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Re: Apply for health insurance: Specific questions
Old 04-18-2007, 07:29 PM   #21
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Re: Apply for health insurance: Specific questions

Quote:
Originally Posted by kramer
Details are sketchy right now.

There is an article on this in today's San Diego Union Tribune:

http://www.signonsandiego.com/news/b...b18insure.html

The general outline pretty much has the support of both houses of the legislature and the governor.

How much warning would one receive if carriers drop out? I would hope at least 12 months. That would give me time to establish residency elsewhere. I am pretty mobile. I could be working overseas on a one year contract while this was going on, though.

Kramer
I'm not totally sure on this, but I think the warning has to be 6 months.

That article is unbelievable! They make it sound like the "underpayments from third-parties" are all from insurance carriers. Howcome they aren't telling the truth... that the underpayments are undercompensation from Medicare and Medicaid. They also don't say anything about how a good portion of those underpayments are made up for in the form of higher negotiated rates with insurance carriers. Hospitals aren't operating at that kind of loss. They are making up for it in the form of higher negotiated rates with private carriers, otherwise, they would be going out of business.

CA's plan is going to cost residents a lot more than they think it will. How much do you want to bet that once it goes into place, we'll all be hearing that tax payers are going to have to pay 2-3 times more than they thought they would in order to get everyone insured?
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Re: Apply for health insurance: Specific questions
Old 04-18-2007, 08:57 PM   #22
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Re: Apply for health insurance: Specific questions

I think we cannot draw too many conclusions as to what will happen in California with their healthcare proposals. However, if California requires all of its citizens to be insured, with subsidies for the poor, this will eliminate the adverse selection problem some other states have which has driven up costs and driven out insurers. Also, given the size of California the risks will be spread out over a large group of people.

I don't know details about the plans and the political process can ruin anything, so we will have to wait and see. But I would not assume insurers will flee California. There are a huge number of customers there.

I am glad to see states experiment. Alfter all, the feds won't.
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Re: Apply for health insurance: Specific questions
Old 04-18-2007, 10:24 PM   #23
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Re: Apply for health insurance: Specific questions

If CA can figure out how to convince none of the carriers to leave the market (otherwise rates will go up) and IF they can really FORCE everyone to purchase the insurance, even if they can't afford it, then the plan will be a success.

Note: There are a large percentage of people who CHOOSE not to purchase insurance because they'd rather have a big house or some other luxury that they are in debt to, and those people may not have the extra funds necessary to be FORCED to purchase insurance, because they are already strapped and in debt up to their eyeballs....so trying to enforce mandatory insurance on those people may be difficult!
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Re: Apply for health insurance: Specific questions
Old 04-18-2007, 10:29 PM   #24
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Re: Apply for health insurance: Specific questions

Quote:
Originally Posted by Martha
I think we cannot draw too many conclusions as to what will happen in California with their healthcare proposals.

I am glad to see states experiment. Alfter all, the feds won't.
Another repercussion to watch is the decreased economic burden of caring for the uninsured. The cost shifting which this has created in the hospital should have no logical reason to persist (think the $25 aspirin tablet). Yet such arrangements don't have a very effective reverse gear in my observation. Subsidies for emergency rooms and other providers of care for the indigent might decrease over time as well.

But the market place (especially in health care) is unfathomably complex and only time will tell. I'll be watching with interest. My guess is that we'll see some bluster and some carriers stomp off with their bat and ball as others seek out their redefined niche. Might take 5 years or more.

As for those who choose to go without insurance, I hope they have nearly unlimited assets, because some of them will get very sick every year and without major financial assets, the taxpayer will end up picking up the tab after their bankruptcy.
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Re: Apply for health insurance: Specific questions
Old 04-18-2007, 10:50 PM   #25
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Re: Apply for health insurance: Specific questions

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Originally Posted by Rich_in_Tampa
Another repercussion to watch is the decreased economic burden of caring for the uninsured. The cost shifting which this has created in the hospital should have no logical reason to persist (think the $25 aspirin tablet). Yet such arrangements don't have a very effective reverse gear in my observation. Subsidies for emergency rooms and other providers of care for the indigent might decrease over time as well.

But the market place (especially in health care) is unfathomably complex and only time will tell. I'll be watching with interest. My guess is that we'll see some bluster and some carriers stomp off with their bat and ball as others seek out their redefined niche. Might take 5 years or more.

As for those who choose to go without insurance, I hope they have nearly unlimited assets, because some of them will get very sick every year and without major financial assets, the taxpayer will end up picking up the tab after their bankruptcy.
If you look at the article that Kramer posted earlier, more than half of the "undercompensated care" comes from "underpayment by third parties". Since probably 95% of that is undercompensation from Medicare and Medicaid, and those programs are probably not going to change, there will still be plenty of cost-shifting.

You also have a large number of the uninsured, people using the ER, who are illegal aliens. Since they probably won't be affected by tax penalties for not carrying insurance, I don't see how you are going to force them to buy insurance. I mean, they won't be eligible for gov't assistance, right? Are they still going to be able to use the ER, even if they don't purchase insurance?

Uncompensated and undercompensated care resulting from Medicare, Medicaid and illegals probably makes up for about 50-70% of the total burden that hospitals have to deal with. How is CA's new program going to take care of that part of the problem? Even if you could take care of the other 30-40% of the problem by forcing people to be insured AND convince carriers not to leave the market, rates, IMO, aren't going to come down that much (maybe 15%).

For the CA "utopia" to work, you've got to have everyone insured. There's going to have to be a way to "grandfather" the mandates in, because I still think there is a good number of people who won't have the extra funds to just go out and buy insurance right away (these are going to be mostly people who could have afforded it, but who have chosen not to buy insurance and instead, use their extra money for something else.) If the plan is only going to provide gov't assistance to the working poor, there's still going to be a lot of people out there who could afford the health insurance, but don't have the money immediately available.
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Re: Apply for health insurance: Specific questions
Old 04-19-2007, 04:25 AM   #26
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Re: Apply for health insurance: Specific questions

Quote:
Originally Posted by kramer
I could be working overseas on a one year contract while this was going on, though.

Kramer
Kramer, did you ask the companies about coverage outside the USA? For me this will
be a key issue.
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Re: Apply for health insurance: Specific questions
Old 04-19-2007, 03:19 PM   #27
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Re: Apply for health insurance: Specific questions

Quote:
Originally Posted by teejayevans
Kramer, did you ask the companies about coverage outside the USA? For me this will
be a key issue.
Tom
Tom, So far I have seen nothing about foreign coverage and am assuming it is either not covered or minimally covered for a short period of time. In fact, I have not seen an actual policy -- only web site overviews, which is a little frustrating. I should probably call and ask that question.

But I figure I need a separate policy for foreign coverage anyway. I am probably willing to go bare during travel. I can afford to pay out of pocket in those situations -- my main concern is just proving to a hospital that I can pay, but a credit card goes a long way toward that (other travelers confirm this). If I am *living* in another country, then I will get separate coverage there.

I think my current Kaiser policy covers me for the first 30 days outside of the country. Also, they only cover you for six months outside of your primary residence area, supposedly (i.e., snowbirds within the US). My dad was traveling when he got sick in an emergency (he died). When Kaiser reimbursed the hospital, the hospital still required more from my mother as they paid their customary charges which were not enough. I think they wanted about six thousand more dollars.

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Re: Apply for health insurance: Specific questions
Old 04-21-2007, 04:52 AM   #28
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Re: Apply for health insurance: Specific questions

Quote:
Originally Posted by mykidslovedogs
If California goes "guaranteed issue" the likely outcome is that most of the the individual insurance carrier(s) will drop out of the state.
...I wonder how they are going to FORCE people to buy insurance
California has a large population and therefore a huge profit potential. I am sure someone will work something out... you are correct, several ins companies will exit the market. Plus prices will rise.

I believe if the ins must offer the policy, that all must participate... otherwise adverse selection will screw all of us that normally would pay.

It could be easily enforced. If you show up to the hospital, you better have insurance or your scr3wed. For those people that attempt to evade... you are a resident and qualify for the plan or not a resident and therfore do not.

If people choose to enter the plan... they could have a pre-existing condition clause. It could extend for up to 18-24 months. Plus on pre-existing conditions, they could jack the person's personal contribution needed for an elimination period.

There are a number of ways to make a workable and affordable plan. For people that are looking for the least expensive route, an HMO would probably work.

I hope Cali tries something! It seems that the state lead the way where the Fed sits back and waits.
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Re: Apply for health insurance: Specific questions
Old 04-21-2007, 02:24 PM   #29
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Re: Apply for health insurance: Specific questions

Quote:
Originally Posted by chinaco
It could be easily enforced. If you show up to the hospital, you better have insurance or your scr3wed. For those people that attempt to evade... you are a resident and qualify for the plan or not a resident and therfore do not.

If people choose to enter the plan... they could have a pre-existing condition clause. It could extend for up to 18-24 months. Plus on pre-existing conditions, they could jack the person's personal contribution needed for an elimination period.
Boy, if they made it so you were required to have insurance in order to receive treatment, then most everyone would have insurance in our current system, too! The problem is, that will never happen. Doctors take the oath that they will save the life, regardless... The tort sytem will ensure that that people will not be required to have insurance in order to get treatment.

NY has a pre-existing condition clause, too, but that didn't stop carriers from fleeing the market, nor did it help keep prices down (avg $700/mo for individual insurance (one person in NY)

Here are some USA uninsured stats:

43.6 million Americans, 15.2%, lack insurance, but about 1/3 qualify for gov't coverage through low-income children or medicaid and haven't signed up for it, and 1/3 are in households with more than $50/k yr (people who probably could afford it, but choose not to buy it). Therefore, only about 14.5% of the uninsured are uninsured because they truly can't afford it, and of those 74.7% will get insurance within the year. Only 2.5% will remain uninsured for more than 3 years. (Devon Herrick, 'Uninsured by Choice: Update' Brief Analysis no 460, National Center for Policy Analysis, Oct 2003)
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Re: Apply for health insurance: Specific questions
Old 04-24-2007, 05:17 PM   #30
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Re: Apply for health insurance: Specific questions

Thanks everyone for all your help on this thread (and others) to answer so many of my questions about health insurance. Especially to MKLD, who really helped me with a lot of specific issues.

Today I received confirmation that I got approved for health insurance with Aetna I only applied on Sunday evening (on-line), so that was pretty fast! I made sure to fill in every detail on the application so that they wouldn't have to ask me for more information. The application is so detailed that there is no way you can fill it out without complete health records so prepare accordingly!

My policy is $5K deductible, HSA-eligible, $10K deductible out-of-network, and no pesky limits on things like outpatient procedures and prescriptions. It also pays for most of a routine annual checkup (this is outside of the deductible). The policy is portable to other states where Aetna operates (and they operate in most of the places that I care about -- they are also expanding, partly thanks to the AARP deal announced last week).

Incredibly, the policy is only $85/month (I am 41 years old and single). The rate is locked for only six months, however. I have not had any major health issues in the last ten years (the look back period for most health issues on the Aetna application), thankfully. In the last two years, I had borderline high blood pressure which is better now, I had a benign skin tag removed, and I had a swollen elbow bursa that had to be drained (leaning on it too much at my desk at work).

In June I will place $2850 in an HSA, and this year that will yield a $712.50 tax savings. This will also effectively pay for my premiums for the rest of the year. In future years the tax savings will be less if I am not working but useful, nevertheless.

Wow, this is a major weight off as I begin semi-FIRE (today is only the 11th day!). I am very thankful. Now I just have to avoid getting sick before the coverage begins on May 15.

Kramer
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Re: Apply for health insurance: Specific questions
Old 04-24-2007, 05:58 PM   #31
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Re: Apply for health insurance: Specific questions

By the way, I was going through the age-based rates for Aetna policies. A rough approximation of rate increase for a middle aged male is 6%/year based on your age. The rates actually go up a little more slowly for lower deductible policies, since older folks are much more likely to exceed the deductible causing high deductible premiums to increase more quickly.

So if one assumes modest nominal health care services inflation of 6% (CPI plus 3.5%) and then age-based inflation of 6%, you end up with about 12% annual inflation. This means one should expect their premium costs to double every 6.1 years (actual out-of-pocket should decrease less rapidly for a fixed deductible). And "real" CPI-linked doubling (12%-2.5%) to happen about every 7.6 years. And this is just what one should expect if things are normal. It does not mean that costs are out of control, this is what one should expect and plan for.

This would mean that in 20 years in today's dollars (in my early 60's) I should expect to be paying $522/month for the same policy for which I just got approved. Someone age 41 should expect to pay double what a policy would cost today. I guess this is just part of the price for medical advances -- purchasing 1990 or 2001 health technology for your insurance plan is not really an option.

Kramer
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Re: Apply for health insurance: Specific questions
Old 04-24-2007, 05:59 PM   #32
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Re: Apply for health insurance: Specific questions

Congratulations, Kramer!

If it makes you feel any better, it has been my experience that most annual rate increases in the individual market have been much lower than your projection. Just off the top of my head, I would say average has been about 5% per year for most of my clients. It does get worse as you get older. Assurant Health is the absolute worst with rate increases. They take them every 9 months, plus when your age changes, while most other carriers only take increases once per year. That's why I really recommend taking advantage of the 3-year rate guarantee option if you apply with Assurant.

FYI Kramer, I have been writing a lot of business with Aetna lately. I think they are trying to "buy" business in order to build up their standing in the indiv. market, so don't be surprised if your first renewal takes a pretty big hit. Al lot of carriers come in too low when they first enter the market, and then take a huge rate bump at the first renewal. Today, Humana released their new product line, Portrait, Autograph and Monogram with lots of new options to choose from, including the option to raise your lifetime max, the option to purchase supplement accident coverage, and the option to reduce your Rx deductible. They now offer a $7500/100% deductible catastrophic plan (Monogram) with a prescription drug card that has a 0 deductible and $15.00 copay on their level one prescriptions (mostly generic). The Monogram plan is not HSA compatible because of the drug card, but it is a really good catastrophic option for those who don't really want an HSA, and the premiums are very low! In Colorado Springs, the premium is only $37.00/mo for a 37 year old male.
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Re: Apply for health insurance: Specific questions
Old 04-24-2007, 06:37 PM   #33
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Re: Apply for health insurance: Specific questions

MKLD, yep I am expecting a big first hit. My region (to which I will be moving) was lower priced compared to Aetna's prices in other regions by about 15-20% than anywhere else in the state. And it was that much cheaper than most other similar policies. So I figured they were buying some business.

I hope that you are right about the rate increases not being too bad in the long run. Basically, I am pretty good about planning. So naturally I am just trying to get a grasp on future expected expenses. I think I will be planning for my overall health expenses (dental, eye, insurance, deductible, prescriptions) to increase about 8% faster than inflation until I am 65.

An HSA will allow me to sock cash away to partially even out my increased health expenses as I get older. And doing these calculations gives me an idea of how prepared that I am.

RE: $37/year in Colorado
That is incredible!

Also, it is great to hear that more products are coming out to increase competition in this market. I know that even 18 to 24 months ago it was not easy to find a proper HSA-eligible policy -- now there are lots to choose from.

Kramer
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Re: Apply for health insurance: Specific questions
Old 04-24-2007, 07:40 PM   #34
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Re: Apply for health insurance: Specific questions

I don't want to rain on anyone's parade, but I do have a question. When you are talking about holding a policy for 20 years, what happens to the lifetime cap? Ten years ago, insurance companies were issuing policies with lifetime caps of $1-2 million. Now, I think many have lifetime caps of $5 million. Twenty years of 6% health care inflation, makes a $5 million cap equal to about $1.6 million in today's dollars. Sure, insurance companies may be issuing policies with $15 million caps then, but good luck switching if you have developed a "pre-existing" condition. Are any of these lifetime caps indexed to inflation?
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Re: Apply for health insurance: Specific questions
Old 04-24-2007, 07:54 PM   #35
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Re: Apply for health insurance: Specific questions

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I don't want to rain on anyone's parade, but I do have a question. When you are talking about holding a policy for 20 years, what happens to the lifetime cap? Ten years ago, insurance companies were issuing policies with lifetime caps of $1-2 million. Now, I think many have lifetime caps of $5 million. Twenty years of 6% health care inflation, makes a $5 million cap equal to about $1.6 million in today's dollars. Sure, insurance companies may be issuing policies with $15 million caps then, but good luck switching if you have developed a "pre-existing" condition. Are any of these lifetime caps indexed to inflation?
No, the cap is not indexed. It is not perfect but very, very good (and I would be comfortable with a lower cap). Also, one should look at the average expense-weighted inflation (say, the figure in 15 years -- that would be $2M in today's dollars), not just what the cap is worth in the final years before Medicare, since many of the earlier expenses before the cap are before 20 years of full inflation have set in. I definitely see the glass as half full here -- way, way more than half full.

If one "only" has an umbrella policy for twice their net worth, they are in mostly the same situation. We can't eliminate risk in life.

I am much, much, much more worried about getting sued for hitting or paralyzing someone with my vehicle (I cannot easily get umbrella insurance and my car insurance won't let me crank up the limits any higher).

Because I am a crazy researcher, I did look up the cost of organ transplants and they were way below these numbers. Most in the quarter to half million dollar ranges with varying ongoing medication costs.

A much bigger risk, IMO, is if you have ongoing medication costs or an expensive chronic condition and so you end up paying the full deductible each year in addition to the premiums. I have tried to budget for this possibility.

Kramer
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Re: Apply for health insurance: Specific questions
Old 04-24-2007, 08:00 PM   #36
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Re: Apply for health insurance: Specific questions

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If one "only" has an umbrella policy for twice their net worth, they are in mostly the same situation. We can't eliminate risk in life.
Poor example. You can always get a bigger umbrella policy. AFAIK, there are no pre-existing conditions involved here.

Also, any expenses that you have been re-imbursed for over the twenty year period count toward the lifetime cap.
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Re: Apply for health insurance: Specific questions
Old 04-24-2007, 08:09 PM   #37
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Re: Apply for health insurance: Specific questions

Quote:
Originally Posted by FIRE'd@51
Poor example. You can always get a bigger umbrella policy. AFAIK, there are no pre-existing conditions involved here.

Also, any expenses that you have been re-imbursed for over the twenty year period count toward the lifetime cap.
Yes, of course I understand that cap is cumulative. However, my point was that a rare, very expensive event is still a long, long ways below the present cap, even a maximally inflation-adjusted rare event.

As far as I know, your preexisting conditions do not affect the cap level on a policy. You either qualify for the policy or you don't. The policy that I got did not let you choose the cap. Also, I had heard that California had a minimum cap of around $5M, but then my research turned up policies that had lower caps than this. Based on my own research, I feel very, very comfortable with a $5M cap.

Kramer
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Re: Apply for health insurance: Specific questions
Old 04-24-2007, 08:12 PM   #38
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Re: Apply for health insurance: Specific questions

Also, if this is an area of concern for you, I did see some policies with $8M caps. I think Assurant Health offered one like that. The older you are and the better idea you have about your health condition, the less necessary a high cap is. It is more important the younger you are, both because you have less knowledge about your future health and because it gives inflation longer to compound.

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Re: Apply for health insurance: Specific questions
Old 04-24-2007, 08:16 PM   #39
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Re: Apply for health insurance: Specific questions

Quote:
Originally Posted by kramer

Because I am a crazy researcher, I did look up the cost of organ transplants and they were way below these numbers. Most in the quarter to half million dollar ranges with varying ongoing medication costs.
OK, but my late wife's final illness cost the insurance company well over $1MM over a 2 year period. That was 10 years ago ... so the point about caps is a good one.

However, you may find that you need to change policies anyway. Elsewhere, Martha has pointed out how insurance companies increase rates for sick people .... basically the trick is to increase rates dramatically for the whole group. Healthy people then switch to a less expensive policy, leaving the sick guys with higher rates. Then the process repeats.

And, by the way, you don't have to be all that sick. Slightly elevated BP will do it for sure. So will recreational Viagra

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Re: Apply for health insurance: Specific questions
Old 04-24-2007, 08:18 PM   #40
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Re: Apply for health insurance: Specific questions

Quote:
Originally Posted by kramer
As far as I know, your preexisting conditions do not affect the cap level on a policy. You either qualify for the policy or you don't. The policy that I got did not let you choose the cap. Also, I had heard that California had a minimum cap of around $5M, but then my research turned up policies that had lower caps than this. Based on my own research, I feel very, very comfortable with a $5M cap.
I don't mean to belabor the point. I'm sure the policy you are getting is "state of the art" for today. My point is, if you feel you need/want a bigger lifetime cap down the road, it will probably be impossible to switch to the new policy if you have developed a "pre-existing condition" in the interim. So you are basically "stuck" in the policy you purchase today unless you remain healthy. I wasn't even able to convert my $5K deductible, completely portable, "fee-for-service" policy to an HSA, because a switch to an HSA-qualifying policy required underwriting, which, unfortunately for me, I couldn't pass.
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