator McConnell at his word.”

OOF: The number of migrant families crossing into the United States surged to yet another record last month. The amount of migrant parents entering the country with children has hit record levels in the three months since the Trump administration ended it’s controversial family separations at the U.S. border with Mexico. 

In September, U.S. Border Patrol Agents arrested 16,658 family members, up 80 percent since July, when the administration halted its policy of separating families at the border.

And the record increases are coming at a politically problematic time for the president, who “campaigned on a promise to stop illegal immigration and build a border wall,” The Post’s Nick Miroff and Josh Dawsey report.

“Aides including [senior policy adviser Stephen Miller] and White House press secretary Sarah Huckabee Sanders have continually told the president that many of the children coming across the border are being smuggled illegally and that the United States is being taken advantage of," they write. "The president’s welling anger has left him pushing once more for a reinstatement of a family-separation policy in some form, which he believes is the only thing that has worked, despite the controversy it triggered."

"The number of 'unaccompanied alien children' and single adults apprehended remained essentially unchanged last month, another indication that more migrants who might have traveled alone in the past are now bringing children with them," they add.

OUCH: At least 92 people across 29 states have been infected with a strain of drug-resistant salmonella as a result of raw chicken products, according to the Centers for Disease Control and Prevention.

No deaths have been reported so far, and the CDC said 21 people had been hospitalized as of yesterday, CNN’s Jen Christensen reports. The particular salmonella strain is resistant to multiple antibiotics.

“The source of the raw chicken is unclear from lab tests, and no single common supplier has been identified,” Jen reports. “The strain has shown up in samples from a variety of raw chicken products including pet food, chicken pieces, ground pieces and whole chickens. The bacteria have also been found in live chickens.”

The CDC is investigating the outbreak, which is also being monitored by the U.S. Department of Agriculture's Food Safety and Inspection Service.

MEDICAL MISSIVES

— The World Health Organization decided not to declare the outbreak of Ebola in the Democratic Republic of Congo a public health emergency of international concern.

"We do have some optimism that this outbreak, just like the one in May, will be brought under control in reasonable time," said Robert Steffen chairman of the WHO International Health Regulations Emergency Committee, CNN’s Debra Goldschmidt and Susan Scutti report.

“If an emergency had been declared, it might have negatively affected travel and trade, which in turn might have hindered the response team efforts,” they write.

Since the beginning of the latest outbreak in August, there have been 216 cases of Ebola, including 139 deaths and 57 people who have recovered from the illness, they write.

AGENCY ALERT

— The CDC and the Alzheimer’s Association today are launching a guide for the next five years that outlines strategies for addressing Alzheimer’s disease as a public health crisis.  The CDC's Behavioral Risk Factor Surveillance System reports 11 percent of adults ages 45 and up have experienced cognitive decline in the last year, according to a news release, but more than half don't discuss it with a health-care provider. The framework from the CDC and Alzheimer's Association looks to the public health community to help reduce risk, and expand early detection and diagnosis of the Alzheimer's disease, among other strategies.

INDUSTRY RX

— Drug manufacturing giant Pfizer plans to cut 2 percent of its global workforce by the early part of next year.

The company, which has about 90,000 employees worldwide, will shrink its staff through voluntary retirements and layoffs between now and then, Reuters reportsSpokeswoman Sally Beatty told Reuters the move was “about creating a simple, more efficient structure and not achieving cost savings.”

“The move follows the announcement earlier this month that Chief Operating Officer Albert Bourla would succeed Ian Read as chief executive in January,” Reuters adds. 

OPIOID OPTICS

— Deputy Attorney General Rod J. Rosenstein touted the administration’s work addressing the opioid epidemic in remarks before America’s Health Insurance Plans' (AHIP) national conference yesterday.

He said Trump and Attorney General Jeff Sessions “understand the extent of opioid addiction in America is staggering.” He detailed some of the enforcement actions that have come from the Justice Department, including charging more than 200 doctors and more than 200 other medical professionals for opioid-related crimes.

Rosenstein also said Trump “set the bold and ambitious goal of reducing opioid prescription rates by one-third in three years. That will make a major impact.” “We recently announced a reduction in opioid production for next year by an average of 10 percent,” he said, according to prepared remarks. “that will bring us to about a 44 percent decrease in opioid production since 2016.”

HEALTH ON THE HILL

— Sen. Elizabeth Warren (D-Mass.) is defending her move to release a DNA test that found she had distant Native American relatives.

“Donald Trump goes in front of crowds multiple times a week to attack me,” Warren told the Boston Globe editorial board on Tuesday, ”How do you sit here if you know what it is, and people ask, and you don’t give an answer?”

Our Post colleague Avi Selk reports her defense came even as “backlash against Warren also swelled within hours, led at first by prominent Native Americans who accused her of attempting to appropriate indigenous ancestry for political points.” And read The Post's Fact Checker Glenn Kessler on how "just about everything" we've read on Warren's DNA test is wrong.

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

The Trump administration has welcomed experimental procedures for veterans’ mental health, even though doctors urge caution.
ProPublica
Novartis said it would buy cancer-drug maker Endocyte for $2.1 billion, the Swiss pharmaceutical giant’s latest move to refocus on higher-value medicines.
Wall Street Journal
TRUMP TEMPERATURE
First lady Melania Trump toured a hospital's neonatal care unit Wednesday to learn about the treatment given to newborns suffering from opioid withdrawal, after she was initially delayed by mechanical issues on her plane.
Associated Press
STATE SCAN
She is ‘still defending that vote’ to repeal the health law, says her Democratic rival for Congress.
Politico
To Your Health
"Though we would have paid any ransom to have her back, any price in the world," it read, "this disease would not let her go until she was gone.”
Lindsey Bever
On Wednesday, Canada becomes the first major world economy to legalize recreational marijuana, presenting the country with enormous public policy challenges.
The New York Times
The pharmacist told the woman he believed she would use the drug to end her pregnancy. A doctor told the patient her fetus was not viable.
MLive.com
DAYBOOK

Today

  • The FDA hosts a meeting of the Gastrointestinal Drugs Advisory Committee.
  • Politico hosts an event on “Using Tech and Innovation to combat opioid abuse and diabetes."
  • Brookings Institution holds a conversation with CMS administrator Seema Verma.
SUGAR RUSH

Just about everything you've read on the Warren DNA test is wrong

Montgomery County has one of the lowest voting rates in Tennessee. The Post asked residents why they don’t plan on voting in the midterm elections: