TRUMP'S 2018 STATE OF THE UNION SPEECH - 9pm EST (LIVE VIDEO); MILESTONES FOR THE TRUMP ADMINISTRATION

TRUMP'S 2018 STATE OF THE UNION SPEECH - 9pm EST:

EXPECTED TOPICS -

MILESTONES FOR THE TRUMP ADMINISTRATION

HOW TO UNIFY OUR NATION

MORE TRAINING FOR U.S. TROOPS

UPDATES ON IMMIGRATION REFORM

GOP TAX PLAN

MORE FUNDING FOR SMALL BUSINESSES

WALL STREET & THE STOCK MARKET

AFFORDABLE EDUCATION & HEALTH CARE

SANCTIONS ON NORTH KOREA & RUSSIA

SEXUAL HARASSMENT IN THE WORKPLACE

ETC.,


Sources: NY Times, Youtube


******* State of the Union: Trump to Declare a ‘New American Moment’


• President Trump will deliver his first State of the Union address tonight at 9 p.m. Eastern, and The New York Times will be streaming it live on our website and on our app. Follow our coverage for the latest updates and analysis.

• The White House has released excerpts from the speech.

• The president will arrive at the Capitol amid remarkable tumult: Anger that he has declined to impose sanctions on Russia and worry over a Republican memo on the origins of the Russia investigation.

White House releases excerpts — “the New American Moment.”
The White House released excerpts from the State of the Union address, a tradition that gives the president a few hours’ head start to highlight what he wants the audience to focus on.

Here are a few, as prepared for delivery:

“We want every American to know the dignity of a hard day’s work; we want every child to be safe in their home at night, and we want every citizen to be proud of this land that we love.”

“Since we passed tax cuts, roughly 3 million workers have already gotten tax cut bonuses — many of them thousands of dollars per worker.”

“This is our New American Moment. There has never been a better time to start living the American dream.”

“For the last year we have sought to restore the bonds of trust between our citizens and their government.”

“In our drive to make Washington accountable, we have eliminated more regulations in our first year than any administration in history.”

“America has also finally turned the page on decades of unfair trade deals that sacrificed our prosperity and shipped away our companies, our jobs and our nation’s wealth.”

“America is a nation of builders. We built the Empire State Building in just one year — isn’t it a disgrace that it can now take ten years just to get a permit approved for a simple road?”

“I am asking both parties to come together to give us the safe, fast, reliable, and modern infrastructure our economy needs and our people deserve.”

“Struggling communities, especially immigrant communities, will also be helped by immigration policies that focus on the best interests of American workers and American families.”

“As we rebuild America’s strength and confidence at home, we are also restoring our strength and standing abroad.”

“Last year I pledged that we would work with our allies to extinguish ISIS from the face of the earth. One year later, I’m proud to report that the coalition to defeat ISIS has liberated almost 100 percent of the territory once held by these killers in Iraq and Syria. But there is much more work to be done. We will continue our fight until ISIS is defeated.”

Sonny Perdue, agriculture secretary, designated survivor.
Yeah, there’s the first lady’s clothes or which big wig will fall asleep this year. But the State of the Union proceedings also have this bit of intrigue: Which cabinet official will earn the distinction of designated survivor?

The mystery this time was solved two hours before Mr. Trump was due to give his address on Tuesday, when the White House said that the honor would go to Mr. Perdue, the former governor of Georgia and the president’s agriculture secretary.

Glamorous in title but, thankfully, not so far in practice, the designated survivor does not attend the president’s address, and is poised to take over the commander-in-chief’s responsibilities in the event that catastrophe strikes the Capitol and wipes out most of the government. If tradition holds, Mr. Perdue will be watching from a distant and secure location while Mr. Trump speaks.

The short tenure of the designated survivor has an oversize presence in the public imagination: There is a TV series by the same title, about a low-profile cabinet member who suddenly assumes the presidency after a terror attack.

How might he measure up in the Oval Office? Mr. Perdue, a conservative Republican, shares something in common with Mr. Trump: As governor of Georgia, he faced ethical criticisms for not appearing to fully separate himself from his business interests. He once ran a grain and fertilizer business.

— Katie Rogers

“You’ve gotta have heart.”
Hours before his first State of the Union address, President Trump told a group of news anchors at a lunch in the White House that his first year in office has taught him that the biggest difference between excelling in business and performing his current job is that governing takes compassion.

“I’ve really learned a lot,” Mr. Trump told the reporters, according to a partial transcript of an off-the-record lunch released publicly by the White House. “In doing what I’m doing now, a lot of it is heart, a lot of it is compassion, a lot of it is far beyond money — such as immigration.”

Mr. Trump, who is expected to use Tuesday night’s speech to call for a bipartisan compromise that pairs legal status for a group of undocumented immigrants brought to the United States as children with funding for a border wall, tougher enforcement and new restrictions on legal immigration, recently said he was hoping to sign a “bill of love.”

That tone is sharply at odds with the president’s approach on immigration thus far, which has included a travel ban against visitors from six countries, slashing refugee resettlement and revoking temporary protected status for people from El Salvador and Haiti. He has been more publicly conflicted about his decision last fall to rescind DACA, or Deferred Action for Childhood Arrivals, the Obama-era program that has given legal status to certain people brought illegally to the United States as children.

“I’m telling you, the immigration is so easy to solve if it was purely a business matter, but it’s not,” Mr. Trump said. “And I think that’s something that I’ve learned maybe more than anything else: You have to — you govern with all of the instincts of a businessperson, but you have to add much more heart and soul into your decisions than you would ever have even thought of before.”

Dreamers head to the Capitol — despite the risk.
Democratic lawmakers have decided to put a face on the difficult negotiations happening in Congress over the fate of young, undocumented immigrants brought to the country as children. They are bringing scores of such “Dreamers” to the Capitol for Tuesday night’s State of the Union address.

Representative Nancy Pelosi’s guest, Melody Klingenfuss, is just one of them. Born in Guatemala, she was brought to Los Angeles when she was 9, earned a degree in communications and political science from California State University, Los Angeles, a master’s degree from the University of Southern California, then won protection under the Obama-era Deferred Action for Childhood Arrivals program in 2015.

“Tonight, when President Trump looks into the gallery during his State of the Union, he will see the dignity, courage and patriotism of dozens of Dreamers,” said Ms. Pelosi, the House Democratic leader.

But there is a flip side. Representative Paul Gosar, Republican of Arizona, has called the cops.

So much for the warm welcome.

Mr. Gosar’s fellow Arizona Republican, Senator Jeff Flake, didn’t take kindly to his colleague’s citizen’s arrest.

Are we facing a “Constitutional crisis”?
The Trump administration’s announcement on Monday that it would not impose sanctions on countries that buy Russian military equipment sparked an angry response in Congress, where the Senate and House overwhelmingly approved the sanctions to punish Russia for interfering in the 2016 election.

Senator Claire McCaskill, Democrat of Missouri who faces a difficult re-election campaign this year, set the tone with a blast on Twitter.

That concern is bipartisan, at least in some quarters of the Republican Party. Senator Susan Collins, Republican of Maine, was flummoxed by the administration’s decision:

“That bill passed with only two dissenting votes in the Senate. It was not partisan in the least,” she said on CNN. “The one thing we know for sure already is the Russians did attempt to meddle in our elections, and not only should there be a price to pay in terms of sanctions, but also we need to put safeguards in place right now for the elections for this year, because we know that the Russians have not given up on their disinformation campaign and their attempt to sow discord in this country and also to undermine faith in democratic institutions.”

Testifying before a Senate panel on Tuesday morning, Treasury Secretary Steven Mnuchin said his department had followed instructions under the sanctions law and drawn up a list of Russian targets for sanctions. An imposition of sanctions could still follow.

Senator Bob Corker, Republican of Tennessee and one of the authors of the sanctions legislation, declined to criticize the administration’s actions. He did say, “I look forward” to the implementation of the sanctions.

Speaker Ryan weighs in on Russia memo.

Speaker Paul D. Ryan of Wisconsin spent part of the morning before Mr. Trump’s speech tamping down expectations about a secretive Republican memo that some House members have claimed contains evidence that could undercut the Russia investigation.

In a closed-door meeting of House Republicans this morning, Mr. Ryan “implored” his fellow lawmakers not to overstate the facts of the memo, which the House Intelligence Committee voted to release Monday night. And he urged them not to tie the contentious document — which Democrats call dangerously misleading — to the work of the special counsel, Robert S. Mueller III, according to a person in the room.

Mr. Ryan reiterated some of those points during a public news conference an hour later, saying that he had faith in the F.B.I. and Justice Department’s broadly and that he thought Deputy Attorney General Rod J. Rosenstein, the man overseeing the Russia investigation, was “doing a fine job.” Still, Mr. Ryan defended the Republicans’ overall approach, saying that they were following proper processes and that only transparency would lead to accountability at the agencies.

That was not enough to quiet the most ardent proponents of the notion that federal law enforcement agents have conspired to bring down the Trump White House. Representative Matt Gaetz, Republican of Florida, called on the president to release the memo during the State of the Union.

Va. Federal Judge Slams Obama's Health Care Law! Purchase Mandate Unconstitutional!

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Va. Federal Judge Strikes Down Health Care Law


A Federal Judge declared the Obama administration's health care law unconstitutional Monday, siding with Virginia's attorney general in a dispute that both sides agree will ultimately be decided by the U.S. Supreme Court.

Read the Va. judge's ruling on the health care law (.pdf)

U.S. District Judge Henry E. Hudson is the first federal judge to strike down the law, which has been upheld by two others in Virginia and Michigan. Several other lawsuits have been dismissed and others are pending, including one filed by 20 other states in Florida.

"The Minimum Essential Coverage Provision is neither within the letter nor the spirit of the Constitution," Hudson wrote in a 42-page decision. However, he declined to invalidate the entire healthcare law, a small victory for Obama.

The law has become a cornerstone of Obama's presidency, aiming to expand health insurance for millions more Americans while curbing costs, and his Justice Department lawyers have been sent around the country to defend it in federal courts.

The Obama administration will likely appeal.

Virginia Republican Attorney General Kenneth Cuccinelli filed a separate lawsuit in defense of a new state law that prohibits the government from forcing state residents to buy health insurance. However, the key issue was his claim that the federal law's requirement that citizens buy health insurance or pay a penalty is unconstitutional.

Hudson, a Republican who was appointed by President George W. Bush, sounded sympathetic to the state's case when he heard oral arguments in October, and the White House expected to lose this round.

Administration officials told reporters last week that a negative ruling would have virtually no impact on the law's implementation, noting that its two major provisions — the coverage mandate and the creation of new insurance markets — don't take effect until 2014.

The central issue in Virginia's lawsuit was whether the federal government has the power under the constitution to impose the insurance requirement. The Justice Department said the mandate is a proper exercise of the government's authority under the Commerce Clause.

Cuccinelli argued that while the government can regulate economic activity that substantially affects interstate commerce, the decision not to buy insurance amounts to economic inactivity that is beyond the government's reach.







Business On Obamacare: Resist, Don't Repeal


Congressional Republicans are touting plans to repeal the Obama Administration's health care reform law, but they face wariness for a full rollback from a key constituency: the business lobby.

In the weeks before the midterm elections, many Republicans used the health care law to tap into anti-government sentiment and angst about the economy. In their Pledge to America, Republican candidates committed to "repeal and replace the government takeover of health care" by any means necessary. Even John Boehner, the incoming House Speaker, filed a brief on Nov. 16 in support of a lawsuit filed by 20 states challenging the constitutionality of a central part of the new law that requires individuals to purchase health insurance. "ObamaCare is a jobkiller, and our economy simply cannot afford this unprecedented, unconstitutional power grab by the federal government," Boehner said in a statement.

But few in the business community want to embark on the grueling process of seeking a full repeal of health care reform, because they believe it will ultimately fail. Even if a repeal effort passed the Republican-led House, it would be certain to die in a Senate still dominated by Democrats. And if repeal legislation miraculously survived the Senate, President Obama would never sign it. The more viable strategy, business believes, is to try to tweak or eliminate key parts of the law. James Gelfand, the U.S. Chamber of Commerce's director of health policy, says of the new law, "We'd like it to go away. But we're business people, and we're pragmatic."

The Big Business game plan is moving forward on several key fronts. The first strike is likely to come on the provision of the law requiring businesses to file 1099 tax forms on any individual or business with which it incurs an expense of more than $600 over the course of a year, starting in 2012. Small-business owners, in particular, warn that the requirement will overwhelm them with paperwork — and, consequently, stymie job creation and economic growth. Last week, a senior Democrat, Senator Max Baucus, announced plans to file legislation repealing the 1099 portion of the law. Second, business groups will focus on new restrictions on how much individuals can deduct on nonprescription drugs, like Tylenol, using flexible spending accounts.

The business community also plans to fight new regulations that would fully implement health reform. On Nov. 17, the U.S. Chamber of Commerce's CEO, Tom Donohue, challenged what the organization calls a "regulatory tsunami" by the government, including the one created by health care. As the health care law is implemented in the coming years, the chamber predicts it will create 183 new agencies, commissions and panels. While the new law sharply expands Americans' access to health care, critics warn of the cost: a CATO Institute report claims that the law will increase taxes by nearly $670 billion in the coming decade. "We've never seen anything on this scale before," Donohue said, adding, "It defies all logic and common sense." The chamber will hire a regulatory economist and encourage its internal law firm to take a more activist posture in fighting increased regulation.

The last prong of the attack will come in congressional oversight. In the coming weeks, Republicans are expected to hold hearings on what has happened with the health care law. That may look good for the television cameras and generate headlines. It will also test the public's willingness to go further with a broader legislative rollback of the law.


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Sources: MSNBC, Politico, TIME, Google Maps

John Boehner's Anti-Stimulus & Anti-ObamaCare Speeches (Videos)

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Sources: C-Span, Youtube, Google Maps

Total Cost Of New Health Care Law Will Exceed $1 Trillion

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Visit msnbc.com for breaking news, world news, and news about the economy

Sources: MSNBC, C-Span, Youtube

55% Of Voters Oppose Democrats' Health Care Bill

Fox News Poll: 55% Oppose Health Care Reform



As Americans wait for Congress to act on health care, a Fox News poll released Thursday finds 55 percent oppose the reforms being considered, while 35 percent favor them.

In addition, just over half of voters think House Democrats are “changing the rules” to get their bill passed.

About a third of voters (31 percent) think House Speaker Nancy Pelosi and the Democrats are “playing by the rules” to get health care through, while 53 percent think they are “changing the rules.” Looking at the results by political party, 53 percent of Democrats think their party is playing by the rules, about one in four think they are changing the rules (27 percent) and the rest are unsure (19 percent). Varying majorities of Republicans (78 percent) and independents (57 percent) think House Democrats are changing the rules to pass the bill.

The level of public support for the health care overhaul has remained fairly steady since last July -- 35 percent favor it now and 36 percent favored it last summer. The number opposed -- 55 percent -- is up from 51 percent in January, and from 47 percent last July. Opposition hit a high of 57 percent in December.

Among partisans, the president’s party faithful are alone in supporting the proposed reforms. Sixty-six percent of Democrats favor them, while 53 percent of independents and 88 percent of Republicans oppose them.

Click here to read the full PDF

When the option of starting over from scratch is included, that’s what a plurality of voters want: 46 percent would toss out the current bill and start over, while 30 percent would stick with what is now on the table. One in five (19 percent) would do nothing on health care now.

On several features, proponents of the reforms have failed to convince voters of the benefits. By two-to-one people think the quality of their family’s health care would be worse, rather than better, if the bill passed. In addition, majorities think the reforms would cost them money (66 percent), and increase their taxes (75 percent).

As the main reason for opposition to the current plan, quality issues lead the way (30 percent), followed by cost (22 percent) and an over-ambitious reach (19 percent).

The number one priority for Americans is the economy, and President Obama says reforming health care will improve it. Yet the poll finds around 6 in 10 voters don’t believe that health care reform would create jobs (56 percent) or boost the nation’s economy (64 percent).

If the bill passes -- or fails -- what should happen next?



If it passes, nearly half (45 percent) would like lawmakers repeal it, 29 percent would expand it, and 18 percent say lawmakers should leave it as is.

If the bill fails, most voters want to either start over from scratch (42 percent) or drop it (36 percent). One in five voters would want Congress to keep trying to pass the current plan (19 percent).

The national telephone poll was conducted for Fox News by Opinion Dynamics Corp. among 900 registered voters from March 16 to March 17. For the total sample, the poll has a margin of sampling error of plus or minus 3 percentage points.

How do voters view President Obama’s continued efforts to get health care reform passed?

Views are sharply divided -- nearly half think he is showing leadership (47 percent) and almost as many think he is showing stubbornness (45 percent).

Almost half (48 percent) think the president is only pushing the Democratic agenda and not trying to compromise, while over half (55 percent) think Republicans are only trying to block the president’s agenda rather than looking for middle ground.

Forty-three percent think Obama is truly trying to find middle ground with Republicans, while 31 percent think Republicans are looking for a compromise.

The president’s overall job rating stands at 46 percent approval and 48 percent disapproval, little changed from late February when 47 percent approved and 45 percent disapproved.

This is only the second time more voters have disapproved than approved of the president’s performance. The first was early last month (46 percent approved and 47 percent disapproved).

The president’s ratings among the party faithful are strong. Fully 80 percent of Democrats approve of the job he’s doing today -- down 5 points from when he took office.

It’s a different story among independent voters, who were critical to President Obama’s election. Since taking office his approval has dropped 17 points among this group -- from 64 percent in January 2009 to 47 percent now.

Approval of the president far outdistances that of Congress, which has an 18 percent approval rating, up from 14 percent in late February. Its disapproval rating stands at 76 percent. Even though Democrats control Congress, 63 percent of Democrats disapprove of the job lawmakers are doing.

Ratings of Congress are in line with the portion of voters who think Congress does what the American people want (17 percent), as opposed to whatever it wants (79 percent)

Likewise, 75 percent of voters feel their views are not represented by the federal government right now, including 58 percent of Democrats, 78 percent of independents and a whopping 92 percent of Republicans.

The poll finds 31 percent of voters approve of the job Nancy Pelosi is doing as speaker of the House, and 57 percent disapprove.

Sources: Fox News, Youtube

Walgreen Stores Turning Away New Medicaid Patients

Walgreens: No New Medicaid Patients As of April 16, 2010


Effective April 16, Walgreens drugstores across the state won't take any new Medicaid patients, saying that filling their prescriptions is a money-losing proposition — the latest development in an ongoing dispute over Medicaid reimbursement.

The company, which operates 121 stores in the state, will continue filling Medicaid prescriptions for current patients.

In a news release, Walgreens said its decision to not take new Medicaid patients stemmed from a "continued reduction in reimbursement" under the state's Medicaid program, which reimburses it at less than the break-even point for 95 percent of brand-name medications dispensed to Medicaid patents.

Walgreens follows Bartell Drugs, which stopped taking new Medicaid patients last month at all 57 of its stores in Washington, though it still fills Medicaid prescriptions for existing customers at all but 15 of those stores.

Doug Porter, the state's director of Medicaid, said Medicaid recipients should be able to readily find another pharmacy because "we have many more pharmacy providers in our network than we need" for the state's 1 million Medicaid clients.

He said those who can't can contact the state's Medical Assistance Customer Service Center at 1-800-562-3022 for help in locating one.

Along with Walgreens and Bartell, the Ritzville Drug Company in Adams County announced in November that it would stop participating in Medicaid.

Fred Meyer and Safeway said their pharmacies would continue to serve existing Medicaid patients and to take new ones, though both expressed concern that the reimbursement rate is too low for pharmacies to make a profit.

The amount private insurers and Medicaid pay pharmacies for prescriptions isn't the actual cost of those drugs but rather is based on what's called the drug's estimated average wholesale price. But that figure is more like the sticker price on a car than its actual wholesale cost.

Washington was reimbursing pharmacies 86 percent of a drug's average wholesale price until July, when it began paying them just 84 percent. While pharmacies weren't happy about the reimbursement reduction, the Department of Social and Health Services said that move was expected to save the state about $10 million.

Then in September came another blow. The average wholesale price is calculated by a private company, which was accused in a Massachusetts lawsuit of fraudulently inflating its figures. The company did not admit wrongdoing but agreed in a court settlement to ratchet its figures down by about 4 percent.

That agreement took effect in September — and prompted a lawsuit by a group of pharmacies and trade associations that said Washington state didn't follow federal law in setting its reimbursement rate, and that that rate is too low. The lawsuit is pending.

"Washington state Medicaid is now reimbursing pharmacies less than their cost of participation," said Jeff Rochon, CEO of the Washington State Pharmacy Association.

Pharmacies that continue to fill Medicaid prescriptions at the current state reimbursement rate are "at risk of putting themselves out of business altogether," he said.




With Medicaid Cuts, Doctors & Patients To Drop Out



Carol Y. Vliet’s cancer returned with a fury last summer, the tumors metastasizing to her brain, liver, kidneys and throat.

As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of comfort in her monthly appointments with her primary care physician, Dr. Saed J. Sahouri, who had been monitoring her health for nearly two years.

She was devastated, therefore, when Dr. Sahouri informed her a few months later that he could no longer see her because, like a growing number of doctors, he had stopped taking patients with Medicaid.

Dr. Sahouri said that his reimbursements from Medicaid were so low — often no more than $25 per office visit — that he was losing money every time a patient walked in his exam room.

The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall.

“My office manager was telling me to do this for a long time, and I resisted,” Dr. Sahouri said. “But after a while you realize that we’re really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.”

It has not taken long for communities like Flint to feel the downstream effects of a nationwide torrent of state cuts to Medicaid, the government insurance program for the poor and disabled. With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition.

Mrs. Vliet, 53, who lives just outside Flint, has yet to find a replacement for Dr. Sahouri. “When you build a relationship, you want to stay with that doctor,” she said recently, her face gaunt from disease, and her head wrapped in a floral bandanna. “You don’t want to go from doctor to doctor to doctor and have strangers looking at you that don’t have a clue who you are.”

The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.

In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.

In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.

If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems.

As a result, she takes new Medicaid patients only if they are relatives or friends of existing patients. But her guilt is assuaged somewhat, she said, because her husband, who is also her office mate, Dr. Bobby B. Mukkamala, an ear, nose and throat specialist, is able to take Medicaid. She said he is able to do so because only a modest share of his patients have it.

The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents. It falls to the states to control spending by setting limits on eligibility, benefits and provider payments within broad federal guidelines.

Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults.

When Randy C. Smith showed up recently at a Hamilton Community Health Network clinic near Flint, complaining of a throbbing molar, Dr. Miriam L. Parker had to inform him that Medicaid no longer covered the root canal and crown he needed.

A landscaper who has been without work for 15 months, Mr. Smith, 46, said he could not afford the $2,000 cost. “I guess I’ll just take Tylenol or Motrin,” he said before leaving.

This year, Gov. Jennifer M. Granholm, a Democrat, has revived a proposal to impose a 3 percent tax on physician revenues. Without the tax, she has warned, the state may have to reduce payments to health care providers by 11 percent.

In Flint, the birthplace of General Motors, the collapse of automobile manufacturing has melded with the recession to drive unemployment to a staggering 27 percent. About one in four non-elderly residents of Genesee County are uninsured, and one in five depends on Medicaid. The county’s Medicaid rolls have grown by 37 percent since 2001, and the program now pays for half of all childbirths.

But surveys show the share of doctors accepting new Medicaid patients is declining. Waits for an appointment at the city’s federally subsidized health clinic, where most patients have Medicaid, have lengthened to four months from six weeks in 2008. Parents like Rebecca and Jeoffrey Curtis, who had brought their 2-year-old son, Brian, to the clinic, say they have struggled to find a pediatrician.

“I called four or five doctors and asked if they accepted our Medicaid plan,” said Ms. Curtis, a 21-year-old waitress. “It would always be, ‘No, I’m sorry.’ It kind of makes us feel like second-class citizens.”

As physicians limit their Medicaid practices, emergency rooms are seeing more patients who do not need acute care.

At Genesys Regional Medical Center, one of three area hospitals, Medicaid volume is up 14 percent over last year. At Hurley Medical Center, the city’s safety net hospital, Dr. Michael Jaggi detects the difference when advising emergency room patients to seek follow-up treatment.

“We get met with the blank stare of ‘Where do I go from here?’ ” said Dr. Jaggi, the chief of emergency medicine.

New doctors, with their mountains of medical school debt, are fleeing the state because of payment cuts and proposed taxes. Dr. Kiet A. Doan, a surgeon in Flint, said that of 72 residents he had trained at local hospitals only two had stayed in the area, and both are natives.

Access to care can be even more challenging in remote parts of the state. The MidMichigan Medical Center in Clare, about 90 miles northwest of Flint, closed its obstetrics unit last year because Medicaid reimbursements covered only 65 percent of actual costs. Two other hospitals in the region might follow suit, potentially leaving 16 contiguous counties without obstetrics.

Medicaid enrollees in Michigan’s midsection have grown accustomed to long journeys for care. This month, Shannon M. Brown of Winn skipped work to drive her 8-year-old son more than two hours for a five-minute consultation with Dr. Mukkamala. Her pediatrician could not find a specialist any closer who would take Medicaid, she said.

Later this month, she will take the predawn drive again so Dr. Mukkamala can remove her son’s tonsils and adenoids. “He’s going to have to sit in the car for three hours after his surgery,” Mrs. Brown said. “I’m not looking forward to that one.”

Sources: NY Times, Walgreens, Fox News, Seattle Times, Youtube

Bob Etheridge, Other NC Dems Voting Against Health Care Bill?

Many N.C. Dems Likely To Oppose Health Care Bill


Depending on the vote of undecided U.S. Rep. Bob Etheridge, half of North Carolina's Democrats could join congressional Republicans this weekend in opposing the final passage of a sweeping health care overhaul.

Already, the state's three most conservative Democrats are expected to vote no - just as they did in November when the health care bill first came up for a vote.

U.S. Reps. Heath Shuler of Waynesville, Larry Kissell of Biscoe and Mike McIntyre of Lumberton say the bill doesn't go far enough to bring down health care costs and would, instead, cost American taxpayers too much.

Etheridge, a Lillington Democrat, supported the Democrats' bill in November. At the time, he waited until the last minute to signal his vote. This time around, he says he is undecided again.

The indecision comes in the waning days of Democratic leaders' push for votes. President Barack Obama has been calling some wavering Democrats, and House Majority Whip James Clyburn is meeting with caucus groups to push the bill.

Jared Bernstein, economic policy adviser to Vice President Joe Biden, said that lawmakers are choosing between keeping the status quo and passing needed - if imperfect - reform.

"These are not easy votes, I grant you that," Bernstein said. "But this is a historic vote."

Families are Hurting

Etheridge is considered a moderate in his party, and he votes with leadership nearly 98 percent of the time, according to a Washington Post database of congressional votes.

Late Wednesday afternoon, he spent five minutes on the House floor reading aloud health care horror stories from his home district.

"It's time to put health insurance back on the side of the folks back home," Etheridge said. "When North Carolina families are hurting, doing nothing really isn't an option for me."

Etheridge has faced strong pressure in the 2nd Congressional District, a largely rural and suburban district that dips into Southeast Raleigh but also curls through the fast-developing farmlands around the eastern and southern edges of the Triangle.

A recent survey by Public Policy Polling, a Democratic firm in Raleigh, found that 53 percent of voters in Etheridge's district oppose health care reform, while only 37 percent support it. And in the past week, members of the tea party movement have held two rallies outside Etheridge's office, urging him to vote no.

North Carolina's other lawmakers have fallen in line with their parties. Supporters of the bill include U.S. Reps. Mel Watt, G.K. Butterfield, Brad Miller and David Price. Price, who represents Chapel Hill, Durham and Cary, held a news conference Monday to announce his support.

All North Carolina Republicans are opposed, with many of them echoing GOP talking points that Congress should "start over" with health reform.

"Take it off the table," said U.S. Rep. Sue Myrick, a Charlotte Republican.

"If [Democratic leaders] thought that this is what the American people wanted and they had the votes to pass health care reform, we would have passed this bill a long time ago," Myrick said. "But they don't have the votes, and this is certainly not what the American people want."

Costs too much

Shuler, Kissell and McIntyre all say the reform would cost too much.

"Health reform is needed, but this bill is too expensive," McIntyre said in an interview Wednesday. He said the bill would create a new federal bureaucracy at the cost of nearly a trillion dollars, while not doing enough to stop the skyrocketing costs of health insurance premiums.

Families USA, a non-partisan health advocacy organization in Washington, estimates that health insurance premiums in North Carolina rose nearly 100 percent in the past decade.

Shuler and McIntyre belong to the Blue Dog Coalition, a group of fiscally conservative Democrats that often weighs in on budget-related bills. They have been targeted by organizations on both sides of the issue.

Callers to Shuler's office Wednesday routinely encountered busy signals or a voicemail message. And McIntyre said his office has received thousands of calls and letters, many of them from across the country.

Small steps

McIntyre said he would rather scrap the current bill, concentrate on jobs recovery and then focus on small goals in health reform. Those could include developing community health centers, improving electronic medical records and creating partnerships between nursing schools and rural communities. He also wants to focus on improving the two government programs that now exist, Medicaid and Medicare.

"They're almost broke," McIntyre said. "My goodness, we've got to honor the commitments that are already there."

Shuler's office did not return calls for comment Wednesday. His spokeswoman told a newspaper in Shuler's district this week that the congressman is undecided, but Shuler is widely expected to vote "no" as he did in November.

Kissell, a former high school civics teacher, said in a statement Wednesday that he will vote No because he doesn't like how the bill is supposed to be paid for.


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Sources: McClatchy Newspapers, Youtube, Google Maps

CBO Scores Obama's Double Counted HC Bill At $940B...Vote Expected Sunday

Health Care Bill Estimated To Cost $940 Billion Over 10 Years


Democrats' new health care reform bill is estimated to cost $940 billion over the next decade without adding to the deficit, sources told Fox News.

Sources said the estimates show the updated bill would save $130 billion over the first 10 years and save $1.2 trillion over the second decade.

The fate of the Democrats' health care reform effort hinges on a report expected Thursday morning from the congressional budget scorekeepers -- an estimate of what a follow-up bill could cost that already is running into trouble.

The Congressional Budget Office is set to release its estimate of the price tag for a so-called "side-car" package of changes to the overall health care reform bill that House Democrats insist on pursuing in exchange for approving, temporarily, the Senate-passed bill.



They want to consider the follow-up bill under "reconciliation" rules, which would allow the Senate to pass it with just 51 votes, instead of 60.

But there's a problem: Some Democrats are jeopardizing that game plan by resisting the kind of sweeping tax needed in order to qualify for reconciliation rules.

In order to qualify, the CBO estimate must show that the bill saves at least $1 billion over five years and creates absolutely no deficit after that period of time. The Senate-passed bill includes a tax on high-value insurance plans to ensure the bill is paid for, but liberal Democrats and unions have long had issues with that tax -- they wanted a straight tax on the wealthy in the original House bill.

Senate Budget Committee Chairman Kent Conrad said the biggest complication at this late stage in the game is making sure the bill qualifies as a reconciliation package.

Rep. Rob Andrews, D-N.J., conceded Wednesday night they were having "technical" issues with provisions like the excise tax.

"This is a process where one little thing affects everything else," he said.

House Democratic leaders insist the bill will be paid for.

"I'm confident the CBO numbers will show that this reduces the deficit in a significant way over a 10-year period," Rep. Chris Van Hollen, D-Md., said.

Some fiscally minded lawmakers want to see the CBO numbers before deciding how to vote. House Speaker Nancy Pelosi is still several votes short of the 216 needed to pass the Senate-approved package.

So far, the earliest a vote on the House floor could happen is Sunday. The plan is for lawmakers to post the reconciliation bill online Thursday afternoon, starting the 72-hour timeframe Democrats say they will allow for the public to review the language.

Sources: Fox News, C-Span, Youtube

Obama Touts CBO Info. On Cost Control, Fact Check: Not So

Pres. Obama's Health Care Plan: A Premium On Accurate Information


As our year long debate on health care comes to a close there’s a lot of misinformation flying around. Case in point: a recent headline suggesting that health premiums would increase under the President’s health care plan. The suggestion of this article was that maybe Americans would be better off and end up paying less if we ditch reform just continue to do nothing.

In fact, the opposite is true. Most people would pay less—in many cases a lot less. Let’s look at why:

In the absence of reform, health premiums are expected to continue skyrocketing. Those 20, 30 and 40% increases that you’ve heard about lately – they’ll be the rule not the exception.

The real question, then, is whether the President’s plan would lower the cost of premiums from what they would be or increase them. Here, we don’t have to rely on hearsay or news articles – the Congressional Budget Office has offered its official view on the question.



According to the CBO, Americans buying the same coverage they have today in the individual market will see premiums fall by 14 to 20 percent compared to what they would pay without health insurance reform. This results from two important things that reform will do:

* First: The President’s Proposal introduces greater competition in the insurance market by establishing state-based exchanges where insurers will need to compete for business. In addition, the proposal streamlines administrative costs by standardized forms and reducing the paperwork burden of providers.

CBO assumes that competition and administrative savings in the reformed market will generate significant savings, which will reduce average premiums for a comparable package of benefits by 7 to 10 percent compared to the cost of such benefits without reform in the individual market.

* Second: As a result of insurance market reforms that will be in place in the individual market and because of the individual responsibility requirement for coverage, CBO assumes that millions more people will have access to the individual market. According to the CBO, the impact of bringing these new people – many of whom are younger and healthier – into the market will help reduce premiums by 7 to 10 percent in the individual market.

But wait, maybe you’ve heard opponents saying that CBO actually found that premiums would go up? Again, the facts matter here.

The CBO assumes that under President Obama's Proposal individuals purchasing coverage in the reformed individual market will have access to a wider range of health benefits than they have in today’s individual market. So people may choose to buy better coverage. Some may pay more because they are getting more for their money.

And let’s not forget that the President’s plan includes the largest middle class tax cut for health insurance in our nation’s history. Critics also fail to point out that the majority of people purchasing coverage in the individual market will receive tax credits that on average will cover two-thirds of their premium.

Once the impact of these new tax credits are taken into account, many people in the individual market could see their premiums drop by almost 60 percent compared to what they would have paid without health insurance reform.

Dan Pfeiffer is White House Communications Director




FACT CHECK: Obama Plan Only Slows Premiums Rise


Buyers, beware: President Barack Obama says his health care overhaul will lower premiums by double digits, but check the fine print.

Premiums are likely to keep going up even if the health care bill passes, experts say. If cost controls work as advertised, annual increases would level off with time. But don't look for a rollback. Instead, the main reason premiums would be more affordable is that new government tax credits would help millions of people who can't afford the cost now.

Listening to Obama pitch his plan, you might not realize that's how it works.

Visiting a Cleveland suburb this week, the president described how individuals and small businesses will be able to buy coverage in a new kind of health insurance marketplace, gaining the same strength in numbers that federal employees have.

"You'll be able to buy in, or a small business will be able to buy into this pool," Obama said. "And that will lower rates, it's estimated, by up to 14 to 20 percent over what you're currently getting. That's money out of pocket."

And that's not all.

Obama asked his audience for a show of hands from people with employer-provided coverage, what most Americans have.

"Your employer, it's estimated, would see premiums fall by as much as 3,000 percent," said the president, "which means they could give you a raise."

A White House press spokesman later said the president misspoke; he had meant to say annual premiums would drop by $3,000.

It could be a long wait.

"There's no question premiums are still going to keep going up," said Larry Levitt of the Kaiser Family Foundation, a research clearinghouse on the health care system. "There are pieces of reform that will hopefully keep them from going up as fast. But it would be miraculous if premiums actually went down relative to where they are today."

The statistics Obama based his claims on come from two sources. In both cases, caveats got left out.

A report for the Business Roundtable, an association of big company CEOs, was the source for the claim that employers could save $3,000 per worker on health care costs, the White House said.

Issued in November, the report looked generally at proposals that Democrats were considering to curb health care costs, concluding they had the potential to significantly reduce future increases.

But the analysis didn't consider specific legislation, much less the final language being tweaked this week. It's unclear to what degree the bill that the House is expected to vote on within days would reduce costs for employers.

An analysis by the Congressional Budget Office of earlier Senate legislation suggested savings could be fairly modest.

It found that large employers would see premium savings of at most 3 percent in 2016, compared with what their costs would have been without the legislation. That would be more like a few hundred dollars instead of several thousand.

The claim that people buying coverage individually would save 14 percent to 20 percent comes from the same budget office report, prepared in November for Sen. Evan Bayh, D-Ind. But the presidential sound bite fails to convey the full picture.

The budget office concluded that premiums for people buying their own coverage would go up by an average of 10 percent to 13 percent, compared with the levels they'd reach without the legislation. That's mainly because policies in the individual insurance market would provide more comprehensive benefits than they do today.

For most households, those added costs would be more than offset by the tax credits provided under the bill, and they would pay significantly less than they have to now. However, the budget office estimated that about 4 in 10 customers shopping for an individual policy would not be eligible for tax credits — and would face higher premiums on average than without the legislation.

The premium reduction of 14 percent to 20 percent that Obama often cites would apply only to a portion of the people buying coverage on their own — those who want to keep the skimpier kinds of policies available today.

Their costs would go down because more young people would be joining the risk pool and because insurance company overhead costs would be lower in the more efficient system Obama wants to create.

The president usually alludes to that distinction in his health care stump speech, saying the savings would accrue to those people who continue to buy "comparable" coverage to what they have today.

But many of his listeners may not pick up on it.

"People are likely to not buy the same low-value policies they are buying now," said health economist Len Nichols of George Mason University. "If they did buy the same value plans ... the premium would be lower than it is now. This makes the White House statement true. But is it possibly misleading for some people? Sure."




CBO Confirms Families Will Save Money Under Health Reform



Today, the Congressional Budget Office (CBO) released an analysis (pdf) of the Senate version health insurance reform – and it contains more good news about what reform will mean for families struggling to keep up with skyrocketing premiums under the broken status quo.

Like other recent analyses, the CBO report finds that lower administrative costs, increased competition, and better pooling for risk will mean lower premiums for American families. Among the findings:

* Americans buying comparable health plans to what they have today in the individual market would see premiums fall by 14 to 20 percent.
* Those who get coverage through their employer today will likely see a decrease in premiums as well.
* And Americans who currently struggle to find coverage would see lower premiums because more people will be covered.

In addition to the welcome relief on costs, the CBO reports that Americans will also have better insurance options. The CBO assumes that many people will take advantage of these better options and "buy up" to purchase better plans than are currently offered in the individual market.

Not surprisingly, some of reform's opponents have already started trying to distort that finding to make false claims that reform will raise costs. So let's be clear: where the CBO does see premiums rising, it's not because Americans are paying more for the same coverage – it's that they’re making a choice to purchase better plans that weren't previously available to them.

In keeping with that finding, the CBO affirms the effectiveness of the grandfather policy, which will allow you to keep what you have if you like it. The report reads, "Moreover, if they wanted to, current policyholders in the nongroup market would be allowed to keep their policy with no changes, and the premiums for those policies would probably not differ substantially from current-law levels."

Finally, it’s worth nothing that for all the good news in the CBO report, the analysis doesn't even take into account all of the bill’s measures to control costs and improve coverage. So if anything, it understates the positive impacts of reform. For example, the CBO does not take into account policies like the catastrophic option available to young adults, and reinsurance provision, that would reduce premiums even further.

It also does not incorporate potential effects of the proposal on the level or growth rate of spending for health care. For instance, CBO’s analysis does not fully capture the effects of the excise tax on high-cost plans, which will bend the cost curve over the long-term. But it did provide a snapshot: for plans affected by the tax in 2016, premiums would be 9-12 percent lower than under current law.


Sources: Whitehouse.gov, C-Span, CBO, Yahoo News, Youtube

Warren Buffet Advises Obama To Scrap Current HC Bill & Start Over

Warren Buffett Would Scrap Current Health Care Bill


Billionaire investor Warren Buffett advised President Barack Obama on Monday to scrap the health care bill and start over.

In an interview with CNBC, Buffett said the current bill does not focus on controlling costs, which he sees as the central problem that must be addressed to reform the system. He added that while he does not like the Senate bill, he’d vote for it in preference to doing nothing.

“What we have now is untenable over time,” said Buffett, an early supporter of Obama’s candidacy. “That kind of a cost compared to the rest of the world is really like a tapeworm eating, you know, at our economic body.”

“We have a health system that, in terms of costs, is really out of control,” he added. “And if you take this line and you project what has been happening into the future, we will get less and less competitive. So we need something else.”

But while Buffett, the chairman and CEO of Berkshire Hathaway, applauded Obama for taking up the reform effort, he said that “unfortunately, we came up with a bill that really doesn't attack the cost situation that much.”

Asked if he would be in favor of scrapping the Senate health care bill, Buffett responded: “I would be.”

If the president were to start over, Buffett would advise him to “just show this chart of what's been happening and say this is the tapeworm that's eating at American competitiveness. And I would say that one way or another, we're going to attack costs, costs, costs, just like they talk about jobs, jobs, jobs.”

Buffett urged Obama to say that “we're going to cut off all the kinds of things like the 800,000 special people in Florida or the Cornhusker kickback, as they called it, or the Louisiana Purchase, and we're going to — we're going to get rid of the nonsense. We're just going to focus on costs and we're not going to dream up 2,000 pages of other things. And I would say, as president, `I'm going to come back to you with something that's going to do something about this, because we have to do it.’”

Like Democrats in Congress, Buffett would like to expand access to health insurance, but he said he does not “believe in insuring more people till you attack the cost aspect of this.”

“If it was a choice today between plan A, which is what we've got, or plan B, what is in front of — the Senate bill, I would vote for the Senate bill,” Buffett said. “But I would much rather see a plan C that really attacks costs. And I think that's what the American public wants to see. I mean, the American public is not behind this bill. And we need the American public behind the bill, because it's going to have to do some tough things.”

Sources: Politico, CNBC

After Health Care Reality Show Dems Set To Use Reconciliation

Visit msnbc.com for breaking news, world news, and news about the economy

Visit msnbc.com for breaking news, world news, and news about the economy

Dems, GOP May Not Bridge The Gap On Reform


After a day of debate and disagreement, President Barack Obama concluded Thursday's unprecedented live talkfest on health care with the bleak assessment that accord between Democrats and Republicans may not be possible. He rejected Republican preferences for starting over, discussing the issue much longer or taking a step-by-step solution.

Obama said he is not sure that Democrats can "bridge the gap" with the GOP to reach a compromise on the plan, and he strongly suggested that Democrats will try to pass a sweeping overhaul without GOP support by using controversial Senate budget rules that would disallow filibusters.

Then, he said, this fall's elections would write the verdict on who was right.

"We cannot have another yearlong debate about this," Obama said at the end of a 7½-hour marathon policy debate.

Senate Republican Leader Mitch McConnell told reporters after the summit that he was "discouraged" by the daylong meeting. Obama and his fellow Democrats made it clear that they want to continue to pursue their own sweeping measure, he said. "What we think he ought to do is start over."

Neither side gave ground throughout, sticking mostly to familiar arguments and talking points. The president urged Republicans to "do a little soul searching" and said majority Democrats would decide quickly how to proceed on the issue that has eluded leaders for half a century.

The lengthy back-and-forth was essentially a condensed, one-day version of the entire past year of debate over the nation's health care crisis, with all its heat, complexity and detail, and a crash course in the partisan divide, in which Democrats seek the kind of broad remake that has eluded leaders for half a century and Republicans favor much more modest changes. With Democrats in control of the White House and Congress, they were left with the critical decision about where to go next.

Obama and his Democratic allies argued at Thursday's meeting that a broad overhaul is imperative for the nation's future economic vitality. The president cast health care as "one of the biggest drags on our economy," tying his top domestic priority to an issue that's even more pressing to many Americans.

"This is the last chance, as far as I'm concerned," Rep. Louise Slaughter, D-N.Y.

Obama lamented partisan bickering that has resulted in a stalemate over legislation to extend coverage to more than 30 million people who are now uninsured. "Politics I think ended up trumping practical common sense," he said.

And yet, even as he pleaded for cooperation — "actually a discussion, and not just us trading talking points" — he insisted on a number of Democratic points and acknowledged agreement may not be possible. "I don't know that those gaps can be bridged," Obama said.

With hardened positions well staked out before the meeting, the president and his Democratic allies prepared to move on alone — a gamble with political risks no matter how they do that.

One option — preferred by the White House and progressives in the Democratic caucus — is to try to pass a comprehensive plan without GOP support, by using controversial Senate budget reconciliation rules that would disallow filibusters. GOP Sen. Lamar Alexander asked Democrats to swear off a jam-it-through approach, while Senate Majority Leader Harry Reid, D-Nev., defended it. Obama weighed in with gentle chiding, asking both sides to focus on substance and worry about process later — a plea he made repeatedly throughout the day with little success.

Popular Opposition

A USA Today/Gallup survey released Thursday found Americans tilt 49-42 against Democrats forging ahead by themselves without any GOP support. Opposition was even stronger to the idea of Senate Democrats using the special budget rules, with 52 percent opposed and 39 percent in favor.

A second alternative for Obama and his party is going smaller, with a modest bill that would merely smooth some of the rough edges from the current system. A month after the Massachusetts election that cost Democrats their Senate supermajority and threw the health legislation in doubt, the White House has developed its own slimmed-down health care proposal so the president will know what the impact would be if he chooses that route, according to a Democratic official familiar with the discussions. That official could not provide details, but Democrats have looked at approaches including expanding Medicaid and allowing children to stay on their parents' health plans until around age 26.

Many lawmakers and Obama stressed areas of agreement, including items such as allowing parents to keep young adult children on their health plans into their 20s, cutting fraud and waste and ensuring that sick people aren't dropped by insurance companies. But such items occupy the edges of reform.

Indeed, any skepticism about reaching broad consensus was vindicated as soon as the first Republican spoke — in opposition to the mammoth bills that have passed the House and Senate. Alexander, of Tennessee, said Congress and the administration should start over and take small steps, including medical malpractice reform, high-risk insurance pools, a way to allow Americans to shop out of state for lower-cost plans and an expansion of health savings accounts.

"We believe we have a better idea," Alexander said. "Our views represent the views of a great number of American people."

Disagreements were not always expressed diplomatically.

Alexander challenged Obama's claim that insurance premiums would fall under the Democratic legislation. "You're wrong," he said. Responded Obama: "I'm pretty certain I'm not wrong."

As with much in the complicated health care debate, both sides had a point. The Congressional Budget Office says average premiums for people buying insurance individually would be 10 to 13 percent higher in 2016 under the Senate legislation, as Alexander said. But the policies would cover more medical services, and around half of people could get government subsidies to defray the extra costs.

Echoes of 2008

Obama and his 2008 GOP opponent for the presidency, Sen. John McCain of Arizona, had a barbed exchange. McCain complained at length about what he said was a backdoor process to produce the original bills that resulted in favors for special interests and carve-outs for certain states.

"We're not campaigning anymore. The election's over," responded a clearly irritated Obama.

"I'm reminded of that every day," McCain shot back, adding that "the American people care about what we did and how we did it."

Said Obama: "We can have a debate about process or we can have a debate about how we're actually going to help the American people at this point. And I think that's — the latter debate is the one that they care about a little bit more."

Generally, polls show Americans want solutions to the problems of high medical costs, eroding access to coverage and uneven quality. But they are split over the Democrats' sweeping legislation, with its $1 trillion, 10-year price tag and many complex provisions, including some that wouldn't take effect for eight years.

The Democratic bills would require most Americans to get health insurance, while providing subsidies for many in the form of a new tax credit. The Democrats would set up a competitive insurance market for small businesses and people buying coverage on their own. Democrats also would make a host of other changes, which include addressing a coverage gap in the Medicare prescription benefit and setting up a new long-term-care insurance program. Their plan would be paid for through a mix of Medicare cuts and tax increases.

"Not only are lawmakers polarized, the parties' constituencies are far apart," said Robert Blendon, a Harvard University professor who follows public opinion trends on health care. "The president is going to use it as a launching pad for what will be the last effort to get a big bill passed. He will say that he tried to get a bipartisan compromise and it wasn't possible."

The Blair House setting wasn't grand, or even particularly comfortable. About 40 senators, representatives and administration officials were crowded shoulder-to-shoulder around a hollow square table, perched for the six-hour marathon on wooden chairs with thin cushions. Coffee breaks were ruled out, so the only pause in the action came during lunch.

C-SPAN carried complete coverage, while news operations from cable networks to public broadcasting were making it the focus of their day.

Leaving the site during a lunch break, Obama was asked by waiting reporters if he thought the debate was engendering a lot of interest across the country.

"I don't know if it's interesting watching it on TV," he responded.


Sources: MSNBC