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POLITICO New York Health Care: Oscar's troubles; Schneiderman goes after insurers

Dear readers: POLITICO New York Pro subscribers receive an enhanced version of this email at 5:30 a.m. each weekday. If you'd like to receive it, along with a customized real-time news feed of New York health care policy news throughout the day, please contact us at and we'll set you up for trial access.

written by Dan Goldberg

OSCAR, OSCAR — Health insurance startup Oscar saw a $12.8 million net loss in its first year of operations in the New Jersey market, adding to the significant shortfall the company reported in New York. The losses come even as Oscar's valuation continues to soar, with Forbes recently reporting that the insurer, which bills itself as a user-friendly alternative, is valued around $2.7 billion. POLITICO New Jersey’s Katie Jennings has more:

...Explain this: The company had 2,798 members in New Jersey in 2015. In a recent interview with The Record, CEO Mario Schlosser said the company had grown to “between 25,000 and 30,000 members” in New Jersey by the end of the 2016 open enrollment period.

...In New York, Oscar Health lost $92.4 million in New York during 2015, according to its financial disclosures with the state’s Department of Financial Services. The loss, which was reported by Bloomberg News, was on a premium revenue of $118.2 million. Read the full Bloomberg report here:

...I’ve been asking readers why they think Oscar is valued at more than $2 billion and what they think the exit strategy is for investors. Is it an IPO? A buyout? Are they in it for the long term? Email me your best ideas at

MORE FINANCES — Buffalo Business First reports: “Excellus Health Plan Inc., Univera’s Rochester-based parent, also turned around operations, posting an operating gain of 0.4 percent or $23 million, compared to operating losses in 2014 of $55 million.”

SHARE ME: Like this newsletter? Please tell a friend to sign up. Give them this link:

AND MAKE SURE YOU FOLLOW Josefa and me on Twitter @J__Velasquez & @DanCGoldberg. And for all New Jersey health news, check out @katiedjennings

WHAT SCHNEIDERMAN IS UP TO — Attorney General Eric Schneiderman is looking to see whether health insurance companies are inappropriately rationing high-priced Hepatitis C drugs in order to pad their bottom line, an inquiry which insurers were quick to dub "misguided."

NOW WE KNOW — We’ve all stepped on a Lego and thought, ‘God, that is a disproportional amount of pain for such a tiny object.’ Want to know why it hurts so much? Science has the answer.

WE'D LOVE TO HEAR FROM YOU: This roundup is for you, so please tell us how we can make it even better. Send tips, news, ideas, calendar items, releases, promotions, job postings, birthdays, congratulations, criticisms and corrections to

TEA LEAVES — U.S. Supreme Court Justice Anthony Kennedy — the likely swing vote — seemed skeptical of a Texas law that imposes strict new requirements on abortion clinics.

TRUMP’S PLAN — Donald Trump on Wednesday released his health care plan. How seriously should this be taken? Pretty seriously, because much of this is standard offerings from the Republican party, which means these are the ideas most likely to pass a Republican controlled Congress whether Trump is the nominee or not.

NO PRESCRIPTION NEEDED — Independent pharmacies will now be able to provide naloxone, the opioid overdose reversal drug, without a prescription, Gov. Andrew Cuomo announced Wednesday. "By making this lifesaving medication available in drugstores without a prescription, we are continuing to prevent needless tragedies from occurring and ensuring that all New Yorkers have access to this critical medication," Cuomo said in a statement. The Department of Health’s Harm Reduction Coalition will issue a standing order to more than 750 independent pharmacies outside of the five boroughs, as well as chain pharmacies that don’t have a designated prescriber, the administration said. In January, Cuomo announced that CVS Pharmacy would begin individual training and provide naloxone to customers without a prescription.

SECURITY BREACH — The cyberattack on Excellus BlueCross BlueShield last September cost the Rochester-based health insurer $17.3 million, the Democrat & Chronicle reports. The data breach exposed names, addresses and social security numbers of their customers.

CHECK THIS OUT — The Manhattan Institute is hosting a conference March 23 on hospital consolidation and competition in New York State. Distinguished health care experts, from academia, business, and nonprofits, will examine various tools that policymakers can use to deliver better outcomes across New York’s vast health care ecosystem, including regulatory reforms to boost competition, better state and federal antitrust oversight, and value-based purchasing strategies.

...I’ll be moderating the first panel and want to know what you think I should ask and/or discuss. Email me at

THE HIGH STAKES — The Journal News reports: “The Westchester Medical Center on Wednesday unveiled plans for a $230 million, 280,000-square-foot Ambulatory Care Pavilion on its Valhalla campus. The sleek multi-story glass and steel building would be the largest health care construction project in Westchester County in decades, and underscores a high-stakes arms race among Lower Hudson Valley hospitals.”

FOOTPRINT — The Real Deal reports: “Health, a digital health care startup, plans to triple its office footprint in New York City, having signed a lease for more than 15,000 square feet at Equity Office’s 114 West 41st Street.”

A HIGHER AUTHORITY — Dominican Sisters Family Health Services Inc., a nonprofit home health agency, signed a letter of intent last week to transfer sponsorship to ArchCare, the archdiocese’s continuing care provider, according to Catholic New York.

MAKING ROUNDS — The Ellis Medicine Board of Trustees announced Wednesday that Paul Milton has been named president and CEO of the Schenectady-based hospital. Since last February, Milton had been the acting president and CEO, after the retirement of James Connolly. Prior to the interim role, Milton had served as Ellis’ executive vice president and chief operating officer for eight years.

...Also making rounds: Dr. Douglas Levine, who has helped to advance early detection and treatment of ovarian cancer, will join the faculty of NYU Langone Medical Center as director of the Division of Gynecologic Oncology at its Laura and Isaac Perlmutter Cancer Center and the Department of Obstetrics and Gynecology, according to a press release from Langone.

COMING ATTRACTIONS — Allison Sesso, Gordon Campbell and Fred Shack will be on Inside City Hall tonight discussing their report, which examined the human services industry. Here’s my take on their report:


-NO LIGHT IN THIS TUNNEL — Financial losses at the 11 remaining Obamacare co-ops nearly doubled during the last three months of 2015, approaching $400 million for the year, according to annual reports filed this week. Just how bad is that? It's about equal to the losses sustained by all original 23 co-ops in 2014, their first year of operations, POLITICO reports. The losses for the remaining 11 co-ops are about a third of their total loans, making it unlikely much of that money will ever be repaid to the feds.

-WHITE HOUSE SUPPORT — Modern Healthcare reports: “The Obama administration supports a bipartisan bill that boosts states' ability to identify providers that have been banned from participating in Medicare or in another state's Medicaid program or the Children's Health Insurance Program.”

-CHANGING THE MIX — - Medicaid expansion is changing the payer mix, according to a report from athenahealth-RWJF. Medicaid patients now represent 21 percent of all primary care doctor visits in Medicaid expansion states, versus just 9.6 percent in non-expansion states.

-NO GO IN SENATE — Senate Republicans have shot down a Democratic proposal to add $600 million to the first major bill addressing the deadly opioid epidemic.

TODAY'S TIP — Comes from the Cleveland Clinic, which offers us: “5 tips to prevent colon cancer in people under age 50.”


-STRESSFUL — Researchers at Stony Brook University and UC San Diego say that chronic psychosocial and emotional stress has well-documented negative effects upon the human immune system, increasing the risk of disease.

MISSED A ROUNDUP? Get caught up here: 3/2, 3/1, 2/29, 2/26, 2/25

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