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Chuck Grassley forges path to confirm Brett Kavanaugh by October. Senate Judiciary Committee Chairman Chuck Grassley, R-Iowa, has laid out the groundwork to confirm Supreme Court nominee Brett Kavanaugh this week. According to an agenda from Grassley’s office, the committee will hold business meeting Thursday where approximately two dozen judicial nominations may receive a vote, including Kavanaugh. Even so, it’s possible that the committee will take up the nomination next week if Democrats choose to delay the vote, as they are permitted to do under committee rules. Grassley said last week Kavanaugh could be confirmed by Oct. 1, coinciding with the start of the next court term. Republicans have a majority on the Judiciary Committee and Kavanaugh is ultimately expected to be approved by the panel before facing a vote by the full Senate.

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Key senators mum on Kavanaugh after four days of hearings. Key Republicans and Democrats in the Senate have yet to indicate whether they will vote to confirm Supreme Court nominee Brett Kavanaugh days after his raucous confirmation hearing concluded last week. Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, said they remain undecided as Kavanaugh this week works to answer follow-up questions from members of the Senate Judiciary Committee, where he spent hours answering questions from lawmakers amid shouts from protesters who infiltrated the committee room. “I am still working through my process,” Murkowski said when asked about her decision on Kavanaugh. Collins has also stayed quiet, and aides wouldn’t say whether she might announce a decision when the Senate returns on Wednesday, or sometime later. A group of moderate Democrats up for re-election has also said nothing, despite growing pressure from outside groups both for and against the nominee. Sen. Joe Manchin, D-W.Va., who voted for Gorsuch but is undecided on Kavanaugh, told the Washington Examiner the need to keep pre-existing conditions covered by Obamacare insurers would help him decide.

Nancy Pelosi: I’m not going anywhere as long as Trump is here, will protect Obamacare. House Minority Leader Nancy Pelosi says she has no plans to step aside as long as President Trump is in the White House. “As long as [Trump is] here, I’m here. I feel very comfortable that the support I have in the caucus and that I will be the speaker of the House,” she told CNN’s Christiane Amanpour.

White House economist cites Obamacare as example of policy that stunted economic growth. A top White House economist said Monday that he doesn’t understand how economists in the Obama administration believe that some of former President Barack Obama’s policies would help create jobs. Council of Economic Advisers Chairman Kevin Hassett said that, while it’s not fair to blame Obama for the Great Recession, several of Obama’s policies stunted growth. “I think the Affordable Care Act … lifted marginal tax rates on individual workers, so much so that the CBO even said that it would have a negative effect on growth,” Hassett told reporters at the White House, referring to the Congressional Budget Office. “He increased marginal tax rates on small businesses, and that’s why small business creation wasn’t so high,” Hassett said.

Fewer drug price hikes in August show Trump’s attacks could be working, Wells Fargo says. Trump’s attacks on drugmakers for raising prices may be paying dividends, as fewer drugmakers raised prices in August, Wells Fargo said in a recent analysis. “We believe August essentially shows that President Trump’s criticism might be working and have at least deterred some companies from raising prices in the near-term and ahead of the midterm elections,” the report concluded. Some drugmakers had announced in July that they would avoid raising prices. Most notable was Pfizer, which initially had said that it would raise prices for 10 percent of its portfolio but then retreated after getting bashed by Trump on Twitter. Sixty drug products saw price hikes in August, and 48 declined in price. In July, there were 110 increases and 32 declines, according to the report. Wells Fargo found that the average increase for drugs that rose in price was 53 percent. The drug with the biggest increase was the antidepressant Fluoxetine at 482 percent, an increase of $180.72. The antibiotic Nitrofurantoin also increased by 400 percent, a $1,917 hike.

Michigan asks Trump administration to allow work requirements for Medicaid. Certain Medicaid beneficiaries in Michigan would be required to work, volunteer, or attend classes as a condition of staying enrolled in the program under a waiver filed Monday to the Trump administration. Michigan officials said that if the plan is not approved within a year then it would end its Medicaid expansion, which provided coverage paid for by the government to 655,000 people. Under the plan, certain Medicaid recipients would need to work or train for work 20 hours a week beginning in 2020, and would need to log their hours with the state. Twelve exemptions are provided, including for people with disabilities, pregnant women, children, seniors, caregivers, and people with chronic health issues. Indiana and New Hampshire also have had applications approved, and others are still being considered. It isn’t clear whether the Trump administration will continue approving work requirements in states after the court rulings.

Appeals court rules Missouri may enforce strict abortion law. A U.S. appellate court ruled Monday that Missouri can enforce a law that forces abortion clinics to meet ambulatory surgical center requirements and requires doctors performing abortions to get admitting privileges at local hospitals, despite a 2016 Supreme Court ruling striking down a similar Texas law. The U.S. Court of Appeals for the 8th Circuit delivered the opinion striking down a ruling from a lower court that eliminated the Missouri law. Abortion rights groups pointed to the Monday ruling as evidence that abortion rights are under threat if Kavanaugh reaches the Supreme Court, since the case could wind up there. Planned Parenthood said in a release that the ruling would shutter all but one abortion clinic in the state because others would not be able to meet the requirements. The anti-abortion group Students for Life said in a statement that the ruling showed “the courts were right to respect efforts to protect women from abortion vendors who have made no plan for emergencies. Legislators have every right to protect women and their preborn infants from disreputable abortionists.”

Sarah Sanders: Talk of ousting Trump with the 25th Amendment is ‘insulting’ to voters. White House press secretary Sarah Sanders rejected allegations from an anonymous New York Times op-ed that said there is internal talk of using the 25th Amendment to get rid of Trump, adding that kind of talk is “insulting” to the millions of people who voted for Trump. Discussions about the 25th Amendment surfaced after the New York Times published an op-ed last week written by an unidentified senior official in the Trump administration. “Given the instability many witnessed, there were early whispers within the Cabinet of invoking the 25th Amendment, which would start a complex process for removing the president,” the anonymous author wrote. Section 4 of the 25th Amendment says the vice president and majority of the Cabinet can notify House and Senate leaders the “president is unable to discharge the powers and duties of his office.” Once that occurs, the vice president assumes the role of “acting president,” but constitutional experts say it’s not clear whether the language could be used to settle a political dispute, rather than create a framework for when a president has a medical issue. Still, some Democrats have argued it could be used to remove an “incompetent” president.

Eating cats and dogs is bad, says Congress. Republicans and Democrats fight like cats and dogs about almost everything, but they’ll join forces this week to support a bill that says neither of those animals should be eaten by humans. On Wednesday, lawmakers are expected to take up the Dog and Cat Meat Trade Prohibition Act, which would ban people from knowingly slaughtering cats or dogs for food, or from being involved in any related transaction. The sponsor of the bill, Rep. Vern Buchanan, R-Fla., says dogs and cats “provide important companionship to millions of people and should not be slaughtered and sold as food.” Under the bill, people could be fined up to $5,000 per violation, although it exempts religious ceremonies conducted by certain Indian tribes from the ban.

New study details problem with doc shortage. There are 44 million people who live in a county with a primary care doctor shortage, according to a new study from the insurer UnitedHealth. The study is the latest evidence of the growing shortage issue facing the U.S. UnitedHealth defined the shortage as less than one primary care physician per 2,000 people. The insurer found that primary care access wasn’t just an issue in rural areas but also suburban and urban communities. However, rural areas are hit the hardest by the shortage. “Rural residents are almost five times as likely to live in a county with a primary care physician shortage compared to urban and suburban residents (38 percent vs. 8 percent),” the study said. UnitedHealth wants states to loosen laws that prevent nurse practitioners from performing some of the same duties as a primary care doctor as a way to navigate the shortage.

ACOs pushing back on administration’s attacks that they don’t save money. A group of healthcare providers called accountable care organizations are pushing back on the Trump administration’s assertion that they don’t save the healthcare system money. A report issued Tuesday by the National Association of ACOs said that ACOs created savings of $1.84 billion in healthcare costs from 2013 to 2015, nearly twice the $954 million the Trump administration asserts they saved. The report seeks to counter a new push by the administration to revamp the program. An ACO agrees to pay the federal government money if Medicare costs go over a certain amount, but if the ACO saves money then the organization gets a cut of those savings. But an ACO can be in the program for six years and not have to pay the government anything but still get a cut of any savings. A proposed regulation issued last month by the Trump administration would change that from six years to two years. Currently there are 561 ACOs and 460 aren’t taking any risk, the administration said.

Pharma company CEO says he has ‘moral requirement’ to raise price 400 percent, report says. The leader of a small drugmaker quadrupled the price of a generic version of the antibiotic called Nitrofurantoin because it has a “moral requirement” to do so, according to a report in the Financial Times. The chief executive of Missour-based Nostrum Laboratories said that it was a moral requirement to “make money when you can … to sell the product for the highest price.” He told the Financial Times the reason for the hike was in response to a rise in price from Casper Pharma that makes the branded version of the drug. Nostrum increased the price from $474.75 to $2,392, Financial Times said. Casper boosted the price by 182 percent from 2015 to March 2018.

RUNDOWN

CNN Nearly 30 percent of all opioid prescriptions lack medical explanation

Associated Press LePage said he will deny applicants for Medicaid expansion until program is funded

NPR Food safety scares are up in 2018. Here’s why you shouldn’t freak out

Bloomberg The secret drug pricing system middlemen use to rake in millions

Tennessean Tennessee’s prescription pill addiction is getting better, but fentanyl looms large

Reuters Young people with opioid addiction not getting proper treatment

STAT News Fact checking an ad war over drug prices, Celgene and Bob Hugin

Kaiser Health News Unwitting patients, copycat comments play hidden role in federal rule-making