DAILY UPDATE: Jerome Powell, DJIA, Reddit and Life Insurance

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Young adults are delaying life insurance purchases due to financial constraints and a preference for spending on immediate experiences. The insurance industry is responding with digital-first strategies and more flexible products.

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The DJIA closed above 40,000 for the first time after briefly crossing the milestone the day before and clinching its fifth winning week. Reddit shot up after announcing a partnership with OpenAI that lets the AI train on your posts and gives Reddit advertising dollars and the ability to use the tech to make new tools.

But, GameStop stock plunged after the recently reinvigorated meme stock filed to sell 45 million new shares and revealed that sales were down last quarter.

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Jerome Powell, chair of the Federal Reserve has tested positive for Covid. But the economy needn’t worry because he’s working from home.

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DAILY UPDATE: Top Causes of Death, Narcan Saves Lives but Scientific Research Fraudulent as DJIA Tops 40,000

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Walgreens has released its own brand of naloxone, a medication that reverses the effects of an opioid overdose. Available online now, Walgreens Brand Naloxone HCl Nasal Spray comes with two doses for $34.99, about $10 cheaper than the name-brand version, Narcan. The over-the-counter medication will also be available in stores by the end of May in the pain aisle, according to a press release, making the life-saving nasal spray more accessible.

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 6.17 points (0.1%) to 5,303.27, up 1.5% for the week; the Dow Jones Industrial Average gained 134.21 points (0.3%) to 40,003.59, up 1.2% for the week; the NASDAQ Composite® ($COMP) lost 12.35 points (0.1%) to 16,685.97, up 2.1% for the week.
  • The 10-year Treasury note yield (TNX) rose more than 4 basis points to 4.42%, down about 8 basis points for the week.
  • The CBOE Volatility Index® (VIX) fell 0.43 to 11.99.

Among major companies, Nvidia (NVDA) dropped 2% Friday but still posted a 2.9% advance for the week ahead of the semiconductor leader’s quarterly earnings Wednesday. Among sectors, energy shares led gainers behind a 1% jump in WTI Crude Oil (/CL) futures. The small-cap Russell 2000® Index (RUT) ended little changed but still gained 1.7% for the week.

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Fraudulent research papers have cost scientific journal publishers millions in lost revenue. (the Wall Street Journal)

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The 10 Top Causes of Adult Death in the U.S.A.

1.  Heart disease 267.2* 2.  Cancer 142.3 3.  Unintentional injuries 64.0 4.  COVID-19 44.5 5.  Stroke 39.5 6.  Chronic lower respiratory disease 34.3 7.  Alzheimer disease 28.9 8.  Diabetes 24.1  9   Kidney disease 13.8 10. Chronic liver disease and cirrhosis 13.8 Deaths per 100,000 population.

Source: Jeffrey Bendix, Medical Economics [5/15/24]

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DAILY UPDATE: Core CPI and ERISA while Markets Remain High with Walmart Up

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Here’s where the major benchmarks ended:

America’s oldest popular stock index, the Dow Jones Industrial Average, hit a brief record high yesterday morning when it traded above 40,000, reflecting renewed hope for the market’s health after Wednesday’s promising inflation report.

  • The S&P 500® index (SPX) fell 11.05 points (0.2%) to 5,297.10; the Dow Jones Industrial Average declined 38.62 points (0.1%) to 39,869.38; the NASDAQ Composite® ($COMP) shed 44.07 points (0.3%) to 16,698.32.
  • The 10-year Treasury note yield (TNX) rose more than 2 basis points to 4.381%.
  • The CBOE Volatility Index® (VIX) dropped 0.03 to 12.42.

Walmart’s strength fueled a strong day for consumer staples shares. The S&P 500 Consumer Staples ($SP500#30), which includes Walmart as well as companies like Coca-Cola (KO) and Procter & Gamble (PG), surged 1.5% to its highest level in over two years. 

Among other companies, Applied Materials (AMAT) fell 1.6% ahead of the semiconductor industry supplier’s quarterly earnings report, which is expected after Thursday’s close.

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And, Core CPI, which tracks the price of goods and services excluding volatile food and energy prices and is closely watched as an inflation indicator, rose 3.6% from the same period last year. That’s the smallest annual increase since April 2021. On a monthly basis, core CPI rose 0.3%, marking the first time in six months that its growth slowed from the prior month. Other good signs include:

  • Grocery prices dropped 0.2% from March, the first decrease in a year.
  • Health insurance and car insurance increased more slowly in April than in March.
  • A separate report released yesterday showed consumer spending stayed steady last month.

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Finally, Joe Manchin (D-W.Va.) and a group of Republican senators are moving to overturn a retirement investment planning rule that was finalized by the Labor Department last month. The Labor Department unveiled the new rule last month that would update the definition of an investment advice fiduciary under the Employee Retirement Income Security Act. Manchin and 15 Republican senators joined in co-sponsoring a Congressional Review Act (CRA) resolution that would overturn this new rule.

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DAILY UPDATE: Healthcare Monopolies, Ark Invest and the Stock Markets Mega Rally

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More people are interested in determining their “heart age” using new tests and tech tools, but some skeptics say it’s not a healthy data point to focus on. (the Wall Street Journal)

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The Cathie Wood-led Ark Invest just made some significant trades. The most prominent among them were the increased stakes in Palantir Technologies Inc (NYSE:PLTR) and the reduced holdings in Coinbase Global Inc (NASDAQ: COIN).

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 61.47 points (1.2%) to 5,308.15; the Dow Jones Industrial Average added 349.89 points (0.9%) to 39,908.00; the NASDAQ Composite rallied 231.21 points (1.4%) to 16,742.39.
  • The 10-year Treasury note yield fell almost 10 basis points to 4.348%.
  • The CBOE Volatility Index® (VIX) dropped 0.97 to 12.45.

Chipmaker shares led the way higher Wednesday, lifting the Philadelphia Semiconductor Index (SOX) almost 3% to a 10-week high. Interest-rate-sensitive sectors like real estate and utilities were also strong. The small-cap Russell 2000® Index (RUT) advanced 1.1% to a seven-week high. The U.S. Dollar Index ($DXY) slumped to its weakest level in five weeks, reflecting expectations for lower interest rates that may reduce the appeal of U.S. fixed income assets.

Among companies, Cisco Systems (CSC) surged 1.5% ahead of its quarterly results expected after Wednesday’s close. Dow member Walmart (WMT) is expected to release results Thursday morning as the unofficial retail earnings season accelerates. 

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And The U.S. Department of Justice (DOJ) announced it has established a new task force to take on healthcare monopolies and collusion. The task force, made up of prosecutors, economists, healthcare industry experts and others, will guide the division’s enforcement strategy and policy approach in healthcare, including by facilitating policy advocacy, investigations and, where warranted, civil and criminal enforcement in healthcare markets.

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DAILY UPDATE: Squarespace, Ark Invest & Hospitals as the Markets Rebound

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 25.26 points (0.5%) to 5,246.68, the highest since a record close March 28; the Dow Jones Industrial Average® ($DJI) gained 126.60 points (0.3%) to 39,558.11; the NASDAQ Composite climbed 122.94 points (0.8%) to 16,511.18.
  • The 10-year Treasury note yield (TNX) fell more than 3 basis points to 4.449%.
  • The CBOE Volatility Index® (VIX) decreased 0.18 to  13.42.

Among companies, Home Depot’s (HD) quarterly results reported earlier Tuesday kicked off the unofficial start of the retail earnings season. The home improvement retailer’s earnings topped expectations, but revenue missed forecasts, initially sending the company’s shares down sharply. 

Home Depot also reaffirmed its full-year guidance for a 1% decline in comparable-store sales and a 1% increase in total sales. The company’s shares bounced back to end with a 0.1% loss.

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And, the Cathie Wood-led Ark Invest just made some significant trades. The most prominent among them were the increased stakes in Palantir Technologies Inc (NYSE PLTR) and the reduced holdings in Coinbase Global Inc (NASDAQ: COIN).

Moreover, the website-building platform Squarespace is to go private, which it announced it’ll be doing in an all-cash deal with Permira, a private equity firm. Squarespace, which was public for nearly three years, joins a group of other smaller tech companies like Qualtrics that have recently pulled themselves off the public market. (CNBC)

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Employers and private insurers are paying hospitals more for inpatient and outpatient services than in previous years, a study from RAND Corporation finds. The American Hospital Association dismissed the report saying it offers a “skewed and incomplete picture.”


And finally … Kaiser Permanente began its 2024 earnings season with more than $2.7 billion in net income and $935 million in operating income, just months after sharing plans to lay off workers.

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DAILY UPDATE: Moderna Down with Mixed Markets

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) fell 1.26 points (0.02%) to 5,221.42; the Dow Jones Industrial Average lost 81.33 points (0.2%) to 39,431.51; the NASDAQ Composite® ($COMP) gained 47.37 points (0.3%) to 16,388.24.
  • The 10-year Treasury note yield (TNX) dropped almost 2 basis points to 4.487%.
  • The CBOE Volatility Index® (VIX) surged 1.05 to 13.60.

Biotechnology and food and beverage shares were among the market’s strongest sectors Monday, while communication services stocks were among the biggest laggards. Energy shares took pressure despite a jump of 1.2% in WTI Crude Oil (/CL) futures, which ended above $79 per barrel after slumping last week to two-month lows.

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Moderna is “bleeding money” as its forthcoming RSV vaccine doesn’t appear to deliver better results than other RSV shots already on the market. (Bloomberg)

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It’s ChatGPT-4o’s time to shine. The “o” stands for omni, and it’s the latest iteration of OpenAI’s signature chatbot. According to the company, it’s much faster with enhanced “capabilities across text, vision, and audio.”

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23% is the average portion of the bill hospitals collected from patients before treatment in Q1 of this year, up 3% YoY. (the Wall Street Journal)

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About Tombstone Securities Advertising and the “New Issue” Propsectus

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A Primer for Physician Investors and Medical Professionals

By: Dr. David Edward Marcinko; MBA, MEd, CMP™

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[PART 2 OF 8]

BU Dr. Marcinko

NOTE: This is an eight part ME-P series based on a weekend lecture I gave more than a decade ago to an interested group of graduate, business and medical school students. The material is a bit dated and some facts and specifics may have changed since then. But, the overall thought-leadership information of the essay remains interesting and informative. We trust you will enjoy it.

Introduction

Despite the SEC restrictions, noted in Part I of this series, some idea of potential demand for a new security issue can be gauged and have a bearing on  pricing decisions.

For example, as CEO of a medical instrument company, or interested investor, would you rather see a great deal of interest in a potential new issue or not very much interest?  There is however, one kind of advertisement that the underwriter can publish during the cooling off period. It’s known as a tombstone ad.  The ad makes it clear that it is only an announcement and does not constitute an offer to sell or  solicit the issue, and that such an offering can only be made by  prospectus.  SEC Rule 134 of the 1933 Act  itself, refers to a tombstone ad as “communication not deemed a prospectus”  because it makes reference to the prospectus in the ad. Tombstones have received their name because of the sparse nature of details found in them.

However, the most popular use of the tombstone ad is to announce the effectiveness of a new issue, after it has been successfully issued. This promotes the success of  both he underwriter, as well as the company.

Since distributing securities involves potential liability to the investment bank, it will do everything possible to protect itself.  So, near the end of the cooling off period, a meeting is held between the underwriter and the corporation. It is known as a due diligence meeting. At this meeting they both discuss amendments that are going to be necessary to make the registration statement complete and accurate. The corporate officers, and the underwriters sign, the final registration statement. They have civil liability for damages that result from omissions of material facts or

Mis-statements of fact. They also have criminal liability if the distribution is done by use of fraudulent, manipulative, or deceptive means. Due diligence takes on a whole new meaning when  incarceration from a half-hearted effort underwriting efforts can occur. The investment bank strives to ensure that there have been no material changes to the issuer or the terms of the issue since the registration statement was filed.

Again, as a physician, how would you feel if you were an investment banker raising capital for a new pharmaceutical company that had developed a drug product that was highly marketable. But, on the day after the issue was effective, there was a major news story indicating that the company was being sued for patent infringement? What effect do you think that would have on the market price of this new issue? It would probably plunge. How could this situation have been prevented? The due diligence meeting is more than a cocktail party or a gathering in a smoke filled room. Otherwise, the company would require specially trained people, to do a patent search lessening the likelihood of this scenario. At the due diligence meeting, work is done on the preparation of the final prospectus, but the investment bank does not set the public offering price or the effective date at this meeting. The SEC will eventually set the effective date for the registration and it is on that date that the final offering price will be determined.

Once the SEC sets the effective date, sales may be executed and money can be accepted by the investment bank. It is at this time that the final prospectus, similar to the red herring but without the red ink and with the missing numbers, is issued. A prospectus is an abbreviated form of the registration statement, distributed to purchasers, on and after the effective date of  the registration. It is not the same as the registration statement. A typical registration statement consists of papers that stand more than a foot high; rarely does a prospectus go beyond 40 or 50 pages. All purchasers will receive a final prospectus and then it becomes permissible for the underwriter to provide sales literature.

In addition to the requirement that a prospectus must be delivered to a purchaser of new issues no later than with confirmation of the trade, there are two other requirements that healthcare executives investors should know.

90-day: When an issuer has an initial public offering (IPO), there is generally a lack of publicly available material relating to the operations of that issuer.  Because of this, the SEC requires that all members of the underwriting group make available a prospectus on an IPO for a period of 90 days after the effective date.

4O-day: Once an issuer has gone public, there are a number of routine filings that must be made with the SEC so there is publicly available information regarding the financial condition of that issuer. Since additional information is now available, the SEC requires that, on all issues other than IPOs, any member of the underwriting group must make available a prospectus for a period of 40 days after the effective date.

In the event that the investment bankers misgauged the marketplace, and the issue moves quite slowly, it is possible that information contained in the prospectus would be rendered obsolete by the SEC. Specifically, the SEC requires that any prospectus used more than 9 months after the effective date, may not have any financial information more than 16 months old. It can however, be amended or stickered, with updated information, as needed.

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  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Syndication Among Underwriters

Because the investment banking firm may be underwriting (distributing) a rather large dollar amount of securities, to spread its risk exposure, it may form a group made up of other investment bankers or underwriters, known as a syndicate. The syndicate is headed by a syndicate manager, or lead underwriter, and it is his job to decide whether to participate in the offering. If so, the managing underwriter will sign a non-binding agreement called a letter of intent. .

If all has gone well and the market place is sufficiently interested in the security, and the SEC has been satisfied with respect to the registration statement, it is time for all parties to the offering to formalize their relationships with a contract including the basic understandings reflected in the letter of intent. Three principal underwriting contracts are involved in the usual public offering, each serving a distinct purpose. These are the: Agreement among Underwriters, Underwriting Agreement, and the Dealer Agreement.

In the Agreement Among Underwriters (AAU), the underwriters committing to a portion of the issue, enter into an agreement establishing the nature and terms of their relationship with each other. It designates the syndicate manager to act on their behalf, particularly to enter into an Underwriting Agreement with the issuer, and to conduct the offering on behalf of each  of them. The AAU will designate the managing underwriter’s compensation (management fee) for managing the offering.

The authority to manage the offering includes the authority to: agree with the issuer as to the public offering price; decide when to commence the offering; modify the offering price and selling commission; control all advertising; and, control the timing and effectiveness of the registration statement by quickly responding to deficiency letters. Each underwriter agrees to purchase a portion of the underwritten securities, which is known as each under-writer’s allotment (allocation).  It is normally signed severally, but not jointly, meaning each underwriter is obligated to sell his allocation but bears no financial obligation for any unsold allotment of another underwriter. This is referred to as a divided account or a Western account. Much less frequently, an undivided or Eastern account, will be used. Each underwriter is responsible for unsold allotments of others, based upon a  proportionate share of the offering.

The above comments referred to firm commitment underwriting. Another type of underwriting commitment  however, is known as best efforts underwriting. Under the terms of  best efforts underwriting, the underwriters make no commitment to buy or sell the issue, they simply do the best they can, acting as an agent for the issuer, and having no liability to the issuer if none of the securities are sold. There is no syndicate formed with a best efforts underwriting. The investment bankers form a selling group, with each member doing his best to sell his allotment. Two variations of a best efforts underwriting are: the all-or-none, and the mini-max (part-or-none) underwriting. Under the provisions of an all-or-none offering, unless all of the shares can be distributed within a specified period of time, the offering will terminate and no subscriptions or orders will be accepted or filled. Under mini-max, unless a set minimum amount is sold, the offering will be terminated.

SEC Rule 15c2-4 requires the underwriter to set up an escrow account for any money received before the closing date, in the event that it is necessary to return the money to prospective purchasers. If the “minimum”, or the “all” contingencies are met, the monies in escrow go to the issuer with the underwriters retaining their appropriate compensation. In order to make sure that investors are properly protected, the escrow account must be maintained at a bank for the benefit of the investors until every appropriate event or contingency has occurred. Then, the funds are properly returned to the investors. If the money is to be placed into an interest bearing account, it must have a maturity date no later than the closing date of the offering, or the account must be redeemable at face with no prepayment penalty as regards principal.

Underwriter Compensation Hierarchy

As we have seen, in a firm commitment the underwriter buys the entire issue from the issuer and then attempts to resell it to the public. The price at which the syndicate offers the securities to the public is known as the public offering price. It is the price printed on the front page of the prospectus.

However, the managing underwriter pays the issuer a lower price than this for the securities. The difference between that lower price and the public offering price is known as the spread or underwriting discount. Everyone involved in the sale of a new issue is compensated by receiving part of the spread. The amount of the spread is the subject of negotiations between the issuer and the managing underwriter, but usually is within a range established by similar transactions between comparable issuers and underwriters. The spread is also subject to NASD [now FINRA] review and approval before sales may commence. The spread is broken down by the underwriters so that a portion of it is paid to the managing underwriter for finding and packaging the issue and managing the offering (usually called the manager’s fee); and a portion is retained by each underwriter (called the underwriting or syndicate allowance) to compensate the syndicate members for their expenses, use of money, and assuming the risk of the underwriting. The remaining portion is allocated to the selling group and is called selling concession. It is often useful to remember the compensation hierarchy pecking order in the following way:

  • Spread (syndicate manager).
  • Underwriters allowance (syndicate members)
  • Selling concession (selling group members)
  • Re-allowance (any other firm)

While the above deal with corporate equity, the only other significant item with respect to corporate debt is the Trust Indenture Act of 1939. This Federal law applies to public issues of debt securities in excess of $5,000,000. The thrust of this act is to require an indenture with an independent trustee (usually a bank or trust company) who will report to the holders of the debt securities on a regular basis.

Successful marketing of a new issue is a marriage between somewhat alien factors: compliance and numerous Federal, state, and self-regulatory rules and statutes; along with finely honed and profit-motivated sales techniques. It’s not too hard to see that there could be a real, or apparent, conflict of interest here. Most successful investment bankers have built their excellent reputations upon their ability to properly balance these two objectives consistently, year after year.

PART ONE:

Understanding investment banking rules, securities markets, brokerage accounts, margin and debt

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DAILY UPDATE: Ark Invest, Dell and “Buy Now-Pay Later”

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While Buy Now-Pay Later (BNPL) reduces friction when purchasing, it’s giving some economy watchers unease. As Americans’ budgets buckle under the weight of inflation and higher interest payments, some worry BNPL is more of an invisible burden than a boon, Bloomberg reports. Beware the “phantom debt,” a Wells Fargo economist recently warned, referring to the BNPL industry’s short-term loans, which go largely unaccounted for by those tracking Americans’ debt load. That’s because, unlike credit cards and auto loan providers, Afterpay, Affirm, Klarna, and other BNPL providers don’t usually report transactions to credit scoring agencies.

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The Cathie Wood-led Ark Invest just made some significant trades. The most prominent among them were the increased stakes in Palantir Technologies Inc (NYSE: PLTR) and her reduced holdings in Coinbase Global Inc (NASDAQ: COIN).

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Dell has recently seen a decline in its revenue. In its most recent earnings report, it revealed that its net revenue shrunk by 11% year-over-year during its fiscal 2024 fourth quarter. For full year 2023, the company’s revenue was down by 14% to $88.4 billion. Partly that was due to a weak personal-computer market and the costs associated with more than 6,000 layoffs. But investors are excited by Dell’s growth potential for its server and computer businesses because of artificial intelligence, the Motley Fool reported.

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DAILY UPDATE: Mortgage Rates, Ascension Healthcare Network Security Event with Mixed Markets

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Novavax, the Covid vaccine-maker’s value doubled after it announced a $1.2 billion deal to develop new shots with Sanofi.

And, Mortgage rates fell for the first time since March, to just over 7%.

Here’s where the major stock market benchmarks ended:

  • The S&P 500 index rose 8.60 points (0.2%) to 5,222.68, up 1.9% for the week; the Dow Jones Industrial Average® ($DJI) advanced 125.08 points (0.3%) to 39,512.84, up 2.2% for the week and its eighth straight daily gain; the NASDAQ Composite® ($COMP) fell 5.40 points (0.03%) to 16,340.87, up 1.1% for the week.
  • The 10-year Treasury note yield (TNX) increased more than 5 basis points to 4.50%.
  • The CBOE Volatility Index® (VIX) fell 0.14 to 12.55.

Chip makers ranked among top gainers Friday after Taiwan Semiconductor Manufacturing (TSM) shares surged 4.5% after the company said its April revenue soared 60% behind AI-driven demand. The Philadelphia Semiconductor Index (SOX) climbed 1% and posted a 1.9% gain for the week. Consumer staples and transportation shares were also strong. Energy shares slipped behind a 1.2% drop in WTI Crude Oil (/CL) futures, though oil still ended slightly higher for the week.

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National hospital operator Ascension said a “cyber security event” has disrupted some of its clinical operations, according to a news release. Ascension, a St. Louis-based nonprofit and Catholic healthcare network, announced it had detected “unusual activity” on some of its systems. In response, the company kicked off an investigation and remediation efforts—including turning to outside cybersecurity firm Mandiant for help, as well as notifying the “appropriate authorities,” per the release.

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Planet Fitness to raise membership price for the first time since 1998. It’s going to take more than $10/month to join a gym once Planet Fitness raises the price of a basic membership for new members to $15 per month this summer. The $10 amount, which has held steady for 26 years, was considered a sweet spot where people were happy to sign up and wouldn’t bother to cancel once they gave up on their fitness goals. But after posting weaker-than-expected Q1 results, the gym chain decided it’s time to change, even though execs acknowledged that customers are looking to save rather than spend.

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DAILY UPDATE: Uber, Lyft and MSFT as the Stock Markets Rally

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Here’s where the major benchmarks ended:

  • The S&P 500 index gained 26.41 points (0.5%) to 5,214.08; the Dow Jones Industrial Average rose 331.37 points (0.9%) to 39,387.76; the NASDAQ Composite® ($COMP) advanced 43.51 points (0.3%) to 16,346.26.
  • The 10-year Treasury note yield (TNX) lost more than 2 basis points to 4.459%.
  • The CBOE Volatility Index® (VIX) fell 0.31 to 12.69.

Interest-rate-sensitive sectors, such as real estate and utilities, were among the strongest performers Thursday. Energy shares were also strong after WTI Crude Oil (/CL) futures rose for a second straight day after sinking to a two-month low earlier this week. Semiconductor shares were under pressure after disappointing revenue guidance from chip designer Arm Holdings (ARM) sent its shares down 2.3%.

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The Dow jumped for the seventh straight day while the S&P 500 closed above 5,200 for the first time in a month as stocks climbed across the board, possibly a reaction to data showing that the cooling labor market could translate into a Federal Reserve interest rate cut in a few months. But, Roblox, tanked 22% yesterday after the company cut its annual bookings forecast. The rough patch suggests that the game’s pandemic-induced popularity has likely peaked.

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Last year, Uber boasted its first full-year profit since going public. But yesterday, the company reported a surprise loss for the first quarter of 2024, dashing investors’ hopes for steady profits and sending its stock way down.

Meanwhile, Uber’s smaller rival Lyft appears to have its foot on the gas pedal. It posted better-than-expected quarterly results on Tuesday and saw a stock bump yesterday.

Microsoft plans to put the cash toward creating an AI data center. President Biden was on hand in Wisconsin to help announce the news—and not just to tout a big investment that’s expected to create jobs.

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DAILY UPDATE: Medicaid & CHIPS Unwind, Steward Health System Bankrupts as the Markets are Mixed

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It’s the first anniversary of the Medicaid unwinding for many states, a process that kicked off when federal rules that had kept people on Medicaid and the Children’s Health Insurance Program (CHIP) through the pandemic expired. And while states could redetermine eligibility again, things have “unwound” more than some experts predicted. Children were kicked off the rolls at higher rates than adults, according to a new study the Urban Institute released May 2. Twelve states—Montana, Iowa, South Dakota, Alabama, Idaho, Georgia, Texas, Arkansas, Oklahoma, Florida, Mississippi, Colorado—exceeded 100% of their total projections for disenrolling children.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) was little changed at 5,187.67; the Dow Jones Industrial Average gained 172.13 points (0.4%) to 39,056.39; the NASDAQ Composite® ($COMP) declined 29.80 points (0.2%) to 16,302.76.
  • The 10-year Treasury note yield (TNX) rose more than 3 basis points to 4.496%.
  • The CBOE Volatility Index® (VIX) fell 0.23 to 13.00.

Retail and real estate shares were among the weakest areas Wednesday, while banks and utilities were firm. Utility shares extended a nearly month-long rally, which may in part reflect greater expectations for Fed rate cuts. Lower interest rates can make utility shares with high dividend yields relative to Treasuries more appealing. The Dow Jones Utility Average ($DJU) rose 0.5% to end at its highest level since late July and is up 12% from a mid-April low.

And, Shopify’s value plunged by nearly $20 billion after the online payments company released a gloomy forecast for this quarter. It’s the latest pandemic darling to stumble: According to the Financial Times, the firms that skyrocketed during lockdowns have lost a collective $1.5 trillion in value since the end of 2020.

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Steward Health Care System, the largest U.S. physician-owned hospital operator, is expected to file for chapter 11 bankruptcy as soon as Sunday, according to a WSJ report, which cited people familiar with the matter. Steward Health Care is the largest tenant of Medical Properties Trust (NYSE: MPW). Steward Health Care hired restructuring advisers to improve its liquidity and restore its balance sheet in January 2024.  

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DAILY UPDATE: Robinhood’s SEC Enforcement with Mixed Stock Markets

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Here’s where the major stock market benchmarks ended:

  • The S&P 500 index rose 6.96 points (0.1%) to 5,187.70; the Dow Jones Industrial Average gained 31.99 points (0.1%) to 38,884.26; the NASDAQ Composite® ($COMP) eased 16.70 points (0.1%) to 16,332.56.
  • The 10-year Treasury note yield dropped more than 3 basis points to 4.457%.
  • The CBOE Volatility Index® (VIX) fell 0.26 to 13.23.

Interest-rate-sensitive sectors, such as real estate and utilities, were among the market’s strongest performers Tuesday. The Philadelphia Utility Index (UTY) rose 1.3%, its fifth straight daily gain, and hit its highest level in almost a year. The recent strength may in part reflect heightened expectations for lower interest rates, which may make utility shares with relatively high dividend yields compared to Treasuries more appealing. The utilities sector is also coming off a strong April, during which it was the only S&P 500 sector with a positive return, with chart patterns suggesting a bullish long-term momentum shift.

The semiconductor sector was among the weakest sectors Tuesday, partly behind a 1.7% drop in Nvidia (NVDA). The shares fell after billionaire investor Stanley Druckenmiller told CNBC he reduced his stake in the chipmaker in late March, saying that artificial intelligence may be a “little overhyped” for the short term.

***

Peloton is reportedly being circled by private equity firms for a potential buyout of the enfeebled fitness company.

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The SEC is preparing to sue over Robinhood’s crypto business. Robinhood just revealed that it’s been notified that the SEC plans to bring an enforcement action against its crypto unit for alleged securities violations. But the online brokerage said it’s not sweating: “We firmly believe that the assets listed on our platform are not securities and we look forward to engaging with the SEC to make clear just how weak any case against Robinhood Crypto would be on both the facts and the law,” Dan Gallagher, Robinhood’s chief legal, compliance, and corporate affairs officer, wrote in a blog post. Such a notice doesn’t always mean a suit will follow, but crypto companies and the agency have been sparring for years over whether crypto tokens count as securities.

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The Biden administration were quick to praise a new report that extends the lifespan of the Hospital Insurance Trust Fund, but the report renewed calls for increasing physician payments.


Amwell, a telehealth company, continues to struggle in the stock market, and both its bottom- and top-line results in the first quarter missed Street analysts’ estimates.


And … between the Change Healthcare cyberattack and Medicare Advantage headwinds, major insurers faced unique challenges in the first quarter.

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Stat: 8.7%. That’s the level to which US consumers can expect the 30-year mortgage rate to rise over the next year, which marks a series high, according to a New York Federal Reserve survey (MarketWatch)

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DAILY UPDATE: FQHCs Down and Healthcare Bankruptcies Up as the Markets Extend Gains

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Low-income communities often struggle to access healthcare services, but a new analysis of federally qualified health centers (FQHCs)—which provide quality care to patients regardless of ability to pay—has helped nail down one reason. When it comes to screening for certain cancers, these nonprofit community health centers have fallen far behind the national average, according to a study led by cancer center researchers at the University of Texas MD Anderson and the University of New Mexico.

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Healthcare bankruptcies surged in 2023, and it turns out many of the companies that went under had one thing in common: private equity (PE) ownership. At least 21% of the 80 healthcare companies that filed for bankruptcy last year were PE-owned, according to a report from the nonprofit Private Equity Stakeholder Project (PESP).

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Warren Buffett on contemplated his own mortality at Berkshire’s meeting. Succession was the topic du jour at the Berkshire Hathaway shareholder meeting in Omaha last week. After his longtime business partner Charlie Munger died last year at 99, CEO Warren Buffett—who turns 94 in August—revealed his heir apparent, Greg Abel, will have the final say on investment decisions in his absence. Buffett ended his Q&A portion with the quip, “I not only hope you come next year. I hope I come next year.” Adding to the ominous vibes, Buffett said AI is a genie that “scares the hell out of me.”

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Here’s where the major benchmarks ended:

  • The S&P 500 index climbed 52.95 points (1.0%) to 5,180.74; the Dow Jones Industrial Average gained 176.59 points (0.5%) to 38,852.27; the NASDAQ Composite advanced 192.92 points (1.2%) to 16,349.25.
  • The 10-year Treasury note yield (TNX) fell about 1 basis  point to 4.491%.
  • The CBOE Volatility Index® (VIX) was little changed at 13.48.

Semiconductors were among the strongest performers Monday behind Micron Technology (MU), whose shares rallied 4.7% after Robert W. Baird upgraded the chipmaker to “outperform” from “neutral.” Micron Technology was the top gainer in the Philadelphia Semiconductor Index (SOX), which advanced 2.2% to near a four-week high.

Small-cap stocks also got out of the gate strong this week. The Russell 2000® Index (RUT) gained 1.2% to end at a four-week high but is still up just 1.7% for the year, while the S&P 500 has gained 8.6%.

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DAILY UPDATE: Stock Markets Rally

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MAY THE FOURTH BE WITH YOU

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 63.59 points (1.3%) to 5,127.79, up 0.6% for the week; the Dow Jones Industrial Average® ($DJI) gained 450.02 points (1.2%) to 38,675.68, up 1.1% for the week; the NASDAQ Composite surged 315.37 points (2.0%) to 16,156.33, up 1.4% for the week.
  • The 10-year Treasury note yield (TNX) fell about 7 basis points to 4.50%, down about 16 basis points for the week.
  • The CBOE Volatility Index® (VIX) fell 1.19 to 13.49.

Technology shares were among the strongest performers Friday behind a 6% rally in shares of Apple (AAPL), which late Thursday reported stronger-than-expected quarterly results and said it will repurchase $110 billion in shares. Amgen (AMGN) soared nearly 12%, leading Dow gainers after the biotechnology company beat earnings expectations.

In other markets, WTI Crude Oil futures (/CL) extended a week-long slump to end just above $78 per barrel, the lowest since mid-March. Crude futures dropped almost 7% this week, partly reflecting rising U.S. supplies and signs of slower fuel demand.

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DAILY UPDATE: Stock Markets Up Beat!

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Yesterday, sales of Wegovy more than doubled last quarter, and at least 25,000 people are starting to take it in the US per week. It also posted a $3.65 billion net profit and increased its sales outlook for 2024. But its stock Novo Nordisk still dropped yesterday.

***

iPhone sales are down but Apple share buybacks are up. Apple managed to keep investors happy, sending its stock shooting up after-hours yesterday, despite selling fewer iPhones last quarter. Sales of the signature phone dipped 10% year over year, and revenue fell 4.3% to $90.8 billion. But Apple also announced $110 billion in share buybacks, the largest in the company’s history, per CNBC. And sales in China, which has been a sore spot, came in at $16.4 billion, less than a year earlier but more than analysts had predicted.

***

Stocks rose yesterday as investors digested Jerome Powell’s recent comments and decided they only had to fear fear itself—and not interest rate hikes. Investors changed into the fast lane to buy Carvana after the used car sales site reported its best earnings ever Wednesday evening.

***

Stat: 16%. That’s the percentage by which CVS stocks plummeted Wednesday after the company reported earnings below expectations and cut its annual outlook, according to (CNBC).

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But Here’s where the major stock market benchmarks ended Thursday:

  • The S&P 500® index (SPX) rose 45.81 points (0.9%) to 5,064.20; the Dow Jones Industrial Average® ($DJI) added 322.37 points (0.9%) to 38,225.66; the NASDAQ Composite® ($COMP) surged 235.48 points (1.5%) to 15,840.96.
  • The 10-year Treasury note yield (TNX) dropped about 1 basis point to 4.583%.
  • The CBOE Volatility Index® (VIX) fell 0.71 to 14.68.

Transportation shares helped lead the market higher after C.H. Robinson (CHRW) reported stronger-than-expected quarterly results, sending the freight logistics and trucking company’s stock up 12%. The Dow Jones Transportation Average ($DJT) jumped 2.5%. Semiconductors were also strong after Qualcomm (QCOM) advanced 9.7% in the wake of the chip maker’s better-than-expected earnings.

Apple (AAPL) shares advanced 2.2% ahead of the company’s quarterly earnings report scheduled after Thursday’s close.

In other markets, WTI Crude Oil (/CL) futures bounced back to end with a slight gain after earlier dropping to a seven-week low under $78.50 per barrel.

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DAILY UPDATE: Walmart, Women’s Health Month, UnitedHealth and the Mixed Stock Markets

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Here’s where the major stock market benchmarks ended:

  • The S&P 500® index (SPX) fell 17.30 points (0.3%) to 5,018.39; the Dow Jones Industrial Average® ($DJI) gained 87.37 points (0.2%) to 37,903.29; the NASDAQ Composite® ($COMP) lost 52.34 points (0.3%) to 15,605.48.
  • The 10-year Treasury note yield (TNX) dropped more than 5 basis points to 4.63%.
  • The CBOE Volatility Index® (VIX) decreased 0.28 to 15.37.

Banks and other financial shares led the market’s afternoon upswing, reflecting renewed optimism over the outlook for interest rates. The KBW Regional Bank Index (KRX) jumped 2.4% and posted its first gain in five days. Biotechnology and communication services were also strong.

Energy shares were among the weakest performers as WTI Crude Oil (/CL) futures extended a week-long nosedive and dropped under $80 per barrel for the first time since mid-March. Crude futures sank over 3% after the Energy Information Administration reported U.S. oil inventories surged 1.6% last week. 

Among top companies, Amazon (AMZN) gained 2.2% after reporting stronger-than-expected earnings and revenue late Tuesday. Starbucks (SBUX) tumbled 16% following unexpectedly soft quarterly results. Apple (AAPL) eased 0.6% ahead of its quarterly results, expected after Thursday’s close.

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Speaking of stock companies, however big you think UnitedHealth is, it’s bigger than that. For example:

  • With a market cap of nearly $450 billion, it’s the fourth-largest company in the US by revenue this year, beating out Alphabet and Microsoft.
  • The company is eyeing a $24.7 billion profit in 2024.
  • One analyst estimated that more than 5% of US GDP flows through UnitedHealth’s systems daily.

And so, lawmakers in Washington are prepared to grill UnitedHealth CEO Andrew Witty in two congressional hearings today, months after a cyberattack on a subsidiary of the healthcare giant, Change Healthcare, rattled the industry and left pharmacies, doctors, and hospitals in the dark. Change processes roughly half of all Americans’ medical claims. Congress wants Witty to clarify how UnitedHealth handled the breach of patient data. But beyond that, it wants to investigate whether the company—the nation’s largest private health insurer—has grown too big and taken on too much risk.

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Retailer Walmart announced plans Tuesday to shutter its network of 51 health clinics in five states, along with its telehealth business. The impending closures signify that Walmart is scuttling its initial plans to expand the services, citing escalating operation costs and “challenging reimbursement environment,” the company said in a news release.

Finally – Happy Women’s Health Month! Women and people assigned female at birth are disproportionately affected by a range of health conditions, including autoimmune diseases, chronic pain, and dementia. The month of May is intended to raise awareness of these disparities and educate women on steps they can take to improve their health, such as getting annual breast exams. For all our woman-identifying readers, take some time to prioritize your health this month!

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DAILY UPDATE: Lumeris Health Tech – MultiPlan, UnitedHealth, Aetna & CVS Payer Data – Stock Melt Down

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MAY FIRST DAY

May Day is a European festival of ancient origins marking the beginning of summer, usually celebrated on 1 May, around halfway between the Northern Hemisphere’s Spring equinox and June solstice. Festivities may also be held the night before, known as May Eve. Traditions often include gathering wildflowers and green branches, weaving floral garlands, crowning a May Queen and setting up a Maypole, May Tree or May Bush, around which people dance. Bonfires are also part of the festival in some regions.

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 80.48 points (1.6%) to 5,035.69; the Dow Jones Industrial Average® ($DJI) lost 570.17 points (1.5%) to 37,815.92, down 5% for the month; the NASDAQ Composite declined 325.26 points (2.0%) to 15,657.82.
  • The 10-year Treasury note yield jumped more than 7 basis points to 4.682%.
  • The CBOE Volatility Index® (VIX) rose 0.98 to 15.65.

Energy shares were among the weakest performers Tuesday, behind a drop in WTI Crude Oil (/CL) futures, which fell a third consecutive session and briefly dropped under $81 per barrel. The Philadelphia Oil Service Index (OSX) tumbled 4.5% to a seven-week low. The small-cap Russell 2000® Index (RUT) shed 2.1% and ended with a loss of 7.1% for the month.

But, it was a better day for Mounjaro maker Eli Lilly, which climbed nearly 6% after its popular weight loss drugs pushed it to raise its 2024 forecast.

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Lumeris Health, a health tech company supporting value-based care operations, raised $100 million in a new funding round to support expansion.

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class-action complaint was filed against MultiPlan and major payers like UnitedHealth Group and CVS Health’s Aetna, arguing payers’ claims data was being used to generate low reimbursement rates.

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DAILY UPDATE: The CHIPS and Science Act & the FOMC as Stocks Edge Higher

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It’ll be a big week for hot takes on the US economy, after the Federal Reserve meeting Tuesday and Wednesday and the April jobs report dropping Friday. Because inflation has been sticking around, the FOMC is expected to hold interest rates steady at this meeting and for the foreseeable future. On the jobs front, economists are projecting another strong month for employment growth.

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In 2022, with bipartisan support, Congress passed the CHIPS and Science Act, an ambitious plan to juice domestic manufacturing of a product vital to national security: semiconductors. Two years later, the government has doled out more than half of the CHIPS Act’s $39 billion in incentives. According to the Financial Times

  • Chip companies and their suppliers have announced US investments of $327 billion over the next 10 years, per the Semiconductor Industry Association.
  • Construction of manufacturing facilities for computing and electronics devices has jumped 15x, government data shows.
  • By 2030, the US will likely produce around 20% of the world’s most advanced chips, according to USCommerce Secretary Gina Raimondo. Right now, it’s making 0%.

The proposed factories are massive and could transform regional economies. Micron, which received $6.1 billion in federal grants last week, plans to invest $100 billion in a manufacturing campus near Syracuse.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 16.21 points (0.3%) to 5,116.17, its highest close in over two weeks; the Dow Jones Industrial Average® ($DJI) gained 146.43 points (0.4%) to 38,386.09, the NASDAQ Composite® ($COMP) advanced 55.18 points (0.4%) to 15,983.08.
  • The 10-year Treasury note yield (TNX) fell more than 5 basis points to 4.616%.
  • The CBOE Volatility Index® (VIX) declined 0.36 to  14.67.

Communication services shares were among the market’s weakest performers Monday, reversing last Friday’s upswing as Alphabet (GOOGL) dropped more than 3% and Meta Platforms (META) lost 2.4%. Banks and retailers were also soft. The Philadelphia Semiconductor Index (SOX) climbed for the sixth-straight day and ended near a three-week high even though its biggest member, Nvidia (NVDA), ended little changed.

In other markets, the U.S. Dollar Index ($DXY) faded from early gains but is still up about 1% in April, driven by expectations domestic rates will remain high. “The U.S. dollar’s strength continues to reflect the relative strength of the economy and the wide interest rate differentials between the United States and other major developed markets,” Schwab Center for Financial Research analysts said in a report.

Despite last week’s strength, the S&P 500 index and the NASAQ Composite are still down 2.6% and 2.4%, respectively, for April and on track to break five-month winning streaks.

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Humana expects to exit Medicare Advantage (MA) markets in 2025, company executives told investors. The company reported its first quarter earnings April 24th. Humana posted $741 million in net income in the first quarter of 2024, beating investor expectations, but pulled its 2025 earnings guidance. 

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DAILY UPDATE: 24/7 NYSE Trading with Last Week’s Market Round-Up

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Last week stocks shrugged off the news that the Fed’s favorite inflation gauge ticked up last month as strong earnings reports from Big Tech pushed them higher giving the NASDAQ and the S&P 500 their best weeks since November. Google parent Alphabet had its best day since July 2015 after showing that some of its Artificial Intelligence investments are paying off for its first-ever dividend distribution.

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The New York Stock Exchange (NYSE) recently asked market participants to share how they’d feel about trading 24/7.

According to Morning Brew, The tradition-shattering proposal by the world’s busiest stock exchange, which operates from 9:30am to 4pm ET Monday–Friday, would make stocks no different from other assets that never stop trading, like crypto and government bonds.

The NYSE’s curiosity comes as the startup 24 Exchange, backed by Mets owner Steve Cohen, is seeking SEC permission to launch a round-the-clock stock exchange. 24 Exchange wants to cater to the growing contingent of amateur investors, some of whom prefer to trade after their kids go to bed. If the NYSE decides to become an exchange that never sleeps, it’d likely upend the day-to-day of the pros on Wall Street. So, let’s consider what 24/7 trading would look like, who’d be in the green, and who’s kept up at night by the prospect. For example:

The NYSE currently allows people to trade stocks outside regular hours from 4am until the market opens and after the closing bell until 8pm, but there are fewer participants trading, and those transactions often come with higher fees. Meanwhile, brokerages like Robinhood and Interactive Brokers have found success in letting investors put in orders for many stocks and stock indexes overnight.

  • Robinhood recently said its overnight trading options are a hit, with trading outside of the NYSE’s regular hours accounting for as much as 25% of activity on the platform.
  • Many customers aren’t used to waiting around for the NYSE to “ding a bell two times a day,” Robinhood’s Chief Brokerage Officer Steve Quirk told Bloomberg.

Many of these nocturnal transactions on brokerage apps happen because of the time difference with the Asia Pacific region, where investors are increasingly eager to tap into the US stock market when most Americans are asleep. The trades are enabled by organizations like Blue Ocean, which are seeing skyrocketing demand for cross-border services. Having the NYSE run 24/7 would make it easier for investors in different time zones to participate in the US stock market.

Proponents also say it could make morning trading less volatile by allowing investors to react to big news (like an Elon Musk tweet about Tesla) as soon as it happens rather than waiting for markets to open.

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Meanwhile, stocks popped off last week thanks to Big Tech’s impressive earnings, with the S&P 500 and NASDAQ posting their best weeks since November. Nvidia notched its best weekly gain in almost a year (up 15%), adding nearly $290 billion in market capitalization.

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DAILY UPDATE: Cannabis, Healthcare and the Stock Market Rally!

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Here’s where the major stock market benchmarks ended:

  • The S&P 500 index gained 51.54 points (1.0%) to 5,099.96, up 2.7% for the week; the Dow Jones Industrial Average® ($DJI) increased 153.86 points (0.4%) to 38,239.66, up 0.7% for the week; the NASDAQ Composite jumped 316.14 points (2.0%) to 15,927.90, up 4.2% for the week.
  • The 10-year Treasury note yield (TNX) lost about 4 basis points to 4.665%.
  • The CBOE Volatility Index® (VIX) fell 0.34 to 15.03.

Alphabet’s rally helped communication services reverse Thursday’s downturn, which was driven by disappointing quarterly results from Meta Platforms (META). The S&P 500 Communication Services index ($SP500#50) surged 4.7% Friday and ended the week with a 2.7% gain. Semiconductor shares were also strong, led by a 6% gain in Nvidia (NVDA). The Russell 2000® Index (RUT) added 1.1% Friday and posted a 2.8% advance for the week.

In other markets, WTI Crude Oil (/CL) futures rose slightly Friday, ending around $83.65 per barrel and shutting down a three-week losing streak.

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  • Midi Health, a health clinic geared toward women in midlife, raised $60 million in Series B funding to expand its network to 150 clinicians by the end of the year, among other efforts. (MobiHealthNews)
  • “We’re fooling ourselves if we think that’s cheap or can be done less expensively.”—Carmela Coyle, president and CEO of the California Hospital Association, on hospital finances and cutting costs (AP)
  • The federal government implemented new staffing rules to improve patient care, but most nursing homes won’t be able to meet that demand. (KFF Health News/NPR)

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The Biden administration is considering a change that would downgrade cannabis from a Schedule I drug to a Schedule III drug this year. The reclassification would have major effects on the business of cannabis, but for that to happen, the Drug Enforcement Agency needs proof of medical effectiveness.

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DAILY UPDATE: GDP Worries as Markets Stumble with Meta but other Technology Stocks are Good

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New GDP numbers out yesterday show a worrying combo of stubborn inflation + waning growth that dampens hopes for a potential interest rate cut. Per the latest data from the Bureau of Economic Analysis, the first quarter of 2024 was a confounding one:

  • GDP increased at a 1.6% annualized rate, far below projections of 2.4% and notably down from 3.4% at the end of 2023.
  • While slow growth would typically signal that the Fed could cut rates, another metric complicates matters: Consumer prices (excluding volatile categories), a solid indicator of inflation, shot up to a much higher than anticipated 3.7%.

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Meta reported record Q1 revenue yesterday, but it was overshadowed by the billions of dollars the company is spending in its efforts to win the Artificial Intelligence race and make the Metaverse happen. Investors were unhappy with the company’s forecast that its spending will rise by $10 billion dollars to support Artificial Intelligence development, sending Meta’s stock price down 15% after hours.

Here’s where the major benchmarks ended:

  • The S&P 500 index fell 23.21 points (0.5%) to 5,048.42; the Dow Jones Industrial Average lost 375.12 points (1.0%) to 38,085.80; the NASDAQ Composite® ($COMP) shed 100.99 points (0.6%) to 15,611.76.
  • The 10-year Treasury note yield (TNX) rose about 5 basis points to 4.704%.
  • The CBOE Volatility Index® (VIX) fell 0.64 to 15.33.

Communication services shares were the weakest S&P 500 sector Thursday behind the plunge in Meta Platforms. Late Wednesday, the Facebook parent provided lighter-than-expected second-quarter revenue guidance, while CEO Mark Zuckerberg discussed spending in currently unprofitable pursuits such as artificial intelligence (AI) and mixed reality. Meta’s first-quarter earnings and revenue both came above analysts ‘ estimates, however.

Meta’s slump helped send the S&P 500 Communication Services index ($SP500#50) down 4%. Banks were also particularly soft amid concern that persistently high interest rates may compress lender margins. Semiconductor and transportation shares were among the few pockets of strength.

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But, Alphabet, Microsoft, and Snap reported Q1 earnings yesterday, and were generally good. Alphabet issued its first-ever dividend and authorized $70 billion in stock buybacks, after it beat Wall Street’s revenue expectations. Microsoft also beat revenue forecasts on the strength of its cloud services. And Snap shares soared after it topped estimates and impressed investors with its 422 million global daily active users. It was a much-needed boost for the sector after Meta spooked the market with how much it’s spending on AI.

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DAILY UPDATE: Retirement Security Rule, National Drug Take Back Day, Spotify, Cleveland Clinic, NAR and the Mixed Stock Markets

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Otherwise known as “National Prescription Drug Take Back Day,” National Drug Take Back Day on April 25th is sponsored by the Drug Enforcement Agency. Its goal is to keep the public aware of the dangers of prescription drug use and misuse. Many Americans don’t know how to safely dispose of the prescription drugs that have been sitting in the medicine cabinet past their prime. Using these expired drugs, or using someone else’s, is dangerous and puts both the public and the environment at risk.

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Spotify made money in Q1. According to Morning Brew, the streaming music giant grew its revenue last quarter by 20% to $3.8 billion on a record $180 million in profit, it announced yesterday. The smash report comes after Spotify cut costs last year, which included laying off more than a quarter of its workforce. The company also raised prices in 2023 for the first time in a decade as it further expanded beyond music into audio books and other categories. Spotify shares soared ~11% following the news.

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Here’s where the major benchmarks ended:

  • The S&P 500 index® (SPX) rose 1.08 points (0.02%) to 5,071.63; the Dow Jones Industrial Average® ($DJI) fell 42.77 points (0.1%) to 38,460.92; the NASDAQ Composite® ($COMP) added 16.11 points (0.1%) to 15,712.75.
  • The 10-year Treasury note yield rose more than 4 basis points to 4.644%.
  • The CBOE Volatility Index® (VIX) rose 0.28 to 15.97.

Transportation shares were among the market’s weakest performers Wednesday behind a drop of more than 10% in Old Dominion Freight Line (ODFL), which reported lighter-than-expected quarterly revenue. The shipper’s nosedive helped send the Dow Jones Transportation Average ($DJT) down 2.3%. Consumer staples, semiconductors, and utilities posted moderate advances. The Dow Jones Utility Index ($DJU) gained for the sixth straight day and ended at a three-and-a-half-month high.

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The National Association of Realtors’ $418 million settlement over an alleged conspiracy to inflate commissions received preliminary approval yesterday. It’s a new world order: Sellers won’t have to pay buyers’ agents anymore. There’s been talk of a metaphorical death of real estate agents, or a mass extinction; the jury is still out, but RE/MAX cofounder and chairman Dave Liniger doesn’t seem too concerned. 

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The Labor Department announced it has finalized its Retirement Security Rule, which aims to protect American workers who are saving for retirement and relying on advice from fiduciaries for it. The new rule will update the definition of an investment advice fiduciary under the Employee Retirement Income Security Act and the Internal Revenue Code.

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Clinicians don’t always get it right, and their mistakes can be costly: Studies show misdiagnoses lead to roughly 800,000 patient deaths or permanent disabilities each year in the US and cost the healthcare system an estimated $20 billion annually. Cleveland Clinic is using telehealth to try to combat misdiagnoses via its virtual second opinions program, which has saved an average of $8,705 per patient by avoiding unnecessary treatments, according to an analysis released in March.

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DAILY UPDATE: Nike Lay-Offs & Retirement “Rule of 55” as Stock Markets Zoom Upward

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Stat: 740. That’s how many employees Nike will lay off at its Oregon HQ before the end of June. In February, Nike CEO John Donahoe informed employees of the company’s plan to reduce 2% of its workforce, which would mean around 1,600 employees in total. (USA Today)

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Let’s say you leave your job at any time during or after the calendar year you turn 55 (or age 50 if you’re a public safety employee with a government defined-benefit plan). Under a little-known separation-of-service provision, often referred to as the “rule of 55,” you may be able take distributions (though some plans may allow only one lump-sum withdrawal) from your 401(k), 403(b), or other qualified retirement plan free of the usual 10% early-withdrawal penalties. However, be aware that you’ll still owe ordinary income taxes on the amount distributed.  This exception applies only to the plan (including any consolidated accounts) that you were contributing to when you separated from service. It does not extend to IRAs.

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 59.95 points (1.2%) to 5,070.55; the Dow Jones Industrial Average gained 263.71 points (0.7%) to 38,503.69; the NASDAQ Composite® ($COMP) surged 245.33 points (1.6%) to 15,696.64.
  • The 10-year Treasury note yield (TNX) decreased about 2 basis points to 4.602%.
  • The CBOE Volatility Index® (VIX) fell 1.25 to 15.69.

Similar to Monday, chipmakers were among the market’s strongest areas, carrying the Philadelphia Semiconductor Index (SOX) to a 2.2% advance. Retailers and communication services shares were also strong. The Dow Jones Utility Index ($DJU) gained for the fifth straight day and ended at its highest level in over three months. The Russell 2000® Index (RUT) surged nearly 2%. 

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DAILY UPDATE: The CPI, Korion Health and the Stock Markets Rebound

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The March Consumer Price Index, which the Bureau of Labor Statistics released last week, revealed that core inflation hit 3.8% Year over Year in March, rising for the first time in 12 months. That’s moving in the wrong direction for the Fed, whose goal is to bring inflation down to 2%.

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 43.37 points (0.9%) to 5,010.60; the Dow Jones Industrial Average® ($DJI) gained 253.58 points (0.7%) to 38,239.98; the NASDAQ Composite advanced 169.30 points (1.1%) to 15,451.31.
  • The 10-year Treasury note yield (TNX) was little changed at 4.617%.
  • The CBOE Volatility Index® (VIX) fell 1.41 to 16.39.

Chipmaker strength lifted the Philadelphia Semiconductor Index (SOX) up 1.7% Monday, partially reclaiming last week’s 9.2% tumble. Banking shares were also among the strongest sectors, while the Russell 2000® Index (RUT) advanced 1%. WTI crude futures earlier dropped to just a few cents above $82 per barrel, the lowest intraday price since late March.

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Telemedicine has a lot of potential to bridge barriers and make it convenient for people to access healthcare. But it’s limited by lack of tools. Your doctor can’t reach through the computer screen.”—Akshaya Anand, co-founder of Korion Health, on the startup’s efforts to create an electronic stethoscope for clinicians to record heart and lung movement (Maryland Today)

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DAILY UPDATE: Anti-Competitive Practices in Healthcare and the NASDAQ and S&P 500 Losing Streak!

HAPPY EARTH DAY

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Feds Open Online Portal for Reporting AntiCompetitive Practices in Healthcare

Federal agencies want to hear from the public about monopolistic and anticompetitive behavior within the healthcare industry. Last Thursday, the Federal Trade Commission (FTC), the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) unveiled HealthyCompetition.gov, an online portal where anyone can submit a healthcare competition complaint for potential investigation.

These submissions, the agencies said, can help the agencies ensure healthcare organizations provide quality care and pay their employees a fair wage.

Source: Dave Muoio, Fierce Healthcare [4/18/24]

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The S&P 500 just had its worst week in more than a year, and the NASDAQ is on a four-week losing streak. Blame skepticism that AI will meaningfully boost profits: Since the NASDAQ peaked last month, the largest US tech companies have lost more than $930 billion in market value. NVIDIA alone lost $212 billion in value on Friday, its biggest plunge since March 2020.

PS: Exxon Mobil is worth more than Tesla for the first time in more than a year.

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Why the Survival and Dominance of Car Manufacturers is Far from Certain

A SPECIAL REPORT

(In case you missed it)

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#12: Vitaliy Katsenelson, Value Investor (invest like Buffett, stocks ...

By Vitaliy Katsenelson CFA

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I am going to share with you excerpts from a research paper I wrote in 2018 about Tesla and electrical vehicles (EVs), which I have turned into a small book for reader convenience (it is available for free, here). I want to share these essays with you today because we are at a pivotal moment for traditional carmakers, and these essays, which I have not updated, present an important thinking framework about the industry.

It is easier to convince shareholders and the board of directors to invest money into new factories when the demand for EVs is growing, even if you are losing money per vehicle. At least there is hope that once you get to scale and perfect new technology, the losses will turn into profits.

However, when the demand for electrical vehicles stutters and your inventory of EVs starts piling up – which is exactly what is happening right now – investing in EVs becomes very difficult (I wrote about it here).

Retreating to what you know, what has worked for almost a century, what doesn’t generate huge losses with every vehicle sold, and what your current workforce is trained for, and comfortable producing, seems like a natural decision. The decisions traditional carmakers will make over the next year or two will be very important for what their future looks like a decade or two from now.
Why the Survival and Dominance of Car Manufacturers is Far from Certain

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DAILY UPDATE: BoA “De-Banks”, Hospitals Merge and Walmart Health Grows as the NASDAQ Dives

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A group of 15 financial officers representing 13 states issued a warning to Bank of America over its alleged practices of “politicized de-banking” targeting conservatives. In a letter to Bank of America CEO Brian Moynihan, the officials said the bank’s practices threaten its own financial health and reputation with customers while simultaneously harming the U.S. economy and Americans’ civil liberties. They pointed to examples of Bank of America shuttering the accounts belonging to Christian groups and leaders and joining a net-zero climate alliance in addition to its poor viewpoint diversity rating.

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Texas and Missouri will soon have about two dozen Walmart health centers, the retail giant announced this month, adding to its 50-site roster. The company plans to open eight clinics in the Houston metro area, 10 sites in the Dallas-Fort Worth area, and four facilities in Kansas City by the end of 2024, Modern Healthcare reported.

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Hospitals reported the strongest quarter of mergers and acquisitions since 2020, according to consulting firm Kaufman Hall. Four of the 20 announced transactions in the first quarter of 2024 were “megamergers” and brought in $12 billion in revenue in that time period, per the firm’s analysis. The era of consolidation is here.

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 43.89 points (0.9%) to 4,967.23, down 3% for the week; the Dow Jones Industrial Average gained 211.02 points (0.6%) to 37,986.40, little changed for the week; the NASDAQ Composite lost 319.49 points (2.1%) to 15,282.01, down 5.5% for the week.
  • The 10-year Treasury note yield (TNX) dropped more than 2 basis points to 4.623%, still up about 10 basis points for the week.
  • The CBOE Volatility Index® (VIX) rose 0.71 to 18.71.

Nvidia (NVDA) plunged 10% to lead the chip sector lower, sending the Philadelphia Semiconductor Index (SOX) down 4.1% to a two-and-a-half-month low. Communication Services shares were also among the weakest sectors, fueled by Netflix weakness. There were several pockets of strength, however. Banking shares posted firm gains Friday behind stronger-than-expected quarterly results from some regional lenders. Utilities also advanced.

The S&P 500 has fallen 5.5% from a record close March 28, more than halfway to the 10% threshold that’s traditionally viewed as a correction. The NASDAQ Composite is down 7.1% from a record close on April 11th.

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DAILY UPDATE: Stark Laws & 23andMe as Wall Street Pulls Back

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If the practice makes a reasonable effort to collect from a patient who is experiencing financial hardship (e.g., job loss due to COVID-19), providers may be able to offer a discount (e.g., settle for 70% of the amount owed) without violating Stark Law, says Reed Tinsley, CPA, healthcare consultant in Houston, Texas. “But remember that just because even if someone doesn’t have a job, they could still have money,” he adds. “There are a lot of people out there with big savings accounts.”

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Source: Lisa A. Eramo, MA, Keith A. Reynolds, Physicians Practice [4/3/24]

  • 23andMe cofounder and CEO Anne Wojcicki wants to take the once-hot DNA company private. 23andMe said a Special Committee would evaluate the proposal in light of other options. The company’s valuation has tumbled since its stock market debut in 2021. The struggling DNA company once valued in the billions — was essentially worthless as of Wednesday.
  • But,shares soared Thursday less than three years after it began selling shares. Wojcicki told board members she is proposing to acquire the company in a potential go-private transaction, according to a filing with the Securities and Exchange Commission.

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 11.09 points (0.2%) to 5,011.12; the Dow Jones Industrial Average® ($DJI) rose 22.07 points (0.1%) to 37,775.38; the NASDAQ Composite lost 81.88 points (0.5%) to 15,601.50.
  • The 10-year Treasury note yield (TNX) gained almost 5 basis points to 4.633%.
  • The CBOE Volatility Index® (VIX) dropped 0.22 to 17.99.

Weakness in chip maker shares pushed the Philadelphia Semiconductor Index (SOX) down 1.7% to a two-month low. Biotechnology and consumer discretionary shares were also among the weakest sectors. Energy companies eroded as WTI Crude Oil (/CL) futures dropped for a third straight trading day and closed at a three-week low. 

The S&P 500 is on track for its third consecutive weekly decline, its weakest stretch since September, while the NASDAQ Composite appears headed for a fourth straight weekly slide.

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DAILY UPDATE: PBM Pricing Structure and UnitedHealth Cyber Fury as Stock Markets Tumble

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Pharmacy Benefits Managers often need more transparency regarding their pricing structures and the rebates they negotiate with drug manufacturers. Some argue that PBMs might receive hidden fees or undisclosed profits from drug manufacturers in exchange for favorable positioning on their formularies (lists of covered medications). This can be seen as a form of kickback, which is illegal.

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Lawmakers Express Fury Toward UnitedHealth in Change Attack Hearing on the fallout surrounding the unprecedented cyberattack on Change Healthcare in late February. Individuals representing the American Hospital Association, private cybersecurity groups and providers testified before members of the House Energy and Commerce Committee on April 16th to discuss the healthcare industry’s response to the attack and how the federal government should act.

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In March, the cyber criminal organization received $22 million in bitcoins, though UnitedHealth Group has not addressed whether the company paid the ransom. On April 15th, ransomware group RansomHub posted files on its dark web leak site comprising of personal and protected health information on patients whose data was taken in the hack. The files also include contracts and agreements between Change and its clients, marking the first time hackers have posted data from the attack.

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Source: Jakob Emerson, Becker’s Hospital Review

Stocks started the day strong yesterday but ended up slumping before the market closed as investors pulled back on tech stocks, including Nvidia. United Airlines took off after releasing a strong forecast for the year despite saying it took a $200 million hit because of Boeing’s troubles.

Here’s where the major benchmarks ended:

  • The S&P 500 index lost 29.20 points (0.6%) to 5,022.21; the Dow Jones Industrial Average declined 45.66 points (0.1%) to 37,753.31; the NASDAQ Composite dropped 181.88 points (1.2%) to 15,683.37.
  • The 10-year Treasury note yield (TNX) decreased more than 7 basis points to 4.585%.
  • The CBOE Volatility Index® (VIX) fell 0.20 to 18.20.

ASML’s slump helped send the Philadelphia Semiconductor Index (SOX) down 3.3% to its lowest level since late February. Transportation shares were also under pressure after trucking company J.B. Hunt Transport Services (JBHT) dropped 8.1% in the wake of disappointing quarterly numbers. Energy shares slipped as WTI Crude Oil (/CL) futures fell 3% to a three-week low. 

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DAILY UPDATE: Tesla Lay Offs, Mammograms, Physician Pay, UnitedHealth and Tele-Health as Stock Markets Close Mixed

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Stat: 10%. That’s the percentage of Tesla employees that will be impacted by its global workforce reduction. Elon Musk sent an email to employees on Monday informing them of the layoffs, which he said were made to “reduce costs and increase productivity,” according to the WSJ. The move comes as the electric vehicle maker deals with a wider slowdown in EV sales. (the Wall Street Journal)

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UnitedHealth Group, reeling from the Change cyberattack, recorded a loss of $1.4 billion in the first quarter. Still, its EPS exceeded expectations and the stock is trading up.


The Florida Medicaid market is a big prize for insurers. Just three plans earned statewide contracts, starting in October.


And … physicians made steady pay gains last year, but increases were undercut by inflation rates. See how other specialties fared, according to a report from Medscape.

The social determinants of health can impact a woman’s chance of being up to date with her mammogram, according to a recent Centers for Disease Control and Prevention report. Women are less likely to get a mammogram if they feel socially isolated, have lost a job or don’t have reliable transportation.


And…A major House subcommittee is considering whether to issue another short-term extension on telehealth flexibilities as they continue to evaluate cost and quality issues or to enact permanent changes to virtual care reimbursement.  The American Telemedicine Association is pushing Congress to make permanent the Medicare telehealth flexibilities implemented during the COVID-19 pandemic.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) declined 10.41 points (0.2%) to 5,051.41, its lowest close in almost two months; the Dow Jones Industrial Average® ($DJI) advanced 63.86 points (0.2%) to 37,798.97; the NASDAQ Composite® ($COMP) eased 19.77 points (0.1%) to 15,865.25.
  • The 10-year Treasury note yield gained almost 4 basis points to 4.667%.
  • The CBOE Volatility Index® (VIX) fell 0.83 to 18.40.

Scaled-back expectations for Fed rate cuts continued to burden interest-rate-sensitive sectors, such as banks and utilities. The KBW Regional Bank Index (KRX) lost 1.4% and ended near a five-month low. The small-cap Russell 2000® Index (RUT) dropped 0.4% and ended at a two-month low.

In other markets, the U.S. dollar index (DXY) strengthened for the fifth consecutive trading day and hit its highest level since late October, reflecting expectations rates will stay elevated. 

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DAILY UPDATE: Dental and Digital Health Start-Ups as Stock Markets Collapse Again!

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Here’s where the major stock market benchmarks ended:

  • The S&P 500 index fell 61.59 points (1.2%) to 5,061.82; the Dow Jones Industrial Average lost 248.13 points (0.7%) to 37,735.11; the NASDAQ Composite® ($COMP) dropped 290.08 points (1.8%) to 15,885.02.
  • The 10-year Treasury note yield (TNX) surged almost 12 basis points to 4.618%.
  • The CBOE Volatility Index® (VIX) rose 1.92 to 19.23.

Interest-rate-sensitive sectors like real estate and utilities were among the weakest performers Monday. Technology shares were also under pressure. The small-cap Russell 2000® Index (RUT) shed 1.4% and ended at a two-month low.

In other markets, the U.S. dollar index (DXY) strengthened for the fourth consecutive trading day and hit its highest level since early November, reflecting expectations rates will stay elevated. Volatility based on the VIX jumped near 19.50, its highest level since late October.

Monday’s session also produced technical damage on the charts of benchmarks like the S&P 500, which closed under its 50-day simple moving average, currently around 5,114, for the first time since early November. The S&P 500 has dropped almost 4% from a record intraday high posted March 28th.

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And, after a tough funding year for digital health startups, the first quarter of 2024 saw a flurry of deals announced—a “positive signal” that the funding landscape is looking up, according to Adriana Krasniansky, head of research at digital health strategy group and venture fund Rock Health’s advisory arm. Overall, the number of digital health funding deals (133) that closed in Q1 was the highest in six quarters, though the average deal size ($20.6 million) was smaller, according to a Rock Health report. Total funding for digital health startups was $2.7 billion, the lowest level since 2019. An increase in the frequency of deals—even if they’re smaller—is a good sign, according to Krasniansky.

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Dental startup Tend aims to simplify the patient billing process via a partnership with health tech startup Cedar, the companies announced on April 11th, 2024. The US spends roughly $165 billion per year on dental services as of 2022, according to professional organization the American Dental Association—but the payment experience can be “opaque” and “confusing,” Matthew Fitzgerald, chief marketing officer at Tend, told Healthcare Brew. “From the outset, Tend has sought to innovate the dental experience by leveraging technology and hospitality to build a company around the patient,” Tend CEO Troy Bage said in a statement. “By partnering with Cedar, we’ll be able to streamline and simplify the payment process for all our members—further enhancing their overall experience with Tend, while unlocking new ways for us to elevate engagement.”

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DAILY UPDATE: Mike Burry MD, Private Equity in Health Systems, Drug Shortages, United Health Stock Sale and the Change Healthcare Hack as the Stock Markets Re-Collapse!

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  • Medical colleague and our financial planning for physicians textbook contributor Michael Burry MD predicted a second inflation surge, and price growth re-accelerated in March,. 2024.
  • The “Big Short” investor first warned of inflation in April 2020, over two years before it peaked.
  • Burry expected a recession, rate cuts, and stimulus spending to reignite inflation.

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A growing number of drugs are in short supply around the U.S., according to pharmacists. 

In the first three months of the year, there were 323 active medication shortages, surpassing the previous high of 320 shortages in 2014, according to a survey by the American Society of Health-System Pharmacists (ASHP) and Utah Drug Information Service. It also amounts to the most shortages since the trade group started keeping track in 2001. “All drug classes are vulnerable to shortages. Some of the most worrying shortages involve generic sterile injectable medications, including cancer chemotherapy drugs and emergency medications stored in hospital crash carts and procedural areas,” ASHP said in a statement

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Scheduling an appointment with a primary care doctor who belongs to a large health system might cause an increase in health care spending, according to a recent study. Such physicians tend to make more referrals to specialists, and emergency room visits and hospitalizations sometimes increase, according to the research out of Harvard T.H. Chan School of Public Health.

In short, physicians who work for health care systems like hospitals are more likely to recommend that patients use other services within those systems, compared with independent physicians. For the study — which was published in JAMA Health Forum, a journal of the American Medical Association — researchers analyzed the experiences of more than 4 million patients in Massachusetts.

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UnitedHealth Chairman Stephen Hemsley and other executives sold $102 million in company stock months before a federal antitrust probe became public, Bloomberg reported.

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Small physician practices are still struggling in the wake of February’s Change Healthcare cyberattack, according to an American Medical Association (AMA) survey released Wednesday.

More than half of ~1,400 respondents (55%) reported that they’ve had to use personal funds to cover their practice’s expenses due to the cyberattack’s effects on cash flow. Practices across the country have been unable to fill prescriptions or process insurance claims as Change Healthcare systems went offline, Healthcare Brew previously reported. About two-thirds of respondents said they’ve experienced restrictions to core functions, such as suspending claim payments (36%), not being able to submit claims (32%), and not being able to obtain electronic remittance advice (39%), according to the survey.

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 75.65 points (1.5%) to 5,123.41, down 1.6% for the week; the Dow Jones Industrial Averagelost 475.84 points (1.2%) to 37,983.24, down 2.4% for the week; the NASDAQ Composite® ($COMP) dropped 267.10 points (1.6%) to 16,175.09, down 0.5% for the week.
  • The 10-year Treasury note yield (TNX) fell more than 5 basis points to 4.52%, still up about 12 basis points for the week.
  • The CBOE Volatility Index® (VIX) rose 2.38 to 17.30.

Semiconductor shares were also among the weakest performers Friday as chip makers reversed Thursday’s sharp gains. The Philadelphia Semiconductor Index (SOX) dropped more than 3% and ended with its third straight weekly decline. Energy companies were also under pressure after crude oil prices retreated from the morning rally. Oil futures are still up 20% this year. The small-cap Russell 2000® Index (RUT) lost 1.9% and posted a 2.9% drop for the week.

In other markets, the U.S. dollar index (DXY) strengthened to a five-month high and gained 1.7% this week, reflecting beliefs the hotter-than-expected inflation readings earlier this week will keep interest rates elevated. Volatility based on the VIX jumped to its highest level since late October.

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DAILY UPDATE: Costco Gold, CPI, US Stamps and the Mexican Peso as Technology Stocks Rise and Private Equity Takes on Medicine

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Costco started selling gold bars to its members last August, and Wells Fargo analysts believe that the product is now bringing in between $100 million and $200 million a month. The retailer doesn’t reveal the price of the 1-ounce bullion to nonmembers online, but it’s estimated to be ~2% above the spot price gold trades at, per CNBC—and that price has soared since Costco got into the gold game. The price of gold has gone up 13% this year and reached record highs as investors pile in amid inflation worries.

The big numbers from the Consumer Price Index data released on Thursday

  • In March, inflation rose 3.5% from the year before, up from 3.2% in February.
  • The “core” CPI reading, which excludes volatile food and fuel prices, came in even higher, rising 3.8% on an annual basis. That’s the same as in February, but this time it’s serious.
  • Half of the increases came from rising gas prices and housing.

After seeing inflation fall by 3% over the course of 2023, Fed officials believed that higher inflation readings in January and February 2024 represented a hiccup in an otherwise downward trajectory. However, with the March reading also coming in hotter than anticipated, analysts say this is more than a fluke. That means hopes for a June interest rate cut are dashed. Even the US Postal Service plans to raise the price of “forever” stamps to $0.73 in July. Get yours now. And the Mexican peso is on an absolute tear, leaving the US dollar behind.

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Here’s where the major stock benchmarks ended:

  • The S&P 500® index (SPX) advanced 38.42 points (0.7%) to 5,199.06; the Dow Jones Industrial Average® ($DJI) lost 2.43 points to 38,459.08; the NASDAQ Composite gained 271.84 points (1.7%) to 16,442.20.
  • The 10-year Treasury note yield (TNX) rose nearly 2 basis points to 4.578%.
  • The CBOE Volatility Index® (VIX) fell 0.89 to 14.91.

Chip maker strength lifted the Philadelphia Semiconductor Index (SOX) more than 2% and extended the benchmark’s year-to-date gain to more than 17%. Communications services and transportation shares were also among the strongest sectors. Financial shares were mixed ahead of expected quarterly results Friday from some major banks including JPMorgan Chase (JPM), Citigroup (C), and Wells Fargo (WFC). 

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  • Big businesses such as hospital systems, insurers, and PE firms are gobbling up medical clinics.
  • Some doctors and industry experts fear corporate owners could prioritize profits ahead of patients.
  • The federal government is dialing up scrutiny of PE firms and other corporate owners in healthcare.

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QUESTION: Are Independent doctors almost a thing of the past?

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DAILY UPDATE: KPMG Fined, Aging Doctors, Water Fluoridation Outcries, Medicare Part C Down, CBO Deficit with Inflation Up as Stock Markets Crash!

MEDICAL EXECUTIVE-POST Today’s Newsletter

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

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NEW YORK (Reuters) -The U.S. accounting watchdog on Wednesday said it has hit KPMG Netherlands with a $25 million civil penalty, a record for the regulator, in response to “egregious” and widespread exam cheating at the foreign affiliate of the major audit firm.

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As millions of Americans approach age 66, they face the inevitable question, is it time to retire? The physician population is aging alongside the general population—more than 40% of physicians in the U.S. will be 65 years or older within the next decade. In the case of surgeons, there is little guidance on how to best ensure their competency throughout their career and at the same time maintain patient safety while preserving mature physician dignity.

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It is a scenario playing out nationwide. From Oregon to Pennsylvania, hundreds of communities have in recent years either stopped adding fluoride to their water supplies or voted to prevent its addition. Supporters of such bans argue that people should be given the freedom of choice. The broad availability of over-the-counter dental products containing the mineral makes it no longer necessary to add to public water supplies, they say. The Centers for Disease Control and Prevention says that while store-bought products reduce tooth decay, the greatest protection comes when they are used in combination with water fluoridation.

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More health systems are going to be opting out of Medicare Advantage (MA) plans, George Hill, a managing director at Deutsche Bank in Boston, predicted Monday at a “Wall Street Comes to Washington” webinar hosted by the Brookings Institution. “I think you’re going to see more large provider organizations threaten to opt out of networks, particularly as it relates to MA,” Hill said, adding that there are a number of reasons for this. “Prior authorizations are the problem, claims denials are a huge problem, delayed payments and rates are the problem — barriers in access to care in all varieties are the problem.”

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The latest budget update from the nonpartisan Congressional Budget Office (CBO) found that the federal government has spent more on paying interest on the national debt than on the military in fiscal year 2024. The CBO’s budget report for March showed that the U.S. has spent $412 billion on military programs at the Department of Defense through the first half of FY-2024, according to preliminary figures from CBO and the Treasury Department. 

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Consumer price increases remained high last month, boosted by gas, rents, and car insurance, the government said Wednesday in a report that will likely give pause to the Federal Reserve as it weighs when and by how much to cut interest rates this year. Prices outside the volatile food and energy categories rose 0.4% from February to March, the same accelerated pace as in the previous month. Measured from a year earlier, these core prices were up 3.8%, unchanged from the year-over-year rise in February. The Fed closely tracks core prices because they tend to provide a good read of where inflation is headed.

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) dropped 49.27 points (1.0%) to 5,160.64; the Dow Jones Industrial Average lost 422.16 points (1.1%) to 38,461.51; the NASDAQ Composite® ($COMP) fell 136.28 points (0.8%) to 16,170.36.
  • The 10-year Treasury note yield (TNX) soared more than 18 basis points to 4.548%.
  • The CBOE Volatility Index® (VIX) jumped 0.82 to 15.80.

Interest-rate-sensitive sectors like banks, real estate, and utilities led Wednesday’s decliners. The KBW Regional Bank Index (KRX) tumbled 5% to its lowest point since late November. The small-cap Russell 2000® Index (RUT) lost 2.5%. Energy shares were among the few gainers as WTI Crude Oil (/CL) futures rebounded after three-straight losing sessions.

In other markets, the U.S. dollar index (DXY) jumped 1% to a five-month high amid expectations interest rates will remain elevated.

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DAILY UPDATE: Stocks Slightly Up Awaiting CPI Report

By Staff Reporters

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Boeing had yet another rough day, at one point dropping 2.5% to its lowest mark in five months after reports that the FAA is investigating a whistleblower’s claims about safety issues with the 787 Dreamliner.

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And, US stocks on Tuesday ended with small moves, weighed down by the financial sector ahead of key earnings reports later this week. Market participants also exhibited caution a day before the latest consumer inflation data. Wall Street’s three major averages opened in the green but then spent most of the day languishing in negative territory.

Finally, the tech-heavy NASDAQ Composite (COMP:IND) eventually closed 0.32% higher at 16,306.64 points, while the benchmark S&P 500 (SP500) added 0.15% to settle at 5,209.94 points. The blue-chip Dow (DJI) fell marginally by 0.02% to conclude at 38,883.67 points.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) gained 7.52 points (0.1%) to 5,209.91; the Dow Jones Industrial Average® ($DJI) lost 9.13 points (0.02%) to 38,883.67; the NASDAQ Composite® ($COMP) rose 52.68 points (0.3%) to 16,306.64.
  • The 10-year Treasury note yield (TNX) fell more than 6 basis points to 4.358%.
  • The CBOE Volatility Index® (VIX) fell 0.21 to 14.98.

Financial and industrial shares led Tuesday’s decliners. Oil services stocks were also soft as WTI Crude Oil (/CL) futures dropped for a third consecutive trading session. The Philadelphia Oil Service Index (OSX) lost 0.7% and ended at its lowest point since April 1. 

In other markets, Gold (GC) futures neared $2,400 per ounce and hit a record high for the eighth consecutive trading session. Gold’s rally has been driven by factors including reports of purchases by China’s central bank as well as expectations for lower interest rates and escalating conflict in the Middle East. Bitcoin (BTC) tumbled about 3.5% and fell to less than $70,000, giving up much of Monday’s gain.

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DAILY UPDATE: U.S.A. Stock Markets Little Changed

By Staff Reporters

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Like use, investors were a little checked out yesterday, focusing on the eclipse or maybe the fact that earnings season starts later this week, and stocks were relatively flat. Diamondback Energy hit an all-time high following several other energy companies that did so last week as oil prices surge.

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) lost 1.95 points (0.04%) to 5,202.39; the Dow Jones Industrial Average® ($DJI) eased 11.24 points (0.03%) to 38,892.80; the NASDAQ Composite® ($COMP) gained 5.44 points (0.03%) to 16,253.96.
  • The 10-year Treasury note yield rose more than 4 basis points to 4.422%.
  • The CBOE Volatility Index® (VIX) fell 0.84 to 15.19.

Bank shares were among Monday’s strongest performers, sending the KBW Regional Banking Index (KRX) up 1.5%. Consumer discretionary companies were also strong. WTI Crude Oil (/CL) futures fell sharply earlier in the session following reports Israel had removed some troops from Gaza but bounced back to end down 0.5% at around $86.47 per barrel.

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DAILY UPDATE: Nvidia in Medicine, IRs and the Big Banks

By Staff Reporters

SAFE SOLAR ECLIPSE DAY

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NVIDIA
is accelerating the pace of healthcare innovation! Last week they unveiled a suite of AI microservices for developers, launched cutting-edge healthcare AI tools, and deepened their collaborations with giants like Johnson & Johnson. Plus, they’re ramping up investment in clinical trials and drug design. 

Do you ever struggle with finding the best sources of information about healthcare AI? Check out my new video, where I share my favorite newsletters, websites, sub-reddits, and a list of must-follow experts. With this toolkit, you won’t miss anything important. Also, I hope you enjoyed a restful and Happy Spring Break – should you celebrate it!

Bertalan Meskó, PhD
The Medical Futurist

READ MORE: https://www.cnbc.com/2024/03/24/nvidias-ai-ambitions-in-medicine-and-health-care-are-becoming-clear.html?utm_source=The+Medical+Futurist+Newsletter&utm_campaign=f5908296a8-EMAIL_CAMPAIGN_2024_04_07_Resend&utm_medium=email&utm_term=0_efd6a3cd08-f5908296a8-399696053&mc_cid=f5908296a8&mc_eid=40fee31c25

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Last week, several Fed officials said they were in no rush to slash interest rates in 2024, which investors have been banking on this year. Meanwhile, oil prices have risen to five-month highs due to concerns about supply shocks in key areas around the world.

And, Wall Street is preparing for a crammed week, with crucial inflation data dropping on Wednesday and big banks (JPMorgan, Wells Fargo, Citigroup) inaugurating earnings season on Friday. The pressure is on companies to post beefy profits to back up their strong stock performance in Q1.

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DAILY UPDATE: Stock Markets Surge

By Staff Reporters

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Here’s where the major benchmarks ended:

  • Markets: Stocks pulled it out for a Friday win after the government dropped encouraging economic data. But all three major indexes were still down for the week, with the Dow enduring its worst of 2024.
  • Stock spotlight: Tesla took a wild ride, plunging after Reuters reported it had scrapped plans to produce its long-awaited Model 2 affordable EV only to regain some ground after Elon Musk denied it. The company then jumped after hours because Musk said it’ll debut a robotaxi on August 8.
  • The S&P 500 index gained 57.13 points (1.1%) to 5,204.34, down 1.0% for the week; the Dow Jones Industrial Average added 307.06 points (0.8%) to 38,904.04, down 2.3% for the week; the NASDAQ Composite® ($COMP) rose 199.44 points (1.2%) to 16,248.52, down 0.8% for the week.
  • The 10-year Treasury note yield (TNX) rose more than 8 basis points to 4.392%.
  • The CBOE Volatility Index® (VIX) fell 0.32 to 16.03.

Meta Platforms (META) and Netflix (NFLX), two members of the “Magnificent Seven” mega-cap group, both jumped around 3% Friday, helping lift the S&P 500 Communication Services Index ($SP500#50) 1.6% to lead top-performing sectors. Meta shares closed at a record above $527, up 49% for the year. 

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DAILY UPDATE: The “Lipstick Index” and Stock Market Crash

By Staff Reporters

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Ulta and other major beauty companies that thrived during the past few years of economic instability provided good fodder for the “lipstick index”—a duct-tape economic measure that assumes people still buy small indulgences (like lipstick) during tough times, keeping the beauty industry recession-proof.

However…it’s not. Ulta’s full-year sales growth target is just 4% to 5%, which falls below Wall Street’s estimates, and Estée Lauder announced in February it was laying off 3% to 5% of its workforce after some difficult months.

And, other consumer goods powerhouses are bracing for a slowdown, too. The parent company of Calvin Klein and Tommy Hilfiger said this week that it’s preparing for a 6% to 7% revenue drop this year.

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MORE: https://medicalexecutivepost.com/2023/09/23/economic-indicators-lipstick-index-and-cosmetic-others/

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Here’s where the major benchmarks ended:

  • The S&P 500 index dropped 64.28 points (1.2%) to 5,147.21; the Dow Jones Industrial Average® ($DJI) tumbled 530.16 points (1.4%) to 38,596.98; the NASDAQ Composite® ($COMP) sank 228.38 points (1.4%) to 16,049.08.
  • The 10-year Treasury note yield (TNX) fell more than 5 basis points to 4.303.%.
  • The CBOE Volatility Index® (VIX) surged 2.07 to 16.39.

Semiconductors were among Thursday’s weakest performers as a drop of more than 8% in Advanced Micro Devices (AMD) helped send the Philadelphia Semiconductor Index (SOX) down 3% to a two-week low. Retail shares were also soft. WTI Crude Oil futures rose for the sixth consecutive day and topped $87 per barrel, marking a gain of 4.3% so far this week. Volatility based on the VIX ended at its highest level since early November. Brent Crude Oil (/BZ) futures, the global benchmark, topped $90 for the first time since October.

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DAILY UPDATE: Iger Survives as Ulta Beauty and Stock Markets Stall

By Staff Reporters

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Ulta Beauty plunged after its CEO revealed that, despite the resilience of the beauty category, sales have slowed.

And, Walt Disney’s current rulers will continue to oversee the kingdom. The company’s board, helmed by CEO Bob Iger, defeated activist investors and Nelson Peltz who had hoped to replace current board members and steer the company in a new direction.

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 5.68 points (0.1%) to 5,211.49; the Dow Jones Industrial Average lost 43.10 points (0.1%) to 39,127.14; the NASDAQ Composite® ($COMP) added 37.01 points (0.2%) to 16,277.46.
  • The 10-year Treasury note yield fell more than 1 basis point to 4.351%.
  • The CBOE Volatility Index® (VIX) declined 0.28 to 14.33.

Energy shares remained one of the market’s strongest performers behind strength in WTI Crude Oil (/CL) futures, which rose a fifth consecutive day and ended above $85 per barrel, the highest since October. The Philadelphia Oil Service Index (OSX) jumped1.6%, extending its year-to-date gain to almost 14%. 

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DAILY UPDATE: Medicare Advantage Plans Down as Stocks Crash

By Staff Reporters

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Medicare Part C papers, glasses and stethoscope.

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Humana and other managed-care stocks were down sharply in trading Tuesday after the Centers for Medicare and Medicaid Services announced an average 3.7% increase in revenue for Medicare Advantage plans in 2025. That amount is the same as the proposed increase the government had announced in January, but it came as a shock to investors who were hoping for a slight bump.

Humana  (HUM)  shares fell sharply in early Tuesday trading, while rivals UnitedHealth UNH and CVS Health  (CVS)  traded firmly in the red, as the health insurance industry received yet another blow to its 2024 profit forecasts. All three major health insurance groups have trailed the broader market this year, with Humana down nearly 25%, amid concern that profit margins will be hit by a surge in medical costs tied to a rise in elective procedures. Those procedures had been delayed by the Covid pandemic. 

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 37.96 points (0.7%) to 5,205.81; the Dow Jones Industrial Average lost 396.61 points (1.0%) to 39,170.24; the NASDAQ Composite slipped 156.38 points (1.0%) to 16,240.45.
  • The 10-year Treasury note yield was up almost 3 basis points to 4.357%.
  • The CBOE Volatility Index® (VIX) rose 0.96 to 14.61.

Retailer, biotechnology, and regional bank shares were among the weakest performers Tuesday, leading a broad market slump in which declining stocks outnumber advancers by a greater than three-to-one ratio. The small-cap Russell 2000® Index (RUT) lost 1.8% and settled at a two-week low. 

Energy companies, by contrast, extended recent strength behind an ongoing climb in WTI Crude Oil (/CL) futures, which surpassed $85 per barrel for the first time since late October. The Philadelphia Oil Service Index (OSX) advanced 2.1% and ended at a 5-½-month high. Oil prices have surged this year due to OPEC production cuts and concern over supply disruptions stemming from the Middle East conflict.

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DAILY UPDATE: Truth Social and Weak Stock Markets

By Staff Reporters

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Quote: “This is a very unusual situation. The stock is pretty much divorced from fundamentals.”Jay Ritter, finance professor and IPO expert at the University of Florida, on the surging value of the newly public Trump Media. Truth Social, its only active product, has been shedding both users and cash. (CNN)

Shares of Truth Social owner Trump Media & Technology Group plunged Monday after the company disclosed that it lost more than $58 million and generated very little revenue in 2023. Former President Donald Trump is the company’s majority shareholder, and his net worth tumbled by more than $1 billion Monday as a result.

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Here’s where the major benchmarks ended:

Stocks started Q2 off soft yesterday, as investors continued to fret about inflation. Stock spotlight: Trump Media, the newly public company that owns Truth Social, plunged yesterday after revealing that it lost $58 million last year, generated just $4.1 million in revenue, and had 10 times fewer users than Threads.

  • The S&P 500 index fell 10.58 points (0.2%) to 5,243.77; the Dow Jones Industrial Average® ($DJI) shed 240.52 points (0.6%) to 39,566.85; the NASDAQ Composite® ($COMP) added 17.37 points (0.1%) to 16,396.83.
  • The 10-year Treasury note yield jumped 13 basis points to 4.323%.
  • The CBOE Volatility Index® (VIX) rose 0.64 to 13.65.

Banks were among the market’s weakest performers Monday, likely reflecting concern that elevated interest rates could pinch margins. The KBW Regional Bank Index (KRX) sank 2% after ending at a two-month high last week. The small-cap Russell 2000® Index (RUT) was also soft, dropping 1% after closing at a two-year high last week. 

Communication services and semiconductor shares turned in strong performances, as did energy, lifted by WTI Crude Oil (/CL) futures’ extending a rally to its highest level since late October. WTI Crude Oil is up almost 18% so far this year amid concern over supply disruptions stemming from the Russia-Ukraine war and Middle East conflict.

In other markets, the U.S. dollar index ($DXY) strengthened for the fourth straight day and reached its highest point since mid-November behind expectations the Fed will keep interest rates high.

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DAILY UPDATE: March Round-Up as Stocks End their Best First Quarter in Five Years

By Staff Reporters

APRIL FOOL’S DAY

April Fools’ Day customs date back to at least Renaissance Europe, but it’s likely the tradition originated long before then. Some historians have linked April Fools’ Day to the ancient Roman festival of “Hilaria,” where at the end of March, people would come together to commemorate the resurrection of the god Attis. It was a celebration of renewal in which revelers would dress up in disguises and imitate others.

It’s also possible that the medieval celebration of the Feast of Fools, where a mock bishop or pope was elected and church customs were parodied, could have inspired the day.

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Stocks had their best Q1 in five years. The S&P 500 ended Thursday—the last trading day of the quarter—up by more than 10%, marking its best start to a year since 2019.

The AI craze, record corporate profits, and optimism around cooling inflation are all contributing to the stock boom. The economy got more good news yesterday when the Stocks had their best Q1 in five years reported that several key gauges, including GDP and consumer spending, grew in Q4 of last year.

And, that’s not all: Home sales bounced back after a January slump, jobless claims fell, and advertisers raised their full-year forecast. Consumer sentiment is now at its highest level since 2021.

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DAILY UPDATE: Good Friday’s Impressive First Quarter Stock Market Returns

By Staff Reporters

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The stock market will be closed Friday, March 29th, for Good Friday. While Good Friday is a stock market holiday, it is not a federal holiday. As a result, the February Personal Consumption and Expenditures (PCE) Price Index will be released this Friday morning.

Yesterday, on the final trading session of March and the first quarter, the returns for major stock indexes are impressive, with the Dow Jones Industrial Average up 5% this quarter or 2,000 points and the S&P 500 and the tech-heavy NASDAQ up 11% apiece. Stock superlatives for 2024’s opening stretch are numerous, including each of the three indexes setting respective all-time highs and the benchmark S&P heading toward its best first-quarter return since 2019 and its second consecutive quarter of double-digit percentage gains since 2011-12.

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Here’s where the major benchmarks ended Thursday:

  • The S&P 500 index added 5.86 points (0.1%) to 5,254.35, up 0.4% for the week; the Dow Jones Industrial Average climbed 47.29 points (0.1%) to 39,807.37, up 0.8% for the week; the NASDAQ Composite lost 20.06 points (0.1%) to 16,379.46, down 0.3% for the week. 
  • The 10-year Treasury note yield rose one basis point to just under 4.21%.
  • The CBOE Volatility Index® (VIX) rose 0.22 to 13.00.

For the month, the S&P 500 index gained 3.1%, the Dow Jones Industrial Average rose 2.1%, and the NASDAQ Composite added 1.8%. For the quarter, the three indexes rose 10.3%, 5.6%, and 9.2%, respectively.

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DAILY UPDATE: Independent Pharmacies Struggle as Stocks Hit New Highs

By Staff Reporters

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Independent pharmacies have struggled in recent years to stay open—and new financial constraints may mean a record number of pharmacy closures in 2024. And, nearly a third of independent pharmacies are at risk of going out of business due in part to a new rule from the Centers for Medicare and Medicaid Services (CMS) that results in lower prescription reimbursements, according to the National Community Pharmacists Association (NCPA), a trade group that represents more than 19,400 US pharmacies.

“This is an emergency,” NCPA CEO B. Douglas Hoey said in a statement. “If Congress fails to act again, thousands of local pharmacies could be closed within months and millions of patients could be stranded without a pharmacy.” The CMS rule, which went into effect on January 1st, requires payers and pharmacy benefit managers (PBMs) to apply what’s called direct and indirect remuneration (DIR) fees at the time a patient picks up a prescription.

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Here’s where the major benchmarks ended:

  • The S&P 500 index added 44.91 points (0.9%) to 5,248.49; the Dow Jones Industrial Average climbed 477.75 points (1.2%) to 39,760.08; the NASDAQ Composite added 83.82 points (0.5%) to 16,399.52. 
  • The 10-year Treasury note yield fell four basis points to just under 4.2%.
  • The CBOE Volatility Index® (VIX) dropped 0.48 to 12.76.

In addition to utility stocks, real estate, industrials, and materials were the strongest sectors. Information technology and communications were the weakest but found late-day strength to finish higher.

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DAILY UPDATE: “Digital Markets Act” Violations as Stocks Slide

By Staff Reporters

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The European Union is investigating Meta, Apple, and Alphabet for potential violations of its Digital Markets Act. And its regulators have started looking into Amazon as well.

The Digital Markets Act is the EU’s law to make the markets in the digital sector fairer and more contestable. In order to do so, the Digital Markets Act (“DMA”) establishes a set of clearly defined objective criteria to identify “gatekeepers”.

And, stocks were headed for a great Tuesday before investors sent stock indexes back down and leaving the Dow largely unchanged. Meanwhile, Donald Trump’s social media company, Truth Social, surged 16% in its first day of trading, just as the former president must pay $175 million as part of his civil fraud trial.

Here’s where the major benchmarks ended:

  • The S&P 500 index lost 14.61 points (0.3%) to 5,203.58; the Dow Jones Industrial Average dropped 31.31 points (0.1%) to 39,282.33; the NASDAQ Composite tumbled 68.76 points (0.4%) to 16,315.70. 
  • The 10-year Treasury note yield (TNX) fell two basis points to 4.23%.
  • The CBOE Volatility Index edged up 0.05 to 13.24.

In terms of sector performance, utilities, information technology, and energy were the weakest. Health care and financials saw relative strength.

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DAILY UPDATE: Nurses Strike as Stocks Decline

By Staff Reporters

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About 1,300 nurses at Staten Island University Hospital (SIUH) will strike on April 2nd if contract negotiations fail, the New York State Nurses Association (NYSNA) announced Thursday. The union, which represents about 42,000 nurses across the state, is looking for higher wages and improved nurse-to-patient ratios for their members—sticking points for Northwell Health, according to NYSNA.

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Here’s where the major benchmarks ended:

  • The S&P 500 index sank 15.99 points (0.3%) to 5,218.19; the Dow Jones Industrial Average dropped 162.26 points (0.4%) to 39,313.64; the NASDAQ Composite lost 44.35 points (0.3%) to 16,384.47. 
  • The 10-year Treasury note yield (TNX) rose three basis points to 4.25% after a four-day retreat.
  • The CBOE Volatility Index® (VIX) edged up 0.14 to 13.20.

The energy sector followed crude oil prices and was the strongest sector Monday. Utilities and materials also saw strength. Weakest sectors included industrials, information technology, and real estate.

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DAILY UPDATE: Wingstop and the Markets

By Staff Reporters

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Investors hope this week on Wall Street will be as enjoyable as the last, when stocks raced higher after Fed Chair Jerome Powell previewed a series of rate cuts. Wingstop stock has surged more than 380% in the last five years.

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Here’s where the major benchmarks ended last week:

  • The S&P 500 index sank 7.35 points (0.1%) to 5,234.18, up 2.3% for the week; the Dow Jones Industrial Average dropped 305.47 points (0.8%) to 39,475.90, up 2% for the week; the NASDAQ Composite rose 26.98 points (0.2%) to 16,428.82, up 2.9% for the week. 
  • The 10-year Treasury note yield dipped five basis points to 4.22%, down nearly nine basis points for the week.
  • The CBOE Volatility Index edged up 0.14 to 13.06, falling 1.34 points for the week.

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