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Republicans abandon strategy of highlighting Obamacare’s losers. Republicans have abandoned their strategy of elevating people hurt by Obamacare as the midterm election pressure has increased. Gone from the airwaves are personal anecdotes from those President Trump once dubbed the “ victims” of Obamacare: people who faced soaring costs or the loss of their doctor. Millions of Obamacare customers still face those problems, but Republicans are no longer talking about the victims they once championed. To be sure, most congressional Republicans still do pledge to repeal Obamacare. Senate Majority Leader Mitch McConnell said this month that Republicans would take another swing at the healthcare law if they retain power, saying that they are "not satisfied with the way Obamacare is working." And the Trump administration has pursued regulatory changes geared toward Obamacare losers. But the tone and focus have shifted. Republicans on the campaign trail aren't highlighting the specific harms customers face as justification for full repeal, and the president hasn't been holding press events with the law's losers, as he did during last year's repeal push. Because Republicans have tried, through Congress and the courts, to undo the law, Democratic attack ads have depicted a GOP-dominated future as one in which millions of people with serious medical conditions would lose healthcare coverage. The pressure has been too much for many Republicans, and they've radically re-focused their campaigns to prioritize pre-existing condition protections, and not the victims who suffered the trade-offs necessary to implement those protections.

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 dailyonhealthcare@washingtonexaminer.com 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.

Trump administration confirms it won’t restore ad funding for Obamacare. The Trump administration will devote $10 million to advertising and outreach for the 2019 open enrollment period, the same as for the 2018 open enrollment period and way down from Obama administration funding. Centers for Medicare & Medicaid Services Administrator Seema Verma previously told the Washington Examiner that the agency was likely to devote only $10 million for the 2019 period, which runs Nov. 1 to Dec. 15 for coverage starting Jan. 1. The agency said it aims to have the same amount of call center staff for 2019 as the 2018 open enrollment. CMS hailed the 2018 open enrollment period as the “agency’s most cost effective and successful experience for HealthCare.gov consumers to date.” Residents in 38 states use the website to buy Obamacare coverage. The $10 million for ad funding for 2019 is a 90 percent cut compared to the $100 million that the Obama administration devoted for the 2017 coverage year.

Democrats, bruised by Obamacare fight, skeptical of Trump siding with them on drug prices. Democrats reacted with skepticism last week when Trump decided to embrace a policy they favor and install price controls on certain Medicare drugs, a reaction that reflects the lingering resentment from 2017's bruising fight over Obamacare repeal. Trump broke with traditional Republican policy when he announced a proposal Thursday to tie reimbursement for certain Medicare drugs to the prices that other wealthy countries like Germany or France pay. Even though congressional Democrats have been receptive to similar policies in the past, they met Trump’s proposal with withering criticism, reminding the public of the president’s pursuit of Obamacare repeal. “It's hard to take the Trump administration and Republicans seriously about reducing healthcare costs for seniors two weeks before the election when they have repeatedly advocated for and implemented policies that strip away protections for people with pre-existing conditions and lead to increased healthcare costs for millions of Americans,” said Senate Minority Leader Chuck Schumer in a statement Thursday. The administration is seeking comments on the proposal now with the goal of putting out a proposed rule in spring 2019. The pro-Obamacare group Families USA praised the proposal, but was skeptical of the timing, coming as it did two weeks before an election in which Democrats are hammering Republicans on healthcare and their unpopular and unsuccessful attempt to repeal Obamacare.

Alex Azar pushes back on big pharma’s criticism that he is “un-American.” Health and Human Services Secretary Alex Azar fired back Friday at drugmakers who labeled him as “un-American” for his new drug price proposal, describing industry resistance as the reason for high U.S. prices. "Something has to change in how Medicare pays for physician-administered drugs,” Azar said at the Brookings Institution. “The only thing standing in the way is the one special interest that has benefited from this program far out of proportion to any other actor, for the last 15 years: The pharmaceutical industry.” The proposal would, over five years, tie drug prices paid by Medicare for a majority of physician-administered drugs to the prices paid by other wealthy countries, such as France, Germany, and Japan. The pharmaceutical industry came out swinging against the proposal, with the Pharmaceutical Research and Manufacturers of America calling it placing foreign price controls from “countries with socialized healthcare systems that deny their citizens access and discourage innovation.” But Azar defended the proposal, saying that it won’t affect innovation. “Our model will save $17 billion in Medicare drug spending over the next five years,” he said. “That’s $3.4 billion a year.” He added that the pharmaceutical industry has previously said the industry as a whole devotes $70 billion a year to R&D. “These savings, while substantial for American patients and taxpayers, cannot possibly pull out more than one percent of R&D,” he said.

But what about biosimilars? One expert said that Trump’s drug pricing policy is missing the mark because it doesn’t go after patents that keep cheaper drugs off the market. Thomas Bollyky of the Council on Foreign Relations wrote in Axios on Monday that the proposal doesn’t do anything to spur the proliferation of biosimilars, which are cheaper versions of extremely expensive specialty biologic drugs. “The U.S. is unique in that it offers strong drug patent protections and limits the ability of public and private payers to appraise new drugs and bargain over prices. In the case of biologics, that problem is compounded. Europe has approved four times as many biosimilars — generic versions of biologics, whose savings can exceed 50% — as the U.S.” he wrote in Axios. The Food and Drug Administration has only approved four biosimilars, but they haven’t gotten on the market due in part to patent litigation with the brand name drugmakers.

CMS proposes allowing more Medicare Advantage coverage for telehealth. The Centers for Medicare and Medicaid Services on Friday proposed allowing Medicare Advantage, which is run by private insurers, to cover more telehealth services. Telehealth helps patients access doctors and other healthcare providers remotely, often through a video, so they can receive medical advice. Centers for Medicare and Medicaid Services Administrator Seema Verma said allowing people to use telehealth would “promote access to care in a more convenient and cost-effective manner for patients.” If the government decides to move forward with the idea then it will start in 2020.

State exchanges get low grades in new scorecard. Seven state exchanges -- Massachusetts, New York, Idaho, Maryland, Vermont, Minnesota, and Connecticut received a D or an F in a report out today from the Council for Affordable Health Coverage, which is made up of different healthcare groups. Healthcare.gov was ranked fourth, with a grade of 81, and the District of Columbia’s exchange, called DC Health Link, was No. 1 with a score of 92. The exchanges were graded according to seven different criteria, including access to detailed plan information, having an out-of-pocket cost calculator, and having tools that allow customers to look at which doctors would be in a plan and which drugs would be covered. "Sadly, our report shows that, once again, too many state exchanges are providing substandard service to users,” CAHC President Joel White said in a statement. “While our findings show modest progress from years past, it remains unacceptable that, in 2018, more progress has not been made.” The group argues that it’s time to toss out public exchanges and so that private firms will carry them instead.  

Midterm candidates scored by anti-abortion group. The anti-abortion organization March for Life has created scorecards for candidates running in Missouri, North Dakota, Tennessee, Texas, and Wisconsin ahead of the midterms. They include information about what candidates said, or how they voted, on Trump’s Supreme Court nominee Brett Kavanaugh, scores they received from Planned Parenthood or NARAL Pro-Choice America, their stance on a 20-week abortion ban, and allowing states to cut off government funding from organizations that provide abortions.

Pollution kills 600,000 children a year, WHO says. More than 600,000 children died from breathing polluted air in 2016, according to a World Health Organization report published Monday. The agency estimated that 93 percent of children under the age of 15 across the world are breathing in dirty air that puts their health and development at risk. Children are affected before they are even born, the report found. When pregnant women are exposed to polluted air, they are more likely to have premature births and have babies that are born underweight. Officials said exposure while in the womb was leading to damage in brain development, resulting poorer testing in schools and impeding motor functions. Officials estimated in the report out Monday that 1 in 10 deaths among children under age 5 are caused by air pollution. Children are particularly vulnerable to illnesses from toxic air because they breathe faster than adults. Pollution can trigger asthma, childhood cancer, and can lead to heart disease later in life.

Federal judge not moved by insurers seeking to end short-term health plan expansion. Things aren’t looking good for a lawsuit filed by the Association for Community Health Plans seeking to stop the Trump administration’s new regulation to expand the duration of short-term health plans. Federal Judge Richard Leon said on Friday that the insurers should pull its request for a preliminary injunction to end the regulation, according to a report in The Hill. The judge disagreed with the group’s arguments that the regulation would hurt businesses and consumers, The Hill added. Leon appeared to side with the Trump administration on the plans, calling them an alternative for healthy people who don’t want to pay Obamacare’s high prices. The insurers’ argument mirrors criticism from pro-Obamacare groups and Democrats that say the plans will destabilize Obamacare’s exchanges because younger or healthier people will go buy the short-term plan. This will cause the risk pool for Obamacare’s exchanges to crumble and raise costs. But the Trump administration charges that the regulation is like an escape hatch for people who are healthy but earn too much to get an income-based subsidy.

A record $111 million is being spent to defeat this California ballot. Opponents to Proposition 8 have spent a record amount of money trying to get a central message out to California voters: If you vote “yes” on this ballot, people will die. Californians on Nov. 6 will get to decide whether to cap dialysis centers' profits, a vote that opponents say will cause clinics to close and put people’s health and lives at risk. Medical groups have spent nearly $111 million to defeat the measure, and the amount could climb even further given that more than a week remains until the election. The opposition campaign has flooded the public with emotionally charged TV, online, and radio ads featuring dialysis patients who warn that the ballot will “cause a lot of lives to be at stake” and “literally threatens my life.” Proposition 8, one ad says, “threatens the lives of over 66,000 kidney dialysis patients.” Dialysis giants have spent the bulk of the cash, with DaVita Healthcare Partners spending $67 million and Fresenius Medical Care North America contributing $33.23 million. The two firms dominate the dialysis market in the U.S. And Proposition 8 opponents are far outpacing the $18 million spent so far by the campaign supporting the measure, which is led by the Service Employees International Union, or SEIU.

RUNDOWN

Associated Press Shoppers may face hard choices again on health marketplaces

New York Times Shopping for insurance? Don’t expect much help navigating plans

Modern Healthcare Will Trump’s push for flexibility help revamp insurance markets?

Wall Street Journal Pre-existing condition discord shows healthcare still a hot-button issue

CNBC Trump administration courts investors in broad effort to combat rising healthcare costs

Washington Post Facing an opioid epidemic, some ERs now offer addiction treatment

Kaiser Health News That’s a lot of scratch: The $48,329 allergy test

MONDAY | Oct. 29

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

6:30 p.m. National Press Club. Book event on “Bad Advice” by Dr. Paul Offit. Details.

TUESDAY | Oct. 30

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.

6:30 a.m. Aetna Inc. third quarter earnings call. Details.

10 a.m. Pfizer Inc. third quarter earnings call. Details.

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

WEDNESDAY | Oct. 31

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

Healthcare.gov 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.