Unsubsidized ObamaCare enrollment dropped 20% in 2017

• The Centers for Medicare and Medicaid Services issued three new reports on the Affordable Care Act Monday, noting a 20% drop in enrollment during plan year 2017 among those not getting subsidies, and casting the data to make their case that federal and state exchanges and state individual health insurance markets are in turmoil.
• Subsidized enrollment, which makes up the vast majority of those enrolled in ACA plans, remained steady with a drop of only 3% during the same period.
• But critics noted the administration’s repeated attempts to undermine the law, including repeal of the individual mandate penalty, pullback of exchange navigators and the expansion of association health plans and short-term, limited-duration insurance, to likely result in skimpier plans and the destabilization of the ACA marketplace.

The Trump administration and Republicans in Congress have made no secret of their opposition to the ACA, attempting and failing to repeal it completely last year.

The exchanges remain stable in 2018, but more people are relying on subsidies than the prior year, according to CMS. In February 2018, approximately 10.6 million enrollees gained coverage through the exchanges, with 87% relying on advance premium tax credits, compared to 10.3 million enrolled at the same time in 2017, with 84% using tax credits.

The agency said that rising premiums have increasingly raised costs to the federal government due to the law’s subsidies.

“It is clear that many Americans are being priced out of the health insurance market, especially for employed people who earn too much to qualify for tax credits and have no access to employer-sponsored coverage,” CMS said. “This underscores the need for CMS to continue efforts to stabilize the market and provide all consumers—including those who do not qualify for large premium subsidies—with more affordable health coverage options.”

CMS Administrator Seema Verma say the new reports are evidence that the ACA is not serving the middle class and is leading to them dropping health insurance coverage.

“As the Trump Administration took office, there were warning signs that we were dealing with a crisis in the individual health insurance market and Obamacare was failing its consumers,” Verma said in a statement.

Protect Our Care, a liberal advocacy group, argued the Trump administration’s cuts to the advertising budget and navigator program amounted to sabotage of the last open enrollment.

“The Administration cut in half the number of days people could sign up for coverage; reduced the outreach budget by [90%]; and used funding to boost open enrollment to launch a propaganda campaign against the ACA. All told, these actions reduced enrollment by more than one million people,” Protect Our Care Executive Director Brad Woodhouse said in a statement.

But CMS said the actions simply shifted the burden of supporting enrollment to the private sector, noting that navigators “enrolled less than 1% of total enrollees.”

The agency also argued that its changes to the special enrollment periods improved risk pools, noting that the requirement for individuals to verify eligibility has cut the number of exceptional circumstance special enrollment periods by 56% in 2017.

https://bit.ly/2z6xasv

Empathy Matters, In Markets And In Life

Shoutout to vlogger Meir Kay, who produced an outstanding video that captures the relationship between anger and empathy.

There’s an important psychological lesson here.

Frustration is a form of anger.  It occurs when we have a goal and something prevents us from reaching that goal.  We develop an idea, place a trade based on that idea, and then a burst of volume comes into the market and moves our position against us.  Our hopes for profit are dashed with the reality of a loss.

We can voice frustration at the market or at the traders who are “obviously manipulating” the market.  We can become frustrated with ourselves and beat ourselves up over how stupid we were to place the trade.  Regardless of the object of our frustration, once we become angry, we enter fight/flight mode and stop processing the world objectively.

The good trader will catch themselves at that moment and take a step back, slow down, calm themselves, and return to their trading.

The great trader, however, will do something quite different.

Remember that markets are always speaking to us.  They tell us where participants are finding value, where participation is waxing and waning, and when participation is dominated by buyers or sellers.  The great trader is like a great listener in a conversation.  That requires empathy: the ability to not just see, but feel what other market participants are doing.

Suppose you bring up a topic in a conversation with someone you care about and they quickly change the subject and start talking about something else.  You can become frustrated, filled with a sense of injustice over being “cut off”, or you can step back and say to yourself, “That’s interesting…my friend doesn’t normally change topics like that.  This must be very important.”  That empathy makes you a better listener.  Going with the conversational flow will bring you closer to your friend.

If you have formulated a great idea for a trade and the market changes the topic on you, perhaps there is an important message there.  Doubling down on your listening skills and drawing upon your empathy opens the possibility of profiting from this new information.  It’s yet another way that developing ourselves as traders is not so different from developing ourselves as human beings.  When we replace anger with empathy, frustration with listening, we make new connections and profit from those–in markets and in life.

https://bit.ly/2tVnDQ9

Alzheimer’s may be caused by haywire immune system eating brain connections

More than 99% of clinical trials for Alzheimer’s drugs have failed, leading many to wonder whether pharmaceutical companies have gone after the wrong targets. Now, research in mice points to a potential new target: a developmental process gone awry, which causes some immune cells to feast on the connections between neurons.

“It is beautiful new work,” which “brings into light what’s happening in the early stage of the disease,” says Jonathan Kipnis, a neuroscientist at the University of Virginia School of Medicine in Charlottesville.

Most new Alzheimer’s drugs aim to eliminate β amyloid, a protein that forms telltale sticky plaques around neurons in people with the disease. Those with Alzheimer’s tend to have more of these deposits in their brains than do healthy people, yet more plaques don’t always mean more severe symptoms such as memory loss or poor attention, says Beth Stevens of Boston Children’s Hospital, who led the new work.

What does track well with the cognitive decline seen in Alzheimer’s disease—at least in mice that carry genes that confer high risk for the condition in people—is a marked loss of synapses, particularly in brain regions key to memory, Stevens says. These junctions between nerve cells are where neurotransmitters are released to spark the brain’s electrical activity.

Stevens has spent much of her career studying a normal immune mechanism that prunes weak or unnecessary synapses as the brain matures from the womb through adolescence, allowing more important connections to become stronger. In this process, a protein called C1q sets off a series of chemical reactions that ultimately mark a synapse for destruction. After a synapse has been “tagged,” immune cells called microglia—the brain’s trash disposal service—know to “eat” it, Stevens says. When this system goes awry during the brain’s development, whether in the womb or later during childhood and into the teen years, it may lead to psychiatric disorders such as schizophrenia, she says.

Stevens hypothesized that the same mechanism goes awry in early Alzheimer’s disease, leading to the destruction of good synapses and ultimately to cognitive impairment. Using two Alzheimer’s mouse models—each of which produces excess amounts of the β amyloid protein, and develops memory and learning impairments as they age—she and her team found that both strains had elevated levels of C1q in brain tissue. When they used an antibody to block C1q from setting off the microglial feast, however, synapse loss did not occur, the team reports today in Science.

To Stevens, that suggests that the normal mechanism for pruning synapses during development somehow gets turned back on again in the adult brain in Alzheimer’s, with dangerous consequences. “Instead of nicely whittling away [at synapses], microglia are eating when they’re not supposed to,” she says.

The group is now tracking these mice to see whether a drug that blocks C1q slows their cognitive decline. To determine whether elevated β amyloid can cause the C1q system to go haywire, Stevens and colleagues also injected a form of the protein which is known to generate plaques into the brains of normal mice and so-called knockouts that could not produce C1q because of a genetic mutation. Although normal mice exposed to the protein lost many synapses, knockouts were largely unaffected, Stevens says. In addition, microglia only went after synapses when β amyloid was present, suggesting that the combination of protein and C1q is what destroys synapses, rather than either element alone, she says, adding that other triggers, such as inflammatory molecules called cytokines, might also set the system off.

The findings contradict earlier theories which held that increased microglia and C1q activity were merely part of an inflammatory reaction to β amyloid plaques. Instead, microglia seem to start gorging on synapses long before plaques form, Stevens says. She and several co-authors are shareholders in Annexon Biosciences, a biotechnology company that will soon start testing the safety of a human form of the antibody the team used to block C1q, known as ANX-005, in people.

Such a central role for microglia in Alzheimer’s disease is “still on the controversial side,” says Edward Ruthazer, a neuroscientist at the Montreal Neurological Institute and Hospital in Canada. One “really compelling” sign that the mechanism is important in people would be if high levels of C1q in cerebrospinal fluid early on predicted developing full-blown Alzheimer’s later in life, he says. Still, he says, “it’s difficult to argue with the strength of the study’s evidence.”

Posted in:

• Brain & Behavior
• Memory Topic

doi:10.1126/science.aaf9857

https://bit.ly/2KzjlIA

Essilor, Delfin extend deadline for combination deal

Essilor (Euronext Paris: EI) and Luxottica (MTA: LUX), announce the extension to July 31, 2018 of the deadline of both the Combination Agreement1and Contribution Agreement2 signed between Essilor and Delfin, Luxottica’s majority shareholder.

As of today, the Chinese competition authority has not yet approved the contemplated combination between Essilor and Luxottica, such approval being a condition precedent to the closing of the combination. The parties remain confident that they will succeed in completing the antitrust processes in China and Turkey in the coming weeks.

The first General Meeting of EssilorLuxottica shareholders which was scheduled for July 25, 2018 will be reconvened by the EssilorLuxottica’s Board of Directors for a later date to be announced as soon as possible.

https://bit.ly/2u4gPik

22nd Century Statement on FDA Nicotine Reduction Plan

22nd Century Group, Inc. (NYSE: XXII) today called attention to comments submitted to the U.S. Food and Drug Administration (FDA) in response to the FDA’s Advance Notice of Proposed Rulemaking (ANPRM) to develop a nicotine product standard in cigarettes that will lower nicotine to minimally or non-addictive levels. The open comment period on the FDA’s ANPRM ends July 16, 2018. To date, major medical associations, government agencies, tobacco insiders, and the public at large have submitted nearly 3,000 public comments to the FDA. Although some companies in the tobacco industry have requested a 90-day extension of the comment period and have facilitated hundreds of “form letter” comments, the responses from scientists and regulators have been overwhelmingly in favor of the FDA’s plan to dramatically reduce the nicotine content of cigarettes. As the only company in the world growing multiple varieties of Very Low Nicotine flue-cured and burley tobacco varieties, 22nd Century makes possible the FDA’s vital new plan.

Below is a summary of some of the most important comments that the FDA has received to date in response to the ANPRM:

“Given the immense public health benefits predicted by the FDA, the ACC strongly supports the implementation of a nicotine product standard in cigarettes to a minimally addictive or non-addictive level.”“The FDA should move quickly to develop and issue a final regulation to maximize the number of lives saved.”

American College of Cardiology, June 5, 2018

“American Society of Addiction Medicine urges the FDA to move forward with a proposed rule within six months after release of its ANPRM and final rule six months after. In addition, we urge the FDA to establish the tobacco product standard no later than one year after publication, as provided in Section 907 of the Family Smoking Prevention and Tobacco Control Act.”

American Society of Addiction Medicine, June 14 2018

“I am encouraged by the strong actions that the FDA is pursuing to improve the health of our nation, facilitate quitting among smokers who are currently struggling with their addiction, and prevent a future generation from becoming addicted to a highly toxic tobacco product.”

Dorothy K. Hatsukami, PhD, Professor of Psychiatry, University of Minnesota, June 11, 2018

“Immediate nicotine reduction is likely to have the largest public health benefit.”

American Psychological Association, College on Problems of Drug Dependence, Society for Research on Nicotine and Tobacco June 12, 2018

“Our results support a conclusion that a national regulatory policy reducing the nicotine content of cigarettes would reduce the addiction potential of cigarette smoking and that those effects would extend to populations that are highly vulnerable to tobacco addiction.”

Stephen T. Higgins Ph.D., Director, Vermont Center on Behavior and Health, April 26, 2018

“Consistent with the aims of this ANPRM, the 2014 Surgeon General’s Report identified reduction of the nicotine content of tobacco products to make them less addictive as a tobacco “end game” strategy to accomplish the U.S. overall goal of a society free of tobacco-related death and disease.”“This action would contribute to a significant reduction in the lives lost and medical costs associated with the burden of smoking-related morbidity and mortality.”

California Department of Public Health, May 4, 2018

“This proposed rule is a necessary step towards protecting youth and adults from the dangers of nicotine dependence.”

Washington County, Oregon Department of Health and Human Services, June 14th, 2018

“…the Montana Department of Public Health and Human Services strongly supports the FDA’s pursuit to lower the nicotine level of cigarettes to minimally or non-addictive levels…”

Montana Department of Public Health and Human Services, June 14, 2018

“Although we will likely see many more comments to the FDA’s plan to require the reduction of the nicotine content of cigarettes to minimally or non-addictive levels, already there is strong scientific, regulatory, and public support for the plan,” explained Henry Sicignano, III, President and Chief Executive Officer of 22nd Century Group. “What’s more, very soon, 22nd Century will submit our Company’s extensive comments regarding a drastically reduced nicotine content standard… and we will address, specifically, questions of commercial feasibility.”

https://bit.ly/2za2Op7

Tesaro debt buydown makes it a buy opp: Citi

Tesaro buying down debt below cost of capital. Citi analyst, Robyn Karnauskas, reiterated her Buy rating.

https://bit.ly/2Np1L7O

How Google, Facebook monopolize ideas

In early May Google banned bail-bond companies from advertising on its platforms. Such companies profit from “communities of color and low income neighborhoods when they are at their most vulnerable,” itexplained in a blog post. They use “opaque financing offers that can keep people in debt for months or years.”

That Google can ban ads from an industry that offends its values is not, by itself, noteworthy. Media companies have long decided what content or ads to carry for the same reason. The difference is that even after decades of consolidation, no media company enjoys a U.S. market share as dominant as Google’s in Internet search (close to 90%) or Facebook Inc.’s in social networking. Like earlier bans on payday-loan ads, Google’s bail-bond ad ban, which Facebook copied the next day, effectively kicked an entire industry out of a major advertising channel.

The debate over whether Google, a unit of Alphabet Inc., and Facebook are too big usually revolves around economics: Do they suppress competition for goods and services? The bail-bond ad ban raises a different, and potentially more troubling, possibility: that they also undermine competition for values and ideas. While Google and Facebook claim to be neutral platforms connecting users, advertisers and content providers, decisions about which ads to ban and which content to delete or reclassify are inherently value-laden, even when those values are embedded in an algorithm.

Data monopolies “can actually be more dangerous than traditional monopolies,” Maurice Stucke, a law professor at the University of Tennessee, Knoxville specializing in antitrust, wrote earlier this yearin Harvard Business Review. “They can affect not only our wallets but our privacy, autonomy, democracy, and well-being.”

Bail bonds aren’t a sympathetic industry. For a steep fee, agents agree to pay the court’s required bail if the client doesn’t show up for a court date. They are, however, legal and, in most states, regulated. And the industry says it serves low-income and minority clients because they are caught up in the criminal-justice system without the means to post bail on their own.

Jeff Clayton, executive director of the American Bail Coalition, whose members insure bail agents, says Google gave the industry no opportunity to comment on or appeal the ban. A Google spokeswoman declined to comment. Facebook did consult with both the industry and criminal-justice-reform groups after announcing its ban, a spokesman said.

Bail-bond agents used to advertise in the yellow pages, but as the public abandoned phone books for Google, so did the industry. “There are just no other options,” Mr. Clayton said. The ban doesn’t extend to regular search results, but it makes it harder for individual companies to stand out.

Conservatives tend to see tech companies’ progressive leanings at work in what gets banned or reclassified—for example, Facebook’s labeling of videos by two prominent supporters of President Donald Trump as “unsafe.” Bail bonds and payday loans have long been targets of progressive activist groups.

But as the companies come under growing pressure to police their platforms and weed out “fake news,” a growing range of content gets banned, labeled or deleted for often opaque or arbitrary reasons. ProPublica and Reveal, both nonprofit news publications, have had content dealing with hate groups and immigrant children, respectively, deleted or rejected by Instagram or Facebook. Video artists complain of viewership and ads being restricted because their content violated YouTube’s community standards.

Unhappy users, advertisers and content providers wouldn’t have as much to complain about if Google (which bought YouTube in 2006) and Facebook (which acquired Instagram in 2012) had strong competitors to which they could switch.

Absent such competition, expect pressure for the government to regulate it. But that’s a slippery slope. Politically appointed overseers may simply replace the companies’ judgments with their own. For that reason the Federal Communications Commission long ago gave up policing the nation’s airwaves for fairness.

Better that monopolies not arise in the first place. In a 2001 article Mr. Stucke and Allen Grunes, then attorneys in the Department of Justice’s antitrust division, noted antitrust law has long sought to preserve competition in ideas, not just products. In 1945 the Supreme Court upheld a landmark antitrust suit against the Associated Press for excluding some newspapers and limiting what member newspapers could share. The First Amendment “rests on the assumption that the widest possible dissemination of information from diverse and antagonistic sources is essential to the welfare of the public,” Justice Hugo Black wrote. “Truth and understanding are not wares like peanuts or potatoes,” Justice Felix Frankfurter added.

This isn’t necessarily a reason to break up tech giants: The legal hurdles are almost insurmountable and the consequences highly unpredictable. It is a reason to ask, when these companies announce their next acquisition, if the market for ideas, not just for peanuts and potatoes, will be stronger as a result.

https://bit.ly/2ITCn6z