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POLITICO New York Health Care: Court considers all payers database; Skelos and the health department

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written by Dan Goldberg

EYES ON THE COURT — U.S. Supreme Court justices appeared receptive to the argument that it would be too burdensome for self-insured plans to turn over their health claims data to state governments. Oral arguments Wednesday morning in Gobeille v. Liberty Mutual Insurance Co. did not receive the attention accorded some other recent health care cases, but state health officials around the country were watching them closely. State health departments have spent tens of millions of dollars developing so-called all-payer claims databases. Attorney General Eric Schneiderman, in an amicus brief on behalf of 17 states and the District of Columbia, sides with Vermont. Read my story here:

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THE SKELOS TRIAL During a third day of testimony at the corruption trial of former state Senate Majority Leader Dean Skelos, Bjornulf White, a vice president at AbTech Industries, described tensions in his office, where Adam Skelos, the senator's son, was employed as a consultant. Prosecutors have sought to paint Adam Skelos as under-qualified for the job at AbTech, which sold sponges that filtered pollutants out of water.

...James Clancy, former assistant commissioner of the Office of Governmental and External Affairs at the state Department of Health, also testified briefly, noting a staffer for Dean Skelos had reached out to set up a meeting between DOH and AbTech.

NOW WE KNOW — Science is finally explaining why straight women like to have gay, male friends. Turns out the Hollywood cliches have some merit. Women place more trust in dating advice from gay men because they have fewer ulterior motives, according to an article in Archives of Sexual Behavior. "It's riskier to trust other straight women when mating competition is high,” said Vivian Ta, one of the authors. “Unlike other women, gay men do not undermine women when they are seeking out mating partners. Gay men do not compete for the same men as straight women do.”

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KEY COMMITMENT ON ZADROGA Fred Upton, chairman of the House Energy and Commerce Committee, on Wednesday called for the permanent reauthorization of the Zadroga Act, and even outlined ideas for how to pay for the expected costs. Rep. King, a vocal proponent of reauthorizing the law, said he remains confident the bill will get passed, and called Upton's endorsement "critical." King said House Speaker Paul Ryan has given assurances the reauthorization will pass by the end of the year. The most likely vehicles are the omnibus spending bill, which must be passed by Dec. 11 to avoid a government shutdown. Upton, a Republican from Michigan, offered to pay for the program by having Medicare beneficiaries who earn more than $1 million ($1.5 million for joint filers) pay more for their Medicare Part B and Part D premiums. King says he would support that measure, but expects Democrats to balk.

THE SENATE SAYS — The Poughkeepsie Journal reports: “Sens. Kirsten Gillibrand and Chuck Schumer may team up Thursday to ask colleagues for unanimous consent to vote on reauthorizing the James Zadroga 9/11 Health and Compensation Act.”

OBAMACARE’S PIZZA FEE Franny’s, a popular Park Slope pizza joint, decided to charge a 3 percent surcharge because of the Affordable Care Act’s mandate that employers provide insurance. That lasted less than 24 hours.

GRANT LAND — The Albert Einstein College of Medicine received $148 million in research funding from the National Institutes of Health during federal fiscal year 2015, which began Oct. 1 2014. That includes grant funding for projects such as studying opioid use among drug users and monitoring the health of the placenta, according to a press release from the school.

See more here:

PAULIN DIVESTS FROM PHARMA COMPANY — Assemblywoman Amy Paulin sold her Merck stock following a scathing cross examination from lawyers for former Assemblyman Sheldon Silver, who delved into her husband’s finances to prove that potential conflicts are unavoidable, During an interview on public radio’s Capitol Pressroom, Paulin said she wanted to avoid the appearance of a conflict of interest.

HOMEWARD BOUND The Wall Street Journal reports: “New York City’s child-welfare agency plans to stop placing older youths in a single intake center on Manhattan’s East Side as they wait to be placed with foster families, and instead find temporary homes for them, city officials said. City officials said the facility, known as the Nicholas Scoppetta Children’s Center, was too chaotic and stressful for the 3,500 to 4,000 teenagers who are placed there within hours of being removed from their homes.”

OSCAR CUTTING COMMISSION — Oscar health insurance is cutting broker commissions, according to Crain’s. “Oscar had planned to pay brokers $14 per contract each month for individual subscribers and up to $26 for enrolled families. Instead, all policies Oscar received after Nov. 6 will generate only $6 a contract per month regardless number of people in the plan, according to the letter. … The announcement came as Oscar reported a $41.5 million loss through the first three quarters of 2015 — more than double its loss during the same period last year, according to financial statements filed to regulators. Oscar doubled its revenue ($83.8 million) and New York membership (34,000), but expenses for hospital and medical benefits and drugs nearly tripled, to $117.2 million.”

DON’T DO THAT — Attorney General Eric Schneiderman fined the University of Rochester Medical Center $15,000 over violations of patient privacy.

ACROSS THE RIVER: Members of the New Jersey Assembly spent Wednesday considering the role the Division of Banking and Insurance should play after the agency approved the new OMNIA tiered health plans. The OMNIA plans separate hospitals in Horizon Blue Cross Blue Shield’s network into two tiers. Tier 2 hospital executives contend the new plans will drive away patients and could lead to financial ruin, particularly for urban independent hospitals already operating on thinner margins than some of the bigger health systems in the state. During a pre-hearing press conference, Assemblyman Reed Gusciora, chairman of the regulatory oversight committee, said he thought DOBI had “rolled over” and hastily approved the plans without considering the “public interest.” POLITICO New Jersey’s Katie Jennings has more:


-$3 TRILLION — Health care spending grew 5.3 percent to more than $3 trillion, according to data from the Centers for Medicare and Medicaid Services. That’s the largest uptick since President Obama took office and demonstrates that the Affordable Care Act may increase costs as more people go to the doctor and buy prescription drugs. (Proponents of the law will argue that the short term costs will yield savings over the long term as emergency room visits are avoided.)

-OBAMACARE NUMBERS — Nearly 400,000 people chose to enroll in Obamacare plans during the fourth week of open enrollment, according to CMS. Those numbers are only for the federally run health exchange. New York, which operates its own exchange, has not yet released numbers for the latest enrollment period.

-SENIOR PRICING — Medicare Part D enrollees will have to pay thousands of dollars for specialty medicines treating cancer, rheumatoid arthritis, multiple sclerosis and hepatitis C, according to a new Kaiser Family Foundation analysis of 2016 drug plans. Read it here:

-MCCAIN’S DILEMMA — Sen. John McCain finds himself in a tough spot. He wants to vote for the GOP’s reconciliation bill, but he isn’t keen on repealing Medicaid expansion, which his home state of Arizona approved. "I am very reluctant to take positions that counter the decisions made by the governor. As a federalist, I believe it puts me in a difficult position," McCain said, according to The Huffington Post. Their story:

TODAY'S TIP — Comes from Health + Hospitals: “Never tell your kids that medicine tastes like candy.” For more tips:


-LACK OF DIVERSITY — The Association of American Medical Colleges offered recommendations to increase the number of black men and women enrolling in medical schools. In 2014, only 515 black men matriculated to medical school, less than the 541 who did so 36 years ago, in 1978. “To better prepare black males for medical school, it’s crucial that advanced placement and enrichment classes be available to minority students in elementary school and middle school.”

-DRIVERS’ ED Scientists from the Icahn School of Medicine at Mount Sinai have developed new software that could help genomics researchers identify drivers of disease with greater efficiency and accuracy, according to a release from Icahn. MEGENA (for Multiscale Embedded Gene Co-expression Network Analysis) projects gene expression data onto a three dimensional sphere, allowing scientists to study hierarchical organization patterns in complex networks that are characteristic of diseases such as cancer, obesity and Alzheimer's, the release said. "These tools fill important and unmet needs in genomics," Dr. Bin Zhang, associate professor in the Department of Genetics and Genomic Sciences, said in the release. “MEGENA will help scientists flesh out novel pathways and key targets in complex diseases, while SuperExactTest will provide a clearer understanding of the genome by comparing a large number of gene signatures."

MISSED A ROUNDUP? Get caught up here: 12/2, 12/1, 11/30, 11/25, 11/24

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