s medicaid expansion.my legislation builds on the succeed of an amendment i introduced with my colleague from indiana, senator donnelly, during last january's budget debate to protect these programs. although our amendment did not pass, it came pretty close, when two republicans joined us in supporting it. it is good to know that some republicans are concerned about seniors, children, and working people who rely on medicare and medicaid every single day. i think it is just astonishing that as we are talking about cutting medicare and medicaid for hundreds of seniors, hundreds of seniors in hawaii that these kind of changes are are being proposed by the very president and the people in -- in congress who gave the richest 1% of the people of our country and corporations a huge -- a huge tax break. by the way, the president is talking about giving the rich people in our country even more of a tax cut. it's just astounding to me that while all of that is happening on the one hand, on the other hand the propose

another concern is the expansion of the medicaid program. the extent that the aca is covering more americans, it's due to this program. medicaid has played a historic role, covering the elderly and the disabled. but the aca extended the program well beyond this making it a source of coverage for 15 million new able-bodied adults, including many without any children. previously, they ensure that these population currently covering more than 90% of the cost than it does for traditional vulnerable medicaid populations. supporting legislation to undo those perverse incentives. is a priority for this administration. in the meantime, we want to rethink how medicaid serves able-bodied working age adults, why we've encouraged states to have working for these populations. for these enrollees, medicaid should be a pathway out of poverty for fuller purpose and better health. this vision for medicaid this laid down by our administrator rejects our general principles for programs that support low income americans. programs should take a holistic approach

slurred through medicaid. i have medicaid and medicare through the president and everyone else, do f with our medicare. good day. hast. >> host: all right. east dublin georgia. good morning. morning.: good how are you? well.t: doing >> caller: this is through the own polling at the family foundation that americans are for universal health care even if it means raising taxes for them and the read it was at 50% through the polling so throughly what we found healthson that universal care is cheaper for not only the country but individuals within the country as comparison a mum before he countries and the united states and purchasing power of the government to buy health care, sorry, parm suit callings in bulk. pharmaceuticals in bulk. it that for everyone else who will call in with their is onms, understand, it you and it is on, it is you change theto political equation to get lower lower drug costs and costs can because it is not a problem of um ber, it is a problem of politics. can control the politics. thanks.

the importance of state flexibility goes beyond medicaid. president trumps budget proposes to replace the entirety of the aca subsidies with medicaid expansion with a flexible block grant. as many of you know this is similar to the approach proposed by state and think tank leaders including some heritage scholars in this room today. it harkens back to the new federalism approach inspired by the heritage foundation and its leadership . the reagan administrations significant amounts of hhs's social service program has been disputed by black grants, freeing states to use the funds in a way that meets their needs. what the president proposes is toapply state flexibility to a much larger pool , a generationally significant state. i realize proposing reforms for two majorentitlement programs is not think the heritage fellows might do for coffee . but it's not often that we have a president who is willing to call for such radical and necessary reform. the president has called for historic changes to another piece of our healthcare system, our marke

louisiana's framework includes a prevention, like better practices, through changes in law and medicaid policy. over the last couple of years, louisiana has seen legislation and policy focused on prevention. it should include media campaigns for public education around opioids and consequences of substance use in general. intervention or rescue by utilizing promoting overdose reversing drugs through standing orders or supporting distribution to community providers and first responders has also been a part of our efforts. we have worked to improve access in treatment and recovery services through grant funds and expanded medicaid services. we work to collect and report that her data around this to provide a more accurate comprehensive and timely data on the opioid epidemic. states could implement action through policy and legislative change and involve the public. every states branch should include policy changes that affect those and perceive -- receive and prescribed opioids and implement meaningful legislation. meaning response to substance use epidemic must address access to insuranc

now, through medicaid expansion in louisiana, access to insurance is increased. states like louisiana, i should say, have expanded medicaid and have seen significant positive impact on our residents in terms of increased access to addiction services. overall since we expanded in january of 2016, we have 460,000 people who received health care coverage. and medicaid expansion has had a significant positive impact on access to care in addition to lowering the prescription of opioid trucks and pills in our -- drugs and pills in our state according to our board of pharmacy which administers the prescription drug monitoring program. even to though we have 460,000 additional people on health care coverage, both the total number of prescriptions and the total number of pills prescribed have actually decreased since medicaid expansion. we also have to focus on increasing the service rate through utilization of initiatives like cms' 1115 waivers. this allows states to be creative in how they attack addiction. in louisiana our 1115 waive insures continued access to vital s

and many medicaid programs, including the one in michigan, use none of their rebates to fund medicaid or even any health initiatives. rather, these funds go back into general state priorities. so long as our system uses technology as a revenue generator at patients' expense, we will never realize the cost savings that technology has brought to other industries. if we want to unleash the power of technology in a way that both improves health and brings down costs, we need a better system. of course, any reforms must appropriately balance innovation and costs. and we should not try to change our system overnight. but i would argue we can move quite a bit faster than we are today. just last week, our company received approval for a new medication for rheumatoid arthritis. a serious condition. we are trying something different. we launched this drug at a 60% discount to the competitors. and those competitors, most of which were launched 20 years ago. this is a kind of experiment to test out a low price, low rebate, less cost shifting type of model. if there's any of my colleagues who are

but the supreme court ruled that was not the case and they said the decision of expanding medicaid was up to the states and today we have 17 states in our country that still have not expanded medicaid and what that means in english, in real terms is today they are on millions and millions of people. people who are ill, people who can't afford healthcare, people who are literally dying because they don't go to the doctor when they should and that is all because of a decision of the united states supreme court. it is not only the issue of campaign-finance or the issue of medicaid and health care where the supreme court has acted in a disastrous way. i think everybody knows that our country has a very, very shameful history in terms of civil rights and it has been a very long and hard struggle for us to finally say that in america regardless of the color of your skin, regardless of your economic position, you have the right to vote. it's not a radical idea but it is a struggle that very brave people brought for many, many decades. in 1965 u.s. congress finally passed the voting rights act

will medicaid recipients become healthie and mor -♪ he's got legs of lumber and arms of steel ♪ ♪ hea bowl of hammers at every meal ♪ ♪ he holds your house in the palm of his hand ♪ ♪ big jim, he's got you covered ♪ ♪ great big jim, there ain't no other ♪ -so, this is covered, take care of it for you right now. giddyup! hi! eeis is jamie. we nsome help. 3oÑr let's talk aboutharibo . aloha.st i can'op eating this orange one. the red one is more good to me cos it tastes like berri b myrs are like doing and back flips and stuff. and then i'm gonna fly it in to my mouth. [all laugh kids and grown ups love it s♪ ♪ the happy world of haribo ♪ now introding haribo starmix.al your favorite gummies, in one bag. your favorite gummies, in one bag. ledad: president trump argues that tariffs, a tax on products imported from overseas are important for national security and will he even tweeteeconomy. are good and easy to win. sayhe president's trade policy is costing millions in revenue among the companies who have. criticized the move isvi a realy dson. they announced this past week they would ha

did you expand medicaid? >> yes, the people between 100- 130% of poverty or in medicaid program in the marketplace. >> tell us who you are when you get the microphone. >> good morning. great to have you representing various diverse parts of the country. part of the development of the affordable care act was that the employers were offering different plans in different states. it was uneven to the extent of whether or not people were covered to their employer plans. my question to you all is, what insights do you have into what is happened with the employer component of the market in your various dates. to what degree that is important in the rural versus urban design. whether or not private employer coverage has increased or decreased in your state. that sort of thing. >> one thing is we didn't really take a close look at that although we have expertise -- i am not an expert in arizona. nationally, it has been notable that employer marketplace has not been strongly affected by the affordable care act. particu

repeal medicaid at the national level. defined planned parenthood which is a healthcare safety and provider for millions of women. time at prince william board of supervisors he/public health spending by 35% as tb and other diseases were going up in the county. we need somebody in the senate who can continue to make healthcare better and may cost cheaper. >>host:e the next question mr. stewart is related to the affordable care act. you said you would like tou repeal the aca do you support the trump administration and congressional republicans in that effort to eliminate the provision ofli this insurance company to discriminate against individuals of pre-existing conditions? >>stewart: the affordable care act and obamacare has been a disaster. but i do support being able to keep your children under the age of 26 on your healthcare plan and also covering pre-existing conditions that is common sense but the problem is obamacare led to these vast increases of healthcare now for to say that was covered under obamacare they have

and medicaid. over $2 trillion in cuts. in medicare and medicaid. seniors and those who depend on medicare and medicaid know that you're losing your benefits to give a tax break to the rich. that's the set of priorities of the republicans in congress. and as house republicans dismantle the pillars of america's retirement security, they're also blocking action to protect our democracy against russian attacks. president trump's disgraceful, dangerous and damaging behavior with putin in helsinki has put the house g.o.p.'s coverup efforts into overdrive. last night house republicans escalated their effort to shutdown special counsel mueller's investigation into russia's attack on our elections by filing a resolution to impeach deputy attorney general rosenstein. today house republicans blocked a vote on congressman engel and connolly's secure our democracy act, which would punish foreign acers who are attacking our -- foreign actors who are attacking our elections. and last week the g.o.p. refused to pray a single penny -- provide a single penny to secu

the aca converts medicaid into a. per capita cap or block grant and and the enhanced funding for the medicaid expansion population under the aca and makes other changes to the program. do you have an announcement of the total amount attributable to the a ca and is at the 1.3? >> the 1.3 trillion would be the total aggregate and the difficulty is that the cbo score of that of the legislation that was published is off of an older baseline. we worked with a cbo in terms of coming up with the best estimate we could of the new aggregate savings that would apply after the passage of time and under a new baseline for the aggregate. i don't have because it affects so many different things the score for that medicaid component isolated under a new baseline. >> is the plans to get that? i would like to see that. >> we would be happy to work with your office. >> okay. what is the total amount of savings assumed in the budget from establishing a mandatory work requirement in medicaid? >> that is 132 billions over ten years. >> wh

>> we expand medicaid but is just straight medicaid expansion but yes, the people between 100-138 poverty level are in a medicaid program instead of our marketplace. >> yes, right here. tell us how you are when you get the microphone. >> good morning. thank you very much. it's great to have people representing various diverse parts of the country before us. part of the development of affordable care act was that employers were offering different plans in different states and it was an even to the extent of whether or not people were covered to the employer plan. so my question to you all is, what insight do you all have into what's happened with the employer component of the markets in your various states? and to what degree that reinforces the rural versus urban, whether or not private employer coverage has increased or decreased in your states? that sort of thing. >> thank you. >> one thing is we didn't really take a close look at that, although with experts in each of the states, since i'm not an expert in arizona i don't know, but nationally it is been notable that the employer market

because you expanded medicaid. >> we expanded medicaid but it was just straight medicaid expansion. yes, the people who between 100 and 138% of the poverty level are in our medicaid program instead of our marketplace. >> yes, right here. tell us who you are when you get the microphone. >> good morning. june o'connell. thank you very much. it's great to have people representing various diverse parts of the country before us. part of the development of the affordable care act was that employers were offering different plans in different states and it was uneven to the extent of whether or not people were covered through their employer plan. so my question to you all is what insight do you all have into what's happened with the employer component of the markets in your various states and to what degree that reinforces the rural versus urban divide, whether or not private employer coverage has increased or decreased in your state, that sort of thing. >> we didn't really take a close look at that, although we have experts in each of the states. nationally it has been notable that the emp

medicaid --expended expanded medicaid. >> yes, the people between 100%-100 30% of the poverty 100%-138% of the poverty level are --. people fromhave diverse parts of the country. part of the affordable care act was that employers offering different plants in different plans inlans -- different states. my question to you all is what insight do you all have into what is happened with the employer component of the markets in your various states, and to what degree that reinforces the rural versus urban divide, whether or not present employer coverage has increased or decreased in your states? that sort of thing. >> thank you. >> so one thing is we did not really take a close look at that, although we have experts in each of the states. i am not an expert, so i don't know. nationally it has been notable that the employer market place -- marketplace has not been strongly affected by the affordable care act. onre was a lot of attention market stabilization and all. prior to the affordable care act we were talking about the smaller group market, and can we fix them with state-based small group

reporter: what is the future of medicaid expansion in your state? about 12% of the state budget goes toward medicaid or medicare today. walker: medicaid expansion saved alaska about $16 million in our budget. it is a matter of fact that we use our spending to provide health care for 42,000. i am a cancer survivor of a few years ago. i would not have found that cancer is headed not in for -- -- found that cancer was enough for that. when people come up and say thank you for the life that you saved, that means an awful lot to me. my own personal experience is something i look at the last in's and hope we are able to maintain the health care coverage we have. reporter: finally, governor walker, does it make to seek that doesn't make sense to keep the capital in juneau when half of the population lives in the anchorage area? well, there's a lot of rich history throughout alaska. every area is unique and special. i am an opponent of the capital staying in juneau. it moved once. very as methods of communication that they can watch live throughout the stat

so that's about medicaid, medicare, medicaid, the about the cost of prescription drugs. it's about health care premiums going up understand the trump proposals. and it's also about a woman's right to choose. thank you all very much. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national able satellite corp. 2018] >> today former f.b.i. agent peter strzok testified on the actions taken by the f.b.i. and the department of justice. in their investigation of the 2016 presidential election. and the clinton email investigation. we'll have that testimony tonight at 8:00 p.m. eastern on -span. >> c-span's "washington journal," live every day with news and policy issues that impact you. coming up friday morning, georgia republican congressman doug collins discusses f.b.i. agent peter strzok's testimony on the 2016 investigations. then california democratic congresswoman norma torres talks about u.s. immigration policy. be sure to watch c-span's "washington journal" live

we had a lot of people covered by medicare and by medicaid and by employer-based insurance but we had a bunch of people who weren't covered. it was to subsidize them to buy insurance in the individual market from private companies. and it's turned out to be really hard. should we give up and do something else? >> i think this structure in a stable policy environment can basically work. i think we were headed on a -- we saw in 2017 insurers could get the pricing right, and i think that would have led to -- i mean, given that we're seeing entry even in this policy environment this year, i think we would have seen much more significant entry over the subsequent years in a counterfactual world. is this perfect? absolutely not. and i think there are things we could do. i tend to think that introducing a public option in this market would be a good idea. i tend to think that larger subsidies would be a good idea, but i think this type of managed competition framework can function. certainly we've seen while there are some important differences, we've seen a sort of managed competition-type

the number of physicians serving medicaid patients. that is what i am saying. he does not understand, it is not the same thing as actually providing access to health care. medicaid is failing. it needs to be brought back. be brought back to the citizens. judy: it is now time for the candidates to ask one another questions. mr. stewart has a question for senator kaine. ran forart: before you vice president you support a drilling off the coast, you supported restrictions on late-term abortions. you supported a lot of things. you supported the transpacific partnership. then, is in a true when you joined the hillary clinton campaign after hillary told you to change your positions, you changed all of those positions and others. sen. kaine: no. not at all. corey, when he got into the race said it would be nasty and fishes. make a personal, make it nasty, is an example.s with drilling, we did an offshore energy plan that said let's explore offshore drilling. not do it, but see if it is worthwhile. remember the bp oil spill? massive? people ch

medicaid is the single largest payer for mental health services in the united states. in 2015 medicaid covered 21% of adults with mental health illness and 26% of adults with serious mental illness. i'm concerned that actions taken by the trump administration to make it more difficult to receive medicaid and increase the cost of health coverage will suspend adjustment payments to insure high cost patients will make it more difficult for americans suffering from mental illness and emotional disturbance to receive treatment they need to live in a full and healthy life. before i close i must note that on the ongoing mental health crisis created by the trump administration regarding the separation of children from their parents. the american academy of pediatrics has emphasized in highly stressful experiences like family separation can cause irreparable harm disrupting a child's brain architecture and affecting his or her short and long term health. this type of prolonged exposure is serious stress known as toxic stress can lead to lifelong consequences for these children.

serving medicaid nation. he wants to give -- medicaid nations. it's nott understand the same thing as providing access to health care. medicaid is failing. it needs to be brought back to the states. the states can do it more efficiently and a better job for the citizens they serve your duty: -- they serve. judy: the first question for senator kaine. before you ran for vice president, you supported drilling off the virginia coast. you supported restrictions on lake -- on late-term abortions. you supported a whole lot of things. you supported the transpacific partnership. true that,sn't it when you joined the hillary clinton campaign after hillary told you to change your positions, you changed all those positions and others? sen. kaine: no. not at all. , when corey got into the ray said it would be ruthless and vicious. is make iteans nasty, make it personal or make it and sometimes do all three. this is an exact -- or make it up and sometimes do all three. this is an example. inon't know if you remember 2010,

the ways and means subcommittee on oversight held a hearing on how the centers for medicare and medicaid services medicare fraud and abuse . witnesses answer questions on how repeal of the affordable care act will impact their efforts. this is justunder an hour . >>. >> good morning. we're going to get started this morning and thank you all for being here. nearly 60 million individuals in the us ally on medicare for their health and in my home state of kansas, i'm a sworn in depend on the medicare program. it's one of the governments largest and most complex programs and it's susceptible to fraud, waste and abuse and because of this medicare has been designated as a high-risk program for old two decades. improper payments accounted for nearly $52 billion of medicare spending. fraud in particular is often challenging to identifyand measure due to its deceptive nature . fraud may also be nonfinancial making it more difficult to measure. the centers for medicare and medicaid services measures improper payments, some of which may result from fraud. however, loss payments identified through t

medicaid is a single largest payer for mental health services and in 2015 medicaid covered 21% of adults and 26% of adults with serious mental illness i am concerned when that action is taken by the trump administration to make it more difficult medicaid and reducing coverage by suspending patent and i'll make it more difficult for american suffering from mental illness to receive the treatment to live in a full and healthy life. before we close with the ongoing mental health crisis with the trump administration with the separation of children from their parents american academy of pediatrics has emphasized family separation can cause irreparable harm to disrupted child's brain and architecture to affect short and long-term health and this type of prolonged exposure with this toxic stress can lead to lifelong consequences for the children currently there are over 3000 children children forcibly separated from parents by federal authorities. we must hear how these separations are impacting the mental health of the children and what action samsa is taking to help them recover from the trau

medicaid expansion in the 50's like establishing marketplace navigator programs to help with plants. the scorecard also finds there still is considerable variation across states in the areas of access. for example the percentage of people who are uninsured ranges from a low of 3.5% in massachusetts to nearly 21% in texas. it is impossible that recent congressional and executive branch actions listed regarding the individual market as well as responses to those changes will widely affect people's ability to get health insurance and health care. the focus of our discussion is how our states are responding to these actions are and what are the likely application specs this first slide shows the first page of the new interact with tool that shows how states are dressing these federalre action. sabrina corlette developed this tool with her colleagues at georgetown and as you can see nearly half the states have picked up stabilization strategies like establishing reinsurance programs come increasing oversight of plans that don't comply with the affordable care act and creating financial in

the federal government picks up about hundred 29 billion of that in payments through medicare, medicaid, veterans affairs, chip program and other programs. in november 2015, alarmed by these price increases, as chairman of the senate aging committee, along with then ranking member, claire mccaskill, i launched an extensive bipartisan investigation into the extreme spike that we were seeing in drugs that have been off patent. in other words, they are patent that had expired.and yet, they did not have a generic equivalent. the drugs that range from drugs to treat dangerous cardiac conditions. it is often found as a standard drug on hospital carts. and drugs used to treat rare genetic diseases. severe infections, such as tuberculosis. and other life-threatening conditions. the findings of our investigation were troubling to say the least. at our first hearing december 2015, we centered on four companies i had acquired decades old off patent, affordable drugs then ranged their prices suddenly and astronomically. so that they were no longer affordable. i remember that one of the drugs had fi

what do you think the impact will be in states that have expanded medicaid, maybe transition some of that population into the private market and now are rolling it back? i'm thinking arkansas and new hampshire in particular have private options for their medicaid expansion population are now kind of backtracking, if that will affect the overall risk pool for good or for bad, just what your thoughts are. thanks. >> i'm not an actuary and so take this for what it's worth, but i think there's some evidence that the population in many states between 100 and 138% of the federal poverty line which i think is what you're talking about where they are currently in medicaid and there's talk about shifting them to the private marketplace, i think there's some evidence that just generally a sicker population and so it could have a negative impact on the marketplace risk pool, but, you know, i think each of those states is going to need to do their own actuarial analyses and figure that out and then, you know, determine whether the tradeoffs are worth it. >> my name is lance kill patrick, i'm jus

medicare and medicaid services.s the trump administration become a party to any lawsuit with changes? guest: yes, they will be. question is whether the trump administration overstepped. to dove to get permission these kinds of experiments which is basically what this is. and the physician that determined, it is not in the medicaid statute. host: walk us through the latest of who took the expansion and who didn't. 34 states now have expanded medicaid in the wake of the affordable care act. guest: virginia was the most recent state. they are democratic governors but republican legislature. last year, they came very close. so actually, virginia and to do it a compromise. because they would ask for work requirements. so we have to see what comes of the work requirements. to thea added itself list of states that expanded medicaid. muchs complained about how up will cost, but in the beginning, the federal government would pay for an hundred percent and even when it , thel the way face down government will still pay 90% of

>>> yesterday, officials from the geo health and human services and the centers for medicare and medicaid services testified on efforts to identify and prevent fraud in medicare. we also touched on the potential repeal of the affordable care act. this runs about 1 hour. >>> good morning. we are going to get started this morning, and thank you for being here. nearly 60 million individuals in the united states rely on medicare for their healthcare. and in my home state of kansas, alone, almost one in five people depend on the medicare program. as one of the government's largest and most complex programs, medicare is highly deceptive -- highly susceptible to fraud, waste, and abuse. because of this, it has been designated as a high risk program for almost 2 tickets. in 2017, alone, improper payments accounted for nearly $52 billion of medicare spending. fraud in particular is often challenging to identify, and measure due to its deceptive nature. fraud may also be nonfinancial, making it more difficult to measure. the centers for medicare and medicaid services or cms measures improper paymen

, on medicaid expansion, i'm sorry. that they have been they've been slower to move to these private insurance issues. but there start to step up to the plate. north carolina is a great example of that. >> any other panelists have sort of a state highlight specific story? >> yes, the state came to mind when alice was asking about rural areas in the last panel. that is really where the aca individual market has struggled. that's how to attract insurers into the markets and when we were looking at bexar county, last year it is almost always a rural county, at the risk of having not having an insurer. i don't know if any state has come up with a solution but i would be interested to hear more on what is happening in new mexico because that is one state where they have not had that problem. i don't know why it is. on the other hand, nevada had an interesting strategy at first which was to try to make that so that if an insurer wanted to diss a desk participate in the medicaid managed care market, they had to also offer on e

incentives they are using in their medicaid program, as well as work to ban gag clauses. there is also an interesting law that is going into effect in maine. it applies more to procedure then to prescription drugs. however, the idea has possibility. it says that if you can find a healthcare provider who can do a neat replacement at a far lower cost than would be covered by your insurance, you can split the savings with the insurance company. i do not believe the law has gone into effect yet so we do not know the result. "the state says -- but the state is a laboratory of innovation and i think we can learn a lot from them. >> i am a longtime health policy analyst. thank you for all your comments and your work. a couple of questions. one, you started off with a blatant description of antitrust violations. what can be done more on that front with the federal trade commission? also, pricing transparency. this seems to be the only market where we do not know what the prices are. shouldn't there be a law that says they have to be posted after the fact? >> two great questions.

the federal government picks up about 129 billion of debt and payments through medicare, medicaid and other programs. programs. programs. succumbingpr november 2015, alarmed by these price increases and the chairman of the committee along with the then ranking member claire mccaskill i launched an investigation into the extreme spikes that we were seeing in drugs that path and expired yet they didn't have a generic equivalent. the drugs that we examined ranged from my true price which is used to treat dangerous cardiac conditions and it is often found as a standard drug on hospital cards to the drugs used to treat rare genetic diseases, severe infections such as tuberculosis and other conditions.eatening the findings of our investigations were troubling to say the least. at the first hearing in december of 2015, we centered on four companies that have acquired decades-old affordable drugs and then raised their prices suddenly and astronomically so that they were no longer affordable. i remembered that one of the drugs had first been introduced in marketplace a year after i had been bo

medicaid expansion. and now overall what states are looking at, it doesn't matter what color they are. blue and red, they are all saying how can i make this work better for the unsubsidized population? i've got my exchange population. we'll call them the sick and subsidized. they're over there. what can i do to stabilize that? what about the other? we'll call them the healthier wealthier? what about them. un-substance died -- diesed is -- unsubsidized is too expensive. how can i get coverage more affordable to them? that's where the states are headed. now let's turn to the states. >> a point of clarification. people may not know the difference between association health plans and multiple employer welfare arrangements. >> if i could do -- going back to school. all association are -- it doesn't matter. association health plans are all because they all involve multiple employers. not all -- are association health plans. there are entities that are always multiple employer welfare arrangements. and everythi