Time for a quick Public Service Announcement from Health Insurance Issues With Dave:

By now almost all of us accept that the Coronavirus threat is real.  The two ways we can protect ourselves and others is to wash our hands properly for a full 20 seconds and to stay home as much as possible.  It turns out that lots of people are asymptomatic and capable of infecting others for days before they start coughing and/or running a fever.  It is important that even though you need to maximize social (physical) distancing, you shouldn’t let this force you to minimize social interaction.  My friend John in New Orleans, a veteran of Hurricane Katrina, has expressed to me his concerns about the mental health implications of both the virus and the necessary lockdown.  Stay connected.  Your friends, your family, and even your co-workers miss you.

The insurance companies have a variety of resources for all Americans, not just their clients.  Aetna has an excellent information post about coping with the obvious and reasonable fears that we are all experiencing with the Coronavirus pandemic.  This link is worth a couple of moments of your time.

Oscar has created a personal risk assessment survey that is available to both their clients and the general public.  This survey is no replacement for a test, but you will find it useful.  This is a reminder that the more information you have the better chance you have to protect yourself.

The federal government reports, per Dr. Fauci and Dr. Birx, that if we do everything correctly between 100,000 and 200,000 Americans will succumb to COVID 19.   Mr. Trump considers 100,000 dead Americans a victory.  Let’s be clear, there is nothing special about being 1 out of 100,000.  Stay Safe.  Stay Healthy.


Picture – A Quiet Place in Tennessee – David L Cunix

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The Connections

The Lakota universe can be described as Mitakuye Oyasin.

         That means that everything is connected,

         Interrelated, and dependent in order to exist.

                     The universe includes all things that grow,

                     things that fly-everything you see in the world

                     or the place that you walk on.

         These are all included in what

         The Lakota see as the universe.

         All of this is related.

                     Robert Two Crow, Community Curator, 1999

For every action there is an equal and opposite reaction.

         Newton’s Third Law

Your car has a group of idiot lights that alert you when the vehicle needs service.  If the tires need air, a light comes on.  When the car needs gas, a different light comes on.  Time for an oil change?  There is a light for that, too.  Until now there hasn’t been an idiot light to warn the American public that our health care system is under attack.  Until now.  On Monday the U.S. Supreme Court agreed to hear Texas v. U.S., the lawsuit that could dismantle the Patient Protection and Affordable Care Act (Obamacare).  The red light is on.

The 974 pages of the PPACA touch every aspect of how Americans access and pay for health care.  It is far from perfect.  It did not even do everything it set out to accomplish.  But millions of Americans have benefited from:

  • Coverage for preexisting conditions
  • Policies that are guaranteed issue
  • Maternity treated the same as any other condition
  • Children covered till age 26 on a parent’s policy
  • Medicaid expanded to cover the working poor
  • No maximum benefit

Successive Republican Congresses and the current administration have promised something better.  There have been over 60 votes to repeal the law.  The Supreme Court has upheld the law twice.  Donald Trump promised that he would cover everybody with a plan that would cost less and provide better coverage.  After he was elected he said, “Nobody knew health care could be so complicated”.  No sir.  Everybody knew but you.

Eliminate the law and you eliminate our protections.  Amend the law, improve the law and we retain the benefits Americans need and have come to expect.

This is all connected.  The Individual Mandate was designed to enlarge the pool of insureds.  We can’t build a health care system based on the sick and responsible.  The 23 year old woman might get pregnant.  The 63 year old man might develop prostate cancer.  And any of us could fall victim to the Coronavirus or countless other risks.  An efficient health care system must collect enough money to be prepared for the illnesses and accidents that inevitably strike all humans.

Few of us could ever pay all of the costs associated with our health care.  So whether or not we wish to admit it, we are connected.  The Texas lawsuit doesn’t end the connection, just our current method of addressing the costs.

There aren’t any viable alternatives on the table.  Russell Voight, Trump’s Acting Office of Management and Budget Director, was asked last month during his Congressional testimony about the president’s health care plan.  “The president is working on his own plan that we’re not yet ready to reveal.”  This plan is as non-existent as his pre-election plan.  Your preexisting conditions are real.  His plans are not.

The Supreme Court will hear oral arguments this summer, but it is unlikely that a ruling will be issued prior to Election Day.  The red is flashing.  The invalidation of Obamacare, ruling that the Patient Protection and Affordable Care Act is unconstitutional, would cause immediate irreparable chaos.

For every action, there is an equal and opposite reaction.


Picture – The Lakota Universe – David L Cunix.  This is part of the exhibit at the National Museum of the American Indian, Washington DC.




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Clean Hands


A friend of mine, an attorney, had a couple of quick questions about Medicare.  He will be turning 65 soon and needed to confirm that he didn’t have to sign up for Medicare Part B since he plans to stay on his wife’s group health policy.  I verified that his wife works for a company with over 20 employees.  So yes, he doesn’t need Medicare Part B.  But, I asked, is the group plan a High Deductible Health Savings Account (HSA) Qualified Policy and do you contribute to the HSA?  He confirmed that Yes and Yes.  In that’s case, he must renounce Medicare Part A, too.  You can not contribute to a Health Savings Account if you have Medicare.  In fact, there is a six month look-back.  He didn’t know.  And if an attorney could have accidentally screwed this up, what are the chances that your average office worker or machinist couldn’t make the same mistake?

Capitol Conference, the annual opportunity for members of the National Association of Health Underwriters to hear from members of the administration and meet with our elected officials, was the last week of February.  Fourteen of us from Northeast Ohio were part of the audience of over 700 that heard from Seema Verma the Administrator of the Center of Medicare and Medicaid Services (CMS).  House members Lauren Underwood (D-IL), Joe Courtney (D-CT), Greg Walden (R-OR), Kurt Schrader (D-OR), Adrian Smith (R-NE) as well as Senator Todd Young (R-IN) shared their views on pending legislation.  The speeches were interesting, the graphs (!) colorful, but the most important part of our annual trip to Washington are our scheduled appointments with our Congressman and Senators.

For many of us, our favorite appointment each year is with Abby Duggan, Senator Sherrod Brown’s legislative aide.  We appreciate that she is well prepared and that Senator Brown has shown a real interest in some of our issues.  Ms. Duggan has acknowledged that we come with “Clean Hands”.  Our issues – Surprise Billing, Employer Reporting, and the big Medicare concerns dealing with the Observation Trap, COBRA as Medicare compliant, and HSA’s – have nothing to do with our incomes.  We are here to solve problems, to represent our clients.

Senator Brown is the sponsor of S. 753 which would allow observation stays to be counted toward the three day mandatory inpatient stay for Medicare coverage of a skilled nursing facility.  This happens to be one of our priorities.

We talked about the Medicare COBRA and HSA issues in Senator Brown’s office three days before my friend asked his questions.  H.R. 2564 and H.R. 3796 address these problems.  Our members discussed these bills with every Congressman and legislative aide we met.

Our #1 issue was Surprise Billing / Balance Billing.  As Congressman Walden noted, 1 in 5 emergency room visits and 1 in 6 hospital admissions produce a Surprise Bill.  We’ve discussed and defined Surprise Billing in previous posts.  Our goal is to take the unsuspecting client out of the equation and to focus on reimbursement being tied to the median in-network amount determined by reasonable, contracted amounts paid by private health plans to similar providers in a geographic area.  Obviously, we don’t want our clients forced into arbitration.

Our friends and clients count on us for good advice and to be alert to their needs.  Our periodic trips to Washington and our state capitols allow us to work with our elected officials to make health insurance, the way most Americans access and pay for health care, better.  We carry with us two messages wherever we go.  All health care is local.  And, we are all on the same team.


Pictures – Looking For Something To Read At The Library Of Congress – David L Cunix

And – A Plane Washington – David L Cunix



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February 4, 2020

Morning Joe broke for a commercial moments after I had turned on the television.  The first ad was from You Know Who, one of the largest marketers of insurance in this country.  They don’t like to admit that they sell insurance.  They prefer to advertise that they endorse certain products.  Yeah. Yeah.  In this day and age of 10 second and 20 second spots, this one full minute Medicare Supplement advertisement felt like a documentary.  As soon as that commercial ended, a new ad, from a different company began.  This one featured a former football star, 40+ years past his glory, pitching all of the free stuff that came with some unnamed Medicare Advantage policy.  The 30 second commercial for Tylenol was a welcomed relief.

I turned 65 today.  That stack of junk mail pictured above is a small fraction of the solicitations I’ve received in the last year.  One company, You Know Who, has been sending stuff to both my home and office.  As an official old person, I find that the television shows that I watch seem to be sponsored by medications, investment companies, and Medicare products.  The newspaper, yes I still get the Plain Dealer delivered, has envelopes inserted for Medicare products.  I sometimes watch football just to be a part of a different demographic.

I had a doctor’s appointment this morning.  My first on Medicare.  I presented my Medicare Card and my Medicare Supplement Card.  I won’t mention the company since I don’t want this to be seen as a recommendation of a particular insurer.  My previous coverage was a Grandmothered $5,500 deductible HSA qualified policy with Anthem Blue Cross.  My January premium was over $800.  My new Medicare premium for a Plan G contract is around $125 per month and my deductible for Part B services is $198!  The doctor’s staff gladly accepted my Medicare Card.  I now have the best, most comprehensive insurance I’ve had in almost 30 years.  And I am covered in all fifty states.

There are people who misuse the word Medicare and apply it to a very different type of coverage, to a policy that covers 100% of everything.  That isn’t Medicare.  That is a fantasy.   Medicare, with its deductibles and copayments, was designed to pay approximately 75% to 80% of a beneficiary’s medical bills.  But just as some long to make Medicare even more comprehensive, there are others trying to weaken it.  As noted in a recent post, the Association of American Physicians and Surgeons is still fighting the existence of Medicare fifty-five years after its creation.  And Mitch McConnell has targeted both Social Security and Medicare for cuts after the next election.  The impact this could have on those reliant on these programs is beyond comprehension.  Some might caution that we should first wait to see the results before we raise our concerns.  But those are the very same people who would have repealed the Patient Protection and Affordable Care Act without any replacement.

My health insurance, the way I will access and pay for care, changed last Saturday.  I am now on Medicare.  But my concern, and the concern of other insurance agents around this country, is unchanged.  We are here to make this system work.  And as our system changes, to make that new one work, too.  About 1,000 of us will be in Washington at the end of this month to meet with members of this administration, the House, and the Senate.  Now is the time to let us know your thoughts and your concerns so that we can share them with the people who write the rules.  That, too, is part of our job.


Picture – Junk Mail – David L Cunix



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The New Normal 2020

Senator George McGovern told Senator Sherrod Brown a story about a time, in 1980, that he was standing in line at a Sioux Falls supermarket.  “…he saw two women standing in front of him paying for their groceries with food stamps, the program no one in Washington had done more to expand then McGovern.  Not having noticed that their senior senator was standing nearby, they were discussing the upcoming Senate race between McGovern and his Republican challenger, James Abnor.  With all of the major problems in our economy, one woman said as she handed the clerk the food stamps, ‘I can’t vote for McGovern.  He’s for too many of those giveaway programs!” (From Desk 88 by Senator Sherrod Brown)

Today is the new normal.  The past is just the past.  The women in line were oblivious to the irony.  They weren’t the recipients of government largesse or even a helping hand.  Apparently they no longer remembered struggling to feed their families.  Their food stamps were THEIR food stamps, as normal for them as their homes or their family pets.  But please don’t spend my money on someone else.  That would be a giveaway.

And that brings us to the Patient Protection and Affordable Care Act (Obamacare).  Today is the new normal.  The past is just the past.  Cancer survivors come into my office during the annual open enrollment period (November 1st – December 15th) to purchase or change health insurance policies without the fear that their preexisting conditions will inhibit the transaction.  Those clients come from across the political spectrum, from the far right to the equally far left.  What they share, aside from preexisting conditions that would have made the purchase of insurance coverage nearly impossible in 2009, is little understanding or appreciation of how Obamacare has opened the door for them.  Today is the new normal.

The expansion of Medicaid under the PPACA is also part of the new normal.  Some of my most virulent anti-Obama / anti-Obamacare clients have taken advantage of this free health care.  And thank G-d for it.  Bringing Medicaid to the working poor, people making up to 138% of the federal poverty level, opens the door for routine care and necessary medication to individuals and families who might not have been able to afford such care.  And, importantly, that door is the front door.  Obamacare removed the stigma attached to Medicare.

In January 2020, Americans expect to have their preexisting conditions covered.  They expect their children to be covered until they are 26 years old by a parent’s policy.  And if their 27 year old can’t get a job, possibly Medicaid.  American women expect maternity to be covered and men concern themselves with how to combat prostate cancer not whether or not their surgeries or radiation will be paid.

The American public has been lulled into complacency.  The benefits of Obamacare have been disconnected from the law.  It is as if Obamacare could be ruled unconstitutional and eliminated, but we get to keep all of the good stuff.  Mitch McConnell was recently asked about his support of the Texas lawsuit to undo the PPACA’s protection for preexisting conditions.  He said, “There’s nobody in the Senate that I’m familiar with who’s not in favor of coverage for preexisting conditions”.

A reader recently complained that this blog was too political.  Really?  Those were politicians who negotiated, argued, and crafted the compromises ten years ago that created the Patient Protection and Affordable Care Act.  There have been politicians trying to destroy the law for the last ten years while other politicians have fought hard to save it.  It is all about politics and it is my job to chronicle the fight.  What it is not about is YOUR health.  The debate is about how medical providers are compensated.  Who pays and how much?  What was once about hospitals and doctors now encompasses hospitals, doctors, pharmaceutical companies, medical testing equipment, therapists, and countless others attached to the business of health.  Every one of them has an army of lobbyists in Washington and every state capitol.  Hell yes this is political.

The new normal in 2020 isn’t perfect.  Our premiums are too high.  Prescription drug pricing is out of control.  There is plenty of room for improvement.  But denying the safety net of Obamacare is a lot like complaining about government giveaways while paying for one’s groceries with food stamps.


Picture – All Was Perfect In The Turtles’ World – David L Cunix

Bonus – Happy Together

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In Other Breaking News

The President was bragging.  The car radio, tuned to CNN, was playing President Trump’s press conference.  Among his other claims of success, real or imagined, was his victory, yesterday, in the Supreme Court.  He quickly corrected himself and changed it to the Appeals Court.  He was talking about the Court of Appeals for the Fifth Circuit declaring the Individual Mandate provision of the Patient Protection and Affordable Care Act (Obamacare) unconstitutional.  Mr. Trump was elated.  He claimed that it was the Individual Mandate that made health insurance expensive.

Read the decision.

Most of the people I know in this industry, from across the political spectrum, realize that the Individual Mandate could lower premiums by expanding the available pool of clients to include the youngest and healthiest amongst us.  Since its origin from within the Heritage Foundation through the introduction of Clintoncare, Romneycare, and the creation of Medicare Part D (Rx) it has been widely accepted that plans that accept everyone (guaranteed issue) and that cover the most unhealthy (preexisting conditions) must be structured to incentivize participation by the entire eligible population.  The Individual Mandate only became a Republican strawman when the PPACA neared passage in 2010.

This blog has discussed the Texas lawsuit, the effort by 18 states and the Trump administration to declare the PPACA unconstitutional, in numerous posts.  We continue to cover it because the lawsuit’s success could eliminate coverage for nearly 54 million Americans with preexisting conditions and disrupt the way every one of us accesses and pays for health care.  Yes, all of us.  The elimination of Obamacare, its rules, its regulations, its heart, will impact individuals, employees covered by group health insurance, Medicare beneficiaries, and entire industries.   Over and above health, and that should be enough, we are also discussing about 20% of our economy.  But, I digress.  Mr. Trump is elated.

The Department of Health and Human Services (HHS), the part of this administration in charge of implementing our system had nothing to say about this latest court decision.  Here is the link to the department’s press releases of the last week.  If the Texas lawsuit succeeded, the nation would turn to HHS for a solution.  How would we cover preexisting conditions?  How would our system react?   As is so often in this administration, creating havoc is everyone’s job.  Solving problems is no one’s.

One of the parties in the lawsuit is the Association of American Physicians and Surgeons.  They aren’t just upset with Obamacare.  The AAPS is still fighting the creation of Medicare!   OY.

Though many legal scholars have derided the underlying legal argument at the heart of the Texas lawsuit, one would be foolish to rely on logic at a time like this.  Senator Lamar Alexander (R-TN), was quoted in a Kaiser Health News article as saying, “I am not aware of a single senator who said they were voting to repeal Obamacare when they voted to eliminate the individual mandate penalty”.  Yes, he was only trying to irreversibly damage the law.  He didn’t mean to kill it!  There are members of this administration that believe that dismantling the law would only impact residents in the 18 states pushing the lawsuit.  As noted recently, H B 390 was just introduced in the Ohio House to address these issues.  It is, at best, a start.

We just completed our annual Open Enrollment Period for individuals under age 65 and the Annual Enrollment Period for Medicare beneficiaries.  In truth, I’m exhausted.  But even more tiring is this struggle to make sure that Americans, at least the ones I impact, have health insurance, the way most of us access and pay for health care.  Yesterday’s breaking news was that the federal government and a group of states are working hard to destroy our health care system without any idea what would happen if, G-d forbid, they succeeded.

Oh yeah, there was another major news story yesterday, but this is an insurance blog!


Picture – Broken! – David L Cunix

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Still Waiting For A Real Solution

You are in the hospital preparing yourself, mentally, for surgery when a doctor enters pre-op.  He introduces himself as Doctor Jones, the anesthesiologist.  He has been asked to participate in today’s procedure.  He is NOT in your network.  This is no time to spring a surprise on you.  You are prepped and ready.  Dr. Jones is prepared.  He has a form for you to sign and he reads the first paragraph that includes these key points:

  1. The individual provider informs the covered person that the individual provider is not in the person’s health benefit plan provider network.
  2. The individual provider provides the covered person a good faith estimate of the cost of the health care services. This estimate shall contain a disclaimer that the covered person is not required to obtain the services at that location or from that individual provider.
  3. The covered person affirmatively consents to receive the health care services.

Here’s the question – Do you sign his form or do you put on your clothes and go home?                                                                                             

Those three points are directly taken from the current Surprise Billing legislation Ohio S B 198.  Until this loophole is removed, Ohioans will still be victimized by Surprise Billing.


Picture – You Had A Choice – David L Cunix

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First Aid

How big a Band-Aid do you need if you are attacked with a machete?  Today’s volunteer paramedics are Ohio House of Representatives Randi Clites (D-75) and Jeffrey Crossman (D-15).  Their bandage is the recently introduced 89 page House Bill 390.  The machete is Texas v. U.S., the lawsuit targeting the Patient Protection and Affordable Care Act (Obamacare).  They may need a bigger Band-Aid.

In an effort to save you time, here is the link to the Detailed Analysis provided by the Ohio Legislative Service Commission.  This is the Summary from the same site:

  • Repeals outright suspended provisions that allowed health insurers to pass on the cost of reinsurance to certain high risk individuals.
  • Codifies in state law the federal Patient Protection and Affordable Care Act’s (ACA’s) limitations on premium charges.
  • Codifies in state law the ACA’s ban of annual and lifetime limits.
  • Codifies in state law the ACA’s ban on preexisting condition exclusions.
  • Codifies in state law the ACA’s provisions requiring health plans to offer certain essential health benefits.
  • Codifies in state law the ACA’s cost sharing limitations.
  • Codifies in state law the ACA’s requirement that a health plan provide benefits that are actuarially equivalent to 60% of the full actuarial value of the benefits provided.

Legislation like this can be a tough slog to read.  It is a step by step process of affirming and / or amending sections of the Revised Code.  There are plenty of opportunities for both missteps and mischief in this type of bill.  Barb Gerken, the Chairperson of the Ohio Association of Health Underwriters’ Legislative Committee, immediately noticed that full-time employment had accidentally reverted to 25 hours per week.  That and other questions about Rx copayments were the first issues she noticed.  A careful reading will find other problems large and small.  Though there are lots of cosponsors, Democrats and Republicans, the final bill, if passed, will undergo significant changes before it might ever land on the governor’s desk.

House Bill 390 is an important first step.  The TV talk shows have featured numerous legal scholars who have derided the merits of the Texas lawsuit.  But the elected leaders of the State of Texas seemed determined to drag the rest of our country down to their level of health care insecurity.  Even if this lawsuit fails, there will be another.  A poker player only needs a “chip and a chair”.  Texas only needs an attorney and a lack of conscience.  We must applaud the efforts of Representatives Crossman and Clites.  In her testimony before the Ohio House Insurance Committee, Representative Clites cited her personal experience as the mother of a child who has endured major medical conditions.  It is estimated that nearly two million Ohioans suffer from a pre-existing condition that would threaten our ability to purchase health insurance.  We share her concern.  The question is whether the Insurance Committee’s Chairman, Representative Thomas E. Brinkman, Jr. (R-27), also shares our concern.

Eighteen states and the Trump White House are swinging a machete at our health care system.  It will take legislation, not Band-Aids, to protect us.  HB 390 is the first legislative step to help Ohioans retain access to health insurance, the way most of us access and pay for health care.  I’m looking forward to other serious proposals.  I just hope to see some soon.  That machete is too close for comfort.


Picture – It’s A Start – David L Cunix 

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I Got My Card!

It is no secret that I will turn 65 in February. My daily mail, the phone calls, and the pop-ups on Facebook are proof that my 65th birthday is eagerly anticipated by a whole host of marketers. And yet, we are all celebrating the same thing, my transition to Medicare.

Countless clients have nervously approached their enrollment into Medicare as if they were buying a house or, worse, unboxing a new cellphone. They thought that it would be confusing and difficult. I have been suggesting the same two options for years. One option is to simply go online to The other option was to go to the local Social Security office. Our local Social Security office (Beachwood, Ohio) has a great reputation for both efficient and respectful service. It was recently my turn to enroll in Medicare Part A and Part B.

Though it was tempting to just go to the Social Security office, I decided that I should try to enroll in Medicare online. The process begins up to three months before your birth month. On Friday, November 1st, I took the first step. The entire process, including registering on the Social Security website, took 20 minutes. It was easy, so easy I was actually worried that perhaps I had screwed up.

I received confirmation that the process had begun within days by both email and snail mail. On November 16th I received an oversized envelope in the mail. My card? I tore open the envelope to find the Extra Help forms. This program is designed to help financially challenged senior citizens pay the monthly premiums, annual deductibles, and co-payments for their Medicare prescription drug program. Thankfully, I don’t need Extra Help. But if I did, this form would have been a breeze to complete.

My Medicare Card came in yesterday’s mail! It took less than three weeks. There is no reason to be nervous. The process is not hard. Sometime in the next month I will apply for my Medicare Supplement and Medicare Part D (Rx). This couldn’t have been easier.

I started to pay in to Social Security and Medicare in 1970 at the age of 15. I never doubted that Medicare would be waiting for me to turn 65. Never. All of that faith has paid off.


Picture – The Newest Medicare Beneficiary – David L Cunix

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The Important News Was On Page 22


The front page of today’s Plain Dealer featured stories about algae, UAW workers second guessing their recent strike, and lead safety rules for child care centers.  Other stories were teased at the very top and bottom of the page.  But the news that will impact millions of Americans and a significant number of Greater Clevelanders was buried on Page 22.  Did you find it?  We now know the important Medicare changes for 2020.

  • Medicare Part B Premium – $144.60, an increase of $9.10 per month
  • Medicare Part A Deductible – $1,408
  • Medicare Part B Deductible – $198, an increase of $13

The Associated Press article by Ricardo Alonso-Zaldivar cited a statement from the Centers for Medicare and Medicaid Services (CMS) blaming these premium and deductible increases on “drugs administered in doctors’ offices.  Those medications are covered under the Part B outpatient benefit and include many cancer drugs”.

There was no mention of government funding, or that Medicare is unable to negotiate drug pricing, or any of the other issues contributing to the rising costs of health care.  Perhaps those are being held in reserve for the 2021 increases.

And when those increases are announced this time next year, don’t be surprised if they won’t be found in a Sunday paper on Page 22.


Picture – Ready For The Birdcage – David L Cunix

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