Upcoming Feb. 25 Atlantic Information Services virtual conference to present a comprehensive overview of designing and executing private exchanges.

Washington, DC (PRWEB) January 14, 2014

Health insurers now face a radically different marketplace as the shift in employer health benefits to defined contribution has triggered a boom in private exchanges. The new mantra is to keep costs under control and involve consumers in plan purchasing. On Feb. 25, Atlantic Information Services, Inc. (AIS) will host “Making Private Exchanges Work for Insurers,” a virtual conference offering details of how private exchanges work, which models are most successful at gaining members, and the pros and cons for insurers of taking part in nonproprietary exchanges versus building their own. Participants will gain a solid understanding of the current legal, marketing and general business strategies for insurers and their employer clients, with an eye on future developments.

Split into four sessions led by many of the nation’s private exchange experts, including top industry consultants, lawyers working in the health care sector and Wall Street analysts, topics to be covered include the following:· The business model for private exchanges and how insurers expect to prosper by operating their own proprietary exchanges or selling coverage on other marketplaces.
· How defined contribution is playing into employer decision making and the ramifications of shifting health benefits to private exchanges.
· Profiles of current private exchanges: Who is operating them? Who is buying and selling products on them? Which models are attracting the most business? How will the 2014 open-enrollment season play into what comes next?
· Detailed action plans on how to build, market and operate a private exchange, with valuable information on dealing with vendors, constructing a consumer-facing online marketplace, and deciding on an attractive product mix that will be most effective at appealing to insurance buyers.

Additionally, each session will conclude with generous time allocated to answering individual questions.

AIS’s virtual conference allows participants to attend a live conference without having to travel to a meeting site. Plus, the registration fee includes a free On-Demand recording of each session, so any agenda items can be reviewed at a later time.

For more information, including a full agenda, speaker biographies and how to register, visit http://aishealth.com/private-exchanges.

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com. Reported by PRWeb 13 hours ago.

The Department of Health and Human Services released new Obamacare numbers Monday for the federal exchange and the 14 state exchanges, including demographic information for the first time.

As of December 28, nearly 2.2 million people had selected a plan on the exchanges. Twenty four percent of them were between the ages of 18 and 35.

The White House had wanted 39% of enrollees to be within that age range to prevent insurers from receiving a significant number of high-risk beneficiaries. However, health analysts have noted in recent weeks that the age demographics are not what matters. It's the health mix that is most important.

A recent study by the Kaiser Family Foundation found that if young people made up 25% of enrollees, it would reduce insurer profits by 2-3%, but would not cause a "death spiral" where insurers raise premiums, driving healthy people out of the market, forcing them to raise premiums again and onwards. The administration is confident that the share of young people who sign up will only increase in the coming months.

Of the 2.15 million people who have a selected a plan, 957,000 have done so through the state exchanges and 1.2 million have done so on the federal marketplace. Sixty percent of people have selected the silver plans, which are expected to cover approximately 70% of a person's health care costs.

After the catastrophic launch of the federal website, the pace of enrollments has improved each week, as many expected would happen as the deadline for selecting a plan approached. More than seven times as many people signed up on the federal exchange in the first 28 days of December as did so throughout all of October and November. 

An additional 3.9 million people were deemed eligible either for Medicaid or the Children's Health Insurance Program (CHIP). It's unclear how many of those 3.9 million are newly eligible because of the Affordable Care Act or have just became aware in recent weeks that they were already eligible.

The administration did not say how many people had paid their first premiums, only how many had chosen a plan. Many insurers allowed people to pay their first premiums up until January 10 - or in some cases even later. The Wall Street Journal reported yesterday that one third-party billing firm that works with insurers in 17 states said that only two-thirds of those who have signed up have actually paid so far.

Join the conversation about this story »

 
 
 
  Reported by Business Insider 13 hours ago.

New report and toolkit shows companies need to gear up for ACA implementation now, not wait until next year.

New Providence, NJ (PRWEB) January 14, 2014

Companies with 50 or more full-time employees seeking to comply with the Affordable Care Act (ACA) breathed a small sigh of relief when the requirement to offer health coverage to employees or pay a penalty was delayed until 2015. However, a number of the ACA's provisions are applicable in 2014, says a new XpertHR report and toolkit on ACA compliance.

"It's important to understand what has been and what has not been delayed," says Tracy Morley, SPHR, Legal Editor, XpertHR. "Even though large employers have a respite until 2015, the requirement for individuals to obtain health insurance in 2014 or pay a penalty was not delayed."

Pushing the "pay or play" mandate off until 2015 was a welcome reprieve but even with the delay, many employers with 50 or more full-time employees are still finding it difficult to understand and comply with the law's complex requirements, many of which take place in 2014, says a new XpertHR report.

ACA mandates taking place in 2014 include the establishment of insurance exchanges that sell qualified health plans to individuals and small businesses, the elimination of all pre-existing condition exclusions, dependent coverage expansion (applicable to grandfathered plans), and the elimination of annual dollar limits on essential health benefits. Employers should be developing action plans to ensure they are ready for compliance.

"The pressure will be on HR departments in 2014 to lead the charge and develop an action plan for the new reporting responsibilities and tax implications," says Morley. "The ACA requirements are so complex that HR professionals will need guidance in spearheading the effort to ramp up for implementation in 2015."

According to a Society for Human Resource Management survey, nearly three-quarters of organizations are educating HR staff members through classes (74 percent) or working with legal/benefits counsel (73 percent) to help them understand the health care law.

XpertHR offers 7 steps for employers to prepare for the ACA:

1. Understand what is (and what is not) delayed.
2. Determine if there is a requirement to offer coverage in 2015 -- companies that meet the 50 full-time employee threshold must either offer coverage or pay a penalty.
3. Understand the affordability and minimum value requirements -- companies that do not offer coverage, or offer coverage that does not provide minimum value or is considered unaffordable, may be subject to a "pay or play" penalty in 2015.
4. Evaluate, strategize and make decisions about health insurance -- consider the cost of penalties and the effect of changing the composition of the workforce.
5. Review and revise plan documents to conform with new ACA design, eligibility and enrollment requirements.
6. Communicate to employees -- the ACA imposes additional communication requirements on employers, many of which are already in effect.
7. Understand new federal reporting requirements -- beginning in 2015, employers will be required to provide certain information to the IRS and to their employees.

The ACA poses significant compliance challenges for employers and changes the landscape of health care in the U.S. To help businesses chart a course to comply with the law's complex requirements, XpertHR is offering a free compliance toolkit containing a report, how-to articles and a timeline of 2014-2015 requirements. The toolkit explains the ACA's provisions, cost implications and deadlines for implementation. For a free copy of XpertHR's ACA compliance toolkit, visit XpertHR.

About XpertHR
XpertHR's online service provides HR professionals with practical compliance tools and comprehensive guidance on federal, state and municipal law, helping employers stay current with evolving and complex employment law issues. XpertHR content is published in association with sister company LexisNexis. XpertHR.com is a unique, easy-to-use solution organized around the day-to-day responsibilities of HR professionals. In addition to smart search features, you can browse through content by task, by topic, or by tool type to help you find just what you need in seconds. Our key features include the popular Employment Law Manual and Liveflo employment workflows.

Media Contact:
Beth Brody, fisher VISTA (For XpertHR)
beth(at)hrmarketer(dot)com
609-397-3737 Reported by PRWeb 12 hours ago.

Washington D.C., Jan 14, 2014 / 04:34 am (CNA/EWTN News).- The editors of USA Today have urged the Obama administration to stop trying to require the Little Sisters of the Poor to abide by the federal contraception mandate in violation of their religious beliefs.

“When the Obama administration picked a fight with Catholics and other religious groups over free birth control coverage for employees, sooner or later it was bound to end up doing battle with a group like the Little Sisters of the Poor,” the USA Today editorial board said.

In a Jan. 12 editorial entitled “Obamacare overreach tramples Little Sisters,” the publication's editors argued that the administration's move is “a political loser,” “constitutionally suspect” and “ultimately unproductive.”

The Little Sisters of the Poor have worked for 175 years to care for the low-income elderly and dying in communities throughout the U.S.

The community says its work is now being threatened by the federal contraception mandate, which was issued under the Affordable Care Act and requires employers to offer health insurance plans covering contraception, sterilization and some drugs that may cause early abortions.

The religious congregation on Dec. 31 secured an emergency stay from the U.S. Supreme Court against the mandate. The Obama administration responded by reiterating its commitment to the mandate and its requirements.

USA Today said the administration is “now stuck arguing that it is justified in compelling nuns who care for the elderly poor to assist in offering health insurance that they say conflicts with their religious beliefs.”

The publication said the administration wrote its religious exemption to the rule “so narrowly” that it failed to exempt Catholic and other religious hospitals, colleges and charities. The Little Sisters of the Poor fail to qualify because they are not affiliated with a particular house of worship.

The Obama administration “could find some less divisive way to provide the coverage,” USA Today said. “Instead, the administration is battling Catholic bishops and nuns, Southern Baptists, Christ-centered colleges and assorted religious non-profits that filed challenges across the country.”

Rather than extending a religious exemption to the Little Sisters, the federal government has instead offered an “accommodation” under which the sisters can sign a document authorizing an outside group to provide the coverage they find morally objectionable.

However, the USA Today editors dismissed this accommodation as “more of a fig leaf than a fix.” They observed that the Little Sisters of the Poor and others say that the requirement “makes them complicit in an act that violates a tenet of their faith.”

The punishment for noncompliance with the mandate is “ruinous fines,” with the Little Sisters facing $4.5 million in annual fines for just two of their 30 homes.

USA Today noted that most of the legal cases against the mandate have been successful so far. More than 300 plaintiffs have filed lawsuits against the mandate, and legal injunctions have been granted in most cases, which are largely still working through the court system.

“The administration should take the hint,” the editorial said, calling on the federal government to adopt the “most expansive” religious exemption.

A “more meaningful” compromise would give religious freedom “the wide berth it deserves,” the publication stated. Reported by CNA 11 hours ago.

MVP Health Care is loving New York's new online marketplace for buying health insurance. MVP, headquartered in Schenectady, reports to me more than 15,000 individuals have bought coverage since the Oct. 1 launch of the state's health insurance "exchange." The exchange - the subject of a state Senate hearing Monday - is a core part of the federal Affordable Care Act, aka Obamacare. The exchanges aim to help consumers and small businesses shop for coverage (ideally coverage that is less costly, thanks… Reported by bizjournals 11 hours ago.

· House Unveils $1.01 Trillion Measure to Fund Government (BBG)
· Credit Suisse Tells Junior Bankers to Take Saturdays Off (BBG)
· Spot the odd word out: ECB Sees Bad-Debt Rules as Threat to Credible Bank Review (BBG)
· Insert laugh track here: Spain GDP grows at fastest pace in almost six years (FT)
· Scandinavian Debt Crisis Waiting to Happen Puzzles Krugman (BBG)
· Fed Said to Release Plan to Limit Banks’ Commodities Activities (BBG)
· Thai Protesters Extend Blockade After Rejecting Poll Talks (BBG)
· China provinces set lower growth goals for 2014 (BBG)
· South Korea cuts future reliance on nuclear power, but new plants likely (Reuters)
· U.S. Posts Record December Surplus on Fannie Mae Payments (BBG)
· Euro-Zone Industrial Production Jumps (WSJ)

 

*Overnight Media Digest*

WSJ

The Telegraph

SCOTTISH INDEPENDENCE: UK'S CREDIT RATING COULD BE THREATENED AS TREASURY GUARANTEES SCOTLAND'S DEBT

Bond traders welcome the Treasury's confirmation that it will stand by all UK debt in the event of Scottish independence but credit rating agencies could be concerned about the UK's bigger burden.

OECD SAYS GROWTH CONTINUES TO 'FIRM' IN UK

Britain is leading a small band of advanced economies where growth is "firming" and the recovery gaining traction, according to the Organisation for Economic Co-operation and Development (OECD).

The Guardian

JAPAN'S SUNTORY BUYS MAKER OF JIM BEAM BOURBON

Illinois-based Beam Inc, the drinks group behind Jim Beam bourbon as well as Scotch whiskies Teacher's and Laphroaig, has been sold to Japanese whisky distiller Suntory as part of a $16 billion deal.

HOMESERVE FACES 35 MLN STG REGULATOR FINE

Home emergencies and repairs group HomeServe has received a draft "warning notice" from the Financial Conduct Authority (FCA) and is set to be fined 34.5 million pounds for mis-selling and poor complaints handling.

The Times

PREDATOR RALLIES INVESTORS IN $62 BLN BID FOR TIME WARNER

The American cable television operator Charter Communications stunned Wall Street and the media world on Monday night by mounting an audacious $62.3billion bid, including debt, for its much larger rival Time Warner Cable .

GOOGLE ACQUIRES NEST FOR $3.2 BILLION

Google Inc continued its push into becoming a maker of consumer electronics by acquiring Nest, a company that sells "smart" thermostats and smoke alarms, in a deal worth $3.2 billion.

The Independent

SPORTS DIRECT BUYS 4.6 PERCENT STAKE IN DEBENHAMS

Mike Ashley's Sports Direct has quietly snapped up a 45 million pound stake in struggling department store Debenhams and Ashley has told the retailer's board that he wants to work closely with them.

AMEC OFFERS 1.9 BLN STG TO BUY RIVAL FOSTER WHEELER

Engineering firm Amec today revealed a $3.2 billion (1.9 billion pound) potential offer for rival Foster Wheeler , keeping up this year's hectic start for takeover activity.

 

FT

U.S. cable company Charter Communications Inc on Monday went public with a proposal to buy Time Warner Cable Inc for $61.3 billion, including debt, only for its larger rival to reject its advances as "grossly inadequate."

Google Inc on Monday announced plans to acquire Nest Labs Inc, a maker of smart thermostats and smoke alarms, for $3.2 billion, making a bold bet on the emerging "internet of things".

Suntory Holdings Ltd said on Monday it would buy U.S. spirits company Beam Inc for $16 billion, including debt, in a deal that underscores the Japanese company's acquisitive global ambitions and Asia's growing thirst for premium spirits.

Three former traders at Dutch lender Rabobank were criminally charged by the U.S. Department of Justice on Monday with manipulating the Yen Libor benchmark interest rate and other key benchmark interest rates.

U.S. drugs wholesaler group McKesson Corp said on Monday it had failed to win enough support for a $8.4 billion offer to buy German distributor Celesio, after a battle with Elliott Associates, the activist hedge fund, over the deal.

Hedge fund Elliott Management Corp urged network equipment maker Juniper Networks Inc to start paying dividends and buy back shares worth $3.5 billion, making it the latest technology company to attract criticism for building up a large cash pile.

 

NYT

* Ford Motor, the second-largest American automaker after General Motors, took the wraps off a radically redesigned pickup truck at the annual Detroit auto show. Ford will replace its F-150 truck's traditional steel body panels with aluminum parts, which saves weight and improves fuel economy.

* Charter Communications offered $37.8 billion to acquire Time Warner Cable, the country's second-largest cable operator. Including debt, the offer is valued at $61.3 billion.

* Japan's Suntory announced it would buy Beam Inc , the maker of Jim Beam and Maker's Mark, for $13.6 billion, in one of the biggest takeovers in the liquor business in years which will transform it into the third-largest distiller globally.

* Apple Inc is campaigning aggressively against a court-appointed inspector, appointed to make sure that the company complied with antitrust laws after it was found last summer to have conspired with five publishers to fix prices for e-books, saying he is intruding on operations.

* People signing up for health insurance through the Affordable Care Act's federal and state marketplaces tend to be older and potentially less healthy, officials said on Monday, a demographic trend that could threaten the law's economic foundations and cause premiums to rise in the future.

* House and Senate negotiators reached an agreement on a trillion-dollar spending plan that will finance the government through September, reversing some cuts to military veterans' pensions that were included in a broader budget agreement last month and defeating efforts to rein in President Obama's health care law.

* FBI investigators do not believe Internal Revenue Service officials committed crimes in the unusually heavy scrutiny of conservative groups that applied for tax-exempt status, a law enforcement official said on Monday.

* Google Inc agreed to pay $3.2 billion in cash for Nest Labs, which makes Internet-connected devices like thermostats and smoke alarms.

 

Canada

THE GLOBE AND MAIL

* A special meeting in which the Toronto city council voted unanimously to ask for C$114 million ($105 million) in ice storm funding from the provincial and federal governments descended into a shouting match, with councillors bickering over who was in charge at city hall after the storm. Councillor Karen Stintz, who intends to run against Toronto Mayor Rob Ford this year, took aim at him for not creating a clear chain of leadership after the storm.

* Health Minister Deb Matthews announced that five hospitals in Southern Ontario will permanently close their doors and be replaced with a new acute-care center as part of a massive overhaul of the troubled Niagara Health System.

Reports in the business section:

* Chrysler Group LLC began discussions with the federal and Ontario governments to seek financial assistance for an investment of more than $1 billion to retool a plant in Windsor for a new generation of minivans.

NATIONAL POST

* Round doorknobs are joining incandescent lightbulbs as outdated technology that Canadian governments are seeking to eradicate - in one case for their carbon footprint, in the other for the obstacle they pose to the disabled.

FINANCIAL POST

* Wind Mobile is withdrawing from bidding in Canada's spectrum auction after failing to secure financial backing to participate from its owner VimpelCom Ltd.

* Canada's two national newspapers, The Globe and Mail and Postmedia Network Canada Corp's National Post, told staff about job cuts on Monday. Postmedia also said it would shut down operations at a Calgary call center this spring and outsource the work of selling classified ads for its newspaper chain to U.S.-based Media Sales Plus Inc.

 

China

CHINA SECURITIES JOURNAL

- The China Insurance Regulatory Commission said it was seeking opinions on insurance fund management and was considering raising the investment ratio for insurance companies in capital markets.

- China's ICBC plans to issue 100 billion yuan ($16.55 billion) worth of interbank deposit in 2014, according to company announcement.

SHANGHAI SECURITIES NEWS

- Shanghai's vice mayor said that the Shanghai free-trade zone will allow exchange of the yuan as part of a bold push to reform the world's second largest economy.

CHINA DAILY

- Shanghai Zhenhua Heavy Industries Co Ltd said it has made an offer for JJ Sietas Schiffswerft, a Hamburg-based shipyard, as part of its drive to diversify and expand its maritime engineering business.

- China Investment Corp, the country's $575 billion sovereign wealth fund, favours European infrastructure and real estate because developed markets will drive the next phase of the global economic recovery, CIC Chairman Ding Xuedong said, adding that the United States will also remain a focus for the Beijing-based fund.

SHANGHAI DAILY

- Shanghai residents spent an average of 31,018 yuan last year through Alipay, a third-party payment service founded by China's largest e-commence company Alibaba . Their expenditure accounted for 9.3 percent of the total spending in the country last year.

PEOPLE'S DAILY

- Chinese citizens should focus on progress while authorities should work on solutions for problems, said a commentary in the paper that acts as the Party's mouthpiece.

 

Britain

The Telegraph

SCOTTISH INDEPENDENCE: UK'S CREDIT RATING COULD BE THREATENED AS TREASURY GUARANTEES SCOTLAND'S DEBT

Bond traders welcome the Treasury's confirmation that it will stand by all UK debt in the event of Scottish independence but credit rating agencies could be concerned about the UK's bigger burden.

OECD SAYS GROWTH CONTINUES TO 'FIRM' IN UK

Britain is leading a small band of advanced economies where growth is "firming" and the recovery gaining traction, according to the Organisation for Economic Co-operation and Development (OECD).

The Guardian

JAPAN'S SUNTORY BUYS MAKER OF JIM BEAM BOURBON

Illinois-based Beam Inc, the drinks group behind Jim Beam bourbon as well as Scotch whiskies Teacher's and Laphroaig, has been sold to Japanese whisky distiller Suntory as part of a $16 billion deal.

HOMESERVE FACES 35 MLN STG REGULATOR FINE

Home emergencies and repairs group HomeServe has received a draft "warning notice" from the Financial Conduct Authority (FCA) and is set to be fined 34.5 million pounds for mis-selling and poor complaints handling.

The Times

PREDATOR RALLIES INVESTORS IN $62 BLN BID FOR TIME WARNER

The American cable television operator Charter Communications stunned Wall Street and the media world on Monday night by mounting an audacious $62.3billion bid, including debt, for its much larger rival Time Warner Cable .

GOOGLE ACQUIRES NEST FOR $3.2 BILLION

Google Inc continued its push into becoming a maker of consumer electronics by acquiring Nest, a company that sells "smart" thermostats and smoke alarms, in a deal worth $3.2 billion.

The Independent

SPORTS DIRECT BUYS 4.6 PERCENT STAKE IN DEBENHAMS

Mike Ashley's Sports Direct has quietly snapped up a 45 million pound stake in struggling department store Debenhams and Ashley has told the retailer's board that he wants to work closely with them.

AMEC OFFERS 1.9 BLN STG TO BUY RIVAL FOSTER WHEELER

Engineering firm Amec today revealed a $3.2 billion (1.9 billion pound) potential offer for rival Foster Wheeler , keeping up this year's hectic start for takeover activity.

 

 

*Fly On The Wall 7:00 AM Market Snapshot*

ECONOMIC REPORTS

Domestic economic reports scheduled for today include:

Retail sales for December will be reported at 08:30--Current consensus is 0.0% for the month

Business inventories for November will be reported at 10:00--Current consensus is 0.3% for the month

ANALYST RESEARCH

Upgrades

Actuant (ATU) upgraded to Buy from Hold at Jefferies
AstraZeneca (AZN) upgraded to Outperform from Market Perform at Leerink
Barnes Group (B) upgraded to Buy from Hold at Jefferies
Brocade (BRCD) upgraded to Overweight from Neutral at JPMorgan
Cameco (CCJ) upgraded to Buy from Neutral at BofA/Merrill
Cliffs Natural (CLF) upgraded to Buy from Hold at Deutsche Bank
Danaher (DHR) upgraded to Buy from Neutral at BofA/Merrill
Flowserve (FLS) upgraded to Buy from Hold at Jefferies
Gorman-Rupp (GRC) upgraded to Hold from Underperform at Jefferies
Intel (INTC) upgraded to Overweight from Neutral at JPMorgan
Jabil Circuit (JBL) upgraded to Conviction Buy from Neutral at Goldman
Juniper (JNPR) upgraded to Outperform from Perform at Oppenheimer
Kaman (KAMN) upgraded to Buy from Hold at Jefferies
Logitech (LOGI) upgraded to Buy from Neutral at Goldman
Luxottica (LUX) upgraded to Neutral from Reduce at Nomura
MPLX (MPLX) upgraded to Overweight from Equal Weight at Barclays
MSC Industrial (MSM) upgraded to Buy from Hold at Jefferies
Magellan Midstream (MMP) upgraded to Overweight from Equal Weight at Barclays
ON Semiconductor (ONNN) upgraded to Outperform from Neutral at Credit Suisse
Pan American Silver (PAAS) upgraded to Buy from Hold at Deutsche Bank
Southern Copper (SCCO) upgraded to Outperform from Market Perform at FBR Capital
Thompson Creek (TC) upgraded to Buy from Neutral at BofA/Merrill
VeriFone (PAY) upgraded to Overweight from Neutral at JPMorgan
XPO Logistics (XPO) upgraded to Buy from Hold at KeyBanc
Yahoo (YHOO) upgraded to Buy from Fair Value at CRT Capital

Downgrades

ASML (ASML) downgraded to Neutral from Outperform at Credit Suisse
Cameron (CAM) downgraded to Equal Weight from Overweight at Morgan Stanley
Cardtronics (CATM) downgraded to Neutral from Overweight at JPMorgan
Celadon Group (CGI) downgraded to Hold from Buy at Stifel
ChannelAdvisor (ECOM) downgraded to Neutral from Buy at Goldman
Delek Logistics (DKL) downgraded to Equal Weight from Overweight at Barclays
Demandware (DWRE) downgraded to Neutral from Conviction Buy at Goldman
Energy Transfer Partners (ETP) downgraded to Equal Weight from Overweight at Barclays
EverBank Financial (EVER) downgraded to Neutral from Buy at Sterne Agee
Family Dollar (FDO) downgraded to Underweight from Equal Weight at Barclays
Freeport McMoRan (FCX) downgraded to Market Perform from Outperform at FBR Capital
General Mills (GIS) downgraded to Underweight from Equal Weight at Morgan Stanley
Genesis Energy (GEL) downgraded to Equal Weight from Overweight at Barclays
Gentiva Health (GTIV) downgraded to Hold from Buy at Deutsche Bank
Heartland Payment (HPY) downgraded to Neutral from Overweight at JPMorgan
Hi-Crush Partners (HCLP) downgraded to Equal Weight from Overweight at Barclays
KiOR (KIOR) downgraded to Market Perform from Outperform at Cowen
Microsoft (MSFT) downgraded to Neutral from Buy at Citigroup
Plexus (PLXS) downgraded to Neutral from Buy at Goldman
Qualcomm (QCOM) downgraded to Market Perform from Outperform at Raymond James
Rudolph Technologies (RTEC) downgraded to Neutral from Outperform at Credit Suisse
Sirius XM (SIRI) downgraded to Equal Weight from Overweight at Barclays
Southcross Energy (SXE) downgraded to Underweight from Equal Weight at Barclays
StealthGas (GASS) downgraded to Market Perform from Outperform at Wells Fargo
TE Connectivity (TEL) downgraded to Buy from Conviction Buy at Goldman
Veolia Environment (VE) downgraded to Neutral from Buy at Citigroup
Volcano (VOLC) downgraded to Market Perform from Outperform at JMP Securities
Western Union (WU) downgraded to Sell from Neutral at Citigroup
YRC Worldwide (YRCW) downgraded to Hold from Buy at BB&T
ZELTIQ (ZLTQ) downgraded to Neutral from Buy at Goldman

Initiations

3D Systems (DDD) initiated with an Outperform at RBC Capital
American Express (AXP) initiated with a Neutral at UBS
BB&T (BBT) initiated with a Neutral at Janney Capital
Capital One (COF) initiated with a Buy at UBS
CatchMark Timber (CTT) initiated with an Outperform at Raymond James
Comerica (CMA) initiated with a Neutral at Janney Capital
Comstock Resources (CRK) initiated with an Outperform at Imperial Capital
Discover (DFS) initiated with a Neutral at UBS
Dyax (DYAX) initiated with an Outperform at Wedbush
Fifth Third Bancorp (FITB) initiated with a Buy at Janney Capital
KNOT Offshore Partners (KNOP) initiated with an Outperform at RBC Capital
KeyCorp (KEY) initiated with a Buy at Janney Capital
M&T Bank (MTB) initiated with a Neutral at Janney Capital
Neenah Paper (NP) initiated with a Buy at DA Davidson
People's United (PBCT) initiated with a Buy at Janney Capital
Red Hat (RHT) initiated with an Outperform at JMP Securities
Regions Financial (RF) initiated with a Buy at Janney Capital
Stratasys (SSYS) initiated with an Outperform at RBC Capital
Synergy Resources (SYRG) initiated with a Hold at Stifel

HOT STOCKS

Charter (CHTR) offered to buy Time Warner Cable (TWC) for ‘low $130s’ per share
Time Warner Cable (TWC) board rejected Charter (CHTR) offer, called it 'grossly inadequate'
Time Warner Cable (TWC) told Charter (CHTR) it would accept $160/share bid, CNBC reports
Google (GOOG) to acquire Nest for $3.2B in cash
Sears (SHLD) ratings placed on CreditWatch negative by S&P
Osisko board considering Goldcorp's (GG) C$5.95 per share offer
HealthSouth (HLS) sees dividends, opportunistic repurchases through FY16
Yum! Brands (YUM) reports December China division SSS up 2%

EARNINGS

Companies that beat consensus earnings expectations last night and today include:
DragonWave (DRWI), Nautilus (NLS)

NEWSPAPERS/WEBSITES

McKesson (MCK) considers JV following failure of Celesio (CAKFY) bid, Bloomberg reports
Fox (FOXA) won't participate in network TV’s pilot season, Bloomberg reports
Dish's (DISH) Ergen says he bought LightSquared debt for himself, Reuters reports
Malone (LMCA, CHTR) seeks consolidation in Time Warner Cable (TWC) bid, Reuters reports
Pfizer's (PFE) generics unit attracts several suitors (VRX, ACT, MYL), Reuters reports
Nasdaq (NDAQ), S&P (MHFI) interested in acquisitions to grow index businesses, Reuters reports
FBI bulletin: Traders may be front running Fannie (FNMA), Freddie (FMCC), Reuters reports
DirecTV (DTV) wants Weather Channel fee reduction as apps take hold, WSJ reports
Ventas (VTR) and Health Care REIT (HCN) held talks, dealReporter reports
Sears (SHLD) may be cut by S&P, Bloomberg reports
Target's (TGT) problems may benefit security firms, NY Times reports

SYNDICATE

Altisource Residential (RESI) files to sell 10M shares of common stock
AmeriGas (APU) files to sell 8M common shares for Energy Transfer affiliate
Full Circle Capital (FULL) files to sell 1.6M shares of common stock
IHS Inc. (IHS) files to sell 3.48M shares of Class A common stock for holders
Methes Energies (MEIL) files to sell 3.54M shares of common stock for holders
RAIT Financial (RAS) files to sell 10M shares of common stock
Workday (WDAY) files to sell 6M shares of common stock Reported by Zero Hedge 10 hours ago.

In North Carolina, 89 percent of the 107,778 individuals who have signed up for a marketplace health insurance plan from the Affordable Care Act qualified for financial assistance, the highest percentage of any state running a federal marketplace. The Obama administration released new figures Monday about the number and demographics of those who have signed up for health insurance plans through the federal exchange, those marketplaces where individuals can comparison shop for plans from private… Reported by bizjournals 10 hours ago.

California Lawmaker Proposes Healthcare for Illegal Immigrants
Headlines
Legal
Nation
Politics
World

Democratic Senator Ricardo Lara of California is making headlines this morning after proposing that illegal immigrants should have access to a state version of President Obama’s Affordable Care Act.

"Immigration status shouldn't bar individuals from health coverage, especially since their taxes contribute to the growth of our economy," said Lara.

Currently, the state health insurance program Covered California does not allow for illegal immigrants to be covered, but many of the 2.6 million undocumented immigrants in the state are already covered by their employers through privatized plans. Lawmakers are currently trying to sort out the details of the proposal and say one option would be to create a program separate from Covered California that would pay for health insurance through state funds instead of federal funds.

"By the end of this year, Covered California will be entirely self-sustaining anyway," said Health Access executive director Anthony Wright, who is working with Lara on the proposal. "It will not be federally funded, it will not be state funded. It's funded by a small fee on each policy sold."

Wright says that this could be a chance for California to pave the way in the fight for immigration reform and rights for undocumented immigrants.

"There is precedent for California to be a leader,” said Wright. “There is precedent for California to piggyback on federal programs but take an extra step to expand to additional folks."

There are a number of different options on the table that could expand health insurance to illegal immigrants in California, and Lara, along with a team devoted to the proposal, is currently figuring it all out.

The support is not unanimous, however. Republican Assemblyman and gubernatorial candidate Tim Donnelly says that Lara’s proposal is misguided and could do economic harm.

"California cannot afford to create another incentive to attract people to come to our state illegally in pursuit of taxpayer-subsidized benefits," said Donnelly. "It's shameful that … Lara would trade on the plight of those who are ineligible."

Still, Lara and his team are moving forward, and it should be interesting to see where the future of government-funded healthcare for illegal immigrants goes in the coming months.

1 Reported by Opposing Views 8 hours ago.

In 2013, 850 users saved $45,000 off their prescription medication costs. The savings were realized through Mobile Health’s prescription discount card program offered free.

New York, NY (PRWEB) January 14, 2014

An end of year report shows that Mobile Health’s prescription discount card program saved users over $45,000 in 2013. The discount applies to most generic and brand name prescriptions sold at pharmacies nationwide. Since the cards are pre-activated and do not require registration, they are available for both individuals and family members to share.

Mobile Health provides the card free online and at all of its six locations in New York City and Long Island.

Total savings came from over 850 users who collectively saved an average of 67% off retail prescription costs. A highlighted transaction shows a user paying $35 for a $275 prescription. “These are real savings that our patients experience and benefit from” shares Rafael Landeiro, Mobile Health’s Marketing Coordinator.

Starting in 2012, Mobile Health partnered with WellCardRx, an affiliate of WellDyne, to provide healthcare cost savings to Mobile Health patients. WellDyne provided Mobile Health with thousands of pre-registered cards in English, Spanish, Mandarin, and Russian. An online version is also available on the Mobile Health website.

Every year over 200,000 patients visit Mobile Health for medical screening needs for their employment. Mobile Health’s medical centers specialize in employee screening services such as physicals, drug tests, vaccines, titers, and other fit to work services.

As more individuals and families register for health insurance as required by the Affordable Care Act, some may find that a discount prescription card will provide greater savings then paying insurance co-pays or a deductible. Others are unable to get health insurance coverage from an employer or are illegible for government subsidies and depend on the discount program to help pay for prescription medication.

Mobile Health is an occupational health provider with a special focus on employee screening services. Their six medical centers in New York City and Long Island perform 250,000 exams a year including pre-employment physicals, drug tests, DOT exams, and a variety of vaccination and employment related lab work. Mobile Health’s corporate headquarters is located at 229 West 36th Street 9th Floor New York, NY 10018. For more information, visit http://www.mobilehealth.net

WellDyneRx, a national pharmacy benefit management company, currently serves their more than 3 million health plan members through a retail network of over 59,000 national pharmacies and two mail service facilities. It also provides access to comprehensive specialty drug therapy for its clients and members. WellDyneRx’ customers include Managed Care Organizations, Medicare and government health plans, as well as those of employers and unions. For more information, visit http://www.welldyne.com/ Reported by PRWeb 8 hours ago.

FORT LAUDERDALE, Fla. (AP) — Roughly 140,000 Floridians signed up for the new federal health insurance program last month. That's nearly eight times the 18,000 others who signed up in October and November combined, according to figures released Monday.

Of the 158,030 enrollments thus far, about 55 percent were women and 45 percent were men. Roughly 20 percent fell into the crucial 18- to 34-years-old demographic and about 60 percent were between 45 and 64 years old. And 83 percent of those who purchased plans qualified for a tax credit, according to enrollment statistics from the Health and Human Services Department.

Florida continues to lead enrollment efforts among the three dozen states relying on the federally run marketplace, one of the main tenants of the Affordable Care Act. Florida's 158,030 enrollees compares to 118,532 in Texas. Nationwide, nearly 2.2 million have selected a plan.

December figures are much higher than the previous months' enrollment, which was plagued by technical glitches from healthcare.gov. But it was still far less than what officials had originally projected for Florida and nationwide.

Federal health officials said during a conference call with the media that they expect the numbers to climb in coming months, with a likely surge closer to the March enrollment deadline.

The Obama administration projected 7 million consumers would sign up for coverage during the first year, including about 477,000 in Florida.

Young healthy adults are among the most important group targeted by federal health officials' outreach efforts, prized by insurers in the marketplace to offset the costs of paying for older, sicker consumers.

Stacy Sylvain a 19-year-old college student in Miami, was one of last month's late sign-ups online. In roughly one hour, the part-time waitress signed up for a plan with a $158 monthly premium with the feds kicking in $48. She has a $2,500 deductible.

"Many people have a preconceived notion that young people are healthy and don't need to go to the doctor," said Sylvain who suffered a minor injury when she fell and hit her head during an indoor soccer class in 2012. "Not having to worry about being uninsured and the what-ifs has made an incredible impact on my life."

It's unclear what percentage of so-called "young invincibles" the government needs to balance out the risk pool. Federal health officials said Monday the figures suggested an appropriate mix, but noted they're only halfway through the open enrollment period.

"We expect that a number of young healthy individuals may wait until the very end to sign up," said Julie Bataille, communications director for the Centers for Medicare and Medicaid Services.

The mid-tier silver plans were the most popular choice among consumers with 60 percent choosing such plans nationally and 57 percent in Florida. Platinum plans were the next most popular choice, accounting for 17 percent in Florida, according to figures from HHS.

Monday's enrollment data did not break out demographics by race. Applicants are not required to give that information.

But federal health officials said they're planning to ramp up outreach to Hispanics, a disproportionately uninsured group, after they've worked out kinks in the Spanish language website. Some groups have complained of sloppy translations and say CuidadoDeSalud.gov moves more slowly than its English counterpart.

Anecdotal evidence suggests Latinos could be lagging their peers because of confusion about subsidies, cumbersome requirements for naturalization documents and fears they could unwittingly identify relatives in the country illegally.

An estimated 1.3 million Hispanic Floridians lack health insurance, according to the Kaiser Family Foundation, a nonprofit that studies health care issues. That's about one-third of the roughly 3.5 million uninsured people in Florida.

The Epilepsy Foundation of Florida, which received a federal grant, has been flooded with Hispanics seeking in-person assistance at its Miami headquarters. But enrollment counselors there said the federal government's website frequently asks for residency and naturalization papers from Hispanic applicants, which can stall the process for weeks if they are mailed in.

Yolanda Madrid, a 52-year-old housekeeper living in Miami, hasn't been able to afford health insurance until now. With the help of a counselor, Madrid learned last week that she qualifies for a tax credit. She hasn't signed up for a plan yet and is still narrowing down her choice, which includes one offering no monthly premium and a very low deductible. She initially tried to sign up for a plan through the federal government's Spanish-language hotline, but the operator couldn't find the application they'd helped her fill out before, so she decided to get help in person last week.

"Now I have more options to choose from that are affordable so I'm happy," she said.

__

Follow Kelli Kennedy on Twitter at www.twitter.com/kkennedyAP Reported by Huffington Post 6 hours ago.

This piece comes to us courtesy of Stateline. Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.
The promise of the Affordable Care Act is right there in its title: Affordable. Yet, anti-poverty agencies across the country fear that even with the federal financial assistance available under the law, health insurance will remain unaffordable for significant numbers of low-income Americans.

“For those with very low wages trying to raise kids, after paying for housing, electricity, food, transportation, and child care, asking people to pay another $50 or $100 a month, that’s just out of reach,” said Sireesha Manne, a staff attorney at the New Mexico Center on Law and Poverty.

The Affordable Care Act (ACA) is designed to make insurance affordable for Americans with low and moderate incomes—particularly since it requires all Americans to have health insurance starting this year, or face financial penalties. The law expands Medicaid eligibility (in the states that have agreed to do so) to the poorest Americans—those making up to 133 percent of the federal poverty line. But it also provides financial assistance for those making up to 400 percent of the poverty level to help them buy private insurance on the new state health exchanges.

Still, the financial help isn’t enough for some. “Even with the subsidies, some people simply won’t be able to manage to pay their health insurance premiums consistently with all the other costs facing them,” said Janet Varon, executive director of the Northwest Health Law Advocates in Seattle which works on health access issues.

-Financial Leverage-

The authors of the ACA anticipated this problem. To address it, the law allows states to create a separate insurance program, called the Basic Health Program, for people who earn too much to qualify for Medicaid and too little to afford insurance on the state exchanges, even with federal aid. Under such a plan, the federal government will give the subsidies directly to the states, instead of to individuals and families. The states are supposed to pool the money and then use the financial leverage to push insurers to offer less expensive coverage.

A number of states, including New York and Washington, are eager to create such programs, but they can’t until the Obama administration issues the regulations that will govern them. “We all thought we were going to be able to start in 2014 and then we waited for the rules, and we waited and waited and waited,” said Varon, who sits on a state board that will develop Washington’s Basic Health Program when the rules are finally written. Some now fear states won’t be able to launch the programs before 2016.

-A Computational Labyrinth-

For now, low-income Americans who aren’t eligible for Medicaid must rely on the financial help that is available to them on the health insurance exchanges.

Determining how much that amounts to is a computational labyrinth. According to the ACA, a family of three whose annual income is at 133 percent of the federal poverty level (an annual income of $24,352), should have to pay no more than 3 percent of their household income in annual premiums, or $731. In that case, the federal government would pay the insurance company the difference between $731 and the actual premium.

The percentage an individual or family is expected to pay rises at higher income levels, up to 400 percent of poverty. At that income level, paying up to 9.5 percent of household income on health insurance is considered affordable. So, a family of three making $73,240 would receive a subsidy to cover premium amounts above $6,958.

People making between 133 and 250 percent of the poverty level also can get help with their out-of-pocket medical expenses, such as co-payments for visits to the doctor, providing they purchase at least a “Silver” plan on the exchange. The exchanges offer up to four different tiers of health insurance plans: “Bronze,” “Silver,” “Gold” and “Platinum.” Bronze plans have the cheapest premiums, but leave policyholders with the highest co-payments and deductibles. Platinum plans have the highest premiums but the lowest co-pays and deductibles.

Under the Silver plans, people making more than 250 percent of the poverty level can expect to contribute an average of 30 percent for their medical costs, with their insurance company paying the rest. But those with incomes below 250 percent of the poverty level can get federal assistance with their out-of-pocket expenses. At 133 percent of the poverty level, an individual or family could contribute as little as 6 percent to the cost of their medical bills with the insurance company and the federal government picking up the rest.

Those cost-saving breaks, however, are only available for those selecting Silver plans, apparently to entice people away from Bronze plans with their high deductibles and co-pays.

-Defining “Affordable”-

Despite all of this assistance, health insurance still may not be “affordable” for some. Affordability, like beauty, is a matter of opinion. “What it means for something to be affordable or not affordable is totally debatable,” said Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service. “It isn’t like there’s a fixed definition of affordability.”

That’s particularly true in the U.S., where the cost of living varies so strikingly. “What’s poor in Mississippi is different from what’s poor in New York state,” said Elisabeth Benjamin, an executive with the Community Service Society of New York. “People have so little disposable income in New York City and other urban areas, but the law doesn’t do geographic indexing.”

Using cost of living data on the Albuquerque area from the Economic Policy Institute, Kelsey Heilman, a former staff attorney with the New Mexico Center on Law and Poverty, showed that a single mother of two making 200 percent of the poverty level would have virtually no money left for health care premiums or health care expenses after paying for housing, food, transportation and other necessities. That mother, Heilman said, might decide to go with the cheaper Bronze plan, but then she would forgo the cost-sharing help the federal government makes available for Silver plan policyholders. As a result, she might pay as much as 40 percent of her medical expenses out of pocket, instead of the 13 percent she would have to pay with a Silver plan. That difference could amount to more than $3,000 a year.

Those who decide to forgo insurance can ask for hardship exemptions from the financial penalty. But getting medical care is likely to become increasingly difficult for them because the federal government is cutting its payments to hospitals that provide charitable care to the poor.

Other possible solutions to the affordability problem have also surfaced. Massachusetts, which enacted its own health care reforms in 2006, won federal permission to use Medicaid dollars to provide premium and cost-sharing assistance for those with incomes below 300 percent of the poverty level who purchased private insurance on the Massachusetts exchange. Other states could apply for permission to do the same, but it is a months-long process.

States also might seek to raise eligibility for Medicaid above the 133 percent threshold. Manne, with the New Mexico Center on Law and Poverty, said some businesses and hospitals have talked about voluntarily undertaking sponsorships to help those unable to pay premiums or meet out-of-pocket obligations.

But, Manne said, broad relief seems months away, if not longer. In the meantime, she predicts that policymakers will be hearing about legions of Americans who still can’t afford health care—no matter the title of the Affordable Care Act. Reported by Huffington Post 7 hours ago.

A government bailout of the health insurance industry looks increasingly likely as too few young, healthy people have signed up for insurance on the Affordable Care Act's, or "Obamacare's," new health insurance exchanges. Reported by Christian Post 7 hours ago.

With the high-profile introduction and rollout of Obamacare, people have had a lot to say on the topic of health insurance -- including Wanda Sykes. On a recent episode of "Wanda Sykes Presents Herlarious," the comedian started her stand-up routine with a focus on government healthcare, beginning with why it might be a good thing for Chicago Bulls point guard Derrick Rose.

"They say the murder rate is down in Chicago, but Derrick Rose has killed off two knees, huh?" Sykes says. "Lucky for Derrick, though, there's Obamacare."

Sykes speculates that the injured NBA player could have had a difficult time qualifying for health insurance with his latest (second) season-ending knee injury. "Insurance companies would have been denying him left and right," she says. "Like, 'Uh-uh. You've got a preexisting condition. I saw it on Sports Center.'"

As for the technical glitches and functional difficulties many experienced with the Obamacare website during its launch, Sykes believes all the trouble could have been avoided.

"Let's be honest. Y'all know they should have only had people under 17 years old working on that damn website," Sykes says. "Nobody who's ever had a typewriter should have been working on that damn website." Reported by PopEater 7 hours ago.

As the record low temperatures hit the Midwest and Northeast earlier this month, kids and adults alike rejoiced as schools and commutes were cancelled so that people could stay inside where it was warm and safe.

Others may have had to make stark choices like to "heat or eat," choosing between staying warm and other essentials, like food or medicine.

Chronic conditions, untreated mental illness, injuries and gaping health disparities plague our healthcare system every single day. During a localized "cold emergency" like the polar vortex, or a large-scale disaster like a hurricane or tornado, these problems can get worse. Fortunately, in the past few years, there have been health reforms that ultimately make Americans more secure and disaster-ready.

The Affordable Care Act (ACA) makes it possible for Americans to access quality, affordable care and health insurance. Because of the law, you can no longer be denied coverage or charged more because of a pre-existing condition. The law also gives states the opportunity to expand Medicaid coverage. With the Medicaid expansion alone, millions of the lowest-income Americans will gain access to the care they need to stay healthy. Many will gain the security and peace of mind that comes with insurance for the first time in their lives.

This is important because the best indicator of how an individual or community will fare and recover after an emergency is how it was doing before the emergency. Odds are that if you are healthy before a disaster strikes, you'll be better able to get out of harm's way. You'll likely fare better if your power gets knocked out, need to evacuate or worse, or lose your home. You will probably recover faster too if you do get hurt.

While health insurance doesn't guarantee that you'll be healthy, it certainly makes it more likely. Health insurance plugs you into the system, and makes is easier to get needed preventive care and disease management. If you are healthier day to day, you'll be more self-reliant in a disaster. When individuals can take better care of themselves, it's good for the entire community. Whether in an outbreak, earthquake or storm, those with these resources can better care for themselves, allowing the authorities to focus on the most vulnerable right away.

Insurance also shields you from the staggering costs of an emergency room visit or hospitalization if you end up sick or injured because of the disaster. If your injury or illness requires long-term care, health reform also makes a difference. The ACA ends lifetime and annual dollar limits on essential health benefits, which protects survivors from medical bankruptcy and allows them to focus on healing.

Importantly, the ACA also requires mental health care and substance abuse services to be covered like any other kind of healthcare, extending these benefits to millions of Americans. In other words, survivors will already have these tools available to heal from the loss and trauma of a crisis already built into their existing plans. It also means that millions who suffer from untreated mental illness can get care before disaster strikes.

Reforms stretching even beyond the ACA also aid emergency response. For example, the Recovery Act in 2009 led to a shift from paper health records to electronic ones. When a tornado tore through Joplin, Mo., in 2011 and destroyed a hospital, old paper and film records were destroyed. Yet the medical personnel retained full access to their patients' electronic health records, allowing nearby hospitals and providers in makeshift emergency rooms to pull up survivor records. Today more than 330,000 health care providers use electronic health records, improving care during disasters and reducing the odds of unnecessary and dangerous medical complications.

There is still much work to do to prevent, prepare for, respond and recover from the adverse health effects of public health emergencies. However, health reform puts into motion important steps to make Americans more resilient and protected in the face of disaster.

Nicole Lurie is the Assistant Secretary for Preparedness and Response at Health and Human Services. Reported by Huffington Post 7 hours ago.

1. Let's begin with what we know: The Department of Health and Human Services reports that 24 percent of the people purchasing health insurance through Obamacare's insurance marketplaces are between ages 18 and 34. That's below the 38 percent that most people -- including the Obama administration -- estimate the law needs if it's to keep premiums as low as everyone hopes. Reported by Washington Post 6 hours ago.

According to some hard core health care reformers, the US should ultimately transition to fully individual-based health insurance. Of course, that's no small task now that Obamacare is in full swing. John R. Graham explains, describing what he calls the "Holy Grail" of free-market reformers. Read on... Reported by The Daily Reckoning 5 hours ago.

The term Obamacare isn't simply a reference to the person responsible for the program. It's also descriptive of the fundamental outlook of the program, i.e. a big government, top down solution of the kind you'd expect from a big government progressive like President Obama.

Monday, health insurance expert Bob Laszewski pondered what health reform might have been if it had been designed by entrepreneurs rather than big government progressives. He concludes that it would have looked very different. Entrepreneurs start from a position of serving people what they say they want and need. Progressives start from the position of dictating what people should have. The result of doing things the Obama-way is a lot of people who get something they don't really want.



There was an article at Kaiser Health News, "One Texan Weighs Obamacare Options: High Deductible Vs. 'Huge Fear." It describes a 43 year-old women who is healthy and spent only about $1,500 for minor health care services last year. The best deal she found on the federal health insurance exchange would cost her $178 a month and would have a $5,000 deductible.

She hasn't bought a policy yet.

She was quoted as saying, "I don't smoke, I'm relatively healthy, so I was pretty insulted when I saw this [the price]. I was extremely angry actually. I felt hoodwinked by the insurance companies: 'Oh, here's this wonderful insurance plan but by the way you need to come up with $6,000 out-of-pocket first before we pay anything."



As Laszewski sees it "Obamacare architects put most of their emphasis on deciding for consumers that they should have a mandate rich health plan." As that decision "drove the cost up, which in turn drove the deductibles up and narrowed the provider networks." That's how you wind up with Obamacare. The alternative would have started from a very different premise.



The entrepreneur might have gone to the woman in Texas––really lots of people in her category–– and asked what she wanted. Then the entrepreneur would have recognized that the federal government was willing to pay something toward the premium in the form of the subsidy.

What kind of deductible would she consider reasonable? What kind of premium would she be willing to pay for a plan with her preferred deductible? What kind of first dollar benefits would she value? What kind of catastrophic benefit would make sense?

Then, with her premium, the federal premium, the deductible she considers reasonable, and the first dollar benefits she would value, what kind of plan could we build for her––and the many healthy people who think like her?



Obamacare didn't start from that premise because big government progressives dictate, they don't take dictation. Laszewski concludes "Until the people who run Obamacare start listening to the people who aren't buying it, Obamacare won't work."

Actually, I'm not sure that's true anymore.

Laszewski's formulation assumes people have a choice and that by expressing those choices they could collectively hurt Obamacare in the long run. But that's really old-fashioned marketplace thinking, i.e. people vote with their wallets and bad ideas fail for lack of funds. That's not actually possible in this case.

Failure is not an option for Obamacare, not so long as the government can wring out your wallet until you agree to take their deal. The government may not be able to make you buy broccoli but it can tax everything else until broccoli looks like the only sensible alternative.

 
 
 
  Reported by Breitbart 5 hours ago.

Hospitals and clinics across the U.S. are racing to upgrade their paper files to electronic ones in order to comply with the Affordable Care Act, which specifies that providers must show "meaningful" implementation of electronic health records by 2015 or face monetary penalties.

But in choosing among hundreds of competing electronic health record systems, health care providers may be creating the same disorganization as the paper trails they set out to streamline.

"The foundations and the intent of the Affordable Care Act are laudable," said Dr. Patrick Soon-Shiong, a Los Angeles-based surgeon and drug inventor-turned-entrepreneur. "The way it's being implemented is a disaster."

On Monday, Soon-Shiong offered up his solution to the "disaster" with the launch of health IT company NantHealth, a subsidiary of his medical technology company NantWorks. He also unveiled NantHealth's intelligent Clinical Operating System (iCOS), which patients and caregivers can use to pull data from dozens of competing electronic medical record systems in order to create a single, easy-to-access profile of individual patients' medical history and current health regimen.

Soon-Shiong said the iCOS platform had the potential to transform electronic medical records in the U.S., adding that it could also deliver real-time vital statistics about patients based on the information medical devices can send up to the cloud that stores their medical data.

"Let's say that you live in Los Angeles but happen to be on a vacation in Florida when you get injured," Soon-Shiong said. A trip to the emergency room in Florida might leave you with an X-ray, he continued, and upon returning home and visiting your primary-care doctor, that X-ray would be available at all times using iCOS.

"It's there for you to see, even though the doctor in Los Angeles has no idea who the doctor in Florida is," he said. "The data is just available to you." Practitioners, for their part, would not be able to access such information without the patient's explicit permission.

iCOS interfaces with major health IT vendors, Soon-Shiong said, opening up lines of communication among doctors and practices that haven't been able to easily share information in the past. That means if even one of your doctors has iCOS, all of your caregivers across multiple health systems will be connected.

The platform also has a software component that gives physicians access to a database of 10,000 cancer clinical trials and more than 1,700 evidence-based cancer therapies to help them make appropriate treatment decisions.

Soon-Shiong hopes iCOS will play a major role in lowering the cost of the world's most expensive health care system. Health care in America is pricier than in other countries largely as a result of the fee-for-service model that pays physicians and hospitals for each treatment administered, as opposed to payment for the patient's overall health.

"The system is completely broken," Soon-Shiong said. "Nobody gets paid for keeping people healthy."

iCOS is designed to gather information about a patient's specific regimen and the costs of specific treatments. It can then continually update a patient's vital signs to give a comprehensive view of his/her health. And that, Soon-Shiong said, is the key to transforming health care from a fee-for-service model to value-based care, in which a physician or hospital is paid to keep a person healthy at the lowest possible cost.

Soon-Shiong built components of iCOS in clinics and hospitals across the country over the past 10 years. He personally invested $800 million in 60 companies and university research programs that worked on each aspect of the operating system, and Monday's announcement confirmed that iCOS is now available for purchase as a fully integrated system.

A spokesperson with the federal Health and Human Services Department's Office of the National Coordinator for Health IT (ONC) declined to comment specifically on iCOS but said the department is "always pleased" to learn about new tools that have the potential to ease the exchange of health information.

ONC said consumers would need to be assured of the privacy of any new tools that allow for the exchange of health information. Soon-Shiong described NantHealth's storage cloud as "HIPAA-secured," meaning that it complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which governs patient privacy and the security of personal medical information.

Soon-Shiong may soon face a competitive marketplace. But, for now, his product is the first of its kind in the field, said Stephen M. Shortell, Ph.D., professor of health policy and management at the University of California, Berkeley School of Public Health.

"He's certainly among the first to propose something this innovative," Shortell said. "There's likely to be competition in that space, and I do know there are others thinking along the same lines that just haven't made public announcements yet."

Catherine DesRoches, DrPH, a health IT researcher at New Jersey-based Mathematica Policy Research, agreed on the need for a tool like iCOS but added a note of caution.

"What [Soon-Shiong] is describing here seems to be out in front of where the market is, which is great," she said. "But the devil is in the details with these kinds of things. Let's see how they implement it."

DesRoches praised NantHealth's real-time, wireless biometrics stored in the cloud but noted that not all of the U.S. is connected with broadband internet. "I think [iCOS] will be implemented in places where they are already far ahead on the curve, and perhaps is not as useful for smaller, rural, limited access types of places where connectivity is still a real issue," she said.

Still, experts agree that NantHealth may be an important advance. Data integration and harmonization is "where everyone wants to go," said Justin Doctor, Ph.D., associate professor at the University of Southern California School of Pharmacy and the director of health informatics at the Schaefer Center for Health Policy and Economics.

"We've been doing electronic medical records for 40 years and we still can't get them to talk to each other," Doctor said. "If it works," he said in reference to iCOS, "the proof will be in the pudding." Reported by Huffington Post 5 hours ago.

Filed under: Auto Insurance, Health Insurance, Homeowners Insurance, Consumer Issues, Consumer Protection

*Getty Images*

By Susan Johnston

When emergencies like car accidents, medical scares or house fires strike, filing an insurance claim may not be top of mind. But once the dust settles and the bills start pouring in, many consumers are relieved to know that insurance could help protect them against financial losses resulting from these calamities. However, the claims process doesn't always run smoothly.

If, for instance, you forget to submit a key piece of documentation, your loss falls under an exclusion or you use an out-of-network provider, your insurance provider may not cover your losses. Here's a look at strategies for maximizing the chances that your claim will get paid.

*Know what's covered.* Ideally, you'd be familiar with the ins and outs of your policy before you actually need it, including the amount of any deductibles you are responsible for, how long you have to file a claim and how long the process takes. Knowing this can help you set realistic expectations and choose providers that are likely to be covered (auto insurers may try to steer you toward a certain body shop, but you are not required to use the shop they prefer).

Issues around health care insurance claims often center on whether the medical provider is in-network or out-of-network, according to Martin Rosen, executive vice president, chief marketing officer and co-founder of Health Advocate, an independent health care advocacy and assistance company. In-network doctors have a contracted rate set with your insurance company, so you'll typically pay less out of pocket. "If you go out of network, doctors are able to bill their regular list charges and then to the extent that you've met your deductible and your insurance kicks in, insurance companies only pay what's usual and customary," Rosen explains.

Unfortunately, the in-network issue isn't always clear to the patient.
Say you have a doctor who's in-network and refers you to a hospital. You might assume that the hospital would also be in-network, but Rosen says this isn't necessarily the case because some doctors practice at multiple hospitals. "All of this ends up in confusion depending on what you did," he adds.

Understanding your policy is also key with property and casualty insurance, where there's an important distinction between replacement cost and actual cash value for your car, home or possessions. Say a tree falls through the roof of your house and destroys your eight-year-old washing machine. "With a replacement cost policy, the insurance company would pay to replace the old machine with a new one," explains Loretta Worters, vice president of the Insurance Information Institute. "If you had an actual cash value policy, the company would pay only a part of the cost of a new washing machine because a machine that has been used for eight years is worth less than its original cost."

When it comes to destruction from floods, standard homeowners and renters insurance policies do not cover flood damage, but separate flood coverage is available from the federal government's National Flood Insurance Program and a few private insurers.

*Keep detailed documentation.* Maintain records of all communication with your insurance company, including copies of documents you mail and logs of phone conversations, the date of each call, the name of the person you spoke to and what was said. If you need to appeal a decision, this documentation can prove critical, according to Rosen.

Amy Bach, executive director of United Policyholders, a nonprofit that advises consumers on the claims process, suggests following up on each conversation to create a paper trail. "If you've had a conversation with the adjuster, follow up on it with a short email confirming what's been agreed to and what still remains outstanding," she says. "Make it clear in your communications that you are a proactive consumer, give your insurer proof of your losses and be very specific in asking for the dollar amounts you are entitled to."

Keep receipts for all out-of-pocket expenses such as a hotel stay while your home is being repaired or towing your car to a body shop following an accident.

Here are your options if your claim is denied and you still believe it should be covered:

*File an appeal.* Once you've exhausted your insurer's internal channels for filing a claim, you can generally appeal with an external review through the government agency that oversees insurance companies in your state. "The insurance company is obligated to provide you with this information, but it might not be in the easiest-to-understand way," Rosen says.

In cases when an insurance company has denied coverage for a medical condition that's considered an emergency, you may be able to apply for an expedited review. Even if it's not an emergency, pay attention to timelines. "Don't ignore things because there are limits on how long you have to appeal [claims], and the clock is running," Rosen says.

*Hire a professional.* For smaller claims, it may not make financial sense to hire an attorney, advocate or public adjuster to help argue your case. But if large sums of money are at stake or the issue is complex, the math may pencil out. Depending on your state and the size of your claim, you may be able to hire a lawyer on a contingency basis, which means the lawyer "will only get paid if they recover for you, and their fee will be a percentage of what they recover for you," Bach says, adding that good contingency lawyers won't take on cases of less than $50,000 because their fee wouldn't be large enough to make it worth their while.

However, in many cases, consumers can recover losses on their own. "Insurance can be very intimidating," Bach says. "The lingo is confusing to the average person, but if you educate and empower yourself, you get a lot more than you think just by speaking up."

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-*More from U.S. News*-

· A Consumer's Guide to 'Obamacare'
· Should You Try Pay-As-You-Drive Insurance?
· Is Life Insurance a Retirement Investment?

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Vermont's efforts to implement the federal Affordable Care Act took another hit Tuesday as officials announced they were suspending efforts to have small businesses enroll in health insurance through a state website and saying they should enroll instead directly with insurance companies. Reported by ajc.com 4 hours ago.