Adriel Bettelheim, Managing Editor at CQ Roll Call

(Music)

Mark Masselli: This is Conversation s on Healthcare , I am Mark Masselli .

Margaret Flinter: And I a m Margaret Flinter.

Mark Masselli: Well Margaret , another key Obama administrator stepping down,
Peggy Hamburg , FDA Commissioner for the past 6 years and now she is leaving her
post at the end of March saying she does have mixed emotions.

Margaret Flinter: Well she certainly wra pped up a number of achievements during
her 10 - year mark. She worked to modernize fo od safety over set stricter tobacco
regulations and approved review process for medical drugs.

Mark Masselli : She has a very large territory to cover as FDA Commissioner with
thousands of drugs to over see and the food stream often threatened by numerous
toxins and pathogens that are harmful to the population.

Margaret Flinter: Certainly the FDA has had to adapt to a growing infiltration fuel of
medical devices, variables, apps that are prepared to improve health, the advance of
genomics ominous change in the drug testing protocols that can take 15 years and
cost billions of dollars. So keeping pace with this ever changing landscape is no
easy task and I think people generally feel she did it quite well.

Mark Masselli: You are speaking of changing lan dscapes in a relatively short period
of time a new generation of parents has opted not to vaccinate their children in this
country and we are starting to see some of the dyer consequences Margaret. The
measle outbreak continues to run a pace in the CDC is out with statistics. There
have been numerous outbreaks across 14 states that began in 2014 and continue to
spread.

st
Margaret Flinter: You know, mark people just are not used to seeing this in the 21
century certainly most of our provider colleagues haven’t seen measles in their
careers since we have had the availability of the measles vaccines and thousands of
people truly risked for contracting this potentially fatal conditions and in the case of
me asles something that is just so highly contagious.

Mark Masselli: You know, and just lot of years ago we were reporting that they
eradicated measles, this whole issue has created a fire storm of debate as the front -
line providers were very concerned abou t the evidence based case supporting
vaccination of newborns boosters for teens and annual flu shots it’s eliminated so
much disease, death and hard ache. Hopefully, this is not going to be a growing
trend.

Margaret Flinter: Well we hope not vaccines an d immunization are the corner stone
of good population health but I will tell you nothing will bring this to the floor like
people seeing their children sick and that’s a sad reality that we are going to try and
prevent.

Mark Masselli: Our guest today is Adriel Bettelheim, Managing Editor for Health at
CQ Roll Call who has been keeping a close eye on the political goings on in the bill
while he is one of the top analysts on Government Health Policy looking forward to
that conversation.

Margaret Flinter: Lori Robertson, Managing Editor of Fact Check.org will be stopping
by. She is always on the hunt for misstatements spoken about health policy in the
public domain and as always if you have comments please e - mail us at
[email protected] or find us on Facebook@chcradio or Twitter@chcradio. We
would love hearing from you.
Margaret Flinter: We will get to our interview with Adriel Bettelheim in just a moment.
Mark Masselli: But first here is our producer Marianne O’ Hare with this week’s
Headlines News .
(Music) Marianne O’Hare: I a m Marianne O’Hare with these Healthcare Headlines . Eighty
million and counting , the estimated number of A nthem customers across the US
whose records were compromised by hackers. The n ation’s second largest insurer says hackers broke into a database containing records for millions of customers and employees and what is looking like the largest data breach of a Healthcare Company till date. The breach is said to have exposed names, addr esses , and social security
numbers, but doesn’t appear to involve medical or financial details. The company
which runs Blue Cross Blue Shield Plans in a number of states is going to reach out
to all customers they believe are compromised will offer credit protection services to those who wish it. California is ground zero for a major measles outbreak that was believ ed to have started in Disneyland infecting hundreds of people with the highly
contagious disease in the state of California is considering a lot that would remove personal preference as a justification for not vaccinating children. The proposed California n law would require all state children to be fully vaccinated before entering
school. You can call him the genomics President, President Obama announced an initiative to advance medical and scientific research by collecting genetic data from at least a mi llion American volunteers the data to be used for a large scale studies
on genetic properties of common chronic disease like diabetes, heart disease and even cancer, and according to recent survey by NPR and Truven Health Data Analytics, a majority of Amer icans have no problem sharing their de - identified health
data for research purposes. 53% of Americans say they wouldn’t mind having their data used for research however that numbers down from 68% a mere 6 months ago. The study suggests, folks might be a bit more skittish about privacy and security then
they were last year. I a m Marianne O’Hare with these Healthcare Headlines .
(Music) Mark Masselli: We are speaking today with Adriel Bettelheim, Managing Editor for Health at CQ Roll Call , and a subsidia ry of The Economist. CQ Roll Call is a leading
provider of conventional news and legislative tracking posting the largest press cord at Capital Hill . Mr. Bettelheim has served as Health regulation team leader at
Bloomberg News. He was reporter and senio r editor at the Ingressional Quarterly

and worked as a reporter at Politifact news. But then were posted in CRQs health
journal. Mr. Bettelheim has earned several awards including that 2009 Pulitzer Prize
for national reporting along with his team as wel l as Cigna Delta (inaudible 5:42 )
Medallion for public service journalism. He earned his BA from Case Western
Reserve University. Adriel welcome to Conversations at Healthcare .

Adriel : Oh nice to be with you and you have a great bird’s eye view of the goings on
inside the beltway and you know, there is an old saying may you live in interesting
times and certainly for a health reporter, the gift that keeps on giving is The
Affordable Care Act. You know, we estimate that 20 million Americans have gained
coverage under that Health law and yet the GOP controlled Congress is still talking
th
about repeal, I think this was their 56 vote just recently and yet really no focusing
on replacing it. Can you give listeners sort of the insider view of the political l ay of
land surrounding The Healthcare Law where it stands right now ?

Adriel: Yeah, well I mean I think there are two types of legislation that the
Republicans are pushing. One is kind of the broad spectrum such as the total rebel
vote that was taken in the house. This would be basically the (inaudible 6:40 ) to
eliminate the whole law and then there are more targeted strikes taking aim at the
risk cord or is that insulate the insurers from losses. The more targeted strikes. You
could be looking with them as kind of bargaining chips for discussions later in the
year when there is must mass legislation for example to increase the Government’s
borrowing authority. So, you have to kind of look at it that way but realistically, I
mean none of the big proposals Republicans are considering have a chance of
betting by presidential veto . E ven if they can get 60 votes in the senate as long as
Obama is President.

Margaret Flinter: ( I naudible 7:19 ) has just unveiled that would elimin ate the mandate
to purchase insurance but still offer tax growth for low income Americans to buy
insurance and there is something, let’s use the example the medical device tax if it
gets repealed certainly other effected by the healthcare law will be linin g up tab, their
taxes repeals as well. How can the GOP proposes pay for the changes that they
would like to see?

Adriel: Well I think that the man may not immediately line up they are also proposing
to do away with things like the medicaid expansions. I think feeling is that something
like the medical device tax is something that does not maybe gutted off and it effects
some democrats and states where there is large device manufacturers and the
referral number of D emocrats have put themselves on record as opposing this so it
becomes kind of a political cuddle for the opponents as law says so , no bend at all.
You love this law so much you want to keep every T and I.

Mark Masselli: You know, we recently had Steven Brill on the show and he was
talking a bout his new book The Americas Bitter Pill, which exposed their cultural
under belly and watching in that led to the crafting in the ACA and you have exposed
the sausage making of the bill way. What are you seeing as you look out both in
Washington and sta te capitals.

Adriel: Yeah and I mean, I think this was an exceptional law and that it really
reshaped the entire medical supply chain. I think what’s happening is from the

beginning when The Obama Administration outlined it’s ambitions, it activated pre tty
much every one up and down the supply chain, now the lobbying is focu sed on you
know, myriad rules that CMS and The Department of Health and human services is
picking out that continues to clarify the law. So there continues to be you know full -
time l obbying frenzy and lots of money being thrown to this so now it goes to that
defense company’s communities rally behind certain weapon systems when they are
being looked at for budgetary savings.

Margaret Flinter: Another piece that we haven’t focussed o n so much is the time
limited nature of some of the benefits under it. Can you talk about the challenge of
getting that medicaid pay parity to be reconciled anytime soon?

Adriel: With Medicaid, pay parity and primary care, this was a real problem becaus e
the law envisions Medicaid becoming one of the primary vehicles to expand
coverage and to improve you know, preventive care and accounts on primary care
professionals but this pay bump as it were expired at the end of the year without
congress taking act ion and now there is talk about reviving it and perhaps rolling it
into whatever dock fix legislation emerges in March, it maybe revived but if it doesn’t
get revived you are just going to end up having a patch work where some states are
taking care of the parity and others are not and it will create a bit of a chaotic
landscape.

Mark Masselli: We are speaking today with Adriel Bettlelheim, Managing Editor for
Health at CQ Roll Call a subsidiary of the Economist G roup. CQ Roll Call is a
leading provider of congressional use and legislative tracking and you know, earlier
on tens of billions of dollars were put in for meaningful use trying to change the
whole landscape of use of electronic health record and the P res ident has recently
again made his agenda clear that we must build an infrastructure for medical and
health data collection that will enhance targeted precision medicine. Can you tell our
listeners more about their President’s proposal?

Adriel: Well on p recision medicine it is a commitment relatively a small in this year’s
the budget just released the physical 2016 budget about 215 million dollars to better
understand the genetic underpinnings of disease and to use pericision medicine that
attacks the ind ividual patients genomic profile to come up in more customized
treatment. They are envisioning a large amount of the sum to go to the NIH to set up
a (inaudible 11:21 ) of at least a million volunteers to participate in research to boost
understanding of t hese disease, understanding that we are not in an era of this many
big block buster drugs any more and the power of understanding the human gene
can yield all such promising cures. Even house in senate you are seeing some
st
efforts to speed up SDA evaluatio n of more next generation 21 century cutting edge
medicines.

Margaret Flinter: There are certainly some measures within the Healthcare law that
are aimed at moving the country away from FIFO service model and towards pay for
value or pay for performanc e and certainly medicare has come up strongly recently
saying what a significant shift it expects to see away from FIFO service in towards
value, you know, it certainly saw some penalties for high readmission rates to
hospitals and that seems to have been effective. Readmission rates are down for
Medicare. Nice to see a proposal to finally repeal the sustainable growth rate

formula for compensating providers who treat medicare patients, can you first of all
for this can you just explain what that sustaina ble growth rate formula is and then
what do you think is likely to come to fruition?

Adriel: Well the sustainable growth rate is a formula that was enshrined in the late
90s budget law that basically dictates cuts to M edicare providers and it has been
cr iticized almost from enactment and congress has acted to block these scheduled
cuts on an almost annual basis. But they would love to totally kill this formula and
never subject medicare providers to these kind of cuts again but they have to find a
way of paying for the cost and the cost has been estimated like you know, something
like 140 billion dollars, you would have to do something pretty big and significant to
make it revenue neutral, which is the mantra here in Washington that and you know,
likeliho od at the end of March they will pass anther one or two - year or some
temporary patch while they continue to talk over whether they can somehow come
up with a permanent replacement for STR. The issue of value driven purchasing
that you rise is very big dea l. It be medicare as you mentioned, just announced they
are going to raise from 20% to 30% by 2016 new targets paying doctors and
hospitals, and the quality of care they are providing not just for the volume of
services. This is a very big deal because a fee for service system had been
enshrined in this big Government health programs for ever but they are anticipating
by 2018, half of medicare service could be shifted one of these new modals and that
could amount to 213 billion dollars or so. So the ques tion is you know, you would
need new legislation can they do this all administratively and how can you incentivise
some of this and you know, they are using all sorts of mechanisms to have these
accountable care organizations which were created by the Heal th lawn of doctors
and hospitals and other providers to share any savings they get if they coordinate
care. Bundled payments, another idea where the medicare would start paying
groped providers set amount for a particular case nd then as you say there is also a
penalty side of this secretary has talked about more savings coming from measures
such as penalizing the hospitals whose patients are discharged and readmitted
within a month. Th e question is how they face the manifesto if it’s gently enough that
i t does not endanger a great deal of opposition from the providers and whether they
can be a little more clear on what these accountable care organization and new
modals are.

Mark Masselli: You know you have done some analysis on Healthcare spending
lands cape and love to hear you projections for spending growth and moving forward
but also I am certainly interested in the amount we spend. We spend about 3 trillion
dollars a year in Healthcare you know, the question is, is that bad. If we got good
outcom es, would it be okay to spend this amount and you know, there is sort of the
implications of if we start reducing this by large numbers sort of have the same effect
that happened in the defense industry, but the under belly of this is about outcomes
and th en about drops.

Adriel: I guess the projections that we are seeing are not like some of the major
increases in the health sector that we are seeing in that 1990s and 2000s. So think,
you know, if the economy continues to recover, and health law expands coverage
and baby boomers continue to join medicare you are going to see how spending
grow I mean I think the projection now are something on the order of 5.7% annually
till 20 - 23. So health share of the economy is going to rise from about 17.2% to over

1 9% by 20 - 23 and increasing more with 5 trillion dollars. I think what’s difficult to
address is, we will sometimes precisely pinpointing the drivers behind the inflation.
You know, there are a l ot of people like to point over utilization how every patient
wants to delay his treatment and the most high - technologies tests and doctors are
allowed to deny that , insurers are intimidated to deny that so there is that sort of
tension. But we will se what happens as they begin to move to these di fferent
payment modules. We are discussing whether they can actually you know, bend the
curb as the Obama care architect we are talking about. It’s worth mentioning that
this economic argument was really one of this essential arguments for enacting the
l aw in the first place, I mean there is a social good of expanding coverage to millions
of newly covered people but to show this to the financial elite’s and the people who
buy our treasury bonds they had to make a point that this will eventually deliver lo ng
term savings and it’s very much an open questions of what will happen.

Margaret Flinter: Almost from the very beginning, we have been keenly aware that
The Supreme Court was an unlikely part of this Healthcare Reforming and certainly
the landmark deci sion upheld the legality of the law but allowed states to choose
whether to expand medicaid and that resulted in a patch work across the country in
terms of coverage but now we have got The High Court ready to hear this challenge
on the legality of the ta x subsidies for those purchasing insurance through the
federal exchange. What are the potential implications of the decision for ongoing
legislative challenged to the affordable care act?

Adriel: Well I mean many of us were surprised that the justice ha d took it on
because it focuses essentially on our interpretation of Six virgin law and whether the
subsidies for insurance coverage will be made available to every state as the IRS
has interpreted the law or whether they are just supposed to be directed t hat states
took the trouble to creat their own exchanges. So it’s depending on how you count
these exchanges it could affect subsidies in 34 or 37 states and millions of people
who have been at received the coverage starting last year would considerably h ave
their care of arrangement thrown into chaos. The first thing we don’t know is how
the justice would rule if they upheld this argument. Would just all the people in these
34 states instantly lose their subsidies and depending on how sweeping or it’s l imited
decision is that you know, would certainly open the door for both administrative
success that Obama team could make or legislation but it’s hard to imagine this
congress and this President agreeing on very much especially if something gets
fundament al as the subsidies for insurance coverage and the entire reshaped
insurance market gets thrown into other chaos, so we don’t know what’s going to
happen and there are a variety of replacement plans and contingency plans that are
being floated out there bu t HHS secretary (inaudible 19:23 ) S enate finance
committee to talk about her budget and gets berated by republicans for refusing to
discuss contingency plans, so what a bad juju out there . We have been ruling like
this is certainly just going to fray norm s and plunge the country and a lot of law
makers who are a little, you know, have a little bit of health law fatigue right back into
the vertex.

Mark Masselli: We are speaking today with Adriel Bettelheim, Managing Editor for
Health at CQ Roll Call, and a subsidiary of the economist group. You can follow his
work by going to CQRollCall.com and you can follow him on Twitter at Abettel.
Adriel thank you so much for joining us on Conversations on Healthcare .

Adriel: Nice talking to you.

Mark Masselli: At Conversation s on Healthcare , we want our audience to be truly
known when it comes to the facts about Healthcare reform and policy . Lori
Robertson is an award winning journalist and manag ing editor of FactCheck.org , a
nonpartisan, nonprofit consumer adv ocate for voters that aim to reduce the level of
deception in US politics. Lori, what have you got for us this week?

Lori Robertson: A third connection between illegal immigration and the recent
measles outbreak, that’s what representative Mil Brooks su ggested, but while it is
difficult to pinpoint precise origins of disease outbreaks, there is no evidence
supporting a link between the recent outbreaks and illegal immigration. In a radio
interview Brooks a republican from Alabama said that the immunizat ion practices in
the home countries of immigrants who are living in the US illegally could be
responsible for outbreaks like the recent spread of measles. That outbreak includes
most of the 102 cases in 14 states in the month of January. It is likely tha t the
outbreak originated from outside the US but the director of the CDCs National Center
for Immunization and Respiratory Diseases has said illegal immigration is into likely
culprit. Americans returning from travel abroad or foreign visitors could have brought
measles to Disneyland Parks in California. The countries under investigation at the
possible source include Indonesia, India and the United Arab Emirates. For part of
2014, the CBC was able to pinpoint the origin for 280 cases of measles. It co unted
45 direct importations of the disease which included 40 US residents returning home
and 5 foreign visitors. Only 3 of the transfers came from the Americans. As per
country’s vaccination rates, back in the 1980s Central American countries had below
rates of measle vaccinations but that’s no longer the case. Since 2000 these
countries rates for 1 - year - olds have been largely on par with or have exceeded that
of the United States and that’s my FactCheck for this week, I am Lori Robertson ,
Managing Edit or of F act C heck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you would like checked, email us
at www.chcradio.com , we will have FactCheck.org ’s Lori Robertson check it out for
you here on Conversations on Healthcare .
(Music) Margaret Flinter: Each week Conversations highlights a bright idea about how to
make well ness a par t of our communities and everyday lives. Following is a
common experience among the elderly and that is not good news. If you are over 65 and you fall and broken you hip 25% of them will die within 12 months, another 25% will never be able to live indepe ndently and full 75% will never regain full mobility.
That’s statistics is our former airbag executive (inaudible 23:15 ) what if you could
apply the technology used in airbags to create wearable devices that protect a person from the impact of falling. S o they did their research and found a
combination of accelerometers and other sensors on the band worn around the waist
could deploy within 6 milliseconds of sensing an immediate fall and protective bags

unfold around the hip joints before impact with the floor significantly reducing the
blow to the joint.

Physics has taught us that bodies in motion stay in motion. It is a movable object
right? In this case the immovable object is the living room floor. With the right
technology we can assure that these people that meet inevitable immovable object
which is the floor cannot only survive that accident, they can walk away.

Mark Masselli: He founded Active Protect Technologies and well his initial focus was
providing a significant barrier to devastating in jury in adults. He has additional
potential markets as well.

With this type of technology we can protect against concussions, we can now protect
Coumadin patients. We can protect postal workers when it’s ICL. We can protect
our military soldiers from I EDs.

Mark Masselli: As simple retooling of airbag technology in a wearable device that
could greatly reduce the devastation of hip fractures leading to better health
outcomes and better quality of life. Now that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Healthcare , I a m Margaret Flinter .

Mark Masselli: And I am Mark Masselli . Peace and health.

Conversations on Healthcare , broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm. org and brought to you by the Community
Health Center.