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Endangered House Republicans scramble on pre-existing condition resolutions. A group of House Republicans, several in tough re-election races this fall, introduced a resolution on Tuesday calling for pre-existing conditions to be protected amid scathing attacks from Democrats that the GOP is endangering the protections with its efforts to repeal Obamacare. The “sense of the House” resolution was introduced Tuesday by Rep. Pete Sessions, R-Texas, and 18 other lawmakers. The resolution discusses the need to protect pre-existing condition protections, but is not legislation. The resolution says that any replacement of Obamacare should let states get “broad authority to reform their individual health insurance markets.” It also says, though, that any reform must ensure that individuals with pre-existing conditions get lower premiums, lower out-of-pocket costs, and accessibility to in-network providers. Democrats have slammed Republicans this election cycle for their attempts to repeal Obamacare last year and, with it, protections for people with pre-existing conditions.

The problem for Republicans is that much of the infrastructure of Obamacare, which would need to be repealed to create any sort of alternative, exists to support the ban on pre-existing conditions. Once they concede that they won’t touch the pre-existing condition ban, they will find it much more difficult to target other aspects of the law. For instance, the community rating requirement that forces insurers to charge the same regardless of health status is one of the main drivers of the skyrocketing premiums for younger and healthier individuals, along with hefty benefit mandates. But targeting those rules having embraced the pre-existing condition requirement would be impossible. Democrats could argue that if insurers are not required to charge the same, that they could simply “offer” insurance to those with pre-existing conditions for thousands of dollars a month -- or without other regulations they could strip down benefits so the plans would be useless for those with a serious illnesses. Republicans could have made the case for alternate ways to ensure coverage for those with pre-existing conditions that do not affect the rest of the insurance market.

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Seema Verma pushes back on Obamacare 'sabotage' charges. Centers for Medicare and Medicaid Services Administrator Seema Verma on Wednesday cited reduced Obamacare premiums and expanded choices as evidence that the Trump administration has not "sabotaged" the healthcare law, as charged by Democrats. "For the very first time, rates have [been] going down... I think we have been successful in that area," Verma said at an event hosted by the Economist Group in D.C. The comments are similar to recent remarks by President Trump and Health and Human Services Secretary Alex Azar. Next year, premiums for Obamacare customers are expected to fall by an average of 2 percent for mid-level plans. Verma previewed a forthcoming report that she said will show more health insurers are entering Obamacare and that they are offering more types of health plans. "You'll be hearing from us very shortly about that," she said. "I think the news will be good."

How critics have responded. Critics, including Democrats, have pushed back on declarations of success by the Trump administration, saying that the rates would be even lower if health officials and the president had acted differently. They have repeatedly accused officials and Republicans of working to "undermine" or "sabotage" Obamacare. But the rate decreases are a departure from widespread predictions that insurers would leave the market and that premiums would surge as a result of undoing the individual mandate, an action that becomes effective in 2019 under the tax law Republicans passed into law late last year. The Trump administration is also allowing plans to be sold outside of Obamacare's rules mandating certain types of medical coverage. One of the reasons the premiums are tempered for 2019 is that insurers overshot their rate proposals when they applied to sell plans for this year, meaning that they lower them for the following year to be more in line with what their costs will be. A small number of states that expected higher increases also passed a reinsurance program that funnels government funding to insurers and allows them to reduce premiums.

Amount workers pay toward premiums drops slightly. The amount workers contributed to their health insurance premiums fell slightly in 2018 even as overall costs went up, according to data released Wednesday by the Kaiser Family Foundation. The latest report found that the cost of health insurance for an employee's premiums averaged $6,896 in 2018, with workers paying $1,186 of that. In 2017, the plans averaged a $6,690 year and workers paid $1,213.  The trend was similar among family plans. Premiums averaged $19,616 in total for families in 2018, with workers paying for $5,547 of that and employers shouldering the rest. In 2017, the plans averaged $18,764 a year and workers paid $5,714. Employees also partially made up for the differences in premiums by taking on a bit more in deductibles, which are the limit in out-of-pocket costs that health insurance customers take on when they use medical care. The average deductible now stands at $1,573 for individual workers, similar to last year’s $1,505 average but up sharply from $735 in 2008.  In 2018, about 85 percent workers had a deductible, up from 81 percent last year. The percentage represents a surge from a decade ago, when and 59 percent of employees had a deductible.

Democrats line up to oppose short-term plans. Sen. Tammy Baldwin, D-Wisc., said that she has secured the votes of all 49 Democratic and Independent Senate Democrats to overturn the availability of short-term plans. The plans became available for purchase beginning on Tuesday under a provision by the Trump administration, and offer a less-costly alternative to Obamacare plans for certain customers. Democrats have referred to the plans as “junk insurance” because they can exclude coverage of certain medical services or turn away people with pre-existing conditions such as cancer or diabetes. Under the new administration they can last up to a year and be renewed twice for a total of two years. Baldwin’s resolution has the support needed to file a discharge petition and force a Senate floor vote in the coming weeks, and it could pass if two Republicans back it.

Some of the lawmakers who signed Sessions’ resolution are in tough re-election races in the midterm elections. GOP Reps. Leonard Lance of New Jersey, John Faso of New York, and Mike Bishop of Michigan are all in races rated by the Cook Political Report as a toss-up. Sessions’ race is also listed as a toss-up. Another lawmaker who signed on — Rep. Kevin Cramer, R-N.D. — is challenging Sen. Heidi Heitkamp, D-N.D. Heitkamp has cited her support for Obamacare and pre-existing conditions as a key plank of her campaign. This is the second resolution from the House attempting to show that Republicans favor protections for pre-existing conditions. Rep. David Young, R-Iowa, introduced a similar resolution last month. Cook also rates his race as a toss-up.

FDA seizes Juul documents as it considers e-cigarette bans. The Food and Drug Administration revealed Tuesday that they raided the San Francisco office of e-cigarette maker Juul last week and seized more than a thousand pages of documents tied to their marketing practices, which regulators have suggested might be geared toward teenagers. Around the same time as the announcement, the Centers for Disease Control and Prevention compounded the damage to the company by releasing a report showing that the sales of Juul, a popular e-cigarette that is shaped like a USB drive, increased more than sevenfold among teens from 2016 to 2017. About 3 million teens use e-cigarettes, and Juul dominates the market. The FDA said in a statement that it was "committed to taking all necessary actions, such as inspections and advancing new policies, to prevent a new generation of kids from becoming addicted to tobacco products." Kevin Burns, JUUL CEO, said in a statement that the company was "committed to preventing underage use."

Senators weigh in on e-cigarette regulations. A pair of senators, Dick Durbin, D-Ill., and Lisa Murkowski, R-Alaska, asked the FDA on Tuesday to “take the strongest action possible to protect our children from a lifetime of nicotine addiction” by considering banning e-cigarettes. Durbin and Murkowski also have introduced a bill that would restrict flavors for e-cigarettes so that manufacturers could only sell them if they've proven to the FDA that they help smokers quit and do not encourage children to take them up. They said in their letter that it was "abundantly clear" that the companies were working to appeal to children and get them hooked on their products.

FDA targets tactic brand drugmakers use to delay generic competition. The FDA is taking steps to prevent brand name drugmakers from organizing citizen petitions aimed at delaying approval of generic competition, which the agency says is unnecessarily bogging it down with meritless petitions. Gottlieb announced new regulatory guidance on Tuesday as part of a broader effort to crack down on practices that officials say brand name drugmakers use to stifle competition. Gottlieb said in a statement that the FDA will consider a range of factors to determine whether a petition is submitted with the "primary purpose of delaying the approval of a generic drug application." The agency will also publicly highlight the petitions it deems are being used to delay generic competition in the hopes of shaming companies from employing the tactic. The FDA recently called out drugmakers for withholding samples from generic companies that they need to win FDA approvals.

Brand name drug industry nets big win in trade deal. A key part of the trade deal between the U.S., Mexico, and Canada gives brand name pharmaceutical manufacturers a longer monopoly on sales of pricey specialty drugs called biologics. The proposed deal between Canada and the U.S. announced on Monday increases the market exclusivity for biologic drugs, which are tissue-based drugs like vaccines, to 10 years for products sold in Canada. A deal between Mexico and the U.S. negotiated announced in August also had the increase to 10 years. The generic drug lobby group called Association for Accessible Medicines said that the trade deal would “provide a windfall for brand-name drug manufacturers and raise prescription drug prices for patients in the United States.” Currently, in the U.S., a brand name drugmaker has exclusivity of 12 years for a biologic drug. In Canada, biologic drugs currently have exclusivity of eight years, and in Mexico, five years. During these exclusivity periods, a competitor who wants to sell a biosimilar cannot market their product.

Hospitals urge Congress to protect drug discount program. More than 700 hospital CEOs sent a letter to congressional leaders on Tuesday asking them to protect the 340B program, which obligates drugmakers give discounts to safety-net providers. Lawmakers are seeking more oversight of the program, saying that hospitals are misusing the savings they get from discounted drugs. Hospital CEOs are pushing back against the effort, which also involves intense lobbying by the drug industry. “Efforts to reduce the scope of the 340B program would not reduce the cost of prescription drugs in the U.S. and would weaken nonprofit hospitals’ ability to serve patients who often have nowhere else to turn,” the CEOs wrote.

Obamacare prices in Nevada to be nearly unchanged. Rates for Obamacare plans in Nevada are leveling off, with only a 0.3-percent-average increase planned for next year. The mild rate increases are expected despite the undoing of Obamacare's individual mandate and despite the Trump administration's actions to allow the sale of plans that fall outside of Obamacare's rules. “The approved rates for next year are incredibly good news for consumers as the rates have remained consistent for next year," Nevada Insurance Commissioner Barbara Richardson said in a statement. "This is a very good sign of market stability in Nevada." Two health insurance companies are offering coverage on the exchange, with prices dropping by an average of 0.4 percent. Nevadans also have the option of buying the insurance directly through an insurer, four of which are offering plans in the state for 2019. The rates for those plans will decrease by an average of 2 percent.

Feds violated 72-hour legal limit before turning migrant children to HHS. Nearly one third of the unaccompanied minors separated from adults at the border under President Trump's “zero-tolerance” policy were detained by U.S. Customs and Border Protection longer than the 72 hour legal limit before they were turned over to Health and Human Services, according to a new report released Tuesday. The Department of Homeland Security's Office of the Inspector General concluded the department as a whole "was not fully prepared to implement the Administration’s Zero Tolerance Policy or to deal with some of its after-effects.”

Pro-marijuana protesters target Andy Harris’ Capitol Hill office. Demonstrators protesting in support of legalizing marijuana gathered outside the office of Rep. Andy Harris, R-Md., on Capitol Hill Tuesday. U.S. Capitol Police told the Washington Examiner that officers responded to a report of unlawful demonstration activity just after noon and were informed that protesters were seeking to enter Harris' office. Additionally, two of the protesters had lit marijuana cigarettes. The two female suspects — Kristin Furnish, 28, and Rachel Ramon Donlan, 46 — were arrested and taken to the U.S. Capitol Police headquarters. They were also charged for possessing and consuming marijuana in a prohibited public space.

Planned Parenthood defunding gets court time in Ohio. The U.S. Court of Appeals will hear oral arguments in a case today that blocks federal funding meant for screening and family planning from going toward Planned Parenthood. The organization said that it will lose $1.4 million in funding if the law stands, and officials tried to end funding because Planned Parenthood also provides abortions.


The Hill Drug companies fear a Democratic Congress

Axios The legal clouds hovering over Medicare Advantage

NPR Patients give doctors high marks for giving antibiotics for the sniffles

Wall Street Journal Former AmerisourceBergen exec blew the whistle that led to settlement

Politico Why Congress is poised to give the pharma industry a $4 billion windfall

STAT News At New England Journal of Medicine, a change at the top offers a chance to reshape the world’s oldest medical journal



Senate in session this week. House not in session.

Oct. 2-4. Penn Quarter. The Atlantic Festival. Details.

11 a.m. FDA White Oak Campus. Vaccine committee meeting to discuss flu shot for next season. Details.

11 a.m. Kennedy Caucus Room, Russell. Former Rep. Patrick Kennedy, former Surgeon General Dr. David Satcher, First Lady of New York City Chirlane McCray, former Sen. Chris Dodd, and Assistant Secretary for Mental Health and Substance Use Elinore F. McCance-Katz to commemorate the 10th anniversary of the Mental Health Parity and Addiction Equity Act Livestream.

2:30 p.m. 430 Dirksen. Senate Health, Education, Labor, and Pensions Committee hearing on “Rare Diseases: Expediting Treatments for Patients.” Details.

FRIDAY | Oct. 5

9:30 a.m. Dirksen G-11. Alliance for Health Policy event on “Improving Care for Children with Complex Medical Needs.” Details.