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Washington (AFP) – President Barack Obama’s landmark health care reforms take effect on Wednesday, granting coverage to millions of previously uninsured Americans after nearly four years of bitter wrangling that has loomed large over the U.S. political landscape.

Since the Affordable Care Act, or “Obamacare,” was passed in 2010, the legislation has survived multiple repeal attempts by Republican lawmakers, a U.S. Supreme Court hearing, and a disastrous rollout of the website set up to assist the launch of the legislation.

But as of January 1, 2014, it will be illegal for insurers to deny coverage because of pre-existing conditions or to limit the level of annual reimbursements for essential services — practices in the past which had left some patients facing financial ruin.

Under the Affordable Care Act, it will now be mandatory for any U.S. resident to enroll in a health care plan.

Failure to do so will be punishable by a $95 fine, a figure that will rise to $695 in 2014.

The economic reasoning of the legislation is that if everyone contributes to the system the premiums paid by healthy people should offset the additional costs associated with the U.S. citizens who are the most costly to insure.

In a significant first, the new legislation defines treatments that insurers must cover. All insurance must now include cover for hospitalizations, including emergencies.

And preventative care — such as screenings for diabetes or cancer, vaccines or contraception — should also be fully reimbursed.

“The new law is transformational for our entire health care system,” Health Secretary Kathleen Sebelius said Tuesday.

For the estimated 150 million Americans who are insured through their employers in the United States, where only the poorest and those over 65 are insured through Social Security, there will be little or no change.

However around 25 million people insured individually through private insurers without the benefit of group rates stand to benefit.

From now on, they will be able to browse and choose different plans from the federal government website Healthcare.gov, which is being used in 36 states.

Fourteen other states have created their own versions of the site.

The government has set a target enrolment figure of seven million people by the end of March 2014. So far 2.1 million individuals have signed up for insurance through the web portals.

The figure is way down on initial projections, something officials have blamed on the disastrous problems which paralyzed Healthcare.gov after its launch in October.

December witnessed a sharp acceleration in registrations as the system improved. Added to the 2.1 million who have registered are a further 3.9 million who are eligible for programs for the poor, including Medicaid.

The U.S. government has not disclosed how many of the six million beneficiaries of the new system were previously uninsured — a key number that will determine the success of the reforms.

In total, around 50 million Americans are living without health insurance.

Observers are also waiting to see if young adults will enrol in the scheme, something which is crucial to its success.

Tony Carrk, of the left-leaning Center for American Progress think tank, said he expected young people would sign up as the March 31 deadline loomed.

“What we know from prior experiences with Massachusetts, the young people are most likely going to wait until March to sign up, toward the end,” Carrk told AFP, referring to a universal health care plan introduced in 2006.

Despite the ushering in of the legislation on Wednesday, Republicans remain violently opposed to the reforms, which have led to higher premiums for some middle-class voters who are too well off to qualify for available tax credits. The issue is already looming large in the build-up to mid-term elections later in 2014.

Meanwhile, government officials acknowledge that the opening days of the new health care era could be marked by confusion in medical offices and hospitals with some policyholders still awaiting insurance cards and computer systems not yet fully operational.

“We have to work very hard to make sure the next few days go well,” senior White House advisor Phil Schiliro said during Tuesday’s conference call.

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Eric Holder

The failure of major federal voting rights legislation in the Senate has left civil rights advocates saying they are determined to keep fighting—including by suing in battleground states. But the little bipartisan consensus that exists on election reform would, at best, lead to much narrower legislation that is unlikely to address state-level GOP efforts now targeting Democratic blocs.

“This is the loss of a battle, but it is not necessarily the loss of a war, and this war will go on,” Eric Holder, the former U.S. attorney general and Democrat, told MSNBC, saying that he and the Democratic Party will be suing in states where state constitutions protect voting rights. “This fight for voting rights and voter protection and for our democracy will continue.”

“The stakes are too important to give up now,” said Damon Hewitt, president and executive director of the Lawyers’ Committee for Civil Rights Under Law, which for years has operated an Election Day hotline to help people vote. “Our country cannot claim to be free while allowing states to legislate away that freedom at will.”

In recent weeks, as it became clear that the Senate was not going to change its rules to allow the Freedom to Vote Act and the John Lewis Voting Rights Advancement Act to pass with a simple majority, there have been efforts by some lawmakers, election policy experts, and civil rights advocates to identify what election reforms could pass the Senate.

“There are several areas… where I think there could be bipartisan consensus,” said David Becker, executive director of the Center for Election Innovation and Research, in a briefing on January 20. “These areas are all around those guardrails of democracy. They are all about ensuring that however the voters speak that their voice is heard… and cannot be subverted by anyone in the post-election process.”

Becker cited updating the 1887 Electoral Count Act, which addressed the process where state-based slates of presidential electors are accepted by Congress. (In recent weeks, new evidence has surfaced showing that Donald Trump’s supporters tried to present Congress with forged certificates as part of an effort to disrupt ratifying the results on January 6, 2021.) Updating that law could also include clarifying which state officials have final authority in elections and setting out clear timetables for challenging election results in federal court after Election Day.

Five centrist Washington-based think tanks issued a report on January 20, Prioritizing Achievable Federal Election Reform, which suggested federal legislation could codify practices now used by nearly three-quarters of the states. Those include requiring voters to present ID, offering at least a week of early voting, allowing all voters to request a mailed-out ballot, and allowing states to start processing returned absentee ballots a week before Election Day.

But the report, which heavily drew on a task force of 29 state and local election officials from 20 states convened by Washington’s Bipartisan Policy Center, was notable in what it did not include, such as restoring the major enforcement section of the Voting Rights Act of 1965, which was removed by the U.S. Supreme Court in 2013. It did not mention the Electoral Count Act nor growing threats to election officials from Trump supporters.

“This won’t satisfy all supporters of the Freedom to Vote Act, but this is a plausible & serious package of reforms to make elections more accessible and secure that could attract bipartisan support,” tweeted Charles Stewart III, a political scientist and director of the MIT Election Data and Science Lab. “A good starting point.”

The reason the centrist recommendations won’t satisfy civil rights advocates is that many of the most troubling developments since the 2020 election would likely remain.

Targeting Battleground States

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Former president Donald Trump

By Rami Ayyub and Alexandra Ulmer

(Reuters) -The prosecutor for Georgia's biggest county on Thursday requested a special grand jury with subpoena power to aid her investigation into then-President Donald Trump's efforts to influence the U.S. state's 2020 election results.

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