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Where we stand on the Special Session as of 4 PM…
DAUDTTODAYTON: Letter from Speaker Daudt to Governor Dayton as it relates to special session and the governor's new proposal Tuesday at noon today.  READ:
DAYTONTODAUDT:  Addressed to Speaker Kurt Daudt at his current location a letter from Gov. Mark Dayton in response.  READ:
ICYMI on 11.30.16 our TAKE: Late this summer there were signs that health care was a major issue in the 2016 election.  Both Republicans and Democrats expressed that it was moving voters in the polls.  Then the rates came out in Minnesota and nationally connected to the Affordable Care Act.  In Minnesota, it became a major public discussion – by most media accounts a crisis.  Even though the rates were only impacting 5 percent of the population.
However, the mood of the public and the dynamics of health care are too complex for tweets and sound bites.  As the Governor and Legislature negotiate a special session to help relieve some costs for MNsure members, we wanted to share a series of recent public opinion surveys on health care and the issues surrounding it.
The fact is that MNsure is taking more blame than it deserves for the mood of the citizens about health care.  There is plenty of anger that the various parts our health care system should be aware of.  While each of these is national, it should give you a good snap shot that there isn’t one simple fix to relieve the anger – instead, its probably time to start a major discussion about health care.  Again.
OPTICS:  The news that Speaker Kurt Daudt, Maj. Leader Joyce Peppin and Sen. Majority Leader Tom Bakk were in the U.S. Virgin Islands beginning yesterday while Gov. Mark Dayton was urging a special session deal is a bit surprising to those who follow Minnesota politics closely.  Going to a conference is completely understandable, especially one hosted by the National Conference on State Legislatures.  However, it was the timing and optics as time runs out on a special session deal for those leaders to not be present in Minnesota creates questions, and complications.  We have written before that staff from the Governor’s office and the legislative leadership teams have been negotiating the terms of the Special Session – however, to date they haven’t been successful.  So imagine the political ads, or tweets about Minnesotan’s suffering higher insurance rates while legislative leaders escape subzero temperatures at a fancy resort.  It just didn’t feel right and if most Minnesotans heard about it, especially those in panic mode over health premiums they would be outraged.  On the heels of suite-ghazi which has many many behind the scenes stories yet to be told, a trip to the tropics shows a lack of consciousness about what the election said.  Voters are angry, they voted that way.  While the ads, the media coverage and the politicians motivation is D vs. R and R vs. D, the new dynamic is that it’s the people vs. the powerful and privileged.  Until that dynamic changes, rolling up your sleeves and getting work done is more important than any networking or policy conference.
ANGER:  Fluence Media has compiled a special edition of Health Take, to showcase leading public opinion research on the mood of America and Minnesota on health care.  INFOGRAPHIC 
PEGGYANDJOE: Meet Peggy and Joe, from UCare.  DETAILS: Peggy & Joe are that long-married couple that know each other’s every quirk. Like every couple, sometimes those quirks are endearing—and sometimes they’re annoying. But in the end, they’re best friends who always have each others’ back, with a sense of humor that saves the day and a bond that has stood the test of time.  WATCH (SPONSORED:  UCare)

MORE:  The NCSL also needs a little help in managing the perception apparently, as the day progressed yesterday NCSL put conference details behind the public portion of the web, scrubbed the location, photos and all legislator names from across the country from the conference agenda.  Here was the list of legislators from across the country attending.  READ
WEB:  Here are screen shots of the agenda’s from before and after media a reports.  SEE
HCMC: from Brandt Williams via Post Bulletin, VERBATIM: “The Hennepin County Board unanimously approved a budget Tuesday that officials say will mean job cuts at Hennepin County Medical Center…It's not clear how many jobs would be lost at the downtown Minneapolis hospital, but officials said they are in the process of figuring that out…The hospital's CEO, Dr. Jon Pryor said expenses this year outpaced income by $11 million, a problem faced by other safety-net hospitals — facilities that serve many uninsured and low-income patients…Commissioner Jan Callison said she understands the challenges the hospital is facing…QUOTE: This is a tough budget. This has been a tough year at the hospital," Callison said. "For those of us who serve on the hospital board, who've put in a lot of time, for those at the hospital itself who deal with this every day, it is difficult to come in here with these numbers." READ:
LEGISLATORS: from David Montgomery via Pioneer Press, VERBATIM: “For the past two years, Minnesota’s divided leaders have pushed almost every major decision to the last minute…A possible legislative special session for health care relief, tax cuts and infrastructure will be no exception…Gov. Mark Dayton and lawmakers are still trying to strike a compromise as they count down the hours to Thursday. If they can’t find common ground by then, after months of negotiations, they’ll have run out of time to prepare and pass the bills before the Christmas holidays…A new Legislature will take office Jan. 3 and could take up the issues then, but there are reasons not to wait, especially for health care. New health insurance policies on the individual market will take effect Jan. 1, and lawmakers want to pass relief for Minnesotans suffering under skyrocketing premiums before then…Meanwhile, House Democrats object to the funding mechanisms in Dayton’s deal, including draining the state’s Health Care Access Fund for the premium relief and pulling $334 million from the state’s budget reserves.” READ:
SESSION: via WDAY News, VERBATIM: “Minnesota Governor Mark Dayton says it's time for legislators to agree on a special session to address health care costs or give up until next year…The Democratic governor sent a letter to legislative leaders Tuesday…He's asking for their approval of a December 20th special meeting, that's a week from Tuesday to approve the health care premium rebates as well as tax relief and $1-billion dollars in public works projects.” READ/WATCH:
MNSURE: from John Lundy via INFORUM, VERBATIM: “There's money on the table, and time is running out to pick it up…That was the message that brought Allison O'Toole, CEO of MNsure, to Duluth on Tuesday for a news conference to encourage Minnesotans to get their health insurance for 2017 during open enrollment…O'Toole was talking about federal tax credits available to "completely or significantly offset" skyrocketing premium increases this year. In the past, she said, many Minnesotans who qualified missed the chance…QUOTE: "Last year, we know about 100,000 Minnesotans passed up these tax credits and left money on the table," O'Toole said in the offices of Generations Health Care Initiatives, which spearheads enrollment efforts in Northeastern Minnesota…The credits are available for singles with incomes up to $47,000 and for a family of four with income up to $97,000, she said…UCare, one of the two insurers with plans available in Duluth, has an enrollment cap, said Megan Halena, program director for Generations. The other plan, Blue Plus, has no cap — but while UCare works with both Essentia Health and St. Luke's, Blue Plus works only with St. Luke's. "So particularly if you're doctoring with Essentia, you want to shop now," she said…The fate of Minnesotans whose income is above the tax credit lines as they try to budget for much higher health insurance premiums has prompted efforts for a fix via a special session of the Legislature…MNsure enrollment started strong this year, with 43,000 signed up for private coverage so far, O'Toole said. That's about triple the number at the same time last year. In the program's fourth year "people are starting to know what to do," she said.” READ:
FLIGHT: from Brett Boese via Post Bulletin, VERBATIM: Mayo Clinic's scope of operations is expected to roughly double by 2034 as part of the ambitious $6.5 billion Destination Medical Center project. Flying just below the radar of that explosive growth — up to 45,000 new employees in Rochester — is an increased need for medical transportation…There's where the shiny, new Beechcraft King Air 350C parked in Mayo's renovated hangar at the Rochester International Airport comes into play…Mayo recently unveiled a customized $8.5 million plane to transport high-risk patients to its facilities around the country. It's the only such medical plane operating in the Midwest and the specialized 52-inch cargo door — meant to accommodate stretchers — is believed to be the only one in existence in the Lower 48 states…The plane is expected to make about 400 transports this year and has already airlifted patients to Rochester from Montana, Texas, Louisiana and Pennsylvania, among other sites…QUOTE: "It's getting the Mayo level of ICU and emergency care to patients quicker," says flight nurse Lisa Jelinek, one of 22 Mayo employees to staff the Rochester-based fixed-wing aircraft. "When we walk into a patient's room, their faces light up when they see the Mayo shield." … The Beechcraft plane helps fill a specialized niche with a max range of 1,500 miles and wings that can be "flexed" to shed ice accumulation, which Mayo spokesman Glenn Lyden says makes it perfect for operating during the region's frigid winter months. There's also an infrared camera equipped on the nose of the plane to further enhance visibility in the case of rain or snow.” READ:
MEDTRONIC: via Life Sciences Intellectual Property Review, VERBATIM: “The US Court of Appeals for the Federal Circuit gave victory to Medtronic yesterday in a patent litigation against Medgraph, a company that produces patient data software…The case was an appeal by Medgraph from the US District Court for the Western District of New York after the company lost a suit in the district court…Medgraph is the owner of the two patents involved—US numbers 5,974,124 and 6,122,351—which cover a method for improving and facilitating diagnosis and treatment of patients…The software company sued Medtronic in December 2009 for alleged infringement of the ‘124 patent…Followed by this, Medgraph filed an amended complaint in October 2010 to assert that Medtronic also infringed a claim of the ‘351 patent…In August 2012, Medtronic filed a motion for summary judgment of non-infringement of all claims of the asserted patents…The district court later dismissed the claims of infringement…In its decision, the Federal Circuit agreed with the counterclaims by Medtronic and stated that a remand is unnecessary in this case, and that the district court correctly construed the claim.” READ:
UOFM: from University of Minnesota press release via Eurek Alert!, VERBATIM: “Researchers at the University of Minnesota have made a major breakthrough that allows people to control a robotic arm using only their minds. The research has the potential to help millions of people who are paralyzed or have neurodegenerative diseases…The study is published online today in Scientific Reports, a Nature research journal…QUOTE: "This is the first time in the world that people can operate a robotic arm to reach and grasp objects in a complex 3D environment using only their thoughts without a brain implant," said Bin He, a University of Minnesota biomedical engineering professor and lead researcher on the study. "Just by imagining moving their arms, they were able to move the robotic arm." … The noninvasive technique, called electroencephalography (EEG) based brain-computer interface, records weak electrical activity of the subjects' brain through a specialized, high-tech EEG cap fitted with 64 electrodes and converts the "thoughts" into action by advanced signal processing and machine learning…He anticipates the next step of his research will be to further develop this brain-computer interface technology realizing a brain-controlled robotic prosthetic limb attached to a person's body or examine how this technology could work with someone who has had a stroke or is paralyzed.” READ:
MAYO: from Heidi Wigdahl via KARE 11, VERBATIM: “3D printing is being used at Mayo Clinic to help surgeons better understand a patient's anatomy before heading to the operating room. It's been around at Mayo Clinic for nearly 10 years but the demand is growing every year…Mayo Clinic's 3D anatomic modeling program began in 2008 when surgeons were planning the separation of conjoined twins. They were able to look at a 3D model of the babies' shared liver before performing the surgery…QUOTE: "The last thing you want to be doing is making rash or rushed decisions based on anatomy that you're maybe not as familiar with and this makes everything kind of crystal clear," said Dr. Jonathan Morris, a neuroradiologist at Mayo Clinic in Rochester…The 3D models are used for complex surgeries. For example, Dr. Morris showed a model of a tumor on a patient's spine. That life-size model was made from the patient's CT or MRI scans…The 3D printers run seven days a week, almost nonstop. Mayo Clinic has four industrial 3D printers in the Department of Engineering and three printers of various technologies in the Department of Radiology.” READ/WATCH:
MAYO2: from Jeff Olsen via Mayo News Network, VERBATIM: “Just in time for resolution season comes the second edition of The Mayo Clinic DietQUOTE: “We got the basics right in the first edition,” says Dr. Donald Hensrud, lead author and medical editor of the diet book. “With this update, we’ve made it an even better lifestyle program.” … The Mayo Clinic Diet makes it possible to eat more and weigh less by breaking bad habits and adopting healthy new ones. There’s no calorie counting or rigid rules, and the plan can be personalized…QUOTE: “No food is off limits,” explains Dr. Hensrud, who is also medical director of the Mayo Clinic Healthy Living Program. “We do watch portion size of some foods, but it’s practical and enjoyable. We think it’s the best way to manage weight.” … In this Mayo Clinic Minute, Dr. Hensrud highlights some of the new resources in the book and how they help with the two phases of the diet.” READ/WATCH:
INSULIN: from Olivia Johnson via Minnesota Daily, VERBATIM: “Nearly a hundred years after its discovery, the cost of insulin — a life-saving drug for diabetics — has continued to rise, leaving many daily users of the drug weary…In November, the American Diabetes Association called upon lawmakers to investigate the medication’s price increase, and to ensure the drug remains accessible, citing a 48 percent increase in the annual cost of diabetes, gestational diabetes and prediabetes over the course of five years in the U.S. The yearly cost in 2012 alone was $322 billion…At the University of Minnesota, concerns surrounding the drug’s expense — especially to low-income or uninsured patients — remain prevalent…Betsy Seaquist, a University diabetes researcher and professor in the Department of Medicine, works directly with diabetic patients and often has to switch them to cheaper types of insulin…Seaquist said insulin costs depend on health insurance and the kind of insulin prescribed. Older types of insulin can be cheaper, but don’t control blood sugar levels as well as newer varieties — which can be over $100 more expensive per 10 milliliter vial.” READ:
OPIOIDS: via WDAY News, VERBATIM: “President Obama signed a bill into law Tuesday that will pump more than $6-billion dollars into healthcare issues…$1-billion of it will be set aside to fight the opioid epidemic in the United States…Senator Amy Klobuchar supported the 21st Century Cures Act because it provides money for preventing addiction in the first place…She brought up an experience she had at a forum in Moorhead last spring…QUOTE: "This puts more funding into treatment. Something I heard about in a forum that I did in Moorhead over and over again. In fact, one of the rehab people told me the story of a guy who had gone to different doctors in Minnesota and North Dakota and South Dakota (who) actually had 85 different prescriptions," said Sen. Amy Klobuchar, U.S. Senator.” READ/WATCH:
SLEEP: from Kent Erdahl via KARE 11, VERBATIM: “With a simple 4 to 3 majority vote on Tuesday night, the St. Paul School District moved forward with a plan to delay the start of school for middle school and high school students by the fall of 2018…QUOTE: “From a science perspective it’s kind of a no-brainer," said Dr. Andrew Stiehm, Director of the Sleep Medicine at Allina Health's United Lung and Sleep Clinic. “For the most part, whenever teenagers are able to start school, particularly after about 8:30 a.m., their grades improve.” … Stiehm says study after study have also shown improvements in mental and behavioral health…It's why St. Paul is not alone in pushing for 8:30 a.m. starts or later. Wayzata and Buffalo were the latest to change their schedules this fall, while Edina led the way 20 years ago, followed by Minneapolis in 1997…A five-year study on that Minneapolis school shift by University of Minnesota researcher Kyla Wahlstrom, found that graduation rates improved by 3 percent every year.” READ:
MASSACHUSETTS: from Associated Press via NewsOK, VERBATIM: “More than a dozen Massachusetts lawmakers and other state officials are headed to Minnesota to learn about that state's approach to controlling health care costs…Total health care expenditures exceeded $57 billion in Massachusetts in 2015, a 4.1 percent increase over the previous year…The delegation leaves Wednesday for Minnesota, which was chosen as the first state to visit because of success it has shown in controlling costs through managed care and alternative payment models.” READ:
COSTS: from Mark Zdechlik via MPR News, VERBATIM: “The same clinic visit or procedure can have a drastically different price tag in Minnesota depending on your health care provider, a new survey found… Minnesota Community Measurement on Tuesday released its third-annual review of cost data from more than 1.5 million insurance claims, and it showed there are still big cost differences from provider to provider around the state… For example, a strep test can cost $8 or $101, depending on the provider. A knee MRI cost some people as little as $216, while others were billed $3,904, according to the review… Higher deductibles and copays are driving the trend, said Jim Chase, president of Minnesota Community Measurement.” READ:
MEDICA: from Anne Polta via West Central Tribune, VERBATIM: “Changes are in store for Kandiyohi County clients enrolled in prepaid Medical Assistance and MinnesotaCare through Medica, following a recent announcement by the health plan that it is withdrawing from some of Minnesota's public programs this coming May… What happens next is still uncertain, said Ann Stehn, director of Kandiyohi County Health and Human Services… The upshot, however, is that Medical Assistance and MinnesotaCare enrollees covered through Medica will have to switch to a different insurer by the end of April… Medica notified the Minnesota Department of Human Services earlier this month that it would no longer provide health insurance to the Medical Assistance and MinnesotaCare population, effective May 1. The company cited losses in excess of $150 million this year… The number of Kandiyohi County clients enrolled in the Prepaid Medical Assistance Program through Medica is not large, Stehn said. The bulk of the county's enrollees are with Blue Cross and Blue Shield of Minnesota or Blue Plus…Statewide, about 300,000 individuals are affected by Medica's decision to exit from the public programs next spring… Medica's exit from the Medical Assistance and MinnesotaCare portion of the market comes less than two years after the company successfully procured a state contract to provide coverage for this population. UCare Minnesota lost its Prepaid Medical Assistance Program contract with the state in the same round of bidding, forcing those clients to find other health plans during open enrollment last year.” READ:
LABOR: from Barb Kucera via Workday Minnesota, VERBATIM: “The general counsel for the National Labor Relations Board has determined that unfair labor practice charges filed against Mayo Clinic have merit, supporting maintenance workers at the Albert Lea Medical Center who have been seeking a contract for more than 18 months…On Monday, the NLRB General Counsel found that Mayo has "failed to bargain in good faith" with SEIU Healthcare Minnesota concerning the skilled maintenance employees working at the hospital, which is part of the Mayo Clinic Health System…This nationally significant determination comes after two Mayo maintenance workers from the hospital went to Washington, D.C., to attend oral arguments before the General Counsel regarding the charges against Mayo… Future dates for bargaining between the Albert Lea maintenance workers and Mayo have not yet been scheduled…The determination by the NLRB General Counsel comes as another charge filed by SEIU Healthcare Minnesota against Mayo is still pending in relation to Mayo’s unilateral outsourcing of hundreds of food service worker jobs in Albert Lea, in Rochester and across Southern Minnesota. READ:
STJUDE: from American Heart Association press release via PR Newswire, VERBATIM: “Impressive results are coming in for St. Jude Medical Foundation's $1 million two-year grant to address heart failure in Minnesota…The two-year pilot initiative aimed to put the American Heart Association's Get With The Guidelines – Heart Failure program in 12 Minnesota hospitals and seven Texas hospitals, is seeing significant quality improvements in the first quarter reports…QUOTE: "We are inspired by the positive results we are seeing so far by this pilot partnership," said Barbara Ducharme, executive director of the American Heart Association's office in Minneapolis. "St. Jude Medical Foundation's support is helping heart failure patients here in Minnesota to live longer, better quality lives with fewer hospital stays." … Heart failure effects nearly 6 million Americans, costs the nation over $30 billion annually, and accounts for about 11,000 hospitalizations in Minnesota each year, according to the Minnesota Department of Health. Get With The Guidelines – Heart Failure is an in-hospital quality improvement program that provides clinical tools, patient education resources, and quality improvement data analysis promoting consistent adherence to the latest scientific treatment guidelines to improve patient care and outcomes…QUOTE: "St. Jude Medical is pioneering heart failure disease management and is proud to support impactful programs like Get With the Guidelines. We are committed to collaborating with heart failure specialists, clinicians and advocacy partners to provide innovative, cost-effective solutions that help reduce hospitalizations and improve patients' quality of life," said Rachel Ellingson, president of St. Jude Medical Foundation and vice president of corporate strategy at St. Jude Medical.” READ:
CHANGE: via Watertown Public Opinion, VERBATIM: “A new report says more than one in five Minnesotans under age 65 had health problems last year that would give them a personal stake in the debate over repealing and replacing the federal health care law…The Star Tribune reports the California-based Kaiser Family Foundation estimates about 744,000 Minnesota residents under 65 would be blocked from coverage if insurance companies reverted to rules that were in place before the Affordable Care Act… the estimate is much larger than the number of people with health problems who've found commercial coverage under the health law, because it includes those with other types of insurance, such as coverage through employer groups.” READ:

HEALTHY: With support from UCare via The Loppet Foundation.  STORYLi'Tavius Munn started with the Loppet Foundation through the Minne-Loppet at Nellie Stone Johnson Elementary. He went on to be a member of the Junior Loppet program during middle school. Li'Tavius is now a Loppet Adventure Camp Counselor and a leader and role model for younger kids.”  WATCH (SPONSOREDUCare

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About Morning Take- In the era of Twitter, Facebook and the 24-hour, minute by minute news cycle morning take is designed to be a short, quick read for Minnesota insiders. morning take the radio version is every morning M-F at 6:20 AM on WCCO-AM with Dave Lee.   The goal of morning take is not to aggregate much news of the day, but rather preview the day ahead and help crystallize or foreshadow items on the horizon  I will be transparent about when clients are included, or if I am involved in some event.   Please provide tips and constructive feedback. thanks - blois

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