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Senate AHCA Version – Premium Increases and Subsidy Reductions

CBPP has this pictorial analysis of the increased premiums resulting from the Senate version of the AHCA for a 60 year old at 350% FPL with an ACA Silver plan. “For a 60-year-old with income of 350 percent of the poverty level (about $42 ,000 today) facing the average premium on HealthCare.gov, out-of-pocket premiums would jump by an estimated $4,994. Premiums would rise by $ 2,022 for a 45-year-old at this income level, and fall by $75 for a 30-year-old. Premiums would rise by $2,694 for a 60-year old with income of 300 percent of the poverty line, and by $1,903 for a 60-year old with income of 150 percent of the poverty line.”

Premium Increase The Senate AHCA Bill increases Premium Costs .

A sixty year old slightly above 350% FPL would face the loss of thousands of dollars in tax credits. Presently, the ACA covers up to 400% FPL and limits how much can be charged for age to 300%. The AHCA goes to 500% and reduces the subsidy coverage to 350% FPL.

Losses in Tax Credits Senate AHCA also eliminates subsidies for those between 350% and 400% FPL resulting in $thousand of dollars in cost for those in the Individuals Market.

Senate Bill Still Cuts Tax Credits, Increases Premiums and Deductibles for Marketplace Consumers CBPP, Aviva Aron-Dine and Tara Straw, June 25, 2017

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BCRA CBO Score

WASHINGTON (AP) — Congressional Budget Office sees 22 million more uninsured by 2026 under Senate health bill.

Toher Spiro appears to be snipping and tweeting the key bits of the CBO report

Premiums for a 64-year old with middle income go from $6,800 under ACA to $20,500 under BCRA

Deductibles for plans eligible for tax credits go from $3,600 under ACA to $6,000 under BCRA

death spiral

open thread.

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Did Conway Con Herself

This is remarkable even for the Trump administration. Kellyanne Conway claimed that the Medicaid slashing BCRA proposed by the gang of 13 doesn’t include “cuts to Medicaid”.

The Trump administration position appears to be that Trump could sign it in to law and keep his promise to protect Medicaid from cuts. Wow.

I am not President of the USA, but this doesn’t seem to be good strategy to me. It makes it clearer than ever that Trump will throw representatives and senators who vote yes under the bus if the horrible bill becomes even more unpopular as a horrible law causing horrible suffering. It also makes it clear that they will have to deal with the debate about whether $ 800 billion is zero. They could choose to repeatedly say that Trump is a liar (which will hurt them as much as voting no) repeatedly tell blatant lies about the suffering they caused, or they can avoid that debate by voting the bill down. To me the third option looks very attractive.

Already Susan Collins has had to say that she “disagrees” with Conway. She should understand that a yes vote will only be the beginning of dignity wraithdom.

It’s a small thing compared to tens of thousands of deaths a year, but Senators don’t like to be humiliated at all. I hope this makes some difference.

Update: Also Price

“HHS Secretary Tom Price making a bold delararion to @DanaBashCNN: “We would not have individuals lose coverage.” “

We know he’s shameless, but how many seantors representatives are willing to stand up for such absurd lies.

Also I don’t think insulting the CBO is optimal strategy right now. For one thing they are working very hard over the weekend to get a report which the Senate needs in order to consier the BRCRA. If someone treated me as Price treats them, I would be very very lazy (trivially true as I am, have always been and will always be very lazy). Also they can calculate effects on coverage outside the 10 year window first (they are doing this) and work backwards.

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McConnell’s AHCA Kabuki

he McConnell Obamacare repeal and replace “discussion draft” is worse than I imagined possible even taking into account that it would be worse than I imagined possible. I fear he made sure it was horrible so moderate Senators could win staged battles and claim they had saved people (needless to say I am not the first to write of this possibility).

I guess a vox explainer is always useful and Sarah Kliff is very smart thorough and reliable.

The bill is surprisingly aweful in two ways. First it doesn’t slow the phasing out of the ACA Medicaid expansion over 7 years but rather does it in 3 (from 2021 through 2024). Several relatively non reactionary Republican senators stressed how important of 7 year phaseout was to them. Also the bill contains no additional funding to deal with the opioid addiction crisis. Many of those senators specifically proposed this increased funding.

I fear that this is all theater. That the so called moderates will get their 7 years and their opioid treatment funding and then vote yes. Not including them in the “discussion draf” will make this more dramatic, allow the self described moderates to claim credit, and give them cover.

The Senators in question are almost saying this is their price.
I will include phone numbers in case any reader is interested in calling to say he or she is not falling for it. All are from the very useful

https://www.trumpcaretoolkit.org/

The Senators include
Robert Portman of Ohio (202-224-3353) who wrote
portman

This almost explicitly says his price is an extended Medicaid phaseout and, especially, money for treatment of opioid addiction.

Shelley Moore Capito of West Virginia (202-224-6472 called senator Capito with the accent on the a not on the i as in the Italian word for understood)
She has a very strong position on increased opioid treatment funding. West Virginia (like Ohio) is hard hit by the epidemic.

Her web page includes

Earlier today, I posted a link to the health care discussion draft on my website for all West Virginians to read. Over the course of the next several days, I will review the draft legislation released this morning, using several factors to evaluate whether it provides access to affordable health care for West Virginians, including those on the Medicaid expansion and those struggling with drug addiction.

Which, again, is very clear. I want to mention that I guessed there was a press release similar to Portman’s before checking, and why, lo and behold, there is (it’s almost as if they coordinated).

Dean Heller of Nevada (202-224-6244 is another self described moderate (and up for election in 2018 and very vulnerable)

His web page has

“Throughout the health care debate, I have made clear that I want to make sure the rug is not pulled out from under Nevada or the more than 200,000 Nevadans who received insurance for the first time under Medicaid expansion. At first glance, I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid. I will read it, share it with Governor Sandoval, and continue to listen to Nevadans to determine the bill’s impact on our state. I will also post it to my website so that any Nevadans who wish to review it can do so. As I have consistently stated, if the bill is good for Nevada, I’ll vote for it and if it’s not – I won’t.”

Again quite clear. The phrase “the rug is not pulled” is almost explicit that slowly sliding it out from under them would be OK. The reference to Sandoval is important, as Sandoval is very popular in Nevada and signed a letter opposing the House AHCA and generally arguing for bipartisan compromise (so did Gov. Kasich of Ohio whom Portman didn’t mention).

update 3: This is interesting. John Ralston is a very highly respected expert on Nevadan politics. He tweeted

“I don’t think so. And will say he [Heller] votes No after consulting with @GovSandoval.”
replying to another top reporter, Ronald Brownstein, who tweeted “#AHCA reduces # covered by Medicaid in NV by 45%. #SenateHealthCareBill proposes > l/t cuts. Can @SenDeanHeller vote Y? @RalstonReports”
end update:

OK how about Lisa Murkowski (202-224-6665 only interested in voice mail from Alaskans) ?
Nothing yet. I actually find this promising. She might not have decided on the price of her vote.

Finally (for moderates for now) Susan Collins of Maine (202-224-2523) Nothing on the McConnell discussion draft yet. A lot on the Opioid crisis (very bad in Maine too). Also “bipartisan” is her favorite word. Actually the web page section on health looks OK. Her voting record doesn’t. Collins and Murkowski strongly support funding for Planned Parenthood. Neither have said they will vote no if the elimination of that funding stays in the bill (most likely they propose an amendment and it goes down 50-51 including Pence). I do not want to count on Senator Collins growing a spine.

update: Collins spoke with the press instead of having a staffer write a press release. Her comments as reported by Tierney Sneed are mildly interesting

Sen. Susan Collins (R-ME) gave the Senate health care bill released Thursday a mixed review, but zeroed in on its major cuts to Medicaid as a potential problem for her.

She took issue with how the Senate bill, starting in 2025, used a rate of growth for federal funding for Medicaid that is significantly slower than the typical increases of costs for the program.

“I’m very concerned about the inflator that would be used in the out years for the Medicaid program,” she told reporters in the Capitol a few hours after the bill was released. “It’s lower than the cost of medical inflation and would translate into literally billions of dollars of cuts.”

She added that she was concerned about how the cuts would negatively affect rural hospitals or prompt states to restrict Medicaid eligibility.

This might amount to something. Unlike “pulling the rug out” Heller, Collins is talking about the long term and a huge amount of money. The ceiling on Medicaid spending amounts to a huge cut over 10 years. It is they key measure used to finance the bill’s tax cuts for the rich. Unlike the 3 year Medicaid extension phase out it can’t be fudged. The case for Heller, Capito, Portman Kabuki is strongly supported by the fact that they don’t specifically address the ceiling.

It is vital that people who had no problem before the ACA understand that they will have huge problems if the AHCA passes, because of the huge cuts of legacy (pre-ACA-expansion) Medicaid spending. The fact that Collins discusses this would be a hint that she might actually vote no (if she weren’t actually Senator Susan Collins (R-Maine) who always always caves).

end update:

update 2: Collins is stealing the stage. I think she is torturing us. She said she can’t vote for a bill which deprives tens of millions of health insurance (I’ll believe she can’t if she votes no and not before)

ehd update 2:

Separately 4 right wing Senators said the McConnell draft is too close to the ACA: Ted Cruz, Mike Lee, Ron Johnson (Wisconsin) and Rand Paul (Kentucky).

I think Paul might really mean it. He is extreme and resistent to party discipline. Also the ACA has benefited Kentucky enormously. Blocking the repeal bill would be good for Rand Paul (and Mitch McConnell). Blocking it for not being extreme enough could be crazy like a fox 11- dimensional Aqua Buddha chess.

Ron Johnson has been hinting a no for a long time. He was just re-elected. Here I think that senators with 6 safe years might be more likely to vote no. Failure to pass a bill with hurt Republicans in the short run. Passing a horrible bill will hurt them in the long run.

I’m pretty sure Cruz and Lee are play acting. My guess is that they said no to establish a bargaining position — if McConnell is the right most position, the bill will move further left than if they pretend they might vote no. I read somewhere thatCruz had an individual statement in which he made it almost clear he was going to get to yes.

Summing up, I have no prediction for how this will end. But I do very strongly suspect that Heller, Capito and Portman will win two (staged) battles and get 7 year phaseout and some opioid money, declare victory and vote yes.

update 4: My prediction was wrong (as usual). Heller denounced the bill. He described many of its horrible aspects, definitely including the long term cuts to legacy Medicaid. This is not an issue which can be fudged, because the amount of money involved is huge. He still might cave, but it would be an authentic cave not a staged victory. This is very good news. Also there is even better news reported by The Washington Post

Sen. Dean Heller (R-Nev.) announced that he could not vote for the legislation without revisions, singling out the measure’s long-term spending cuts to Medicaid as the reason for his opposition. The announcement caught some Republicans in Senate Majority Leader Mitch McConnell’s orbit by surprise.

If McConnell had been counting on Heller, his count could be off. In particular, he might have counted to 49 and assumed he could get one more from a senator unwilling to decide the victory for the Democrats. Heller’s announcement takes pressure off of her (she is named Lisa or Susan).

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McConnell’s AHCA Bill Text and WP Interpretation

I have not had a chance to read through this; but, I thought I would put this out here for all of us to read, Senate Version AHCA McConnell

Updated this post with the changes proposed in the McConnell Senate Bill as taken from today’s Washington Post.

Washington Post Version

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How Senate Republicans Plan to Dismantle Obamacare; Washington Post; Haeyoun Park and Margot Sanger – Katz; June 22, 2017

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Mitch McConnell, Healthcare, and the ACA

I am always curious about why certain people make it a mission to get rid of things. I think it truly is about Addison Mitchell McConnell trying to erase the accomplishments of what the first black President Barack Obama did as the president. I did some rather easy digging and pulled up Wikipedia. here is what they said about Mitch.

As a youth, Addison (Mitch) McConnell overcame polio. He received “government-provided healthcare” in Warm Springs saving him from being disabled for the rest of his life.” Addison Mitchell McConnell

Given that you Senator McConnell received government-provided healthcare during your youth which saved you from being disabled, why do you feel the need to strip 24 million people of their healthcare? This healthcare may save their lives also.

Paul Ryan benefited from government survivor benefits which allowed him to go to college.

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Blue Dogs in NY State Legislature.

Diane Ravitch points to the New York State legislature in her blog this week. NY is a Blue State having gone Dem in presidential elections; however, the state legislature is divided with the Dems controlling the Assembly and Repubs the Senate.

What makes the New York state legislature interesting is the emergence of a Blue Dog Democrat segment of the State Assembly, which sides with the Senate Republicans on various issues. Blue Dogs (which I kind of like as a descriptor for them) conjures up thoughts of when the US Senate version were negotiating special deals before the ACA was finally passed. Not that there is a relationship between the federal and NY state variety of Blue Dogs, it still fits and the identity of Democrat is a misnomer.

The Senate Independence Campaign Committee (SICC) was formed by the Independence Party and is chaired by IDC chair Senator Jeff Klein. The SICC is a formal party campaign committee. The SICC as a party campaign committee allows donors to circumvent the stricter limits on direct donations to candidates as donations limits to party committees are much higher and the same as the limits on how much party committees can give to candidates.

Calling themselves the IDC or the Independent Democratic Caucus, they move to the influence of special interest groups. Now you would think the usage of the word “Independent” in their group name would imply they would not be swayed by any particular interest group, heh? Being the independent swing group in the NY State legislature, the IDC has power to dispense for the right donation regardless of its majority constituency. They could go with Republicans or Democrats based upon interest group influence or ideology. One would hope they would be swayed by the needs and the interests of an entire school population rather than a minority.

Charter School DonationsWhile it is not mystery to find it out, the Alliance for Quality Education (AQE) shed some light upon the IDC’s source of funding. In its report Pay to Play,” the Alliance reveals how the IDC played off Democrats in both the Assembly and the Senate with funding schools, the funding it receives from individuals, foundations, and Pacs, and who the donations went to over a six year period.

From 2011 to 2016, the IDC received $676,850 from charter school political interest groups and individuals which was spread amongst multiple recipients. The detail of who donated and to whom it went to can be found in the first table.

NYS Student EnrollmentNew York State Charter school students make up 5% of the total student population. 2.6 million students across the state attend Public schools and approximately 100,000 students attend privately run charter schools.

In 2006 the COA ruled that state government was consistently underfunding schools in a lawsuit filed in 1993 (Campaign for Fiscal Equity). The court ordered the state to provide a remedy. The state legislature and Governor Spitzer “replaced the 30 funding formulas with a needs-based, wealth equalizing formula known as the Foundation Aid, and committed to providing a $5.5 billion increase in operating aid to schools across the state over the course of four years. Only two years of the phase-in were completed and most of the funding was cut during 2010 and 2011. The state currently owes approximately$3.6 billion of that money

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Backstepping

No, not the Control Theory version of Backstepping developed around 1990 by Petar V. Kokotovic. In the Marine Corp there was a Back Stepping cadence. The entire squad or platoon would move in 15 inch steps backwards after coming to a complete halt.

It appears DOE Secretary has started to backstep on her comments on allowing states, Charter schools, and parents decide what is acceptable discrimination. The Senate Committee on Education was not too happy with her comments about letting states and schools decide. One problem still remaining is cutting the funding for the Department of Education and it’s Office of Civil Rights. This will curtail the oversight the DOE has today on local schools.

“Education Secretary Betsy DeVos on Tuesday said she will pursue allegations of discrimination “in any form,” pushing back against criticism that the Trump administration might allow private and religious schools to accept federal funding while at the same time rejecting or discriminating against LGBT students.”

Who would have thought the Michigan billionaire-iron-lady of the DOE could be moved by so called “hurtful” remarks about her very apparent indifference to discrimination? In a follow-up comment, Betsy lamented;

“’Anyone who knows me knows that they (the Senate Committee) couldn’t be further from the truth,’ she said. ‘Discrimination in any form is wrong. And I’ve said before and I’ll say again: the department is committed to ensuring that every child has a safe and nurturing environment, and we are and will be continuing to pursue allegations of discrimination in any form as well. So that has been a really hurtful thing for me personally, because it’s not who I am.’”

I guess I do not know her either and my Vulcan Mind-Meld is not working on her to find out what she is really like. Sorry Betsy, we have to take you at your word or what you do not say too! A case in point as to the impact of Betsy Devos’s efforts with school choice and the results of it can be found in Holland, Michigan very close to the DeVos homestead. “Betsy DeVos and the Segregation of School Choice.” Ms. DeVos knew what was happening in Holland and the rest of the state all along. Michigan is the laughing stock of the nation when it comes to Charter Schools.

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“Flat Earthers”

President Trump has proposed budget cuts to programs and the departments running them. Amongst those departments impacted by Trump’s proposals is the Department of Education and it’s Office of Civil Rights. “ The DOE Department of Civil Rights function is to investigate discrimination complaints in school districts across the nation and create standards for responding to allegations of sexual assault and harassment.” Trump’s decreased budget would force cuts in departmental staffing making it more difficult to investigate complaints and also enforcing the law.

As the new Secretary of the DOE, Betsy DeVos proposes giving more power to states and communities in an effort to allow them to make decisions based upon local needs. This sounds good in the telling of it as people living in these communities would probably know what is needed for their schools. Often times what is ignored in state policy, is the favoring of wealthier districts over poor districts, majority citizens over minority citizens, the disabled, and those needing special education in order to learn. These are costly additions to a budget and local citizens do not like to pay taxes. Nowhere else can this be seen more vividly as it is in DeVos’s home state of Michigan where Detroit and Flint needs are played off against richer school districts. In her recent appearance in front of the Senate Education Committee, DeVos is proposing a “leap-of-faith” proposal of states getting the needs of public and private school educational correct without oversight or direction by the DOE.

In a “Return of DeVos-2″ visit to the Senate Education Committee, she discusses along similar lines a proposal of allowing states to determine if private schools accepting publically funded vouchers can be allowed to discriminate amongst students. Again DeVos claims the states know better than the DOE about what is needed and necessary locally. In which case, why would we need a DOE Office of Civil Rights if states protected the needs of all students? That is sound reasoning; although historically, states do not protect all students and many fall through the cracks without the oversight.

Not liking the pushback from Democrats and those arguing back against her push to expand school of choice with no oversight, DeVos goes on to call those who oppose the program “flat-earthers” accusing those who find fault with and question her programs lacing vision and refusing to face the facts.” Some of her comments during this last meeting with the Senate Education Committee were quite revealing. Perhaps if during her nomination process, if these remarks she made had come out then, others might have voted against her. A Big If for Republicans . . .

Some of Betsy DeVos’s ideology:

1. Should states have the flexibility to decide whether private schools that accept publicly funded voucher students have the ability to discriminate amongst students for any reason?

Rep. Katherine M. Clark (D-Mass.): One private voucher school in Indiana says it can deny admission to any LGBT student or a student who comes from a homosexual or bisexual family. With regard to federal funding, Rep. Clark posed a question to Ms. DeVos of whether she would tell the state (Indiana) it could not discriminate in that way and extended the question to include involved African American students.

DeVos: “Well again, the Office of Civil Rights and our Title IX protections are broadly applicable across the board, but when it comes to parents making choices on behalf of their students …”

Rep. Clark: “This isn’t about parents making choices, this is about the use of federal dollars. Is there any situation? Would you say to Indiana, that school cannot discriminate against LGBT students if you want to receive federal dollars? Or would you say the state has the flexibility?”

DeVos: “I believe states should continue to have flexibility in putting together programs . . . ”

Rep Clark: So if I understand your testimony — I want to make sure I get this right. There is no situation of discrimination or exclusion that if a state approved it for its voucher program that you would step in and say that’s not how we are going to use our federal dollars?”

Me: Going back and forth with Ms. Devos claims it was a hypothetical question, Rep. Clark countered with it not hypothetical and her allotted time ended.

DeVos: “I go back to the bottom line — is we believe parents are the best equipped to make choices for their children’s schooling and education decisions, and too many children are trapped in schools that don’t work for them. We have to do something different. We have to do something different than continuing a top-down, one-size-fits-all approach. And that is the focus. And states and local communities are best equipped to make these decisions.”

Rep. Clark: “I am shocked that you cannot come up with one example of discrimination that you would stand up for students.”

Me: Except in many cases, states have not made those decisions and often times the decision-making dies in the legislatures who will not spend the money or make a political decision impacting themselves.

2. States should have the flexibility to decide whether students with disabilities who are using publicly funded vouchers to pay for private – school tuition should still be protected under the IDEA federal law.

Rep. Nita M. Lowey (D-NY): In voucher and voucher-like programs in which public money is used to pay for private school tuition and educational expenses, families are often required to sign away their IDEA protections, including due process when a school fails to meet a child’s needs. Lowey asked DeVos if she thought that was fair.

DeVos: “Each state deals with this issue in their own manner,”

Tens of thousands of disabled students attend private schools in Florida. Florida requires voucher recipients to give up their IDEA rights.

Me: There was a time, you could not sign away your legal rights and protections. Individuals should not have to do this.

3. High-poverty school districts get more funding than low-poverty schools.

Rep. Lucille Roybal-Allard (D-CA): Proposed education budget’s Title I plan reduces funding to high – poverty schools, according to numerous experts. Rep. Roybal-Allard asked DeVos whether she believes that high – poverty school districts should get “more funding resources” than schools with lower levels of poverty.

DeVos: “Yes, I think the reality is that they do receive higher levels of funding.”

Rep. Roybal-Allard: “Just to be clear … you do agree that high – poverty schools should receive more federal resources than lower levels of poverty schools? Was that your testimony?”

DeVos: “Yes, I think that this is the case.”

Rep. Roybal-Allard: “They don’t.”

It is clear, Ms. DeVos does not know whether schools in higher poverty areas receive more funding or not. It is relatively certain most states and local government make no additional exception for schools in higher poverty area either.

Me: Betsy lives about as far away from Detroit and Flint as she can get. Detroit schools were under State of Michigan management and were released from it in almost the same fiscal shape as when they started. Uncertified teachers can instruct in Detroit as determined by the state.

4. The administration is not shifting money for public schools in the budget in order to fund school choice experiments.

DeVos: “It is. If there are cuts to public schools, and there is new money going to school choice, that can’t mean anything else.”

5. DeVos would not say whether private and religious schools accepting students paying with public funds should be accredited or held accountable in the same way that traditional public schools are.

Rep. Mark Pocan (D-WI): On teaching practices, private schools taking public dollars claim students could learn how to read by simply putting a book in their hands. Asking DeVos if she was “going to have accountability standards” in any new school choice program.

DeVos: “States should decide what kind of flexibility they are going to allow.”

Me: I have seen similar happen in Michigan. Charter Schools may or may not offer a better education than a public school and often times the results are worse. The standard is not the same for both types of schools and there is a need for accountability. Ms. DeVos will not be bringing the much needed improvements to public education any time soon and may indeed hurt it more.

Five startling things Betsy DeVos just told Congress” Valerie Strauss, The Washington Post, May 25, 2017

The Impact of Cutting Public School Funding and How It Pays Out in Oklahoma Emma Brown, The Washington Post, May 28, 2017

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My Sources Tell me that in the Closed Session Comey Said he has proof Trump is a Russian agent and a Lizard person

Lifted from Robert’s Stochastic Thoughts:

My Sources Tell me that in the Closed Session Comey Said he has proof Trump is a Russian agent and a Lizard person

COTTON: “Do you believe Donald Trump colluded with Russia?” COMEY: “It’s a question I don’t think I should answer in open session.” Sen Cotton has a degree from Harvard Law where they didn’t teach him to never ask a question unless he knows how the witness will answer. I don’t think Comey is going to tell the committee in closed session that he knows of no evidence that Trump colluded. I am confident enough that if I were a reporter I would be tempted to fudge a scoop with a made up source. But you aren’t supposed to report that something was said in closed session before the closed session starts. I know, that’s why I am waiting to hit the publish key. Damnit I flinched.

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