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In a large dutch oven cook sausage on medium heat, until meat is brown. Drain off fat.
Add diced bell peppers, dried elbow macaroni, marinara sauce, and water. Bring to boil; reduce heat to simmer. Simmer, covered, for about 20 minutes until macaroni is tender, occasionally stirring.
Add half and half, sprinkle with cheese, and mix everything well. Remove from heat, cover and let it sit for about 2 minutes or until cheese melts.