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Last week for health insurance on battleground Obamacare markets

Enerica Rodriguez didn’t wait until the last minute. She signed up for health insurance at the end of November, ensuring that she and her husband Marcelino continued the coverage they’ve been relying on.

“We are trying to hold onto that insurance,” said Rodriguez, 40, who works at a Dallas-area dry cleaners. She’s a fan.

Despite attacks on the Affordable Care Act by Republicans in Congress and President Donald Trump, millions are signing up in the last days of open enrollment for health insurance on the exchanges the law created.

Most have access to free policies, or to very cheap coverage.

f88b2_171213-healthcare-signup-ac-659p_4ae22fd9d56cad7e5896538de6ddc695.nbcnews-fp-360-360 Last week for health insurance on battleground Obamacare markets


f88b2_171213-healthcare-signup-ac-659p_4ae22fd9d56cad7e5896538de6ddc695.nbcnews-fp-360-360 Last week for health insurance on battleground Obamacare markets

Rodriguez snapped up one inexpensive policy.

“As soon as the Obama insurance came out, that’s when we started buying,” Rodriguez said.

She is not alone. As of last Saturday, 4.7 million people had signed up for health insurance on the federal exchanges set up by the 2010 Affordable Care Act, the Health and Human Services Department reports.

Related: Obamacare signups surge but enrollment may end lower, anyway

That’s 650,000 more than had signed up at the same time last year.

But open enrollment ends sooner this year than in years past. Friday is the last day for people wanting to buy insurance that starts Jan. 1 on the federal exchanges. Some states that run their own exchanges have extended this period — Maryland extended the signup period for its exchange to December 22, while Massachusetts allows signups until Jan. 23.

And so unless another 4 million people sign up in the coming days, total enrollment will likely fall short of last year’s total of 9.2 million who got health insurance on the federal exchanges.

“This is clearly a critical week,” said Sara Collins of the nonprofit Commonwealth Fund, which conducts research into public health.

It is about more than just numbers. In the U.S., having health insurance is a basic requirement for people to get medical treatment.

“If people are going to continue to be able to get and afford the health care they need, it will be essential to hold on to and build on these coverage gains,” Collins said.

Related: Here’s your cheat sheet for buying Obamacare

“Millions of people who got health insurance will enjoy better health status over time,” added Commonwealth Fund president Dr. David Blumenthal.

‘Death by a thousand cuts’

Report after report show the number of people going without health insurance has plummeted since 2013.

“Between 2013 and 2016 — the first three years of the ACA’s major coverage expansions — the number of uninsured Americans under age 65 fell by an estimated 17.8 million. Uninsured rates declined in every state and the District of Columbia,” the Fund said in a report released Thursday.

But the Trump Administration and a new Republican-dominated Congress waged open war on the ACA for most of 2017, with Trump repeatedly saying Obamacare was dead, even as Congress failed repeatedly to repeal the laws.

The White House ordered HHS to scale back enrollment outreach and fought with insurance companies over subsidies, a battle that resulted in higher premiums in some places.

And HHS also shortened the enrollment period for 2018, raising fears that four years of coverage gains would be lost.

“They cut the enrollment period, they slashed the outreach and they are trying to do everything they can to give it death by a thousand cuts,” said Wisconsin Rep. Mark Pocan, a Democrat.

“Many incorrectly believe Obamacare has been repealed,” said Kevin Nix, spokesman for Legacy Community Health, a not-for-profit federally qualified health center in Texas.


f88b2_171213-healthcare-signup-ac-659p_4ae22fd9d56cad7e5896538de6ddc695.nbcnews-fp-360-360 Last week for health insurance on battleground Obamacare markets


The worry was that with Trump declaring Obamacare “dead”, people would give up on getting insurance. And the federal government has said it won’t enforce the mandate, which requires most people to have some sort of health insurance or pay a fine on their income tax.

“When Obama left office, people thought so did Obamacare,” said Trilena Amos, director of patient access for Legacy. “Initially, people were very confused. They didn’t know the difference between Obamacare and marketplace insurance.”

Groups and clinics like Legacy launched their own outreach campaigns, buying ads on social media, television and radio, posting billboards, and holding events. And they are holding their own events to help people get signed up — a complex and confusing process made harder without the help of teams of navigators that were deployed in years past by the federal government.

Health insurance companies have been advertising heavily, also.

“We have been having to educate people,” Amos said. But she fears efforts will fall short, anyway.

“With it being the shortest open enrollment period that we have ever had, we are not touching everyone,” Amos said. “I don’t know if everyone is set.”

News media have typically covered open enrollment heavily, especially after the disastrous first year of the exchange rollout when the web-based signup system crashed repeatedly.

Unexpected benefits

The controversy over the ACA may have made some people want health insurance more badly than ever before, said Amos. Social science shows that people often value something more if they have had it and may lose it.

“I think the community may have grown in appreciation,” Amos said.

“A lot of individuals become very excited wanting to enroll, because they know — if I can get insurance now let me go for it. Those who missed opportunities in the past, they definitely want to take advantage of it now.”

Collins agreed.

“People are much more aware of the availability of coverage than before,” she said.

ACA critics have pointed to rising premiums and the decision by many insurance companies to pull out of markets they’d previously offered policies in. The result has been that people in many counties have just one, or maybe two, companies to choose from.

But there have been some unexpected benefits for people, too. Rising premiums aren’t necessarily passed on to the customer and many people have options for free health insurance. Health consulting firm Avalere Health reported this week that 98 percent of counties covered by Healthcare.gov have at least one free policy on offer.

“In 2018, these highly-subsidized consumers will also have access to free silver plan options in 18 percent of counties,” Avalere said.

f88b2_171213-healthcare-signup-ac-659p_4ae22fd9d56cad7e5896538de6ddc695.nbcnews-fp-360-360 Last week for health insurance on battleground Obamacare markets


f88b2_171213-healthcare-signup-ac-659p_4ae22fd9d56cad7e5896538de6ddc695.nbcnews-fp-360-360 Last week for health insurance on battleground Obamacare markets

“Further, 10 percent of counties will have free gold plan options available to individuals making $18,090, or 150 percent of poverty, per year. While availability of free subsidized options decreases for individuals with higher incomes, 2018 will have a high number of free subsidized options.”

That includes markets with no competition. Medica, the only company offering policies in Iowa and Nebraska, says 24,000 of its customers have plans with 100 percent of the premium covered by the federal government.

Related: Obamacare’s biggest day, in 2016

Children’s coverage at risk

HHS says 80 percent of people signing up on Healthcare.gov have the choice of a plan with premiums of just $75 or less a month— although people buying those plans may have higher co-pays and deductibles.

Nonetheless, the outlook remains uncertain for people relying on federal government support for health insurance. Congress has failed to renew funding for the Children’s Health Insurance Program (CHIP), which covers more than 9 million low-income kids.

Rodriguez said she may be forced to buy a more expensive ACA plan if her kids, aged 10 and 13, lose CHIP. And her plan won’t cover their medication for asthma, eczema and ADHD.

“It will be expensive for us,” she said.

“In the absence of an extension, more than half of states are projected to run out of federal CHIP dollars by March 2018,” Commonwealth said. “The result could be a loss of coverage for millions of children.”

So for the next two days, the push is on.

“This is the busiest week of my career,” said Amos. She hopes people don’t wait until the very last moment.

“History has proved that on busier days the website does blow up a little bit,” she said.

“We will see a lot of sad people on the 15th.”

Last week for health insurance on battleground Obamacare markets

Enerica Rodriguez didn’t wait until the last minute. She signed up for health insurance at the end of November, ensuring that she and her husband Marcelino continued the coverage they’ve been relying on.

“We are trying to hold onto that insurance,” said Rodriguez, 40, who works at a Dallas-area dry cleaners. She’s a fan.

Despite attacks on the Affordable Care Act by Republicans in Congress and President Donald Trump, millions are signing up in the last days of open enrollment for health insurance on the exchanges the law created.

Most have access to free policies, or to very cheap coverage.

f88b2_171213-healthcare-signup-ac-659p_4ae22fd9d56cad7e5896538de6ddc695.nbcnews-fp-360-360 Last week for health insurance on battleground Obamacare markets


f88b2_171213-healthcare-signup-ac-659p_4ae22fd9d56cad7e5896538de6ddc695.nbcnews-fp-360-360 Last week for health insurance on battleground Obamacare markets

Rodriguez snapped up one inexpensive policy.

“As soon as the Obama insurance came out, that’s when we started buying,” Rodriguez said.

She is not alone. As of last Saturday, 4.7 million people had signed up for health insurance on the federal exchanges set up by the 2010 Affordable Care Act, the Health and Human Services Department reports.

Related: Obamacare signups surge but enrollment may end lower, anyway

That’s 650,000 more than had signed up at the same time last year.

But open enrollment ends sooner this year than in years past. Friday is the last day for people wanting to buy insurance that starts Jan. 1 on the federal exchanges. Some states that run their own exchanges have extended this period — Maryland extended the signup period for its exchange to December 22, while Massachusetts allows signups until Jan. 23.

And so unless another 4 million people sign up in the coming days, total enrollment will likely fall short of last year’s total of 9.2 million who got health insurance on the federal exchanges.

“This is clearly a critical week,” said Sara Collins of the nonprofit Commonwealth Fund, which conducts research into public health.

It is about more than just numbers. In the U.S., having health insurance is a basic requirement for people to get medical treatment.

“If people are going to continue to be able to get and afford the health care they need, it will be essential to hold on to and build on these coverage gains,” Collins said.

Related: Here’s your cheat sheet for buying Obamacare

“Millions of people who got health insurance will enjoy better health status over time,” added Commonwealth Fund president Dr. David Blumenthal.

‘Death by a thousand cuts’

Report after report show the number of people going without health insurance has plummeted since 2013.

“Between 2013 and 2016 — the first three years of the ACA’s major coverage expansions — the number of uninsured Americans under age 65 fell by an estimated 17.8 million. Uninsured rates declined in every state and the District of Columbia,” the Fund said in a report released Thursday.

But the Trump Administration and a new Republican-dominated Congress waged open war on the ACA for most of 2017, with Trump repeatedly saying Obamacare was dead, even as Congress failed repeatedly to repeal the laws.

The White House ordered HHS to scale back enrollment outreach and fought with insurance companies over subsidies, a battle that resulted in higher premiums in some places.

And HHS also shortened the enrollment period for 2018, raising fears that four years of coverage gains would be lost.

“They cut the enrollment period, they slashed the outreach and they are trying to do everything they can to give it death by a thousand cuts,” said Wisconsin Rep. Mark Pocan, a Democrat.

“Many incorrectly believe Obamacare has been repealed,” said Kevin Nix, spokesman for Legacy Community Health, a not-for-profit federally qualified health center in Texas.


f88b2_171213-healthcare-signup-ac-659p_4ae22fd9d56cad7e5896538de6ddc695.nbcnews-fp-360-360 Last week for health insurance on battleground Obamacare markets


The worry was that with Trump declaring Obamacare “dead”, people would give up on getting insurance. And the federal government has said it won’t enforce the mandate, which requires most people to have some sort of health insurance or pay a fine on their income tax.

“When Obama left office, people thought so did Obamacare,” said Trilena Amos, director of patient access for Legacy. “Initially, people were very confused. They didn’t know the difference between Obamacare and marketplace insurance.”

Groups and clinics like Legacy launched their own outreach campaigns, buying ads on social media, television and radio, posting billboards, and holding events. And they are holding their own events to help people get signed up — a complex and confusing process made harder without the help of teams of navigators that were deployed in years past by the federal government.

Health insurance companies have been advertising heavily, also.

“We have been having to educate people,” Amos said. But she fears efforts will fall short, anyway.

“With it being the shortest open enrollment period that we have ever had, we are not touching everyone,” Amos said. “I don’t know if everyone is set.”

News media have typically covered open enrollment heavily, especially after the disastrous first year of the exchange rollout when the web-based signup system crashed repeatedly.

Unexpected benefits

The controversy over the ACA may have made some people want health insurance more badly than ever before, said Amos. Social science shows that people often value something more if they have had it and may lose it.

“I think the community may have grown in appreciation,” Amos said.

“A lot of individuals become very excited wanting to enroll, because they know — if I can get insurance now let me go for it. Those who missed opportunities in the past, they definitely want to take advantage of it now.”

Collins agreed.

“People are much more aware of the availability of coverage than before,” she said.

ACA critics have pointed to rising premiums and the decision by many insurance companies to pull out of markets they’d previously offered policies in. The result has been that people in many counties have just one, or maybe two, companies to choose from.

But there have been some unexpected benefits for people, too. Rising premiums aren’t necessarily passed on to the customer and many people have options for free health insurance. Health consulting firm Avalere Health reported this week that 98 percent of counties covered by Healthcare.gov have at least one free policy on offer.

“In 2018, these highly-subsidized consumers will also have access to free silver plan options in 18 percent of counties,” Avalere said.

f88b2_171213-healthcare-signup-ac-659p_4ae22fd9d56cad7e5896538de6ddc695.nbcnews-fp-360-360 Last week for health insurance on battleground Obamacare markets


f88b2_171213-healthcare-signup-ac-659p_4ae22fd9d56cad7e5896538de6ddc695.nbcnews-fp-360-360 Last week for health insurance on battleground Obamacare markets

“Further, 10 percent of counties will have free gold plan options available to individuals making $18,090, or 150 percent of poverty, per year. While availability of free subsidized options decreases for individuals with higher incomes, 2018 will have a high number of free subsidized options.”

That includes markets with no competition. Medica, the only company offering policies in Iowa and Nebraska, says 24,000 of its customers have plans with 100 percent of the premium covered by the federal government.

Related: Obamacare’s biggest day, in 2016

Children’s coverage at risk

HHS says 80 percent of people signing up on Healthcare.gov have the choice of a plan with premiums of just $75 or less a month— although people buying those plans may have higher co-pays and deductibles.

Nonetheless, the outlook remains uncertain for people relying on federal government support for health insurance. Congress has failed to renew funding for the Children’s Health Insurance Program (CHIP), which covers more than 9 million low-income kids.

Rodriguez said she may be forced to buy a more expensive ACA plan if her kids, aged 10 and 13, lose CHIP. And her plan won’t cover their medication for asthma, eczema and ADHD.

“It will be expensive for us,” she said.

“In the absence of an extension, more than half of states are projected to run out of federal CHIP dollars by March 2018,” Commonwealth said. “The result could be a loss of coverage for millions of children.”

So for the next two days, the push is on.

“This is the busiest week of my career,” said Amos. She hopes people don’t wait until the very last moment.

“History has proved that on busier days the website does blow up a little bit,” she said.

“We will see a lot of sad people on the 15th.”

Apple loses ground to Android in a few key markets

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Apple loses ground to Android in a few key markets

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Securing the internet of things means using markets, not mandates

A surprising number of everyday devices are now connected to the internet. And it’s not just your Amazon Echo or Google Home; it may be your thermostat, your car, or even your toaster.

These devices, and many more like them, make up the “internet of things” (IoT). Though new, these devices are proving quite useful to businesses and consumers. However, the proliferation of billions of new connected devices also presents novel security threats that demand serious attention.

IoT devices create opportunities for bad actors to commandeer devices and use them for nefarious purposes — like temporarily disabling major websites. These incidents have triggered calls for government to proactively regulate IoT security.

Yet, as we argue in a recent policy study from the R Street Institute and Internet Governance Project, market-driven measures are better equipped to address these challenges.

 

The rationale for avoiding government involvement is twofold. First, the government regulations currently contemplated, though appealing in theory, may forestall necessary security updates and act with an overabundance of caution. Second, private mechanisms already show promise in responding to vulnerabilities.

Though perhaps counterintuitive, government regulation in the form of pre-market approval or particular design requirements would leave firms poorly situated to respond to evolving threats that necessitate real-time response. Far from being built for speed, government regulatory processes are intentionally slow. In the context of IoT security, delay is costly; rapid updates to devices and software are essential to repair vulnerabilities and respond to attacks.

Thus, requiring government entities to approve updates before rollout may do more harm than good. It could lead to scenarios in which the damage caused by an attack compounds while bureaucratic deliberations grind on. Pre-market approval systems, in particular, are prone to potentially harmful delays; in the context of medical devices, pre-market approval systems often delay device deployment by more than 20 months.

Another fundamental limitation of the public sector is the inability of governments to rely on market signals the same way private firms do. Governments are not disciplined by profit and loss because their revenue is a function of taxation, not market exchange. Thus, while expending more resources can always marginally increase security, government is not well equipped to evaluate whether the cost of that regulation is worthwhile. And the proper scope of intervention is hard to calculate without using market prices and profit/loss feedback.

The second reason for avoiding government intervention in the realm of IoT security is that private firms have already forged ahead on providing solutions. Services like Microsoft’s Azure, Amazon’s AWS IoT and Google’s Cloud IoT Core provide trusted-device registration and allow users to control how their devices interact.

Besides having the right incentives to optimize for accessibility and security, these private platforms can also cross borders more readily than jurisdictionally-limited governments. Thus, private firms can maintain both the security of individual devices and the system as a whole. Profit motive also pushes these firms to register as many devices as possible. By aligning incentives and bypassing barriers, these private registries are more likely to foster optimal security arrangements than government-mandated ones.

Cyber insurance is another promising, private option for IoT security. Since their money is at stake in securing IoT systems, insurance companies carefully review potential clients’ risk before writing policies. Once written, policies may require insured parties to maintain security best-practices and practice good cyber hygiene, like completing regular updates and crafting secure passwords, to keep their coverage. Annual renewal procedures also provide a recurring opportunity for both insurer and insured to reassess their preparedness.

Like all technological developments, these market-driven measures are still fairly young but are growing rapidly. In some sense, the IoT field of today is akin to the fledgling PCs of the 1980s and the smartphones of the early 2000s. Security for those devices started weak but grew stronger over time not because of government regulation, but because manufacturers learned more about threats and how to respond to them. Likewise, the well-meaning yet ill-equipped government should not stifle the IoT security market’s potential for growth.

IoT security cannot afford to move at the speed of government. Only by harnessing market driven measures can we can enhance both the security and the possible benefits of the internet of things.

Ian Adams (@IAaboutCA) is associate vice president and Joe Kane (@TheJoeKane) is technology policy associate for the R Street Institute.

This Emerging Markets Internet ETF Celebrates Anniversary In Style

55149_technology-785742_1920_78 This Emerging Markets Internet ETF Celebrates Anniversary In Style

With over 2,000 exchange traded products listed in the U.S., hardly a day goes by without at least one celebrating an anniversary of some kind. One of the more noteworthy anniversaries in the world of exchange traded funds is the third anniversary of the EMQQ Emerging Markets Internet E-Commerce ETF (NYSE: EMQQ).

Earlier this month, EMQQ celebrated its third anniversary and did so in style. The fund is up 73 percent year-to-date, making it one of the best-performing, non-leveraged ETFs this year.

“EMQQ seeks to track, before fees and expenses, the performance of EMQQ The Emerging Markets Internet and ECommerce Index, which requires that its constituents derive at least half of their revenue from Internet and Ecommerce businesses in emerging or frontier markets,” according to a statement from EMQQ’s issuer.

The EMQQ Story

While traditional, cap-weighted emerging markets benchmarks have recently increased their exposure to fast-growing Internet and technology stocks, these indexes still have comparatively light allocations to some of the more exciting emerging markets themes. That has opened the door for more tactical ETFs, such as EMQQ, to attract investors’ assets.

Indeed, that is what EMQQ, particularly this year. EMQQ has about $350 million in assets under management, of which nearly $285 million has flowed into the fund just this year. More importantly, EMQQ’s performance tops that of standard emerging markets benchmarks.

“As of November 13, 2017, the fund had $347.57 million in assets under management, and had returned an average of 14.92% annually since launch, compared to 10.24% percent for the SP 500 and 5.70% percent for the MSCI Emerging Markets Index,” according to EMQQ’s issuer.

Usual Suspects

Although EMQQ is not restrained at the geographic or sector levels, the ETF is predictably heavily allocated to China. Several of the ETF’s top 10 holdings are Chinese Internet giants, including Tencent Holdings Ltd. (OTC: TCEHY), Alibaba Group Holdings (NYSE: BABA) and Baidu.com Inc. (NASDAQ: BIDU). That trio combines for 26.7 percent of EMQQ’s roster.

China accounts for nearly two-thirds of EMQQ’s underlying index while South Korea and Russia combine for nearly 21 percent.

“The populations in the emerging markets as defined by MSCI are younger and growing faster than in the developed world, and are in general becoming more affluent,” said Kevin Carter, co-founder and chief executive officer of EMQQ Index. “At the same time, these emerging market countries are leap frogging the traditional bricks and mortar way of doing business and moving substantial portions of their economies directly online. We think these are long running secular trends that could continue to drive ecommerce and EM growth for the foreseeable future.”

Related Links:

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Posted-In: Long Ideas Emerging Markets Emerging Market ETFs Top Stories Markets Trading Ideas ETFs Best of Benzinga

Apple needs to win 2 of these 3 markets to make up for HomePod delay: Wolff

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c72b4_104861592-6ED1-CB-AppleLee-112417.600x400 Apple needs to win 2 of these 3 markets to make up for HomePod delay: Wolff


Apple typically sells tens of millions of iPhones each holiday season, regardless of whether the company offers holiday discounts.

But with its HomePod smart speaker officially delayed until next year, a limited supply of the iPhone X and no virtual reality headset, Apple faces intense pressure this shopping season, economist Max Wolff said on Friday.

“The super hot phone …. they were late to it, Samsung got there first,” Wolff told CNBC’s “Closing Bell” on Friday. “They’re certainly not the first entry into the smart home space. They’re about to also get to VR, but also not first. They need to hit the cover off the ball in two of those three things to continue to be the biggest company in the world by market cap.”

Apple wasn’t immediately available to comment on Wolff’s remarks.

Apple’s iPhone X may be popular, but it’s behind competitors like Samsung in adding features like bigger and brighter screens. Now, as Amazon’s Echo saturates the market, the HomePod is further behind, Wolff said. Apple’s new iPhones feature augmented reality tools, but CEO Tim Cook has said he doesn’t see as much potential in headsets like Facebook’s Oculus or Microsoft’s HoloLens.

That all means the iPhone X will be “hugely important” for Apple, especially if the iPhone 8 turns out to be a dud.

“They really need this to shine,” Wolff said.

c72b4_104861592-6ED1-CB-AppleLee-112417.600x400 Apple needs to win 2 of these 3 markets to make up for HomePod delay: Wolff

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Apple needs to win 2 of these 3 markets to make up for HomePod delay: Wolff

<!– –>




c72b4_104861592-6ED1-CB-AppleLee-112417.600x400 Apple needs to win 2 of these 3 markets to make up for HomePod delay: Wolff


Apple typically sells tens of millions of iPhones each holiday season, regardless of whether the company offers holiday discounts.

But with its HomePod smart speaker officially delayed until next year, a limited supply of the iPhone X and no virtual reality headset, Apple faces intense pressure this shopping season, economist Max Wolff said on Friday.

“The super hot phone …. they were late to it, Samsung got there first,” Wolff told CNBC’s “Closing Bell” on Friday. “They’re certainly not the first entry into the smart home space. They’re about to also get to VR, but also not first. They need to hit the cover off the ball in two of those three things to continue to be the biggest company in the world by market cap.”

Apple wasn’t immediately available to comment on Wolff’s remarks.

Apple’s iPhone X may be popular, but it’s behind competitors like Samsung in adding features like bigger and brighter screens. Now, as Amazon’s Echo saturates the market, the HomePod is further behind, Wolff said. Apple’s new iPhones feature augmented reality tools, but CEO Tim Cook has said he doesn’t see as much potential in headsets like Facebook’s Oculus or Microsoft’s HoloLens.

That all means the iPhone X will be “hugely important” for Apple, especially if the iPhone 8 turns out to be a dud.

“They really need this to shine,” Wolff said.

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Get government out and let markets work in health care

Ask the average American what he thinks about health care costs, and he’ll tell you a few things. He’ll tell you it is too expensive and too complicated, that he pays too much for too little, and how outrageous it is that Americans pay more for health care than any country in the world. In all cases, he’ll be spot on. He knows there’s a problem, and he doubts it can be solved — but it can. 

Here’s what we know: America is predicted to spend $3.5 trillion on health care in 2017, but about a third of that spending will have no health impact whatsoever; we know that health care inflation accelerated when the government became the primary purchaser of health care for more than half the country; and we know that around $100 billion of government health spending is the result of fraudulent billing and improper payments.

Put simply: the American health care system is broken. Decades of government mismanagement and over-regulation have encouraged waste, fraud, and inefficiency, which may benefit the healthcare industrial complex, but harms patients and tax payers in the long run. To fix this, we need policies that encourage competition and transparency, allowing markets to function freely and lower costs across the board.

Fortunately, this idea has begun to gather widespread support. A recent study from the Brookings Institution argues that the way to really lower health care costs is to address anticompetitive regulations and practices, like Certificate of Need requirements, health systems acquiring physician-owned practices, and hospital mergers.

 

The study also argues for federal and state authorities to more actively enforce antitrust laws in the health care industry, which is one of the most important steps that can be taken towards real health care reform. Without real competition, hospital systems, like all monopolies, are free to charge high prices for a subpar product — which is, in this case, your medical care.

These reforms are all necessary, and would have a real impact, but there is still one thing that has not been offered to remedy the barriers to accessing fairly priced, high quality care: price discovery.

Most proposals for health care reform are based around the assumption that people either can’t or won’t take initiative in finding the best health care to meet their needs, and so someone – either an employer or the federal government – has to make those choices for them. This couldn’t be more untrue. The Amish community is a perfect example of how to shop for health care and save a few dollars in the process. I dealt with plenty of Amish patients in my 25 years as a practicing physician, and I was always impressed by their determination — and success — in shopping for value. I get the sense that they buy health care in the open market cheaper than the most sophisticated employer-based plans would provide. 

The Amish are, of course, a special case, driven to this kind of frugality by their religious convictions. But they don’t have to be. A wave of new websites and apps – like HealthEngineMedefy, and MedEncentive – are saving patients and employers hundreds of thousands of dollars a month by making it easy to search for the best values among providers and other medical services. As employers continue to make use of these tools, providers will be forced to compete for patients’ business, not just by lowering prices, but by increasing the time they spend with patients or offering additional services, like telemedicine. 

The way I see it, in other markets, the sellers chase us — telling us their prices, their quality, and how much better they are than their competitors. Other businesses, like Trip Advisor, Car Fax, and Schwab help us to sort through our options.   It shouldn’t be any different in health care.

Today, inefficient hospital chains, big insurance companies, and a bloated federal bureaucracy like the status quo, not because it’s the best option for American patients, but because it’s the best way for them to maintain their profit margins and power. By rolling back anticompetitive regulations and broadening the use of price transparency tools, we can level an unfair playing field, and make it possible for individuals to regain control of their health care.  

The benefits of competition have already been demonstrated by the direct primary care model, where medical practices don’t take insurance. Instead pay a monthly fee – usually around $100 – in exchange for unlimited primary care services. Without insurance to reimburse them, doctors have to compete for patient business, offering a variety of perks, most especially longer visits. Longer physician visits have a broader benefit, since doctors who spend more time with patients order fewer expensive (and unnecessary) tests, and have lower treatment costs in general. 

How can we introduce this level of competition into the rest of the health care space? The simplest change would be for the federal government to unleash all of Medicare and Medicaid’s information on hospital and physician charges by zip code, and let private entrepreneurs mine the data to find the most efficient providers. Congress could take this a step further by passing a law that mandates all hospital and physician prices must be published and made available to the public in a clear and concise format. As soon as people can readily access this information, they will begin voting with their feet.

When it comes to lowering health care costs, we’ve tried everything but price transparency. Our best option is to empower individuals to choose what’s best for them in a free and open market.

It works for 80 percent of our economy — who says it can’t work here? 

Dr. Tom Coburn is the Nick Ohnell Fellow at the nonprofit Manhattan Institute and a former two-term U.S. senator from Oklahoma.

EMQQ, The First Broad-Based Emerging Markets Internet and Ecommerce ETF, Marks Third Anniversary

SAN FRANCISCO–(BUSINESS WIRE)–EMQQ, the first broad-based emerging markets Internet and Ecommerce
exchange traded fund (ETF), marked its third anniversary earlier this
month. As of November 13, 2017, the fund had $347.57 million in assets
under management, and had returned an average of 14.92% annually since
launch, compared to 10.24% percent for the SP 500 and 5.70% percent for
the MSCI Emerging Markets Index.

EMQQ was created to provide investors with exposure to the growth of
online consumption in emerging markets (EM),” said Kevin Carter,
co-founder and chief executive officer of EMQQ Index, which designed the
index on which EMQQ is based.

The populations in the emerging markets as defined by MSCI are younger
and growing faster than in the developed world, and are in general
becoming more affluent. At the same time, these emerging market
countries are leap frogging the traditional bricks and mortar way of
doing business and moving substantial portions of their economies
directly online. We think these are long running secular trends that
could continue to drive ecommerce and EM growth for the foreseeable
future,” Carter said.

EMQQ seeks to track, before fees and expenses, the performance of EMQQ
The Emerging Markets Internet and ECommerce Index
, which requires
that its constituents derive at least half of their revenue from
Internet and Ecommerce businesses in emerging or frontier markets. The
index is agnostic when it comes to exchange listing or company domicile;
as long as a company generates more than half of its revenue in emerging
markets, it is eligible for consideration for inclusion in the index. As
of September 30, 2017 the top five country exposures were China
(65.11%), South Korea (11.12%), Russia (9.8%) South Africa (6.44%), and
Argentina (3.71%). India was sixth at 1.54%.

Carefully consider the Fund’s investment objectives, risk factors,
charge’s and expenses before investing. This and additional information
can be found in the Fund’s prospectus, which may be obtained by visiting
www.emqqetf.com.
Read the prospectus carefully before investing.

Investing involves risk, including the possible loss of principal.
Investments in smaller and mid-sized companies typically exhibit higher
volatility. The fund is non-diversified. International investing may
involve risk of capital loss from unfavorable fluctuations in currency
values, from differences in generally accepted accounting principles, or
from economic or political instability in other nations. Emerging
markets involve heightened risks related to the same factors as well as
increased volatility and lower trading volume. Frontier markets
generally have less developed capital markets than traditional emerging
market countries, and, consequently, the risks of investing in foreign
securities are magnified in such countries. These countries are subject
to potentially significant political, social and economic instability,
which could materially and adversely affect the companies in which the
Fund may invest. The Fund invests in the securities of Internet
Companies, including internet services companies and internet retailers,
and is subject to the risk that market or economic factors impacting
technology companies and companies that rely heavily on technology
advances could have a major effect on the value of the Fund’s
investments.

There is no guarantee that the Fund or the index will achieve its
investment objective.

The NAV of the Fund’s shares is calculated each day the national
securities exchanges are open for trading as of the close of the regular
trade on the New York Stock Exchange (NYSE), normally 4:00 p.m. Eastern
time (the NAV Calculation Time). Shares are bought and sold at the
market price, not NAV. Closing price returns are based on the midpoint
of the bid/ask spread at 4:00 p.m. Eastern Time (when NAV is normally
determined) and do not represent the returns you would receive if you
traded shares at other times. Brokerage commissions will reduce returns.

 

 

 

 

 

 

 

 

 

Month End as of: 09/30/2017

 

 

 

 

 

 

EMQQ

Cumulative (%)

Avg Annualized
(%)

Since

Since

1 Mo.

3 Mo.

Inception

1 Year

3 Year

Inception

Fund NAV

1.97

14.52

40.42

34.66

12.49

Closing Price

 

2.14

 

14.56

 

39.77

 

33.65

 

 

 

12.31

 

The performance data quoted represents past performance. Past
performance does not guarantee future results. The investment return and
principal value of an investment will fluctuate so that an investor’s
shares, when sold or redeemed, may be worth more or less than their
original cost and current performance may be lower or higher than the
performance quoted. Shares are bought and sold at market price and not
individually redeemed from the fund. Brokerage commissions will reduce
returns. For performance current to the most recent month-end, please
visit 
www.emqqetf.com.

Exchange Traded Concepts, LLC serves as the investment advisor and
Penserra Capital Management LLC serves as a sub-advisor to the fund. The
Funds are distributed by SEI Investments Distribution Co. (1 Freedom
Valley Drive, Oaks, PA, 19456), which is not affiliated with Exchange
Traded Concepts, LLC or Penserra Capital Management LLC.

Apple suppliers top European stock markets after strong demand for iPhone X

International Edition

Administration Denies More States’ Plans To Customize Insurance Markets

e4b10_gov_iowa-1-0fbc854441fad7dfdd9d97ffa537b3c71dcf6f62-s1100-c15 Administration Denies More States' Plans To Customize Insurance Markets

“Obamacare gives states very little flexibility for innovation,” said Iowa Gov. Kim Reynolds, after withdrawing the state’s insurance waiver request.

Charlie Neibergall/AP


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Charlie Neibergall/AP

“Obamacare gives states very little flexibility for innovation,” said Iowa Gov. Kim Reynolds, after withdrawing the state’s insurance waiver request.

Charlie Neibergall/AP

Two states looking for approval to customize their health insurance systems under the Affordable Care Act reversed course after the Trump administration said their applications couldn’t be approved in time for next year.

Iowa withdrew its proposal to the Centers for Medicare Medicaid Services for a waiver to alter its Affordable Care Act markets. Massachusetts’ proposal was effectively denied by the administration.

Both states sought to use some of the money that would have gone toward subsidies for consumers to instead create reinsurance programs that would protect insurers from major losses. Reinsurance often lowers premiums.

Iowa Gov. Kim Reynolds, a Republican, blamed the rules of the Affordable Care Act for the failure of her state’s proposal. “Obamacare gives states very little flexibility for innovation,” Reynolds said at a news conference.

She gave credit to CMS Administrator Seema Verma for trying to get the waiver approved. “Unfortunately Obamacare is an unworkable law,” Reynolds said. She then urged Congress to pass a law to repeal the Affordable Care Act.

But there’s another way of looking at it. CMS took a “hard line” on its interpretation of the law, said Larry Levitt, a senior vice president at the Kaiser Family Foundation. In a letter to Iowa, the agency said the state’s proposal doesn’t meet the law’s requirements that the alternative plan not add to the federal deficit.

“The question is how sharp the pencils have to be that reviewers in HHS are using” Levitt said. “They could be a little looser in their analysis, but would risk a negative report down the road.”

On the same day that Iowa withdrew its waiver, CMS told Massachusetts that the agency couldn’t approve the state’s waiver in time for open enrollment, which begins Nov. 1. The Affordable Care Act requires all proposals to allow 90 days for public comment. CMS said Massachusetts’ application came too late.

The failures of the two states’ waiver applications follow a trend. Several states have seen their proposals delayed, denied or only partly approved, after administration officials actively encouraged states to apply.

Some critics say the denials are part of an administration effort to force the ACA marketplaces to fail. But Levitt says the agency is on solid legal ground in its strict interpretation of the rules.

Still , there appears to be a switch, given the administration’s previous invitation to states to seek permission for insurance market changes.

e4b10_gov_iowa-1-0fbc854441fad7dfdd9d97ffa537b3c71dcf6f62-s1100-c15 Administration Denies More States' Plans To Customize Insurance Markets

Former HHS Secretary Tom Price, who resigned last month, encouraged states to apply for the waivers. Just weeks after he was sworn in in February, Price wrote a letter to every governor in the country urging them to consider creating reinsurance programs and high-risk pools.

HHS “invites states to pursue approval of waiver proposals that include high-risk pool/state-operated reinsurance programs,” the letter says. “The Departments will work with states to review all applications within the timeframe provided … and do our best to work with states to review their applications on an expedited basis.”

Sen. Lamar Alexander, R-Tenn., has sought to relax the waiver process. A bipartisan bill he co-authored with Sen. Patty Murray, D-Wash., would cut the wait time for waivers to be approved and allow states to go ahead with just the approval of the governor rather than a vote from the legislature. The bill would also make it easier for states to get copycat waivers once a program has been approved elsewhere.

Alexander said his bill would fix the problems that doomed the Massachusetts proposal. “Under the Alexander-Murray bill, states can get waivers approved in 45 days if the situation requires urgent action,” he said in a statement. “So Massachusetts could have had its waiver approved by now to help reduce chaos when open enrollment begins next week. This is further evidence that the Affordable Care Act needs changes and that states need our bill to get flexibility from the law.”

The Alexander-Murray bill, which was co-sponsored by 24 senators, has yet to be scheduled for a vote, and President Trump has wavered on whether he supports the plan.

Trump appears to support a short-term deal to stabilize health-care markets

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a962d_104778414-RTS1GVLX-donald-trump.530x298 Trump appears to support a short-term deal to stabilize health-care markets

President Donald Trump on Tuesday appeared to signal his support for a tentative deal in Congress to stabilize insurance markets by extending cost-sharing reimbursements for two years – just days after Trump announced that the subsidies, known as CSRs, would be eliminated.

“It is a short-term solution, so that we don’t have this very dangerous little period – including dangerous periods for insurance companies,” Trump said. “For a period of one year, two years, we will have a very good solution.”

Trump made the comments during a Rose Garden press conference with Prime Minister Alexis Tsipras of Greece, just moments after news broke on Capitol Hill that Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., had arrived at a tentative agreement to extend the CSRs in exchange for providing states more latitude to make changes to certain types of insurance plans.

The president emphasized that he was aware of what Alexander and Murray were working on, telling reporters, “I know very much what they’re doing.”

Trump added: “Lamar has been working very, very hard with the Democratic – his colleagues on the other side, and Patty Murray is one of them, in particular. And they’re coming up and they’re fairly close to a short-term solution.”

The White House then appeared to walk back the president’s apparent endorsement.

“We are willing to work with Congress to reach a legislative solution,” an administration official told NBC News. “We will not provide bailouts to insurance companies until we provide the American people with relief from the Obamacare disaster.”

It was unclear late Tuesday whether the White House will ultimately get on board with what has become known as the Alexander-Murray plan.

Top Senate Republicans, likewise, appeared to hedge their bets. Majority Leader Mitch McConnell, R-Ky., was asked if there was a plan in place yet to move the deal through the Senate. “We haven’t had a chance to think about the way forward yet,” he told reporters.

Nonetheless, Alexander made a point on Tuesday of thanking the president for repeatedly “encouraging” him to work on the deal with Murray.

“I’m grateful to the president for encouraging me on two occasions and phone calls to try and get a bipartisan agreement with Senator Murray,” Alexander told reporters on Capitol Hill. “He said he didn’t want people to be hurt during these next two years, while we’re arguing about the long-term direction of health care in the country.”

Trump announced the end of the CSRs on Thursday, after months of threatening to end them. The announcement followed a determination by Attorney General Jeff Sessions that the payments were illegal. According to Sessions, the CSRs, which reimburse insurance companies for discounts they are required by law to provide to low income Obamacare customers, need explicit congressional appropriation, which they did not have at the time.

The Alexander Murray deal could offer a temporary solution, authorized by Congress, to fund the CSRs.



Senators Reach Deal to Shore Up Health-Insurance Markets

Two senators on Tuesday finalized the basic contours of a bipartisan deal designed to shore up the nation’s health-insurance markets while giving states more say in how they implement rules set out by the Affordable Care Act.

The bill would, among other things, preserve for two years the billions of dollars in payments made to insurers to help offset consumers’ out-of-pocket costs, lawmakers and aides said. President Donald Trump last week said his administration would be ending the payments, a move Democrats and health analysts…