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Opening of Brett Kavanaugh hearing interrupted by protesters, Democrats. The opening minutes of Judge Brett Kavanaugh’s confirmation hearing before the Senate Judiciary Committee descended into chaos this morning, as numerous demonstrators protested his nomination and called for the members of the committee to oppose his nomination. Protesters raised issues including abortion and healthcare. Senate Democrats also repeatedly interrupted the opening, citing the release of approximately 42,000 pages of documents Monday evening from Kavanaugh’s work in the George W. Bush White House, and a further 100,000 pages that have not been produced because President Trump asserted executive privilege. Sens. Kamala Harris, D-Calif., Amy Klobuchar, D-Minn., Cory Booker, D-N.J., and Richard Blumenthal, D-Conn., among others, urged Chairman Chuck Grassley to delay the hearing in the wake of the document release. Blumenthal moved to adjourn the hearing. Watch the hearing live.

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior HealthcareWriter 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.

Kavanaugh: ‘I am a pro-law judge.’ Like Chief Justice John Roberts in his confirmation hearing, Kavanaugh plans to liken the role of a judge to an umpire when testifying in the Senate, describing himself as a “pro-law judge” who does not decide cases by his “personal or policy preferences.” “A good judge must be an umpire — a neutral and impartial arbiter who favors no litigant or policy,” Kavanaugh will say, according to his prepared remarks. “I don’t decide cases based on personal or policy preferences. I am not a pro-plaintiff or pro-defendant judge. I am not a pro-prosecution or pro-defense judge. I am a pro-law judge.” Kavanaugh plans to talk about his time serving with 17 other judges on the U.S. Court of Appeals for the District of Columbia Circuit, including Merrick Garland, the court’s chief judge who President Barack Obama nominated to the Supreme Court in 2016 following the death of Justice Antonin Scalia. “If confirmed to the Court, I would be part of a Team of Nine, committed to deciding cases according to the Constitution and laws of the United States,” Kavanaugh will say. “I would always strive to be a team player on the Team of Nine.” Kavanaugh will also offer words of praise for Justice Anthony Kennedy, who retired from the Supreme Court at the end of July and whose seat Kavanaugh will fill if confirmed by the full Senate. Kavanaugh clerked for Kennedy on the Supreme Court. “To me, Justice Kennedy is a mentor, a friend, and a hero. As a member of the Court, he was a model of civility and collegiality,” he will say. “He fiercely defended the independence of the Judiciary. And he was a champion of liberty.”

Delay, demand, derail: The Democrats’ attack plan against Kavanaugh. For Senate Democrats, Tuesday’s hearing marks a culmination of weeks of effort aimed at derailing his nomination. Since President Trump named Kavanaugh as his nominee during a prime-time event at the White House on July 9, Democrats have worked to drum up opposition by highlighting his views on abortion, healthcare, and executive power, and launched a heated battle for access to Kavanaugh’s records from his tenure serving in George W. Bush’s White House. Their goal: To defeat the president’s second nominee to the Supreme Court, one who, if confirmed, would shift the high court’s ideology to the right. But Democrats face an uphill battle, as they have control of 49 seats compared to Republicans’ 50. Some Senate Democrats have no misgivings about the challenge they face as the minority party, but believe a thorough review of Kavanaugh’s record will give them a remote chance of convincing moderate Republicans to vote with them. As Kavanaugh’s confirmation hearing drew near, Democrats tweeted using the hashtags #StopKavanaugh and #WhatsAtStake, delivering soliloquies the Senate floor, and appearing at rallies hosted by advocacy groups.

Planned Parenthood rolls out six-figure ad buy targeting Kavanaugh. Planned Parenthood announced a six-figure ad buy targeting Supreme Court pick Brett Kavanaugh on the same day that his confirmation hearings start in the Senate. The TV and radio ads are expected to air in Alaska and Washington, D.C., the women’s health and abortion provider said on Tuesday. Planned Parenthood and other abortion rights groups have charged that Kavanaugh’s appointment could roll back Roe v. Wade, the landmark 1973 Supreme Court decision that made abortion a constitutional right. The ads target centrist GOP Sen. Lisa Murkowski of Alaska. Her opposition alongside Sen. Susan Collins, R-Maine, is key to sinking Kavanaugh’s nomination.

Kavanaugh’s four-day slog through the Senate. The main event started at 9:30 a.m., when the Judiciary Committee’s 21 members expected to hear introductions from former Secretary of State Condoleezza Rice, Sen. Rob Portman, R-Ohio, and Lisa Blatt, a self-described “liberal feminist” lawyer. Over the course of the next two days, Kavanaugh will be grilled by Senate Democrats and Republicans in two rounds of questioning. The first round will begin Wednesday, when members of the Judiciary Committee will get 30 minutes apiece. On Thursday, each senator will have 20 minutes for the second round of questioning. The fourth day of Kavanaugh’s hearing, Friday, will hear from four panels of witnesses from the majority and the minority. Before the close of the hearing, senators will hear from a group that includes two former solicitors general, Kavanaugh’s ex-law clerks, legal scholars, and other members of the legal community, who will offer their support for the Supreme Court nominee. Among those scheduled to testify for Judiciary Committee Democrats are John Dean, the former White House counsel for President Richard Nixon, Congressional Black Caucus Chairman Rep. Cedric Richmond, D-La., and Aalayah Eastmond, a survivor of the February shooting at a high school in Parkland, Fla. The witnesses for the minority will speak about abortion, healthcare, executive power, gun violence, and abortion rights, among other issues, according to the office of Sen. Dianne Feinstein, D-Calif.

Texas Obamacare suit ready for its first close up. A federal judge is expected to hear oral arguments starting Wednesday on a lawsuit brought by Texas and 19 states to strike down Obamacare. The hearing itself is on a preliminary injunction from the states that calls for federal enforcement of Obamacare to be halted while the lawsuit makes its way through the courts. The injunction would ensure that enforcement of the individual mandate penalty, which doesn’t go away until 2019, would stop. But It would also stop the federal government from enforcing requirements on Obamacare insurance plans like pre-existing condition protections. A collection of 17 states are defending Obamacare after the Justice Department decided earlier this year to not defend the law in court. A ruling is not expected to be delivered immediately after the hearing.

Senate may consider opioid legislation this week. Senate Majority Leader Mitch McConnell said last week that Republicans had signed off on a legislative package, and that the bill may receive a vote as early as this week. Senate Democrats have not yet announced whether they will support the bill or whether they have any qualms with it. The legislation will likely include the Synthetics Trafficking and Overdose Prevention Act, which is meant to give the Postal Service more tools to stop shipments of illicit fentanyl from getting into the U.S.

Immigrants dropping out of government aid program over fears of losing green card eligibility: Report.  Immigrants have begun dropping out of a federal aid program out of fear that relying on government support could hurt their chances of obtaining a green card following the Trump administration’s reported plan to make those dependent ineligible for permanent residency, according to a report published Monday. Health providers who oversee WIC — a federal nutrition program for pregnant women and babies — in 18 states have noticed a decline of up to 20 percent in the number of people filing for help, Politico reported. Enrollment in the WIC program, begun in 1974, dropped from 7.4 million when Trump took office in January 2017 to 6.8 million in May, shortly after the administration’s plans to change the public charge rule were leaked. However, the decline is also connected to improvement in the economy and a decrease in birth rates.

Lawmakers search for answers on oversight of controversial drug discount program. Bipartisan lawmakers are looking to the Trump administration to boost oversight of a controversial drug discount program while the outlook for legislative fixes this year darkens. Lawmakers on both sides have been demanding greater transparency of the program, called 340B, as various legislation has stalled so far in Congress amid an intense lobbying war between pharma and hospital groups. So bipartisan lawmakers want the Trump administration to use existing power to clarify the requirements of the program, which Trump cut by $1.6 billion this year. While the administration has called on Congress for more authority, the leadership of the relevant committees believe it already isn’t using its full power to oversee 340B. It wants the administration to do a better job of defining what the intent of the program is and the requirements for both participating hospitals and pharmaceutical companies providing the discounts.

Healthcare costs cut into wage growth for workers, report says. Rising healthcare costs are taking a hit to take-home pay for U.S. workers, a new analysis released Tuesday found. The analysis from the Council for Affordable Health Coverage looks at how staggering healthcare costs have eclipsed wage growth. The average U.S. health expenditure was $10,348 per person in 2016. It also found that in 2001 employers allocated 41.9 percent of benefits to healthcare and 58 percent to retirement benefits. But by 2015, the split was in the other direction as 63.5 percent was for health benefits and 36 percent for retirement, the report found. “Our analysis illustrates the escalation of health care premiums, which have absorbed most or all compensation growth in recent years for many workers — leaving little or nothing to add to their paychecks,” said healthcare consultant Sylvester Schieber, one of the study’s co-authors. “Wage gains have often been more than absorbed by higher employee premiums.”

Pediatricians encourage kids to opt for flu shot over nasal spray. To protect against the flu season ahead, the American Academy of Pediatrics recommends that children six months and older opt for the shot over the nasal spray. The AAP is prioritizing the shot because the nasal spray, known as FluMist, has a spotty track record of effectiveness. Still, the organization said the spray in children older than 2 was better than not being vaccinated at all, calling its effectiveness “an unknown” this season. AAP had recommended against the nasal spray during the previous two flu seasons, though it can be popular with children who are afraid of needles. The last flu season resulted 179 deaths among children, a record. Eighty percent of those who died had not been vaccinated.

RUNDOWN

Forbes Red state Medicaid expansion polls well as vote looms

Axios Big tech’s central role in opioid epidemic debate

NPR Analysts predict healthcare marketplace premiums will stabilize for 2019 coverage

The Hill McCaskill launches campaign targeting Hawley on healthcare.

CNN Florida gubernatorial candidate says Medicare for All requires corporate tax increase

Politico Immigrants, fearing Trump crackdown, drop out of nutrition programs

STAT News Is mistrust of pharma enough to unseat a Democratic stalwart of Congress?

Vox Medicaid expansion’s private option is nearly gone