As the House Ways and Means Committee conducted a hearing Friday on targeted scrutiny of conservative advocacy groups by the Internal Revenue Service, Republicans reacted with dismay to news that the IRS official in charge of the conservative targeting is now leading the IRS office responsible for administering the tax provisions in the Affordable Care Act.

“Absolutely outrageous,” said Sen. Roy Blunt, R- Mo. in his Twitter account.

The IRS official, Sarah Hall Ingram, served as head of the office that determined whether certain groups would be eligible for tax-exempt status between 2009 and 2012 and is now director of the IRS Affordable Care Act office.

According to an estimate last year from the Government Accountability Office, total IRS implementation costs for the health care law would reach $881 million through September of this year, with most of that money coming from a fund in the Department of Health and Human Services.

In his budget proposal for the new fiscal year, President Barack Obama requested $44 million in new funding for the IRS to implement the health care law.

While the Department of Health and Human Services is the lead agency for issuing regulations under the new law, the IRS and the Department of Labor have key roles in carrying the law.

Obama’s budget proposal said, “Tax provisions play an important role in the health care law’s implementation, and many of its provisions are scheduled to take effect in 2014. The Budget provides funding for the IRS to implement these tax provisions and to respond effectively to public inquiries about the Affordable Care Act’s new benefits and standards.”

Starting next year, the Affordable Care Act will impose penalties for noncompliance on those uninsured people who do not purchase health insurance. It will be the job to of the IRS to determine and collect those penalties.

Also certain individuals, who purchase coverage through the new insurance marketplaces, or exchanges, will be eligible for subsidies or premium assistance in the form of federal tax credits. According to the Congressional Budget Office (CBO), 19 million people will receive premium tax credits.

This story was originally published on Fri May 17, 2013 10:31 AM EDT

The House voted Thursday to repeal the Affordable Care Act, with Republicans using this week’s furor over the Internal Revenue Service targeting conservative advocacy groups to warn against the power the IRS will have to help administer the health care law’s new insurance coverage requirements.

The vote was 229 to 195, with two Democrats crossing party lines to vote with Republicans for the repeal effort.

The two Democrats who voted to repeal the law were Rep. Jim Matheson of Utah and Rep. Mike McIntyre of North Carolina, both of whom represent very Republican-leaning districts.

It marked the 37th time the House has voted to repeal all or part of the law, but the vote allowed new members elected last November to take a symbolic stand on the law. The bill stands no chance of passage in the Democratic-controlled Senate.

The Congressional Budget Office has estimated that repeal of the law would cause an increase in budget deficits of $109 billion over the next ten years.  If the law were rescinded, spending would be cut by $890 billion and revenues by $1 trillion over the ten-year period.

Much of the debate Thursday revisited polemical points both sides have made since the law was first debated in 2009 and 2010.

House Ways and Means Committee chairman Rep. Dave Camp, R- Mich., said the law “puts the federal government precisely where it doesn’t belong: between Americans and their doctors. Instead of families deciding what coverage is best for them, or families and employers deciding how much they can afford, this law has the secretary of health and human services and the IRS making those decisions.” 

But Rep. Sander Levin, D-Mich., the senior Democrat on the House Ways and Means Committee, called Thursday’s vote “a Republican obsession” and “an embarrassing spectacle that has consumed House Republicans for more than two years, to the detriment of our economy and millions of Americans looking for work.”

Other Democrats such as Senate Finance Committee chairman Sen. Max Baucus, D- Mont., an architect of the law, have in recent weeks fretted about the way in which the Obama administration is moving to implement the law, inform the public, and sign up uninsured people.

Baucus told Secretary of Health and Human Services Kathleen Sebelius at a hearing of his committee last month, “Small businesses have no idea what to expect ... . I just see a huge train wreck coming ... .” 

Sebelius herself has become a Republican target in recent days after the Washington Post reported that she has made phone calls to health industry executives and others urging them to contribute money to nonprofit groups such as Enroll America, which is headed by a former Obama administration official, which are working to inform the uninsured about how to sign up for coverage.

Sen. Lamar Alexander, R-Tenn., said “Secretary Sebelius’s fundraising for and coordinating with private entities helping to implement the new health care law may be illegal, should cease immediately and should be fully investigated by Congress.”

He charged that her fundraising circumvents the requirement that only Congress may spend money to implement a law or run a federal program.

As procrastinating Americans raced to confirm brunch plans and flower deliveries for Mother’s Day, the president of the United States took a policy-oriented approach to the holiday, pitching the benefits of his health care reforms to moms nationwide.

Mandel Ngan / AFP - Getty Images

President Barack Obama speaks on the Affordable Care Act on May 10, 2013 in the East Room of the White House.

During an event at the White House, President Barack Obama decried “misinformation” about the law and urged parents not to be “bamboozled” by those critical of the law’s lingering criticisms about the 2009 legislation. 

Flanked by female supporters, the president praised the legislation’s provisions, including new rules that eliminate price hikes relating to women’s health and allow young people to stay on their parents’ insurance plans for longer.

“This is too important for political games,” he added. “Most moms and dads don’t think about politics when their kid gets sick.” 

The Affordable Care Act was passed in 2009 over the vigorous objections of Republicans, but most of its sweeping provisions are only beginning to be implemented now. The process of enacting the reforms has had a rocky start; bill drafter and Senate Finance Committee Chairman Max Baucus, a Democrat, warned that businesses confused about the law could face a “train wreck.” 

Obama conceded that “undoubtedly there will be some mistakes and hiccups as this thing gets started up” but that the program’s implementers are quickly responding to problems.

Touting the legislation’s specific benefits to women, Obama reminded foes that the 2012 election results mean the “law is here to stay.” 

“The same folks who fought tooth and nail a couple years ago and tried to make political hay out of ‘Obamacare’ are still telling tall tales about its impact,” he said. 

At the outset of his remarks, the president offered a tongue-in-cheek reminder to those who may have forgotten the upcoming Mother’s Day holiday.

He joked that, early in his marriage to wife Michelle, he wondered aloud why such a fuss is made over moms for one day in May. 

“Because every other day is Dad’s day,” she responded. 

This story was originally published on Fri May 10, 2013 3:47 PM EDT

The battle to define health-care’s implementation… Obama holds implementation event at 2:40 pm ET, while House Republicans hold another vote next week to repeal the law… When a talking point isn’t a talking point… The Gang of Eight sticks together during first day marking up the immigration legislation… Rand Paul speaks in Iowa tonight, and he represents the anti-“compassionate conservative” crowd… Bosom Buddies: Biden talks up his relationship with Obama… First Read’s weekly 2016 round-up… And grinding things to a halt.

Deborah Cannon / AP

President Barack Obama speaks during a visit to the Applied Materials facilities in Austin, Texas, Thursday, May 9, 2013.

*** The battle to define health care’s implementation: In recent weeks, President Obama has stressed the importance of the health-care law’s implementation at a Planned Parenthood conference, and he also argued at a White House news conference that implementation affects just a fraction of Americans (mostly the uninsured). Today, he returns to the topic when he holds a 2:40 pm ET event -- with women and families, just before Mother’s Day -- on the health-care law that’s fully up and running by next year. Per the White House, the audience for this event will consist of representatives from women’s organizations who “will help amplify the benefits of the Affordable Care Act for women and help us communicate … the benefits that are now available to them and their families.” This comes, of course, as Republicans are doing the opposite: emphasizing how chaotic the implementation will be. As Senate Minority Leader Mitch McConnell said yesterday, “The president should rethink the purpose of this event. I hope he will use it instead as a platform to prepare women for the actual consequences many of them will soon face under Obamacare.” This also comes as House Republicans will vote next week to repeal the health-care. GOP leaders say this will be the 38th vote to repeal or replace parts of the health-care law (four of which were changes that the president signed into law), according to NBC’s Frank Thorp.

*** The name of the game: getting Americans to enroll: As we’ve indicated before, this is a different type of campaign and policy fight. White House will be doing events like today a lot more between now and April 2014 (the end of the enrollment period). The name of the game for them is convincing younger HEALTHIER uninsured Americans to enroll. Why? Because without younger healthier Americans, the numbers don’t work. As for the GOP, this is their last shot at stopping this law, and they know it. Once it’s in place and Americans are enrolled, they’ll have a harder and harder time trying to unwind it. Time is not on their side.

*** When a talking point isn’t a talking point: The news today on the Benghazi front once again puts the spotlight on Hillary Clinton’s State Department. The issue in question appears to be just how active the State Department was in trying to rewrite the talking points in the hours and days after the attack. Both the Weekly Standard and ABC News have versions of the same story, quoting specific email exchanges between the CIA, the White House, and State suggesting it was the State Department that kept insisting on revisions. While the politics of this continues to get ugly -- especially as it relates to conservative groups targeting Hillary Clinton, the latest is from Karl Rove’s American Crossroads -- every day creates more questions for Clinton’s State Department. So expect more Republicans to do what Speaker Boehner did yesterday (calling on the White House to release all emails related to the incident) or what Sen. Lindsey Graham did as well (calling on Clinton to come back and testify before Congress).

*** The Gang sticks together -- so far: NBC’s Carrie Dann covers the first day of the Senate Judiciary Committee marking up the Gang of Eight’s bipartisan immigration legislation. Bottom line: The legislation was largely kept intact. “As expected, Democrats on the 18-member Senate Judiciary Committee were joined by two Republican members of the bipartisan Gang of Eight in opposing the most stringent border security amendments offered by opponents of the bill, ranging from a massive influx of boots on the ground at the nation’s southern border to delays to the program that would make undocumented immigrants eligible for a probationary legal status.” More: “But the panel also adopted a total of 21 amendments, including eight proposed by Republicans. Those included measures to beef up oversight of the legislation’s implementation, offer greater flexibility to the Department of Homeland Security to allocate funds for technology and infrastructure, and include private landowners in a task force consulting on border security.” As leading opponent Sen. Jeff Sessions (R-AL), said: “The Gang stuck together – as we’d been told they would – on anything that significantly impacted their legislation that they drafted with their friends.”

*** Enter Rand Paul: Still almost 1,000 days before the first votes in the 2016 contest, Republicans right now are split into two camps about how to move forward after their two-straight presidential losses. The first camp -- highlighted by all the George W. Bush nostalgia from his presidential library opening last month -- wants the GOP to return to “compassionate conservatism.” These are the people (think Jeb Bush, the Bush campaign alums, the RNC, and Marco Rubio) who support comprehensive immigration reform, believe the party must do a better job of appealing to minorities, and think there’s a role for government (albeit not as much as Democrats do). The other Republican camp largely found its voice in REACTION to the Bush years and President Obama. These folks don’t believe in a role for government; they’re suspicious (if not downright hostile) to military force; and they don’t think it’s a priority for the GOP to woo minority voters. Representing this camp is former presidential candidate Ron Paul and his son Sen. Rand Paul (R-KY), who speaks tonight at the Iowa GOP’s Lincoln Day dinner in Cedar Rapids, IA. You could call this second camp -- which includes Sen. Ted Cruz (R-TX) -- the anti-“compassionate conservatives.”

*** Can a small political machine conquer the GOP? Politico has a different story on Paul: Can his relatively small team have success in 2016, if he runs? “When Rand Paul touches down in Iowa Friday, it will be almost exactly three years to the day after his landslide 2010 Senate primary victory – an unlikely and decisive triumph over the Republican establishment that instantly transformed Paul into a national political phenomenon. Now, as Paul weighs a 2016 presidential bid, a different kind of challenge confronts him: Can the plain-spoken former Bowling Green ophthalmologist build a campaign to back up his popular appeal? For all Paul’s success as a media brand and a mobilizer of the conservative grassroots, the Kentucky senator has done relatively little since 2010 to assemble a political machine around his own personality. For now, the Rand Paul project is a high-wire act that works largely without a net.”

*** Bosom Buddies: In other 2016 news, Vice President Biden spoke to historian Douglas Brinkley for an article in Rolling Stone, and the gist Biden gives Brinkley: “Look at how close Obama and I are.” As Brinkley writes, “Never before have a president and vice president been as close personally and professionally as Barack Obama and Joe Biden – just think about the past 80 years. FDR switched out VPs with the regularity of a farmer rotating his crops. Harry Truman had little use for the lightweight Alben Barkley. Dwight Eisenhower never really trusted Richard Nixon... Of course, Al Gore and Dick Cheney were formidable presences in the past two White Houses. But by the time both of those men left Washington, their relationships with their bosses were strained.” Biden tells Brinkley in the interview: “I spend an average of four to five hours a day with him, every single day… Literally, every meeting he has, I'm in. You don't have to wonder what the other guy's thinking; I don't have to guess where the president's going. So it's been really great.”

*** First Read’s weekly 2016 round-up: After the Benghazi hearing Wednesday, former Secretary of State Hillary Clinton (D) landed back in the GOP crosshairs after a four-year hiatus... But she’s still leading potential GOP contenders Chris Christie (R-NJ) and Bob McDonnell (R-VA) in potential 2016 matchups in their home states, despite their over-60% approval ratings, according to new NBC/Marist polls... Sen. Marco Rubio (R-FL) took aim at Clinton on FOX and in a USA Today op-ed… The political world discovered that Christie had lap-band surgery, and he also told NBC’s Brian Williams: “I'll worry about the presidency if and when I ever decide to run for it. But if you're saying to me, how do I feel as a Republican? I'm a damn good Republican and a good conservative”  … Vice President Joe Biden (D) told a Sierra Club volunteer that he was against the Keystone Pipeline but, he added, “I am in the minority.” … Gov. Bobby Jindal’s (R-LA) voucher plan was struck down by the Louisiana Supreme Court … Martin O’Malley is dealing with the fallout of a prison scandal and he went nose-to-nose with the Dalai Lama. No word if he gave him a Flacco jersey, too. … New York Gov. Andrew Cuomo (D) went on air with his “Clean Up Albany” campaign that sounds and looks like a message one could hear from a presidential candidate… And Paul Ryan (R-WI) criticized progressivism and again said Republicans have to do a better job selling their agenda to the nation.

*** Grinding things to a halt: Yesterday, we noted that there were some mixed numbers when it comes to measuring the state of the Republican Party’s brand. On the one hand, our NBC/Marist poll found the GOP with an upside-down fav/unfav in the crucial state of Virginia, 37%-53%, and a Pew poll found respondents blaming Republicans by 20 points (42%-22%) for failing to better work with President Obama on key issues. On the other hand, the same Pew survey showed the Republican Party either even or slightly ahead of Democrats on top issues like guns, the economy, and immigration. But here’s a legitimate question to ponder: Is the GOP’s full-scale obstruction is the best way to improve the party’s long-term standing? Consider all the recent activity, per CQ Roll Call’s David Hawkings: Senate Republicans have blocked Obama’s nomination to head the Labor Department, Tom Perez, from moving to the floor; Senate Republicans also BOYCOTTED a hearing to prevent advancement of Gina McCarthy’s nomination to lead the EPA; and Senate Minority Leader Mitch McConnell and Speaker John Boehner announced their refusal to name recommendations to serve on the federal health-care law’s Independent Payment Advisory Board. Several years ago, any of these stories would have been closely scrutinized news. Now? They’ve become routine.

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A Tea Party member reaches for a pamphlet titled "The Impact of Obamacare", at a "Food for Free Minds Tea Party Rally" in Littleton, New Hampshire October 27, 2012. REUTERS/Jessica Rinaldi

As the Obama administration girds for “glitches and bumps” along the path to full implementation of the health-care law, a new poll indicates many Americans are still unclear about the details of the new law and, in some cases, unaware it’s actually law of the land.

A whopping 42 percent of Americans do not know that the Affordable Care Act is, in fact, law. Included in that 42 percent -- 12 percent believe it has been repealed by Congress, 7 percent think the U.S. Supreme Court overturned it, and 23 percent are unsure of its status, according to a Kaiser Family Foundation health tracking poll.

For the record, no portion of the law has been repealed; and the Supreme Court upheld it last summer in a 5-4 decision. The law continues to be viewed more negatively than positively, with just 35 percent saying they have a favorable view and 40 percent saying they have an unfavorable one. But the prolonged implementation, complexity of the law, and messaging by opponents has aided in the confusion. The administration is starting to push back, beginning with the president.

“It’s still a big undertaking,” President Barack Obama acknowledged Tuesday in a press conference at the White House. "And what we’re doing is making sure that every single day we are constantly trying to hit our marks so that it will be in place. ... Even if we do everything perfectly, there will still be glitches and bumps. ... And that’s pretty much true of every government program that’s ever been set up."

The poll comes as the administration Tuesday took one step to streamline the application process for health insurance for the uninsured, unveiling a shorter, three-page application form rather than the earlier, 21-page version that was criticized. Enrollment begins Oct. 1 for insurance that would take effect Jan. 1.

Nearly half of all Americans – 49 percent – say they still do not have enough information about the law and how it will impact their families. There are plenty of people happy to try and fill in the gaps.

Republicans, for example, have begun mounting a messaging campaign against the law’s implementation, hoping it can help them in the 2014 midterms and potentially hand over control of the Senate to the GOP, which needs to net six seats to accomplish that goal. 

They have seized, in particular, on retiring Democratic Sen. Max Baucus’ comment at a hearing earlier this month that implementation of the law will not just see “glitches and bumps,” but said it will be a “train wreck.”

“I urge my friends on the other side to join with Republicans and stop this ‘train wreck’ before things get even worse,” Senate Minority Leader Mitch McConnell, up for re-election in 2014, said on the floor of the upper chamber.

Views of the law have gotten worse since the presidential election, sliding from 43 percent favorable to 35 percent. Democrats are mostly responsible for the drop, as pre-election partisanship begins to fade and details of implementation begin to come into focus. 

But on Tuesday, President Obama –  in his most extensive defense of the implementation of the law so far –  said, “Despite all the hue and cry and ‘sky is falling’ predictions about this stuff, if you’ve already got health insurance, then that part of ‘Obamacare’ that affects you, it's pretty much already in place.”

What remains, he added, is getting the 10 percent to 15 percent of Americans who do not have health insurance, and who will face a penalty next year if they choose not to purchase it, to enroll in state or federal exchanges. The federal government’s job is also made more difficult, the president said, because big states like Florida and Texas, both states with Republican governors, have opted against setting up exchanges.

The “only impact” on people who already have insurance “is that their insurance is stronger, better, more secure than it was before,” Obama contended. “Full stop. They don’t have to worry about anything else. The implementation issues come up for those who don’t have health insurance.”

He added, "What we’re doing is we’re setting up a pool, so that they can all pool together and get a better deal from insurance companies. And those who can’t afford it, we’re going to provide them with some subsidies. That’s it." 

But the uninsured, those who will be most affected by the changes in the next year, are undereducated about the law, the Kaiser poll found. Fifty-eight percent of the uninsured said they did not have enough information to know how the law would impact their families.

By a 40 percent to 32 percent margin, more of the uninsured had a favorable view of the law. Nearly three-in-10 did not know or have an opinion on it.

“My assumption is that number starts shrinking,” said Molly Ann Brodie, senior vice president and director for public opinion and survey research for the Kaiser Family Foundation, noting that with more information on what the law actually does and how to sign up for it, the uninsured will begin to look more favorably on the health-care law.

“It’s going to be a difficult and confusing time,” Brodie said, noting the “tight time frame for enrollment.” She added, “Certainly, it’s going to be a messaging challenge and a framing challenge, but all the folks involved in implementation and expansion know that. The key is to focus on the folks who will be affected. … Let the political fight happen in the background.”

While opponents of the law will continue to message against it, Brodie noted that there will also be arguments from proponents highlighting positive stories.

“This will be a case where there are plenty of bumps and challenges to focus on,” she said, “but also some success stories – where people are getting care where they weren’t before. The question is which one wins from a political standpoint.”

Despite those “bumps,” “challenges,” and “glitches,” Obama tried to keep the focus on the big picture, sounding a note from his campaign.

"In a country as wealthy as ours, nobody should go bankrupt if they get sick," he said, adding, "We would rather have people getting regular checkups than going to the emergency room because they don’t have health care — if we keep that in mind, then we’re going to be able to drive down costs; we’re going to be able to improve efficiencies in the system; we’re going to be able to see people benefit from better health care. And that will save the country money as a whole over the long term."

This story was originally published on Tue Apr 30, 2013 3:42 PM EDT

As Republicans mount opposition once again to President Barack Obama’s health-care law, the president appealed to women and specifically Planned Parenthood for help in fighting back.

Mike Theiler / Reuters

President Barack Obama speaks at the Planned Parenthood National Conference at the Marriott Wardman Park Hotel in Washington April 26, 2013.

"I am here to also ask for your help, because we need to get the word out," Obama told Planned Parenthood Friday.

Much of the Affordable Care Act will begin being implemented next year, including the unpopular mandate, requiring those who do not have health insurance to obtain it or pay a fine. The Supreme Court upheld the law in a 5-4 decision last year.

Republicans, led by Senate Minority Leader Mitch McConnell, R-Ky., have begun a messaging campaign against the law’s implementation in much the same way the GOP did before the law’s passage in 2009.

“I urge my friends on the other side to join with Republicans and stop this ‘train wreck’ before things get even worse,” McConnell said Thursday in a Senate floor speech. McConnell’s up for reelection in 2014 in Kentucky.

The Republican leader’s use of the phrase “train wreck” was a reference to retiring Democratic Sen. Max Baucus of Montana. Baucus, who ironically helped write and pass the health-care law, gave Republicans ammunition last week while questioning Health and Human Services Secretary Kathleen Sebelius during a Senate hearing.

"I just see a huge train wreck coming down,” he said. "You and I have discussed this many times, and I don't see any results yet."

Baucus, who was up for reelection in a red state in 2014, made the remark the same day he voted against the compromise gun background check legislation.

He announced his retirement just six days later.

Republicans have indicated it will use concerns about the law’s implementation against Democrats in next year’s midterm, hoping it will help fuel a takeover of the Senate.

“In 2014, ObamaCare will be a political tsunami.... and Democrats are terrified,” National Republican Senatorial Committee spokesman Brad Dayspring said in a tweet, part of a series of tweets messaging against health care and highlighting other Democrats’ concerns.

Republicans need to net six seats to gain control of the Upper Chamber and make McConnell majority leader.

During the first fight over the health plan, before it became law in 2009, President Obama was seen as the best messenger for it. There were few, if any, other Democrats who showed an ability to frame the argument in favor of the plan as well as Republicans who opposed it.

Health-law advocates, however, worry that the president will be consumed with immigration over the next several months into the fall, just as the behind-the-scenes implementation of the law will be taking place.

That’s one reason Obama is looking for allies, and there’s no better place for him to start than Planned Parenthood, a group that helped advocate for the law’s passage.

“Planned Parenthood’s not going anywhere,” Obama told the group, referring to Republican attempts to de-fund it. “It’s not going anywhere today; it’s not going anywhere tomorrow. … You've got a president who's going to be right there with you in that fight every step of the way."

This story was originally published on Fri Apr 26, 2013 12:30 PM EDT

In a largely symbolic move, the Senate voted overwhelmingly Thursday night to repeal one of the taxes that is paying for President Barack Obama’s 2010 health care overhaul.

By a vote of 79 to 20, the Senate moved to rescind the 2.3 percent tax on manufacturers and importers of medical devices. The tax will raise nearly $2 billion in new revenue in 2013 and $20 billion over the next seven years.

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Thursday night’s vote was nonbinding since it was on an amendment to a Senate budget resolution which is not likely to result in a budget plan that Republican-controlled House would agree to.

The medical device tax is one of $24.6 billion in 2013 tax increases mandated by the Affordable Care Act which took effect on Jan. 1.

But the lopsided margin on the medical device vote indicated the discontent among senators with one tax which helps fund the Affordable Care Act.

Twenty-eight of the 79 senators who voted to repeal the tax on Thursday night had voted for the Affordable Care Act in 2010.

Of the Democratic senators up for re-election and in potentially close races, next year, only three voted against the amendment to kill the tax: Senate Finance Committee chairman Sen. Max Baucus of Montana, Tim Johnson of South Dakota and Mary Landrieu of Louisiana.

The bipartisan amendment to rescind the tax was co-sponsored by Sens. Orrin Hatch, R-Utah and Amy Klobuchar, D- Minn.

 At the end of last year during the “fiscal cliff” negotiations, Klobuchar and other senators had worked to delay at least for one year the tax on medical device manufacturers. But that effort failed.

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In a statement after the vote, Stephen Ubl, the president of the Advanced Medical Technology Association, a group which represents American medical technology firms, said, “The reasons behind mounting support to repeal the tax are clear: Across the country, this tax is cutting high-quality jobs and investments in tomorrow's treatments and cures at companies large and small. We encourage leaders in Congress and the Administration to seize on this momentum and act to repeal this harmful tax”.

In another vote Thursday night on an amendment to the Senate budget resolution, senators rejected by a vote of 59 to 40 the budget blueprint passed by the House on Wednesday.

Forty GOP senators voted for the House plan while five opposed it. All Democratic senators voted against the House plan.

The rejection of the House budget plan indicated how far the Senate Democrats and House Republicans would need to go to reach an accord on a budget plan for the fiscal year that begins on Oct. 1. 

This story was originally published on Fri Mar 22, 2013 8:37 AM EDT

Updated 5:35pm ET Even as President Barack Obama and House Speaker John Boehner struggle to find a way to avoid income tax increases in the New Year on almost all households, a separate set of tax increases which Obama signed into law as part of the 2010 Affordable Care Act (ACA) will begin to affect workers, investors and employers on Jan. 1.

Even if Boehner and Obama reach a deal on the “fiscal cliff,” $24.6 billion in 2013 Obamacare tax increases must take effect on Jan. 1 in order for the carefully designed health care overhaul to function in budget terms as its supporters promised it would: not adding anything to future budget deficits, but, according to an estimate by the Congressional Budget Office (CBO), reducing cumulative deficits by $132 billion between 2010 and 2019.

The Obamacare tax increases which begin on New Year’s Day are:

• A 2.3 percent tax on manufacturers and importers of medical devices.
• A limit on the tax deductibility of medical expenses for people who pay some of their medical costs out of pocket.
• A limit on tax-sheltered health flexible spending accounts.
• An increase in the Medicare payroll tax on single earners making more than $200,000 and married couples making more than $250,000.

The delicate balance of tax increases and spending increases in Obamacare will work only if Congress allows the tax increases to take effect, so they can offset the cost of substantial new insurance subsidies and other Obamacare outlays.

But some Senate Democrats are trying to delay at least for one year the tax on medical device manufacturers, which will raise nearly $2 billion in new revenue in 2013 and $20 billion over the next seven years.

In a letter Monday, Sen. Amy Klobuchar, D-Minn., Sen. Kay Hagan, D-N.C. and others asked Senate Majority Leader Harry Reid to work to postpone the medical device tax.

Both Klobuchar and Hagan voted for the ACA and Minnesota is home to one of the biggest medical device makers, Medtronic.

A delay in the tax could be part of the year-end fiscal package. “My guess that it would be part of bigger deal before the end of the year,” Klobuchar told NBC News Tuesday.

The Democrats calling for delay are emphasizing the need for medical device industry jobs.

“We’re focused on this because there’s a number of small start-up companies (which would be affected by the tax),” Klobuchar said.  The medical device tax was set to raise $40 billion over 10 years “and then reduced in half without real negotiation about how it would affect jobs and the industry. So this one, above all to me, cries out for a change.”

She said the IRS regulation spelling out exactly how the tax will be collected and enforced was issued last week toward the end of the year “without giving them (the medical device firms) time to figure out how to comply. So we’re simply at this point looking for a delay and if we can make some changes to reduce or repeal it, that would be the goal,” Klobuchar said.

Hagan said, “There’s so much innovation in this field right now and they do create so many good jobs in our country that we have the risk of losing these jobs to Ireland and to many other countries. And that’s the problem,” said Hagan, who is up for re-election in 2014.

When she added that the tax would have “an adverse effect on jobs throughout our country,” she was asked whether the tax – after the one-year delay that she and Klobuchar are requesting – would have an equally adverse effect on jobs in 2014. “We can certainly look at that over time,” she said. 

J.C. Scott, senior executive vice president of government affairs for the Advanced Medical Technology Association said, "We appreciate Sen. Klobuchar and Sen. Hagan's leadership on this issue and also appreciate the broad bipartisan support for preventing the implementation of the device tax which is slated to go into effect Jan. 1. Delay of the tax is an important step, but Congress must fully address the device tax as it works to develop a long-term solution to help our economy move forward, reduce our debt and reform our tax code."

The industry group said that the U.S. medical technology industry supports nearly 2 million jobs and that nearly 43,000 jobs might be at risk if the tax takes effect.

But a Senate Finance Committee aide told NBC News Tuesday, "Medical device companies are expected to enjoy trillions of dollars in growing sales over the next decade, with profit margins that would make Warren Buffett blush. Health reform is providing the medical device industry with 30 million new customers and Medicare is the industry's largest paying customer. Particularly at a time when we're all working to cut our debt, there's no need to single out any industry for a special carve out."

If the call from Democrats such as Klobuchar for delay and “reduce or repeal” reflects a weakening of support for Obamacare’s revenue raisers, that could be worrisome for both deficit reduction and cost reduction since both of those were goals of Obama’s health care overhaul.

Even as they voted for the health care overhaul in 2010, some congressional Democrats said they thought that another one of the tax increases in the law, the tax on high-cost “Cadillac” health insurance plans would never fully take effect because Congress would water it down or repeal it before 2018 when it is set to effect.

Hannah Foslien / AP

Sen. Amy Klobuchar, D Minn., speaks at an election night event at the Crowne Plaza on Tuesday, Nov. 6, 2012 in St. Paul, Minn.

If Democrats delay, reduce or repeal the medical device tax, then the ACA will not cut costs as much as its proponents and the CBO predicted it would.

Senate Democratic Whip Dick Durbin of Illinois made exactly that point in comments to reporters Tuesday: “I’ve met with medical manufacturers in my state. And I think many of them are going to face some serious hardships when it comes to their competitive edge and research. But I’ve also told them quite frankly, ‘We’ve got to make up the revenue. If we’re going to walk away from any part of this revenue, we have to find another source.’”

With the Obama administration posing no objection, the U.S. Supreme Court today gave a Christian college in Virginia a chance to carry on its claim that the Obama health care law violates religious freedom.

Liberty University was among the first challengers of the law, arguing that two provisions violate its religious freedom -- the individual mandate and the requirement that employers provide health insurance or pay a penalty. The case was never fully developed, however, because the court of appeals for the Fourth Circuit ruled that the law could not be challenged before it went into effect. On the first time through the courts, the trial judge ruled against the school, but the appeals court said a federal law that imposes a tax cannot be challenged ahead of time.

Saul Loeb / AFP - Getty Images

Today's action by the Supreme Court does not mean that the justices think Liberty University is right. It simply means the court has concluded that the school should be given a chance to start over rather than leaving the question unresolved.

The Obama administration had told the court that it poses no objection to giving Liberty a shot at making its religion arguments, even though the government believes "those claims lack merit."

Updated 6 p.m. ET - Republicans' efforts to undo President Barack Obama's health care reform law appear to have come to an end, as House Speaker John Boehner described it Thursday as the "law of the land."

In an interview with ABC News, the nation's top elected Republican seemed to indicate that Congress wouldn't engage in the type of repeated repeal votes the way it had in the past two years. Boehner's office provided a transcript of the exchange:

SAWYER:

A couple of other questions about the agenda now.  You have said next year that you would repeal the healthcare vote.  That's still your mission?

BOEHNER:

Well, I think the election changes that.  It's pretty clear that the president was reelected, Obamacare is the law of the land.  I think there are parts of the healthcare law that are gonna be very difficult to implement.  And very expensive.  And as the time when we're tryin' to find a way to create a path toward a balanced budget everything has to be on the table.

SAWYER:

But you won't be spending the time next year trying to repeal Obamacare?

BOEHNER:

There certainly may be parts of it that we believe-- need to be changed.  We may do that.  No decisions at this point.

The speaker's pronouncement, if nothing else, signifies a pivot away from Republicans' efforts to showcase for conservatives their doggedness in looking to repeal "Obamacare."

It's also a recognition that the 2009-2010 health care law that came to define Obama's first term in office -- and propel Republicans to a majority in the House -- is here to stay.

A spokesman for Boehner sought to clarify the speaker's comments.

"While ObamaCare is the law of the land, it is costing us jobs and threatening our health care," said Kevin Smith, the speaker's communications director. "Speaker Boehner and House Republicans remain committed to repealing the law, and he said in the interview it would be on the table."

The Supreme Court's summer 2012 ruling upholding the constitutionality of the law disarmed conservatives of one of their best possible chances of defeating the health care law once and for all.

And Mitt Romney's loss on Tuesday meant that Republicans won't have in the White House a president that could severely limit the scope of the law before its key provisions begin to take effect in 2014.

Eric Gay / AP

A sign promoting the debate is held up at a rally on the Centre College campus, on Oct. 11, 2012, in Danville, Ky.

Vice President Joe Biden enters Thursday night's vice presidential debate with a mandate to aggressively defend President Barack Obama's record following the presidential debate last week, which saw Republican presidential nominee Mitt Romney score a prime-time victory over the president.

The political spotlight turns this evening to Danville, Ky., where Paul Ryan — the Wisconsin congressman who, two months ago, agreed to serve as Romney's running mate — hopes to build upon the momentum earned by Romney last week in Denver.

Biden and Ryan will meet tonight at Centre College for their first and only debate, but one that is a high-stakes affair.  In contrast to the presidential debates, the running mates often serve as the unofficial "attack dog" for the top of the ticket, raising the prospect for fireworks in the 90-minute affair, moderated by ABC's Martha Raddatz.

The Biden-Ryan matchup will help further set the stage for the two more debates between Obama and Romney scheduled for later this month.

Romney's previous debate performance, which saw the GOP hopeful deliver crisp attacks and adopt a more centrist tone, has helped him make up ground against Obama in several national and state-level polls. Obama's advantage narrowed to a point among likely voters in Florida (48 percent to 47 percent), according to NBC News/Wall Street Journal/Marist polls released Thursday, and Romney led Obama by a point (48 percent to 47 percent) among likely voters in Virginia. Obama maintained a 51 percent to 45 percent advantage over Romney in the key battleground state of Ohio, as well.

Republicans hope a second strong outing, this time by their ticket's No. 2, will help propel Romney to a better position to overtake the Democratic incumbent in the final weeks of the campaign.

Ryan wound down his preparations Wednesday in Florida, where former solicitor general Ted Olson played the role of Biden in practice sessions. Speaking to reporters while making a stop for ice cream, Ryan said his debate prep "went well."

"What I am excited about is we get to offer the American people a very clear choice," Ryan said. "Look, Joe Biden has been on this stage before. He has been on these big stages. This is my first time. But what he can’t run from is President Obama’s indefensible record. They are just offering more of the same. I am excited because we have a chance yet again to offer this country a very clear."

Biden, meanwhile, has been squared away back at his personal residence in Delaware to prepare for tonight's contest.

"You can expect the vice president to do what he does best: talk about what's at stake for the middle class in this election," Maryland Rep. Chris Van Hollen, who is playing Ryan in debate preparations with Biden, said in an online video Wednesday. "The vice president is taking this moment seriously, speaking directly to the American about their hopes, and this ticket's plan to keep fighting for the middle class and moving the country forward in a second term, is what he's great at and what he loves to do."

The vice president's practice debates were attended by Obama campaign staff and longtime aides to the former Delaware senator. Biden has also reportedly been reading the "Young Guns" manifesto by Ryan, House Majority Leader Eric Cantor, R-Va., and House Majority Whip Kevin McCarthy, R-Calif., as part of his prep work.

Despite the preparations, both campaigns have sought to downplay expectations for their respective candidates' performances this evening, a time-honored tradition that extends to vice presidential debates.

And Biden and Ryan both bring a series of strengths and weaknesses to the table.

The vice president, for instance, has become an effective advocate for Obama in white, working-class towns where the president typically struggles. Biden's folksiness and readily apparent comfort before blue collar crowds has made him able to make inroads in communities where the president might not otherwise tread.

"I would tell Joseph Biden, be yourself, you're very good at this," Democratic New York Sen. Charles Schumer said Tuesday on MSNBC.

But that's also a sentiment shared by Republicans, given how Biden's off-the-cuff demeanor has sometimes led to gaffes that snowball into a headache for the Obama campaign. Republicans turned the vice president's recent comment that the middle class had been "buried" by the economy in the last four years into a self-referential attack on the administration (though Biden had been alluding to the lingering effects of the Bush economy).

Likewise, Ryan offers Republicans opportunity and vulnerability.

The Wisconsin congressman is regarded as one of the GOP's more articulate voices when it comes to fiscal issues; Republicans often argue that if they were to pick one person to explain the party's plans to reform entitlements and the tax code, it would be Ryan.

But the House Budget Committee chairman will also be held to account for some of the more controversial elements of the two budgets he's authored, especially for their proposed changes to Medicare. Democrats have accused his first budget of eliminating Medicare as it's commonly known and turning it into a voucher system. (A second iteration allowed seniors to maintain traditional Medicare or chose a reformed "premium support" plan.)

Ryan also pales in foreign policy experience compared to Biden, a key adviser to Obama on global and diplomatic issues and a former chairman of the Senate Foreign Relations Committee. But Ryan has shown more ease in recent week echoing Romney's own criticism of the Obama administration's foreign policy, which focuses on its handling of a recent attack on a U.S. diplomatic mission in Libya, and the deterioration in the U.S. relationship with Israel.

CHESTER, VA -- Virginia Gov. Bob McDonnell and Louisiana Gov. Bobby Jindal came to Mitt Romney's defense today over remarks the Republican presidential nominee made Tuesday, saying he wouldn't seek new anti-abortion legislation as president.

"There's only one pro-life candidate running for president, and that's Governor Romney," Jindal told reporters. 

Tuesday, in an interview with the Des Moines Register's editorial board, Romney said, "There's no legislation with regards to abortion that I'm familiar with that would become part of my agenda." 

Jindal today went on to rebuff attacks from Democrats, including an Obama campaign conference call this morning pointing to Romney's past support for restrictions on access to abortion.

 "The reality is, its no surprise that President Obama would want to talk about anything but the economy," Jindal said. 

The remarks came after he and McDonnell visited a barbecue restaurant here in Chester, one of three stops today across a wide swath of eastern Virginia as the two men get out the vote for the Republican presidential ticket.

Recommended: Ryan says he feels 'good' about debate versus Biden

McDonnell said that Romney was signaling that his presidential agenda "isn't focusing on social issues." 

"Having read those comments from Governor Romney," McDonnell said of the Register interview, "what he was saying is, his overwhelming priority is going to be creating jobs, getting the economy back on track."

Both McDonnell and Jindal are outspoken on social issues and are fervently anti-abortion -- though when asked today they would not say they were disturbed by Romney's remarks. 

Republicans are likely hoping a strong debate performance by vice presidential nominee Paul Ryan in Thursday's debate against Vice President Joe Biden will shift the conversation.

Speaking to supporters earlier, Jindal -- once a much-speculated about contender for veep himself -- said he didn't want raise expectations for Ryan, with whom he earlier served in Congress.

But Jindal spoke highly of Ryan's chances.  "I don't think its going to be a fair fight," he said.

Pointing to sections of the interview in which Romney cites his support for cutting funding to countries promoting abortion, McDonnell said the "no legislation" remarks are being taken out of context. 

"Governor Romney's pro-life.  Pro-life bills that get to his desk, there's no question in my mind he will sign." McDonnell said.  

"He's pro-life, Obama's pro-choice, and now let's talk about the economy."