FILE - In this Aug. 10, 2009 file photo, Karen Ignagni, president of America's Health Insurance Plans, an association representing member companies that provide medical insurance coverage speaks during an interview with The Associated Press in Washington. A different health care issue has emerged for Democrats, in sync with the party’s pitch to workers and middle-class voters. It’s not the uninsured, but the problem of high out-of-pocket costs for consumers who already have coverage. “It can’t be looked at in isolation,” said Ignagni. (AP Photo/J. Scott Applewhite, File)