'Our Singapore Conversation' reaches out to nearly 10,000 S'poreans so far

SINGAPORE: The 'Our Singapore Conversation' initiative has reached out to nearly 10,000 Singaporeans so far.

Speaking to the media, Chairman of the 'Our Singapore Conversation' and Education Minister Heng Swee Keat said this is quite a significant number over a three-month period and this has been done through multiple platforms.

These include face-to-face interactions, online media and also with Singaporeans in the US, Britain and China.

The New Year will see the launch of the Conversation's next phase of engagement of the citizenry.

Mr Heng said the team plans to act on some of the ideas that have already emerged especially which can be done immediately. One example is the discussion on extending MediShield coverage to include congenital and neonatal conditions.

Mr Heng said this topic has been raised in the 'Our Singapore Conversation' sessions, which he said he strongly supports including them in the MediShield coverage.

In the meantime, he said that three broad themes have emerged under the categories of hope, heart and home.

In the area of "hope", there has been interest in ways to keep Singapore vibrant, create opportunities for individuals to fulfil their career aspirations and non-career aspirations.

The second area relates to "heart" where discussions have been focused on how Singaporeans can care for each other and those who are vulnerable, those with special needs and the elderly. There has also been discussions on the need for the right policies and programmes to reach out to this group.

Mr Heng said the third area is the topic of Singapore as "Home" where the need to create the sense of community and bonding and the kampong spirit has been discussed by the participants. There has also been a lot of discussion about the Singapore identity, the values and culture. "There is an interesting theme of Singapore as 'Home' that appeals to us and at the same time maintaining our important social fabric of a multi-racial, multi-cultural and multi-religious society."

For the new year, the 'Our Singapore Conversation' will continue with discussions in the open-ended format in January with a few more sessions.

The team plans to take a break and resume at the end of February to delve into the specific under the broad themes.

"For example in the area of education, we can talk about not just education specifically but how education provides opportunities, how do we provide hope and opportunities and I think to have a rich conversation about that we need to bring in not just parents and students but also members of the public, employers to see how the entire education system can help us create opportunities and hope," he explained.

Mr Heng added that the ideas coming out from 'Our Singapore Conversation' initiative provide inputs for the public service to examine some of the existing policies.

Information from the different sessions are collated and fed back to the different ministries so that they can look at the ideas, concerns and aspirations.

He is confident that if the 'Our Singapore Conversation' initiative is done well, the result would be better policies and programmes for Singapore. Mr Heng however added that it was not possible for every idea to be implemented.

- CNA/ck

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Section 66A of IT Act undemocratic: RS MPs

NEW DELHI: In a passionate debate on section 66A of the IT Act in the Upper House on Friday, several MPs strongly supported the amendment of the section. Most called it " anti-democratic"; one MP from Karnataka even called it an instance of " legislative terrorism". The resolution for amendment of section 66A was moved by CPM MP from Kerala, P Rajeeve. The Union minister for Communications and Information Technology Kapil Sibal is expected to respond when the House reconvenes next week.

MPs such as Gyan Prakash Pilania of the BJP, D. Bandyopadhyay of the AITC and Baishnab Parida of the BJD, Narendra Kumar Kashyap of the BSP and Basavaraj Patil of the BJP supported the resolution. INC MP from Odisha Rama Chandra Khuntia partially supported the motion, differing on the point of reducing the scope to one-to-one communication. Goa MP Shantaram Naik of INC opposed the resolution, saying misuse of a law isn't strong enough reason to scrap or amend it.

P Rajeeve questioned the distinction between print, visual and new media (internet) when it came to freedom of speech. "Most print and visual media have published cartoons, stories or editorials that are more critical than online content. But they are not booked. Why is this not allowed to new media?"

As for Sibal's position of putting in place guidelines when enforcing 66A, Rajeeve said that the guidelines were in contravention of the parent Act. According to Sibal's proposed guidelines, a complaint can be registered only after authorization of the Inspector General of Police or the Director General of Police. Sections 78 and 80 of the IT Act allow any police officer "not below the rank of Deputy Superintendent of Police" to investigate and make arrests. "These guidelines do not have the force of law," said Rajeeve.

Rajeeve also pointed out how the bill was passed without discussion. "The bill was passed in seven minutes on 23 December 2008 -- the last day of the winter session -- without any discussion," he said. He further noted how the jail terms for the same offences, such as defamation, causing nuisance etc, were longer under the IT Act than under the Indian Penal Code (IPC).

During question hour, Sibal had defended the current shape of the law by citing the US and the UK laws that deal with internet governance. Responding to that, Rajeeve called the drafting of the Indian Act a "poor cut and paste exercise". He quoted parts of the Indian Act that were verbatim taken from the UK ones before pointing out one difference. "It is important to note that it (the UK law) deals with information sent from one person to another," said Rajeeve, adding that hence, it was not applicable in social media where the act has been invoked in India so far.

Independent MP Rajeev Chandrasekhar recommended that "reducing the scope of Section 66A to direct communications would make it less prone to misuse."

Both ministers also quoted from the archaic Indian Post Office Act which prohibits sending by post materials of "grossly offensive character," a phrase that has come in for scrutiny for vagueness within the IT Act as well. "The big difference between Section 20 (b) of the IPO Act and Section 66A of the IT Act is that the former is clearly restricted to one-to-one communication, as is the case of almost all the international precedents being referred to by the Hon'ble Minister," said Chandrasekhar.

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Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

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Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

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Conn. Shooter Adam Lanza: 'Obviously Not Well'

Adam Lanza of Newtown, Connecticut was a child of the suburbs and a child of divorce who at age 20 still lived with his mother.

This morning he appears to have started his day by shooting his mother Nancy in the face, and then drove her car to nearby Sandy Hook Elementary School, armed with two handguns and a semi-automatic rifle.

There, before turning his gun on himself, he shot and killed 20 children, who President Obama later described as "beautiful little kids" between five and 10 years of age. Six adults were also killed at the school. Nancy Lanza was found dead in her home.

A relative told ABC News that Adam was "obviously not well."

Family friends in Newtown also described the young man as troubled and described Nancy as rigid. "[Adam] was not connected with the other kids," said Barbara Frey, who also said he was "a little bit different ... Kind of repressed."

State and federal authorities believe his mother may have once worked at the elementary school where Adam went on his deadly rampage, although she was not a teacher, according to relatives, perhaps a volunteer.

Nancy and her husband Peter, Adam's father, divorced in 2009. When they first filed for divorce in 2008, a judge ordered that they participate in a "parenting education program."

Peter Lanza, who drove to northern New Jersey to talk to police and the FBI, is a vice president at GE Capital and had been a partner at global accounting giant Ernst & Young.

Adam's older brother Ryan Lanza, 24, has worked at Ernst & Young for four years, apparently following in his father's footsteps and carving out a solid niche in the tax practice. He too was interviewed by the FBI. Neither he nor his father is under any suspicion.

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"[Ryan] is a tax guy and he is clean as a whistle," a source familiar with his work said.

Police had initially identified Ryan as the killer. Ryan sent out a series of Facebook posts saying it wasn't him and that he was at work all day. Video records as well as card swipes at Ernst & Young verified his statement that he had been at the office.

Two federal sources told ABC News that identification belonging to Ryan Lanza was found at the scene of the mass shooting. They say that identification may have led to the confusion by authorities during the first hours after the shooting. Neither Adam nor Ryan has any known criminal history.

A Sig Sauer handgun and a Glock handgun were used in the slaying and .223 shell casings – a round used in a semi-automatic military-style rifle -- were also found at the scene. Nancy Lanza had numerous weapons registered to her, including a Glock and a Sig Sauer. She also owned a Bushmaster rifle -- a semi-automatic carbine chambered for a .223 caliber round. However, federal authorities cannot confirm that the handguns or the rifle were the weapons recovered at the school.

Numerous relatives of the Lanzas in New Jersey, Connecticut, Massachusetts, as well as multiple friends, are being interviewed by the FBI in an effort to put together a better picture of the gunman and any explanation for today's tragedy.

"I think the most important thing to point out with this kind of individual is that he did not snap this morning and decide to act out violently," said former FBI profiler Mary Ellen O'Toole. "These acts involve planning and thoughtfulness and strategizing in order to put the plan together so what may appear to be snap behavior is not that at all."

With reporting by Pierre Thomas, Jim Avila, Santina Leuci, Aaron Katersky, Matthew Mosk, Jason Ryan and Jay Shaylor

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With successful launch, Kim and allies cement rule in North Korea

SEOUL (Reuters) - When North Korea's Kim Jong-un commemorates a year of his rule next week, he will be able to declare he has fulfilled the country's long-held dream of becoming a "space power".

Sharing the limelight with the 29-year old will be three civilians who have grown stronger in the past year and have helped Kim exert control over the country's powerful military, which may be an advantage in edging the country closer to an attempt to reopen dialogue with the United States.

Wednesday's successful rocket launch, in which North Korea put a satellite in space for the first time, may have helped cement the position of Kim's uncle Jang Song-thaek and Choe Ryong-hae, the military's top political strategist, as well as Ju Kyu-chang, the 84-year-old head of the country's missile and nuclear program.

"The rocket launch is a boost politically to the standing of Jang Song-thaek and Choe Ryong-hae, who have been around Kim Jong-un," said Baek Seung-joo of the Korea Institute of Defense Analyses, a government-affiliated think tank in South Korea.

While Washington has condemned the rocket launch and called for tougher sanctions on North Korea it was, as recently as February, willing to offer food aid to Pyongyang. At that time it was just over a year since the North shelled a South Korean island, killing civilians, and sank a South Korean warship.

The rise of Jang and Chae especially, once ridiculed as "fake" military men by army veterans, together with the country's aging chief missile bureaucrat, could also mean the renegade state will try its hand at using what is now stronger leverage in negotiations to extract aid and concessions.

Jang is the brother-in-law of Kim Jong-il and was the chief promoter of his son Kim Jong-un when the elder Kim died on December 17 last year. Jang has further increased his prominence in recent weeks with high-level public appearances, at times in unprecedented proximity to the leader of a country where appearance and formality are rigidly controlled.

Jang accompanied Kim to the rocket command centre to watch the successful launch on Wednesday, the North's state news agency KCNA said.

He is officially a vice chairman of the ruling National Defence Commission and an army general in name only, but is widely believed to be the North's second-in-command in reality.

Jang is considered a pragmatist who is willing to engage both allies and enemies abroad, but also one who understands the challenge of cementing the position of the young and relatively untested grandson of the state's founder.

Baek noted that comments by the North's Foreign Ministry, customarily the channel used by the leadership to wage war of words with the United States, had been tempered recently, indicating Pyongyang may seek a way back into negotiations.

"The North may start to send active indications to the United States and China that it is willing to talk, even to go back to the six-party talks, and to say that its pledge for a missile test moratorium still stands," Baek said.

The six-party talks are aimed at halting North Korea's nuclear program and involve the North, the United States, China, Japan, Russia and South Korea. They have been held since 2003 but have stalled since 2008.

CIVILIANS IN MILITARY GARB

Choe is another Workers' Party faithful now donning army uniform. He is head of the General Political Department of the North's 1.2-million strong Army, and is seen as the other major beneficiary of this week's rocket launch.

Jang and Choe are anomalies in a country that claims its roots in the armed struggle against Japan, in that they have not risen through the army's ranks but have received military titles that are said to be a source of ridicule among their opponents.

"Choe and Jang will benefit from the launch because they are the ones who will have undermined the military's influence and strengthened the party's status," said Moon Hong-sik of South Korea's Institute for National Security Strategy, a government-linked thinktank.

The surprise success of Wednesday's launch after a failure in April will be credited to Jang and Choe while Kim will boost his credibility as a leader who gets the job done, said Suh Choo-suk, who was chief national security advisor to former South Korean President Roh Moo-hyun.

"I think Kim Jong-un's overall control is already solid. His control will be even stronger through the rocket launch."

The technical aspects of the North's longstanding missile program and possibly its nuclear project are led by a quiet and elderly engineer Ju Kyu-chang, another civilian in army garb.

Ju has been around since the North first tested its long-range missile technology in the summer of 1998 and is still believed to be in charge of the day-to-day running of the project to develop missiles and possibly nuclear weapons.

Recognition appears to have come relatively late in life for the silver haired technocrat Ju, who is believed to have trained as a metal alloy specialist, as he started to appear in public with the country's top leader only when he turned 70.

Officially, Ju is the head of the ruling Workers' Party of Korea's oddly named Machine-Building Industry Department. He was also named to the National Defence Commission, the country's top military body, after the North's 2009 long-range missile test.

Ju is among the North's most heavily sanctioned individuals, personally named in several government blacklists.

"His rise coincided with the escalation of pace in the North's missile and nuclear programs," said an expert with a South Korean state-run think tank who did not want to be named.

"It could very well have been as a reward for his contribution."

(Additional reporting by Narae Kim; Editing by David Chance and Raju Gopalakrishnan)

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Thai "Red Shirt" protest leaders go on trial

BANGKOK: A trial against Thai leaders of the 2010 "Red Shirt" protests began on Friday, a day after the nation's former premier was charged over his role in the deadly unrest.

The 24 accused, who include five current lawmakers, could in theory face the death penalty in the case, which was delayed again on Thursday because of the absence of key witnesses.

All but one defendant was present at Bangkok Criminal Court on Friday, according to an AFP reporter at the court.

About 90 people were killed and nearly 1,900 were wounded in a series of street clashes between demonstrators and security forces, which culminated in a bloody military crackdown in May 2010. Two foreign journalists were among those killed.

The Red Shirt leaders, most of whom surrendered to police after the government sent in armoured vehicles and troops firing live rounds, have vowed to prove their innocence.

Key Red Shirt leader Jatuporn Prompan on Thursday told reporters at the court that the group would "fight the case to the end".

"But people of every political group should be granted an amnesty," he said.

Former premier Abhisit Vejjajiva, who was Thai prime minister during the anti-government rallies, and his then-deputy Suthep Thaugsuban were charged with murder on Thursday over the death of a taxi driver shot by soldiers during the violence.

They are the first officials to face court over the violence in Thailand. The pair have denied the allegation.

The Red Shirts -- mostly supporters of ousted premier Thaksin Shinawatra -- were demanding immediate elections in their 2010 protest.

They accused Abhisit's government of being undemocratic because it took office in 2008 through a parliamentary vote after a court stripped Thaksin's allies of power.

Polls in 2011 brought Thaksin's Red Shirt-backed Puea Thai party to power with his sister Yingluck as premier, sweeping Abhisit into opposition.

The accused Red Shirt leaders pleaded not guilty in August 2010. Their trial is expected to last months or even years because hearings can only be held when parliament is not in session as sitting lawmakers have immunity.

- AFP/xq

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Granite scam: Durai Dayanidhi surrenders before Madurai court

MADURAI: Union Minister MK Alagiri's son Durai Dayanidhi on Friday surrendered at a Madurai court three days after being granted anticipatory bail in connection with the multi-crore granite scam by the Madras High Court.

Durai has been on the run since August this year after his involvement in the illegal granite scam came to light.

On Monday, Justice C.T. Selvam of the Madurai bench of the court directed Dayanidhi to surrender his passport and also to appear daily at the Melur police station in Madurai district, where the case is registered against him, until further orders.

On August 7, cases were registered against 10 persons, including Durai Dayanidhi, charging companies owned by them with mining sand and granite without permission.

The action came close on the heels of a detailed survey of 175 granite quarrying sites by the district administration on a report by former District Collector U Sagayam, estimating loss to the state exchequer by illegal quarrying at Rs16,338 crore.

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Study: People worldwide living longer, but sicker

LONDON (AP) — Nearly everywhere around the world, people are living longer and fewer children are dying. But increasingly, people are grappling with the diseases and disabilities of modern life, according to the most expansive global look so far at life expectancy and the biggest health threats.

The last comprehensive study was in 1990 and the top health problem then was the death of children under 5 — more than 10 million each year. Since then, campaigns to vaccinate kids against diseases like polio and measles have reduced the number of children dying to about 7 million.

Malnutrition was once the main health threat for children. Now, everywhere except Africa, they are much more likely to overeat than to starve.

With more children surviving, chronic illnesses and disabilities that strike later in life are taking a bigger toll, the research said. High blood pressure has become the leading health risk worldwide, followed by smoking and alcohol.

"The biggest contributor to the global health burden isn't premature (deaths), but chronic diseases, injuries, mental health conditions and all the bone and joint diseases," said one of the study leaders, Christopher Murray, director of the Institute of Health Metrics and Evaluation at the University of Washington.

In developed countries, such conditions now account for more than half of the health problems, fueled by an aging population. While life expectancy is climbing nearly everywhere, so too are the number of years people will live with things like vision or hearing loss and mental health issues like depression.

The research appears in seven papers published online Thursday by the journal Lancet. More than 480 researchers in 50 countries gathered data up to 2010 from surveys, censuses and past studies. They used statistical modeling to fill in the gaps for countries with little information. The series was mainly paid for by the Bill & Melinda Gates Foundation.

As in 1990, Japan topped the life expectancy list in 2010, with 79 for men and 86 for women. In the U.S. that year, life expectancy for men was 76 and for women, 81.

The research found wide variations in what's killing people around the world. Some of the most striking findings highlighted by the researchers: — Homicide is the No. 3 killer of men in Latin America; it ranks 20th worldwide. In the U.S., it is the 21st cause of death in men, and in Western Europe, 57th.

— While suicide ranks globally as the 21st leading killer, it is as high as the ninth top cause of death in women across Asia's "suicide belt," from India to China. Suicide ranks 14th in North America and 15th in Western Europe.

— In people aged 15-49, diabetes is a bigger killer in Africa than in Western Europe (8.8 deaths versus 1 death per 100,000).

— Central and Southeast Asia have the highest rates of fatal stroke in young adults at about 15 cases per 100,000 deaths. In North America, the rate is about 3 per 100,000.

Globally, heart disease and stroke remain the top killers. Reflecting an older population, lung cancer moved to the 5th cause of death globally, while other cancers including those of the liver, stomach and colon are also in the top 20. AIDS jumped from the 35th cause of death in 1990 to the sixth leading cause two decades later.

While chronic diseases are killing more people nearly everywhere, the overall trend is the opposite in Africa, where illnesses like AIDS, malaria and tuberculosis are still major threats. And experts warn again shifting too much of the focus away from those ailments.

"It's the nature of infectious disease epidemics that if you turn away from them, they will crop right back up," said Jennifer Cohn, a medical coordinator at Doctors Without Borders.

Still, she acknowledged the need to address the surge of other health problems across Africa. Cohn said the agency was considering ways to treat things like heart disease and diabetes. "The way we treat HIV could be a good model for chronic care," she said.

Others said more concrete information is needed before making any big changes to public health policies.

"We have to take this data with some grains of salt," said Sandy Cairncross, an epidemiologist at the London School of Hygiene and Tropical Medicine.

He said the information in some of the Lancet research was too thin and didn't fully consider all the relevant health risk factors.

"We're getting a better picture, but it's still incomplete," he said.

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Online:

www.lancet.com

http://healthmetricsandevaluation.org

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Health-Exchange Deadline Looms

All of the Affordable Care Act, also known as "Obamacare," doesn't go into effect until 2014, but states are required to set up their own health care exchanges or leave it to the federal government to step in by next year. The deadline for the governors' decisions is Friday.

The health insurance exchanges are one of the key stipulations of the new health care law. They will offer consumers an Internet-based marketplace for purchasing private health insurance plans.

But the president's signature health care plan has become so fraught with politics that whether governors agreed to set up the exchanges has fallen mostly along party lines.

Such partisanship is largely symbolic because if a state opts not to set up the exchange, the Department of Health and Human Services will do it for them as part of the federal program. That would not likely be well-received by Republican governors, either, but the law forces each state's chief executive to make a decision one way or the other.

Here's what it looks like in all 50 states and the District of Columbia:

20 states that have opted out -- N.J., S.C., La., Wis., Ohio, Maine, Ala., Alaska, Ariz., Ga., Pa., Kan., Neb., N.H., N.D., Okla., S.D., Tenn., Texas and Wyo.

Charles Dharapak/AP Photo

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Several Republican governors have said they will not set up the exchanges, including Chris Christie (N.J.), Nikki Haley (S.C.), Bobby Jindal (La.), Scott Walker (Wis.), John Kasich (Ohio), Paul LePage (Maine), Robert Bentley (Ala.), Sean Parnell (Ark.), Jan Brewer (Ariz.), Nathan Deal (Ga.), Tom Corbett (Pa.), Sam Brownback (Kan.), Dave Heineman (Neb.), John Lynch (N.H.), Jack Dalrymple (N.D.), Mary Fallin (Okla.), Dennis Daugaard (S.D.), Bill Haslam (Tenn.), Rick Perry (Texas), and Matt Mead (Wyo.).

3 States Out, but a Little More Complicated -- Mont., Ind. and Mo.

The Montana outgoing and incoming governors are both Democrats, but the Republican state legislature rejected the Democratic state auditor's request to start setting up a state exchange. So a federal exchange will be set up in Montana as well.

The Indiana outgoing and incoming governors are both Republicans and outgoing Gov. Mitch Daniels deferred the decision to governor-elect and U.S. Rep. Mike Pence, who said his preference is not to set up a state health care exchange, paving the way for the feds to come in too.

In Missouri, Gov. Jay Nixon is a Democrat, but Prop E passed on Nov. 6, which barred his administration from creating a state-based exchange without a public vote or the approval of the state legislature. After the election, he sent a letter to the Department of Health and Human Services saying he would be unable to set up a state-based exchange, meaning the federal government would have to set up its own.

1 State Waiting for the White House -- Utah

Utah already has a state exchange set up, a Web-based tool where small-business employees can shop and compare health insurance with contributions from their employee. In a letter Republican Gov. Gary Herbert sent to the White House Tuesday, he asked for its exchange, called Avenue H, to be approved as a state-based exchange under the Affordable Care Act as long as state officials can open it to individuals and larger businesses.

Norm Thurston, the state's health reform implementation coordinator, says authorities there "haven't received an official response" from the White House, but "we anticipate getting one soon."

There are some sticking points that don't comply with the exchanges envisioned by the Affordable Care Act and Utah would like to keep it that way.

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For North Korea, next step is a nuclear test

SEOUL (Reuters) - North Korea rattled the world on Wednesday by putting a satellite into orbit using the kind of technology that appears to demonstrate it can develop a missile capable of hitting the United States.

Its next step will likely be a nuclear test, which would be the third conducted by the reclusive and unpredictable state. Its 2009 test came on May 25, a month after a rocket launch.

For the North and its absolute ruler Kim Jong-un, the costs of the rocket program and its allied nuclear weapons efforts - estimated by South Korea's government at $2.8-$3.2 billion since 1998 - and the risk of additional U.N. or unilateral sanctions are simply not part of the calculation.

"North Korea will insist any sanctions are unjust, and if sanctions get toughened, the likelihood of North Korea carrying out a nuclear test is high," said Baek Seung-joo of the Korea Institute of Defense Analyses.

The United Nations Security Council is to discuss how to respond to the launch, which it says is a breach of sanctions imposed in 2006 and 2009 that banned the isolated and impoverished state from missile and nuclear developments in the wake of its two nuclear weapons tests.

The only surprise is that the Security Council appears to believe it can dissuade Pyongyang, now on its third hereditary ruler since its foundation in 1948, from further nuclear or rocket tests.

Even China, the North's only major diplomatic backer, has limited clout on a state whose policy of self reliance is backed up by an ideology that states: "No matter how precious peace is, we will never beg for peace. Peace lies at the end of the barrel of our gun".

As recently as August, North Korea showed it was well aware of how a second rocket launch this year, after a failed attempt in April, would be received in Washington.

"It is true that both satellite carrier rocket and (a) missile with warhead use similar technology," its Foreign Ministry said in an eight-page statement carried by state news agency KCNA on August 31.

"The U.S. saw our satellite carrier rocket as a long-range missile that would one day reach the U.S. because it regards the DPRK (Democratic Peoples Republic of Korea) as an enemy."

CASH IN EXCHANGED FOR COLDER WAR

The end-game for the North is a formal peace treaty with Washington, diplomatic recognition and bundles of cash to help bolster its moribund economy.

"They might hope that the U.S. will finally face the unpleasant reality and will start negotiations aimed at slowing down or freezing, but not reversing, their nuclear and missile programs," said Andrei Lankov, a North Korea expert at Kookmin University in Seoul.

"If such a deal is possible, mere cognition is not enough. The U.S. will have to pay, will have to provide generous 'aid' as a reward for North Koreans' willingness to slow down or stop for a while."

Recent commercially available satellite imagery shows that North Korea has rebuilt an old road leading to its nuclear test site in the mountainous in the northeast of the country. It has also shoveled away snow and dirt from one of the entrances to the test tunnel as recently as November.

At the same time as developing its nuclear weapons test site, the North has pushed ahead with what it says is a civil nuclear program.

At the end of November, the International Atomic Energy Agency (IAEA) said the construction of a light water reactor was moving ahead and that North Korea had largely completed work on the exterior of the main buildings.

North Korea says it needs nuclear power to provide electricity, but has also boasted of its nuclear deterrence capability and has traded nuclear technology with Syria, Libya and probably Pakistan, according to U.S. intelligence reports.

It terms its nuclear weapons program a "treasured sword".

The missile and the nuclear tests both serve as a "shop window" for Pyongyang's technology and Kookmin's Lankov adds that the attractions for other states could rise if North Korea carries out a test using highly enriched uranium (HEU).

In its two nuclear tests so far, the North has used plutonium of which it has limited stocks which fall further with each test. However it sits on vast reserves of uranium minerals, which could give it a second path to a nuclear weapon.

"An HEU-based device will have a great political impact, since it will demonstrate that North Korean engineers know how to enrich uranium, and this knowledge is in high demand among aspiring nuclear states," Lankov said.

(Editing by Raju Gopalakrishnan)

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