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POLITICO New York Health Care, presented by Professional Women in Advocacy Conference: NY health exchange found deficient

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written by Josefa Velasquez

DEFICIENCIES IN THE EXCHANGE— A federal audit of the state’s health insurance exchange has found that some internal controls the state relied on to make sure people were eligible for coverage were ineffective.In a report released Wednesday by the inspector general for the U.S. Department of Health and Human Services, auditors found that not all of the state’s marketplace internal controls were “effective in ensuring that individuals were enrolled in qualified health plans” per the federal requirements.The controls used for verifying applicants' household income — used for determining financial assistance eligibility — were deficient, according to the review of 45 sample applicants for the enrollment period between October 2013 and March 2014. The audit also found that the state exchange's way of resolving inconsistencies in eligibility data and ensuring programs were only approved for consumers who don't have employer-sponsored insurance wasn't always effective.

...In response to the audit, the state’s Health Department said it agreed with the recommendations and said the concerns raised by the report had already been addressed.

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INVESTIGATE TURING— Attorney General Eric Schneiderman should investigate the New York-based pharmaceutical company under fire for increasing the price of a drug from $13.50 to $750 a pill, the Human Rights Campaign said in a letter on Wednesday. The Washington-based organization, which focuses on LBGT issues, accused the company, Turing Pharmaceuticals, of an “irresponsible and shameless price increase." The group asked Schneiderman to "assess whether these dubious actions violate New York state law.”The 62-year-old drug is used to treat life-threatening parasitic infections. According to the Mayo Clinic, the drug is used to prevent malaria and treat toxoplasmosis, a parasitic disease.Toxoplasmosis is typically seen in those with compromised immune systems, including patients undergoing cancer treatments or an HIV infection, as well as pregnant women.

NOW WE KNOW The reason your head aches after eating ice cream, or anything cold, too quickly is due to the dilation and constriction of blood vessels in the bundle of nerves on the roof of your mouth. Upon sensing the cold, the body reacts by sending in warm blood and the change in blood flow could be the reason behind the pain.

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TAMPERED?— The attorney for a woman who says she was raped by Chicago Blackhawks player Patrick Kane, a Buffalo native, said that the rape test kit evidence bag containing DNA evidence was anonymously delivered to the mother of the alleged victim. The evidence bag, attorney Thomas Eoannou, was torn open.

MERGER MONEY— Property records filed Tuesday with the city show that Montefiore Medical Center’s control over Yeshiva University’s Albert Einstein College of Medicine is worth roughly $209 million. The deal includes 24 along Morris Park Avenue, Pelham Parkway South and Eastchester Road in the Bronx, the Real Deal reported.

NORTH SHORE-LIJ EYEING AN EXPANSION— Kathonah-based Westchester Health Associates is negotiating the terms of an agreement to join the North Shore-LIJ Health system. Both companies signed a letter of intent to begin exclusive negotiations with the goal of reaching a final agreement this fall.


A TROUBLED PAST— ”Martin Shkreli is either the boy genius or the bad boy of pharmaceuticals, depending on one’s point of view.” The New York Times profiled Shkreli, the CEO of Turing Pharmaceuticals, who has come into the media spotlight after his company raised the price of a drug from $13.50 to $750 a pill. Here are some of the highlight: “This is not the first time that Mr. Shkreli, a former hedge fund manager with a reputation for outspokenness, has been at the center of a controversy.While in his 20s, he drew negative attention for urging the Food and Drug Administration not to approve drugs made by companies whose stock he was selling short. He was among a group of investors ordered by a New York judge to pay $2.3 million to Lehman Brothers to cover a losing bet on the markets in 2007. Two former employees sued him for not paying their wages, while another former employee accused Mr. Shkreli of taking over his personal email and Facebook accounts and harassing his family through social media.”

… Shkreli’s Twitter account was made private Wednesday afternoon.

...Lawmakers want Shkreli to testify before the Congressional Oversight Committee next week.

SIGN UP SEASON— The Obama-administration plans to focus on 10.5 million uninsured Americans to get them to sign up for the Affordable Care Act as the third open-enrollment season draws nearer. Health and Human Services Secretary Sylvia Mathews Burwell said the size of the group is disproportionately young adults or minorities who lack health care coverage but qualify to buy plans through insurance exchanges. This may prove more difficult given that roughly half of those who qualify are younger and may think they don’t need insurance. The effort will be concentrated in Dallas, Houston, Chicago, Miami and Northern New Jersey.

HAND IT OVER— Two courts ruled that the anti-abortion activist, David Daleiden, and the Center for Medical Progress, who have been behind the series of videos about Planned Parenthood selling fetal tissue, have to turn over private documents and submit themselves to questions about how they coordinated the video sting. POLITICO reports that the ruling requires Daleidien to turn over information on how he got into the National Abortion Federation Conference and provide the full, raw footage of his meetings while posing as an executive of a fake tissue procurement firm.

OPINION— Drew Altman, the president and CEO of the Kaiser Family Foundation asks why consumer issues are rising on the health agenda. In short, out of pocket costs have been increasing while wages have remained stagnant.

TODAY'S TIP — Comes from Mount Sinai. Here’s how to tell the difference between a cold and fall allergies.


-FATTENING UP— Despite calls to eat less foods that are high in saturated in fat, a report published by the Credit Suisse Research Interview shows the opposite. In the United States the sale of food high in saturated fats is increasing. The report found that the sale of butter in the U.S. rose by 14 percent last year and climbed another 6 percent in the first three months of 2015, the Times reports. Sales of whole milk rose 11 percent in the first half of this year, while skim milk purchases fell 14 percent. And while it doesn’t look good on paper, the trend reflects a shift from process foods to “more wholesome, natural” foods.

-DONT SIT— There’s plenty of studies showing how sitting too long is dangerous to your health. But a new study published in Experimental Physiology found that children sitting for extending periods of time can face health consequences. A study of a group of girls found that their vascular function declined after sitting for three uninterrupted hours.

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MISSED A ROUNDUP? Get caught up here: 9/22, 9/21, 9/20, 918, 9/17,

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