Tag Archives: Patient Protection and Affordable Care Act

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Health Care:The GOP’s Health Care Flip Flop


In Oct. 2009, former Massachusetts Gov. Mitt Romney (R) urged Congress to use the insurance program he created in Massachusetts as a model for nationwide health reform. This proved to be excellent advice, since President Obama signed a law that is based on Romney’s health plan several months later. Nevertheless, Romney plans to deliver a “major policy speech” later today disawowing the very advice he gave Congress less than two years ago — laying out a plan to repeal “Obamacare” and replace it with an unambitious array of minor health reforms. Moreover, Romney’s speech comes just two days after a federal court of appeals heard the first appellate case challenging the ACA on the grounds that it is unconstitutional to require someone to either carry insurance or pay slightly more income taxes. Even though the the Constitution and Supreme Court precedent both unambiguously establish that the ACA is constitutional, the GOP has nearly unanimously endorsed the meritless constitutional attack on the ACA. It wasn’t always this way, however.

THE MANY FACES OF MITT ROMNEY: Romney’s support for a health plan that provides life-saving, affordable health care to nearly every Massachusetts resident has not endeared him to the GOP primary electorate, which is why he’s tried to distance himself from his own single most significant accomplishment. Earlier this year, Romney tried to excuse his decision to sign the prototype for the ACA by explaining that it was just fine for him to sign a state health care plan, but absolutely unacceptable for Obama to sign an almost identical federal health care plan. Needless to say, this kind of hairsplitting did nothing to rescue Romney’s incipient campaign. Sixty-one percent of Republicans in the crucial state of Iowa indicate that they will not vote for someone who “supported a bill at the state level mandating that voters have health insurance.” More importantly, Romney’s bizarre state/federal distinction is at odds with his longstanding position on federal health reform. As far back as 1994, Romney indicated that he would support a Republican health plan that included an insurance coverage mandate. Today’s speech is Romney’s second attempt to wash away his proudest achievement. In it, Romney will recycle a discredited McCain-Palin proposal that would cost 20 million people their employer provided health care, he will embrace the GOP’s plan to gut Medicaid, and he supports a completely unworkable scheme that will allow patients to wait until they get sick to buy insurance, draining all the money out of an insurance plan that they have not previously paid into and leaving nothing left for the rest of the plan’s consumers.

THE GOP’S INDIVIDUAL MANDATE: In 1991, four conservative health policy scholars proposed requiring all Americans to carry health insurance in an effort to “persuade President George H.W. Bush and his administration to adopt a universal health-care proposal that would keep the government from eventually taking over the sector.” Two years later, Sen. John Chafee (R-RI) and 21 mostly Republican co-sponsors introduced a bill which took up this proposal for an individual insurance mandate. Five senators who opposed the ACA — Robert Bennett (R-UT), Kit Bond (R-MO), Chuck Grassley (R-IA), Orrin Hatch (R-UT), and Richard Lugar (R-IN) — co-sponsored Chafee’s bill. In mid-2006, Romney became the first elected official to sign an individual insurance mandate into law. Two Republican Senators even voted for an insurance mandate before they voted against it. Sen. Olympia Snowe (R-ME) voted in support of a Senate Finance Committee proposal which included an insurance mandate, and Sen. Scott Brown (R-MA) voted in support of Romney’s health plan as a member of the state legislature. In other words, for all their strident rhetoric against insurance coverage requirements, the truth is this requirement was invented, nurtured and supported for nearly two decades by the GOP.

TEARING UP THE CONSITUTION: Hypocrisy, incoherence, and unworkable plans are the least of the GOP’s sins. They are prepared to tear up the Constitution as well. In a series of lawsuits challenging the ACA, Republicans claim, falsely, that Congress has never before passed a law that imposes a consequence on people who don’t buy a product, and that this somehow makes the ACA unconstitutional. Yet, as a panel of federal judges pointed out on Tuesday, this claim has no basis in the actual text of the Constitution. Rather, the Constitution provides that Congress may “regulate Commerce…among the several states,” and the very first Supreme Court decision interpreting this language made clear that this power is “plenary,” meaning that Congress may choose whatever means it wishes to regulate interstate marketplaces so long as it does not violate another textual provision of the Constitution. Thankfully, it is very unlikely that the Supreme Court will take the GOP up on its offer to replace the actual Constitution with a tenther manifesto, but the fact that one of the nation’s two great political parties believes that they can rewrite the Constitution shows nothing less than utter contempt for the nation’s founding document.

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what’s happening on the floor of Congress: -the Republican led House -the Senate


the Senate Convenes at 10:00amET May 3, 2011

Following any Leader remarks, there will be a period of morning business until 5:00 pm, with senators permitted to speak therein for up to 10 minutes each. The Republicans will control the first 30 minutes and the Majority will control the next 30 minutes.

The Senate will recess from 12:30 until 2:15 pm to allow for the weekly caucus meetings.

The filing deadline for all first degree amendments to S.493, the Small Business Jobs bill is at 2:30pm today. If your Senator has a germane first degree amendment and would like to preserve his or her right to offer, please send a signed copy of the amendment to the cloakroom prior to 2:30pm today. If you have already filed, there is no need to re-file.

At 2:15pm, the Senate will proceed to the consideration of S.Res.159, a resolution honoring the members of the military and intelligence community who carried out the mission that killed Osama bin Laden, and for other purposes, with up to 90 minutes of debate equally divided and controlled between the two Leaders or their designees. The final 10 minutes of debate will be reserved for the two Leaders, with the Republican Leader controlling five minutes and the Majority Leader controlling the final five minutes.

Upon the use or yielding back of time (at approximately 3:45pm), the Senate will proceed to a roll call vote on adoption of the resolution. Senator Reid encourages Senators to vote from their desks.

The Senate is currently in a period of morning business until 5:00pm for debate only with Senators permitted to speak for up to 10 minutes each.

There will be no further roll call votes today.

Votes:

63: Adoption of S.Res.159, honoring the members of the military and intelligence community who carried out the mission that killed Osama bin Laden, and for other purposes; Adopted: 97-0

Unanimous Consent:

S.Res.160, designating May 6, 2011, as “Military Spouse Appreciation Day”.

S.Res.161, designating May 2011 as “National Inventors Month”.

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CURRENT HOUSE FLOOR PROCEEDINGS

LEGISLATIVE DAY OF MAY 3, 2011

112TH CONGRESS – FIRST SESSION

6:45 P.M. – SPECIAL ORDER SPEECHES – The House has concluded all anticipated legislative business and has proceeded to Special Order speeches.

6:44 P.M. – ONE MINUTE SPEECHES – The House proceeded with further one minute speeches.

H.R. 1214: to repeal mandatory funding for school-based health center construction

6:43 P.M. – Committee of the Whole House on the state of the Union rises leaving H.R. 1214 as unfinished business.

On motion that the Committee rise Agreed to by voice vote.

Mr. Burgess moved that the Committee rise.

6:42 P.M. – POSTPONED PROCEEDINGS – At the conclusion of debate on the Pallone amendment No. 2, the Chair put the question on adoption of the amendment and by voice vote, announced that the ayes had prevailed. Mr. Pallone demanded a recorded vote and the Chair postponed further proceedings on the question of adoption of the amendment until a time to be announced.

6:39 P.M. – DEBATE – Pursuant to the provisions of H. Res. 236, the Committee of the Whole proceeded with debate on the Pallone amendment numbered 2 under the five-minute rule.

6:38 P.M. – Amendment offered by Mr. Pallone. An amendment numbered 2 printed in the Congressional Record to require a GAO study to determine school districts most in need of constructing or renovating school-based health centers.

6:37 P.M. – POSTPONED PROCEEDINGS – At the conclusion of debate on the Jackson Lee amendment No. 1, the Chair put the question on adoption of the amendment and by voice vote, announced that the ayes had prevailed. Ms. Jackson Lee demanded a recorded vote and the Chair postponed further proceedings on the question of adoption of the amendment until a time to be announced.

6:28 P.M. – DEBATE – Pursuant to the provisions of H.Res. 236, the Committee of the Whole proceeded with debate on the Jackson Lee (TX) amendment No.1 under the five-minute rule.

6:27 P.M. – Amendment offered by Ms. Jackson Lee (TX). An amendment numbered 1 printed in the Congressional Record to insert a new paragraph requiring the Secretary of Health and Human Services to post a notice of recission of unobligated funds made available by the Patient Protection and Affordable Care Act not later than 10 days after the date of enactment of this Act on the Department’s public website.

6:26 P.M. – The House resolved into Committee of the Whole House on the state of the Union for further consideration.

6:25 P.M. – Considered as unfinished business.

H.R. 1213: to repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges

6:21 P.M. – Motion to reconsider laid on the table Agreed to without objection.

On passage Passed by recorded vote: 238 – 183 (Roll no. 285).

6:14 P.M. – On motion to recommit with instructions Failed by recorded vote: 190 – 233 (Roll no. 284).

5:48 P.M. – DEBATE – The House proceeded with 10 minutes of debate on the motion to recommit with instructions. The instructions contained in the motion seek to require the bill to be reported back to the House with an amendment inserting a provision that would require health insurance issuers to disclose the extent to which coverage has been denied or premiums have been increased for an individual. A point of order was reserved, but was subsequently withdrawn.

5:47 P.M. – Mr. Boswell moved to recommit with instructions to Energy and Commerce. Mr. Boswell moves to recommit the bill H.R. 1213 to the Committee on Energy and Commerce with instructions to report the same to the House forthwith with the following amendment: � In section 1, add at the end the following: � (c) CANCER OR OTHER PREEXISTING CONDITION NON-DISCRIMINATION DISCLOSURE CONDITION. — ***

5:46 P.M. – The previous question was ordered pursuant to the rule.

The House rose from the Committee of the Whole House on the state of the Union to report H.R. 1213.

5:45 P.M. – On agreeing to the Ellison amendment Failed by recorded vote: 180 – 242 (Roll no. 283).

5:37 P.M. – On agreeing to the Waters amendment Failed by recorded vote: 178 – 242 (Roll no. 282).

5:30 P.M. – On agreeing to the Jackson Lee (TX) amendment Failed by recorded vote: 177 – 239 (Roll no. 281).

5:07 P.M. – UNFINISHED BUSINESS – The Chair announced that the unfinished business was on the question of adoption of amendments which had been debated earlier and on which further proceedings were postponed.

The House resolved into Committee of the Whole House on the state of the Union for further consideration.

Considered as unfinished business.

H.R. 1214: to repeal mandatory funding for school-based health center construction

5:06 P.M. – Committee of the Whole House on the state of the Union rises leaving H.R. 1214 as unfinished business.

On motion that the Committee rise Agreed to by voice vote.

5:05 P.M. – Mr. Burgess moved that the Committee rise.

3:55 P.M. – GENERAL DEBATE – The Committee of the Whole proceeded with one hour of general debate on H.R. 1214.

The Speaker designated the Honorable Steven C. LaTourette to act as Chairman of the Committee.

House resolved itself into the Committee of the Whole House on the state of the Union pursuant to H. Res. 236 and Rule XVIII.

3:54 P.M. – Rule provides for consideration of H.R. 1213 and H.R. 1214 with 1 hour of general debate for each bill. In both cases, the previous question shall be considered as ordered except motion to recommit with or without instructions. The measures will be considered read. In the case of H.R. 1213, specified amendments are in order. In the case of H.R. 1214, the resolution makes in order only those amendments that are received for printing in the portion of the Congressional Record designated for that purpose in clause 8 of rule XVIII in a daily issue dated May 2, 2011, and pro forma amendments for the purpose of debate.

Considered under the provisions of rule H. Res. 236.

H.R. 1213: to repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges

Committee of the Whole House on the state of the Union rises leaving H.R. 1213 as unfinished business.

On motion that the Committee now rise Agreed to by voice vote.

Mr. Burgess moved that the Committee now rise.

3:53 P.M. – On agreeing to the Welch amendment Failed by voice vote.

3:43 P.M. – DEBATE – Pursuant to the provisions of H. Res. 236, the Committee of the Whole proceeded with 10 minutes of debate on the Welch (VT) substitute amendment No. 5.

Amendment in the nature of a substitute offered by Mr. Welch.

A substitute amendment numbered 5 printed in House Report 112-70 to preserve funding for establishment of Health Benefit Exchanges for states that apply for early innovator grants before 2012. The funds used shall be subject to availability of appropriations up to $1.9 billion.

On agreeing to the Pallone amendment Failed by voice vote.

3:31 P.M. – DEBATE – Pursuant to the provisions of H. Res. 236, the Committee of the Whole proceeded with 10 minutes of debate on the Pallone amendment No. 4.

Amendment offered by Mr. Pallone.

An amendment numbered 4 printed in House Report 112-70 to require GAO to report on benefits of funding in setting up state run exchanges that reflect that state’s marketplace, as opposed to state exchanges established and operated by the federal government.

3:30 P.M. – POSTPONED PROCEEDINGS – At the conclusion of debate on the Ellison amendment no. 3, the Chair put the question on adoption of the amendment and by voice vote, announced that the noes had prevailed. Mr. Ellison demanded a recorded vote and the Chair postponed further proceedings on the question of adoption of the amendment until later in the legislative day.

3:19 P.M. – DEBATE – Pursuant to the provisions of H. Res. 236, the Committee of the Whole proceeded with 10 minutes of debate on the Ellison amendment No. 3.

Amendment offered by Mr. Ellison.

An amendment numbered 3 printed in House Report 112-70 to require the Secretary of Health and Human Services to submit to Congress a report on the impact of H.R. 1213 on the possible delays and potential enrollment reductions to Health Benefit Exchanges.

POSTPONED PROCEEDINGS – At the conclusion of debate on the Waters amendment no. 2, the Chair put the question on adoption of the amendment and by voice vote, announced that the noes had prevailed. Mrs. Waters demanded a recorded vote and the Chair postponed further proceedings on the question of adoption of the amendment until later in the legislative day.

3:12 P.M. – DEBATE – Pursuant to the provisions of H. Res. 236, the Committee of the Whole proceeded with 10 minutes of debate on the Waters amendment No. 2.

Amendment offered by Ms. Waters.

An amendment numbered 2 printed in House Report 112-70 to require, within 6 months after enactment, the Secretary of Health and Human Services to submit to Congress a report on the extent to which states are expected to have difficulties establishing Health Benefit Exchanges without the federal assistance repealed and rescinded under this bill.

3:11 P.M. – POSTPONED PROCEEDINGS – At the conclusion of debate on the Jackson Lee (TX) amendment no. 1, the Chair put the question on adoption of the amendment and by voice vote, announced that the noes had prevailed. Mrs. Jackson Lee (TX) demanded a recorded vote and the Chair postponed further proceedings on the question of adoption of the amendment until later in the legislative day.

3:00 P.M. – Amendment offered by Ms. Jackson Lee (TX). An amendment numbered 1 printed in House Report 112-70 to require the Secretary of Health and Human Services to post notice of rescission of funds and the amount rescinded on the public website of the Department of Health and Human Services.

DEBATE – Pursuant to the provisions of H. Res. 236, the Committee of the Whole proceeded with 10 minutes of debate on the Jackson Lee (TX) amendment No. 1.

1:49 P.M. – GENERAL DEBATE – The Committee of the Whole proceeded with one hour of general debate on H.R. 1213.

The Speaker designated the Honorable Steven C. LaTourette to act as Chairman of the Committee.

House resolved itself into the Committee of the Whole House on the state of the Union pursuant to H. Res. 236 and Rule XVIII.

1:48 P.M. – Rule provides for consideration of H.R. 1213 and H.R. 1214 with 1 hour of general debate for each bill. In both cases, the previous question shall be considered as ordered except motion to recommit with or without instructions. The measures will be considered read. In the case of H.R. 1213, specified amendments are in order. In the case of H.R. 1214, the resolution makes in order only those amendments that are received for printing in the portion of the Congressional Record designated for that purpose in clause 8 of rule XVIII in a daily issue dated May 2, 2011, and pro forma amendments for the purpose of debate.

Considered under the provisions of rule H. Res. 236.

H.R. 1425: to reauthorize and improve the SBIR and STTR programs, and for other purposes

1:46 P.M. – RE-REFERRAL OF H.R. 1425 – Mr. Hall(TX) asked unanimous consent the H.R. 1425 be re-referred to the Committee on Small Business, and in addition, to the Committees on Science, Space, and Technology and Armed Services. Agreed to without objection.

H. Res. 236: providing for consideration of the bill ( H.R. 1213) to repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges, and providing for consideration of the bill ( H.R. 1214) to repeal mandatory funding for school-based health center construction

On agreeing to the resolution Agreed to by recorded vote: 237 – 185 (Roll no. 280).

Motion to reconsider laid on the table Agreed to without objection.

1:39 P.M. – On ordering the previous question Agreed to by the Yeas and Nays: 234 – 185 (Roll no. 279).

12:16 P.M. – DEBATE – The House proceeded with one hour of debate on H. Res. 236.

12:13 P.M. – Considered as privileged matter.

12:02 P.M. – ONE MINUTE SPEECHES – The House proceeded with one minute speeches which by direction of the Chair, would be limited to 15 per side of the aisle.

PLEDGE OF ALLEGIANCE – The Chair designated Mr. Payne to lead the Members in reciting the Pledge of Allegiance to the Flag.

12:01 P.M. – The Speaker announced approval of the Journal. Pursuant to clause 1, rule I, the Journal stands approved.

12:00 P.M. – Today’s prayer was offered by Reverend Dr. Alan Kieran, Office of the U.S. Senate Chaplain, Washington DC.

The House convened, returning from a recess continuing the legislative day of May 3.

10:43 A.M. – The Speaker announced that the House do now recess. The next meeting is scheduled for 12:00 P.M. today.

10:02 A.M. – MORNING-HOUR DEBATE – The House proceeded with Morning-Hour Debate. At the conclusion of Morning-Hour, the House will recess until 12:00 p.m. for the start of legislative business.

10:01 A.M. – The Speaker designated the Honorable Tom McClintock to act as Speaker pro tempore for today.

10:00 A.M. – The House convened, starting a new legislative day.

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Medicare:Broken Contract


For decades, Americans have counted on a basic promise: A secure retirement is the reward for a lifetime of labor. Yet last Friday, House Republicans voted almost unanimously to break one of America’s most sacred promises that the cost of health care will not bankrupt seniors and their families once they enter retirement. Less than one year after Republicans hurled misleading claims that the Affordable Care Act‘s provisions to make Medicare more efficient would somehow deprive seniors of care, the House GOP passed a budget that will phase out Medicare and leave seniors entirely at the mercy of the large health insurance companies (ironically, while still keeping many of the Medicare cuts they once criticized). And just one year after Republicans peppered the airwaves with claims that Democrats were ramming major changes to the health system through Congress by spending just one year debating health reform, the GOP-controlled House took only two weeks to debate and pass their plan to eliminate Medicare. If the Republican budget ever becomes law, it will shred America’s contract with seniors who worked every day of their lives knowing that Medicare would be there for them in their retirement.

THE END OF MEDICARE, PERIOD: The GOP budget does not “reform” Medicare. It does not provide seniors with the same coverage Members of Congress receive. And it does not end Medicare “as we know it.” The GOP budget ends Medicare, period. The centerpiece of the House Republicans’ plan is a proposal that repeals traditional Medicare and replaces it with a health insurance voucher that loses its value over time. Because the value of the Republicans’ privatized Medicare replacement does not keep up with the cost of health care, their plan will gradually phase out Medicare as its increasingly worthless vouchers will eventually only cover a very tiny fraction of the cost of a health insurance plan. Worse, as President Obama told the nation last week, the GOP budget immediately fritters away much of the savings from eliminating Medicare with hundreds of billions of dollars worth of tax cuts for the very wealthiest Americans. The rich get richer, and America’s seniors are tossed out into the cold.

THE PATH TO MEDICARE REPEAL: Although the GOP budget phases out Medicare gradually over many years, it will deal a body blow to America’s seniors the minute it goes into effect. The GOP plan eliminates traditional Medicare and forces seniors into the private insurance market. But health insurers have substantially higher administrative costs than traditional Medicare, and they lack Medicare’s ability to negotiate lower rates from doctors and hospitals. As a result, seniors will pay more for less as soon as the GOP plan becomes a reality. According to the CBO, total health care expenditures for a typical 65-year-old “would be almost 40 percent higher with private coverage under the GOP plan than they would be with a continuation of traditional Medicare” in the very first year that the GOP plan goes into effect. As a clear sign that the GOP understands that seniors will not stand for losing their access to traditional Medicare, Republicans claim that Americans over age 55 will not lose their access to the nation’s most successful health care program, but this claim is also misleading. The GOP’s plan will shunt younger, healthier seniors into privatized plans, leaving traditional Medicare with an ever diminishing pool of the very oldest beneficiaries, and stealing away Medicare’s power to drive a hard bargain with health providers. Moreover, it’s not even clear that many health insurance companies will even be willing to offer private plans to seniors, who represent the “oldest, sickest, and least profitable demographic.”

THE GOP’S WAR ON HEALTH CARE: Lest there be any doubt, the GOP plan to end Medicare is just one part of a full-scale assault on America’s health care safety net. The GOP budget does not simply kill Medicare, it guts Medicaid, forcing states to either cap enrollment, cut eligibility, slash benefits, lower payments to doctors or somehow dig up additional funds to pay for their newly starved health care system. This assault on Medicaid deals another body blow to seniors, as Medicaid pays for nearly half of all long term care costs in the United States. Nor is the GOP’s war on the health care safety net anything new. The GOP lined up in near-unanimous opposition to the landmark Affordable Care Act, and they just as resoundingly embraced the utterly meritless notion that health reform violates the Constitution. Many GOP lawmakers go even further, claiming that Medicare, Medicaid, SCHIP and any other federal health care programs are unconstitutional. And the GOP’s last campaign for the White House was built upon a plan to gut state laws protecting health insurance consumers and leave them to the mercy of the insurance industry. In other words, it’s clear that the Republican Party has wanted to dismantle the nation’s health care contract with all Americans for many years — they just finally got the votes to pass this radical agenda through the House.

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William, was born with a genetic disorder called tuberous sclerosis complex


I want to tell you about a family in Minnesota.

Justin and Kari live in Brooklyn Park, right outside of Minneapolis. They’re parents to three children. Their three-year-old, William, was born with a genetic disorder called tuberous sclerosis complex.

For the rest of his life, William will wrestle with tumors in his brain, his heart, his kidneys, his skin, and possibly other major organs. He must take medication to control seizures and faces the threat of kidney disease.

What Justin and Kari want for William is a future. And because of health reform, that’s what he’ll have.

Today, insurance companies are no longer able to discriminate against William because of the condition he’s dealt with since birth. Now, Justin and Kari know they’ll be able to get the kind of care that William needs — today and into the future.

Their story isn’t unique, but it’s one of many that need to be told. We all know people whose lives have been changed because of the Affordable Care Act, even if we don’t realize it. So we’ve found a way to show exactly how reform is working for all of us — for our parents, our siblings, our kids, ourselves.

Will you take a minute to take our Health Reform Checkup and let the people you love know how reform is working for them?    http://my.barackobama.com/Checkup5?email=lifestyle2000cc@yahoo.com&zip=98115

Before the Affordable Care Act, Justin and Kari weren’t sure about the future. They worried that they’d never be able to find coverage for William again if Justin lost his job. They worried about the life that William would lead — whether he’d ever be able to work or support a family.

Not anymore. William’s condition isn’t going away, but he’ll always be able to get care. The Affordable Care Act is one year old today, and it has already changed William’s life — and this country — for good.

Today, there are families who feel better about the future than they did a year ago. They’ve found some security, some relief. And these are people we know. They’re our neighbors, our colleagues, our friends, our families — the people next to us every day.

On the one-year anniversary of the Affordable Care Act, I think we have a duty to discuss how reform is already working.

Watch Justin and Kari tell their story, and take a moment to learn how health reform is changing the lives of those you know:

http://my.barackobama.com/Checkup

A year ago, I stood next to the President as he signed health reform into law — and we have you to thank for making that possible.

Yours,

Joe

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From Gallup.Com: One Year Later, Americans Split on Healthcare Law


One year after President Obama signed the Patient Protection and Affordable Care Act into law, Americans are divided on its passage, with 46% saying it was a good thing and 44% saying it was a bad thing. Most Americans are skeptical that the law will improve medical care in the U.S. or their own personal medical care.

Read more at www.GALLUP.com

http://www.gallup.com/poll/146729/One-Year-Later-Americans-Split-Healthcare-Law.aspx?utm_source=alert&utm_medium=email&utm_campaign=syndication&utm_content=morelink&utm_term=Healthcare