[Congressional Record Volume 152, Number 133 (Wednesday, December 6, 2006)]
[House]
[Pages H8809-H8812]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  PHYSICIANS FOR UNDERSERVED AREAS ACT

  Mr. SENSENBRENNER. Mr. Speaker, I move to suspend the rules and pass 
the bill (H.R. 4997) to permanently authorize amendments made by the 
Immigration and Nationality Technical Corrections Act of 1994 for the 
purpose of permitting waivers of the foreign country residence 
requirement with respect to certain international medical graduates, as 
amended.
  The Clerk read as follows:

                               H.R. 4997

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Physicians for Underserved 
     Areas Act''.

     SEC. 2. WAIVER OF FOREIGN COUNTRY RESIDENCE REQUIREMENT WITH 
                   RESPECT TO INTERNATIONAL MEDICAL GRADUATES.

       Section 220(c) of the Immigration and Nationality Technical 
     Corrections Act of 1994 (8 U.S.C. 1182 note; Public Law 103-
     416) (as amended by section 1(a)(1) of Public Law 108-441) is 
     amended by striking ``June 1, 2006.'' and inserting ``June 1, 
     2008.''.

     SEC. 3. EFFECTIVE DATE.

       The amendment made by section 2 shall take effect as if 
     enacted on May 31, 2006.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Wisconsin (Mr. Sensenbrenner) and the gentleman from Michigan (Mr. 
Conyers) each will control 20 minutes.
  The Chair recognizes the gentleman from Wisconsin.


                             General Leave

  Mr. SENSENBRENNER. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks and include extraneous material on H.R. 4997 currently 
under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Wisconsin?
  There was no objection.

                              {time}  1500

  Mr. SENSENBRENNER. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, H.R. 4997, the Physicians for Underserved Areas Act, 
reauthorizes for 2 years the program under which physicians on J-1 
visas can work in underserved areas. The program expired on June 1 of 
this year.
  Each year numerous foreign doctors come to the United States to 
complete their residency training. Many do so using the J-1 visa. One 
of the requirements for physicians who use the J-1 visa is that the 
participant return to his or her own country for 2 years upon 
completion of the training program in the United States. The purpose of 
this foreign residency requirement is to encourage U.S.-trained 
physicians to return to their country and to improve medical conditions 
there.
  Since 1994, Congress has waived the 2-year foreign residency 
requirement for physicians who agree to work in an underserved area of 
the United States, as designated by the Department of Health and Human 
Services. Each State receives 30 such waivers a year.
  The waiver program allows States to recruit physicians to areas that 
have trouble attracting newly trained American physicians. Because of 
this waiver program, many communities that might otherwise have no 
access to medical services now have physicians nearby. It also responds 
to an overall shortage of physicians in the United States, which is a 
disconcerting trend.
  A 2-year reauthorization of this program in its current form also 
gives Congress time to consider whether future changes may be needed to 
the program. For example, larger States like Texas have expressed a 
need for additional waivers beyond the 30 currently allowed. It is 
important that we consider ways to address this problem without putting 
the small States at a disadvantage. By reauthorizing the waiver 
program, we will provide States with some relief for the physician 
shortage they are facing, particularly in rural and underserved areas.
  I urge Members to support this bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. CONYERS. Mr. Speaker, I yield myself such time as I may consume.
  I am pleased to have reached a bipartisan agreement to extend the J-1 
visa waiver program for another 2-year period. This visa waiver program 
is critically important to bringing essential medical services to 
residents of underserved rural and urban areas, including my own 
district in Detroit, Michigan. The J-1 program allows some foreign 
doctors who have completed their medical training in the United States 
to remain here to practice medicine for 2 years if they will serve 
patients in a region of the country that the Federal Government defines 
as medically underserved. These tend to be less affluent urban areas 
with high population densities and insufficient access to general 
practitioners and specialists as well as rural areas that are far from 
medical centers and may have trouble attracting enough doctors to meet 
the communities' needs. These communities are particularly desperate 
for physician services because of the growing national shortage of 
doctors our country is facing.
  This past summer a Los Angeles Times article detailed the looming 
crisis in medical care in the United States as the demand for medical 
service explodes. The article noted industry fears that shortages may 
even become more severe over the next decade due to the flat medical 
school enrollments, aging baby boomers, and the high number of doctors 
heading for retirement.
  While some communities enjoy a glut of physicians, one in five 
Americans, in fact, live in rural and urban areas with so few doctors 
that the Federal Government has classified these regions as ``medically 
underserved.'' It is these Americans that foreign doctors assist when 
they get a J-1 visa waiver to practice medicine in communities that 
don't have enough American doctors.
  I believe we need to make improvements in this program so that it 
better meets the needs of the underserved. Right now some States who 
receive J-1 doctors through the ``Conrad-30 program'' do not lose their 
allotment of 30 waivers each year while other States find that 30 
waivers are insufficient to meet the medical needs of their 
communities. In addition, some States may

[[Page H8810]]

not need 30 waivers, but other States have trouble recruiting all the 
doctors they need. The result is that some citizens are still unable to 
get essential medical care.
  We need a plan that ensures that States having trouble recruiting 
enough doctors will be able to fill their allotment for J-1 doctors and 
ensure that States which fill their annual allotment of J-1 doctors can 
get more such doctors to meet their needs without impinging upon those 
allotted to any other State. In this way the needs of all States and, 
most importantly, all of the citizens in underserviced areas can be met 
until U.S. medical schools are able to increase the number of graduates 
to meet our domestic needs.
  I look forward to working with my colleagues in the House and Senate 
in the 110th Congress to improve, extend, and sustain this vital visa 
program in the very near future.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SENSENBRENNER. Mr. Speaker, I yield 4 minutes to the author of 
the bill, the gentleman from Kansas (Mr. Moran).
  Mr. MORAN of Kansas. Mr. Speaker, I want to thank Chairman Hostettler 
and Ranking Member Jackson-Lee and the two chairmen and ranking members 
of the full committee, who are here today, for their leadership and 
effort.
  This has been a long time coming. The J-1 visa Conrad program has 
expired 6 months ago, and communities are waiting for the certainty of 
this legislation's passing, and I am grateful to the leadership of the 
committee as well as the House to see that this bill is on the floor 
today.
  I came to Congress as a Member who wanted to do something about 
preserving and improving the way of life in rural America, and one of 
the things I quickly discovered was if there is going to be a future 
for rural communities we are going to have to have access to affordable 
medical care. If you want your community to have that future, you have 
got to have hospital doors that remain open, physicians in communities, 
home health care, nursing home care, and other professional health care 
providers that can meet the needs. Otherwise, our senior citizens that 
make up such a large portion of our population will reluctantly move 
away and young families will decide we can't take the risk of living in 
a community that does not allow us the opportunity to have our children 
treated with adequate medical facilities.
  The J-1 visa program, though not solving all of the challenges we 
face in meeting the health care needs of Americans, is one step in that 
direction that needs to be there. It needs to be in place, and I am 
pleased that the committee has recognized its importance.
  The physician shortage that has been mentioned is real. In fact, the 
U.S. Department of Health and Human Services estimates that although a 
quarter of the population of our country lives in rural America, only 
10 percent of the physicians serve that population. We have a 
tremendous gap. And the unique thing about this, as is with many what I 
would call rural health care issues, is it brings urban Members of 
Congress and rural Members of Congress together because our needs are 
so identical. We are so underserved that the core center of cities and 
the most unpopulated areas of the country face the same challenges: How 
do we meet the health care needs of Americans who choose to live where 
they live? Kansas has been able to recruit 66 physicians since 2002 
when we developed our State program, and it has made a tremendous 
difference. Three communities, Rush County Memorial Hospital now has 
had three J-1 visa physicians, the only physicians in the county. The 
same thing with Greensburg, Kansas. For the last 10 years, no physician 
in the community but a J-1 visa, and those J-1 visa doctors have 
attracted three mid-level practitioners. And, finally, the most recent 
success in Kansas is a community health clinic, the United Methodist 
Mexican-American Ministries, where they just recruited a J-1 visa 
doctor from Peru who now can address the needs of many Hispanic members 
of that community in southwest Kansas. It is wonderful now to have a 
bilingual J-1 visa doctor.
  Again, there are issues that we would love to work on to address the 
distribution of J-1 visa physicians, and I look forward to trying to 
meet that challenge with my colleagues from across the country. But 
this program is important. It saves lives. It is often the only health 
care opportunity that many Americans will ever receive, and the J-1 
visa program is about good health and saving lives.
  I am very grateful for the opportunity to be here today.
  Mr. CONYERS. Mr. Speaker, I would like to yield such time as she may 
consume to the distinguished gentlewoman from Texas, Sheila Jackson-
Lee, the ranking member of the Subcommittee on Immigration in the 
Judiciary Committee.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the distinguished 
ranking member for yielding, and I look forward to his leadership in 
the 110th Congress. I thank him for his leadership on this legislation. 
I thank the full committee chairman as well. I pay great respect to my 
good friend from Kansas, Mr. Moran, for his leadership and authoring of 
this bill and for his very careful, meticulous work with the committee 
of jurisdiction, the Judiciary Committee, and the Subcommittee on 
Immigration, Border Security, and Claims.
  This is what you call a stellar example of real immigration reform. 
Rational, reasonable thinking, putting immigration in a good light. And 
it is a right light and a positive light. And it is, as Mr. Moran has 
just previously said, about good health care. And I am delighted to 
hear his noted examples that this is a real question for good health 
care in America.
  The Physicians for Underserved Areas Act that I have worked on with 
the chairman of the subcommittee, Mr. Hostettler, would reinstate and 
extend the J-1 visa waiver program. Foreign doctors who want to receive 
medical training in the United States on J visas are required to leave 
the country afterwards. They must return to their own countries for 2 
years before they can receive a visa to work in the United States as 
physicians. In 1994, Congress established a waiver of this requirement. 
The waiver is available to doctors who will commit to practicing 
medicine for no less than 3 years in a geographic area designated by 
the Secretary of Health and Human Services as having a shortage of 
health care professionals. The good news is that it is both in rural 
and urban areas that we can find this very vital and important tool.
  Just a few weeks ago, I saw a doctors hospital in Houston literally 
shut down. Shut down for a number of reasons, management care problems. 
But that means that those doctors will be scattered in many different 
places. Urban areas can also be the victims of a lack of doctors.
  The waiver program has been successful for more than a decade. It 
permits each State to obtain waivers permitting up to 30 physicians to 
work in medically underserved areas. It is not a permanent program. It 
is sunsetted on June 1 of this year. That is why we need the Physicians 
for Underserved Areas Act. H.R. 4997 would reinstate and extend the 
program for 2 years. This is the second time that we have co-sponsored 
this extension with Mr. Hostettler.
  We have a longstanding commitment to ensuring that legislation that 
can be bipartisan moves through this committee and the full committee. 
The need for physicians in underserved areas is not a partisan issue. 
The J-1 visa waiver is also known as a Conrad program to reflect the 
fact that Senator Conrad established it. Senator Conrad and I have 
worked together on the program and decided that more data was needed on 
how successfully the program is being implemented. So we asked the 
General Accounting Office to investigate the implementation of the J-1 
visa program. GAO issued a report in November of this year, and among 
other things, GAO found that the use of the J-1 visa waiver is a major 
means of providing physicians to practice in underserved areas of the 
United States. More than 1,000 waivers were requested in each of the 
fiscal years 2003 through 2005 by States and three Federal agencies, 
the Appalachian Regional Commission, the Delta Regional Authority, and 
the Department of HHS. GAO also found that the present system of 
providing up to 30 waivers per State is not working. A substantial 
percentage of States do not

[[Page H8811]]

need 30 waivers. There were 664 unused waivers in fiscal year 2005. 
Other States need more than 30 waivers a year for their medically 
underserved areas. The States that report needing more than 30 waivers 
only want between 5 and 50 more physicians. Their needs can be met by 
redistributing some of the unused waivers, but this must be done 
carefully. Some States expressed concern to GAO about redistributing 
unused waivers. They are afraid that physicians would wait and apply to 
more populous States that would be receiving the redistributed waivers. 
This problem has to be resolved before we can move forward with the 
development of a redistribution plan. That was a very important issue 
for some States such as Texas, but out of a commitment to 
bipartisanship but really the recognition that the J-1 visa extension 
is so crucial to the health needs of so many Americans, we have come 
together to look forward into the 110th Congress for the leaders who 
are going forward on this issue to begin to address how do we make more 
fair the redistribution of these visas and to ensure the best health 
care for Americans.

                              {time}  1515

  We are hoping that the other body will likewise see the wisdom of 
delaying this issue which hospitals in the State of Texas have worked 
very hard on. And I want to make it very clear that I look forward to 
working with hospitals around America to ensure that this 
redistribution process is fairly put in place so that we will have the 
kind of doctor distribution that will help all of us.
  Let me also acknowledge, as I bring my remarks to a close, that 
although this is a bill that simply generates an extension, might I say 
to you that this has been a long journey to come this far, and I want 
to thank all of the staff. I want to thank, of course, Mr. Pomeroy, who 
I hope will make remarks. We worked very closely with his office. And 
Mr. Moran. As I said, the chair of the full committee, the chair and 
the ranking member.
  As I close, let me acknowledge the fact that this may be the last 
bill that I will have the opportunity of working with Mr. Hostettler 
on, and I simply wanted to acknowledge his integrity and his commitment 
and dedication to important principles, and his work on this particular 
legislation as we worked together, and thank him again for his service, 
and also his attentive concern to legislation that we hope will be seen 
in the next Congress, and that is the energy workers compensation bill, 
which we have just had five hearings on, which the last one was 
yesterday, and that will help to compensate many victims.
  I conclude by thanking all of the sponsors and saying this a good 
bill, and I ask my colleagues to support it.
  I rise in support of the Physicians for Underserved Areas Act, H.R. 
4997, that I have offered with my colleague Representative John 
Hostettler. It would reinstate and extend the J-l Visa Waiver Program.
  Foreign doctors who want to receive medical training in the United 
States on J visas are required to leave the country afterwards. They 
must return to their own countries for two years before they can 
receive a visa to work in the United States as physicians. In 1994, 
Congress established a waiver of this requirement. The waiver is 
available to doctors who will commit to practicing medicine for no less 
than three years in a geographic area designated by the Secretary of 
Health and Human Services as having a shortage of health care 
professionals.
  The waiver program has been successful for more than a decade. It 
permits each state to obtain waivers permitting up to 30 physicians to 
work in medically underserved areas. It is not a permanent program. It 
sunsetted on June 1st of this year. The Physicians for Underserved 
Areas Act, H.R. 4997, would reinstate and extend the program for two 
years. This is the second time that I have cosponsored an extension 
with Representative  Hostettler. We have a long standing relationship 
of cooperation on this issue. The need for physicians in underserved 
areas is not a partisan issue.
  The J-l Visa Waiver is also known as the Conrad program, to reflect 
the fact that Senator Kent Conrad established it. Senator Conrad and I 
have worked together on the program. We decided that more data was 
needed on how successfully the program is being implemented, so we 
asked the General Accountability Office (GAO) to investigate the 
implementation of the J-l Visa Waiver Program.
  GAO issued a report in November of this year. Among other things, GAO 
found that the use of J-l visa waivers is a major means of providing 
physicians to practice in underserved areas of the United States. More 
than 1,000 waivers were requested in each of fiscal years 2003 through 
2005 by states and three federal agencies--the Appalachian Regional 
Commission, the Delta Regional Authority, and the Department of Health 
and Human Services.
  GAO also found that the present system of providing up to 30 waivers 
per state is not working well. A substantial percentage of the states 
do not need 30 waivers a year. There were 664 unused waivers in FY2005. 
Other states need more than 30 waivers a year for their medically 
undeserved areas.
  The states that reported needing more than 30 waivers only want 
between 5 and 50 more physicians. Their needs can be met by 
redistributing some of the unused waivers, but this must be done 
carefully. Some states expressed concern to GAO about redistributing 
unused waivers. They are afraid that physicians would wait and apply to 
the more popular states that would be receiving the redistributed 
waivers. This problem has to be resolved before we can move forward 
with the development of a redistribution plan.
  We will continue to work on a distribution system next year. I am 
confident that we will succeed in developing a new version of the J-l 
Visa Waiver Program that would facilitate the use of all of the 
available waivers and place the physicians where they are needed most.
  It has been a long journey to get this bill to the floor. In addition 
to the work it took to get subcommittee and full committee markups, we 
have had an ongoing dialogue with our counterparts in the Senate. They 
wanted the program to have a redistribution program now. They do not 
want to wait until next year. I share their desire for a redistribution 
system. It would be a great help to my state, the State of Texas. 
Nevertheless, I do not want to do it at the cost of hurting the states 
that are finding it difficult to attract waiver physicians. My staff 
has advised me that the senators are very close to reaching an 
agreement on postponing consideration of redistribution. We will work 
on a resdribution program in the 110th Congress.
  In closing, I would like to say a few words about my colleague, 
Representative Hostettler. I have enjoyed working with Mr. Hostettler. 
He is an honest and sincere man who is dedicated to his principles. 
Recently, we worked together to respond to attempts by the 
administration to impose cost containment measures on the Energy 
Worker's Compensation bill. We both felt that this was outrageous, and 
we have cooperated in conducting a series of 5 oversight hearings to 
ensure that everything about the situation would be out in the open and 
to leave a roadmap for the next Congress. Mr. Hostettler has led this 
subcommittee with distinction. I wish him well in whatever he chooses 
to do in the future.
  I urge you to vote ``yes'' for H.R. 4997--For good health care in 
America.
  Mr. CONYERS. Mr. Speaker, I yield as much time as he may consume to 
the gentleman from North Dakota (Mr. Pomeroy), who is the original 
cosponsor of this legislation.
  Mr. POMEROY. Mr. Speaker, I want to congratulate the gentlewoman from 
Texas, Sheila Jackson-Lee, for the remarks she just made, particularly 
in respect to the cooperation with Chairman Hostettler.
  You know, this bill is before us at this critical hour for this 
program because of the work of the chairman and the persistent advocacy 
of the gentlewoman. What impresses me in particular is the 
gentlewoman's agreement to advance this bill forward, even though it 
was not reformed in ways that she had sought.
  For rural areas, this was just so urgent. And we are really pleased 
that we can get this done, even as the session comes to conclusion. You 
see, we have trouble in rural areas. We have trouble getting doctors 
that we need to practice there. And this Conrad 30 program has played 
an incredibly important role in getting doctors into areas who need 
them in rural America. In fact, the physician practice vacancies in 
North Dakota have been cut roughly in half out in the rural areas as a 
result of this program. If this program were to expire, we would 
literally have hospitals without doctors. We would have people without 
the care they need. Frankly, we would have lives lost, because when you 
are getting into areas of western Kansas or North Dakota, you are 
talking about vast reaches of territory that take considerable time to 
cross before you can get someone, who may have an emergency medical 
condition, to an urban center where they might be treated.

[[Page H8812]]

  So this program which is tried, true, tested and part of the 
landscape, is about to expire. Again, to sum up, continuation of it 
continues what we have got. We have agreed, I have agreed with the 
gentlewoman to take a look at how we reform it in ways that respond to 
her concerns. But I am just so pleased that she has agreed to move this 
forward, and also pleased with the working relationship she has with 
Chairman Hostettler.
  So, at this point in his congressional career, he instilled a sense 
that this come to the floor for a conclusion. Good for you, madam, 
gentlewoman, Sheila Jackson Lee, and good for you, Chairman Hostettler. 
This is one rule America sorely needs. We thank you for it.
  Mr. Speaker, I rise today in support of H.R. 4997, the Physicians for 
Underserved Areas Act, which helps to address the physician shortage in 
rural areas across America.
  H.R. 4997 reauthorizes for two years the Conrad 30 program. This 
program, which was established by fellow North Dakotan, Senator Kent 
Conrad, allows graduates of foreign medical schools who complete their 
training in the United States on a J-l cultural exchange visa to remain 
in the U.S. for three years if they agree to serve in a medically 
underserved community.
  Many of these medically underserved communities are in rural areas. 
In fact, only about ten percent of physicians practice in rural America 
despite the fact that nearly one- fourth of the population lives in 
rural areas. In my own state of North Dakota, eighty-one percent of 
North Dakota's counties are designated as health professional shortage 
areas, or HPSAs.
  In communities like Crosby and Tioga, North Dakota, the J-l visa 
waiver physicians pool serves as the primary resource to meet rural 
clinics and hospitals physician needs. For example, Dr. Ivan 
Tsutskiridze, serves Crosby, North Dakota, under the Conrad 30 program 
and is the communities' sole physician. Prior to the creation of the 
program, Crosby and other communities were chasing physicians. In fact, 
since 1994, this program has cut in half the number of family practice 
physician vacancies in North Dakota.

  The importance of this program is evident. Last year alone, over 
6,000 physicians participated in the J-l waiver program and it is 
heavily relied upon by a majority of the states. However, its need for 
reauthorization remains as the physician shortage in this country is 
projected to reach 200,000 by 2020. That is why I am pleased to see 
this bill before the House today to reauthorize this important program 
that has provided many rural areas with capable, much-needed 
physicians.
  I would like to thank the people who have worked to bring this bill 
to the floor today, especially Representative John Hostettler, 
Representative Sheila Jackson-Lee and Representative Jerry Moran. This 
bill makes a real difference for medically underserved areas across the 
United States and in North Dakota. I urge a ``yes'' vote on H.R. 4997.

  Mr. CONYERS. Mr. Speaker, I yield 30 seconds to the gentlewoman from 
Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. I would like to add my appreciation to all 
of the staff, majority and minority, who helped in the waning hours of 
this particular Congress, the 109th Congress, to help move this bill to 
suspension and to help move it forward. And I do thank Kristen Wells 
and Nolan Rappaport for their excellent cooperation and work on the 
minority staff in generating what I think is an important extension for 
doctors across America.
  Ms. BORDALLO. Mr. Speaker, I rise today in strong support of H.R. 
4997, the Physicians for Underserved Areas Act. This bill will 
permanently authorize the J-1 visa waiver program, allowing foreign 
physicians certain visa waivers in exchange for their service in 
medically underserved areas within the United States including the 
territories. A recent study conducted by the Government Accountability 
Office (GAO) attributed the J-1 visa waivers as a major means through 
which communities have successfully placed physicians in underserved 
areas.
  The J-1 visa waiver program, since its inception in 1994, has brought 
physicians from areas around the world to the United States to improve 
access to primary medical care for individuals in underserved 
communities. Every year, nearly 1,000 requests for J-1 visa waivers are 
submitted, which is a testament to this program's popularity and 
effectiveness among U.S. medical schools and medically underserved 
communities.
  As the representative from Guam, I know first-hand the challenges 
rural and medically underserved areas face. For instance, there is no 
oncologist on the island of Guam today. Cancer patients must travel to 
Hawaii to receive treatment. Because of the J-1 visa waiver program, 
however, the Government of Guam was able to apply for J-1 visa waivers 
for two physicians in 2005.
  The Physicians for Underserved Areas Act, by making this program 
permanent, will go far toward helping medically underserved areas like 
the one I represent. Healthcare is a national priority, and as 
legislators, we are tasked with doing all that we can at the federal 
level to ensure that adequate medical care is available to all and that 
medical professionals can be recruited to serve medically underserved 
communities.
  Mr. CONYERS. Mr. Speaker, I yield back the balance of my time.
  Mr. SENSENBRENNER. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Culberson). The question is on the 
motion offered by the gentleman from Wisconsin (Mr. Sensenbrenner) that 
the House suspend the rules and pass the bill, H.R. 4997, as amended.
  The question was taken; and (two-thirds of those voting having 
responded in the affirmative) the rules were suspended and the bill, as 
amended, was passed.
  The title of the bill was amended so as to read:
  ``A bill to extend for 2 years the authority to grant waivers of the 
foreign country residence requirement with respect to certain 
international medical graduates.''.
  A motion to reconsider was laid on the table.

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