Candidates make health care a key part of closing pitch - Politico

Joe Biden says Obamacare's "not as good as it should be," and D.C. brings up in the rear in today's new Leapfrog safety scores. But first: how health care issues are playing a key role in the election's final stretch.

CANDIDATES MAKE HEALTH CARE PART OF CLOSING PITCH — With Election Day just eight days away, both Donald Trump and Hillary Clinton have ramped up the health care focus in their stump speeches, albeit in very different ways.

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Trump vows he's 'never going to forget' Jonathan Gruber. Since HHS announced significant rate hikes for Obamacare plans last week, the Republican candidate has been hitting the health law hard — and has been invoking a so-called Obamacare architect on the trail as a symbol of what's wrong with Washington politics.

"We're catching all of these people," Trump said at a New Hampshire rally on Friday, where he invoked Gruber's name five times in 45 seconds. "I said I am never going to forget Jonathan Gruber, the architect of Obamacare and what he said. So we did not forget … . it's like a little more than a week before the election. We didn't forget the name Jonathan Gruber."

… Trump also implied that HHS is understating the premium hike. "They sent out a director from the White House, they were trying to say 25 percent," Trump said at a Colorado rally on Saturday. "You should be so lucky," he added, alluding to his team's review of rate increases. "We haven't found too many" premium hikes that match HHS's statement.

… While in New Hampshire, Trump also took part in a roundtable discussion about opioids, two weeks after his campaign released a more formal policy on how the Republican nominee would address the opioid epidemic. More^[1].

Clinton hits trail with abortion rights advocates. The Democratic candidate was joined by Planned Parenthood's Cecile Richards and NARAL's Ilyse Hogue at an Iowa rally this weekend, seeking to emphasize women's health issues in the election.

"Make no mistake — women's health and rights, our futures, and the futures of our daughters and granddaughters, are on the ballot," the Democratic candidate said on Friday. "We were reminded of that in the last debate when [Trump] pledged to overturn Roe v. Wade and end safe and legal abortion."

Is California Nurses Association sitting out Clinton v. Trump? The powerful labor union, which backed Sen. Bernie Sanders in the Democratic primary, hasn't endorsed a candidate in the general election. One issue: While Clinton supports coverage expansion, she hasn't come around to Sanders' advocacy for single-payer.

"Our position is still under consideration," union spokesman Chuck Idelson told^[2] the San Francisco Chronicle. Although Idelson suggested that CNA wouldn't support the Republican nominee — "we know that nurses are not going to vote for Trump," he said — the union's leader RoseAnn DeMoro explicitly blasted the Clinton campaign on Twitter last week.

"#PodestaLeaks show Clinton camp trying to get press to attack #Nurses supporting Bernie," DeMoro tweeted, pointing to an internal campaign email released by Wikileaks. "Never happened in Obama era." ^[3][4]

WELCOME TO MONDAY PULSE — Where your author watched 10 recent Trump speeches and was fascinated by how the Republican nominee consistently went off-script on Obamacare, whether praising his deceased uncle or resurrecting his vague argument about "the lines." Trump also used a convenient line to talk about premium hikes: "The number is so big that I refuse to tell you what it is because I want you to leave here happy," he told one crowd in Colorado. Send tips and your own big numbers to ddiamond@politico.com^[5] or @ddiamond^[6] on Twitter.

With help from Adam Cancryn (@AdamCancryn^[7])

DAYS UNTIL ACA OPEN ENROLLMENT: 1

FROM THE HUMPHREY BUILDING

CMS sets 2017 pay rates for kidney disease. The agency on Friday finalized a slight increase in 2017 Medicare payments for dialysis facilities treating end-stage renal disease patients.

According to the agency's final rule^[8], facilities will see a 0.73 percent average increase in payments next year. Hospital-based dialysis facilities should see the biggest bump, at a 0.9 percent increase. Medicare expects to pay about $9 billion total to 6,000 facilities treating the debilitating kidney disease in 2017. More^[9] .

ON THE TRAIL

Where medical marijuana is on the ballot. Voters in three states — Arkansas, Florida and North Dakota — will consider whether to legalize medical marijuana, while Montana has a ballot measure that would remove restrictions from the state's current medical marijuana law. Success in those states would make medical marijuana legal in a clear majority of states. More^[10].

Health care super PAC makes Spanish-language ad buy in Nevada. Working Americans for Affordable Health Care on Friday announced a $150,000 investment in Spanish-language ads targeting GOP Reps. Joe Heck and Cresent Hardy. Heck is running for Senate Minority Leader Harry Reid's seat, while Hardy is running for reelection. The super PAC was launched by labor organization UNITE HERE.

Health care leaders send cash to Hillary Clinton, shun Donald Trump. That's according to a Modern Healthcare review of 100 prominent health care leaders and federal election records. Overall, one-quarter of the leaders reviewed had donated to Clinton … and zero had given to Trump, despite having a history of donating to conservative causes.

— The biggest donors. Five executives in the publication's sample gave the maximum — $5,400 — to Clinton. Those executives were Geisinger Health System CEO David Feinberg, Independence Blue Cross CEO Daniel Hilferty, Adventist Health System's retiring CEO Donald Jernigan, Centene CEO Michael Neidorff and Duke Health System CEO Eugene Washington. More^[11].

** A message from PhRMA: Insurance coverage does not necessarily mean access to care. More medicines are being excluded from coverage, deductibles and copays are going up and insurance companies are increasingly imposing other barriers to access. Know the 4 things^[12] to think about when you choose your health plan. Learn more at AccessBetterCoverage.org^[13]. **

OBAMACARE

Why the FTC is poised to play even bigger role in Obamacare's future. Health care providers are continuing to consolidate, and that puts even more pressure on the Federal Trade Commission to scrutinize and regulate a rising number of deals, Harvard's Ashish Jha writes at the JAMA Forum. Many of those deals have implications for the Affordable Care Act, Jha argues, citing evidence that provider consolidation:

1. Can raise overall costs for patients, hurting the perception that care is affordable.
2. Limits the available provider networks in ACA exchanges, which could lead to an "erosion of confidence" in Obamacare plans as narrow networks increase and media attention focuses on lack of access to key doctors and hospitals
3. May directly affect the success of the Accountable Care Organization model. Many independent physician groups are saving money under the ACO model, but consolidated health systems are not, Jha points out.

"If the ACA is to thrive under the next president, he or she must ensure that we have a dynamic health care marketplace," Jha argues. "The ability of the ACA to fulfill its promise of greater access at an affordable price will depend as much on the effectiveness of the FTC as it will on the effectiveness of the CMS." More^[14].

Joe Biden says Obamacare is 'not as good as it should be.' The vice president said the law needs fixes, but added that "I don't think it's in peril," he told John Dickerson on "Face the Nation" yesterday. "There's a whole range of things that still justify [the law]," Biden added, pointing to the law's protections for pre-existing conditions and expanded coverage to younger Americans.

One change that Biden would like to see: Ramping up subsidies to lure younger, healthier Americans into the marketplace. "We should be in a position where we are providing a greater subsidy for young people to get into the marketplace that can't afford to get in," he said

… Biden also said that the next president must quickly address Obamacare's woes. "It's going to be very high on … assuming it's Hillary, on her priority list," Biden added. "It has to be. I think it's important."

ON THE HILL

Research!America and United for Medical Research want action on Cures. The groups are pushing Congress to pass the 21st Century Cures package in the looming lame-duck session. "Putting this bill off until the next Congress likely means putting it off for the foreseeable future — a terrible outcome for our country," said UMR's Friday's letter to House and Senate leaders. "This is a rare opportunity to make a real difference in the lives of all Americans."

ZIKA VIRUS

Puerto Rico reports first case of Zika-related microcephaly in newborn. The case, which was reported on Friday, is expected to be the first in a wave, according to The Associated Press. The baby's severe brain defect was not identified until the mother was nearly eight months pregnant, raising concerns that the scope of Zika and related microcephaly on the island is not fully known. More for Pros^[15].

2,980. That's how many pregnant women across the United States and territories showed evidence of Zika infection as of October 20, according to CDC. The actual total is almost certainly higher, public health experts caution; a recent study suggested that the number of pregnant women infected with Zika in Puerto Rico could be four times larger than recorded.

AROUND THE NATION

D.C. brings up the rear on hospital safety. That's according to new grades from the Leapfrog Group, which ranked the District of Columbia among the worst in the nation for hospital safety and quality. Alaska, Delaware and North Dakota also received the lowest possible score, with no hospitals in those states earning "A" grades.

Hawaii, meanwhile, topped the list with eight of its 12 hospitals receiving an "A." See Leapfrog's full list of safety scores out today: More^[16].

STATE WEEK: New Mexico considers Medicaid co-payments. The state is considering asking CMS for authority to add co-payments and other costs for beneficiaries, the Associated Press reports. The announcement — which comes ahead of federal approval — comes as New Mexico is grappling with a budget crisis. More,^[17]

At this hospital, heart patients are banned from talking Clinton v. Trump. Worried about exacerbating patients' stress, staff at Southampton Hospital's cardiopulmonary rehabilitation gym have taken an unusual step: They've asked them to stop arguing over the election. "Due to the fact that we have patients with heart conditions we cannot allow political debates in the gym," a sign reads in the New York hospital. More^[18].

CANCER MOONSHOT

Joe Biden: What I've learned since starting the moonshot. The vice president, who delivered the White House's weekly address this weekend, touted how the White House's moonshot initiative is working to "break down silos" that have hindered cancer care research and delivery.

Biden pointed to the effort to get more cancer patients enrolled in clinical trials through trials.cancer.gov^[19] and reiterated the call for would-be volunteers to visit cancer.serve.gov^[20]. "The private sector is also reimagining what it can and should do," he added, citing how firms like Microsoft and IBM have offered their support and technical services.

"Most of you assume we've already been doing this," Biden said. "We weren't before, but now we are."

WHAT WE'RE READING

The Obama administration's argument that ACA subsidies will defray consumers' costs overlooks many crucial caveats, NYT's Robert Pear writes, like the eventual impact on taxpayers and the millions of Americans who don't stand to benefit. More^[21].

WSJ's Denise Roland looks at how drug makers are combining cheap generics in order to produce expensive pills. More^[22].

Aaron Carroll has a pessimistic read on a JAMA study that debunks some health effects of cranberry juice: "Nothing works. Nothing." More^[23].

The director of a ferret association writes at Vox that Obamacare's premium hikes — while "bad" — shouldn't take away from how the law has been a "godsend" for people who work unusual jobs and need health insurance, like her. More^[24].

At Healthcare Dive, Jeff Byers runs through the tactics that ACA advocates will use this enrollment period. More^[25].

POLITICO's Dan Goldberg flags that roughly 18 percent of New Yorkers chose a platinum plan in 2016, compared to just 2 percent across the nation. More^[26].

** A message from PhRMA: Open enrollment is upon us once again. Whether you are picking a plan through your employer or a health insurance marketplace, whether you are getting coverage for the first time or changing to a new plan, understanding your coverage options can help with your decision process. Even if you like your plan, it is always smart to spend a little time doing research to make sure your plan is the right one for you, especially as plans change year to year. Here are four helpful things to consider when choosing your health plan. (1) Where can you go for treatment? (2) Review the plan deductible and premium. (3) Find out if and how your medicines are covered. (4) Learn about your potential out-of-pocket costs. These 4 things ^[27] can help you be a better engaged and empowered health care consumer. Get our quick tips at AccessBetterCoverage.org^[28]. **

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