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WASHINGTON (AP) -- Three years, two elections, and one Supreme Court decision after President Barack Obama signed the Affordable Care Act, its promise of health care for the uninsured may be delayed or undercut in much of the country because of entrenched opposition from many Republican state leaders.

In half the states, mainly led by Democrats, officials are racing deadlines to connect uninsured residents to coverage now only months away. In others it's as if "Obamacare" - signed Mar. 23, 2010 - had never passed.

Make no mistake, the federal government will step in and create new insurance markets in the 26 mostly red states declining to run their own. Just like the state-run markets in mostly Democratic-led states, the feds will start signing up customers Oct. 1 for coverage effective Jan. 1. But they need a broad cross-section of people, or else the pool will be stuck with what the government calls the "sick and worried" - the costliest patients.

Insurance markets, or exchanges, are one prong of Obama's law, providing subsidized private coverage for middle-class households who currently can't get their own. The other major piece is a Medicaid expansion to serve more low-income people. And at least 13 states have already indicated they will not agree to that.

"It could look like two or three different countries," said Robert Blendon, a Harvard School of Public Health professor who studies public opinion on health care. "The political culture of a state is going to play an important role in getting millions of people to voluntarily sign up."

Civic leadership - from governors, legislators, mayors and business and religious groups - is shaping up as a huge factor in the launch of Obama's plan, particularly since the penalty for ignoring the law's requirement to get coverage is as low as $95 the first year.

People-to-people contacts will be key, and the potential for patchwork results is real.

"Obviously it's a possibility in terms of there being some real difficulties," said Sen. Bob Casey, D-Pa., whose efforts helped pass the law. Casey also said he believes the Obama administration will be ready to lead in states holding back.

Disparities already are cropping up.

Town Meeting Day - the first Tuesday in March - is a storied tradition in Vermont, and this year it provided a platform to educate residents about their options under the health care law. As many as 250,000 may eventually get coverage through Vermont Health Connect, as the state's marketplace is known.

"Even before we were a state, these town meetings existed," said Sean Sheehan, director of education and outreach. "It's a way people come together as a community, and we are counting on those community connections to get the word out." The health care plan was on the agenda at about 100 town meetings, and other local gatherings are taking place.

Texas residents are entitled to the same benefits as Vermonters, but in the state with the highest proportion of its population uninsured, Gov. Rick Perry will not be promoting the federal insurance exchange, a spokeswoman said. Nor does Perry plan to expand Medicaid.

The result is a communications void that civic and political groups, mayors, insurers and hospitals will try to fill.

"You have people who aren't really charged up about it because they don't even know that they would qualify," said Durrel Douglas, spokesman for the Texas Organizing Project, an activist group. A national poll this week by the nonpartisan Kaiser Family Foundation found that two of every three uninsured people don't know enough about the law to understand how it will affect them.

Supporters of Obama's law in Texas say the federal government hasn't shown up yet to launch the state's insurance exchange and no one is sure when that will happen.

"It is a much bigger lift here," said Anne Dunkelberg, associate director of the Austin-based Center for Public Policy Priorities, which advocates for low-income people. "The sooner the federal exchange can get engaged and working with all the folks here who want to promote enrollment, the better."

The Congressional Budget Office predicts a slow start overall, with only 7 million gaining coverage through the exchanges next year, rising to 24 million in 2016.

At a recent insurance industry meeting, federal officials directing the rollout rattled off a dizzying list of deadlines. Public outreach will begin in earnest this summer and early fall, said Gary Cohen, head of the Center for Consumer Information and Insurance Oversight.

The government sees three main groups of potential customers for the new insurance markets, he said.

There's the "active sick and worried," people who are uninsured or have pre-existing medical conditions. Under the law, insurers will no longer be able to turn the sick away.

There's the healthy and young. "They feel invincible, they don't feel a need for health insurance," said Cohen.

Finally, there's the passive and unengaged. "For these people, a significant education effort needs to happen," he said.

To keep premiums affordable, the government will need to sign up lots of people from the last two groups to balance those in poor health, who will have a strong motivation to join.

The official heading consumer outreach for the rollout, Julie Bataille, acknowledges the challenge but says she's confident.

"This is a really an enormous opportunity for us to change the conversation around health care and help individuals understand the benefits they can get," she said.

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QUANTICO, Va. (AP) — The commander at Marine Corps. Base Quantico in northern Virginia says a shooting in which a Marine killed a male and female colleague before killing himself was isolated to a single building.

Base commander Col. David W. Maxwell told reporters Friday that authorities were called to the scene around 10:30 p.m. Thursday where they found one person dead at a barracks. They later found a second victim dead, along with the body of the suspected shooter, who died of a self-inflicted gunshot wound.

A base spokesman initially described the situation as a standoff. Maxwell said later in the morning that there was no standoff.

Base spokesman Lt. Agustin Solivan later clarified that after the first shooting, police had the shooter "isolated" in a barracks dorm room.

JERUSALEM (AP) — Wrapping up a three day visit to Israel, President Barack Obama paid respects to the nation's heroes and to victims of the Holocaust, solemnly reaffirming the Jewish state's right to exist.

Accompanied by Israeli Prime Minister Benjamin Netanyahu and President Shimon Peres, Obama laid wreaths at the graves of Theodor Herzl, the founder of modern Zionism who died in 1904 before realizing his dream of a Jewish homeland, and former Israeli Prime Minister Yitzhak Rabin, who was assassinated in 1995.

He also toured the Yad Vashem Holocaust memorial, declaring after that the memorial illustrates the depravity to which man can sink but also serves as a reminder of the "righteous among the nations who refused to be bystanders."

Friday's stop at Herzl's grave, together with Thursday's visit to see the Dead Sea Scrolls, the ancient Hebrew texts, were symbolic stops for Obama that acknowledged that the rationale for Israel's existence rests with its historical ties to the region and with a vision that predated the Holocaust. Obama was criticized in Israel for his 2009 Cairo speech in which he gave only the example of the Holocaust as reason for justifying Israel's existence.

"Here on your ancient land, let it be said for all the world to hear," Obama said at Yad Vashem Friday, in a clear response to that criticism. "The state of Israel does not exist because of the Holocaust, but with the survival of a strong Jewish state of Israel, such a holocaust will never happen again."

Later in the day, Obama was traveling to Jordan where he planned to meet with King Abdullah II. Among the topics is Jordan's struggle with the influx of a half-million refugees from the Syrian civil war. Abdullah has voiced fears that extremists and terrorists could create a regional base in Jordan.

Before leaving for Jordan, Obama had lunch with Netanyahu and then took his motorcade to Bethlehem in the West Bank to visit the Church of the Nativity.

Obama had been scheduled to take a helicopter to Bethlehem but had to change plans due to unusually high winds. The route gave Obama a clear look at Israel's separation barrier with the West Bank, which runs south of Jerusalem and is the subject of weekly protests by Palestinians.

About 300 Palestinians and international pilgrims gathered near the Nativity Church, awaiting Obama's arrival. But a knot of protestors along the route held up signs stating: "Gringo, return to your colony" and "US supports Israeli injustice."

At a nearby mosque, Mohammed Ayesh, a Muslim religious official in Bethlehem, issued a plea to Obama in a speech to worshippers: "America, where are your values? Where are the human rights? Isn't it time that you interfere to make it stop?"

Amid high security, Obama toured the church with Palestinian Authority President Mahmoud Abbas. They stopped at the Grotto of the Nativity, which is said to stand where Jesus Christ was born. About 20 children waving U.S. and Palestinian flags greeted Obama in a courtyard outside the sanctuary. He posed for photographs with Abbas and Bethlehem's mayor, Vera Baboun.

Earlier in Jerusalem, Obama and his Israeli hosts arrived at the somber Herzl grave site under cloudless skies. Obama approached Herzl's resting place alone and bowed his head in silence. He turned briefly to ask Netanyahu where to place a small stone in the Jewish custom, then laid the stone atop the grave.

"It is humbling and inspiring to visit and remember the visionary who began the remarkable establishment of the State of Israel," Obama wrote in the Mt. Herzl guestbook. "May our two countries possess the same vision and will to secure peace and prosperity for future generations."

At Rabin's grave a short walk away, Obama was greeted by members of Rabin's family. He initially placed a stone on Rabin's wife's side of the grave, then returned to place one atop Rabin's side. In a gesture linking the U.S. and Israel, the stone placed on Rabin's grave was from the grounds of the Martin Luther King memorial in Washington, the White House said.

Rabin, Obama told family members, was "a great man."

Chatting with the family, Obama joked that "Bibi arranged for perfect weather," using Netanyahu's familiar name. He then added that "Shimon plied me with wine" at the official state dinner Thursday evening. At one point the talk turned to the singer who performed at the dinner, and Obama pointed out that he was known to sing, too. "They had me on YouTube," he said with a laugh. "Check it out -- Obama singing Al Green."

At Yad Vashem, Obama donned a skull cap and was accompanied by Rabbi Israel Meir Lau, a survivor of the Buchenwald Concentration camp who lost both parents in the Holocaust. Among his stops was Yad Vashem's Hall of Names, a circular chamber that contains original testimony documenting every Holocaust victim ever identified.

"Nothing could be more powerful," Obama said.

---- Associated Press writers Dalia Nammari in Bethlehem and Daniel Estrin contributed.