Local members of MoveOn.org gathered outside U.S. Sen. Claire McCaskill's St. Louis office today as part of the trickle-down effort to promote President Barack Obama's plan to change the nation's health-care system.

McCaskill's staff reported that about 40 members of MoveOn showed up, with several then relaying personal health-care stories. A McCaskill spokeswoman emphasized that the senator supports a public option for health-care coverage.

Said spokeswoman Maria Speiser, "Today both the progressive MoveOn.org and the conservative tea party group targeted our office. It's difficult to know if that's about Claire or if it's more indicative about the passion behind this issue. Then again, Claire had been an independent moderate her entire time in the Senate and is happy to hear from all sides as she examines this issue. Either way, this is a very healthy and welcomed way to express an opinion and to be involved in our wonderful democracy."  

Countering the group were about 30 members of a local conservative Tea Party group, who also showed up outside the senator's St. Louis office. Tea Party activists complained about the potential cost of Obama's health-care proposals.

MoveOn's "Health Care Day of Action" came the day after the president's national TV address in which he laid out his reasons for pressing for change. Obama offered more details on his health-care plan today at a stop in Cleveland, Ohio.

Earlier today, the Obama administration's federal budget chief -- Peter Orszag with the Office of Management and Budget -- also went local by conducting a conference call with regional reporters from around the country. Orszag reprised some of the same points that he and the president have made for months: that changing the nation's health-care system is necessary to expand access and curb the rising health-care costs to the federal government, as well as the public.

Orszag outlined what he called a "belt and suspender approach." The "belt'' controls costs by such practices as shifting to electronic records and ending "wasteful practices'' in health-care delivery, while the "suspender'' expands access.

Orszag emphasized the administration's belief that the changes won't add to the federal budget deficit, and will actually save the government money over the long term. As it stands now, he said, the medical community has "strong incentives to provide more care instead of better care."

He was less clear when asked about the concerns of some governors in both parties -- aired at last weekend's National Governors Association conference -- that the federal efforts may include forcing them to expand their Medicaid rolls, which cover low-income people. Since states' split Medicaid costs with the federal government, an expansion would increase state spending on the program. (Read a New York Times story on the governors' concerns.)

Missouri, for example, sought to cut its Medicaid costs by cutting its rolls in 2005, even though that meant foregoing even more federal matching money. Missouri reduced its coverage to people who earn only up to 20 percent of the federal poverty level. Illinois and many other states cover people whose incomes are much higher.

Neither Missouri Gov. Jay Nixon nor Illinois Gov. Pat Quinn attended last weekend's governors meeting because both were among a small group of governors traveling instead to the Middle East and Afghanistan.

Nixon, however, had sought in vain earlier this year to reinstate some people to the Medicaid rolls by hiking the fees that hospitals pay to the state. The hospitals had supported the idea, as did the Missouri Senate, but it failed to pass the state House.

Orszag did make clear that he wasn't commenting on today's events by MoveOn and others to pressure some Democratic senators seen to be wavering on the issue of health-care reform.

McCaskill has said she backs the general idea, but she emphasized Wednesday that she opposed what she understood to be the latest plan pushed by House Democratic leaders. Quipped Orszag: "I'm not licensed to practice politics."