THE PROGNOSIS

The tossup race for retiring Arizona Sen. Jeff Flake’s (R) seat is a prime example of how treatment of Americans with preexisting medical conditions has become Republicans’ hottest political potato before next week’s midterm elections.

In a race that will help decide which party controls the Senate, Democratic Rep. Kyrsten Sinema has been relentlessly attacking her opponent, Republican Rep. Martha McSally, over voting for last year’s House GOP health-care bill, which passed the House last summer (a similar measure then failed in the Senate). The House bill didn’t eliminate but did weaken the Affordable Care Act’s protections for Americans with serious preexisting conditions such as cancer or diabetes.

Sinema appears to hold a slight edge over McSally — a new NBC News/Marist poll released yesterday had her up by six points — and that could bode poorly for other Republican candidates facing similar attacks around the country. Arizona is widely regarded as a bellwether state in this year’s Senate contests, but Republicans are still thought to generally have an edge in retaining Senate control.

It’s doubly interesting that Sinema has been so effective in leveraging a pro-Obamacare message in Arizona, considering the state’s marketplace has struggled more than most  in offering individual market consumers a variety of plan options. Insurer exits and big premium spikes plagued many of the marketplaces in recent years, but the severity of the problem varied county by county.

Just two years ago, Arizona’s Pinal County appeared in danger of losing all its Obamacare insurers and becoming the first “bare” country until the Obama administration persuaded Blue Cross Blue Shield of Arizona to stay put despite massive losses. Even now, there is just one marketplace insurance option in most areas of Arizona, with the exception of Pima County, which includes Tucson.

McSally noted that reality in her single debate with Sinema earlier this month. “In 14 of 15 counties in Arizona, there was only one choice last year, and that is not a choice,” she said at the debate.

But McSally has spent most of the campaign on defense when it comes to health care — illustrating what a pickle House Republicans put themselves in by passing the deeply unpopular American Health Care Act, only to see the whole "repeal-and-replace" effort ultimately fail in the Senate.

Sinema and her supporters have gone after McSally tooth and nail for backing the AHCA. Of the dozen ads touching on health care that aired from the beginning of September to the middle of October, 11 ads directly mentioned preexisting conditions, and 10 of the ads supported Sinema, according to an analysis by NBC.

“The reality is that Arizonans are worried about losing access to this critical coverage, and Martha voted to take that protection away,” Sinema said during the Oct. 15 debate.

McSally appears to recognize she's in an unenviable position, telling Sean Hannity that she's getting her "a-- kicked" for voting for the AHCA.

"Well, Sean, I did vote to repeal and replace Obamacare on that House bill — I’m getting my a-- kicked for it right now because it’s being misconstrued by the Democrats," she said last week on Hannity's radio show. "They’re trying to, you know, invoke fear in people who have family members or loved ones with preexisting conditions."

It's not the first time McSally, a retired Air Force colonel, has used colorful language to talk about health-care policy. Sinema recently reminded Arizona voters of this, in a tweet:

We should point out that Sinema’s messaging isn’t completely accurate. The AHCA would have retained Obamacare’s requirement that insurers cover people with preexisting conditions. What it would have done, however, was provide a limited pathway via federal waivers for states to temporarily allow higher premiums for people with preexisting conditions. That would effectively mean that sick people would need to pay more for insurance.

The waiver provision was added in as a somewhat messy compromise between House conservatives, who demanded a lifting of Obamacare regulations, and moderates, who wanted to ensure people with preexisting conditions would still be protected. It helped give GOP leaders enough votes to pass the measure — but it also virtually wrote Democrats’ attack ads for them.

For her part, McSally has touted her push for additional funding in the AHCA to argue she cares about patients:

But as McSally has tried to gain the upper hand, she’s made claims that are misleading if you know anything about the history of protecting coverage for people with preexisting conditions. Up until the ACA was passed in 2010, sick folks often couldn’t get coverage because insurers weren’t required to accept them. For the first time, the health-care law guaranteed that the country’s sickest, most expensive patients would be able to enroll in a health-insurance plan.

McSally not only voted for the AHCA; she also has run in past elections on ditching Obamacare. In 2015, she voted for a simple measure that would have repealed all of Obamacare. Yet she claimed in this recent ad that she is “leading the fight … to force insurance companies to cover preexisting conditions":

That ad prompted some pretty hilarious mocking around the Internet. From Axios's Sam Baker:

AHH, OOF and OUCH

AHH: Ahead of the midterm elections, the pharmaceutical industry is preparing itself for the possibility of Democrats recapturing the House, and the potential for House Minority Leader Nancy Pelosi (D-Calif.) to regain the speaker's gavel and lead an aggressive drug-pricing agenda, Stat’s Lev Facher reports.

Lev describes how last summer, Pelosi marched into the offices of the Pharmaceutical Research and Manufacturers of America, the industry’s top trade group, and “spoke in detailed terms of a federal statute that allows the U.S. government to effectively strip drug companies of exclusive licenses to some blockbuster medicines.”

“Pelosi’s foreboding words, first described to STAT by multiple sources with knowledge of the encounter and later confirmed by the Democratic leader’s office, were intended as a ‘come-to-Jesus’ moment for the industry,” Lev reports.

“Democrats have made real action to lower prescription drug prices central” to Democrats’ campaign strategy, Pelosi said in a statement to Stat. “It will be one of our first legislative priorities in the majority.”

This could be just the beginning of many such confrontations if Democrats take control of the chamber. The drug industry has already drawn ire from Democrats, as well as from Republicans and the Trump administration, over concerns about skyrocketing prescription drug costs.

And Democrats’ agenda, if they do win the House, will rely on more than just Pelosi, Lev writes. It will also depend on who controls the relevant committees and subcommittees.

“Already, a lengthy cast list of drug-pricing hawks is emerging to fill those roles should Democrats retake the House, which pollsters and election forecasters say is highly likely,” he adds. “Three Democratic congressmen in particular — Reps. Elijah Cummings (Md.), Peter Welch (Vt.), and Lloyd Doggett (Texas) — have already positioned themselves as pharma antagonists, and will likely be front and center in the party’s effort to advance drug-pricing reforms.”

OOF: Pfizer CEO Ian Read suggested the drug manufacturer will return to “business as normal” at the beginning of next year, after announcing in July that he would delay planned price increases under pressure from the Trump administration.

The Hill’s Peter Sullivan reports that Read said during an earnings call for the company that the agreement to halt price increases would end after this year, "at which point the company will return to pricing based on the market.”

“We price to the marketplace, we price competitively,” Read said, according to Peter. 

But Read did say during the call that the company had been working with the Trump administration "on parts of the blueprint," Market Watch's Emma Court reports, referring to the drug pricing proposal Trump announced in May. 

The president touted Pfizer's move back in July to delay its price hikes. 

OUCH: The U.N. Security Council is urging a halt to ongoing attacks by rebel groups in Ebola-affected areas that are hampering the response to the outbreak. The U.N. body condemned the attacks “in the strongest terms” and adopted a resolution to call on all parties to “ensure full, safe, immediate and unhindered access for humanitarian and medical personnel,” the Associated Press’s Edith M. Lederer reports.

The resolution also said there was a critical need for communication with the public and to enhance safety and health protocols in order to “mitigate against misinformation and undue alarm about the transmission and extent of the outbreak among and between individuals and communities.”

“This is the first time an Ebola outbreak has occurred in Congo’s far northeast, where multiple rebel groups are active," Edith writes. “Last week, the ministry of health said teams responding to the Ebola outbreak are attacked three or four times a week on average, a level of violence unseen in the country’s nine previous outbreaks of the virus." 

"In trying to contain the outbreak, which was declared on Aug. 1, health experts have faced resistance from wary communities, with infected people slipping away. Safe burials are often flashpoints where families bristle at outsiders telling them how to say goodbye to loved ones.”

AGENCY ALERT

— Open enrollment starts tomorrow at Healthcare.gov, the Obamacare marketplace where around 11 million people get their health coverage. It's the sixth enrollment period since the ACA was passed -- and advocates for the health-care law are spreading the message.

Joshua Peck, co-founder of the group Get America Covered, said his group is trying to fill in holes created by the Trump administration and its less-than-enthusiastic response to the Obamacare marketplaces.

“Get America Covered is returning for a second year because the administration is once again not doing their job,” Peck said in a statement provided to The Health 202. “People need the facts. So that’s what we’re going to do, make sure that people have the basic information they need to sign up for coverage.”

Enrollment for 2019 ends on Dec. 15.

— Former Health and Human Services secretary Tom Price defended Republicans by arguing last year's failed GOP health-care bill would not have stripped protections from people with preexisting conditions.

He said at a campaign event for Rep. Karen Handel (R-Ga.) that Republicans in fact “support making sure that preexisting conditions get covered,” the Wall Street Journal’s Reid J. Epstein reports.

But as we noted in today's Prognosis (and has been pointed out by our Fact Checker colleague Glenn Kessler), the AHCA would have allowed for state waivers that in effect would have let insurers charge more to people with preexisting conditions if they'd gone uncovered for a specified amount of time.

Huh? Price also said he doesn’t “support requiring insurance companies to cover preexisting conditions,” Reid reports.

“The question is who is going to make the decision about what your health coverage is,” Price said. “Is it you? Or is it the government? That’s the fundamental question, always has been.”

“The Democrats wouldn’t be doing it unless they thought it gave them an opportunity,” he added. “The problem is what they are describing and reality don’t resemble each other.”

STATE SCAN

— With just a week left before voters go to the ballots, Idaho's Republican Gov. C.L. “Butch” Otter endorsed the ballot initiative that looks to expand Medicaid in the state.

“We cannot continue to let hardworking Idahoans go without healthcare. I’m proud that the citizens of Idaho have come up with a solution to solve this long-standing problem,” Otter said in a release, as our colleague Colby Itkowitz reports. “I strongly support expanding healthcare to folks who need it. It’s good sense and it’s the right thing to do.”

Idaho is one of three red states where conservative legislatures have not yet chosen to expand Medicaid, but where voters will have a chance to do so next week, as The Health 202 wrote about Monday.  While Medicaid expansion was a central part of the ACA's plan to expand coverage, the Supreme Court ruled in 2012 that individual states could decide whether to expand the program for low-income Americans.

Otter, the three-term conservative governor with an independent streak, is not seeking reelection. “The Republican gubernatorial candidate in Idaho, Lt. Gov. Brad Little, said he would support the will of the people if they vote to expand Medicaid. Democratic gubernatorial candidate Paulette Jordan supports the ballot measure,” Colby writes.

Read more from Colby on the three states voting on expansion. And from our colleague Dave Weigel, read about the effort on the ground in Salt Lake City, where the battle for Medicaid expansion is “being waged from a small, three-desk office in a downtown high-rise, by three women in their 20s and 50 or so volunteers.”

HEALTH ON THE HILL

— Republicans have turned the confirmation of Brett M. Kavanaugh into an election year rallying cry, The Post’s Elise Viebeck and Robert Barnes report. The party is hoping voters turn out to defend the traditional values that the conservative justice represents.

“In the sprint to next week’s midterms, the GOP has used Kavanaugh and his fight for Senate confirmation amid allegations of sexual assault to energize Republican voters in districts and states won by President Trump in 2016,” Elise and Robert write. “They have cast Kavanaugh as a wrongly accused family man — the victim of an overzealous #MeToo movement and Democrats seeking retribution for Hillary Clinton’s loss.”

“Trump has invoked Kavanaugh repeatedly at campaign rallies across the country this month, calling the accusations — which Kavanaugh has vehemently denied — a political setup by Democrats,” they add. Recently, Trump said at a rally that the elections were about “the caravans, the Kavanaughs, law and order, tax cuts and . . . common sense, because most of it is common sense.”

And Elise and Robert report that it’s not at all usual for a Supreme Court justice to be politicized in this way.

— And here are a few more good reads: 

PowerPost
In last-minute moves, Republicans are spending money on ads in South Carolina, Georgia, Florida, Virginia and Washington state in hopes of preserving their majority.
Sean Sullivan and David Weigel
TRUMP TEMPERATURE
MEDICAL MISSIVES
High School Sports
This high school quarterback had symptoms for months after a hit to the head last year. But his love of the game led to his parents allowing him back on the field.
Samantha Pell
Early Lead
Massachusetts prison officials redacted this claim because of an ongoing investigation into prison drug use.
Matt Bonesteel
INDUSTRY RX
Brokers are selling your data to your doctor, and no one’s regulating it.
Politico
REPRODUCTIVE WARS
Administration officials hope that the changes will overcome judges’ objections without fundamentally altering the purpose or the effects of the rules.
The New York Times
Internal memos reflect the growing influence of conservative Christians in the Trump administration.
Foreign Policy
DAYBOOK

Today

  • The National Press Club hosts an event on next-generation broadband and telemedicine.

Coming Up

  • HHS Advisory Committee on Heritable Disorders in Newborns and Children holds a meeting on Thursday and Friday.
  • The FDA holds a joint meeting of the Psychopharmacologic Drugs Advisory Committee and Drug Safety and Risk Management Advisory Committee on Friday.
SUGAR RUSH

'Love is going to win': Squirrel Hill residents react to shooting

Thousands line streets for Pittsburgh victim Jerry Rabinowitz: