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POLITICO New York Health Care: The ACA's unintended effect; Breast cancer in New York

Dear readers: POLITICO New York Pro subscribers receive this email at 5:30 a.m. each weekday. If you'd like to receive it at that time, 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

UNINTENDED CONSEQUENCES — The Affordable Care Act seems to be having a negative impact on the bottom lines of nearly all of New York’s nonprofit regional health plans, many of which offer coverage in underserved parts of western and upstate New York. The most pronounced underwriting losses stem from the Medicare Advantage line of business. In 2015, more than 1.2 million New Yorkers were enrolled in Medicare Advantage plans. If the trend continues, consumers who rely on these regional nonprofits will face higher premiums as insurers pass on the increased costs in order to survive. The worst-case scenario, if the losses are sustained over a long enough period of time, is that the insurers stop offering certain plans.

...POLITICO New York’s Katie Jennings’ analysis of the 2014 annual statements filed with the National Association of Insurance Commissioners found underwriting losses in the tens of millions of dollars for all of New York’s nonprofit insurance companies operating at least one plan under Article 43. EmblemHealth, which serves the greater New York City area, reported a net underwriting loss of more than $167 million from the Medicare business across its two health plans—Group Health Incorporated and the Health Insurance Plan of Greater New York. Excellus Blue Cross Blue Shield and HealthNow New York, which both serve the western New York region, posted underwriting losses of $31.91 million and $78.97 million for Medicare respectively. Albany-based CDPHP reported a loss of $33.87 million in Medicare across its two plans, and Buffalo-based Independent Health saw a loss of $71.71 million. Schenectady-based MVP lost $32.51 million. Make sure you read this story:

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THE BREAST CANCER QUESTION — Hamilton County in the North Country has the state’s highest breast cancer incident in New York. What causes breast cancer rates in women to be higher in different areas of the state? What differentiates women on Long Island, where the breast cancer rate is among the state’s highest, from those in New York City? POLITICO New York’s Josefa Velasquez explains: (And make sure you check out the interactive map we made showing breast cancer rates by county in New York.)

NOW WE KNOW — Don’t breathe in other people’s vomit. It might make you sick, according to a study in PLOS One, which found that vomit can create airborne virus particles that can infect people who breathe them in. Here’s the best part. These researchers created their own vomiting device to test their hypothesis, specifically on norovirus. Jell-O instant pudding was added to make the lab vomit thicker. NPR has a great photo.

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THURSDAY’S BIG QUESTION — What if prisons paid readmission penalties the way hospitals do? Think about it. The Brookings Institution sure did.

ETHICAL TIGHTROPE — The Albany Times-Union asks whether Courtney Burke is going to have any trouble with ethics laws because she is in a government relations positions at Albany Medical Center after serving as deputy secretary for health in the Cuomo administration. “New York's Public Officers Law bans former government officials from appearing before their old state agencies for two years in a paid capacity. The law also says state employees cannot ever practice, appear before or ever even ‘communicate’ with those agencies on matters over which they were ‘directly concerned’ during their state employment, or which were under their ‘active consideration.”

FINANCES — South Nassau Communities Hospital reported an operating gain of $4.5 million for the six months ending June 30. That's about $2 million less than it reported during the same period in 2014. Income from operations was $3.2 million, which included investment income of $2.7 million, according to its most recently reported financial documents. Salary and benefits increased $9.5 million to $133.4 million, driven by physician acquisition practices, the opening of an urgent care facility in Long Beach and the acquisition of a family practice office in Long Beach. Read the full report here:

GRANT LAND — Weill Cornell Medical College has received a $5.8 million grant from the National Institute on Drug Abuse to study the economic costs and benefits of treating the more than 7 million people with substance abuse disorders. WCMC will create a center that disseminates economic evidence surrounding treatment options, with the goal of informing the public debate, according to a press release from the college.

ENDING AIDS — As part of his agenda to end the AIDS epidemic in New York by 2020, Gov. Andrew Cuomo on Wednesday announced $2.5 million in state funding for 11 legal support service programs for families and people living with HIV. View the 11 recipients here:

PHARMA REPORT: Bloomberg News examines whether insurance companies will cover the new female libido pill.


-BREAKING DOWN WALLS — POLITICO reports: “A year ago, heroin killed more New Jerseyans than homicide and HIV combined. Horrified by watching so many of their citizens die, state health and law enforcement officials concocted an unprecedented plan. For the first time, they would share information on the state’s heroin epidemic. Public health officials would open access to data on overdose deaths and emergency room admissions that police previously waited up to a year to see. Police would support health officers fighting drug addiction. New Jersey’s double-barreled attack on heroin is part of a growing trend in which officials use information technology to tear down the walls separating health care from services such as housing, welfare and policing. New York City hired a data company that tracks evictions, allowing tablet-carrying city officials to arrive on time with health information, housing chits and other services.” [PRO]

-WORKING MOMS The Washington Post reports: “In the United States, nearly a quarter of employed mothers return to work within two weeks of giving birth, according to a new report from In These Times, a nonprofit magazine, which analyzed data from the Department of Labor and collected stories from mothers who kept working through pain and grief.”

-VOTING ON DRUG CAPS — Californians will get the chance to vote for a measure that, if passed, would require government health programs pay no more for prescription drugs than the prices negotiated by the Department of Veterans Affairs, according to POLITICO. [PRO]

-HOW THEY SPEND THE MONEY — POLITICO reports: “[Aetna] has been on a hiring spree in the past week, engaging four firms to help its acquisition of Humana stay on track. Bloom Strategic Counsel, CGCN Group, The Gibson Group and West Front Strategies will all be lobbying the federal government on Aetna’s proposed $37 billion merger with Humana — the insurance industry’s largest ever. The company, which has already spent $1.4 million on lobbying this year, also registered Capitol Hill Consulting Group and Sidley Austin.”

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TODAY'S TIP — Comes from the Cleveland Clinic, which reminds us that “a regular yoga practice can help you feel better and live healthier”


-THE EYES ARE THE WINDOW — Researchers at New York Eye and Ear Infirmary of Mount Sinai and Rutgers University say tracking structural changes in the eye may be able to explain the risk and progression of Schizophrenia. The authors of the study examined results from 170 existing studies and found that there are no reports of people with schizophrenia who were born blind. "The retina develops from the same tissue as the brain," co-author Richard Rosen, Director of Ophthalmology Research at New York Eye and Ear Infirmary of Mount Sinai, and Professor of Ophthalmology at the Icahn School of Medicine said in a press release accompanying the article. "Thus retinal changes may parallel or mirror the integrity of brain structure and function. When present in children, these changes may suggest an increased risk for schizophrenia in later life. Additional research is needed to clarify these relationships, with the goals of better predicting emergence of schizophrenia, and of predicting relapse and treatment response and people diagnosed with the condition."

-NOT WORKING RIGHT — POLITICO reports: “Just a small portion of Berkeley’s new tax on sugary beverages is being passed onto customers, according to a new working paper that could raise doubts that the levy will reduce consumption as much as its supporters expected. The researchers found about one-fifth of the so-called soda tax’s cost is being passed onto Berkeley consumers, which they say is much smaller than the experience of previous “pass-through” taxes meant to curb consumption — and supporters of the tax approved last November had predicted its entire cost would be passed onto consumers. The authors of the NBER working paper hypothesize that stores in the California city are hesitant to boost prices, worried about losing business to surrounding towns without the tax. They also say it’s possible that stores haven’t fully adjusted their prices to account for the tax, which was first collected in March.” The study:

MISSED A ROUNDUP? Get caught up here: 8/19, 8/18, 8/17, 8/14, 8/13

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