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The latest news on Obamacare from Business Insider

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    Larry Ellison

    After shelving its Oracle-led Obamacare website on Friday, Oregon is considering halting a second multimillion-dollar Oracle-led project.

    An internal task force recommended that Oregon stop work on a $142 million project to upgrade the state's Department of Health Services, according to an internal review of the project, posted online by The Oregonian (PowerPoint).

    This follows news on Friday that the state would scrap its $250 million Obamacare health-care exchange and use the federal exchange instead.

    That decision came after months of delays, cost overruns, and finger-pointing, with state officials publicly blaming Oracle.

    Today, the health-care exchange is still unable to sign people up for health insurance without a time-consuming, partially paper process.

    The nonfunctional website hasn't stopped Oregon from successfully completing more than 200,000 enrollments for health insurance, with about 140,000 of them Medicaid customers, reports The Oregonian's Jeff Manning.

    Oregonians aren't fully footing the bill for the failed project themselves. Most of the money comes from federal funds from the Affordable Care Act.

    Still, a lot of money has been spent: Oregon has paid $134 million to Oracle and doled out another nearly $7 million on the paper-processing efforts, reports NPR.

    Meanwhile, there was this second multimillion-dollar contract with Oracle. The state also hired Oracle to help it build a new system for its Department of Health Services. That system was supposed to let people electronically apply for food stamps and other benefits, and was supposed to go live in October 2013.

    Work on the DHS system was halted to redirect all resources to fixing the troubled health-care exchange.

    Now, an internal task force has reviewed the DHS project and discovered that only 11% of its features are completed, another 30% are partially done, and the remaining 60% aren't close to being completed.

    The total budget for the project was $142 million from 2008 through 2015, with about $71 million spent and $48 million going to Oracle, reports The Oregonian's Manning.

    The task force recommended stopping work on the project and to "research systems that would meet the needs."

    Gov. John Kitzhaber, a Democrat and a former emergency-room doctor, once hailed these projects as a "defining moment" for how a state could save money on Medicare.

    But the state has little to show for the millions it spent on these systems. 

    The state has hired a Portland law firm to explore potential litigation against Oracle, a representative for Oregon's health-care exchange, Cover Oregon, confirmed to Business Insider.

    For its part, an Oracle representative sent us this statement: 

    "Oracle looks forward to providing any assistance the State needs in moving parts of Oregon's health care exchange to the Federal system if it ultimately decides to do so. Oracle will continue to support the State in providing long term solutions for Oregonians, and to assist with its ongoing health care modernization efforts."

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    Barack Obama

    For much of the past seven months, Republican strategy for winning the 2014 midterm elections has revolved around casting "Obamacare." However, with the law's implementation now beginning to exceed many expectations, a new poll makes it clear the Affordable Care Act is gaining in popularity — even in districts friendly to the law's opposition.

    A new poll conducted by the Democratic firm Democracy Corps and released Monday displays an incredible swing in voters' attitudes toward Obamacare. 

    Even in Republican-held districts, the plurality of voters now want to implement and fix the law, rather than repeal and replace it. The pollsters argue the results should push Democrats to advocate the former approach in their campaigns — the latter position aligns with what Republicans have continued to advocate since the law was passed.

    One of the most startling changes was observed among Independent voters. In a December survey from Democracy Corps, conducted when the law was mired in the third month of a disastrous rollout, 53% said Congress should "repeal and replace the health care reform law." In the new poll, only 41% of independents said Congress should "implement and fix it."

    Today, those numbers have swung a combined 19 points. Now, 50% say Congress should "implement and fix"— only 43% still want to repeal and replace. 

    Here's a chart: Obamacare poll

    Overall, the poll found 52% of voters prefer the "implement and fix" option, compared with the 42% who want to "repeal and replace." That aligns with voters in Republican-held seats, which accounts for another big swing in the past four months.

    In December, 47% of voters in Republican-held districts said they wanted to "implement and fix" the law, compared with 46% who were for "repeal and replace." Those numbers now: 53% for implementing and fixing, and only 42% for repealing and replacing. 

    Here's a look:

    Obamacare poll

    "The drop in intensity on the opposition/repeal side risks the GOP’s off-year turnout strategy – and indeed, in the Republican seats, the continued focus on ACA produces a somewhat lower turnout of base Republicans. In any case, by continuing to focus on the ACA, Republicans are emphasizing their weakest message according to this battleground poll," the pollsters wrote.

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    Barack Obama

    After Obamacare enrollment exceeded the wildest expectations, President Barack Obama took a series of victory laps trumpeting the Affordable Care Act's strong finish. But according to a new poll from the Kaiser Family Foundation released Tuesday, it's clear the law known as "Obamacare" will continue to be a tough sell this election season.

    According to the poll, a decent amount of respondents — 43% — were able to identify correctly that "about 8 million people" had signed up through exchanges created by the health-care law. Obama trumpeted those final enrollment numbers at least three times: during a Rose Garden statement the day after the signup deadline, during a statement announcing the departure of Secretary of Health and Human Services Kathleen Sebelius, and during a press conference two weeks ago. 

    But based on the poll's findings, the American people aren't swayed by the strong enrollment numbers. Though respondents were largely aware of the numbers, a majority — 57% — still said the law's first enrollment period "fell short of expectations." Only 35% said it either met or exceeded expectations. 

    Here's a chart showing the contrast:

    Obamacare poll

    The number underscores that no matter how many people ultimately enrolled, Obamacare's tumultuous first enrollment period will be hard to tout ahead of this year's midterm elections where Democrats will be fighting to hold onto control of the Senate. 

    Overall, according to the Kaiser poll, the Affordable Care Act is viewed slightly more positively now than it was at the start of the year — 38% say they support the law, compared with 34% in January.

    Another new poll released Tuesday from The Washington Post and ABC News also found the law could be a major hindrance for Democrats this fall. Among the findings of that poll, 47% of respondents said the law is making their health-care costs go up; just 7% said it's making costs go down and 41% say their health-care costs have stayed about the same.

    Still, there's a silver lining for Democrats. Back-to-back recent polls showed more people are clearly lining up with Democrats' preferred position on Obamacare — keep the law and work to fix problems with it — than with Republicans' continued call for the law to be repealed and replaced. 

    According to the Kaiser poll, 58% of respondents said Congress should work to improve the law. Only 35% said they think Congress should continue to work toward repealing and replacing the law at this point. Those results align with findings from a Democracy Corps poll released Monday, which dug a bit deeper into individual states' views on the subject

    In December, according to the poll, 47% of voters in Republican-held districts said they wanted to "implement and fix" the law, compared with 46% who were for "repeal and replace." Those numbers now: 53% for implementing and fixing, and only 42% for repealing and replacing. 

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    surgeon, doctor, OR

    Spending on health care grew an astounding 9.9% in the Bureau of Economic Analysis' advance estimate of first-quarter GDP

    It's the biggest percent change in health-care spending since 1980, when health-care spending jumped 10% in the third quarter. Analysts said it's primarily due to a consumption boost from the implementation of the Affordable Care Act. Adjusted for inflation, America is spending more on health care than ever before.

    Personal consumption grew by 3.0%, about half of which was due to the growth in health-care spending, said Ian Shepherdson, chief economist for Pantheon Macroeconomics. 

    "If health-care spending had been unchanged, the headline GDP growth number would have been -1.0%," Shepherdson said.

    A BEA representative said the uptick "reflects additional spending associated with the implementation of the Affordable Care Act."

    The first-quarter advance estimate reflects spending from January through March, the first three months when millions of people who gained insurance by signing up on exchanges established by the law or by qualifying for Medicaid coverage under the program's expansion. 

    Jared Bernstein, the former chief economist to U.S. Vice President Joe Biden and now a senior fellow at the Center on Budget and Policy Priorities, speculated that the growth was more likely associated with the Medicaid expansion at this point.

    Sign-ups through the exchanges exploded in March, the last month of the first open enrollment period. Of the more than 8 million people who eventually enrolled in insurance plans, nearly half signed up in March or in a special two-week extended period in April. This means the uptick in health-care spending could be even bigger next quarter.

    The detailed consumption data in the advance GDP report displays that spending on doctors and hospital services began to rise rapidly last fall, when the law known as Obamacare was implemented.

    "Both are now running at more than twice their pre-Obamacare trend, indicating that pent-up/hidden demand for healthcare was huge," Shepherdson said.

    "Next question: How long will it last?"

    Here's a chart from Pantheon that shows the growth over the past year in spending on doctor and hospital services, the two factors that dominate the health-care portion of GDP:

    Obamacare chart

    Here's a chart from Business Insider's Andy Kierz that shows the annualized quarterly change since 1980:

    Health care spending

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    Barack Obama

    The White House has been trumpeting the fact that 8 million people selected insurance plans through state and federal exchanges set up by the Affordable Care Act. 

    But how many of those people really gained coverage — that is, how many were previously uninsured? 

    For the first time on Thursday, the White House released data on that question. According to the Department of Health and Human Services, about 87% of people who signed up through federal health care exchanges were previously uninsured. 

    Here's how the percentage was determined: Of the 5.45 million people who signed up through the federal exchange, 5.18 million (or 95%) applied for financial assistance in their insurance plans. In doing so, they were required to answer a question about whether they already had health insurance. Only about 695,000 people (13%) indicated they did have coverage. 

    HHS said data from state-based exchanges would be available at a later date. 

    In total, the White House said more than 8 million people had selected insurance plans through exchanges established by the health-care law. Almost half of those — 47% — came in the last month of enrollment and during a special two-week enrollment period in April. 

    The administration also said more than 5 million people gained coverage through the Medicaid expansion under the Affordable Care Act. It's not known how many of those who qualified for Medicaid coverage were previously uninsured, but experts have said new enrollees in Medicaid were "primarily" without insurance before.

    According to a RAND Corp. study released last month, most of the new Medicaid enrollees either did not have coverage last year or had it through other means like Medicare, retiree health insurance, and other government plans.

    The White House did not say how many enrollees in new plans had paid their first premiums. On a conference call with reporters, an HHS spokesperson said it wouldn't have that data until sometime later in the year. 

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    peter orszag

    Something doesn't square with two big recent economic data releases. 

    In Wednesday's advance estimate of first-quarter GDP, health-care spending exploded to its highest levels in more than 30 years. But the jobs report Friday revealed no significant uptick in employment. 

    Former OMB Director Peter Orszag first pointed this out on Twitter: For both spending to have exploded with health-care employment growing at an average pace, it would mean an absurd boom in in health-care productivity.

    Here's the chart Orszag posted on Twitter:

    Orszag chart

    "Employment is barely moving in health care," Orszag told Business Insider in a brief phone interview Friday. "So the implication of that is either we're experiencing a boom in productivity growth, because output is increasing much more rapidly than employment. Or the preliminary GDP numbers might be revised down, and so this whole thing may be a bit of a mirage."

    The GDP numbers have been seized on by critics of the Affordable Care Act, and interpreted to mean that the record-slow growth in health-care spending was coming to an end. 

    With a more complete picture now, though, Orszag said the type of productivity increase is not very plausible. Health-care employment grew by about 19,000 in April, which was about in line with the previous 12-month average of 17,000. 

    What Orszag thinks it might come down to is a flaw in how people interpret the uptick in GDP numbers, given how they are calculated. For example, once someone qualifies for Medicaid, that counts as an increase in both their income and spending, even if they don't actually consume health-care services, Orszag said. About 4.8 million qualified for Medicaid coverage through the program's expansion under the Affordable Care Act, the White House said Thursday.

    Jared Bernstein, the former chief economist to U.S. Vice President Joe Biden and now a senior fellow at the Center on Budget and Policy Priorities, had also speculated that the GDP growth was more likely associated with the Medicaid expansion at this point.

    "It would mean that somehow we're able to produce so much more health care with each worker, in a dramatic fashion, starting magically with the fourth quarter of last year," Orszag said. "OK, maybe? It's just not really plausible. If all of this were real, it would mean that suddenly, magically, health-care workers have become a lot more productive."

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    The White House on Thursday released final data from the first enrollment period under the Affordable Care Act, which also included a look at each state's relative success or failure in the law's first enrollment period. 

    Nationally, just more than 8 million people enrolled in health insurance plans through federal and state exchanges established by the law. But the story was different in all 50 states and the District of Columbia — some wildly exceeded expectations, and others brutally disappointed.

    This chart shows which states did well in signing up people through their exchanges, and which did poorly:

    May 2014 Obamacare Enrollment Chart

    Here's a look at that in map form:

    May 2014 Obamacare Enrollment MapSome of the states that immediately jump out include Vermont, which signed up more than 6% of its population — more than a full percentage point above the next most-effective state, Florida. Nationally, about 2.6% of Americans signed up for private health insurance made available by the Affordable Care Act between Oct. 1 and March 31, surpassing the law's original goals. 

    But overall, the final results present a stark contrast from December, when was floundering and state-based exchanges dominated in signing up people for insurance. The federal exchange, which serves 36 states, did its part to make up for a lackluster start. Sign-ups more than doubled in the last month of enrollment — from about 2.6 million on March 1 to 5.4 million by the end of enrollment. State-run exchanges also saw a significant increase — from 1.6 million to 2.6 million — but it wasn't nearly as astronomical. 

    Interestingly, much of the uptick in enrollment came from red-leaning and/or other swing states. Enrollment in Florida, for example, jumped from about 442,000 through the first five months to about 555,600 by its end. More than 55,000 Louisiana residents enrolled in the final month. Texas exploded from 295,000 through February to 733,757 by the end of the period. And in South Dakota and Alaska, respectively, enrollment doubled in the final month. 

    "Americans across the country want the affordable coverage offered through the marketplaces," a Department of Health and Human Services spokesperson said on a conference call Thursday. 

    Here are some other demographic stats about the 8 million enrollees:

    • 54% are female and 46% are male;
    • 34% are under age 35;
    • 28% are between the ages of 18 and 34
    • 62.9% of those reporting are white;
    • 16.7% are African American;
    • 10.7% are Latino;
    • 7.9% are Asian.

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    The rate of uninsured in the U.S. is at its lowest level since 2008, according to a new Gallup survey released Monday. The uninsured rate in April was 13.4%, the lowest level ever recorded in Gallup's ongoing survey that dates back to January 2008. 

    Gallup's new estimates are the best estimate of the effect of the Affordable Care Act after the end of its first full open enrollment period, which dragged on through the first two-plus weeks of April. Ultimately, the simplest goal of the law — one that cuts through the spin of the sign-up numbers — is to reduce the number of uninsured in the U.S.

    The uninsured rate has plunged from a peak of 18% last October. Gallup said the steep drop "coincided" with the opening of the federal and state insurance marketplaces established under the Affordable Care Act, as well as the expansion of the federal Medicaid program in 27 states and the District of Columbia. As Gallup has noted, the uninsured rate is falling much faster in states that have expanded Medicaid.

    Here's the chart from Gallup showing the history of its tracking on the question, including the peak last year followed by the sharp decline:

    Gallup Obamacare chart

    The drop in the uninsured rate was even more pronounced among African-Americans (down 7.7 points) and Latinos (down 5.5 points). Lower-income Americans (those with an income of $36,000 or less) saw a 5.5-point drop in their rate of uninsured.

    Overall, the survey mirrors other studies conducted in the final stages of Obamacare's first open enrollment period. A RAND Corp. survey released early last month found the uninsured rate dropped almost 5 percentage points. Subsequent figures from the Congressional Budget Office showed a drop to 16%. The CBO said it expects the uninsured rate to fall even farther in the coming years.

    According to Gallup, there are several factors that could swing the uninsured rate in either direction over the coming months. More people could gain coverage if more states adopt the Medicaid expansion, which has faced steep resistance from Republican-led states. But if a significant number of people who gained insurance through the exchanges do not pay their premiums, the uninsured rate is likely to spike again.

    Despite the steep drop in the uninsured rate, the health-care law remains unpopular heading into the midterm elections. A Pew Research survey found disapproval of the law is tied for its highest level ever.

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    Barack Obama Mitt Romney debate

    Eight years after then-Massachusetts Gov. Mitt Romney signed the landmark healthcare legislation known as Romneycare into law, a new study says it has saved thousands of lives. 

    According to new research published this week in the Annals of Internal Medicine, the expansion of health insurance in Massachusetts has resulted in more than 300 lives saved each year since its enactment, a 4.5% reduction.

    The law — which expanded Medicaid coverage, offered subsidies in private insurance, and established a mandate to purchase health insurance — is considered the model for the Affordable Care Act.

    To conduct the study, researchers Benjamin Sommers, Sharon Long, and Katherine Baicker compared Massachusetts counties with similar counties across the U.S. that did not have a health-insurance expansion program.

    Specifically, they looked at conditions "amenable to health care," screening for information on different types of cancer, cardiovascular disease, infections, and other situations in which a person would be more likely to survive with better medical care. Certain types of cancer, for example, can often be prevented with earlier screening or treated more successfully with early detection.

    Overall, the researchers found that "health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care." As Adrianna McIntyre points out at The Incidental Economist, the effects of health reform were more pronounced in counties with comparably lower incomes and with low pre-reform insured rates.

    Following is a chart from the study showing the comparison. The gap in deaths between Massachusetts and counties in other states grows wider after 2006, when the law championed by Romney started to be implemented.

    Romneycare study

    The study could lead to debate over the Massachusetts law's costs, and the costs of the Affordable Care Act, going forward. The study found that for every 830 adults who gained insurance each year one fewer person died.

    According to the Massachusetts Taxpayers Foundation, the state spends about $91 million more each year on health costs compared to the years before the law was enactment.

    According to projections released by the Congressional Budget Office, the net cost of Obamacare in its first year will be about $36 billion, a number that is expected to grow exponentially as more people gain coverage through federal and state exchanges, and through the law's expansion of the federal Medicaid program.

    The Obama administration said last week that more than 8 million people had enrolled through the exchanges in the law's first open-enrollment period, and about 4.8 million more have gained coverage through the Medicaid expansion.

    The authors warned that their study cannot be completely drawn to demonstrate causality. Compared with the nation as a whole, too, Massachusetts differs demographically and has more physicians per capita than any other state. But the authors wrote it will be important to monitor not only the coverage effects from the Affordable Care Act but also the effects on mortality and other health provisions.

    "Although this analysis cannot demonstrate causality, the results offer suggestive evidence that the Affordable Care Act — modeled after the Massachusetts law — may impact not only coverage and access but also mortality," the authors wrote. 

    "The extent to which our results generalize to the United States as a whole is therefore unclear, which underscores the need to monitor closely the Affordable Care Act’s effect on coverage, access, and population health across all states," the authors said.

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    Barack Obama smile

    Last week, the Republican-led House Committee on Energy and Commerce released information claiming only 67% of enrollees in insurance exchanges established by the Affordable Care Act made their first premium payment. The data was paraded around as a talking point ahead of the Obama administration's final release of stats from the law's first open enrollment period.

    On Wednesday, that talking point blew up.

    Three of the country's largest insurers — Aetna, WellPoint, and Health Care Service Corp., which operates Blue Cross Blue Shield plans in several states — said between 80-90% of new customers who enrolled through Obamacare paid their first month's premiums. Executives from the companies announced the news in testimony before the very same House Committee on Energy and Commerce where Republicans touted the contrary data last week.

    WellPoint said the number of customers who paid their premiums by the deadline was 90%. For Aetna, it was in the "low-to-mid 80s range." Health Care Service Corp. said their number was at least 83%. 

    Since the Affordable Care Act's enrollment numbers ended up better than preliminary forecasts, Republicans, who initially wanted to make attacks on Obamacare a key part of their strategy in this year's midterm elections, latched onto the possibility that a good chunk of enrollees wouldn't pay their premiums. On Wednesday, the insurance executives directly criticized the House committee's previous study.

    "WellPoint was pleased to provide the committee last month with enrollment data from Oct. 1, 2013, through April 15, 2014, for states where we participate in the Federally Facilitated Exchange. As we stated to the committee at the time of submission, this data is not final and only represents a snapshot in time," said Dennis Matheis, the vice president of exchange strategies at WellPoint.

    "As outlined in our prior submissions to the Subcommittee, these are dynamic figures and do not reflect final enrollment numbers," added Paul Wingle, the executive director of exchange operations and strategy at Aetna.

    Insurers and health-policy observers blasted the House GOP's study upon its release last week, saying it was based on incomplete data — specifically from plans whose premium deadlines had not passed when the committee sent out its survey.

    The committee surveyed insurers for the total number of enrollments and premium payments as of April 15. That number, insurers said Wednesday, was about 70%. However, the surge in April enrollment was not reflected. Almost 1 million plan enrollments occurred in April after the Obama administration extended the sign-up deadline for people who had already started the process. For those people, the first premium payment wasn't due on April 15, but the committee counted them as unpaid enrollees.

    In essence, the House GOP's talking point will only be true if virtually none of the enrollees in April pay their premiums. That doesn't seem likely, given that insurers reported a steady premium payment percentage throughout the year. 

    Here's a chart from Health Care Service Corp.  The percentage of premium payments received from people covered through Obamacare exchanges was similar to those who were not:

    Insurance chart

    Though the White House was quick to criticize the committee's report last week, the Department of Health and Human Services has yet to release figures of its own. Last week, a spokesperson said it doesn't plan to do so until "later this year."

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    A woman picks up a leaflet at a health insurance enrollment event in Cudahy, California March 27, 2014. REUTERS/Lucy Nicholson

    SOMERSWORTH, New Hampshire (Reuters) - Barack Obama and his Democratic allies in the Congress have grown more confident in recent months about their ability to use the president's signature healthcare law as a draw rather than a liability in this November's midterm elections.

    Three races in New Hampshire illustrate the challenge, offering a test of whether Democrats can overcome voter skepticism about the 2010 Affordable Care Act. The law, aiming to expand health insurance coverage to millions more Americans, has come under sustained attack from Republicans.

    The president has urged Democrats campaigning in the November 4 congressional elections not to run away from "Obamacare," but instead to "forcefully defend" it. Obama has said that a surge in enrollment shows the system is running smoothly now, after its disastrous debut last October.

    New Hampshire, which is closely divided between Democrats and Republicans, is one of about 10 states where Republicans hope to make gains in order to pick up six seats they need to put the Democratic-led Senate under their control.

    Senators Jeanne Shaheen of New Hampshire, Kay Hagan of North Carolina and Mary Landrieu of Louisiana have been among the Democratic targets of anti-Obamacare ads by conservative groups such as Americans for Prosperity.

    Republicans are counting on voter antipathy toward Obamacare to try to take charge of the Senate and expand their majority in the House of Representatives. But while Obamacare may now be working better, national polls clearly show more people disapprove than approve of the law.


    In New Hampshire, Shaheen and Representative Carol Shea-Porter, a fellow Democrat, were among the earliest advocates of the healthcare law. The state's other Democratic Representative, Ann Kuster, was elected after the law passed, but also backs it.

    Shaheen said in an interview she shared Obama's view that as Americans get to know Obamacare, they are embracing it. Shaheen said there was "a lot of misinformation" about the law. "The reality is it's beginning to work for people," she said.

    But 51 percent of New Hampshire adults oppose Obamacare while just 37 percent support it, the University of New Hampshire Survey Center reported last month in a WMUR-Granite State poll. Sixty-one percent of the state's voters think medical costs will increase under the act.

    "The perception is, 'it will hurt my family and costs will go up,'" said Andrew Smith, director of the center. "In a political campaign, that is a big boulder to push uphill."

    Skeptics include people like Derek Gagnon, a 33-year-old auto mechanic who says he would not even consider voting for anyone who had backed the Affordable Care Act.

    He has no health insurance, but he also says he has no intention of signing up for the private insurance offered through the government-run website,

    "I shouldn't be forced to do something like that in a free country," said Gagnon, referring to the law's requirement, known as the "individual mandate," that almost all legal U.S. residents buy health insurance or pay a fine.

    "I'll pay the fine this year and next year," Gagnon said at a frozen yogurt store outside New Hampshire's state capital, Concord. "Maybe I won't have to pay it the third year, because by then Obama will be out of office."

    Gagnon's distaste for the individual mandate dovetails with a principal line of conservative attacks nationally on the law.

    Obamacare is meant to extend subsidized health coverage to millions of uninsured Americans through new online private insurance markets and an expansion of the Medicaid program for the poor. But conservative critics portray it as a government intrusion in a major sector of the economy that will hurt job growth and erode freedoms.

    Shaheen's leading Republican opponent in the Senate race, Scott Brown, is betting that theme will resonate in New Hampshire, where the state's famous motto is "Live Free or Die."

    In April, Brown kicked off his candidacy with the declaration that New Hampshire could "Live Free or Log On" - a caustic reference to signing up online for Obamacare.

    Lately, he has been traveling the state on an "Obamacare Isn't Working" tour. Brown, a former senator from neighboring Massachusetts, says the act should be completely repealed and the issue of healthcare reform should be left to the states.

    Brown has been rising in the polls against Shaheen. But she was ahead 45 to 39 percent in a recent WMUR-Granite State poll.


    Dean Spiliotes, a New Hampshire political analyst, said Shaheen, a former New Hampshire governor, still had political capital in the state, and he doubted the healthcare issue alone could defeat her.

    "People view her as not an ideologue. That has helped her with voters," said Spiliotes, a political science professor at Southern New Hampshire University. "If Obamacare rises to the level of taking out Jeanne Shaheen, there is something larger going on."

    To be sure, Obamacare faces unique challenges in New Hampshire. Just one insurance company in the small state offered insurance policies through the program this year, and the insurer doesn't cover healthcare in 10 of the state's 26 hospitals, deficits Shaheen and Shea-Porter have been working to fix.

    Spiliotes said New Hampshire Democrats are defending Obamacare "but they are kind of doing it in fits and starts. It's not a uniform, rah-rah kind of support."

    In one hopeful sign for Democrats, enrollment in Obamacare in the state of 1.3 million people has reached 40,000 - double the number that had been expected.

    Shea-Porter, a former social worker who came to Congress in 2006 campaigning on healthcare reform, said she would never run away from Obamacare because she considers the law to be a "great joy and triumph."

    "I am always going to support it," she said.

    That said, she understands the political perils for Democrats of Obamacare. She lost her seat in Congress in 2010 elections after her vote for the law, only to be re-elected in 2012. Her 2014 race is considered a toss-up although her Republican opponent has yet to be chosen in a September primary.

    Shea-Porter, who met last week with recent healthcare enrollees in Somersworth, said she is aware of the qualms some people have, including wariness of providing personal information on a government website.

    But she said the best way to advertise Obamacare's benefits is to publicize the stories of people who signed up and discovered that "nothing terrible happened."

    Patrice Glynn, 54-year-old New Hampshire resident, is already convinced. Glynn, a diabetic, lived without health insurance for nine months after she lost her job and before she signed up on "If it was so bad, would 40,000 people be on it?" she asked.

    (Editing by Caren Bohan and Frances Kerry)

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    Barack Obama smirk smile

    A new poll released by CNN and ORC International Sunday contains some interesting data about how independent voters feel about Obamacare. The poll showed only a small number of independents believe the health care law has been a success. 

    According to the poll, just 8% of independents would call the Affordable Care Act successful. About 42% of independents describe the law as a failure while half say its too soon to tell. 

    Overall, the numbers aren't much better for Obamacare supporters. While the poll found 27% of Democrats called the law a success, just 12% of total voters gave it a thumbs up. 

    Republicans have been hoping to exploit dissatisfaction with Obamacare in this year's midterm elections and recent evidence the law's rollout exceeded initial expectations has led some observers to question that strategy.

    The evidence electorally-crucial independents are unhappy with the Affordable Care Act is definitely bad news for Democrats hoping to fend off GOP challengers in the midterms.

    However, the poll included some good news for Obamacare supporters. The poll showed the majority of voters, 61%, want to keep the law as is or make improvements while just 38% want it repealed. It found 55% of independents want to keep or improve Obamacare. Indications voters, even those who would call the law a failure, would rather see it fixed than repealed by Republicans have been seen as a sign Democrats can succeed with a midterm strategy focused on the idea the law should be both defended and improved.

    View the full results of the CNN/ORC poll here.  

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    When the cost of an employer-provided health insurance plan is compared to the cost of an Affordable Care Act plan bought on a state health insurance exchange, the ACA plan will be more affordable on average, a new analysis from PricewaterhouseCoopers' Health Research Institute finds.

    "In 2014, the premiums for health plans offered on new state exchanges under the Affordable Care Act (ACA) are comparable to — and in some cases lower than — those being offered by employers with similar levels of coverage," the analysts concluded. "The data suggest the new exchanges are competitive with the current insurance market."

    The analysis is based on employer-sponsored premiums of 156 million people in 2013. Here's an infographic illustrating those numbers (this is the median annual price for each kind of plan):

    obamacare aca premiums pwcBecause the cost of an insurance plan varies significantly from person to person, these median prices do not reflect realities for every individual. But overall, the cost of insurance on the exchanges is competitive: about 4% less than employer plans, before taking subsidies into account.

    Some of those cost savings come from the exchange plans' narrower networks — that's fewer available doctors and hospitals to choose from.

    But what about all those news stories about people whose premiums had shot way up? Those were often people whose pre-ACA insurance did not meet even the most basic standards set forth by the law.

    "Some of the sticker shock noted among enrollees in the new exchanges is due to more comprehensive insurance coverage in the exchange plans," the PwC analysis notes, citing research in Health Affairs. "More than half the people in the individual market had coverage below the bronze level of 60%, the lowest level in the exchanges."

    That means that the people most likely to see their rates going way up were people whose insurance would not actually have helped them much when they needed it most.

    SEE ALSO: The GOP's Latest Anti-Obamacare Talking Point Just Went Down In Flames

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    Barack Obama

    One of the earliest and most popular provisions of the Affordable Care Act — the one that allows young people to stay on their parents' plans until age 26 — may have a more far-reaching effect than previously measured, according to a new study published in the Journal of Health Economics. 

    The study determined the provision offers young adults more flexibility making both educational and work choices earlier in their lives. This flexibility leads to better employment matches for new workers entering the labor force. It also leads to higher overall wages, according to the study. 

    To conduct the study, researchers looked at similar provisions in state-based laws that were in effect before the passage of the Affordable Care Act. Between 1995-2010, at least 35 states began requiring employers to allow their employees' children to stay on their coverage plans until various ages — from 24 to 30. 

    Based on the provision's effect in those states and the fact more employers will have to provide coverage nationally under the Affordable Care Act, the study estimates the provision will increase wages by an average of 3.5% to 4.6% for people who were 18 or younger when the health-care overhaul passed.

    The study identified a few ways Obamacare's dependent provision could influence labor-market decisions by young people.

    First, without the provision, people attending college at later ages — at colleges that often require them to have health insurance — will experience lower costs from staying on their parents' plan. It could also lead them to pursue more time in college or graduate school, rather than immediately needing to find a job that offers health insurance. 

    Having health insurance also reduces the phenomenon known as "job-lock," in which workers feel confined to a job because they cannot take their employer-sponsored health insurance with them. With job-lock lessened, the researchers said, people are free to move around — often ending up with better-matching and higher-paying jobs.

    "This would be particularly important early in people’s careers before people gain experience in careers that are not their best matches," the researchers wrote.

    Finally, the researchers cited a third possible effect — called the "compensating differential theory"— that suggests since having health insurance through an employer should lower ultimate wages, young workers could enter the labor force through jobs that offer higher wages but do not offer health insurance.

    Based on the state lawsstudied in the research, women experience wage gains of about 3.1% while they have access to their parents' health insurance, an increase that largely continues to be evident after they lose access to dependent coverage. Men, meanwhile, experience gains of about 1.6% after they no longer have access to dependent coverage.

    The extension of dependent coverage is one of the only universally popular provisions of Obamacare, which as a whole is still widely unpopular. According to a March poll conducted by the Kaiser Family Foundation, 80% of respondents said they had a favorable view of the provision — including 76% of Republicans. 

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    skydiving scared

    The Affordable Care Act has been implemented, and open enrollment is over.

    The numbers indicate that eight million people now have health insurance who didn’t before, but the marketplace was a mess for a while, especially when Obamacare deadlines kept changing. That means lot of people waited until the last minute to sign up, and it’s no surprise since many Americans are confused by the provisions in the law.

    But health insurance has always been confusing. The terms deductible, summary of benefit, and explanation of benefits have vexed consumers for years. What if this confusion and procrastination led you to purchase the wrong plan? Well, if you purchased insurance through the federal marketplace, you may not be able to change it unless you have a qualifying life event, including changes in income, moving out of state, or having a baby. If not a lot changed for you this year, you’ll have to wait until the 2015 marketplace opens on Nov. 15.

    Since health insurance is so confusing, it may be the case that you just don’t know whether your insurance plan is right for you. There’s no shame in that, and it doesn’t just go for new health insurance enrollees, either. It’s easy to imagine people with employer-sponsored plans picking the least (or most) expensive plan their employer offers and never give it another thought.

    Here’s how to tell if your health insurance plan, no matter how old, is the wrong one for you and your family.

    1. You would go to a different doctor if you could afford it.

    Do you wish you could go back to your old doctor, but he or she isn’t in your network? Many Americans distrust their doctors, but trust is an important component in the patient-doctor relationship, so it makes no sense to stay with a doctor you don’t like or distrust. If you avoid visiting your doctor or haven’t chosen one since your current health insurance kicked in because you wanted to stick with your old doctor, it’s a clear sign to change plans.

    Maybe you’re not pining after an old doctor because you feel like you’ve never had a really great physician that you liked and trusted completely. A lot of people may choose a doctor close to home or work who will take their health insurance or just rely on a friend’s recommendation. Sometimes this works out, but you don’t have to keep your doctor out of convenience and habit if you think there might be one out there who understands you better. A good doctor is worth the time you take to find him or her, and if you find one outside your insurance network, it’s reasonable to think about switching plans.

    2. You travel a lot and worry when you do.

    Whether it’s for business or pleasure, if you’re a frequent traveler who worries about getting hurt or sick when you’re away, it may be an insurance red flag. This is especially relevant for individuals or families with health maintenance organization or exclusive provider organization plans. HMO and EPO plans are so restrictive that except in the case of certain emergencies, policyholders must stay in-network or pay medical fees in full.

    These plans work for some people, as they tend to cost less in copays and premiums than other more flexible plans. That said, they don’t work for everybody, and which type of health insurance you have matters. Take a moderate or frequent traveler who may occasionally need medical attention that isn’t an emergency, like a trip to a clinic for a migraine or minor infection. EPOs will deny coverage in the case of certain serious emergencies if you go out of network — all in the name of keeping costs low. If the low cost of an EPO or HMO doesn’t seem worth the risk for your lifestyle, you may want to consider a different type of plan.

    3. You avoid seeing a doctor to avoid costs.

    If your copays are so high that you don’t have enough room in your monthly budget to squeeze in a doctor’s appointment, you may want to examine your other options. Even if your employer is covering part or all of the premium, it may be worth it to make room in your budget and pay for an upgrade. The monthly cost increase might be worth it if more of your services are covered so you and your family are up to date on physicals. 

    What good is health insurance if you don’t use it, anyway? It’s there so you can afford to have a qualified professional catch any illness or injury around the corner and the ones you may not know you already have. Preventive care is becoming the new norm in health care, and it’s for good reason: You don’t want to be stuck with the stress, the pain or the bill if a little problem becomes a big one down the road.

    4. Your preventive services aren’t free.

    Speaking of preventive care, did you know that a lot of it is now free? That is, it should be free. Many Americans were relieved to know they could keep their health insurance plans after the ACA was implemented, but there is a downside to that. Many of the plans grandfathered into the current system lack the perks of Obamacare. This includes certain preventive exams and diagnostics, like an annual checkup for women, certain vaccines, and sexually transmitted infection screenings.

    So, it’s true: You may not have had to worry about changing insurance and signing up for a new plan in the marketplace. But if it’s the same insurance you’ve had for years, it may not be the best insurance you can get for your premiums. Come Nov. 15, you might want to consider switching to one of the new plans — especially if you’re a woman, have children or are looking to expand your family in 2015. There may be a health insurance policy that suits you better than the one you have now.

    Lacie Glover writes for NerdWallet Health. She has a background in chemical and clinical research and aims to empower consumers to find high quality, affordable health care.

    SEE ALSO: The Worst Money Mistakes To Make At Any Age

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    Mike Pence Indiana

    Indiana Gov. Mike Pence, a Republican whose name has recently been thrust into 2016 presidential speculation, unveiled on Thursday a plan to expand healthcare coverage to low-income people in Indiana. 

    Pence is opposed to the Affordable Care Act and has rejected the law's expansion of the federal Medicaid program. The coverage expansion in Indiana is a nod to Obamacare's Medicaid expansion, but Pence attempted to cast it in terms more palatable to conservatives. 

    Overall, he's attempting to walk a fine line between earning hundreds of millions of dollars in federal support and maintaining support from fellow conservatives. Pence said his plan, an upgraded version of the Healthy Indiana Plan, will balance the two by requiring patients applying for coverage to take more personal responsibility for their insurance. 

    Pence's office said the strategy, which would replace the traditional Medicaid program for people ages 19 to 64 with incomes up to 138 percent of the federal poverty level, would provide coverage to more than 350,000 Hoosiers.

    This would help alleviate what is known as the "coverage gap" in the state. Overall, according to the Kaiser Family Foundation, more than 4.8 million Americans sit within the gap of having incomes too high to qualify for traditional Medicaid coverage but too low to qualify for subsidies through insurance plans under the exchanges.

    But Pence took pains to make clear what he sees as a clear distinction between his plan and expanding Medicaid. 

    "From the beginning of my tenure as Governor, we have been saying 'no' to the Affordable Care Act in Indiana. We refused to set up a state-based exchange, and we have made it clear that we will not expand traditional Medicaid," Pence said in announcing the plan Thursday. 

    "Medicaid is not a program we need to expand. It is a program we need to change. Nobly created 50 years ago to help the poor and those with disabilities access quality health care, Medicaid has morphed into a bureaucratic and fiscal monstrosity that does less to help low-income people than its advocates claim."

    Pence's plan flows with many other red-state or Republican-governor coverage expansions. Hoosiers with incomes below the federal poverty level can either pay a small monthly premium or be dropped to a more basic level of coverage without dental and vision benefits. Those making above the poverty level must pay a monthly premium or be dropped from the coverage for at least six months.

    Here are the three basic tiers:

    • HIP Plus — This is the highest level of coverage, which requires monthly contributions of between $3-$25.
    • HIP Basic — A lower level of coverage that only requires co-payments, not monthly contributions.
    • HIP Employer Benefit Link — This type of coverage aids Hoosiers in payments for private plans through their employers. Pence said it would "encourage the use of private insurance options."

    Pence now plans to submit a final waiver proposal to the federal government to harness billions of dollars of federal money. He is expected to do that by the end of June, after the state holds hearings and the two required "comment periods."

    The Obama administration must then approve the waiver. Though the administration didn't immediately signal its intentions, one official referenced the administration's collaboration with Arkansas on its "private option" expansion.

    "Just like we worked with Arkansas and other states on a unique plan, we look forward to doing the same with Indiana once they submit a formal proposal," the official told Business Insider.

    In a statement, Department of Health and Human Services spokesperson Emma Sandoe said the administration was "encouraged" by the developments on Thursday. If approved, Indiana would be the 27th state, along with the District of Columbia, to expand coverage for people who would have been covered under the law's Medicaid expansion.

    "We are encouraged by Indiana and Governor Pence’s commitment to helping cover more of the state’s uninsured population through the Healthy Indiana program and look forward to seeing his proposal," Sandoe said.

    "The Medicaid coverage expansion provides federal funds to cover 100% of the cost of newly eligible beneficiaries for the first three years and no less than 90% after that. In Indiana, it would mean coverage for thousands of additional Hoosiers."

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    “After the primaries, expect a shift in Republican candidates’ rhetoric against Obamacare,” McInturff said.

    “Only few want to repeal the law; most want to fix and keep it," he continued, likely referencing the consistent polling that has shown Americans would rather improve the law than repeal it.

    He added that the law could still be a net negative for Democrats in 2014, but predicted the Republican shift because its approval numbers have improved in recent months.

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    Barack Obama

    One of the major selling points of the Affordable Care Act was its theoretical potential to reduce costly emergency room visits, given the law's access to coverage. 

    But a new survey shows that so far under the healthcare law, more people are going to the emergency room. The survey, conducted by the American College of Emergency Physicians, found that since Jan. 1 — the day coverage went into effect for millions of Americans — 46% of emergency physicians have experienced jumps in patients. Half that percentage reported a decrease, and 27% of physicians said the influx has stayed about the same.

    And even though it was one of the points President Barack Obama and Democrats used to sell the law ahead of its passage, doctors said they've been expecting this all along.

    "We told you this was going to happen. We don't mind that it has. But we'd sure appreciate some support," Howard Mell, a spokesman for the ACEP and an emergency care physician, told Business Insider on Wednesday. 

    Emergency physicians only expect it to get worse over the next few years. Eighty-six percent of emergency physicians expect there to be a slight or "great" increase in the amount of visits to their departments over the next three years. Moreover, 77% of these doctors think their facilities are not prepared for the expected influx of patients.

    Emergency care physicians also expect payments for ER visits to sharply reduce. They think access to emergency care will improve overall, but that doesn't mean quality care will follow — a plurality of emergency physicians expect the ACA to have a negative effect on quality and patient safety. 

    Part of the increase can be expected. Emergency room use is a covered benefit, and when people get insurance, the use of those benefits would be expected to increase somewhat.

    Obamacare surveyBut here's the problem: Though the healthcare law has helped get more people insured, it doesn't guarantee care. ACEP says there is an overall shortage of primary care doctors.

    Many of the millions who qualified for coverage under the expansion of the federal Medicaid program could also be out of luck, since many primary care doctors do not accept Medicaid patients. Because Medicaid coverage pays so little, it is the main problem, whereas more than 8 million people signed up for private insurance through exchanges established by the law.

    The Obama administration said the study comes too soon to draw any long-term conclusions. 

    "This survey, looking at only the first three months of coverage, cannot speak to the long-term effects of expanded coverage, which will be shaped by our continuing efforts to help people use their new primary care and preventive care benefits and to invest in innovative approaches aimed at improving our nation’s system of primary care," a Department of Health and Human Services told Business Insider in a statement.

    Still, according to the Association of American Medical Colleges, there will be a shortage of about 30,000 too few primary care physicians to keep up with patient demand next year. And the problem is expected to grow — over the next decade, according to the study, primary care physicians will rise by only 7%.

    Combined with the fact the American population is getting older — a 36% increase in the American population over 65 — ACEP is warning the U.S. is on something of a "collision course."

    "Emergency visits will increase in large part because more people will have health insurance and therefore will be seeking medical care," said Alex Rosenau, the president of ACEP. 

    "But America has severe primary care physician shortages, and many physicians do not accept Medicaid patients, because Medicaid pays so low. When people can't get appointments with physicians, they will seek care in emergency departments.  In addition, the population is aging, and older people are more likely to have chronic medical conditions that require emergency care."

    A classic example of where the problem continues to manifest is with a patient who has asthma but waits until an emergency to seek coverage. As Mell explains, a primary care doctor should be able to solve the health problem in its infancy — for example, prescribing an inhaler to an asthma-inflicted patient. Instead, the patient will wait until they have an asthma attack. That means $50-$100 worth of medicine becomes thousands of dollars in emergency care.

    Some health-policy experts think much of the increase can be mitigated by educating patients about their healthcare options. Many people who just gained insurance for the first time are simply used to routinely going to the emergency room for their healthcare needs.

    "Part of the need in this new environment is to teach people who have not had insurance at all or very often in the past how best to use it and the best ways to access care," said Linda Blumberg, a senior fellow at the Urban Institute. "That is, they need help to understand the importance of identifying and using a usual source of care outside of the ER for non emergent situations."

    Obamacare survey

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    medicine, anesthesiologists, doctor

    Kleiner Perkins Caufield & Byers partner Mary Meeker has released her latest annual presentation.

    In it, she gives a bullish take on the future of the U.S. healthcare system, saying it looks like it may be at an "inflection point."

    Meeker lists the challenges facing the U.S. healthcare system — still-high costs, lots of waste, and rising costs for both individuals and employers.

    Some recent reforms perpetrated by the Affordable Care Act, though, give her reason for optimism. More than 8 million people have gained coverage through insurance exchanges established by the law, and she writes that the law is aiding the "digitization of healthcare — 84% of hospitals and academic or institutional practices are now using a fully functioning electronic health record (EHR) system. Digital health venture investments are up almost 40% year over year.

    Meeker is also bullish because of the emphasis of moving toward quality care over quantity. By 2015, 60% of employers will offer price-transparency tools in their healthcare plans, she writes.

    Here are the three slides from Meeker's presentation:


    slide (1)

    slide (2)

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    physician's assistant doctor nurse

    New Hampshire's health insurance exchange will have a drastically different look during the Affordable Care Act's next open-enrollment session. And the new developments look to provide consumers with more choices and, potentially, lower prices.

    The New Hampshire Insurance Department said Monday that five insurers plan to sell policies in the suddenly crowded New Hampshire marketplace. It's a stark contrast from the first open-enrollment period of the law known as "Obamacare," when only one insurer — Anthem — offered plans. 

    The lack of choice served as the major limitation for New Hampshire's insurance exchange. Anthem also has a narrow network excluding more than 10 hospitals. It has been the subject of a hearing at the Insurance Department.

    "With only one carrier on the exchange for 2014, it really limited people's choices, particularly because that carrier had a narrow network," Jennifer Patterson, the legal counsel for the New Hampshire Insurance Department, told Business Insider on Tuesday. 

    She said consumers often found themselves with a near-impossible choice — take the government subsidy to join a plan with a limited network, or pay more for a plan including your preferred doctors and hospitals.

    Overall, five insurers are expected to offer plans through the marketplace in the state: Anthem, Harvard Pilgrim, Minuteman Health, Assurant Health, and Maine Community Health Options. 

    The competition is important. A 2014 study conducted by the National Bureau of Economic Research found that if all insurers active in states had participated in the states' marketplaces, the second-lowest priced silver premium (which is linked to federal subsidies) would be 11.1% lower. It also would have reduced federal subsidies by about $1.7 billion the study found.

    Maine Community has been one of the success stories of the law's first open-enrollment season. A co-op that is funded mostly by taxpayer loans through the health-care law, it grabbed almost 80% of enrollments in the individual market this year. 

    It plans to expand staff by close to 30 over the next two years, executive director Kevin Lewis told Business Insider. He said Maine Community was "pleased" to be part of an increasingly competitive marketplace that could provide consumers with better choices.

    "The reason for us to offer coverage in New Hampshire stems from the strong network we've already begun and have had available to Maine members this year," Lewis said. "We had a good initial year and were received very positively, and we picked up our target enrollment off the exchange, too."

    The first open-enrollment season in New Hampshire was successful despite the lack of competition. The state enrolled more than 40,000 people — and about 211% of its original goal, the highest in the country.  

    The enrollment success and the new expansion of insurance options has Democrats thinking it could bolster their chances in a key Senate race this November between incumbent Democratic Sen. Jeanne Shaheen and likely Republican challenger Scott Brown.

    "Republican candidates want to repeal Obamacare and have no plan to replace it," New Hampshire Democratic Party Chair Ray Buckley said in a statement.

    "They would return us to the days when insurance companies could drop people when they got sick, charge women more money for care than men, or deny people with pre-existing conditions, and they would cost nearly 100,000 Granite Staters to lose their coverage."

    SEE ALSO: Here's Where People Signed Up For Obamacare

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