US Health Care Reform

Started by Netto Azure October 13th, 2009 11:27 AM
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Does the US Healthcare system need to be reformed?

Netto Azure

Kiel

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Currently the a stool in the Domestic policy of the Obama Administration, my favorite topic: Health Care reform, is being publicly debated throughout the United States.

Original thread: http://www.pokecommunity.com/showthread.php?t=189588

The Current Status of United States Healthcare Reform
(January 01, 2010)


US President Barack Obama says he wants to pass Healthcare reform by the 2010 State of the Union Address


Introduction
“To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.”

Summary:
The summary of the bill includes the following elements, among others:
  • prohibiting health insurers from refusing coverage based on patients' medical histories
  • prohibiting health insurers from charging different rates based on patients' medical histories or gender
  • repeal of insurance companies' exemption from anti-trust laws
  • establishing minimum standards for qualified health benefit plans
  • requiring most employers to provide coverage for their workers or pay a surtax on the worker's wages up to 8%
  • restrictions on abortion coverage in any insurance plans for which federal funds are used
  • an expansion of Medicaid to include more low-income Americans by increasing Medicaid eligibility limits to 150% of the Federal Poverty Level and by covering adults without dependents so as long as either or any segment doesn't fall under the narrow exceptions outlined by various clauses throughout the proposal.
  • a subsidy to low- and middle-income Americans to help buy insurance
  • a central health insurance exchange where the public can compare policies and rates
  • a government-run insurance plan (public option); according to some analyses, the plan would be prohibited from covering abortions
  • requiring most Americans to carry or obtain qualifying health insurance coverage or possibly face a surtax for non-compliance.
  • a 5.4% surtax on individuals whose adjusted gross income exceeds $500,000 ($1 million for married couples filing joint returns)
  • a 2.5% excise tax on medical devices
  • reductions in projected spending on Medicare of $400 billion over a ten-year period
  • inclusion of language originally proposed in the Tax Equity for Domestic Partner and Health Plan Beneficiaries Act
  • inclusion of language originally proposed in the Indian Health Care Improvement Act Amendments of 2009.
Status:

US House of Representatives: Affordable Health Care for America Act (H.R. 3962, introduced October 29, 2009, passed on November 7, 2009)

The United States House of Representatives has passed it's version of the bill by a vote of 220 Yay - 215 Nay.

The bill was supported by 219 Democrats and one Republican - Joseph Cao from New Orleans. Opposed were 176 Republicans and 39 Democrats.

Now the bill must be reconciled with the Senate Version in a Joint US House-Senate Conference Committee.

US House of Representatives (1st Vote): Bill Passed (220 Yay - 215 Nay)

Tri Committee:
House Energy and Commerce: Bill revised/Passed (31 Yes - 28 No)
House Ways and Means : Bill revised/Passed (23 Yes – 18 No)
House Education and Labor:Bill revised/Passed (26 Yes - 22 No)

US Senate: The Patient Protection and Affordable Care Act (H.R. 3590) is a bill passed by the United States Senate at 7:05am on December 24, 2009.

On December 21, the Senate voted to end the Republican filibuster and vote on their version of health care reform, by 60 to 40.

On Christmas Eve of 2009, the Senate arrived at 7am Eastern Time, the first time the Senate had met on Christmas Eve since 1895, and passed the bill to be compromised by both houses of Congress by a vote of 60-39, with only Jim Bunning (R-KY) failing to vote.

The bill will need to go to Conference where differences with the House version may be resolved. If the Joint Conference Committee is able resolve any differences between each chamber's passed version of comprehensive health care reform, the resulting Committee Report becomes the lead proposal and goes back to each chamber to be voted on by the full-body. The Committee Report, if passed, can then be presented to President Barack Obama for his signature into law or be vetoed back to Congress.

US Senate (1st Vote): Bill Passed (60 Yay - 39 Nay)

Senate Health, Education, Labor and Pensions (HELP) Committee: Bill revised/Passed (13 Yes – 10 No)
Senate Finance Committee: Bill revised/Passed (14 Yes - 9 No)

No Country for Sick Men: To judge the content of a nation's character, look no further than its health-care system.




United States - Private system
Private sector funded, with more than half from private sources. Private health insurance available through employer, government or private schemes.

15.3% of population (45.7 million people) do not have health insurance.

Federal government is largest healthcare insurer - involved in two main schemes, Medicaid and Medicare, each covering about 13% of population.

Medicaid - joint funded federal-state programme for certain low income and needy groups - eg children, disabled.

Medicare - for people 65 years old and above and some younger disabled people and those with permanent kidney failure undergoing dialysis or transplant.

Most doctors are in private practice and paid through combination of charges, discounted fees paid by private health plans, public programmes, and direct patient fees.

In-patient care is provided in public and private hospitals. Hospitals are paid through a combination of charges, per admission, and capitation.



UK - Universal, tax-funded system

Public sector funded by taxation and some national insurance contributions.


About 11% have private health insurance. Private GP services very small.
Healthcare free at point of delivery but charges for prescription drugs (except in Wales), ophthalmic services and dental services unless exempt.
Exemptions include children, elderly, and unemployed. About 85% of prescriptions are exempt.
Most walk-in care provided by GP practices but also some walk-in clinics and 24-hour NHS telephone helpline. Free ambulance service and access to accident and emergency. In patient care through GP referral and follow contractual arrangements between health authorities, Primary Care Trusts and the hospital.
Hospitals are semi-autonomous self-governing public trusts.

France - Social insurance system
All legal residents covered by public health insurance funded by compulsory social health insurance contributions from employers and employees with no option to opt out.
Most people have extra private insurance to cover areas that are not eligible for reimbursement by the public health insurance system and many make out of pocket payments to see a doctor.

Patients pay doctor's bills and are reimbursed by sickness insurance funds.
Government regulates contribution rates paid to sickness funds, sets global budgets and salaries for public hospitals.
In-patient care is provided in public and private hospitals (not-for-profit and for-profit). Doctors in public hospitals are salaried whilst those in private hospitals are paid on a fee-for-service basis. Some public hospital doctors are allowed to treat private patients in the hospital. A percentage of the private fee is payable to the hospital.
Most out-patient care is delivered by doctors, dentists and medical auxiliaries working in their own practices.

Singapore - Dual system
Dual system funded by private and public sectors. Public sector provides 80% of hospital care 20% primary care.

Financed by combination of taxes, employee medical benefits, compulsory savings in the form of Medisave, insurance and out-of-pocket payments.
Patients expected to pay part of their medical expenses and to pay more for higher level of service. Government subsidises basic healthcare.

Public sector health services cater for lower income groups who cannot afford private sector charges. In private hospitals and outpatient clinics, patients pay the amount charged by the hospitals and doctors on a fee-for-service basis.
Ok now, combine the bills and re-debate it. Senate passes one w/o public option. House Passes one with it.

Goes to conference, Obama swoops in to influence the final legislation.

Final Bill goes to both Houses, Rahm Emanuel pressures the Lib Dems to support it w/o public option, Senate votes through reconciliation (50+1 Majority) and the President signs it into law.

twocows

The not-so-black cat of ill omen

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Senate panel passes health bill




Healthcare and reform: Strong opinions in US


YAHOO~


Ok now, combine the bills and re-debate it. Senate passes one w/o public option. House Passes one with it.
Goes to conference, Obama swoops in to influence the final legislation.
Final Bill goes to both Houses, Rahm Emanuel pressures the Lib Dems to support it w/o public option, Senate votes through reconciliation (50+1 Majority) and the President signs it into law. :P

No longer 50-50, the momentum is there even if it is the bare-bones Massachusetts plan. :P

Shoot, it's past the 1 month mark. TT^TT

Do I have to make another thread for this? Or just re-title it as revived?
Yay, a bill without public option! Just what I always wanted! Now I'll be able to continue being ripped off by insurance companies! It's like my birthday, only in hell!
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Netto Azure

Kiel

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Yay, a bill without public option! Just what I always wanted! Now I'll be able to continue being ripped off by insurance companies! It's like my birthday, only in hell!
There are 4 other bills that contain a public option LOL.

Support the eventual House version and stem the money buffet AHIP is giving Congress. :P

Seriously, that's why I'm frustrated at this. But it's what were getting. =/

NarutoActor

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if its going to breakrupt our econmy no its not in direr need of fixing just tweeking govement oversight not gorverment take over
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Mario The World Champion

Tepig!

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If they have ANYTHING in there saying that people who don't get health insurance will be penalized, I'm moving to England.

They have that in place in Massachusetts. And I HATE IT! That's why I despise Mitt Romney so much.
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Esper

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if its going to breakrupt our econmy no its not in direr need of fixing just tweeking govement oversight not gorverment take over
Not sure if you're saying it will bankrupt the government or that it's bad only if it does bankrupt the government (and if it doesn't... it's okay?)

I for one am willing to pay more taxes to help fund this. It's not like I'd be paying more to the government than I would to insurers. Glad to see that stopping pre-existing conditions exclusions is almost the very top of the list. That's the kind of law that should be enshrined in the Constitution. Something like:

Spoiler:
"The right of citizens of the United States to have affordable health care shall not be denied or abridged by the United States or by any State on account of race, color, or pre-existing condition."

.Fenris

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Yay, a bill without public option! Just what I always wanted! Now I'll be able to continue being ripped off by insurance companies! It's like my birthday, only in hell!

Haha, my thoughts exactly...


C'mon people, talk to me. I don't bite... not hard, anyway...

twocows

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if its going to breakrupt our econmy no its not in direr need of fixing just tweeking govement oversight not gorverment take over
It won't bankrupt our economy any more than "socializing" law enforcement did when the country was made. Would you rather have police be owned by private corporations? Can you say "protection money?"

Haha, my thoughts exactly...
Cool, I got siggied. :3
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Netto Azure

Kiel

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If they have ANYTHING in there saying that people who don't get health insurance will be penalized, I'm moving to England.

They have that in place in Massachusetts. And I HATE IT! That's why I despise Mitt Romney so much.
Well that's why the insurance companies want to increase the penalties, to force people to buy from them, hence the need for the public option (As Massachusetts has shown us) to create true competition.

And the House bills don't have penalties I think. They just out and out tax those who make $2+ M. :S

if its going to breakrupt our econmy no its not in direr need of fixing just tweeking govement oversight not gorverment take over
To be frank it won't bankrupt us as much as letting things go on like this. AND THIS IS GOVERNMENT REGULATIONS, hence no more Pre-existing stuff, and arbitary caps on coverage/dropping your policy. It's not "a government takeover" as have been trumpeted multiple times. IT'S NOT SINGLE-PAYER. @[email protected]

NarutoActor

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I also have a problem with insuring illiagal imigrants if they illigal they shouldent be here and they shouldent have any perks
why should be reware the bad
and punsih the good(high taxes)
also I dont want to be find If I dont have heath covage
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.little monster

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If they have ANYTHING in there saying that people who don't get health insurance will be penalized, I'm moving to England.

They have that in place in Massachusetts. And I HATE IT! That's why I despise Mitt Romney so much.
I prefer the Canadian HCS over England's. Not much difference but enough to like one better than another.

...The entire point of this is for public option. Without public option there is no real point.

Well, let me rephrase. Not a big enough one to waste my time debating. What it is now, is still good and a step towards what we need. But frankly, we need more than that an everyone knows it. Except Republicans who don't know how to breathe.

Also, I am not saying all Republicans are idiots.

Netto Azure

Kiel

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I also have a problem with insuring illiagal imigrants if they illigal they shouldent be here and they shouldent have any perks
why should be reware the bad
and punsih the good(high taxes)
also I dont want to be find If I dont have heath covage
http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200:

SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS.
  • Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.
You need Health coverage, we don't want to be paying for your absurd emergency room costs. >.>
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I don't like the fact that our government is trying socialized medicine. It's not even that I prefer the way it is now, it's one of the signs of turning to a socialist government entirely. The USSR showed that socialism on such a scale does not work in the real world. One angry president later, the US may not exist anymore...

On a more focused point, whether or not it passes, there had better be a public option or I'll want to gtfo the country. Forcing something like this down the throats of everybody in the USA? Nooo thanks. Birthday in hell indeed.
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Esper

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I don't like the fact that our government is trying socialized medicine. It's not even that I prefer the way it is now, it's one of the signs of turning to a socialist government entirely. The USSR showed that socialism on such a scale does not work in the real world. One angry president later, the US may not exist anymore...
The USSR was communist (and we'll never be sure how long they would have lasted if the US hadn't bankrupted them with an arms race). Most of the developed world is already more socialized than the US will be if it gets this into law. The US is not getting anywhere near what the USSR was. That's just fearmongering.

22sa

ロミオとシンデレ �� �� �� �� �� �� �� ��

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Amazing, I don't even remember the last time I went to the doctor for some care.

Why are Americans willing to spend so much.

I don't like that summary, they need to leave private enterprises alone.

. きみさえ~ いれば

Darkfox1525

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i voted maybe so because i don't really care. i mean, one way or another, we're going to die, if its from the health care re-form or not. so why should i bother caring about something that might kill us or not, when i could be worrying about some more important to me? and before anyone says anything, this is my OPINION!
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Amazing, I don't even remember the last time I went to the doctor for some care.

Why are Americans willing to spend so much.

I don't like that summary, they need to leave private enterprises alone.
That's like telling the government to turn a blind eye to rape. Privatized insurance companies have taken the business of keeping us healthy and turning it into a business of making themselves rich, without regard for people's actual welfare. It isn't even so much an economical debate anymore so much as a moral one, how can we let so many people suffer because they cannot afford insurance in order to take themselves to the doctor? Dentist? Their kids to the ER?

It's just such a ridiculous situation. Luckily my family has no financial trouble, but I have plenty of friends who do not have health insurance and they have run into some real trouble. Business cannot come before the basic needs of humans. That is pure greed.

22sa

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That's like telling the government to turn a blind eye to rape. Privatized insurance companies have taken the business of keeping us healthy and turning it into a business of making themselves rich, without regard for people's actual welfare. It isn't even so much an economical debate anymore so much as a moral one, how can we let so many people suffer because they cannot afford insurance in order to take themselves to the doctor? Dentist? Their kids to the ER?

It's just such a ridiculous situation. Luckily my family has no financial trouble, but I have plenty of friends who do not have health insurance and they have run into some real trouble. Business cannot come before the basic needs of humans. That is pure greed.
I thought that summary was directed towards all employers?

I don't mind if the government is just bothering the Medical Insurance companies with this bill.

. きみさえ~ いれば

Netto Azure

Kiel

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i voted maybe so because i don't really care. i mean, one way or another, we're going to die, if its from the health care re-form or not. so why should i bother caring about something that might kill us or not, when i could be worrying about some more important to me? and before anyone says anything, this is my OPINION!
Well I just hope you have some way to pay when you get in an accident. =/

*Updated the Summary

Netto Azure

Kiel

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A bit late but still here:




Senate Democrats, bolstered by polls and party support, shape a provision that would let states opt out. Republicans criticize the idea.


Reporting from Washington - In a dramatic sign of Democrats' growing confidence that they have the votes to pass a far-reaching healthcare overhaul, Senate Majority Leader Harry Reid (D-Nev.) said Monday that the bill he intended to send to the Senate floor next month would include a "public option."



The provision would allow the federal government to create an insurance plan to be offered to Americans who do not get medical coverage through their employers -- with the proviso that states could opt out of the program.



"While the public option is not a silver bullet, I believe it's an important way to ensure competition and to level the playing field for patients with the insurance industry," Reid said during a Capitol news conference.



Reid's announcement reflected a sharp change in the political outlook for one of the most contentious elements in the healthcare debate.



Although passage of a healthcare bill that includes a so-called public option is virtually assured in the House, many Democrats were convinced the Senate would never approve a government-run plan. Instead, the Senate Finance Committee proposed the creation of state-level co-ops to compete with private insurers.



And some senators, most notably Maine Republican Olympia J. Snowe, favored adding a "trigger" to the public option -- letting a government-run plan be offered several years down the road only if private insurers failed to meet cost and coverage targets.



But bolstered by polls showing steady public support for the government option, Senate Democratic head-counters think they are within one or two votes of securing the 60 needed to cut off an expected Republican filibuster. At least 55% of Americans favor a government insurance plan, polls have consistently shown.



The possibility of such a plan getting through the Senate substantially increases the likelihood of final approval by Congress.



The opt-out provision falls short of liberals' hope for unconditional approval of a public plan, but it comes closer than the co-op or trigger mechanisms. For one thing, it would be national in scope and could be activated immediately. Also, by requiring states to take legislative action to exit the plan, it increases the burden for opponents.



Monday's announcement was cheered both by conservative Democrats and liberal grass-roots groups such as MoveOn.org's political action committee. "There's now real momentum toward meaningful healthcare reform," said MoveOn's executive director, Justin Ruben.



Senate Finance Committee Chairman Max Baucus (D-Mont.), a centrist whose healthcare bill did not include a public option, said in a statement that he would support "any provision, including a public option, that will ensure choice and competition and get the 60 votes needed to pass the Senate."



White House Press Secretary Robert Gibbs said that President Obama -- who has come under fire from some on the left for not pushing hard enough for a government plan -- also applauded Reid's move.



"As he said to Congress and the nation in September, he supports the public option because it has the potential to play an essential role in holding insurance companies accountable through choice and competition," Gibbs said.



Reid's decision also signaled that prospects for any Republican support for a healthcare overhaul were dimming even further.



Snowe, who has been the only Republican lawmaker to back the Democratic healthcare campaign, has been sharply critical of creating a national public option. And she said she was "deeply disappointed" by Reid's choice.



But the majority leader said he was still interested in working with Snowe and other Republicans. "We looked for Republicans on this," he said. "It's just a little hard to find them."



With a 60-40 voting majority, which includes two independents who caucus with Democrats, Reid has to hold all his members or pick up Republicans to head off a filibuster.



Several GOP lawmakers criticized Reid's proposal. "The so-called public option is nothing more than a Trojan horse that will ultimately result in government-run healthcare," said Sen. John Cornyn of Texas.



Republican critics were joined by the insurance industry, which for months has warned that a government competitor that pays providers less could force hospitals and others to charge commercial insurers more.



"A new government-run plan would underpay doctors and hospitals rather than driving real reforms that bring down costs and improve quality," said Karen Ignagni, president of America's Health Insurance Plans, the industry's Washington-based lobbying arm. "The American people want healthcare reform that will reduce costs, and this plan doesn't do that."



Under Reid's proposal, which mirrors a provision written by the Senate health committee, the national coverage program would be offered through a new insurance exchange that probably would be available initially to about 11 million people. Senior Democrats envision that the exchange would be open only to people who do not get coverage through their employers or who work for small companies that elect to enter the exchange.



Private insurers as well as the federal government would offer competing plans in this exchange, so only a fraction of those 11 million customers would choose the public option, according to estimates by the nonpartisan Congressional Budget Office.



To level competition, Reid's proposal would require the government plan to negotiate payments to providers, rather than rely on Medicare rates, which are typically lower than those used by private insurance companies.



Reid said Monday that states would have to choose to opt out of the public plan by 2014, a year after the government plan would come into being, according to bills pending in the House and Senate. The majority leader did not provide any detail about how states would go about doing that.



Reid and House Speaker Nancy Pelosi (D-San Francisco) are advancing separate healthcare bills, which would have to be reconciled later this year before final legislation could be sent to the White House for Obama's signature.



For now, House Democrats are poised to pass a bill that would create a nationwide government plan without any option for states not to offer the plan. Pelosi indicated Friday that the opt-out alternative could be included in a reconciled bill.



But House lawmakers still disagree over how much such a plan should pay doctors, hospitals and other medical providers. Liberals, including Pelosi, favor a proposal that would link those payments to the existing Medicare program. Proponents think such an arrangement would save money and help drive down costs.



Many conservative Democrats, particularly from rural areas where Medicare typically pays less, favor an approach like the Senate's in which the government would negotiate its rates with providers, as commercial insurers do.



Pelosi hopes to settle those differences in time to unveil a bill this week, her office said.
Well, well, isn't it ironic that the Senate Majority Leader from NEVADA is willing to gamble upon the Health Care reform bill? Not a surprise when he's under pressure for the US Primary next year. >.>



Still, there are 2 versions of the Public option:



1. The "Robust" version which uses Medicare rates and the like, found in one of the House bills.



2. The "Haggling" version where the government has to negotiate rates from the start which as the Senate will adopt.



Whateves, I really was ready to accept a Senate bill w/o a PO and just simply pressure the House. But hey it's a boon to moderate Healthcare reform. :P

Pelosi unveils House health bill[/URL]


Nancy Pelosi was flanked by top Democrat lawmakers


The Speaker of the US House of Representatives, Nancy Pelosi, has unveiled a healthcare bill that would extend coverage to 36m more Americans. The top House Democrat said the legislation would provide affordable healthcare to 96% of all Americans.
It would also let the government sell insurance in competition with private companies and make insurers offer cover to those with pre-existing conditions.
The bill is the latest step in a long-running battle over healthcare reform.
President Barack Obama has made reform of the healthcare system a central plank of his domestic agenda.
Scaled-back
Speaking on the steps of the Capitol building in Washington DC, Ms Pelosi called the bill a "historic moment for our nation and families".
She said the legislation would also include a so-called "public option", referring to a controversial new government-run insurance option.


However, the public option she unveiled was a scaled-back version, falling short of the one liberal Democrats had demanded and which had thrown the bill into a logjam.
US President Barack Obama welcomed the legislation in a written statement, saying that "a public option that competes with private insurers is the best way to ensure choice and competition that are so badly needed in today's market".
The bill will now go before the House of Representatives, where it could be voted on as early as next week.
Once both the House and Senate have approved their own versions, a conference committee, made up of lawmakers from both houses, will convene to reconcile the two.
If both chambers then vote in favour of the reconciled version, it will be sent to Mr Obama for his approval, and become law.
Well they went with what I said~

Senate THEN House~

Netto Azure

Kiel

Age 30
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Seen November 17th, 2021
Posted September 29th, 2021
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15 Years
I don't like the house bill. Feels compromised
LOL. Didn't I already poured out my feelings over the blatant buying of Congress? XD