Political Memo: Fault-Finding Grows Intense as Cuts Near

WASHINGTON — First the White House and Congress created a potential fiscal crisis, agreeing more than a year ago to once-unthinkable governmentwide spending cuts in 2013 unless the two parties agreed to alternative ways to reduce budget deficits.

Now that those cuts are imminent — because compromise is not — they have created one of Washington’s odder blame games over just whose bad idea this was.

The battle lines over cuts that are scheduled to begin on Friday, known in budget parlance as sequestration, were evident on Saturday in President Obama’s weekly address and the Republican response, by Senator John Hoeven of North Dakota.

“Unfortunately, it appears that Republicans in Congress have decided that instead of compromising, instead of asking anything of the wealthiest Americans, they would rather let these cuts fall squarely on the middle class,” said Mr. Obama, who proposed a substitute mix of spending cuts and revenues from repealing some tax breaks for wealthy people and corporations.

He added: “Are Republicans in Congress really willing to let these cuts fall on our kids’ schools and mental health care just to protect tax loopholes for corporate jet owners? Are they really willing to slash military health care and the Border Patrol just because they refuse to eliminate tax breaks for big oil companies?”

For Republicans, who oppose any tax increases, Mr. Hoeven countered: “He blames Congress for the sequester, but Bob Woodward, in his book ‘The Price of Politics’ sets the record straight. Woodward says it was President Obama who proposed — and promoted — the sequester.”

What makes this debate over blame so odd is that both sides’ fingerprints — and votes — are all over the sequestration concept. The point of sequestration, in fact, was to define cuts that were so arbitrary and widespread that they would be unpalatable to both sides and force a deal.

That won Republicans’ support for increasing the government’s debt limit in 2011, and averted the nation’s first default. The Republican-led House and Democratic-led Senate each passed the accord overwhelmingly, and Mr. Obama gladly signed it.

The idea for sequestration did come from the White House, as news accounts made clear at the time. Jacob J. Lew, then Mr. Obama’s budget director and now his nominee for Treasury secretary, was the main proponent.

Mr. Lew, who was a senior adviser to the House speaker in the 1980s, lifted language from a 1985 law he helped negotiate, the Gramm-Rudman law. It was conceived by two Republican senators to be “a sword of Damocles,” poised to strike both parties unless they compromised on deficit reduction.

The law was ruled unconstitutional, and afterward, the Democratic-controlled Congress and President Ronald Reagan enacted a modified version, which resulted in relatively minor cuts until 1990. That year, the law’s call for much larger cuts in the face of growing deficits helped force Congress and President George Bush to negotiate spending cuts and tax increases widely credited with contributing to balanced budgets later that decade.

Fast-forward to the summer of 2011. Mr. Obama and Congressional Republicans, once again facing deficits, were able to agree to nearly $1 trillion in reductions over a decade in “discretionary” spending programs, which cover just about everything the government does except the entitlement benefit programs like Medicare, Medicaid and Social Security.

But they could not agree on the final $1.2 trillion. The president demanded that that amount come from higher taxes on the wealthy and some reductions in entitlement spending. Republicans insisted on entitlement cuts only.

So both parties started negotiating for a trigger, as they called it — an undesirable, automatic action that would slash deficits if Democrats and Republicans could not. Mr. Obama and Democrats wanted a trigger mandating automatic spending cuts and tax increases; Republicans insisted on spending cuts only.

Democrats conceded, and that is when Mr. Lew — along with Gene Sperling, director of Mr. Obama’s National Economic Council — proposed the Gramm-Rudman sequestration. Given that law’s Republican parentage, the Obama advisers figured this kind of trigger would appeal to Republicans, and it did.

Speaker John A. Boehner and three-quarters of House Republicans voted for the agreement. To use Mr. Hoeven’s word, both parties “promoted” their compromise, including sequestration. Mr. Boehner said he had gotten “98 percent” of what he wanted.

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Dozens of stars rehearse day before Oscar ceremony

LOS ANGELES (AP) — Some dressed down in jeans and hoodies. Others looked camera-ready in suits or chic dresses and spiky stilettos.

But no matter how they looked, all of the stars who rehearsed Saturday for the 85th Academy Awards seemed excited about being a part of the big show.

They paraded through the Dolby Theatre in 15-minute increments: Meryl Streep. Ben Affleck. Reese Witherspoon. Richard Gere. Jennifer Aniston. John Travolta. Nicole Kidman. Jack Nicholson. And dozens more.

Each practiced their lines in front of an audience of show workers and awarded prop Oscars to rehearsal actors. They also scanned the theater from the stage, searching for their show-night seats.

"Oh, wow. That's a very dramatic picture of me," best-actress nominee Jessica Chastain said after spotting her seat-saving placard. "I'm looking at everyone's headshots. It's kind of incredible."

Affleck confessed his excitement from the stage as he looked out at all the famous faces expected Sunday.

"This is like the most memorable aspect of the Oscars," the "Argo" director said. "You see all these place cards (at rehearsal), then you come back and they're all here!"

Affleck also chatted backstage with the college film students who won a contest to serve as trophy carriers during the ceremony.

"I love that," he said. "It's super cool."

Travolta spent time with the students, too.

"I was there when that idea was born and I said it was the best idea they could possibly come up with," he told the aspiring filmmakers backstage. "And here you are!"

Travolta plans to bring his 13-year-old daughter, Ella Bleu, to the ceremony.

Kidman made rehearsals a family affair. Husband Keith Urban and their eldest daughter, Sunday, watched from the audience as Kidman ran through her lines.

She looked impeccable in a wine-colored dress and tall metallic shoes, but other stars were decidedly more casual. Kristen Stewart arrived in jeans, sneakers and a backward ball cap. (She also limped on an injured right foot.) Renee Zellweger also opted for comfort in jeans and running shoes.

The cast of "Chicago," including Gere, Zellweger, Queen Latifah and Catherine Zeta-Jones, injected their rehearsal with silliness. Latifah purposely over-enunciated her lines, and when a pair of rehearsal actors claimed an Oscar onstage and gave an acceptance speech, Zeta-Jones started to play them off with an imaginary violin.

"Get outta here!" Gere said with a smile.

Octavia Spencer, who won the supporting actress Oscar last year for her performance in "The Help," also had a little fun.

"I'm going to do a soft-shoe," she said, shuffling off stage.

Streep and Jane Fonda were each wowed by the set design. Fonda snapped a photo with her iPhone, and Streep marveled at how far the walk to the microphone was.

"All the way to here?!" she asked. "Oh my God."

Halle Berry literally stumbled during her first rehearsal, her pointy heel catching on part of the stage. She insisted on trying again.

"Woo hoo," she said. "Made it."

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AP Entertainment Writer Sandy Cohen is on Twitter: www.twitter.com/APSandy .

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The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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Iraq President’s Health Is Improving, Doctor Says

KIRKUK, Iraq (Reuters) - Iraqi President Jalal Talabani is now able to talk, his doctor said, adding he was hopeful the Kurdish statesman would soon be fit to return to Iraq from Germany, where he has been receiving medical treatment for a stroke.

A peace-maker who often mediated among Iraq's Shi'ite, Sunni and Kurdish factions, 79-year-old Talabani was flown abroad in December in critical condition.

"I am in continuous contact with the German team treating President Talabani," said Najmaldin Karim, who is also governor of the city of Kirkuk.

"He can talk now with the people around him and started to think in a good way. I and the German team are optimistic that he will get much better and can return back to Iraq soon."

During Talabani's absence, Iraq's political crisis has intensified, with thousands of Sunni Muslims taking to the streets in protest against the Shi'ite-led government

The veteran politician often worked to ease tensions in the country's fragile power-sharing government and negotiated between Baghdad and the autonomous Kurdistan region, which are locked in feud over land and oil rights.

(Writing by Isabel Coles; Editing by Nick Macfie)

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Adele, 'Les Miserables' cast sing on Oscar stage

LOS ANGELES (AP) — It was an extra starry, musical day at the Dolby Theatre.

Adele took the stage first Friday, followed by the cast of "Les Miserables," singing together of the first time.

Oscar nominees Hugh Jackman and Anne Hathaway, along with co-stars Russell Crowe, Amanda Seyfried, Helena Bonham-Carter, Sasha Baron-Cohen, Eddie Redmayne, Aaron Tveit and Samantha Barks rehearsed their performances on the Oscar stage. They were backed by members of the musical's stage productions from London and Broadway.

"Les Miserables" director Tom Hooper sat in the front row of the theater as his cast sang.

Moments earlier, Adele dazzled the tiny audience of show workers with her performance of the James Bond theme "Skyfall."

"I need a lot more reverb on me," she said after her first run. "You might need to get a new reverb machine."

The 24-year-old multiple Grammy winner arrived wearing a black tunic, black leggings and flats, with no makeup and her hair in a ponytail.

"I'm going to have very high heels on the night, guys," she announced from the microphone, sipping tea between verses.

"Do you need the dresses?" she asked, and a team of stylists brought out the gowns Adele is considering for her Oscar performance.

The dress producers favored? "It's very heavy — I mean I struggle to stand in it," Adele said. "Come and feel how heavy it is, so you don't think I'm a wimp!"

She performed her Oscar-nominated song five times before leaving the theater. "It's been good, yeah?" she asked producer Neil Meron, who nodded in approval.

Just after Adele wrapped, the star-studded "Les Miserables" cast took the stage. Hathaway chatted with Bonham-Carter as Jackman sang a capella. Then Hathaway checked her microphone with a quick verse.

"Ooh, that was flat," she said.

The entire cast assembled for a final run-through when Jackman spontaneously began singing "My Bonny Lies over the Ocean."

"My bonny lies over my daddy," the ensemble responded, breaking into laughter.

Other stars rehearsing Friday included Jennifer Hudson, who is set to perform a song from "Dreamgirls" at Sunday's ceremony.

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AP Entertainment Writer Sandy Cohen is on Twitter: www.twitter.com/APSandy .

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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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Pistorius Returns to Bail Hearing

PRETORIA, South Africa — Oscar Pistorius, the double amputee track star accused of murdering his girlfriend, returned to court on Friday for the fourth straight day of hearings about whether he should be granted bail in a case that has riveted the nation.

News reports said he slipped into the courthouse, his head covered by a jacket, some time before the start of hearings that have packed the courtroom with a scrum of journalists alongside legal teams, family members and onlookers. He took his place on Friday to a clatter of photographers’ cameras. In the latest in a series of abrupt twists in the affair on Thursday, the South African police replaced the lead investigator after revelations that he was facing seven charges of attempted murder stemming from an episode in which police officers fired at a minivan.

After widespread news reports about the charges, Gerrie Nel, the prosecutor, said at the start of a hearing on Thursday that he had just learned about them. The national police commissioner, Riah Phiyega, said later that a divisional police commissioner, Lt. Gen. Vinesh Moonoo, would be assigned to preside over “this very important investigation.” The change was announced a day after the original lead investigator, Detective Warrant Officer Hilton Botha, acknowledged several mistakes in the police work and conceded that, based on the existing evidence, he could not rule out the version of events presented by Mr. Pistorius.

The prosecution says Mr. Pistorius committed the premeditated murder of Reeva Steenkamp, a 29-year-old model and law graduate, when he fired four shots through a locked bathroom door while she was on the other side in the early hours of Feb. 14.

With his head bowed as he entered the court on Friday, Mr. Pistorius appeared to be struggling to hold back tears, his jaw clenched, the prosecutor, described Ms. Steenkamp’s plight that morning.

“I am not saying the planning of the murder of Reeva Steenkamp happened weeks ahead, days ahead,” Mr. Nel said. “I am saying the planning to kill Reeva Steenkamp happened that night.”

Ms. Steenkamp took refuge in the bathroom either to escape a fight or a gun, he said. The prosecution is seeking to persuade the magistrate, Desmond Nair, to deny the sprinter’s application be released on bail until a full trial, arguing that he might flee.

Mr. Pistorius has said that he opened fire believing there was an intruder in his home, in a gated community in Pretoria, and that he had no intention of killing Ms. Steenkamp, 29, a model and law school graduate.

On Thursday, Mr. Nel labeled Mr. Pistorius’s account “improbable.”

“What we can’t forget is the applicant is charged with murdering a defenseless, innocent woman,” Mr. Nel said.

Mr. Pistorius has said that he did not realize Ms. Steenkamp was no longer in bed as he rose to check for an intruder, shouting to her to call the police.

“You want to protect her, but you don’t even look at her?” Mr. Nel said on Thursday. “You don’t even ask, ‘Reeva, are you all right?’ 

On Thursday, a police brigadier, Neville Malila, told reporters that Detective Botha was scheduled to appear in court in May on the attempted murder charges in connection with an episode in which Mr. Botha and two other police officers fired at a minivan.

“Botha and two other policemen allegedly tried to stop a minibus taxi with seven people,” Brigadier Malila said. “They fired shots.” While the charges were initially dropped, “we were informed yesterday that the charges will be reinstated,” he said.

Medupe Simasiku, a spokesman for the National Prosecuting Authority, told reporters that the decision to reinstate the charges was made on Feb. 4, long before Ms. Steenkamp was killed.

Lydia Polgreen reported from Pretoria, South Africa, and Alan Cowell from London.

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Oscar animators ready to be taken seriously

BEVERLY HILLS, Calif. (AP) — In the animated feature film category at this year's Oscars, there's a film set in medieval Scotland, another that features old-school video game characters, one that relies heavily on dry British humor, while the other two take inspiration from the supernatural.

It's not exactly kid stuff — and that's how the directors like it.

"I think this year with these films — and so many more — the envelope for animation is being pushed," said "Brave" director Mark Andrews at an Academy Awards event Thursday night honoring the animated feature film nominees. "We keep seeing more risky, deep films that we wouldn't have seen 10 years ago coming out. I wanna be one of those guys pushing it more and more and more because it's not only an awesome medium, but there's so many more stories that we can tell."

The Scotland-set "Brave," a darker fable from Pixar about a rebellious red-headed princess named Merida, will face off against four other animated films at Sunday's 85th annual Academy Awards. The category was first introduced at the 2002 ceremony, with "Shrek" winning the inaugural trophy.

Despite the less lighthearted tone of this year's animated nominees, none cracked the best picture category for a spot alongside the likes of "Argo," ''Lincoln" and "Zero Dark Thirty." (Only three animated films have ever been nominated for best picture at the Oscars: "Beauty and the Beast," ''Up" and "Toy Story 3.")

"Edward Scissorhands" and "The Nightmare Before Christmas" mastermind Tim Burton could take home his first-ever Oscar at the Dolby Theatre ceremony for "Frankenweenie," his black-and-white stop-motion film based on his 1984 live-action short film of the same name.

"Frankenweenie" is among three of the five Oscar nominated films this year that employ stop-motion, the intricate and time consuming animation method that use miniature sculptures and sets. Despite a strong stop-motion presence at this year's Oscars, Burton cited finances, not the omnipresence of computer animation, as the reason that more stop-motion films aren't produced.

"In the case of 'Frankenweenie,' it's not like it was a studio wish-list to-do: 'Let's make black-and-white stop-motion animation,'" said Burton. "You hope it can survive. We all love it."

The other stop-motion nominees are the English seafaring comedy "Pirates! Band of Misfits" from director Peter Lord and the undead tale "ParaNorman" from directors Sam Fell and Chris Butler.

"Wreck-It Ralph" director Rich Moore told the crowd at the motion picture academy's Beverly Hills headquarters that he never envisioned the video game adventure from Disney as a musical, but "Book of Mormon" co-writer Robert Lopez and his wife Kristen Anderson-Lopez did create an original song for the film.

"It didn't work, so it's not in the movie," said Moore. "That's our process. We try lots of stuff. We throw it against the wall, and the stuff that sticks stays in the movie. It's a very organic process making films like this."

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Follow AP Entertainment Writer Derrik J. Lang on Twitter at http://www.twitter.com/derrikjlang.

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Governors Fall Away in G.O.P. Fight Against More Medicaid

Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.

The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.

The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more later. But many Republican governors and lawmakers immediately questioned whether that commitment would last, and whether increased spending on Medicaid makes sense, given the size of the federal budget deficit. Some flatly declared they would not consider it.

In Florida, where Gov. Rick Scott reversed his position and on Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives, but also create jobs and stimulate the economy. Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced their intention to expand Medicaid.

The shift has delighted supporters of the law.

“I think this means the dominoes are falling,” said Ronald F. Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”

 Nationwide, Medicaid covers 60 million people, most of them low-income or disabled. The Congressional Budget Office has estimated that 17 million more people could be enrolled if all states took the expansion option. So far, 22 states have said they will expand the program, 17 have opted against it, and 11 have not yet decided, according to Avalere Health, a consulting firm.

Some Republican governors remain firmly opposed to the expansion of Medicaid. In her State of the State address, Gov. Nikki R. Haley said, “As long as I am governor, South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion.”

Gov. Rick Perry affirmed that “Texas will not expand Medicaid” and said he was proud that Texas did not follow other states “scrambling to grab every tax dollar they can.”

The change of heart for some Republican governors has come after vigorous lobbying by health industry players, particularly hospitals. Hospital associations around the country signed off on Medicaid cuts under the health care law on the assumption that their losses would be more than offset by new paying customers, including many insured by Medicaid.

Politics could also be a factor in states where Republican governors have decided to expand Medicaid. Mr. Obama won all of those states except Arizona and North Dakota in last year’s election, a fact that may have influenced several of the governors’ decisions. Some of the seven are also up for re-election next year.

Religious leaders have added a moral dimension to the campaign in some states. The Roman Catholic bishops of Salt Lake City and Little Rock, Ark., for example, have urged state officials to expand Medicaid.

The Obama administration has tried to win over skeptical state officials by offering new flexibility to manage Medicaid as they like. On the same day that he agreed to expand Medicaid in Florida, Mr. Scott got federal permission to move more Medicaid beneficiaries into private managed care plans.

Mr. Scott’s support for expanding Medicaid is particularly significant — Florida is the fourth most populous state — and surprising. A onetime hospital executive, he has been among the most strident critics of the health care law, and his opposition to it was a cornerstone of his 2010 campaign for governor.

The battle is not over, however. In Florida, as in many other states, expansion is subject to approval by the Legislature, whose Republican leaders have expressed misgivings. The legislative session begins next month, and advocates say they plan to press ahead with a lobbying campaign.

Leah Barber-Heinz, a spokeswoman for Florida Chain, a health advocacy group, said it was trying to inform lawmakers and the public about who would benefit from an expansion of Medicaid. More than one-fifth of Florida residents, roughly 4 million of 19 million people, lack health insurance.

“There are so many misperceptions about the uninsured,” Ms. Barber-Heinz said. “So we’re trying to show faces of who would be impacted: people who have been hit by the recession, people who have been laid off, educated people, people who own homes.”

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Sign of a Comeback: U.S. Carmakers Are Hiring

Tony Dejak/Associated Press

Joseph R. Hinrichs, head of Ford's Americas region, with a two-liter EcoBoost engine at the Cleveland plant.

DETROIT — A few years ago, American automakers cut tens of thousands of jobs and shut dozens of factories simply to survive.

But since the recession ended and General Motors and Chrysler began to recover with the help of hefty government bailouts and bankruptcy filings, all three Detroit car companies including Ford Motor Company have achieved one of the unlikeliest comebacks among industries devastated during the financial crisis.

Now steadily rising auto sales and two-tier wage concessions from labor have spurred a wave of new manufacturing investments and hiring by the three Detroit automakers in the United States. The latest development occurred on Thursday, when Ford said it was adding 450 jobs and expanding what had been a beleaguered engine plant in Ohio to feed the growing demand for more fuel-efficient cars and S.U.V.’s in the American market.

Ford, the nation’s second-largest automaker after G.M., said it would spend $200 million to renovate its Cleveland engine plant to produce small, turbocharged engines used in its top-selling models. Ford plans to centralize production of its two-liter EcoBoost engine — used in popular models like the Fusion sedan and Explorer S.U.V. — at the Cleveland facility by the end of next year.

Its move to expand production in the United States is yet another tangible sign of recovery among the Detroit auto companies. Industrywide sales in the United States are expected to top 15 million vehicles this year after sinking beneath 11 million in 2009.

Last month, G.M. announced plans to invest $600 million in its assembly plant in Kansas City, Kan., one of the company’s oldest factories in the country. And Chrysler, the smallest of the Detroit car companies, is adding a third shift of workers to its Jeep plant in Detroit.

The biggest factor in the market’s revival has been the need by consumers to replace aging, gas-guzzling models. “Pent-up demand and widespread access to credit are keeping up the sales momentum,” said Jessica Caldwell, an analyst with the auto research site Edmunds.com.

And Joseph R. Hinrichs, the head of Ford’s Americas region, explained in an interview that the company’s Ohio revival plan was “all based on increased demand.”

“We’re putting the capacity here because that’s where we need it most,” he said.

Yet even though Ford is enjoying a resurgence in the United States, it is racing to reduce costs in its troubled European division. The workers in Spain who were building the small EcoBoost engines that have been shipped to America will be moved to an assembly plant that is taking on work from a plant to be closed in Belgium.

While Ford survived the industry’s financial crisis without government help, it still cut thousands of jobs and shuttered several factories to reduce costs and bring production more in line with shrinking sales.

But now, the burst of showroom business has prompted automakers to increase output at remaining plants. In Ford’s case, the company added about 8,000 salaried and hourly jobs last year, and has said it plans to hire about 2,200 white-collar workers in 2013. Ford is also moving some vehicle production from Mexico to a Michigan plant, where it will add 1,200 jobs.

The investment in Cleveland is indicative of how Ford and other carmakers have trimmed domestic labor costs and improved productivity since the recession. Just a few years ago, the company was forced to consolidate two engine plants into one in northern Ohio, and close a major component operation. “No question we have been through a lot in northern Ohio,” Mr. Hinrichs said. “But now our North American business is very competitive with the best in the world.”

Mr. Hinrichs said that a new local agreement with the United Automobile Workers union in Cleveland paved the way for the expansion. Currently the plant employs about 1,300 workers.

The Detroit companies are also benefiting from their ability to hire lower-paid, entry-level workers as part of their national contract with the U.A.W. Many of the 450 new workers at the Cleveland plant will start at $16 an hour, compared to about $28 for veteran union members, and some of the new engine plant workers could include employees from other Ohio plants.

“With our competitive labor agreements, we can bring business back to the U.S. from Spain and Mexico,” Mr. Hinrichs said.

Employment still falls far short of levels in the 1990s, when cheap gas and the popularity of S.U.V.’s led to big profits in Detroit.

The auto manufacturing sector employed 1.1 million people in the United States as recently as 1999, according to a recent study by the Center for Automotive Research in Ann Arbor, Mich. About one-third of those jobs were in the final assembly of vehicles, and the balance in the production of auto parts.

Employment dropped as low as 560,000 in 2009. Since then, about 90,000 jobs have been added, the report said.

This article has been revised to reflect the following correction:

Correction: February 21, 2013

Because of an editing error, an earlier version of this article gave a false impression of sales among the Detroit auto companies. Overall auto sales in the United States are expected to top 15 million this year, not sales among the Detroit automakers.

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