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Election day is one week away: Here’s a guide to healthcare ballot measures. An opposition fund aimed at defeating a healthcare ballot is the most expensive this year, and perhaps even in history. Nearly $111 million has been raised to get voters to sink Proposition 8, a measure that would place spending caps on dialysis treatment in California.

California voters will face other healthcare questions, including whether to use bonds to improve children’s hospitals, and whether to set more guidelines around ambulance workers’ jobs, including breaks, mental health coverage, and training.

Voters in Idaho (more on which below), Nebraska, and Utah will decide through ballot measures whether to allow more low-income people onto the Medicaid program, a move already advanced by 33 states and the District of Columbia.

Voters in a fourth state, Montana, will decide whether to make the Medicaid expansion permanent through a tax on nicotine products.

In Oklahoma, superstores such as Walmart and Costco are hopeful that residents will vote to allow them to provide eyecare services, something 47 other states already allow.

Georgians will consider whether to expand housing for people with mental illness, Nevadans will consider a tax exemption for medical equipment, and Massachusetts voters will consider whether to limit how many patients nurses can care for at a time.

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 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.

More ballot measures -- voters in three states to decide on abortion restrictions. A measure in Oregon would block state and municipal employee health plans, as well as Medicaid funds, from paying for abortions. It has exemptions for rape, incest, and ectopic pregnancies, which occur when an egg becomes fertilized outside the uterus.

Alabama and West Virginia ballot measures would amend their state constitutions to say that abortion rights are not protected. Anti-abortion advocates are preparing for a possible overturn of Roe v. Wade, which would turn the legalization of abortion to the states. Alabama’s measure seeks to establish “personhood” rights for fetuses, writing that a “yes” vote would make it state policy to “recognize and support the sanctity of unborn life and the rights of unborn children, including the right to life.”

SBA List launches $500,000 campaign for W.Va. ballot measure. The anti-abortion group Susan B. Anthony’s List has launched a $500,000 TV, radio, and digital campaign to urge West Virginia voters to support Amendment 1, another ballot measure that would end Medicaid funding for abortion in the state. SBA list has been supporting the candidacy of Attorney General Patrick Morrisey, who is the GOP Senate hopeful, to unseat centrist Democrat Sen. Joe Manchin. “On Election Day, voters have a chance to turn the tide by passing Amendment 1 and by electing pro-life champions – not Joe Manchin,” said SBA List spokeswoman Mallory Quigley said in a statement.

Idaho Governor endorses Medicaid expansion ballot measure. Idaho’s Medicaid expansion ballot initiative got a big boost on Tuesday when Republican Gov. Bruce Otter endorsed the measure. “Allowing the healthcare coverage gap to persist any longer is not an option,” Otter said in a statement that was reported by the Idaho Statesman newspaper. He added that the Medicaid expansion measure will provide healthcare for 62,000 Idahoans and could bring “$400 million of our tax dollars back to Idaho.” The endorsement signals that if the expansion is approved by voters, the administration will implement it, which hasn’t been the case in Maine, where Republican Gov. Paul LePage has refused to implement expansion authorized by voters, causing a major court battle.

Candidates in Kentucky race spar over healthcare in race that could determine House majority. Candidates in a critical Kentucky race that could flip control of the House sparred over healthcare Monday night, with Republican Rep. Andy Barr accusing his Democratic challenger Amy McGrath of supporting socialized medicine and McGrath calling the incumbent a liar. Barr, who is facing his first real challenge, has tried to label McGrath as being on the “extreme far Left” on healthcare, defending against attacks that he voted for the House Republican plan to repeal the Affordable Care Act. “How can you continue to lie?” McGrath challenged Barr as he accused her of supporting single-payer healthcare, which has become a rallying cry for progressives in other parts of the country.  When pressed on his vote to repeal the ACA and comments by Senate Majority Leader Mitch McConnell, R-Ky., that Republicans could again try to repeal the law, Barr said he wants to “replace it.” “I certainly don’t want to just repeal the law and go back to the status quo,” he said.

Trump’s ‘plan’ for covering pre-existing conditions revealed. White House Press Secretary Sarah Huckabee Sanders created a bit of a mystery Monday when she claimed that Trump had a healthcare plan that “covers pre-existing conditions. Nobody would be charged higher premiums if they keep their coverage.”

Such a plan would square Trump’s support for a lawsuit to end Obamacare with his stated support for pre-existing conditions, which the lawsuit would strip away, but it wasn’t obvious what plan Sanders was referring to. A White House aide told the Washington Examiner that she meant the American Health Care Act, which the House passed in May 2017. The bill would have let states gut pre-existing condition protections for people whose coverage lapsed for more than 63 days. The bill eventually died in the Senate, which failed to pass its own Obamacare repeal bill. Trump also infamously called the House bill “too mean.”

FDA mulls requiring sesame seeds be disclosed as food allergy on labels. The Food and Drug Administration is exploring the possibility of requiring warnings for sesame seed allergies in food the way it does for peanuts or eggs. The agency said on Monday it is pursuing the issue because of a rise in allergic reactions. “Unfortunately, we’re beginning to see evidence that sesame allergies may be a growing concern in the U.S.,” FDA Commissioner Scott Gottlieb said.

Heritage blasts Trump’s FDA for ‘overreach’ on regulations. Gottlieb’s FDA took incoming fire Monday from the conservative think tank Heritage Foundation, which blasted the agency for  overreaching on issues that range from e-cigarettes to almond milk. Gottlieb has generally been praised by conservatives, who are especially pleased with his record approvals of generic drugs. But some of the things he’s done have irked free-marketers, and are laid out in the new report. Chief among Gottlieb's infractions is the FDA’s decision in July to consider restricting the term “milk” from being used for plant-based products like almond, coconut, or soy milk.

Ahead of merger with CVS, Aetna exceeds earnings expectations. Health insurance giant Aetna made $1 billion during its third quarter, beating Wall Street expectations. The company’s latest report will likely be its last before its merger with pharmacy chain CVS Health. The company credited lower federal taxes and growth in its Medicare business.

Pfizer profits soar as Trump fights to lower drug prices. Profit soared at Pfizer in the third quarter, a sign President Trump’s crusade against high drug prices has yet to significantly affect the world’s largest pharmaceutical company.

Gun injuries sent 75,000 kids to the ER over nine years: Study. Gun injuries were responsible for sending 75,000 children and teens to the emergency department from 2006 to 2014, according to a study published Monday in the Journal of the American Medical Association. Almost half the gun injuries were from assaults, nearly 40 percent were unintentional and 2 percent were suicides. Over most of that period the injuries declined, but there was an uptick in the final year. A third of the children were hospitalized and six percent died. The study is an analysis of estimates on emergency department visits in a database from the Agency on Healthcare Research and Quality.

James Carville: 'The caravan is the Ebola of 2018.' Longtime Clinton loyalist and Democratic operative James Carville said Monday that the migrant caravan is "the Ebola of 2018." In recent weeks, news of a large group of Central American migrants pressing into Mexico on their way to the southern border of the U.S. has gripped headlines, particularly in right-leaning media. President Trump has called the caravan, which is still weeks away from getting close to the U.S.-Mexico border, an "invasion," and his administration is poised to send thousands of troops to help prevent migrants from illegally entering the country. During a discussion on foreign policy and the 2018 midterm elections in Washington, D.C., Carville said he sees a similar pattern now to the "crisis" that was Ebola in 2014, when the last midterm elections took place, and predicted that “the caravan is out of the news a week from tomorrow."

9th person dies from respiratory illness in NJ. Another person has died at a pediatric rehabilitation center following a respiratory virus outbreak, said New Jersey Health Officials. Most of the deaths are linked to adenovirus, which typically isn’t dangerous for healthy people, causing mild cold symptoms, though some strains also cause diarrhea and conjunctivitis.


Pittsburgh Tribune-Review Doctor comes face to face with shooting suspect: ‘He’s a very lost man’

STAT News Pharma’s ‘come to Jesus’ moment: The industry braces for a Pelosi speakership and Democrats’ drug pricing agenda

Kaiser Health News GOP’s latest campaign punch relies on classic hook: Medicare

Washington Post Democrats hype estimates of pre-existing conditions

The Hill Physician groups urge FTC to monitor insulin pricing

The Guardian ‘Supporting greed over need:’ The groups taking on big pharma in the midterm elections

Morning Consult American cities on the front lines of the opioid crisis


TUESDAY | Oct. 30

House and Senate in recess until the Nov. 6 midterm elections.

Oct. 30-31. 500 5th St. NW. National Academies of Sciences, Engineering, and Medicine workshop with the Committee on Medication-Assisted Treatment for Opioid Use Disorder. Details.

Oct. 30-Nov. 1. Dallas. Health and Human Services SBIR/STTR Conference. Agenda.

Noon. 214 Massachusetts Ave. NE. Heritage Foundation event on “Chemical Slavery: Understanding Addiction and Stopping the Drug Epidemic.” Details.


8:30 a.m. Anthem Inc. third quarter earnings call. Details.

9:30 a.m. National Press Club. 529 14th St. NW. Event on “Is Next-Generation Broadband the Key to Improving Patient Outcomes through Telemedicine?” Details.

THURSDAY | Nov. 1 open enrollment begins, runs through Dec. 15.

Nov. 1-2. Health and Human Services advisory committee meeting on “Heritable Disorders in Newborns and Children.” Agenda.

8:30 a.m. Cigna Corp third quarter earnings call. Details.