Medicaid Archives - Page 4 of 33 - Florida Politics

Jennifer Ungru: Funding for hospitals serving low-income patients presents challenges, opportunities

Three little letters — L-I-P — can spell panic in the hearts and minds of many hospital officials, as revenue estimators are forecasting a lean budget year for 2017.

LIP or the Low Income Pool is a combination of state and federal funding that helps supplement Medicaid payments hospitals receive. The funding comes from local tax dollars matched with federal Medicaid funds.

The LIP program was designed to ensure a significant return on investment for the local contributors because the local dollars invested in this program supporting Medicaid are optional.

Additionally, the program allows for a significant return on investment for the local tax districts that choose to invest in these programs in their communities and contribute the money on behalf of a named hospital.

Here’s how it works: Local tax districts contribute the money on behalf of a named hospital, the local dollars then draw down federal dollars where the combined amount is large enough to be worthwhile for participation in the program, as well as creating a remaining “pool” to be divided among other low-income-serving health care providers.

 This “guaranteed return” allowed for named hospitals to increase their Medicaid rates as well as “buy back” past legislative cuts to Medicaid hospital rates — a practice others who rely on state dollars to support their programs and services only dream about.

The remaining “pool” would be divided among the other providers based on a legislative formula agreed to by the federal government.

At the height of the program, these combined dollars accounted for nearly $2 billion in health care funding, or roughly 15 percent of total hospital Medicaid reimbursement. Since the overall health care budget is so large, this number needs to be put into perspective. Consider, outside of stand-alone children’s hospitals, Medicaid, on average, is only about 20 percent of a hospital’s overall payments.

Unfortunately, like all good things, Florida’s LIP program has an expiration date. In 2015, the Obama administration announced the program would be phased out within two years. For 2016/2017 the traditional $1 billion LIP program, the “pool,” was limited to approximately $680 million and the corresponding $800-900 million hospital rate enhancement investment was eliminated altogether.

Not only were the dollars limited, even the structure of the pool was dramatically changed, leaving questions as to whether local hospitals will even participate in this final year of the program.

Next year, the federal government will remove its remaining $400 million from the program. While local shares of the initial and current program still exist, those entities will have to determine how to best use those dollars.

Leaving state budgeters with the question of what to do next. Removing almost $2 billion within the health care system across the state in a period of two years is a lot, no matter where you stand on the issue.

The state has three options: do nothing and the program ceases, attempt the funding status quo and use general revenue to pick up the federal share, or try something new. As explained below, each option presents challenges and opportunities for our state policymakers.

— Do nothing. Local governments can decide what to do with the local tax dollars they’re collecting. Two years ago, local governments submitted $760 million to LIP, and this year, locals may contribute up to $272 million to the pool. This is a lot of money that can make a dramatic difference in local communities. Local governments could continue to collect the same tax dollars but reinvest them in ways to support local health care needs, or even return the dollars back to the taxpayer. Doing nothing, some would argue, levels the playing field. Unlike other programs that rely on state funding, hospitals have uniquely been able to “buy back” past budget cuts. Doing nothing would force hospitals to realize a true cut as other worthwhile programs have faced during lean times.

— Use state revenue to fill the hole. Remember Special Session 2015? For 2015-2016 budget, the Legislature provided an additional $400 million for hospitals within the Medicaid budget to soften the impact of the phasing out of the program. Lawmakers could provide a similar increase again. Because these dollars are designated for those hospitals that serve a larger portion of lower-income Floridians, some argue these supplemental payments actually keep the cost of health care down and avoid shifting the cost to privately insured customers.

— Finally, the Legislature could do something new, be bold and try to shake up the way of thinking in health care. To change behavior, the state needs to change the motivation. One option would be to build an incentive structure with local and state matched dollars focused on rewarding programs that actually lower the cost of health care. Instead of just bailing out the hospitals and increasing rates, why not set up a system where the state will match the local contribution when an ER diversion programs actually show true cost savings to the state. Emergency departments are the most expensive settings for care. If hospitals are truly committed to ER diversion, then why are wait times advertised regularly and off-site ERs are being built more rapidly than Starbucks? To make this work, the savings would have to be actual savings to the state, not just cost avoidance. While everyone talks about the rise in health care costs, we haven’t given a great look toward rewarding efforts that truly lowers the costs for Floridians. It is an idea worth lawmakers taking a look.

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Jennifer Ungru is a corporate affairs adviser in Jones Walker LLP’s Tallahassee office. Before joining Jones Walker, Ungru served as the chief of staff for the Agency for Health Care Administration (AHCA), which oversees the state’s Medicaid program and regulates more than 45,000 health care facilities. During her tenure, the agency implemented major health reforms, including the movement to Statewide Medicaid Managed Care, the largest procurement in state history.

Personnel Note: Beth Kidder named interim deputy secretary for Medicaid

beth-kidder-head-shot-2015Beth Kidder is Florida’s new interim deputy secretary for Medicaid, overseeing the state’s nearly $26 billion state program that pays health costs for the poor.

Christine Sexton of POLITICO Florida reports the announcement was made Oct. 6 in an email to Agency for Health Care Administration employees.

In the current year budget, Sexton writes, the Medicaid program is slated for $25.7 billion, which could increase to $26.4 billion to pay health care costs for elderly and disabled Floridians who qualify.

Kidder is taking the place of Justin Senior, who left Oct. 3 to become the agency’s interim secretary.

Senior replaced Liz Dudek, who has led the AHCA since the agency’s creation in the 1990s.

State records show Dudek was paid $141,000 annually. Senior, who reported directly to Dudek, earns $142,000 a year.

Dudek, who resigned unexpectedly Sept. 21, served as AHCA Secretary for both Gov. Rick Scott and former Gov. Charlie Crist.

Before becoming interim deputy secretary for Medicaid, Sexton notes Kidder served as assistant deputy secretary for Medicaid policy and quality. According to a state government website, Kidder has been with the state since 2001 and earns $120,000.

8 Reasons Rick Scott is the perfect veep for Donald Trump

Rick Scott is basically as awful as Donald Trump in so many ways. But before Floridians start petitioning Trump to introduce Scott to a presidential election turnout and an embarrassing loss before Scott runs for U.S. Senate in 2018, read all eight reasons.

8) Cons. Scott didn’t build his $300-some million fortune with a fraudulent university, but he did help build a company that defrauded Medicare and Medicaid by way more, paying a record $1.7 billion fine.

7) Muslims. Scott was offending Muslims and Hispanics long before Trump descended down the escalator at Trump Tower. Scott put some of his first campaign dollars into fearmongering about Muslims in “Obama’s Mosque” near Ground Zero in 2010. Also, mic cut.

6) Hispanics. Similar to Trump, and despite all evidence, Hispanics love Scott, according to … only Rick Scott. Scott claims he “won” the Hispanic vote in 2014, despite actually losing it by 20 percent.

5) Little Marco. While Trump’s insults are infamous, Scott is doing his part in Florida. He backed Trump over Rubio (and Jeb!) and is now working against Rubio in his U.S. Senate race, supporting mini-Trump Carlos Beruff, best known for unapologetically calling President Obama an “animal.”

4) Smarts. Trump could own Anderson Cooper‘s “RedicuList” segment, but Scott once got on it for insulting “everybody’s intelligence” trying to defend himself for using on-duty cops at campaign events.

3) Votes. Trump needs turnout to be as depressed as Jeb! after South Carolina. Scott has been hard at work, rolling back civil rights reforms that allowed nonviolent ex-felons to vote.

2) Money. Scott won in 2014 by outspending his opponent on TV by $33 millionRomney lost Florida by less than 1 percent in 2012, but only outspent Obama by $17 million. An extra $16 million might have bought 29 electoral votes.

1) Florida. Trump can’t win without Florida, and Rick Scott knows how to win here.

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Kevin Cate owns CATECOMM, a public relations, digital, and advertising firm based in Florida.

Geraldine Thompson: Profits ahead of patients spells trouble for Floridians

As a longtime community advocate and state legislator in Orlando, I work every day to make sure that consumers in Florida have access to quality, affordable health care. The recent approved mergers of Aetna with Humana and Anthem with Cigna pose great challenges for Florida consumers.

While the idea of mergers to create bigger companies may seem like a good idea – the results can be disastrous. As citizens, we must demand that mergers like these are held up to the highest standards, and that the process is transparent, open and fair.

Although companies merge for a variety of reasons, the most important to them is that they increase their bottom line. Because of this, it is our responsibility to make sure that we keep up our standard of care, even while the insurance companies are working to cut access to health care for our hardworking Florida residents.

According to a health economics expert at the University of Southern California’s Schaeffer Center for Health Policy and Economics, “when insurers merge, there’s almost always an increase in premiums.” We are concerned that the increased market power post-mergers of Anthem-Cigna and Aetna-Humana will lead to rising costs for Florida, when they are already seeing a rise in health insurance premiums and where things are projected to rise significantly in 2016.

We have seen in the past that mergers lead to consumers paying higher premiums, are made to suffer through limited networks and most importantly, they wind up receiving worse service.  A proposed consolidation of health insurers, now under consideration by the Florida Office of Insurance Regulation, will affect millions of Floridians.

Mergers like these will do away with competition, which is a critical component of lowering costs, and promoting access and choice.  These mergers will also create new, dominant insurance entities that have no incentive to improve care.

According to industry experts, these mergers could “undercut” the critical innovation efforts needed to improve health care. This would not only harm consumers as insurers compete less with providers to offer new insurance products, but a concentrated insurance market like this often has less innovative offerings.

Additionally, with less competition to bring innovative health care to customers, we will likely see a decrease in quality of care and a lack of access to innovative products that often deliver better care at lower costs.

Floridians already feel the pain from a lack of expanded Medicaid access in the state, but, with the mergers of five major insurance carriers, more Floridians will without a doubt see higher prices due to less competition in Florida’s health care marketplace. Over 88 percent of Floridians are clear in the message that the pending mergers are driving concerns up and competition down.

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State Sen. Geraldine Thompson represents Senate District 12, which includes parts of Orlando and western Orange County.

SEIU Florida endorses Patrick Murphy for U.S. Senate

SEIU Florida — which has led the “Fight for $15!” campaign to raise the minimum wage in Florida over the past two years — announced on Monday that it is endorsing Jupiter U.S. Rep.  Patrick Murphy for the U.S. Senate.

“Congressman Murphy is well prepared to serve as our United States Senator and has earned the support of SEIU Florida members across the state by aggressively fighting for policy solutions that are important to Florida’s working families,” said Monica Russo, president of SEIU Florida, in a statement. “We support candidates who are willing to be a champion and a voice for working-class families who are sick and tired of being pushed aside. Patrick Murphy is one of those candidates.”

In its statement announced its support, the SEIU — one of the most politically powerful unions in Florida — noted how Murphy demonstrated his commitment to raising the minimum wage to $15 an hour by taking the union’s “minimum wage challenge” last year. That’s when he took up the proposal (as have other Florida lawmakers) to live on just $85 a week to bring attention to the impact of low wages, and his solidarity with that movement.

The SEIU also applauded Murphy for advocating for Medicaid expansion in Florida,  noting that “He is committed to closing the coverage gap for nearly 1 million Floridians and the millions of Americans around the country who don’t have access to quality, affordable healthcare.

“The vast, vast majority of people on minimum wage want to be working, want to be making more money, want to be giving more back to the community, are doing a lot of jobs that are very important, and they deserve to be paid more,” said Murphy. “It’s unacceptable to be on the minimum wage, be working 40 hours a week, and live in poverty. That’s unacceptable in this country.”

It should be noted that Orlando-area Congressman Alan Grayson, Murphy’s top competitor in the Democratic primary, also took the minimum wage challenge this past March.

According to the SEIU Florida’s website, the labor union represents more than 55,000 active and retired healthcare professionals, public employees, and property service workers in the state of Florida.

Judge sets date in settlement of decade-old Medicaid reimbursement lawsuit

A Miami federal judge has agreed to a hearing date for the settlement of a decade-old class-action lawsuit over children’s Medicaid services in Florida.

LobbyTools reports that Friday the judge set a June 28 hearing to formally consider the settlement in a suit that seeks to increase medical and dental services to nearly 2 million Florida children.

Pediatricians are hopeful the state will honor its agreement.

“Like any settlement, it’s a compromise,” says attorney Carl Goldfarb, who represents pediatricians. “Both sides gave certain things up. But we think it’s in the best interest of the children of the state and we think it will improve their access to care.”

Doctors and dentists brought the suit more than a decade ago, arguing that low Medicaid reimbursements in Florida denied preventative care to as many as 500,000 children.

The settlement mandates the state to give significantly higher payments. However, LobbyTools notes that other specialists who participate in the Medicaid program may not comparable increases.

Andy Gardiner, Lars Houmann, call for more health care access, but not Medicaid

At an industry-sponsored summit in Orlando Tuesday, outgoing Florida Senate President Andy Gardiner and the leader of one of Florida’s biggest hospital system both called for urgent help in providing more access to health care.

But not through Medicaid.

Gardiner, an Orlando Republican, and Lars Houmann, president of the Florida Division of Adventist Health System, told the Florida Health Care Affordability Summit that the great challenge is opening up health care to uninsured and low-income residents of Florida.

“I would encourage you to also talk about access, and access for all individuals,” Gardiner told the forum, organized by the Associated Industries of Florida.

They both said Florida has another chance, and should take it, to negotiate with the federal government for a waiver from the federal Medicaid program that might allow the Sunshine State to take federal Medicaid expansion money but use it for alternative programs to Medicaid.

For the past three years, the federal government has been trying to encourage states to accept money to expand Medicaid programs to provide coverage for people too poor to buy Obamacare insurance, but who make too much money to qualify for Medicaid. In Florida’s case, that’s about $50 billion over ten years. Gardiner’s Senate has twice crafted deals to negotiate waivers with the federal government for Florida-driven programs, but the Florida House has refused.

“If the desire in the state of Florida is not necessarily to look at free-market options, that is for a debate for another day, I would encourage you to talk about models like the money we put into free and charitable clinics,” Gardiner said.

Houmann also urged expansion of access to uninsured and laid out economic slides showing what they cost hospitals and Florida.

He also stressed that at Adventist Health, which runs the Florida Hospital systems in Orlando and Tampa Bay, the strategic thinking is turning toward keeping people healthy — keeping them out of hospitals.

Yet he argued that Medicaid is just a bad program for both patients, doctors and hospitals, and should not be expanded, but replaced with something that works better. Medicaid, he argued, comes with too many strings and too little money to be a good business for doctors or hospitals, and patients are punished because few doctors accept it, and their services suffer from overload.

“Yes, it is an entitlement program. Yes, it does take care of a larger part of our population,” he said. “But frankly, I could not put my heart into term ‘expand Medicaid.’

“I could put my heart into bringing the money that the Affordable Care Act made available for Florida for expanding coverage,” he added. “Frankly, this is a political lecture; we did have an opportunity to bring a deal to Washington … to restructure our program. But we couldn’t get that done.”

Martin Dyckman: Rick Scott doesn’t know when to shut up

There was once a senator from Virginia who was dismayed to find his picture on the cover of New Times magazine under the headline “the dumbest Congressman of them all.”

He called a news conference to deny it, thereby proving it to be true.

His name was Scott. William Scott.

You can probably guess where this is going.

From that day in 1974 to now, no public official has so witlessly confirmed the substance of a harsh criticism as Florida Gov. Rick Scott did the other day.

A more prudent man would have shrugged off his chance encounter with the citizen, Cara Jennings, who loudly called him an “asshole.”

Left alone, its notoriety would have subsided after the first 2 million or so YouTube and Facebook views.

But Scott is Scott, with an ego nearly as large as that of his newest buddy, Donald Trump, and a slush fund to match.

His Let’s Get to Work political committee swiftly made and posted a video savagely disparaging Jennings.

Unlike a bystander’s smartphone cinema verité video of the original incident at a Gainesville Starbucks, Scott’s riposte is a professional job. A professional hit job.

In the course of claiming that thousands of new jobs have been created in that Gainesville neighborhood, the announcer says “almost everybody” has a job, “except those who are sitting around coffee shops demanding public assistance, surfing the Internet and cursing at customers who come in.”

A former Lake Worth city commissioner, Jennings is a self-described anarchist who refused on principle to say the Pledge of Allegiance. Scott’s body slam harps on her background and calls her a “latte liberal” before getting around to implying that she’s a freeloader.

In fact, she is a freelance consultant who says she was in Gainesville on business, stopped for coffee at Starbucks, and was at work on her computer when Scott walked in. What’s more, she said she doesn’t get a dime of public assistance.

“What I find very offensive is for him to infer that I’m unemployed and just hanging out at Starbucks,” she told me. “I’ve never seen this type of attack against a private citizen.”

Neither have I. To trade public punches with another politician, or a media critic, is an accepted part of the game. To defame a private citizen — one who wasn’t even responsible for publicizing the original incident — is out of bounds.

Some people I know, having seen only the Starbucks video, which begins partway through their confrontation, were critical of Jennings for shouting at Scott.

But to hear the whole story is to understand why she lost her temper.

She began by upbraiding him for refusing to expand Medicaid and for signing a bill to keep state money away from Planned Parenthood, and says “you should be ashamed to show your face around here.”

That’s tough language, to be sure, but nothing worse than what hundreds of editorials have said.

Scott then resorts to his standard mantra, his answer for everything, his non-denial denial for any criticism, by replying that Florida has gotten 1 million jobs on his watch. That’s when she loses it.

As he retreats, she shouts, “A million jobs? Great. Who here has a great job or is looking forward to finishing school? Do you really feel like you have a job coming up?”

She utters the epithet with which he will forever be identified. That is not so much because it was said, but because he dignified it with a response.

For the governor to claim credit for 1 million jobs is somewhat like boasting of making the sun rise or the tides ebb and flow.

PolitiFact acknowledged the statistic to be mostly true.

“That said, ” it added, “we’ll note one caveat that we always raise when analyzing claims such as Scott’s: It’s a stretch for the governor (or the president, or a mayor) to claim credit for such gains.

“But even if governors do deserve some credit for how the economy performs on their watch, there are other things over which they have no control that can have impacts that are at least as big, if not bigger. These include changes in technology, fluctuations in the national and international economy, demographic shifts (the Census Bureau estimates the state’s population has increased by about 1.46 million people since April 2010, for instance), and events like natural disasters.

“Indeed, governors — like presidents — tend to get too much credit when things are going well, and too much blame when things are going poorly.”

Scott bought his way into power when Florida was still recovering from the 2008 recession. The job growth since then owes in some part to President Barack Obama‘s stimulus program, which Scott’s predecessor praised and was rejected by his party for saying so.

In any case, Florida’s job growth is beside the point that Jennings wanted to impress on Scott. It’s that his policies have condemned thousands of Floridians to needless sickness and death for want of the Medicaid expansion money. The spiteful defunding of Planned Parenthood will make that worse.

The name she called him hardly seems too strong for that.

***

Martin Dyckman is a retired associate editor of the St. Petersburg Times. He lives in suburban Asheville, North Carolina.

Martin Dyckman: Rick Scott doesn't know when to shut up

There was once a senator from Virginia who was dismayed to find his picture on the cover of New Times magazine under the headline “the dumbest Congressman of them all.”

He called a news conference to deny it, thereby proving it to be true.

His name was Scott. William Scott.

You can probably guess where this is going.

From that day in 1974 to now, no public official has so witlessly confirmed the substance of a harsh criticism as Florida Gov. Rick Scott did the other day.

A more prudent man would have shrugged off his chance encounter with the citizen, Cara Jennings, who loudly called him an “asshole.”

Left alone, its notoriety would have subsided after the first 2 million or so YouTube and Facebook views.

But Scott is Scott, with an ego nearly as large as that of his newest buddy, Donald Trump, and a slush fund to match.

His Let’s Get to Work political committee swiftly made and posted a video savagely disparaging Jennings.

Unlike a bystander’s smart phone cinema verité video of the original incident at a Gainesville Starbucks, Scott’s riposte is a professional job. A professional hit job.

In the course of claiming that thousands of new jobs have been created in that Gainesville neighborhood, the announcer says “almost everybody” has a job, “except those who are sitting around coffee shops demanding public assistance, surfing the internet and cursing at customers who come in.”

A former Lake Worth city commissioner, Jennings is a self-described anarchist who refused on principle to say the Pledge of Allegiance. Scott’s body slam harps on her background and calls her a “latte liberal” before getting around to implying that she’s a free-loader.

In fact, she is a free-lance consultant who says she was in Gainesville on business, stopped for coffee at Starbucks, and was at work on her computer when Scott walked in. What’s more, she said she doesn’t get a dime of public assistance.

“What I find very offensive is for him to infer that I’m unemployed and just hanging out at Starbucks,” she told me. “I’ve never seen this type of attack against a private citizen.”

Neither have I. To trade public punches with another politician or a media critic is an accepted part of the game. To defame a private citizen — one who wasn’t even responsible for publicizing the original incident — is out of bounds.

Some people I know, having seen only the Starbucks video, which begins partway through their confrontation, were critical of Jennings for shouting at Scott.

But to hear the whole story is to understand why she lost her temper.

She began by upbraiding him for refusing to expand Medicaid and for signing a bill to keep state money away from Planned Parenthood, and says “you should be ashamed to show your face around here.”

That’s tough language, to be sure, but nothing worse than what hundreds of editorials have said.

Scott then resorts to his standard mantra, his answer for everything, his non-denial denial for any criticism, by replying that Florida has gotten 1 million jobs on his watch. That’s when she loses it.

As he retreats, she shouts, “A million jobs? Great. Who here has a great job or is looking forward to finishing school? Do you really feel like you have a job coming up?”

She utters the epithet with which he will forever be identified. That is not so much because it was said, but because he dignified it with a response.

For the governor to claim credit for 1 million jobs is somewhat like boasting of making the sun rise or the tides ebb and flow.

Politifact acknowledged the statistic to be mostly true.

“That said, ” it added, “we’ll note one caveat that we always raise when analyzing claims such as Scott’s: It’s a stretch for the governor (or the president, or a mayor) to claim credit for such gains.

“But even if governors do deserve some credit for how the economy performs on their watch, there are other things over which they have no control that can have impacts that are at least as big, if not bigger. These include changes in technology, fluctuations in the national and international economy, demographic shifts (the Census Bureau estimates the state’s population has increased by about 1.46 million people since April 2010, for instance), and events like natural disasters.

“Indeed, governors — like presidents — tend to get too much credit when things are going well, and too much blame when things are going poorly.”

Scott bought his way into power when Florida was still recovering from the 2008 recession. The job growth since then owes in some part to President Barack Obama’s stimulus program, which Scott’s predecessor praised and was rejected by his party for saying so.

In any case, Florida’s job growth is beside the point that Jennings wanted to impress on Scott. It’s that his policies have condemned thousands of Floridians to needless sickness and death for want of the Medicaid expansion money. The spiteful defunding of Planned Parenthood will make that worse.

The name she called him hardly seems too strong for that.

***

Martin Dyckman is a retired associate editor of the St. Petersburg Times. He lives in suburban Asheville, North Carolina. Column courtesy of Context Florida.

New video: Let’s Get to Work calls Rick Scott heckler a “latte liberal”

Let’s Get to Work, the political fundraising committee affiliated with Gov. Rick Scott, is striking back against the Starbucks patron who called him an “a**hole” this week, labeling her a “latte liberal” in a new video. 

The 1-minute clip surfaced Friday on the group’s website and YouTube.

The governor had stopped into a Gainesville Starbucks when former Lake Worth City Commissioner and self-professed “anarchist” Cara Jennings dressed him down in a separate video that went viral.

“You’re an a**hole. You don’t care about working people,” she shouted at Scott, referring to his refusal to accept the federal government’s Medicaid expansion program in Florida. “You should be ashamed to show your face around here.”

When Scott tried to defend himself by saying a million new jobs had been created while he’s been in office, she countered: “A million jobs? Great, who here has a great job?”

In response, the group’s video calls her “a terribly rude woman” and replays some of the original viral video, including the “a**hole” remark, unbleeped.

It calls her out for being a “former government official who refused to recite the Pledge of Allegiance.” It then notes that “9,300 new jobs” have been created in the Gainesville area, and unemployment was cut in half.

“So who has a great job?” the narrator asks. “Almost everybody. Except those who are sitting around coffee shops, demanding public assistance, surfing the Internet and cursing at customers who come in.”

Jennings, who couldn’t be reached Friday, was rated on her rants in the original video by PolitiFact Florida, which judged her claims “half true.”

Let’s Get to Work last reported cash on hand of $848,513, state campaign finance records show.

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