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How much notice do you have to give? starting allopurinol after gout attack The main reason, he said, is that the money flowing to the 16 states and the nation's capital that are running their own ACA exchange is what's called a "permanent appropriation," enshrined in the 2010 healthcare reform law. Because the funds are not subject to annual appropriations, they will continue to be available to states that need to pay employees and contractors and buy equipment and supplies.

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