States given more time to work on health exchanges

WASHINGTON (Reuters) – The Obama administration gave states extra time to work toward setting up new health insurance exchanges on Friday, days after President Barack Obama‘s re-election ensured the survival of his healthcare reform law.

The move is seen as a concession to dozens of states that delayed compliance with the Patient Protection and Affordable Care Act until after the November 6 election. Opponents of the plan had hoped a victory for Republican Mitt Romney would ultimately result in the law’s repeal.

But with Obama now heading into a second term, and a November 16 federal deadline to declare their plans looming, many states needed more time to prepare for exchanges, complex marketplaces meant to offer working families private insurance at federally subsidized rates beginning in 2014.

Since Tuesday’s election, seven states including Texas, Kansas, Virginia and Florida have said they will not pursue state-operated exchanges and conservative political donors are mounting a publicity campaign to encourage more defections.

But there are also signs that opposition could be waning in some states.

In cases where states decide not to participate, the federal government says it will go in and build an exchange on its own.

“The administration would like to do whatever it can to bring states in,” said Larry Levitt, a healthcare policy expert with the nonpartisan Kaiser Family Foundation, which tracks health issues.

“It’s always been expected that if the president got reelected, a lot of states sitting on the sidelines would realize they don’t want the federal government building a state health insurance system. That’s what we’re seeing happening.”

U.S. Health and Human Services Secretary Kathleen Sebelius said in a November 9 letter to governors that the administration still expects states to declare whether they intend to operate their own exchanges by next Friday.

But they now have until December 14 to file blueprints showing how they would operate the marketplaces. So far, about 13 states are well on their way to setting up their own exchanges.

States can also choose to develop their exchange in partnership with the federal government. As many as 30 could go that route.

Sebelius said states that prefer a partnership now have until February 15, 2013, to declare their intentions and prepare the appropriate paperwork. She said states can still apply to run exchanges in subsequent years but emphasized that the start date for coverage has not changed.

“Consumers in all 50 states and the District of Columbia will have access to insurance through these new marketplaces on January 1, 2014, as scheduled, with no delays,” she said in the letter, which described the deadline extension as a response to state requests for more time.

Analysts characterized the extension as a substantial offer from the federal government.

“It’s about as far as they reasonably could extend, knowing that the systems have to be ready by Oct 1, 2013,” said Patrick Howard, who advises states on healthcare issues for Deloitte.

The Affordable Care Act, the most sweeping health legislation since the 1960s, would extend health coverage to more than 30 million uninsured Americans. About half would receive coverage through a planned expansion of the Medicaid program for the poor, and the other half through the exchanges.

The list of states that say they will not participate in the healthcare exchanges grew this week when Virginia and Kansas added their names.

Texas, South Dakota, South Carolina, Alaska and Florida confirmed to Reuters on Friday that they will not participate in exchanges. Louisiana had also opposed the plan before the election, but officials there did not respond to inquiries about their plans under Obama’s second term.

But Maine, which advised the administration last April that it did not intend to pursue a state-based exchange, said on Friday that further guidance from Sebelius’ department could make a difference.

“It’s too soon to tell,” said Adrienne Bennett, spokeswoman for Republican Governor Paul LePage.

“We’re willing to look at the information and move forward. But we can’t move forward if we don’t have information from the Obama administration. So we’re in a holding pattern,” she said.

Several Republican advocacy groups are expected to push against the implementation of Obama’s healthcare law. Americans for Prosperity, a conservative non-profit in part funded by billionaire Koch brothers, on Friday urged U.S. governors to reject the state-based exchange options, calling them “flawed” and “bloated bureaucracies” that put states’ budgets at risk.

(Writing by David Morgan; Editing by Michele Gershberg, Eric Walsh, Claudia Parsons and David Gregorio)

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How 'poor judgment' felled military star Petraeus

WASHINGTON (Reuters) - David Petraeus was a star on the battlefield, commanding the Iraq and Afghanistan wars, but was undone by "poor judgment" in engaging in an extramarital affair that led to his downfall as CIA director.

Just two days after his 60th birthday, Petraeus stepped down from the spy agency where he had held the top office since September 6, 2011.

"After being married for over 37 years, I showed extremely poor judgment by engaging in an extramarital affair. Such behavior is unacceptable, both as a husband and as the leader of an organization such as ours. This afternoon, the President graciously accepted my resignation," Petraeus told the shadow warriors he commanded at CIA.

It was a stunning downfall for a revered military man who was seen as one of the top American leaders of his generation and was once considered a potential contender for the White House.

Petraeus was credited with pulling Iraq from the brink of all-out civil war and for battlefield successes in Afghanistan after overseeing a surge of 30,000 troops ordered by President Barack Obama in late 2009. He became known for counter-insurgency strategies that were seen as gaining ground against the Taliban in Afghanistan.

"I don't think he was professionally overrated. His were genuine accomplishments," said James Carafano, a war historian with the conservative Heritage Foundation think tank.

At the time of his nomination to the CIA post, some Washington insiders had said the White House wanted to find a prominent position for Petraeus to ensure he would not be recruited by Republicans as a challenger to the 2012 Obama-Biden ticket.

When he was nominated to lead the CIA there were some concerns in intelligence circles that the high-profile four-star Army general might not be able to lead from the shadows as appropriate for a spy chief.

But once he took over the head office at the U.S. spy agency, Petraeus kept a decidedly low public profile.

Senate Intelligence Committee Chairman Dianne Feinstein, a Democrat, expressed regret about the resignation of "one of America's best and brightest" and said it was an "enormous loss" for the country.

"At CIA, Director Petraeus gave the agency leadership, stature, prestige and credibility both at home and abroad. On a personal level, I found his command of intelligence issues second to none," she said.

RESIGNATION ACCEPTED

After accepting his resignation about a year-and-a-half after nominating Petraeus to the CIA post, Obama said: "By any measure, he was one of the outstanding General officers of his generation, helping our military adapt to new challenges, and leading our men and women in uniform through a remarkable period of service in Iraq and Afghanistan, where he helped our nation put those wars on a path to a responsible end."

Earlier this week, in a Newsweek article entitled "General David Petraeus's Rules for Living," he listed 12 lessons for leadership. Number 5 was: "We all will make mistakes. The key is to recognize them and admit them, to learn from them, and to take off the rear­ view mirrors - drive on and avoid making them again."

In 2010 Petraeus stepped into the breach as the new commander of U.S. forces in Afghanistan to replace General Stanley McChrystal who was fired by Obama in a scandal over an article in which McChrystal and his aides made mocking comments about the president and some of his top advisers.

In 2009 Petraeus was diagnosed with early-stage prostate cancer and underwent radiation treatment. The media-friendly general joked at that time at a Washington event that reporters were only gathered "to see if the guy is still alive."

Petraeus, born in Cornwall, New York, lives in Virginia with his wife Holly. They have two grown children, a son who was an Army Ranger who served in Afghanistan, and a daughter.

Petraeus's wife, Holly, is an activist and volunteer who champions military families, and she continued that work after her husband retired from the military and moved to the CIA.

She currently is assistant director of the office of servicemember affairs at the Consumer Financial Protection Bureau, where she tries to keep unscrupulous lenders from taking advantage of military personnel. The bureau was championed by Harvard law professor Elizabeth Warren, who was elected to the Senate from Massachusetts this week.

Holly Petraeus is the daughter of four-star General William Knowlton, who was superintendent of the U.S. Military Academy at West Point when Petraeus was a cadet.

She briefed the press at the Pentagon on her efforts recently and was introduced by Defense Secretary Leon Panetta, who called her "a true friend of the Department of Defense and a dedicated member of our military family."

Petraeus has four Defense Distinguished Service Medal awards, three Distinguished Service Medal awards, the Bronze Star Medal for valor, and the State Department Distinguished Service Award.

He has a doctorate in international relations from Princeton University.

(Additional reporting by David Alexander, Matt Spetalnick and Diane Bartz; Editing by Warren Strobel and Jackie Frank)

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Assad says will live and die in Syria

DOHA (Reuters) – President Bashar al-Assad said he would “live and die” in Syria and warned that any Western invasion to topple him would have catastrophic consequences for the Middle East and beyond.

Assad’s defiant remarks coincided with a landmark meeting in Qatar on Thursday of Syria’s fractious opposition to hammer out an agreement on a new umbrella body uniting rebel groups inside and outside Syria, amid growing international pressure to put their house in order and prepare for a post-Assad transition.

The Syrian leader, battling a 19-month old uprising against his rule, appeared to reject an idea floated by British Prime Minister David Cameron on Tuesday that a safe exit and foreign exile for the London-educated Assad could end the civil war.

“I am not a puppet. I was not made by the West to go to the West or to any other country,” he told Russia Today television in an interview to be broadcast on Friday. “I am Syrian; I was made in Syria. I have to live in Syria and die in Syria.”

Russia Today’s web site, which published a transcript of the interview conducted in English, showed footage of Assad speaking to journalists and walking down stairs outside a white villa. It was not clear when he had made his comments.

The United States and its allies want the Syrian leader out, but have held back from arming his opponents or enforcing a no-fly zone, let alone invading. Russia has stood by Assad.

The president said he doubted the West would risk the global cost of intervening in Syria, whose conflict has already added to instability in the Middle East and killed some 38,000 people.

“I think that the price of this invasion, if it happened, is going to be bigger than the whole world can afford … It will have a domino effect that will affect the world from the Atlantic to the Pacific,” the 47-year-old president said.

“I do not think the West is going in this direction, but if they do so, nobody can tell what is next.”

QATAR, TURKEY CHIDE OPPOSITION

Backed by Washington, the Doha talks underline Qatar’s central role in the effort to end Assad‘s rule as the Gulf state, which funded the Libyan revolt to oust Muammar Gaddafi, tries to position itself as a player in a post-Assad Syria.

Qatari Prime Minister Hamad bin Jassim Al Thani urged the Syrian opposition to set its personal disputes aside and unite, according to a source inside the closed-door session.

“Come on, get a move on in order to win recognition from the international community,” the source quoted him as saying.

Turkish Foreign Minister Ahmed Davutoglu delivered a similar message, saying, according to the source: “We want one spokesman not many. We need efficient counterparts, it is time to unite.”

An official text of a speech by Qatari Foreign Minister Khalid Mohamed al-Attiyah showed he told the gathering: “The Syrian people awaits unity from you, not divisions … Your agreement today will prove to the international community that there is a unity … and this will reflect positively in the international community’s stance towards your fair cause.”

Across Syria, more than 90 people were killed in fighting on Thursday, the Syrian Observatory for Human Rights said.

In Turkey’s Hatay border province, two civilians, a woman and a young man, were wounded by stray bullets fired from Syria, according to a Turkish official. Turkish forces increased their presence along the frontier, where officials have said they might seek NATO deployment of ground to air missiles.

Syria poses one of the toughest foreign policy challenges for U.S. President Barack Obama as he starts his second term.

International rivalries have complicated mediation efforts. Russia and China have vetoed three Western-backed U.N. Security Council resolutions that would have put Assad under pressure.

Syria’s conflict, pitting mostly Sunni Muslim rebels against forces dominated by Assad’s Alawite minority, whose origins lie in Shi’ite Islam, has fuelled sectarian tensions across the Middle East. Sunni Arab countries and Turkey favor the rebels, while Shi’ite Iran backs Assad, its main Arab ally.

“VICIOUS CIRCLE”

The main opposition body, the Syrian National Council (SNC), has been heavily criticized by Western and Arab backers of the revolt as ineffective, run by exiles out of touch with events in Syria, and under the sway of the Islamist Muslim Brotherhood.

British Foreign Minister William Hague said London would now talk to rebel groups inside Syria, after U.S. Secretary of State Hillary Clinton last week criticized the SNC and called for a new opposition body to include those “fighting and dying”.

But the plan for a body that could eventually be considered a government-in-waiting capable of winning foreign recognition and therefore more military backing ran into trouble almost as soon as it was proposed by SNC member Riyad Seif.

The meeting has so far been bogged down by arguments over the SNC representation and the number of seats the rival groups – which include Islamists, leftists and secularists – will have in a proposed assembly. Seif said he hoped for agreement on that on Thursday night, although the talks may continue into Friday.

Senior SNC member Burhan Ghalioun said the participants were moving towards consensus: “The atmosphere was positive. We all agree that we don’t want to walk away from this meeting in failure,” he told reporters.

Seif’s proposal is the first concerted attempt to merge opposition forces to help end the devastating conflict.

The initiative would also create a Supreme Military Council, a Judicial Committee and a transitional government-in-waiting of technocrats – along the lines of Libya’s Transitional National Council, which managed to galvanize international support for its successful battle to topple Gaddafi.

Michael Doran of the Brookings Institute in Washington told a forum in Doha it would not work for Syria. “It’s not a ridiculous idea, but it’s not going to succeed,” he said.

A diplomat on the sidelines of the talks said international divisions in the U.N. Security council did not help.

“It’s a vicious circle. They are asking the opposition to unite when they admit they are not themselves united,” he said.

(Writing by Tom Perry and Samia Nakhoul; Editing by Alistair Lyon, Alastair Macdonald and Philippa Fletcher)

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Call me JackSUN, says singer Jermaine

LOS ANGELES (Reuters) – Jackson 5 singer Jermaine Jackson has petitioned to change his name, according to court documents filed earlier this week in Los Angeles.

The older brother of pop stars Michael and Janet Jackson, Jermaine wants to change his famous last name to Jacksun for “artistic reasons.”

Asked why Jermaine wanted to change his name, his attorney Bret D. Lewis, who filed the petition on Jackson’s behalf, told Reuters “If Prince and P Diddy can do it, why can’t and shouldn’t Jermaine?”

If all goes to plan, Jackson’s name will officially change following a court hearing set for February 22.

Jermaine, 57, and brothers Jackie, Marlon and Tito are currently in Europe on a Unity Tour, under the name The Jacksons, performing hits made famous by the Jackson 5 along with a tribute to their late sibling Michael.

Jermaine Jackson unofficially adopted the name Mohammad Abdul Aziz after converting to Islam in 1989.

(Reporting By Eric Kelsey, editing by Jill Serjeant and Bernard Orr)

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11,000 fled Syria in past 24 hours, total now 408,000: UNHCR

GENEVA (Reuters) – About 11,000 Syrian refugees have fled to three neighboring countries in the past 24 hours, the largest exodus in “quite some time”, the United Nations refugee agency said on Friday.

The latest exodus into Turkey (9,000), Lebanon (1,000) and Jordan (1,000) brings to 408,000 the total number of Syrian refugees registered or being assisted in the region, Panos Moumtzis of the U.N. High Commissioner for Refugees said.

“It just indicates a significant crisis, the continuation of the conflict,” Moumtzis told a news briefing in Geneva after aid agencies held a Syria Humanitarian Forum. “In Turkey, we know from most refugees that they come from Aleppo or Idlib or northern areas. That has been the trend so far.”

(Reporting by Stephanie Nebehay; Editing by Andrew Heavens)

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11,000 flee Syria in huge one day exodus

DEAR ABBY: My brother lost his wife, the love of his life, three years ago. He has three children. His oldest, a 25-year-old daughter, "Jenny," told him that "when you marry, it is for life." She has threatened that if he dates someone or sees anyone, she will be out of his life and he won't be able to see his future grandchildren. (Jenny is getting married next summer.)My brother is very upset. He wants to settle this argument before she is married. He hasn't dated anyone, but feels she shouldn't be trying to control his life. Please help, Abby. ...

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Ghana building collapse traps dozens, kills 1

ACCRA, Ghana (AP) — A five-story shopping center built earlier this year in a bustling suburb of Ghana‘s capital collapsed Wednesday, killing at least one person and leaving several dozen people trapped in the rubble, authorities and eyewitnesses said.

Rescue crews used cranes to try and remove debris from the top of the building amid fears that machinery sifting through the wreckage could injure trapped survivors. Crowds of bystanders gathered as rescuers sifted through cement and glass.

The fatality at the Melcom Shopping Center at Achimota, a suburb of Accra, was confirmed by Public Affairs Officer of the Ghana Fire Service Billy Anaglate. “We are still working to find out the fate of others who may be trapped under,” he said.

Other officials told The Associated Press that the death toll was likely to rise.

An AP reporter at the scene saw at least one man pulled from the debris, covered in dust and who was then whisked into an ambulance.

A Greater Accra Regional Public Affairs officer, deputy superintendent Freeman Tettey, confirmed that one person died and told the AP that 51 have been rescued and sent to hospitals around the capital.

“I was on my way to the shop when l saw it crumpling down,” Kojo Boadi, an eyewitness, said.

President John Mahama declared the scene a disaster zone and cut short his election campaign in the north of the country to be able to visit the site. The presidential election is scheduled for December.

The five-story store opened in February is part of the Melcom chain owned by Indian immigrant magnate, Bhagwan Khubchandani. His late father arrived in Ghana in 1929 as a 14-year-old to work as a store boy in the-then Gold Coast.

The store sells a variety of cheap, imported household goods and appliances that are popular with working-class Ghanaians.

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Ex-oil man to be next Anglican leader: UK media

LONDON (Reuters) – A former oil executive who went to the same exclusive school as Prime Minister David Cameron will shortly be named Archbishop of Canterbury, spiritual leader of the world’s 80 million Anglicans, British newspapers said on Thursday.

Justin Welby, 56, the Bishop of Durham, who has had a meteoric rise up the Church of England hierarchy since quitting the world of commerce in 1992, will be announced as the next archbishop as early as Friday, the reports said.

The nomination follows weeks of speculation that the Church body assigned to elect the future archbishop was split over choosing a reformer or a safe pair of hands to maintain the status quo.

Cameron’s spokesman said an announcement would come “soon”.

Welby, who went to the same exclusive school, Eton College, as Cameron, London mayor Boris Johnson and Princes William and Harry, has already accepted the position, according to the Daily Telegraph.

Bookmaker William Hill stopped taking bets on the future archbishop after a run of bets on Welby on Tuesday.

“In the space of less than an hour we had to cut the odds three times, so took the decision to close the book as we know a decision is already overdue and it seems word may have leaked out,” the bookmaker said in a statement

Welby will replace left-leaning incumbent Rowan Williams, who has said his successor as head of the global Anglican Communion will need “the constitution of an ox and the skin of a rhinoceros”.

Welby is widely reported to be against gay marriage but broadly in favor of the ordination of women bishops, two of the most divisive issues in the communion.

The new archbishop will earn about 74,000 pounds ($ 120,000) a year. He will have lodgings in the Old Palace in Canterbury, southeast England, and the historic riverside Lambeth Palace in London. His tenure will last until retirement at 70 or until he decides to move on.

(Reporting By Alessandra Prentice; editing by Steve Addison/Maria Golovnina)

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UK police open inquiry into breast cancer surgeon

LONDON (AP) — British police say a surgeon is being investigated by both detectives and the country’s General Medical Council over allegations about his treatment of more than 1,000 breast cancer patients.

Ian Paterson is alleged in negligence suits filed by former patients to have performed up to 1,150 “unnecessary, inappropriate or unregulated” operations.

The General Medical Council, which licenses doctors, suspended Paterson’s registration in October pending its inquiry.

West Midlands Police, in central England, said Thursday it was opening a criminal inquiry.

Lawyers allege 700 cases involve procedures in which some breast tissue was left behind after a mastectomy. Other patients allege they received invasive breast surgery when a biopsy may have been sufficient.

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Obama, GOP leaders lay down markers on budget deal

WASHINGTON (AP) — Taking little time to celebrate, President Barack Obama is setting out to leverage his re-election into legislative success in an upcoming showdown with congressional Republicans over taxes, deficits and the impending "fiscal cliff." House Speaker John Boehner says Republicans are willing to consider some form of higher tax revenue as part of the solution — but only "under the right conditions."

All sides are setting out opening arguments for the negotiations to come.

Even before returning to Washington from his hometown of Chicago, Obama was on the phone Wednesday with the four top leaders of the House and Senate — Boehner included — to talk about the lame-duck Congress that convenes just one week after Election Day.

Without a budget deal to head off the fiscal showdown, the nation faces a combination of expiring Bush-era tax cuts and steep across-the-board spending cuts that could total $800 billion next year. Economists have warned that could tip the nation back into recession.

Vice President Joe Biden, flying to his home in Delaware from Chicago, told reporters aboard Air Force Two that the White House was "really anxious" to get moving on the problem. He said he'd been making a lot of calls and "people know we've got to get down to work and I think they're ready to move." He didn't identify whom he'd been speaking with but predicted the "fever will break" on past legislative gridlock after some soul-searching by Republicans.

The White House held out this week's election results as a mandate from voters for greater cooperation between the White House and Congress. At the same time, it reiterated Obama's top priorities: cutting taxes for middle-class families and small businesses, creating jobs and cutting the deficit "in a balanced way" — through a combination of tax increases on wealthier Americans and spending cuts.

Obama told the congressional leaders he believed "the American people sent a message in yesterday's election that leaders in both parties need to put aside their partisan interests and work with common purpose to put the interests of the American people and the American economy first," the White House said in a statement.

Senate Majority Leader Harry Reid, D-Nev., channeled Obama in calling for a quick solution to the fiscal showdown and saying that asking "the richest of the rich" to pay more should be part of the equation. He added that he'd "do everything within my power to be as conciliatory as possible" but added, "I want everyone to also understand you can't push us around."

"Waiting for a month, six weeks, six months, that's not going to solve the problem," Reid said on Capitol Hill. "We know what needs to be done. And so I think that we should just roll up our sleeves and get it done."

Former Senate Democratic leader Tom Daschle said the postelection congressional session offers a good chance to reset the dynamics between the White House and congressional Republicans in search of compromise.

"I think there's the urgency of the matter that probably goes beyond anything we've seen to date," he said. "The urgency of the repercussions of driving off the cliff are so grave that I can't imagine that failure is an option."

Both Biden and Reid pointed to election exit poll results showing that most Americans support higher taxes on the wealthy.

Biden said there was "a clear sort of mandate about people coming much closer to our view about how to deal with tax policy," adding that "there's all kinds of potential to be able to reach a rational, principled compromise."

Boehner, for his part, said that for Obama to get support for new revenues, "the president must be willing to reduce spending and shore up the entitlement programs that are the primary drivers of our debt."

"We aren't seeking to impose our will on the president; we're asking him to make good on his 'balanced' approach," the Ohio Republican said on Capitol Hill.

The reference to a balanced approach to deficit reduction reflected Obama's campaign-long call for higher taxes on incomes above $200,000 for individuals and $250,000 for couples. That was something Boehner made plain he opposes.

The House speaker said conditions on higher taxes would include a revamped tax code to make it cleaner and fairer, fewer loopholes and lower rates for all, adding that "we're closer than we think to the critical mass needed legislatively to get tax reform done."

Boehner did not specify what loopholes House Republicans might consider trimming.

Obama spent a rare morning off Wednesday at his home on Chicago's South Side, then stopped off at campaign headquarters to meet privately with staff and thank them for their work in the long, grueling campaign. Workers climbed on top of desks to get a good look at the president.

Then Obama and his family flew back to Washington together on Air Force One. The president appeared to be in a good mood, racing younger daughter Sasha up the steps, then calling out "Come on slowpokes" to wife Michelle and older daughter Malia.

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Associated Press writers Julie Pace, Ken Thomas and Andrew Taylor contributed to this report.

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