| Good morning, y'all ☀️ This health reporter is stocking up on coffee, chocolate and power bars this week. Got snack recommendations? Send them to rachel.roubein@washpost.com. Today's edition: A deep dive into Senate, House and governors races that could flip in the midterms, and flu hospitalization rates are the highest they've been this early in the season in a decade. But first … | What tomorrow's elections mean for health care |  House Speaker Nancy Pelosi (D-Calif.) holds her weekly news conference at the Capitol. (Sarah Silbiger for The Washington Post) | | | It's just one day until the midterm elections. Control of Congress is at stake — and the Senate is very much up in the air. The balance of power in Washington has huge implications for the nation's health policy, partisan gridlock and probes into the White House's coronavirus response. President Biden's legislative agenda could be doomed if Republicans take control of one or both chambers. Here are the key races and ballot measures we're watching — and what it all means: | | Who will win control? This is a toss-up. Races in Arizona, Nevada, Pennsylvania and Georgia are extremely tight, and polling averages put at least eight Senate races within 5 percentage points. The view from Democrats: Senate Majority Leader Chuck Schumer (D-N.Y.) has already said he wants to take another crack at a major spending bill if the party picks up a few more seats in the midterms. Over the summer, Democrats passed a package aimed at lowering prescription drug costs for seniors and extending enhanced financial aid for people to buy plans on Obamacare's insurance exchanges. | | But the legislation left off major policies on the party's wishlist. That includes an expansion of Medicare, investing in affordable housing, improving child care and extending Medicaid to roughly 2.2 million Americans. "If we win, we're going to have to do a reconciliation bill that will take care of a lot of the things that we couldn't do," Schumer told our colleague Tony Romm over the summer, referring to the process allowing Democrats to pass legislation without GOP votes. The view from Republicans: A Republican-led Senate would have a major focus on oversight. Sen. Rand Paul (R-Ky.) would likely lead either the chamber's sweeping health panel or its more targeted oversight committee should the GOP win the majority. The libertarian doctor has been a fierce critic of the Biden administration's coronavirus response and recently pledged he'd subpoena documents in a recent fundraising email for his own reelection race. | | Who will win control? This will be crucial to the direction of the next Congress. Republicans hold advantages on the issue of the economy and inflation and appear poised to claim a majority, according to a recent a Washington Post-ABC News poll. Historically, the party in the White House usually loses seats in the midterm elections — and Republicans are growing more confident that they'll take back the chamber. Last week, the Cook Political Report moved 10 seats in blue states in the GOP's direction. States with particularly tight races include California, Nevada, New York, Pennsylvania and Virginia. The view from Republicans: Key lawmakers have pledged a deluge of investigations into the Biden administration's pandemic response and the health industry if they're in power. This includes investigating the origins of covid-19, cracking down on prescription drug middlemen, probing how pandemic relief dollars have been spent and scrutinizing key federal health agencies. The view from Democrats: If Democrats kept control of the House (this doesn't seem very likely), they could take another run at a sprawling package, assuming the party also maintains control of the Senate. "That's very much in the cards," said a senior House Democratic aide, who spoke on the condition of anonymity to be candid, if both chambers don't change hands. | | Advocates view citizen-led petitions as a critical tool to circumvent state legislatures and shape policies in their state. This year, voters will decide on 133 ballot measures, from abortion access to marijuana legalization to Medicaid expansion. | | Here's what to watch on health care: | | |  | Midterms watch | | Breaking down Senate, House, governor races that could flip in midterms |  Abortion has become a central issue in several of the most hotly contested races in the midterms. (Ted Shaffrey/AP) | | | Our colleagues Hannah Knowles, Liz Goodwin, Marianna Sotomayor, Joanna Slater and Gregory S. Schneider were out this weekend with a deep dive on the midterm races that have the potential to flip on Tuesday. Here are three contests where questions on abortion rights have taken center stage: In New Hampshire: Republican Senate hopeful Don Bolduc has made late gains in the race against incumbent Democratic Sen. Maggie Hassan, who won her seat six years ago. Hassan has zeroed in on Bolduc's past support for abortion restrictions in the very pro-abortion rights state, which has tended to back more middle-of-the-road candidates. Bolduc's campaign has focused on moderating his more extreme positions in the race's final weeks, including his earlier commitment to never vote against "pro-life" initiatives, which raised questions about whether he would vote for a national abortion ban. In Michigan: Gov. Gretchen Whitmer (D) is facing Republican Tudor Dixon, a conservative commentator and first-time candidate. The state has been the scene of one of the most intense battles over abortion in the post-Roe era, with Whitmer suing to prevent the state's 1931 abortion ban from taking effect. Dixon, who does not support the procedure — even in cases of rape or incest, has attempted to downplay abortion as a factor in the campaign, saying the issue is "off the table" in the race to select the next governor. Instead, she has attacked Whitmer on rising prices, parental rights and pandemic-era restrictions. In Oregon: Democratic gubernatorial nominee Tina Kotek has kept abortion front and center in her tight race to keep her opponent Christine Drazan from becoming the state's first Republican governor in 40 years. Abortion remains a protected right in Oregon, and Drazan, who opposes abortion and has received endorsements from the state's antiabortion groups, has said repeatedly during the campaign that she has no plans to change current law. Even still, Kotek is pressing the issue hard in the campaign's final days. She argues that even with a Democratic majority likely to prevail in the state legislature, a Drazan administration could easily move to restrict abortion rights, "undermining the laws without changing them," from appointments of antiabortion officials to cuts to budgets for abortion services, our colleague Lisa Rein writes. | | Sen. Catherine Cortez Masto (D): |  | | | | | Republican Senate candidate Adam Laxalt: |  | | | | | |  | Agency alert | | CDC warns of tough winter as flu, RSV and covid-19 collide |  Hospitals already swamped with pediatric RSV cases are bracing for rising flu cases and new coronavirus variants. (Mark Rightmire/MediaNews Group/Orange County Register/Getty Images) | | | An early spike in influenza has pushed hospitalization rates for the illness to the highest it's been this early in the season in a decade, straining a health-care system that is already struggling to recover from the worst of the coronavirus pandemic, our colleague Fenit Nirappil writes. The usually early start to flu season comes as hospitals are also battling against surging rates of respiratory syncytial virus (RSV) infections among children and new coronavirus variants that have shown a remarkable ability to dodge immunity from prior infection or vaccination. Given the confluence of influenza, RSV and the coronavirus, "there's no doubt we will face some challenges this winter," said Dawn O'Connell, assistant Health and Human Services secretary for preparedness and response. By the numbers: So far this season, there have been an estimated 1,600,000 illnesses, 13,000 hospitalizations and 730 deaths from the flu nationally, according to data released by the Centers for Disease Control and Prevention. For context, the burden of the flu hasn't been this high this early since the 2009 H1N1 swine flu pandemic, although health officials said they've yet to see evidence that this strain of influenza is more virulent than years past. Health officials are urging Americans to get their annual flu shot and updated coronavirus booster dose to avoid severe illness and alleviate the burden on hospitals. The federal government is prepared to deploy medical teams and provide supplies like personal protective equipment and ventilators from its stockpile if the nation's health systems are stretched too thin, but officials said that no states have requested additional support yet. | | Scott Gottlieb, former commissioner of the Food and Drug Administration, on CBS News's "Face the Nation": |  | | | | | |  | In other health news | | - Democrats are hinging their hopes to flip a state senate seat in the closest race in the Maryland legislature on the potency of abortion rights in a district that has favored Republicans for decades, The Post's Erin Cox writes.
- Pfizer's antiviral treatment Paxlovid, which lowers rates of severe illness and death in people infected by the coronavirus, also appears to reduce the risk of long covid symptoms, a new study by researchers at the Department of Veterans Affairs found.
- Some Eli Lilly employees are seeking transfers from the drugmaker's Indiana operations after the Republican-controlled state legislature approved a bill banning most abortions there, even though the law is temporarily on hold, the Financial Times reports.
- Two Florida medical boards finalized a rule Friday to ban medications and surgery for adolescent patients seeking gender transitions. The move circumvents the Republican-controlled state legislature, which has declined to take up a bill aiming to restrict such treatment twice, the New York Times reports.
| | |  | Health reads | | | By Julie Creswell and Matt Richtel | The New York Times ● Read more » | | | | | |  | Sugar rush | | | Thanks for reading! See y'all tomorrow. | |
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