119 
ments of this section are met in connection with claims 
filed under the plan.’’. 
SEC. 406. COOPERATION BETWEEN FEDERAL AND STATE 
AUTHORITIES. 
Section 506 of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1136) is amended by adding 
at the end the following new subsection: 
‘‘(d) RESPONSIBILITY OF STATES WITH RESPECT TO 
ASSOCIATION HEALTH PLANS.— 
‘‘(1) AGREEMENTS
WITH
STATES.—A State 
may enter into an agreement with the Secretary for 
delegation to the State of some or all of— 
‘‘(A) the Secretary’s authority under sec-
tions 502 and 504 to enforce the requirements 
for certification under part 8; 
‘‘(B) the Secretary’s authority to certify 
association health plans under part 8 in accord-
ance with regulations of the Secretary applica-
ble to certification under part 8; or 
‘‘(C) any combination of the Secretary’s 
authority authorized to be delegated under sub-
paragraphs (A) and (B). 
‘‘(2) DELEGATIONS.—Any department, agency, 
or instrumentality of a State to which authority is 
delegated pursuant to an agreement entered into 
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120 
under this paragraph may, if authorized under State 
law and to the extent consistent with such agree-
ment, exercise the powers of the Secretary under 
this title which relate to such authority. 
‘‘(3) RECOGNITION
OF
PRIMARY
DOMICILE 
STATE.—In entering into any agreement with a 
State under subparagraph (A), the Secretary shall 
ensure that, as a result of such agreement and all 
other agreements entered into under subparagraph 
(A), only one State will be recognized, with respect 
to any particular association health plan, as the 
State to which all authority has been delegated pur-
suant to such agreements in connection with such 
plan. In carrying out this paragraph, the Secretary 
shall take into account the places of residence of the 
participants and beneficiaries under the plan and the 
State in which the trust is maintained.’’. 
SEC. 407. EFFECTIVE DATE AND TRANSITIONAL AND 
OTHER RULES. 
(a) EFFECTIVE DATE.—The amendments made by 
sections 101, 104, and 105 shall take effect on January 
1, 2007. The amendments made by sections 102 and 103 
shall take effect on the date of the enactment of this Act. 
The Secretary of Labor shall first issue all regulations 
necessary to carry out the amendments made by this sub-
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121 
title before January 1, 2007. Such regulations shall be 
issued through negotiated rulemaking. 
(b) EXCEPTION.—Section 801(a)(2) of the Employee 
Retirement Income Security Act of 1974 (added by section 
101) does not apply in connection with an association 
health plan (certified under part 8 of subtitle B of title 
I of such Act) existing on the date of the enactment of 
this Act, if no benefits provided thereunder as of the date 
of the enactment of this Act consist of health insurance 
coverage (as defined in section 733(b)(1) of such Act). 
(c) TREATMENT
OF CERTAIN EXISTING HEALTH 
BENEFITS PROGRAMS.— 
(1) IN GENERAL.—In any case in which, as of 
the date of the enactment of this Act, an arrange-
ment is maintained in a State for the purpose of 
providing benefits consisting of medical care for the 
employees and beneficiaries of its participating em-
ployers, at least 200 participating employers make 
contributions to such arrangement, such arrange-
ment has been in existence for at least 10 years, and 
such arrangement is licensed under the laws of one 
or more States to provide such benefits to its par-
ticipating employers, upon the filing with the appli-
cable authority (as defined in section 813(a)(5) of 
the Employee Retirement Income Security Act of 
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122 
1974 (as amended by this Act)) by the arrangement 
of an application for certification of the arrangement 
under part 8 of subtitle B of title I of such Act— 
(A) such arrangement shall be deemed to 
be a group health plan for purposes of title I 
of such Act; 
(B) the requirements of sections 801(a)(1) 
and 803(a)(1) of the Employee Retirement In-
come Security Act of 1974 shall be deemed met 
with respect to such arrangement; 
(C) the requirements of section 803(b) of 
such Act shall be deemed met, if the arrange-
ment is operated by a board of directors 
which— 
(i) is elected by the participating em-
ployers, with each employer having one 
vote; and 
(ii) has complete fiscal control over 
the arrangement and which is responsible 
for all operations of the arrangement; 
(D) the requirements of section 804(a) of 
such Act shall be deemed met with respect to 
such arrangement; and 
(E) the arrangement may be certified by 
any applicable authority with respect to its op-
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123 
erations in any State only if it operates in such 
State on the date of certification. 
The provisions of this subsection shall cease to apply 
with respect to any such arrangement at such time 
after the date of the enactment of this Act as the 
applicable requirements of this subsection are not 
met with respect to such arrangement. 
(2) DEFINITIONS.—For purposes of this sub-
section, the terms ‘‘group health plan’’, ‘‘medical 
care’’, and ‘‘participating employer’’ shall have the 
meanings provided in section 813 of the Employee 
Retirement Income Security Act of 1974, except 
that the reference in paragraph (7) of such section 
to an ‘‘association health plan’’ shall be deemed a 
reference to an arrangement referred to in this sub-
section. 
TITLE V—IMPROVEMENT TO AC-
CESS 
AND 
CHOICE 
OF 
HEALTH CARE 
SEC. 501. REFUNDABLE AND ADVANCEABLE CREDIT FOR 
HEALTH INSURANCE COSTS. 
(a) IN GENERAL.—Subpart C of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to refundable credits) is amended by redes-
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124 
ignating section 36 as section 37 and by inserting after 
section 35 the following new section: 
‘‘SEC. 36. HEALTH INSURANCE COSTS. 
‘‘(a) IN GENERAL.—In the case of an individual, 
there shall be allowed as a credit against the tax imposed 
by this subtitle an amount equal to the amount paid dur-
ing the taxable year for qualified health insurance for cov-
erage of the taxpayer, his spouse, and dependents. 
‘‘(b) LIMITATIONS.— 
‘‘(1) MAXIMUM CREDIT.— 
‘‘(A) IN GENERAL.—The amount allowed 
as a credit under subsection (a) to the taxpayer 
for the taxable year shall not exceed the sum of 
the monthly limitations for months during such 
taxable year. 
‘‘(B) MONTHLY LIMITATION.—The month-
ly limitation for any month is the amount equal 
to 1⁄12 of the lesser of— 
‘‘(i) the product of $1,000 multiplied 
by the number of individuals taken into ac-
count under subsection (a) who are covered 
under qualified health insurance as of the 
first day of such month; or 
‘‘(ii) $3,000. 
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125 
‘‘(2) EMPLOYER SUBSIDIZED COVERAGE.—Sub-
section (a) shall not apply to amounts paid for cov-
erage of any individual for any month for which 
such individual participates in any subsidized health 
plan maintained by any employer of the taxpayer or 
of the spouse of the taxpayer. The rule of the last 
sentence of section 162(l)(2)(B) shall apply for pur-
poses of the preceding sentence. 
‘‘(c) QUALIFIED HEALTH INSURANCE.—For pur-
poses of this section— 
‘‘(1) IN GENERAL.—The term ‘qualified health 
insurance’ means insurance which constitutes med-
ical care if— 
‘‘(A) such insurance meets the require-
ments of section 223(c)(2)(A)(ii), 
‘‘(B) there is no exclusion from, or limita-
tion on, coverage for any preexisting medical 
condition of any applicant who, on the date the 
application is made, has been continuously in-
sured during the 1-year period ending on the 
date of the application under— 
‘‘(i) qualified health insurance (deter-
mined without regard to this subpara-
graph), or 
‘‘(ii) a program described in— 
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126 
‘‘(I) title XVIII or XIX of the 
Social Security Act, 
‘‘(II) chapter 55 of title 10, 
United States Code, 
‘‘(III) chapter 17 of title 38, 
United States Code, 
‘‘(IV) chapter 89 of title 5, 
United States Code, or 
‘‘(V) the Indian Health Care Im-
provement Act, and 
‘‘(C) in the case of each applicant who has 
not been continuously so insured during the 1- 
year period ending on the date the application 
is made, the exclusion from, or limitation on, 
coverage for any preexisting medical condition 
does not extend beyond the period after such 
date equal to the lesser of— 
‘‘(i) the number of months imme-
diately prior to such date during which the 
individual was not so insured since the ill-
ness or condition in question was first di-
agnosed, or 
‘‘(ii) 1 year. 
‘‘(2) EXCLUSION
OF
CERTAIN
PLANS.—Such 
term does not include— 
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127 
‘‘(A) insurance if substantially all of its 
coverage is coverage described in section 
223(c)(1)(B), 
‘‘(B) insurance under a program described 
in paragraph (1)(B)(ii). 
‘‘(3) TRANSITION RULE FOR 2007.—In the case 
of applications made during 2007, the requirements 
of subparagraphs (C) and (D) of paragraph (1) are 
met only if the insurance does not exclude from cov-
erage, or limit coverage for, any preexisting medical 
condition of any applicant. 
‘‘(d) SPECIAL RULES.— 
‘‘(1) COORDINATION
WITH
MEDICAL
DEDUC-
TION, ETC.—Any amount paid by a taxpayer for in-
surance to which subsection (a) applies shall not be 
taken into account in computing the amount allow-
able to the taxpayer as a credit under section 35 or 
as a deduction under section 162(l) or 213(a). 
‘‘(2) DENIAL OF CREDIT TO DEPENDENTS.—No 
credit shall be allowed under this section to any indi-
vidual with respect to whom a deduction under sec-
tion 151 is allowable to another taxpayer for a tax-
able year beginning in the calendar year in which 
such individual’s taxable year begins. 
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128 
‘‘(3) MARRIED COUPLES MUST FILE JOINT RE-
TURN.— 
‘‘(A) IN
GENERAL.—If the taxpayer is 
married at the close of the taxable year, the 
credit shall be allowed under subsection (a) only 
if the taxpayer and his spouse file a joint return 
for the taxable year. 
‘‘(B) MARITAL STATUS; CERTAIN MARRIED 
INDIVIDUALS LIVING APART.—Rules similar to 
the rules of paragraphs (3) and (4) of section 
21(e) shall apply for purposes of this para-
graph. 
‘‘(4) VERIFICATION
OF
COVERAGE, ETC.—No 
credit shall be allowed under this section to any indi-
vidual unless such individual’s coverage under quali-
fied health insurance, and the amount paid for such 
coverage, are verified in such manner as the Sec-
retary may prescribe. 
‘‘(5) COORDINATION WITH ADVANCE PAYMENTS 
OF CREDIT.—With respect to any taxable year, the 
amount which would (but for this subsection) be al-
lowed as a credit to the taxpayer under subsection 
(a) shall be reduced (but not below zero) by the ag-
gregate amount paid on behalf of such taxpayer 
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129 
under section 7527A for months beginning in such 
taxable year. 
‘‘(6) COST-OF-LIVING
ADJUSTMENT.—In the 
case of any taxable year beginning in a calendar 
year after 2007, each dollar amount contained in 
subsection (b)(1)(B) shall be increased by an 
amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar 
year in which the taxable year begins by sub-
stituting ‘calendar year 2006’ for ‘calendar year 
1992’ in subparagraph (B) thereof. 
Any increase determined under the preceding sen-
tence shall be rounded to the nearest multiple of 
$10.’’. 
(b) ADVANCE PAYMENT OF CREDIT.—Chapter 77 of 
such Code (relating to miscellaneous provisions) is amend-
ed by inserting after section 7527 the following new sec-
tion: 
‘‘SEC. 7527A. ADVANCE PAYMENT OF CREDIT FOR HEALTH 
INSURANCE COSTS. 
‘‘(a) GENERAL RULE.—The Secretary shall establish 
a program for making payments on behalf of individuals 
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130 
to providers of qualified health insurance (as defined in 
section 36(c)) for such individuals. 
‘‘(b) LIMITATION ON ADVANCE PAYMENTS DURING 
ANY TAXABLE YEAR.—The Secretary may make pay-
ments under subsection (a) only to the extent that the 
total amount of such payments made on behalf of any indi-
vidual during the taxable year does not exceed the amount 
allowable as a credit to such individual for such year under 
section 36 (determined without regard to subsection (d)(5) 
thereof).’’. 
(c) CONFORMING AMENDMENTS.— 
(1) Paragraph (2) of section 1324(b) of title 
31, United States Code, is amended by inserting ‘‘or 
36’’ after ‘‘section 35’’. 
(2) The table of sections for subpart C of part 
IV of subchapter A of chapter 1 of the Internal Rev-
enue Code of 1986 is amended by striking the item 
relating to section 36 and inserting the following 
new items: 
‘‘Sec. 36. Health insurance costs. 
‘‘Sec. 37. Overpayments of tax.’’. 
(3) The table of sections for chapter 77 of such 
Code is amended by inserting after the item relating 
to section 7527 the following new item: 
‘‘Sec. 7527A. Advance payment of credit for health insurance costs.’’. 
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131 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2006 
SEC. 502. EXCLUSION FOR EMPLOYER PAYMENTS MADE TO 
COMPENSATE EMPLOYEES WHO ELECT NOT 
TO PARTICIPATE IN EMPLOYER-SUBSIDIZED 
HEALTH PLANS. 
(a) IN GENERAL.—Part III of subchapter B of chap-
ter 1 of the Internal Revenue Code of 1986 (relating to 
items specifically excluded from gross income) is amended 
by inserting after section 139A the following new section: 
‘‘SEC. 139B. TREATMENT OF COMPENSATING PAYMENTS 
MADE FOR EMPLOYEES WHO ELECT NOT TO 
PARTICIPATE 
IN 
EMPLOYER-SUBSIDIZED 
HEALTH PLANS. 
‘‘(a) IN GENERAL.—Gross income of an eligible em-
ployee shall not include the amount of any compensating 
coverage payment made by an employer of such employee 
for such employee’s benefit. 
‘‘(b) ELIGIBLE EMPLOYEE.—For purposes of this 
section, the term ‘eligible employee’ means any employee 
who is eligible to participate in any subsidized health plan 
of an employer for any period and who elects not to par-
ticipate in any subsidized health plan of such employer 
for such period. 
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132 
‘‘(c) COMPENSATING
COVERAGE
PAYMENT.—For 
purposes of this section, the term ‘compensating coverage 
payment’ means— 
‘‘(1) any payment made by the employer for 
qualified health insurance specified by the employee 
(for any period for which the employee is described 
in subsection (b)) which covers all of the individuals 
who, but for the election referred to in subsection 
(b), would be covered under the subsidized health 
plan of the employer, and 
‘‘(2) any payment made by the employer to any 
Archer MSA or health savings account of such em-
ployee or spouse for a period for which the employee 
is covered by qualified health insurance. 
‘‘(d) QUALIFIED HEALTH INSURANCE.—For pur-
poses of this section, the term ‘qualified health insurance’ 
has the meaning given such term in section 36(c). 
‘‘(e) EMPLOYER PARTICIPATION.— 
‘‘(1) IN GENERAL.—This section shall apply to 
a compensating coverage payment made by an em-
ployer for an employee’s benefit only if— 
‘‘(A) the employer, and all other employers 
which are members of any controlled group 
which includes such employer, agree to make 
such payments to all their eligible employees, 
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133 
‘‘(B) the amount of such payment is not 
less than the employer health plan contribution 
for such period with respect to the employee, 
and 
‘‘(C) the employer permits the election re-
ferred to in subsection (b) to be made by em-
ployees— 
‘‘(i) at the commencement of employ-
ment with the employer, and 
‘‘(ii) during open enrollment periods 
(not less frequently than annually) of at 
least 30 days. 
‘‘(2) EXCEPTION FOR CERTAIN EMPLOYEES.— 
Paragraph (1) shall not apply to— 
‘‘(A) any employee who is covered under a 
subsidized health plan of another employer of 
such employee or of an employer of such em-
ployee’s spouse, 
‘‘(B) any employee who normally works 
less than 25 hours per week, 
‘‘(C) any employee who normally works 
during not more than 6 months during any 
year, 
‘‘(D) any employee who has not attained 
age 21, and 
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134 
‘‘(E) except to the extent provided in regu-
lations, any employee who is included in a unit 
of employees covered by an agreement which 
the Secretary of Labor finds to be a collective 
bargaining agreement between employee rep-
resentatives and the employer. 
‘‘(3) CONTROLLED GROUPS.—Rules similar to 
the rules of subclauses (II) and (III) of paragraph 
(4)(D)(iii) shall apply for purposes of paragraph 
(1)(A). 
‘‘(4) EMPLOYER
HEALTH
PLAN
CONTRIBU-
TION.—For purposes of this section— 
‘‘(A) IN
GENERAL.—The term ‘employer 
health plan contribution’ means the applicable 
premium for the employee reduced by the em-
ployee’s share of such premium. 
‘‘(B) APPLICABLE
PREMIUM.—Except as 
provided in subparagraph (D), the term ‘appli-
cable premium’ means an amount which is not 
less than 98 percent of— 
‘‘(i) the applicable premium (as de-
fined in section 4980B(f)(4)) for the em-
ployee, or 
‘‘(ii) if an election under subpara-
graph (D) is in effect with respect to an 
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135 
employee, the applicable premium deter-
mined under subparagraph (D). 
‘‘(C) EMPLOYEE’S SHARE.—The term ‘em-
ployee’s share’ means, with respect to the appli-
cable premium for any employee, the amount of 
the cost to the plan which is paid by the simi-
larly situated beneficiaries who are taken into 
account in determining such premium for such 
employee. 
‘‘(D) AUTHORITY TO USE AGE, SEX, AND 
GEOGRAPHY
IN
DETERMINING
CONTRIBU-
TION.— 
‘‘(i) IN GENERAL.—An employer may 
elect to determine the applicable premium 
for an employee on an actuarial basis tak-
ing into account age, sex, and geography of 
the employee and similarly situated bene-
ficiaries. 
‘‘(ii) 
DETERMINATION
OF
EM-
PLOYEE’S SHARE.—In the case of an em-
ployer who determines the applicable pre-
mium under clause (i), the employee’s 
share of such premium shall be the same 
percentage of such premium as the employ-
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136 
ee’s share of the applicable premium deter-
mined without regard to clause (i). 
‘‘(iii) CONSISTENCY REQUIRED.— 
‘‘(I) IN
GENERAL.—Except as 
provided in subclause (III), an em-
ployer may determine the applicable 
premium under this subparagraph for 
any employee only if such employer, 
and all other employers which are 
members of any controlled group 
which includes such employer, elect to 
determine the applicable premium 
under this subparagraph for all their 
employees. 
‘‘(II) CONTROLLED GROUP.—All 
persons treated as a single employer 
under subsection (a) or (b) of section 
52 or subsection (m) or (o) of section 
414 shall be treated as members of a 
controlled group for purposes of sub-
clause (I). 
‘‘(III) TREATMENT OF SEPARATE 
LINES OF BUSINESS.—If an employer 
is treated under section 414(r) as op-
erating separate lines of business dur-
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137 
ing any taxable year, subclause (I) 
shall not apply to employees employed 
in such separate lines of business. 
‘‘(f) SPECIAL
RULE
FOR
ARCHER
MSAS
AND 
HEALTH SAVINGS ACCOUNT CONTRIBUTIONS.—Sections 
220(b)(5) and 223(b)(4) shall not apply to an employer 
contribution which is excludable from gross income under 
subsection (a). 
‘‘(g) EXCLUSION APPLICABLE IN DETERMINING EM-
PLOYMENT TAX LIABILITY.—The exclusion under this 
section shall be treated for purposes of subtitle C in the 
same manner as the exclusion under section 106.’’. 
(b) EMPLOYER HEALTH PLAN CONTRIBUTION TO 
BE REPORTED ON W–2.—Subsection (a) of section 6051 
of such Code (relating to receipts to employees) is amend-
ed by striking ‘‘and’’ at the end of paragraph (12), by 
striking the period at the end of paragraph (13) and in-
serting a comma, and by inserting after paragraph (13) 
the following new paragraphs: 
‘‘(14) the amount of the employer health plan 
contribution (as defined in section 139(c)(3)), and 
‘‘(15) the amount of compensating coverage 
payment (as defined in section 139(c)(1)).’’. 
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138 
(c) CLERICAL AMENDMENT.—The table of sections 
for such part III is amended by inserting after the item 
relating to section 139A the following new item: 
‘‘Sec. 139B. Treatment of compensating payments made for employees who 
elect not to participate in employer-subsidized health plans.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2007. 
TITLE VI—PATIENT ACCESS TO 
INFORMATION 
SEC. 601. PATIENT ACCESS TO INFORMATION REGARDING 
PLAN COVERAGE, MANAGED CARE PROCE-
DURES, 
HEALTH 
CARE 
PROVIDERS, 
AND 
QUALITY OF MEDICAL CARE. 
(a) IN GENERAL.—Subpart 2 of part A of title 
XXVII of the Public Health Service Act is amended by 
adding at the end the following new section: 
‘‘SEC. 2707. PATIENT ACCESS TO INFORMATION REGARD-
ING PLAN COVERAGE, MANAGED CARE PRO-
CEDURES, HEALTH CARE PROVIDERS, AND 
QUALITY OF MEDICAL CARE. 
‘‘(a) DISCLOSURE REQUIREMENT.—Each health in-
surance issuer offering health insurance coverage in con-
nection with a group health plan shall provide the adminis-
trator of such plan on a timely basis with the information 
necessary to enable the administrator to include in the 
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139 
summary plan description of the plan required under sec-
tion 102 of the Employee Retirement Income Security Act 
of 1974 (or each summary plan description in any case 
in which different summary plan descriptions are appro-
priate under part 1 of subtitle B of title I of such Act 
for different options of coverage) the information required 
under subsections (b), (c), (d), and (e)(2)(A). To the ex-
tent that any such issuer provides such information on a 
timely basis to plan participants and beneficiaries, the re-
quirements of this subsection shall be deemed satisfied in 
the case of such plan with respect to such information. 
‘‘(b) PLAN BENEFITS.—The information required 
under subsection (a) includes the following: 
‘‘(1) COVERED ITEMS AND SERVICES.— 
‘‘(A) CATEGORIZATION OF INCLUDED BEN-
EFITS.—A description of covered benefits, cat-
egorized by— 
‘‘(i) types of items and services (in-
cluding any special disease management 
program); and 
‘‘(ii) types of health care professionals 
providing such items and services. 
‘‘(B) EMERGENCY MEDICAL CARE.—A de-
scription of the extent to which the coverage in-
cludes emergency medical care (including the 
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extent to which the coverage provides for access 
to urgent care centers), and any definitions pro-
vided under in connection with such coverage 
for the relevant coverage terminology referring 
to such care. 
‘‘(C) PREVENTATIVE
SERVICES.—A de-
scription of the extent to which the coverage in-
cludes benefits for preventative services. 
‘‘(D) DRUG FORMULARIES.—A description 
of the extent to which covered benefits are de-
termined by the use or application of a drug 
formulary and a summary of the process for de-
termining what is included in such formulary. 
‘‘(E) 
COBRA 
CONTINUATION
COV-
ERAGE.—A description of the benefits available 
under the coverage provided pursuant to part 6 
of subtitle B of title I of the Employee Retire-
ment Income Security Act of 1974. 
‘‘(2) LIMITATIONS, EXCLUSIONS, AND RESTRIC-
TIONS ON COVERED BENEFITS.— 
‘‘(A) 
CATEGORIZATION
OF
EXCLUDED 
BENEFITS.—A description of benefits specifi-
cally excluded from coverage, categorized by 
types of items and services. 
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‘‘(B) 
UTILIZATION
REVIEW
AND 
PREAUTHORIZATION REQUIREMENTS.—Whether 
coverage for medical care is limited or excluded 
on 
the 
basis 
of 
utilization 
review 
or 
preauthorization requirements. 
‘‘(C) LIFETIME, ANNUAL, OR OTHER PE-
RIOD LIMITATIONS.—A description of the cir-
cumstances under which, and the extent to 
which, coverage is subject to lifetime, annual, or 
other period limitations, categorized by types of 
benefits. 
‘‘(D) CUSTODIAL CARE.—A description of 
the circumstances under which, and the extent 
to which, the coverage of benefits for custodial 
care is limited or excluded, and a statement of 
the definition used in connection with such cov-
erage for custodial care. 
‘‘(E) 
EXPERIMENTAL
TREATMENTS.— 
Whether coverage for any medical care is lim-
ited or excluded because it constitutes experi-
mental treatment or technology, and any defini-
tions provided in connection with such coverage 
for the relevant plan terminology referring to 
such limited or excluded care. 
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