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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

December 2, 2019

Massachusetts is known for its dedication to expanding access to health care, especially for the most vulnerable populations, including children. As a state, Massachusetts has led the cause by developing health coverage systems which were used as models for the Children’s Health Insurance Program (CHIP) and the Affordable Care Act (ACA). The Georgetown University Health Policy Institute Center for Children and Families (Georgetown CCF) recently released their annual report about the child uninsurance rate. This year’s report, The Number of Uninsured Children is On the Rise, compares health insurance data from the US Census Bureau’s American Community Survey from 2016 through 2018.

While children’s health coverage rates had been improving for many years prior to 2014, due in large part to the creation of programs like CHIP, the ACA further decreased the rates and number of children without insurance to their lowest levels in 2016. These programs allowed for an increase in coverage eligibility and simplification in the enrollment process. However, since 2016, children’s participation rates in Medicaid and CHIP have decreased for the first time since 2008, when participation began to be measured.

Although the state continues to lead with the lowest uninsured rate for children in the US, the uninsurance rate for the Commonwealth’s children increased by 0.2%, comparing 2016 and 2018. Our blog post on last year’s Georgetown CCF report on uninsured children highlights an increase in the child uninsurance rate even in Massachusetts – from 1% to 1.5% from 2016 to 2017. Looking at this year’s report, it appears the uninsurance rate for children in the state has actually decreased from 1.5% to 1.2% between 2017 to 2018. However, compared to 2016, the actual number of uninsured children continues to be slightly higher.

To put this in context, Massachusetts continues to lead the nation in health coverage for children. The Georgetown CCF report highlights other states where state and federal policy decisions have led to an increase in uninsured children, with no progress in moving the needle in this respect. Almost half (49.6%) of uninsured children in the US reside in just six states – Texas, Florida, California, Georgia, Arizona, and Ohio. Of these states, Texas, Florida, and Georgia have not expanded Medicaid for parents or childless adults, and there are still several other states that are “holdouts” in this regard – which can impact health coverage for children as well. The report shows one state – North Dakota – has made some progress in decreasing the child uninsurance rate.

Many factors can lead to the continued downward trend of health coverage for children during the past couple of years. The report cites the decrease in public health coverage as a major factor in the increase in uninsured children. Current federal policymakers have had a different approach when it comes to access to care. Attempts from Congress to repeal the ACA and the administration in chipping away at certain ACA protections, the repeal of the individual mandate penalty in 2017 and funding cuts for ACA outreach and enrollment have all brought a reduction in infrastructure and focus on ensuring enrollment in health coverage. Even the delayed budget extension for CHIP led to confusion among families who rely on the program about whether the benefits would continue. Researchers at Georgetown CCF believe that the increase in negative immigration rhetoric and policies on the federal level have also deterred families from enrolling their children in public benefits, including health insurance, such as parents disenrolling their eligible children despite their legal immigration status.

In Massachusetts, Health Care For All and stakeholders in the health care community are dedicated to protecting and improving access to health coverage. We also know that having health insurance does not necessarily translate into having access to care. Some health insurance comes with high costs and some safety-net programs, even for children, have caps on services and leave gaps in coverage of necessary care. That is why HCFA and the Children’s Health Access Coalition is advocating for a bill which would ensure that low-income immigrant children in our state have equitable access to coverage. An act to ensure equitable health coverage for children (H. 162/ S. 677) better known as Cover All Kids, seeks to expand comprehensive MassHealth coverage to low-income children who would otherwise be eligible except for their immigration status. This bill would help more than 30,000 children and young people in our state obtain the coverage they need, to live, learn, and thrive. If your child or the children you serve are facing barriers to accessing because they depend on the Children’s Medical Security Plan (CMSP), MassHealth Limited, or the Health Safety Net (HSN), share your story today and together we can a difference! Now is the time for Massachusetts to Cover All Kids.

August 22, 2019

The Blue Cross Blue Shield of Massachusetts Foundation has released a new report on uninsurance rates across the state, The Geography of Uninsurance in Massachusetts: An Update For 2013-2017. The report is based on the five years of data from the census’ American Community Survey (ACS), which surveys 2 million households annually to identify uninsured residents. Here is a basic rundown of the findings of their research and what you need to know! If you’re interested, you can find the full report here.

The uninsurance rate across the state varies drastically but there are some clear trends. Communities in more urban areas, like the Boston region, have the highest uninsurance rates. However, in wealthier and more suburban communities, like those in the MetroWest Region, the uninsurance rate is the lowest in the state. Below, you can see the top 10 communities in both uninsurance rate and number of uninsured.

Health Care For All’s HelpLine provides multilingual and culturally competent direct services to improve access to health insurance and care for underserved communities such as the ones listed in the table.

The residents in these communities are generally from similar demographics. A little bit less than half of these residents are noncitizens and about one-quarter of the families have incomes below the federal poverty line. Residents from the most uninsured communities face barriers to receiving consistent coverage because of these disadvantages. In the map below, the red shows communities with the most uninsured residents and the beige show communities with the fewest. The biggest concentration of uninsured residents comes in and around the Boston area.

If you know someone who is uninsured or needs help navigating the complicated healthcare system, please connect them to HCFA’s HelpLine at 1-800-272-4232.

May 23, 2019

Last Saturday, Health Care For All (HCFA), in partnership with the Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA), the Massachusetts Law Reform Institute (MLRI) and Health Law Advocates (HLA), implemented a training under the title “Democracy School 2019: Building Health Care Power in Immigrant Communities”. Even though it was a beautiful day in Boston, 35 people - including advocates, community leaders and members, immigration and medical providers - chose to spend their Saturday attending the session and learning more about the struggles our immigrant communities face to live productive and healthy lives in the current environment. 

This session was part of a coordinated, ongoing effort to inform immigrants and the groups that serve them about their health care rights. It also aimed to dispel the growing fear and mistrust within immigrant communities that is preventing many individuals and families from seeking the health care services they need - when they need them.

The training went over important topics that combine immigration and health care such as: immigrants’ health care rights, the state of immigrants in Massachusetts and state efforts to protect them, immigrant eligibility for health insurance, how to apply for health insurance, understanding the proposed rule on “pubic charge” and other potentially damaging policies impacting immigrants’ use of benefits, and how to access and navigate the immigrant health toolkit. The evaluations were very positive, participants were very engaged and had interesting questions regarding the topics laid out.Thank you Liza Ryan (MIRA), Vicky Pulos (MLRI), Justin Lowe (HLA), 

HCFA is committed to ensure that all participants have access to the resources they need to provide accurate information to our immigrant communities regarding their health care rights. Many of the attendees submitted written questions that we are currently working on getting appropriate answers for. We will upload all the documents - presentations, fact sheets and Q&As - on the immigrant health toolkit on https://www.hcfama.org/immigrant-health  in the next weeks. Feel free to reach out to Rosana Gijsen at rgijsen@hcfama.org if you have more inquiries that were not addressed during the session or if you want to get involved in the Immigrant Health Care Access Project (IHAP).  


May 21, 2019

MassHealth – the state’s combined Medicaid and Children’s Health Insurance Program (CHIP) – is a cornerstone of the Massachusetts health coverage system, providing coverage of medical, behavioral health and community-based services for 1.8 million low-income Massachusetts residents. MassHealth enrollees are often characterized by a narrow set of baseline statistics; however, MassHealth enrollees represent a diverse range of life experiences and health care needs.

MassHealth serves our most vulnerable residents across their life spans from infants and children with special needs who gain access to comprehensive health care and support services required to reach their full potential, to the elderly and those living with disabilities who receive community-based care that helps them remain in their home. MassHealth provides health insurance to more than 1 in 4 Massachusetts residents, including: more than half of the population with disabilities; more than 40% of all children; and 3 out of 5 people in low-income families.

Health Care For All is proud to partner with Manatt Health and the Blue Cross Blue Shield of Massachusetts (BCBSMA) Foundation on a new publication, Faces of MassHealth: Portrait of a Diverse Population. This detailed set of data and narrative profiles of MassHealth enrollees illustrate the different life circumstances that lead people to MassHealth, and the various ways that MassHealth touches their lives.

Key findings from the quantitative portion of this project include:

  • The geographic distribution of MassHealth members mirrors that of the Commonwealth’s population.
  • The vast majority of MassHealth enrollees have very low incomes, well below the poverty level.
  • Women account for more than half of all adults and nearly two-thirds of seniors enrolled in MassHealth.
  • Unstable housing is a problem for more than 1 in 10 MassHealth enrollees.
  • Children, seniors and people with disabilities make up 60% of the MassHealth population.
  • While most MassHealth enrollees speak English as their primary language, a substantial minority do not.
  • The MassHealth population is racially and ethnically diverse, but more than 6 in 10 enrollees self-identify as white.

In addition to the quantitative analysis, the qualitative portion of the report includes five journalistic profiles of MassHealth enrollees. Health Care For All extends gratitude to Jessica, Anne, Kristal and Sal, Angela and Massimo, and Amy, for sharing their stories, which made this project possible. Special thanks go to Natalie Litton, Health Care For All’s former Policy and Policy Coordinator, who led this section of the project, undertaking extensive outreach efforts, conducting interviews, and writing the five journalistic profiles contained in the report.

We hope this report will help policymakers and other stakeholders better understand the breadth and diversity of the individuals and families across the Commonwealth who rely on MassHealth coverage in order to access the health care they need. Faces of MassHealth points to the critical work of protecting and sustaining the MassHealth program over the long term, to ensure that the program is available to Massachusetts residents from all walks of life who need it.

May 15, 2019
Prescription drug prices continue to rise, placing a considerable burden on families and the state's budget. Over the past five years, prescription drug spending has nearly doubled in MassHealth, twice the rate of other spending in the program.
The Senate Ways and Means Committee recently included strong language in their proposed FY20 budget that would give MassHealth critical new tools to negotiate lower prices for unreasonably priced drugs.
Senator Boncore has filed an amendment that would significantly weaken this provision. Amendment #654 would keep drug price negotiations behind closed doors and prevent MassHealth from being able to hold drug manufacturers accountable.
Drug manufacturers should be able to make a profit on their life-saving products, but patients and the state should understand how much these drugs cost and be able to negotiate a fair price. Drugs only work if people can afford to buy them.
Beginning next week, the Senate will hold its budget debate. Please call or email your Senator this week to urge them to oppose Amendment #654 and maintain their commitment to address rapidly rising drug costs.
Find out who your Senator is and their contact information hereand you can use the email and call scripts below. 
We appreciate you taking action on this critical issue to address high drug costs in the MassHealth program. Please contact Yaminah Romulus at yromulus@hcfama.org or 617-275-2935 if you have questions about how to oppose this amendment.
Thank you,
Phone Script Opposing Amendment #654:
Hi, my name is ______.
May 9, 2019

Just as the mouth is part of the body, oral health is a part of overall health. People cannot be healthy unless they have access to the dental services they need.When dental disease is left untreated it can lead to systemic infection, hospitalization, and the worsening of other medical conditions. For years, Health Care For All has worked on issues related to oral health, including public awareness about the importance of oral health, and access to comprehensive dental care for everyone.


Last Tuesday, HCFA and our allies in the Oral Health Advocacy Taskforce took to Beacon Hill to testify before the Joint Committee on Public Health in support of An Act to Improve Oral Health For All Massachusetts Residents (S.1215/H.1916) legislation that authorizes an additional dental professional, called the dental therapist, to work with a dentist to provide oral health care to more people. HCFA also testified on behalf of An Act Relative to the Restoration of MassHealth Adult Dental Benefits (S. 1212/H. 1917) A bill that will restore full MassHealth dental benefits to more than 1 million individuals, including over 113,000 seniors and 230,000 people living with disabilities. HCFA also provided key testimony to the committee in support of An Act to Promote Public Health Through the Prevention and Wellness Trust Fund (S. 1293/H. 2012) This bill would maintain the solvency of the Prevention and Wellness Trust Fund (PWTF) which funded successful clinical-community partnerships focused on childhood asthma, falls among older adults, hypertension, and tobacco use.


The room at the hearing was packed on Tuesday. A wide range of stakeholders, including: The Better Oral Health in Massachusetts Coalition, the MassLeague of Community Health Centers, the Mass Dental Hygienists Association, the Forsyth Institute, Massachusetts Senior Action Council, Rosie’s Place, and the ARC of Massachusetts, to name a few, testified in support of the two oral health bills.

HCFA’s Oral Health Program Director, Dr. Neetu Singh, led the charge in providing expert testimony for both bills. Dr Singh made the case that restoring full MassHealth adult dental benefits would not only benefit the Commonwealth’s oral health, but the state’s financial health as well, pointing out that patients who have to skip the dentist’s office are far more likely to end up in the emergency room. Dr. Singh shared research showing that MassHealth members disproportionately use the Emergency Department (ED) for preventable oral health conditions at a cost 4-7 times that of a community-based dental office visit. In just one year, there were over 36,000 preventable oral health ED visits in Massachusetts, costing the health care system between $15 million and $36 million.

April 12, 2019

Prescription drugs don’t work if people can’t afford them, and too many people in Massachusetts can’t afford the high cost of prescription drugs. Here at Health Care For All (HCFA), we know all too well – from real-life stories and statistical data alike – that this is true. That’s why HCFA is a leading member of the MA Prescription Drug Affordability Coalition, a broad-based coalition representing a wide range of stakeholders, including consumer advocates, seniors, children, individuals with disabilities, providers, provider groups, unions, faith-based groups, mental health organizations and health policy experts.

Yesterday marked a significant milestone in our fight to reduce prescription drug costs as we headed to the State House to testify before the Joint Committee on Health Care Financing, chaired by Senator Cindy Freidman and Representative Jennifer Benson. HCFA submitted both written and oral testimony in support of An Act to Ensure Prescription Drug Cost Transparency and Affordabilty (H.1133 / S.706), sponsored by Senator Jason Lewis and Representative Christine Barber. The legislation aims to make prescription drugs more affordable and available to consumers, make pharmaceutical costs more transparent, and contain costs for MassHealth, employers, and across the health care system.

The hearing room was packed as individuals and groups on both sides of the debate converged to testify on this and other bills related to prescription drug costs. Mary Mack came all the way from Nantucket to share her story as someone who lives with advanced heart failure and muscular dystrophy as the result of a genetic defect. When she started a new cardiac drug, it made “a significant difference” in her life. At $150, however, the copay was the equivalence of a car payment or a trip to the grocery store to feed her family. In order to afford the copay, she was forced to neglect other doctors appointments, accrue credit card debt and fall behind on bills. When the copay increased even more, Mary had to stop taking the drug in order to meet her car payments. Now that Mary has paid off her car, she is taking the medication again, but in order to afford the monthly $225 copay, Mary and her family must make other sacrifices.

Panels included consumers who have struggled with the cost of insulin to treat their Diabetes, seniors and representatives from Health Law Advocates, the Massachusetts Medical Society, MASSPIRG, 1199SEIU, the Disability Policy Consortium, the Greater Boston Interfaith Organization, and AARP-MA.

HCFA Executive Director Amy Rosenthal drew on the stories of callers to our consumer HelpLine as she emphasized the importance of a crucial element of this legislation: giving state regulators the authority to set an Upper Payment Limit (UPL) on prescription drugs deemed unreasonably expensive. This would create an upper limit on what anyone, including doctors, pharmacies, insurers and patients, could be required to pay for a drug. Amy also placed the fight for increased transparency and lower costs in the broader context of health care access. “Health reform worked because of shared responsibility among the state, consumers, employers, payers and providers.” Of the current efforts, she said, “It’s time for the pharmaceutical industry to step up.”

Chairwoman Cindy Freidman seemed to agree. "You all have had a long time to be transparent," she told Bob Coughlin, president and CEO of MassBio, a pharmaceutical industry trade organization. "Pharmaceutical companies have had a long time to come to the table and say let us be as transparent as our insurance companies are and as all the other parts of health care that we patrol. You have had that opportunity, and you haven't done it. With all due respect, we want you at the table but we need you to be equal partners and be willing to understand that you have skin in the game, we have skin in the game, everybody in this room does."

Multiple panels featured the testimony of those who have the most “skin in the game” – Massachusetts consumers who, for too long, have been forced to make unfair decisions between the necessities of life and the prescription drugs their lives often depend on. HCFA and the MA Prescription Drug Affordability Coalition invite you to join our fight for #AffordableRxNow. This is just the beginning.

-Natalie Litton

April 5, 2019

The immigrant community has always been at the core of much of the work that Health Care For All (HCFA) does. HCFA’s HelpLine handles over 20,000 calls each year, and 50% percent of these calls come from individuals who do not speak English as a first language. Many of our callers are immigrants. Over the years, we have implemented outreach and educational activities in areas of Massachusetts with a higher concentration of foreign-born populations, such as Framingham, Chelsea, Lowell, Waltham, and Somerville. Even though health disparities persist, we have made great strides in connecting foreign-born communities to health coverage and care. Some of that progress is now on the line.

Soon after the presidential election in November 2016, we started hearing from providers about immigrant patients who were delaying care or skipping doctors’ appointments altogether due to fear and mistrust. The constant attack on our communities, the anti-immigrant rhetoric coming from the Trump Administration and newly introduced policies, were leading a part of the population back into the shadows. These policies include the end of programs such as the Temporary Protected Status (TPS) and Deferred Action for Childhood Arrivals (DACA), the changes to public charge regulations (a proposed rule that can prevent immigrants who use specific public benefits from adjusting status or becoming permanent residents), a surge in immigration enforcement activities, detention and deportation raids, news about immigrant children detained at facilities at the border, and other policies.

HCFA is in regularly in contact with community leaders who have told us about residents not attending English classes or showing up at community events. We also heard about people not renewing their health care coverage, skipping vaccinations, not seeing a doctor before flu symptoms got out of control that turned into pneumonia, and other instances where our neighbors were not accessing the preventive services they need to get healthy and stay healthy. This places our public health system at risk.

We knew it was time to step up work in this area and with the support of several foundations, we developed and implemented a project to educate community members, leaders, advocates, providers and other stakeholders about the rights that immigrants have to health insurance and access to health care services. These efforts have helped bring important information to our communities and, as a result, we have conducted trainings throughout the region, with a particular focus on the Greater Boston and Greater Framingham areas.

In 2018, HCFA, in collaboration with the Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA) and Health Law Advocates (HLA) held “Democracy School: Building Health Care Power in Immigrant Communities”. At this event, 65 activists, immigration and service providers, and volunteers improved their understanding of how immigration issues relate to health care and public health. Participants were then able to bring the lessons learned in this training back to their agencies and communities. These three organizations are partnering again in 2019, and we are inviting those interested to attend a new edition of the Democracy School that will take place in downtown Boston on Saturday May 18th, from 9:30AM to 2 PM. You can be part of the solution by joining us that day. Please contact Rosana Gijsen, HCFA’s Outreach Coordinator at  rgijsen@hcfama.org  to confirm attendance by April 20th.  

- Maria Gonzalez, Strategy and Communications Director, Health Care For All



This blog is part of HCFA’s 2019 Public Health Awareness Week series.

April 4, 2019

Well-baby and well-child visits, vaccines, eyeglasses, and dental services are the building blocks of a healthy childhood and provide an essential foundation for wellness throughout the life-span. Data shows that comprehensive Medicaid coverage facilitates access to this care in childhood, and although children’s health insurance coverage in Massachusetts is strong, gaps still exist. While we can be proud that 98% of the Commonwealth’s children have some form of health insurance, we must address the inequities that remain.

Today in Massachusetts thousands of low-income children meet every requirement for MassHealth eligibility except for their immigration status. As a result, these children can access only the bare-bones Children’s Medical Security Plan (CMSP) as their primary coverage. This provides preventive care but places strict annual caps and limits on other benefits such as prescription drugs, outpatient mental health visits and durable medical equipment. As a result, many children are left without the full range of care that they need to live, learn and thrive here in the Commonwealth.

This is why Health Care For All (HCFA) and our Children’s Health Access Coalition (CHAC) are teaming up with partners across Massachusetts to pass An Act to Ensure Equitable Health Coverage for Children (HB 162 / SB 677) with lead sponsors Senator Sal DiDomenico and Representative Dave Rogers. The legislation would expand full comprehensive MassHealth coverage to all income-eligible children regardless of immigration status because all kids deserve an equal start at building a healthy life and preventing long-term health problems.

Real stories guide our campaign. Stories of children like seven year-old Sonya who has Type-1 Diabetes. Her doctors had great difficulty regulating her blood sugar levels until she got an insulin pump, which changed her life. However, the medical supplies to keep Sonya’s pump operable cost approximately $1,000 each month. In less than one month, she exceeded CMSP’s $500 coverage limit on durable medical equipment. Sonya’s mother has to rely on charity care and donations to pay for the supplies, and Sonya’s health was at risk.

Data grounds our campaign and shows us that investments in comprehensive coverage for children today means healthier adults tomorrow, too. Research shows that children with comprehensive coverage are more likely to receive preventive care and are less likely to have unmet medical and dental needs. The benefits of comprehensive coverage extend beyond the doctor’s office and show that children with comprehensive coverage have increased success in school and higher educational attainment than kids who don’t have comprehensive coverage. Finally, comprehensive coverage in childhood has been linked to better overall health in adulthood, including lower prevalence of high blood pressure, diabetes, heart disease or heart attack, and obesity.

HCFA advocates for health justice by working to promote health equity and ensure coverage and access for all. Equitable, comprehensive coverage for all kids is a crucial piece of the health equity puzzle. To share your story, learn more about the campaign or to get involved, please contact Natalie Litton at nalitton@hcfama.org or (617)275-2897.

- Natalie Litton, Policy & Project Coordinator, Health Care For All


This blog is part of HCFA’s 2019 National Public Health Awareness Week series.

April 3, 2019

As many of us have experienced first-hand, taking a regular regimen of medication prescribed by a provider can have remarkable effects on the quality of our daily lives and our ability to build a healthy future for ourselves and those around us. Prescription drugs are critical to curing disease, managing medical conditions, controlling debilitating symptoms and helping us avoid the need for more serious and expensive care. In short, prescription drugs bring hope and improved health to individuals and families and contribute to the public health of the Commonwealth every day.

But there is more to the story: Prescription drugs don’t work if people can’t afford them, and too many people in Massachusetts can’t afford the high cost of prescription drugs. Consider John, who reached out to Health Care For All (HCFA) for help. John had suffered a stroke and a heart attack but was forced to wean himself off of most of his medications because he could not afford the co-pays under his wife’s insurance plan. After his wife passed away, John was working part-time and staying at friends’ homes and in hotel rooms. HCFA helped him complete an application for MassHealth, but while he was trying to find a doctor and waiting to receive verification of his income for his coverage, he ran out of medication. John ended up in the emergency room and, because of all this, he lost his job. The good news is that HCFA’s HelpLine counselors were able to finalize John’s MassHealth enrollment, and helped him fill the prescription while he was in the hospital. The reality is that the unaffordability of his prescription drugs had a negative impact on John, his health, and his life multiple times over the course of this time period.

Stories like John’s are common – and such anecdotal evidence is backed up by multiple studies that show that high cost-sharing for prescription drugs leads patients not to take the drugs their doctors prescribe. The affordability of prescription drugs goes to the core of health justice. Access to life-changing and life-saving prescription drugs must be a right for all who need them – not a privilege reserved for those who can afford them.

As a result, HCFA is leading the charge here in Massachusetts to make prescription drugs more affordable for consumers and increase the transparency surrounding what it actually costs to produce a drug. Along with lead sponsors Representative Christine Barber and Senator Jason Lewis, HCFA filed An Act to Ensure Prescription Drug Cost Transparency and Affordability (HB 1133 / SB 706). This bill seeks to:

  • Make drugs affordable and available to consumers
  • Make pharmaceutical costs more transparent and affordable for the health care system
  • Contain costs for MassHealth
  • Require the pharmaceutical industry to do their fair share to control health care costs

This legislation uses a number of strategies that include providing transparency around the underlying costs to produce prescription drugs; restraining abuses of pharmacy benefit managers (PBMs); authorizing the HPC to set upper payment limits for unreasonably high-priced drugs; requiring pharmacists to inform consumers if purchasing a drug at the retail price would be cheaper than using health insurance; providing tools to strengthen MassHealth’s ability to negotiate lower drug prices; and permanently authorizing and funding “academic detailing,” an evidence-based prescriber education program.

Personal stories are a powerful tool when advocating for change. If you or a family member have struggled to afford prescription drugs, and want to share your story, please contact Yaminah Romulus at yromulus@hcfama.org.

- Natalie Litton, Policy & Project Coordinator, Health Care For All


This blog is part of HCFA’s 2019 Public Health Awareness Week series.