Conversations much like today. There is a lot to cover today. First of all, were really pleased to bring this program together. With Grant Thornton and mcguire woods. The event is part of, as you can see here, the future ready Business Campaign that is presented byeries bloomberg bna. You can check out the url on the back of the card. I am also particularly grateful grateful to mary moore hamrick. She was really instrumental in organizing todays conversation. So now i would like to introduce the Global Partner for health care who will be offering a few brief welcome remarks before we begin. Ann has been representing healthcare clients for 25 years and worked extensively with large health systems, academic medical centers, and managed care organizations. Please join me in welcoming and anne. Thank you. [applause] thank you for cohosting this. This space is gorgeous. This is the first one of this kind that Grant Thorton has hosted so we are excited about this. We would like to do more in the future. I am pleased to present our two moderators. They will introduce the two senators. We have marry more hamrick. Eric mentioned mary moore. Managing principal for Public Policy initiatives. As such, she leads all the Public Policy initiatives. As such, she liaisons with members of congress and regulators. With accounting standard setters. Mary moore will be leading the discussion with the senators along with jonathan nicholson. We are pleased to have jonathan as well. The budget and house leadership. It jonathan is considered a foremost expert in the federal Budget Initiative here. He writes on a lot of them. Expect, health care falls squarely into his wheelhouse. He is very well renowned here and all around washington. You, jonathan, and welcome to both you and mary moore for leading this discussion with the senators. [applause] yes. Yes, you do. Good afternoon. I am thrilled to be here today and i am honored to introduce senator bill cassidy. Dr. Cassidy is uniquely qualified to help us understand the complex 80s of Todays Health Care debate the complexities of Todays Health Care debate. Cassidy has taught lsu medical students. He cofounded the Greater Baton Rouge Community clinic. And hes provided Emergency Health care for Hurricane Katrina evacuees. Senator cassidy has served in the Louisiana State senate, the u. S. House of representatives, and was elected in 2014 to the u. S. Senate where he serves on the Influential Health education, labor, and finance committees. Wrote, newspaper oneonone, dr. Cassidys attentiveness and kindness stands out. His approach to voters resembles the way a good doctor handles patients with a gentle but informed bedside manner. Please join me in welcoming senator cassidy. [applause] senator carper is a native of west virginia, raised in virginia. Went to ohio state where he got a degree in economics. He knows about health care from having served in various levels of government. They came to the senate in 2001. Reelected in 2006, 2012. His reputation is as one of the and wonky people in the senate. Hes ranking on environment and public works. Senior member on Homeland Security and government affairs. But theowboat, workmanlike committees. They talk about expedited precision. The details were you try to give money back. So those are the introductions. The two members will give a couple of opening remarks and we will do our questions and save some time at the end for some q a. I am a graduate of lsu. It is also a way of giving a shout out. A big lsu fan. Thanks for having me, mary. What a time to be here. We spoke about doing this months ago. It serendipity, i hope. I approach this as a physician. Think about the letter i got this past weekend. A fellow attorney, makes good money, describing how he and his family are paying 20,000 a year for their premium. And they deductible is going to 14 k. He is saying he cant afford this. We hear that story across the nation. Sisterinlaw in san francisco, the exact same story. The insurance consultant if i said his name, you would recognize the exact same story culminating with a friend back home. Policy, 39,000 last year. We cannot afford that. As a docu approach it , how is the family doing with that . Not very well. It is not just anecdotal. Article monthly has an that i just saw yesterday about how people cant afford the deductibles they have. And it describes the family in new york, i suppose, in which the 6,000 deductible would prohibit their receiving treatment except that they are able to get help from charity to pay their deductible. This is not the way it is supposed to be. When President Trump man, he made a commitment along the following lines. Coverage,uld continue care for preexisting conditions, eliminating the mandate that people do not like, and lowering premiums. We think there is a way to get there. Susan collins and i introduced a bill and we have republican senators that cosponsored it that designed to achieve those objectives and deliberately designed to reach across the aisle that democrats would be able to sign on and not feel like they were doing damage for their support of the Affordable Care act. A blue thingcan do and a red state can do a red thing, but we allow that power to return to the states. Ultimately, we allow the power to return to the patient. If theres a bit of Common Ground that tom and i have, the patient should be the focus of all of our considerations. Out, if she comes is the focal point or if she has the power at the end of the day, we will have done our job. I am happy to be here with bill. Thank you for joining us. I spent half my life in the military. In Southeast Asia and others. There is a patriarch for mission command. One of the things i love about the military was access to health care. What basie are on, naval base, air force, marines, you have access to health care. You get an annual physical. They look pretty good. Pretty healthy. We are encouraged to take care and exercise. There is a real focus. Think of theont Affordable Care act as a focus on prevention. But there is a huge focus on prevention and how to get better results for less money. Truman talked about providing Health Care Coverage to the american people. All of the american people. And one after the other, they bent and broken sword on doing that. Becamerack obama president , he said, why dont we look around the world to see what works. And one of the things we ended up building on the Affordable Care act is something they were doing in massachusetts with governor romney who took the idea from senate republicans. John chafee. Orrin hatch. Chuck grassley. He had a brilliant idea in 1993 to create exchanges. Thattplaces in every state people who didnt have coverage could get coverage on the exchanges. The folks that were low income could benefit from a sliding scale tax credit. It could be high. In 93ing that legislation 2004. The idea of the individual mandate. To providead coverage for their employees. The last provision was one that if you are a Health Care Insurer and you want to stop you cant do that. That turned out to be a big part of the foundation of the Affordable Care act. The stuff that my republican friends are most critical of, it is their stuff. Go figure. Everything i do i know i can do better. The Affordable Care act could be better. Worth of0 days hearings, roundtables, discussions. Over 300 amendments were offered, half by republican colleagues that were adopted. A perfect process, but very much an open process. Concerns me these days is that this process is closed. With senior democrats chairing the committee, if you see something, say something. You see something about the wese bill you dont like, dont know what the republicans are working on now. Its just not an open process. Important,hat is hundreds of american people, and this is something we shouldnt do as republicans, or frankly, as democrats. Go it it g go alone. If you want to go far, go together. If you get a lot further and a lot more young. We might even have our own ratings. Lets talk about process before we get to the particulars. Can you tell us where the senate is in the process on health care and where you expect to build that . Haseader mcconnell indicated he wishes the bill to come out soon. They have been in an iterative process having to score it piecemeal by the cbo. There are rumors afloat, but i cant comment on the rumors except to say i expected to be soon. Could i follow up . Approach, i applaud him for that. Chuck schumer last week sent a letter to his counterpart mitch weonnell and suggested that do something we dont do often enough. Go to the Old Senate Chamber and close the door, and maybe not bear our souls, but open up with one another. Have you thought of this . Have you thought of that . Inwe are interested deserving the best parts of the aca and fixing those things that must be fixed, what might fly . Chuck suggested to mitch last week, that it can only be helpful. Can i comment on that . Were thrilled to have this bipartisan conversation. Where do you think the senate is currently making progress . What are some of the sticking points. Where can we make progress . Let me comment on what tom just said. I would love if we had a bipartisan conversation. Bill was written with a bipartisan conversation. I met with tom and nine other democratic senators. When susan announced our bill, it was not yet filed. Chuck schumer publicly condemned it in no uncertain terms. Got on the floor and started saying how terrible it was. He hadnt read the bill. It,e we introduced respecting federalism and respecting a way forward. I think sarah cliff of fox vox said it a unique way. Schumer criticized it vehemently before he had read it. I sure hope we need and get something out of there. I have to admit that the opening play might make me think it might be politics. I dont want to condemn a process but it makes me cynical. Chuck schumer i wonder if he is the first to ever criticize a bill he hasnt read. We will find out. Lets focus on the positives. Where can we make progress on bipartisan areas of agreement . What dont each of you comment on that. Share areas were we can come together. My professors would say not enough, but enough to graduate. Use interested in how we Market Forces for good public purpose. In one of the things are like very much about the foundation on which we build the plan. One of the Market Forces, the people that dont have coverage like to be part of purchasing , may have a sliding scale tax credit. One of the things that is critical for this to work is to have stability in the marketplace. They ensure who is trying to get their coverage that they can make money and are not going to lose their shirts. On thing they are dependent and asked for is that they make sure there is Something Like reassurance. And a couple of different provisions that are needed for us to be able to make money in this arena. And in 2014, we took away like lucy and charlie brown, taking away the football. Our friends in the Insurance Industry said we have to raise premiums and raise to dr. Bulls and copays in order to cover. And they did. They lost money in 2014. They raised premiums and copays. A pretty much broke even. The arrangements, they are probably not going to do that . And were not going to force the individual mandate. And we are not all that interested in insurance. Getting coverage in an exchange in every county and every state beginning this year. They cant do that anymore. Some of thedo things they called for. I think we can agree on insurance. There are some other things as well. There has got to be some way to have an individual mandate, something that really makes sure that we get people into the exchanges. I would say one area i would say one area we have Common Ground is how to stabilize the individual market. The Affordable Care act didnt really work that well. Again, the feature which has been praised by a former , a conservative economist. One thing for Common Ground is moving power back to the states. I have no problem with massachusetts doing romneycare. Washington dc and alaska have about the same number of people. Alaska was stretch from georgia to the pacific ocean. Clearly, you might end up with a different solution for two vastly different population centers. A real prime example of that, the high risk pool. So many sick folk have ended up in the individual Market Driving a premiums. The Affordable Care act told us that they couldnt be in business. We should get more power back to the states. Estate politician anymore than a federal. The power should go back to the patient. But to the degree that it should be government authority, it should be closer to the patient and not here in washington, d. C. Where do we agree . Stability in the exchanges. There are several ways to do that. Program willcaid it would take medicaid coverage up to 100 . If we did this as a way to make sure that people went to work, they would not lose their Health Care Coverage right away. We want to be better off when they are working. One of the things i think we agree on is that taste should have the ability to get waivers. The idea and the waivers are granted by secretary of health and social services. Pence. Ng governor and those are some areas where there might be some agreement. The individual mandate is what romney did in massachusetts. They raise the amount and gotten more young people. Slow on the uptake encouraging people to get to the exchanges. We can have opt in versus opt out. That was going to be my question. People that dont want to be in medicare, they say they dont want to be enrolled. You get 95 enrollment. They receive sufficient credit for the annual premium and would automatically be enrolled. I dont want to be. You are out. Make sure you per put your son on the insurance policy. And again, i just told you 39,000 a year premium for a couple. They said that if they did that enrollment, you lower premiums by 20 just by that feature alone. I do think that auto enrollment is a way to go. Just ind work not louisiana but a lot of other states. That is the plan to make that a state option. I want to go back here because there is a lot of uncertainty is the calendar and the way things are going. There has been talk about maybe you guys should stick around for the recess. I want both of your quick takes on the recent activity and the likelihood of that happening. My suspicion is most people look forward to the recess. Some just cover their states. It is an easy train ride for me, but a lot of people are from places like alaska and hawaii and idaho. They just dont get home as much as the rest of us. They go to every county in their state. I do that on most every day. [laughter] it is not that hard. If you would do a private survey and ask everybody, if you thought by staying here through the month of august, that we could hammer out a real compromise on the Affordable Care act and what bills susan has been working on, if we thought we had a shot of doing that, i think everyone would stay and we should. Im a big believer that the amount of work we spend and deadlines force action. I read a quote. So much that he could only get it done in 11 months. If it were true that we could further the agenda, repeal and replace as well as tax reform, i would be open to that and i am sure others would be as well. There is something about a deadline to sharpen a man and a womans mind. I hope those deadlines force the action. That is a lien against. I am for whatever is most effective. I think deadlines make you more effective. You have gone over the say little bit but im curious, it kind of comes down to the top. If looking for bipartisanship, especially among certified walks such as yourselves, should each of you name the one or two must haves that would have to be in a bill for you to vote for it . Without those come you would not vote . I like to see lower premiums with questionable coverage passing the jimmy kimmel test. If your loved one has a need that must be addressed quickly, and extensively, that your loved one has policy here. It goes back to the deductible of 6,000. If your daughter needs to go to the urgent care center, you have a little bit of fat to buy her a an antibiotic. Lower premiums, credible coverage, passing the jimmy kimmel test. Quite slim donald trump was candidate trump, he said health care covers everybody, it would provide excellent coverage at a lower price. When he was president elect, he said the same thing. Legislation coming out of the house of representatives does not do the thanks. With the legislation tim kaine and i made us to provide exchanges, if you look at the health care, 3 Million People in it, most of them, floridabased health care. For most of them, they are going up by less than they used to. A lot of that is managed care. It seems to be working well. 50 to 20 get medical care. About 12 years. The parts were arguing most about, that was the part that really came out from 1993. My hope is we could focus on that, find some agreement, and im reaching out across the country saying what do you guys need . It is a 5050 deal for medicaid. There is a lot of curiosity and interest and that gets us to taxes. What changes do you see as it relates to Insurance Companies and any of the other taxes mentioned . Comments or thoughts on that . Going directly toward the premium and reason the cost of the premiums, those are fairest game for immediate review. Insurance policies, one of those. You are taxing to make insurance affordable. That would be one example. Sen. Carper lets go back to the Affordable Care act. Something they did not do right away on bill, hopefully they will do this and republican friends will come up in the senate, they said we do not want to pass Health Care Coverage to the country for better coverage, and increase the budget deficit, we dont want to do that. The cbo said we reduce the budget deficit for the for 14 years, by 100 billion, 17 years by 1 trillion. The idea that we can find better coverage and affordable coverage, doing it in a way that does not increase the budget deficit, we do that. That was as advertised but not as fact. For the record, the Medicaid Expansion we did not make it up, cbo said they said it before hand but Medicaid Expansion costs 50 more than they anticipated. Deductibles and copays steadily rose. Although the premium increases litigated, the outofpocket exposure increased dramatically. Pharmacy costs have skyrocketed. I will not accept that the act tax would be continually postponed, is actually how it will go into effect. It is not. They are far more than originally described, including premiums will go down by 2500, premiums premiums are going up because of lack of predictability. They were going up prior to peer there are 11 states and spirals prior to trump getting elected. Though the premium i described, 39,000 for one year, that was not considered a death spiral. Premiums will go 40 . All of that was prior to President Trump being inaugurated. There has been real good pr but the cost of at actually exceeded that which was predicted. Should she be involved . Yes. I think we both agree on that. A large part of the aca was taxes, a large part of the repeal would be repeal of those taxes and reduction in that spending. Can you give us an idea of an impact you see a repeal happening on the tax reform project later this year . I think you have to get the Health Care Reform issue settled. Some have said you have to peel obamacare to set up tax reform. The tax reform bill basically did not touch any from obamacare except for a medical device tax. You concern the do it without touching it, but you have to settle your baseline is. Would you prefer a more camp line camp like approach . I would prefer the taxes be addressed all whole piece. I do not think we should repeal these taxes and then do a Health Care Reform and then do another set of taxes. We should establish who we will cover and how much it costs to cover them and then we do the tax reform allinone is it it seems a more logical way to do it to me. We will see the republican senators come up. Look at the taxes and the way taxes are treated in the house bill, folks made off very well under that and in many cases, people dependent on medicaid and tax credit, they did not do so well. Some people described the work in the house on health care as the Health Care Reform, the tax reform masquerading as Health Care Reform. There is actually something to it. Do you want to a dress that it is tax reform masquerading as health care . I do not know that was the intent but it is the effect. I think we should do Health Care Reform. Many reference the employerbased system as well providing health care. Many employers are listening to it i would love to know your advice for what do these employers do in dealing with changes and the Health Care ReformGoing Forward and how can they help control costs . Any thoughts for that segment of of the community . Used to be the ceo of said safeway, some of those actually included the Affordable Care act. Safeway has huge influences for employees for wellness. Not far from oakland, thousands of people work. They can go work out on campus for free. You pay more and people actually end up having to pay a little more for health care who are overweight. For people who lose overweight or they have highpriced high Blood Pressure and they bring it down, it is positive reinforcement. They are rewarded for good behavior. My advice is call steve and find out what he did at safeway and what is he does advising other companies to save money. A lot of it is what i said, lifestyle and exercise and incentivizing people. I want to respond to that in two different ways. First, what repeal and replace should not do. We will agree that we should not diminish coverage to the degree that people who formerly were receiving a primary care physician will now go to an emergency room episodically for i care. The reason for that is i worked at a Charity Hospital for 25 years. Foaming blood, schizophrenic, diabetic, she was treated. A person uninsured still got it treated. A Major Corporation should negotiate and keep rates lower. She has got 75 employees and is a little bit at the mercy of providers and she is the honorable. We have to recognize that congress 20 or 30 years ago created a right to health care. It was an Unfunded Mandate on states and municipalities and Small Businesses and i think we should step forward and make sure we provide access for those folks that would keep them out of the emergency room and lower the cost. Number two, we have to ultimately decrease the cost of health care. It is important for business and individuals. I would like to think, however this settles out, we are able to come back on i partisan basis and work toward price transparency. Wouldnt it be nice if you knew the cost of a blood test before you got the blood test . A website in new orleans had a story. The woman got her blood test and it was 300. 4 and she did not find out until she was billed six weeks later. She could have gotten the same blood test for 30 or 40 down the street. Dont you think she would have of course she would have. Price transparency is something we should be put into play. I give you example after example. If you get it in the doctors office, it costs 174 cash. In the hospital, maybe 13,000. The numbers are astronomical. It will come down and do some sort of meeting median. Anyway, two things. I have got go back for just a second, the former ceo of safeway. They looked around tos the what a colonoscopy costs. They found a wide range anywhere from 1000 to thousands. I said what is the difference between the ones that costs 1000 and the ones that cost 5000 or more . They said they dont use anesthesia. I thought he was just kidding. As bill suggests, a wide range of discrepancies and what these providers charge. If we are smart, we figure out how we get better results for less money. Talking about employers, when a friend and i were working on the legislation, again, it had exchanges, the individual mandate, prohibition against throwing people off coverage. Romney took that and basically the individual mandate. Is there is reason to believe if you look at the numbers, we need Something Like the individual mandate. They will help people get coverage. There are questions about, fears about employers dumping employees. For the most part, it turns out the fear was unfounded. There is a number of employees that put patients on medicaid. I heard from the governor that in his state, a lot did. Maybe not on the exchanges, but on the Medicaid Program. I think it is fair game. Figure out what works, do more than that, drill down on what is happening in terms of the employer mandate. Do you need to modify it in some way . One thing i worry most about is sometimes the burden on small employers, between 50 and 100 and somewhere in that range, i worry about the burden they are carrying and the fact that they are slow to go under a certain limit in order to avoid certain requirements. I know they are thrilled you can together as part of the conversation on this. Were doing our best to get everyone on the same page and have this conversation. I would like to ask each of you what steps you plan to take to go forward today in trying to foster that continuing conversation and come up with a solution to health care Going Forward question mark forward . Obviously, the folks that i work with are continuing to try to shake that. If two or three democrats wanted to Mitch Mcconnells office and said we are here to deal, it only needs 50 votes, but it is h or menace opportunity for democrats. A tremendous opportunity for democrats. Democrats would have to walk in, a to 12, it only takes two or three. That could begin to address the issue for these patients, represented by a republican or a democrat paying for her premiums. After repeal and replace, there are 10 different bills i have working with democrats on the other side of the aisle and are hoping to. It got into the 21st century bill, public health, or, just go down the list. We will have health care as an issue for some time. There will be a lot of opportunity to Work Together across the spectrum. Some people think it is broken or it it is bending but do not think it is broken yet. It is a little different from the house. In the house, you have 435 people. They tend to be a little more partisan one way or the other. A little bit less so and a bunch of us are former governors. Ted kennedy used to say to me and others a quick story. Ted kennedy, senior democrat. Mike, a republican from wyoming. A conservative guy. They were incredibly successful getting things done. Mike, how are you and ted kennedy so different and get some much done . He said ted and i believe in the 8020 rule. He said we agree on 80 of the stuff and we disagree on 20 of the stuff here we decided to focus on 80 percent that we agree on. It might he a helpful thing. We have good relations. There is still a desire below the surface for democrats and republicans to Work Together and get things done. We need to dust that often dust that off and say, lets redouble efforts. We have a democrat showing up later this week in the Senate Chamber and some of our republican colleagues will join us, close the door and have a conversation and see where we can agree and maybe we surprise ourselves. More important than that, too democrats going to Mitch Mcconnells private office. That is my take on it. Lets open it up to questions from the floor. We have got some microphones going around. Right here is fine, thank you. I am megan mccue from northwestern university. Thank you for your time today, senator. A quick question on the issue of federalism. I was wondering the extent to which you talked to governors or representatives from state legislatures about readiness and the capacity to take on these tough issues surrounding Health Care Reform . Great question. It goes to the heart of it. I spoke personally to five or six governors, maybe more. I lose track. Two democrats asking them what they like to do. I dont trust governors or state legislators anymore than i trust federal politicians. The power should be with the patient. From my perspective, credit should go to the patient and she chooses the policy she wants. They are notorious for using the money to fill in the government shortfalls. On the other hand, you need the governor to regulate. We in congress should set the role that the patient has the power but that the first level of regulation comes from those who govern closest and then go from there. But it should be returned and should be allowing massachusetts to come up with romney care but another state doing what is more likely to work. Governor from 1993 two 2001, the National Governors association, he serves as chairman and vice chairman, senator for best practices trying to solve problems less parochial. One thing i like to do is use the states. To find out what works. The idea of having a Medicaid Program with a waiver, does it actually work . Does the idea of having a managed care approach, did that actually work . What can we learn from that . I am reluctant to say what we need to do, but were oh is a trusted to see if we can come up with a better idea and get that are results. What does the constitution say . It is assumed to be done, we can usually learn quite a bit from the states. Final question . A pleasure to see you again. I want to thank you both. You only cut only talked a couple of times. Want to thank you both. It was very useful and helpful and i think it would be great if there were more of this going on. Were thinking of cloning us. My comment goes to the issue, you have all been focused a lot on the individual market and i get why. There have been a lot of increases and it can beat a just a lot of ways, not least of which is helping young people with a larger subsidy and making it more affordable. A lot more people are covered through medicaid care that is a real concern and a very effective way of covering people and very inexpensive. Senator cassidy, what we have been hearing is that your caucus is looking at phasing out medicaid over seven years, reducing the federal match. The concern becomes once you get below 85 , most will not do anything about medicaid. Your state has an 80 match. You did not do anything until you had a democratic governor appeared when you were a governor, you had a 56 match. The concern is keeping it somewhere close to 85 for as long as possible. I would hope you could share that with your caucus and tell us whether it is a realistic possibility, thank you. I agree with you that expansion is the reason coverage has increased so dramatically. Because the federal taxpayer was paying 100 , really paying top dollar. 50 percent more than the population than they are per person in the traditional population. Roughly 20 Million People are enrolled nationwide. Now states are having to pick up a portion of that, receiving a 90 of the federal share expansion. They cannot handle the 10 . When the full 10 kicks in in 2020, my still have to put in 310 million per year. California will have to put up roughly 2. 2 billion per year. I have not seen sums like that in baton rouge or sacramento or any other places around the nation. State legislators in arkansas and oregon recommended rolling back and even eliminating the fashion because they cannot afford 10 , or rolling it back to 100 . I am pretty sure her john kasich saying, and i hope he does not mind me falsely attribute in, it would be to bring 138 federal poverty down to 100 federal poverty level. Inherent in that is ohio may have a hard time of 4010 from affording the 10 . That is the issue before us. How do we make medicaid sustainable for the federal and state taxpayer . At this point, it is sustainable for neither. Just about out of time. I got elected state treasurer right out of the navy. I used to think medicaid was for poor women and their children. It is in part but most of the people work and most of the people who benefit from medicaid happened to be the anson uncles uncles who do not have much money and they have dementia and that is where we spend most of our money. I hope there are a couple of million veterans we have to be careful how we treat that population. I would like to turn over for a close. We would like to assist bit send our sincere appreciation to the senators for coming today. It was an excellent discussion. Lets give a big hand. [applause] we are adjourned. [laughter] [indiscernible] thank you all for coming. Conversation] [indiscernible conversation] [indiscernible conversation] announcer recently on cspan, and new orleans mayor on the removal of a robert e lee statue. To actually layout the reasons why the statues were erected in the first place, why we were taking them down, and how we could recover from the hold battles we have suffered from for so long. In that dark time of history we were after all one of the markets. Largest slave i felt that i can do other people in the city had a special responsibility to help our nation continue to move through racial discord. At atress mers go hargitay conference for ending sexual violence. These words like dehumanizing. These lives derailed. The way lives go off track. Aese are not kits sitting on shelf. These are peoples lives sitting on a shelf getting derailed. Told were getting derailed. 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Its june 20th for this edition of washington journal to our first hour, we want get your input on the best way to train the u. S. Workforce. Trumpomes especially as administration making a big push on getting more businesses to invest in Apprenticeship Program a means of train people on a skill this could result in good paying jobs. From you its l