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Republicans embrace key tenets of Obamacare.  Montana U.S. Senate candidate Matt Rosendale is running in a new world for Republicans: one where Obamacare repeal is not the clear-cut winner it was in the last two midterm elections. Rosendale said in an interview with the Washington Examiner that he opposes the federal mandates in Obamacare that force health insurance carriers to cover pre-existing medical conditions and prohibit lifetime caps on payouts, but would find other ways to provide coverage. Republicans have found themselves on the defensive on healthcare, as they struggle to maintain their opposition to Obamacare while accommodating the more popular provisions that form the backbone of the law. Rosendale, challenging Democratic Sen. Jon Tester in the midterm elections, pointed to proposals he authored as Montana’s elected state auditor that he said would address pre-existing conditions without Obamacare's mandates. “I support covering pre-existing and chronic conditions and have put solutions forward to do so. And, we can do it without having a federal mandate that dictates to everybody how they are to take care of their healthcare needs,” Rosendale told the Washington Examiner, as he campaigned across Western Montana. It’s possible that Rosendale is one of those Republicans that President Trump is going to want to speak to about the issue. Trump, who rallied for Rosendale in Missoula, Mont., on Thursday, suggested in a tweet posted the same day that that he backs the current Obamacare protections — and that he’ll have a talking-to with any in his party who disagree.

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Republicans loud in supporting pre-existing condition coverage, but quiet on how they'd do it. Many Republicans running for election are quick to tell voters that they support health insurance protections for people with pre-existing conditions, but they often are reluctant to offer details on how they’d ensure it.

Senate candidates who are attorneys general mum on plan if lawsuit successful. Missouri Attorney General Josh Hawley and West Virginia Attorney General Patrick Morrisey both joined 18 other states in a lawsuit that would get rid of all of Obamacare, including pre-existing condition protections. Hawley is challenging Sen. Claire McCaskill, D-Mo., and Morrisey is going up against Sen. Joe Manchin, D-W.Va. Both have said that they support coverage for pre-existing conditions, but neither has offered a plan to ensure that coverage if the lawsuit is successful. Neither Hawley nor Morrisey returned a request for comment. The same goes for President Trump, who has said that Republicans support pre-existing conditions even though the Justice Department supports the lawsuit’s efforts to gut them.

Pelosi, Schumer on Trump's 'Chuck & Nancy, call me' tweet: No diversion from healthcare. Democratic Leaders Rep. Nancy Pelosi, Calif., and Sen. Chuck Schumer, N.Y., responded to President Trump’s challenge for them to make a deal on immigration, claiming he is trying to divert attention from healthcare by focusing on immigration. “The president is desperate to change the subject from healthcare to immigration because he knows that healthcare is the number one issue Americans care about,” the leaders said in a joint statement released Saturday.

“Mitch McConnell, Paul Ryan, and Republicans in Washington are making a mess of our healthcare system, causing premiums to increase and care to decrease while threatening to gut protections for pre-existing conditions,” the leaders’ statement continued. “Democrats are focused like a laser on health care and will not be diverted.”

Trump mulls narrowing transgender rights. A recent memo by the Health and Human Services Department to other federal agencies in the Trump administration called for adopting a narrow definition of gender that would effectively roll back many legal protections granted to transgender people during the Obama administration. HHS called on government agencies to adopt a definition of gender that used “a biological basis that is clear, grounded in science, objective and administrable.” The department said that gender should be defined as simply male or female from birth and be considered immutable, according to a New York Times report.

“The sex listed on a person’s birth certificate, as originally issued, shall constitute definitive proof of a person’s sex unless rebutted by reliable genetic evidence," the memo proposed. Such a definition would sweep away a series of administrative definitions by the Obama administration that extended protected status to transgender people at schools, prisons, and other federally funded institutions.

Planned Parenthood calls change “cruel and discriminatory.” The women’s health and abortion provider quickly slammed the reported change. “This move would hurt millions of transgender people’s ability to live free from discrimination and access critical services like health care. Congress must reject this discriminatory agenda,” said Dawn Laguens, executive vice president of Planned Parenthood Federation of America, in a statement.

Obamacare website suffers breach, 75,000 people have information compromised. Information from 75,000 people who use the federal government's Obamacare website was hacked earlier this week, the Centers for Medicare and Medicaid Services reported Friday. Staff at CMS said in a statement that they noticed "anomalous activity" in a part of the site that allows agents and brokers to connect people with health insurance. The agency did not say who was responsible for the hack, but said it had followed protocol by notifying federal law enforcement officials.

The number of people affected represents a small fraction of the roughly 9 million people who enroll in the system, but CMS called the breach "unacceptable." “Our number one priority is the safety and security of the Americans we serve," CMS Administrator Seema Verma said in a statement. The site is still accessible and open enrollment is still scheduled to start on time Nov. 1. The agency is notifying people who were affected.

FDA commissioner floats banning e-cigarette sales in convenience stores. FDA Commissioner Scott Gottlieb said Friday that he is weighing banning sales of e-cigarette products in convenience stores and confine them to vape shops if use among minors is not lowered. "We're looking at what can be sold in brick-and-mortar stores and whether or not flavored products can be sold in regular stores like a 7-Eleven and a truck stop and a gas station, or whether or not flavored products on the market should be confined to adult vaping shops, which generally tend to do a better job of checking ID," Gottlieb said on CNBC.

FDA kicks off two-day meeting on e-cigarette approval regulations. The agency is holding a two-day meeting starting Monday to discuss the regulations surrounding approval for e-cigarette products before they reach the shelves. A 2009 law required any e-cigarette product made after February 2007 to get agency approval, but the FDA has repeatedly delayed implementation. Gottlieb said Monday that the review process is important because it allows the FDA to determine whether products appeal to kids.

Maryland asks Supreme Court to uphold its generic drug anti-gouging law. Maryland has appealed to the Supreme Court to keep intact a state law that requires generic drug manufacturers to refrain from massive price hikes. The outcome could have major ramifications across the country as states step in to attack high drug prices.

At issue is an April decision by the 4th Circuit Court of Appeals to strike down the state's anti-gouging law on the grounds that, by imposing requirements on drugmakers in other states selling generics in Maryland, it violates the Constitution’s Commerce Clause. Now the state is petitioning the Supreme Court to overrule the appeals court and keep the law.

Local officials raise alarm about shortage of epidemiologists. Local health departments will need to grow their epidemiology staffs by 40 percent to meet public health emergencies, according to a report published Friday by the Big Cities Health Coalition and Council of State and Territorial Epidemiologists. A shortage of “disease detectives” would be particularly concerning amid the opioid crisis and the latest spread of paralysis-inducing acute flaccid myelitis.


Wall Street Journal A billionaire pledges to fight high drug prices, and the industry is rattled

The Hill GOP Iowa governor proposes over the counter birth control meds

Associated Press Analysis: Obamacare shapes opioid grant spending

STAT News Decrying political pressure at the FDA, former commissioners push breakaway for the agency

Politico The ballot revolt to bring Medicaid expansion to Trump country

NPR Legal battle over Missouri clinic could foretell abortion fights in other states

Reuters New health insurer policy may mean you pay for your ER visit


MONDAY | Oct. 22

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

Oct. 21-23. Renaissance Washington. 999 9th St. NW. Medicaid Health Plans of America annual conference on “Medicaid: The Great Debate.” Details.

TUESDAY | Oct. 23

Oct. 23-24. Milken Institute Future of Health Summit. Details.

6 a.m. Centene third quarter earnings call. Details.


White House to host event commemorating “a year of historic action to combat the opioid crisis.” President Trump expected to sign the SUPPORT for Patients and Communities Act.

THURSDAY | Oct. 25

Oct. 25-26. Ronald Reagan Building and International Trade Center. 1300 Pennsylvania Ave. NW. Medicaid and CHIP Payment and Access Commission October meeting. Details.

MONDAY | Oct. 29

National Press Club. Book event on “Bad Advice” by Dr. Paul Offit. Details.