By STEVEN SLOAN

WASHINGTON (AP) — The president was barely a year into his administration when a health care debate began to consume Washington.

On Capitol Hill, partisan divides formed as many Democrats pressed for guaranteed insurance coverage for a broader swath of Americans while Republicans, buttressed by medical industry lobbying, warned about cost and a slide into communism.

The year was 1945, and the new Democratic president, Harry Truman, tried and failed to persuade Congress to enact a comprehensive national health care program, a defeat Truman described as the disappointment of his presidency that “troubled me the most.” Since then, 13 presidents have struggled with the same basic questions about the government’s role in health care, where spending now makes up nearly 18% of the U.S. economy.

The fraught politics of health care are on display again this month as millions of people face a steep rise in costs after the Republican-controlled Congress let Affordable Care Act subsidies expire.

While the subsidies are a narrow, if costly, slice of the issue, they’ve reopened long-festering grievances in Washington over the way health care is managed and the legacy of the ACA, the signature legislative achievement of President Barack Obama that was passed in 2010 without a single Republican vote.

“That’s the key thing that I’ve got to convince my colleagues to understand who hate Obamacare,” said Sen. Bernie Moreno, R-Ohio, who’s leading a bipartisan group of lawmakers discussing ways to extend some of the subsidies. “Let’s take two years to actually deliver for the American people truly affordable health care.”

Sen. Bernie Moreno, R-Ohio, center, talks with reporters as he walks through the Ohio Clock Corridor at the Capitol, Tuesday, Jan. 13, 2026, in Washington. (AP Photo/Rod Lamkey, Jr.)

Democrats have heard that refrain before and argue Republicans have had 15 years to offer an alternative. They believe the options being discussed now, which largely focus on allowing Americans to funnel money to health savings accounts, do little to address the cost of health care.

“They’ve had a lot of time,” said Rep. Steny Hoyer, the Maryland Democrat who was House majority leader during the ACA debate.

And with that, welcome back to the health care debate that never seems to end.

The challenge of reaching consensus

The often-tortured dynamics surrounding health care have remained remarkably consistent. Obamacare dramatically expanded coverage but remains — even in the minds of those who crafted the law — imperfect and more expensive than many would prefer.

And Washington seems more entrenched in stalemate rather than marching toward a solution.

FILE – U.S. Ambassador to Japan nominee Rahm Emanuel arrives for a hearing to examine his nomination before the Senate Foreign Relations Committee on Capitol Hill in Washington, Oct. 20, 2021. (AP Photo/Patrick Semansky, File)

“People hate the status quo, but they’re not too thrilled with change,” Rahm Emanuel said as he reflected on the arc of the health care debate that he has watched as a top aide to President Bill Clinton, chief of staff to Obama and Chicago mayor. “That’s the riddle to the politics of health care.”

Major reforms inevitably run into a health industry — a broad group of interests ranging from pharmaceutical and health services companies to hospitals and nursing homes — that spent more than $653 million on lobbying last year, according to OpenSecrets, which tracks political spending.

“Any time you try to figure out how to bring costs down, somebody thinks, ‘Uh oh, I’m about to get less,’” said Hoyer, who announced last week he won’t seek reelection after serving since 1981.

FILE -Rep. Steny Hoyer, D-Md., speaks at a news conference about the Protect Our Probationary Employees Act on Capitol Hill, March 11, 2025, in Washington. (AP Photo/Mark Schiefelbein, File)

When Obamacare was passed, opinion on the law was mixed, although views tended to be more positive than negative, according to KFF polling. But the law has steadily grown in popularity. A KFF poll conducted in September 2025 found about two-thirds of Americans have a favorable view of the ACA.

That’s put Trump and Republicans in a bind.

Trump’s ‘concepts of a plan’

Since the ACA’s passage, Republicans largely dedicated themselves to the law’s destruction. Trump issued social media posts calling for a repeal as early as 2011 and spoke in generalities during each of his presidential campaigns about delivering better coverage at lower cost. During his 2024 debate against Democratic rival Kamala Harris, he referred to “concepts of a plan.”

Under pressure to offer more specifics, Trump on Thursday outlined a proposal he dubbed “The Great Healthcare Plan.” The plan doesn’t repeal the ACA. But it would focus on lowering drug prices and providing options for Americans to send money directly to health savings accounts to bypass the federal government and handle insurance on their own. Democrats have rejected that as an insufficient way to cover high health care costs.

Throughout his second term, Trump has criticized Obamacare as unfairly subsidizing insurers, a point that could’ve been addressed had the legislation created a public option that would’ve competed alongside the private sector. Republicans — and a sizable number of Democrats — objected to that approach, arguing it would give the government an outsize role in health care.

But in a reminder that the past is never really over, a small group of Democrats is aiming to revive the debate over the public option, even if the prospects in a Republican-controlled Congress are dim. Sens. Sheldon Whitehouse of Rhode Island and Elissa Slotkin of Michigan and Rep. Jan Schakowsky of Illinois last week introduced legislation that would create a public health insurance option on the ACA exchanges.

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Last year, a record 24 million people were enrolled in the ACA, though fewer appear to be signing up this year as the expired subsidies make coverage more expensive. The Supreme Court has upheld the law, and Republicans have failed to repeal, replace or alter it dozens of times. In the most famous example, Sen. John McCain, an Arizona Republican, cast the deciding vote in 2018 to keep the legislation in place, underscoring the lack of an alternative by noting there was “no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens.”

Democrats successfully turned the repeal efforts into a rallying cry in the 2018 midterms and see an opportunity to do so again this year with the expired subsidies. Sen. Thom Tillis, R-N.C., who isn’t seeking reelection, has warned this moment could be even more perilous for Republicans because, unlike the subsidies, voters didn’t lose anything during the 2018 debate.

“Us failing to put something else in place did not create this cliff,” Tillis said. “That’s the fundamental difference in an election year.”

ACA veterans acknowledge challenges

Even those who crafted the ACA concede the health care system created in its wake has problems. Former Sen. Max Baucus, a Montana Democrat who was among the bill’s architects as chair of the finance committee, acknowledged “nothing is perfect,” pointing to high health care costs.

FILE – Sen. Max Baucus, D-Mont., enters the Speaker’s office for a meeting about tax cuts on Capitol Hill in Washington, Dec. 1, 2010.(AP Photo/Alex Brandon, File)

“Bending the cost curve, that has not bent as much as we’d like,” he said.

That’s in part why some Republicans have expressed openness to a deal on subsidies. They see it less as an endorsement of the ACA than a bridge that would give lawmakers time to address more complex issues.

“We need to get to a long-term solution,” said Rep. Don Bacon, R-Neb.

Veterans of past health care negotiations, however, are skeptical that lawmakers can produce anything meaningful without the type of in-depth negotiations that led up to the ACA.

“It takes a long time to figure all this out,” Baucus said.

Asked whether he’s studied that history as he dives into the next chapter of health care talks, Moreno noted that he’s only been in Congress for a year.

“I don’t know s—-,” he said. “What that means is I don’t have scars.”

Associated Press writers Amelia Thomson-DeVeaux in Washington and Ali Swenson in New York contributed.

By ANNIKA HAMMERSCHLAG

CARLSBAD, Calif. (AP) — Some four miles off the Southern California coast, a company is betting it can solve one of desalination’s biggest problems by moving the technology deep below the ocean’s surface.

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OceanWell’s planned Water Farm 1 would use natural ocean pressure to power reverse osmosis — a process that forces seawater through membranes to filter out salt and impurities — and produce up to 60 million gallons (nearly 225 million liters) of freshwater daily. Desalination is energy intensive, with plants worldwide producing between 500 and 850 million tons of carbon emissions annually — approaching the roughly 880 million tons emitted by the entire global aviation industry.

OceanWell claims its deep sea approach — 1,300 feet (400 meters) below the water’s surface — would cut energy use by about 40% compared to conventional plants while also tackling the other major environmental problems plaguing traditional desalination: the highly concentrated brine discharged back into the ocean, where it can harm seafloor habitats, including coral reefs, and the intake systems that trap and kill fish larvae, plankton and other organisms at the base of the marine food web.

“The freshwater future of the world is going to come from the ocean,” said OceanWell CEO Robert Bergstrom. “And we’re not going to ask the ocean to pay for it.”

It’s an ambitious promise at a time when the world desperately needs alternatives. As climate change intensifies droughts, disrupts rainfall patterns and fuels wildfires, more regions are turning to the sea for drinking water. For many countries, particularly in the arid Middle East, parts of Africa and Pacific island nations, desalination isn’t optional — there simply isn’t enough freshwater to meet demand. More than 20,000 plants now operate worldwide, and the industry has been expanding at about 7% annually since 2010.

“With aridity and climate change issues increasing, desalination will become more and more prevalent as a key technology globally,” said Peiying Hong, a professor of environmental science and engineering at King Abdullah University of Science and Technology in Saudi Arabia.

But scientists warn that as desalination scales, the cumulative damage to coastal ecosystems — many already under pressure from warming waters and pollution — could intensify.

A search for solutions

Some companies are powering plants with renewable energy, while others are developing more efficient membrane technology to reduce energy consumption. Still others are moving the technology underwater entirely. Norway-based Flocean and Netherlands-based Waterise have tested subsea desalination systems and are working toward commercial deployment. Beyond southern California, OceanWell has signed an agreement to test its system in Nice, France — another region facing intensifying droughts and wildfires — beginning this year.

For now, its technology remains in development. A single prototype operates in the Las Virgenes Reservoir where the local water district has partnered with the company in hopes of diversifying its water supply. If successful, the reverse osmosis pods would eventually float above the sea floor in the Santa Monica Bay, anchored with minimal concrete footprint, while an underwater pipeline would transport freshwater to shore. The system would use screens designed to keep out even microscopic plankton and would produce less concentrated brine discharge.

Gregory Pierce, director of UCLA’s Water Resources Group, said deep sea desalination appears promising from an environmental and technical standpoint, but the real test will be cost.

“It’s almost always much higher than you project” with new technologies, he said. “So that, I think, will be the make or break for the technology.”

Las Virgenes Reservoir serves about 70,000 residents in western Los Angeles County. Nearly all the water originates in the northern Sierra Nevada and is pumped some 400 miles (640 kilometers) over the Tehachapi Mountains — a journey that requires massive amounts of energy. During years of low rainfall and snowpack in the Sierra, the reservoir and communities it serves suffer.

California’s desalination dilemma

About 100 miles (160 kilometers) down the coast, the Carlsbad Desalination Plant has become a focal point in the state’s debate over desalination’s environmental tradeoffs.

The plant came online in 2015 as the largest seawater desalination facility in North America. Capable of producing up to 54 million gallons (204 million liters) of drinking water daily, it supplies about 10% of San Diego County’s water — enough for roughly 400,000 households.

In Southern California, intensifying droughts and wildfires have exposed the region’s precarious water supply. Agricultural expansion and population growth have depleted local groundwater reserves, leaving cities dependent on imported water. San Diego imports roughly 90% of its supply from the Colorado River and Northern California — sources that are becoming increasingly strained by climate change. Desalination was pitched as a solution: a local, drought-proof source of drinking water drawn from the Pacific Ocean.

But environmental groups have argued the plant’s seawater intake and brine discharge pose risks to marine life, while its high energy demands drive up water bills and worsen climate change. Before the plant came online, environmental organizations filed more than a dozen legal challenges and regulatory disputes. Most were dismissed but some resulted in changes to the project’s design and permits.

“It sucks in a tremendous amount of water, and with that, sea life,” said Patrick McDonough, a senior attorney with San Diego Coastkeeper, which has participated in multiple legal challenges to the project. “We’re not just talking fish, turtles, birds, but larvae and spores — entire ecosystems.”

A 2009 Regional Water Quality Control Board order estimated the plant would entrap some 10 pounds (4.5 kilograms) of fish daily and required offsetting those impacts by restoring wetlands elsewhere. Seventeen years later, that restoration remains incomplete. And a 2019 study found the plant’s brine discharge raises offshore salinity above permitted levels, though it detected no significant biological changes — likely because the site had already been heavily altered by decades of industrial activity from a neighboring power plant.

Those impacts are especially acute in California, where roughly 95% of coastal wetlands have been lost largely to development, leaving the remaining lagoons as vital habitats for fish and migratory birds.

“When we start messing with these very critical and unfortunately sparse coastal lagoons and wetlands, it can have tremendous impacts in the ocean,” McDonough said.

Michelle Peters, chief executive officer of Channelside Water Resources, which owns the plant, said the facility uses large organism exclusion devices and one-millimeter screens to minimize marine life uptake, though she acknowledged some smaller species can still pass through.

The plant dilutes its brine discharge with additional seawater before releasing it back into the ocean, and years of monitoring have shown no measurable impacts to surrounding marine life, she said.

Peters said the Carlsbad plant has significantly cut its energy consumption through efficiency improvements and operates under a plan aimed at making the facility carbon net-neutral.

Many experts say water recycling and conservation should come first, noting wastewater purification typically uses far less energy than seawater desalination and can substantially reduce impacts on marine life. Las Virgenes is pursuing a wastewater reuse project alongside its desalination partnership.

“What we are looking for is a water supply that we can count on when Mother Nature does not deliver,” Las Virgenes’ Pedersen said. “Developing new sources of local water is really a critical measure to be more drought and climate ready.”

Follow Annika Hammerschlag on Instagram @ahammergram.

The Associated Press receives support from the Walton Family Foundation for coverage of water and environmental policy. The AP is solely responsible for all content. For all of AP’s environmental coverage, visit https://apnews.com/hub/climate-and-environment

Public meetings are planned for road improvement projects for Minnesota Highway 280 from Interstate 94 in St. Paul to Minnesota Highway 36/Interstate 35W in Roseville.

The work — which will involve a closure of that section of the highway later this year — is scheduled to begin in April of 2026.

State Department of Transportation officials will host an in-person meeting from 5 to 7 p.m. on Wednesday, Jan. 21 at the CASE building atrium, located at 767 Eustis St. N, St. Paul. Those attending will learn about the project and can ask questions. No formal presentation is planned and those interested can stop by at any time.

Also, a virtual meeting is planned from 6 to 7 p.m. on Tuesday, Feb. 3. This meeting will include a presentation and those attending can ask questions. A link to register for the virtual meeting is available on the MnDOT project website.

Starting in April through fall of 2026, MnDOT will resurface that section of the highway as well as repair bridges, ramps, drainage and make additional improvements to make for a smoother, safer ride, according to MnDOT officials.

Closure of MN 280 from I-94 to MN 36/I-35W

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MN 280 from St. Paul to Roseville to fully close for portion of 2026

Motorists can expect a full closure of 280 from Interstate 94 to Highway 36/Interstate 35W in 2026. The will allow crews to handle construction quickly and safely.

That section of highway will reopen before the start of the State Fair in late August. After the State Fair, state officials say they will make efforts to limit traffic impacts to lane closures through the fall of 2026.

In the spring of 2028, MnDOT will continue to repair bridges and work on accessibility improvements. For more information go to mndot.gov/metro/projects/hwy280stpaul-roseville.

By JON GAMBRELL

DUBAI, United Arab Emirates (AP) — The nationwide protests challenging Iran’s theocracy appeared increasingly smothered Thursday, a week after authorities shut the country off from the world and escalated a bloody crackdown that activists say has killed at least 2,637 people.

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The prospect of U.S. retaliation for the deaths of protesters still hung over the region, though President Donald Trump signaled a possible de-escalation, saying the killing appeared to be ending.

Meanwhile, the U.S. announced new sanctions on Iranian officials accused of suppressing the protests, which began late last month over the country’s faltering economy and the collapse of its currency. The Group of Seven industrialized democracies and the European Union said they too were looking at new sanctions to ratchet up the pressure on Iran’s theocratic government.

The U.N. Security Council scheduled an emergency meeting on Iran for Thursday afternoon at the request of the United States.

In Iran’s capital, Tehran, witnesses said recent mornings showed no new signs of bonfires lit the night before or debris in the streets. The sound of gunfire, which had been intense for several nights, has also faded.

Iranian state media has announced wave after wave of arrests by authorities, targeting those it calls “terrorists” while also apparently looking for Starlink satellite internet dishes, which offer the only way to get videos and images out to the internet.

“Since Jan. 8, we saw a full-fledged war, and anybody who was in the gathering since then is a criminal,” said Justice Minister Amin Hossein Rahimi, according to a report Wednesday from the judiciary’s Mizan news agency.

Iranian state media broadcast a roster of damage from what it called a “terrorist operation,” including damage to hundreds of stores and public buildings, scores of cars and ambulances and several “heritage sites.” including mosques and shrines.

China’s foreign ministry said Iranian Foreign Minister Abbas Araghchi told his Chinese counterpart that the situation in the country was now stable.

But as Iran tries to assert control at home, it has signaled worries about threats from abroad, including the United States, which has threatened military action over the killing of peaceful demonstrators. Tensions soared after Trump’s comment Tuesday that “help is on its way” to Iranian protesters.

The Islamic Republic shut down its airspace for hours early Thursday without explanation, something it has done in previous rounds of attacks between it and Israel, as well as during the 12-day war in June. The U.S. also took steps to move some personnel from Qatar’s Al Udeid Air Base while warning diplomats in Kuwait to stay away from military bases where American troops are stationed. Britain closed its Tehran embassy and withdrew British staff from Iran.

Airspace shut

The airspace closure lasted for over four hours, according to pilot guidance issued by Iran, which lies on a key east-west flight route. International carriers diverted north and south around Iran, but after one extension, the closure appeared to have expired, and several domestic flights were in the air just after 7 a.m.

Even before the closure, several international airlines had reduced or suspended services to Iran, “and most carriers are avoiding Iranian airspace,” said the website SafeAirspace, which provides information on conflict areas and air travel. “The situation may signal further security or military activity, including the risk of missile launches or heightened air defense, increasing the risk of misidentification of civil traffic.”

In the past, Iran has misidentified a commercial aircraft as a hostile target. In 2020, Iranian air defense shot down Ukraine International Airlines Flight PS752 with two surface-to-air missiles, killing all 176 people on board.

Iran protests spark reaction abroad

Videos of demonstrations have stopped coming out of Iran, likely signaling the slowdown of their pace under the heavy security force presence in major cities. In the meantime, protests against Iran have been held around the world as global attention has focused on the crackdown.

Trump made a series of statements that left unclear what action, if any, the U.S. would take. In comments to reporters Wednesday, Trump said he had been told that plans for executions in Iran have stopped, without providing many details. On Thursday he hailed as “good news” reports that a protester’s death sentence had been lifted.

Araghchi, Iran’s foreign minister, also sought to tone down the rhetoric, urging the U.S. to find a solution through negotiation.

Asked by Fox News what he would say to Trump, Araghchi said: “My message is: Between war and diplomacy, diplomacy is a better way, although we don’t have any positive experience from the United States. But still diplomacy is much better than war.”

Activists warned that hangings of detainees could come soon, though Araghchi said “there is no plan for hanging.”

The change in tone by the U.S. and Iran emerged hours after the chief of the Iranian judiciary said the government must act quickly to punish the thousands who have been detained.

New sanctions on senior Iranians

Among those hit with U.S. sanctions Thursday was the secretary of Iran’s Supreme Council for National Security, whom the Treasury Department accuses of being one of the first officials to call for violence against protesters. The Group of Seven, of which the U.S. is a member, also warned they could impose more sanctions if Iran’s crackdown continues.

European Union chief Ursula von der Leyen said the 27-nation bloc was looking at strengthening sanctions “to push forward that this regime comes to an end and that there is change.”

The clampdown on the demonstrations has killed at least 2,637, according to the U.S.-based Human Rights Activists News Agency. The figure reported Thursday is an increase of 22 from the figure a day earlier, and the organization says the number will likely continue to climb. The death toll exceeds that of any other round of protest or unrest in Iran in decades and recalls the chaos surrounding the country’s 1979 Islamic Revolution.

The U.S.-based agency, founded 20 years ago, has been accurate throughout multiple years of demonstrations, relying on a network of activists inside Iran that confirms all reported fatalities.

With communications greatly limited in Iran, the AP has been unable to independently confirm the group’s toll. The government of Iran has not provided casualty figures.