Daily Insurance Report  
Walt Bernard Podgurski,  Editor,  440-773-1108, 
Walt@DailyInsuranceReport.com

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Editorial Mission Statement: The goal of this publication is to provide readers a broad selection of what is being written about the insurance industry and related issues. Some articles may have a “tilt” towards a particular perspective one way or another. Inclusion in this newsletter is not an endorsement of any views or content; but report the various and differing views appearing in media.
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The "Daily Insurance Report" is now subscribed to by almost 25,000 elite insurance industry influencers who receive it Monday - Friday at 5:05 am EDT, and have a quick overview of what is appearing in the media regarding the insurance industry; with an emphasis on life, health, and employee benefits.


Dem states take first step in appealing ObamaCare ruling
LYDIA WHEELER AND JESSIE HELLMANN / THE HILL

A coalition of Democratic states defending ObamaCare filed notice Thursday to appeal a recent federal court ruling that struck down the health-care law as unconstitutional, sparking what's likely to be a lengthy legal fight that could reach the Supreme Court and influence the 2020 elections.

California Attorney General Xavier Becerra (D) said that by appealing to the Louisiana-based 5th Circuit Court of Appeals, the 17 states are standing up for Americans who count on health care.

“In this particular case we believe the stakes are not only great, but compelling,” he said Thursday on a call with reporters.

Judge Reed O’Connor last month sided with the 20 Republican-led states that sued to overturn ObamaCare. He ruled that the 2010 law could not stand without the individual mandate penalty, which Congress repealed. O’Connor, an appointee of former President George W. Bush, issued another ruling on Sunday that ObamaCare can remain in effect while his decision is appealed.



After Obamacare ruled unconstitutional, profit-driven critics risk our 1-year-old son's life
Joel Vikre and Emily Vikre, Opinion contributors / USA TODAY

Our son’s life could depend on the final outcome of a politically driven lawsuit that he’s too young to even know about. On Dec. 14, a federal judge in Texas ruled the entire Patient Protection and Affordable Care Act unconstitutional, potentially undoing the most positive step in American health care law in more than a generation.

Last year, when our son Vidar was born, he had several heart defects that required immediate surgery. At just five days old, doctors operated and successfully repaired his heart, but instead of recovering he ended up on life support.

Those months in the hospital were the most terrifying of our lives, but our health care came through for us. We own a distillery, and we provide private health insurance to our full-time employees and their families, including ourselves. Our insurance company spent well over $2 million on Vidar before he even came home from the hospital.

But once we got home, we saw a different side of American health care — the frustrating, expensive, uncoordinated, time-consuming side.



DOJ Recovers $2.5B in Healthcare Fraud, False Claims in 2018
The DOJ collected more than $2.5 billion in judgments and settlements related to healthcare fraud and false claims in 2018.
Jennifer Bresnick / HEALTHPAYER INTELLIGENCE

2018 was a bad year to be a healthcare fraudster. The Department of Justice (DOJ) has announced that $2.5 billion of the total $2.8 billion recovered under the False Claims Act can be attributed to fraud and improper claims from healthcare providers during the fiscal year.

This was the ninth consecutive year that civil healthcare fraud settlements and judgments have topped $2 billion, officials added.

Thanks to the DOJ’s efforts, a number of state Medicaid entities recovered additional millions not included in the federal total.



New Maine Gov. Janet Mills immediately reverses GOP predecessor, pursues Obamacare Medicaid expansion
Kimberly Leonard / Washington Examiner

Democrat Janet Mills used her first executive order as governor of Maine to implement an Obamacare expansion of the Medicaid program to the poor.

The action puts into effect a ballot measure that state voters supported in 2017, which makes the government-funded insurance available to anyone making less than roughly $17,000 a year. The expansion of Medicaid, a major part of Obamacare, had been held up by former Republican Gov. Paul LePage, who said that he would block it until the legislature found a way to fund it. He continued to delay the expansion despite a judge's orders to implement it.

Mills said Thursday that she was seeking "expedited" approval for the program from the Trump administration, and added that she would seek for the benefits to stretch back to July 2, 2018, when the plan was originally supposed to take effect. Expanding Medicaid was one of her campaign promises.



A Better 401(k) Default Investment
Leland Hevner / President, National Association of Online Investors (NAOI) / Nasdaq

Target Date Funds (TDFs) are mutual funds that hold both Stock and Bond equities with an allocation of money to each asset class determined by the number of years until the investor’s retirement date – i.e. their “time-horizon.” Individuals with a longer time-horizon, e.g. 20+ years, are given a TDF with a larger allocation to Stocks that can provide higher expected returns but with higher risk. Individuals with a shorter time-horizon are given a TDF with a larger allocation to Bonds that has less risk but also lower expected returns. TDFs automatically change their stock/bond allocation over time with the goal of lowering risk as the target date nears.

TDFs were designated in 2006 by the government to be the default investment for 401(k) investors. In the absence of an investor requesting specific investments, an advisor will typically recommend a TDF that is deemed appropriate for the client’s expected retirement year. Examples of such funds are: “2030 Target Date Fund” or “2040 Target Date Fund”.

A problem exists in the fact that TDFs neither enable investors to take full advantage of the positive returns potential of the market nor to protect their savings from stock market crashes such as the one we experienced in 2008.



Insurance companies sue PG&E over California wildfire damages
ASSOCIATED PRESS / MarketWatch

Several insurance companies have filed lawsuits blaming Pacific Gas & Electric Co. for a deadly California wildfire that destroyed 14,000 homes and triggered billions of dollars in insurance claims.

The lawsuits filed by Allstate ALL, +3.10% , State Farm, USAA and their subsidiaries come on top of several other cases filed by victims of the Camp Fire, which devastated the towns of Paradise, Magalia and Concow north of Sacramento after it started Nov. 8.

Investigators have not pinpointed a cause for the fire. But the insurance companies note in their lawsuits that flames ignited near the site of a transmission-line irregularity reported by the utility. They also note a potential second ignition point involving PG&E distribution lines.

Under California law, PG&E PCG, +1.96% is held entirely liable if lawyers can prove the fire is linked to the utility’s power lines or other equipment — a fact that sent shares of the company tumbling following the start of the fire.




HealthBI Doubles Customer Base in 2018 After Launching First Multi-Payer Platform for Medicare Advantage and Medicaid Managed Care Coordination

Closing a year marked by aggressive market expansion, HealthBI, a division of Equality Health, saw its CareEmpower® platform become the most widely used, payer-driven care coordination system today for both Medicare Advantage and Medicaid managed care members. As the first payer-agnostic system, CareEmpower is the provider’s central vehicle for meeting quality measures across multiple health plans.

At the beginning of 2018, CareEmpower was deployed in more than 63,000 clinical sites in all 50 states. By the end of the year, CareEmpower’s customer base had doubled, with Banner Health and Anthem just two examples of notable customer wins. Meanwhile, CareEmpower was deployed in over 8,000 additional clinical sites, which effectively makes HealthBI the largest provider of multi-payer care coordination technology today.



Student insurance provider for 4 Ohio colleges abruptly shuts down
Alyssa Rege / BECKER'S HOSPITAL REVIEW

The student insurance provider for at least four Ohio universities abruptly shut down in December, leaving hundreds of uninsured students in search of a replacement without a lapse in coverage, according to cleveland.com.

Student Educational Benefit Trust covered students at Columbus-based Ohio Dominican University, Hiram College, the University of Akron and the University of Toledo.

A University of Akron spokesperson told cleveland.com the insurer notified the university of its intent to shut down less than two weeks before students' coverage expired. The spokesperson said roughly 800 international students depend on the coverage, as student visas often require students to show proof they would be insured overseas. Almost 200 domestic students were also receiving coverage through SEBT.








  Archives

Monday, 12/31/18 - Hospitals to list service prices starting January 1 due to new federal rule

Tuesday, 12/18/18 - 2019 Open Enrollment is over, but you may still have options

Wednesday, 01/02/19 - Judge Who Ruled Against Obamacare Says It Can Stay In Place During Appeals

Thursday, 01/03/19 - CVS Got Aetna. Next Up, Reimagining Health Care

Friday, 12/21/18 - Legislation Opens Door for Retirement Match on Student Loan Repayments




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Walt Bernard Podgurski - - Editor
440-773-1108
Walt@DailyInsuranceReport.com