Health Care Update

Health Care Update

© GLOW IMAGES

by Don Ingwerson

I’m sharing what I hope is helpful and informative from christianscience.com on our interests in health care. Please click on this link at christianscience.com to read press articles about this health care issue, as well as video and text of recent House of Representatives debate on this current issue.

Armed With Spiritual Clarity on Capitol Hill

Armed With Spiritual Clarity on Capitol Hill

© GLOW IMAGES

by Don Ingwerson

For today’s blog I wanted to share with you a new metaphysical article from the Federal Committee on Publication site. This blog is about a December trip that Christian Scientists from Delaware took to visit Capitol Hill to talk to their representatives about a legislative effort  to promote an exemption to purchase health insurance as required by the Affordable Care Act. Josephine Bayard, an interior designer and owner of Plain and Fancy Interiors in Wilmington, initially felt a strong resistance to making the trip. She writes about how she worked through her sense of “I didn’t want to go” and ended up finishing the day thinking, “I’m glad I went.” This article can be found here: From “I didn’t want to go to I’m glad I went”: armed with spiritual clarity on Capitol Hill and is written by Josephine Bayard.

I didn’t want to go.

For so long I had felt inadequate, uninformed, and unwilling to try to represent Christian Science publicly. Finally, Christ broke through that resistance with the thought that Mrs. Eddy asked members to show up for various assignments on short notice regardless of their resume, obligations at home, or lack of self-confidence. I have always admired those early workers and now it was my turn.

Alfred Farlow’s metaphysical points were surprisingly relevant in 2013! His mention of fairness and justice struck me as all that we are asking of our legislators in their provisions for Christian Scientists. Considering our Constitution, fairness and justice are not too much to ask, and this strengthened my resolve and confidence in our mission.

His reminders to stay awake did keep me focused when my mind wandered during discussion of political ramifications. I could feel myself beginning to daydream about the artistry of the architecture, and lovely lunch we had shared. Very quickly Farlow’s words came to me, “my usefulness to the Cause is in proportion to my wakefulness.”

In preparing for the day, I noticed the story of the man healed of a withered hand in the lesson. I felt the Christ calling me to “stand forth” – stand up for what I knew to be the Truth, and “stretch forth” – extend my conviction beyond my comfort zone, trusting the Comforter, in the zone of divine Love, to govern man. Bearing witness to the patience and persistence of the Federal Office as it performs its vital work with our Congressmen and women, was evidence that the restoration of justice and fairness was and is going on.

The idea that “angels are God’s representatives” (see p. 299 ofScience and Health with Key to the Scriptures by Mary Baker Eddy) stayed with me that day as we watched the members of the House of Representatives voting and networking with each other. It was a precious opportunity to see government, prayer, and the Christ in action.

As a church member and constituent of my state, I look on that day with great gratitude for Christian Scientists working in Boston and Washington, and for our elected officials, committed to getting it right. There was definitely the presence of Mind in our meetings, and obvious prayerful preparation, leading to a collegial meeting and a successful result.

I’m glad I went.

 

How to be an Ambassador

How to be an Ambassador

© GLOW IMAGES Models used for illustrative purposes

by Don Ingwerson

Continuing to keep in touch with local and federal legislative representatives is vital to the unimpeded practice of Christian Science. The Federal office has shared some insights into this work in the article below, “An Insider’s Look at Capitol Hill and Christian Science.” I hope this information inspires you to become more active with your political leaders!

Have you ever wondered what Capitol Hill is really like, beneath the surface that’s portrayed in the media, and how this relates to the work of the U.S. Federal Office?

Recently, three Christian Scientists with experience working on Capitol Hill took time out of their very busy schedules to “come all the way off the Hill” and talk with Christian Scientists participating in Capitol Hill Day 2013. Their wealth of experience made for a fascinating insider’s look—especially as it relates to Christian Science on the Hill.

These individuals were Elizabeth Crow, a Policy Advisor to California’s Congressman Garamendi; Allison Rose, a professional staff member of the Committee on Science, Space and Technology in the House of Representatives; and Matt Sonnesyn, former Chief of Staff to Tennessee’s Senator Alexander and current Director of Research at the Business Roundtable.

Before the conversation even started, the audience got a taste of what a Capitol Hill staffer’s life is like: holding up her BlackBerry, Allison mentioned that she would “literally have to be checking this” throughout the panel. “The day in the life of a staff person, whether in a personal office of a Congressman or as a committee staffer, is 24/7,” Allison explained.

But Elizabeth made a key point: despite their very full plates, Members of Congress and their staffs really do “want to hear the issues and want to do good.” Later, Matt echoed this sentiment: “These offices are receptive to good. Most of the people you will encounter on the Hill are there because they want to make a difference,” he said.

We have experienced this firsthand: while each meeting is different, most offices Christian Scientists have met with have been genuinely interested in talking with us and learning about how we approach topics like health and well-being, even though in the grand scheme of things, this may not be a top legislative priority for them.

But has this translated into making real progress in our mission as the Committee on Publication? According to Matt, the Church’s activity on Capitol Hill has had a significant impact:

“As someone who has been on the Hill for ten years, I can tell you that when I came to Washington, there was no presence of our church on the Hill that I was aware of for at least five years. The last five years—everyone knows about the presence of our Church and it is positive.”

When you think about it, that’s pretty outstanding—and bears testament to the value of the hundreds of Congressional meetings that Church members throughout the country have participated in. It’s not only about achieving support for specific legislative goals; it’s about building bridges with legislators, bringing to legislators and their staffs an understanding of Christian Science, maintaining a presence on Capitol Hill such that Christian Science is seen as having a legitimate and valuable contribution to make in conversations about health care.

Christian Scientists, then, have an important role in educating their representatives. As Allison put it, “You are the best ambassador for [educating Members about Christian Science]. You are a voter, you are in their district, you do make a difference to them. Your presence is very much appreciated on many levels, whether you’re aware of it in the immediate meeting or not.”

Legislative Calendar for 2014

Legislative Calendar for 2014

© GLOW IMAGES

by Don Ingwerson

Here is the California legislative calendar for 2014 for your information! I’ve received some comments in the past that this information is helpful!

Jan. 01, 2014              Statutes take effect.

Jan. 06, 2014              Legislature reconvenes.

Jan. 10, 2014              Budget Bill must be submitted by Governor.

Jan. 17, 2014               Last day for policy committees to meet and report to bills introduced in their house in 2013 for referral to fiscal committees.

Jan. 20, 2014              Martin Luther King, Jr. Day observed.

Jan. 24, 2014              Last day to submit bill requests to the Office of Legislative Counsel.

Jan. 24, 2014              Last day for any committee to meet and report to the Floor bills introduced in their house in the 2013.

Jan. 31, 2014              Last day for each house to pass bills introduced in their house in 2013.

Feb. 17, 2014              Presidents’ Day observed.

Feb. 21, 2014              Last day for bills to be introduced.

Mar. 31, 2014             Cesar Chavez Day observed.

Apr. 10, 2014             Spring Recess begins upon adjournment.

Apr. 21, 2014             Legislature reconvenes from Spring Recess.

May. 02, 2014            Last day for policy committees to meet and report to Fiscal Committees fiscal bills introduced in their house.

May. 09, 2014            Last day for policy committees to meet and report to the floor non-fiscal bills introduced in their house.

May. 16, 2014            Last day for policy committees to meet prior to June 2.

May. 23, 2014            Last day for fiscal committees to meet and report to the floor bills introduced in their house.

May. 23, 2014            Last day for fiscal committees to meet prior to June 2.

May. 26, 2014            Memorial Day observed.

May. 27-30, 2014      Floor session only. No committee may meet for any purpose, through May 30, 2014.

May. 30, 2014            Last day to pass bills out of the house of origin.

Jun. 02, 2014             Committee meetings may resume.

Jun. 15, 2014              Budget bill must be passed by midnight.

Jun. 26, 2014             Last day for a legislative measure to qualify for the Nov. 4 General Election ballot.

Jun. 27, 2014              Last day for policy committees to meet and report bills.

Jul. 03, 2014               Summer Recess begins upon adjournment, provided Budget Bill has been passed.

Jul. 04, 2014               Independence Day observed.

Aug. 04, 2014             Legislature reconvenes from Summer Recess.

Aug. 15, 2014             Last day for fiscal committees to meet and report bills to the floor.

Aug. 18-31, 2014        Floor session only. No committee may meet for any purpose.

Aug. 22, 2014             Last day to amend bills on the Floor.

Aug. 31, 2014             Last day for each house to pass bills. Recess begins upon adjournment.

Sep. 30, 2014             Last day for Governor to sign or veto bills passed by the Legislature before Sept. 1 and in the Governor’s possession on or after Sept. 1.

Oct. 02, 2014              Non-urgency bills enacted on or before this date take effect January 1, 2015.

Nov. 04, 2014             General Election.

Nov. 30, 2014             Adjournment sine die at midnight.

Dec. 01, 2014              2015-16 Regular Session convenes for Organizational Session at 12 noon.

Jan. 01, 2015               Statutes take effect.

Advice From Teddy Roosevelt

Advice From Teddy Roosevelt

© GLOW IMAGES
Models used for illustrative purposes

by Don Ingwerson

My Thursday blogs have most often been on some aspect of legislative or media work – and lately most of these blogs have been around the subject of the Affordable Care Act. But today I want to share with you an interesting Christian Science Monitor article about working together – since the government is still working to end the shut down and needs our prayers. The article is titled, “Advice from Teddy Roosevelt as Congress heads toward debt shutdown deal” and is written by Danny Heitman:

To end their political brinkmanship, today’s leaders in Washington need as much good advice as they can find. One promising source of wisdom is Theodore Roosevelt, who left the presidency more than a century ago. Roosevelt led the country from 1901 to 1909, and he’ll get a renewed profile with the November release of “The Bully Pulpit,” the book about his tumultuous times by historian Doris Kearns Goodwin. But lately, instead of Roosevelt’s political battles, I’ve been thinking about his efforts to seek out fellow citizens across party lines, and divisions of class, creed, and culture, too. As the government grapples with shutdown and debt, his thoughts on collegiality and politics, outlined in a January 1900 article for Century Magazine, seem as timely now as when they were first printed. (Read More)

Former Intern Discusses the ACA

Former Intern Discusses the ACA

© GLOW IMAGES
Model used for illustrative purposes

Elodie Reed, the Government Relations Division’s Summer 2013 intern, is now a reporter for New Hampshire’s Monadnock Ledger-Transcript. In her hot-off-the-press article, “Find a health care voice: The individual mandate, individualized,” Elodie discusses Christian Scientists and the Affordable Care Act.

Check out Elodie’s article!

You may also be interested in Elodie’s metaphysical perspective on her summer interning with the Government Relations Division: “Understanding government: an intern’s perspective”.

Affordable Care Act Updates

Affordable Care Act Updates

© GLOW IMAGES

by Don Ingwerson

We’re coming down to the home stretch in terms of the implementation of the Affordable Care Act and many questions are still being asked. The Federal Office hosted an online Town Hall Meeting titled “The Affordable Care Act and You” on September 24th and for anyone who wants to review it or missed it the first time, there is a replay available. I also wanted to give you some new information and helpful links on the state insurance marketplaces that opened up October 1:

“The Affordable Care Act and You”: the replay

  • learn about how you can prepare for Jan. 1 and what options currently exist for Christian Scientists
  • find the answers to your questions
  • hear inspiring remarks from Margaret Rogers of the Christian Science Board of Directors.

Over 2300 computers, tablets, and phones tuned in during the live event, from Alaska and Hawaii to Montana to Maine and everywhere in between—and in many cases, branch church congregations and other groups were listening together. Here’s what a few of these listeners wrote us after the event:

  • “Thanks so much for this informative session….Thank you also for ending the meeting with the wonderful treatment from Margaret Rogers.”
  • “This was such an interesting program. I have not followed any of this before and so it is a wake up call for me to pay attention and get educated to make choices for myself.”
  • “I am so glad I took the time to listen. This was so helpful in answering questions about the ACA and it’s good to know so much is being done toward practical solutions for Christian Scientists.”

Check out the replay!

ACA update: state insurance marketplaces open October 1, 2013

The Affordable Care Act requires that most Americans obtain qualifying medical health insurance starting Jan. 1, 2014, and also provides for online state health insurance exchanges (marketplaces). Here, individuals can compare and enroll in insurance plans (and find out whether they are eligible for federal subsidies to purchase insurance).

For individuals who would like to purchase an insurance plan in the online marketplace, Oct. 1 marks the first day of open enrollment, which will continue until March 31, 2014.

Note that the government shutdown does not affect the functioning of the exchanges.

For more information about your state’s exchange, visit www.healthcare.gov. The marketplace also has a 24/7 customer call center (800-318-2596) to answer questions, as well as a website with information.

Other ACA-related questions? Check out our FAQs and Resources web pages!

Upcoming Congressional Meetings

Upcoming Congressional Meetings

© GLOW IMAGES
Models used for illustrative purposes

by Don Ingwerson

As you know, putting a face to Christian Science is important! With this in mind, coming up this week, selected assistant committees and local church members will be meeting with several members of congress – who are home during their recess from duties in Washington D C. – about the ACA (Affordable Care Act).  Not only are these people and their efforts important to the Cause, but others not personally involved in these meetings are also important. To read more about personally getting involved in the Committee work, click on the Christian Science Federal Office link: Get Involved

Health Care FAQs Update

Health Care FAQs Update

© GLOW IMAGES

by Don Ingwerson

Last year the Federal Committee on Publication office put out questions and answers on Christian Science and the Affordable Care Act. I posted it on the blog at the time, but I just noticed that there are some additional questions and answers that have been added, and reviewing all of the answers may be helpful to you as well. So here is the updated Q&A. If you want to read this on the Federal Committee on Publication site, click here: Frequently asked questions.

1. How is the U.S. Federal Office responding to the Patient Protection and Affordable Care Act (the ACA), which was signed into law in March 2010?

We are actively seeking appropriate ways for a religious accommodation and/or exception to be recognized in the new health care reform law. For example, the U.S. Federal Office is continuing to:

A) request that the Department of Health and Human Services (HHS) include the coverage of spiritual care services, including Christian Science practitioner and Christian Science nursing (including facility) services, in the benefits that will be offered by health insurance companies under the new law; and

B) seek a legislative solution with Congress that would allow anyone with a “sincerely held religious belief” against the federally mandated health insurance coverage to be exempt from the tax penalty for failing to have the required coverage.

We feel both of these initiatives are important components of an overall solution to the inequity Christian Scientists face under the ACA.

2. Doesn’t the ACA already contain a religious opt-out or an accommodation for Christian Scientists and others who use spiritual care services for their health?

No. The 2010 Patient Protection and Affordable Care Act includes neither a religious opt-out nor an accommodation from the health insurance mandate for those who use spiritual care to meet their health needs.

Accordingly, there is no requirement that Christian Science practitioners and Christian Science nursing services be covered and reimbursed in health insurance plans under the new legislation. However, neither is there anything in the legislation that would restrict or eliminate existing provisions in the law that recognize spiritual care or that would prohibit insurance plans participating in the new health insurance exchanges from offering coverage for spiritual care.

In earlier stages of the legislation, several committees in the House and Senate adopted a “religious non-discrimination” provision that the Committee on Publication had requested. The provision was designed to prevent insurance companies from arbitrarily discriminating against spiritual care services, including the reimbursement of Christian Science practitioner and nursing services. However, the non-discrimination provision was not included in the final health care legislation.

3. Was there opposition to finding a legislative solution for Christian Scientists under the new law?

Yes. We are working to address misperceptions held by some atheist groups, separation-of-church-and-state organizations, and long-time critics of the Christian Science Church, who do not support accommodating those who use spiritual care services.

4. If there is no religious exemption or accommodation from the health insurance mandate for those who use spiritual care, what effect might this have on Christian Scientists? When does the new law take effect?

Most aspects of the legislation, including the health insurance mandate, do not begin to take effect until 2014. And many of the details of what is included in the legislation will be determined over the next few years by federal regulators and subsequent legislation. Accordingly, the responses we’re providing here are based on information that’s available now and is subject to change.

We’ve been assured by members of Congress that nothing in the new legislation is intended to minimize or reduce existing provisions in the law that recognize spiritual care, and that nothing in the new legislation is meant to prohibit insurance companies from covering spiritual care.

One of the provisions that will impact all Americans, including Christian Scientists, is a requirement that individuals who choose not to obtain the mandated health insurance pay a yearly penalty unless they can show they’re exempt or covered by qualifying health insurance. This penalty will be phased in over a number of years. Starting in 2014, the penalty would be the greater of $95 per year per individual or 1 percent of modified adjusted gross income and would increase annually, rising to $695 or 2.5% of income in 2016.

5. To what extent do U.S. federal, state, and private health insurance plans already provide for the reimbursement of spiritual care and treatment services?

Here are some examples that may be of interest to you:

• 17 Christian Science nursing facilities are Medicare providers.  So, individuals who are eligible for Medicare Part A coverage can receive reimbursement for Christian Science nursing care at those facilities. This benefit has been in place for over forty years.

• If you work for the U.S. government as a civilian employee you have the option of choosing from four Federal Employee Health Benefit (FEHB) plans that cover Christian Science nursing/practitioner care: 1) the Government Employees Health Association (GEHA) plan; 2) the Mail Handlers Benefit Plan; 3) the Compass Rose Health Plan; and 4) the Special Agent Mutual Benefit Association (SAMBA) plan.

• If you are a member or a dependent of a member of the U.S. armed forces, you may qualify for the TRICARE insurance program, which covers Christian Science nursing care and Christian Science practitioner treatment.

• If you are a state employee in the following states, then Christian Science nursing and practitioner services may be available to you under your state employee insurance plan: California, Colorado, Illinois, Kansas, Missouri, Oklahoma, Oregon, and Texas.

• Christian Science practitioner and nursing services also qualify as tax-deductible medical expenses under the income tax deduction provided for in Section 213(d) of the IRS code.  Because of this designation, individuals who have health savings accounts (HSAs) or flexible spending accounts (FSAs) and contribute money to them may use pre-tax dollars to pay for Christian Science practitioner and nursing services.

• Several private insurance plans and self-insured companies include Christian Science nursing and practitioner services as a reimbursable benefit. A few of these companies are AETNA, Blue Cross/Blue Shield, CIGNA, Ford, GE, IBM, Intel, and the Tufts Health Plan.

Visit our insurance page for more information on this subject.

Currently, trying to get a claim processed for Christian Science nursing and practitioner services under any of these public or private insurance plans is difficult. There are a number of reasons for this. Overall, a small number of claims are made for Christian Science health care services, so public and private insurers are unfamiliar with them.  In addition, the health care industry’s coding system for electronically processing these claims does not contain accurate codes for Christian Science health care services. As a result, Christian Science insurance claims have to be processed manually, which is a time-consuming and expensive process for insurance providers. We are diligently working to remove these barriers to achieve the efficient processing of health insurance claims by Christian Scientists.

6. Currently, is there any basis on which Christian Scientists may be exempt from the requirement to purchase health insurance under the new law?

Yes, but it depends on their situations. Christian Scientists are not exempt on religious grounds, though various media outlets have incorrectly reported they are. However, under the new legislation, it appears that individuals—including Christian Scientists—who meet the following criteria will not be required to purchase health insurance or pay a penalty for failing to do so:

• individuals aged 65+ (because they’re automatically enrolled in Medicare Part A)
• Medicaid recipients
• members of the U.S. Armed Forces and their dependents
• U.S. military retirees

In addition, there are exemptions from the requirement to buy health insurance for the Amish (see FAQ #7), members of health care sharing ministries (another group that objects to having insurance and provides for the health care expenses of its members), Native Americans, and persons eligible for a hardship exemption due to limited income.

7. Isn’t there some kind of general religious exemption from the requirement to purchase health insurance under the legislation?

No. While there is a “religious conscience exemption” from the health insurance mandate, it applies primarily to individuals who are of the Amish faith. The exemption has the following requirements:

• The individual must be a member of a religious group whose tenets and teachings establish that its members are conscientiously opposed to receiving any benefits of private or public insurance, including Social Security and Medicare benefits.
• The individual must waive all Social Security and Medicare benefits.
• The religious organization must pay for the health care and disability costs of its members.

8. Why did Congress agree to provide a religious exemption for the Amish and not for Christian Scientists?

The ACA religious exemption language was lifted directly from a preexisting exemption included in the Internal Revenue Code, which excluded the Amish and other religious groups from participating in Social Security, Medicare, and other social programs. This exception for the Amish carried over to the ACA because the Amish have a religious objection to carrying insurance of any kind. Furthermore, the Amish often provide for the health care expenses of their own members.

9. What are state exchanges?

The ACA generally requires that all states have health insurance exchanges in place by January 2014. Essentially, state exchanges are health insurance marketplaces where individuals and small businesses can compare and enroll in insurance plans (and can find out if they are eligible for federal subsidies to purchase insurance). Massachusetts and Utah already had exchanges in place before the ACA was passed (Massachusetts’s is most similar to the ACA concept of a state exchange). The Department of Health and Human Services (HHS) has left a fair amount of discretion to the states regarding the creation of their individual exchanges, but if a state fails to create an exchange, it falls to HHS to provide it.

10. Did the Church consider participating in the U.S. Supreme Court case regarding the health care law?

The Church weighed very carefully and prayerfully the idea of filing an amicus, or friend-of-the-court, brief. Two of the factors that led to the ultimate decision not to file a brief were that the none of the lawsuits that were before the U.S. Supreme Court for decision raised any claims involving freedom of religion, and secondly, the Court itself did not designate religious freedom as an issue it wanted the attorneys to brief. (See our article on the Supreme Court oral arguments for more information about the four issues the Supreme Court agreed to hear.) Additionally, though several religious challenges to the law were filed in the lower federal courts (e.g., Mead v. Holder, 766 F. Supp. 2d 16 (2011), and Liberty v. Geithner, 753 F. Supp. 2d 611 (2011)), none had made its way up to the Supreme Court for oral argument, briefing, and hearing.

11. Has the Church considered filing a lawsuit to challenge the health care reform law?

Christian Scientists are neither accommodated nor exempted under the Affordable Care Act. That’s an anomaly because there’s a longstanding history of accommodation and recognition of Christian Science health care services by the federal government. In view of that significant precedent, the Church has chosen for now to participate in the democratic process, working with the Administration and Congress to resolve the dilemma facing Christian Scientists under the ACA, rather than filing suit. Truly, our willingness to work in this way has earned us much good will and has provided significant opportunities to provide accurate information about Christian Science. We’re encouraged by the good progress we’re making.The democratic process can be very rewarding, yet it always requires patience. We will continue to stand firmly for religious liberty; and the Church preserves all options regarding its response to the ACA.

12. Would the Serving Christian Scientists, Inc (“SCS”) plans qualify under the health care reform law?

We recommend that you be in touch with SCS directly about this. As it stands now, it looks like the SCS benefit plans do not cover all of the benefit categories that must be covered by a qualifying plan under the Affordable Care Act. This is true not just of SCS’s plans, but other “high deductible” insurance plans too. That said, it’s possible that SCS could adjust their insurance offerings before 2014 to meet the new standards and regulations that are still being written.

13. Is there a religious accommodation regarding elder care in the health care reform law?

Yes. The legislation creates a new Elder Justice program to help prevent the neglect of elders. This section provides that nothing in the new law is intended to interfere with an elder’s right to practice his or her religion through reliance on prayer alone for healing. This religious accommodation was originally contained in the Older Americans Act and has been a part of several elder justice bills.

14. Does the existing accommodation for Christian Science practitioners and Readers under the Social Security law still continue?

Yes. The new legislation does not appear to affect the ability of Christian Science practitioners and Readers to claim an exemption from paying into and receiving benefits from the Social Security system. The practitioner or Reader must file a form with the Internal Revenue Service that states that he or she is conscientiously opposed to receiving the benefits of any public insurance.

15. I’m already enrolled in Medicare Part A—do I need to purchase additional insurance to meet the requirements of the ACA?

No. Medicare Part A satisfies the ACA’s “individual mandate” requirement.

How the ACA Affects You

How the ACA Affects You

© GLOW IMAGES

by Don Ingwerson

We have less than a year to go before the ACA (Affordable Care Act) goes into effect. I’ve noticed many news articles that show many people still have questions about what this means for them. A post by the Federal Committee on Publication site tries to alleviate the confusion by appointing someone as the lead person to answer questions from the Field. Here is the post by the Federal office and it can also be read directly from their site by clicking Questions about the Affordable Care Act (ACA) and how it affects you:

The Church’s Office of the General Counsel has hired an individual to help communicate with the Field about this topic. This person is Roger Whiteway, whom some of you may also recognize as the Committee on Publication for Virginia. Roger will certainly not be the sole point of communication with the Field. He will be responding to questions and issues along with others, including those working in our office.

We will continue to send regular updates, including notices of online information sessions, via our newsletters.

There are multiple resources available to you, including: