[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2229 Introduced in Senate (IS)]


109th CONGRESS
  2d Session
                                S. 2229

     To provide quality, affordable health care for all Americans.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            January 31, 2006

  Mr. Kennedy introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
     To provide quality, affordable health care for all Americans.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare for All 
Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Medicare for all.
                     ``TITLE XXII--MEDICARE FOR ALL

        ``Sec. 2201. Description of program.
        ``Sec. 2202. Eligibility, enrollment, and coverage.
        ``Sec. 2203. Benefits.
        ``Sec. 2204. Choice of coverage under private health care 
                            delivery systems.
        ``Sec. 2205. Medicare for All Trust Fund.
        ``Sec. 2206. Administration.
Sec. 3. Financing through employment tax.

SEC. 2. MEDICARE FOR ALL.

    (a) Establishment of Program.--The Social Security Act is amended 
by adding at the end the following:

                     ``TITLE XXII--MEDICARE FOR ALL

``SEC. 2201. DESCRIPTION OF PROGRAM.

    ``The program under this title--
            ``(1) ensures that all Americans have high quality, 
        affordable health care;
            ``(2) ensures that all Americans have access to health care 
        as good as their Member of Congress receives; and
            ``(3) reduces the cost of health care and enhances American 
        economic competitiveness in the global marketplace.

``SEC. 2202. ELIGIBILITY, ENROLLMENT, AND COVERAGE.

    ``(a) Eligibility.--
            ``(1) In general.--Each eligible individual is entitled to 
        benefits under the program under this title.
            ``(2) Eligible individual.--
                    ``(A) In general.--For purposes of this title, the 
                term `eligible individual' means an individual who--
                            ``(i) is--
                                    ``(I) a citizen of the United 
                                States; or
                                    ``(II) a person who is lawfully 
                                present in the United States; and
                            ``(ii) is not eligible for benefits under 
                        part A or B of title XVIII.
                    ``(B) Lawfully present.--For purposes of 
                subparagraph (A)(i)(II), a person is lawfully present 
                in the United States if such person--
                            ``(i) is described in section 431 of Public 
                        Law 104-193;
                            ``(ii) is described in section 103.12 of 
                        title 8, Code of Federal Regulations (as in 
                        effect as of the date of enactment of the 
                        Medicare for All Act);
                            ``(iii) is eligible to apply for employment 
                        authorization from the Department of Homeland 
                        Security as listed in section 274a.12 of title 
                        8, Code of Federal Regulations (as in effect as 
                        of the date of enactment of the Medicare for 
                        All Act); or
                            ``(iv) is otherwise determined to be 
                        lawfully present in the United States under 
                        criteria established by the Secretary, in 
                        consultation with the Secretary of Homeland 
                        Security.
            ``(3) Phase-in of eligibility.--Under rules established by 
        the Secretary, eligibility for benefits under this title shall 
        be phased-in as follows:
                    ``(A) During the first 5 years the program under 
                this title is in operation, eligible individuals who 
                are under 20 years of age or who are over 55 years of 
                age are eligible for such benefits.
                    ``(B) During the second 5 years the program under 
                this title is in operation, eligible individuals who 
                are under 30 years of age or who are over 45 years of 
                age are eligible for such benefits.
                    ``(C) All eligible individuals are eligible for 
                such benefits beginning with the eleventh year in which 
                the program under this title is in operation.
    ``(b) Automatic Enrollment.--
            ``(1) In general.--The Secretary shall establish a process 
        under which each eligible individual is deemed to be enrolled 
        under the program under this title. Such process shall include 
        the following:
                    ``(A) Deemed enrollment of an eligible individual 
                upon birth in the United States.
                    ``(B) Enrollment of eligible individuals at the 
                time of immigration into the United States.
            ``(2) Issuance of card.--The Secretary shall provide for 
        issuance of an appropriate card for individuals entitled to 
        benefits under the program under this title. Not later than the 
        sixth year the program under this title is in operation, the 
        Secretary shall ensure that each such card is linked securely, 
        and with strong privacy protections, to an electronic health 
        record for each such individual. In order to accomplish such 
        linkage, the Secretary is authorized to award grants, issue 
        contracts, alter reimbursement under the program under this 
        title, or provide such other incentives as are reasonable and 
        necessary.
    ``(c) Coverage.--
            ``(1) In general.--Subject to paragraph (2), the Secretary 
        shall provide for coverage of benefits for items and services 
        furnished on and after the date an individual is entitled to 
        benefits under the program under this title.
            ``(2) Initial coverage.--No coverage is available under the 
        program under this title for items and services furnished 
        before the date that is 18 months after the date of the 
        enactment of the Medicare For All Act.
            ``(3) Expiration of coverage.--An individual's coverage 
        under the program under this title shall terminate as of the 
        date the individual is no longer an eligible individual.
    ``(d) Relation to Other Programs.--
            ``(1) Construction.--
                    ``(A) Continued operation of public programs.--
                Nothing in this title shall be construed as requiring 
                (or preventing) an individual who is entitled to 
                benefits under the program under this title from 
                obtaining benefits under any other public health care 
                program to which the individual is entitled, including 
                under a State Medicaid plan under title XIX, the State 
                Children's Health Insurance Program under title XXI, a 
                health program of the Department of Defense under 
                chapter 55 of title 10, United States Code, a health 
                program of the Department of Veterans Affairs under 
                chapter 17 of title 38 of such Code, or a medical care 
                program of the Indian Health Service or of a tribal 
                organization.
                    ``(B) Continued operation of private health 
                insurance.--Nothing in this title shall be construed as 
                preventing an individual who is entitled to benefits 
                under the program under this title from obtaining 
                benefits that supplement or improve the benefits 
                available under such program from any private health 
                insurance plan or policy.
            ``(2) Primary payor; other public programs providing wrap 
        around benefits.--The program under this title shall be primary 
        payor to other public health care benefit programs and the 
        benefits under such other public health care benefit programs 
        shall supplement the benefits under the program under this 
        title.

``SEC. 2203. BENEFITS.

    ``(a) Comprehensive Benefit Package.--The Secretary shall provide 
for benefits under the program under this title consistent with the 
following:
            ``(1) Medicare fee-for-service benefits.--The benefits 
        include the full range and scope of benefits available under 
        the original fee-for-service program under parts A and B of 
        title XVIII.
            ``(2) Prescription drug coverage.--The benefits include 
        coverage of prescription drugs at least as comprehensive as the 
        prescription drug coverage offered as of January 1, 2006, under 
        the Blue Cross/Blue Shield Standard Plan provided under the 
        Federal employees health benefits program under chapter 89 of 
        title 5, United States Code (in this title referred to as 
        `FEHBP'). Such coverage shall be administered in the same 
        manner as other benefits under this section.
            ``(3) Inclusion of epsdt.--The benefits include benefits 
        for early and periodic screening, diagnostic, and treatment 
        services (as defined in section 1905(r)) for individuals who 
        are under the age of 21.
            ``(4) Parity in coverage of mental health benefits.--
                    ``(A) In general.--There shall not be any treatment 
                limitations or financial requirements with respect to 
                the coverage of benefits for mental illnesses unless 
                comparable treatment limitations or financial 
                requirements are imposed on medical and surgical 
                benefits. Nothing in this subparagraph shall be 
                construed to require coverage for mental health 
                benefits that are not medically necessary or to 
                prohibit the appropriate medical management of such 
                benefits.
                    ``(B) Related definitions.--For purposes of this 
                paragraph--
                            ``(i) Financial requirements.--The term 
                        `financial requirements' includes deductibles, 
                        coinsurance, co-payments, other cost-sharing, 
                        and limitations on the total amount that may be 
                        paid by an individual with respect to benefits 
                        and shall include the application of annual and 
                        lifetime limits.
                            ``(ii) Mental health benefits.--The term 
                        `mental health benefits' means benefits with 
                        respect to services for all categories of 
                        mental health conditions listed in the 
                        Diagnostic and Statistical Manual of Mental 
                        Disorders, Fourth Edition (DSM IV-TR), or the 
                        most recent edition if different than the 
                        Fourth Edition, if such services are included 
                        as part of an authorized treatment plan that is 
                        in accordance with standard protocols and such 
                        services meet medical necessity criteria. Such 
                        term does not include benefits with respect to 
                        the treatment of substance abuse or chemical 
                        dependency.
                            ``(iii) Treatment limitations.--The term 
                        `treatment limitations' means limitations on 
                        the frequency of treatment, number of visits or 
                        days of coverage, or other similar limits on 
                        the duration or scope of treatment under the 
                        qualifying health benefit plan.
            ``(5) Preventive services.--The benefits shall include 
        coverage of such additional preventive health care items and 
        services as the Secretary shall specify, in consultation with 
        the United States Preventive Services Task Force.
            ``(6) Home and community based services.--The benefits 
        shall include coverage of home and community-based services 
        described in section 1915(c)(4)(B).
            ``(7) Additional benefits.--The benefits shall include such 
        additional benefits that the Secretary determines appropriate.
            ``(8) Revision.--Nothing in this subsection shall be 
        construed as preventing the Secretary from improving the 
        benefit package from time to time to account for changes in 
        medical practice, new information from medical research, and 
        other relevant developments in health science.
            ``(9) Adjustment authorized.--The Secretary shall, on a 
        regular basis, evaluate whether adding any of the benefits 
        described in paragraphs (1) through (7) is necessary or 
        advisable to promote the health of beneficiaries under the 
        program under title XVIII. The Secretary is authorized to 
        improve the benefits available under such program, based upon 
        such evaluation.
    ``(b) Cost-Sharing.--
            ``(1) In general.--Except as otherwise provided under this 
        subsection or subsection (a)(4), with respect to the benefits 
        described in subsection (a)(1), such benefits shall be subject 
        to the cost-sharing (in the form of deductibles, coinsurance, 
        and copayments) and premiums applicable under the program 
        described in such subsection.
            ``(2) Prescription drug coverage.--With respect to the 
        benefits described in subsection (a)(2), such benefits shall be 
        subject to the cost-sharing (in the form of deductibles, 
        coinsurance, and copayments) applicable under the plan 
        described in such subsection.
            ``(3) Treatment of preventive and additional services.--
        With respect to benefits described in paragraphs (5) and (7) of 
        subsection (a), such benefits shall be subject to cost-sharing 
        (in the form of deductibles, coinsurance, and copayments) that 
        is consistent (as determined by the Secretary) with the cost-
        sharing applicable under paragraph (1).
            ``(4) Treatment of epsdt and home and community-based 
        services.--With respect to benefits described in paragraphs (3) 
        and (6) of subsection (a), such benefits shall be subject to 
        nominal cost-sharing (in the form of deductibles, coinsurance, 
        and copayments) that is consistent (as determined by the 
        Secretary) with the cost-sharing applicable to such services 
        under section 1916 (as in effect on January 1, 2006).
            ``(5) Reduction in cost-sharing for low-income 
        individuals.--The Secretary shall provide for reduced cost-
        sharing for low-income individuals in a manner that is no less 
        protective than the reduced cost-sharing for individuals under 
        section 1902(a)(10)(E) (as in effect on January 1, 2006).
    ``(c) Freedom to Choose Your Own Doctor and Health Plan.--Except in 
the case of individuals who elect enrollment in a private health plan 
under section 2204, the provisions of section 1802 shall apply under 
this title.
    ``(d) Payment Schedule.--
            ``(1) In general.--The Secretary, with the assistance of 
        the Medicare Payment Advisory Commission, shall develop and 
        implement a payment schedule for benefits covered under the 
        program under this title which are provided other than through 
        private health plans. To the extent feasible, such payment 
        schedule shall be consistent with comparable payment schedules 
        and reimbursement methodologies applied to benefits provided 
        under parts A and B of title XVIII, except, that with respect 
        to the coverage of prescription drugs, the Secretary shall 
        provide for payment in accordance with a payment schedule 
        developed and implemented under the previous sentence.
            ``(2) Additional payments for quality.--The Secretary shall 
        establish procedures to provide reimbursement in addition to 
        the reimbursement under paragraph (1) to health care providers 
        that achieve measures (as established by the Secretary in 
        consultation with health care professionals and groups 
        representing eligible individuals) of health care quality. The 
        Secretary shall ensure that such measures include measures of 
        appropriate use of health information technology.
    ``(e) Application of Beneficiary Protections.--The Secretary shall 
provide for protections of beneficiaries under the program under this 
title that are not less than the beneficiary protections provided under 
title XVIII, including appeal rights and limitations on balance 
billing.

``SEC. 2204. CHOICE OF COVERAGE UNDER PRIVATE HEALTH CARE DELIVERY 
              SYSTEMS.

    ``(a) In General.--The Secretary shall provide a process for--
            ``(1) the offering of private health plans for the 
        provision of benefits under the program under this title; and
            ``(2) the enrollment, disenrollment, termination, and 
        change in enrollment of eligible individuals in such plans.
    ``(b) Offering of Private Health Plans.--
            ``(1) In general.--The Secretary shall enter into contracts 
        with qualified entities for the offering of private health 
        plans under the program under this title. In entering into such 
        contracts the Secretary shall have the same authority that the 
        Director of the Office of Personnel Management has with respect 
        to health benefits plans under FEHBP.
            ``(2) Requirements.--The Secretary shall not enter into 
        such a contract for the offering of a private health plan under 
        the program under this title unless at least the following 
        requirements are met:
                    ``(A) Benefits as good as your Congressman gets.--
                Benefits under such plans are not less than the 
                benefits offered to Members of Congress and Federal 
                employees under FEHBP. Such plans may provide health 
                benefits in addition to such required benefits and may 
                impose a premium for the provision of benefits. Such 
                plans may not provide for financial payments or rebates 
                to enrollees.
                    ``(B) Beneficiary protections.--Enrollees in such 
                plans have beneficiary protections that are not less 
                than the beneficiary protections applicable under this 
                title to individuals not so enrolled and shall include 
                beneficiary protections applicable under both FEHBP and 
                part C of title XVIII.
                    ``(C) Other administrative requirements.--The plans 
                are subject to such requirements relating to licensure 
                and solvency, protection against fraud and abuse, 
                inspection, disclosure, periodic auditing, and 
                administrative operations and efficiencies as the 
                Secretary identifies, taking into account similar 
                requirements under FEHBP and part C of title XVIII.
    ``(c) Annual Open Enrollment.--The process under subsection (a)(2) 
shall provide for an annual open enrollment period in which individuals 
may enroll, and change or terminate enrollment, in private health plans 
in a manner similar to that provided under FEHBP as of January 1, 2006.
    ``(d) Payment to Private Health Plans.--
            ``(1) In general.--In the case of an individual enrolled in 
        a private health plan under this section for a month, the 
        Secretary shall provide for payment of an amount equal to \1/
        12\ of the annual per capita amount (described in paragraph 
        (2), as adjusted under paragraph (3)).
            ``(2) Annual per capita amount.--The annual per capita 
        amount under this paragraph shall be the annual average per 
        capita cost of providing benefits under the program under this 
        title (including both individuals enrolled and not enrolled 
        under private health plan), as computed by the Secretary based 
        on rules similar to the rules described in section 1876(a)(4).
            ``(3) Risk-adjustment.--In making payment under this 
        subsection, the Secretary shall apply risk adjustment factors 
        similar to those applied to payments to Medicare Advantage 
        organizations under section 1853, except that the Secretary 
        shall ensure that payments under this subsection are adjusted 
        based on such factors to ensure that the health status of the 
        enrollee is reflected in such adjusted payments, including 
        adjusting for the difference between the health status of the 
        enrollee and individuals receiving benefits under the program 
        under this title who are not so enrolled. Payments under this 
        subsection must, in aggregate, reflect such differences.
    ``(e) Requirements for FEHBP Carriers.--Each contract entered into 
or renewed under section 8902 of title 5, United States Code, shall 
require the carrier to offer a plan under this section on similar terms 
and conditions to the plan offered by the carrier under FEHBP.

``SEC. 2205. MEDICARE FOR ALL TRUST FUND.

    ``(a) Establishment of Trust Fund.--There is hereby created on the 
books of the Treasury of the United States a trust fund to be known as 
the `Medicare for All Trust Fund' (in this section referred to as the 
`Trust Fund'). The Trust Fund shall consist of such gifts and bequests 
as may be made as provided in section 201(i)(1), and such amounts as 
may be deposited in, or appropriated to, such fund as provided in this 
part.
    ``(b) Transfers to Trust Fund.--There are hereby appropriated to 
the Medicare for All Trust Fund, out of any moneys in the Treasury not 
otherwise appropriated, amounts equivalent to--
            ``(1) the taxes received in the Treasury under sections 
        1401(c), 3101(c), and 3111(c) of the Internal Revenue Code of 
        1986;
            ``(2) such portion of the taxes received in the Treasury 
        under section 3201 as are attributable to the rate specified in 
        section 3101(c) of such Code;
            ``(3) such portion of the taxes received in the Treasury 
        under section 3211 of such Code as are attributable to the sum 
        of the rates specified in section 3101(c) and 3111(c) of such 
        Code; and
            ``(4) such portion of the taxes received in the Treasury 
        under section 3221 as are attributable to the rate specified in 
        section 3111(c) of such Code.
The amounts appropriated by the preceding sentence shall be transferred 
from time to time from the general fund in the Treasury to the Trust 
Fund, such amounts to be determined on the basis of estimates by the 
Secretary of the Treasury of the taxes, specified in the preceding 
sentence, paid to or deposited into the Treasury, and proper 
adjustments shall be made in amounts subsequently transferred to the 
extent prior estimates were in excess of or were less than the taxes 
specified in such sentence.
    ``(c) Incorporation of Provisions.--
            ``(1) In general.--Subject to paragraph (2), subsections 
        (b) through (i) of section 1817 shall apply with respect to the 
        Trust Fund and this title in the same manner as they apply with 
        respect to the Federal Hospital Insurance Trust Fund and part A 
        of title XVIII, respectively.
            ``(2) Miscellaneous references.--In applying provisions of 
        section 1817 under paragraph (1)--
                    ``(A) any reference in such section to `this part' 
                is construed to refer to this title;
                    ``(B) any reference to taxes referred to in 
                subsection (a) of such section shall be construed to 
                refer to the taxes referred to in subsection (b) of 
                this section; and
                    ``(C) the Board of Trustees of the Medicare for All 
                Trust Fund shall be the same as the Board of Trustees 
                of the Federal Hospital Insurance Trust Fund.

``SEC. 2206. ADMINISTRATION.

    ``Except as otherwise provided in this title--
            ``(1) the Secretary shall enter into appropriate contracts 
        with providers of services, other health care providers, and 
        medicare administrative contractors, taking into account the 
        types of contracts used under title XVIII with respect to such 
        entities, to administer the program under this title;
            ``(2) benefits described in section 2203 that are payable 
        under the program under this title to such individuals shall be 
        paid in a manner specified by the Secretary (taking into 
        account, and based to the greatest extent practicable upon, the 
        manner in which they are provided under title XVIII); and
            ``(3) provider participation agreements under title XVIII 
        shall apply to enrollees and benefits under the program under 
        this title in the same manner as they apply to enrollees and 
        benefits under the program under title XVIII.''.
    (b) Conforming Amendments to Social Security Act Provisions.--
            (1) Section 201(i)(1) of the Social Security Act (42 U.S.C. 
        401(i)(1)) is amended--
                    (A) by striking ``or the Federal Supplementary '' 
                and inserting ``the Federal Supplementary''; and
                    (B) by inserting ``or the Medicare for All Trust 
                Fund'' after ``such Trust Fund)''.
            (2) Section 201(g)(1)(A) of such Act (42 U.S.C. 
        401(g)(1)(A)) is amended by striking ``and the Federal 
        Supplementary Medical Insurance Trust Fund established by title 
        XVIII'' and inserting ``, the Federal Supplementary Medical 
        Insurance Trust Fund established by title XVIII, and the 
        Medicare for All Trust Fund established under title XXII''.
    (c) Maintenance of Medicaid Eligibility and Benefits.--In order for 
a State to continue to be eligible for payments under section 1903(a) 
of the Social Security Act (42 U.S.C. 1396b(a)) the State may not 
reduce standards of eligibility or benefits provided under its State 
Medicaid plan under title XIX of the Social Security Act below such 
standards of eligibility and benefits in effect on the date of the 
enactment of this Act.

SEC. 3. FINANCING THROUGH EMPLOYMENT TAX.

    (a) Tax on Employees.--Section 3101 of the Internal Revenue Code of 
1986 is amended by redesignating subsection (c) as subsection (d) and 
by inserting after subsection (b) the following new subsection:
    ``(c) Medicare for All.--In addition to other taxes, there is 
hereby imposed on the income of every individual a tax equal to 1.7 
percent of the wages (as defined in section 3121(a)) received by him 
with respect to employment (as defined in section 3121(b)).''.
    (b) Tax on Employers.--Section 3111 of such Code is amended by 
redesignating subsection (c) as subsection (d) and by inserting after 
subsection (b) the following new subsection:
    ``(c) Medicare for All.--In addition to other taxes, there is 
hereby imposed on every employer an excise tax, with respect to having 
individuals in his employ, equal to 7 percent of the wages (as defined 
in section 3121(a)) paid by him with respect to employment (as defined 
in section 3121(b)).''.
    (c) Tax on Self-Employment.--Section 1401 of such Code is amended 
by redesignating subsection (c) as subsection (d) and by inserting 
after subsection (b) the following new subsection:
    ``(c) Medicare for All.--In addition to other taxes, there shall be 
imposed for each taxable year, on the self-employment income of every 
individual, a tax equal to the applicable percent of the self-
employment income for such taxable year. For purposes of the preceding 
sentence, the applicable percent is a percent equal to the sum of the 
percent described in section 3101(c) plus the percent described in 
section 3111(c).''.
    (d) Railroad Retirement Tax.--
            (1) Tax on employees.--Section 3201(a) of such Code is 
        amended by striking ``subsections (a) and (b) of section 3101'' 
        and inserting ``subsections (a), (b), and (c) of section 
        3101''.
            (2) Tax on employee representatives.--Section 3211(a) of 
        such Code is amended by striking ``subsections (a) and (b) of 
        section 3101 and subsections (a) and (b) of section 3111'' and 
        inserting ``subsections (a), (b), and (c) of section 3101 and 
        subsections (a), (b), and (c) of section 3111''.
            (3) Tax on employers.--Section 3221(a) of such Code is 
        amended by striking ``subsections (a) and (b) of section 3111'' 
        and inserting ``subsections (a), (b), and (c) of section 
        3111''.
            (4) Determination of contribution base.--Clause (iii) of 
        section 3231(e)(2)(A) is amended to read as follows:
                            ``(iii) Hospital insurance and medicare for 
                        all taxes.--Clause (i) shall not apply to--
                                    ``(I) so much of the rate 
                                applicable under section 3201(a) or 
                                3221(a) as does not exceed the sum of 
                                the rates of tax in effect under 
                                subsections (b) and (c) of section 
                                3101, and
                                    ``(II) so much of the rate 
                                applicable under section 3211(a) as 
                                does not exceed the sum of the rates of 
                                tax in effect under subsections (b) and 
                                (c) of section 1401.''.
    (e) Application of Tax to Federal, State, and Local Employment.--
Paragraphs (1) and (2) of section 3121(u) and section 3125(a) of such 
Code are each amended by striking ``sections 3101(b) and 3111(b)'' and 
inserting ``subsections (b) and (c) of section 3101 and subsections (b) 
and (c) of section 3111''.
    (f) Conforming Amendments.--
            (1) Section 1402(a)(12)(B) of such Code is amended by 
        striking ``subsections (a) and (b) of section 1401'' and 
        inserting ``subsections (a), (b), and (c) of section 1401''.
            (2) Section 3121(q) of such Code is amended by striking 
        ``subsections (a) and (b) of section 3111'' and inserting 
        ``subsections (a), (b), and (c) of section 3111''.
            (3) The last sentence of section 6051(a) of such Code is 
        amended by striking ``sections 3101(c) and 3111(c)'' and 
        inserting ``sections 3101(d) and 3111(d)''.
    (g) Effective Date.--The amendments made by this section shall 
apply to wages paid and self-employment income derived on or after 
January 1 of the year following the date of the enactment of this Act.
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