Archive | health care reform RSS for this section

Obamacare’s first unintended victims- child-only policies

Only a few months into America’s new Obamacare era, most child-only policies were dropped by private insurance carriers due to the poorly written legislation that would allow parents to sign up their kids after they were sick or injured and leave the carriers bearing all the costs.

The child-only coverage is just the latest problem to arise from the massive 2,500 page health care overhaul legislation. Earlier this month large corporations, like McDonalds, requested special exemptions from the Patient Protection and Affordable Care Act in order to preserve plans they have in place for part-time employees.

This left the White House scrambling to cover children as promised by law, and allowed the insurance carriers to raise premiums for child-only policies in order to offset expenditures.

Insurance companies as well as brokers only discovered the last minute purchase option the government included in the bill once Obama signed the bill into law. This provision would have placed a significant burden on revenue and force companies to ration benefits to in order to stay in business.

As a result, insurance companies established an open-enrollment period where companies will accept all children, regardless of health, for a one month time period, once the enrollment period ends parents can purchase insurance coverage for their children, but the policy could be tripled.

Once the administration reviewed the paperwork they gave health insurance carriers the green light to raise the rates more expensive child-only policies.

“They can adjust their rates based on health status until 2014, to the extent state law allows,” according to Jay Angoff, director of Office of Consumer Information and Insurance Oversight at the Department of Health and Human Services.

Once attorneys and under-writers waded through the legalese memos were sent out to insurance brokers about the new changes.

“We have reviewed the rules regarding the provisions of the Patient Protection and Affordability Care Act (PPACA) limiting the application of pre-existing condition exclusions for children under 19. Unfortunately, there remains a great deal of uncertainty as to how the rules will be implemented and what the impacts might be on participating insurers. Unfortunately, this has created an unlevel competitive environment. As a result, Anthem Blue Cross has decided to suspend the sale of child-only policies indefinitely, beginning September 17, 2010,” a memo read. “We will continue to monitor the situation and provide additional details on any changes to our process and policies as they become available.”

In the meantime it is the health insurance brokers who are left to sift through the changes, added paperwork and disgruntled customers. “Most of my existing clients are just upset that we’re all paying more now and they were quite happy with the insurance coverage they had,” says one broker.

Other large providers like, Cigna, quickly followed suit and let providers know the child-only plans would now longer be available without purchasing a family plan including parents.

While other companies like Aetna have decided to cancel all their child-only plans and will no longer accept any applications. The company plans to notify policy holders of other options for coverage, but acknowledged the cost would be substantially higher.

“Effective immediately, any applications received requesting a child-only policy with a 12/15/10 effective date (or later) will be closed. Underwriting will notify applicants by mail of their ineligibility, but also provide options for coverage,” another memo stated. “This change positions Aetna for the future so we can effectively handle upcoming changes resulting from healthcare reform. New federal rules require guaranteed issue (GI) of coverage for individuals under the age of 19 and no corresponding coverage requirement. These conditions have the potential to significantly increase the cost of premiums and make coverage unaffordable.”

These glaring changes prompted Health and Human Services Secretary Kathleen Sibelius to clarify the HHS regulation that implements key early provisions of the Affordable Care Act, signed into law on March 23, 2010 to prevent insurers from denying coverage to children based on a pre-existing condition. This HHS clarification outlines different options for insurers and states that offer child-only policies, however it rejects the insurers’ idea of denying coverage to sick children outside the open-enrollment period.
“The Affordable Care Act was designed to ensure that Americans who need health insurance are no longer denied access to the care they need – and that includes the youngest and most vulnerable Americans,” said Sebelius. “We have been working closely with the states in their role as insurance regulators and with insurance companies to find ways to improve access to coverage for America’s families.”

Some states are taking preemptive action in an effort to guide insurance companies through the perils of government-controlled health insurance.

“Working with Maryland’s General Assembly, we will establish by regulation an open enrollment period to be sure Maryland families have more options in purchasing insurance for their children, and I commend Kaiser Permanente of the Mid-Atlantic and CareFirst BlueCross BlueShield for their decision to continue to offer this coverage once the regulations are enacted,” said Maryland Insurance Commissioner Beth Sammis. “We are committed to working to ensure children can get the health care they need, and are glad we have been able to find a solution where these insurers will sell new policies.”

According to Sebelius, it was unfortunate that some insurers decided to stop writing new business in the “child-only” insurance market. The HHS Secretary said insurance companies were “reneging on a previous commitment made in a March letter to ‘make pre-existing condition exclusions a thing of the past.’”

Meanwhile the child-only market is considered a small market and children currently insured by these policies should not be affected. Nevertheless the decision for some health insurance companies to discontinue new polices for children was disappointing to the government.

“Nothing in the Affordable Care Act, or any other existing federal law, allows us to require insurance companies to offer a particular type of policy at this time,” a letter from Sebelius said.

“We have been trying to work with the insurance industry to resolve this situation. Some insurers have said they would sell new child-only policies if they could accept year-round those applicants who are healthy, while restricting access for children with pre-existing conditions to a time-limited open enrollment period,” Sebelius claims. “We have carefully considered these insurers’ legal and policy arguments, and have concluded that the approach they advocate is legally infirm, and inconsistent with the language and intent of the Affordable Care Act. Nor would it be lawful for a state to allow denials of coverage for children based on pre-existing conditions outside of an open enrollment period.”

Keeping tabs on a growing government that is mandating new rules for insurance carriers has sent most to question the effectiveness of health care moving forward. Not only is the country in the middle of a stubborn recession many employees are stuck working overtime to ensure a smooth transition.

Another unintended consequence of Obamacare comes in the mailbox as families begin to open their health-care statements they are finding health insurance premiums are going up, not down as President Obama promised.

For more stories;

The Terminator rescinds support of Obamacare

The Obama Administration lost the only Republican governor who supported the Democrat health care reform bill; California’s Governor Arnold Schwarzenegger-R announced at his annual State of the State message he would no longer support the President’s bill to landmark health care reform.

In a stunning reversal, Schwarzenegger slammed the backroom meetings and sweetheart deals as a deal breaker for the constituents of California.

“Congress is about ready to put billions of dollars of responsibilities on Californians with the health care bill. While I enthusiastically supported health care reform; it is not reform to push more costs onto the states that are already struggling while other states are getting sweetheart deals,” he said.

“Health care reform, which started as noble and needed legislation, has become a trough of bribes, deals and loopholes,” the California governor said. “You’ve heard of the bridge to nowhere. This is health care to nowhere.”

Governor Schwarzenegger explained to excited Sacramento legislators the congressional delegation should vote against this health care bill because it would be a disaster for California. He went on to explain that if these representatives are bent on supporting health care it was their duty to go back to Washington D.C. and fight for the same deals the Cornhusker State received.

Senator Nelson “got the corn and we got the husk,” Schwarzenegger quipped.

In October President Obama touted the “unprecedented consensus that has come together” with the health care reform. Since then the numbers in support for the bill as well as President Obama have dropped like a rock.

The 2,000 plus-page bill has lost support from Americans who are more concerned with jobs, than health care. It didn’t help the administration that members of Congress didn’t bother to read the legislative monstrosity.

Opposition leaders point out that this is Obama’s signature legislation, yet it is being passed in the middle of the night behind closed doors without any Republican input.

The jig is up with the American people who realize you can’t cover 30 million new people without raising taxes, decreasing care or increasing the deficit.

It has been reported that the White House told Speaker of the House Nancy Pelosi (D- CA) to drop the opposition regarding the taxation of the “Cadillac plans” because the 40 percent tax increase was needed to help cover the uninsured. This amounts to another broken promise by the president to raise taxes on the middle class as many union middle-class employees get these types of plans as work incentives.

The pressure now turns to California lawmakers who either fight for Californians or sell them out.

“Now that Barbara Boxer’s home state governor has rescinded his support for the costly and contentious health care bill, will Senator Boxer do what’s right for her constituents, or will she continue to stand by a flawed bill that has been crafted behind closed doors and that will bankrupt California,” said Amber Wilkerson Marchand, NRSC Press Secretary. “To date, Boxer has been unwilling to explain how California can afford this bill because the reality is that it will be paid for on the backs of families, seniors, and small business owners in her state. Senator Boxer’s constituents are watching closely and are prepared to hold her accountable for this failed legislation in the November elections.”

This is certainly true when it comes to small business owners like Catherine Bragg a small business owner of Flourchylde Bakery. “As a small business owner I’ll be forced to pay a fee (they won’t call it a tax) but a fee in order to pay into a pool that they will gather for the next four years. And while they are gathering the money nobody will have insurance between now and then,” Bragg explains. “I have employees that I won’t be able to afford to buy insurance for now or then either.”

It sounds like the American people are listening and they will hold politicians accountable the only way they know how – in the voting booth.

For more stories;

Health care transparency takes a back seat at White House

C-SPAN is taking the White House to task by asking to be part of the backroom deals this week as the House and Senate health care reform bills are merged into one giant piece of legislation. C-SPAN wrote a letter to the Speaker of the House Nancy Pelosi, Senate Majority leader Harry Reid, House Minority Leader John Boehner and Senate Minority Leader Mitch McConnell.

According to the letter sent by C-SPAN to Congressional leaders, the network requested a more serious effort by members inside backroom meetings regarding health care so they can televise the last minute shenanigans for the American people.

“The C-SPAN networks will commit the necessary resources to covering all of these sessions ‘Live’ and in their entirety. We will also, as we willingly do each day, provide C-SPAN’s multi-camera coverage to any interested member of the Capitol Hill broadcast pool,” the letter read.

Those in the media, Congress as well as President Obama himself have talked about the importance of transparency during the process of health care debate. Stepping up on their intentions to remind the White House of their promises, C-SPAN said, “Now that the process moves to the critical stage of reconciliation between the Chambers, we respectfully request that you allow the public full access, through television, to legislation that will affect the lives of ever single American.”

Well over a year ago on the campaign trail, Obama told every reporter and camera who would listen that his administration would be completely transparent.

“The Freedom of Information Act (FOIA) should be administered with a clear presumption: In the face of doubt, openness prevails,” Obama told government offices on his first day as president. “The government should not keep information confidential merely because public officials might be embarrassed by disclosure, because errors and failures might be revealed, or because of speculative or abstract fears.”

Jeff Stachewicz, the founder of Washington-based FOIA Group Inc., which files hundreds of requests every month on behalf of companies, law firms and news organizations said; “This administration, when it wants something done, there are no excuses. You just don’t see a big movement toward transparency.”

A few weeks back the Associated Press wrote a scathing article regarding the lack of transparency the Obama White House has been providing. “Those with any sense of decency, any sense of moral rightness, any common sense, will see this administration for what it is…”

While transparency met with resistance on some important issues, the Obama Administration produced information only after watchdogs and journalists spent weeks or months pressing, in some cases it took lawsuits to recover documents.

The documents procured from the resistant government included what cars people were buying using the $3 billion “Cash for Clunkers” program (it turns out most trades involved trucks for trucks with only slightly better gas mileage); how many times airplanes have crashed into birds (a ton); if lobbyists and donors meet with the Obama White House (they do); rules for the interrogation of terror suspects (the FBI and CIA continue to disagree over what is permitted); and who was negotiating with Treasury Secretary Timothy Geithner (he has close relationships with a lot of Wall Street fat cats whose multibillion-dollar companies survived the economic crisis with his assistance).

If there is anything transparent about the new administration it is the lack of transparency.

For more stories;

The health care debate begins -Senator Nelson pleads his case

With their belly’s full of turkey and stuffing, Senators will now look to dissecting the 2,000 page health care bill. The gigantic legislation is waiting to ignite the passionate Liberals and inflame the Conservatives; the lively debate will surely include fireworks over hot-button issues like the public-option and abortion.

The ensuing discussion will not be pretty, the sausage making process will include various special interests groups looking to take their place in the bureaucratic regulation and average citizens will look to their representatives to make the right decisions regarding an industry that carves out a huge part of the economy and affects every American citizen who visits a health care facility.
Current poll numbers from Rasmussen show lagging support for the Congressional and Presidential health care bill. Only 36 percent favor the legislation as it is written, while a staggering 59 percent oppose the health care reform package offered by Democrats.

Senior citizens have been following this legislation closer than anyone and have written letters to their Senators in large numbers. The following is a letter written by Senator Ben Nelson-D of Nebraska.

From: []
Sent: Wednesday, November 25, 2009 3:44 PM
To: cd
Subject: Responding to your message

Dear Carol:

Thank you for contacting me regarding health care reform. I appreciate hearing from you on this critical issue.

As you may know, the greatest long-term economic concern our nation faces is out of control spending on health care. The Government Accountability Office said last year, “If there is one thing that could bankrupt America, its runaway healthcare costs.” Additionally, the Medicare program is predicted to become insolvent in 2017. We must not allow that to happen.

On November 21, 2009, the Senate held a vote, which I supported, on the motion to proceed to the bill currently before the Senate, the Patient Protection and Affordable Care Act. I would like to explain what a vote on the motion to proceed means because there has been a lot of commentary in the media, by special interest groups, and in Congress offering definitions. The motion to proceed is a vote to begin debate, consider amendments, and have an opportunity to make improvements. I anticipate weeks of debate and the consideration of dozens of amendments.

Some seek to define a vote for the motion to proceed as one in favor of or in opposition to the Senate bill; those who do so are either misinformed or intentionally trying to mislead people. Others define the vote as supporting or opposing President Obama and his agenda because they want him to either succeed or fail. And still others define it as the last chance to stop bad legislation because they have a political agenda.

All of this is more of the old Washington political gamesmanship with which Americans are fed up. Congress needs to be working together on a bipartisan basis for the good of the American people, and we need to take the time to craft the right health care bill. So, in reality, the meaning of the motion to proceed is very simple: It is a motion to commence debate, which will give the Senate the opportunity to make changes, and be pro-active on an issue affecting every American.

If the changes I believe must be made to this bill are not possible, I will oppose the second cloture motion to end debate (one which requires 60 votes) and ultimately oppose the final bill. But I will not slam the Senate doors in the face of fellow Nebraskans now. The Senate owes Americans a full and open debate to try to improve our health care system and make sure the changes are the right ones for Nebraskans.

I have posted links to the bill, as well as other resources pertaining to the current health care reform debate, on the Health Reform feature on my website at:

I hope you find this information useful.

As I continue to scrutinize this legislation and do all I can to make positive changes, I will work to ensure that the final plan provides Americans with reliable and secure health care at all stages of their lives. The final health plan should reduce costs, extend the solvency of Medicare and be one which stresses prevention and wellness and improves quality in the delivery of health care services, while not raising taxes, increasing the deficit, rationing care, or funding abortions. These are some of the basic principles which will remain my guides as Congress works its way through this difficult issue.

I am truly thankful that so many Nebraskans such as yourself have shared their opinions and ideas with me on this crucial matter. Rest assured I will keep them in mind as Congress needs the input of all Americans to solve such an important issue.

Ben Nelson
U.S. Senator

Carol’s reply:

Dear Mr. Nelson,

This “health care reform” bill has nothing to do with health care – and everything to do with the total control of citizens of this once-great Constitutional Republic. No where in the Constitution can you find justification for any of the provisions of this bill.

Nowhere in the Constitution (to which you took a Solemn Oath to protect) does it say a word about being forced to buy health insurance – or anything else mandated by government.

I strongly suggest that you read some information about the Constitution – including the Federalist Papers, which ‘explain’ the Constitution for those who might have a difficult time understanding what is said in that document which was the basis for this nation. The Constitution is the reason why this county grew in such a relatively short historical period and has grown into the strongest nation in the world – one to which millions of people in other nations look to for hope and freedom.

I think someone should have the moral courage to stand up one day in Congress and read the entire Constitution, even now, as amended over the years, that document is only 17 pages long.

You and your colleagues had better start planning now for a major shake up in Congress for the coming 2010 mid-term elections! We the people have awakened. To use what has become a seemingly trite saying, “You have awakened a Sleeping Giant”. There are more of us and our voices, when joined, are loud and strong. And we, sir, have the Constitution and God on our side.

Respectfully, Carol

Only time will tell if lawmakers in Washington will heed the American public’s strong objection to this legislation. With massive deficits, uncontrollable spending seems to be weighing on the minds of all citizens – employed or not.

For more stories;

Health care reform bought and paid for by the Obama Administration

The House barely passed the 2,000-page health care bill and the Senate is now wading through its own complex version, what many American’s don’t know is all the high-powered endorsements come with a price tag.

Much to the dismay of doctors across the country, the American Medical Association (AMA) supported the President’s health care reform package. The cost for this support came in the form of doctor reimbursements.

According to Dick Morris, doctors faced a 21 percent cut in their reimbursement for Medicare, but if the association backed Obama, the administration promised to make that cut go away. This amounts to Chicago strong-arm tactics, but it worked.

Second, the AARP jumped on board the Obama Health care express. Why? By in large seniors oppose the Medicare cuts and are fearful of the new plan. However, the White House stepped in again and offered a sweetheart deal to those in charge at AARP.

By eliminating Medicare Advantage, AARP can offer another program to seniors looking to bridge the gap in care. Medi-gap is a plan offered by AARP to seniors at a much higher premium and seniors who can afford the new higher premium will return to AARP once they are dropped by the government-backed Medicare Advantage.

The next industry to join the Obama express was the big pharmaceutical companies. The industry offered $80 billion cuts for the next 10 years and in return the White House promised to continue the ban on low-cost Canadian drugs coming into America. But that’s not all, the White House wanted free advertising supporting health care to encourage skeptical Americans reform was a good idea.

Finally, the White House needed to prod the insurance companies themselves.

This would prove to be easy; the promise of 40 million new customers was dangled in front of the greedy insurance companies. The government was not only going to give these new customers to the likes of Blue Cross, but the penalties and threat of jail time grabbed the insurers hook, line and sinker.

However, once the Senate lowered the penalties for non-insurers – the insurance companies went back to their capitalist ways and jumped ship, leaving the White House without the support from the insurance companies.

Another medical industry that decided to steer clear of Obamacare was the medical device companies. They chose to stand by the seniors and veterans who depend on them for items like, wheelchairs, pacemakers, arterial stints, prosthetic limbs, artificial knees and hips.

The medical device field was promptly hit by the Senate Finance Committee, who imposed a tax on the very devices many seniors and veterans feel are necessary for their quality of life.

It is crystal clear; nothing is free not even in health care reform.

For more stories;

La Raza looks to the Senate to claim their slice of health care

Millions of Americans including those in the country illegally are one step closer to getting health care benefits courtesy of the U.S. government and American taxpayer.

The Nation Council of La Raza (NCLR) is seeking their slice of the health care pie in the nation’s capitol. When it comes to health care reform the NCLR says, “The Senate needs to complete the task and build on the House effort.”

The largest national Latino civil rights and advocacy organization inside America, NCLR has declared their support of several key elements in the health care reform legislation Congress passed over weekend.

A major issue the group is standing behind is the “emphasis on preventative care.”

“The House bill would ensure that illnesses and diseases are detected at the earliest possible stages and it takes tremendous steps to improve health care delivery,” a NCLR statement explained.

In an effort to make up inequalities and health disparities of Latinos, the House bill will identify and eradicate unequal access.

Furthermore, NCLR says “roadblocks to insurance must be eliminated by removing excessive verification requirements that raise costs and increase barriers to health care.”

The group also maintains that the Senate must promote an equitable system for all, “restrictions on legal immigrants, access to federal aid such as Medicaid, Medicare and Children’s Health Insurance Program (CHIP) must be removed.”

Looking to the leadership of the Congressional Hispanic Caucus, NCLR applauded the caucus for fending off efforts by some lawmakers to strip the health care bill of unnecessary immigrant restrictions.

However, it is exactly measures like this make reform unpopular with most Americans.

“It is disappointing that despite assurances by President Obama and promises by Senate Democrats, the latest version of the House health care bill still contains loopholes that will allow illegal immigrants to benefit under the plan. When will House Democrats listen to the American people? Taxpayers do not want to subsidize people who are here illegally,” said Rep. Lamar Smith-R TX.

The Congressional Research Service (CRS) found that the House bill contains no restrictions on noncitizens, whether legally or illegally in the country to participate in taxpayer-funded health care.

“Even President Obama and Democratic Senator Baucus reject this radical move and oppose participation by illegal immigrants,” said Smith.

However, the NCLR doesn’t mention the fact that an overwhelming number of Americans are not happy about providing extra health care to those in the country illegally.

The latest Rasmussen Reports poll confirms that “83 percent of voters nationwide say that people should be required to prove they are a citizen of the United States before receiving government health care subsidies.”

Finally, something most Americans can agree on.

For more stories;

Pelosi’s health care bonanza includes jail time for those who don’t buy in

If the House health care bill squeaks through the Senate and is signed into law by the President, those failing to buy into the health insurance business will face steep fines and even jail time.

According to the nonpartisan Joint Committee on Taxation, the House version of this trillion dollar health-care boondoggle will pay a fine of 2.5 percent of their yearly salary or face up to five years in prison.

Pelosi’s massive health legislation describes the penalties in section 7203; it is a misdemeanor to willfully fail to pay for health insurance and it is punishable by a fine of up to $25, 000 and/or imprisonment of up to one year.

In section 7201 it will be a felony to willfully evade purchasing health insurance and it is punishable by five years in prison and/or $250,000 fine.

If American’s would like to pass on jail time, they will need to pony up some serious Benjamin’s by 2016. The Congressional Budget Office (CBO) estimated that a family of four would have to pay $15,000 per year.

The Obama vision of health care will cost low-income families, who make $45,000, approximately 8 percent of their salary. While those making upwards of $65,000 will have to pitch in approximately 12 percent of their earnings in order to pay their insurance tab.

To be fair, The Joint Committee on Taxation reported the Senate Finance Committee bill doesn’t include the same prison time provisions. It also points to the fact that it will be a tough road for both bills to reconcile in order to present unified health care legislation for the President’s to sign.

For more stories;

Blue Cross tells insurance agents- premiums will raise significantly if reform passes

In an effort to prepare Blue Cross health care insurance providers with ample time, the major insurance provider in California announced that premiums will rise significantly for individual and small businesses.

One Blue Cross agent wasn’t surprised by the inter-company memo. “This is the first step to eliminating my job,” said the agent who wished to remain unnamed. “Many of my customers will no longer be able to afford the increase and will opt out of Blue Cross.”

The memo suggested certain proposed reforms will result in lower-risk individuals who have lower premiums because they are healthily will face increased premium costs post health care reform.

“Additionally, other market reforms will generally increase premiums for everyone regardless of risk,” the Blue Cross memo explained.

Blue Cross says most insurance purchasers will see higher premium costs immediately after health care reform is passed, and it shows purchasers of average age and average health are expected to face higher premiums post-reform in any case.

For complete Blue Cross memo;

For more stories;

Pelosi care is more of the same, 2,000 pages of government takeover

The House leadership has put forth their massive 2,000 page health care bill, while there may have been minor tweaking; much of the bill remains the same.

“The plan unveiled today by House Democrats represents more of the same,” said Congressman Duncan Hunter-R CA. “Despite the need for responsible health care reform, this proposal once again amounts to nothing more than a massive government takeover of our health care system.”

There is no question that health care reform is needed and most Americans would like to see some changes, but this package is just too large for the taxpayers to understand.

“The status quo is insufficient, but what has been proposed today comprises a partisan overreach that will destroy the basic foundation of our health care system, eliminate jobs and drive up already record debt levels,” Hunter explained.

Hunter also expressed his disappointment that his amendment to protect small businesses, despite being accepted by the House Education and Labor Committee, was substantially weakened by Democratic leadership.

The legislation also contains the same loopholes in the prior House bill that will allow illegal immigrants to receive taxpayer-funded benefits.

“It is disappointing that despite assurances by President Obama and promises by Senate Democrats, the latest version of the House healthcare bill contains the same loopholes in previous legislation,” says Lamar Smith-D TX. “When will House Democrats listen to the American people? Taxpayers do not want to subsidize people who are here illegally.”

The House Democratic leadership hasn’t even included the verification mechanisms in their bill that the Senate Democrats added in order to curb illegal immigrant’s participation in taxpayer-funded health care.

For more stories;

Lieberman to filibuster health care reform with GOP

In an announcement after Senate Majority Leader Harry Reid-D proposed a public option plan, Lieberman said he would join the GOP in standing against the embattled Democratic Party health care reform efforts.

Lieberman, an Independent, caucuses with the Democrats while touting his fiscal responsibility to the American people. In a report from Politico, Lieberman said he would oppose any reform bill that included a public option even if the states can opt-out.

“We are trying to do too much at once,” Lieberman explained.

His reasoning behind splitting from the Democrat Party stems from the fact the country simply cannot afford another entitlement program where the taxpayers are on the hook.

With the defection of Lieberman, the Democrats are unable to beat a Republican filibuster. It looks like it will be back to the drawing board for the Obama Administration and their quest to change the health care delivery system.

For more stories;

%d bloggers like this: