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After years on defense, Democrats weaponize Obamacare. The voter anger over healthcare that once propelled Republicans to the majority in the House and Senate is now buoying Democrats’ hopes for the midterm elections. When Democrats passed and rolled out Obamacare, voters shouted down lawmakers at town halls and rallied in huge demonstrations to protest changes in coverage, rising premiums, and the loss of their doctors. Now, Republicans are facing the same threat for attempting to undo the healthcare law. There’s been a massive shift in voters’ attitudes, and their outrage is now centered on the possibility of people with pre-existing conditions losing coverage. Democrats, in turn, are campaigning confidently on healthcare with an enthusiasm not seen since Obamacare passed. At every turn, they are casting themselves as the protectors of sick people, and Republicans as antagonists. Candidates across the country are cutting campaign ads highlighting Obamacare’s rules blocking insurers from turning away sicker people, from charging them more, or from refusing to pay for coverage associated with their illness. Only the elections will reveal whether the strategy works. But the provisions, for people who have pre-existing conditions such as cancer, asthma, migraines, or diabetes, have consistently polled well among most voters. Read Kimberly Leonard’s feature on how healthcare is playing out in the midterms.

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19).  Email [email protected] for tips, suggestions, calendar items and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list.

Patty Murray: Final opioid bill likely to come today. Sen. Patty Murray, D-Wash., said Monday that she expected the remaining differences between House and Senate versions of major opioid legislation to be resolved by Tuesday, clearing a path to President Trump’s desk for the legislation. “I think we will have this pretty well resolved in the next 12 hours,” she said late Monday, referring to the opioid legislation. Murray told the Washington Examiner that she believes that the final Senate-House compromise bill will be ready for the House to vote on this week, before it recesses until the November elections.

But what about pharma? One major outstanding consideration, though, is whether a provision favoring the pharmaceutical industry will make it into the final compromise bill. The pharmaceutical industry has been seeking to include in the package a measure to avoid having to offer large discounts for certain drugs covered under Medicare. Several outside groups say that pharmaceutical industry lobbyists are still looking to insert the industry-friendly provision into the opioid legislation.

FDA weighs banning online sales of e-cigarettes.  The Food and Drug Administration is considering banning companies from selling e-cigarettes online to reduce the prevalence of vaping among teens. “That’s going to be one thing that’s on the table,” FDA Commissioner Scott Gottlieb said at an Axios event Tuesday about the possibility of online sales. “It’s very clearly something we are now looking at.” The FDA will be putting out proposals in November for regulating e-cigarettes, and will allow several months for feedback before a final decision is issued. Agency officials have asked vaping companies to put out their own proposals about how to reduce the use of their devices among teens. The FDA also is considering banning flavored e-cigarettes from being sold to anyone. Gottlieb said that he did not want to see teens develop a dependency on nicotine that would last their whole lives, or to see them transition to traditional cigarettes. The main factors driving teen use, he said, were “access and appeal.”

Susan Collins, a pivotal vote, says she doesn’t believe Kavanaugh will overturn Roe v. Wade. Sen. Susan Collins, R-Maine, a pivotal vote on Kavanaugh’s nomination to the Supreme Court, said she doesn’t believe that he would vote to overturn Roe v. Wade. “I do not believe he’s going to repeal Roe v. Wade,” Collins said on Showtime when asked about the effect that her prospective decision to confirm the Supreme Court nominee could have on abortion rights. The comments from Collins were made public on Monday but the interview occurred Friday, before the latest sexual misconduct allegations against Kavanaugh had surfaced. Collins said she was still undecided about whether she would vote to confirm Kavanaugh, saying that she first wanted to hear testimony from Christine Blasey Ford, the first woman who accused him of sexual assault. Both Kavanaugh and Ford are scheduled to testify Thursday before the Senate Judiciary Committee. “I’m close, I’m very close,” Collins said of where she was on making a decision. “But I’m not all the way there yet. And professor Ford deserves to be heard.”

In ad, Missouri GOP candidate maintains he supports protections for people with pre-existing conditions, despite anti-Obamacare lawsuit. Attorney General Josh Hawley has released a new ad in which he shares that his son was born with a rare disease. In the ad he said he supports a rule forcing health insurance companies to cover pre-existing conditions, such as cancer or diabetes. Hawley is running against incumbent Sen. Claire McCaskill, D-Mo., and is currently signed onto a lawsuit that asks a court to invalidate Obamacare, including its rules on pre-existing conditions. His team has said that the protections can be maintained through another mechanism.

Drug pricing reform group ramps up support for McCaskill. The advocacy group Patients for Affordable Drugs Action released a new report and radio ad praising vulnerable red state McCaskill. The ad and report are the latest efforts by the group, which pushes for reforms in Congress to tackle high drug prices, to support McCaskill who is in a tough re-election race this fall in the midterm elections. “The report examines McCaskill’s fearless advocacy for reforms that lower prescription drug prices, and it compares her leadership to Josh Hawley’s actions to allow insurance companies to stop providing prescription drug coverage,” according to the group that primarily gets its funding from the Laura and John Arnold Foundation.

AHIP adds three to executive team. America’s Health Insurance Plans has hired Keith Fontenot as executive vice president of policy and strategy; Elizabeth Goodman as executive vice president of government affairs and innovation, and John Mathewson as chief operating officer. Fontenot comes from Hooper Lundy & Bookman, PC; Goodman from the Massachusetts Medicaid program; and Mathewson has been on the team since June coming from CEO of the DC Primary Care Association. “AHIP is committed to fighting for health care and coverage that works for every patient and consumer,” Matt Eyles, AHIP president and CEO, said in a statement. “The extensive experience and expertise that Keith, Elizabeth, and John bring to AHIP will help us deliver what every American deserves: lower costs, better coverage, better care, and more personalized control.”

HHS terminates fetal tissue research contract after outcry from anti-abortion groups. Health and Human Services has terminated an agreement with a fetal tissue research facility that was providing fetal tissue to the FDA. HHS said late Monday that it canceled the contract with the company, Advanced Bioscience Resources, because it didn’t include “appropriate protections” for fetal tissue procurement. The agency’s statement did not go into specifics. The agency said in a statement that it has “initiated a comprehensive review of all research involving fetal tissue to ensure consistency with statutes and regulations governing such research.” The FDA signed a contract with Advanced Bioscience Resources in June to acquire fetal tissue for research into creating mice with human immune systems. A group of more than 30 anti-abortion groups wrote to HHS earlier this month calling for an end to the contract.

Drug prices have defied Trump’s promises, analysis shows. Drugmakers are raising prices far more often than they are cutting them, according to a new analysis from the Associated Press, defying President Trump’s promises that they would voluntarily cut prices. Shortly after releasing a blueprint for lower drug prices in May, Trump declared that drug companies would lower prices voluntarily “within two weeks.” But an analysis published by the Associated Press Monday indicates that Trump’s promise has not come to fruition. It found that since Trump’s “two weeks” promise, there have been more than 16 drug price hikes for every decrease. The AP said it looked at 26,176 list price changes for brand-name drugs from 2015 through 2018.

To rein in drug middlemen, states go further than Congress. Several states are going even further than Congress or the Trump administration in reining in drug middlemen they blame for high prices, advancing strict reforms like license requirements. Arkansas enacted a law earlier this year requiring licenses for pharmacy benefit managers, which manage drug plans for employer- and union-sponsored health plans. Arkansas Gov. Asa Hutchinson, a Republican, signed the licensure bill, which requires any PBM to get a license to do business in the state. The law was passed in response to complaints from pharmacists in the state who said that PBMs cut reimbursements for cheaper generic drugs too low. The new law requires a PBM to provide a “fair and reasonable” compensation program for the reimbursement of pharmacist services in order to get a license, according to a summary from the Arkansas Pharmacist Association, which fought for the law. Arkansas is the latest state to turn to licensure of PBMs. It joins four other states that have passed a law to require PBMs get a license to do business: Florida, Louisiana, Maryland and Tennessee. Other states, like California, are considering similar bills.

HHS searches for treatment for mustard gas. The Trump administration has partnered with the pharmaceutical company MediWound to develop a treatment for injuries caused by mustard gas, which was first used in World War I but officials worry could be used by terrorists. The Department of Health and Human Services announced the $43 million partnership with the Israeli company to develop a skin treatment for injuries on Monday. Currently, there are no treatments available for mustard gas approved by the FDA. “Mustard agents have been used in conflicts for over 100 years, yet there still are no approved treatments for the injuries they cause,” said Rick Bright, director of the Biomedical Advanced Research and Developmental Authority, a part of HHS. Mustard gas can damage the skin, eyes and lungs. “Skin exposure to sulfur mustard can cause redness and blistering, similar to a second- or third-degree burn,” HHS said in a release. “The damage is slow to heal and can lead to scarring. Severe exposure can be fatal.” Terrorists, most notably the Islamic State, have reportedly used mustard gas before in attacks.

WHO fears ‘perfect storm’ in Congo’s Ebola outbreak. The World Health Organization said Tuesday it’s worried that an Ebola outbreak in the Democratic Republic of the Congo is about to spread further within that country. Dr. Peter Salama, WHO deputy director-general, said in a press conference Tuesday that troubling factors in the region “may be coming together over the next weeks to months to create a potential perfect storm.” The area is plagued with violence, people have been actively running away from health workers who try to vaccinate and treat them, and politicians in the North Kivu province have been spreading conspiracy theories that the government is causing Ebola to spread. “We can see this situation deteriorating very quickly,” Salama said. Though 11,700 people have received an experimental vaccine, at least 150 people are infected and 100 people have died.

RUNDOWN

Axios Ban Ki-Moon: U.S. healthcare system morally wrong

CNBC UnitedHealthcare warns hospitals it may drop major ER doctor network from plans

Wall Street Journal Novartis to cut 2,000 jobs amid revamp

STAT News With PBMs firmly in Washington’s crosshairs, their top lobbyist steps down with no regrets

New York Times A GOP senate candidate highlights his drug industry career. Should he?

Reuters JUUL copycats flood market despite FDA rule

Bloomberg Gilead to sell cheaper versions of drug that sparked price debate in Washington