�鶹Ů��

Like other HealthCare.gov customers, immigrants are relieved that the government's health insurance website is working fairly well this year. They're baffled, though, by what looks like an obvious lapse: There is no clear way to upload a copy of their green card, the government identification document that shows they are legal U.S. residents and therefore entitled to benefits under President Barack Obama's health care law. (Alonso-Zaldivar, 11/19)

Sign-ups have generally gone more smoothly than last year for HealthCare.gov, although some consumers and insurance agents are having problems with the site that are reminiscent of last fall's open enrollment experiences. Numerous log-in and password failures were reported Monday, but federal officials call these cases the exception. (O'Donnell and Ungar, 11/18)

National health insurer Humana said Tuesday that policyholders who have bought its health plans on a federal or state insurance exchange or through its website can now pay their monthly premiums at any CVS Health store. The move can be seen as an attempt by insurers like Humana to more directly engage their growing customer base and improve consumers' adherence to their payment obligations, observers say. (Herman, 11/18)

Kentucky's online health insurance marketplace has run pretty smoothly since Obamacare open enrollment launched Saturday, even as many others have faltered. The federal HealthCare.gov site, which melted down last year during the first launch, is still suffering a spate of problems. Washington state, which like Kentucky developed its own exchange, had to take its site offline temporarily over the weekend because tax credits were being calculated inaccurately. Several angry California residents posted comments Tuesday on Covered California's Facebook page saying they were having problems with the site. And Maryland had to revamp its website completely after last year because its software didn't work. (Ungar and O'Donnell, 11/18)

Officials at the Maryland health exchange had a plan: Roll out their revamped online insurance marketplace slowly and have a tech team ready to jump on problems. But unlike last year, when the site crashed the first day, open enrollment came and there haven't been any problems yet. The website, created under the Affordable Care Act to provide coverage to those who do not get insurance through their employers, functioned as it should when the officials quietly opened it to the public Monday. (Cohn, 11/18)

State lawmakers on Tuesday voiced their continued frustration with the technical problems still afflicting the Washington Healthplanfinder insurance exchange. On Saturday, the first day of enrollment for the second round of insurance signups on the exchange, the site was live for only a couple of hours before a technical error was discovered and the exchange was taken offline for repairs. Meanwhile, first-round problems involving the transfer of payment information from the exchange to insurance companies have not been corrected, despite assurances they would be fixed by now. (Stiffler, 11/18)

The federal grant spigot that’s been around for several years to get states to set up Obamacare exchanges has been shut off, but before the last deadline Friday, more than half a dozen states rushed to get another drink. The grants have been instrumental in helping states establish their own systems, with a Congressional Research Service report showing $4.8 billion disbursed as of Oct. 14. (Pradhan, 11/18)

Illinois lawmakers may have one more chance to approve a state-run health insurance marketplace during the fall legislative session that starts Wednesday, and they are under pressure from an end-of-the-year deadline and a pending court decision. Supporters of creating a state-run website say the impending deadline to receive up to $300 million in federal funding plus a U.S. Supreme Court decision on tax credits due in the spring create urgency. Currently, Illinois residents purchase insurance on the national HealthCare.gov website. (Johnson, 11/18)

An Idaho work group has tweaked its recommendations on expanding Medicaid eligibility in a last-minute effort to make their plan more politically palatable to lawmakers. Work group facilitator Corey Surber says the 15-member group approved a hybrid model Friday. The group had finalized a proposal to Gov. C.L. "Butch" Otter back in August. However, lawmakers warned the proposal's blanketed support of Medicaid expansion would fail to even be considered when the Republican-controlled Legislature convenes in January. (Kruesi, 11/18)

Though Republican leaders in the Missouri General Assembly have already doused any hopes for Medicaid expansion next year, lobbyist and former U.S. Sen. Christopher "Kit" Bond is rounding up supporters to push for it. Bond teamed up with state Sen. Ryan Silvey, R-Kansas City, today to announce that Missouri's military veterans organizations support expanding and reforming the joint state and federal health care program for the poor. The uninsured population in Missouri includes more than 50,000 veterans and their family members, according to the statement released by Bond's lobbying firm, Kit Bond Strategies of Columbia, Mo. About half of the veterans and their family members could be eligible for Medicaid if it were expanded, based on a study by the Urban Institute. (Young, 11/18)

Any plan Gov. Pat McCrory’s administration presents for expanding Medicaid would have a tough time getting through the state legislature. A key House member said Tuesday it would probably be premature to consider expanding Medicaid next year with the future of the federal health care law uncertain. The Republican-controlled Congress is expected to make changes to the Affordable Care Act, under which states had the option to make more people eligible for the government health insurance program. The U.S. Supreme Court will hear a case about who is eligible for tax credits under the law. (Bonner, 11/18)

The impact of the Affordable Care Act is projected to raise the number of North Carolinians qualified for Medicaid by 107,000 to nearly 1.92 million residents, state health officials said Tuesday. The N.C. Department of Health and Human Services told legislators of the projected 5.9 percent increase for fiscal year 2014-15 at an oversight committee meeting. (Craver, 11/18)

President Barack Obama made a personal pitch for his health care act Tuesday, convening a call with what the White House says was a bipartisan group of 200 plus state and local elected officials. Most of them are working to enroll people in health plans under the Affordable Care Act and the White House says Obama noted that since last year “more than 10 million Americans have gained the financial security and peace of mind that comes with having health insurance.” (Clark, 11/18)

People who bought insurance through the marketplaces created last year by the health law and who then were offered medical coverage through an employer may feel as if they have more choices than ever before. But the arcane rules about federal subsidies for buying coverage could wind up costing them in the long run. Under the law, those offered employer-sponsored insurance that meets certain federal requirements are not eligible for subsidies that can be used in insurance marketplaces. Those who accept aid they’re not entitled to may wind up having to repay the government when they file their taxes in 2016. (Adams, 11/18)

Retired Dallas police Sgt. Tom Wafer recently received a call from a commander that “shocked the fool” out of him: The city can’t let him or any of his fellow retirees watch police surveillance camera feeds anymore when the year is over because of an obscure provision of the Affordable Care Act. City officials say they had to cut Wafer, 74, along with two dozen other retired officers because the health care law put them in a costly bind. (Hallman and Benning, 11/18)

House Republicans are hoping the third time is a charm in their effort to sue President Barack Obama over his signature health care law. After two Washington law firms backed out of earlier commitments to represent House Republicans in their legal challenge, House Speaker John Boehner hired Jonathan Turley on Tuesday. Turley is a George Washington professor who is an expert on constitutional law and well known to cable TV viewers as a legal analyst. (Walsh, 11/18)

GOP leaders have said the lawsuit is expected to focus on the White House’s decision last year to give employers a one-year reprieve on enforcing a requirement under the Affordable Care Act that they offer health coverage or pay a penalty. That requirement was originally delayed until 2015 and then subsequently revised to say that employers with between 50 and 99 full-time workers wouldn’t have to comply or pay a fee until 2016. Some rank-and-file lawmakers have suggested the lawsuit should be expanded to include any executive actions taken by Mr. Obama on immigration, something GOP leaders have previously contemplated. Mr. Boehner’s spokesman said there is no current plan to expand the lawsuit, but that it remains an option depending on what actions are taken by the White House. (Crittenden, 11/18)

Turley has testified on Capitol Hill in support of the lawsuit, which has been criticized as a nonstarter in parts of the legal community. He confirmed his contract with House Republicans on his personal blog. "It is a great honor to represent the House of Representatives," Turley wrote on Monday. (Viebeck, 11/18)

Turley, who said he voted for Obama in 2008 and supports national health care, is now the third lawyer that Speaker John Boehner has hired on this lawsuit since it was announced this summer. Turley's hiring has drawn some quick derision from the left. House Democratic Leader Nancy Pelosi during a press conference on Tuesday referred to Turley as a "TV lawyer," a dig on his frequent appearances on cable news networks ... For his part, Turley says that he's been alarmed by what he sees as a creeping power grab by the executive branch, regardless of which party is in the White House. (Milman, 11/19)

House Speaker John Boehner became eligible for Medicare when he turned 65 years old Monday, but he’s not planning to sign up. Instead, Boehner is going to keep his “expensive” Obamacare insurance plan. The Affordable Care Act required members of Congress to get off the federal government’s insurance plan and, in most cases, enroll in an Obamacare policy. When members turn 65, they become eligible for Medicare as well. (Haberkorn, 11/18)

The White House continued to distance itself from a controversial adviser Tuesday, suggesting that Jonathan Gruber had a narrow role focused on economic issues when he worked on the development of the Affordable Care Act. White House Press Secretary Josh Earnest said Mr. Gruber, who received about $400,000 from the Department of Health and Human Services for his work, advised the administration on the economics of health care – not on the logistics of getting the law passed. (McCain Nelson, 11/18)

Of all the taxes in ObamaCare, none is more onerous than the whopping 40 percent Cadillac tax on the more generous employer-provided health care plans, which often are union plans. The now-famous former outside adviser on ObamaCare, Jonathan Gruber of MIT, spoke about the Cadillac tax before an audience at the Pioneer Institute in 2011, saying, "It turns out politically, it's really hard to get rid of. And the only way we could get rid of it was first by mislabeling it, calling it a tax on insurance plans rather than a tax on people, when we all know it's a tax on people who hold those insurance plans." (Angle, 11/19)

At a town hall meeting where he campaigned for health care legislation in 2009, President Barack Obama pledged to voters that he did not want any tax on health insurance plans he perceived as wastefully generous to ever impact average Americans. But in recent comments by one of the men who helped draft the legislation, MIT economist Jonathan Gruber, that is not only precisely what will happen -- but that was the intention of the tax. (Tapper, 11/18)

Jonathan Gruber was “the man” behind Obamacare, according to a former adviser to President Barack Obama. “The problem is not that Gruber helped them put Obamacare together, because he was the man,” Steve Rattner, who worked as Obama’s lead adviser in 2009 for the Presidential Task Force on the Auto Industry, said Tuesday on MSNBC’s “Morning Joe.” “The problem is what he said in the last two weeks and how the White House has handled it,” Rattner added. (Breitman, 11/18)

A key Obamacare official engaged in a “cruel and uncaring march” to launch the federal health care website last year and wasn’t open to seeking a delay despite concerns, according to a newly revealed email from her former second-in-command. ... In the September 2013 email to Todd Park, the former Chief Technology Officer of the U.S., [Michelle Snyder, the then-chief technology officer at the Centers for Medicare and Medicaid Services,] characterized her then-boss, CMS Administrator Marilyn Tavenner, as a temper tantrum-throwing, demanding official who vowed the website would launch on time "no matter what." Snyder implied that Tavenner had threatened her job if Snyder was unable to deliver. (McNeal, 11/19)

Since the implementation of the Affordable Care Act, many small businesses have been intrigued by the possibility that they might be able to stop dealing with health insurance entirely and instead offer their employees a stipend to go buy insurance on the individual exchanges. But in a clarification issued in early November, the federal government appears to have taken a stand against that strategy. (Mandelbaum, 11/18)

Here’s some good news for boomers in need of health insurance: Premiums for the most popular plans available under the Affordable Care Act are slated to rise by a relatively modest 3% to 4% in 2015. Open enrollment runs from Nov. 15 through Feb. 15. The data comes from Avalere Health, a health-care consulting firm in Washington D.C., which priced the three cheapest policies in the 30-plus states where consumers purchase policies through federally run exchanges. (The data doesn’t include premium prices in the 13 states that run their own exchanges. Nor does it include data from Oregon, Nevada, and New Mexico, which run their own programs but use the federal government’s healthcare.gov site.) (Tergesen, 11/18)

You don’t get a pass this year on big health insurance decisions because you’re not shopping in an Affordable Care Act marketplace. Employer medical plans — where most working-age folks get coverage — are changing too. Rising costs, a looming tax on rich benefit packages and the idea that people should buy medical treatment the way they shop for cell phones have increased odds that workplace plans will be very different in 2015. (Hancock, 11/19).

About 15 years ago, the Cystic Fibrosis Foundation made what was considered a risky foray for a nonprofit organization into the world of business. It began giving money to a small biotechnology company to entice it to develop drugs for the deadly lung disease. But that funding, a total commitment of $150 million, has now paid off enormously. The foundation is to announce on Wednesday that it will receive $3.3 billion from selling the rights to the royalties to those drugs. That is 20 times the foundation’s budget last year. (Pollack, 11/19)

A controversial new rule for updating generic drug labeling that the FDA was expected to finalize next month will not be published until the fall of 2015, an agency spokeswoman says. The rule, which the FDA proposed last year, would allow generic drug makers to independently update safety warnings, something that only brand-name drug makers can currently do before receiving FDA permission. (Silverman, 11/18)

Citing “new, troubling allegations,” members of Minnesota’s congressional delegation are asking for an investigation of claims that the Hibbing VA clinic tampered with patient schedules. The schedules were altered, according to some former workers at the clinic, to make it appear that veterans were being seen on a more timely basis than was true. (Brunswick, 11/18)

The Veterans Affairs Department has begun implementing the second phase of its "choice card" program, mailing cards to veterans currently waiting more than 30 days for appointments with the VA. The mailing, announced by the VA Tuesday, is the second of three stages in providing the cards to more than 9 million enrollees. The choice card serves as a voucher that will permit eligible veterans to access federally-subsidized health care outside of the VA's health system. The first phase of the implementation took place on Nov. 5 when the VA began issuing cards to veterans who live at least 40 miles from a VA facility. (O'Brien, 11/18)

It cost more than $1 million to treat two Ebola patients at the Nebraska Medical Center, said Jeffrey Gold, chancellor of the hospital’s academic partner. That’s the direct cost of providing the care, Gold said Tuesday during a hearing before the House Energy and Commerce oversight and investigations subcommittee. It doesn’t include the opportunity cost of taking those 10 beds out of service, which he estimated was close to $148,000 so far. (Sun, 11/18)

A new poll shows Ebola is the one of the top health concerns of Americans, below access to health care and affordable health care. Robert Siegel talks to Frank Newport, editor in chief at Gallup. (11/18)

Bolstering a chief complaint about Obamacare coverage, California regulators said two major health insurers violated state law by overstating the number of doctors available to patients. More than 25 percent of physicians listed by Anthem Blue Cross and Blue Shield of California weren't taking Covered California patients or were no longer at the location listed by the companies, according to state reports released Tuesday. (Terhune, 11/18)

Two major health insurers selling policies on the Covered California insurance exchange violated state law over the last year when they listed names of doctors in online directories who were not part of their networks. (Seipel, 11/18)

California regulators determined that Anthem Blue Cross and Blue Shield of California violated state law and significantly exaggerated the number of doctors available and accepting patients under Covered California, the state’s year-old health insurance exchange. Representatives for the insurers questioned the methodology used in the probe and dismissed a pair of reports released Tuesday as flawed. (Cadelago, 11/18)

Starting this year, a new federal rule will require states to ensure that long-term care alternatives to nursing homes—such as assisted living facilities, continuing care retirement communities, group homes and adult day care—work with residents and their families to develop individual care plans specifying the services and setting each resident wants. The overarching goal is to create a “home-like” atmosphere, rather than an institutional one and to give residents choices about their care. While nearly everyone supports the concept, states, providers and even some consumer advocates are complaining that the rule could make it difficult for health care providers to fulfill increasing demand for long-term care outside of nursing homes. (Vestal, 11/18)

A new University of Tennessee report says the number of uninsured people in Tennessee has hit a 10-year low. Media cited the study in reporting that the number of people without health insurance shrunk about 25 percent in the first year of the health insurance marketplace, which was implemented under the federal Affordable Care Act. It was the biggest drop since the university began collecting data 20 years ago. (11/18)

Some states are making this process easier, passing laws that allow terminally ill patients access to drugs that have not been approved by the government. In Arizona, such a provision quietly won approval during the midterm elections. This type of measure – passed also in Colorado, Louisiana, Michigan and Missouri – is known as a "right to try" statute. It allows dying patients to request access to treatment that has not been approved by the Food and Drug Administration, the federal agency that reviews testing by drug companies to decide whether medications are safe and effective. The laws allow doctors, hospitals and manufacturers to bypass the FDA and protect them from prosecution, even if they request medication from a drugmaker in another state. (Leonard, 11/18)

California’s experiment aimed at moving almost 500,000 low-income seniors and disabled people automatically into managed care has been rife with problems in its first six months, leading to widespread confusion, frustration and resistance. Many beneficiaries have received stacks of paperwork they don’t understand. Some have been mistakenly shifted to the new insurance coverage or are unaware they were enrolled. And 44 percent of those targeted for enrollment through Oct. 1 opted out. (Gorman, 11/19)

About 50,000 Californians so far have enrolled in Cal MediConnect, according to figures released Monday by the Department of Health Care Services, which oversees the program. However, about twice that number -- a little more than 100,000 duals -- have chosen to opt out of the program. (Gorn, 11/18)

Hawaii will save about $21.5 million by tapping into federal funding to pay for health care for people living in the state under the Compact of Free Association, a newspaper reported Tuesday. Roughly 7,500 adult migrants from the Federated States of Micronesia, Palau and the Marshall Islands will be able to sign up for medical coverage under the Affordable Care Act. Under the compact, Pacific Island citizens freely live and work in the U.S. with no time constraints in exchange for allowing the U.S. military to control strategic land and water areas in the region. (11/18)

North Carolina's Medicaid office predicted Tuesday it would have a small surplus for this fiscal year despite a spike in prescription drug spending and continued enrollment growth for the health insurance program that serves more than one in six state residents. The forecast is another sign the beleaguered program is in a better financial position compared to recent years, when shortfalls reached hundreds of millions of dollars. Acting state Medicaid finance director Rudy Dimmling said the agency's forecast of spending $68 million less than state appropriations and receipts taken in by the end of June comes with many caveats. (Robertson, 11/18)

Colorado employers face an 8 percent increase in the cost of renewing employee health insurance plans for 2015, the latest in a decade of steep increases, according to a survey released Tuesday. If there's good news in the survey's findings, it's that the hike will be lower than the double-digit increases that have occurred nearly every year since at least 2004. (Draper, 11/18)

Starting Jan. 1, 2015, a tobacco product ban in effect at both University of Maryland Upper Chesapeake Health hospital campuses in Harford County will become even more stringent, and as of July 1, 2015, Upper Chesapeake will not hire anyone who uses tobacco, the health care company said this week. Upper Chesapeake is Harford County's largest private employer, with more 3,100 employees, according to the most recent fact sheet posted on the organization's website. Hospital admissions, emergency room and outpatient visits to the two campuses exceed 285,000 annually. (Anderson, 11/18)

Nine regional hospitals and clinics [in northern Minnesota] came together on Monday, not in a merger, but rather a collaboration with the goal to improve patient health care. The group, Wilderness Health, connects these health care providers spanning in a triangle from Grand Marais down to Moose Lake and back up to International Falls. The Executive Director of Wilderness Health, Cassandra Beardsley, said data integration is just one example of how they'll work together. (Kruse, 11/18)

A federal agency has sent notice that Medicare payments to overcrowded Osawatomie State Hospital will be terminated, but state officials say they will address concerns before the deadline and avoid the termination. Kari Bruffett, secretary of the Kansas Department for Aging and Disability Services, said Tuesday that she is aware of the termination notice from the federal Centers for Medicare and Medicaid Services. But she said the state has until Dec. 8 to correct deficiencies and will do so. (Marso, 11/18)

When we are patients, we want our doctors to make recommendations that are in our best interests as individuals. As physicians, we strive to do the same for our patients. But financial forces largely hidden from the public are beginning to corrupt care and undermine the bond of trust between doctors and patients. Insurers, hospital networks and regulatory groups have put in place both rewards and punishments that can powerfully influence your doctor’s decisions. Contracts for medical care that incorporate “pay for performance” direct physicians to meet strict metrics for testing and treatment. (Drs. Pamela Hartzband and Jerome Groopman, 11/18)

Americans could find the new insurance rates for the Affordable Care Act in online marketplaces last week. Prices of many plans went up. But just how much depends on how you measured them. (Margot Sanger-Katz, 11/18)

The big revelation of this week has been how many political pundits have spent six years of the Obama administration opining furiously about the administration’s signature policy without making the slightest effort to understand how it works. They’re amazed and in denial at the suggestion that it has the same structure as Romneycare, which has been obvious and explicit all along; they are shocked, shocked to learn that it uses the mandate as an alternative to taxing and spending, which has always been completely obvious and open. (Paul Krugman, 11/18)

Poor Jonathan Gruber. Having written the 2010 Patient Protection and Affordable Care Act all by his lonesome, he now has to watch the accolades heaped upon the law upon its passage turn into denunciations because he revealed the shocking truth about its contents. Oh, wait -- Gruber, an economics professor at the Massachusetts Institute of Technology, didn't actually write the law, which has never had a lot of public support. And contrary to Gruber's comments about lawmakers disguising the tax increases in the ACA, critics have been offering detailed lists of the law's tax effects for years. Still, it was stunning to see someone so close to the Obama administration say such damning things about the way the ACA became law. (Jon Healey, 11/18)

I'm probably not alone among journalists writing about the Affordable Care Act in finding that the lowest-information emails landing in my inbox lately come from people who have learned one thing about the act, and one thing alone: that some guy named Jonathan Gruber, its ostensible “architect,” said some insulting things about American voters’ stupidity and how they had to be gulled into supporting the bill. So this is how low the debate over the most far-reaching social insurance program of our time has fallen. (Michael Hiltzik, 11/18)

Economist Jonathan Gruber has become a household name in the nation's capital and the media for saying that Democrats disguised unpopular provisions of the healthcare reform bill in order to win Congress' approval. Yet his comments didn't reveal anything about the substance of the 2010 Affordable Care Act that the public didn't already know. Rather, they betrayed Gruber's deep cynicism about the legislative process and the “stupid” American electorate. For someone who supposedly had a front-row seat, Gruber missed how well the months-long debate over the act conveyed what it would do and why. (11/18)

After the [health] law's Medicaid expansion and with the population aging into Medicare eligibility, the 107 million under Medicaid or Medicare in 2013 rapidly increases to 135 million just five years later, according to CMS projections. By the end of the decade, a full 140 million Americans will have their health care access directly controlled by the U.S. government, a growth rate far higher than private insurance. The problem is that government insurance does not correspond to access to medical care, nor does it imply good health outcomes. Medicaid is already refused by more than half of doctors across America, according to 2013 data from a 2014 Merritt Hawkins survey. (Scott Atlas, 11/18)

Dear Republicans: What’s the matter with Governor John Kasich of Ohio? Why didn’t he jump to the top of your list of 2016 presidential contenders with his stunning re-election in the ultimate swing state? ... Kasich is suspect as a squish, maybe even the last surviving example of that earlier species of Republican, the compassionate conservative. ... he did take his Medicaid expansion dollars. Aides who want the governor to keep his party card have since hedged his position but he is explaining why full repeal of the Affordable Care Act is a Republican pipedream. “The opposition to it was really either political or ideological," he said in October. "I don't think that holds water against real flesh and blood, and real improvements in people’s lives.” (Margaret Carlson, 11/17)

Expanding Medicaid may be anathema to Texas political leaders. For hospitals, though, it would be a godsend. ... Gov. Rick Perry and others have said Texas is not interested in pouring more money into a broken system. One way health care providers agree that Medicaid is broken is in the meager amount this state-federal partnership program pays for care. Hospitals say they lose money on every Medicaid patient they treat. The American Hospital Association calculates Medicaid paid only 93 cents of every dollar spent on Medicaid patient care in 2012. (Jim Landers, 11/18)

In Tennessee, inaction on Medicaid [expansion] has meant the loss of nearly $1 billion in federal funds, a number that grows by $2.5 million each day. This money would not have gone into some unnamed bureaucracy; it would have been used to provide quality, affordable health-care coverage to the 300,000 Tennesseans who fall in the Medicaid gap. The benefits of Medicaid expansion aren’t limited to the health of those individuals. Providing this coverage means that 300,000 people can go see a doctor on a regular basis, limiting their need for emergency care at hospitals. When these individuals did need ambulatory care, the admitting hospital would receive a Medicaid reimbursement rate for their services, which currently they have to write off as charity care. (Tenn. State Rep. Craig Fitzhugh and Tenn. State Sen. Jeff Yarbro, 11/18)

It appears that opponents to Medicaid expansion, after making arguments about costs of the program and need for reform, have simply chosen to not mention it in the upcoming session and hope it will go away. As for the economics, several studies have shown that Medicaid expansion will have a positive benefit on the state economy. The federal government will assume 93 percent of expansion costs over 2014- 2022. As it stands now, without Medicaid expansion, our federal tax dollars are now being lost to states in which Medicaid expansion has occurred. Missouri is losing approximately $5 million per day. With Medicaid expansion, the costs of uncompensated care by the state and local governments will decrease markedly. Medicaid expansion will save over 24,000 jobs primarily in the health care workforce in the state. (Dr. John Mihalevich, 11/16)