Government Watch

More Cuts In Store For Medicare Plans — Here Are The Options That Will Shrink Most For Seniors

from Forbes – by Scott Gottlieb – The privately run Medicare plans known as “Medicare Advantage” have been in the political crosshairs of the Obama White House. Even after facing steep cuts under Obamacare, the Advantage plans are now slated to take a brand new round of reductions in 2015. These new cuts will cause the private Medicare option to shrink further in the next few years, and pressure the insurance companies that offer them.

The latest cuts are the consequence of a slowdown in the overall growth of Medicare spending — some of it owing to reduced utilization of medical services as a result of the slack economy. The Medicare program recently told the private plans that, since per capita costs are trending lower than prior estimates, the feds are now assuming that Medicare Advantage will take another cut in 2015, on top of existing reductions.

This means that in 2015, the rates that the feds pay these plans is slated to go from an earlier 1.7 percent increase to a new, -2.0 percent decrease. This is on top of other cuts that have already been announced or implemented. Combined with these other cuts mandated by Obamacare, the Medicare Advantage plans are looking at significant reductions when they had been expecting small increases.

The slower rate of growth in overall Medicare spending will come as welcome news. Yet basing Medicare Advantage rates off this metric was always flawed. The translation between Medicare’s per-capita costs and beneficiary costs in the Medicare Advantage program was never precise. They don’t track each other well, as the Advantage plans often implement reforms and realize savings in ways that are detached from trends underway in the broader medical marketplace.

These 2015 rate adjustments will affect the investment decisions that the advantage plans make. Now that anticipated increases are turning into cuts, more health plans are likely to skinny down the options that they offer.

Hardest hit are going to be the health plans that have made the biggest investments in Medicare Advantage. At the top of this list is Humana.

Humana has about 2.5 million Medicare Advantage members and 3.3 million participants in Medicare Part D drug plans. The company’s Medicare business accounts for 70 percent of its revenue. So watch the plan as a bellwether for the impacts of these policy trends.

Humana has been making aggressive investments in the way it delivers care to seniors and integrates their medical services. It’s part of a broader effort to improve medical outcomes, and save money on medical costs. But these are long term investments that might not pay off in time to offset the near term cuts. That’s the problem with the way Washington budgets around healthcare. The year-to-year budget adjustments don’t provide enough opportunity for insurers to realize the savings from making longer-term investments in healthcare. If Humana’s Medicare business starts to shrink, or benefits get trimmed in noticeable ways, it will be a reflection of the recent cuts.

All of this begs the question why the private Medicare plans remain a target?

The original gripe that the Obama team had was that the MA plans were being paid more for each beneficiary that they covered than what the government spent on an average senior enrolled in traditional fee-for-service Medicare.

The math on this costs per-beneficiary estimate was always fuzzy. It baked in a lot of fungible assumptions. Nonetheless, Obamacare sanded away any perceived discrepancy, cutting more than $150 billion from these plans.

The net effect of all of these cuts is already expected to shrink the program. The Obama Administration is disproportionately shifting these cuts onto so-called Medicare “special needs” plans. These are Medicare Advantage plans that are specifically designed to enroll patients with certain serious and costly chronic illnesses like diabetes and heart disease. Many of these patients are low income, and dually eligible for both Medicare and Medicaid.

These SNP plans are paid more to effectively siphon these less healthy patients away from other Medicare schemes like Medicare’s fee-for-service program. The idea is that these specialized Medicare Advantage plans will be able to more closely manage these patients, reducing morbidity associated with chronic ailments, and in turn lowering costs to the Medicare program. There is evidence that this kind of focused health plan works to improve clinical outcomes, and reduce costs.

More than 1.5 million seniors were covered by about 500 of these plans in 2013. Avalere Health, a Washington-based health policy firm estimates that at least 13% of these plans will be eliminated as a result of the cuts.

The targeting of SNPs is illustrative of the incongruous nature of the President’s policies when it comes to Medicare Advantage. The White House has been using a “demonstration” project authorized under Obamacare to forcibly turn many of these same patients over to state-run healthcare programs. The states, in turn, are typically enrolling these seniors into the HMOs used by their Medicaid programs. It’s going to be hard to argue that low-income seniors with chronic medical problems will be better off in state-run Medicaid HMOs (getting the equivalent of a Medicaid benefit) than they were in the private Medicare SNPs.

The Obama demonstration program aims to improve the medical management of these seniors. But the SNPs were already doing the same thing that the states are now trying to figure out. And the SNPs are using managed care plans tailored to seniors, and not designed to serve state Medicaid programs. The effort to turn these seniors over to the states always looked like it was more about politics than sound healthcare — a backdoor scheme to cross subsidize state Medicaid programs with money from Medicare.

It can’t help but seem like the real aim of the successive cuts is to shrink the advantage program. Yet more than a quarter of Medicare beneficiaries enroll in the private Medicare Advantage plans. Many of these are low-income seniors who choose these options because they can’t afford the Medigap policies that richer seniors use to plug the increasing gaps in traditional, fee-for-service Medicare. The private Medicare Advantage plans typically have fewer out-of-pockets costs than traditional Medicare, eliminating the need to buy a costly, supplemental health plan.

The Obama team has made a warm embrace of managed care options when it comes to Obamacare and Medicaid. But for Medicare, they want to deny low-income seniors these options. All of the administration’s old arguments on why they resisted these private Medicare plans have been largely mooted, or never materialized. Only one possible reason remains prominent. It’s a Bush era program that sought to privatize aspects of this public program. And it will continue to be opposed largely on those grounds.


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PDW
8 years ago

Ideology first and foremost with America running in second place.
Obama could care less about the seniors for one obvious reason we have traveled a greater distance and have seen the likes of him before. His target is in the Colleges / Universities fundamentally changing the American youth. We have been written off. Sad days for youth as they graduate with student debt looking for jobs. Think of how many of these graduates have moved back home as they cannot find jobs or the jobs offered do not pay enough to stand on their own. This admin has made the min. wage a career!!!!

Steffie
8 years ago

I have been trying to make people aware (even before the last presidential election) but there are a lot of hard heads out there oblivious to what is going on around them. I have but one comment regarding what is happening to us – SOMEONE PLEASE HELP!!!!

HAM
8 years ago
Reply to  Steffie

You are just beating your head against the wall if you are talking to Liberals. A majority of them have no clue of what communism is about & have their heads in the sand. We all need to concentrate on getting the Conservatives/Republicans to the voting booth in November. Remember, 3 million registered Republicans did not vote in 2012.

Rosemarie Guarini
8 years ago
Reply to  HAM

I agree with Ham. I am ashamed of my fellow conservatives who simply decided not to vote in the last election, especially when Obama did not get what I would call….a clear mandate. As long as liberals keep preaching that they will take care of everyone from cradle to death, it’s very hard to convince voters that that is just not the American way and will bury all of us in the end. Education has to begin in the schools and, unfortunately, they are chock full of liberal teachers and, worse, liberal-minded administrations. How can this economy and this country survive if 90% of our population winds up being supported by 10%…and the way I see it, that’s where we are headed. The way to a sounder economy is not giving out all these “benefits”; it is making sure that every able-bodied and able-minded/educated American HAS A JOB!

Phil
8 years ago

We were warned about the death panels under Obamacare, The fact is, Obamacare is THE death panel and the intended target is seniors. Obamcare is designed to for young people. A very socialist program to ensnare and rule over them. Obama and his minions know that life is fairly short for seniors and by taking direct aim at Medicare with cuts and more cuts, that process can be speeded up. Its kind of like some of the Eskimo cultures. When a person gets too old, they put that elderly person on a small boat and shove them out to sea to die. Obamacare is that small boat intended for us seniors.

Paul
8 years ago

King Obama wants to destroy all Medicare Advantage Plans — Why? Because it’s a form of independence and he wants you to be dependent on the government. He doesn’t like citizens who can think for themselves and ones that can take care of themselves. He want’s you to be dependent on the government for whatever hand-outs that are available. Government welfare employees get promotions and bonuses based on how many more people they can bring in for Food Stamps, Housing, Obama phones, etc. In other words – your success is not how few people you qualify for programs – but how many more you can sucker into the Dependency. And when you are dependent on the government programs you will tend to vote for the Democrats who gave you the goodies. Great plan!

CHUCK
8 years ago

CHUCK THIS IS NOT AS YET COMPLETED/ EDITED ETC BUT I THOUGHT I WOULD SEND IT ALONG ANYWAY. AT LEAST 15 MILLION OF US NEED TO RISE UP AND BE HEARD ,SEEN, AND ANYTHING ELSE IT TAKES TO STOP THIS DEVASTATION OF THE ADVANTAGE PLANS AND START THEIR EXPANSION.

WE NEED TO GET THE WORD OUT!
11/23/14 STARTED

SENATOR CRUZ THIS IS A PLEA FOR HELP FROM 25 MILLION PEOPLE ON MEDICARE ADVANTAGE PLANS

Not sure about the number but I have heard as high as 25 million.

No matter how many that is a lot of voting power which includes all races and genders.

Most politicians do not have a clue about what Advantage Plans are. They may know that they have to do with Medicare, but that is about where it stops. Even though many of them qualify for the plans, they don’t have to get them, as they have “Cadillac” plans probably paid for by us. This is evidenced by Sen Kyle on Greta’s show where they both concurred that the plans were for rich people. Recently on FOX Stewart Varney was discussing the plans with reasonable understanding. Elizabeth then chirps in to point out that it effects pregnant women?????? I am certain that there are many many more examples.

A quick overview: Advantage Plans are part C of Medicare. The carriers allowed to participate in these programs are compensated a certain amount per enrollee. This amount is determined COUNTY BY COUNTY throuout the United States. Ia m in Lee County Florida and let’s say Humana, my carrier, is paid I.e. $800 a month. ($9600 a year) With those dollars they are responsible for providing at least what Medicare provides subject to various deductibles and copays. They also include Part D (drug coverage)..I consider that the outsourcing of Medicare by the Federal government. The programs are overseen by CMS. (Very Very Regulated !) Many programs have a zero premium associated with them. That is the case here in Lee County. If you are not on an Advantage Plan, you may still be on a major medical employer plan, you may use the V.A. , you may be on a Government plan like Tri Care, you may have an employer subsidized Supplement Plan, or you may have original Medicare only. Most of us fend for ourselves. We either have an Advantage Plan, a Supplement, or Nothing but Original Medicare. If you have a Supplement and also purchase Part D, your premiums will be $200 or more a month at age 65, and will increase annually. For a married couple on Medicare that is $400 plus a month for starters. It is no wonder that the Advantage plans are popular. The expense, under an Advantage plan, for my wife and myself last year was around $400. However, it was more than offset by health benefits not included in “Original Medicare. (dental, health club membership known as Silver Sneakers etc.)

2014 BENEFITS: In light of the $716 Billion he stole from US and gave to OBMACARE, the Advantage Plans had to scale back their plans for 2014. They used higher Maximum out of Pocket copays, higher copays in general, fewer providers (doctors and hospitals), fewer health related benefits , fewer plan choices.etc WHY? Because they cut the compensation to the carriers.!!! What about 2015??

WHAT DO WE NEED TO DO TO EXPAND AND INSURE THE MEDICARE ADVANTAGE PLANS.?
So let’s say the compensation to Humana for me per year is $9,600. They are charged with providing me at least the benefits that Original Medicare provides. Currently they do much more than that with the compensation provided them by CMS. The Advantage Plan providers also monitor fraud and abuse within their plans. BY COMPARISON WE NEED TO FIND OUT (WITH YOUR HELP) HOW MUCH DOES IT COST THE FEDERAL GOVERNMENT ON AVERAGE TO PROVIDE ORIGINAL MEDICARE BENEFITS (WHICH ARE ONLY 80% OF TOTAL COSTS) . ALL COSTS NEED TO BE DETERMINED, JUST LIKE THE PRIVATE CARRIERS HAVE TO PAY ALL COSTS. I CONTEND THIS NUMBER WILL BE ASTRONOMICAL IN COM[PARISON. THE OBVIOUS CONCLUSION TO EXPAND AND PROMOTE THE OUTSOURCING OF MEDICARE WILL THEN BECOME IMMEDIATELY EVIDENT. FROM THERE IT WOULD BE NICE IF WE COULD GET OUR $716 BILLION BACK SO THAT MEDICARE DOESN’T GO INSOLVENT. IT DISGUSTS ME THAT WE ARE BEING TOLD THAT THE YOUNGER PEOPLE ARE NEEDED TO PAY FOR THE OLDER PEOPLE. WHAT ABOUT OUR 4716 BILLION THAT WE PUT IN THE MEDICARE POT.? WHO IS YTHAT PAYING FOR? . .

THE END FOR NOW! MORE TO FOLLOW! AMAC PLEASE HELP GET THE WORD OUT TO ALL CONCERNED AMERICANS AND LET.S GET AN ANSWER TO THE ABOVE QUESTION. . THANKS

Al
8 years ago

“Now more than ever before, the people are responsible for the character of their Congress. If that body be ignorant, reckless and corrupt, it is because the people tolerate ignorance, recklessness and corruption. If it be intelligent, brave and pure, it is because the people demand these high qualities to represent them in the national legislature…. If the next centennial does not find us a great nation … it will be because those who represent the enterprise, the culture, and the morality of the nation do not aid in controlling the political forces.”

James Garfield, the twentieth president of the United States, 1877

Rd2d
8 years ago

So far no one in this thread has mentioned another reason why liberals are giving seniors the short end of the stick, healthwise: Seniors tend to vote Republican.

Lenore Levy
8 years ago

Leelee says:

It is time to stop griping and act. 2nd Chronicles 7:14. If we want our land healed we must as a nation pray. Let us set a time and day for all to go to our churches or public squares enmasse and pray for the revival of our country.We must have a nationwide response with millions of people praying at the same time. Will someone step up to get this plan into motion?

Emory Riley
8 years ago
Reply to  Lenore Levy

It has been done. It was Reign Down USA.

If you want to do it again, check with the organiziers of that event. It was about 5 or 10 years ago but the had about 2500 people praying on the National Mall and events in all 50 states at the same time.

Earl
8 years ago

My working plan is to persuade all conservatives to go to wwwconventionofstates.com and to read Mark Levin’s book “The Liberty Amendments”. In this manner we can address the problem of an out of control federal government by all getting on the same page, and using the power of the Constitution to legally return much of the power to the people and to the states. If you and everyone who reads this will study this plan carefully and all get on the same message you may be surprised at how fast things can be turned around.

Archie Wallace
8 years ago

We are in the middle of the progressive distruction of our nation. Most of our schools are promoting the promoting values of the former soviet union. How many remember Nikita Kruschev beating his shoe on the desk yelling “WE WII BURY YOU!”? He wasn’t talking militarily, he was referring to the inroads in our education system the soviets had made since the early 1930’s and 1940’s when we were building “friendships and allies to thwart Hitlers influence. Socialists posing as progressive Democrats gained influence and positions in our colleges and began teaching our children “People live very well under socialism”. This is the mindset of most educators today, after all this is what they have been taught. I had the fortunate experience of attending a one room and a two room scoolhouse when a child with no-nonsence teachers and old history books we were given to compare to new books we had to buy. Even in the late 40’s they didn’t always match up and we were told to use the old book for reference. We also read some of the writings of the founding fathers, enough to know if they lived today and heard the lie’s told about them and the direction of this country we would probably have another revolution. I still remember reading Lenin said ” the way to control the masses is to control their healthcare” and “the aim of socialism is communism”. I might add the aim of Progressives is Socialism!

PaulE
8 years ago
Reply to  Archie Wallace

All essentially correct Archie. This nation has been under a stealth assault by socialism (progressivism) for over a 100 years now. The slow but steady pace of systematic change, designed to corrupt our system of government and the education process of each successive generation of children, has been relentless over the decades. We’re finally at the point where a majority or near majority of the voting public would openly embrace socialism, because they have been systematically brainwashed to believe it is superior.

Rita A. Murphy
8 years ago

I have chronic diseases and I am 76 and want to see my grandchildren and greatgrandchildren (God-willing) grow up.and not be forced to take obamacare.

Paul
8 years ago

No one gets my vote who will not go on record not just to support, but help sponsor term limits. Career politicians and bureaucrats have corrupted both Partys.

PaulE
8 years ago
Reply to  Paul

We already have term limits. It’s called VOTING! The fact that a majority of the voters in this country are either incapable of voting out ineffective representatives and replacing them with people, who would be more accountable and responsive to the electorate, or are simply too lazy to vote at all, isn’t the fault of the politicians. It’s the fault of the voting public. In most national elections, we’re lucky if 60 percent of eligible voters actually cast a vote. That is pathetic! People around the world literally risk their lives for the chance to vote, yet a significant portion of the American public is either too apathetic or too ignorant to use this right to vote intelligently.

No long-term politician is going to seriously back term limits. They may talk about once in a while to placate the public, but it is just empty talk. Why would they seriously back such legislation? Incumbents are usually re-elected 70 percent of the time or greater. So they have no fear of the voter. Why would a politician today be willing to back legislation to put himself out of the best job he’s ever likely to have in his or her life, when you factor in pay, benefits, hours actually worked, the lack of any real accountability for the work performed, and an amazing generous retirement package?

Canman
8 years ago

I am over 65 and collecting SS. I am still working and enjoy my job. Since I am collecting SS, I cannot have a Health Savings Account (HSA); this is a screw job by the government. Elderly people should be able to put money into a health account to prepare for the most likely possibility that they will need more medical care in the future. Also, the government has reduced the amount of money that a person can put into a Flexible Savings Account (FSA) from $5,000 to $2,500. Thus, the pretax option has been taken away or reduced by this corrupt government.

ron
8 years ago

they want to completely erase our history. also population reduction and start getting ride of us older folks.
new world order, agenda 21 all the same thing. it’s about power and control.
people wake up before it’s too late [ praying we still have a chance ]

EvBaer
8 years ago

Harry Reid is a senior citizen who thinks he is beyond Obamacare, getting exempted with his staff and even his family connections, but I have noticed that when the haughty think they have it made, the Lord has a surprise for them. Have you noticed, if you read the scriptures, that God works with irony? It is ironic that right from the beginning God created Adam and Eve – male and female – and married them in the Garden – before any death came into the world – and now, society is screwing up marriage and confusing Adam & Eve, fouling up “multiplying the earth” and “subduing it” (conservation zealots take note) and all kinds of things, and everyone seems to think that there are no consequences. THAT is really ironic.

HAM
8 years ago
Reply to  EvBaer

I am a big believer of “what goes around, comes around” and also “God works in mysterious ways” (this may be the same as “God works with irony”).

Dee
8 years ago
Reply to  EvBaer

Amen to the above. Only God can undo or straighten out this mess. If you read the Bible it’s like a road map telling us exactly what is about to happen and what is happening. The Bible also says, If my people who are called by my name will humble themselves and pray and seek my face, I WILL save them and heal their land. God have mercy on all of us and may we wake up to what is happening. You are right, and God does and will get the last say. I’ve said many times Harry Reid seems to think he’s not getting old, but of course if we all leave him in office he thinks he’s exempt.. The good part about God is HE sees what is going on behind all the closed doors. Again, the Bible, Can any hide himself in secret places that I shall not see him, do not I fill heaven and earth. I put my trust in God and wait for HIS almighty decision, and it will come.

Wes
8 years ago
Reply to  EvBaer

Amen Ev….you go my friend. We have been the “Silent Majority” too long. Its time we stood up, spoke out and let our voices be heard. We are children of the Most High God….who are we to fear? More importantly, we must battle in the “spirit” for we don’t war against flesh and blood, but evil spirits.

We must rememeber: We are the head and not the tail; we are the above and not the beneath; we are somebody and we have worth (Jesus provided our worth).

Okay, off my soapbox….at least for the moment.

Wes

Chuck
8 years ago
Reply to  Wes

K A R M A folks…just hope it doesn’t happen too late to deal justice to the Reids, Pelosis and obamas of this world. There should be a wall and a blindfold awaiting them all.

Sandy
8 years ago

I am not eligible for Medicare or Medicaid yet, as I am 58 years young. I work for the State of Florida & am enrolled in a HMO plan. I recently asked for a refill of an anti-anxiety prescription, which I use occassionally. I was informed that I had to come to the office & fillout & sign a 4-page document required by Obummercare before the doctor would refill my prescription. So the plan is affecting every man, woman, & child in America now. It is only going to get worse. I advise those of us who are pro-gun to keep yours if you have them. We all need to be ready & able to defend our Republic, & our homes & families against what is coming. I also pray that Jesus comes before the worst of the worst hits, but just in case He isn’t ready to get us up out of here, I’m going to use my God-given inalienable right to resist tyrrany wherever it shows up!

Norma
8 years ago
Reply to  Sandy

AMEN to that! I never wished so much for THE RAPTURE

Rose
8 years ago

What can we do? What will we do? Remember why and by whom the Revolutionary War started.

Laurie
8 years ago

I’m in complete agreement with Sova, The uninformed of this country, placed this so-called president in office for another 4 years, no matter what takes place, we have a promise from our Heavenly Father that He and He alone is in control, and we have to remember this and live our lives according to His PROMISES.

Paula J. Cotter
8 years ago
Reply to  Laurie

Lauri, I fully agree with you. I also believe in the I quote”What goes around comes around” So Obumma what sad for you happy for us awakening you have coming.
Also in the years 2014 & 2016 Voters please get informed… You are living in what happens when you Vote as a very misinformed person. Lets PAY ATTENTION and THINK before you VOTE. When OBUMMER says anything his nose just grows…….By now you must realize he can not be trusted.

Rik
8 years ago

Here’s where I’m going to start … Last Sunday, being the 1st Sunday of the month, when I went to church I received my church’s January newsletter … Of course I didn’t look at it until I got home later, but guess what, inside was an article about some founder of the Tea Party who supposedly made a comment that the Methodist Church should be closed. Of course, the article had appeared in the Huffington Post in 2010 and forwarded to our church’s newsletter editor by his brother in another state. Our newsletter editor happens to be a retired school teacher who I know voted for Obama. Also, at the bottom of the page, obviously, to fill the page … was a paragraph quoting a passage from the United Methodist Book of Discipline on how church members should treat undocumented immigrants, which he used to headline into the message. You can imagine, I was seeing “red” as in Communist Red … well, I can’t wait to attend church services tomorrow morning … I know this was not given the approval of our Pastor. Since I am the Worhip Leader assisting the Pastor tomorrow, I plan on announcing to the congregation that I consider myself a Tea Party Conservative and have been attending this church every Sunday for the past 19 years and have never heard or made any comments about doing away with the Methodist Church. I want to question why an article generated by a known Socialist organization is even in our newsletter. I will also comment on how there are very few young adults attending our church and all churches in general. I plan on also pointing out that our current President, Pinocchio Obama, professes to be a Christian, yet, how is it that he has “lied” at least 30 times about “if you like your insurance and your doctor, you can keep them” and why is it that as editor of the newsletter, he could have editorialized on how we Christians have been deceived by numerous politicians who claim they are Christians for our votes at election time, but, after they are elected, their actions are contrary to Christian beliefs. Oh, that’s right, the old separation of church and state song and dance! Perhaps, young people view Christians in general as hypocrites because of all the “lies” they hear from our so-called Christian political leaders!!! I will also point out that the United Methodist Book of Discipline statement on how to treat immigrants does not include any reference to illegals, you know, people who have knowingly entered our country illegally like thieves in the night. Also, just because your neighbor’s dog crawled under your porch to give birth, doesn’t mean the puppies belong to you! I also plan to announce that I am going to actively speak out to all Christian churches educating their members of the harm these lying so-called Christian politicians do to the Christian faith and how we need to expose these charlatans and vote against every one of them. Perhaps, we Christian people, no church hierarchy included, need to hold “conventions” to identify these phony Christian politicians and publicly renounce them and encourage all Christians to vote “our own endorsed candidates” … that would be a good start! What do you think people?

EvBaer
8 years ago
Reply to  Rik

You are 100% on the mark and expressed yourself extremely well. God bless your comments on Sunday, that they may help others see more clearly what is happening in our government and society, which used to be solidly Constitutionally supported.

Paula J. Cotter
8 years ago
Reply to  Rik

Rik, I’m Catholic and a practicing one. This BOZO that calls himself a President is also trying to bully our Holy Sisters that are taking care of our poor elderly. Lord knows what else he is up too. I love and believe all that you said. But especially the part ” If your neighbors dog crawls under your fence and has puppies under your porch does not mean the puppies are yours.” So True. I’m also in agreement with Holding a Convention to “Identify these phony Christian politicians and publicly renounce them and encourage all Christians to vote “our own endorsed candidates”

David Burke
8 years ago

Only option other than our military removing these parasites, VOTE THEM ALL OUT and email and call them constantly and complain. I have a wish list. On it is a way to stop this BS. Democrates and Republicans , both are screwing us.

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