Tuesday, April 2, 2013

Washington Post On Climate: Obama Must ‘Discuss The Science, The Real Reason To Cut Carbon Emissions’

Obama surprised almost everyone when he channeled his inner climate hawk in his powerful second inaugural address. Now everyone is wondering what he will say in his State of the Union address Tuesday.

This weekend, the Washington Post editorial board weighed in:

President Obama will deliver his 2013 State of the Union address on Tuesday, and expectations are high that he will devote significant time to climate change. We hope that he adopts a different approach to explaining the need for action than he did in much of his first term.

In past addresses, talking about green jobs didn’t work, nor did talking about energy independence. The credible way to justify fighting climate change is to discuss the science, the real reason to cut carbon emissions. There is overwhelming evidence that the planet is warming. The widespread burning of fossil fuels, meanwhile, pumps heat-trapping greenhouse gases into the atmosphere every second….

It is certainly nice to see the Washington Post opinion page — home to George Will and other deniers — acknowledge that those of us who have been urging blunt talk on climate science for years have been right all along (see Brulle [1/11]: “By failing to even rhetorically address climate change, Obama is mortgaging our future and further delaying the necessary work to build a political consensus for real action).

Let me say that while I think talking about green jobs and energy independence was — and is — a good idea, those who urged only talking about those things were clearly wrong in retrospect. That’s because the oil and gas folks have been able to make a rhetorically strong (albeit flawed) case that they are the ones who can deliver jobs and reduced oil imports. Only one set of technologies can deliver jobs, energy independence, and preserve a livable climate. So only one set of technologies can avoid betraying our children and future generations. Game, set, and match.

Certainly team Obama worked hard to make sure that when he and other political and environmental leaders did talk about the need for action, the science was left out (see “Team Obama Launched The Inane Strategy Of Downplaying Climate Change Back In 2009“).

To remind you of how much the President has muzzled himself in recent years, recall what he said about the “never seen before” Fargo flooding in March 2009:

I actually think the science around climate change is real. It is potentially devastating,” Obama told reporters Monday. “If you look at the flooding that’s going on right now in North Dakota and you say to yourself, ‘If you see an increase of two degrees, what does that do, in terms of the situation there?’ That indicates the degree to which we have to take this seriously.

Precisely. Yet for nearly four years of record heat, record drought, record wildfires — and record-shattering frankenstorms, Obama had little to offer but climate silence.

That’s why it was so surprising he said last month:

We will respond to the threat of climate change, knowing that the failure to do so would betray our children and future generations.  Some may still deny the overwhelming judgment of science, but none can avoid the devastating impact of raging fires, and crippling drought, and more powerful storms.

Now it’s time for him to spell out the threat even more clearly — as well as the technologies and policies needed to address it.

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Presidential Memorandum -- Presidential Determination Regarding Drawdown Under Section 506 (a)(1) of the Foreign Assistance Act of 1961, as Amended, for Chad and France to Support Their Efforts in Mali

Increasing Opportunities For Chinese Direct Investment In U.S. Clean Energy

By Melanie Hart via CAP. The PDF has all citations.

In President Barack Obama’s first term, economic issues were often a source of friction between the United States and China, particularly regarding clean energy. But things started off relatively well a few years ago: President Obama made his first trip to China as president of the United States in November 2009, and energy cooperation was high on the agenda. President Obama and Chinese President Hu Jintao signed multiple agreements pledging to cooperate on a range of important energy initiatives such as the U.S.-China Clean Energy Research Center and a U.S.-China renewable-energy partnership.

These initiatives are important. The United States and China are the world’s biggest energy consumers and biggest greenhouse gas emitters. Our two nations have similar energy and climate problems but different comparative advantages for addressing those problems. The United States leads in cutting-edge clean energy innovation, and China leads in the rapid commercialization and deployment of those technologies.

Working together on clean energy just makes sense. If U.S. and Chinese clean energy enterprises can have open access to both markets, that access will improve their abilities to achieve good economies of scale and drive down costs. If both markets are competitive, that will give enterprises in both countries strong incentives to innovate, and innovation will lead to new technologies and new business models that should speed our transition to a clean energy economy. That would be good for U.S. and Chinese consumers, good for our economies, and good for the planet as a whole.

Despite those macro-level incentives to cooperate, however, things can get a bit more complicated when we actually delve into the details. Although we want to cooperate at a macro level, the United States and China are also big competitors at a market level. Both countries want to see their own companies dominate in critical industries such as solar and wind. Neither Washington nor Beijing is happy about being too reliant on energy products or services provided by foreign enterprises. Balancing cooperation with competition and our respective national ambitions is always difficult, and clean energy is no exception.

Although the United States and China expanded bilateral cooperation with critical projects such as the Clean Energy Research Center, throughout President Obama’s first term we increasingly butted heads in the trade realm. U.S. steel workers filed a World Trade Organization petition against China’s wind-power equipment subsidies in 2010; U.S. solar panel and wind turbine manufacturers filed U.S. Department of Commerce countervailing duty petitions and antidumping petitions against Chinese manufacturers producing those same products in 2011; and the American Semiconductors Corporation is still engaged in an ongoing legal battle with China’s Sinovel Wind Group over alleged intellectual property theft.

These U.S.-China clean energy trade frictions are serious, and unfortunately they are unlikely to disappear anytime soon. China’s regime to protect intellectual property rights is still developing. Some local officials in China are still more interested in protecting local companies than in adhering to international trade laws, and China’s relative lack of administrative transparency can make the resultant trade complaints very hard to resolve.

One area in which the Obama administration has proven especially adept, however, is approaching the U.S.-China relationship issue by issue without letting frustrations on one issue spill over and impede cooperation elsewhere. As my colleague Nina Hachigian recently wrote, President Obama has taken a “clear-eyed, nuanced and effective approach” toward China. Where cooperation makes sense, the president has been ready to deal. Where he feels American interests are being harmed, he has not hesitated to get tough.

This is exactly what we will need more of in U.S.-China relations in the clean energy sector. We need to continue to keep an eye on clean energy trade to ensure that American companies have a level playing field, but trade frictions should not hold us back from pursuing promising opportunities with China in other areas.

One of our most promising opportunities for U.S.-China clean energy cooperation is inward Chinese direct investment. Many Chinese companies want to come to the United States, directly invest in this country, and create jobs here. That is exactly what our economy needs, particularly in sectors such as renewable energy generation that generally do not pose national security concerns and will require large amounts of investment capital to develop. The problem is, however, that we do not have a good policy framework in place to encourage these investments.

In President Obama’s first term, the White House signaled general support for increasing Chinese direct investment. During Vice President Joe Biden’s August 2011 China trip, for example, the vice president stated:

President Obama and I, we welcome, encourage and see nothing but positive benefits flowing from direct investment in the United States from Chinese businesses and Chinese entities. It means jobs. It means American jobs.

From the perspective of most potential Chinese investors, however, those general statements of welcome are not enough to make the U.S. market look like a good bet. These investors need to be able to predict how the U.S. government will respond to particular foreign-invested business models—and that requires actual policies. The only policies we have at present are the national security review policies of the Committee on Foreign Investment in the United States, which are designed to block foreign direct investments that could pose national security concerns. National security protections are very important, but we should pair those protections with additional policies designed to encourage foreign investment in the sectors where security is not an issue. In this era of economic difficulty, we should not let those opportunities go by the wayside.

This issue brief will outline the opportunities and current problems in attracting Chinese direct investment and offer policy recommendations for how the United States can make the most of Chinese capital and knowledge in the clean energy sector.

President Obama’s administration made great strides in his first term toward building a sustainable U.S. clean energy economy that will provide jobs for middle-class Americans and reduce our nation’s dependence on foreign oil and fossil fuels. But more work is needed. Moving toward a clean energy economy in the United States will require more than $1 trillion of investment in the electricity grid, new fuels, mass transit, power generation, and manufacturing. An investment of this size will require the United States to mobilize every possible source of capital, including foreign direct investment.

While the United States has a sizeable investment need, Chinese investors are eager for new opportunities in foreign markets—and the U.S. market in particular. Their goals are not always perfectly aligned with ours, nor do U.S. market opportunities always perfectly meet their needs. That said, however, there are times when Chinese direct investment in the U.S. clean energy economy would be mutually beneficial.

Chinese enterprises would like to invest in the United States for many reasons, including:

Some potential investors are seeking infrastructure investments with stable returns.Others are seeking access to innovative technology and processes or high-yield opportunities in manufacturing.Directly investing in the United States can give Chinese enterprises a local presence and a closer relationship with U.S. consumers—two critical prerequisites for building and promoting Chinese name-brand goods and services.

All of these possible reasons for Chinese investment in the United States are supported by the fact that the Chinese government has amassed more than $3 trillion in foreign-exchange reserves. They cannot convert those reserve holdings into Chinese renminbi—the official currency of China—and invest them domestically without triggering inflation, so Chinese banks and enterprises are constantly looking for good investment opportunities abroad. Over the past 5 to 10 years, Chinese enterprises have grown more adept at operating in foreign markets, and that has triggered a shift from lower-yield portfolio investments—where Chinese entities buy minority shares in foreign assets—to higher-yield direct investments—where Chinese entities actually play an operational role by building and operating manufacturing plants abroad.

China’s total cumulative outward foreign direct investment now amounts to around $230 billion worldwide. Annual Chinese direct investments in overseas markets grew from less than $2 billion in 2004 to more than $40 billion in 2009, and some analysts predict that China’s total global stock in outward foreign direct investment could reach $2 trillion by 2020. If handled correctly, these investments could play a large role in revitalizing economies worldwide, including the U.S. economy.

Chinese direct investment in the United States is already rising steadily. Annual investment has surged in recent years—from $375 million in 2004 to more than $6.5 billion in 2012, which is the largest annual total so far. As of the end of 2012, Chinese enterprises have directly invested a cumulative total of more than $22 billion in the U.S. economy. And more than 27,000 American workers are currently employed by firms in which a majority of investments come from the Chinese.

Among China’s current U.S. direct investments, energy is a primary focus. Energy projects accounted for about 45 percent of total inward Chinese investments in 2012. Most of these energy investments, however, are minority-share fossil-fuel acquisitions by China’s state-owned energy companies. The China National Offshore Oil Corporation, for example, has invested more than $3 billion in U.S. shale gas fields since 2010, and the China Petroleum and Chemical Corporation, or Sinopec, has invested another $2.5 billion over the same time period. Comparatively, however, Chinese investment in clean energy is very low. (see Figure 1)

More work is needed to open up comparable investment opportunities in renewable energy sources, utilities, and energy efficiency. The interest is there: Chinese investments in U.S. clean energy sectors have increased significantly in recent years, from $4 million in 2006 to $264 million in 2011.

When you compare those investment numbers to the investment numbers for fossil fuels, however, clean energy is still just a drop in the bucket.

One reason Chinese direct investment in U.S. clean energy sectors still lags behind Chinese investment in U.S. fossil-fuel sectors is because our investment incentives for clean energy still do not measure up to the tax breaks and other policies supporting oil and natural gas. Leveling the playing field for clean energy technologies is still a work in progress in this nation, and that impacts foreign direct investment just as it impacts domestic investment. Additionally, the clean energy incentives that we do have are hard for most foreign companies to utilize.

The three main national-level U.S. clean energy incentives are the Department of Energy loan guarantee program, the production tax credit, and the investment tax credit. The U.S. Department of Energy loan guarantee program—section 1703 of the loan program—supports pre-commercial clean energy technologies by guaranteeing bank loans issued to companies pursuing those technology development projects. Department of Energy loan guarantees lower the otherwise-high investment risks associated with these companies, making them more attractive to private lenders.

Legally, Chinese and other foreign enterprises are eligible to receive clean energy loan guarantees from the Department of Energy as long as the project itself is located in the United States. In reality, though, in the current political climate it would be a serious liability for the Department of Energy to provide loan guarantees to a foreign company, particularly a Chinese company. U.S. politicians routinely attack clean energy deals that appear to allow Chinese companies to benefit from U.S. government funding. In 2010, for example, some U.S. senators protested a clean energy program that provided stimulus funding to U.S. wind farms that were importing their wind turbines from China. Similar protests arose last year when China’s Wanxiang Group moved to acquire A123, a U.S. battery company that had received federal clean energy funding before going bankrupt. Even when Chinese companies are not involved, the Department of Energy already has its hands full defending clean energy loan guarantees from fossil-fuel lobbying efforts. Adding Chinese companies into the mix would make that difficult job even harder.

In addition to the loan guarantee program, the United States also has two renewable energy tax credits: a production tax credit and an investment tax credit. The production tax credit provides a per-kilowatt-hour tax refund for companies that generate electricity using wind, biomass, hydropower, and other renewable sources. That tax credit can substantially reduce the costs of some renewable generation projects—particularly for wind, closed-loop biomass, and geothermal projects, which can receive a tax credit of 2.2 cents per 1 kilowatt hour.

The investment tax credit provides a 30 percent tax credit for residential solar systems, commercial solar systems, fuel cells and small wind systems, and a 10-percent tax credit for geothermal energy, small wind turbines (those with below 2 megawatts of power), and combined heat and power systems.

These two tax credits are great programs for electric utilities and other companies considering investing in renewable energy. The problem is, however, that tax rebates primarily benefit big companies that are already established in the United States, that already have big tax bills, and that can pay all project costs up front and wait until the end of the year to get a rebate. That is not the case for most foreign investors. Those companies generally do not have large existing operations in the United States looking for tax breaks, and they often have limited operating capital. What those companies are looking for is incentive programs that can reduce project costs from day one.

China’s ENN Group, for example, recently negotiated with the Clark County Commission in Nevada to purchase 9,000 acres of public land along the Nevada/California border to build a large solar project. The land was appraised at around $3,000 to $4,000 per acre, but Clark County sold the land to ENN at $500 per acre, thus substantially lowering ENN’s cost to construct the solar facility. In exchange, in addition to constructing the new facility, ENN promised to hire local labor, buy building materials locally, and create at least 1,000 jobs for the state of Nevada. That project appears to be a win-win: The land discount enabled ENN to save money at the outset, and Nevada got a new job-creating project.

Similar local-level investment incentives exist across the United States. They vary by locality depending on what the individual state and local governments have to offer and what types of investments they want to attract. But it can be difficult for state and local governments to connect with Chinese investors interested in building the types of projects that make sense for their regions. Even when local governments can make those connections, the Chinese companies are often scared off by what they perceive to be a relatively high risk that their projects will be blocked for national security reasons.

Chinese enterprises report that one of their biggest concerns with direct investments in the United States is the national security review. The Committee on Foreign Investment in the United States includes the secretaries of treasury, homeland security, commerce, defense, state, and energy; the U.S. attorney general; the secretary of labor; and the director of national intelligence. (The latter two are nonvoting members.) The committee is tasked with reviewing foreign business acquisitions in the United States to determine if those acquisitions create any national security risks. If the committee does find a security risk, they pass those findings on to the U.S. president, who can then block or reverse the business deal.

This review process has created a problem for some foreign investors in the United States, as it is difficult to predict what the committee will consider to be a national security threat. The governing regulations give the committee wide leeway to make that determination, and that makes it hard for foreign enterprises to foresee which deals will trigger security concerns. Recent regulatory reforms have expanded the committee’s focus to specifically target U.S. energy sectors, particularly the electric grid and other critical infrastructure. The committee generally considers foreign government ownership to be a red flag, so a Chinese state-owned enterprise investment in U.S. utility infrastructure, for example, would likely trigger committee review.

Recent high-profile national security review cases involving Chinese enterprises include the CNOOC deal in 2005, the Huawei deals in 2007 and 2011, and the Ralls Wind Corporation deal in 2012. In 2005 CNOOC issued an unsolicited $18.5 billion bid for Unocal, a California oil company; this high bid created a political firestorm in Washington. Many U.S. policymakers questioned whether the acquisition would threaten U.S. energy security by transferring critical oil assets to the Chinese government, and the U.S. House of Representatives passed a bill calling on then-President George W. Bush to review the transaction. It became clear to CNOOC that the deal would require an extensive committee review and that the likelihood of passing that review was almost zero, so the organization dropped the offer.

Chinese telecommunications equipment provider Huawei ran into similar difficulties in 2007 when it tried to acquire—with help from private equity firm Bain Capital—a minority interest in electronics manufacturer 3Com for $2.2 billion. 3Com provided Internet security software to the U.S. military, and the committee blocked the transaction due to concerns that Huawei could give the Chinese military access to U.S. defense software. Huawei ran afoul of the committee again when the company acquired cloud computing technology and 15 employees from U.S. server firm 3Leaf LLC in 2010. The U.S. Department of Defense raised concerns that Huawei might transfer 3Leaf technology secrets to the Chinese military for cyberattacks against the United States. That triggered a review of the deal, and the committee eventually forced 3Leaf and Huawei to unwind the transaction.

More recently, in September 2012 President Obama issued an order forcing China’s Ralls Wind Corporation to divest a wind farm that the company had purchased in Oregon. According to the U.S. Treasury Department, which chairs the committee, the purchase of the wind farm was deemed a national security risk because the site overlooked a U.S. Navy weapons-training facility.

The Committee on Foreign Investment in the United States system is designed to target and block potentially problematic foreign investment projects while letting the vast majority go forward. And in general, that is how the process works. Many foreign companies directly invest in the U.S. economy without triggering any national security concerns whatsoever, including many Chinese companies. The ENN Energy case mentioned above is one example of a Chinese direct investment project that went forward without any committee blocks. And the projects that do trigger the review process can still win approval. Wanxiang Group, a Chinese auto parts company, recently underwent a review for its planned acquisition of A123 Systems, a U.S. company that specializes in lithium-ion battery technology. Wanxiang came out of the review process with official U.S. government approval for the acquisition.

Although there are plenty of success cases, however, when most potential Chinese investors see big state-owned enterprises such as CNOOC and state champions such as Huawei get tangled up in the committee’s red tape, they assume that if those giants cannot get through to the U.S. market, then smaller Chinese companies definitely would not have a chance. But the reality is that the opposite is true. Smaller, privately owned companies that do not have strong connections to the Chinese government are much less likely to trigger security concerns than their state-owned counterparts. Foreign government control is one of the key issues the committee process tries to detect. The more independent the investor, the less likely foreign government control will be a problem.

Of course, nonstate investors run into problems too, just as China’s Ralls Corporation did with the Oregon wind farm project. That is where foreign firms start to get a bit confused. From the Chinese perspective, it can be hard to anticipate which projects will trigger security concerns. The end result is that many potential Chinese direct investors view the U.S. market as extremely high risk, and that deters them from launching projects that would be a win-win for both nations.

The U.S. government needs to provide a more stable and predictable policy framework for foreign direct investment so that we can leverage opportunities to expand our clean energy economy.

First and foremost, the United States needs to clarify where foreign direct investment is welcome and where it is not. At present, we simply do not have a coherent national policy on inward foreign direct investment. The U.S. federal government appears to divide inward foreign direct investment into two buckets: deals that threaten national security and deals that do not. That line, however, is not always clear.

One thing that has become increasingly clear since 2008: Any transaction involving the U.S. electric grid will most likely face a security review. Safeguarding our critical infrastructure is certainly important, particularly in the cyber era. U.S. intelligence officials are already finding malware in our domestic utility networks. Intelligence officials believe foreign governments are inserting the malware in hopes that they can use it to shut down critical U.S. utility networks in future conflicts with the United States. Given these national security concerns, it is justifiable to keep some parts of our critical infrastructure under U.S. ownership to guard against potential foreign government control. Clean energy development is also important, however, and electric grids are critical elements in the U.S. clean energy economy.

We need to achieve two goals at once: keeping our critical infrastructure secure and bringing in much-needed private-sector capital, including foreign direct investment, to stimulate our clean energy markets. To achieve both goals at once, the United States will have to send very clear signals to Chinese and other foreign firms clarifying which clean energy sectors they are welcome to engage in and which clean energy sectors are going to be generally off limits.

In his first official meeting with new Chinese General Secretary Xi Jinping, President Obama should clearly state that the United States strongly welcomes Chinese companies to come to the United States, directly invest in our economy, and create jobs. President Obama has said quite a bit thus far about clean energy trade enforcement but nothing concrete about Chinese direct investments in the U.S. economy. Trade enforcement is important, and the United States should not slack off on this important task. When the president is only emphasizing Chinese trade infringements, however, Chinese firms start to assume that U.S. markets are hostile to them. The reality is that as long as Chinese firms are willing to play by the rules—just as U.S. firms do—many of them will be warmly welcomed.

It is high time for the United States to clarify that message, starting at the top. Chinese officials and enterprises pay a great deal of attention to leadership statements—and particularly to those from the United States. We should take advantage of that attention and use a presidential statement to spread the word that U.S. clean energy markets are open for business—and Chinese companies in particular are welcome to participate.

The United States should also rank clean energy sectors by degree of national security concern and publicize that general ranking to help foreign firms more accurately gauge the risks involved in specific investment projects. It is impossible to construct a perfect ranking system because the details of a particular deal can have a dramatic impact on the perceived security risks. Renewable energy generation, for example, is generally open to foreign investment, but the Ralls wind farm acquisition was blocked because the site happened to overlook a U.S. naval base. Most cases do actually follow a predictable pattern, however. After all, the Committee on Foreign Investment in the United States process is based on legislation that provides a general outline of what the United States considers to be a red flag. Helping potential Chinese investors translate that general outline into a sector-specific risk analysis would go a long way toward reducing current perceptions of U.S. market uncertainty.

Additionally, the United States should do more to connect Chinese firms with the U.S. state and local governments that are willing and eager to provide good investment incentives for clean energy projects. In 2011 the Obama administration launched the Commerce Department SelectUSA initiative that is working to promote the United States as a destination for foreign direct investment. This initiative provides foreign investors with general statistics on the U.S. market and general information about federal- and state-level investment incentives. It is basically a federal-government public relations initiative aiming to convince foreign investors that the United States is a good place to do business.

That is a wonderful and much-needed effort, but industry-specific efforts are also needed. The United States should roll out supplementary programs for specific sectors such as clean energy. Sector-specific initiatives could provide much more information on specific investment incentives, particularly the local-level incentives that vary by location and project. Only some U.S. state and local governments are directly participating in the SelectUSA program, so it is not yet a one-stop shop. It would be extremely beneficial for all involved if the United States did have a one-stop shop to connect our state and local governments interested in attracting clean energy projects with the potential foreign direct investors looking for good project locations.

To be sure, China also has some work to do. As Chinese direct investors expand their presence in the United States, that expansion could generate concerns that some Chinese firms—particularly state-owned firms—are benefiting from state subsidies and other preferential policies in China and using that support to gain an unfair edge in the U.S. market. Unlike the United States, China has national industrial policies that direct massive state support toward developing new and emerging industries. Across the board, the policy support that Chinese companies receive almost always exceeds what companies receive in the United States. That can trigger accusations that there is an uneven playing field—that when Chinese companies drive their U.S. counterparts out of business, it is due to government subsidization, not natural market forces.

Part of this dynamic is a U.S. problem. The United States does not have a comprehensive industrial policy for developing clean energy, and that sometimes puts U.S. companies at a disadvantage in the global market. Part of this dynamic is also a Chinese problem, however. China’s industrial policies are often not transparent, and that can make it very difficult for foreign observers to determine how much and what types of support Chinese companies receive.

Chinese companies and Chinese policymakers often argue that the Western world needs to give the Chinese administrative system more time to develop. They argue that since China is still at an early development stage, it is natural to have some problems with transparency today, but those issues will improve as China moves up the economic ladder. The fact is, however, that China has already reached a relatively high point on that ladder. Top Chinese companies are already going abroad, investing directly in the United States, and gaining significant market share in sectors such as wind and solar power. These new successes bring new responsibilities that demonstrate that those Chinese companies are making those achievements on a level playing field. The more Chinese firms can themselves strive to abide by international standards on issues such as corporate-governance transparency, the more they will be welcomed to compete in foreign markets, including the U.S. market.

Melanie Hart is a Policy Analyst for Chinese Energy and Climate Policy at the Center for American Progress. She would like to extend many thanks to Richard Caperton for his comments on and contributions to this issue brief. The PDF is here.

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State Lacks Doctors To Meet Demand Of National Healthcare Law

Demonstrators outside the Supreme Court Or is it? One major obstacle is that there won't be enough doctors to see all the newly insured patients under Obamacare. Some California lawmakers want to fill the gap by redefining who can provide healthcare. (Saul Loeb, AFP/Getty Images / June 28, 2012)

SACRAMENTO — As the state moves to expand healthcare coverage to millions of Californians under President Obama's healthcare law, it faces a major obstacle: There aren't enough doctors to treat a crush of newly insured patients.

Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

"We're going to be mandating that every single person in this state have insurance," said state Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and leader of the effort to expand professional boundaries. "What good is it if they are going to have a health insurance card but no access to doctors?"

Hernandez's proposed changes, which would dramatically shake up the medical establishment in California, have set off a turf war with physicians that could contribute to the success or failure of the federal Affordable Care Act in California.

Doctors say giving non-physicians more authority and autonomy could jeopardize patient safety. It could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics, they said.

"Patient safety should always trump access concerns," said Dr. Paul Phinney, president of the California Medical Assn.

Such "scope-of-practice" fights are flaring across the country as states brace for an influx of patients into already strained healthcare systems. About 350 laws altering what health professionals may do have been enacted nationwide in the last two years, according to the National Conference of State Legislatures. Since Jan. 1, more than 50 additional proposals have been launched in 24 states.

As the nation's earliest and most aggressive adopter of the healthcare overhaul, California faces more pressure than many states. Diana Dooley, secretary of the state Health and Human Services Agency, said in an interview that expanding some professionals' roles was among the options policymakers should explore to help meet the expected demand.

At a meeting of healthcare advocates in December, she had offered a more blunt assessment.

"We're going to have to provide care at lower levels," she told the group. "I think a lot of people are trained to do work that our licenses don't allow them to."

Currently, just 16 of California's 58 counties have the federal government's recommended supply of primary care physicians, with the Inland Empire and the San Joaquin Valley facing the worst shortages. In addition, nearly 30% of the state's doctors are nearing retirement age, the highest percentage in the nation, according to the Assn. of American Medical Colleges.

Physician assistants, nurse practitioners, pharmacists and optometrists agree that they have more training than they are allowed to use.

"We don't have enough providers," said Beth Haney, president of the California Assn. for Nurse Practitioners, "...so we should increase access to the ones that we have."

Hernandez, who said he would introduce his legislation and hold a hearing on the issue next month, said his own experience as an optometrist shows the need to empower more practitioners. He said he often sees Medicaid patients who come to his La Puente practice because they have failed their vision test at the DMV. Many complain of constant thirst and frequent urination.

"I know it's diabetes," he said. But he is not allowed to diagnose or treat it and must refer those patients elsewhere. Many of them may face a months-long wait to see a doctor.

The California Medical Assn. says healthcare professionals should not exceed their training. Phinney, a pediatrician, said physician assistants and other mid-level professionals are best deployed in doctor-led teams. They can perform routine exams and prescribe medications in consultation with physicians on the premises or by teleconference.

Allowing certain health workers to set up independent practices would create voids in the clinics, hospitals and offices where they now work, he said. "It's more like moving the deck chairs around rather than solving the problem," Phinney said.

His group proposes a different solution: It wants more funding to expand participation in a loan repayment program for recent medical school graduates. Doctors can now receive up to $105,000 in return for practicing in underserved communities for three years.

Still, it typically takes a decade to train a physician. Health experts say the pool of graduates cannot keep pace.

"We're not going to produce thousands of additional doctors in any kind of short-term time frame," said Assemblyman Roger Dickinson (D-Sacramento). "It makes sense to look at changes that could relieve the pressure that we're going to undoubtedly encounter for access to care."

Administrators of community clinics and public hospitals say nurse practitioners and other non-physician providers already play key roles in caring for patients, a trend they predict will grow as more Californians become insured and enter the healthcare system.

At Kern Medical Center in Kern County, two clinical pharmacists have run the hospital's diabetes clinic, treating about 500 patients a year, since the specialist physician in charge retired. They are licensed to perform physicals, order lab tests, prescribe medicines and counsel patients on lifestyle changes.

"We're going to have to get a whole lot more creative about how care is provided," said Paul Hensler, Kern Medical Center's chief executive.

michael.mishak@latimes.com


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Republicans Ditch Plan To Walk Out On Hagel Vote

Earlier reports that Republicans were planning on walking out on tomorrow’s confirmation vote on Chuck Hagel to become Secretary of Defense have proven to be a bust, according to information relayed to ThinkProgress.

On Sunday, Politico sourced “GOP aides” in reporting that some Republican members of the Senate Armed Services committee were “considering the possibility of walking out” during the procedure, rather than casting a vote. This morning, Sen. Carl Levin (D-MI) set the confirmation vote for Hagel at 2:30 PM Tuesday. Soon thereafter, The Hill reported that neither Ranking Member Sen. James Inhofe (R-OK) nor Sen. John McCain (R-AZ) had plans to join any walk-out.

Further questioning revealed no stomach for the GOP to walk out after all. Staffers reached in the office of Sen. Ted Cruz (R-TX) hadn’t heard of the bid to walkout and were unable to confirm whether the Senator backed the proposal. However, a staffer in the office of Sen. Mike Lee (R-UT) — by no means a supporter of Hagel’s nomination bid — confirmed to ThinkProgress that there are no longer any Republicans who plan on walking out during tomorrow’s meeting.

The swift backtracking by the GOP highlights an unfortunate tendency of the media to eagerly report on whatever shifting reason that Hagel opponents cite as being true. Dave Weigel at Slate on Friday pointed out the widespread use of anonymous GOP staffers as the sourcing for their reports, refusing to even name an office connected with the informant, as a method to promote attacks on Hagel. The result is a sounding board in the media for an ever-widening array of charges against Hagel that Republicans hope to make stick.

The full text of McCain’s statement has been released:

With this in mind, I have examined the information and responses to Members’ questions that Senator Hagel has provided to the Committee, and I believe that he has fulfilled the rigorous requirements that the Committee demands of every Presidential nominee to be Secretary of Defense.


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Colorado Senate Grants Final Passage Of Civil Unions

With a final vote of 21-14, the Colorado Senate has approved its third and final passage of SB 11, the civil unions bill. There was no additional debate before today’s vote. The bill proceeds to the House, where its sponsor, openly gay Rep. Mark Ferrandino (D), is now the chamber’s Speaker.


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U.N. Conspiracy Theorist Ron Paul Turns To U.N. To Solve Website Dispute

Former Congressman Ron Paul (R-TX) is taking a set of entrepreneurs to a body of the United Nations to gain control over the rights to RonPaul.com.

The whole affair stems from the fact that Paul owns neither RonPaul.com nor RonPaul.org, with both instead being owned and maintained by supporters of his. Those same supporters also maintain an e-mail list of over a hundred thousand names, by their count, a valuable asset to any politician or movement leader. When Paul stated on a radio show that he regretted not owning the rights to the domain RonPaul.com, the owners offered what they viewed as a fair price to Paul for ownership of the sites as well as the mailing list.

A quick summary provided by the maintainers of RonPaul.com explains the situation that followed:

The value we put on the deal was $250k; we are getting our mailing list appraised right now but we are confident it is easily worth more than $250k all by itself. Claims that we tried to sell Ron Paul “his name” for $250k or even $800k are completely untrue, and there is little doubt that our mailing list would have enabled Ron Paul to raise several million dollars for the liberty movement this year. It would have been a win/win/win situation for everyone involved.

Instead of responding to our offer, making a counter offer, or even accepting our FREE gift of RonPaul.org, Ron Paul went to the United Nations and is trying to use its legal process related to domain name disputes to actively deport us from our domain names without compensation.

The mention of “the United Nations” refers to the World Intellectual Property Organization (WIPO), one of many international bodies that falls under the U.N. umbrella of organizations. WIPO is empowered by the International Cooperation for Assigned Names and Numbers — the independent group that manages domains and website registries — to provide arbitration on name ownership disputes. Paul has filed a claim under what’s known as the Uniform Domain Name Dispute Resolution Policy (UDRP), which has the authority to turn over the rights of RonPaul.com to Paul — should he prevail in the case.

While Paul may have a case, the irony, however, of the former Republican congressman turning to the United Nations is palpable for several reasons. First, for constantly espousing free trade, that Paul would refuse to negotiate directly over a market value for a piece of property is stunning. What’s more, though, Paul has been a harsh critic of U.S. membership in the United Nations for years. He’s fallen firmly in the camp of those who believe that the United Nations is set to take the freedoms of Americans through such benign measures as Agenda 21. For someone who once said that “the choice is very clear: we either follow the Constitution or submit to U.N. global governance,” the whole supposed “global governance” thing doesn’t seem too bad to Paul once it becomes useful.


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Manchin: 'I do not support an assault weapons ban'

Sen. Joe Manchin (D-W.Va.) said Monday that he opposes an assault weapons ban.

Speaking on MSNBC, Manchin, who has an "A" rating from the National Rifle Association and in December called for federal action to reduce gun violence, said he thinks there's a better way to reduce mass shootings without introducing new restrictions for gun owners.

"I do not support an assault weapon ban because the definition of assault weapon is still hard to come by," Manchin said. "So I am not going to comment on people's legislation. I do not support that approach right now."

Manchin is part of a quartet of legislators working to tighten background checks required to purchase a gun. The other members of the group are Sens. Charles Schumer (D-N.Y.), Mark Kirk (R-Ill.), and Tom Coburn (R-Okla.).

Manchin has been a prominent legislator in the debate on reducing gun violence that arose in the aftermath of the Sandy Hook shootings in December that resulted in 28 dead. Manchin, along with a number of other legislators, have called for action to reduce gun violence. He has previously stressed, however, that his call for action did not necessarily mean a call for banning guns.

"Everything has to be talked about. But you know what?…I'm not supporting a ban on anything. I'm supporting a conversation on everything," Manchin said in December to a local West Virginia radio station.

While both Republicans and Democrats have signaled an openness to new legislation aimed at reducing gun violence, lawmakers seem more divided over an assault weapons ban. President Obama has called for an assault weapons ban while critics say that restriction would go too far. Last month Sen. Dianne Feinstein (D-Calif.) formally introduced legislation reinstating an assault weapons ban. The last ban expired in 2004.

On Sunday Sen. Angus King (I-Maine) said he was "skeptical" of a new assault weapons ban.

"You can take exactly the same mechanics of a gun and change the stock from a wooden stock to a folding stock and put something on the barrel, and suddenly it meets the definition of an assault weapon," King said. "It doesn't shoot faster, further, anything else."

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Statement by President Obama on SBA Administrator Karen Mills’ Departure

Statement by President Obama on SBA Administrator Karen Mills’ Departure | The White House Skip to main content | Skip to footer site map The White House. President Barack Obama The White House Emblem Get Email UpdatesContact Us Go to homepage. The White House Blog Photos & Videos Photo Galleries Video Performances Live Streams Podcasts 2012: A Year in Photos

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Issues Civil Rights It Gets Better Defense End of Iraq War Disabilities Economy Jobs Reform and Fiscal Responsibility Strengthening the Middle Class A Plan for Refinancing Support for Business Education Energy & Environment Ethics Foreign Policy Health Care Homeland Security Immigration Immigration Reform Taxes Tax Receipt The Buffett Rule Rural Urban Policy Veterans Joining Forces Technology Seniors & Social Security Service Snapshots Creating Jobs Health Care Small Business PreK-12 Education Women Violence Prevention Now Is The Time

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Office of the Press Secretary

For Immediate Release February 11, 2013 Statement by President Obama on SBA Administrator Karen Mills’ Departure

I want to thank Administrator Mills for her outstanding work on behalf of America’s small business owners and entrepreneurs.  I asked Karen to lead the Small Business Administration because I knew she had the skills and experience to help America’s small businesses recover from the worst economic crisis in generations – and that’s exactly what she’s done.  Over the last four years, Karen has made it easier for small businesses to interact with the federal government by reducing paperwork and cutting through red tape.  She has played a leading role in my Administration’s efforts to support start-ups and entrepreneurs.  And she was instrumental in the passage of the Small Business Jobs Act.  Because of Karen’s hard work and dedication, our small businesses are better positioned to create jobs and our entire economy is stronger. I want to thank Karen and am grateful for her service.

Extending Middle Class Tax Cuts

Blog posts on this issue February 11, 2013 6:00 AM ESTState of the Union 2013: President Obama's Speech is Just the Beginning

Check out all the ways you can get involved with President Obama's State of the Union Address.

February 10, 2013 1:40 PM ESTSolving the Sequester: The Facts

With less than three weeks before devastating, across the board cuts - the so-called "sequester" - are slated to hit, affecting our national security, job creation and economic growth, we must make sure we are having a debate over how to deal with these looming deadlines that is based on facts- not myths being spread by some Congressional Republicans who would rather see these cuts hit than ask the wealthiest and big corporations to pay a little bit more.

February 09, 2013 5:45 AM ESTWeekly Address: Averting the Sequester and Finding a Balanced Approach to Deficit Reduction

President Obama urges Congress to act to avoid a series of harmful and automatic cuts—called a sequester—from going into effect that would hurt our economy and the middle class and threaten thousands of American jobs.

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Statement by the President on His Holiness Pope Benedict XVI

Statement by the President on His Holiness Pope Benedict XVI | The White House Skip to main content | Skip to footer site map The White House. President Barack Obama The White House Emblem Get Email UpdatesContact Us Go to homepage. The White House Blog Photos & Videos Photo Galleries Video Performances Live Streams Podcasts 2012: A Year in Photos

A unique view of 2012

2012: A Year in Photos

Briefing Room Your Weekly Address Speeches & Remarks Press Briefings Statements & Releases White House Schedule Presidential Actions Executive Orders Presidential Memoranda Proclamations Legislation Pending Legislation Signed Legislation Vetoed Legislation Nominations & Appointments Disclosures Visitor Access Records Financial Disclosures 2012 Annual Report to Congress 2011 Annual Report to Congress 2010 Annual Report to Congress on White House Staff A Commitment to Transparency

Browse White House visitor logs

President Obama greets White House visitors

Issues Civil Rights It Gets Better Defense End of Iraq War Disabilities Economy Jobs Reform and Fiscal Responsibility Strengthening the Middle Class A Plan for Refinancing Support for Business Education Energy & Environment Ethics Foreign Policy Health Care Homeland Security Immigration Immigration Reform Taxes Tax Receipt The Buffett Rule Rural Urban Policy Veterans Joining Forces Technology Seniors & Social Security Service Snapshots Creating Jobs Health Care Small Business PreK-12 Education Women Violence Prevention Now Is The Time

To do something about gun violence

Now Is The Time

7 Things You Need to Know

About the American Taxpayer Relief Act of 2012

Explore the President's Plan

The Administration We the People

Create and Sign Petitions Now

We the People

President Barack Obama Vice President Joe Biden First Lady Michelle Obama Dr. Jill Biden The Cabinet 2010 Video Reports White House Staff Chief of Staff Denis McDonough Deputy Chief of Staff Rob Nabors Deputy Chief of Staff Alyssa Mastromonaco Counselor to the President Peter Rouse Senior Advisor Valerie Jarrett Executive Office of the President Other Advisory Boards About the White House White House On the Go

Download our mobile apps

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2012: A Year in Photos

A unique view of 2012

2012: A Year in Photos

Inside the White House Interactive Tour West Wing Tour Video Series Décor and Art Holidays Presidents First Ladies The Oval Office The Vice President's Residence & Office Eisenhower Executive Office Building Camp David Air Force One White House Fellows President’s Commission About the Fellowship Current Class Staff Bios News and Newsletters White House Internships About Program Presidential Department Descriptions Selection Process Internship Timeline & FAQs Tours & Events 2012 Easter Egg Roll Kitchen Garden Tours Mobile Apps Our Government The Executive Branch The Legislative Branch The Judicial Branch The Constitution Federal Agencies & Commissions Elections & Voting State & Local Government Resources /* Maximize height of menu features. */if(typeof(jQuery)!='undefined')jQuery.each($('#topnav'),function(i,v){var o=$(v),oh=o.height(),sh=o.siblings().height();if(oh HomeBriefing Room • Statements & Releases   The White House

Office of the Press Secretary

For Immediate Release February 11, 2013 Statement by the President on His Holiness Pope Benedict XVI

On behalf of Americans everywhere, Michelle and I wish to extend our appreciation and prayers to His Holiness Pope Benedict XVI. Michelle and I warmly remember our meeting with the Holy Father in 2009, and I have appreciated our work together over these last four years.   The Church plays a critical role in the United States and the world, and I wish the best to those who will soon gather to choose His Holiness Pope Benedict XVI’s successor.

Extending Middle Class Tax Cuts

Blog posts on this issue February 11, 2013 6:00 AM ESTState of the Union 2013: President Obama's Speech is Just the Beginning

Check out all the ways you can get involved with President Obama's State of the Union Address.

February 10, 2013 1:40 PM ESTSolving the Sequester: The Facts

With less than three weeks before devastating, across the board cuts - the so-called "sequester" - are slated to hit, affecting our national security, job creation and economic growth, we must make sure we are having a debate over how to deal with these looming deadlines that is based on facts- not myths being spread by some Congressional Republicans who would rather see these cuts hit than ask the wealthiest and big corporations to pay a little bit more.

February 09, 2013 5:45 AM ESTWeekly Address: Averting the Sequester and Finding a Balanced Approach to Deficit Reduction

President Obama urges Congress to act to avoid a series of harmful and automatic cuts—called a sequester—from going into effect that would hurt our economy and the middle class and threaten thousands of American jobs.

view all related blog posts ul.related-content li.views-row img {float: left; padding: 5px 10px 0 0;}ul.related-content li.view-all {padding-bottom: 3em;} Stay ConnectedFacebookTwitterFlickrGoogle+YouTubeVimeoiTunesLinkedIn   Home The White House Blog Photos & Videos Photo Galleries Video Performances Live Streams Podcasts Briefing Room Your Weekly Address Speeches & Remarks Press Briefings Statements & Releases White House Schedule Presidential Actions Legislation Nominations & Appointments Disclosures Issues Civil Rights Defense Disabilities Economy Education Energy & Environment Ethics Foreign Policy Health Care Homeland Security Immigration Taxes Rural Urban Policy Veterans Technology Seniors & Social Security Service Snapshots Women Violence Prevention The Administration President Barack Obama Vice President Joe Biden First Lady Michelle Obama Dr. Jill Biden The Cabinet White House Staff Executive Office of the President Other Advisory Boards About the White House Inside the White House Presidents First Ladies The Oval Office The Vice President's Residence & Office Eisenhower Executive Office Building Camp David Air Force One White House Fellows White House Internships Tours & Events Mobile Apps Our Government The Executive Branch The Legislative Branch The Judicial Branch The Constitution Federal Agencies & Commissions Elections & Voting State & Local Government Resources The White House Emblem En español Accessibility Copyright Information Privacy Policy Contact USA.gov Developers Apply for a Job

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Defense Department Offers Limited Benefits To Military Same-Sex Partners

It took 17 months, but the Defense Department has finally issued guidance about benefits that can be extended to the same-sex partners of military servicemembers now that “Don’t Ask, Don’t Tell” no longer requires that they hide their identities. The list does not address some serious issues of concern, including health care, housing, and survivor benefits because of the Defense of Marriage Act, but does allow servicemembers to designate specific protections to their partners, including some through the recognition of a domestic partnership. Here are a few of the new benefits:

Service Members Group Life Insurance BeneficiaryVeterans’ Group Life Insurance BeneficiarySurvivor Benefit Plan Beneficiary for RetireesCasualty NotificationDesignation of Persons Having Interest in Status of a Missing MemberHospital Visitation PrivilegesDesignation of Persons Authorized to Direct Disposition of Remains of Members of the Armed ForcePresentation of the Flag of the United StatesDependent ID cardsCommissary PrivilegesExchange PrivilegesMorale, Welfare, and Recreation programsEmergency LeaveYouth ProgramsFamily Center ProgramsChild CareLegal AssistanceJoint Duty Assignments

The memo announcing the benefits notes that should the Defense of Marriage Act no longer apply to the department, policy will be to “construe the words ‘spouse’ and ‘marriage’ without regard to sexual orientation, and married couples, irrespective of sexual orientation, and their dependents, will be granted full military benefits.” It also contains a new process for same-sex couples to declare to the military that they are, in fact, domestic partners, which presumably even couples that are already married would have to fulfill to receive the benefits.

OutServe-SLDN praised outgoing Defense Secretary Leon Panetta for “getting us a few steps closer to full equality.”


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Maryland Lawmakers Propose Mandatory Paid Sick Leave For Workers

American workers rarely receive paid sick leave, but cities and states across the country are taking up proposals to mandate that employers pay employees who have to miss work because they are sick. A group of Democratic lawmakers has added Maryland to that list with a proposal that would mandate up to seven earned sick days.

Under the proposal, the leave would be accrued based on hours worked, the SoMdNews.com reports:

The proposal, led in the House by Del. John A. Olszewski Jr. (D-Baltimore), allows all full-time employees to earn an hour of sick time for every 30 hours worked, or up to seven sick days per year. Part-time workers would earn fewer days, depending on how often they work.

Nearly 40 percent of America’s private sector workers do not receive paid sick leave, and the number swells to 80 percent for both low-income workers and food workers, 60 percent of whom said they have reported to work even while sick. A 2011 study found that 40 percent of Maryland’s private sector workers don’t receive paid sick leave.

The lack of such leave jeopardizes the health and safety of other workers — in 2009, it led to an addition 5 million cases of the H1N1 flu virus, according to estimates.

Business groups have targeted paid sick day legislation with faulty studies, but in other areas where paid sick leave is being considered, studies have shown the legislation would have little effect on labor costs. The Main Street Alliance of Oregon, a supporter of Portland’s paid sick leave proposal, estimates it would add no more than 1.9 percent to labor expenses for the city’s businesses.


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