Funding, Deals & Partnerships: BIOLOGICS & MEDICAL DEVICES; BioMed e-Series; Medicine and Life Sciences Scientific Journal – http://PharmaceuticalIntelligence.com
Patient Protection and Affordable Care Act Featured at RAND
Reporter: Aviva Lev-Ari, PhD, RN
Below the reader will find a compilation of all the articles related to Affordable Care Act Featured at RAND
The Patient Protection and Affordable Care Act (ACA)—the sweeping health care reform sometimes known as “Obamacare”—was enacted in 2010. The law aims to expand access to health coverage for uninsured Americans.
The ACA does this through several provisions: an individual mandate requiring adults to have health insurance or pay a fine; an employer mandate requiring firms with 50 or more employees to offer coverage or pay a fine; a requirement that each state establish a health insurance exchange or accept a federally established exchange in which individuals and small businesses can buy coverage; an expansion of Medicaid eligibility to cover greater numbers of lower-income people. (A 2012Supreme Court decision held that states could not be required to expand Medicaid, thus leaving expansion up to the states.)
In addition, the ACA makes changes to Medicare intended to cut costs, shore up the program’s fiscal solvency, and improve delivery of care.
What’s Next for the ACA
With most of the ACA’s provisions taking full effect in 2014, the complex process of implementing the law is underway across the country. RAND research is tracking the progress of implementation and assessing the potential consequences of choices facing decisionmakers at many levels: federal and state governments, employers, families, and individuals.Our recent work has examined the likely impact of the ACA in four key policy areas:
Through a number of provisions — such as individual and employer mandates, health insurance exchanges, and the expansion of Medicaid — the Patient Protection and Affordable Care Act (ACA) aims to expand access to health care for uninsured Americans. RAND has examined implementation challenges, cost and coverage implications, Medicaid expansion, state health insurance exchanges, and reforms to both care delivery and payment.
The RAND Health Reform Opinion Study tracks public opinion of the Affordable Care Act by surveying the same people over time. This allows us to observe true changes in public opinion, rather than changes based on who was surveyed randomly.
With the complex process of implementing the ACA underway, RAND research is tracking the progress of implementation and assessing the potential consequences of choices facing federal and state governments, employers, families, and individuals.
The latest data from the RAND Health Reform Opinion Study indicates that positive opinion of the ACA continues to increase. The overall favorable rating is now as high as it was in late September, prior to the opening of the health insurance exchanges.
Last week we introduced the RAND Health Reform Opinion Study, a new way to measure public opinion of the Affordable Care Act. Negative opinion about the ACA seems to be stabilizing, while positive opinion is increasing. Those undecided about the ACA are decreasing.
Whether the public will begin to settle on an overall positive or negative perception of the Affordable Care Act (ACA) is very much an open question. But understanding how opinion of the law evolves over time could offer valuable insight into Americans’ appetite both for the ACA and for health reform more broadly.
For most lower-income people who obtain coverage as a result of the Affordable Care Act, health care spending will fall. But spending by some newly insured higher-income people will increase because they will be now paying insurance premiums.
Large coverage expansions under the ACA have reignited concerns about physician shortages. These estimates result from models that forecast future supply and demand for physicians based on past trends and current practice. While useful exercises, they do not necessarily imply that intervening to boost physician supply would be worth the investment.
2014 will be an important year for the Patient Protection and Affordable Care Act. Health insurance exchanges will offer people new ways to buy insurance. Medicaid will expand in many states. And people without “minimum essential coverage” may have to pay a fee.
As the ACA is implemented, policy makers should be attuned to potential inefficiencies and inequities created by a system with different regulatory and tax rules for small employers, large employers, and individual health plans. Attempts to equalize the playing field may be difficult.
ACA reforms can potentially address barriers that get in the way of individuals with asthma getting the care they need. At the population level, the law has the potential to improve outcomes and efficiency and equity of services for chronic conditions such as asthma for which cost-effective preventive treatments exist.
David Mastio, Forum editor at USA TODAY, asked RAND’s Christine Eibner four questions about President Obama’s plan to fix the problem with people getting their insurance canceled.
In “Redesigning the Health Care Workforce,” a new special issue of the journal Health Affairs, RAND researchers contribute to several timely examinations of challenges, opportunities, and potential solutions relating to the future of health care staffing in the U.S. and abroad.
The Affordable Care Act (ACA) expands coverage to millions of Americans. But the newly eligible may face challenges enrolling if they lack understanding of how the health care system itself works. Laurie Martin explains the role of health literacy in determining how successful the ACA will be in providing coverage for America’s uninsured.
Expanding Medicaid under the Affordable Care Act (ACA) is both contentious and complicated. RAND mathematician Carter Price has been using the COMPARE model to help those making decisions understand what their choices mean for their budgets and population health.
America’s prison population tends to be sicker than the general population. While Medicaid eligibility under the ACA offers an historic opportunity, enrolling the formerly incarcerated into the health exchanges or Medicaid will be neither simple nor straightforward.
One of the chief aims of the Affordable Care Act (ACA) is the expansion of insurance coverage to individuals who at present either cannot afford it or choose not to purchase it. Unfortunately, many Americans lack the financial literacy needed to navigate the numerous and complex options thrust upon them by the ACA.
Out-of-pocket spending on health care will decrease for both the newly insured as well as for those changing their source of insurance. These decreases will be largest for those who would otherwise be uninsured.
As of October 1, many Americans can now shop for health insurance through state exchanges created as part of the Affordable Care Act (ACA)—the sweeping health care reform often referred to as “Obamacare.” To provide some insight into the ACA, RAND’s Carter Price hosted an “Ask Me Anything” session on Reddit today.
The Affordable Care Act will have a varied impact on health spending by individuals and families, depending primarily on their income and whether they would have been uninsured in 2016 without the program.
The Affordable Care Act will have a varied impact on health spending by individuals and families, depending primarily on their income and whether they would have been uninsured in 2016 without the program.
Through a number of provisions — such as individual and employer mandates, health insurance exchanges, and the expansion of Medicaid — the Patient Protection and Affordable Care Act (ACA) aims to expand access to health care for uninsured Americans. RAND has examined implementation challenges, cost and coverage implications, Medicaid expansion, state health insurance exchanges, and reforms to both care delivery and payment.
The RAND Health Reform Opinion Study tracks public opinion of the Affordable Care Act by surveying the same people over time. This allows us to observe true changes in public opinion, rather than changes based on who was surveyed randomly.
With the complex process of implementing the ACA underway, RAND research is tracking the progress of implementation and assessing the potential consequences of choices facing federal and state governments, employers, families, and individuals.
The growing number of Americans newly-insured under the ACA will undoubtedly lead to a surge in demand for care, whether through Medicaid or insurance exchanges. But, if predictions hold, the increase won’t be as dramatic as some may fear, writes David I. Auerbach.
The bottom line is that the employer mandate does not provide a large inducement for firms to change their health insurance offerings, but it does raise a substantial amount of money to pay for the ACA’s coverage provisions over time.
An analysis of 10 states and the United States overall predicts that there will be no widespread premium increase in the individual health insurance market under the ACA. However, the cost of policies will vary among states and will be influenced by individual factors such as a person’s age and whether they smoke.
An analysis of 10 states and the United States overall predicts that there will be no widespread premium increase in the individual health insurance market under the ACA. However, the cost of policies will vary among states and will be influenced by individual factors such as a person’s age and whether they smoke.
A one-year delay in requiring large employers to provide health insurance to their workers will not significantly hurt the goals of the Affordable Care Act, but a repeal of the requirement would seriously undermine financial support for the law.
A one-year delay in requiring large employers to provide health insurance to their workers will not significantly hurt the goals of the Affordable Care Act, but a repeal of the requirement would seriously undermine financial support for the law.
Mathematician Carter Price discusses the potential impacts to low-income populations and local economies in states that choose not to expand Medicaid under the Affordable Care Act.
Resolving the question of whether or not the U.S. has finally gotten a handle on health care spending is vitally important, because the choices we make going forward will have profound implications for our economy, the financial wellbeing of millions of American families, and ultimately America’s standing in the world.
The Affordable Care Act (ACA) contains many Medicaid-related provisions. RAND is working closely with decisionmakers at the federal and state levels to help resolve challenges associated with implementing the ACA’s sweeping reforms.
RAND’s work for the Centers for Medicare & Medicaid Services reflects the diverse, widespread nature of CMS’s programs. Major topics examined by our health policy experts include improving Medicare payment policies, implementation of the ACA’s Medicaid provisions, Medicare demonstration projects, measuring quality of care, and assessing patients experience.
Alignment with best P4P practices varies across Medicare programs; the program for Medicare Advantage aligns most strongly. It is unclear which P4P design elements are critical for quality improvement. Unintended consequences of design features are poorly understood.
While the expansion of Medicaid under the Affordable Care Act will require additional spending by the Commonwealth of Pennsylvania, these costs will be more than offset by additional revenue or reductions in other spending in the 2014-2020 timeframe.
Because of the ACA’s regulations, some smaller employers with young and healthy workers are considering avoiding the purchase of health care coverage in the regulated market, opting instead to self-insure their employees.
RAND researchers have analyzed how opting out of Medicaid expansion would affect insurance coverage and spending and whether alternative policy options—such as partial Medicaid expansion—could cover as many people at lower costs to states.
The dependent coverage provision of the Affordable Care Act is working as intended, say Andrew Mulcahy and Katherine Harris. In 2011, it spared individuals and hospitals from $147 million in emergency room costs.
Some governors have stated publicly that their states will not participate in Medicaid expansion. A recent RAND study explores how this could affect government costs and coverage.
States that choose not to expand Medicaid under federal health care reform will leave millions of their residents without health insurance and increase spending on the cost of treating uninsured residents, at least in the short term.
States that choose not to expand Medicaid under federal health care reform will leave millions of their residents without health insurance and increase spending on the cost of treating uninsured residents, at least in the short term.
A series of studies on sources of variation in individual valuation of employer-provided group health care found that the effects of bundling health insurance with employment in the U.S. can vary significantly within different population groups.
A new federal law allowing young adults to remain on their parents’ medical insurance through age 25 has shielded them, their families, and hospitals from the full financial consequences of serious medical emergencies.
Through a number of provisions — such as individual and employer mandates, health insurance exchanges, and the expansion of Medicaid — the Patient Protection and Affordable Care Act (ACA) aims to expand access to health care for uninsured Americans. RAND has examined implementation challenges, cost and coverage implications, Medicaid expansion, state health insurance exchanges, and reforms to both care delivery and payment.
The RAND Health Reform Opinion Study tracks public opinion of the Affordable Care Act by surveying the same people over time. This allows us to observe true changes in public opinion, rather than changes based on who was surveyed randomly.
With the complex process of implementing the ACA underway, RAND research is tracking the progress of implementation and assessing the potential consequences of choices facing federal and state governments, employers, families, and individuals.
While a governor or legislator may disagree with Medicaid expansion for philosophical reasons, the claims that the expansion will be a burden on states’ economies seem misguided given the full range of projected economic impacts on the states, writes Carter C. Price.
Multistate plans are most likely to appeal to out-of-state students, interstate migrants, out-of-state workers, seasonal movers (e.g., “snowbirds”), and similar groups that require improved access to health care across state lines.
Expanding Medicaid in Pennsylvania under the Affordable Care Act would boost federal revenue to the state by more than $2 billion annually and provide 340,000 residents with health insurance.
If Pennsylvania opts into Medicaid expansion under the Affordable Care Act, more residents would have health coverage and the state would enjoy a positive economic effect. However, benefits would have a long-term cost, with uneven regional results.
The ACA requires the government to work with insurance issuers to establish at least two multistate plans (MSPs) in each state’s health insurance exchange. MSPs may be especially attractive to those interested in issuers that operate in multiple states, such as out-of-state students or temporary workers.
Public and private sector purchasers are actively working to design value-based payment programs to achieve the goals of improved quality and more efficient use of health care resources. How these programs are designed is a complex undertaking and one that will determine the likelihood of their success.
In this video, Amelia Haviland presents the results of several new RAND studies on cost and quality in consumer-directed health plans, and explores how switching plans affects the quality of care.
The Medicaid expansion under the ACA will result in about 400,000 people newly insured in Arkansas by 2016. Of these, about 190,000 would be newly enrolled in Medicaid and the rest would be newly insured through the new insurance exchanges. The state is likely to save about $67 million for reduced uncompensated care costs for the uninsured.
For Arkansas, the Affordable Care Act will result in an increase in GDP of around $550 million and the creation of about 6,200 jobs. The new law will also increase health insurance coverage by 400,000 newly insured individuals.
In its second term, the Obama Administration can restrain further health care spending growth—without compromising quality—by employing four broad strategies: fostering efficient and accountable providers, engaging and empowering consumers, promoting population health, and facilitating high-value innovation.
Regardless of which candidate wins in November, and regardless of whether “Obamacare” is repealed, amended, or defended by the next Congress, the next president will have to contend with the spiraling cost of health care in the United States—a problem that is growing more acute with each passing year, writes Arthur Kellermann.
As we look for ways to provide efficient, high-quality and cost-effective healthcare to more Americans, states may study California as a potential model for how to do more to deliver on what the Affordable Care Act has to offer women, while saving money at the same time, writes Chloe Bird.
Whether the Affordable Care Act is repealed, defended, or weakened will hinge on who holds the balance of power next January. Regardless of what happens with the ACA, the spiraling cost of health care in the United States will remain a huge challenge.
Retail health care clinics provide treatment for acute conditions like bronchitis as well as vaccinations and other preventive care. With the role of retail clinics expanding and U.S. health care entering a dynamic period of change, it is important to consider what we know about this emerging health care setting.
As we look for ways to provide efficient, high-quality, and cost-effective health care to more Americans, we can’t afford to ignore women’s health issues, including reproductive health care and the cost savings that contraceptive access provides, writes Chloe Bird.
A problem with using surveys to predict behavior is that they measure employer sentiment toward the ACA today, rather than the economic decisions employers typically make when the time comes, writes Art Kellermann.
The bottom line is this: With or without the Affordable Care Act, the nation can no longer kick the can down the road on costs, writes Arthur Kellermann.
Now that the Supreme Court has upheld key provisions of the Affordable Care Act, what lies ahead for health care in America? RAND experts sound off in the wake of this momentous decision.
The U.S. Supreme Court’s ruling on the Affordable Care Act is unquestionably historic, but there is a critical aspect of health care reform that still needs to be fixed. The nation needs to take decisive action to address the rising costs of health care, writes Arthur Kellermann.
Switching to a consumer-directed health plan (CDHP) could save families 20 percent or more on their health care costs. Families with CDHPs initiate less episodes of care and spend less per episode, however, they also tend to scale back on high-value preventive care, such as child vaccinations.
If the individual mandate requiring all Americans to have health insurance were eliminated, it would sharply reduce the number of people gaining coverage and slightly increase the cost for those who do buy policies through the new insurance exchanges.
If consumer-directed health plans grow to account for half of all employer-sponsored insurance in the United States, health costs could drop by $57 billion annually—about 4 percent of all health care spending among the nonelderly.
As the U.S. Supreme Court considers the constitutionality of the Affordable Care Act’s (ACA) individual mandate, one of the questions being debated is what effect the mandate would have on employer-sponsored health insurance coverage. A factor to consider in this is the effect the ACA would have on small businesses, which employ the majority of America’s private-sector workforce.
If the individual mandate were ruled unconstitutional, subsidies and the age structure of premiums should keep enough healthy people in the insurance exchanges to prevent huge spikes in premiums, write Carter C. Price and Christine Eibner.
RAND economist Christine Eibner spoke at a Bloomberg Government and RAND Corporation event in Washington, D.C. Eibner briefed the attendees on the results of her recent study, How Would Eliminating the Individual Mandate Affect Health Coverage and Premium Costs?
As the Affordable Care Act expands health insurance coverage in the U.S., the “cost” of applying for SSDI will decline for many. Studying the effect of Massachusetts health care reform in 2006 may provide insights into the impact the ACA may have on SSDI applications and awards.
Eliminating a key part of health care reform that requires all Americans to have health insurance would sharply lower the number of people gaining coverage, but would not dramatically increase the cost of buying policies through new insurance exchanges.
An analysis of the effects of implementing the Affordable Care Act without an individual mandate found that over 12 million people who would have otherwise signed up for coverage will be uninsured and premium prices will increase by 2.4 percent.
Eliminating a key part of health care reform that requires all Americans to have health insurance would sharply lower the number of people gaining coverage, but would not dramatically increase the cost of buying policies through new insurance exchanges.
The individual mandate of the Patient Protection and Affordable Care Act of 2010 (ACA) requires that most Americans either obtain health coverage or pay an annual fine. How much will overturning the individual mandate affect costs and coverage?
Rules that allow some small employers to avoid regulation under the federal Affordable Care Act are unlikely to have a major impact on the future cost of health insurance unless those rules are relaxed to allow more businesses to opt out.
Rules that allow some small employers to avoid regulation under the federal Affordable Care Act are unlikely to have a major impact on the future cost of health insurance unless those rules are relaxed to allow more businesses to opt out.
Most will agree with the undeniable fact that a new era in US medicine and US health care begins in less than two years. The key question is what potential measures should be monitored to determine both anticipated and unanticipated effects of the new law on the health of the US population, writes Robert H. Brook.
The Affordable Care Act marks a new era in US health care and US medicine. This commentary suggests ways to monitor the act’s effect on the health of the US population.
Since Massachusetts enacted health reform legislation in 2006, health care employment in the state has grown more rapidly than in the rest of the United States, primarily in administrative positions.
California, the state with the nation’s largest prison population, is releasing increased numbers of inmates under its 2011 Public Safety Realignment Plan. RAND was asked to study the public health implications of returning prisoners for the communities they return to and has found both challenges and opportunities.
Medicare’s payment for physician work and malpractice liability expenses is the same regardless of where a service is provided, but payments differ for facility-related components of care.
The Patient Protection and Affordable Care Act has piqued employers’ interest in new benefit designs. This paper reviews consumer-controlled personal health management systems that could help individuals control and manage their health care.
Analysis of the Massachusetts Health Care Reform Plan suggests national health care reform may require larger numbers of support personnel, rather than requiring greater numbers of physicians and nurses themselves.
Policymakers are facing new challenges as they implement the Patient Protection and Affordable Care Act (ACA). RAND COMPARE is a modeling tool that simulates the impact of implementation decisions on insurance coverage, premiums, and health care spending.
Implications of the Patient Protection and Affordable Care Act of 2010 (as Modified by the Health Care and Education Reconciliation Act) for small firms’ decisions to offer self-insured health plans and consequences of self-insurance for enrollees.
Content for a toolkit was designed to help community and faith-based organizations take advantage of opportunities presented in the Patient Protection and Affordable Care Act and engage leaders in promoting health in their communities.
A series of new reports by the RAND Corporation outlines the impact that national health care reform will have on individual states, estimating the increased costs and coverage that are expected in five diverse states once reform is fully implemented in 2016.
National health care reform will help 6 million California residents obtain health insurance and increase health care spending by state government by about 7 percent when it is fully implemented in 2016.
National health care reform will help 170,000 Connecticut residents obtain health insurance and decrease health care spending by state government by about 10 percent when it is fully implemented in 2016.
National health care reform will help 1.3 million Illinois residents obtain health insurance and increase health care spending by state government by about 10 percent when it is fully implemented in 2016.
National health care reform will help 125,000 Montana residents obtain health insurance and increase health care spending by state government by about 3 percent when it is fully implemented in 2016.
National health care reform will help 5 million Texas residents obtain health insurance and increase health care spending by state government by about 10 percent when it is fully implemented in 2016.
High-deductible plans significantly reduce health care spending but also lead consumers to cut back on their use of preventive health care — even though high-deductible plans waive the deductible for such care.
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in five states.
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Illinois through 2020.
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Texas through 2020.
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in California through 2020.
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Montana through 2020.
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Connecticut through 2020.
Health care spending reforms should be met with new efforts to develop and refine quality of care and other performance measures in order to assure that any changes will improve medical care and not harm patients.
An analysis of two rules that allow small businesses to avoid participating in health reform concludes they will have only a minor impact because relatively few businesses are likely to take advantage of the options.
Finds that the Affordable Care Act will increase the percentage of employers that offer health coverage to workers: from 57 percent to 80 percent for firms with 50 or fewer workers, and from 90 percent to 98 percent for firms with 51 to 100 workers.
The nature of employer-sponsored coverage may change substantially after implementation of the Patient Protection and Affordable Care Act, with an increase in the number of workers offered coverage through the health insurance exchanges.
The Patient Protection and Affordable Care Act will increase insurance offer rates at small businesses. By 2016, rates would increase from 53 to 77 percent at firms with ten or fewer workers and from 71 to 90 percent at firms with 11 to 25 workers.
To avoid changes in current health coverage, the Patient Protection and Affordable Care Act exempts existing plans from some regulations. These exemptions may lead to higher employer-sponsored insurance enrollment and lower government spending.
This article discusses the range of health information technology initiatives included in the 2009 economic stimulus legislation that collectively are known as the Health Information Technology for Economic and Clinical Health (HITECH) initiative; these include proposed regulations on
Compares President Obama’s Proposal for Health Reform, the U.S. House and Senate health care reform bills, and the status quo on changes in number of uninsured and government and national costs, as estimated by the RAND COMPARE microsimulation model.
Compares how two health care reform bills, HR. 3962 and H.R. 3590, passed by the U.S. House and Senate, respectively, in late 2009 compare on a variety of projections made using the RAND COMPARE microsimulation model.
Using the COMPARE microsimulation model, estimates the effects of the Patient Protection and Affordable Care Act (H.R. 3590) on the number of uninsured, the costs to the federal government and the nation, and consumers’ health care spending.
Health reform as set forth in legislation passed by the U.S. House of Representatives in November would cut the number of uninsured Americans to 24 million by 2019 (a 56 percent decrease) and increase personal spending on health care by about 3.3 percent cumulatively between 2013 and 2019.
Using the COMPARE microsimulation model, estimates proposed health care reform legislation’s effects on the number of uninsured, the costs to the federal government and the nation, revenues from penalty payments, and consumers’ health care spending.
Using the COMPARE (Comprehensive Assessment of Reform Efforts) microsimulation model, this study evaluated how the recently enacted health reform law performed compared with alternative designs on measures of effectiveness and efficiency and found that only a few different approaches would cover more individuals at a lower cost to the government; however, these appeared politically untenable because they included substantially higher penalties, lower subsidies, or less generous Medicaid expansion.
Another health policy window has opened; through it will stream proposals to reform the US health care system. President Obama has demanded that reform proposals improve both coverage and quality of care and make health care more affordable for all Americans. Extending coverage without worrying about costs would be relatively easy. Improving quality of care without worrying about costs might also be achievable. But extending coverage and improving quality while also making coverage more affordable will be difficult.
Policy Researcher; Professor, Pardee RAND Graduate School
Ph.D. in health economics, Harvard University; M.S. in environmental science & policy, MIT; M.S. in chemistry, University of California, Berkeley; B.S. in chemistry, MIT
Associate Physical Scientist; Professor, Pardee RAND Graduate School
Ph.D. and M.S. in biomathematics, University of California, Los Angeles; B.S. in physics, MIT
Director, Public Health Systems and Preparedness Initiative, RAND Health; Senior Economist; Professor, Pardee RAND Graduate School
Ph.D. in economics, University of Maryland, College Park; M.A. in economics, University of Maryland, College Park
The RAND Health Reform Opinion Study tracks public opinion of the Affordable Care Act by surveying the same people over time. This allows us to observe true changes in public opinion, rather than changes based on who was surveyed randomly.
With the complex process of implementing the ACA underway, RAND research is tracking the progress of implementation and assessing the potential consequences of choices facing federal and state governments, employers, families, and individuals.
2012pharmaceutical
Amandeep Kaur
Aashir Awan, Phd
Abhisar Anand
Adina Hazan
Alan F. Kaul, PharmD., MS, MBA, FCCP
alexcrystal6
anamikasarkar
apreconasia
aviralvatsa
David Orchard-Webb, PhD
danutdaagmailcom
Demet Sag, Ph.D., CRA, GCP
Daniel Menzin
Dror Nir
dsmolyar
Ethan Coomber
evelinacohn
Gail S Thornton
Irina Robu
jayzmit48
jdpmd
jshertok
kellyperlman
Ed Kislauskis
komal23ingle
larryhbern
Madison Davis
marzankhan
megbaker58
ofermar2020
Dr. Pati
pkandala
Rosalind Codrington, PhD
ritusaxena
Rick Mandahl
satwik Sunnam
sjwilliamspa
Srinivas Sriram
stuartlpbi
Dr. Sudipta Saha
tildabarliya
vaishnavee24
zraviv06
zs22
Leave a Reply