Tag Archives: Affordable Care Act

Republicans revamp U.S. health bill, boost benefits to older Americans

Speaker of the House Paul Ryan (R-WI) speaks to the media on Capitol Hill in Washington, U.S., March 16, 2017. REUTERS/Joshua Roberts

By Susan Cornwell and Valerie Volcovici

WASHINGTON (Reuters) – U.S. House Republicans are working on changes to their healthcare overhaul bill to provide more generous tax credits for older Americans and add a work requirement for the Medicaid program for the poor, House Speaker Paul Ryan said on Sunday.

Ryan said Republican leaders still planned to bring the healthcare bill to a vote on the House of Representatives floor on Thursday. Speaking on the “Fox News Sunday” television program, he said leaders were working to address concerns that had been raised by rank-and-file Republicans to the legislation.

Republicans remain deeply divided over the healthcare overhaul, which is President Donald Trump’s first major legislative initiative. It aims to fulfill his campaign pledge to repeal and replace the Affordable Care Act, popularly known as Obamacare, the signature healthcare program of his Democratic predecessor, Barack Obama.

Democrats say the Republican plan could throw millions off health insurance and hurt the elderly, poor and working families while giving tax cuts to the rich.

“We think we should be offering even more assistance than the bill currently does” for lower-income people age 50 to 64, Ryan, the top Republican in Congress, said of the tax credits for health insurance that are proposed in the legislation.

Ryan also said Republicans were working on changes that would allow federal block grants to states for Medicaid and permit states to impose a work requirement for able-bodied Medicaid recipients.

Trump told reporters in a brief conversation aboard Air Force One that he had meetings about healthcare reform in Florida at the weekend and that the effort to sell the proposal was going well.

He has been wooing lawmakers to vote for the bill and won the backing of a dozen conservative lawmakers on Friday after an Oval Office meeting in which the president endorsed a work requirement and block-grant option for Medicaid.

Trump is set to meet Ezekiel Emanuel, a health policy special adviser under Obama who helped shape the Affordable Care Acton, at the White House on Monday, along with Ryan and Health and Human Services Secretary Tom Price.

Block grants would give states a set amount of money to cover people on the Medicaid program and provide flexibility in spending decisions. However, there is no guarantee funding would keep up with future demands.

“TRYING TO FIX BILL”

While Ryan said he felt “very good” about the health bill’s prospects in the House, a leading conservative lawmaker, Representative Mark Meadows, told the C-Span “Newsmakers” program that there were currently 40 Republican “no” votes in the House. Republicans hold a majority in the chamber but cannot afford to have more than 21 defections for the measure to pass.

Meadows and two other Republican opponents of the bill, Senators Mike Lee of Utah and Ted Cruz of Texas, met at Trump’s Mar-a-Lago estate in Florida on Saturday “negotiating with the president’s team, trying to fix this bill,” Cruz told CBS’ “Face the Nation.”

North Carolina Republican Meadows said the changes being considered for the Medicaid program would not go far enough if they left it up to states to decide whether to put in place a work requirement.

Price acknowledged the tough negotiations, telling ABC’s “This Week”: “It’s a fine needle that needs to be thread, there’s no doubt about it.”

The healthcare bill would face significant challenges in the Senate even if it were to pass the House.

Senator Tom Cotton, a conservative Arkansas Republican, said the bill would not reduce premiums for people on the private insurance market. “It’s fixable, but it’s going to take a lot of work,” Cotton said on CNN’s “State of the Union.”

Moderate Republicans have also expressed concerns about the bill, and their worries are often not the same as that of conservatives.

Speaking on NBC’s “Meet the Press,” Republican Senator Susan Collins of Maine worried the bill would harm older Americans, and shift Medicaid costs to states – something critics say a block-grant approach would only make worse.

Collins said coverage issues must also be dealt with, citing a report from the Congressional Budget Office that said 14 million people would lose health coverage under the House bill over the next year and 24 million over the next decade.

Affordability has been one of the bigger concerns that insurers and hospital groups have raised about the legislation. To the extent that a change in tax credits makes healthcare more affordable for some people, insurers and hospitals could stand to benefit.

The BlueCross BlueShield Association emphasized the need for the replacement to be affordable when the draft of the healthcare bill was released earlier this month. The association represents BCBS insurers that cover the vast majority of the roughly 10 million people enrolled in 2017 Obamacare plans.

Republicans to press ahead with plan to dismantle Obamacare health plan

File photo: Information cards are stacked on a table during an Affordable Care Act outreach event for the Latino community in Los Angeles, California September 28, 2013. REUTERS/Jonathan Alcorn

WASHINGTON (Reuters) – U.S. President Donald Trump and his Republicans were set to press ahead in Congress on Thursday with a plan to dismantle Obamacare, negotiating changes as they go, with their bill slated to move to the budget committee on its way to a crucial vote soon by the full House of Representatives.

Conservatives have demanded a quicker end to the expansion of the Medicaid program put in place under the Affordable Care Act, the healthcare overhaul approved under former Democratic President Barack Obama.

They also want to add work requirements for some recipients of Medicaid, the government health insurance program for the poor.

The White House said it was discussing such tweaks with House Republican leaders, including Speaker Paul Ryan.

“There’s no perfect piece of legislation. There’s gonna be this framework that’s going to be added to or subtracted to during the process, and eventually it’s going to pass the House and it’s going to pass the Senate,” White House budget director Mick Mulvaney told Fox News in an interview on Thursday.

Mulvaney acknowledged the difficulty the draft legislation could face in the Senate, where Republicans hold a slimmer majority and several of them have already voiced doubts.

On Wednesday, Trump held a campaign-like rally in Tennessee as he tried to build momentum for his first legislative initiative to make good on his campaign promise to repeal and replace Obamacare.

Trump administration officials and House Republican leaders have not given a timetable for a vote on the legislation, although Ryan has said he wants to pass it by lawmakers’ mid-April recess.

Two House committees approved the bill’s provisions with no changes last week. On Thursday, the Budget Committee will try to unify the plan into a single bill for consideration on the House floor.

Signs have emerged that the White House was winning over reluctant conservatives who initially questioned the legislation on the grounds that it too closely resembled Obamacare. But Republican moderates have raised concerns that tax credits in the bill will not be enough to help people buy health insurance.

Senate Republicans have also voiced dissatisfaction with the bill.

“As written, the House bill would not pass the Senate. But I believe we can fix it,” Senator Ted Cruz said on Wednesday.

Republican Senator Rand Paul, a fierce critic of the House plan, also said the White House has been more open to negotiation than House leaders.

(Writing by Susan Heavey; Editing by Bernadette Baum)

Trump backs House healthcare plan, says open to negotiations

The federal government forms for applying for health coverage are seen at a rally held by supporters of the Affordable Care Act, widely referred to as "Obamacare", outside the Jackson-Hinds Comprehensive Health Center in Jackson, Mississippi, U.S. on October 4, 2013. REUTERS/Jonathan Bachman/File Photo

WASHINGTON (Reuters) – U.S. President Donald Trump on Tuesday backed a draft Republican proposal to dismantle Obamacare that was unveiled Monday, saying the proposed healthcare legislation was “out for review and negotiation.”

Trump, in a tweet on Tuesday morning, described the bill proposed by fellow Republicans in the House of Representatives as “Our wonderful new healthcare bill.”

The plan, released late on Monday, would undo Democratic President Barack Obama’s 2010 healthcare law, removing the penalty paid by Americans without insurance coverage and rolling back extra healthcare funding for the poor.

The plan was swiftly criticized by Democrats.

Although Obamacare has long been a common target of Republicans, the proposal also met with skepticism from some in the party who are concerned about the replacement plan’s tax credits for buying health insurance and changes to coverage under Medicaid, the government health insurance program for the poor.

The plan must pass both the Republican-led House of Representatives as well as the Senate, where it faces a higher bar for passage, making its future uncertain.

Trump was due to meet with the team of House lawmakers charged with tracking support for legislation later on Tuesday as lawmakers on two key House committees prepare to review the bill on Wednesday.

White House Office of Budget and Management Director Mick Mulvaney, speaking in a round of television interviews on Tuesday, said he expected the plan to pass the House before lawmakers leave for recess in mid-April.

Still, Obamacare remains popular with many Americans. Some 20 million previously uninsured Americans gained coverage under the law, although higher insurance premiums have angered some. Nearly half of those gained insurance under an expansion of Medicaid, which would end in 2020 under the Republicans’ new plan, then face funding caps.

Polls have shown most Americans want to maintain Medicaid’s expansion.

Some industry groups have also expressed concern that lawmakers are moving forward without knowing how much the new proposal will cost or how it will affect healthcare coverage. Mulvaney told CBS he expected the Congressional Budget Office’s review of the bill in a few days.

House Democratic leader Nancy Pelosi said on CBS program “This Morning” that the Republican plan would take millions of people off health insurance rolls. “Show us the numbers about what the impact is personally on people,” she said.

(Reporting by Susan Heavey and Doina Chiacu; Editing by Frances Kerry)

Trump gives nod to Republican tax-credit proposal on Obamacare

President Donald Trump delivers his first address to a joint session of Congress. REUTERS/Jim Lo Scalzo

By Yasmeen Abutaleb

WASHINGTON (Reuters) – U.S. President Donald Trump backed the use of tax credits to help people purchase health insurance in a speech to Congress on Tuesday, the first time he signaled support for a key component of House Republican proposals to replace Obamacare.

Republicans, who control the White House and Congress, are united in their opposition to former Democratic President Barack Obama’s signature 2010 healthcare law, but have so far failed to agree on the details of how to replace it.

“We should help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts,” Trump said. “But it must be the plan they want, not the plan forced on them by our government.”

Democrats are ardently opposed to tampering with Obamacare, which provided coverage to millions of previously uninsured people.

A draft Republican replacement for Obamacare would include an age-based monthly tax credit that Americans who do not get health insurance through their employer could use to buy coverage and take from job to job.

Some Republicans have voiced resistance to that plan.

The president’s comments were also a nod to health insurers – whom Trump met with on Monday – who say tax credits are necessary to keep people in the market.

“The fact that he used the word tax credits is a signal to congressional Republican ranks” that he supports their proposals, said Tom Miller, a resident fellow in health policy at the American Enterprise Institute think tank.

Trump also said Americans should be able to buy insurance across state lines, a proposal favored by health insurers because it would enable them to offer plans in states with fewer regulatory hurdles.

Trump said state governors should be given resources and flexibility on Medicaid, the government health insurance program for the poor, and ensure that “no one is left out.” That appeared to be an attempt to ease concerns from the more than 30 governors who expanded Medicaid coverage under Obamacare.

But Trump offered few details on how he would reconcile House Republican plans to unwind the expansion of Medicaid with promises to maintain coverage for those who gained health insurance under Obamacare.

He also reaffirmed that those with pre-existing conditions should have access to coverage but did not say how that would be accomplished.

(Editing by Nick Tattersall and Peter Cooney)

Trump meets insurers, promises catastrophic year for Obamacare

Health and Human Services Secretary Tom Price (C) and Aetna CEO Mark Bertolini (R) listen to U.S. President Donald Trump speak during a meeting with health insurance company CEOs at the White House in Washington, U.S.

WASHINGTON (Reuters) – President Donald Trump told several chief executives of large insurance companies on Monday that 2017 will be a “catastrophic” year for the Affordable Care Act as he seeks to make good on a campaign promise to repeal the measure.

The Republican president told the insurers they must all work together to save Americans from the law known as Obamacare and try to bring down health care prices. He said he hoped to work with Democrats on a health care plan to repeal the law, which provided coverage for millions of uninsured Americans.

(Reporting by Steve Holland; Writing by Doina Chiacu)

Overhaul of Medicaid expansion could cost states $32 billion: report

A woman picks up a leaflet at a health insurance enrollment event in Cudahy, California March 27, 2014. REUTERS/Lucy Nicholson

By Hilary Russ

NEW YORK (Reuters) – Proposals in Congress that would effectively end Medicaid expansion in 31 U.S. states would cost those states at least $32 billion altogether in 2019, according to a report released on Friday.

“Few, if any, states could absorb such new costs,” the Center on Budget and Policy Priorities, a Washington-based, left-leaning think tank, said in its report.

Republican President Donald Trump has pushed to fulfill a campaign promise to replace Obamacare, his Democratic predecessor’s signature healthcare plan, with the help of a Republican-controlled Congress.

More details of potential replacements by U.S. House Republicans for former President Barack Obama’s Affordable Care Act emerged on Friday, though they have yet to agree on a single detailed policy proposal to repeal and replace the healthcare law.

One scenario to phase out enhanced federal funding would convert the current system, in which states share the cost of Medicaid enrollees with the federal government, into fixed payments, or block grants, sent to the states.

But that would dramatically affect the 31 states and the District of Columbia that chose to expand Medicaid, the government health insurance program for low-income Americans, and collect extra dollars that came with expansion.

Those states would have to find the extra $32 billion themselves to maintain their expansions, the center said in its report.

The block grant conversion would “shrink federal Medicaid funding over time, result in even deeper funding cuts when needs increase, and ultimately place coverage for tens of millions more Americans at risk,” the center said in its report.

The reduced federal funding would cause the automatic end of the expansion in seven states. Other expansion states would “almost certainly drop or substantially scale back their expansions,” the report said.

Medicaid sits at the heart of the federal-state fiscal relationship. Over $330 billion in federal Medicaid dollars flowed to states in fiscal year 2016, accounting for more than half of all federal grants sent to state and local governments and the largest individual program, according to Standard & Poor’s.

(Reporting by Hilary Russ; Editing by Jonathan Oatis)

U.S. healthcare costs to escalate over next decade: government agency

doctor holds hand of patient

WASHINGTON (Reuters) – The cost of medical care in the United States is expected to grow at a faster clip over the next decade and overall health spending growth will outpace that of the gross domestic product, a U.S. government health agency said on Wednesday.

A report by the U.S. Centers for Medicare and Medicaid Services (CMS) cited the aging of the enormous baby boom generation and overall economic inflation as prime contributors to the projected increase in healthcare spending.

Overall healthcare spending will comprise 19.9 percent of the economy in 2025, up from 17.8 percent in 2015, the report forecast. The pace of growth in U.S. spending on health is expected to pick up in 2017, increasing 5.4 percent over 2016. That compares with an estimated 4.8 percent spending uptick in 2016. Spending for 2016 was estimated at $3.4 trillion.

When the final numbers are in, the growth in prescription drug spending for 2016 is expected to have slowed to 5 percent from 9 percent in 2015. However, CMS has forecast growth of 6.4 percent per year between 2017 and 2025, in part because of spending on expensive newer specialty drugs, such as for cancer and multiple sclerosis.

The projections for 2016 to 2025 were made assuming that the Affordable Care Act (ACA), former President Barack Obama’s signature healthcare law widely known as Obamacare, would remain intact. It does not take into account likely changes to the law.

The Republican-led Congress and President Donald Trump have vowed to repeal and replace the ACA, but a viable replacement plan has yet to emerge.

Trump signed an executive order on his first day in office last month to freeze regulations and enable government agencies to take other steps to weaken Obamacare.

The ACA expanded Medicaid, the government health insurance program for the poor, in more than 30 states and set up private healthcare exchanges that enabled previously uninsured people to buy health insurance. After high enrollment between 2014 and 2015, Medicaid and private health insurance spending were expected to have slowed in 2016.

But spending on Medicare, the government health insurance program for the elderly, is expected to grow between 2017 and 2025 as a larger elderly population requires more medical services.

The overall insured rate of the population is expected to reach 91.5 percent in 2025, up from 90.9 percent in 2015, the report said.

(Reporting By Yasmeen Abutaleb; Editing by Tom Brown)

With eye on Obamacare, Price takes helm as U.S. health secretary

Tom Price

By Susan Cornwell

WASHINGTON (Reuters) – Tom Price was sworn in as U.S. secretary of health on Friday, putting in place a determined opponent of Obamacare to help President Donald Trump fulfill his pledge to dismantle his predecessor’s law and reshape the country’s healthcare system.

As head of the Department of Health and Human Services (HHS) Price has the authority to rewrite rules implementing the 2010 Affordable Care Act, also known as Obamacare. He could move quickly to rework the regulations while waiting for Republicans in Congress to keep their pledge to scrap the law entirely.

The Republican president signed an order on Jan. 20, his first day in office, to freeze regulations and take other steps to weaken the law enacted by former Democratic President Barack Obama, a directive that will fall largely on Price. But Trump said in a recent Fox News interview that a replacement for the law may not come until next year.

Trump said on Friday the effort was a “difficult process” but could now get going with Price in place.

“Now we get down to the final strokes,” he told reporters at a separate news conference at the White House alongside visiting Japanese Prime Minister Shinzo Abe. He did not offer more details but said the country would end up with “tremendous healthcare at a lower price.”

Republicans, who have long viewed Obamacare as federal overreach and who have the majority in Congress, are trying to craft a replacement but have not agreed on one. Twenty million Americans gained health insurance under the law.

“Having Dr. Tom Price at the helm of HHS gives us a committed ally in our work to repeal and replace Obamacare,” said U.S. House of Representatives Speaker Paul Ryan, who has vowed to pass a new plan this year.

Price, a member of the House since 2005 who chaired the budget committee, offered legislation in 2015 to repeal Obamacare and replace it with age-adjusted tax credits for the purchase of health insurance.

While Price’s fellow Republicans have controlled the House since 2011, they did not advance his bill and it was not considered by the full chamber.

The Senate voted 52-47 earlier on Friday to approve Price, a former orthopedic surgeon, to oversee the HHS, which has an annual budget of more than $1 trillion.

Price’s nomination was dogged by questions about his trading in hundreds of thousands of dollars in health company stocks while working on healthcare legislation. Democrats accused him of making misleading statements. Price defended his actions.

Democrats also criticized Price for his opposition to Obamacare, his ideas about restructuring the Medicare program for the elderly and disabled, and his opposition to Planned Parenthood, an organization that provides abortions and other affordable healthcare and education services.

With Price confirmed, the Senate is expected to vote on Monday on Trump’s U.S. Treasury secretary designate, Steven Mnuchin.

(Additional reporting by Susan Heavey and Steve Holland in Washington, and Brendan O’Brien in Milwaukee; Editing by Bernadette Baum and Frances Kerry)

Medical students, faculty rally to try to save Obamacare

Medical students protesting for obamacare

By Bob Chiarito

CHICAGO (Reuters) – Hundreds of medical students and faculty members gathered at Northwestern University’s school of medicine in Chicago on Monday to voice their opposition to the dismantling of Obamacare.

The demonstration was part of a larger White Coats for Coverage effort organized by medical students across the country and came a day before the annual deadline to enroll in the Affordable Care Act (ACA), former President Barack Obama’s healthcare law.

“The ACA is not perfect, but pulling the rug out from under the feet of our most vulnerable patients is not the answer,” Dr. Bruce Henshaw, a faculty member at Northwestern’s Feinberg School of Medicine, told the group of around 600 people.

“We will not stand idly by as our patients lose their rights. We will not stop today. We will write and call our representatives to ensure this doesn’t happen.”

Students organized the event. Northwestern University spokeswoman Marla Paul said the school had no official position on the issue.

Photos on social media showed students rallying at numerous universities and cities.

“Proud to join my Yale colleagues to collectively say #protectourpatients. Improve the ACA, DON’T repeal it,” Ryan Murphy, who shared photos of a rally at Yale University, said on Twitter.

Republican President Donald Trump’s first executive order, signed hours after taking office, directed the federal government to scale back regulations, taxes and penalties under the ACA.

Republican Representative Tom Price, Trump’s nominee to lead the Department of Health and Human Services, has said an overhaul of Obamacare will initially focus on individual health plans sold through online exchanges and the Medicaid health insurance program for low-income Americans.

Trump has said he wants to keep some elements of the program, such as allowing young adults to be covered under their parents’ insurance. He favors plans that use health savings accounts and sale of insurance across state lines.

More than 8.8 million Americans were signed up for 2017 coverage under the ACA through HealthCare.gov as of Jan. 14, according to the site, up from around 8.7 million sign-ups as of Jan. 14 last year.

Arturo Salow, a second year student at Northwestern from Miami, Florida, urged people to sign up for ACA coverage before Tuesday’s deadline, saying more enrollees would make a rollback more challenging for Republicans.

“I’d advise any patient to sign up immediately,” Salow said. “If they are going to take away coverage, let’s make it as difficult as possible.”

(Editing by David Gregorio)

Trump tells Republican lawmakers: Enough talk. Time to deliver

Donald Trump speaking to Congress

By Richard Cowan and Susan Cornwell

PHILADELPHIA (Reuters) – President Donald Trump pushed Republican lawmakers on Thursday for swift action on a sweeping agenda including his planned U.S.-Mexican border wall, tax cuts and repealing the Obamacare law, despite tensions over timetables and priorities.

Congressional Republicans were in Philadelphia for a three-day retreat to hammer out a legislative agenda, with the party in control of the White House, Senate and House of Representatives for the first time in a decade.

“This Congress is going to be the busiest Congress we’ve had in decades, maybe ever,” Trump said in a speech to the lawmakers at a Philadelphia hotel.

“Enough ‘all talk, no action.’ We have to deliver,” Trump added.

But Trump did not hold an expected question-and-answer session with the lawmakers, and his speech veered into side issues such as predicting crowd size for an anti-abortion march in Washington, alleging American voting irregularities and touting winning Pennsylvania in the Nov. 8 election.

House of Representatives Speaker Paul Ryan, who initially hesitated in endorsing Trump last year and has criticized him on some issues, disputed the notion that congressional Republicans were not in synch with the New York businessman who was sworn in less than a week ago having never previously held public office.

“We are on the same page with the White House,” Ryan said during a joint news conference with Senate Majority Leader Mitch McConnell.

“This is going to be an unconventional presidency,” Ryan added. “I think you know this by now. … I think we’re going to see unconventional activities like tweets and things like that. I think that’s just something that we’re all going to have to get used to.”

Trump pressed the lawmakers for action on repealing and replacing Democratic former President Barack Obama’s Affordable Care Act, known as Obamacare, even as Republicans scramble to devise a replacement plan, and lowering taxes on “all American businesses” and the middle class.

For weeks, Republicans talked about formulating an agenda for the first 100 days of Trump’s presidency. In recent days, the talk has turned into a 200-day agenda for passing major legislation before the lawmakers’ August recess.

“It’s going to take more than simply 100 days,” Ryan said.

Ryan said that it is “our goal is to get these laws done in 2017,” without guaranteeing that a replacement for Obamacare and a tax reform bill would be enacted by the end of December.

McConnell said lawmakers will take up legislation to provide $12 billion to $15 billion to pay for Trump’s planned wall along the U.S.-Mexico border. Trump signed an executive order on Wednesday for the wall to proceed, part of a package of measures aimed at curbing illegal immigration, although the action has tested already frayed relations with Mexico.

House Republican leader Kevin McCarthy said the pace of legislative action may frustrate Trump.

“President Trump comes from a different world,” McCarthy told reporters. “Out in the business community, he likes things done fast, and he’s going to continue to push them.”

PROTESTS IN PHILADELPHIA

Thousands of anti-Trump protesters took to the streets in Philadelphia, a heavily Democratic bastion that is one of the cities that could be stripped of federal funds for protecting illegal immigrants under a Trump directive.

Marchers carried signs including, “Fascist Pig,” “Protect My Health Care,” “Immigration Makes America Great,” “Planet Over Profit” and “Impeach Trump.”

During his speech, Trump took time to explain his side of the story on Mexico’s president canceling a meeting next week because of Trump’s insistence that America’s southern neighbor eventually pay for the wall. Mexico has said it will not.

Trump said a tax reform bill “will reduce our trade deficits, increase American exports and will generate revenue from Mexico that will pay for the wall, if we decide to go that route.”

McConnell and Ryan did not say whether Congress would offset the wall’s cost by cutting other programs or simply add to huge budget deficits that Republicans have criticized for years.

Ryan and McConnell also indicated congressional Republicans do not plan to modify U.S. law banning torture even as Trump considers bringing back a CIA program for holding terrorism suspects in secret overseas “black site” prisons where interrogation techniques often condemned as torture were used.

“I think the director of the CIA (Mike Pompeo) has made it clear he’s going to follow the law. And I believe virtually all of my members are comfortable with the state of the law on that issue now,” McConnell said.

“Torture’s not legal,” Ryan said. “And we agree with it not being legal.

In a highly unusual move for a visiting foreign leader, British Prime Minister Theresa May, who will see Trump in Washington on Friday, addressed the retreat, calling herself a “fellow conservative who believes in the same principles that underpin the agenda of your party.”

She was loudly applauded for praising Trump’s victory.

“Because of what you have done together, because of that great victory you have won, America can be stronger, greater, and more confident in the years ahead,” May said.

(Additional reporting by David Morgan and Doina Chiacu; Writing by Will Dunham; Editing by Frances Kerry and Cynthia Osterman)