1976. there are not a lot of primary clinics that have restained their status for that long, and i'm proud of us for that. >> we welcome our international viewers for our state of the union report this sunday, july 12th. this is our "state of the union" for this sunday, july 12th. president obama wants congress to deliver a health care reform bill for him to sign this year. but can the united states afford to implement ambitious and expensive changes with an ailing economy? the health secretary kathleen sebelius outlines the administration's case. plus, four key u.s. senators weigh in on the health care debate and whether there's a need for another economic stimulus package. stour four key senators are here to weigh the debate and see if there's a need for a second economic stimulus. he's pushing a new plan to try to get gays and lesbians to be

able to serve openly in the united states military. patrick murphy gets the last word. that's all ahead in this hour of "state of the union." a beautiful sunday here in the nation's capital, up on the other end of pennsylvania capitol hill, the u.s. congress, where they're debating health care reform while president obama spent the past week overseas tending to global matters. his administration pressed ahead with the effort to revamp the health care system. the vice president joe biden announced a new agreement with the hospital industry to help pay for reforms, but there are still major issues to resolve, including whether to tax health care benefits in order to finance that final reform plan. here to outline the obama administration's view is the health and human services secretary kathleen sebelius. madame secretary, thanks very much for joining us. >> great to be with you. >> how are you going to pay for $ 1 trillion if not more?

>> well, president obama has outlined his preferred payment plans about $660 billion in savings out of the existing system. so money that's already in the system that's not making us healthier and going to procedures and practices that work very well. and about $330 billion in a proposal that would cap the itemized deductions at the wealthiest americans take. return them to the level where they were in president reagan's days. the house and senate have different variations, a lot of the same savings. >> the house version that charlie wrangle, the chairman of the ways and means committee announced on friday would tax the wealthiest americans additional tax to help pay for the hundreds of billions of dollars that would still be needed if you make more than $300,000 a year or $400,000 a year, make more than $1 million, you're going to be paying a lot more taxes in the years to come.

>> well, the house has a version, there are a couple of different proposals being worked on in the senate. >> you like the house version? >> i think it's one of the ideas that will be discussed in the long run. i prefer the president's version, i think it makes good sense that, again, the wealthiest americans pay -- >> but you're open to the version of increasing taxes on richest -- the richest americans to pay for health care for everyone else? >> well, i think the bottom line is, it's got to be paid for. and we all have a shared responsibility that we all need to play a role. the house and senate version also have employers included, individuals included. and what's been remarkable, wolf, are the stake holders in the early '90s were the most vocal opponents of anything changing in the health care system are at the table with their own suggestions of how to pay -- >> just to be precise, you're open to wrangle's proposal. >> well, everything's on the table. >> are you also open to taxing

health care benefits that employers provide their workers? >> i think, again, the president's made it clear from the beginning. certainly during the course of the campaign and since then that that proposal may well dismantle the current employer-based system. he has always suggested that we want to build on the current system 180 million people have insurance provided by employers, what we don't want to do is discourage employers from offering coverage. >> this is what he said back when he was a candidate in september of 2008. i'm going to play this little clip. >> okay. >> everyone in america, everyone, will pay lower taxes than they paid in the 1990s under bill clinton at a time when the economy was growing and we produced 22 million new jobs. >> so just to be precise, you're rejecting a proposal to tax health care benefits employees get from their employers? >> again, wolf, the house and

senate are busily at work and i think the president continues t reemphasize he has opposed the notion we would tax health care benefits. continues to think that is not the best strategy to go forward. if at the end of the day that's the chosen way, i mean, the house clearly doesn't have it in, the health committee doesn't have taxing benefits as part of the proposal. we're waiting to see what finance comes up with. but he continues to work with the finance committee saying this is not the preferred strategy. >> not the preferred, but it's not necessarily completely being ruled out? >> no lines in the sand at this point. the most important thing is a health care reform bill passed this year, comprehensive reform because we can't afford to pay what we're paying right now. we're paying twice as much as any nation on earth, living sicker, dying younger, and that isn't good for any american. >> will the president accept health care reform that does not include a public option? in other words public government-run health insurance companies competing with the private health insurance companies? >> again, he has said

consistently and very strongly a public option is one of the strategies that will help lower costs, provide some competition for private insurers, and make sure that consumers in many parts of the country have a choice. absent that, you won't have cost competition and you won't have choice. >> so be precise, is the president going to reject any -- if the house and senate says, you know what? we can do this with co-ops, other ways, but there's not going to be a public government-run health system, is the president going to accept this? >> i think you're going to hear from senators in a little while about a variety of strategies to get to a public option. there isn't one size fits all. so he, i think, the president has said we can have -- the issues are competition and choice and how you bring that into the private marketplace there probably are a variety of strategies. all of which are on the table. the good news is that congress is hard at work. we've got republican senators

working day in and day out with democratic senators trying to figure out how to make sure reform happens this year. and they're working really hard. >> when is the president going to say, enough, the house and senate have their own version, i'm going to come up with a barack obama version that i want you guys to pass? >> well, everybody assumed i had the 1,000-page plan in my purse as i traveled through the senate for my preconfirmation hearings. what the president understands is that this package of legislation, this very comprehensive bill needs to be a bipartisan approach. it needs to be owned by the house and the senate with lots of input from the administration. that's exactly what's going on now. progress happening day in and day out, people at the table, senator grassley is working hard with senator baucus and senator conrad and others, i think we're going to have a bipartisan bill with not only votes from republicans and democrats, but lots of ideas to reform the

health care system. >> let's talk about the swine flu. you're getting ready -- >> h1n1. >> going to be starting in the fall here in the northern hemisphere. it's going pretty wild right now in the southern hemisphere. will there be a vaccine that will be ready when the flu season starts in the united states? >> by october, we will have a vaccine ready. when exactly? we can't predict. >> we have about 1 million cases of h1n1 right now. >> around the world? >> no, in the united states right now. and 102 countries are seeing presentations of this disease. the good news is that it's not terribly lethal right now. we've had about 170 deaths, that's too many, but we know 36,000 people die every year with seasonal flu. so we're watching southern hemisphere, no vaccine, h1n1 mixing with flu right now. we'll know a lot more as we move toward the fall, but we are preparing to keep americans safe and secure.

>> give us a preview of the announcement you're going to make tomorrow on the vaccine. >> there'll be another $1 billion worth of orders placed to get the bulk ingredients for an h1n1 vaccination. congress has agreed with the president that this is the number one priority. keeping americans safe and secure. >> great to see you. >> thank you. president obama even sees a health care bill says he wants to see a health care bill on his desk by the end of this year. lawmakers on capitol hill have to agree on what goes into it. up next, key u.s. senators break down what needs to be done to reach a bipartisan agreement. also, anderson cooper's exclusive interview with president obama in africa. it's a remarkable interview from the exact location where millions of africans were sold into slavery. you're going toe see it right here on "state of the union." thh

well, we just heard the obama administration's view of health care reform, now let's turn to four u.s. senators who are playing a key role in crafting a plan. in his home state of new hampshire, republican judd gregg and from her home state of michigan, democratic senator debbie st debbie stabano, here with me in washington, lamar alexander of tennessee, and democrat of north dakota, senator conrad, let me start with you.

you just heard kathleen sebelius the secretary of health and human services say the obama white house is open to this house proposal that charlie wrangle, the chairman of the ways and means committee has put forward to put additional taxes on the richest american families to pay for health care reform for everybody else who doesn't have it yet. is that a good idea? >> look, everything does have to be on the table. you can't negotiate properly without that rule in place. but i don't think the house proposal as i've heard it will be what's part of the final package. i think there may be some request from those of us who at the highest levels of income this country to pay a bit more. but there will be a much broader package of revenue as well as spending reductions in order to make this package work. >> yeah, are you open to the house version to consider a tax on people making more than let's say $250,000 or $350,000 a year at 1% or 2% additional tax on their gross income to pay for health care reform? >> that's a bad idea, wolf.

what is on the table seems to be taxes like that more state taxes to support medicaid, more cuts in medicare, more employer taxes. what should be on the table and more government programs, what should be on the table are more proposals like the one senator greg has made or senator burr, senator coburn. there are 14 of us, democrats and republicans, who support the plan, that would give every american dollars with which to buy their own health insurance and could be done without adding a penny to the debt. >> you want to tax benefits, health care benefits that employers provide to their employees as income? >> i'm willing to stop giving tax deductions to people for cadillac health insurance plans in order to give everybody a chance to buy their own health care insurance and not add a penny to the debt. i think that would be a good way. >> no matter what -- >> no matter -- >> no matter what -- >> what it means is if you've got a cadillac insurance plan

and your employer gives you that, then some of it's going to be taxed. that money will be used to make sure we do -- we can't keep adding to the debt in the way -- >> senator, is that okay with you? >> well, wolf, i think realistically, the one thing that is off the table is taxing employee benefits. i think we'll see some other combination of things. but employees don't determine what insurance companies are going to charge them for their health care for their family. and i think that's pretty much off the table. what's most important -- >> senator alexander says it should be on the table. >> that may be his view. i respect that. but it is not the majority opinion. i think what's also important in this discussion is that over half of the cost of reforming and changing the health care system is going to come with greater efficiencies, it's going to come with changing from quantity of tests to paying for quality, paying for health care not sick care. >> the hundreds of billions of

dollars, senator, are still going to be required and that money according to president obama he wants a deficit neutral plan. doesn't want the taxpayers to be burdened with additional costs. that's going to have to come from somewhere, and that's what i hear you saying is you don't want it to come from taxing health insurance benefits. let me ask senator greg what he said. >> that's correct. >> what do i think about that issue? well, i think the uaw is calling the shots there, that's why it's not on the table. they've got high-end health policies, and they don't want them, their union members to have to reduce those health policies. why don't we look at trying to control the rate of spending by looking at better quality delivery systems, which are more affordable, we've got a lot of excellent studies that tell us you can deliver a lot better health care at a lot less cost if you give people incentives,

if you give the employers capacity to reward people for purchasing health care intelligently and giving up lifestyles which are basically counterproductive such as smoking. >> well, quickly, senator greg, would you support, could you see yourself voting in favor of health care reform legislation that includes this public option? a public government-run insurance company to compete with the private insurance companies like blue cross and blue shield or united health care or some of these others? >> no. we do not want to go down the road that basically undermines our federal health care delivery in this country. >> senator conrad, you're not convinced that that public option would necessarily pass, that's why you've come up with your own compromise version of co-ops. having these co-ops that wouldn't necessarily be completely public or private, it would be somewhere in the middle. you think that's passable? >> i do. and really just to be clear, the cooperative plan is is something

that we see across many business lines in the country, very successful. the associated press is a co-op, we've got ace hardware as a co-op, land o'lakes is a co-op. the beauty of it, it does provide competition for insurance companies. but it is not government-run, government-controlled, it's membership-run, membership-controlled. >> do you support that, senator alexander? >> it all depends. blue cross could fit under his definition of a co-op. the problem with a government-run plan would be this. say the president said let's buy the rest of general motors to keep the ford company honest. that wouldn't matter unless he gave the government car some advantage. so he might say, well, all your repairs are going to be at a very low cost, but all of the mechanics might say, we're not going to -- we're not going to work on the government car. that's what you have with a government plan today with medicaid, 40% of the doctors won't serve medicaid patients because of the low service and it's the only option -- >> i want to ask, i'll rephrase

the question for senator stabenow. could you support health care reform that does not include a public option? >> well, my first and strong choice is a public option. and i have to say, wolf, is what my friends are saying, senator gregg and alexander are really scare tactics put forward by folks who don't want to change the system because they make a lot of money off the current system right now. >> very quickly, if you can give me a yes or no answer, i'm going to play a clip of what the president of the united states said in exchange with a reporter in italy on friday. and i want your answer. listen to this. >> is it a pretty much do or die by the august recess? >> i never believe anything is a do or die. but i really want to get it done by the august recess. >> will there be legislation on the president's desk, senator gregg, by the august recess? >> on health care, i think that's highly unlikely since the finance committee doesn't even

have a bill drafted yet. and we're in the middle of the sotomayor hearings for this week and then we're going to be debating her nomination for a week before we adjourn for the august recess. >> chairman, what do you think? >> i think we'll be through the finance committee by the august recess and i think that's a realistic goal. you know, there really is plenty of time. congress is going to be in session until christmas eve. >> what do you think? >> no, there's no reason to rush, we need to get it right, not add debt, not have a washington takeover. >> is the president going to be disappointed senator stabenow? >> i think he'll be pleased with the progress we're making, i think we're going to move this through the finance committee, get it done as quickly as possible. the most important thing is to get it right. the american people have waited for a long time. >> i want all of you to stand by because we have a lot more to discuss. we're coming back with the senators. we're going to talk about the confirmation hearings that begin

and word the cia withheld information about a secret counter-terrorism program from congress on direct orders from then vice president dick cheney. plus anderson cooper's exclusive interview with president obama recorded hours before the president left africa. done in the gulf coast castle. that was a prison where africans were held before being sold into slavery. you're going to want to see it and hear it right here on "state of the union."

we're back with four u.s. senators, republican judd gregg and debbie stabenow, and democrat kent conrad. senator alexander, the stories in the "new york times," we've confirmed it that the former vice president dick cheney over nearly eight years told the cia on one very sensitive piece of

intelligence. and we don't know what that piece of intelligence is. do not share that information with the u.s. house of representatives or the senate. is that appropriate? >> well, let's -- we don't know whether it was appropriate. the cia is in the secrecy business. and what i hear from the democratic members of congress is they want the cia to tell more of them what's going on. the best way to ruin a secrecy business is to tell -- >> even if you just tell the leaders, if you tell eight leaders, four in the house and four in the senate, the majority and minority leader, and the chairman and the ranking member of the two -- >> that is appropriate. >> that's the tradition, you tell the eight or so-called gang of eight. >> what i'm hearing from the democratic members of the house is tell us all, tell more of us about it. if the eight leaders think what vice president cheney did was inappropriate, they should sit down with the new president and the new cia director and say we'd like to know more. that's the way to fix that problem.

i have no way of knowing -- nor do you or anybody else. >> no because presumably, even these eight leaders who traditionally are informed i think of almost everything, they were told by the vice president if you believe this story, don't even tell them about this program. >> that's a serious breach. look, you can't gloss over it. it has nothing to do with what the house is asking going forward. this is a question of whether something was not given the elected leaders of the congress, which is required by law. that's a serious matter. >> if the current vice president, senator gregg, told the cia, you know what? there's a really sensitive program, i don't want you to tell these eight leaders of the house and senate what's going on, would that be appropriate? >> no. but let's -- there's no question that's not appropriate. but the problem here is different than that in my opinion. this continued attack on the cia and our intelligence gathering organizations is undermining the morale and capacity of those

organizations to gather intelligence. the war we're in today is a war of intelligence. the only way we're going to stop a terrorist of using a weapon of mass destruction on us is to find out who they are and what they have before they attack us. the only way we're going to get that information is through intelligence gathering. we have to have an extraordinarily robust and strong cia, and extraordinarily and robust intelligence gathering organization. and this national attempt by some of our colleagues on the other side of the aisle to basically undermine the capacity to protect and develop intelligence is, i think, going to harm us in the long run. this is wrong, if somebody told the cia not to inform the appropriate members of congress on information, that's wrong, but that isn't -- that isn't a reason to disassemble the cia and make them a whipping child in the middle of this public opinion which undermines the morality. >> no one wants dismantle the cia, at least someone in a serious position. but if the former vice

president, dick cheney, i want to pin you down on this, if he did tell the cia don't share this information with the house and the senate, if he did say that, would he have been wrong? >> yes, if that information was correctly -- it should have been shared. i don't know what the information was, you don't know what it was, and there are instances, i presume, where something is so sensitive that it can't be released. but it's a very practical matter if it should have been shared, it should have been shared. >> i looked back at the legislation, at the law, of the 1947 law, senator stabenow, and it does leave a loophole there for the executive branch of the u.s. government not to share certain intelligence information with the legislative branch of the u.s. government. it says that the congressional intelligence committee should be fully and currently informed of all intelligence activities, but it does say this. to the extent consistent with due regard for the protection from unauthorized disclosure of classified information relating to sensitive intelligence, sources, and methods or other

exceptionally sensitive matters. so presumably, the former vice president could've determined this was such an exceptionally sensitive matter, it would fall into that loophole. >> well, i would be extremely surprised if that was the case, wolf. i think the person who has been undermining the credibility of the cia is the former vice president by his actions if, in fact, this is true. >> well, listen, wolf, this is a big issue, not only from the standpoint of what the vice president did, but from the issue of the morale and capacity of the cia to develop information. and other intelligence gathering

the former vice president of the united states denied certain sensitive information to the intelligence leaders in congress. that is not acceptable. >> well, i'm sure there's going to be a lot more of this coming up, but i want to thank all four of the senators for joining us on "state of the union." how. and it is the how that makes all the difference. to the planet we all share.

i'm wolf blitzer, and this is "state of the union." here are stories breaking this sunday morning. >> this brings the number of u.s. troops killed in afghanistan to 106.

a source confirms to cnn, the cia withheld information about a secret terrorism program from congress on direct orders from the then vice president dick cheney. the cia director leon panetta has informed lawmakers about cheney's role and his program. efforts to contact the former vice president for reaction so far have been unsuccessful. nasa will try to launch the shuttle again tonight. but only if the shuttle's electrical system checks out and the weather cooperates. last night's launch was scrubbed after several lightning strikes near the launch pad. if the mission gets the thumbs up, liftoff is set for 7:13 p.m. eastern later tonight. those are the headlines on "state of the union." after a week of international travel, president obama and his family arrived back at the white house just after midnight before he left his final stop in ghana, he sat down with anderson cooper for an exclusive interview. you can see, by the way, the

full interview tomorrow monday night on "ac 360." the number one topic, as it was for most of us, the u.s. economy. >> vice president biden said you misread the economy. you said no, no, no, we had incomplete information, and you said you would not have done anything differently. wow, that seems contradictory. how can you say that if you had known unemployment would go to 9.5%. wouldn't you ask for more money? >> no, it's not contradictory. keep in mind that we got an $800 billion stimulus package. by far the largest stimulus package ever approved by a united states congress. and the stimulus package is working exactly as we had anticipated. we gave out tax cuts early so that consumers could start spending or at least pay down debts so they could at a later date start spending.

we put in $144 billion to states so that they wouldn't have to cut teachers and police officers and, you know, other social services vital, particularly at a time of recession. and we always anticipated that a big chunk of that money then would be spent not only in the second half of the year, but also next year. this is designed to be a two-year plan and not a six-month plan. now, it may turn out that the enormous loss of wealth, the depth of the recession that's occurred requires us to reevaluate and see what else we can do in combination with the -- >> a second stimulus? >> well, there are a whole range of things, anderson, that we've done. the banks have stabilized much more quickly than we had anticipated. they're not all the way to where we'd like them to, but we see significant progress.

if you look at both the financial sectors, the ability of the businesses to get loans, the drop off of volatility that's taken place, the general trajectory is in the right direction. >> anderson also asked the president about a story that broke last week. a possible war crime committed by an ally of the united states during the 2001 war in afghanistan. >> it now seems clear that the bush administration resisted efforts to pursue investigations of an afghan war lord who was on the cia payroll. it's now come out they were hundreds of taliban prisoners under his care that got killed. some suffocated in a steel container. would you support, would you call for an investigation into possible war crimes in afghanistan?

>> the indications that this had not been properly investigated just recently was brought to my attention. so what i've asked my national security team to do is collect the facts for me that are known and we'll probably make a decision in terms of how to approach it once we have all of the facts gathered up. >> but you wouldn't resist categorically an investigation? >> i think that, you know, there are responsibilities that all nations have, even in war. and if it appears that our conduct in some way supported violations of laws of war, then i think that, you know, we have to know about that. >> finally the president spoke of how he was personally and deeply affected by the tour he took with his family visiting the cape coast castle of prisons where enslaved africans were held before being sold and shipped overseas. anderson spoke to the president during that tour. >> you think what happened here still has resonance in america? that the slave experience still is something that should be

talked about and should be remembered and should be present in every day life? >> well, you know, i think that the experience of slavery is like the experience of the holocaust. i think it's one of those things you don't forget about. i think it's important that the way we think about it and the way it's taught is not one in which there's simply a victim and a victimizer. and that's the end of the story. i think the way it has to be thought about, the reason it's relevant is because whether it's what's happening in darfur or what's happening in the congo or what's happening in too many places around the world, you know, the capacity for cruelty still exists. >> and don't forget, you can see anderson's interview with the president tomorrow night, 10:00 p.m. eastern only here on cnn.

pennsylvania democratic congressman patrick murphy gets the last word when "state of the union" returns.

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reporters were out there on the sunday morning talk sthoez shoez, but only one gets the last word. that honor goes to patrick murphy from pennsylvania. thanks for coming in. >> great to be with you, wolf. >> if it's true that the former vice president of the united states, dick cheney, ordered the cia not to share with leaders in the house and senate some sort of classified intelligence program that was under way, we don't know what it was, would that be appropriate under some circumstances? >> absolutely not, wolf. there is a reason why we have three branches of government that are co-equal branches of government. the fact he put the cia in a bad position saying, don't tell the congress. even those select few members of congress that really should know what's going on. it's disturbing. when it comes to national security, you know politics should always stop atwater's edge. i really think the vice president put them in a bad position here.

the cia is doing their job to try to keep our families safe. >> you're on the house senate committee. do you know this program that the vice president apparently thought was so secret, so important, that the details should not be shared with the house and intelligence senate committees? >> i have been briefed by director pa nnetta by the intelligence and senate committees. it is classified, but i will say it's a program that, to director panetta's credit, he stopped immediately as cia director. he went immediately to congress and brought us together and said, listen, i just found out about this, i want to be straight with you. and we want to work with the executive branch, we want to work with these people in the cia because they're trying to keep us safe. but we cannot allow folks that take note to defend the constitution to disregard that

branch. >> should eric holder ask for a special prosecutor or special counsel to investigate the bush administration's behavior in some of these areas, especially the enhanced interrogation techniques. >> i'm not going to tell attorney general holder how to do this job, but i will tell in you my job as a member of the intelligence committee, we're getting after this, and we're going to find out what was said, what was known, what happened because it is disturbing, no doubt about it. listen, i came back from 7:30 mass this morning and i read the new york times of what happened, and i tell you, i was pretty upset, and i'm upset with the facts as they came out as rel e related to me by the director leon panetta. >> you're trying to get away from the don't ask, don't tell policy that bars homosexuals from serving openly in the united states military. you're a veteran of the iraq war, you served in the military. why now, in the middle of two wars, do you think it's a good

time to move away from the don't ask, don't tell policy? >> it's actually the best time to move away from it, because we've discharged over 13,000 troops. that's over 3.5 combat brigades. if it's sexual misconduct, they should be thrown out. but just because of their orientation, just because they're gay, it doesn't make any sense whatsoever. when paratrooper like i was, you care if they can kick out a door in baghdad or kabul or whether or not they can do their job and whether or not you can make it home alive to see your family. >> since 1993 when the don't ask, don't tell policy was brought into line, they say it's served pretty well and it's good for unit co heeghesion, for mor for the troops. what do you say to people who is

this isn't a good idea, keep it as it is? >> our men and women in america are professional soldiers, as professional as the 24 other countries that have allowed our troops to serve openly. even our strongest allies, great britain and israel, have allowed our troops to serve openly. these heroes who are 18, 19, 20 years old, they don't care about this. they care about whether they can get the job done. i tell you, it's disheartening when i hear them question the professionalism of our men and women in uniforms. >> do you have any reason to believe that the people since the campaign have said, i think it's time to move beyond don't ask, don't tell, but so far he hasn't done it. do you believe he will take the steps necessary to remove this policy? >> wolf, in fact, he has done that. he talked a week ago to the secretary of defense and the joint chiefs of staff and said, listen, be ready to implement a

change in the don't ask, don't tell policy, and it's our job to overturn that policy. president obama understands and has a healthy respect for a co-equal branch of government. he's not saying to the military, disregard what congress passed 16 years ago, no matter how wrong it may be. they put this discriminatory law into place. it will take an act of congress to repeel it. we'll have the votes. that's my job, to quarterback this through the house and get it to the president's desk after it gets to the senate to overturn this change in policy. >> congressman in pennsylvania. thanks for coming in. >> thanks, wolf. i appreciate it. and don't forget coming up at the top of the hour at 1:00 p.m., he takes a controversial look at world leaders and journalists. this week fareed speaks with timothy geithner in an exclusive interview. >> if you look at the response as you go through this period of

time, when people are most concerned about risk, generally they want to be investing in the most liquid in the world for treasury bills, and i think you've seen that pattern consistently over a period of time, and we want to make sure we can sustain that basic response. >> stay tuned for fareed zakaria gps. it comes up at the top of the hour. up next, challenges that come with the change in health care. many avoid getting even the most basic care because they can't afford it. hi. number two, please. would you like that to hurt now or later? uh, what? sir, it's a simple question. do you want heartburn pain, now or later? these heartburn medicines make you choose... between hurting now or later. pepcid complete doesn't. it starts to neutralize acid in seconds... and keeps it under control all day or all night. sometimes you gotta make compromises, man. no, you don't... man.

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only meineke lets you choose the brake service that's right for you. and save 50% on pads and shoes. meineke. welcome back to "state of the union." i'm wolf blitzer sitting in for john king. every once in a while, john likes to get inside washington and speak with you about the debates right here in washington. up close, how many in rural america worry their unique concerns and challenges might not fit with washington's debate over accessible and affordable health care. >> clay, west virginia is tucked into the remote rolling hills of coal country. the nearest hospital is 50 miles away on these winding rural roads. with the poverty rate approaching 30%, many here can barely afford to drive, let alone the care, like carla elizabeth walsh.

>> if life and death depended on money, i would have to die. carla had a massive heart attack a little more than a month ago. first, an ambulance ride to a rural hospital. then a med i vac to charleston. >> she took it with dignity and we had no money. >> most of their savings went to pay for back surgery elizabeth had a while back. she has diabetes and is legally blind. >> why won't you go to the doctor? >> because i can't pay for it. i could go and i get bills, and i can't pay those bills, so -- >> thousands and thousands of dollars worth of bills come in, and what can you do about it? >> so you'd rather not go to the

doctor than to have a bill come that you can't pay? >> right. >> did you get in touch with her regarding that repeat on the mammogram? >> it is a dilemma she faces every day, trying to convince people not to wait for the medical problem, to seek medical care. >> we offer a sliding fee payment scale. if they're at 100% medical care, they owe us 5%. >> the focus here is medical care because they know many of their poor and uninsured medical patients will ignore suggestions to see a medical specialist. >> we see a large portion of die bekt, hypertensive and hyper

cholesterol patients. our hope is that we keep people away from needing extensive health care services. so our role in a rural setting is key. the question is, how do we keep paying for it? how do we keep getting discounted care? how do we afford to keep the doors open? >> a big chunk of the federal budget comes from federal grants. she says she has not heard much talk from washington about how to protect places like this in small town, amerimercamericmera. >> how is our role defined after that? i worry that we have patients here who will maybe not fall into some category ask somehow slip through the cracks. >> carla elizabeth walsh shared that concern. they owned two small businesses, watched the money go to health care bills, and now that thousands of dollars more because of carla's heart attack.

>> we have worked all of our life and tried, and we can't seem to get any programs that have worked for us. >> it's not that the walshes or dr. shenard oppose health care programs. quite the contrary. it's just that when there's talk of big change, places like this so often get left behind. >> john king reporting. we're just getting this in from the white house. the president was in the oval office, and he phoned sonia sotomayor to wish her good luck as she finished preparations for the confirmation hearings that begin tomorrow morning. he complemented her for making phone calls to 89 senators. remember, our special coverage tomorrow will begin at 10:00 a.m.