Mid-Term Elections 2014: The Forecast Less Than 3 Weeks Out Rare Disease Legislative Advocates Meeting October 16, 2014 Nick Manetto Faegre BD Consulting

What We Know

Some (relatively) Safe Bets ► We will continue to have divided government. The question is how divided will the Congress be. ► Republicans will gain House seats. The question is how many. ► Democrats will lose seats in the Senate. The question is how many. ► There will be very limited opportunity for legislating in 2015 before everyone is focused on the 2016 Presidential cycle, and the final two years of Presidential terms are not known for major actions. Will this cycle remain or will leaders find a way to address issues of national significance?

Some Key Questions & What to Watch For ► Watch the polls closely including sample size, type of voter, etc. Pay attention to trends and don’t put too much stock in an outlier. ► Watch where the national parties and outside groups are putting and pulling their money. Candidates will try to spin in their favor, but pull outs often are bad news. ► Consider the larger climate and factors, such as the impact of other races, voter turnout, etc. ► Will a national climate in favor of Republicans be realized at the state level, or will Democrats be successful in keeping their distance from the Administration and Senate leaders?

The National Map Today

Where Have We Been Since Late February? ► ~10 or so Senate races remain pivotal and the list has remained pretty consistent with a few real surprises (Kansas, maybe South Dakota). ► Republicans have been able to avoid self-inflicted wounds that plagued them in 2010 and No Republican incumbent has been defeated, but some, notably Sen. Thad Cochran and Sen. Pat Roberts, have been bruised. ► While the math simply is against the Democrats this cycle, many of the key races remain close a little more than two weeks out.

The Senate Today

A Safe Bet ► 2 seats now held by Democrats – West Virginia and Montana – very likely to flip to Republicans. ► Brings us to 53 Democrats (Counting King and Sanders) and 47 Republicans.

Battlegrounds or Bust? ► South Dakota has long appeared likely to go Republican, but two most recent polls trend against former Gov. Mike Rounds, and a unique three-way race involving former Sen. Larry Pressler makes it quite interesting. ► Michigan looked like more of a Republican pick-up possibility earlier in the year, but Democrat Rep. Gary Peters seems to have a stable lead.

Republican Seats In Question ► Kansas certainly a surprise to Republicans. Big questions – will voters in a deep red state cast votes to potentially keep the Senate in Democratic hands, and how will the gubernatorial race and schism in the state GOP impact this race? GOP rescue effort appears to be working with Greg Orman’s lead going away. ► Georgia polls have David Perdue lead of Michelle Nunn narrowing. Are polls under-representing traditionally Democratic constituencies, and could this race head to a post-New Year’s run-off? ► In Kentucky, Minority Leader McConnell has led most polls. Will he pull it out like Harry Reid in 2010, or will Democrats “Daschle” him? DSCC pull out bodes well for McConnell.

Democrat Seats in Question – Slide 1 ► New Hampshire, Colorado and Iowa are all examples of Republican’s success in widening the map. ► New Hampshire : Recent polls show Scott Brown gaining, but a big question is whether or not he will have enough time with a just a little more than two weeks to go. ► Iowa : Joni Ernst continues to lead but by very narrow margins. Will it be enough to turn a long-blue seat red? ► Colorado : Very similar to Iowa – can Rep. Cory Gardner maintain a lead in a state that has been increasingly purple?

Democratic Seats in Question – Slide 2 ► North Carolina : Sen. Hagan has held leads between 1 to 4 percent in polls over the past month. In the end, will this be enough, and will voters mobilize to turn out for her? ► Alaska : Dan Sullivan has led all polls since winning the nomination in early August and recent polls have him up between 3 to 6 percent. How accurate is the polling? ► Arkansas : Recent polls show Rep. Tom Cotton maintaining his lead. Given the red hues of the state, will this be too much for Sen. Pryor this go-around? ► Louisiana: With Sen. Landrieu firing her campaign manager, the big question appears to be run-off or no run-off? ► Pryor and Landrieu may end up like Lincoln Chafee, Nancy Johnson, and Chris Shays – generally well-regarded lawmakers defeated because their party label just did not fit their state and region.

So What Do I think Happens? ► We start at ► Republicans pick up West Virginia and Montana (53-47). ► Republicans hold Georgia, Kansas & Kentucky and Democrats hold Michigan, New Hampshire and North Carolina (53-47). ► Republicans pick up Alaska, Arkansas, Louisiana & South Dakota (49- 51). ► Parties split Colorado and Iowa. ► 114 th Senate: 52 Republicans, 48 Democrats.

What Might We See in 2015? ► Certainly expect an early dose of ACA/Obamacare related votes. ► A new “Majority Leader” McConnell will likely face continued challenges managing a very diverse caucus. ► At the same time, in 2016 the tables will be turned on Republicans as ~6 or so Republican Senators from blue or purple states elected in the 2010 ACA backlash year will be up for re-election (Toomey, Johnson, Kirk, Rubio, Portman, Ayotte).

What Does It Mean for Our Community? ► Rare disease and patient advocacy groups more broadly are fortunate to have strong champions and supporters on all sides. This goodwill should continue going forward. ► Fiscal challenges, notably the scheduled return of sequestration, continue to have a significant impact on the sector. One big question – will or how will sequestration be addressed going forward? ► Will the energy and momentum behind 21 st Century Cures remain or will it fizzle? Can something happen near-term with thornier issues positioned for PDUFA VI? ► Enactment of targeted and narrowly focused bills remains a real possibility, such as modest updates or reauthorizations ( muscular dystrophy, autism, etc.) or modest new programs ( pediatric research network ).