THE VILLAGES, Fla. (AP) President Donald Trump on Thursday accused Democrats of an all-out attempt to totally obliterate Medicare and portrayed himself as the programs defender while signing a directive to expand Medicares private insurance options.

But no Democrat is proposing to take coverage or benefits away, a fact that undercuts Trumps rhetoric, and Trump did not dwell on his own budget proposals for cuts in Medicare payments to hospitals and other providers.

RECOMMENDED: President Trump's visit to Sumter County for Medicare event rescheduled for Oct. 3

Trump spoke at The Villages, a bustling community for adults in Central Florida, as he tried to turn attention away from House Democrats impeachment inquiry and focus on pocket-book issues instead.

Thats why they do the impeachment crap, because they know they cant beat us fairly, he told the friendly audience, which included many seniors. That part of Florida voted overwhelmingly for Trump in 2016.

Health care has emerged as a central issue for Democrats competing for their partys 2020 presidential nomination. Much of the debate has centered on Sen. Bernie Sanders Medicare for All plan, which would cover everyone under a government-run plan and eliminate most private insurance. Trump said electing a Democrat would jeopardize seniors access to health care.

FLORIDA NEWS | The latest headlines from Florida

Medicare is under threat like never before, Trump said. Almost every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare.

Far from obliterating Medicare, Sanders says his plan would lower costs and provide new benefits, including coverage for long-term care. Medicare, which covers about 60 million seniors and disabled people, is the governments flagship health care program.

Trump also signed an executive order directing his administration to pursue changes to Medicare. Much of what he wants to do is geared toward enhancing Medicare Advantage, the private insurance option picked by about one-third of seniors.

Medicare Advantage plans offer savings on premiums and an annual limit on out-of-pocket costs. These plans provide one-stop shopping, eliminating the need for separate supplemental insurance. Offered by major insurers, the plans also cover prescription drugs in most cases.

But there are trade-offs. People joining a Medicare Advantage plan generally must accept limits on their choice of hospitals and doctors as well as prior insurer approval for certain procedures. If they change their minds and decide to return to traditional Medicare, theyre not always guaranteed supplemental Medigap coverage, which is also private.

The presidents order is basically a to-do list for the Department of Health and Human Services that will require months of follow-up. Among the other priorities are an expansion of telemedicine and changes to avoid overpaying for procedures just because they get done in a hospital instead of a doctors office.

Health and Human Services Secretary Alex Azar said Trumps order directs his department to examine whether its current policies and practices put traditional Medicare ahead of the private Medicare Advantage option. Some advocates for older people say that its the other way around and that the administration is trying to put private plans ahead.

The executive order does not involve a major overhaul of Medicare, which would require congressional approval.

So far the debate about Medicare for All has mainly been about its projected costs to the government, estimated at $30 trillion to $40 trillion over 10 years.

The Sanders plan would eliminate most private health insurance, including the Medicare Advantage option. Sanders, who unexpectedly underwent a heart procedure this week, says Medicare for All would nonetheless offer seniors broader benefits and lower costs.

Sanders style of single-payer health care has long been popular among liberals. But recent polling has shown that a majority of Democrats and independents who lean Democratic prefer expanding coverage by building on the Affordable Care Act, or the Obama-era health law. Trump is asking federal courts to overturn that law as unconstitutional.

As a presidential candidate, Trump promised not to cut Medicare. As president, he has avoided calling for privatization of the program, raising the eligibility age beyond 65 or rolling back benefits.

But Trumps latest budget proposed steep cuts in Medicare payments to hospitals and other service providers, prompting protests from the industry and accusations by Democrats that he was going back on his promises to seniors. The Medicare cuts went nowhere in Congress.

Companies touting these so-called "free" genetic testing got a pricey dose of reality from the Department of Justice (DOJ).

In a national take down worth more than $2 billion, federal investigators along with the Department of Health & Human Services Office of Inspector General say they busted dozens of genetic testing labs accused of duping medicare recipients in a scheme that "capitalized on fears," according to a press release issued by the DOJ Friday.

The schemes involved "free" cancer screening that wasn't free and, often, didn't provide patients with any results.

Last month, we first told you how it works after Tammy Rose of West Palm Beach, described to us how her 83-year-old mom got a call from a telemarketer and fell for the pitch.

"She was to swab one cheek corner and then swab the other cheek corner and put them in separate bags and send it back to the facility," she told us.

RELATED: We all pay the price for 'free' DNA cancer screening

Senior advocates across the state have been fielding complaints from seniors concerned they're being targeted by telemarketers. At the Southwest Florida Area Agency on Aging, community manager Camilita Aldridge has spent months warning seniors about fraudulent claims of free testing. The scheme, which targets Medicare and Medicaid recipients, will pitch victims over the phone, at health fairs, parks or senior centers the chance to learn if they're at risk of cancer by taking a simple swab test.

Each willing participant can be worth tens of thousands of dollars to thieves who bill the government for the medically unnecessary tests.

"We've seen medicare being billed anywhere from 10 to upwards of $30,000 for these tests, one DNA test," Aldridge told us last month..

According to the DOJ, the latest bust resulted in charges against 35 people nationwide including doctors. Several in Florida included the owners of marketing and telemedicine companies. The alleged scheme involved the payment of illegal kickbacks and bribes by testing labs in exchange for the names of Medicare recipients. Some of those charged, according to the feds, allegedly paid doctors to prescribe genetic cancer testing without seeing the patient or only talking to them briefly over the phone.

"I'm angry that my mother was targeted," said Tammy Rose. "Someone's getting rich off this and they need to be in prison."

Now investigators want you to know, some are finally paying the price.

SUMTER COUNTY, Fla. President Donald Trump's original trip to Central Florida in August has been rescheduled for Thursday, Oct. 3, according to a White House official.

President Trump's visit to The Villages in Sumter County was postponed in the wake of the mass shootings that took place in El Paso, Texas, and Dayton, Ohio on Aug. 3.

FLORIDA NEWS | The latest headlines from Florida

While at The Villages on Oct. 3, the President is expected to sign an Executive Order in relation to protecting and improving the Medicare program in the United States.

The White House released the following statement with the announcement of the rescheduled visit:

Sen. Bernie Sanders on Tuesday unveiled plans for a hefty tax on the ultra-rich that he says will pay for several of his expensive social spending proposals, including part of "Medicare for All."

Sanders, a Vermont independent, has come under fire from a number of his 2020 Democratic presidential primary rivals over the cost of his plans, which would run into the trillions of dollars. While he has maintained that the wealthy would foot the bill for most of those proposals, Sanders has acknowledged that the middle class would see their taxes rise to pay for Medicare for All. He says that many Americans would still come out ahead because they would no longer pay premiums or out-of-pocket bills for health care.

The new proposal was rolled out a day after Bloomberg reported that a polling firm associated with former Vice President Joe Biden had been studying which arguments against Medicare for All would be most effective with voters. One of its conclusions: the cost to taxpayers. Sanders responded to the news by insisting again that "no one earning less than $29,000 will pay any new taxes" under his plan, which he called "a great deal for the American people."

Massachusetts Sen. Elizabeth Warren has already unveiled plans to push for a similar wealth tax , which she often cites on the campaign trail -- to roaring approval from supporters -- as the potential source of funding for a series of ambitious programs. Sanders could be angling to establish a similar pitch, and respond to Biden, with a populist win-win proposal that pays for expensive new programs by soaking the rich.

Under Sanders' "tax on extreme wealth," married couples worth more than $32 million would pay a 1% tax on their wealth above that threshold. The rate would rise to 2% on net worth between $50 million and $250 million, climbing in increments to a 8% tax on wealth above $10 billion.

The tax would be levied on single filers worth more than $16 million, with the top 8% rate assessed on their wealth above $5 billion.

Sanders has long railed against the growth in income inequality in the US, noting that over the last 30 years, the top 1% has seen a $21 trillion increase in its net worth, while the bottom half has lost $900 billion in wealth.

"We are going to take on the billionaire class, substantially reduce wealth inequality in America and stop our democracy from turning into a corrupt oligarchy," said Sanders, who earlier this year released a proposal that would expand the federal estate tax on the wealthiest 0.2% of Americans, imposing a top rate of 77% on estates worth more than $1 billion.

His wealth tax, meanwhile, would hit the richest 180,000 households in US who are in the top 0.1%, according to the proposal. It would cut the wealth of billionaires in half over 15 years.

The levy would raise $4.35 trillion over a decade, according to University of California Berkeley economics professors Emmanuel Saez and Gabriel Zucman, who analyzed the plan for the Sanders campaign. It would eliminate the gap in wealth growth between billionaires and the middle class.

The professors, who are well known for their work on income inequality and taxing the rich, also evaluated Warren's wealth tax proposal , which she released in January. Warren is calling for a 2% levy on wealth above $50 million, with an additional 1% tax on net worth above $1 billion. Saez and Zucman estimated her plan would raise $2.75 trillion over 10 years from about 75,000 households.

Sanders would use the revenue raised from his tax to pay for his universal childcare proposal and his affordable housing plan, which calls for capping annual rent increases and investing in affordable housing. His housing plan is estimated to cost $2.5 trillion over a decade.

It would also help fund Medicare for All, which independent experts have estimated could cost around $32 trillion over 10 years.

Taxing wealth, however, could be very difficult to do. There are questions about whether it is permitted by the US Constitution, with legal scholars falling on both sides of the argument. Also, wealth taxes can be tough to administer since the rich often have assets that are hard to value.

Sanders maintains a wealth tax is constitutional, and his proposal includes several enforcement mechanisms.

One of the biggest retirement mistakes you can make is not realizing what you dont know.

I regularly hear from people in or near retirement who misunderstand how Social Security works, dramatically underestimate life expectancies or fail to plan for big expenses, such as long-term care or taxes.

These arent folks looking for advice. Theyve already made up their minds and want to argue about financial planning precepts, such as when to take Social Security or how much retirement is likely to cost. But what they think they know just isnt so.

The reality is that most people dont get good, objective financial advice before they retire, says actuary Steve Vernon, consulting research scholar at the Stanford Center on Longevity. Many people simply wing it, figuring that if they have a Social Security check and a little savings, somehow everything will work out.

Unfortunately, retirement is complicated, and your decisions can have irreversible consequences. Talking with a professional ideally a fee-only financial planner could save you from a costly mistake, including any of the following.

If you die early in retirement, your worries about paying for it are over. Live longer, though, and you easily could outlive your money. That stacks the deck in favor of waiting to start Social Security , since each year you put it off from age 62 to 70 increases your benefit by about 7% to 8%. Thats a guaranteed return on a stream of income that you cant outlive or lose in a stock market downturn.

Plus, you may live longer than you think. The average U.S. life expectancy is just under 79, but thats from birth. If you make it to 65, you can expect to live another 20 years or so. Half of all women currently in their mid-50s will live to 90, as will 1 in 3 men, according to the Society of Actuaries. People with healthy lifestyles and more education tend to live longer than average.

Speaking of Social Security: When one spouse dies, one of the couples two Social Security checks goes away. The survivor has to get by on the larger of the two checks. Its important to maximize this survivor benefit by having the higher earner delay filing for Social Security as long as possible. Also, married people who will get a pension should strongly consider a joint and survivor option that allows payments to continue for both lives.

If youre wealthy, having debt may not be a big deal you have plenty of income to make the payments, and your investments may be earning more than youre paying in interest. If youre not rich, though, you may be pulling too much from your savings to service the debt. That could increase the chances youll run out of money. Big withdrawals from retirement funds also could push you into a higher tax bracket and increase your Medicare premiums. Give yourself some options by planning to have debt paid off by retirement, but consult a financial planner before you tap retirement accounts to pay off any big debts, such as a mortgage.

If theres anything people want to ponder less than death, its decrepitude. Yet someone turning 65 today has a 70% chance in the future of needing help with daily living tasks, such as bathing, eating or dressing. Family and friends will help some, but about half will incur costs for long-term care and 15% will incur costs of $250,000 or more. Long-term care insurance may be one solution, or you may want to earmark certain investments or your home equity.

About half of retirees report leaving the workforce earlier than they had planned. A few get lucky, thanks to windfalls or strong stock markets. Many more retire because they lose their jobs and cant find replacements or because of ill health (their own or a loved ones). Working longer can help you make up for not saving enough, but its not an option you can count on.

With all this gloom and doom, now Im telling you to hurry up already? This bit of advice is for my fellow ants living in a grasshopper world: Sometimes, the grasshoppers get it right. Time, good health and energy are all finite resources. Spend a few hundred bucks of your hard-earned savings on a fee-only financial planner and find out if its time to start living the future youve been saving for.

This article was written by NerdWallet and was originally published by The Associated Press.

More From NerdWallet

Liz Weston is a writer at NerdWallet. Email: lweston@nerdwallet.com. Twitter: @lizweston.

The article The 6 Big Retirement Mistakes and One Way to Avoid Them originally appeared on NerdWallet.

Public versus private. Government versus private sector. Big bureaucracy versus big business.

Delivering healthcare to Americans is once again a central question in this year's presidential election, and the plans proposed by two of the top Democrats in the 2020 field have very little in common.

For Elizabeth Warren, she is proposing an entirely public plan with no role for private insurance.

At the June presidential debate, Warren agreed that she would eliminate private insurance if she has her way.

Look at the business model of an insurance company, Warren said. It's to bring in as many dollars as they can in premiums and to pay out as few dollars as possible for your health care"

But a change from private to public would be a dramatic change for most Americans. Nearly 66 percent of Americans used private insurance in 2017, according to U.S. Census figures.

Also, a number of Americans are employed by insurance companies. According to the Insurance Information Institute, more than 500,000 Americans are employed in the insurance industry.

These facts are not lost on Biden, who advocated at Thursday's debate to maintain the private insurance system.

"I think the Obamacare worked," Biden said at Thursday's debate. "I think the way we add to it, replace everything that has been cut, add a public option, guarantee that everyone will be able to have affordable insurance, number one."

Warren claimed during Thursday's debate that a Medicare-for-All system would lower overall costs.

"And the answer is on Medicare for All, costs are going to go up for wealthier individuals and costs are going to go up for giant corporations," Warren said. "But for hard-working families across this country, costs are going to go down and that's how it should work under Medicare for All in our health care system."

The Congressional Budget Office released a report in May on the total cost of moving to a government-run healthcare system. The report says that nearly half of healthcare expenses in the U.S. come from the private sector, with the rest being funded through federal, state and local governments.

Overall, Americans spend $3.5 trillion in healthcare per year, the CBO says. But the CBO could not put an estimate on exactly how much the average person would spend with a Medicare-for-All system. The report says a number of factors such as whether state governments will pay into the system, and whether citizens can opt out of public insurance all options would affect costs.

The CBO states that the federal government has lower administrative costs than private insurance. The cost to administer all of Medicare was 6 percent, compared to 12 percent for private insurers in 2017, the CBO says.

The CBO added that administrative costs could decrease even further as a Medicare-for-All system would have fewer eligibility exclusions.

Although both Biden and Warren still lack key details for their plans, Biden has stated his goal is to have 97 percent of Americans insured. Warren claims that nearly 100 percent is possible with her plan.

As of 2017, 91 percent of Americans were insured. The number of uninsured in 2010, at the time of Obamacare's passage, was nearly double, according to the Census.

Even without changes to law, healthcare costs will likely rise in the U.S. Government estimates peg healthcare spending per year at $6 trillion by 2027. The rate that healthcare expenses will rise will outpace overall GDP by .8 percent per year, according to government figures.

Thursday's Democratic Party debate, in Houston, features the 10 candidates who met polling and fundraising thresholds set by the Democratic National Committee.

It comes as former Vice President Joe Biden and his rivals -- including Sens. Bernie Sanders and Elizabeth Warren -- have sharpened their criticism of one another's campaign themes. This debate featured heated moments over health care, criminal justice and immigration, among other topics. The two previous debates (fact checks here and here ) have also included lengthy exchanges on health care.

The debate also features South Bend, Indiana, Mayor Pete Buttigieg, Sen. Kamala Harris of California, former Rep. Beto O'Rourke of Texas, businessman Andrew Yang, Sen. Cory Booker of New Jersey, Sen. Amy Klobuchar of Minnesota and former Housing and Urban Development Secretary Julin Castro.

Here are the facts.

How many people will be covered under Biden's health care plan

Castro attacked Biden's health care plan, saying "the problem with your plan is that it leaves 10 million uncovered."

Facts First: Castro is right.

It's not the first time a Democratic contender has criticized Biden's plan. Harris made an issue of it on the debate stage in Detroit.

Biden's proposal -- which builds on the Affordable Care Act by creating a government-backed health insurance option and increasing Obamacare's federal subsidies -- would insure more than an estimated 97% of Americans , according to his plan.

That means out of the population of 327 million in the country, roughly 10 million would be left without any health insurance.

However, it's unclear exactly who would be uninsured. But under Biden's plan, families buying coverage on the Obamacare exchanges would spend no more than 8.5% of their income on health insurance -- a sum that might be too pricey for some Americans.

-Donna Borak

The future of private health insurance

Klobuchar went after Sanders' defense of his Medicare for All bill, attempting to turn his signature line of "I wrote the damn bill' into a one-liner of her own.

"And while Bernie wrote the bill, I read the bill. And on page 8 -- on page 8 of the bill, it says that we will no longer have private insurance as we know it. And that means that 149 million Americans will no longer be able to have their current insurance."

Facts First: This is true according to one estimate by a prominent health care research center.

On page 8 of the legislation Klobuchar references -- S.1129, the Medicare for All Act of 2019 -- there is a provision that stipulates it would be unlawful under the plan for "a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act." The bill also bans employer-provided coverage on the same page.

However, different organizations have different estimates for how many Americans have private insurance, and who therefore would be at risk of losing it under a Medicare for All plan. Klobuchar cites a number backed by a 2014 survey conducted by the Kaiser Family Foundation , a national nonpartisan nonprofit. That survey indicated that 149 million non-elderly people had employer-sponsored coverage.

While some Republicans and Democrats have cited the higher figure, the US Census Bureau estimated that in 2017, more than 181 million people had employment-based health insurance .

-Sarah Westwood and Caroline Kelly

US health care spending vs. other wealthy countries

Sanders repeated a claim he's often made on the amount of money the US spends on health care.

"We are spending twice as much per capita on health care as the Canadians or any other major country on Earth," Sanders said.

Facts First: Sanders is right about Canada. While there's no universal definition of "major country," so there's some subjectivity here, it's not true that the US spends twice as much per capita on health care as every other country in the Organisation for Economic Co-Operation and Development, a group of 36 wealthy countries around the world.

At $10,586 per capita in 2018, the US did spend more than twice as much as Canada ($4,974) and more than twice as much as the OECD average ($3,992) in 2018 -- but Switzerland ($7,317), Norway ($6,187) and Germany ($5,986) all were substantially above half the US level; Sweden ($5,447), Austria ($5,395) and Denmark ($5,299) were also above half, though more slightly.

You can read a longer version of this fact check here . Sanders has been repeating this same exaggeration since at least 2009, when fact-checkers at PolitiFact first noted that it wasn't true.

-Daniel Dale

Family separations at the border

In a discussion of immigration policy, former Vice President Joe Biden said: "We didn't lock people up in cages, we didn't separate families."

Facts first: Both of Biden's claims are false. While the Obama administration didn't systematically separate families, it did happen under certain circumstances.

Separations did sometimes occur under Obama, but they were non-routine and much less frequent , according to immigration experts and former Obama officials.

They occurred in exceptional cases. Examples include those where the parent was being criminally prosecuted for carrying drugs across the border or other serious crimes aside from illegal crossing, those where human trafficking was suspected and those where the authorities could not confirm the connection between the child and the adult.

The separations didn't happen as a result of a blanket policy, however, as was the case during the Trump administration's controversial "zero tolerance" policy last year.

Similarly, fenced enclosures at processing facilities along the border, the structures that have been labeled as cages, existed under the Obama administration. Some individuals -- including children -- were held in those cells during processing.

-Priscilla Alvarez

Trump's tariffs are costing jobs

Sen. Amy Klobuchar said that Trump's trade war is costing American jobs. "One forecast recently says that it has already cost us 300,000 jobs," she said.

Facts First: This is true according to one major economic analysis. A September report from Moody's Analytics estimates that Trump's trade war with China has cost "almost 300,000 jobs" since it started about a year ago.

It's tricky to calculate exactly how many jobs have been lost because of Trump's tariffs on Chinese-made goods. One reason the trade war could be hurting American jobs is because Trump's tariff strategy has created a lot of uncertainty for businesses. They don't know how long the tariffs will be in place or whether the rate of the tariff will go up as part of a negotiating strategy -- making it hard to make investments and hire new workers.

But the Moody's report isn't the only one that suggests the duties are having an effect on US workers. A report from staffing firm Challenger, Gray & Christmas said that trade difficulties were cited as the reason for more than 10,000 job cuts in August alone.

-Katie Lobosco

NRA member support for gun control measures

Former Vice President Joe Biden claimed that gun control measures put forward by the Obama administration had a majority of support from NRA members.

"Those proposals I put forward for the President had over 50% of gun -- members of the NRA supporting them," he said.

Facts First: According to one poll, a majority of NRA members did support some gun control measures proposed by the Obama administration, but not all.

In a 2013 poll conducted by Johns Hopkins University, 74% of people who identified as NRA members supported universal background checks, which the Obama administration proposed following the mass shooting at Sandy Hook.

A majority -- 62 percent -- of this cohort "supported prohibiting gun ownership for 10 years after a person has been convicted of violating a domestic-violence restraining order," according to the poll . And 70 percent supported increasing penalties for individuals who sell a gun to someone who is not allowed to own a gun.

As part of its proposals following Sandy Hook, the Obama administration proposed a ban on so-called assault weapons and high capacity magazines (those that hold more than ten bullets). Only 15% of NRA members supported the ban of so-called assault weapons and 19% supported the banning of sales of high capacity magazines, according to the JHU poll.

-Holmes Lybrand

Environmental cleanup in Los Angeles

In discussing air pollution, Sen. Kamala Harris brought up the progress Los Angeles has made in cleaning up its air.

"If any of you have been to Los Angeles 20 years ago, you'll remember the sky was brown. You go there now, the sky is blue and you know why? Because leaders decided to lead and we took on these big fossil fuel companies," she said. "We have some of the most important and strongest laws in the country and we made a difference."

Facts First: Harris was correct that L.A.'s skies are less polluted than they were 20 years ago, but it remains one of the most polluted cities in the country.

Air quality has improved in LA and in many cities around the country since the 1990s. This is largely due to better air quality-control policies at the federal, state and local levels. The improvement in air quality has had a positive health impact on L.A. residents. Studies show better lung function in children who live in the region.

Those bluer skies, though, are still extremely polluted . The Los Angeles area has the worst level of ozone pollution in the country, according to the annual American Lung Association's State of the Air report . Ozone, also called smog , essentially causes a sunburn of the lung , irritating and inflaming the lining of our lungs when we breathe it in. It can leave us winded, cause asthma attacks , make us more susceptible to infection and even shorten our lives.

In 2018, the region violated federal smog standards 87 days in a row, the longest single stretch in 20 years.

-Jen Christensen

Federal investigators call it the latest scheme targeting consumers on Medicare and it all begins with claims of free screening for cancer.

Tammy Rose fears her 83-year-old mom, who lives in Sebastian, recently fell for the scam after receiving a call from a telemarketer.

They started asking her questions like what did your mother die from? What did your father died from? Whats your family history?

Tammys mom has heart issues, cancer runs in the family so when the telemarketer pitched free cancer screening, her mom bought in. A package of q tip swabs and a dispenser arrived a few days later.

She was to swab one cheek corner and then swab the other cheek corner, Tammy said. Her mom was directed by the company to place the swabs in separate bags and send it back to the facility, which she did. A few days later, Tammy received a frantic call from her mom.

My mom called me crying saying she just saw something on TV saying it was a fraud, she said.

On the west coast of Florida, complaints about fraudulent DNA cancer screening is now the number one call at the Area Agency on Aging for Southwest Florida says senior advocate Camalita Aldridge.

Were seeing more and more of these cases. There are various forms of the scam. Folks can receive these kits at home whether theyre solicited or not, Aldridge said.

Aldridge says companies who do this fraudulently are targeting Medicare patients by telling them each screening is free. These companies are screen patients for which cancer or genetic testing is not medically necessary and/or not ordered by the beneficiarys doctor. But every DNA screening test represents an opportunity to cash in since Medicare (taxpayers) will pay for it. Each screening can range from $10,000 per test to upwards of $30,000 says Aldridge.

They work on someone fear, she said. If a consumer thinks that if I can know ahead, diagnose and then treat, then I might prevent [cancer], scammers know this so thats what they do, she said.

While legitimate DNA cancer screening can be helpful for some people who qualify, experts advise any health screening should take place at your doctors office and be approved by your own doctor not a stranger.

Cancer screening, a lucrative business

Cole Buckley of Fort Myers showed us several flags and fliers he had made for what he thought would be a lucrative DNA cancer screening business.

I was going to be the man on the ground, he said. I was going to go to different things like health fairs, flea markets and set up a booth where we can pre-screen people, he explained about the pitch he heard about in January.

Buckley said the company, which no longer offers DNA screening, told him to only target seniors on Medicare and a company doctor, who Buckley never met, would approve each test. Buckley said he spent $200 to sign on with the company and another $1000 in marketing for the flags, fliers and business cards he had made which all tout free DNA cancer screening. But in the end, he said, the company pulled out and never sent him any cancer screening kits. Buckley said he felt duped.

I thought I was going to make a lot of money, he said. When asked how much, Buckley said he was told by the company it would be thousands per month.

Tammy Roses mother doesnt know yet if Medicare was charged for her screening. She hasnt received any results from her so-called free screening but she did file a police report and Tammy reported the company to Medicare knowing if her mother fell for it, chances are, thousands of others are doing it too.

Im angry that my mother was targeted. Someones getting rich off this and they need to be in prison, she said.

How to protect yourself from falling victim to "free" cancer screening

- If a genetic testing kit is mailed to you, dont accept it unless it was ordered by your doctor or return it to the sender.

- Keep a record of the senders name and date of your returned items.

- Be suspicious of anyone who offers you free genetic or cancer screening and then requests your Medicare number.

- Be cautious of unsolicited requests for your Medicare numbers. Dont provide your Medicare information to anyone you dont know.

- If you suspect Medicare fraud, contact the Office of Inspector General

LOS ANGELES, Calif. A man in the Los Angeles area is facing federal charges for selling rapper Mac Miller fentanyl-laced pills two days before he died of an overdose at age 26, according to a press release from the United States Attorney Central District of California.

Officials say 28-year-old Cameron James Pettit agreed to sell Miller 30 milligram oxycodone pills, as well as cocaine and the sedative Xanax. Instead of providing the rapper with genuine oxycodone, authorities say Pettit gave Miller counterfeit oxycodone pills that contained fentanyl.

RELATED: Report: Musician Mac Miller found dead at age 26

Fentanyl is a synthetic opioid that is 50 times more potent than heroin.

Two days after Pettit supplied Miller with the pills, the rapper was found dead in his Studio City home. A medical examiner later determined that Miller died of mixed drug toxicity involving fentanyl, cocaine and alcohol.

An affidavit says that hours after the death of Miller was reported, Pettit sent a message to a friend saying, Most likely I will die in jail."

Investigators believe Miller died after snorting the counterfeit pills, according to the press release.

Fentanyl disguised as a genuine pharmaceutical is a killer which is being proven every day in America, said United States Attorney Nick Hanna. Drugs laced with cheap and potent fentanyl are increasingly common, and we owe it to the victims and their families to aggressively target the drug dealers that cause these overdose deaths.

While the death of any victim of the opioid epidemic is tragic, todays arrest is another success for the DEAs HIDTA Fusion Task Force, said DEA Los Angeles Deputy Special Agent in Charge Daniel C. Comeaux. Let our message be clear, if you peddle illegal drugs and kill someone, the DEA will be the voice of the victim. We will not rest until you face the justice system.

If convicted of the drug trafficking charge alleged in the complaint, Pettit would face a statutory maximum sentence of 20 years in federal prison.

The investigation is on-going and is being conducted by the High Intensity Drug Trafficking Areas (HIDTA) Opioid Response Team, which operates under the direction of the DEA. The Los Angeles Police Department also provided substantial assistance.

This case is being prosecuted by Assistant United States Attorney Matthew J. Jacobs of the General Crimes Section.

The Tampa Bay area is no stranger to the opioid epidemic that is sweeping the nation. Major pharmaceutical companies promoting opioids pumped tens of thousands of dollars into the pockets of Tampa Bay area doctors in just the last year alone, an I-Team review found.

Back in August, I-Team investigator Kylie McGivern analyzed new federal data from the Centers for Medicare and Medicaid Services and found the payments for speaking fees, consulting work and meals to doctors in the Tampa Bay area in 2018.

RELATED: Pharmaceutical companies promoting opioids pay big bucks to Tampa Bay area doctors

You can search whether your doctors or local teaching hospitals have received payments from drug makers in recent years through a search tool on the federal governments website: openpaymentsdata.cms.gov/search/physicians/by-name-and-location

For resources on addiction recovery go to 211.org or call 2-1-1.

TAMPA, Fla. Major pharmaceutical companies promoting opioids pumped tens of thousands of dollars into the pockets of Tampa Bay area doctors in just the last year alone, an I-Team review found.

I-Team investigator Kylie McGivern analyzed new federal data from the Centers for Medicare and Medicaid Services and found the payments for speaking fees, consulting work and meals to doctors in the Tampa Bay area in 2018.

Lakewood Ranch anesthesiologist Steven Chun raked in $270,000 while on the payroll of Insys Therapeutics, a disgraced fentanyl spray maker with controversial marketing practices that included a rap video.

Dr. Chun was one of the top five paid doctors on the payroll for the pharmaceutical company from 2013 to 2016. Those are the same years he also ran a pain clinic in Lakewood Ranch. Federal records show Dr. Chun was paid for speaking engagements on behalf of Insys, which declined comment for this story.

The founder for Insys and four former company executives were convicted in federal court in May on racketeering charges. During the trial, prosecutors said the company bribed doctors to prescribe the fentanyl spray.

Although Dr. Chun accepted payments from Insys, prosecutors have never alleged he accepted bribes from the company. Dr. Chun wouldnt speak with the I-Team on camera but said in an emailed statement, These speak presentations had absolutely no impact on my prescribing habits. I have always been dedicated to my patients and have provided them

With the highest medical care.

They shouldnt be on the payroll

The payments Dr. Chun and other local doctors received from pharmaceutical companies is all perfectly legal, but medical ethicist Art Caplan told the I-Team studies have shown those payments can impact care.

We have pretty strong evidence thats been built up from study after study that payments to doctors definitely influence their prescription practices, said Caplan, director of the Division of Medical Ethics at the NYU School of Medicine.

Caplan said he believes doctors shouldnt accept any money from big pharma promoting their pain pills.

When its opioids in the middle of an enormous epidemic thats killed tens and tens of thousands of Americans, they shouldn't be on the payroll of those companies at all, said Caplan.

It got out of control

Recovering addict Stephen Sundquist is one of those who got caught up in the epidemic.

The former baseball player for River Ridge High School in New Port Richey said he was first prescribed opioids in 2006 as a teenager, following a Tommy John surgery.

After the operation at age 17, Sundquist said he left the hospital with a prescription for opioids.

I was never, you know, made aware of what these drugs were going to do to me the side effects nothing like that, said Sundquist. It got out of control very quickly.

New federal numbers, analyzed by the Washington Post, show Sundquists addiction began as opioid pills were flooding the Tampa Bay area.

Over a seven-year period, from 2006 to 2012, there were enough opioids distributed in Pasco County for every man, woman and child to take 61 pills a year.

The numbers rose to 67 pills per person in Hillsborough County while Hernando County posted a rate of 71 pills annually per person.

Its not necessarily a bad thing

Katherine Drabiak told the I-Team pharmaceutical payments to doctors can include education on new drugs, which can have a useful purpose.

This provides physicians up-to-date access to the latest treatments and cures and the latest research, said Drabiak, a public health professor at the University of South Florida. Most physicians are just trying to do the best for their patients.

Drabiak said in most cases physicians wont tell the patient if they received money from a company making the same drug they are prescribing.

State Sen. Darryl Rouson, who represents St. Petersburg, wants to change that.

Senator pushes for transparency

Rouson, who has been in recovery for 21 years, said the law should force doctors to tell patients when they receive a paycheck from big pharma.

I will certainly look at legislation next session that requires this type of disclosure and transparency, said Rouson. People are dying. People are hurting. Theyre becoming addicts. We should know whether or not a doctor is on the payroll of a pharmaceutical company at the time he's prescribing pain relief for people.

The I-Team focused in on doctors prescribing opioids, but local physicians are also paid to promote other types of drugs.

You can search whether your doctors or local teaching hospitals have received payments from drug makers in recent years through a search tool on the federal governments website: openpaymentsdata.cms.gov/search/physicians/by-name-and-location

For resources on addiction recovery go to 211.org or call 2-1-1.

Full statement from Dr. Steven Chun:

House Speaker Nancy Pelosi took a jab at Senate Majority Leader Mitch McConnell Wednesday, calling him "Moscow Mitch" -- a cutting nickname that recently prompted the Republican leader to take to the Senate floor to decry "modern-day McCarthyism."

"Moscow Mitch says that he is the 'Grim Reaper.' Imagine describing yourself as the 'Grim Reaper' -- that he's going to bury all this legislation," Pelosi said at an event in Illinois on Wednesday. The California Democrat added the legislation her chamber has passed is "live and well in the general public."

In July, Republicans in the Senate blocked the advancement of election security legislation hours after former special counsel Robert Mueller testified before Congress warning of Russian election interference. MSNBC host Joe Scarborough blasted McConnell's block of the legislation, dubbing him "Moscow Mitch," and Washington Post opinion columnist Dana Milbank called him a "Russian asset."

The comments drew a fiery McConnell to the Senate floor, saying, in part, "I don't normally take the time to respond to critics in the media when they have no clue what they're talking about. But this modern-day McCarthyism is toxic and damaging because of the way it warps our entire public discourse."

McConnell has previously said he believes strongly that elections should be primarily controlled by state and local authorities and not managed by Washington. He argues the federal government has already responded to the problems raised from the 2016 campaign and more does not need to be done at this time.

A spokesman for McConnell, David Popp, pointed to the Senate leader's speech when asked by CNN Wednesday about Pelosi's calling McConnell "Moscow Mitch."

Popp highlighted the following passage from McConnell's floor speech: "Now here we are in 2019. Again, (Russian President Vladimir) Putin and the Russians seek to provoke fear and division in our country. To undermine faith in our institutions. To exacerbate our political differences until we tear ourselves apart. And, once again, it seems there are some who blindly take the bait. American pundits calling an American official treasonous because of a policy disagreement. If anything is an asset to the Russians, it is disgusting behavior like that."

McConnell faces new questions after The Washington Post reported Wednesday about how one Russian company with ties to the Kremlin benefited from the lifting of economic sanctions, which McConnell aided by preventing from passing congressional efforts to keep the sanctions in place. That company then made a major investment in a project in McConnell's home state of Kentucky. Popp told the Post that McConnell "was not aware of any potential Russian investor before the vote."

At the Wednesday event hosted by the Illinois Democratic County Chairs' Association, Pelosi touted legislation passed by her chamber that the Senate has not taken up, including legislation raising the minimum wage, addressing the climate crisis, increasing protections for sexual orientation and gender identity, strengthening election security and lowering the cost of prescription drugs.

McConnell in April referred to himself as the "Grim Reaper," vowing to kill what he called socialist legislation, including the Green New Deal and "Medicare For All" measures. "None of that stuff is going to pass. None of it," the Kentucky Republican said at an event in his home state at the time.

Pelosi on Wednesday urged the Senate to pass a pair of bills approved by the House this year aimed at strengthening gun background checks in the wake of two deadly mass shootings that killed more than 30 people in Texas and Ohio earlier this month.

"We've been waiting since February, and now public sentiment must weigh in to save lives, to pass our bill," Pelosi said.

McConnell recently told a Kentucky radio station the Senate will put background check legislation and "red flag" laws "front and center" when Congress reconvenes after its summer recess. McConnell made no commitments about what would come to the Senate floor.

President Trump has postponed his trip to central Florida after the weekend's mass shootings.

The move comes after almost 30 people were killed in two separate shootings.

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He was scheduled to visit The Villages for a "Medicare-focused event."

A White House official confirmed to ABC Action News that the event was postponed due to the tragic events in Ohio and Texas over the weekend.

No official reschedule date has been announced.

President Donald Trump began his rally in Cincinnati talking about inner cities that are "run exclusively by Democrat politicians" but said he wouldn't name names, because he doesn't "want to be controversial."

It was a clear reference to the recent attacks he launched on Democratic Rep. Elijah Cummings . Trump criticized the prominent African American politician's West Baltimore district as "rat and rodent infested" and a place where no human would want to live.

Some of the President's aides have been uncomfortable with those attacks, but Trump has shown no signs of backing away from it.

The President's last rally in North Carolina came after Trump leveled a racist broadside at a foursome of Democratic congresswomen of color known as "The Squad," telling them to "go back" to the countries they came from even though three of them were born in the US. Trump supporters at that rally amplified the attack with chants of "Send her back!"

Trump told the crowd Thursday night that "no one has paid a higher price for the far left destructive agendas than Americans living in our inner cities," before saying the issues are caused by communities that "have been run exclusively by Democrat politicians."

"Look, we can name one after the other but I won't do that. I won't do that because I don't want to be controversial," the President added.

Minutes later when a protester disrupted the rally, Trump exclaimed: "You must have a Democrat mayor. Do you have a Democrat mayor?"

The President also claimed that "so many" of the mayors of inner cities are now in jail.

Trump, who has sought to brand all the Democratic candidates as socialists , took the stage at the campaign rally in the battleground state of Ohio eager to exploit the ideological fissures in the Democratic Party laid bare in this week's debates.

"The people on the stage tonight, and last, were not those that will either Make America Great Again or Keep America Great!" Trump tweeted soon after Wednesday night's debate , referring to his two campaign slogans. "Our Country now is breaking records in almost every category, from Stock Market to Military to Unemployment. We have prosperity & success like never before."

Trump campaign and Republican Party officials have already spent the last two days amplifying the Democratic candidates' most progressive positions and magnifying attacks on frontrunner, former Vice President Joe Biden, whom Trump and many of his advisers privately consider the biggest general election threat.

The top issues that revealed the most division between the Democratic candidates -- and the extent to which the party has moved to the left in recent years -- were indeed on health care and immigration. On health care, candidates debated the merits of a fully government-run health insurance system vs. a public option that would preserve private insurance. And on immigration, some candidates advocated for decriminalizing illegal border crossings while others talked of creating a more compassionate system while still keeping laws against illegal immigration on the books.

After the debate, some political strategists argued that Democrats' most progressive positions fed into Trump's sweeping characterization that Democrats support "open borders" and want to eliminate private health care plans that some Americans would like to keep.

More moderate Democratic candidates who support universal health care but oppose an entirely government-run system that would eliminate private health insurance were accused of parroting Republican talking points. While Trump's opposition to Obamacare sets him well apart from all of the Democratic presidential candidates, Trump and his team have already zeroed in on the most progressive Democrats' proposals to move toward a "Medicare for All" system.

The Democratic candidates ganged up on former Vice President Joe Biden as the second presidential debate turned to immigration on Wednesday night, leaving Biden taking shots from all sides while defending his record.

When the debate shifted to immigration, it was former Housing and Urban Development Secretary Julin Castro who criticized Biden's record during the Obama administration, and sought to turn it into an argument that it is time for new leadership.

Moderators noted that 800,000 immigrants were deported during the first two years of the Obama administration, and asked the former vice president whether those deportations would continue if he was president. Biden said they would not, and went on to note that he and Castro had been in many meetings together when he never raised his current position about opening the borders.

"We sat together in many meetings, I never heard him talk about any of this when he was the secretary," Biden said.

"It looks like one of us has learned from the lessons of the past and one of us hasn't," Castro snapped back.

Castro later said, "There's still going to be consequences if somebody crosses the border. It's a civil action. Also we have 654 miles of fencing. We have thousands of personnel at the border. We have planes, we have boats, helicopters, we have security cameras. ... We need to have some guts on this issue."

The stage showed off the diversity of the Democratic field and also the generational differences among the candidates. California Sen. Kamala Harris and Booker, for example, have argued for a new generation of leaders who better reflect the diversity of the Democratic Party.

Also on the stage on Wednesday were Colorado Sen. Michael Bennet, Castro, de Blasio, Hawaii Rep. Tulsi Gabbard, New York Sen. Kirsten Gillibrand, Washington Gov. Jay Inslee and businessman Andrew Yang.

Biden under the microscope

Biden knew he would be a target early on in the debate.

"Go easy on me, kid," he said to Harris as they greeted one another at center stage.

Whether it was a warning shot or simply one of those folksy Biden phrases, it was a signal that he would not be blindsided again the way he was in the first debate when Harris dispatched a fierce attack on his record opposing busing to desegregate schools decades ago. In that exchange, he appeared totally unprepared and caught off-guard.

But Wednesday night in Detroit he sought to write a different narrative. In his opening statement, he noted that Democrats were "expecting some engagement here."

"I expect we'll get it," he said.

Biden defended his record noting that had pushed to send $750 million for Guatemala, El Salvador and Honduras so that people there could "change the circumstance" of "why people fled in the first place."

"We're in a circumstance where if you say you can just cross the border, what do you say to all of those people around the world who want the want the same thing to come to the United States and make the case, that they have to wait in line," Biden said. "The fact of the matter is... if you cross the border illegally, you should be able to be sent back. It's a crime."

Calling for unity, New Jersey Sen. Cory Booker made a forceful argument for immigration offenses to be civil penalties instead of criminal penalties.

"We are playing into Republican hands who have a very different view and are trying to divide us against each other. I'm listening to the language of my colleagues," Booker said. "No, Mr. Vice President, we are not going to let people cross the border."

A few moments later, New York Mayor Bill de Blasio used his time to ask the former vice president to explain what he had done to stop the deportations during the time that Biden was Obama's vice president.

"I asked the vice president if he used his power to stop those deportations," de Blasio asked. "If you want to be president of the United States, you need to be able to answer the tough questions. I guarantee you, if you're debating Donald Trump, he's not going to let you off the hook. Did you say those deportations were a good idea or did you go to the President and say, 'This is a mistake, we shouldn't do it.' Which one?"

It was a question Biden wouldn't answer, citing his private conversations with Obama.

Candidates spar over criminal justice

As expected, Booker denounced Biden's record on criminal justice, noting that the former vice president bragged until recently about his work on 1994 crime bill. He also charged that Biden had been on the wrong side of many issues, including tougher sentencing laws that led to a disproportionate number of black and brown Americans being incarcerated.

"The house was set on fire and you claimed responsibility for that fire," Booker said to Biden about his record criminal justice reform.

In a surprising twist, Biden turned on Booker by challenging his record in Newark.

"There was nothing done to deal with" with a police department "that was corrupt," Biden said of Booker's record as mayor of Newark.

Booker appeared to relish the exchange, saying, "If you want to compare records, and I'm shocked that you do, I am happy to do that." He added that Biden didn't know what he was talking about when the former vice president went after Booker's history as mayor.

"There's a saying in my community that you're dipping into the Kool-Aid and you don't even know the flavor. You need to come to the city and see the reforms we put in place," Booker said.

Biden used the exchange with Booker to remind the audience that Barack Obama picked him as his vice president.

"I find it fascinating, everybody is talking about how terrible I am on these issues," Biden said. "Barack Obama knew exactly who I was. He had 10 lawyers do a background check and everything about me on civil rights and he chose me and said it was the best decision he ever made."

Booker had an answer for that too.

"You invoke President Obama more than anybody in this campaign. You can't do it when it's convenient and dodge it when it's not," he said.

After another contentious exchange it was Yang who sought to remind his rivals of their real opponent.

"I speak for just about anyone watching that I would trust anyone on this stage more than I trust our President. We have to focus on beating Donald Trump in 2020," he said.

As the discussion went on, both Biden and Gabbard turned to Harris' record as district attorney and as California's attorney general.

Biden faulted Harris for defending cases that were found to have involved prosecutorial misconduct, and for not disclosing more quickly to defense attorneys that evidence in the San Francisco crime lab had been tampered with.

"She had a police department when she was there that in fact was abusing people's rights and the fact was that she, in fact, was told by her own people -- by her own staff -- that she should do something about and disclose to defense attorneys like me," Biden said, "that you in fact have been -- the police officer did something that did not give you information that would help your client. She didn't do that."

Gabbard delved further into the more controversial aspects of Harris' record as a prosecutor, attacking her over positions she took as California attorney general.

"She blocked evidence that would have freed an innocent man from death row," Gabbard said. "She kept people in prison beyond their sentences to use them as cheap labor for the state of California, and she fought to keep cash bail system in place that impacts poor people in the worst kind of way."

Fiery debate over the future of health insurance

Immediately, Harris and Biden began to spar over the differences in their health care plans. While Biden would expand Obamacare with the goal of universal coverage but not force Americans to give up their private health insurance, Harris' plan would phase in "Medicare for All" and phase out private insurance over 10 years.

"The senator has had several plans so far, and anytime someone tells you you're going to get something good in 10 years, you should wonder why it takes 10 years," Biden said, alluding to Harris' plan. "If you notice, there is no talk that the plan in 10 years will cost $3 trillion."

Harris replied that Biden's description of her plan was "simply inaccurate."

"The reality is our plan will bring health care to all Americans under a Medicare for All system," the California senator said. "Our plan will allow people to start signing up on the first day, babies will be born into our plan and right now 4 million babies, almost, are born every day -- or every year in America. Under our plan we will ensure everyone has access to health care. Your plan, by contrast, leaves out almost 10 million Americans."

Over and over again -- even when responding to criticism from Gabbard -- Harris returned to criticize Biden's plan.

"I'm going to go back to Vice President Biden," she said when given the opportunity to respond to Gabbard, "because your plan does not cover everyone in America by your staff's and your own definition ... as many as 10 million people will not have access to health care, and in 2019 in America."

Tonight's lineup features front-runner, former vice president Joe Biden , as well as Sen. Kamala Harris of California , who went after Biden in the last debate over his past record on mandatory busing . It also includes Sen. Cory Booker of New Jersey , who has attacked Biden over the issue of race .

The debate has had heated exchanges over health care, immigration and criminal justice among other topics.

Here are the facts.

Obama did not sign DACA into law

Former Vice President Joe Biden was the target of multiple attacks, from protesters and from others onstage, about the deportation record of President Barack Obama. Biden defended his former boss against New York Mayor Bill de Blasio by saying Obama "came up with the idea for the first time ever of dealing with the DREAMers. He put that into law."

Facts First: That's false. Obama didn't put it into law -- and that's a hugely important point.

The "DREAMers" are undocumented immigrants who were brought into the United States as children and there has long been bipartisan support to give a pathway to legal status. The DREAM Act was a bill written by Sen. Dick Durbin of Illinois. It never became law despite multiple efforts -- but the name stuck.

But there was not enough support to put it into law. And when a comprehensive immigration plan failed in congress, Obama instead used executive authority to give DREAMers temporary protection with the Deferred Action for Childhood Arrivals, or DACA, program.

If they met certain requirements, signed up for the program and stayed out of trouble, he promised they could stay in the country. But it was a temporary fix and not ever put into law.

So when Donald Trump came into office, he moved to end DACA. Trump says he supports a legal status for DREAMers, but has said Congress must pass a law giving it to them. His effort to end the DACA program is currently stalled in the courts.

So no, Obama did not put anything for the DREAMers into law. And that's part of the point of his record on immigration that frustrates immigration advocates.

-Z. Byron Wolf

Profits in the pharmaceutical and insurance industries

While criticizing former vice president Joe Biden's health care plan, California Sen. Kamala Harris said, "Let's talk about the fact that the pharmaceutical companies and the insurance companies last year alone profited $72 billion, and that is on the backs of American families."

Facts First: Harris was in fact understating the profits of these industries . Ten of the largest US-based drug companies alone made $69 billion in profits last year. Health insurance companies made $23 billion.

The profits of the top US drug companies were as follows: Johnson & Johnson ($15.3 billion), Pfizer ($11.2 billion), Amgen ($8.4 billion), Merck ($6.2 billion), AbbVie ($5.7 billion), Gilead ($5.5 billion), Bristol-Myers Squibb ($5 billion), Biogen ($4.4 billion), Celgene ($4 billion), Eli Lilly ($3.2 billion).

Not all of these profits came from the companies' operations in the United States.

A report from the National Association of Insurance Commissioners said the health insurance industry generated net earnings of $23.4 billion in 2018.

-Daniel Dale

US law allowing for family separations

Several candidates criticized the Trump administration's policy of separating migrant children from their parents at the border, citing a long-standing US law that can result in such action.

Facts First: This is true -- and the law has been a flashpoint in the immigration debate.

Last year, the Trump administration implemented its controversial "zero tolerance" policy, using a section of US law to criminally prosecute all adults who illegally crossed the southern border. The policy led to the separation of thousands of families, given that children can't be held in federal jail with adults. The policyand the section of the code at the center of it have become a flashpoint in the immigration debate.

Democratic candidates remain divided over the law, referred to as Section 1325, with some wanting to instead make crossing the border illegally a civil offense, instead of a criminal offense.

Former HUD Secretary Julian Castro shot the issue into the national dialogue at the last round of debates and hammered in on his position Wednesday night.

"The only way that we're going to guarantee that we don't have family separations in this country again is to repeal section 1325 of the immigration nationality act," Castro said Wednesday. "That is the law that this President, this administration is using to incarcerate migrant parents and then physically separate them from their children."

Former Vice President Joe Biden added: "The fact of the matter is, when people cross the border illegally, it is illegal to do it unless they're seeking asylum. People should have to get in line. That's the problem. And the only reason this particular part of the law is being abused is because of Donald Trump. We should defeat Donald Trump and end this practice."

-Priscilla Alvarez

Biden's health care plan leaving out 10 million Americans

Sen. Kamala Harris attacked former Vice President Joe Biden's health care plan, saying it "leaves out almost 10 million Americans."

Facts First: Harris is right.

Biden's plan -- which builds on the Affordable Care Act by creating a government-backed health insurance option and increasing Obamacare's federal subsidies -- would insure more than an estimated 97% of Americans, according to his plan.

That means out of the population of 327 million in the country, roughly 10 million would be left without any health insurance .

However, it's unclear exactly who would be uninsured. But under Biden's plan, families buying coverage on the Obamacare exchanges would spend no more than 8.5% of their income on health insurance -- a sum that might be too pricey for some Americans.

-Donna Borak and Tami Luhby

The current high cost of health care

Attacked by former Vice President Joe Biden for the high cost of her "Medicare for All," plan, California Sen. Kamala Harris said that America already spends trillions on health care.

"We are now paying $3 trillion a year for health care in America," she said. "Over the next 10 years, it's probably going to be $6 trillion."

Later on, she said that the US is on its way "in just a handful of years of literally spending 20% of our economy, one out of every $5 spent on health care."

Facts First: This is true. If anything, Harris underestimated the numbers. According to the most recent data, America spends $3.5 trillion on health care, which equates to nearly 1 in 5 dollars of total GDP.

The nation shelled out $3.5 trillion on health care in 2017, according to the most recent data available from the Centers for Medicare & Medicaid Services. That's expected to rise to nearly $6 trillion in 2027.

Health care spending accounted for 17.9% of the economy in 2017,according to the report. It's expected to hit 19.4% by 2027.

-Tami Luhby

Democrats voting for a pathway to citizenship

Sen. Michael Bennet said that all Democrats voted to back a pathway to citizenship for 11 million people and spending $46 billion on border security.

Facts First: This is true. All Senate Democrats and 14 Republicans voted for the Senate immigration bill that passed in 2013.

Bennet was one of eight senators four Republicans and four Democrats who became the bipartisan group known as the "gang of eight" that hammered out an immigration compromise bill in 2013. The legislation, which included a pathway to citizenship, passed the Senate, 68-32, and Bennet is correct that all 54 Senate Democrats voted for it, along with 14 Republicans. A majority of Republicans, 32, opposed the bill.

While the bill passed the Senate, then-House Speaker John Boehner did not take it up in the Republican controlled House, and the legislation died at the end of 2014. It's not clear whether Bennet and the other senators in the 2020 presidential race could strike a similar compromise or another major immigration bill in today's Senate.

-Jeremy Herb

Amazon's effect on retail commerce

Andrew Yang said: "Raise your hand in the crowd if you've seen stores closing where you live. It is not just you. Amazon is closing 30% of America's stores and malls."

Facts First: Yang is right that up to 30% of malls may close in the next few years, but that's not all because of Amazon.

Malls have been closing fast, and will continue to do so, according to Wall Street retail analysts. A report from Credit Suisse in 2017 projected that between 20% and 25% of malls would close within five years. Cowen & Company estimated that 20% of stores in large mall chains will close, and that all class C and D malls which comprise about 30% of the total are at dire risk.

E-commerce has played a role in the shrinkage of brick and mortar stores, rising from less than 1% of all retail in 1999 to 10.2% now, according to the Census Bureau . Amazon comprises nearly half of online retail in the United States, according to EMarketer .

But retail has also been challenged by overcapacity, given a years-long retail boom that saw real estate developers building more malls than consumers really wanted. That bubble is now bursting, as consumer preferences have shifted away from enclosed malls. Also, many large chains from Payless Shoes to Toys "R" Us have slipped into bankruptcy after being acquired by private equity firms that loaded them up with debt .

-Lydia DePillis

Former Vice President Joe Biden set the tone for his second matchup with California Sen. Kamala harris the moment she walked on stage and shook his hand.

"Go easy on me, kid," he said to Harris as they greeted one another at center stage.

Whether it was a warning shot or simply one of those folksy Biden phrases, it was a signal that he would not be blindsided again the way he was in the first debate when Harris dispatched a fierce attack on his record opposing busing to desegregate schools decades ago. In that exchange, he appeared totally unprepared and caught off-guard. It led many voters to question whether he would be ready to go toe-to-toe against Trump, but his friends and advisers said it was much needed wake-up call.

But Wednesday night in Detroit was different. In his opening statement, he noted that Democrats were "expecting some engagement here."

"I expect we'll get it," he said, before turning his attention to Trump.

"Mr. President, this is America," Biden said, alluding to the diversity of the Democratic field on stage. "We are stronger and great because of this diversity, Mr. President, not in spite of it, Mr. President. So Mr. President, let's get something straight. We love it. We are not leaving it. We are here to stay and we're certainly not going to leave it to you."

Harris, in her opening statement, argued that she too was ready to take on Trump.

"I come from fighters," she said. "My sister Maya and I joke we grew up surrounded by a bunch of adults that marched about this thing called justice and I'm prepared to march with you to fight with you for the best of who we are and to successfully prosecute the case of four more years of Donald Trump. And against him."

The stage will show the diversity of the Democratic field and also the generational differences among the candidates. Harris and New Jersey Sen. Cory Booker, for example, have argued for a new generation of leaders who better reflect the diversity of the Democratic Party.

Booker, who is hoping for a breakout performance to help him move from the bottom of the pack toward the top tier of contenders, has signaled that he will be trying to show Wednesday night that it is time for fresh leadership and new ideas. Booker's camp has signaled he'll plan to target Biden as well, having previously gone after the vice president over his stances on racial issues and criminal justice.

Also on the stage on Wednesday will be Colorado Sen. Michael Bennet, former Housing and Urban Development Secretary Julin Castro, New York Mayor Bill de Blasio, Hawaii Rep. Tulsi Gabbard, New York Sen. Kirsten Gillibrand, Washington Gov. Jay Inslee and businessman Andrew Yang.

Fiery debate over the future of health insurance

Immediately, Harris and Biden began to spar over the differences in their health care plans. While Biden would expand Obamacare with the goal of universal coverage but not force Americans to give up their private health insurance, Harris' plan would phase in "Medicare for All" and phase out private insurance over 10 years.

"The senator has had several plans so far, and anytime someone tells you you're going to get something good in 10 years, you should wonder why it takes 10 years," Biden said, alluding to Harris' plan. "If you notice, there is no talk that the plan in 10 years will cost $3 trillion. You will lose your employer-based insurance and in fact, you know, this is the single most important issue facing the public. (To) be very blunt and to be very straightforward, you can't beat President Trump with double talk on this plan."

Harris replied that Biden's description of her plan was "simply inaccurate."

"The reality is our plan will bring health care to all Americans under a Medicare for All system," the California senator said. "Our plan will allow people to start signing up on the first day, babies will be born into our plan and right now 4 million babies, almost, are born every day -- or every year in America. Under our plan we will ensure everyone has access to health care. Your plan, by contrast, leaves out almost 10 million Americans."

Over and over again -- even when responding to criticism from Gabbard -- Harris returned to criticize Biden's plan.

"I'm going to go back to Vice President Biden," she said when given the opportunity to respond to Gabbard, "because your plan does not cover everyone in America by your staff's and your own definition. ... As many as 10 million people will not have access to health care, and in 2019 in America, for a Democrat to be running for president with a plan that does not cover everyone, I think, is without excuse."

At one point, Booker interjected with a plea for unity.

"The person that's enjoying this debate most right now is Donald Trump," Booker said. "We pit Democrats against each other while he is working right now to take away Americans' health care. There is a court case working through the system that will gut the Affordable Care Act. ... I was raised by two civil rights parents that told me to always keep your eye on the prize and that is in the United States of America. Every Democrat should stand with the belief that everyone should have access to health care -- that it's a human right. How we get there, it has to be to end this broken system."

A handful of low-polling moderates hoped to break through in a crowded Democratic field during Tuesday's debate by confronting the top-tier candidates on stage, Massachusetts Sen. Elizabeth Warren and Vermont Sen. Bernie Sanders.

Warren and Sanders withstood the attacks -- and counterpunched much harder.

The two most progressive candidates in the 2020 Democratic field struck inspirational tones, with Warren urging Democrats to be "the party of big, structural change." And they won over the crowd as they debated with moderate critics who tried to question their electability and the feasibility of their ideas, but failed to knock either candidate on their heels even once.

In the process, they could have eased primary voters' fears that their policy proposals would make ripe targets for President Donald Trump and the GOP in a general election.

For their part, moderates pushed back as they tried to define themselves on health care and decriminalizing the border. Mostly, though, their highlighting of ideological differences within the party offered Warren and Sanders a tune-up for higher-stakes showdowns this fall against the Democratic front-runner, former Vice President Joe Biden.

Here are seven takeaways from Tuesday night, the first of the two nights of CNN's Democratic debate in Detroit:

1. Warren and Sanders swat away their critics

Former Maryland Rep. John Delaney's argument for pragmatism midway through the debate teed Warren up -- and she landed a haymaker.

"I don't understand why anybody goes to the trouble of running for president of the United States just to talk about what we really can't do and shouldn't fight for," Warren said.

The crowd erupted. Before the debate ended, Delaney's Wikipedia page had been updated to say he'd died at Warren's hands in Detroit.

It wasn't the only time Warren took on Delaney. Early on, she called his attacks on "Medicare for All" proposals "Republican talking points."

Then there was Sanders' retort when Ohio Rep. Tim Ryan told him that "you don't know that" as he questioned the coverage Medicare for All would provide.

"I do know. I wrote the damn bill," Sanders shot back.

The visuals were memorable, too. Sanders at one point threw his hands up at Hickenlooper. Warren rubbed her hands at the thought of implementing her 2% wealth tax on Delaney's $65 million personal fortune.

Delaney, Ryan, former Colorado Gov. John Hickenlooper and Montana Gov. Steve Bullock all went at Sanders and Warren from the right. Delaney began the debate by comparing the two to failed Democratic nominees George McGovern (1972), Walter Mondale (1984) and Michael Dukakis (1988).

The problem facing the moderates is that their arguments largely consisted of dire warnings about the political consequences of moving too far left. They didn't offer Democratic voters an alternative vision for a post-Trump America.

It's why none of them landed real blows on Warren or Sanders all night. If anything, sparring with the low-polling quartet served to sharpen Warren and Sanders for the fights against stronger opponents ahead.

2. No daylight between Warren and Sanders

The top two-polling progressives in the Democratic field were positioned on stage next to each other Tuesday night. But they showed no appetite for a fight with each other.

Instead, Warren and Sanders largely stood together, beating back moderate critics all night.

The two are courting different voters right now, but eventually, one of the them will need to consolidate progressive support to win the Democratic nomination.

Still, Tuesday night showed that the time to turn against each other could be months away. Both are considered top-tier candidates who poll viably and are raising money effectively, and both appear to believe it's far too early to take such a risk.

3. 'Dark psychic force'

Author Marianne Williamson provided one of the night's most memorable moments when she addressed the water crisis in Flint, Michigan, with a stirring condemnation of environmental racism -- and other candidates' approach to talking about it.

"This is part of the dark underbelly of American society, the racism, the bigotry, and the entire conversation that we're having here tonight -- if you think any of this wonkiness is going to deal with this dark psychic force of the collectivized hatred that this President is bringing up in this country, then I'm afraid that the Democrats are going to see some very dark days," she said.

"We need to say it like it is," Williamson said. "It's bigger than Flint. It's all over this country. It's particularly people of color. It's particularly people who do not have the money to fight back, and if the Democrats don't start saying it, why would those people feel they're there for us? And if those people don't feel it, they won't vote for us and Donald Trump will win."

The answer was a reminder of how powerful the perspective of a political outsider can be in presidential races. Williamson is a low-polling long-shot, but generated buzz with her condemnation of "wonkiness" on racism.

4. Seeking a middle ground on health care

The debate began with a battle over health care dominated by Sanders and Warren defending Medicare for All against Delaney, Hickenlooper and Montana Gov. Steve Bullock, who cast it as politically fraught in a general election.

Former Texas Rep. Beto O'Rourke and South Bend, Indiana, Mayor Pete Buttigieg sought middle grounds -- and their answers on health care underscored where they are trying to fit into the Democratic field.

O'Rourke touted a plan called "Medicare for America." It would enroll uninsured Americans in Medicare, and allow those who are dissatisfied with their private insurance to opt into Medicare -- while retaining private insurance for those who wish to keep it.

"Our plan ensures everyone is enrolled in Medicare or can keep their employer-sponsored insurance," he said.

Buttigieg argued for a similar approach -- and said Democrats should stop worrying about being called socialists by Republicans over the health care policies they back.

"If it's true that if we embrace a far-left agenda, they're going to say we're a bunch of crazy socialists. If we embrace a conservative agenda, you know what they're going to do? They're going to say we're a bunch of crazy socialists," he said. "So let's just stand up for the right policy, go out there and defend it."

5. Arguments for reparations

Asked about racism, O'Rourke was the first Democrat on stage to argue for a step toward reparations.

"The very foundation of this country -- the wealth that we have built, the way we became the greatest country on the face of the planet -- was literally on the backs of those who were kidnapped and brought here by force," he said.

O'Rourke said he backs legislation by Texas Rep. Sheila Jackson Lee that would create a commission to study reparations.

It was an effective moment for O'Rourke -- who, like Buttigieg, Williamson and Minnesota Sen. Amy Klobuchar -- didn't end up playing a part of the memorable clashes with other candidates, because they didn't fit into the progressives-vs.-moderates theme that Warren, Sanders and their critics established early on.

Williamson also had a moment as she defended her plan to offer $200 billion to $500 billion in reparations.

"We need to recognize when it comes to the economic gap between black and whites in America, it does come from a great injustice that has never been dealt with," she said.

6. Trying to make moments

Klobuchar struggled more to get into the action. She didn't attack Warren and Sanders the way others did, and there are reasons for her approach -- Klobuchar could end up a viable contender for the vice presidential nomination. But she did stake out moderate ground in her opening statement.

"You're going to hear a lot of promises up here, but I'm going will tell you this," she said. "Yes, I have bold ideas but they are grounded in reality. And, yes, I will make some simple promises. I can win this. I'm from the Midwest. And I have won every race, every place, every time."

Buttigieg's best moment came when he made the case for structural reform to the American political system -- the issue on which his proposals have been the furthest-reaching in the Democratic field.

"Of course we need to get money out of politics, but when I propose the actual structural democratic reforms that might make a difference -- end the electoral college, amend the Constitution if necessary to clear up Citizens United, have D.C. actually be a state, and depoliticize the Supreme Court with structural reform -- people look at me funny, as if this country was incapable of structural reform," Buttigieg said.

"This is a country that once changed its Constitution so you couldn't drink and changed it back because we changed our minds and you're tell me we can't reform our democracy in our time. We have to or we will be having the same argument 20 years from now."

7. Ideological split on decriminalizing the border

Mirroring the debate on health care, progressives and more moderate candidates split on the question of whether to decriminalize crossing the border illegally.

Warren said the current law "has given Donald Trump the tool to break families apart." Sanders also said he would decriminalize crossing the border.

But more moderate candidates said they would retain laws against crossing the border illegally.

"We can argue over the finer points of which parts should be handled by civil law and criminal law," Buttigieg said.

He later added: "If fraud is involved, that's suitable for the criminal statute. If not, it should be handled under civil law."

O'Rourke said he would waive green card fees, give so-called "Dreamers" -- undocumented immigrants who were brought into the US as children -- citizenship, ease the process of seeking asylum and aid struggling Central American countries.

"Then, I expect that people will come here, follow our laws, and we reserve the right to criminally prosecute them if they do not," he said.

Hickenlooper said: "I agree that we need to secure borders. There is no question about that. The frustration with what's going on in Washington is they are kicking the ball back and forth. Secure the borders and make sure whatever law we have doesn't allow children to be snatched from parents and put in cages."

On Wednesday, a team of eye doctors will perform free surgeries to restore vision of people suffering with cataracts.

It's free to uninsured patients at Sarasota-based Center for Sight.

If you can't make it, the service will be available again on August 7, but you must first apply online and meet the requirements.

Applicants must be United States citizens, have a confirmed diagnosis of cataracts, live at or below the poverty level set by the United States Department of Health and Human Services, and be without medicare, medicaid, or third-party insurance coverage.

You can apply for the program here.

Elizabeth Warren and Bernie Sanders immediately became the target of more moderate Democrats running for the White House as their rivals argued during the debate Tuesday night that some of their ideas would be too costly and risky for the middle class.

Montana Gov. Bullock, who appeared on the debate stage for the first time, introduced himself to America as a person who had governed a state that President Donald Trump won. Bullock argued that he knew how to connect with those voters. Within minutes, both he and former Rep. John Delaney, of Maryland, argued vigorously against Warren and Sanders' full-throated support of "Medicare for All."

"At the end of the day I won't support any plan that rips away quality health care from individuals," Bullock said. "This is an example of wish-list economics. It used to be Republicans that wanted to repeal and replace, now many Democrats do as well."

The argument illuminated the stark ideological divide within the Democratic Party.

Since Hillary Clinton's loss to Trump in 2016, Democrats have carried on an internal debate about whether they must do more in 2020 to attract the more centrist, white working-class voters who cast ballots for Trump or if they should embrace a bold agenda that would dramatically restructure government by enacting proposals like Medicare for All and the Green New Deal.

And it didn't take long for Warren and Sanders to fight back and defend their side of the ideological divide with gusto.

"I don't understand why anybody goes to all the trouble of running to the president of the United States to talk about what we really can't do and shouldn't fight for. I don't get it," Warren said in response to Delaney. "Our biggest problem in Washington is corruption. It is giant corporations that have taken our government and that are holding it by the throat, and we need to have the courage to fight back against that and until we're ready to do that, it's just more of the same. Well, I'm ready to get in this fight. I'm ready to win this fight."

Sanders added, "To win this election and to defeat Donald Trump -- which by the way, in my view is not going to be easy -- we need to have a campaign of energy and excitement and of vision. We need to bring millions of young people into the political process in a way that we have never seen by among other things, making public colleges and universities tuition free and canceling student debt."

Medicare for All takes the spotlight in the Motor City

Tuesday's debate took place in Detroit, the largest city in the battleground state of Michigan. It's a place Democrats are working hard to flip after losing it to Trump by a narrow margin in 2016 -- the first time the state had gone to a Republican since 1988.

That setting provided an opening for some of the lesser-known moderates in the race, some of whom are hanging on by a thread already as they fight to keep their campaigns alive. In the opening stages of the debate, that was obvious in how some candidates attacked the progressive Medicare for All position.

Delaney noted that his father was a union worker for many years to earn his health care, and that he and many other Americans would not want Democrats completely restructuring the system. He charged that Sanders' "math" was wrong.

Author Marianne Williamson noted that she often agrees with Warren and Sanders on policy issues but not on Medicare for All.

"I'm normally way over there with Bernie and Elizabeth, but on this one. I hear the others," she said.

Williamson rejected Warren's argument that Democrats were using Republican talking points to demonize the Medicare for All plan. "I do have concern that it will be difficult. I have concern that it will make it harder to win, and I have a concern that it will make it harder to govern," she said.

One terse exchange between Sanders and Ohio Congressman Tim Ryan unfolded as Sanders was questioned about the estimated 600,000 union members in Michigan who would be forced to give up their private health insurance plans if Medicare for All were enacted.

"Can you guarantee those union members that the benefits under Medicare for All will be as good as the benefits that their union reps fought hard to negotiate?" moderator Jake Tapper asked.

"They will be better because Medicare for All is comprehensive and covers all health care needs for senior citizens, it will finally include dental care, hearing aids and eyeglasses --," Sanders said.

"You don't know that, Bernie," Ryan interrupted. "You don't know that."

"I do know!" Sanders responded sharply. "I wrote the damn bill."

Ryan, undeterred, continued to make the point about union workers.

"Sen. Sanders does not know the union contracts in the United States," Ryan said. "I'm trying to explain that these union members are losing their jobs. Their wages have been stagnant. The world is crumbling around (them). The only thing they have is possibly really good health care, and the Democratic message is going to be -- we're going to go in, and the only thing you have left, we're going to take and do better. I do not think that's a recipe for success for us. It's bad policy and it's certainly bad politics."

Candidates seek to break out

Some lower-tier candidates sought to create viral moments that could buoy their campaigns in the latter stages of the debates.

Among them was Williamson, who drew cheers with answers on the Flint water crisis and reparations for slavery.

"The entire conversation that we're having here tonight, if you think any of this wonkiness is going to deal with this dark psychic force of the collectivized hatred that this President is bringing up in this country, then I'm afraid that the Democrats are going to see some very dark days," she said.

"We need to say it like it is: it's bigger than Flint. It's all over this country. It's particularly people of color, it's particularly people who do not have the money to fight back, and if the Democrats don't start saying it, why would those people feel they're there for us? And if those people don't feel it, they won't vote for us and Donald Trump will win."

Former Texas Congressman Beto O'Rourke had perhaps one of his strongest answers of the debate when talking about race relations in America.

"I want to acknowledge something that we're all touching on, which is the very foundation of this country, the wealth that we have built -- the way we became the greatest country on the face of the planet -- was literally on the backs of those who were kidnapped and brought here by the legacy of slavery and segregation and Jim Crow," O'Rourke said, "and suppression is alive and well in every aspect of the economy and country. Today as president I will sign into law a new voting rights act. I will focus on education, address health care disparities and also sign into Sheila Jackson Lee's reparations bill so we can have the national conversation we waited too long in this country to have."

President Donald Trump is planning a trip to Central Florida next week, according to reports.

According to the Tampa Bay Times, President Trump is making a stop at The Villages for a "Medicare-focused event" on Tuesday, August 6.

President Trump's visit comes weeks after he announced his re-election bid at a rally in Orlando.

RELATED: President Trump announces re-election bid at Orlando rally

According to the president, they received more than 130,000 requests for tickets for the June event. It was held at the Amway Center and First Lady Melania Trump, VP Mike Pence and Second Lady Karen Pence were all in attendance.

The scheduled event is expected to be for "official White House business," the Tampa Bay Times reports.

President Trump has not publicly addressed Tampa Bay Times' report on his upcoming visit to The Villages.

It has been nearly a month since 20 Democrats met for the first debate to vie for the partys nomination in next years presidential election. On Tuesday and Wednesday, 20 Democrats will once again take the stage, this time in Detroit.

What is different

While there will be 20 Democrats on the stage -- 10 each night -- one Democrat has since dropped out of the race. Rep. Eric Swalwell of California ended his bid for the presidency earlier this month. His spot on the debate stage has since been filled by Montana Gov. Steve Bullock.

With this debate being aired on CNN, there will be a different set of moderators. Don Lemon, Dana Bash and Jake Tapper will conduct the debate.

Unlike last months Miami debate, CNN has told the candidates that there will be no show of hands or one-word, down-the-line questions.

Also different, CNN has threatened to reduce the time of candidates who are constantly interrupting.

What is the same

Candidates will be given 60 seconds to answer and 30 seconds for follow ups. The requirements to qualify for the debate also remained the same, and was based off of polling and fundraising criteria.

Biden back as frontrunner

Vice President Joe Bidens lead took a bit of a hit in the days following the last debate thanks to a contentious confrontation from Sen. Kamala Harris of California. Harris emotional rebuke of Bidens stance on public school busing in the 70s was easily the most memorable moment of the night.

It also seemed to have, at least temporarily, cut into Bidens lead. Polls from CNN and Quinnipiac University had Bidens polling as low as 22 percent. Harris, for her part, saw her numbers increase to above 10 percent. Biden has seen his polling number return to near 30 percent. Harris, however, has continued to poll above 10 percent, indicating that she perhaps draw some support from some of the other candidates.

Biden and Harris are the two center-stage candidates for the July 31 debate.

But Harris might not be Bidens biggest concern on Wednesday. Sen. Cory Booker and Biden have been involved in a spat in recent days over criminal justice reform. Booker called Biden an architect of mass incarceration. This is over Bidens support for the 1994 Crime Bill.

Warren/Sanders showdown

Sens. Bernie Sanders and Elizabeth Warren are generally allies in the Senate, but on Tuesday, they will square off on stage. The two senators are vying for the support of the liberal wing of the party.

Sanders and Warren have been contending for No. 2 in polling.

Is it quite possible that Tuesdays debate will consist of the moderators trying to find some daylight between the two candidates.

Both candidates make income inequality a central theme of their campaigns. Both are strong proponents of Medicare-for-all. Both support increasing the national minimum wage.

How candidates qualified

To qualify for the second round of debates, candidates had to fulfill one of two criteria: either get 65,000 donors to their campaigns, with at least 200 donors in 20 different states, or obtain at least 1% in three polls recognized as legitimate by the committee.

Here are the candidates:

On July 30, these candidates will be on stage:

On July 31, the candidates who will debate are:

How to watch:

The debates will be aired live from 8 to 10:30 p.m. ET on CNN on July 30 and 31.

Joe Biden is preparing for a confrontation with New Jersey Sen. Cory Booker and California Sen. Kamala Harris .

Days from the second Democratic presidential debate in Detroit, Biden has become more aggressive against his rivals on the campaign trail -- and a senior campaign official says Biden himself is the driver of his new approach.

Several advisers had encouraged Biden to be "more aggressive" earlier in the campaign, one adviser said. But after the debate -- which Biden rewatched afterward -- the former vice president told aides he felt he needed to fight back more.

In Biden's first months in the 2020 race, he attempted to stay out of the Democratic fray, keeping his focus on President Donald Trump. But his four decades in national politics gave other Democrats a lengthy record to attack -- a reality that has forced Biden to make adjustments.

"He isn't going to allow his record to be weaponized," the official said. "He isn't going to take hits from any of the candidates sitting down. He won't personally attack anyone, but he will be very clear about the contrasts between he and the other candidates in the race."

"He's spent his life in public service and isn't going to let others define that service for political purposes," another senior Biden campaign official said.

One official said Biden genuinely believes he was a little too polite in the last debate -- noting that he abided by the ground rules of the debate while other candidates did not.

Biden plans to huddle with top aides and advisers in the days leading up to the debates and will hold another round of mock debates.

Standing between his rivals

At least some of the criticism awaiting Biden on the debate stage is already clear: In recent days, Booker has repeatedly attacked Biden over his role in the passage of the 1994 crime bill, while, in the first debate, Harris eviscerated Biden over his opposition to federally mandated busing to desegregate schools.

Biden will be sandwiched between the two on stage in Detroit on Wednesday night, the second night of the two-night debate hosted by CNN.

As Booker has ramped up his criticism, the Biden camp felt the New Jersey senator had presented "multiple mischaracterizations" of the former vice president, a Biden aide said.

That has fueled the Biden campaign's willingness to attack Booker. Beyond Biden's own words, his aides have increasingly taken aim at Booker on social media. On Thursday morning, Biden's deputy campaign manager Kate Bedingfield cited Booker's recent comments about the importance of engaging and exciting black voters, tweeted, "We couldn't agree more!" and highlighted a poll that shows Biden vastly outperforming Booker among black voters.

Biden has also notably sharpened his thinly veiled attacks on Harris on the issue of health care since the last debate. The official said Biden decided weeks ago that he wanted to "draw a line in the sand on health care and a defense" of the Affordable Care Act.

"He has drawn stark contrasts between himself and the other candidates specifically on this issue," the official said. "Sen. Harris just doesn't seem to know where she stands exactly when it comes to health care."

Before the first debate, Biden campaign officials had already decided on a change in tone and strategy aimed at making the former vice president a bigger part of the everyday conversation in the Democratic primary -- and that shift was accelerated by what happened in the debate, a source close to Biden's campaign said.

"The mindset of the campaign changed that night," the source said.

Biden is also being aided by his research shop that's now had the benefit of three months of a campaign and has settled into its Philadelphia headquarters, the source said.

"He wants to be president," the source said. "He's not running for a lifetime achievement award or expecting this to be given to him. Anybody who thinks he's going to quietly go into the night -- this is a guy that's survived 40 some odd years of public life; he's not just going to roll over."

Biden's shift toward a more aggressive tone began about three weeks ago when, in a speech in Sumter, South Carolina, he fired back at Democratic critics of his record on racial issues.

"It's as if my opponents want you to believe I served from 1972 until 2008, and then took the next eight years off. They don't want to talk much about my time as vice president," he said.

Then, during a campaign swing through New Hampshire, he made pointed attacks on Medicare for All -- the single-payer health program proposed by Vermont Sen. Bernie Sanders and backed by Harris -- a feature in his stump speech.

He credited Sanders with being "honest" about the costs and ramifications of Medicare for All -- but said other candidates who back the proposal, including Harris, have "so far, not" been honest. Biden has continued that line of attack in recent days.

Harris has said she would implement Medicare for All without increasing middle-class taxes -- but has not explained how she would pay for it.

"I think we should have an honest debate," Biden told reporters Wednesday in Michigan. "Look, you can't go out and you can't run for president and beat Donald Trump without leveling with the American people about what you're going to do and how you're going to pay for it. I'm anxious for that debate."

Biden said Wednesday he "was probably overly polite in the way I did respond to an attack" in the first debate when Harris lambasted his record on busing.

In a pre-recorded interview with the Tom Joyner Morning Show that aired Thursday, Biden said of Harris: "I thought we were friends. I hope we still will be."

CITRUS COUNTY, Fla. A U.S. Navy veteran was cremated after a man falsely claiming to be his nephew signed off on his cremation and death certificate, the I-Team uncovered.

Navy veteran Robert Walaconis of Hernando, Florida died June 5, 2018 at 71 years old.

His son and daughter said they found out months later.

They claim items were missing from their fathers home including a gun collection and told the I-Team they were shocked when they discovered his death certificate listed a nephew named Todd Smith.

But Walaconis doesnt have a nephew, according to his son, Michael.

We went to the health records office and we saw a name on there, a Todd Smith, said Michael. And I had no idea who that was. My father was an only child.

The Florida agency overseeing funeral homes and cemeteries has now opened an investigation after I-Team Investigator Kylie McGivern began asking questions about the case.

Robert Walaconis bank also confirmed to the I-Team it has opened a fraud investigation into why someone changed the contact information for the phone number and address on his account.

Michael said that fake nephew also made decisions against his father's wishes.

He wanted to be buried in Fort Indiantown Gap in Pennsylvania, said Michael. I cant believe this could happen to someone.

The I-Team wanted to know the same thing.

Mark Downing, the owner of Downing Funeral Home, said he took Todd Smith at his word when he signed off on Robert Walaconis cremation.

Todd is the nephew thats the paperwork were given, said Downing. He shouldve told us that there was a son and daughter.

Florida statute gives close family members priority over funeral decisions.

Downing said he has performed online searches on Facebook and used other tools to search for surviving family members, but in this case, Downing said he had no idea Robert Walaconis had children.

When asked if he requested identification from Smith, Downing said, The identification came from Todd from hospice, the hospitals and everything else that he was a nephew.

Robert Walaconis died after a short time at HPH Hospice in Brooksville, Florida, the I-Team confirmed.

A spokesperson for the parent company of that facility agreed to an on-camera interview and then later declined, emailing in a statement that the facility follows all federal rules, which dont require it to question properly executed forms.

The I-Team obtained the forms the hospice facility sent the funeral home. On one form, a hospice nurse wrote they called his nephew, Todd Smith, who was having a locksmith open Walaconis locked chest file to find info concerning finances.

The nurse also wrote Walaconis had not been in contact with his children for 20 years.

But Michael and his sister told the I-Team thats not true. The siblings said they spoke to their father on the phone from time to time. They also provided emails they traded with him and retirement fund documents Robert signed, naming his children as beneficiaries.

Michael admits he and his father had a troubled relationship.

He was a very good businessman and was a very good citizen, said Michael. But he wasnt the best at being a father, so, through the years I wanted to tell him that I forgive him for that And I didnt get that.

As his daughters college graduation approached, Michael said he reached out to his dad.

We tried to call. The phone was disconnected, said Michael. We thought he was just trying to get some space, which he did over the years. If he didnt want to talk to you he wouldnt.

I called to do a health and welfare check on him and we found that he had passed several months before, said Michael.

Michael and his sister immediately drove from Pennsylvania to their fathers home in Hernando, Florida.

We walked into trash, all his financial records poured all over that was the only thing that was out, said Michael.

Michael said some of his fathers belongings were gone and his guns were missing.

He collected antique guns. The last time I saw, he had well over 20 valuable guns, said Michael.

Michael and his sister called the Citrus County Sheriffs Office, which never opened an investigation into the claims of missing guns. Thats because Walaconis children didnt know the serial numbers of their fathers firearms, according to a spokesman for the sheriffs office.

If we had a list, serial numbers or anything that would have actually said, Yes, this object is missing, we could research it, said Special Operations Sgt. Lee Carey.

According to the report by the responding deputy, he asked Smith if he had written permission from Walaconis to take anything from the home.

he advised no, but the only things he took was a bed, a chair and a flat screen television, the deputy wrote in his report.

When asked if Smiths response raised any red flags for law enforcement, Lee said, At this point, we werent able to determine who the property belonged to, so it becomes a civil matter, that the family must go to the court system, through probate, to determine.

The I-Team reached out to Todd Smith, who agreed to an on-camera interview and said he was close with Walaconis.

I mean he was family to us. He really was, said Smith. He was at all our family dinners, his birthday we celebrated with him, everything.

The I-Team asked Smith to provide photos, texts or emails that would back up his story, but he did not provide any.

I was the one that was there to wipe his butt when he had an accident, when he was sick and couldnt get up out of bed, said Smith. His kids werent here for the last six and a half years and Im not trying to make them out to be bad people or anything, but it happened. And Im sorry that it happened this way. I didnt want to have to make these decisions.

When asked why he said he was Roberts nephew, Todd said, I didnt say that. He is the one who told the nurse at the hospital that I was his nephew.

I-Team Investigator Kylie McGivern asked Smith why he never corrected anyone and signed documents naming him as the nephew, including his death certificate.

Smith didnt directly answer that question but said, I tried to get a hold of his family.

Smith also told the I-Team he didnt know anything about the claims of missing guns.

When asked why people should trust him, Smith said, Im a trustworthy person. I mean I did nothing wrong. I dont think I did anything wrong.

Smith admitted he never picked up Robert Walaconis ashes from the funeral home.

His son, Michael, tracked down his fathers remains 10 months later and finally laid him to rest in a funeral in Pennsylvania complete with military funeral honors.

Im trying to do the right thing and basically make sure this doesnt happen to other people, said Michael.

You can search license and disciplinary information, funeral or cemetery services as well as find directions for how file a complaint on the states website.

HPH Hospice and Chapters Health System released the following statement:

This story came from a tip. If you have something youd like the I-Team to investigate, email kylie.mcgivern@wfts.com or call 1-866-428-NEWS.

Vermont Sen. Bernie Sanders will travel to Canada later this month with Type 1 diabetes patients seeking cheaper insulin as part of his ongoing efforts to highlight the hardships imposed by pharmaceutical companies on Americans, his campaign announced Thursday.

The trip, which will leave from Detroit, is scheduled for two days before CNN's presidential primary debates in the city on July 30 and 31.

Sanders has so far set the pace for the 2020 health care debate , with the other candidates either signing on to his "Medicare for All" single payer plan or talking about how their vision differs. And throughout much of his political career, Sanders has targeted pharmaceutical companies over the cost of prescription drugs. He often lists the industry among the powerful few whose interests are at odds with the American public, alongside Wall Street and the wider health care system.

In an interview with CNN Thursday, Sanders directly attributed the rising cost of drugs in the United States, and the disparity with prices in Canada, to the overall difference between the health care systems in the two countries. His focus on prescription drugs is just one part of a broader push for the US to adopt a system similar to the one in Canada.

"Canada has a nationalized, single-payer system that allows them to negotiate much better prices with the drug companies," Sanders told CNN. "In our country it is a much different story. The pharmaceutical companies brought in $69 billion in profit. That is insane and it is a real threat to the health of every American. Congress needs to do something about this and when I am president we will lower the cost of prescription drugs."

Sanders also argued that, contrary to President Donald Trump's claims, the current administration's policies have only made things worse.

"He is not telling the truth, which likely comes as a surprise to no one," Sanders said. "The cost of prescription drugs have gone up during his administration."

More than 30 million Americans have diabetes, with an estimated 7.5 million requiring insulin, according to the American Diabetes Association. More than 1.5 million of them have type 1 diabetes. The average price of the drug nearly tripled between between 2002 and 2013, the ADA said last year.

This is not the first time Sanders will cross over into Canada joining people in search of cheaper medicine. Two decades ago, he took part in a similar trip, mostly made up of women fighting breast cancer; they headed out of Saint Albans, Vermont, in search of lower drug prices.

"Now 20 years later, we are basically in the same place -- we are going to take a group of people from Detroit into Windsor, Ontario, which is right over the border, to purchase the drugs they need to save their lives at a greatly reduced cost."

On the campaign trail, Sanders often refers to that first trip to Canada.

"I'll never forget this as long as I live," Sanders told a crowd in Marshalltown, Iowa, last month. "These are women, working class women, struggling with a life-and-death issue of breast cancer. We walked into the pharmacy there, and they bought what was then a widely prescribed breast cancer drug."

Sanders also frequently points to the Canadian and other health care systems as models for what Medicare for All in the US could become.

"If Canada can provide health care to every man, woman and child, and the UK and every other major country on earth, please do not tell me the US cannot do the same," Sanders said at a recent town hall.

Maggots growing around a dying man's feeding tube. Staff failing to treat the wounds of a patient with Alzheimer's disease, forcing the amputation of a leg. Caregivers unable to recognize injuries on a woman's pelvic area as signs of sexual assault and repeatedly trying to insert a urinary catheter instead, sending the woman to a hospital.

These are just a few of the graphic details revealed in two reports on US hospice care released Tuesday by the Office of Inspector General for the Department of Health and Human Services. More than 80% of end-of-life facilities in the United States had at least one deficiency, the report found, and more than 300 -- about 18% -- were poor performers with serious problems that jeopardized patient health and safety.

The inspector general found that "these hospices did not face serious consequences for the harm described in this report" and argued that the Centers for Medicare and Medicaid Services (CMS) needs greater legal authority to penalize hospices with life-threatening violations.

"CMS cannot impose penalties, other than termination, to hold hospices accountable for harming beneficiaries," the report said. Congress would have to give the agency permission to impose fines on hospices, which it can already levy against nursing facilities, and the inspector general urged CMS to seek that authority.

It is also nearly impossible for the public to know about hospice deficiencies like those described in the report because CMS does not include that information on its Hospice Compare website.

The agency cannot legally disclose all deficiency information it receives -- such as survey reports from outside accrediting organizations -- but the agency can publish reports from state agencies, according to the inspector general. So far, it has chosen not to.

In a statement, a CMS spokesperson said that the agency "has zero tolerance for abuse and mistreatment of any patient, and CMS requires that every Medicare-certified hospice meet basic federal health and safety standards to keep patients safe."

Medicare spent more than $17 billion on hospice care in 2017, according to the report, and cared for more than 1.5 million patients. But some of that government-funded care actively endangered patients, according to the Office of Inspector General, and hospices suffered few consequences.

In one case, a woman was consistently abused by her daughter, who was acting as her caregiver. "The daughter would use a chain and elastic seatbelt to keep the beneficiary from getting out of bed," the report stated. "The daughter would also leave her mother in a wheelchair in the bathroom with the lights off and would spray her with water when she called out for help."

The hospice's social worker was notified of signs of abuse, the report found, but did not visit the patient for several weeks. When the social worker finally visited, he didn't assess the patient's safety.

In another case, a woman sustained significant injuries in her pelvic area, on her upper leg and on her right forearm. Hospice staff failed to recognize these as signs of a possible sexual assault, the report found, and did not report them to hospice administrators or local law enforcement.

Instead, the hospice obtained a physician's order to insert a urinary catheter, which staff tried and failed to insert multiple times. The woman was eventually sent to a hospital, where staff recognized signs of the possible sexual assault and called the police.

But the hospice said that it was under no obligation to report the possible sexual assault to CMS, according to the inspector general report. "CMS requires a hospice to report abuse, neglect, and other harm in only one circumstance: when it involves someone furnishing services on behalf of the hospice and the hospice has investigated and verified the allegation," the report notes.

Because an accusation of assault had not been leveled against a hospice employee, "the hospice claims that it had no obligation to investigate the possible assault of a beneficiary in its care," according to the inspector general.

In another case, one patient's neighbor repeatedly came into his apartment "naked, high, and drunk" and stole medications, including opioids and anti-anxiety pills. While several hospice employees were aware of the situation, "the hospice planned no further actions to notify law enforcement or to ensure the beneficiary's safety," according to the report.

While nursing facilities must report all alleged abuse or exploitation to officials, including CMS, the hospices have no such obligation under Medicare reporting requirements, according to the inspector general.

In a letter to the inspector general that was included in the report, CMS administrator Seema Verma defended her agency's record and argued that the report highlighted only the worst violations.

"While these cases that were identified during surveys of hospices are very serious," said Verma, "we want to reassure beneficiaries considering hospice care that these cases are not indicative of the type of care the majority of hospice beneficiaries receive."

CMS agreed with most of the inspector general's recommendations, such as educating hospices on common deficiencies and increasing oversight of the most serious offenders, but argued that state reports on hospice violations should not be publicly accessible on the agency's website, Hospice Compare .

"CMS stated that while it supports increased transparency of hospice survey findings, publicly reporting survey reports only from State agencies -- while CMS is currently prohibited from sharing information from surveys by accrediting organizations -- may be misleading to consumers while researching hospice options," according to the inspector general.

Those state reports are currently required to be publicly available, according to the report, but CMS has not made them easily accessible. President Trump's 2020 budget includes a proposal to allow disclosure of survey reports from accrediting organizations, Verma said. If the agency receives that authority, she added, CMS will "evaluate the best approach for publicly disclosing these reports."

The agency said in a statement that it has taken other actions to ensure patient safety, arguing that it is "laser-focused on improving its oversight of healthcare facilities, including hospices," according to a spokesperson.

"Just this year, CMS issued new guidance to surveyors -- who inspect hospices and other facilities -- to help them more quickly identify and address the most grave patient safety situations, called 'immediate jeopardy,' " said the spokesperson. "CMS now requires surveyors to follow a standardized process when they identify immediate jeopardy situations."

But agency actions can only go so far, according to the inspector general, and actually improving conditions may fall to congress. "CMS should seek statutory authority to establish additional, intermediate remedies for poor hospice performance," said the report. "To effectively protect beneficiaries from harm, CMS must have enforcement tools."

A federal judge in Washington struck down a Trump administration plan, set to take effect Tuesday, that would have required drugmakers to include pricing information in ads seen on TV.

U.S. District Judge Amit Mehta, in a 27-page ruling, said the administration,which announced the initiative in May, had failed to show it possessed the proper legal authority.

Mehta wrote that, ultimately, such a decision rests with the legislative branch -- not with the Department of Health and Human Services.

"To be clear, the court does not question HHS's motives in adopting the WAC Disclosure Rule. Nor does it take any view on the wisdom of requiring drug companies to disclose prices. That policy very well could be an effective tool in halting the rising cost of prescription drugs," Mehta wrote. "But no matter how vexing the problem of spiraling drug costs may be, HHS cannot do more than what Congress has authorized. The responsibility rests with Congress to act in the first instance."

Health and Human Services Secretary Alex Azar, a former executive at Eli Lilly, which filed the lawsuit along with industry peers Merck and Amgen, said when the administration announced the plan two months ago that consumers would "have vastly more information to choose among different therapies and pick the most affordable one."

Drug companies spend about $4 billion annually on advertising. Those that sued after the Trump administration's announcement in May cited First Amendment grounds.

In a statement released on Monday, Caitlin Oakley, a spokeswoman for HHS, said, in part: "We are disappointed in the courts decision and will be working with the Department of Justice on next steps related to the litigation. President Trump and Secretary Azar remain focused on lowering drug prices and empowering patients through more transparency in healthcare costs. Although we are not surprised by the objections to transparency from certain special interests, putting drug prices in ads is a useful way to put patients in control and lower costs."

The rule, had it taken effect, would have required ads for any prescription drug or biological product covered by Medicare or Medicaid with a list price of at least $35 -- per month or per course of treatment -- to include that information. The 10 treatments most frequently advertised, according to HHS, had list prices of $535 to $11,000.

Democratic voters tuned into Thursday night's debate searching for the candidate who could take down Donald Trump in the 2020 presidential election -- and many flipped on their television sets expecting that person to be front-runner Joe Biden.

In a surprise twist, it was former prosecutor Kamala Harris who took command of the debate stage, outshining her rivals time after time with succinct and fiery denunciations of the Trump administration's policies on everything from the treatment of migrant children to the gaping income equality in this countryand even setting the tone early in the debate by reminding her colleagues that Americans don't want a "food fight," they want to know Democrats are "going to put food on the table."

The drama of that exchange overshadowed the two-hour debate that encapsulated a broad array of policy debates, and a clear divide on the stage between candidates like Sanders and Warren who want to see the party veer in a more leftist direction with "Medicare-for-All" and the disappearance of private health insurance, and more moderate candidates like former Colorado Gov. John Hickenlooper and Colorado Sen. Michael Bennet who worry that the Democrats' shift to left will endanger the parties chances of retaking the White House.

But it was the spell-binding moment when she challenged Joe Biden over his invocation of working with former colleagues who were segregationists and his record on busing that will be replayed hundreds of times.

With a withering series of questions and an emotional allusion to the fact that she was one of those little girls who rode those buses, Harris went a long way toward proving to Democratic voters that she can -- as she often tells audiences -- fiercely prosecute the case against Trump.

In this case, Biden was her foil.

Leaning heavily on the skills that made her so effective both as a prosecutor and as an interrogator of Trump nominees in Senate hearings over the past few years, she began quietly by alluding to the controversy that Biden stirred last week at a fundraiser when he noted that he had worked with segregationist senators in the 1970s and 1980s during what he framed as a less polarizing, more civil time in politics.

"Vice President Biden, I do not believe you are a racist, and I agree with you, when you commit yourself to the importance of finding common ground," Harris said. "But I also believe -- and it's personal -- it was actually hurtful to hear you talk about the reputations of two United States senators who built their reputations and career on the segregation of race in this country."

As Biden stared straight ahead, looking somewhat pained, Harris continued by criticizing the former vice president for trying to prevent the Department of Education from enforcing school busing to integrate schools during the 1970s, noting that decision hurt a little girl in California.

"That little girl was me," Harris said with emotion swelling in her voice. "So I will tell you that on this subject, it cannot be an intellectual debate among Democrats. We have to take it seriously. We have to act swiftly."

His voice rising, Biden attempted to strike back, calling Harris' remarks a "mischaracterization of my position across the board."

"I did not oppose busing in America," Biden replied. "What I opposed is busing ordered by the Department of Education, that's what I opposed."

Harris brushed off Biden's argument for local control, arguing the federal government must step in to keep civil rights from being violated "because there are moments in history where states fail to preserve the civil rights of all people."

The moment dealt the front-runner a serious setback that is likely to lead more than a few voters to question whether he is the best-equipped candidate to take on the current occupant of the White House. Biden eventually seemed to concede the exchange after attempting to list a long litany of civil and equal rights causes that he had championed, simply saying, "My time is up."

Despite strong answers out of the gate about income inequality in America and Trump's economic policies that that favor the wealthiest Americans, Biden and Sanders, at times, seem to recede on the stage as Harris and South Bend, Indiana Mayor Pete Buttigieg delivered composed, thoughtful and emotionally charged answers that have resonated with Democrats who are seeking a fresh generation of leadership.

One of the most striking answers from Buttigieg was about his frustration that he has not been able to do more to diversify the police force and soothe the racial tensions that flared after a white police officer shot and killed an African American man.

When asked about the lack of diversity in the police force, Buttigieg answered frankly: "I couldn't get it done."

He acknowledged that situation has been complicated by the fact that the officer didn't have his body camera turned on.

"We are hurting. I could walk you through all of the things we have done as a community," Buttigieg said. "All of the steps we took, from bias training to de-escalation, but it didn't save the life of Eric Logan. When I look into his mother's eyes, I have to face the fact that nothing that I say will bring him back."

Buttigieg said he was determined "to bring about a day" when a white person driving a vehicle and a black person driving a vehicle experiences the same feeling when a police officer approaches: "Not of fear, but of safety."

Many candidates looked to score points on Biden, none more so than California Rep. Eric Swalwell, who is barely registering in the polls, who took a direct jab at Biden's age.

"I was 6 years old when a presidential candidate came to the California Democratic Convention and said it's time to pass the torch to a new generation of Americans," Swalwell said. "That candidate was then-Sen. Joe Biden. Joe Biden was right when he said it was time to pass the torch to a new generation of Americans 32 years ago. He is still right today."

With a grin, Biden responded by saying "I'm still holding on to that torch," and then quickly moving on to his education plans, including focusing on schools in distress and tripling federal funding for Title I schools."

The debate, the second of two back to back match-ups among 10 candidates on NBC in Miami, was the first test for the former vice president since he left government in January 2017, and he aimed to show that he has the kind of message discipline that has been lacking in some of the bumpier parts of his career in politics.

In addition to Sanders, Harris, Buttigieg and Swalwell, the former vice President shared the stage on Thursday night with New York Sen. Kirsten Gillibrand, Bennet, Hickenlooper, businessman Andrew Yang and author Marianne Williamson, who all met the threshold set by the Democratic National Committee.

Sanders unapologetically advocated for his plan for Medicare-for-All and made no excuses for the fact that taxes for the middle class would go up under his plans while arguing their health care costs would go down.

"We have a new vision for America," Sanders said. "At a time when we have three people in this country owning more wealth than the bottom half of America while 500,000 people are sleeping on the streets today. We think it is time for change."

It was a moment early in the debate that was firmly on Sanders' ground, as many candidates were left attempting to answer questions about his signature health insurance policies.

Biden made an argument that may go over better with the moderates and independents he plans to target in the general election - stating that he would force major change in the economic system by reversing Donald Trump's tax cuts.

"Donald Trump thinks Wall Street built America; ordinary middle class Americans built America," Biden said. "Too many people in the middle class have seen the bottom fall out."

Harris took that opening early in the debate to weigh in with the core argument of her candidacy: "Working families need support and need to be lifted up and frankly, this economy is not working for working people," she said.

Several of the lower tier candidates, however, challenged Sanders and his ideas -- arguing that they would be too far out of the comfort zone of average Americans in a General Election

After one of the moderators noted that Sanders identifies as a Democratic socialist, Hickenlooper warned that the specter of socialism would give Republicans an opening to "come at us every way they can."

Bennet said that while he agreed with Sanders about the importance of addressing income inequality: "Where I disagree is on his solution of Medicare-for-All," he said. Bennet proposed a slower approach toward achieving universal health care.

But Sanders defended his potential to take on Trump by citing the latest head-to-head matchups with the President as proof of his electability.

Some of the most unusual moments of the night came in the answers from Williamson, an author and spiritual adviser.

At one point when the candidates were asked to name the first thing they would do in office, Williamson replied: "My first call is to the prime minister of New Zealand, who said that her goal is to make New Zealand the place where it's the best place in the world for a child to grow up. And I would tell her, 'Girlfriend, you are so wrong, because the United States of America is going to be the best place in the world for a child to grow up.' "

Williamson's closing argument took on the same other-worldly quality. She said she was sorry that the candidates hadn't talked more about how they were going to beat Donald Trump -- even though that was one of the major themes of the debate.

"I have an idea about Donald Trump. Donald Trump is not going to be beaten just by insider politics talk. He's not going to be beaten just somebody who has plans. He's going to be beaten by somebody who has an idea what this man has done," Williamson said. "This man has reached into the psyche of the American people and he has harnessed fear for political purposes. So, Mr. President, if you're listening, I want you to hear me, please. You have harnessed fear for political purposes and only love can cast that out."

"So I, sir, I have a feeling you know what you're doing. I'm going to harness love for political purposes. I will meet you on that field. And, sir, love will win."

Sen. Elizabeth Warren of Massachusetts was the top-polling Democratic presidential candidate onstage Wednesday night, and the early moments of the party's first 2020 debate showed why.

Warren was asked four other questions before most of the nine other contenders had been asked two. Her platform set the pace for the night, with other candidates embracing elements of it -- or at least passing on opportunities to break directly with her.

Meanwhile, two of the most aggressive candidates onstage, New York Mayor Bill de Blasio and former Housing and Urban Development Secretary Julin Castro , chose another target to mercilessly attack: former Rep. Beto O'Rourke of Texas. De Blasio hammered O'Rourke on health care, while Castro accused his fellow Texan of failing to do his homework on immigration.

Sen. Cory Booker of New Jersey was a steady presence onstage Wednesday night, offering an aspirational message and separating himself from other candidates on gun control.

Warren dominated the debate's first half hour, moving herself closer to Sen. Bernie Sanders of Vermont on single-payer health care -- a move that could ease the concerns of progressives in the process. She faded the rest of the way, but went unscathed.

Another candidate who took no fire: former Vice President Joe Biden, the party's front-runner, who will debate with nine other Democrats on Thursday night.

Here are eight takeaways from the opening night of Democrats' first 2020 presidential debates:

Warren goes all in on 'Medicare for all'

One question going into the debate was how hard Warren -- who has cut deeply into Sanders' hold on Democrats' progressive wing -- was willing to fight for single-payer health insurance when she had signaled an openness to more moderate plans in the past.

"I'm with Bernie on 'Medicare for all,' " Warren said.

Her answer further narrowed the political distance between Warren and Sanders, who will be on the debate stage Thursday night.

In her response, Warren channeled Sanders' attacks on the insurance industry, casting it as a fundamentally corrupt enterprise, then targeting candidates who, for whatever reason, opposed or cast doubt on the plan.

"There are a lot of politicians who say, 'Oh, it's just not possible. We just can't do it. There's a lot of political problems,' " Warren said, before further sharpening her language: "What they're really telling you is they just won't fight for it. Well, health care is a basic human right and I will fight for basic human rights."

A night for Spanish speakers and women

O'Rourke got the third question of the night, about the economy -- and answered it in Spanish before delivering the English version.

It was an effort to show the former El Paso congressman's ability to reach Spanish-speaking voters as immigration takes center stage in the Democratic race -- as well as to reach the audience watching live on Telemundo.

Booker's stare-down of O'Rourke during the answer got buzz on Twitter -- and 30 minutes later, it became clear why: Booker went with the same move, beginning his answer on immigration by speaking Spanish.

Castro got in a line in Spanish, too, at the beginning of his closing remarks.

It was by far the most Spanish that had ever been spoken on a presidential debate stage.

And it came on the heels of history being made at the debate's outset: Three female candidates (Warren, Sen. Amy Klobuchar of Minnesota and Rep. Tulsi Gabbard of Hawaii) were onstage, more than ever before.

Battle of the Texans

Castro took aim at his fellow Texan, O'Rourke, over immigration in what was by far the most direct and personal clash of the night.

Castro has called for decriminalizing crossing the border by repealing Section 1325 of the Immigration and Nationality Act -- a position O'Rourke opposes, saying he wants a "comprehensive rewrite" of immigration laws and backs plans to "ensure you don't criminalize those who are seeking asylum."

Castro jumped on these comments, telling O'Rourke that "if you did your homework on this issue" he would understand that what he is talking about is different from what Castro is proposing.

Castro brought up comments O'Rourke had made on CNN earlier this month, when he told CNN's Jake Tapper that he did not think the law should be repealed.

"Let's be very clear: The reason that they are separating these little children from their families is that they are using Section 1325 of that act, which criminalized crossing over the border, to incarcerate the parents and then separate them," Castro said. "Some of us on this stage have called to end that section, to terminate it; some, like Congressman O'Rourke, have not."

Castro added: "And I want to challenge all of the candidates to do that. I just think it is a mistake, and I think if you truly want to change the system then we have to repeal that section."

'There are three women on this stage'

Klobuchar brushed Washington state Gov. Jay Inslee back on abortion rights, responding to his claim that he was the only person onstage to sign into law measures that protect women's choice by saying that "there are three women on this stage" who have fought for abortion rights.

It was a simple but effective reminder that there are more women on this debate stage and the one Thursday night than you've ever seen on a presidential debate stage.

Klobuchar also brought a straightforward approach to the stage Wednesday night. She was the first to attack President Donald Trump, and invoked him in nearly every answer.

Warren sets the pace while O'Rourke wears the target

Warren was the highest-polling candidate onstage Wednesday night. But several lower-tier contenders had clearly decided their best chance at a breakout moment would come by ignoring her and instead attacking O'Rourke -- the candidate positioned to her left.

First, New York Mayor Bill de Blasio assailed O'Rourke for saying his health care plan would preserve a role for private insurance.

"Private insurance is not working for tens of millions of Americans," de Blasio said.

Then Castro launched his sustained attack on the issue of immigration.

Warren, meanwhile, dominated the first half hour of the debate. Moderators asked her four questions before any other candidate had been asked a third, and before most had been asked a second. And her vast policy platform steered the terms of the debate.

Booker separates himself on guns

Booker took an opportunity Wednesday night to draw a contrast with other candidates on gun control.

"If you need a license to drive a car, you should need a license to buy and own a firearm," he said, adding that "not everybody in this field" agreed with that position.

Booker unveiled his gun plan in May. It would create a gun license, making it a federal standard, similar to a driver's license or a passport. The license would require fingerprints, an interview and completion of a gun safety course.

"My plan to address gun violence is simple," the New Jersey Democrat said in a statement at the time. "We will make it harder for people who should not have a gun to get one."

Biden gets a pass

Biden isn't onstage until Thursday night -- but it had seemed likely that other Democrats would have something to say about him.

After all, O'Rourke had criticized Biden's reversal on the Hyde Amendment. Booker had called on him to apologize for his comments about "civility" with segregationist senators. Warren had cast him as backward-looking and out of touch with systemic problems.

But Biden didn't come up at all on Wednesday night. Trump was a punching bag, as expected; O'Rourke took a lot of shots; and lower-tier candidates like Rep. John Delaney of Maryland looked to inject themselves at every possible opportunity. But for the most part, the candidates didn't take aim at members of the vast Democratic presidential field who weren't there -- including the party's front-runner.

De Blasio goes New York

The exception to that rule was de Blasio.

He was willing to interject at every turn. He pummeled O'Rourke all night. And he also made reference to South Bend, Indiana, Mayor Pete Buttigieg, who isn't onstage until Thursday night.

De Blasio said he's had serious conversations with his black son, Dante, about how to protect himself.

He went on to describe some of the discussions he's had with his son, including "how to deal with the fact that he has to take special caution because there have been too many tragedies between our young men and our police, too, as we saw recently in Indiana."

It was a reference to criticism of Buttigieg after a white police officer shot and killed a black man in South Bend.

"Look, obviously they are going through a tragedy there in South Bend and a lot of cities, including our city, have been through tough, tough moments like that. I certainly, my heart goes out to everyone in South Bend. It is a tough, tough thing to go through," de Blasio said.

It took a little bit to warm up, but candidates began heating up the first Democratic debate of the 2020 presidential campaign with jabs at one another over immigration and national security.

As the immigration crisis overshadowed Wednesday's presidential debate, the tension between two Texans -- Julian Castro and Beto O'Rourke -- erupted on the stage on Wednesday night as the two tangled over immigration policy.

O'Rourke, the former Texas congressman, was answering a question about what he would do on Day One in office to deal with the migrants seeking asylum, and he referenced the searing photograph of a Salvadorian father and daughter who drowned this week while trying enter the US.

"We would not turn back (Valeria) and her father Oscar, we would accept them into this country and follow our own asylum laws," O'Rourke said. "We would accept them into this country and follow our own asylum laws. We would not build walls, we would not put kids in cages. In fact we would spare no expense to reunite"

At that moment, Castro, the former Secretary of Housing and Urban Development, began repeatedly interrupting O'Rourke taking issue with his past stance on border crossings until he was admonished by the moderators.

"The reason they are separating these little children from their families is they are using section 1325 of that act, which criminalizes coming across the border, to incarcerate the parents and separate them. Some of us on this stage have called to end that section, to terminate it. Some, like Congressman O'Rourke, have not," Castro said.

"I just think it's a mistake, and I think if you truly want to change the system that we've got to repeal that section," Castro added.

In a pointed jab, Castro went on to challenge O'Rourke's policy depth: "If you did your homework on this issue, then you would know that we should repeal this section," Castro said to O'Rourke.

Later, Hawaii Rep. Tulsi Gabbard and Ohio Rep. Tim Ryan went after each other on their opposing strategies for the war in Afghanistan.

Gabbard, who has had a quiet few months after declaring her run for president, had a stand out moment challenging Ryan's assertion that the United States needs to be engaged in Afghanistan in order to tamp down the threat of terrorism.

"We are no better off in Afghanistan today than we were when the war began," Gabbard said.

Ryan shot back, "I don't want to be engaged. I wish we were spending all this money in places that I'm representing that have been completely forgotten." But he argued that withdrawing all American troops would allow the Taliban to support terrorists that could strike at America.

Gabbard dismissed the idea and said it would be impossible to totally defeat the enemy. "The Taliban has been there long before we came in," she said. "We cannot keep US troops deployed to Afghanistan thinking that we are going to squash this Taliban that has been there that every other country that has tried has failed."

The lineup, determined through a drawing by NBC once candidates met the Democratic National Committee criteria, placed the Massachusetts senator on stage in this first round with New Jersey Sen. Cory Booker, O'Rourke, Minnesota Sen. Amy Klobuchar and six other candidates who have barely registered in the polls: former Maryland Rep. John Delaney, Gabbard, Castro, Ryan, New York Mayor Bill de Blasio and Washington state Gov. Jay Inslee.

Candidates try to break through with stand out moments

The initial moments of the debate were a time for candidates to deliver the lines they would hope break through the crowded field on the stage.

Klobuchar drew applause when she touted her record working on abortion rights.

"There's three women up here who have fought pretty hard for a woman's right to choose," Klobuchar said to loud applause.

In another stand out moment, O'Rourke began his response in English. But he then switched to Spanish, saying, "We need to include each person in the success of this economy. But if we want to do that, we need to include each person in our democracy. Each voter, we need the representation, and each voice, we must listen to."

He then reverted back to English for the rest of his remarks.

Former Housing and Urban Development Secretary Julin Castro got a strong response from the audience when he pledged to pass the Equal Rights Amendment. This came in response to a question about what he would do to close the pay gap between men and women. The Equal Rights Amendment is a proposed amendment to the Constitution that would ensure equal rights -- regardless of sex -- to all Americas.

And in the first testy exchange of the debate, de Blasio criticized O'Rourke over the former Texas congressman's approach to health care. O'Rourke had just explained that he backed a plan that would allow Americans to opt into Medicare but preserve a role for private insurance.

De Blasio jumped in, saying, "but private insurance is not working for tens of millions of Americans."

The exchange marked the first clash between de Blasio and O'Rourke -- and demonstrated how candidates tried to use the issue of health care to differentiate themselves.

Former Maryland Rep. John Delaney jumped in on O'Rourke's side. "I think we should be the party that keeps what's working and fixes what's broken," he said.

Inslee got off a zinger early in the debate that hit President Donald Trump by turning to the Washington governor's signature issue: climate change.

Trump "says wind turbines cause cancer. We know they cause jobs," Inslee said to applause.

Trump, whose disdain for wind power dates to his battles with Scottish officials over a plan to build turbines in view of one his golf resorts, suggested earlier this year that the noise from wind turbines "causes cancer."

Dems tackle kitchen table issues

Warren and her ideas dominated the early part of the debate. The Massachusetts senator was pressed to defend the cost of some of her most expensive ideas -- like forgiving student loans to reduce the debt of college students -- in the very first question of the debate. Moderator Savannah Guthrie noted that more than two-thirds of Americans believe the economy is doing well and could conclude that the change required by some of her ideas could put the economy at risk.

It was an easy opportunity for Warren to deliver her central message that the current tax structure helps the rich, while putting average Americans at a disadvantage.

"It's doing great for a thinner and thinner slice at the top," Warren said of the economy. "When you've got a government; when you've got an economy that does great for those with money and isn't doing great for everyone else, that is corruption pure and simple. We need to call it out. We need to attack it head on. And we need to make structural change in our government, in our economy, and in our country."

Klobuchar, who has said that she wishes she has a magic wand to get rid of all student debt but sees that as an unreasonably expensive proposition, was given the opportunity to go after Warren directly in the question that followed. However, the Minnesotan declined the opportunity to go directly after her Senate colleague.

"We know that not everyone is sharing in this prosperity and Donald Trump just sits in the White House and gloats about what's going on when you have so many people that are having trouble affording college and affording their premiums," Klobuchar said. "So I do get concerned for paying for college for rich kids. I do."

"But I think that my plan is a good one, and my plan would be, to first of all, make Community College free, and make sure that everyone else besides that top percentile gets help with their education.... If billionaires out there can pay off their yachts, students should be able to pay off their student loans."

Booker subtly knocked his opponents at Wednesday's debate, faulting the majority of them for not supporting is plan to require a license to buy and own a gun.

"If you need a license to drive a car, you should need a license to buy and own a firearm," Booker said, adding that "not everybody in this field" agreed with that position.

Immigration becomes a flashpoint

Several of the candidates have already visited or intend to visit the Homestead Detention Center to draw attention to the conditions that migrants are facing when they come to the US illegally, which include reports of children being denied basic sanitary supplies like toothpaste, tissues and soap. Other reports, including ones from CNN, indicate children are being forced to sleep on bare floors as older children are asked to take care of younger charges.

The news of those indignities and the public health risks gave Democrats an opening for impassioned critiques of the Trump administration during the debate.

"On Day One, I will make sure that no. 1, we end the (Immigrations and Customs Enforcement) and the Customs and Border policies that are violating human rights," Booker said.

De Blasio pointed to the heartbreaking photo of the father and daughter dead in the Rio Grande and said Americans have to say "this is not America."

"Those are not our values," de Blasio said, in a pointed critique of the Trump administration.

Ryan also took aim at the Trump administration and the conditions of the detention centers in which migrant children are being held.

"What kind of country are we running where we have a President of the United States who is so focused on hate and fear?" Ryan said.

"The end result is we have kids laying in their own snot with three-week old diapers that haven't been changed. We have to tell the President that is not a sign of strength, that is a sign of weakness."

Wednesday's debate will be followed by another showdown on Thursday night. In that debate, Biden, Sanders and two other strong contenders -- California Sen. Kamala Harris and South Bend Mayor Pete Buttigieg -- will take the stage for their matchup.

The first 2020 Democratic presidential debate kicked off in Miami with 10 candidates trying to stand out in a crowded field . They took on taxes, equal pay, health insurance and immigration reform.

Here are the facts .

Income inequality

When responding to a question about income inequality, Washington Gov. Jay Inslee said: "It is not right that the CEO of McDonald's makes 2,100 times more than the people slingin' hash at McDonald's."

Facts First: While technically true, it's worth noting that this includes the wages of part-time employees working abroad, not just US-based employees.

McDonald's reported that CEO Stephen Easterbrook's total 2018 compensation was $15.9 million, while its median employee earned a total compensation of $7,473. That median employee however is a part-time employee located in Hungary.

Still, that dynamic resulted in a pay ratio of 2,124 to 1, according to a financial filing the company posted in April.

-Katie Lobosco

Insurance companies

Cory Booker said: "The overhead for insurers that they charge is 15%, while Medicare's overhead is only at 2%"

Facts First: This is roughly true, although an apples-to-apples comparison is difficult to make.

According to the 2019 annual report from the Boards of Trustees for Medicare, administrative expenses come to $9.9 billion, or about 1.3% of Medicare's total expenditures in 2018.

According to a report from the nonpartisan Congressional Budget Office in 2016, as a share of premiums per enrollee, the administrative costs of private insurance companies ranged between 11% and 20% depending on whether they serve large employers, small companies or the individual market.

Some of Medicare's overhead costs are paid by the Social Security system, so the actual administrative expenses are likely higher, but it is true that Medicare's administrative costs are lower as a share of overall expenditures than they are in the private market.

-Lydia DePillis

Immigration

Former Housing and Urban Development Secretary and San Antonio Mayor Julian Castro suggested that the Trump administration's policy of limiting asylum at ports of entry led to the deaths of the Salvadorian father and child found face down in the Rio Grande that is the subject of a now infamous photo .

Facts First: 'Metering' has led to longer waits, but it's unclear if those wait times resulted in the family deciding to cross illegally

"They have been playing games with people who are coming and trying to seek asylum at our ports of entry. Oscar and Valeria went to a port of entry and then they were denied the ability to make an asylum claim so they got frustrated and they tried to cross the river and they died because of that," Castro said.

The Trump administration's policy, called "metering," has led to longer wait times, though it's difficult to ascribe motive behind a migrant's decision to cross the border illegally.

In the case of the father and child who died trying to cross the Rio Grande river, the man's mother told CNNE that they left the country in April in hopes of making it to Dallas to work. She said the family wanted to buy their own house and better their financial situation.

Customs and Border Protection has said it doesn't know how many migrants have been turned away as a result of metering.

-Priscilla Alvarez

Taxes

Former Texas Rep. Beto O'Rourke said that Congress passed "a $2 trillion tax cut" that favored corporations which were sitting on record piles of cash and the very wealthiest in the country at a time of historic wealth inequality.

Facts First: Though there are a variety of estimates projecting the cost of the 2017 Tax Cuts and Jobs Act, according to the Congressional Budget Office, O'Rourke's statement appears to be roughly accurate.

Last year, the Congressional Budget Office projected that when incorporating the additional debt service costs, the tax cut would add $1.9 trillion to the deficit over the ten-year window.

But other cost estimates varied. According to an estimate by Congress' Joint Committee on Taxation before the law passed, it would cost $1.4 trillion over ten years, or just over $1 trillion when incorporating a broader look at its economic impacts.

A year after the law passed, the conservative-leaning Tax Foundation found that the cost was even less, at $1.47 trillion on a conventional basis and $448 billion over the ten-year window when taking into account its effect on the economy.

A key Senate committee passed a sweeping, bipartisan bill Wednesday, marking the chamber's first effort to address several major health care issues plaguing the nation.

The Senate Health Committee voted 20-3 to advance the legislation, which seeks to tackle surprise medical billing , lower drug prices and increase transparency in the cost of health care. The bill was cosponsored by the committee's chair, Republican Sen. Lamar Alexander of Tennessee, and ranking member, Democratic Sen. Patty Murray of Washington state.

Also included is a provision sponsored by Majority Leader Mitch McConnell, a Kentucky Republican, and Sen. Tim Kaine, a Virginia Democrat, that would raise the minimum age for buying tobacco products to 21, from 18.

Alexander and Murray hope the full chamber will vote on the bill before the August recess.

The legislation is not without controversy. Hospitals and doctors are not pleased with the surprise medical billing provision, which would protect patients when they receive emergency care at hospitals or by doctors who aren't in their insurance networks. Consumers would be responsible only for paying the in-network rates for that treatment and, if they are admitted, they must be given advanced notice of any out-of-network charges, under the legislation.

To settle the rest of the tab, insurers would pay hospitals and doctors the local median contracted rate. Providers say this could wind up limiting access to care and could limit insurers' incentive to build comprehensive networks.

"This bill solves the immediate problem for patients, but the unintended consequences of rate setting will lead to more narrow networks and a precedent of government interference in free market negotiations," said Chip Kahn, chief executive of the Federation of American Hospitals, which represents for-profit facilities.

The American Medical Association says there should be a process to resolve disputes, such as an independent arbitrator -- an option the committee considered but ultimately rejected.

The legislation also seeks to make it easier for lower-cost generic drugs to come to market and bans certain practices by providers and insurers that could raise prices for consumers

The Senate Health Committee's legislation is one of several efforts to address high health care costs being formulated on Capitol Hill.

The Senate Finance Committee is also crafting bipartisan legislation aimed at lowering drug prices in Medicare and Medicaid, with the goal of holding a vote before the August recess.

The House, meanwhile, has passed several measures to spur the development of generic drugs and is working on legislation to address surprise billing .

AP Sixty seconds for answers, a television audience of millions and, for some candidates, a first chance to introduce themselves to voters.

The back-to-back Democratic presidential debates beginning Wednesday are exercises in competitive sound bites featuring 20 candidates hoping to oust President Donald Trump in 2020. The hopefuls range widely in age, sex and backgrounds and include a former vice president, six women and a pair of mayors.

The challenge: Convey their plans for the nation, throw a few elbows and sharpen what's been a blur of a race so far for many Americans.

What to watch Wednesday at 9 p.m. Eastern on NBC, MSNBC and Telemundo:

RECOMMENDED:

Ten presidential candidates, led by Sen. Elizabeth Warren, will converge on the debate stage on Wednesday on the first night of Democratic debates to offer their pitches to voters and attempt a breakout moment for their campaigns.

For many of the White House hopefuls, it will be the highest-profile opportunity yet to offer their vision for the country and, if for just two hours, chip into a political news cycle often dominated by President Donald Trump. Given the massive field, the debate will be split over two nights, with 10 other candidates including former Vice President Joe Biden and Vermont Sen. Bernie Sanders appearing Thursday.

But on opening night, Warren will take center stage. The Massachusetts senators constant stream of policy proposals has helped her campaign gain ground. Strategists say that Warren, widely viewed as a talented debater, is well positioned to showcase her strengths.

I dont think anyone else on that night has her level of skill and her level of experience in this format, said Maria Cardona, a Democratic strategist. I think she should look at this as an opportunity to really shine and come out of the first night as the one that is dominating the conversation.

Yet Warren could still face challenges. The other candidates on stage Wednesday arent as well known and could use the moment to take aggressive stances against Warren in an effort to find a breakout moment.

Shes liable to have a target on her back and a lot of people potentially coming after her on that stage, said Charles Chamberlain, the chairman of the progressive political action committee Democracy for America. But on the other hand, that will let people see how she handles attacks and can fend them off.

Asked whether she felt the pressure of effectively being the front-runner during the first debate, Warren shrugged off her center-stage position.

This is just a chance to be able to talk to people all across this country about how this government works better and better and better for a thinner and thinner slice at the top, and its just not working for the rest of America, she told reporters after her Tuesday rally in Miami. 2020s our chance to change that.

Beyond Warren, the candidates who will debate on Wednesday are Sens. Cory Booker of New Jersey and Amy Klobuchar of Minnesota, Reps. Tulsi Gabbard of Hawaii and Tim Ryan of Ohio and former Reps. Beto ORourke of Texas and John Delaney of Maryland, along with Washington Gov. Jay Inslee, New York Mayor Bill de Blasio and ex-Obama housing secretary Julin Castro.

One split that could emerge Wednesday centers on Medicare for All, the single-payer health plan introduced by Sanders and supported by Warren and others. But some candidates are not fully on board, preferring more incremental reforms. Delaney has been especially vocal in his criticism.

With so many White House hopefuls on stage, it could be difficult to dive too deep on any given issue. NBC News, which is hosting the debate, said candidates will have 60 seconds to answer questions and 30 seconds for follow-ups. They will be allowed closing statements but no openers.

All the candidates are competing ahead of a major fundraising deadline that will have lasting implications. The end of the second fundraising quarter on Sunday gives candidates a chance to make a splash with strong numbers ahead of the mid-July deadline to report that information to the Federal Election Commission.

A strong debate performance could fuel more donations, which is critical to the candidates ability to participate in future debates. The Democratic National Committee is enforcing more stringent requirements for participating in the presidential primary debates this fall, so candidates who are struggling to gain a foothold may not have another similar opportunity on a nationally televised stage unless they are able to significantly boost their standing in the polls and fundraising numbers.

For some of them, this might be their best opportunity to land a blow, said Joel Payne, a Democratic strategist.

The debate will unfold as many Democratic voters are just beginning to tune in.

Only 35% of registered Democrats say theyre paying close attention to the campaign, according to a new poll from The Associated Press-NORC Center for Public Affairs Research. Two-thirds say theyre paying some or no attention.

People may have heard (the candidates) names, but they couldnt pick them out and dont know much about them, said Jesse Ferguson, a veteran Democratic strategist. None of them are going to seal the deal in the first debate, but they need to get people interested enough to want to learn more.

The debates second night on Thursday features more of the leading Democrats in the race. Biden will stand at center stage with Sanders at his left and Mayor Pete Buttigieg of South Bend, Indiana, at his right. The former vice president has come under fire from fellow Democrats after recently recalling that the Senate was once a more civil place, pointing to his work with two segregationist former senators.

Several of the candidates went to Florida early to raise money or court voters in the critical battleground state. Buttigieg held two Florida fundraisers on Monday night and stayed in Florida for debate prep. Warren, meanwhile, was in the state Tuesday to campaign for her new proposal to boost election security.

Not to be outdone, Vice President Mike Pence was also in Miami on Tuesday to launch Latinos for Trump as part of an effort to engage Latino voters for 2020. The Trump campaign said it was running ads in Wednesdays Miami Herald and El Nuevo Herald touting the presidents achievements on behalf of Latinos.

___

Associated Press writers Sara Burnett in Chicago, David Bauder in New York, Alexandra Jaffe in Miami and Elana Schor in Washington contributed to this report.

MIAMI (AP) After circling each other for months, Democratic presidential candidates will converge on the debate stage in Miami on Wednesday as the campaign enters a new and likely more contentious phase.

Given the massive field, the debate will be split over two nights with 10 candidates appearing each evening. It's the highest-profile opportunity yet for many White House hopefuls to offer their vision for the country and if for just two hours chip into a political news cycle often dominated by President Donald Trump.

Elizabeth Warren will take center stage at the debate's opening night. The Massachusetts senator's constant stream of policy proposals has helped her campaign gain ground, and she's the sole top-tier candidate who will appear at the Wednesday debate. Widely viewed as a talented debater, Warren is well positioned to showcase her strengths, strategists say.

"I don't think anyone else on that night has her level of skill and her level of experience in this format," said Maria Cardona, a Democratic strategist. "I think she should look at this as an opportunity to really shine and come out of the first night as the one that is dominating the conversation."

Yet Warren could still face challenges. The other candidates on stage Wednesday aren't as well known and could use the moment to take aggressive stances against Warren in an effort to find a breakout moment.

"She's liable to have a target on her back and a lot of people potentially coming after her on that stage," said Charles Chamberlain, the chairman of the progressive political action committee Democracy for America. "But on the other hand, that will let people see how she handles attacks and can fend them off."

Beyond Warren, the candidates who will debate on Wednesday are Sens. Cory Booker of New Jersey and Amy Klobuchar of Minnesota, Reps. Tulsi Gabbard of Hawaii and Tim Ryan of Ohio and former Reps. Beto O'Rourke of Texas and John Delaney of Maryland, along with Washington Gov. Jay Inslee, New York City Mayor Bill de Blasio and ex-Obama housing secretary Julin Castro.

One split that could emerge Wednesday centers on "Medicare for All," the single-payer health plan introduced by Vermont Sen. Bernie Sanders, a fellow Democratic presidential candidate, and supported by Warren and others. But some candidates are not fully on board, preferring more incremental reforms. Delaney has been especially vocal in his criticism.

With so many White House hopefuls on stage, it could be difficult to dive too deep on any given issue. NBC News, which is hosting the debate, said candidates will have 60 seconds to answer questions and 30 seconds for follow-ups. They will be allowed closing statements but no openers.

All the candidates are competing ahead of a major fundraising deadline that will have lasting implications. The end of the second fundraising quarter on Sunday gives candidates a chance to make a splash with strong numbers ahead of the mid-July deadline to report that information to the Federal Election Commission.

A strong debate performance could fuel more donations, which is critical to the candidates' ability to participate in future debates. The Democratic National Committee is enforcing more stringent requirements for participating in the presidential primary debates this fall, so candidates who are struggling to gain a foothold may not have another similar opportunity on a nationally televised stage unless they are able to significantly boost their standing in the polls and fundraising numbers.

"For some of them, this might be their best opportunity to land a blow," said Joel Payne, a Democratic strategist.

The debate will unfold as many Democratic voters are just beginning to tune in.

Only 35% of registered Democrats say they're paying close attention to the campaign, according to a new poll from The Associated Press-NORC Center for Public Affairs Research. Two-thirds say they're paying some or no attention.

"People may have heard (the candidates') names, but they couldn't pick them out and don't know much about them," said Jesse Ferguson, a veteran Democratic strategist. "None of them are going to seal the deal in the first debate, but they need to get people interested enough to want to learn more.

The debate's second night on Thursday features more of the leading Democrats in the race. Former Vice President Joe Biden will stand at center stage with Sanders at his left and Mayor Pete Buttigieg of South Bend, Indiana, at his right. Biden has come under fire from fellow Democrats after recently recalling that the Senate was once a more civil place, pointing to his work with two segregationist former senators.

The remarks elicited condemnation from his rivals, notably Booker and Sen. Kamala Harris of California, who raised questions about Biden's understanding of the history of segregation. Booker, who was among Biden's sharpest critics, called on him to apologize.

Were the two candidates to share a stage, the episode could have been a defining moment of the debate, with the two men discussing the issue in real time. But Booker will take the stage on Wednesday, with Biden and Harris among the candidates to follow on Thursday.

If Booker were to bring up the episode, or respond to a moderator's question about it, Payne said, "it's almost like he's attacking him in absentia."

A memo released by the Booker campaign ahead of the debate said their goal was "straightforward: Cory will look to introduce himself to voters just tuning in to the race."

Several of the candidates went to Florida early to raise money or court voters in the critical battleground state. Buttigieg held two Florida fundraisers on Monday night and stayed in Florida for debate prep. Warren, meanwhile, was in the state on Tuesday to campaign for her new proposal to boost election security .

Not to be outdone, Vice President Mike Pence was also in Miami on Tuesday to launch "Latinos for Trump" as part of an effort to engage Latino voters for 2020.

MIAMI (AP) Vice President Mike Pence told a Latino crowd Tuesday that President Trump has been "a great champion of Latino and Hispanic Americans," touting the president's economic policies while warning Democrats want to bring socialism to America.

"Tomorrow night, many of (the Democratic Party's) leading candidates, and the night after that, are actually going to openly advocate for an economic system that has impoverished millions," he said at an event aimed at Hispanic voters in Miami.

"Now, Latino Americans know better than most about the cost of socialism. It's impoverished generations and stolen the liberty of millions," he added, a reference to a number of South American countries that have been roiled by socialist governments, most recently Venezuela.

Pence declared: "We must say, as the president said in his State of the Union address, America will never be a socialist country."

Pence's remarks came as part of an event launching the "Latinos for Trump" coalition, an effort to woo Hispanic voters in advance of next November's election. He told the crowd they would be "one of the most important coalitions of the 2020 campaign." The event comes a day ahead of the first Democratic presidential primary debates in Miami, and a week after President Trump held his official campaign kickoff rally in Orlando, signaling Florida's significance to his re-election hopes.

And the vice president used much of his speech to go after Democrats in advance of their first presidential primary debates this week in Miami. He said at the debates over the next two days, Democrats would "promise more taxes, more regulations" and policies like Medicare for All and the Green New Deal, which he attacked as ineffective and expensive. He also attacked Democrats on abortion, noting nearly every candidate has advocated for rolling back restrictions on using taxpayer funding for abortion.

But he also made an economic pitch to the crowd, touting the record-low unemployment rates among Hispanics and what he called "a time of unbridled growth and prosperity for Latino Americans." And while the Trump administration has faced sharp criticism from Latino community leaders for its hardline immigration policies, Pence told the crowd that the president was working to secure the border and "fix this broken immigration system," while "it's been the Democrats that have been denying there's a crisis at our border, that have been denying us the resources and reforms to end that crisis."

Florida is home to more than 2 million registered Latino voters, and the Trump campaign believes they have an opening with Latino voters because of the president's economic policies, which they say have contributed to low unemployment rates among Latinos, among other issues. Republicans see an opportunity particularly in South Florida, where the sizable Cuban population tends to lean conservative.

But Trump has also come under fire for his hardline immigration policies and rhetoric toward Latinos, with his policy of separating immigrant children from their parents at the border again coming under scrutiny last week following reports of unsafe living conditions for children being held at detention centers.

In comments to the Miami Herald, Democratic National Committee Chairman Tom Perez argued that Trump's "agenda has been toxic" for the Latino community, hammering Republicans for their efforts to roll back the Affordable Care Act and for their immigration policies.

In November's elections, however, 32 percent of Latinos voted for Republicans, according to AP VoteCast data, a nationwide survey of more than 115,000 midterm voters including 7,738 Latinos. That was largely consistent with Trump's share of the Latino vote in 2016, despite the president's controversial comments and policies, and a strong performance among Latinos in Florida in particular helped Republicans defeat Democrats in the gubernatorial and Senate races in 2018.

The nation's federal debt is now projected to balloon to "unprecedented levels" over the next 30 years, if policymakers fail to change laws, potentially pushing the country into the risk of a "fiscal crisis," the nonpartisan Congressional Budget Office said in a new report Tuesday .

Federal debt is expected to rise from 78% of GDP in 2019 to 92% percent in 2029 and 144% in 2049, the most ever in history, the CBO said.

"That level of debt would be the highest in the nation's history by far, and it would be on track to increase more," said the agency.

Deficits have climbed following two major fiscal stimulus measures under the Trump administration, including a $1.5 trillion tax cut and a massive spending bill. Congress is now negotiating a new deal to replace the budget, which expires on October 1.

"It's bad enough that our annual deficit will soon reach $1 trillion, but CBO's long-term projections show that the deficit will continue growing into the future, with no end in sight," said Michael Peterson, CEO of the Peter G. Peterson Foundation. "These clear projections should motivate our lawmakers to begin managing the debt immediately, and budgeting responsibly to help America meet its most pressing challenges."

Federal deficits are expected to rise as spending outpaces taxes collected by the federal government. The deficit as a share of GDP is projected to rise from 4.2% to 4.5% in the next decade. That's significantly more than the 2.9% rate over the last 50 years.

CBO projections assume there will be no changes to the law, and that benefits paid through federal safety programs -- like Social Security and Medicare -- are paid in full.

Debt held by the public has been rapidly rising at a significant clip since 2007. At the time, federal debt stood at 35% of GDP, but deficits arising from the 2007-2009 recession and subsequent policies caused debt to grow sizably in relation to the economy over the next five years. By the end of 2012, debt as a share of GDP had doubled, reaching 70%.

Even so, the CBO's report points out that the nation's debt and deficit are now expected to grow slower than previously forecasted as a result of lower interest rates and reduced disaster spending.

The national debt will hit 141% of GDP over the next 30 years, according to the agency. The new estimate is 11 percentage points lower than last year.

CBO officials warned policymakers that the nation's debt and deficit issue still "poses substantial risks" to the US economy.

"The prospect of such large deficits over many years, and the high rising debt that would result, poses substantial risks for the nation and presents policymakers with significant challenges," the agency said.

Abuse in nursing homes remains under-reported in the United States, according to reports released Wednesday by the Department of Health and Human Services' Office of the Inspector General.

One report estimated that 1 in 5 ER visits from a nursing home is the result of abuse. It analyzed 37,607 "high-risk hospital ER claims" made to the Centers for Medicare and Medicaid Services, known as CMS, by nursing home residents in 2016.

The report also found that nursing homes frequently failed to report incidents of abuse to either CMS or local law enforcement, as required by federal regulators. In addition, the report said that CMS regulations needed to be bolstered to "track all incidents of potential abuse or neglect."

In a statement to CNN, the Office of the Inspector General for the Department of Health and Human Services said: "Patient safety and quality of care are top priorities for OIG. During our audits, we found numerous cases in which mandatory reporters failed to comply with laws designed to protect beneficiaries. We recommend that the Centers for Medicare and Medicaid Services use available data to better defend against the potential abuse and neglect of beneficiaries."

CMS concurred with the Office of the Inspector General's recommendations on how to better ensure that incidents of potential abuse are tracked.

"CMS remains diligent in our duties to monitor nursing homes participating in Medicare and Medicaid across the country, as well as the state agencies that survey them, and we appreciate the ongoing work of the OIG in this area and will continue to work with them as we make improvements to our oversight efforts," CMS Administrator Seema Verma said in a letter responding to and included in the report.

The reports follow preliminary research that was released in 2017.

The second report reviewed 34,664 claims to Medicare -- federal health insurance for Americans with certain disabilities or 65 and older -- that indicated injuries that could be linked to abuse. Inspectors found that 89% of those cases between January 2015 and June 2017 were associated with evidence of potential abuse or neglect. The office recommended using Medicare claims as a way to track abuse of the elderly and people with developmental disabilities in nursing facilities.

In response to the second report, Verma wrote, "While OIG's review of claims data provides helpful insight into past incidents involving potential abuse and neglect, including injuries of unknown source, this data may not be timely enough to address acute problems since providers generally have up to 12 months (one calendar year) from the date the service was provided to submit claims for services rendered."

She pointed to CMS' current complaint intake and investigation process, which works with state oversight agencies. She also noted recently updated guidance for identifying potential abuse cases.

The-CNN-Wire

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MONTGOMERY, Ohio When Karen Klugos daughter, Alexis, needed hearing aids at 18 months, Klugo and her husband didnt want her hearing to slow her down.

Of course we wanted to do everything that we could to make sure that she had normal development and that she would learn to hear and speak as well as any other child, Klugo said.

They took her to an audiologist, speech and language therapy and something called aural rehabilitation to help her become a better listener.

Then I got the bills and realized that not one penny of any of the services that we went through were covered by insurance, Klugo said. This was considered a cosmetic type of thing.

Klugo was stunned. She and her husband could afford the $4,000 bill for their daughters first hearing aids and the hundreds of dollars that each audiologist appointment and therapy appointment cost. As the years passed, however, Klugo became increasingly worried about working families across Ohio who cant afford the help their hard-of-hearing children needed.

Michael Snyder | MJS Photography Limited

Now Klugo, a Cincinnati eye surgeon, is one of two local moms working to get Ohio law changed. She and Monica Schneider, a political science professor, have met with state lawmakers sponsoring House Bill 243, a measure that would require health insurance to cover hearing aids and related services for children until the age of 22.

Medicaid does offer coverage, Medicare offers coverage, but theres nothing in between, said Rep. Casey Weinstein, a Democrat from Hudson and one of the bills primary sponsors. So youve got a lot of families that are above the poverty level with kids who are working families and dont have coverage.

The legislation would require private health plans to cover $2,500 per hearing aid $5,000 total every four years.

Twenty-three states, including Kentucky, already require that health benefits plans pay for hearing aids for children, according to the American Academy of Audiology. Five of those states also require hearing aid coverage for adults.

It would have killed me

Like Klugo, Schneider learned the hard way that her health plan didnt cover the entire cost of hearing aids for her son, Harrison. Her policy only covered $500 total.

Harrison was born with Down syndrome and didnt have any problems with his hearing initially, Schneider said. But when Harrison was about 5, he developed a hole in his eardrum that made him hard of hearing, she said.

We realized he wasnt hearing everything we were saying, she said. When we decided to get hearing aids, I expected that my insurance would cover it as it does with his glasses.

She and her husband have been able to afford hearing aids for Harrison, who is now 7, she said, and it has made a big difference for him.

Courtesy of Monica Schneider

Talking is something thats very hard for him, and he has intellectual disabilities. He really doesnt talk much. But when he wears his hearing aids, he responds to us, she said. Its a big deal.

Its such a big deal, in fact, that Schneider began to worry about other families who have children with Down syndrome that couldnt afford hearing aids. Hearing loss is more common among children with Down syndrome, in part because of their smaller facial anatomy, she said.

Our expectation for Harrison is that he grow up to be a productive, taxpaying member of society," Schneider said. "We expect him to live independently, and in order for him to do that, he has to be able to hear. It would have killed me if I could not have paid for both of his hearing aids.

Far too many parents are faced with that problem, Klugo said.

She recalled a time when Alexis was little and approached another little girl in the audiologists waiting room. Alexis asked why the other girl only had one magic ear, which is what the audiologist called her hearing aids at the time.

And she said, My mom and dad could only afford one, Klugo said. Weve heard all kinds of stories like this. Its just heartbreaking.

Klugo and her husband both carry a gene that can result in congenital hearing loss, and their son also was born hard of hearing. Chases hearing loss is more severe than his older sisters. He is now 10 and got fitted for his first hearing aids at three weeks old.

Lucy May | WCPO

He does well in school and is taking accelerated math classes, Klugo said, but he wouldnt be thriving without his hearing aids.

He needs them to hear the fire alarm and to know if somebodys at the door, she said. Its a matter of safety, and it could be life or death.

Not everyone is sold

Alexis, who is now 13, said its difficult to imagine what her life would be like without her hearing aids.

I use my hearing aids for everything, she said. When I dont have them in, I struggle a lot.

They are so important to her, in fact, that as Alexis has gotten older she has asked for donations to the Cincinnati Childrens Hearing Aid Trust & Early Hearing Intervention program for her birthday instead of gifts.

The program, known as CCHAT, helps provide money to families that cant afford the hearing aids their children need.

Michael Snyder | MJS Photography Limited

Im very fortunate that my parents are able to afford what I need to be able to hear, and I believe that other kids should be able to hear as well and that they should have the same opportunity, Alexis said.

Thats the goal of House Bill 243, which has early support from both Democrats and Republicans in Columbus.

But not everyone is sold.

Chris Ferruso, the legislative director of the National Federation of Independent Businesses/Ohio, noted that the proposed mandate would not apply to self-insured plans, which cover a significant part of the insurance market.

Theres a very real potential to have a significant gap in coverage out there in the marketplace, Ferruso said. Our plea is to try to find a mechanism to ensure that all Ohioans have coverage.

Ferruso said most of the businesses that are members of his organization struggle to provide health insurance for their employees, and any cost increase makes it more difficult.

Weinstein said similar legislation in Georgia only added 15 cents to the cost of insurance per insured person, but Ferruso said that merits further study.

Its going to vary from one employer to another, he said. And if it is 15 cents per person, can the state find the money to cover that?

Courtesy of Casey Weinstein

Weinstein said Ohios population of children who are hard of hearing is relatively small. Roughly one in 1,000 kids is affected.

I call this a Right to Hear bill, he said. Were giving kids an opportunity to reach their maximum potential during the important formative years in their lives. It makes so much sense to intervene early, morally and economically.

Klugo and Schneider are among hundreds of parents across Ohio determined to encourage state lawmakers to do just that.

More information about House Bill 234 is available online. Parents of children who are hard of hearing can learn more or get involved through a Facebook group called Let Ohio Hear.

MONTGOMERY, Ohio When Karen Klugos daughter, Alexis, needed hearing aids at 18 months, Klugo and her husband didnt want her hearing to slow her down.

Of course we wanted to do everything that we could to make sure that she had normal development and that she would learn to hear and speak as well as any other child, Klugo said.

They took her to an audiologist, speech and language therapy and something called aural rehabilitation to help her become a better listener.

Then I got the bills and realized that not one penny of any of the services that we went through were covered by insurance, Klugo said. This was considered a cosmetic type of thing.

Klugo was stunned. She and her husband could afford the $4,000 bill for their daughters first hearing aids and the hundreds of dollars that each audiologist appointment and therapy appointment cost. As the years passed, however, Klugo became increasingly worried about working families across Ohio who cant afford the help their hard-of-hearing children needed.

Michael Snyder | MJS Photography Limited

Now Klugo, a Cincinnati eye surgeon, is one of two local moms working to get Ohio law changed. She and Monica Schneider, a political science professor, have met with state lawmakers sponsoring House Bill 243, a measure that would require health insurance to cover hearing aids and related services for children until the age of 22.

Medicaid does offer coverage, Medicare offers coverage, but theres nothing in between, said Rep. Casey Weinstein, a Democrat from Hudson and one of the bills primary sponsors. So youve got a lot of families that are above the poverty level with kids who are working families and dont have coverage.

The legislation would require private health plans to cover $2,500 per hearing aid $5,000 total every four years.

Twenty-three states, including Kentucky, already require that health benefits plans pay for hearing aids for children, according to the American Academy of Audiology. Five of those states also require hearing aid coverage for adults.

It would have killed me

Like Klugo, Schneider learned the hard way that her health plan didnt cover the entire cost of hearing aids for her son, Harrison. Her policy only covered $500 total.

Harrison was born with Down syndrome and didnt have any problems with his hearing initially, Schneider said. But when Harrison was about 5, he developed a hole in his eardrum that made him hard of hearing, she said.

We realized he wasnt hearing everything we were saying, she said. When we decided to get hearing aids, I expected that my insurance would cover it as it does with his glasses.

She and her husband have been able to afford hearing aids for Harrison, who is now 7, she said, and it has made a big difference for him.

Courtesy of Monica Schneider

Talking is something thats very hard for him, and he has intellectual disabilities. He really doesnt talk much. But when he wears his hearing aids, he responds to us, she said. Its a big deal.

Its such a big deal, in fact, that Schneider began to worry about other families who have children with Down syndrome that couldnt afford hearing aids. Hearing loss is more common among children with Down syndrome, in part because of their smaller facial anatomy, she said.

Our expectation for Harrison is that he grow up to be a productive, taxpaying member of society," Schneider said. "We expect him to live independently, and in order for him to do that, he has to be able to hear. It would have killed me if I could not have paid for both of his hearing aids.

Far too many parents are faced with that problem, Klugo said.

She recalled a time when Alexis was little and approached another little girl in the audiologists waiting room. Alexis asked why the other girl only had one magic ear, which is what the audiologist called her hearing aids at the time.

And she said, My mom and dad could only afford one, Klugo said. Weve heard all kinds of stories like this. Its just heartbreaking.

Klugo and her husband both carry a gene that can result in congenital hearing loss, and their son also was born hard of hearing. Chases hearing loss is more severe than his older sisters. He is now 10 and got fitted for his first hearing aids at three weeks old.

Lucy May | WCPO

He does well in school and is taking accelerated math classes, Klugo said, but he wouldnt be thriving without his hearing aids.

He needs them to hear the fire alarm and to know if somebodys at the door, she said. Its a matter of safety, and it could be life or death.

Not everyone is sold

Alexis, who is now 13, said its difficult to imagine what her life would be like without her hearing aids.

I use my hearing aids for everything, she said. When I dont have them in, I struggle a lot.

They are so important to her, in fact, that as Alexis has gotten older she has asked for donations to the Cincinnati Childrens Hearing Aid Trust & Early Hearing Intervention program for her birthday instead of gifts.

The program, known as CCHAT, helps provide money to families that cant afford the hearing aids their children need.

Michael Snyder | MJS Photography Limited

Im very fortunate that my parents are able to afford what I need to be able to hear, and I believe that other kids should be able to hear as well and that they should have the same opportunity, Alexis said.

Thats the goal of House Bill 243, which has early support from both Democrats and Republicans in Columbus.

But not everyone is sold.

Chris Ferruso, the legislative director of the National Federation of Independent Businesses/Ohio, noted that the proposed mandate would not apply to self-insured plans, which cover a significant part of the insurance market.

Theres a very real potential to have a significant gap in coverage out there in the marketplace, Ferruso said. Our plea is to try to find a mechanism to ensure that all Ohioans have coverage.

Ferruso said most of the businesses that are members of his organization struggle to provide health insurance for their employees, and any cost increase makes it more difficult.

Weinstein said similar legislation in Georgia only added 15 cents to the cost of insurance per insured person, but Ferruso said that merits further study.

Its going to vary from one employer to another, he said. And if it is 15 cents per person, can the state find the money to cover that?

Courtesy of Casey Weinstein

Weinstein said Ohios population of children who are hard of hearing is relatively small. Roughly one in 1,000 kids is affected.

I call this a Right to Hear bill, he said. Were giving kids an opportunity to reach their maximum potential during the important formative years in their lives. It makes so much sense to intervene early, morally and economically.

Klugo and Schneider are among hundreds of parents across Ohio determined to encourage state lawmakers to do just that.

More information about House Bill 234 is available online. Parents of children who are hard of hearing can learn more or get involved through a Facebook group called Let Ohio Hear.

TAMPA, Fla. -- Several nursing home facilities in the Tampa Bay region were included in a list of more than 400 nursing homes with ongoing health, safety or sanitary problems.

And government sources say its not likely that those facilities will likely face any additional scrutiny from government agencies.

A total of 488 facilities made the list, out of more than 15,000 nursing home and rehab facilities nationwide which are rated by Medicare.

Seven facilities on the list are in the Tampa Bay area. Three nursing homes in Tampa made the list.

I-TEAM INVESTIGATIONS | Our latest investigations

They include Bristol at Tampa on East Fletcher Avenue, Brighton Gardens on North Dale Mabry Highway and Excel Care Center on Camps Hill Drive.

Hawthorn Health and Beneva Lakes in Sarasota, North Rehabilitation Center in St. Petersburg and Oak Haven Rehabilitation Center in Auburndale also made the list.

People who are on Medicaid, they don't have any choice they've got to go wherever they put them, said Ruben Barretto, who we talked to when he was going to visit a friend at Excel Care.

U.S. Senators Bob Casey (D-Pa.) and Pat Toomey (R-Pa.) asked for information from the U.S. Department of Heath and Human Services following a March hearing of the Senate Finance Committee.

In that hearing they heard from witnesses about issues with Medicares flawed nursing home ratings system called Nursing Home Compare.

The Senators learned from that federal agency that there was a list that was not available to the public naming nursing home facilities with persistent records of poor care.

Oversight of Americas poorest quality nursing homes falls short of what taxpayers should expect, the senators said in the joint report.

The government said the 400 facilities were candidates for the "Special Focus Facilities" program, which provides more government oversight, including more frequent inspections and progressive fines.

New facilities are only added to the SFF program when space allows.

These are the ones that are systematically having problems with government surveys, said Tampa nursing home negligence attorney Bennie Lazzara, who has sued several of the facilities on the list.

He said making the list public is a good start.

There shouldn't be any secrets in this area. Talk about transparency, this is an area where transparency is essential, Lazzara said.

The 400 nursing homes that were named in the once-secret list likely won't face additional regulation, since the government says it doesn't have enough money to expand the program.

It's all taxpayer dollars that these nursing homes are running under, primarily Medicare and Medicaid money is what keeps these nursing homes going. So there ought to be enough taxpayer dollars to properly monitor them and regulate them, Lazzara said.

Here are statements from some of the facilities named as candidates for the SFF program:

Brighton Gardens of Tampa:

Hawthorn Village of Sarasota:

The Bristol at Tampa:

Here is the list of nursing homes which are in the SFF program or are candidates for the program:

To check out a specific nursing home, follow this link: https://www.medicare.gov/nursinghomecompare/search.html?#state=FL&lat=0&lng=0

If you have a story youd like the I-Team to investigate, email us at adam@abcactionnews.com.

WASHINGTON (AP) The federal government for years has kept under wraps the names of hundreds of nursing homes around the country found by inspectors to have serious ongoing health, safety or sanitary problems.

Nearly 400 facilities nationwide had a persistent record of poor care as of April, but they were not included along with a shorter list of homes that get increased federal scrutiny and do have warning labels, according to a Senate report released Monday.

There are at least 17 Florida nursing homes on the list, which you can find here.

Budget cuts appear to be contributing to the problem by reducing money available for the focused inspections that are required for nursing homes on the shorter list, according to documents and interviews.

The secrecy undermines the federal commitment to ensure transparency for families struggling to find nursing homes for loved ones and raises questions about why the names of some homes are not disclosed while others are publicly identified, according to two senators who released the report on Monday.

Weve got to make sure any family member or any potential resident of a nursing home can get this information, not only ahead of time but on an ongoing basis, said Sen. Bob Casey, D-Pa., who along with Sen. Pat Toomey, R-Pa., issued the report .

When a family makes the hard decision to seek nursing home services for a loved one, they deserve to know if a facility under consideration suffers from systemic shortcomings, said Toomey.

The senators released a list provided them by the Centers for Medicare and Medicaid Services, or CMS, of nursing homes with documented problems whose names were not publicly disclosed by the government.

About 1.3 million Americans are nursing home residents, cared for in more than 15,700 facilities. The senators report noted that problem nursing homes on both lists account for about 3 percent.

CMS does publicly disclose names of a smaller group of about 80 nursing homes that are getting special scrutiny to help them resolve documented quality problems. Theyre in whats called the Special Focus Facility program. Nursing homes that dont improve can be cut off by Medicare and Medicaid.

Consumers can identify special focus facilities on the governments Nursing Home Compare website by looking for an icon shaped like a small yellow triangle that resembles a traffic caution sign. The website does not display starred quality ratings for the special focus facilities. Usually, nursing homes receive from a low of one star to the highest quality score of five stars.

The nearly 400 facilities that are candidates for the shorter list qualify for the program because they are identified as having a persistent record of poor care but are not selected for participation as a result of limited resources at (CMS), said the report from Casey and Toomey.

Despite being indistinguishable from (special focus nursing homes) in terms of their qualifications, candidates are not publicly disclosed, the report added.

In a letter last month to Casey, CMS Administrator Seema Verma singled out federal budget problems as a factor.

The total number of (special focus) slots and total number of (special focus) candidates nationally are based on the availability of federal resources, Verma wrote. She added that as recently as 2010, there was room for 167 nursing homes in the special focus program and 835 candidates. Thats now down to as many as 88 special focus slots and up to 440 candidates.

She said federal budget cuts in 2014 reduced the number of available slots.

Verma said her agency is evaluating whether it can publicly release the list of candidate nursing homes. The Trump administration has asked Congress for more money for health care inspections, but the final amount and how it will distributed remain unclear.

In a statement, CMS said its starred ratings on the Nursing Home Compare website are already the best yardstick for consumers to understand and use. About 2,900 nursing homes have the lowest one-star overall rating.

But consumer groups say such ratings are not enough, and greater disclosure is overdue.

It might help (consumers) avoid facilities that the government is acknowledging are very, very troubled, said Toby Edelman, a senior policy lawyer with the nonprofit Center for Medicare Advocacy.

A nursing home industry group says it generally supports transparency and takes no position on release of the list. David Gifford, vice president for quality with the American Health Care Association, said the inspection reports on which the CMS lists are based are only one measure, and people should also consider other factors such as staffing levels and clinical outcomes.

Mondays report from Sens. Casey and Toomey identified several nursing homes from the list of special focus candidates. Among the details:

In Quitman, Texas, the Heritage Healthcare Residence did not prevent the septic system from backing up, causing a foul-smelling black substance to come through the drains and seep into the kitchen floor near food-preparation areas. In an interview, officials of the company that currently owns the nursing home said they had corrected all the problems after purchasing the facility in February. Suzanne Koenig, president of the company that now runs the nursing home, renamed the Heritage House Healthcare Centre, said shed be concerned about releasing the list since it doesnt really focus on what is going on in the facility.

In Ormond Beach, Florida, inspectors found that staff at Avante at Ormond Beach, were not cleaning and disinfecting blood sugar measuring devices between tests of different patients, putting the residents at risk of infection. The same inspection report noted the nursing home quickly started to address the issue. John Hornack, a vice president of the nursing homes management company, said in an interview the old devices were replaced with new ones and the staff was retrained. Hornack said the problem has now been completely resolved.

As dozens of federal investigators descended on a professional office building in Largo, FL last month, leasing manager Terry Velivasakis was just beginning his work day in the buildings main office.

I look up and the entire lobby is filled with FBI agents, Velivasakis told us just a few days later. It was a shock, he said.

By early afternoon, agents from the FBI and Department of Health & Human had confiscated boxes of evidence and computers from nearly a dozen medical supply companies inside, according to Velivasakis.

I assumed it all to be on the up and up, he said about the companies which started leasing space in his building about a year-ahalf ago. Thats when a man, who he said appeared to be in his 30s, first approached him looking for office space.

We showed him a couple of spaces and he was like, Ill take them all, he said.

One-by-one the companies moved in, eventually taking up nine offices on two floors of the building.

When asked what he knew about the companies, Velivasakis replied, the way I understand it, this company would provide knee braces, this company would provide hip braces, whatever brace you need that's what they would provide, he said.

Now the feds are investigating. A press release issued last month said they had seized millions of dollars and froze assets while executing search and seizure warrants at 20 different medical supply companies in the Tampa Bay area as part a conspiracy. The raids were part of a national investigation into Medicare fraud involving medical supply companies and telemarketing companies suspected of exploiting the elderly and defrauding taxpayers by sending Medicare recipients medical equipment they didnt need, want or order but were all paid for through Medicare reimbursements. Its a story weve been following for months.

With hidden cameras, we found one staffed with just one person answering the phones. Boxes piled high with leg braces filled the back portion of the office and, what appeared to be, a patient fitting area. Yet the sole worker told us patients never go there, instead everything is handled over the phone.

Dyann Bertrand showed us inside a box her mom recently received in the mail.

Theres a knee brace, a wrist brace, another wrist brace, another knee brace and another one, she said while showing us all the medical braces. If she put all this on, shed look like a robot, said Bertrand.

When asked if her mother ordered the braces Bertrand said no. Bertrand also said her 91-year-old mother didnt need the braces or want them but yet she received them and Medicare, ie taxpayers foot the bill for it all.

We tracked the box of braces sent to Bertrands mother to an office in Holiday, FL where we found more than a dozen more medical supply companies that were also raided by the feds last month and started by the same players, according to the buildings owner David Spezza.

Theyve both always been very professional. I know this has been very hard on them, Spezza told us.

State business record link Schuyler Poppe and Kelly Wolfe to, at least, 50 medical equipment companies primarily in the Tampa Bay area including the businesses we visited in Holiday and Largo that were all raided by the feds last month. Another one we found recently set up right across the street from a county Sheriff headquarters.

To date, neither have been charged with any crimes.

Florida property records show Wolfe owns two waterfront homes in Clearwater including a million-dollar Gulf-front townhome she purchased last year.

Brian Albritton is a former U.S. Attorney in Floridas Middle District and used to prosecute Micare fraud cases. Now he works to defend companies accused of fraud.

If you dont have patients but yet its made to appear that patients in fact are coming then that, itself, is a badge of fraud, he told us.

While charges have not been filed, he says the volume of medical supply companies linked to the same players is suspicious.

Just the sheer number of them defies normal economic expectation, he said. Thats not normal practice, Albritton said.

We found Wolfe and Poppe back at one of the complexes where state records show several medical supply companies opened offices in the last year or so and several were raided by the feds. Its also a complex where, state records show, Wolfe runs a medical supply billing and consulting office.

Neither Wolfe or Poppe agreed to speak with us about the raids, the medical supply businesses or any investigation they may be the subject of.

It seemed like they're business model was get the company started, get it up and running and sell it to another person, said Velivasakis.

State records also show some of the medical supply companies are no longer registered to Poppe or Wolfe. Instead, it appears the companies changed hands to new owners or operators crossing both coasts of Florida. A few are listed as being based in California. We attempted to reach out to them. Of those we were able to contact, none of them agreed to speak to us on the record, a few hung up on us shortly after we identified that we were journalists.

The majority of these medical supply companies shut down after their visit from the feds. But the bigger problem is this, more medical supply companies are finding a home in Florida and profits in taxpayers. For those companies operating with the wrong intentions, victims can be left at the mercy of whos behind the next box of medical goods they didnt want, need or order but arrived anyway on their doorstep.

Somebody has to put a stop to it. Its just not fair, it really isnt, said Dyann Bertrand.

Experts say dont ever provide any personal medical information over the phone. If you receive medical equipment you didnt want or order, report it : https://oig.hhs.gov/fraud/report-fraud/index.asp

WASHINGTON (AP) Drugmakers will be required to reveal the prices of their prescription medicines in those ever present TV ads, the Trump administration is set to announce on Wednesday, even as some insured patients can pay thousands of dollars for critical medications.

Health and Human Services Secretary Alex Azar told The Associated Press the administration is finalizing regulations that will require drug companies to disclose list prices of medications costing more than $35 for a month's supply.

"What I say to the companies is if you think the cost of your drug will scare people from buying your drugs, then lower your prices," Azar said. "Transparency for American patients is here."

The pricing details are expected to appear in text toward the end of commercials, when potential side effects are being disclosed. TV viewers should notice the change later this year, perhaps as early as the summer.

The government's move is part of a multilevel blueprint President Donald Trump announced last year to try to lower prescription drug costs .

Other elements include regulations affecting Medicare and legislative proposals pending in Congress. With the cost of medicines a top concern for voters, Trump and lawmakers of both major political parties want accomplishments they can point to before the 2020 elections. Democrats say measures like price disclosure won't force drugmakers to lower what they charge, and they want to authorize Medicare to negotiate.

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The drug industry opposes the price reveal, saying companies would rather provide the information on their websites. But Johnson & Johnson, based in New Brunswick, New Jersey, announced this year that it would start disclosing the cost of its blood thinner Xarelto in TV advertising. That drug is used to treat and prevent blood clots that can cause strokes.

Among drug industry complaints is that the government would be infringing on First Amendment free speech rights by forcing companies to disclose prices. Azar points out that the government has for decades required carmakers to post their sticker prices on vehicles.

"Prices of automobiles are vastly less important to your health and affordability than drugs," he said.

According to the government, the 10 most commonly advertised drugs have prices ranging from $535 to $11,000 per month or for a usual course of therapy.

The disclosure requirement will not apply to print or radio ads for the foreseeable future.

"Over $4 billion of pharma spend is in TV ads ... that is their most impactful form of advertising," Azar said. "That is where the patient has the most need of being informed."

The disclosure requirement applies to all brand name drugs covered by Medicare and Medicaid, which is nearly all medications.

The government is hoping that patients armed with price information will start discussing affordability with their doctors, and gradually that will put pressure on drugmakers to keep costs in check.

Most people rely on lower cost generic drugs to manage their health problems, but the advent of revolutionary medications for once-fatal or intractable diseases has put consumers on edge. Genetic and cellular-based treatments can cost hundreds of thousands of dollars a year, which has put a strain on the budgets of insurers and government programs.

A recent poll from the nonpartisan Kaiser Family Foundation found that 1 in 3 Americans said they haven't taken medications as prescribed because of costs. People who take four or more medications, those who spend $100 a month or more on meds, patients in fair to poor health and middle-aged adults are more likely to report affordability problems.

Although most patients do not pay the full list prices that will be included in ads, experts say those prices are still important. They're the starting point for negotiations between drugmakers and insurers. Also, copays that patients face are often based on list prices. And many people who have high-deductible insurance plans pay list prices for medications because their insurance doesn't start covering until patients have spent several thousand dollars of their own money.

In other economically advanced countries, governments negotiate drug prices to keep medications more affordable for patients. But except for some government programs like the Veterans Affairs health system, the U.S. has held back from government-set prices.

Democrats argue it's time to abandon that practice and let Medicare take a direct role in negotiating prices. There's no support for that route among congressional Republicans, and the Trump administration's more activist role for government stops short.

Azar, who is leading the effort for Trump, is a former drug company executive. He held senior posts with Indianapolis-based insulin maker Eli Lilly and Co. after an earlier stint in government service during the George W. Bush administration.

The regulations will take effect 60 days after they're published in the Federal Register.