| There are just 41 days until November’s midterm elections, and the political environment has been inching in Democrats’ favor, according to new analyses from key election-watchers. What’s notable for our purposes is that health care issues could be underlying some of that shift. The Cook Political Report on Wednesday moved three Senate races toward the Democrats, saying a “very blue environment” is forming nationally. The Senate map is now a “true toss-up,” according to Jessica Taylor, who studies Senate and gubernatorial races at the nonpartisan organization. Both parties have viable paths to control the chamber, Taylor says, and Democrats just need to pick up four additional seats. (She predicts they could pick up anywhere from a net one to five seats.) Sabato’s Crystal Ball, another nonpartisan election site, made several similar moves on Tuesday, including shifting Michigan’s Senate race to “Leans Democratic” and Iowa’s race for an open Senate seat to a toss-up. It also shifted an Iowa House race featuring Rep. Mariannette Miller-Meeks (R-Iowa), a physician, to “Leans Democratic” — giving a slight edge to challenger Christina Bohannan, a former state representative running against Miller-Meeks for the third time. (Cook Political Report is still calling the race a toss-up.) The math for Democrats is much more favorable in the House, they only need to pick up three additional seats — and there are many more races in play. → Campaigns are already pressing health care: It’s the top issue in Senate advertising in competitive races and second only to taxes in ads connected to competitive House races, according to the Cook Political Report. Both forecasters have moved Sen. Roger Marshall’s (R-Kansas) race from “Likely Republican” to “Leans Republican.” Marshall, an OB-GYN who sits on the Senate health panel, has been running an advertisement touting that he has “taken on … big insurance.” His Democratic challenger, Adam Hamilton, has a 30-second ad spot that aims to contrast him with Marshall, saying he wants to lower drug prices, help rural hospitals, stop health care cuts and expand health insurance coverage. → While neither election forecasting organization is saying the election is settled, the movement reflects a broader national environment that is increasingly uncomfortable for Republicans. And two new polls out this week help explain why health care could matter in that environment. More on those below. Why it matters: Health care is colliding with the issue that appears to be driving much of a broader political shift among voters, centered around cost-of-living concerns. The Trump administration has been trying to drive home its efforts to lower drug prices, go after health care fraud and tout policies involving healthier food. Democrats, meanwhile, have been attacking the GOP cuts to Medicaid and failure to revive enhanced federal subsidies that helped some people afford Affordable Care Act plans. The Democrats have also pledged additional reforms to the system. A NBC News national poll found that voters trust Democrats over Republicans on health care by 22 points. Although Democrats have generally held an edge on the issue among voters for decades, it is especially relevant this year as many Republicans try to make affordability a central part of their campaign message. In Michigan, Democrat Abdul El-Sayed, a public health official, has been pushing Medicare-for-all as a key part of the state’s competitive Senate race. His Republican challenger, former congressman Mike Rogers, has slammed the coverage expansion proposal, and instead is running advertising centered on lowering drug prices. “I’ll make sure our health care is more affordable. I’ll make sure you don’t have to pay more for your prescription than they do in Canada,” Rogers says in the ad, which mirrors Trump administration policies that tie U.S. drug prices with those in other wealthy nations. Meanwhile, a new KFF/AP survey of rural registered voters found that about three-quarters rate the cost of living where they live as “fair” or “poor,” a 25-percentage-point increase from 2017, according to the nonpartisan organization KFF. Sixty-six percent of rural voters say they’re at least “somewhat worried” about being able to afford health care for themselves or their families. Concerns about transportation costs and the price of gas are more pressing by only a single percentage point. → Digging down into the health care numbers is particularly informative. Just 17 percent of rural voters said the Trump administration’s health care policies have had a positive impact on their health care costs. Forty-one percent said the policies have had no impact, while another 41 percent said they had a negative impact. Almost all — 90 percent — of rural voters said it is very or extremely important for candidates to talk about health care costs. Those results may not necessarily motivate rural voters to cross party lines at the ballot box, as many still generally trust their own party on health care issues. But it does suggest that Republicans cannot assume their traditional voters are satisfied with the status quo. Health Secretary Robert F. Kennedy Jr. has been dispatched to campaign across the country to bring in voters who might not otherwise support Republicans. Kennedy has been touting the administration’s moves to overhaul what Americans eat and the ways it’s trying to make people healthier — including appearing with Miller-Meeks in Iowa. Kennedy’s department has also been trying to publicize money being distributed by the $50 billion Rural Health Transformation Program, created by Republicans’ One Big Beautiful Bill last year and meant to offset some of the hundreds of billions of Medicaid cuts from the law. However, the KFF/AP survey of rural voters found that 61 percent said they’d heard nothing about the rural health fund — roughly the same across all political parties. Just 13 percent had heard “some” information about it. A new coalition of employers, clinicians and health care companies is pushing Congress and the administration to make it easier for employers to contract directly with health care providers and bypass some of the traditional insurance arrangements. The Association for Direct Care, launched Wednesday, says it wants to expand direct contracting across the commercial market and federal health programs. Its members include Nomi Health, the American Academy of Family Physicians, the National Alliance of Healthcare Purchaser Coalitions, Grounded Health, the ERISA Industry Committee and the Employers’ Forum of Indiana. Why it matters: The launch comes as employers continue to grapple with rising health care costs and growing interest in arrangements that give purchasers more direct control over prices and their relationships with health care providers. The coalition is being led by Taylor Hittle, a former GOP congressional aide and Department of Health and Human Services official, who tells me the group is working to put together legislation. “Direct contracting offers a better way to purchase health care by lowering costs, cutting administrative waste and bringing greater transparency to the system,” Hittle said. “The time is right for employers, clinicians and health care innovators to lead the way.” Direct contracting has been gaining attention among employers looking for alternatives to traditional health plan arrangements, but the coalition is asking for federal policy changes that could make the model easier to use across the health care system. The policy pitch: The coalition seeks a federal framework for employer-provider contracts under ERISA, the law that governs employer-based health plans. The group is also pushing for permission for employers to combine their purchasing power, and is asking Congress to implement protections from policies that it says can prevent employers from directing patients toward providers offering what it says is higher-value care. For smaller employers, the Association for Direct Care wants the federal government to provide grants to help them build direct-contracting infrastructure. Drug giant Pfizer went from covid vaccine developer to having a steep post-pandemic sales slump. The company’s leader, Albert Bourla, talked about navigating that whiplash in a conversation with Time’s Alice Park at the Concordia Annual Summit in New York, my WP Intelligence colleague Nour Wood reports from the summit. Here’s one key exchange from the discussion: Park: [You went] from saving millions of lives with the covid vaccine to — after the pandemic was over — seeing your sales of the vaccine drop by half. How did you, as a leader, both for yourself and for your teams, help them pull through that valley? Bourla: How did I take it? Very bad. … And very quickly I switched from this phase of grief and depression to, ‘What do we do about it?’ And we did a significant amount of things. We renegotiated all our agreements with the Europeans and Americans. We made huge acquisitions in oncology that will help us offset the revenue. On the cultural front, I spend most of my time talking to my people, telling them that the fact that the stock price is down doesn’t mean that we are different [from] those that made the vaccine. You are the same people, and we are going to do it again …. It was a few months of difficult times, and then we took over again. “States can soon access covid vaccines for low-income children, after delay,” The Post’s Lena H. Sun and Rachel Roubein report. “Chatbots are still falling short in mental health conversations with kids,” Gerrit De Vynck writes at The Post. “Trump administration backing off NIH grant order amid pushback,” report David Lim, Burgess Everett and Shelby Talcott at Semafor. “RFK Jr.’s Enhanced Security Was Funded With Money From Minority Health Office,” Liz Essley Whyte reports at the Wall Street Journal. “A private equity-owned hospital chain is becoming a nonprofit. Is it just a bailout for investors?” Tara Bannow reports for STAT. This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from The Washington Post newsroom. Learn more about WP Intelligence. | 
