Join our email list to receive news updates on Blue Cross Blue Shield at Children's

Blue Cross Blue Shield will drastically curtail its coverage of health care to BC/BS members using Children's Hospital

Reportedly, Blue Cross Blue Shield will drastically curtail its coverage of health care to BC/BS members using Children's Hospital originally schedule on January 1, 2003.  On December 18, the deadline for coverage was extended through January 31, 2003.  Once the scheduled change occurs, for some, this means that there will be no covered visits at all when patients use Children's for health care.  For others, it will mean that they will have to pay a much higher co-payment than they currently do.  Read more about this issue in a recent media article.  Read statement by Children's Hospital about this plan termination.

send an email to relevant government officials and insurance executives to urge them to keep Blue Cross/Blue Shield at Children's Hospital.

You can do something to stop this!  While the details of this problem are still unfolding, we urge you to RIGHT NOW send an email to relevant government officials and insurance executives to urge them to keep Blue Cross/Blue Shield at Children's Hospital.

Why Oppose the Conversion to For-Profit?

Please click here to read David Catania's legislation to prohibit the conversion of CareFirst to a For-Profit.

  Why  Keep Blue Cross at Children's Hospital of D.C.!

Do most major insurance companies cover visits to Children's Hospital?

THIS IS UNPRECEDENTED! Most major area insurance companies provide insurance coverage to insured people for health services received at Children's Hospital. 

What is CareFirst?

It is the name of the still non-profit holding company that owns our local BlueCross BlueShield.  Chartered in Maryland, CareFirst reports that the company has 6,400 medical associates.  CareFirst, Inc. is managed and controlled by a Board of Directors. The company operates through its three wholly owned affiliates: CareFirst of Maryland, Inc., and Group Hospitalization and Medical Services, Inc., doing business in the Washington, D.C. area under the name CareFirst BlueCross BlueShield; and BCBS, Inc., doing business as Blue Cross Blue Shield of Delaware.

How many people will be affected by this departure of BCBS from Children's?

According to CareFirst, it is has affiliates that provide health care and related services to nearly 3.2 million members in the Mid-Atlantic region. There are no figures available to determine how many of these members are children.  We assume the number is substantial.

How will children with BlueCross insurance continue to access Children's Hospital once BCBS leaves Children's?

Children's has advised current patients to switch to a different health insurance plan.  Clearly many families are locked in to BlueCross because the employer of the family's policy holder offers insurance exclusively under BlueCross BlueShield.  Such families will have to look for pediatric care outside Children's Hospital or pay out-of-pocket to continue to use Children's Hospital.

BlueCross has advised its members to switch to health care providers who use hospitals other than Children's.  This raises some concern among area residents whose children have special needs or who want the high quality expert specialty care available exclusively at Children's.  Among the many providers suggested by BlueCross is Johns Hopkins, located in Baltimore, Maryland, which is anywhere from 45 minutes to an hour's drive from most locations in Washington, D.C.. Travel there would likely require greater expense and time from families who currently use Children's Hospital and Children's Outpatient Centers, Children's Ambulatory Surgery Center, and Children's specialty doctors that are geographically accessible to Children's patients.

Will this termination of BCBS coverage diminish the quality of care for many of the Washington community's children?

CHILDREN'S HOSPITAL NEEDS BCBS TO CONTINUE ITS EXCELLENT CARE OF ALL CHILDREN! Children's Hospital is the preeminent service provider of health care to sick children in the region.  In addition to providing top notch professional care, Children's provides the critical and honorable community service of granting urgent care to children without regard to ability to pay.  Insured or uninsured, the sick child who shows up at Children's can count on first-rate quality care for critical needs.  Children's also serves health needs of poor children for non-emergent care as well.

How does this relate to the larger issue of inadequate health for Americans?

HEALTH INSURANCE SHRINKAGE HAS BEEN DEVASTATING POOR AND WORKING AMERICANS FOR YEARS.  NOW THE SHRINKAGE THREATENS TO SQUEEZE US ALL!

The BCBS withdrawal of coverage exemplifies problems with the overall insurance industry. THE OVERALL INSURANCE INDUSTRY TREND has been to withdraw the safety net of health insurance from working and poor people locally and nation-wide.

Email Decision-makers Now.

Locally, how does this fit in with the other developments in health care delivery by the city - the financial crisis that endangers Greater Southeast and the significant contraction of services that has virtually closed D.C. General?

Clearly this is one more shrinkage the citizens can ill afford.

Also, as described above, CareFirst BlueCross BlueShield of Maryland (covering D.C., Md and Delaware policy holders) recently initiated conversion to for-profit status. This is likely to impact a community with a growing number of losses in its health care provider community.  Sharon Ambrose, D.C. Councilmember, chairs the committee - Consumer and Regulatory Affairs - that legislates around and oversees the regulation of such conversions.  The Commissioner of Insurance Regulation must approve conversion to for-profit status.  D.C. Appleseed, a research and advocacy group, is a party to the conversion process and with the Care First Watch Coalition seeks to safeguard the health and welfare of the public affected by the conversion bid of the area's largest insurance carrier. 

Is there a connection between the CareFirst/Blue Cross proposal to convert to a for-profit company and this departure of BCBS from Children's?  What does Maryland Health Insurance Commissioner Steve Larsen have to do with any of this?

Questions exist around the potential connection between this conversion and the current plan to withdraw from Children's.  Is this a change in service that the Blue Cross of Maryland asserted would not take place under its current conversion scheme?  Is this an attempt to cut or shift costs? 

Lobbyline urges Councilmember Ambrose, the chair of the Council committee responsible for conversion process laws and regulations, to ask BlueCross to halt its plans to leave Children's at least until the conversion application process is complete. The conversion application process is complex and designed to ensure the welfare of the public.  It leaves room for grave concern that such a drastic change in health care services for such a large number of the most vulnerable of our city - children - could be contemplated when BlueCross is involved in a process that requires it to minimize the detrimental impact of such changes on the community.

Visit these sites for more details on the conversion/privatization process currently underway to change BlueCross into a for-profit.

-  CareFirst Watch;

-  D.C. Appleseed Report

How will this affect health care for children in the city?

This means that thousands of D.C. children will lose access to the area's top notch health facility uniquely designed and staffed to handle the specialized needs of children. It will further shrink the ever-reducing pool of health providers for children, leading eventually to more expensive health care for members of all health plans.  Children will lose also because the research of Children's will suffer when Children's is forced to cut costs to make up for losses in revenue generated by the departure of Blue Cross and its members.  The poor will lose because there will exist fewer resources all around. The uninsured poor, mainly the illegal immigrant community currently may turn to Children's for health care in spite of their insurance status.

What can you do about this?

Please do something about it. Either you or someone you know will be affected by this! Here is how to do something about this - visit www.lobbyline.com/bcbs4children.htm.  This website allows you to write a letter of your own or mail the default form letter to all of the relevant hospital, insurance and government officials.  Please edit the default letter to reflect your own sentiments. D.C. licenses and regulates health insurance provision.  Lobbyline is organizing citizens to ask that Children's, Blue Cross Blue Shield return to the negotiating table, delay the scheduled termination date of December 31, 2002.  We are also asking that D.C. Council members Sharon Ambrose and Sandy Allen hold public hearings and help broker a deal between Children's And Blue Cross officials.

Email decision-makers now.

Will this affect just Blue Cross Members?  In the short term, yes.  In the long run, it affects us all!

If the largest insurance carrier in this area leaves Children's, it will probably lead to premium hikes for all the other insurance plans who cover visits to Children's.  Children's will probably raise the rates it charges other insurance providers.  This will come out of all of our pockets. Children's might have to cut back on the services, the doctors, the research, and sadly the free access it gives to indigent children who now receive care regardless of their insurance status.

 ASK QUESTIONS!  SEEK ANSWERS TO THE QUESTIONS SURROUNDING BCBS' WITHDRAWAL FROM CHILDREN'S!

You have a right to ask questions.  Insurance companies are government regulated, and must be responsive to their members and abide by rules meant to protect their members and the public at large. 

 Please email decision-makers now!

What is at the bottom of the dispute between CareFirst and Children's? 

A memo from a member of the CareFirst Watch coalition Member: (www.carefirstwatch.com).

This email provides background on the rate setting dispute that is at the heart of
the Children's and CareFirst negotiation impasse.  The following email originated
with a member of the CareFirst Watch coalition, an invaluable source of
information about the conversion issue www.carefirstwatch.com.

Date: Thursday, December 12, 2002 10:19 AM
 Subject: Children's Hospital
"I called Children's yesterday for some background on rates they get
from various insurers and am writing to share the info. They said that
they successfully reconstructed with Kaiser in the spring and Aetna a
year ago and are satisfied with the rates and inflators in those
contracts. They do not foresee problems with other insurers in the near
future, and CareFirst has represented a much larger share of their
business than others.

In aggregate, other plans come close to meeting
their costs, while they say CareFirst is 27% below costs. The increase
they requested from CareFirst is also a higher percent increase than
they received from other plans, because previously they were on a
three-year contract with CareFirst that ended at lower rates. They say
the January 2000 rates didn't fully cover costs, but they had a decent
increase built into their first year, and unfortunately didn't put in
adequate inflationary adjusters the second and third years.

CareFirst's payment method to them is different than other insurers -
CareFirst pays based on DRGs (diagnostic referral groups - a system used
nationally by Medicare, although actually Medicare pays Children's on a
different basis.) Children's says that CareFirst's comparisons of their
rates with other hospitals' rates doesn't look at their case mix and
that they haven't explained how they compare to the only other
children's hospital in the network, which is Dupont's in Delaware.
 

I asked why Children's also did not reach an agreement with Medicaid
 managed care for behavioral health in DC (Value Options) - they say that
Medicaid had paid them about 30% more when they were a fee-for-service
provider than Value Options offered. I asked about Children's nonprofit status

 and what they had to prove to regulators about their own finances. They have to provide community benefits; any excess of revenue to expenses must go back to the nonprofit mission; their 990 filings are available to the public. For
more info, contact their legal office." End (Memo on rates at the center of the Children's CareFirst dispute).

March 6, 2003,

 Commentary

The Insurance Commissioner of Maryland has denied the CareFirst conversion bid, as he should have done. We have seen what profit motives can do to the mission of an insurance provider. It can rip away the care from an entity that prides itself on care first. It can place second the health of a community by an entity that prides itself on prioritizing the community's health first. If CareFirst for-profit-to-be can be drawn to business deals that jeopardize the health of the community's children - CareFirst the for-profit indeed can do far worse. Don't allow the conversion. We want to enlarge, not shrink health coverage for our most vulnerable uninsured and insured population.   Read more here: http://www.washingtonpost.com/wp-dyn/articles/A48264-2003Mar5.html.

Lobbyline Commentary

February 1, 2003

Lobbyline is pleased to announce that its new paradigm of local civic involvement has contributed to the renewal of a 3 year contract between D.C. Children's Hospital and CareFirst BlueCross BlueShield.  Using our favorite and widely read outlet of The mail at D.C. Watch, we are humbled to have been able to conduct an advocacy campaign whose work included supporting CareFirst parent advocates, public education and outreach and channeling individual emails and administrative complaints through our website to corporate and government legislators and regulators to push the parties to the new deal. This renewal - whose terms are still being reviewed for changes to the old contract - are said to immediately benefit at least 7800 families- many of whom have critically ill and disabled children and who actively use Children's Hospital.  This renewal makes again accessible to Children's Hospital a total of 3.2 million CareFirst subscribers in the Mid-Atlantic region overall.  To all of the readers and supporters of TheMail I give the salute of Susan Gushue, a CareFirst policyholder parent who says "Thank you so much.  I have children who suffer from asthma and seizure disorder and the thought that we would not be able to use Children's was terrifying.  Thank you , thank you , thank you."    

Although leadership on this issue among Washington officials was non-existent, other officials throughout the Metro region stepped up to the plate.  To give thanks to any involved officials on this issue, please visit www.lobbyline.com and send our draft email or modify it to create a letter of your own.  You can even print and mail the letter from the website.

 THE FOR-PROFIT CONVERSION AND A HEALTH CARE OMBUDSMAN

 Let's hope that our local officials will be more responsive to the will of the public on the issue underlying this near-disaster with Children's.  Let's hope that D.C. officials will now clearly see the need to prevent the for-profit conversion bid of CareFirst, which continues despite the deal between Chlidren's and CareFirst.  The ill effects of a conversion are most evident in what almost happened in the Children's case.  Advocates for health care for the poor and small and individual policyholders must fight the conversion of CareFirst BlueCross BlueShield.  We have seen what profit motives can do to the mission of an insurance provider.  It can rip away the care from an entity that prides itself on care first.  It can place second the health of a community by an entity that prides itself on prioritizing the community's health first.

 If CareFirst for-profit-to-be can be drawn to business deals that jeopardize the health of the community's children - CareFirst the for-profit indeed can do far worse.  Let's oppose the conversion.  We want to enlarge, not shrink health coverage for our most vulnerable uninsured and insured population.  For more information on the conversion, contact Sam Jordan of Health Care Now! at www.healthcarenowdc.org and go to www.carefirstwatch.org.

 In addition, our experiences this last month illustrate the real need for a health care ombudsman for D.C.  Families USA have been toiling with others for the addition of this much needed post.  In conjunction with organizations like that of Sam Jordan, of Health Care Now, whose aim is to further the cause "to rationalize health care in the Washington Metropolitan area and across the nation,"  Lobbyline counts advocacy of a health care ombudsman among its future projects.

 Lobbyline's mission is to use a combination of the best web-based technology and traditional advocacy strategies to train and empower citizens on the local level to influence corporate and government decision-makers in order to benefit their local and national communities. 

 DID YOU FILE A COMPLAINT? 

Did you file an administrative complaint regarding the CareFirst-Children's matter with the Washington, Virginia, or Maryland insurance commissioners, complaining about deceptive marketing practices by Care First in the fall/winter of 2002, during enrollment periods?  In light of the contract extension, your complaint may be affected.  Please feel free to contact Sue Frazier-Harris at worknomoresue@hotmail.com regarding developments in this regard.

NEWS RELEASE:  Children's Hospital

FOR IMMEDIATE RELEASE                                                            Contact:  Jacqueline Bowens

January 27, 2003                                                                                                 202-884-4500

  Three-year agreement ensures that Children’s remains in insurer’s network 

WASHINGTON, D.C. (January 27, 2003) -- CareFirst BlueCross BlueShield and Children’s National Medical Center today announced that they had reached agreement on a new three-year contract that ends almost three months of uncertainty over whether the pediatric specialty hospital would remain in the provider networks of the region’s largest health insurer.

The contract provides CareFirst's nearly 2 million greater Washington-area members continued access at network rates to Children's Hospital, its 300 pediatric specialists, six regional outpatient centers, and ambulatory surgery center.

In keeping with corporate policy of not discussing details of contracts, CareFirst and Children’s officials said the terms of the agreement represented compromise from both organizations. The agreement supports the best interests of the children both organizations serve, while supporting the financial objectives of both CareFirst and Children’s Hospital.

Unable to reach agreement before their contract was to expire, both organizations agreed in December to extend the existing agreement through the end of January.  The additional negotiating time enabled both sides to gain a greater understanding of the financial and operational challenges facing both organizations.

“Under this agreement, CareFirst’s reimbursements to Children’s Hospital will fall within the general framework of fees for comparable high quality, cost-effective pediatric services at other network facilities, including Johns Hopkins and the University of Maryland Medical System,” according to David D. Wolf, CareFirst’s executive vice president for medical services and corporate development.

 Edwin K. Zechman, Jr., president and CEO of Children’s, added, “Throughout the negotiations, both organizations worked toward a common goal of ensuring that the families we serve would enjoy continued, uninterrupted care from the physicians and hospital they have come to trust and rely upon -- one of the top 10 children's hospitals in America.”

Wolf and Zechman said both organizations regret any concern the extended negotiations caused for some families, and added that CareFirst and Children’s stand ready to work together in a renewed spirit of cooperation they have enjoyed as partners in the care of the area's children for many years.  Neither organization will have any additional public comment on the contract issue.

Insurance regulators in both the District of Columbia and Maryland have been informed of the settlement.

# # #

Children's National Medical Center, located in Washington, D.C., is a leader in the development of innovative new treatments for childhood illness and injury.  Among the top pediatric hospitals in America, CNMC has been serving the nation's children for over 130 years. Visit our web site at www.dcchildrens.com.

# # #

CareFirst, Inc., an independent licensee of the Blue Cross and Blue Shield Association, is a not-for-profit health care company which, along with its affiliates and subsidiaries, offers a comprehensive portfolio of health insurance products, direct health care and administrative services to nearly 3.2 million individuals and groups in Northern Virginia, the District of Columbia, Maryland and Delaware.  For more information, visit the CareFirst web site at www.carefirst.com.

PUBLIC HEARINGS

CareFirst Conversion Hearings

Jan. 28-31; Feb. 3-4

Baltimore Inner Harbor Marriott at 9:30 A.M.

Maryland Insurance Commissioner Steven Larsen will hold the final round of public hearings on the conversion of CareFirst BlueCross BlueShield to for-profit status and merger with WellPoint Health Networks, Inc. for January 28-31 and February 3-4, 2003.  No testimony will be given on January 28-31.

January 13, 2003

Report on January 8 Demonstration; Moran reaffirms his commitment

Carrin Brandt, a Concerned CareFirst Families organizer, makes this report about the January 8 demonstration. "Thank you all for your support at this morning's demonstration. We had great media coverage: NBC Channel 4, ABC channel 7, WTOP radio, and The Wash Post all covered the event. Sam Jordan with Health Care Now and Congressman Moran attended and made a statement to the press.  Several families were interviewed. {Also, the January 9 edition of the Washington Post, Section B page 3, featured photos from the demonstration.}  NBC Channel 4 is showing today's coverage at 4:45 and 6:40 this evening.  The main story will be at 6:40pm.  ABC expects to run several segments on channel 7 and channel 8 this evening.  

Children's plans to have a town meeting for families in the next several days to update us on the situation.  Our plan would be to meet at that meeting to discuss next steps.  Some of us thought that the Health expo sponsored by NBC at the Washington Convention center may be a good place to have a presence. CareFirst and Children's have exhibits near each other. That expo is on the weekend of 1/18 and 1/19."  (End of Ms. Brand't report).

Jim Moran again indicated his ongoing  effort to maintain coverage for CareFirst families with children.  He described in a statement to the families at the January 8 demonstration his intention to secure for CareFirst children, continued and easily accessible coverage at Children's at affordable out of network rates, in the event Children's and CareFirst fail to renegotiate a contract.  Reports indicate that nearly 8,000 CareFirst families receive medical care at Children's Hospital.

January 8, 2003

Join A Peaceful Demonstration of CareFirst Families To Keep CareFirst at Children's

When:  January 8, 2003

Time:10 a.m.

Where:  Children's Natl Medical Center, 111 Michigan Avenue, N.W. Washington

Please Bring Posters and Dress in Red

Carrin Brandt, one of the parent organizers of Concerned CareFirst Families, announces a peaceful demonstration of CareFirst families and supporters on Wednesday, January 8 at Children's Hospital.  Mrs. Brandt states that 'we are trying to get as many people as possible to gather next Wednesday at 10 am at Children's Hospital to demonstrate for the negotiations which are expected to be taking place next Tues and Wed." She urges all supporters to please inform all media contacts of this event to help spread the word.  Marchers are asked to please bring posters and dress in red if possible.  Mrs. Brandt states " I hope to see you all there".  Please check back here at the website frequently and sign up for updates for notification of any change of plans.  If you have questions, please contact Carrin Brandt at 703-455-1820.

Commentary on January 8th Demonstration.

New! CareFirst Moms Are Headed To Washington.  Armed with Posters and Wearing Red, Join Virginia and Maryland Moms Who Will March at Children's Hospital, Michigan Avenue To Urge Children's and CareFirst to Make A Fair Deal and To keep CareFirst at Children's.  With Congressman Jim Moran A Vocal Supporter, Will These Maryland and Virginia CareFirst Moms Be Forced  To Take Their Case To Local D.C. Officials And  Members of the D.C. Panels of the United States Congress?

December 28, 2002

Planning Meeting of CareFirst Families and Supporters.

A planning meeting was held on December 28, 2002 to develop strategy for CareFirst families and supporters to maintain pressure on Children's and CareFirst to reach a fair deal that will allow CareFirst families to continue to use Children's Hospital/Children's National Medical Center under a fair multi-year contract between the two parties.  For information on meeting details, please write Sue Harris.

December 20, 2002

CareFirst Families Gain New Champion At Dec. 19 Meeting: Congressman Jim Moran

Home Rule Incursion Alert

Again thanks to the work of citizens like you all, BCBS and Children's will maintain their relationship a bit longer; policyholders can continue to use Children's through January 31, 2003.  This was due to public pressure.  But it is not over. Please continue to go to lobbyline.com to speak out to officials.

Last night at an area meeting of CareFirst parents gathered to discuss the Children's issue, Congressman Jim Moran  vowed to take this issue on possibly through Congressional oversight committees for D.C.  Mr. Moran also blasted D.C. officials for their inaction on the Children's BlueCross crisis.  They have not held hearings about the Children's issue, which they can or Commissioner Mirel can.  Mr. Moran particularly singled out D.C. Insurance Commissioner Lawrence Mirel for his fecklessness and blamed his connections as a former insurance lobbyist for his failure to stand up on this issue the way that Maryland officials have.  Most importantly, Moran signaled possible Congressional intervention when CareFirst comes to D.C. to complete the conversion requirements. 

Because of Congress' oversight role, and particularly as CareFirst is congressionally chartered, Congress is involved but if they perceive D.C. to be dropping the ball and their constituents to be getting a raw deal - which as policyholders they would - it is my prediction that Congress is going to enter the scene starting with hearings early next session.  Mr. Moran made this public statement before a crowd of Virginia residents and the broadcast and print media.  This is a sign that Congress is now involved.  Mr. Moran is a former BlueCross policyholder (having switched plans in recent days during open season because of the impending BCBS departure) with a child who has a chronic medical problem and uses Children's.

Many Virginia residents are affected by this as CareFirst covers policies for D.C. (federal employees) and Maryland BCBS members - many of whom are Virginians, and even some Virginia Blue Cross policyholders are affected. 

Mr. Moran addressed a group of CareFirst families to support their effort to keep BCBS at Children's.  The group met on December 19 at the Falls Church High School in Virginia.  The group was briefed on the CareFirst conversion and told that the current impending departure of BCBS from Children's is linked to its actions to become a for-profit organization.  At the meeting, the heads of area advocacy organizations encouraged parent and consumer advocacy.  Terry Newmayer, of Fair Care Foundation and Sam Jordan, of Health Care Now! urged the group to continue to spread the word and to make use of the website to get friends and listserv members to speak out.  The public pressure exerted so far is credited with the December 18 announcement to extend coverage another month for BCBS policyholders using Children's

If Children's and Blue Cross do not resolve this problem once and for all, if D.C. does not get involved - by holding hearings, passing strong legislation like Maryland did to hold CareFirst to a high standard in its review of the conversion application; if this does not happen - enter the Congressional overseers.  Home Rule Advocates should stand up and press local lawmakers to do the right thing, before Congress does it for us.  City officials must avoid the appearance of rubber stamping the conversion of CareFirst to for-profit status.  Or risk the entrance of  Congress.

On December 18, during the for-profit conversion hearings of CareFirst BlueCross, it was announced that CareFirst will continue its relationship with Children's Hospital of D.C. through January 31, 2003.  Maryland Insurance Commissioner Larry Mirel has scheduled a January 17th date for the parties to report back on their negotiation efforts. This development is heralded by some as a sign that in the aftermath of intense public pressure and media scrutiny, both parties have gone back to the negotiating table hopefully to work in the best interests of the region's children and hammer out a deal that is fair and reasonable to both sides.  Please continue to do your part to encourage this important negotiation process by speaking out to relevant decision-makers through the email campaign of Lobbyline.com. For more details, click here.

December 18 Extension

NOTICE OF RELATED COMMUNITY EVENTS

FAMILIES WITH CAREFIRST INSURANCE : MEETING!  MEETING!  MEETING!

 Notice of: Meeting to discuss Children's Hospital and whether quality of care will be available to families like ours.

 Come learn how this affects you, and what you can do about it.

 When:          This Thursday -- December 19, 7 p.m.

 Location:       Falls Church High School , 7521 Jaguar Trail, Falls Church VA,  

Contact:        Barbara Foster for more information ,  703-642-8997

 Children Welcome

 Directions:  Take 495 -Beltway- to 50 East exit. Take a right onto Jaguar Trail and the school is on the right. Meeting is in the cafeteria.

Scheduled Speakers include Sam Jordan, Health Network Now, Fair Care officials.  Invited speaker from Children’s Hospital.

Note: The parents organizing this meeting are not employed by or agents of CareFirst BlueCross or Children's.  They are consumers.

PLEASE TAKE ACTION NOW.