Overnight Health Care: Medicaid’s popularity on the ballot in four red states | GOP in a bind on pre-existing conditions | Pelosi urges Dems to push health message day before midterms

Welcome to Monday’s Overnight Health Care, where it’s almost Election Day!

Obviously, the party that wins control of the House and Senate will have a huge effect on health care policy, whether it means another run at ObamaCare repeal if Republicans keep control, or new momentum to tackle drug prices and numerous oversight investigations if Democrats prevail.

But there are also a range of other health care issues to watch. Medicaid expansion is on the ballot in four red states (Utah, Idaho, Montana and Nebraska). Medicaid could eventually be expanded in even more places if Democrats win races for governor in states like Florida and Georgia.

We’ll also be watching some key players from last year’s repeal effort to see how they fare. Most prominently Rep. Tom MacArthur (R-N.J.), leader of a compromise with the conservative Freedom Caucus that revived the ObamaCare repeal effort last year, is in a tough race. Rep. Fred Upton (R-Mich.), who also helped broker a deal to advance the legislation (remember the “Upton amendment?”), is favored to win but isn’t in the clear yet.

Be sure to visit TheHill.com tomorrow for our election coverage. Overnight Health Care will be back in your inboxes on Wednesday.

A deeper dive on Medicaid expansion.

Voters in four red states will decide Tuesday whether to expand Medicaid to thousands of low-income adults, potentially circumventing GOP legislators who for years have blocked one of ObamaCare’s key provisions.

Ballot initiatives in Idaho, Montana, Nebraska and Utah aim to bring those states in line with the 32 that have already embraced Medicaid expansion.

The ballot measures would expand Medicaid eligibility to those making 138 percent of the federal poverty level — which is about $17,000 for an individual and $25,000 for a family of four.

Why it matters: In all, 325,000 people would become eligible for Medicaid if voters approve the initiatives in Idaho, Utah and Nebraska.

Expansion in Montana expires next year unless voters on Tuesday vote ‘yes’ to make it permanent — and fund it with a tax increase on tobacco products. At the beginning of this year, 90,000 people had coverage through Montana’s expanded Medicaid program.

The odds: Supporters think they have a good shot at passage in Idaho, Montana and Nebraska, where organized opposition is limited.

But the tobacco industry has spent $17 million against the initiative in Montana, and a recent poll shows 41.4 percent in support and 40.8 percent in opposition. Another 17 percent are undecided.

Read more here.

Republicans put in a bind on pre-existing conditions

Health care has defined the 2018 campaign, and pre-existing conditions have been at the forefront of almost every Democratic attack ad.

Republicans have been forced to play defense and try to convince the public that even though they oppose ObamaCare, they will not take away people’s health care.

But actions speak louder than words, and recent actions from the Trump administration are complicating efforts of vulnerable Republicans to show their support for those pre-existing condition protections.

What are they doing? The Trump administration moved recently to allow states to waive certain ObamaCare requirements and pursue conservative health policies that were previously not allowed under the Obama administration.

In Wisconsin, the administration approved Gov. Scott Walker’s request to impose work requirements on Medicaid beneficiaries, and to charge premiums. It’s the first state where people at or below the federal poverty level will have to pay a monthly fee in order to keep their eligibility.

What this means for politicians: Republicans are tying themselves in knots to parry attacks from Democrats accusing them of wanting to take away pre-existing condition protections.

In a tight race for re-election, the attacks have forced Scott Walker to say that he was willing to adopt ObamaCare’s pre-existing protection language verbatim, a stunning change of direction from a man who’s spent the last eight years trashing the law. And even though the Medicaid waiver doesn’t explicitly mention pre-existing conditions, health advocates say those are the people who would be disproportionately impacted.

Important note: Walker said he’ll adopt ObamaCare’s language, but he has not asked the state to withdraw from a federal lawsuit that would invalidate those very protections.

Read more here

Meanwhile, Nancy Pelosi is urging Democrats to hit the gas on health care messaging with just hours before Election Day 2018.

“I write to acknowledge the vital role Congressional Democrats played in protecting the Affordable Care Act and exposing the GOP’s monstrous health care agenda – and I urge all of us to continue to push this message in the next 24 hours,” Pelosi wrote in a letter to House Democrats.

“Tomorrow, the American people will decide on the fate of our nation and the future of America’s working families. Health care is the key factor in voters’ decisions.”

Democratic congressional candidates have zeroed in on health care and protections for people with pre-existing conditions in their campaigns, putting Republicans on the defensive for attempting to repeal ObamaCare.

Democrats’ work over the past two years fighting the administration and Congressional Republicans on health care has “made victory possible tomorrow,” Pelosi said.

Read more here.

CDC says cases of polio-like illness on the rise

Cases of a paralyzing illness affecting mostly children are still on the rise, the Centers for Disease Control and Prevention said Monday.

The CDC has identified 80 confirmed cases of Acute flaccid myelitis (AFM) among 219 reports in 2018, officials said. The cases were spread across 25 states.

Despite an increase in cases since 2014, AFM remains a very rare condition, the CDC said. Less than one in a million people in the United States get AFM each year.

Read more here

What we’re reading

The 2 House Republicans who put it all on the line for ObamaCare repeal could lose Tuesday (Vox)

Would Republicans take another shot at ObamaCare? (Politico)

Cancer society executive resigns amid upset over corporate partnerships (The New York Times)

State by state

Does Mike Braun in Indiana support the lawsuit to end ObamaCare? (PolitiFact)

Texas law banning common abortion procedure goes before 5th Circuit Court of Appeals (Houston Chronicle)

Checking Claire McCaskill on GOP’s plan for pre-existing conditions (PolitiFact)

Tobacco tax battle could torch Montana Medicaid expansion (Kaiser Health News)