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Affiliated with the Rhode Island AFL-CIO “Fighting for the future of our members.” “NOW, more than ever!!!” Publication 2018 Issue 30 Published in house by the RI ARA

July 29, 2018 E-Newsletter

All Rights Reserved RI ARA 2018©

Trump Administration Drug Pricing Proposals May Actually Raise Out-of-Pocket Costs for People with Medicare Last week, the Medicare Rights Center submitted comments on a Request for Information (RFI) from the Department of Health and Human Services (HHS). This RFI asked for feedback on a host of potential changes touted as ways to lower prescription drug costs for people with Medicare and Medicaid. In May, the Trump Administration released a “blueprint” of various proposals in an attempt to bring down drug costs. Medicare Rights supports efforts to make prescription drugs more affordable. Many people with Medicare struggle to afford their medications, and Medicare

affordability is one of the top issues on our national helpline every year. Something must be done to ensure the millions of people with Medicare have access to needed prescriptions. We were disappointed, however, to discover that this expansive RFI covered dozens of topics, but failed to introduce ideas to address the fundamental issue of high prices set by drug manufacturers. Instead, most of the proposals in the RFI involve merely shifting costs from one party to another. We fear that the ultimate impact of this set of ideas would result in, at best, no direct improvement for beneficiaries. At worst, they could cause sharp increases in out-of-pocket costs.

Your new Medicare card is coming soon Keep an eye on your mailbox — we’re starting to mail new Medicare cards in your state! Now that card mailings have started in your state, it’ll take at least a month to finish. So you might get your new Medicare card at a different time than friends or neighbors in your area. One tip: if you have a account, you can sign in and see when your new card has been mailed. Don’t have a account yet? It’s easy to sign up — just

One proposal we can support would be the establishment of an out-of-pocket maximum for people with Medicare Part D. Part D should have a cap that reduces the incredible financial burden on those who have the highest drug costs. However, we have concerns that the Administration would only pursue such a cap if it could also pursue damaging changes that would increase the burden on people with Medicare such as extending the time those with high drug costs spend in the so-called “donut hole,” where their coverage is less robust. In addition, HHS proposes lessening the number of drugs people with Medicare would have access to and potentially

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sharply increasing the cost for some drugs by changing coverage rules. Such changes seem to be heading in exactly the wrong direction to ensure beneficiaries have access to needed medications. While there are some ideas in the RFI that Medicare Rights supports, the Administration should reconsider the problem of drug pricing and introduce a more robust set of proposals that would get at the fundamental issues of unaffordable medications. Simply shifting sky-high costs around and allowing people with Medicare to fall further and further behind is not a solution at all. Read Medicare Rights Comments on a Request for Information.

free, secure way for you to access your personal Medicarerelated information. Wondering what’s new? The new cards are still paper, but they look a little different. The biggest change is that your new card will have a new Medicare Number that’s unique to you, instead of a Social Security Number. This will help pr otect your identity. Though you’ll have a new card, rest assured your Medicare coverage and benefits will stay the same. Sincerely, The Medicare Team

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •

AFGE President Testifies About Harm to VA Staffers and Veterans from Recent Law American Federation of Government Employees President J. David Cox, Sr. testified before the House Committee on Veterans Affairs on Tuesday. Cox stated that the VA Accountability Act of 2017, a law that stripped civil service protections from many Department of Veterans Affairs employees, has had devastating consequences. He pointed out that the legislation has made federal workers more vulnerable and made it easier to fire whistleblowers who expose

problems within the agency. “The VA has tried to hide the true harm that Act has caused,” said Cox. “Despite the limited published data, the Act’s disproportionately large impact on VA’s low wage and veteran workforce is undeniable.” He expressed particular concern that older, retired, and disabled veterans are the most negatively impacted by the new law, especially because the standard of veterans’ care has

been hurt by the large number of vacancies caused by increased firings. Cox also informed the committee that studies have proven the VA provides a better standard of care than private companies, and suggested that addressing mismanagement is key. “The VA cannot fire its way to success,” Cox testified. Others witnesses expressed concern about legislation directed against a veteran-heavy federal workforce. Several

congressmen asserted that the Trump administration has not tolerated dissent well, and could be looking to prevent veterans and other workers from speaking out by firing them. “The Accountability Act could not have strayed farther from its intended purposes,” said Secretary-Treasurer Joseph Peters, Jr. “Letting management punish whistleblowers is a poor way to promote accountability, and diminishes quality of much needed care for our veterans.”

CMS Proposes Drug Pricing, Price Transparency Changes for Medicare CMS has proposed new policies to improve prescription drug affordability for beneficiaries and has released a request for information on price transparency regulations. CMS has proposed a ser ies of policy changes for Medicare that would promote prescription drug affordability within Medicare, and has also requested stakeholder comments about ways to improve price transparency for Medicare services. As part of changes to the 2019 Medicare Physician Fee

Schedule (PFS), CMS would adopt a new pricing model for Medicare Part B drugs so that the prices patients pay for prescription drugs accurately reflect the true cost. The new drug purchasing model aims to reduce out-of-pocket spending for senior citizens. The proposed rule cuts the price tag add-on to the wholesale acquisition cost (WAC) of Part B drugs from 6 percent to 3 percent. The agency is amending this policy to

reduce beneficiary cost sharing and high expenditures within Part B. In addition, CMS has issued a Request for Information (RFI) around strategies to promote price transparency about the cost of healthcare services for beneficiaries. “We are seeking information from the public regarding barriers preventing providers and suppliers from informing patients of their out-of-pocket costs; what changes are needed to support greater transparency

around patient obligations for their out of pocket costs; what can be done to better inform patients of these obligations; and what role providers of health care services and suppliers should play in this initiative,” CMS said. The agency is enthusiastic about the changes in the proposed rule and believes that the new policies would enhance patient experience with the Medicare program, while reducing program cost and administrative burden….Read More

Déjà Voodoo: Pharma’s Promises To Curb Drug Prices Have Been Heard Before Prescription drug prices were soaring. Angry policymakers swore they’d take action. Pharma giant Merck responded by promising to address the problem voluntarily, vowing to keep price increases under the overall rate of inflation. “We believe these moderate increases are a responsible approach, which will help to contain costs,” the Merck CEO said at the annual shareholders meeting. That assurance wasn’t made last week, when multiple drug

companies offered similar pledges amid similar criticism. It was nearly three decades ago, in 1990. Promises by the pharmaceutical industry to contain prices are a familiar — and fleeting — phenomenon, say analysts who have watched the unstoppable rise in drug costs over the years. History’s lesson, they say, is that price-restraint vows last only as long as it is politically necessary for companies to

make them. Recent pharma pledges are unlikely to be any different, they predict. “These things are always very temporary,” said Paul Ginsburg, director of the University of Southern California-Brookings Schaeffer Initiative for Health Policy. “I don’t think anyone considers this significant.” Last week, Swiss drugmaker Novartis said it would not raise prices on U.S. products between now and the end of the year.

Pfizer, Merck, Sanofi and Roche have all made similar announcements in the wake of repeated criticism from policymakers, especially President Donald Trump. The current assurances come as the administration floats proposals that could contain costs at the margins, such as promoting competition from generic drugs or changing Medicare drug-purchase policies, some analysts believe….Read More

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •

Medicare Rights Center Offers Beneficiary Perspective on Proposed Changes to Medicare Part D .Today, Joe Baker, president of the Medicare Rights Center, participated in a Capitol Hill briefing on Tackling Prescription Drug Prices: An Examination of Proposed Medicare Part D Reforms. Hosted by the National Coalition on Health Care, the goal of this educational briefing was to shed light on proposed reforms to Medicare Part D, identify the trade-offs involved, and explore the impacts on Medicare beneficiaries. Other panelists included Jack Hoadley, Research Professor Emeritus, Health Policy Institute, Georgetown University; and Len Nichols, Director, Center for Health Policy Research and Ethics, George Mason University. John Rother, President and CEO of the National Coalition on Health Care served as moderator. In his remarks, Mr. Baker

discussed the need to improve the affordability of prescription drugs for people with Medicare, citing data from the 2016 Medicare Rights Helpline Trends Report that show too many older adults and people with disabilities continue to have problems affording coverage and their prescription drugs. He also called on Congress to maintain existing policies that achieve this goal, in particular the provisions of the Bipartisan Budget Act of 2018 that will close the Medicare Part D donut hole one year early and provide beneficiaries in the coverage gap with a higher discount on their prescription drugs. This higher discount will allow beneficiaries who fall into the coverage gap to move through the donut hole more quickly,

lowering their out-ofpocket costs and making it easier for them to afford needed medication. On July 18, Medicare Rights sent a letter to congressional leaders, urging them to reject efforts that would roll back this progress or otherwise shift costs onto people with Medicare. Mr. Baker also examined several recent drug pricing proposals and the trade-offs associated with each. Echoing comments Medicare Rights submitted earlier this week in response to the Trump Administration’s Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs, he discussed how moving coverage of certain drugs from Medicare Part B to Part D, loosening Part D formulary standards, and requiring Part D plans to pass through rebates at the point of

sale could benefit some people with Medicare but disadvantage others. Medicare Rights appreciates the opportunity to share our experiences and perspective during today’s briefing. Looking ahead, we will continue to support efforts and advance policies to make prescription drugs more affordable that do not otherwise increase costs or reduce access to care for people with Medicare. Read our letter to Congress on the BBA of 2018’s Part D donut hole reforms. Read our comments in response to the Administration’s Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs. Read the 2016 Helpline Trends Report.

Medicare: Strong and Built to Last Medicare is an essential program that guarantees access to health care for older adults and people with disabilities. But there are a lot of misconceptions and misinformation about how the program functions, and that means too many decisions get made without adequate information. We want to be sure you have the information you need to understand how Medicare works and why it’s so important to so many people. Over the next few weeks, Medicare Rights will release a series of policy fact sheets on our Protect & Strengthen

including who uses it, why it’s important, and its financial footing. Future installments will include fact sheets on how Medicare and Medicaid work Medicare page that deal with needs and protect their welltogether, how proposals like various Medicare policy being. This includes people like raising the eligibility age or proposals, threats to Medicare Arthur, whose family was able allowing private contracting and other programs that help to buy a car once his would affect the Medicare older adults and people with grandmother was eligible for program, and how State Health disabilities, as well as Medicare, which meant he could Insurance Assistance Programs, underappreciated benefits of take on more responsibilities or SHIPs, help people with these programs. Included with and eventually go to college. Medicare better understand their many of the fact sheets are To launch our new series, we coverage options. stories from people who call our begin with “Medicare: Strong Visit www.medicarerights.o national helpline—those who and Built to Last.” This fact rg/protect to learn more. depend on the Medicare sheet gives some basic statistics program to help meet their about the Medicare program,

What’s Your Story How has Medicare, ACA help us protect and Medicaid or the Affordable strengthen the health care Care Act (ACA) helped you or programs we all rely on. your family? Your stories about the value Share Your Story today! of Medicare, Medicaid and the Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •

No Gaps In Understanding: Here’s Your Primer On Medigap Coverage Every year, older adults can opt out of a Medicare Advantage plan and opt in to original Medicare during open enrollment season, which begins on Oct. 15. But unexpected problems can arise with this change. Notably, seniors who want to return to original Medicare might not be able to purchase Medicare supplemental insurance, also known as Medigap coverage. Medigap covers some or all of the out-of-pocket costs associated with Medicare (deductibles, copayments and coinsurance), minimizing the financial risk to seniors. Under original Medicare, there is no limit to an individual’s out-ofpocket liability. (By contrast, Medicare Advantage plans limit out-of-pocket costs to a maximum $6,700 a year.) Yet private insurers are required to offer Medigap policies only when people first enroll in Medicare and under a few special circumstances.

Otherwise, insurers can refuse to cover people with preexisting conditions, such as diabetes and heart disease. “People think they can choose Medicare Advantage one year and traditional Medicare another year, and go back and forth without difficulty,” said Tricia Neuman, senior vice president at the Kaiser Family Foundation and a co-author of a new report on consumer protections in Medigap. “But in states that don’t guarantee supplemental coverage, this might not be a realistic option.” (Kaiser Health News is an editorially independent program of the foundation.) Only four states require insurers to issue Medicare supplemental policies to adults age 65 and older, regardless of their health status: Connecticut, Massachusetts, Maine and New

York. Dozens of other states have more limited protections. Craig Boyle, 69, learned about uncertainties surrounding Medigap the hard way three years ago, after he ran over a fire hose while biking to work in Denver and landed on his head. Rushed to the emergency room, Boyle was told that he’d broken a couple of vertebrae but had a much bigger problem: Scans revealed two tumors at the top of his spine, compressing his spinal cord. Surgery was in order, and doctor friends recommended two local surgeons with significant experience in this rare procedure. But neither worked with Kaiser Permanente of Colorado, the Medicare Advantage plan Boyle had chosen when he turned 65. “I have to say, I’m fairly knowledgeable about insurance,

but I had no idea that this was a possibility,” Boyle said. He ended up getting lucky: A Medicare Advantage plan offered by Aetna in Colorado had in its network the University of Colorado surgeon he wanted to see. Boyle joined that plan (Medicare Advantage plans are required to accept all applicants), had the procedure and experienced no significant complications afterward. Because your health needs can change after you first sign up for Medicare, it’s important to understand the ins and outs of supplemental coverage, said Fred Riccardi, director of programs and outreach at the Medicare Rights Center. Your local chapter of SHIP (which often stands for Senior Health Insurance Assistance Program) is a good place to start. Read More

It’s All Connected – ACA, Medicaid and Medicare are All Under Threat President Trump and Republican leaders in Congress have promised to repeal and “replace” the Affordable Care Act. They also plan to gut the Medicaid program by imposing block granting or per-capita caps. Speaker Ryan, HHS Secretary Price, and many others in Congress also want to further privatize Medicare by turning it into a voucher program. These are not isolated threats to be analyzed and defended against individually. Rather, these efforts comprise a collective threat to the health care and coverage of millions of Americans. Drew Altman of the Kaiser Family Foundation recently noted that, if carried through, this “health policy trifecta” would “fundamentally alter the direction of the federal role in health and core elements of the social contract” in a

manner that would services (although be “likely to shift some ACA costs to individuals “replacement” and states as well proposals quietly as reduce keep the Medicare consumer savings in order to protections–and offset the costs of result in a significant increase in killing the ACA). the number of uninsured.”  Gutting the Medicaid program through block Repeal of the Affordable Care Act (ACA) would granting or imposing pereliminate health insurance capita caps would likely coverage for over 20 million impact tens of millions of people. This would include low-income families roughly 10 million people through cuts to eligibility, who have Medicaid thanks to benefits and provider expanded coverage through payments. This would the ACA. A full repeal of include the roughly 10 million people who have the ACA would also reduce both Medicare and Medicaid the solvency of Medicare’s (known as “dual eligibles”) Part A trust fund, re-open for whom Medicaid can the Part D prescription cover Medicare premiums, drug “donut hole” and, among other things, cost-sharing and additional benefits. remove coverage for a number of preventive  Privatizing

Medicare through premium support/vouchers would replace Medicare’s promise of a defined benefit with a coupon to shop for coverage, launching the traditional Medicare program chosen by twothirds of beneficiaries into a death spiral. Read more about Medicare "Reform" and the value of the straditional Medicare program at http:// www.medicareadvocacy.or g/medicare-reform. The threats are real. And they are imminent, with some policymakers suggesting that they should all be dealt with at once. Help protect the social contract and stand up for our health care. For the latest updates on the Fight to Protect Medicare, ACA …..Read More

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •

RI ARA HealthLink Wellness News


Many Americans With Dementia Don't Know They Have It: Study Many older Americans with dementia don't know they have the disease, a new study indicates. A review of data from 585 Medicare recipients with probable dementia found nearly 6 out of 10 were either undiagnosed or unaware of their diagnosis. Those who had less than a high school education, who went to medical visits alone and who had fewer problems with daily tasks were more likely to be among the unaware ones. Hispanics were also more likely

to have undiagnosed dementia, according to the study. "There is a huge population out there living with dementia who don't know about it," said study lead author Dr. Halima Amjad. "The implications are potentially profound for health care planning and delivery, patient-physician communication and much more." Amjad is an assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore. "If dementia is less severe and people are better able to perform day-to-day tasks independently,

symptoms of cognitive loss are more likely masked, especially for patients who visit the doctor without a family member or friend who may be more aware of the patient's symptoms," she said in a university news release. About 5.7 million people in the United States have dementia, but only half of them have a formal doctor's diagnosis, according to the Alzheimer's Association. Early diagnosis is important for maintaining or improving health and for planning care, Amjad said. These findings could help doctors identify which patients may need more

careful screening, she added. "There are subsets of people doctors can focus on when implementing cognitive screening, such as minorities, those with lower levels of education and those who come in by themselves," Amjad said. The study was published in the July issue of the Journal of General Internal Medicine. More information The U.S. National Institute of Neurological Disorders and Stroke has more on dementia. SOURCE: Johns Hopkins Medicine, news release, July 17, 2018

Later-Life Fractures Up Risk of Early Death A broken bone in older age may increase your risk of death for the next 10 years, researchers say. "A fracture is the starting point for much wider health issues that persist long after the fracture has healed, and can ultimately result in earlier death," said study author Jacqueline Center, who's with the Garvan Institute of Medical Research in Sydney, Australia. The study included all people in Denmark over age 50 with a

fragility fracture in 2001. They were followed for up to a decade. A fall from a standing height or less that causes a broken bone is called a fragility fracture, according to the National Osteoporosis Foundation. In the year after breaking a hip, men had a 33 percent higher risk of death, and women, a 20 percent higher risk. In the year after femur or

pelvic fractures, the risk of death rose between 20 percent and 25 percent. There was a higher risk of death 10 years after a hip fracture, and about five years after non-hip fractures. The study was published July 19 in the Journal of Clinical Endocrinology & Metabolism. "Our findings emphasize just how crucial early intervention is," Center said in a journal news

release. "While intervention after the first fracture is critical, we also need to diagnose those at risk of breaking bones before these major health impacts have occurred," Center concluded. More information The U.S. National Institutes of Health offers fracture prevention tips. SOURCE: Journal of Clinical Endocrinology & Metabolism, news release, July 19, 2018

Why smells bring back such vivid memories A new study, published in the journal Nature Communications,shows that our brains integrate smell with information about space and time to form episodic memories. The findings may lead to better Alzheimer's "sniff tests." When the smell of Madeleines prompted Proust to write hundreds of pages worth of memories, little did he know that he was helping uncover a new area of neuroscientific study. Decades later, researchers

hypothesized that the exceptional ability that smells have to trigger memories — known as "the Proust effect" — is due to how close the olfactory processing system is to the memory hub in the brain. Indeed, the amygdala, the almond-shaped brain structure that processes sensory information, and the hippocampus, the area responsible for storing episodic

memories for later access, sit close together in the brain. Episodic memories are autobiographical memories of specific past events. In Proust's case, the smell of Madeleines triggered memories about his aunt's "old grey house upon the street, [...] and with the house the town, from morning to night and in all weathers, the square where I used to be sent before

lunch, the streets along which I used to run errands, the country roads we took when it was fine." It's no coincidence that Proust's memories were about space and time. New research shows that spatiotemporal information is integrated in a brain region known as the anterior olfactory nucleus (AON), which is implicated in Alzheimer's disease ...Read More

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •

Finding Long-Term Care for a Person with Alzheimer's Sometimes you can no longer care for a person with Alzheimer’s disease at home. The person may need around-the-clock care. Or, he or she may be incontinent, aggressive, or wander a lot. You may not be able to meet all of his or her needs at home anymore. When that happens, you may want to look for a long-term care facility for the person. You may feel guilty or upset about this decision, but moving the person to a facility may be the best thing to do. It will give you greater peace of mind knowing that the person is safe

and getting good care. Choosing the right place is a big decision. It’s hard to know where to start. The following overview of options, along with questions to ask and other resources, can help you get started.  Residential Care  Next Steps: Gathering Information  How to Make Moving Day Easier  Be an Advocate Click here for more information on the above.

Dementias Education and Referral (ADEAR) Center Eldercare Locator 1-800-438-4380 (toll-free) 1-800-677-1116 (toll-free) Centers for Medicare & The National Institute on Medicaid Services Aging’s ADEAR Center offers 1-800-633-4227 (toll-free) information and free print 1-877-486-2048 (TTY/toll-free) publications about Alzheimer’s disease and Joint Commission related dementias for families, 1-630-792-5800 caregivers, and health professionals. ADEAR Center National Center for staff answer telephone, email, Assisted Living and written requests and 1-202-842-4444 make referrals to local and national resources. Argentum National Clearinghouse for 1-703-894-1805 For More Information About Long Term Care Information Long-Term Care 1-202-619-0724 and Alzheimer's NIA Alzheimer’s and related

How Soon Is Soon Enough To Learn You Have Alzheimer’s? Jose Belardo of Lansing, Kan., spent most of his career in the U.S. Public Health Service. He worked on the front lines of disasters in such places as Haiti, Colombia, Nicaragua and the Dominican Republic. At home with his three kids and wife, Elaine, he’d always been unfailingly reliable, so when he forgot their wedding anniversary two years in a row, they both started to worry. “We recognized something wasn’t right and pretty much attributed it to being overworked and tired,” Elaine said. But the symptoms grew. Last year, when Jose was 50, he got

an evaluation at the Walter Reed National Military Medical Center that included a battery of cognitive tests and an amyloid PET scan of his brain. The scan detects betaamyloid plaques — sticky clumps of protein fragments that tend to build up particularly in the brains of people with Alzheimer’s disease (though some healthy older adults have these plaques, too). Jose said his diagnosis of earlyonset Alzheimer’s disease came as an inconvenient shock. Still,

he and his wife said they believe it is better to have a diagnosis than not. Jose said he is determined not to let the shock of the diagnosis distract him from living a full life. “I’ve got responsibilities, man. I can’t go away,” Jose said. “I’ve got kids. I’ve got graduations coming up. I’ve got all this stuff coming up. I’m not going to let Alzheimer’s take that away from me. That’s for sure.” The prospect of having Alzheimer’s can be so scary, and the current treatment

options so few, that many people dismiss memory problems or other symptoms rather than investigate them, say Alzheimer’s specialists; it’s estimated that as many as half of all cases aren’t diagnosed. But that may soon change. Researchers are making progress in measuring betaamyloid and other Alzheimer’s biomarkers in blood that might eventually be able to reliably, inexpensively and noninvasively identify the disease years before cognitive symptoms develop. ...Read More

How To Save A Choking Senator: Heimlich Heirs, Red Cross Disagree On Technique Sen. Claire McCaskill (DMo.) found herself in a dangerous situation last month when she started choking during a Democratic members’ luncheon. Sen. Joe Manchin (DW.Va.) swooped in, grabbed her around the middle and squeezed her, performing the Heimlich maneuver to dislodge the food. Manchin’s act likely saved McCaskill’s life. But in

Washington, where no topic seems immune to controversy, Manchin’s use of the well-known technique has resurfaced a decades-old debate about whether to slap or squeeze. Phil and Janet Heimlich aim to end that controversy. The son and daughter of Dr. Henry Heimlich, who developed the

abdominal thrusts to stop choking more than four decades ago and died in 2016, are launching a campaign called “Hug, Don’t Hit” to raise awareness on how to use the maneuver. The duo is trying to put pressure on the American Red Cross, which trains 9 million people a year in lifesaving

techniques, according to its website. The Red Cross is one of several groups recommending that aid to choking victims should start with five slaps to the back followed by the Heimlich maneuver. The Heimlichs say those back blows could harm the choking victim by moving the lodged object farther down the windpipe and may waste valuable time….Read More

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RI ARA July 29, 2018 E-Nersletter  

RI ARA July 29, 2018 E-Nersletter  

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