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Once a supporter, Trump now attacks single-payer. When President Trump ran for office, he did so as a Republican with a track record of making statements that contradicted many of the party’s typical positions. Perhaps no example demonstrates his conversion from a heterodox independent Republican to a more traditional conservative on policy than his shift on single-payer, which he had publicly admired for decades. In his 2000 book “The America We Deserve,” Trump described himself as a “liberal” on healthcare and suggested the U.S. should look to Canada’s socialist system as a “prototype.” In a Republican presidential debate, he said the socialist systems in Canada and Scotland worked well and in a a “60 minutes” interview said government should pay for universal coverage. As the midterm elections approach and more Democrats are openly advocating some variation of a socialized system, Trump has gone on the attack, and is sounding more like a traditional Republican. On Wednesday, Trump said that he believed differences on healthcare between Republicans and Democrats could help bolster the party into a “red wave” for the midterm elections. “And they’re such opposites in a sense,” Trump told the Hill of Democrats. “Like, if you take insurance they want single payer, which can’t be afforded, and we want really great healthcare where people get a great price. You know, really great stuff where people get a great price.”

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 [email protected] 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.

Addict advocates call on Congress to add more money to opioid legislation. Some substance abuse treatment advocates and experts charge that lawmakers must add long-term funding to the massive opioid package currently working its way through Congress in order to fully tackle the epidemic. The Opioid Response Act, passed by the Senate on Monday, includes a slew of proposals to combat the crisis but only minimal funding, with Republicans instead counting on future annual appropriations bills for additional funds. The Senate and House, which passed its own slate of bills in June, are poised to work out a compromise between the versions of their bills, both of which would expand treatment options, spur development of nonaddictive painkillers, and crack down on the tide of illicit fentanyl flooding into the U.S. However, advocates say that the legislation should not head to President Trump’s desk without more long-term funding dedicated to expanding treatment for addiction.

Generics would hit the market faster under Senate bill, saving more than $3B, says CBO.

Lower-price drugs would hit the market faster under a bipartisan bill awaiting a vote in the Senate, according to a score released Wednesday by the Congressional Budget Office and the Joint Committee on Taxation. “CBO expects that the bill’s provisions would allow generic drugs … to enter the market earlier, on average, than they would under current law,” authors of the report concluded. The legislation, known as the CREATES Act, passed the Senate Judiciary Committee in June but hasn’t yet been scheduled for a vote on the floor. CBO estimates that it would reduce spending by $3.3 billion from 2019 to 2028, mostly through the Medicare and Medicaid programs spending less on prescription drugs.

Grassley rejects FBI probe, still pushing for testimony from Kavanaugh’s accuser.  Senate Judiciary Committee Chairman Chuck Grassley on Wednesday rejected the idea of having the FBI investigate sexual assault claims against Supreme Court nominee Brett Kavanaugh, and said he is still working to have Kavanaugh’s accuser, Christine Blasey Ford, testify in his committee next week. “No other OUTSIDE investigation is necessary for the Cmte to do its investigation,” Grassley tweeted. “Don’t know why Dems are refusing to cooperate in the cmte’s investigation I hope Dems will join me.”  Grassley’s declaration came hours after Ford said she will not attend a hearing with Kavanaugh scheduled for Monday that was meant to give her a chance to tell her story to committee members. He said he still wants her to show up, even if her comments are taken in private, with no cameras running.

Condom use declines in teens. Use of condoms declined from 59 percent of all high school students in 2013 to 54 percent in 2016, according to a study out this morning from the Guttmacher Institute. The decrease is occurring just as public health officials have noted a rise in the number of young people with sexually transmitted diseases. It has also come at the same time as more than doubling in the use of long-acting reversible contraceptives, such as intrauterine devices, from 2 percent in 2013 to 5 percent in 2015. Guttmacher said that the decline in condom use “warrants further research.” In 2017, 40 percent of high school students reported they had ever had sex, the lowest percentage since 1991, when the study began.

Surgeon general spotlights opioid addiction. Surgeon General Jerome Adams released a digital “postcard” to the public to help them prevent opioid misuse. It encourages people to carry the overdose-reversal drug naloxone and to talk to doctors about how to manage pain. “With the right treatment and supports, people do recover,” one portion reads. “There is hope.” Accompanying the postcard is an extensive report about the breath of the problem, including on mental health and on other addictions such as alcohol.

Nonprofit takes on drugmakers’ lobbying on Medicare drug discount. A group seeking lower drug prices is launching new attacks on the pharmaceutical industry to stop them from nixing a policy that will require them to give steeper discounts for Medicare drugs. The group Patients for Affordable Drugs Now released an ad on Tuesday highlighting the drug industry’s attempts to cut a “backroom deal” with Congress to eliminate a provision of law that requires them to give a bigger discount for certain drugs covered under Medicare. The six-figure digital ad will run for an undetermined amount of time as negotiations in Congress continue, the group told the Washington Examiner.

Pharma has been trying to end the policy for a while. The policy was inserted into a government spending bill in March. The policy required drugmakers to offer a 70 percent discount on drugs in the Medicare Part D coverage gap called the “donut hole” instead of 50 percent. Obamacare mandated that the donut hole be closed in 2020, but it will now be closed in 2019 because of the March legislation. Technically the coverage gap still exists, but the senior will only have to pay 25 percent of the cost of their drugs from the time they enter and leave it. Pharma lobbyists are working with lawmakers to lower the discount from 70 percent to 64 percent. Pressure is on pharma’s main lobbying group, the Pharmaceutical Research and Manufacturers of America, to get rid of the clause. The group is said to be working with lawmakers to overturn it in exchange for support for the CREATES Act and a two-year delay of a $1,200 increase in out-of-pocket spending for Medicare Part D beneficiaries expected to start in 2020, our colleague Joe Williams reported last week.

Medical groups slam GOP pre-existing condition bill they say falls short. A collection of 33 medical groups slammed a bill from Sen. Thom Tillis, R-N.C., and nine other GOP senators as inadequate to protect people with pre-existing conditions. The bill was a way for Republicans to get political cover for an issue that Democrats have been hammering them on. But the groups, which include the American Heart Association and American Diabetes Association, said that the bill does not actually go far enough to preserve pre-existing condition protections. The bill was in response to a lawsuit from 20 states that seeks to gut Obamacare’s pre-existing condition protections along with the rest of the law. “This bill as written is far from an adequate replacement for the protections for individuals with pre-existing conditions that are provided under current law,” the letter to Tillis and GOP senate leadership said. The group also said that preserving essential health benefits, which the bill doesn’t address, is tantamount to ensuring protections for pre-existing conditions as insurers could decide to not cover certain treatments. These criticisms emerged when the bill was first released a few weeks ago. Tilis told reporters recently that there is still a chance to iron out the details to address such concerns.

Indicted Republican lawmaker Chris Collins resumes re-election campaign. Rep. Chris Collins announced Wednesday he will resume his campaign for re-election, despite being under indictment for insider trading. “Voters can be assured that with the recent turn of events, they can count on me to actively campaign for Congress, and to serve should voters re-elect me,” the New York Republican wrote on Twitter. “The stakes are too high to allow the radical left to take control of this seat in Congress,” he tweeted. “As a result, I will fight on two fronts. I will work to ensure the 27th Congressional District remains in Republican hands, while I fight to clear my good name in the courts.” Collins was charged by federal prosecutors last month who accused him of insider trading with the pharmaceutical company Innate Immunotherapeutics.

Democrats call for subpoena for HHS, CMS docs on Medicaid work rules. House Democrats want to subpoena the Trump administration to turn over documents on their efforts to impose work requirements for Medicaid. Democratic Reps. Elijah Cummings of Maryland and Raja Krishnamoorthi of Illinois sent a letter to House Oversight Committee Chairman Rep. Trey Gowdy, R-S.C., to ask for the subpoena on Thursday. The lawmakers wrote to Health and Human Services and Centers for Medicare & Medicaid Services back in August to get documents on potential coverage losses from implementation of the work rules. “Because these proposed work requirements have not been adequately thought through, they could cause many low-income Americans and their families to lose their health insurance simply by complying with these new requirements,” the letter said.

RUNDOWN

ProPublica Black patients miss out on promising cancer drugs

STAT News Expanding addiction treatment, embracing the bully pulpit: Jerome Adams on his first year as surgeon general

CNN Walmart wants to bring its everyday low prices to healthcare

Post Register Idaho still in talks to allow non-ACA plans

Politico Republicans ‘duck and cover’ on pre-existing conditions

Modern Healthcare HHS to work with startups and investors to foster innovation

Des Moines Register Iowa Medicaid’s per-member cost increases nearly triple since privatization