Many Elderly Medicare Beneficiaries Unaware of Reform Provisions
A survey released in July 2010 by the National Council on Aging (NCOA) indicated that only 17% of seniors across the country were able to correctly answer half of the 12 random questions about the new health reform law and its key provisions. The survey, which was conducted by Harris Interactive from July 9 to July 12, was based on 636 responses from adults ages 65 and older.
“There are about 45 million Americans enrolled in Medicare,” says Alan Weinstock, an insurance broker at www.MedicareSupplementPlans.com. “And many of them need help understanding how the new Patient Protection and Affordable Care Act (ACA) will impact the Medicare program and in particular, their benefits.”
That is why the Centers for Medicare and Medicaid Services sent out a new mailing called “Medicare and the New Health Law – What it Means to You.” The purpose of the brochure is to outline the key points to the new Affordable Care Act that was put into law on March 23.
National Council on Aging Survey Findings
NCOA officials said that the survey illustrates the broad misunderstanding among Medicare beneficiaries about the health reform law. In particular, the survey found that:
None of the respondents correctly answered all 12 questions
Nearly half of the respondents incorrectly said the federal health reform law will increase the national deficit over the next 10 years
More than 62% of the respondents were unsure about the expected changes in Medicare Advantage under the overhaul
Only 14% knew that the law does not cut payments to physicians who treat Medicare beneficiaries
Less than one quarter (24%) knew that the ACA is expected to extend the solvency of the Medicare trust fund
A mere 14% were aware that the new law is projected to reduce deficit spending
An astonishing 42% thought that the new law would reduce their Medicare benefits
“This is further evidence why seniors who have questions about Medicare and the new health law might want to reach out to service organizations for assistance,” indicates Weinstock. Medicare beneficiaries have help at their fingertips through their State Health Insurance Assistance Program (SHIP).
NCOA ‘Straight Talk’ Education Campaign Launched
The survey coincided with a new NCOA national education campaign called “Straight Talk for Seniors on Health Reform.” The program — intended to help the elderly better understand the health reform law — will include town-hall meetings, interactive quizzes and online seminars to better educate seniors.
Advocacy groups for seniors as well as the Obama administration are planning outreach programs as well to address the misinformation and/or lack of information about the short- and long-term effects of the new reform law among older residents.
Sophie Ben is an expert author and has more then 5 years of experience in writing Technical articles like Medicare Supplemental Insurance, Medicare Supplemental Comparison, Medigap Insurance California, Medicare Insurance,Medicare Plans.
Categories: Centers for medicare and medicaid services Tags: Beneficiaries, Elderly, Many, Medicare, Provisions, Reform, Unaware
Medicare rules & regulations: A survival guide to policies, procedures and payment reform, 1998
Medicare rules & regulations: A survival guide to policies, procedures and payment reform, 1998
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Categories: Medicare Tags: 1998, Guide, Medicare, Payment, Policies, procedures, Reform, Regulations, Rules, Survival
The New Healthcare Reform Bill Passed by Congress Prompts Expansion of Claims Recovery Company (CRC)
Rockford, IL (PRWEB) November 9, 2009
CRC, Claims Recovery Company, LLc, announced the expansion of its unique healthcare appeal services, following the House of Representatives passage the sweeping health care bill, H.R. 3962 representing the largest expansion of health care coverage since Medicare was created more than 40 years ago. President Obama said he was “absolutely confident” the Senate will follow suit in passing its version of the bill. Although turning the bill into law will see revision and Senate approval, it is now clear that claims regulations for reimbursement under this new federal law is based on ERISA and well settled from the bipartisan Bills. It will now be urgent for healthcare providers to take full advantage of ERISA regulation provisions.
“We have advocated since our inception, the use of federal ERISA law to resolve payment disputes with hospitals. We are thrilled that Congress agrees with us and hope that the Senate will too” Says F. Scott Winslow, CEO of the two year old CRC. “CRC has been utilizing the thirty four year old ERISA law and its claim regulations providing for a ‘full and fair review’ with a properly formatted, properly submitted ERISA appeal for its hospital clients from coast to coast.”
Although it is currently uncertain what final provisions will be signed into law, the antitrust provisions of H. R. 3962 represent a sweeping opportunity for health providers to “level the playing field with the insurance industry through the new laws use of ERISA 29 CFR 2560.503-1, and equal anti-trust provisions for both insurers and providers for the first time. ERISA will be statutorily incorporated in its entirety into the new law for all qualified health benefit plans (QHBP), as the most important provisions from H. R. 3962 for healthcare providers for reimbursement purposes. The Affordable Health Care for America Act will create a new federal agency, Health Choices Administration, regulating qualified health benefit plans (QHBP), consisting of employment-based health plans, the traditional voluntary ERISA plans, and health insurance exchange plan, the new mandatory ERISA plans. The new legislation, H.R. 3962, is significant to CRC in following provisions:
1. Sec. 232 (b) of the Act, Requiring Fair Grievance and Appeals Mechanisms of the Act provides: “(b) INTERNAL CLAIMS AND APPEALS PROCESS.–Under a qualified health benefits plan the QHBP offering entity shall provide an internal claims and appeals process that initially incorporates the claims and appeals procedures (including urgent claims) set forth at section 2560.503-1 of title 29, Code of Federal Regulations, as published on November 21, 2000 (65 Fed. Reg. 70246) and shall update such process in accordance with any standards that the Commissioner may establish”. CRC is expert in this area and currently offers this service to existing clients.
2. Sec. 232 (c) of the Act also creates a new federal external review process based on ERISA claim regulation to provide for an impartial, independent, and de novo review of denied claims, and the Health Choices Commissioner’s decision shall be binding on the plan and the entity, as the final claim decision in absence of judicial review, which will now be available for punitive damages for exchange participating health plans. CRC foresees an extended ability to assist clients as it has prepared files for this process since its inception under the existing regulation process.
3. Sec. 233 of the Act, Requiring Information Transparency and Plan Disclosure, enhanced the existing ERISA disclosure obligations for the plan and insurance company, and requires “Accurate and Timely Disclosure”, for both exchange participating health benefit plans and employment-based health plans, to both the Health Choices Commissioner and the public, doctors, hospitals and the patients, of plan documents, plan terms and conditions, claims payment policies, and practices, periodic financial disclosure, data on the number of claims denials, data on rating practices, information on cost-sharing and payments with respect to any out-of-network coverage, and other information. CRC expects a more timely compliance with its ERISA based appeals and document reviews under this section of a new law.
4. Sec. 233 (5) of the Act, Cost-Sharing Transparency, requires the plan to disclose to the healthcare provider the real fee schedule, plan UCR limit for individual service and supplies at CPT & HCPCS code level. CRC foresees a distinct advantage in resolving its appeals on behalf of its clients the UCR provisions have been the most tightly held secrets of the insurance industry and subject to actions by attorneys’ general.
5. Sec. 235 of the Act, Timely Payment of Claims, provides new federal “Prompt Pay” laws, based on Medicare Part C timeframe, Managed-Care Medicare, to comply with the requirements of section 1857(f) of the Social Security Act.
6. Sec. 238 of the Act, State Prohibitions on Discrimination against Health Care Providers, has adopted “Any Willing Provider Laws” from existing state laws. CRC sees a great advantage to it’s out of network clients and predicts a new era of contracting with insurance companies for its hospital clients if this provision is written into the final version of the law.
7. Sec. 251 of the Act provides new consumer protections, with state law compensatory and punitive damages as remedies for exchange-participating health plan members. Although the new law does not change the status of ERISA preemption as desired by the insurance industry, state punitive damage remedies for employment-based health plans (traditional ERISA plans) will remain in effect.
8. Sec. 257 of the Act allows state attorney general to sue for the compensatory and punitive damages on behalf of the private citizen of the state for any violations by the exchange-participating health plans, although traditional ERISA plans are still immune from state government actions from insurance Commissioners or attorneys general.
9. Sec. 262 of the Act, Restoring Application of Antitrust Laws to Health Sector Insurers, if signed into law, this will cripple the existing managed care practice model and in conjunction with vigorous enforcement of the new provision for federal ERISA claim regulations, complete disclosure of plan information and fee schedules will now be mandatory under a proper ERISA appeal.
The Affordable Health Care for America Act is 1990 pages long. For more information and relevant documents, please visit the Website of House Of Representatives:
http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1687&catid=156&Itemid=55
CRC offers, as an outside service, a process to appeal bad debt insurance claims (up to six years old) under federal ERISA law as a patient advocate. This has the potential to deliver substantial portions of the contractuals for any claim where the commercial insurance coverage was issued by an employer (government, church and a few other minor categories are accepted). CRC performs this “administrative appeal” process with no upfront fees and is paid a percentage of new payments delivered directly to the hospital. CRC’s staff performs all work and answers all correspondence. CRC’s approach has been utilized by hospitals and other providers for over ten years and they have clients from California to New York.
For more information or to arrange an interview, please visit www.crcclaim.com , or contact Mr. F. Scott Winslow, CEO at 815-397-8002.
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Categories: Social Security Tags: Bill, claims, Company, Congress, expansion, Healthcare, Passed, Prompts, Recovery, Reform
Franken On The Public Option And Election Reform
Follow Dusty Trice on Twitter: twitter.com Senator Al Franken discusses the public option, medicare part D and election reform. — Last week, Sen. Al Franken was accosted by Tea Party activists at the Minnesota State Fair. He turned an ambush into a productive discussion, and I turned that conversation into a youtube video. YOU turned that video into an online sensation. More than half a million people tuned in to watch a United States Senator debate calmly, rationally, with his constituents – whether or not they agreed with him. There was no name-calling, no wrist-slitting, no Obama-with-a-Hitler-mustache posters. Ana Marie Cox called it terrible tv, but great democracy. And the even greater news is that you cared. THERE IS AN AUDIENCE FOR SANE NON-VIOLENCE. Even outside of Minnesota. — Read more at DUSTYTRICE.COM Follow me on Twitter: @DustyTrice
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Health Reform & Americans with Disabilities (05/20/2010 Web chat)
Get answers to your questions about how the Affordable Care Act will give Americans with disabilities greater choices and more control over their health care. www.healthreform.gov Guests Jeffrey Crowley – Director, Nat’l AIDS Policy & Sr Advisor on Disability Policy to the President Meena Seshamani – Director, Policy & Analysis, HHS Office of Health Reform Henry Claypool, Director, HHS Office on Disability We allow comments according to our comment policy: newmedia.hhs.gov US Department of Health & Human Services www.hhs.gov
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Categories: Medicare Tags: 05/20/2010, Americans, Chat, disabilities, Health, Reform
Individual Health Insurance Reform EasyToInsureME
December 17, 2009
It appears that the U.S. Senate will vote to close debate on its version of federal health care reform as early as this weekend. Whether or not you have contacted your senators previously, now is the time for you to consider contacting both of your senators and encourage them to continue debate and to improve the legislation.
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Individual health insurance
Health insurance quote
It is difficult to overstate the negative implications of Senate Majority Leader Harry Reid’s (D-NV) proposal. According to the Congressional Budget Office, this legislation – if enacted – will have a significant, negative impact on the cost and nature of coverage for our customers. The administration’s chief actuary for Medicare and Medicaid Services has determined that if the Senate health care bill became law, it would increase national health care spending more than if we did nothing. Our own analysis concurs with these assessments and further indicates that Sen. Reid’s proposal will likely lead to higher premiums for many of our customers without reducing the growth in underlying health care costs.
A new Washington Post-ABC News poll indicates that 53% of Americans understand that their personal costs will increase under this proposal and only 37% believe that their personal health care will improve under this legislation. The Senate needs to set aside this version of health care reform and construct a proposal that has broad and deep public support.
Throughout the health care reform debate, our company has sought to partner with our elected leaders in both parties to pursue responsible, sustainable reform that lowers costs and increases access. The current legislation does not meet these goals and Congress needs to hear from individuals who are concerned about the consequences of well-intended but flawed reforms.
While we continue to support health care reform, we cannot support reform that fails to address the cost and quality issues in our health care delivery system and undermines the bipartisan consensus for responsible and sustainable reform.
The holiday season is a busy time for all. Now is the time to get involved today.
The Senate needs to hear from you and time is short.
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Categories: Medicaid News Tags: EasyToInsureME, Health, Individual, Insurance, Reform
Healthcare Reform- Not Destruction!
Healthcare Reform- Not Destruction!
I am all for healthcare REFORM and I am for any and ALL REFORM that truly is REFORM. Are you getting the sense of what I am saying here? As I look at nearly everything that GOVERNMENT tries to REFORM it makes it worse! Way back in 1913 the Federal Reserve was established to bring reform to our financial system and PROTECT the US$, which has lost 98% of its value in the last 95 years!
Need we look any further back than the Cash For Clunkers program?
Do we need to review our bankrupt social security program, the fiscal failure of Medicare and Medicaid? Has the postal system or Amtrak been successful? Can you imagine how much worse off the automobile industry is going to be now that it’s RUN by the U.S. government. But, let’s take a look at healthcare specifically.
Healthcare in America NEEDS REFORM! What we don’t need is the government to take it over. REFORM, not destruction!
Why don’t we take LESSONS from those who have gone this route before us? The Canadian national healthcare system is a shambles and getting worse by the month- by their own admission. And what we’re seeing in England who has been working a national healthcare system the longest is more than scary! Thousands of women in the UK are having to give birth outside maternity wards because of a lack of midwives and hospital beds. The lives of mothers and babies are being put at risk as births in locations ranging from lifts to toilets – even a caravan – went up 15 per cent last year to almost 4,000.
We want this? 
Health chiefs in England admit a lack of maternity beds is partly to blame for the crisis, with hundreds of women in labor being turned away from hospitals because they are full. Latest figures show that over the past two years there were at least:
>63 births in ambulances and 608 in transit to hospitals
>117 births in A&E departments
>115 births on other hospital wards
>399 in parts of maternity units other than labor beds
We’re just talking about one area of medical needs.
REFORM yes! But yet another government run MESS? Hell no!
As a spiritual-futurist, I have a BA degree majoring in history. One cannot know the future without knowing the past which holds clues to what is on the horizon. The world is in such a rapid expansion of knowledge that we are close to entering a tipping point that will forever change earth as we know it.
Categories: Uncategorized Tags: Destruction, Healthcare, Reform
Health Care Reform, the Medical Community and You
Health Care Reform, the Medical Community and You
There is a tremendous effort by the President and the Democratic Party to swiftly replace our current system of health care insurance with a government sponsored insurance program designed to bring health insurance coverage to all Americans. Of course, this sounds like a wonderful idea, however, after understanding the details outlined in the proposed legislation, many may want to reconsider their position.
There are a few facts you just can’t get around. When more than 47 million uninsured Americans are added to a system that currently accommodates 260 million Americans, something is going to have to give. Assuming the same patient load, approximately 10,000 more physicians will need to be available or care for the 47 million. Other Americans will need to be delayed or eliminated. This is not unusual in places like England, France and Canada where National Healthcare has been in place for quite some time. Additionally, facilities, resources and support staff will be effected proportionally. The promoters of this legislation can promise all day long that this won’t happen, but unless they have the same capabilities that Christ had when he fed 500 followers with two loaves of bread and seven fish around 2000 years ago, the numbers say it just can’t work without serious health care rationing.
The next issue that stands out is the promise of reforming health care thereby significantly reducing costs. If we look at Medicare and Medicaid as examples and understand the tremendous deficit that is growing due to poor management and excessive fraud, how could we even imagine we could increase the size and responsibility of a program and then believe it would be operated efficiently enough to reduce costs. These are wonderful dreams, but they are just dreams. TARP is operating with little control or knowledge of recipients use of funds, the American Recovery and Reinvestment Act has been unable to disperse funds or lower unemployment as projected and the Cash for Clunkers program was so grossly miscalculated that it ran out of funds in the first week and hasn’t been
able to issue reimbursement payments to auto dealers effectively. We were told these programs would work great and they had to be in place immediately.
But let’s assume for one moment we can some how accommodate the extra 47 million insured and that through some miracle we are able to control costs without reducing the quality or quantity of care. How do we get past the fact that the majority of Americans do not want or support the health care reform legislation being proposed? It appears our elected representatives don’t really care what we want.
Yes, they were elected to represent us, but they represent themselves and their party’s position first. Once they have accommodated them, then they may consider understanding our preferences. Of course, the exception to this position is at election time when every promise is to represent the people that elect them.
Charles Patti is President/CEO of NCD Medical Corp. and National Consulting and Development Corp. Charles is based in northeast Ohio and has been in business since 1987. His diverse background includes sales, engineering, and business management. He has strong experience in Diagnostic Imaging Systems, Document Management Systems, Main Frame Computer Systems, and Combustion Control Systems.
Charles J Patti, President/CEO
Categories: Uncategorized Tags: Care, Community., Health, Medical, Reform
Is Abortion Going To Stop Healthcare Reform In Its Tracks?
Healthcare reform seems to be moving along in Congress. Speaker of the House Nancy Pelosi appears to have a majority of Democratic representatives on board, while Senate Majority Leader Harry Reid is on his way to getting 60 votes in the Senate. However, there is one major issue that has the potential to derail Democrats’ reform efforts: abortion. Some pro-life Democrats in Congress, like Rep. Bart Stupak are worried that the current bill will force the government to pay for abortions. It isn’t a direct payment to providers that they’re concerned with; rather, it’s a seemingly benign subsidy meant to help low-income individuals and families purchase health insurance–either the public option or a private plan. Pro-choice leaders in Congress have already agreed to prevent recipients from using the subsidies specifically to pay for an abortion, instead leaving that expense to employer- or individual-paid premiums. Despite that provision, opponents still consider it federal funding since money can’t be directly separated. Their belief is that if a woman receives a discount on a health insurance plan through a federal subsidy, she may then use the money she saved on that procedure. Technically, you could also make the argument that food stamps promote illegal drug use because they free up funds that would otherwise be used to feed people, and can instead be used to buy drugs. Stupak is planning to block the healthcare reform bill from moving out of committee unless House leaders like Henry Waxman allow him to offer a separate amendment that further prevents any of the new health care funds from being used for abortion services.
Abortion is a very controversial subject. It is the only legal health procedure with special regulations in the House’s reform. Activist groups like NARAL grudgingly accepted the compromise presented by House leaders, realizing that it was probably the best they could get, but see Stupak’s new proposals as a path to banning abortion coverage in the private health insurance market altogether. The 1976 Hyde Amendment already forbids the federal government from funding abortion through Medicaid, its existing public health insurance plan for low-income Americans. However, it doesn’t apply to newly provided funds. Rep. Stupak’s amendment would expand the Hyde restrictions to the new subsidies, offering even stronger assurance that no federal money will pay for abortion except under certain circumstances (when the life of the mother is in danger, or when rape or incest are involved). House leadership will probably try their best to block the amendment. In that case, Stupak threatens to create a coalition of representatives that will vote no on a procedural vote. That would serve to prevent debate on the House’s healthcare reform bill in its entirety. States will be allowed to cover abortion services on a state-by-state basis, but using solely their own money. Some states would be more likely to provide abortions to their residents than others. Whatever your views on abortion (and I realize it’s an extremely sensitive topic), that type of law is, in effect, creating unequal access. A wealthier woman’s health insurance plan will cover an abortion, while poorer women will see heavier restrictions on the insurance they can buy. Granted, in the case of the subsidies taxpayers could be, however indirectly, funding a procedure they oppose; just like those who are anti-war have to pay for Iraq and Afghanistan.
Stupak’s amendment would ban people from using the subsidies to buy private health insurance plans that cover abortions, as opposed to preventing only those specific funds from being used for that purpose. Why not let Stupak propose it? For one thing, it will probably result in division of the Democratic party at a time when unity is essential to reach their goal. There are quite a few pro-life Democrats that would vote for such an amendment; Stupak claims that he can get 40 Democrats on his side, which would eat up most of the party’s majority in the House. Despite that, a large percentage of supporters would most likely be Republicans–who wouldn’t vote for the final bill anyway, regardless of how stringent its limits on abortion funding are. In exchange, it would alienate some liberal Democrats. These representatives are relatively reliable votes, but they are already skeptical of the bill because they feel the public option doesn’t go far enough. Either way, Democrats need virtually all of their caucus to vote with them on healthcare reform, and this issue will certainly be a factor in how they vote. House Majority Leader Steny Hoyer claims that progress is being made on the issue, but both sides seem to be standing firm. The future of the House’s healthcare reform largely rests on this issue, so it’ll be interesting to see how it plays out.
(Image: number of abortions per 1,000 women each year; Guttmacher Institute)
Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they don’t have to go without a health insurance plan while waiting for a public option, if it ever gets passed. Yamileth lives in Miami, FL.
Categories: Applying for medicaid Tags: Abortion, Going, Healthcare, Reform, Stop, Tracks
Passing health reform could be a nightmare for Obama
Barack Obama’s quest for historic health-care legislation has turned into a parody of leadership. We usually associate presidential leadership with the pursuit of goals that, though initially unpopular, serve America’s long-term interests. Obama has reversed this. He’s championing increasingly unpopular legislation that threatens the country’s long-term interests. “This isn’t about me,” he likes to say, “I have great health insurance.” But of course, it is about him: about the legacy he covets as the president who achieved “universal” health insurance. He’ll be disappointed. Even if Congress passes legislation — a good bet — the finished product will fall far short of Obama’s extravagant promises. It will not cover everyone. It will not control costs. It will worsen the budget outlook. It will lead to higher taxes. It will disrupt how, or whether, companies provide insurance for their workers. As the real-life (as opposed to rhetorical) consequences unfold, they will rebut Obama’s claim that he has “solved” the health-care problem. His reputation will suffer.
It already has. Despite Obama’s eloquence and command of the airwaves, public suspicions are rising. In April, 57 percent of Americans approved of his “handling of health care” and 29 percent disapproved, reports the Post-ABC News poll; in the latest survey, 44 percent approved and 53 percent disapproved. About half worried that their care would deteriorate and that health costs would rise.
These fears are well-grounded. The various health-care proposals represent atrocious legislation. To be sure, they would provide insurance to 30 million or more Americans by 2019. People would enjoy more security. But even these gains must be qualified. Some of the newly insured will get healthier, but how many and by how much is unclear. The uninsured now receive 50 to 70 percent as much care as the insured. The administration argues that today’s system has massive waste. If so, greater participation in the waste by the newly insured may not make them much better off.
The remaining uninsured may also exceed estimates. Under the Senate bill, they would total 24 million in 2019, reckons Richard Foster, chief actuary of the Centers for Medicare & Medicaid Services. But a wild card is immigration. From 1999 to 2008, about 60 percent of the increase in the uninsured occurred among Hispanics. That was related to immigrants and their children (many American-born). Most illegal immigrants aren’t covered by Obama’s proposal. If we don’t curb immigration of the poor and unskilled — people who can’t afford insurance — Obama’s program will be less effective and more expensive than estimated. Hardly anyone mentions immigrants’ impact, because it seems insensitive.
Meanwhile, the health-care proposals would impose substantial costs. Remember: The country already faces huge increases in federal spending and taxes or deficits because an aging population will receive more Social Security and Medicare. Projections the Congressional Budget Office made in 2007 suggested that federal spending might rise almost 50 percent by 2030 as a share of the economy (gross domestic product). Since that estimate, the recession and massive deficits have further bloated the national debt.
Obama’s plan might add almost an additional $1 trillion in spending over a decade — and more later. Even if this is fully covered, as Obama contends, by higher taxes and cuts in Medicare reimbursements, this revenue could have been used to cut the existing deficits. But the odds are that the new spending isn’t fully covered, because Congress might reverse some Medicare reductions before they take effect. Projected savings seem “unrealistic,” says Foster. Similarly, the legislation creates a voluntary long-term care insurance program that’s supposedly paid by private premiums. Foster suspects it’s “unsustainable,” suggesting a need for big federal subsidies.
Obama’s overhaul would also change how private firms insure workers. Perhaps 18 million workers could lose coverage and 16 million gain it, as companies adapt to new regulations and subsidies, estimates the Lewin Group, a consulting firm. Private insurers argue that premiums in the individual and small-group markets, where many workers would end up, might rise an extra 25 to 50 percent over a decade. The administration and the CBO disagree. The dispute underlines the bills’ immense uncertainties. As for cost control, even generous estimates have health spending growing faster than the economy. Changing that is the first imperative of sensible policy.
So Obama’s plan amounts to this: partial coverage of the uninsured; modest improvements (possibly) in their health; sizable budgetary costs worsening a bleak outlook; significant, unpredictable changes in insurance markets; weak spending control. This is a bad bargain. Health benefits are overstated, long-term economic costs understated. The country would be the worse for this legislation’s passage. What it’s become is an exercise in political symbolism: Obama’s self-indulgent crusade to seize the liberal holy grail of “universal coverage.” What it’s not is leadership.
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