he will see that pvm's point the finger at the manufactures and say they are the reason drug prices are so high and manufactures point their fingers at the dvm since they are creating artificial spreads when they go ahead and dispense or have their reimbursements with the pharmacists. there is a lot of finger-pointing as to why prescription drug costs are so high and i think people need to take a look at that and at a policy level to get to the bottom of that if you are going to get traction on any solution. >> kate with the american physical therapy association. my question would he think the impact will be on the states that have expanded medicaid and maybe transition from it population into the private market and now are going back and i'm thinking arkansas and new hampshire in particular. they are kind of backtracking and will that affect the overall risk pool for good or for bad or what your thoughts are on that. >> i'm not an actuary and so take this for what it's worth but i think there is some evidence that the population is between 10130% of the federal poverty line where they