Category Archives: Health Care Reform

N.H. PPACA panel members agree that they’re stuck

NOTE- The New Hampshire Exchange will have only one insurance carrier on it.  –  Reeve


CONCORD, N.H. (AP) — After months of arguing, New Hampshire lawmakers overseeing implementation of the federal Patient Protection and Affordable Care Act (PPACA) have agreed on one thing Tuesday: They’re at a stalemate.

The joint Health Care Oversight Committee includes three Republicans and three Democrats.

The members have spent a significant amount of time disagreeing about the authority accorded to various players involved in implementing PPACA, including the insurance department, the governor and the committee itself.

Tuesday’s meeting started with the insurance department outlining the state’s role in educating businesses and consumers about the law, then opened up into a wider discussion that included whether the state should have any role at all.

In the end, members acknowledged that, even if they agreed, they couldn’t take any action until the rest of the Legislature sorts out two bills related to PPACA — one would let the insurance department accept a $5 million federal grant to start a consumer assistance program, the other would align the state’s insurance market rules with the federal law.

“Basically we’re at a stalemate,” said Sen. Peggy Gilmore, D-Hollis.

Under PPACA, new insurance marketplaces will offer individuals and their families a choice of private health plans resembling what workers at major companies already get. The government will help many middle-class households pay their premiums, while low-income people will be referred to safety net programs they might qualify for. Enrollment starts Oct. 1 with coverage taking effect Jan. 1. After that, virtually everyone in the country will be required by law to have health insurance or face fines.

While the last Legislature passed a law prohibiting the state from setting up its own markets, or exchanges, Democratic Gov. Maggie Hassan decided in February to have the state partner with the federal government to manage the health plans offered through the markets and to provide consumer assistance.

The oversight committee approved her letter of intent, but Republicans argue it’s not a done deal. Sen. Andy Sanborn, R-Bedford, continues to push for a detailed explanation to spell out how the partnerships would operate, and said the public can’t be educated about a plan that doesn’t exist. And Sen. Jeb Bradley, R-Wolfeboro, again argued that the partnership would violate the state law prohibiting a state-run marketplace.

“The law’s the law, and I think the law’s really clear,” he said. “The more we talk about this, whether it’s planned management, or in-person assisters, the more we are getting to a state-based exchange.”

Democrats argued that there should be a New Hampshire-specific outreach effort that would build upon existing organizations that are already in touch with the uninsured population.

“Come January 1, the Affordable Care Act will go into effect, and if we slow down and do nothing, our citizens will have less information, less access to knowing what’s going on, and less ability to take advantage of the possibilities the Affordable Care Act provides,” said Rep. Ed Butler, D-Harts Location. “It seems to me, the responsibility of our committee ought to be to find a responsible way to move forward. What I hear you saying is, finding a way to prevent us to move forward.”

But Rep. John Hunt said the state had no business providing consumer assistance, rather it should only be responsible for consumer protection, as it is now. He questioned how much help consumers will need given that only one company — Anthem, a unit of WellPoint Inc. (NYSE:WLP) — plans to offer medical insurance plans through the individual and small group exchanges.

“All our Web page would have to say is, ‘Call 1-800-Anthem, have a nice day!'” he said.

Rep. Cindy Rosenwald, D-Nashua, reminded Republicans that they earlier had argued that the committee holds policy-setting authority.

“Either we do or we don’t, I don’t think we can have it both ways,” she said. “Since we’ve said we do have that authority, we should take advantage of that and put our stamp on how we think it should go.”


Pent-up demand likely to distort PPACA impact on premiums

Dan Cook | BenefitsPro | June 12, 2013


Forget about 2014 as the year we’ll find out the true cost of Obamacare. Because of an expected short-term jump in medical services usage, the baseline cost won’t be evident until at least 2016.

So says a report from HealthPocket, a firm that compares and ranks all available health plans.

HealthPocket wanted to know whether there was a pent-up demand for health services that the Patient Protection and Affordable Care Act would release. So the company surveyed 1,356 U.S. adults, asking them: “Would better health insurance coverage lead you to see the doctor more often or get a medical procedure you had put off?”

The findings: While 57 percent said they would change the way they currently use health services, 15 percent said they’d elect to have a medical procedure done that they’d been postponing, and 27 percent said they’d definitely go to the doctor more frequently.

So, with 42 percent of respondents indicating they would increase their medical services usage, HealthPocket drew this conclusion:

“Insurance premiums in the second year of Obamacare, 2015, may experience a temporary rise due to the pent-up demand for medical procedures being addressed in 2014. Assuming a two-year period for consumers to exhaust pent-up healthcare demand, the true baseline for Obamacare’s effect upon health insurance premiums should be evident in 2016.”

HealthPocket further opined that the increase due to pent-up demand for a postponed procedure would disappear from the system by 2016. But the added cost of more frequent trips to the doctor’s office would remain, and the premium hike attributed to that should be identifiable during 2016.

The results are hot off the presses, by the way; the research was conducted from June 5-7.


PPACA spurring massive health clinic growth

BenefitsPro | Kathryn Mayer | June 13, 2013


The number of retail health clinics nationwide will grow sharply in the next three years due to the influx of newly insured patients under the Patient Protection and Affordable Care Act, according to new analysis.

Consulting firm Accenture predicted the number of walk-in medical facilities located in retail stores will double by 2015, from roughly 1,500 clinics now to 3,000 by 2015. The clinics are expected to account for 10 percent of non-primary care outpatient visits within three years.

Reform will trigger “a significant demand” from millions of newly insured patients, Dr. Kaveh Safavi, managing director for Accenture’s North America health business, said in a statement. PPACA is expected to bring in anywhere between 15-30 million newly insured patients in the next couple years.

“The convergence of retail convenience with walk-in care services will provide a ‘release valve’ for strained health systems as they handle the influx of new patients,” he said.

In its report out this week, Accenture said that historically, retail clinics experienced a five-year trend of rapid growth from 2003-2008, ranging from 50 percent to 92 percent annually during that time. But growth in the sector stalled, falling to just 2 percent per year from 2008-2012.

PPACA spurring massive health clinic growth

“Although primary care physicians and hospitals once regarded retail clinics as a business threat, in a post-reform landscape, they are viewed as critical to facilitating future growth,” Safavi said. “In fact, retail clinics will reduce capacity constraints by referring lower-acuity patients to clinics while ensuring hospitals have capacity for more complex cases.”

The clinics generally remain open for longer hours than a doctor’s office and on weekends, and are often staffed by nurse practitioners or physicians assistants instead of doctors. They are cheaper than a typical visit to the doctor’s office or emergency room and do not require an appointment. Drug chains CVS and Walgreens, as well as big-box retailers Wal-Mart and Target have been expanding their retail clinics.

A recent Harris Interactive/HealthDay poll from earlier this year found that popularity of walk-in retail clinics is growing among consumers, in part due to convenience, low cost and shortage of primary care doctors.

That survey found that 27 percent of all adults surveyed said they have used either walk-in retail clinics (19 percent) or work-based clinics (11 percent) to obtain medical care in the past two years. That’s up from just 7 percent in 2008.

Worksite clinics, which are generally offered by larger employers, also are a growing trend, especially as PPACA takes shape.

Consumers in the Harris/HealthDay poll said they were most likely to visit either a retail or work-based clinic for run-of-the-mill complaints such as colds or flu-like symptoms, minor cuts and wounds, and for routine needs such as flu shots, prescriptions and to check blood pressure or cholesterol.

Accenture said the growing number of retail health clinics is expected to drive $800 million in annual cost savings by 2015 and will add capacity for 10.8 million patient visits per year, compared to 5.1 million in 2011.


The Bond Bubble – threatening your retirement money…

Sometimes people forget that you can lose money in bonds, and we have recently experienced just that.  The stock market is known for its volatility and the bond market for being, well, “safe” and not volatile.

Two years ago I began warning you about my expectation that the bond fund returns we have been experiencing would not be as high as the past few years and that has now occurred, with negative numbers the last few months.

FINRA “…is sounding alarms about the possibility of a plunging bond values as the economy recovers and interest rates rise.” (Reuters, “Preparing Clients for looming bond risk” June 3, 2013)WHY?  A number of things may be causing this.  In as non-technical terms as I can muster…

The economy is doing much better, so people are moving their money into stocks, which reduces the demand for bonds.  Lowered demand = reduced value.

The government has been shoring up the economy by buying bonds since November 2008 (“Quantative Easing”).  Their goal has been to keep the country out of a deeper recession.  It also kept the demand for bonds higher.  The Fed has now made a lot of noise about “tapering” off that program.

An improving economy, combined with the “tapering” off quantative easing is generally expected to cause a rise in interest rates.  This reduces the value of the bonds currently held in bond funds.

WHAT ELSE COULD HAPPEN?  Well, there are a lot of people that believe we are due for a market pullback.   Here are some recent quotes:

From USA Today – “The Standard & Poor’s 500 Index is up a rarefied 140 percent since the low of March 9, 2009, high enough for many investors to feel among the clouds. That begs the question of when the next big correction will occur.(1)”


My crystal ball is broken, and I cannot find a certified repairman…

From Graham Summers in Market Oracle – A short-term market correction would not have a lot of effect on the bond market.  However, a longer-term drop in the market might actually help the Bond Markets.  Some are forecasting such a drop:

“Investors take note… now is the time to be prepping for a market correction.  As Friday’s action showed, when it comes, it’s going to be fast and violent.(2)”

SO WHATS YOUR PLAN?  I agree with the prevailing opinion to pull back into “short-duration” bond funds. Depending on your risk profile, it may be appropriate to add some stock holdings into the mix.

Please give me a call to discuss this.



1-  USA Today, May 17, 2013, John Morgan “Wall Street Awaits a Stock Market Correction”

2-  Market Oracle, June 3, 2013, Graham Summers, “Fridays Stock Market Drop was just a hint of whats coming”

3- Reuters, June 3, 2013, Suzanne Barlyn, “Preparing clients for looming bond risk”



IRS scandals threaten funding for PPACA

It’s the IRS that will be in control of the “subsidy budget” for Health Care Reform exchanges.  Will the recent scandals jeopardize funding critical to the successful implementation of the Exchange system? – Reeve


WASHINGTON (AP) — Mounting scandals at the Internal Revenue Service are jeopardizing critical funding for the agency as it gears up to play a big role in the Patient Protection and Affordable Care Act (PPACA).

Obama sought a significant budget increase for the IRS for next year, when the agency will start doling out subsidies to help people buy health insurance on state-based exchanges. Congressional Republicans, however, see management problems at the IRS as an opportunity to limit the agency’s funding just as it is trying to put in place the massive new law.

Republicans have been fighting the health care law ever since Democrats enacted it in 2010 without a single GOP vote. Unable to repeal the law, some Republicans hope to starve it by refusing to fund its implementation.

The IRS scandals are giving them a timely excuse.

“I think it’s safe to say they’re not going to get the kind of increase they’re asking for,” said Rep. Ander Crenshaw, R-Fla., chairman of the House appropriations subcommittee that fundsthe IRS.

“The question is, based on their bad behavior, are they going to end up with less money?” Crenshaw said.

Last month, the IRS was rocked by revelations that agents had targeted tea party and other conservative groups for extra scrutiny when the groups applied for tax-exempt status during the 2010 and 2012 elections. A few weeks later, an inspector general’s report said that the agency had spent lavishly on employee conferences during the same time period.

From 2010 through 2012, the IRS spent nearly $50 million on employee conferences. In 2010, the agency used money that had been budgeted to hire enforcement agents to instead help pay for one conference that cost $4.1 million, according to the watchdog’s report.

Three congressional committees and the Justice Department are investigating the targeting of conservative groups, and much of the top leadership at the IRS has been replaced.

Obama appointed a new acting IRS commissioner, Danny Werfel, a former White House budget official. Werfel is conducting an internal review of the agency and is expected to issue recommendations for changes by the end of June.

All this is happening as the agency works to implement the health law that includes some of the most sweeping changes to the tax code in a generation.

“The IRS needs to repair the plane while it’s in flight right now,” said Paul Cherecwich, chairman of the IRS Oversight Board, an independent board within the agency. “Should the current budget environment continue, the IRS will have to continue to have to do more with less while rebuilding taxpayer trust. It has no choice, and it won’t be easy.”


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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck