You might have missed it but Congress averted a government shutdown last week. While several appropriations bills passed on time for the first time in years, several agencies, including the FDA, were funded on a continuing resolution (CR). The CR provides funding until December 7th and will need to be addressed again by that time. However, the House is now in recess and won't be back in town until after the midterm elections. So the lame duck session will have a few 'must dos' on the list.

On the health care front, the Senate is expected to move the opioids bill to the President's desk. The bipartisan legislation should provide a small boost to both sides as a bill with political implications moving before the midterms. Following passage, attention will turn to potential regulatory actions from the Administration as well as the upcoming ACA open enrollment.

HEALTH CARE AND THE CAMPAIGN SEASON

How will health care play on the campaign trail? Does it play nationally in all races or only locally in a few targeted races? The next five weeks will provide the answers.

It should not be a huge surprise that health care is the top issue dominating the midterm election for Democrats. Freed from having to defend the ACA as a whole, Democrats are able to focus their messaging around health care costs, along with preserving access to care—especially pre-existing conditions. It's noteworthy as Democrats go on offense on health care and make it a central message of their party, as the polling suggests it works in both the House and Senate.

On the other hand, Republicans will continue to play health care on a race by race basis. Where the ACA remains unpopular, opposition to it will suffice. In races where the Democratic attacks gain traction, Republicans will be forced to finesse attacking the ACA while defending its more popular provisions. Can that be done effectively is the real question.

Looming on the political horizon are conversations about Medicare for All or single-payer initiatives. Policies like those are making headlines in some races now, but once we move into the 2020 cycle (starting November 7, 2018) those will become dominant issues for the political conversation.

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