The Science of Ross Business: Healthcare Management At The Ross School – Poets&Quants

Doctor working in hospital writing prescription clipboard, working an Laptop on desk in hospital with report analysis, Healthcare and medical concept, selective focus
Coming into business school, my long-term goal was to become a leader in the healthcare space. Besides my own prior experience in the field, I was motivated by strong growth opportunities that came from the increasingly high demand for experienced managers with knowledge of the healthcare industry.
When considering which MBA programs to apply to, I looked for schools with strong healthcare offerings. The Ross School of Business at the University of Michigan has provided me with many opportunities to explore healthcare management through academic courses, club activities, and internship recruiting FACT groups – all of which were crucial in developing my skills in this area.
TACKLING THE BIG ISSUES
Vaishnavi Sitarama
Out of the various healthcare-focused courses, one class I consider particularly essential for all aspiring healthcare managers is “The Commercialization of Biomedicine”. This course dove deep into different subcategories within the healthcare space – biotech, medical devices, pharma, payers, and providers – and demonstrated ways how products are taken from conception to actualization. The course is intended to be an introduction to key issues faced by companies as they merge science with business to bring products to market.
One such issue that we discussed was how companies classify products for FDA approval – should a product be classified as a medical device, a biologic, or a drug? Certain classifications lead to lower regulation, while others require stringent clinical trials. Beyond regulatory considerations, these different classifications present differences in risk and potential payoffs. For example, medical devices are significantly more loosely regulated, but also sell for lower prices and therefore have lower profit margins. Hence, we explored questions like the best conditions to operating in this space. The course also presents current practices, rationales behind company decisions, and analytic frameworks by which to understand regulation, financing, risk, alliances, and organizational configurations in the life sciences space. Given that many managers in these industries operate in product-focused roles, this course provides a window into the topics that we as future healthcare managers may be expected to tackle in our post-MBA full-time roles.
The course is also interdisciplinary and welcomes students from other schools at U-M, such as life sciences, engineering, pharmacy, and public health. I really appreciated this aspect of the course because it allowed me to learn from the experiences of peers in complementary fields. One discussion topic that proved particularly applicable to my path in healthcare consulting involved the adoption and marketing of new products. Considering drug and device marketing, we explored different methods to enter healthcare markets, such as by working with physicians during the development process and obtaining pre-market insurance coverage. The diversity within the class led to deeper exploration of this topic as members from different backgrounds all had different viewpoints. Students with medical backgrounds strongly advocated for involving physicians from the early stages of the development process, whereas others with pharma backgrounds supported distancing from the medical field in the initial stages to allow for unconstrained creativity and exploration.

2020 Ross MBA MAP Reveal
JUST THE FACT(S)
In addition to academic courses, Michigan Ross provided opportunities to interact directly with the healthcare space through the Healthcare and Life Sciences Club. HLS caters to people switching into the healthcare field and offers speaker series and informational sessions on various healthcare subindustries. In particular, the HLS Bootcamp at the beginning of the academic year and the HLS Symposium are great opportunities to learn about the field and interact with Ross alums working in healthcare positions. These events offer informational sessions, discussion forums, and networking opportunities. Together, they provide real world exposure to the healthcare field and help many career switchers understand the differences between the subindustries. At the HLS Symposium this year, panelists from various life sciences companies spoke about the advent of digital health. As a future consultant with a focus in health technology, I found this an incredible opportunity to network with professionals working in the field and analyzing trends in the industry. I hope to take the connections I formed and grow them further as I enter the workforce post Ross.
The Career Development Office’s (CDO) FACT groups are small CDO Peer Coach-led groups that help MBA1s with internship recruiting. CDO and Peer Coaches collaborate on the weekly curriculum, and these also play a large role in understanding the healthcare-specific post-MBA paths. Although the primary focus of CDO FACT groups is recruiting, many groups have informal journal club-like series designed to introduce MBA students to new developments in the field and speak knowledgeably on related topics. My CDO FACT group was healthcare-consulting specific, and many of the topics we spoke about related to management practices when working with doctors, engineers, scientists, and people from highly technical backgrounds. One such topic that we explored in my CDO FACT group was being able to translate highly technical jargon into layman terms that were understandable to not only scientists and engineers but also executive level and non-technical staff. By learning to simplify our own prior career experiences and by practicing translating external technical documents, we were able to develop communication skills specific to technical fields. This skill proved incredibly useful during my internship last summer as I was able to help translate some of the client jargon into more easily communicable concepts.
The overall Michigan Ross healthcare MBA program, and particularly the healthcare management concentration, gives students a strong base in healthcare topics and prepares students to tackle specific issues healthcare managers may face as hospital administrators, medical practice managers, insurance executives, pharma and biotech leaders, medical device product managers, and more. Ross helped me develop as a business leader in the healthcare space and I can’t wait to put my new skills to use as a healthcare consultant after graduation.

Bio: My name is Vaishnavi Sitarama and I am a second-year MBA student at the University of Michigan’s Ross School of Business. A Californian and Silicon Valley native, I received my degrees in Molecular Biology and Public Policy from the University of California, Berkeley.  With prior experience in metastatic breast cancer research and afterwards in artificial DNA design, I am now pursuing my MBA to gain knowledge in scientific management and the business of healthcare. This past summer, I interned with Strategy& (part of the PwC network) as a Strategy Consultant in their Healthcare vertical. Aside from work, I am a flautist (I even played with Beyonce, Coldplay, and Bruno Mars in the 2016 Halftime Show!), an avid reader, and an amateur DIY crafter. Follow my Linkedin and Instagram to learn more about me and my time at Ross!
DON’T MISS: THE SCIENCE OF ROSS BUSINESS: FROM THE LAB TO B-SCHOOL
 
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What to consider when signing up for health insurance – KGW.com

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PORTLAND, Ore. — Signing up for health insurance can be overwhelming. It can be confusing picking the right plan; whether open enrollment is coming up at work or someone turns 26 and will soon be booted from their parent’s insurance.
Angela Dowling, president of Regence Blue Cross Blue Shield of Oregon, offered tips to help people navigate the process.
“If COVID has taught us anything: We’re not invincible,” Dowling said. “And so people need to plan for those occasions when maybe they need some additional assistance in the health care space.”
For many, health insurance comes through their employer during open enrollment. It’s a window that opens once a year, often in the fall, when people can sign up for health insurance, adjust their current plan, or cancel it.
“Open enrollment happens for every employer at different times of the year. However, about 70% of them do open enrollment in the fourth quarter. So, timing is good,” Dowling said. “It’s good to think about what your benefit needs are and what your healthcare needs are at this time.”
OTHER STORIES: Here comes the sun: Why is it so important to be wary of UV rays?
Open enrollment is a familiar place for many, but for young adults, it’s a whole new world and confronting health insurance decisions come quickly.
“They have to make a decision, likely for the first time in their lives, around insurance and it’s confusing,” Dowling said.  
As students head off to college, most will be required to have health insurance at their school of choice. Many will offer their own health plan.
“When your student goes off to college, if you have health insurance for your dependents, including your student, you don’t need to enroll in the college plan. Keep that in mind. That could lower your expenses if your student is going off to college,” Dowling said.
Being a dependent on a parent’s insurance, however, only lasts so long. Young people have the option to stay on their parent’s plan, as a dependent, until the age of 26. Even with a full-time job, many people stay on their parent’s plan. When the birthday month arrives, though, soon-to-be 26-year-olds need to opt out and get their own coverage.
“When that dependent rolls off into their own plan, they need to either go on to their current employers plan and/or get an individual plan that they can get in the marketplace,” Dowling said. “A producer or an agent can help them get that coverage or they can go to the exchange and secure that coverage themselves.”
OTHER STORIES: Doctor weighs in on taking the first steps to address depression and anxiety
When it comes time to pick a plan, Dowling suggests taking the time to weigh the options and think about how healthcare has been utilized in the past.
“If you’ve had a large number of claims because you have a condition where you see physicians frequently or medications, think about that in terms of how you want to continue your future health care expenditures. That helps you decide what kind of plan decide do you really need to accommodate for your health situation,” Dowling said.
Also, consider the provider and whether it’s in the carrier network.
“There are no pre-existing conditions. So, if you want to change carriers, you absolutely can, but you should make sure that if you’re seeing a specialist or seeing a particular provider that you’re very interested in or have a relationship with – that [the] individual is in the network and is reimbursed at the level that you can afford,” Dowling said.
Another tip is to consider the plan type. There are several different types, each with pros and cons depending on a person’s situation.
“Go back to your original situation. If you have a chronic condition, that might not be a great plan for you, but it really depends on the contributions that your employers make to the plan. So, maybe the cost of the monthly premium is offset by that cost of the deductible?” Dowling said.
Yes, picking a plan can be overwhelming, but there are resources in person and online to help people sift through the confusion.
Here are some online resources:
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Florida receives $14 million federal grant for health insurance navigators – State of Reform – State of Reform

Florida received $14 million last week in federal grant funding to assist health insurance navigator programs in the state. As open enrollment for the 2023 plan year is set to begin November 1st, navigators are preparing to deliver information and services to those who need to apply for or change their coverage.
 
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The funding comes from the 2022 CMS Navigator Cooperative Agreement awards. On August 26th, 2022, CMS awarded a total of $98.9 million in funding to 59 organizations that serve as navigators in the 30 states with a federally-facilitated marketplace.
Florida’s award is split across two organizations: Florida Covering Kids and Families at the University of South Florida (FL-CKF), with a statewide network of 200 navigators, received $12,908,382. Urban League of Broward County, Inc., which services Broward, Leon, Palm Beach, and Pinellas counties, received $2,624,933.
FL-CKF subcontracts with several organizations across the state to provide navigator services, including the Florida Primary Care Access Network, the Family Healthcare Foundation and health planning councils. FL-CKF also partners with a range of community-based organizations, including health centers, faith-based organizations, Goodwill, and United Way.
Urban League of Broward County subcontracts with Tallahassee Urban League, Pinellas County Urban League, and Urban League of Palm Beach County. It also has community relationships with YMCA, Broward Health Memorial Healthcare System, Hispanic Unity of Florida, and more.
“Our goal is to get [insurance] information in front of consumers in many different ways using messages that resonate,” said FL-CKF Principal Investigator and Project Director Jodi Ray. “The most important thing is knowing that there are options out there and where to get help. That’s what really makes access for the consumer. They don’t need to know everything, as the navigators can help them with that. What they need to know is, ‘Where do I get answers, and how do I help in the way that I need it?’”
Ray says navigators have plenty of work ahead as the state prepares for the end of the federal public health emergency (PHE), which suspended Medicaid disenrollments, regardless of eligibility status. Navigators are conducting outreach to communities to assure their information is updated as their eligibility is redetermined. 
“Eligible people who could add coverage, either Medicaid, CHIP, or the marketplace are going to fall right through the gap and not be able to get coverage for various administrative and process reasons,” Ray said. “Our team is gearing up for this. We want to make sure everybody’s up to speed on understanding the Medicaid eligibility process, and how we navigate all of the coverage system as we work together and make sure that people are moving through that system.”
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Supreme Court declines to hear UnitedHealthcare appeal of Medicare overpayment rule – Healthcare Finance News

 
Photo courtesy of UnitedHealthcare
The U.S. Supreme Court has declined to hear UnitedHealthcare’s challenge to a federal rule stipulating insurers offering Medicare Advantage plans refund payments based on unsupported diagnoses in patients’ medical records.
The rule, which has been in place since 2014, requires that if an insurer learns a diagnosis submitted to CMS for payment lacks support in the beneficiary’s medical record, the insurer must refund the payment within 60 days.
UnitedHealthcare had wanted the Supreme Court to review a 2021 federal appeals court decision that effectively restored the Medicare overpayment rule following a lower court’s decision siding with the insurance giant.
In that case, presented to the United States Court of Appeals for the District of Columbia, UHC claimed the overpayment rule is subject to actuarial equivalence and that the rule fails to comply. Actuarial equivalence requires CMS to model a demographically and medically analogous beneficiary population in traditional Medicare to determine the lump sum payments to MA insurers. 
But the judge disagreed. Actuarial equivalence does not apply to the overpayment rule or the refund obligation, Judge Cornelia Pillard said at the time. Rather, actuarial equivalence appears in another statutory subchapter.
The Supreme Court denied UHC’s appeal with comment.
UHC said in a statement that it would continue to comply with CMS rules and said it was proud of its efforts “to bring greater clarity to the rules governing the growing and successful Medicare Advantage program.”
WHAT’S THE IMPACT?
The overpayment rule is part of the government’s ongoing effort to trim unnecessary costs from the Medicare Advantage program, Pillard said last year.
About 40% of people on Medicare have a private Medicare Advantage plan. CMS pays these plans a lump sum per capita amount each month.
Overpayment to Medicare Advantage insurers is a serious drain on the Medicare program’s finances, Pillard said. In 2016 alone, audits of the data submitted by Medicare Advantage insurers to CMS showed that CMS paid out an estimated $16.2 billion for unsupported diagnoses, equal to “nearly ten cents of every dollar paid to Medicare Advantage organizations.”
THE LARGER TREND
Payments to the Medicare Advantage program depend on participating insurers accurately reporting to CMS their beneficiaries’ salient demographic information and medically documented diagnosis codes. To better control erroneous payments, including those garnered from reported – but unsupported – diagnoses, Congress in 2010 amended the Medicare program’s data-integrity provisions. 
The amendment specified a 60-day deadline for reporting and returning identified overpayments and confirmed that such payments not promptly returned may trigger liability under the False Claims Act. CMS promulgated the Overpayment Rule to implement those controls on Medicare Advantage.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com





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How to put medical innovation's potential risks in perspective – American Medical Association

Vaccines, blood transfusions, gene therapy and other medical innovations have increased the lifespan of Americans by 30 years. But with innovation, risk often follows.
Medicine doesn’t stand still, and neither do we. AMA members don’t just keep up with medicine—they shape its future.
Fear of adverse events shouldn’t stifle innovation, says Paul Offit, MD, an attending physician in the Division of Infectious Diseases and director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
“We should be made wise by our experiences, not nervous by them,” he said.
In an episode of “AMA Moving Medicine,” Dr. Offit detailed the take-home message of his new book, You Bet Your Life: From Blood Transfusions to Mass Vaccination, the Long and Risky History of Medical Innovation.
The book is intended to prompt a more thoughtful conversation.
“It’s about asking people to have realistic expectations when there’s a medical innovation,” Dr. Offit said.
“I don’t think we numerically ever understand risk,” he added, referring to the general population. “New York State, for example, sells lottery tickets where you have roughly a 14 million-to-one chance of winning, with a simple phrase, ‘It could happen to you.’ I think that’s how people see it.”
AMA Moving Medicine” highlights innovation and the emerging issues that impact physicians and public health today. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.
 
 
Nothing is risk-free, Dr. Offit noted. Any time you get a whole-blood transfusion, for example, you’re taking a risk.
“There may be new viruses that are introduced into the population or there may be viruses that we don’t test for,” he said. In medicine, the goal is to make sure benefits outweigh risks, even if some risks are unknown, added Dr. Offit, co-inventor of the rotavirus vaccine RotaTeq.
The Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee had to weigh the risks and benefits of the Pfizer-BioNTech and Moderna vaccines in December 2020. The committee’s decisions would affect millions based on studies of 15,000–20,000 people.
“This was a novel technology, and so the question was, when was the other shoe going to drop? How bad was that problem going to be, and how rare was it going to be?” said Dr. Offit, a member of the panel.
The risk, as it turned out, was remarkably small. The mRNA vaccines are a rare cause of myocarditis. Johnson & Johnson and AstraZeneca in very rare cases causes blood clots.
 
“Myocarditis and blood clots are caused by the disease at a far more common rate,” Dr. Offit said. Both findings surprised the FDA advisory panel.
But that’s thing about innovation: “You learn as you go.”
Some tragedies have led to greater oversight, but realistically, it’s impossible to eliminate the risk that comes with medical innovation, Dr. Offit argued.
“That was the purpose of writing this book—to try and make that point,” he said.
Dr. Offit added that, generally, people have a poor understanding of risk and have a tendency to “overrate risks from something that you do.”
“For example,” he explained, “if you give yourself or you give your child a vaccine and there is a risk associated with that, they rate that much higher than a risk, say, of not giving the vaccine, and then having the disease.
“There are no risk-free choices. There are just choices to take different risks. So, the goal is always to take a lesser risk, and I think that when people, for example, think, ‘Well, I’m just not going to get this vaccine,’ then that’s they think that’s a risk-free choice—but it’s not,” Dr. Offit said.
“In the case of COVID, for example, you’re far more likely to suffer myocarditis, far more likely to suffer blood clots for example, if you risk the disease—which is common—than if you choose the vaccine. I think we don’t get that.”
Learn what to tell patients about myocarditis after COVID-19 vaccination.
Get the latest news on the COVID-19 pandemic, vaccines and variants, and more reliable information directly from experts and physician leaders with the “AMA COVID-19 Update.”
You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version.
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Why You Shouldn't Rush Weight Loss – Everyday Health

Losing weight too quickly could jeopardize your chances of long-term success, plus it could introduce a host of side effects. Here’s why the slow and steady approach to shedding pounds is best.
Not seeing weight loss results as fast as you’d like? That may be a good thing.
For a lot of us — especially during the pandemic — the scale can feel a bit like the speedometer of a race car, accelerating rapidly in mere moments without warning. But weight gain doesn’t happen overnight, even if it sometimes feels that way.
To make matters worse, we often expect weight loss to happen quickly. We believe that as soon as we make up our mind to cut back on snacking, the pounds should magically melt away, and we get impatient if our pants are still fitting snugly after the first week.
“People make the decision that they want to start losing weight, and they want to see something in real, substantial numbers, so they go on to this crazy diet,” says Kuldeep Singh, MD, director of the Maryland Bariatric Center at Mercy in Baltimore. “But the fact of the matter is that this is a problem and a concern that has been there for some time. It didn’t develop in a day, and it should not go away in a day.”
While we’d all love weight loss to be as speedy as as an oil change, there are reasons the slow and steady approach is better, safer, and more effective.
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The first — and perhaps best — reason to pace yourself when it comes to weight loss is that it tends to be more effective at keeping the pounds off. Fad or crash diets that promise fast results aren’t usually something the average dieter can sustain over months or years. Experts believe that as many as 95 percent of dieters regain weight, according to the Cleveland Clinic. If you’re trying to avoid the dreaded yo-yo dieting effect of regaining the weight you’ve shed (and maybe packing on more), taking it slow is a good idea. People who lose weight at a rate of about 1 to 2 pounds per week are more successful at maintaining their progress than those who lose at a faster rate, according to the Centers for Disease Control and Prevention.
This assertion is backed up by a systematic review and meta-analysis published in December 2020 in the British Journal of Nutrition, which found that, even when the amount of weight loss was similar, dieters who lost the weight gradually as opposed to rapidly saw greater reductions in body fat percentage and fat mass. When rapid weight loss occurs, you’re far more likely to lose water weight, muscle, or even bone mass, reports the Academy of Nutrition and Dietetics.
“Good weight loss is losing fat,” says Dr. Singh. “Bad weight loss is losing muscle.” You want to maintain your muscle mass for many reasons, but in a weight loss sense, muscle boosts metabolism by helping you burn more calories even when at rest, according to the Mayo Clinic. Singh adds that you’d likely need to be following a crash diet for a month or so for those health issues to take effect. Extreme forms of this are anorexia or bulimia, but milder forms are probably much more common than people think, he says.
RELATED: 5 Reasons You Gained Weight This Winter
Plenty of fad diets promise rapid weight loss by eliminating foods or entire food groups, or drastically restricting calories, but in doing so, they also eliminate important sources of nutrition, according to the Cleveland Clinic. Losing more than 2 pounds a week over several weeks is considered rapid weight loss, and it is generally the result of eating too few calories, according to MedlinePlus. That practice is not usually recommended unless you’re under the supervision of a healthcare professional.
“It depends on what weight you’re starting at, and your age, but people between 150 and 300 pounds should not be losing more than 2 to 5 pounds a week at any given time,” says Singh. “Anything more than that on a sustained basis is not healthy.”
Losing weight quickly can put stress on the body and alter your hormonal response, according to MedlinePlus. The hunger hormones leptin and ghrelin, which tell your body when you’re full and when you’re hungry, respectively, can get out of sync, making you want to eat more often, according to Northwestern Medicine. Dropping 10 pounds during the first week of a new diet, for example, may seem like a huge success, but the weight loss will likely slow down and you may even gain that weight right back once you stop or relax the diet, according to MedlinePlus.
Your metabolism may get out of whack as well. According to the Cleveland Clinic, your body adjusts to the lower calorie intake by slowing down the rate at which it burns calories, in an effort to guard against starvation. This is called “metabolic adaptation,” and it happens whenever you burn more calories than you take in, according to research published in May 2018 in Obesity. Once you go back to eating regularly, your body won’t know what to do with the extra calories, and that’s where weight gain sets back in. Linda Anegawa, MD, a Honolulu-based double-board-certified physician in internal medicine and obesity medicine, and medical director with PlushCare, a virtual health platform, says that when you regain weight, you mostly regain fat.
Rapid weight loss can have other unhealthy side effects too. In addition to losing muscle mass, water, and bone density, it can introduce health issues, including gallstones, gout, fatigue, constipation, diarrhea, and nausea, according to MedlinePlus.
Losing weight too quickly may be especially dangerous for people with underlying health conditions, especially diabetes or kidney or stomach diseases, Singh says. Dr. Anegawa adds that quick weight loss could alter the appropriate dosages of medications, so it’s important to work closely with a doctor to adjust your regimen if you’re seeing big changes on the scale.
RELATED: 21 Tips for Weight Loss That Actually Work
So, there you have it — approaching weight loss in a measured way can help you avoid potential health complications, and it raises the odds of long-term success at maintaining a healthy weight. But what’s the best way to go about it?
Unlike short-term fad diets that make drastic changes, healthy weight loss usually involves implementing lifestyle changes that you can stick with far into the future. “Without sustainable lifestyle changes that you can continue for the long term, you won’t be able to keep the health benefits of weight loss, plain and simple,” Anegawa says.
Developing healthy habits like eating a nutritious diet, moving often, managing stress, and sleeping well really can pay off over time, Singh says. “Those things are essential components of the weight loss picture,” he says.
These habits shouldn’t go out the window once your goal weight is achieved. The idea is that by introducing habits you can stick with in the long run, a healthy lifestyle will become second nature, which will help you keep the weight off.
A systematic review of several weight loss registries published in February 2020 in Obesity Reviewsidentified the most successful strategies for weight loss and maintenance. These included making healthy foods available at home, eating breakfast regularly, eating more vegetables and fewer sugary and fatty foods, and increasing physical activity.
Don’t worry if you’re not seeing results quickly — they will come. “Keep an eye on the long term — there’s nothing you’re going to gain out of short-term weight loss,” Singh says. He says trying to do too much too quickly can be overwhelming, and many people quit when they feel that way. Instead, Singh says to make small but permanent changes toward your goal. “You want to have a long, sustained weight loss program,” he says. “You want to take baby steps and enjoy those small goals that you achieve, and then set a new goal and move forward.”
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Executive Order on Ensuring Robust Consideration of Evolving National Security Risks by the Committee on Foreign Investment in the United States – The White House

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By the authority vested in me as President by the Constitution and the laws of the United States of America, including section 721 of the Defense Production Act of 1950, as amended (50 U.S.C. 4565) (section 721), and section 301 of title 3, United States Code, it is hereby ordered as follows:

Section 1.  Policy.  The United States welcomes and supports foreign investment, consistent with the protection of national security.  The United States commitment to open investment is a cornerstone of our economic policy and provides the United States with substantial economic benefits, including “the promotion of economic growth, productivity, competitiveness, and job creation, thereby enhancing national security,” as the Congress recognized in section 1702(b)(1) of the Foreign Investment Risk Review Modernization Act of 2018 (FIRRMA) (Subtitle A of Title XVII of Public Law 115-232).  Some investments in the United States by foreign persons, however, present risks to the national security of the United States, and it is for this reason that the United States maintains a robust foreign investment review process focused on identifying and addressing such risks.

It is important to ensure that the foreign investment review process remains responsive to an evolving national security landscape and the nature of the investments that pose related risks to national security, as the Congress recognized in section 1702(b)(4) of FIRRMA.  One factor for the Committee on Foreign Investment in the United States (Committee) to consider, as the Congress highlighted in section 1702(c)(1) of FIRRMA, is that national security risks may arise from foreign investments involving “a country of special concern that has a demonstrated or declared strategic goal of acquiring a type of critical technology or critical infrastructure that would affect United States leadership in areas related to national security.”  Along these lines, I previously underscored in Executive Order 14034 of June 9, 2021 (Protecting Americans’ Sensitive Data From Foreign Adversaries), and emphasize in this order the risks presented by foreign adversaries’ access to data of United States persons.  With respect to investments directly or indirectly involving foreign adversaries or other countries of special concern, what may otherwise appear to be an economic transaction undertaken for commercial purposes may actually present an unacceptable risk to United States national security due to the legal environment, intentions, or capabilities of the foreign person, including foreign governments, involved in the transaction.  It is the policy of the United States Government to continue to respond to these risks as they evolve, including through a robust review of foreign investments in United States businesses.

In light of these risks, this order provides direction to the Committee to ensure that, in reviewing transactions within its jurisdiction (covered transactions), the Committee’s review remains responsive to evolving national security risks, including by elaborating and expanding on the factors identified in subsections (f)(1)-(10) of section 721.  This order shall be implemented consistent with the Committee’s statutory mandate to determine the effects of each covered transaction reviewed by the Committee on the national security of the United States.

Sec. 2.  Elaboration on Existing Statutory Factors. (a)  In considering the factors described in subsection (f)(3) of section 721, the Committee shall, taking into account the requirements of national security, consider the following, as appropriate:

(i)   It is important to national security that the Committee continues to assess the effect of foreign investment on domestic capacity to meet national security requirements, including those requirements that fall outside of the defense industrial base.  In particular, the resilience of certain critical United States supply chains may have national security implications.  The United States recognizes the importance of cooperating with its allies and partners to secure supply chains; however, certain foreign investment may undermine supply chain resilience efforts and therefore national security by making the United States vulnerable to future supply disruptions.  These vulnerabilities may occur if an investment shifts ownership, rights, or control with respect to certain manufacturing capabilities, services, critical mineral resources, or technologies that are fundamental to national security — including because they are critical to United States supply chain resilience — to a foreign person who might take actions that threaten to impair the national security of the United States as a result of the transaction, or to other foreign persons, including foreign governments, to whom the foreign person has commercial, investment, non-economic, or other ties (relevant third-party ties) that might cause the transaction to pose a threat to national security.

(ii)  The Committee shall consider, as appropriate, the covered transaction’s effect on supply chain resilience and security, both within and outside of the defense industrial base, in manufacturing capabilities, services, critical mineral resources, or technologies that are fundamental to national security, including:  microelectronics, artificial intelligence, biotechnology and biomanufacturing, quantum computing, advanced clean energy (such as battery storage and hydrogen), climate adaptation technologies, critical materials (such as lithium and rare earth elements), elements of the agriculture industrial base that have implications for food security, and any other sectors identified in section 3(b) or section 4(a) of Executive Order 14017 of February 24, 2021 (America’s Supply Chains). 

(A)  The Committee shall consider, as appropriate, the degree of involvement in the United States supply chain by a foreign person who is a party to the covered transaction and who might take actions that threaten to impair the national security of the United States as a result of the transaction, or who might have relevant third-party ties that might cause the transaction to pose such a threat.
(B)  The Committee shall consider, as appropriate, the United States capability with respect to manufacturing capabilities, services, critical mineral resources, or technologies, including those described in subsection (a)(ii) of this section; the degree of diversification through alternative suppliers across the supply chain, including suppliers located in allied or partner economies; whether the United States business that is party to the covered transaction supplies, directly or indirectly, the United States Government, the energy sector industrial base, or the defense industrial base; and the concentration of ownership or control by the foreign person in a given supply chain, among other factors that the Committee determines to be appropriate in considering whether the covered transaction may undermine the resilience and security of supply chains critical to national security.
(b)  In considering the factors described in subsection (f)(5) of section 721, the Committee shall, taking into account the requirements of national security, consider the following, as appropriate:
(i)    Although foreign investments can in many circumstances help to foster domestic innovation, it is important to protect United States technological leadership by addressing the risks posed by investments by foreign persons who might take actions that threaten to impair the national security of the United States as a result of the transaction, and by addressing whether such persons have relevant third-party ties that might cause the transaction to pose such a threat.
(ii)   The Committee shall consider, as appropriate, whether a covered transaction involves manufacturing capabilities, services, critical mineral resources, or technologies that are fundamental to United States technological leadership and therefore national security, such as microelectronics, artificial intelligence, biotechnology and biomanufacturing, quantum computing, advanced clean energy, and climate adaptation technologies.  The Committee shall also consider, as appropriate, relevant third-party ties that might cause the transaction to threaten to impair the national security of the United States.
(iii)  The Committee shall consider, as appropriate, whether a covered transaction could reasonably result in future advancements and applications in technology that could undermine national security.
(iv)   The Office of Science and Technology Policy (OSTP), in consultation with other members of the Committee, shall periodically publish a list of technology sectors, including those technologies listed in subsection (b)(ii) of this section, that it assesses are fundamental to United States technological leadership in areas relevant to national security.  OSTP shall, as appropriate, draw on the findings of other United States Government efforts to identify technology sectors that are fundamental to United States technological leadership.  The Committee shall consider the list described in this subsection, as appropriate.

Sec. 3.  Additional Factors to be Considered.  (a)  In addition to the factors identified in subsections (f)(1)-(10) of section 721, the Committee shall consider, in reviewing the effects of a covered transaction on the national security of the United States, the following factors relating to aggregate industry investment trends that may have consequences for an individual covered transaction’s impact on national security:

(i)    Incremental investments over time in a sector or technology may cede, part-by-part, domestic development or control in that sector or technology and may give a foreign person who might take actions that threaten to impair the national security of the United States as a result of the transaction, or their relevant third-party ties that might cause the transaction to pose such a threat, control of or rights in United States businesses in a manner that may result in national security risk.  A series of acquisitions in the same, similar, or related United States businesses involved in activities that are fundamental to national security or on terms that implicate national security may result in a particular covered transaction giving rise to a national security risk when considered in the context of transactions that preceded it.  In aggregate, these transactions may facilitate harmful technology transfer in key industries or otherwise harm national security through the cumulative effect of these investments.  As the Congress identified in section 1702(c)(2) of FIRRMA, the Committee may consider “the cumulative control of, or pattern of recent transactions involving, any one type of critical infrastructure, energy asset, critical material, or critical technology by a foreign government or foreign person” in considering national security risks.  Contextualizing the Committee’s review of an individual transaction in light of the aggregate or series of related transactions could reveal national security risks arising from the covered transaction that were not otherwise apparent.

(ii)   The Committee shall consider, as appropriate, as part of the Committee’s review of a covered transaction, the risks arising from the covered transaction in the context of multiple acquisitions or investments in a single sector or in related manufacturing capabilities, services, critical mineral resources, or technologies, by any foreign person who might take actions that threaten to impair the national security of the United States as a result of the transaction, or involving relevant third-party ties that might cause the transaction to pose such a threat.

(iii)  The Committee may request, as part of the Committee’s review of a covered transaction, that the Department of Commerce’s International Trade Administration provide the Committee an analysis of the industry or industries in which the United States business operates, and the cumulative control of, or pattern of recent transactions by, a foreign person, including, directly or indirectly, a foreign government, in that sector or industry.

(b)  In addition to the factors identified in subsections (f)(1)-(10) of section 721, the Committee shall consider, in reviewing the effects of a covered transaction on the national security of the United States, the following factors relating to cybersecurity risks resulting from a covered transaction that threaten to impair national security:

(i)    It is important for the United States to ensure that foreign investment in United States businesses does not erode United States cybersecurity.  Investments by foreign persons with the capability and intent to conduct cyber intrusions or other malicious cyber-enabled activity — such as activity designed to affect the outcome of any election for Federal, State, Tribal, local, or territorial office; the operation of United States critical infrastructure; or the confidentiality, integrity, or availability of United States communications — may pose a risk to national security.  The Congress, in section 1702(c)(6) of FIRRMA, identified “exacerbating or creating new cybersecurity vulnerabilities” as a relevant consideration for the Committee when considering national security risks arising from a covered transaction.  Review of foreign investment is an important tool as part of broader United States efforts to ensure the cybersecurity of the United States.

(ii)   The Committee shall consider, as appropriate, whether a covered transaction may provide a foreign person who might take actions that threaten to impair the national security of the United States as a result of the transaction, or their relevant third-party ties that might cause the transaction to pose such a threat, with direct or indirect access to capabilities or information databases and systems on which threat actors could engage in malicious cyber‑enabled activities affecting the interests of the United States or United States persons, including:
(A)  activity designed to undermine the protection or integrity of data in storage or databases or systems housing sensitive data;
(B)  activity designed to interfere with United States elections, United States critical infrastructure, the defense industrial base, or other cybersecurity national security priorities set forth in Executive Order 14028 of May 12, 2021 (Improving the Nation’s Cybersecurity); and
(C)  the sabotage of critical energy infrastructure, including smart grids.
(iii)  The Committee shall also consider, as appropriate, the cybersecurity posture, practices, capabilities, and access of both the foreign person and the United States business that could allow a foreign person who might take actions that threaten to impair the national security of the United States as a result of the transaction, or their relevant third-party ties that might cause the transaction to pose such a threat, to manifest cyber intrusion and other malicious cyber-enabled activity within the United States.

(c)  In addition to the factors identified in subsections (f)(1)-(10) of section 721, the Committee shall consider, in reviewing the effects of a covered transaction on the national security of the United States, the following factors relating to national security concerns surrounding sensitive data:

(i)    Data is an increasingly powerful tool for the surveillance, tracing, tracking, and targeting of individuals or groups of individuals, with potential adverse impacts on national security.  In section 1702(c)(5) of FIRRMA, the Congress recognized that the Committee may consider whether a covered transaction may “expose, either directly or indirectly, personally identifiable information, genetic information, or other sensitive data of United States citizens to access by a foreign government or foreign person that may exploit that information in a manner that threatens national security.”  Moreover, advances in technology, combined with access to large data sets, increasingly enable the re‑identification or de‑anonymization of what once was unidentifiable data.  Therefore, it is important for the United States Government to stay current with threats posed by advances in such technology, including by considering potential risks posed by foreign persons who might exploit access to certain data on United States persons to target individuals or groups within the United States to the detriment of national security.  Accordingly, the Committee shall consider whether foreign investments in United States businesses that have access to or that store United States persons’ sensitive data, including health and biological data, involve a foreign person who might take actions that threaten to impair the national security of the United States as a result of the transaction, including whether the foreign person might have relevant third-party ties that might cause the transaction to pose such a threat.

(ii)   The Committee shall consider, as appropriate, whether a covered transaction involves a United States business that:

(A)  has access to United States persons’ sensitive data, including United States persons’ health, digital identity, or other biological data and any data that could be identifiable or de‑anonymized, that could be exploited to distinguish or trace an individual’s identity in a manner that threatens national security; or

(B)  has access to data on sub-populations in the United States that could be used by a foreign person to target individuals or groups of individuals in the United States in a manner that threatens national security. 

(iii)  The Committee shall also consider, as appropriate, whether a covered transaction involves the transfer of United States persons’ sensitive data to a foreign person who might take actions that threaten to impair the national security of the United States as a result of the transaction, and whether the foreign person has relevant third-party ties that have sought to exploit such information or have the ability to exploit such information to the detriment of national security, including through the use of commercial or other means.

Sec. 4.  Periodic Review.  Consistent with the policy described in section 1 of this order, it is important for the Committee, on an ongoing basis, to continue to review its processes, practices, and regulations, and to continue to make any updates as needed and appropriate to ensure that the Committee’s consideration of national security risks remains robust alongside changes to the national security landscape.  Accordingly, the Committee shall regularly review its processes, practices, and regulations, and shall periodically provide to the Assistant to the President for National Security Affairs a report documenting the results of its review.  The report shall also include any resulting policy recommendations that the Committee considers necessary to meet the evolving set of national security risks.

Sec. 5.  Definitions.  For purposes of this order, terms shall have the same meanings ascribed to them in section 721 and regulations promulgated by the Committee under section 721. 

Sec. 6.  General Provisions.  (a)  Nothing in this order shall be construed to impair or otherwise affect:

(i)   the authority granted by law to an executive department or agency, or the head thereof; or

(ii)  the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b)  This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c)  This order is not intended to, and does not, affect the requirements in section 721 relating to the scope of the Committee’s jurisdiction.

(d)  This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.
                       
   JOSEPH R. BIDEN JR.

THE WHITE HOUSE,
September 15, 2022.
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NJ Obamacare sign-ups hit record as Murphy extends deadline – NorthJersey.com

More New Jersey residents signed up for health insurance through the Affordable Care Act this year than ever before, thanks to the appeal of higher subsidies as well as the loss of job-based coverage during the pandemic.
To reach even more people, the state announced this week that lower income residents could sign up for subsidized coverage on Get Covered New Jersey, the state-run marketplace, at any time this year. People with incomes up to $25,760 for an individual and $53,000 for a family of four won’t be limited to the usual three-month window for open enrollment, which ended Jan. 31.  
More than 324,000 New Jersey residents signed up for Obamacare coverage through Jan. 31, an increase of 20% over last year. Medicaid enrollment also increased by 9%, to 2.1 million in January this year — a sign that the safety net is strong and expanding, but perhaps the economy is not. 
Higher enrollment in these programs may signal the erosion of job-based coverage in New Jersey, as the unemployment rate remains stubbornly above the national average. The December unemployment rate in New Jersey stood at 6.3%, compared with a national  rate of 3.9%.
Gov. Phil Murphy cited the “Expanded Access” initiative as one of many steps his administration has taken, with the help of the Legislature, to make insurance affordable for more residents, especially during the administration of President Donald Trump, who worked to roll back various provisions of the Affordable Care Act.
Actions in New Jersey to expand coverage included the creation of a state-run marketplace to replace the federal website to purchase health insurance and a requirement that every resident have health coverage or pay a penalty at tax time. The open enrollment period also has been doubled to three months for most people and outreach efforts have increased.
“We continue to take actions based on belief that health care is a right, not a privilege,” Murphy said.
About 6.4% of New Jersey residents were without health insurance in 2020, according to the U.S. Census, compared with 8.6% nationally. 
The Democratic Governors Association, of which Murphy is vice-chair, went out of its way to praise his administration’s record enrollment and expanded sign-up period for the Affordable Care Act plans. “Gov. Murphy hasn’t stopped fighting to lower costs for working families,” the association’s senior communications adviser said In a press release highlighting his administration’s actions for a broader national audience.
This year’s Obamacare enrollees included some 30,000 people who became eligible for subsidies when the state, with the help of federal funds, raised the income threshold to six times the federal poverty rate — $77,280 for an individual or $159,000 for a family of four.
The enhanced federal aid from the American Rescue Plan — which capped premiums at 8.5% of income — will run out at the end of this year without congressional action. The Build Back Better Act would have extended the premium help through 2025.)
“All of this was made possible from the flow of increased subsidies from the American Rescue Plan,” said Laura Waddell, health care program director for New Jersey Citizen Action, an advocacy group for low- and moderate-income people. “That’s why it’s urgently important for Congress to pass legislation to make those subsidies permanent.”
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The state should also take steps to set up a basic health coverage program for lower-income people, Waddell said. Those plans, permitted under the Affordable Care Act, have lower premiums and cost-sharing. New York and Minnesota currently have such programs.   
Lifting the enrollment deadline this year for the lowest-income residents will make it easier for them to sign up, especially if they are moving out of Medicaid because their income has improved. Those enrollees will pay very low or no premiums for coverage, said Marlene Caride, commissioner of the Department of Banking and Insurance.
The Expanded Access initiative  “is a major step forward in our effort to promote health equity and continue to expand health care affordability and access,” she said.
Lindy Washburn is a senior health care reporter for NorthJersey.com. To keep up-to-date about how changes in health care affect you and your family, please subscribe or activate your digital account today.
Email: washburn@northjersey.com 
Twitter: @lindywa 

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The Senate Deal Could Keep Millions from Losing Health Insurance – Route Fifty

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Your daily read on state and local government
Connecting state and local government leaders
By Kery Murakami
After worrying for months that American Rescue Plan Act subsidies that made health insurance more affordable would go away, state health officials around the country are now hopeful that they’ll be extended and that millions may not lose their coverage as they’d feared.
That optimism stems from Wednesday’s announcement by Democratic Senate Majority Leader Chuck Schumer and West Virginia Sen. Joe Manchin that they’d reached a deal on a multi-billion dollar package they’re calling the Inflation Reduction Act. The legislation would extend the subsidies, now due to expire at the end of the year, for another three years.
With $433 billion in new spending, Schumer and Manchin’s proposal is a considerably slimmed-down version of House Democrats’ $1.75 trillion Build Back Better plan. But it would actually do more in terms of health care coverage.
The new proposal, which includes $369 billion in climate funding, would spend $64 billion to extend the insurance subsidies for three years, a year longer than under Build Back Better.
There’s no guarantee Schumer, of New York, will be able to muster the unanimous support of all 50 Senate Democrats he needs to pass the measure over the expected unanimous opposition of Republicans.  
Still, Zachary Sherman, executive director of Pennie, the agency responsible for running subsidized Affordable Care Act insurance in Pennsylvania, said Friday he was “thrilled” to see the proposal. “These subsidies are the difference for so many Pennsylvanians, allowing them to afford and access necessary health care services,” he said in a statement to Route Fifty
“At a time when household budgets are already stretched thin, avoiding an increase in what families pay for their health insurance will go a long way, and more Pennsylvanians will stay and get covered as a result,” he added.
Kevin Patterson, chief executive officer of Connect for Health Colorado, that state’s health coverage agency, was also hopeful. 
“Though we know negotiations are not quite done yet, it’s extremely important that the enhanced subsidies are extended,” he told Route Fifty in a statement. “When affordability increases, so does enrollment, and the ability for people to get health care.” 
Sherman and Patterson were among the heads of 19 state health insurance programs who warned congressional leaders two weeks ago that if the subsidies are not extended, an estimated “3.1 million Americans will drop their health insurance because they can no longer afford it.”
Hemi Tewarson, executive director of the National Academy for State Health Policy, which organized the letter, said officials had wanted the additional subsidies to be made permanant. But they were still “thankful,” she said, with how the deal shaped up.
State officials like Covered California executive director Jessica Altman worried in interviews and statements that people will no longer be able to get the medical care they need. 
But, given that accidents and heart attacks will still happen, state and local governments would likely end up having to spend more to treat people when they show up at publicly-funded emergency rooms and clinics without insurance.
Double Threat
Making matters worse is that all this would happen at the same time millions of others could lose their Medicaid coverage. In addition to responding to the Covid-19 pandemic by creating the ARPA subsidies, Congress barred states from removing people from Medicaid, the federal program that provides medical coverage to low-income people.
The ban in the 2020 Families First Coronavirus Response Act, though, will lapse when the Biden administration declares an end to the public health emergency tied to the pandemic—something that could happen as soon as in October
An estimated 15 million people could get kicked off of Medicaid as a result. State officials have been hoping to help them continue to have health coverage by getting them enrolled in the subsidized ACA plans. But should ARPA’s subsidies end, the price of getting that insurance would go up for the former Medicaid recipients, probably beyond what they could afford.
Covered California estimated that without the ARPA subsidies, 1 million in their state would see ACA premiums more than double. New York officials said those who get subsidized ACA coverage would see their premiums rise by 58%.
Manchin blocked the bigger Build Back Better package in the Senate last year, arguing it was too expensive. But, during a press conference on Thursday, he said that when he began thinking about what he could support in a scaled-down bill, keeping insurance costs lower, at a time when inflation is high, was something he could back. His and Schumer’s plan also includes a proposal to lower drug prices.
Lower Premiums, Broader Eligibility
“The subsidies that came with the American Rescue Plan have been really significant,” Sherman had said in an interview last week before Schumer and Manchin announced their deal.
Prior to the pandemic, the Affordable Care Act required that even low-income people pay something for health insurance. 
Those making below 138% of the poverty level, about $31,700 for a family of three this year, had to pay 2% of their premiums. The federal government paid the rest. 
Those making between three and four times the poverty level had to pay 8.5% of the premiums. Those who made more did not qualify for help.
To get more people insured during the pandemic, ARPA made ACA coverage free for those making 150% of the federal poverty level or less. 
It also allowed people making more than four times the poverty level to receive subsidized insurance, as long as they paid 8.5% of the cost.
Sherman said that reduced how much those making less than four times the poverty rate had to pay in out of pocket costs, including premiums, by 15% in 2022, the year after ARPA was passed.
Those who make more than four times the poverty level and now qualify for subsidies paid 28% less.
“There was a really big drop in what consumers were paying,” he said.
As a result, 37,000 more people in Pennsylvania received subsidized coverage in 2022, an 11% increase.
Nationally as well, the health officials said in the letter to congressional leaders that the ARPA subsidies led to record numbers of people enrolled in ACA coverage. The number of 18 to 34 year olds getting subsidized coverage rose by 21%.
In Maryland, the number of people between 55 and 64 years getting subsidized coverage more than doubled. In Colorado, the number of people in rural areas getting coverage rose by 19%.

Patterson said in an interview that the number of people getting ACA coverage in Colorado went up by 10% after ARPA.
Should the subsidies sunset, he said 76% of the state’s enrollees would get less help and the amount spent on premiums for ACA coverage could go up by 40%.

In California, officials estimated that 220,000 people would no longer be able to afford insurance.
To make matters worse, the subsidies would also go away at the same time that premiums are expected to go up, the health officials told Congress.
Demand for health care is rising as more people go to the doctor to get care they deferred during the worst of the pandemic. In turn, medical costs and insurance premiums are increasing.
The health officials noted that in the 16 states that have released the information thus far, insurance companies offering ACA insurance are asking regulators to let them raise premiums next year by between 5.7% to 20.7%. Companies are seeking double-digit increases requested in Colorado, Connecticut, the District of Columbia, Maine, Maryland, New York, and Vermont.
More of the cost of caring for people would also shift from insurance companies to local and state governments should more people become uninsured, Christina Cousart, a senior policy associate with The National Academy for State Health Policy, said in an interview.
Sherman and other state officials agreed. “If you’re uninsured, it’s not like their health care needs go away or unexpected events will go away,” Sherman said.
Michael Karpman, senior research associate at the Urban Institute’s Health Policy Center, noted that a study he authored for the Kaiser Family Foundation last year found that when the number of uninsured dropped after the creation of the 2010 Affordable Care Act, so did the amount spent on what’s called uncompensated care. 
The total annual amount nationally of uncompensated care, about a third of which is paid by state and local governments, dropped from $62.8 billion between 2011 and 2013 to $42.4 billion between 2015 and 2017.
All the uncertainty, including the coming end of the Medicaid benefits, has been stressful for health coverage officials.
“Usually in the health care world one big thing like this is happening. There are a number of big things this year,” Patterson said. “We have to plan for all of these things happening at the same time,” he added. “There’s a lot of big plates spinning and we’re doing everything in our power to make sure they don’t affect the consumer.”
NEXT STORY: ‘Chronic Underfunding’ of Public Health Threatens Lives in US, Report Finds
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