TMC Brief Presented by America’s Health Insurance Plans: How Enroll America is Getting Ready for the End of Obamacare Enrollment, Talks on Hospital Merger Break Down

Today’s Washington Read:

How Enroll America is Getting Ready for the End of Obamacare Enrollment
from Washington Post by Sarah Kliff

Enroll America is gearing up for its own version of March Madness — one that has nothing to do with basketball. The pro-health law group has spent months now honing its outreach techniques and developing data-intensive maps meant to help their 18,000 volunteers and 2,000 partner organizations reach as many uninsured people before open enrollment on the exchanges ends March 31. The end of open enrollment has arguably taken on additional significance after the botched roll-out of HealthCare.gov, which made it difficult for shoppers to sign up in October and November. The Obama administration is about 1 million people short of where it had projected it would be on enrollment at the end of January. “We’re at this moment now, six weeks out from the end of open enrollment, and we’re looking at every tool that we have at our disposal about how we should be focusing our efforts,” Enroll America president Anne Filipic says. One new tool that the group has begun rolling out to partner organizations are a set of maps that show where, down to the census tract, uninsured Americans live — and how well that does, or doesn’t, line up with where people meant to help them enroll in Obamacare are based.

Today’s Business Strategy Read:

Talks on Hospital Merger Break Down
from Boston Globe by Robert Weisman

With the region’s hospital industry already in flux, merger talks between Beth Israel Deaconess Medical Center and two other major health care organizations have collapsed, adding more uncertainty over the future shape of the marketplace. The potential alliance of Beth Israel, Lahey Health, and the Atrius Health consortium of doctors groups was considered a key part of a regionwide move toward consolidation into a few dominant health care systems. But the negotiations stumbled over issues such as who would lead the new organization and serve on its board of directors, according to people with knowledge of the discussions. The parties declined to comment. For months, it appeared that three major players were emerging on the Eastern Massachusetts health care scene: Partners HealthCare System, Steward Health Care System, and a combination of Beth Israel, Lahey, and Atrius. But the breakdown of the three-way negotiations, disclosed in e-mails to employees Friday, changes the script.

Today’s “Chart” Review:

Example of Enroll America Targeting: Uninsured Heat Map, Tampa
from Washington Post by Sarah Kliff

Mark Your Calendars (All Times Eastern):

Monday: HHS Secretary Sebelius event on the Affordable Care Act in Orlando @1130am
Monday: President’s Day; House and Senate in recess
Tuesday: Quarterly earnings: Community Health Systems, Healthcare Trust of America, HealthStream,Medtronic, National Health Investors, NSP Pharmaceuticals
Wednesday: Quarterly earnings: Acadia Healthcare, Health Care REIT, Healthcare Realty Trust, HealthSouth,Medbox, Medicines Company, United Health Insurance Holdings
Wednesday: Brookngs event on payment and delivery reform and social media @830am
Wednesday: Kaiser Family Foundation event on the Affordable Care Act and California @12pm

Wednesday: FasterCures webinar on risk assesment @1pm
Thursday: Quarterly earnings: Actavis, Allscripts, AMN Healthcare Services, Cyberonics, Depomed, eHealth,Epizyme, Express Scripts, IPC The Hospitalist, Kindred Healthcare, Pharmacyclics, Select Medical Holdings
Thursday: MACPAC meeting @830am
Thursday: Chamber of Commerce event on healthcare and trasportation @2:45pm
Thursday: Families USA call on state Medicaid enrollment @12pm
Friday: Quarterly earnings: Acceleron Pharmaceutical
Friday:  Institute for Defense and Government Advancement event on military behavioral health @9am
Friday-Sunday: National Governors Association Winter Meeting

NEWS ARTICLES
1-4: General
5-8: Payers
9-12: Providers
13-19: Pharma/Biotech/Device
18-20: Health IT

OPINIONS, EDITORIALS, PERSPECTIVES
20-21: Washington Post
22: Wall Street Journal
23: New York Times
24: USA Today
25: Huffington Post

RESEARCH REPORTS, ISSUE BRIEFS, CASE STUDIES
26, 27, 28: National Bureau of Economic Research

NEWS ARTICLES

General

1) In the Debate Over Healthcare, ‘Real People’ Become Human Volleyballs
from New York Times by Jonathan Weisman

In the Republican response to the State of the Union address, Representative Cathy McMorris Rodgers of Washington lamented the travails of “Bette in Spokane,” whose insurance policy had been canceled because of the health care law and who faced huge premium increases to replace it. The reality for Bette Grenier of Chattaroy, Wash., was more complicated. She did dash off an angry letter to Ms. McMorris Rodgers, her congresswoman, in September, but on further exploration Ms. Grenier’s options were wider than she had thought. Since her star turn, she has been harassed and mocked by “some pretty mean people,” she said. The “real people” political prop is a durable ingredient in politics, first popularized at the State of the Union address when Ronald Reagan invited Lenny Skutnik, who had dived into the icy Potomac River to rescue victims of a plane crash, to serve as an example of Everyman heroism. It is a trope that every president since has used. But with the continuing fight over the Affordable Care Act, it has become a blood sport for both parties. Every real face is fact-checked, every perceived distortion attacked. And real people have been caught in the crossfire.

2) On Health Law, Democrats Run to Mend What GOP Aims to End
from New York Times by Ashley Parker

The ad supporting Representative Ann Kirkpatrick, Democrat of Arizona, opens with a montage of Americana Main Streets, followed by the green fields and dirt roads of the West — the “small towns and wide-open spaces,” the narrator explains, where Ms. Kirkpatrick “listens and learns.” His voice remains tranquil even as he turns to a more cutting message about President Obama’s signature health care law: “It’s why she blew the whistle on the disastrous health care website, calling it ‘stunning ineptitude’ and worked to fix it,” he says, before adding, “Ann Kirkpatrick: Seeing what’s wrong, doing what’s right.” As Democrats approach the 2014 midterm elections, they are grappling with an awkward reality: Their president’s health care law — passed almost entirely by Democrats — remains a political liability in many states, threatening their ability to hold on to seats in the Senate and the House. As a result, party leaders have decided on an aggressive new strategy to address the widespread unease with the health care law, urging Democratic candidates to talk openly about the law’s problems while also offering their own prescriptions to fix them.

3) GOP: Obamacare Hitting Seniors Hard
from Politico by Susan Levin

Republican Rep. Tom Rooney of Florida took aim today at Obamacare’s impact on older Americans, saying that seniors across the country are paying “more money for fewer choices, less access and far less peace of mind.” In the GOP’s weekly address, Rooney castigated President Barack Obama’s very public pledge that Americans of all ages would be able to keep their doctors under the health law. Since the fall, the president has had to backtrack on that statement, acknowledging that the law was forcing changes in insurance plans that meant some people were losing their physicians. “Here’s the reality,” Rooney said as he blamed Obamacare for “deep cuts” made to the popular Medicare Advantage program that serves low-income seniors, among others.

4) How Enroll America is Getting Ready for the End of Obamacare Enrollment
from Washington Post by Sarah Kliff

Enroll America is gearing up for its own version of March Madness — one that has nothing to do with basketball. The pro-health law group has spent months now honing its outreach techniques and developing data-intensive maps meant to help their 18,000 volunteers and 2,000 partner organizations reach as many uninsured people before open enrollment on the exchanges ends March 31. The end of open enrollment has arguably taken on additional significance after the botched roll-out of HealthCare.gov, which made it difficult for shoppers to sign up in October and November. The Obama administration is about 1 million people short of where it had projected it would be on enrollment at the end of January. “We’re at this moment now, six weeks out from the end of open enrollment, and we’re looking at every tool that we have at our disposal about how we should be focusing our efforts,” Enroll America president Anne Filipic says. One new tool that the group has begun rolling out to partner organizations are a set of maps that show where, down to the census tract, uninsured Americans live — and how well that does, or doesn’t, line up with where people meant to help them enroll in Obamacare are based.

Payers

5) Group Led by Starr Near Deal to Buy MultiPlan
from Wall Street Journal by Dana Mattioli and Mike Spector

A group led by Starr Investment Holdings is near a deal to purchase health-care services firm MultiPlan Inc. for about $4.4 billion, according to people familiar with the matter. The deal for MultiPlan, which is currently owned by a duo of private-equity firms, could be announced as early as Monday, the people said. Starr, like other insurers, is looking for ways to boost investment returns amid historically low interest rates. As part of that effort, the firm is vying to become a bigger player in the private-equity industry. Its strategy involves buying companies and holding them for as many as 10 years, considerably longer than what is typical for private-equity shops. Founded in 1980, MultiPlan helps manage the claims process for big health insurers. One of the largest independent preferred provider organizations, MultiPlan says it generates more than $11 billion in cost savings a year on about 40 million claims. According to its website, MultiPlan has nearly 900,000 health-care providers under contract and an estimated 68 million consumers accessing its products.

 6) California Health Exchange Faulted for Not Reaching Out More to Latinos
from LA Times by Soumya Karlamangla and Chad Terhune

Some California politicians are turning up the heat on the state’s health insurance exchange to boost Latino enrollment in Obamacare before a March deadline. U.S. Rep. Loretta Sanchez (D-Santa Ana) held a sign-up event Thursday in Orange County and prodded the Covered California exchange to do more to reach the area’s large population of uninsured. Statewide, about 1.2 million, or 46%, of the 2.6 million Californians eligible for federal premium subsidies under the healthcare law are Latino. But Covered California said only 20% of enrollees through December described themselves as Latino on their application. “We’ve been disappointed with the Latino numbers and with Covered California,” Sanchez said. “I think we are starting to turn it around.” The exchange is expected to release updated enrollment figures next week.

7) Medicaid’s Death Bill Leaves Homes, Assets at Risk
from USA Today by Shannon Mullen

After their 92-year-old mother died, Richard Pfieffer and his siblings were set to sell her New Jersey home when a bill for $25,347 brought them up short. The amount was the total cost of the home-based medical care their mother received through Medicaid in the last years of her life. If the bill wasn’t paid in full, the family was informed, the state would place a lien on the property. “It was like, ‘What the hell are they talking about?’ ” said Pfieffer, 65. Although it often comes as a shock to families, Medicaid has worked this way for more than 20 years. By law, the state can force the families of deceased Medicaid recipients to sell off their loved one’s home, heirloom jewelry and other possessions to repay the cost of whatever benefits the person received from age 55 on.

8) Humana and Walmart Team Up to Expand Health Care Access
from San Antonio Business Journal by Scott Bailey

Humana is working with retail giant Walmartto provide expanded access to health care in San Antonio. The Louisville, Ky.-based company has developed three new Humana Health & Well-being Centers that will be open to its members and to the general public. Two of those centers will officially open later this month in Alamo City Walmart stores located at S.E. Military Drive and 6703 Leslie Road. A third Humana Health & Well-being Center is located in Kentucky. The centers will offer an array of health care resources and services, including telemedicine suites featuring digital audio and video interaction with physicians who can evaluate, diagnose and treat various medical conditions.

Providers

9) Dems to Walmart: Quit Tobacco
from Politico by Burgess Everett

A powerful group of Democrats is challenging Wal-Mart to be the next store to quit the tobacco industry. In a letter to Wal-Mart chief Doug McMillon released Friday afternoon, seven Senate Democrats urged the country’s largest retailer to follow in the footsteps of CVS and renounce tobacco sales to improve public health. “We write to urge Walmart, as the number one retailer of cigarettes in the country, to stop selling tobacco products in all of its stores,” the senators said. “We recognize the legality of selling and profiting from tobacco products; however, Walmart’s position as the nation’s largest retailer of any kind puts your company in a unique position to contribute to the health and well-being of all Americans.” The lawmakers said that while the federal government and states are making productive efforts in combating smoking, they believe that the “private industry has an important role to play in tobacco control and prevention efforts.”

10) Talks on Hospital Merger Break Down
from Boston Globe by Robert Weisman
With the region’s hospital industry already in flux, merger talks between Beth Israel Deaconess Medical Center and two other major health care organizations have collapsed, adding more uncertainty over the future shape of the marketplace. The potential alliance of Beth Israel, Lahey Health, and the Atrius Health consortium of doctors groups was considered a key part of a regionwide move toward consolidation into a few dominant health care systems. But the negotiations stumbled over issues such as who would lead the new organization and serve on its board of directors, according to people with knowledge of the discussions. The parties declined to comment. For months, it appeared that three major players were emerging on the Eastern Massachusetts health care scene: Partners HealthCare System, Steward Health Care System, and a combination of Beth Israel, Lahey, and Atrius. But the breakdown of the three-way negotiations, disclosed in e-mails to employees Friday, changes the script.

11) Partners HealthCare Cites Dropping Patient Volume for Weak Results
from Modern Healthcare by Beth Kutscher

Partners HealthCare System reported thinner year-over-year operating margins in the first quarter of its fiscal 2014 as the 12-hospital group faced declining patient volume and a more adverse payer mix. The Boston-based not-for-profit system also said its weaker results reflected investments in its managed-careorganization, Neighborhood Health Plan, to prepare to operate on the Massachusetts insurance exchange and bring in new commercial members. Partners reported (PDF) $46 million in income from operations in the first quarter of its fiscal year, which ended Dec. 31, compared with a loss of $12 million during the prior year period. Net patient service revenue increased 11% to $1.8 billion. But when one-time factors were excluded from the year-over-year comparison, Partners’ operating margin was 1.8% compared with 2.5% in the first quarter of fiscal 2013. Those results were “weaker than expected,” Peter Markell, the system’s chief financial officer and treasurer, said in an earnings release.

12) LifePoint Cites Healthcare Reform in Forecasting 4%-5% Earnings Bump
from Modern Healthcare by Beth Kutcher

LifePoint Hospitals is forecasting a 4% to 5% earnings boost this year as more patients gain insurance under healthcare reform. The publicly traded Brentwood, Tenn.-based chain reported its projections for 2014 revenue as well as earnings before interest, taxes, depreciation and amortization on an earnings call to discuss fourth-quarter and full-year 2013 results. Despite weak patient volume and Medicare reimbursement cuts, the chain has a number of reasons to be optimistic this year, said Leif Murphy, executive vice president and chief financial officer. LifePoint is participating in exchange products in every one of its markets, and in 90% of those, its hospitals are included in both the lowest-priced bronze and silver plans. Moreover, it has been successful in negotiating payment rates that are close to commercial rates.

Pharma/Biotech/Device

13) Drug Quality Concerns Spur New U.S. FDA Oversight Effort
from Bloomberg by Anna Edney

Drug quality concerns, such as those that have banned U.S. sales of generic medicines from several Indian manufacturing plants, have spurred regulators to create a new unit to sharpen their oversight. The Food and Drug Administration is establishing an Office of Pharmaceutical Quality to improve the agency’s scrutiny of brand-name, generic and over-the-counter drugs, Janet Woodcock, director of the Food and Drug Administration’s Center for Drug Evaluation and Research, said today at the Bloomberg health-care summit. The FDA is talking with the industry to develop data that may signal which manufacturing plants are straying from standards and need inspection, she said. The agency now collects such information only during inspections. The thrust of the effort would be to head off potential concerns before the agency wields penalties such as banning products from troubled factories, Woodcock said. FDA Commissioner Margaret Hamburg has been in India the past week and met with generic-drug companies to discuss quality. “We want to use leading indicators,” Woodcock said in an interview after her appearance via webcast at the summit in New York. “These people aren’t in trouble yet but they could be.”

14) Medicines Made in India Set Off Safety Worries
from New York Times by Gardiner Harris

India, the second-largest exporter of over-the-counter and prescription drugs to the United States, is coming under increased scrutiny by American regulators for safety lapses, falsified drug test results and selling fake medicines. Dr. Margaret A. Hamburg, the commissioner of the United States Food and Drug Administration, arrived in India this week to express her growing unease with the safety of Indian medicines because of “recent lapses in quality at a handful of pharmaceutical firms.” India’s pharmaceutical industry supplies 40 percent of over-the-counter and generic prescription drugs consumed in the United States, so the increased scrutiny could have profound implications for American consumers. F.D.A. investigators are blitzing Indian drug plants, financing the inspections with some of the roughly $300 million in annual fees from generic drug makers collected as part of a 2012 law requiring increased scrutiny of overseas plants. The agency inspected 160 Indian drug plants last year, three times as many as in 2009. The increased scrutiny has led to a flood of new penalties, including half of the warning letters the agency issued last year to drug makers.

15) FDA Rejects Wider Use of Xarelto Drug
from Reuters by Ransdell Pierson

U.S. health regulators have again declined to approve proposed wider uses of Bayer AG and Johnson & Johnson’s lucrative blood clot preventer Xarelto, the drugmakers said on Friday. The companies had sought approval from the U.S. Food and Drug Administration (FDA) to market the blockbuster pill for prevention of new heart attacks and strokes, and death, in patients with acute coronary syndrome (ACS), and also to prevent clogging of heart stents. ACS is an umbrella term covering any condition brought on by sudden reduced blood flow to the heart, including heart attack and chest pain. Xarelto’s biggest current approved use is to prevent blood clots and strokes in patients with an irregular heartbeat called atrial fibrillation. The condition occurs mainly in the elderly.

16) Generic Drug Makers Fight Rule on Health Risk Warnings
from LA Times by David Savage

Companies that make generic drugs, the medications most Americans buy, are fighting to kill a proposed federal regulation that would require them for the first time to warn patients of all the known health risks of each drug they sell. The proposed rule change by the Food and Drug Administration “would be nothing short of catastrophic,” said Ralph G. Neas, president of the Generic Pharmaceutical Assn., an industry trade group. It could raise healthcare costs and “create dangerous confusion” for doctors and patients, he said. At issue is a legal loophole created by Supreme Court rulings that drew a sharp distinction between brand-name drugs and lower-cost generics, which are the same products but usually are marketed under their chemical names. In 2009, the high court confirmed drug makers could be sued if they failed to warn patients that a brand-name drug carried a serious potential health risk.

17) Medtronic Heart Monitor Spots Stroke Dangers in Study
from Bloomberg by Michelle Fay Cortez

Medtronic Inc.’s Reveal XT, a tiny heart monitor that’s inserted under the skin on the chest, detects more potentially deadly erratic heart rhythms in stroke patients than standard approaches, a company-funded study found. The results suggest a better way to find the cause of thousands of strokes in the U.S. each year, said Richard Bernstein, a professor of neurology at Northwestern University Feinberg School of Medicine in Chicago. While the irregular heart rhythm called atrial fibrillation is one cause, the reason for more than one-quarter of the 800,000 strokes a year is unknown, the Centers for Disease Control and Prevention said. Medtronic’s Reveal XT found 7.3 times more cases of atrial fibrillation than the current methods for detecting it, including Holter monitors and electrocardiograms, in the study released today of 441 people who had unexplained strokes. After three years, 30 percent of those getting continuously monitored with Reveal were shown to have atrial fibrillation, compared with 3 percent of those getting older approaches.
Health IT

18) Home Monitoring Fuels Telehealth Market
from FierceHealthIT by Susan Hall

Home is not only where the heart is, but also where the telehealth market is focused, based on a recently published Frost & Sullivan survey from the American Telemedicine Association’s 2013 annual meeting. The home, including remote patient monitoring, is the area of biggest impact and opportunity in the telehealth market, driving interest from major device makers and startups alike. Startups from other countries–especially from Asia–have their eye on the U.S. market, according to an announcement. After home-based monitoring, respondents cited video telemedicine providing diagnostic consultation and remote specialist services, and telemental health as areas that will have the biggest impact on the market in the coming years.

19) When squirrels attack! There’s a medical code for that.
from Washington Post by Sarah Kliff

In 1855, European statisticians gathered in the stately chambers of France’s Corps Législatif. There on the banks of the Champs-Elysées, they made the world’s first formal attempt to list every single way a person could die. More than 150 years later, in a beige and windowless hotel ballroom thousands of miles away, hundreds of American medical coders are diligently chipping away at the exact same task. They’ve set out to master the nuances of the sprawling ICD-10, formally known as the Tenth Edition of the International Classification of Diseases. With 14,000 codes, ICD-9 seems puny by comparison. The new manual explodes that code set to 68,000 much more granular and detailed terms to define — very exactly and specifically — what ails us. Americans spend $2.8 trillion each year on medical care. These codes determine how that fortune — nearly one-fifth of the nation’s economy — gets divvied up among thousands of hospitals and the doctors who work there. It is how the federal government, and most private health insurers, assess a value for each patient visit.

AHIP’s National Health Policy Conference: ACA and the Year Ahead, March 5-6 in Washington, D.C., will convene key Administration and state officials, Members of Congress, and the foremost health care thought leaders and health insurance industry professionals to provide high-level insight, analysis and policy recommendations on health care issues and trends. Don’t miss this timely opportunity to engage and share ideas with industry experts and vested stakeholders. Register today

OPINIONS, EDITORIALS, PERSPECTIVES

Washington Post

20) New GOP Healthcare Plan is a Starting Point, Not a Replacement
from Washington Post by Editorial Board

For years, Republicans have sniped at the Affordable Care Act without offering a reasonable alternative. Three GOP senators are trying to change that. Richard Burr (N.C.), Tom Coburn (Okla.) and Orrin G. Hatch (Utah) have offered an outline of a health-care-reform package that they say could take the ACA’s place. Given the shrill rhetoric from the GOP side, one might expect that Republican reform would have nothing in common with Obamacare. But there are only so many ways to preserve the patient protections that the ACA offers, which Republicans say they want to keep, while maintaining a private insurance market and assisting those who can’t afford coverage. The proposal would push people, particularly the poor, toward much skimpier coverage than the ACA offers. Since they could trade up when they got sick, people would have an incentive to avoid paying for more comprehensive plans until they needed them. Those comprehensive plans might well have a less healthy pool and so would become even more expensive. The proposal would offset this effect somewhat by lifting restrictions on tax-free health-spending accounts, but that’s not very helpful for people hovering around the poverty line.

21) The Poetry of Bad News Around Obamacare
from Washington Post by Kathleen Parker

It is easy these days to imagine that one is living in a fairy tale, albeit a dreary one. In fairy tales, as in Washington, things are true that can’t possibly be — and what is not true can be defended by tilting the facts a certain way and catching the light just so. Objective truth, it seems, has gone the way of trolls, goblins and gremlins, by which one should not infer that Truth has taken up residence in the U.S. Congress. Cognitive dissonance is a rational response to recent news that Obamacare will reduce the workforce, which is hardly helpful to the economy, and insure less than half of the uninsured — from 55 million down to 31 million.

Wall Street Journal

22) At the Obamacare Improv
from Wall Street Journal by Editorial Board

President Obama predicted at the House Democratic retreat on Friday that “10 years from now, five years from now” people will look back on the Affordable Care Act as “a monumental achievement.” He’s right in the limited sense that, given the delays he has sanctioned so far, it will take years before anyone can tell if it works. Now that we’ve had more time to parse this week’s announcement of a second delay of the employer mandate, the political reason for the carve-out is becoming clearer. Far from the economic relief that the White House claimed, the rule ismeant to turn back the lifeboats toward the capsized ObamaCare ocean liner so the women and especially the children can help with the rescue. If Mr. Obama really wanted to help alleviate labor market uncertainty, then he’d ask Congress to repeal the mandate permanently. No business is going to take the long-term risk of hiring and staffing decisions based on a temporary mandate holiday declared through unilateral administrative discretion.

New York Times

23) A Watchful Eye in Hospitals
from New York Times by Tim Lahey

Despite the intensely personal moments that happen in hospitals, patient privacy can be elusive. Hospitals are multimillion-dollar corporations that look like shopping malls and function like factories. Doctors knock on exam room doors to signal they are about to enter — not to ask permission. The curtain that encircles the hospital bed always lets in a crack of light. Yet we do expect some degree of privacy in hospitals. We trust doctors with our secrets in part because they take a 2,000-year-old Hippocratic oath to respect our privacy, an oath enforced by laws like the Health Insurance Portability and Accountability Act. But sometimes, doctors have to weigh patients’ privacy against their health and safety, and that’s when things get complicated. The use of video monitoring — covert or disclosed, of patients or providers — has proliferated as high-quality, inexpensive technology has become increasingly accessible. The possibilities range from watching elderly patients at risk of falling in their rooms to recording doctors and nurses at sinks to make sure they’re washing their hands.

USA Today

24) Expand Medicaid to Close Racial Health Gap
from USA Today by LeeAnn Hall and Brian Smedley

In his State of the Union Address, President Obama noted millions of Americans have signed up for health coverage since Oct. 1, most of them through Medicaid, according to the Department of Health & Human Services. Despite years of political obstruction and months of website troubles, enrollment is now growing rapidly. The health care train is picking up steam. But who’s getting on board? Specifically, what is the breakdown by race and ethnicity? The Affordable Care Act has great potential to shrink the racial gap in coverage. But we can’t tell how it’s doing without data on race and ethnicity. HHS officials say they’re collecting only some data and don’t know when, or even if, they will be released. That’s inexcusable. For the law to work, we need to be able to track its results. The failure to collect full federal data suggests that HHS doesn’t see closing the coverage gap as a high priority.

Huffington Post

25) Leveraging Mobile Technology for Improved Public Health
from Huffington Post by Garth Graham

According to the Pew Research Center, 91 percent of Americans own cell phones, 56 percent of which are smartphones. As a physician and president of the Aetna Foundation, I have witnessed this rapid increase in technology usage firsthand. I’ve been encouraged by both patients and their family members using mobile technology to track their health behaviors. In my experience, it was as simple as a young girl from Baltimore looking up her grandmother’s heart condition on her iPhone and downloading an evidence-based fitness application to track their daily walks. When they returned to my office, the young girl had a new wealth of knowledge and her grandmother was incorporating exercise into her daily life. For my patients and their caregivers, like all of us, ease of use and access can make all the difference. Most of us are aware that racial and ethnic minorities experience disparities in health and health care services. In my view, there is a clear need for innovative solutions that can empower these underserved populations with information and tools that allow them to take charge of their own health.

ACA’s Future: The Good, the Bad and the Ugly. Avik Roy of the Manhattan Institute for Policy Research, and Jonathan Cohn of the New Republic, will discuss the politics and fiscal implications surrounding the ACA’s full implementation and certain future. You’ll find this and more valuable sessions and engaging speakers at AHIP’s National Health Policy Conference: ACA and the Year Ahead, March 5-6 in Washington, D.C. Register today

RESEARCH REPORTS, ISSUE BRIEFS, CASE STUDIES

National Bureau of Economic Research

26) The Role of Health in Retirement
from National Bureau of Economic Research by Alan Gustman and Thomas Steinmeier

This paper constructs and estimates a dynamic model of the evolution of health for those over the age of 50 and then embeds that model of health dynamics in a structural, econometric model of retirement and saving. The health model traces the effects of smoking, obesity, alcohol consumption, depression and other proclivities on medical conditions, including hypertension, diabetes, cancer, lung disease, heart problems, stroke, psychiatric problems and arthritis. These in turn influence an overall index of health status based on self-reported health, work limitations and ADLs, which is used to classify the population into good, fair, poor or terrible health.

27) Regulatory Redistribution in the Market for Health Insurance
from National Bureau of Economic Research by Jeffrey Clemens

In the early 1990s, several U.S. states enacted community rating regulations to equalize the health insurance premiums paid by the healthy and the sick. Consistent with severe adverse selection pressures, their private coverage rates fell by around 8 percentage points more than rates in comparable markets over subsequent years. By the early 2000s, following substantial public insurance expansions, coverage rates in several of these states had improved significantly. As theory predicts, recoveries were largest where public coverage expanded disproportionately for high cost populations. The analysis highlights that the incidence of public insurance and community rating regulations are tightly intertwined.

28) Efficiency versus Equity in the Allocation of Medical Specialty Training Positions in Spain
from National Bureau of Economic Research by Jeffrey Harris (et al)

In Spain’s “MIR” system of allocating residency training positions, medical school graduates are ranked according to their performance on a national exam and then sequentially choose from the remaining available training slots. We studied how changes in the MIR system might address the inadequate supply of practitioners of family and community medicine in that country. Both random ranking and restrictions in supply resulted in a relatively small efficiency gains from training more productive medical school graduates in family and community medicine, but at the same time a substantial equity losses. Improvements in two key attributes of family and community medicine – professional prestige and the proportion of income from private practice – resulted in substantial gains in both equity and efficiency.