Members of the U.S. military salute during a rehearsal for the upcoming Inauguration Day parade for U.S. President-elect Donald Trump in Washington, U.S. January 15, 2017. Photo by Jonathan Ernst/Reuters

WASHINGTON — An essential element is missing from President Donald Trump’s plan for boosting the budgets of the U.S. military services by $54 billion in 2018. How, exactly, does the commander in chief intend to use the world’s most potent fighting force?

Beyond the threat posed by the Islamic State and other militant groups, Trump doesn’t articulate what he’s defending the country from. Defeating what Trump and his aides call “radical Islamic terrorism” doesn’t require an additional investment of tens of billions of dollars. And Trump, whose “America First” mantra suggested an isolationist approach, has viewed Russia as a potential partner, not an adversary.

Trump’s proposed defense budget of $639 billion, which includes $65 billion for ongoing emergency war-fighting, totals more than the next seven countries combined. Yet documents released Thursday by the White House provide little detail about where all the money will be spent, other than to say the goal is to rebuild an American military that Republicans have accused former President Barack Obama of allowing to fall into disrepair.

The Trump budget makes no specific mention of Iran, North Korea or China. Instead, the documents employ broad strokes to cast the $54 billion increase as “the groundwork for a larger, more capable, and more lethal joint force, driven by a new National Military Strategy that recognizes the need for American superiority not only on land, at sea, in the air, and in space, but also in cyberspace.”

Republican defense hawks in Congress immediately panned Trump’s 2018 proposal. GOP lawmakers including Sen. John McCain of Arizona, the chairman of Armed Services Committee, want at least $37 billion more than what Trump is recommending to begin to reverse an erosion in the military’s readiness for combat.

“It is clear that this budget proposed today cannot pass the Senate,” said McCain, who called Trump’s defense plan only slightly better than what Obama would have crafted if he were still in office.

And much more money will be needed over time to buy all the ships, missiles, jet fighters and more needed to replace an arsenal heavily taxed by 15 years of war, according to McCain and like-minded congressional colleagues. He envisions defense spending increasing steadily in the coming years, culminating with an $800 billion budget for the armed forces in 2022.

READ NEXT: Does Trump’s budget defend America or erode American power? Lawmakers weigh in

Still, Trump’s 2018 plan would be welcomed at the Pentagon. Senior U.S. military leaders have warned Congress that strict caps on government spending imposed in 2011 have squeezed them so hard that beating powers such as Russia or China is far tougher than it used to be as aging equipment stacks up, waiting to be repaired, and troops don’t get enough training.

Military leaders have told Congress they’ve been forced to rob their maintenance and procurement accounts to help pay for missions in Afghanistan, Iraq and elsewhere. That’s led to critical maintenance being postponed and lengthy delays in the acquisition of new equipment, according to the Pentagon’s top brass.

“It’s a simple matter of supply can’t meet demands,” Adm. William Moran, the vice chief of naval operations, told the Senate Armed Services readiness subcommittee during a February hearing.

Despite Trump’s focus on the Islamic State group, that’s a war under control, according to top defense officials. “We’re fully ready and have shown repeatedly that we can fight today’s fight against a violent extremist organization,” Gen. Stephen Wilson, the Air Force’s vice chief of staff, told the House Armed Services Committee last month.

Trump’s budget avoids a knock-down fight with Congress over base closings. The Army and Air Force have said that shuttering excess installations would save billions of dollars. But they remain open because the GOP-led Congress has so far refused to allow a new round of base closures. Military installations are prized possessions in congressional districts.

Conservatives gave Trump’s defense plan high marks because the increase is paid for by slashing spending for foreign aid and domestic agencies that had been shielded under Obama.

But Rep. Raul Labrador, a member of the House Freedom Caucus, said he and other deficit hawks have no intention of giving the president’s plan a free pass.

“We should make sure we’re using military spending wisely like we look at every other item in the budget,” the Idaho Republican said. “I think we make a mistake as Republicans when we say it’s OK to plus-up (defense) spending and decrease everything else without really looking closely.”

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A corn field is seen in DeWitt, Iowa, on July 12, 2012. Photo by Adrees Latif/Files/Reuters

Editor’s note: We’ve all heard of the great divide between life in rural and urban America. But what are the factors that contribute to these differences? We asked sociologists, economists, geographers and historians to describe the divide from different angles. The data paint a richer and sometimes surprising picture of the U.S. today.

1. Poverty is higher in rural areas

Discussions of poverty in the United States often mistakenly focus on urban areas. While urban poverty is a unique challenge, rates of poverty have historically been higher in rural than urban areas. In fact, levels of rural poverty were often double those in urban areas throughout the 1950s and 1960s.

While these rural-urban gaps have diminished markedly, substantial differences persist. In 2015, 16.7 percent of the rural population was poor, compared with 13.0 percent of the urban population overall – and 10.8 percent among those living in suburban areas outside of principal cities.

Contrary to common assumptions, substantial shares of the poor are employed. Approximately 45 percent of poor, prime-age (25-54) householders worked at least part of 2015 in rural and urban areas alike.

The link between work and poverty was different in the past. In the early 1980s, the share of the rural poor that was employed exceeded that in urban areas by more than 15 percent. Since then, more and more poor people in rural areas are also unemployed – a trend consistent with other patterns documented below.

That said, rural workers continue to benefit less from work than their urban counterparts. In 2015, 9.8 percent of rural, prime-age working householders were poor, compared with 6.8 percent of their urban counterparts. Nearly a third of the rural working poor faced extreme levels of deprivation, with family incomes below 50 percent of the poverty line, or approximately US$12,000 for a family of four.

Large shares of the rural workforce also live in economically precarious circumstances just above the poverty line. Nearly one in five rural working householders lived in families with incomes less than 150 percent of the poverty line. That’s nearly five percentage points more than among urban workers (13.5 percent).

According to recent research, rural-urban gaps in working poverty cannot be explained by rural workers’ levels of education, industry of employment or other similar factors that might affect earnings. Rural poverty – at least among workers – cannot be fully explained by the characteristics of the rural population. That means reducing rural poverty will require attention to the structure of rural economies and communities.

– Brian Thiede, Assistant Professor of Rural Sociology and Demography, Pennsylvania State University

2. Most new jobs aren’t in rural areas

It’s easy to see why many rural Americans believe the recession never ended: For them, it hasn’t.

Rural communities still haven’t recovered the jobs they lost in the recession. Census data show that the rural job market is smaller now – 4.26 percent smaller, to be exact – than it was in 2008. In these data are shuttered coal mines on the edges of rural towns and boarded-up gas stations on rural main streets. In these data are the angers, fears and frustrations of much of rural America.

This isn’t a new trend. Mechanization, environmental regulations and increased global competition have been slowly whittling away at resource extraction economies and driving jobs from rural communities for most of the 20th century. But the fact that what they’re experiencing now is simply the cold consequences of history likely brings little comfort to rural people. If anything, it only adds to their fear that what they once had is gone and it’s never coming back.

Nor is it likely that the slight increase in rural jobs since 2013 brings much comfort. As the resource extraction economy continues to shrink, most of the new jobs in rural areas are being created in the service sector. So Appalachian coal miners and Northwest loggers are now stocking shelves at the local Walmart.

The identity of rural communities used to be rooted in work. The signs at the entrances of their towns welcomed visitors to coal country or timber country. Towns named their high school mascots after the work that sustained them, like the Jordan Beetpickers in Utah or the Camas Papermakers in Washington. It used to be that, when someone first arrived at these towns, they knew what people did and that they were proud to do it.

That’s not so clear anymore. How do you communicate your communal identity when the work once at the center of that identity is gone, and calling the local high school football team the “Walmart Greeters” simply doesn’t have the same ring to it?

Looking at rural jobs data, is it so hard to understand why many rural people are nostalgic for the past and fearful for the future?

– Steven Beda, Instructor of History, University of Oregon

3. Disabilities are more common in rural areas

Disability matters in rural America. Data from the American Community Survey, an annual government poll, reveal that disability is more prevalent in rural counties than their urban counterparts.

The rate of disability increases from 11.8 percent in the most urban metropolitan counties to 15.6 percent in smaller micropolitan areas and 17.7 percent in the most rural, or noncore, counties.

While rural-urban differences in disability have been analyzed previously, researchers have had little opportunity to further explore this disparity, as updated data on rural disability were unavailable until recently. Fortunately, the census released updated new county-level disability estimates in 2014, ending a 14-year knowledge gap.

The release of these estimates has also allowed us to build a picture of geographic variations in disability across the nation. Disability rates vary significantly across the U.S. Although the national trend of higher disability rates in rural counties persists at the regional and even divisional level, it is clear that disability in rural America is not homogeneous. Rates of rural disability range from around 15 percent in the Great Plains to 21 percent in the central South.

Data reveal notable differences between rural and urban America. Source: American Community Survey (ACS) 2011-2015 5 year estimates, Table S1810, CC BY. Image courtesy of The Conversation

A variety of factors may be behind these regional and rural differences, including differences in demographics, economic patterns, health and service access and state disability policies.

While this survey provides a glimpse into the national prevalence of disability and reveals a persistent rural-urban disparity, it is important to note its limitations. Disability is the result of an interaction between an individual and his or her environment. Therefore, these data do not directly measure disability, as they measure only physical function and do not consider environmental factors such as inaccessible housing.

– Lillie Greiman and Andrew Myers, Project Directors at the Rural Institute for Inclusive Communities at the University of Montana; Christiane von Reichert, Professor of Geography, University of Montana

4. Rural areas are surprisingly entrepreneurial

The United States’ continuing economic dominance is perhaps most attributable to the very smallest elements of its economy: its entrepreneurial start-ups. Nearly 700,000 new job-creating businesses open each year. That’s almost 2,000 every day, each helping to create new market niches in the global economy.

Most people mistakenly believe these pioneering establishments occur in overwhelmingly in metropolitan areas, such as in the now-mythic start-up culture of Silicon Valley.

Yet, according to the U.S. Census Bureau, it is in fact nonmetropolitan counties that have higher rates of self-employed business proprietors than their metropolitan counterparts.

Furthermore, the more rural the county, the higher its level of entrepreneurship. Some of these counties have a farming legacy – perhaps the most entrepreneurial of occupations – but farmers represent less than one-sixth of business owners in nonmetro areas. Even for nonfarm enterprises, rural entrepreneurship rates are higher.

The reality is that rural areas have to be entrepreneurial, as industries with concentrations of wage and salary jobs are necessarily scarce.

Start-up businesses have notoriously difficult survival prospects. So it is perhaps even more surprising that relatively isolated nonmetropolitan businesses are on average more resilient than their metro cousins, despite the considerable economic advantages of urban areas, which boast a denser networks of workers, suppliers and markets. The resilience of rural start-ups is perhaps due to more cautious business practices in areas with few alternative employment options.

This resilience is also remarkably persistent over time, consistently being at least on par with metro start-ups, and regularly having survival rates up to 10 percentage points higher than in metro areas over 1990-2007.

– Stephan Weiler, Professor of Economics, Colorado State University; Tessa Conroy and Steve Deller, Professors of Economics, University of Wisconsin-Madison

This article was originally published on The Conversation. Read the original article.

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President Donald Trump and German Chancellor Merkel will hold a joint news conference at 1:20 p.m. EDT. Watch in the player above.

WASHINGTON — It was all smiles as President Donald Trump welcomed German Chancellor Angela Merkel to the White House on Friday, their first personal encounter since he frequently criticized her during the 2016 presidential campaign.

Their agenda included discussions on strengthening NATO, fighting the Islamic State group and resolving Ukraine’s conflict, all matters that require close cooperation between the U.S. and Germany. The meeting, which was postponed from Tuesday because of a snowstorm, will be capped with a joint news conference.

Trump and Merkel smiled in front of cameras in the Oval Office at the start of their meeting, with the president urging journalists to “send a good picture back to Germany, please.” The new president told reporters merely that he and Merkel would be discussing “many things” in their first face-to-face exchange of his presidency.

Their sit-down could be a restart of a relationship complicated by Trump’s rhetoric on the campaign trail.

He spent a good part of 2016 bashing the chancellor, accusing her of “ruining” Germany for allowing an influx of refugees from Syria.

“You watch what happens to Angela Merkel, who I always thought of as a very good leader until she did this. I don’t know what went wrong with her,” said then-candidate Trump at an August rally in Virginia. “What went wrong? Angela, what happened?”

Then, Trump seemed to care little about the potentially awkward ramifications were he to win. He invoked Merkel as a foil at his rallies, accusing his campaign rival, Hillary Clinton, of wanting to be “America’s Angela Merkel.” He lashed out at Time magazine when it named Merkel “Person of the Year” in 2015 instead of him.

Trump, at the time, did find ways to voice his respect. When a television station in September asked him to name a world leader he admired, he cited Merkel.

In his meetings with world leaders since the inauguration, Trump has adopted a more diplomatic public persona. He recently spent a weekend bonding with Japanese Prime Minister Shinzo Abe, golfing and dining with Abe at his Mar-a-Lago estate in Florida. He has cultivated a closer friendship with Israeli Prime Minister Benjamin Netanyahu, whom he has known for years.

But Merkel is used to an altogether different type of American leader, having shared a strong bond with President Barack Obama. She was the last of Obama’s key European allies still in power when he left office. And as the leader of Europe’s biggest economy and most stable government, Merkel emerged in recent years as the leading voice for a continent struggling with slow growth, identity issues and increased security threats after a string of terrorist attacks.

Reflecting their connection, Obama and his wife called Merkel and her husband on the day before Trump’s inauguration to thank her for “her strong, courageous and steady leadership.” It was Obama’s final call with a foreign leader, his advisers said.

Merkel’s first major encounter with Trump comes as she seeks a fourth term as chancellor in elections later this year. She has acknowledged the contest could be difficult and has stressed a need for stability after Britain’s decision to leave the European Union.

She reportedly has studied Trump’s speeches and policies in advance of her trip, eager to find areas for cooperation. Steven Keil, a fellow with The German Marshall Fund of the United States, said Merkel has little reason to dwell on Trump’s past comments.

“Merkel is extremely pragmatic in her approach here, but she’s also going to have some situations in which it will be tough for her to give too much,” Keil said.

Trump has rattled European leaders with his “America first” mantra. He also backed Brexit and is skeptical of multilateral trade agreements. Merkel is expected to reiterate her belief that a strong EU remains in America’s strategic and economic interests, a message she shared last month in Munich with Vice President Mike Pence.

She was accompanied by a trade delegation that includes top executives of BMW and Siemens, employers of tens of thousands of Americans. Many live in Southern states that Trump won in the U.S. election.

Military matters may be testy. Trump declared NATO “obsolete” before telling European leaders the alliance remains important. But he is expected to reiterate calls for NATO members to meet a minimum commitment for defense spending. Only the U.S. and four other members currently reach the benchmark of spending 2 percent of GDP on defense. Germany lags significantly behind.

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Author Mohsin Hamid. Credit: Photo by David Levenson/Getty Images

Here at the NewsHour Arts desk, we regularly ask figures in the arts for their recommendations on what we should be reading, listening to, or watching this weekend.

This week, we turned to Mohsin Hamid, author of the new and magical novel “Exit West,” which follows the love story of two refugees as they leave home. His previous novel, “The Reluctant Fundamentalist,” a 9/11 book written from the perspective of a young Pakistani, was shortlisted for the 2007 Man Booker Prize.

“I have been moving around my whole life: California, Pakistan, London, New York, Pakistan again. And I wanted to write about the experience of migration,” Hamid, a native of Lahore, Pakistan, told the NewsHour about why he wrote “Exit West.” “I also felt this resistance to migrants was growing, and I wanted to write in response to that.”

Here is what Hamid — who now splits time between Pakistan, the U.S. and Europe — says you should be listening to or reading.

For a political look at Pakistan, there’s Mohammed Hanif’s “Case of Exploding Mangoes,” a wonderful Catch-22 type satire.

Credit: Knopf/US

For a look at the Pakistani village life, there’s Daniyal Mueenuddin’s “In Other Rooms, Other Wonders.”

Credit: W. W. Norton & Company

There are several novels by Kamila Shamsie, including a new one that hasn’t been released. But perhaps readers could begin with “In The City By The Sea.”

Credit: Bloomsbury

If music is to your liking, I would suggest the amazing singer Abida Parveen, who is a bit like a Nina Simone [or] Aretha Franklin figure in the Pakistan tradition. She’s incredible.

And of course, the soundtracks to really any of the films by Mira Nair, but in particular the soundtrack to the film she made for “The Reluctant Fundamentalist,” my novel.

On that soundtrack, I would suggest a wonderful track called “Kaindey Ney,” sung by one Zahra Khan who also happens to be my wife, but I’m really partial to that one.

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White House Press Secretary Sean Spicer holds his daily press briefing at the White House in Washington, U.S. March 16, 2017. Photo by Jonathan Ernst/Reuters

WASHINGTON — The White House has promised that it won’t repeat its claim that U.K. spies snooped on President Donald Trump, the British government said Friday.

The agreement comes after White House press secretary Sean Spicer pointed to the debunked claim publicly in a bid to defend Trump’s earlier suggestion that former President Barack Obama wiretapped Trump Tower. Trump has not provided any evidence to support that claim, and several lawmakers say there isn’t any.

Downing St. said that Britain’s ambassador to Washington, Kim Darroch, spoke to White House press secretary Sean Spicer directly, and that the prime minister’s national security adviser, Mark Lyall Grant, also spoke to people in the Trump administration to put the claim to rest.

Spicer asserted Thursday that Trump’s Twitter accusations that President Barack Obama wiretapped his phones in October were a broad reference to “surveillance,” not to wiretapping specifically.

In an attempt to bolster his case, Spicer spent nearly 10 minutes reading from news reports which he said pointed to possible evidence of surveillance. Among the items he quoted from was a transcript of a recent appearance by Fox News analyst Andrew Napolitano on the network, in which Napolitano suggested GCHQ, the British electronic intelligence agency, had helped with the alleged tapping. Obama, he claimed, “went outside the chain of command” so there were “no American fingerprints on this.”

READ NEXT: Why Americans want answers on Trump’s wiretap claims

According to a Western diplomat, Spicer had been made aware two days prior to Thursday’s White House press briefing that the Napolitano report was untrue. Spicer and Darroch had spoken by telephone on Tuesday the diplomat said, during which time Darroch asserted that there was no basis to the report.

A White House official confirmed that Darroch and Lyall expressed their concerns to both Sean Spicer and Trump’s national security adviser, Lt. Gen. H.R. McMaster. Spicer and McMaster both said that Spicer was simply pointing to public reports and not endorsing any specific story, the official said.

The diplomat and White House official both spoke on condition of anonymity to discuss private conversations.

A spokesman for British Prime Minister Theresa May said Friday that the British government made it clear to Spicer that the “ridiculous” claims should be ignored.

“We have a close, special relationship with the White House and that allows us to raise concerns as and when they arise as was true in this case,” said May spokesman James Slack. “We have made clear to the administration that these claims are ridiculous and that they should be ignored and we have received assurances that these allegations won’t be repeated,” he told reporters at a regular briefing on Friday.

Trump tweeted earlier this month that Obama “was tapping my phones in October” and compared the incident to “Nixon/Watergate” and “McCarthyism.”

The claim is prompting growing bipartisan agreement that there’s no evidence to back up the claim and mounting pressure to retract the statement. The Senate Select Committee on Intelligence weighed in Thursday, finding “no indications” that Trump Tower was the subject of surveillance.

READ NEXT: Senate Intelligence leaders dismiss claim of Trump wiretap

Republicans in Congress also said Trump should retract his claims. Rep. Charlie Dent, R-Pa., called the accusation against Britain “inexplicable” and the accusation against Obama unfounded.

“A president only has so much political capital to expend and so much moral authority as well, and so any time your credibility takes a hit, I think in many ways it weakens the officeholder,” Dent said.

Slack would not say whether Spicer or any other American officials apologized, noting, “we have received assurances that these allegations won’t be repeated and this shows the administration doesn’t give the allegations any credence.”

However, the Western diplomat confirmed that Spicer was very apologetic when confronted by Darroch at a White House dinner on Thursday.

The British intelligence agency, which rarely comments on allegations about intelligence matters, flatly denied the claim, responding with a statement calling the allegations “nonsense.”

“They are utterly ridiculous and should be ignored,” read the statement, which was issued on condition that it be attributed to an anonymous spokesperson to protect the identity of agency staff.

Slack pointed out that GCHQ could not have spied on Trump because the U.K. and the U.S. are both members of the Five Eyes intelligence-sharing alliance, and under “the Five Eyes pact, we cannot use each other’s capabilities to circumvent laws.”

Lawless reported from London. Associated Press writers Jill Colvin and Erica Werner contributed to this report from Washington.

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U.S. President Donald Trump waves with Speaker of the House Paul Ryan (R-WI) after attending a Friends of Ireland reception on Capitol Hill in Washington, U.S., March 16, 2017. Photo by Joshua Roberts/Reuters

WASHINGTON — President Donald Trump agreed to add fresh Medicaid curbs to the House Republican health care bill Friday, bolstering the measure with support from some conservative lawmakers but leaving its prospects wobbly. House leaders discussed other amendments calibrated to round up votes and scheduled a showdown vote for Thursday.

“I just want to let the world know I am 100 percent in favor” of the measure and the changes, Trump said at the White House after meeting around a dozen House lawmakers and shaking hands on revisions. “We’re going to have a health care plan that’s going to be second to none.”

While the rapid-fire events seemed to build momentum for the pivotal GOP legislation, its fate remained clouded. One leading House conservative said the alterations were insufficient and claimed enough allies to sink the measure, and support among GOP moderates remained uncertain.

“My whip count indicates that there are 40 no’s,” enough to defeat the bill, said Rep. Mark Meadows, R-N.C., who leads the hard-line House Freedom Caucus. He said the change “doesn’t move the ball more than a couple yards on a very long playing field.”

Across the Capitol, Sen. Dean Heller, R-Nev., who faces re-election next year, became the fourth Republican senator to announce his opposition. That left Senate GOP leaders at least two votes shy of what they’d need to prevail.

Congressional Democrats remain solidly opposed to the GOP effort.

The Republican bill would kill much of former President Barack Obama’s health care law, including tax penalties for people who don’t buy insurance and its expansion of Medicaid, the federal-state health program for the poor. It would create new tax credits that would be less generous than current federal subsidies for many consumers, and repeal levies on the wealthy and medical firms that helped finance Obama’s expansion of coverage to 20 million Americans.

The deal between Trump and lawmakers would let states choose to impose work requirements on some of Medicaid’s roughly 60 million recipients. Details were initially unclear, but Republicans have recently discussed using them for healthy people with no dependents.

The agreement would also allow states to decide to accept a lump-sum federal payment for Medicaid, instead of an amount that would grow with the number of beneficiaries. The program currently costs the federal government around $370 billion annually and automatically covers costs, no matter the amounts.

“These changes definitely strengthen our numbers,” said the House GOP’s top vote counter, Rep. Steve Scalise of Louisiana, among those who met Friday with Trump. “But they also show that President Trump is all-in now,” a help in winning converts.

Among those accepting the agreement was Rep. Mark Walker, R-N.C., leader of the Republican Study Committee, a large group of House conservatives.

“We’re a yes. We’re excited to be there,” he said at the White House.

It seemed clear that GOP leaders remained short of the 216 votes they’ll need, and additional changes were in the works.

Rep. Tom McClintock, R-Calif., said he’d been assured by House Speaker Paul Ryan, R-Wis., that the bill’s tax credit would be adjusted to focus more benefits on lower-income people. Rep. Robert Aderholt, R-Ala., among those who met with Trump, said the president “told his people” to work on changes making the measure more generous for lower-earning and older Americans.

“Everything has to be a change that would increase the vote count,” Scalise said.

Conservatives seemed likely to not achieve their demands that the GOP bill’s phase-out of Obama’s Medicaid expansion — now 2020 — be accelerated to next year and that the tax credit not go to people with little or no tax liability. Centrist Republicans remained wary of a bill they fear will yank many constituents from coverage. Many of them are from states where voters have gained Medicaid and other health insurance under the 2010 statute.

“We’ll see what changes they’re going to make. I’m listening,” said Rep. Charlie Dent, R-Pa.

In a report this week that prompted many GOP lawmakers to emerge as opponents, the nonpartisan Congressional Budget Office said the legislation would leave 24 million people uninsured in a decade, including 14 million next year, and boost out-of-pocket costs for many.

Heller joined three other GOP senators in opposing the bill: Susan Collins of Maine, Rand Paul of Kentucky and Mike Lee of Utah. Republican Sens. Tom Cotton of Arkansas and Ted Cruz of Texas have voiced strong objections, and moderates in the Senate are wary of booting constituents off coverage.

Republicans have only a 52-48 Senate majority.

Nevada has expanded Medicaid and GOP Gov. Brian Sandoval has expressed opposition to the Republican legislation.

AP reporters Erica Werner, Kevin Freking, Matthew Daly, Jill Colvin and Kenneth Thomas contributed to this report.

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JUDY WOODRUFF: Finally tonight, “Atlantic” magazine writer Derek Thompson, author of the recent book “Hit Makers,” looks at how stories help us understand and even change the way we see the world.

It’s the latest installment in In My Humble Opinion.

Have a listen.

DEREK THOMPSON, Author, “Hit Makers: How Things Become Popular”: One thing I learned writing a book about pop culture hits in entertainment is that stories are weapons, for good or ill.

Movies like “Frozen” can teach us female empowerment. Movies like 1915’s “The Birth of a Nation” can teach us prejudice.

For example, take one of the most ancient and universal myths, vampires. For hundreds of years, people didn’t understand death or disease. Why did people get sick in bunches? Why did people often die after their friends did?

So, all over the world, different civilizations made up the same story: Death comes from the undead.

Before the 1800s, the belief in vampires stretched from Transylvania to China. Albanian vampires ate intestines, while their Indonesian brethren drank blood. In Eastern Europe, they discriminated against people they thought might become vampires, including the disabled, atheists, and even seventh children.

Today, we know germs exists and vampires do not. It’s tempting to say it was just a stupid story, but the truth is that vampires were the perfect story. It didn’t just explain the mystery of death. Even more, it explained the chaos of life with a spectacular tale that empowered villagers by telling them that everybody had the capacity to fight evil with potions, garlic, prayers, chastity, stakes, swords, and fire.

We have come a long way since vampires. Or have we? Even today, society is bound by the stories that we tell each other. In an office, loud women are bossy, but loud men are assertive. An outspoken white person is authoritative, but an outspoken black person is threatening.

Are men smarter than women, or whites smarter than other races? There is no scientific basis for these ideas. They are stories that had to be invented, constructed, told, and believed.

From the time we are children, we hear stories about the way the world ought to work. Who should we trust? Who should we fear? These are social narratives passed down, like bedtime stories, across generations, telling us how to live and what to expect.

Science finally killed the folk belief in vampires, but how do we drive a stake through misogyny or prejudice? History is full of men and women who successfully championed justice and equal rights. Empathy and equality are powerful stories. They need equally powerful storytellers.

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JUDY WOODRUFF: Now: a new work from acclaimed author Neil Gaiman explores deities, dwarves and giants.

Jeff is back with this otherworldly addition to the NewsHour Bookshelf.

JEFFREY BROWN: The mighty Thor, god of thunder, as portrayed by Jack Kirby in his 1960s comic book series, one-eyed Odin, highest and oldest of the Gods from Roger Lancelyn Green’s “Myths of the Norsemen.”

NEIL GAIMAN, Author, “Norse Mythology”: I would have been 6 years old when I first encountered the — just the idea of these Norse gods.

I remember looking at them and going, this is amazing.

JEFFREY BROWN: These stories of the Norse gods were read and absorbed by the young Neil Gaiman.

Now 56, Gaiman has sold more than 15 million books, as one of today’s leading writers of fantasy and science fiction, the clash of the very human and the otherworldly.

The British-born Gaiman first gained fame for his comic book series “The Sandman.” He would go on to write much more in many genres, including novels such as “Neverwhere,” “American Gods,” and “The Ocean at the End of the Lane.”

And he’s now done his own retelling of the old tales, titled “Norse Mythology.”

We spoke recently at Scandinavia House in New York.

NEIL GAIMAN: I had encountered the stories of the Greeks, even of the Egyptians. And you look at the supreme gods, the top gods. You look at Zeus, you look at Ra, and they are powerful and all-wise and to be aspired to.

And yet here is Odin. And if he turns up at your house, he will probably turn up in disguise and, you know, leave with half your cutlery, and possibly having seduced your daughter.

JEFFREY BROWN: Yes.

NEIL GAIMAN: These are unreliable people.

When I started writing these stories — and I started working on this book about four years ago — from my perspective, it was the joy of just going, this is part of the heritage of the human race. Let me give it to a new generation.

JEFFREY BROWN: Tell me what you’re doing. You’re not — you’re rewriting the myths?

NEIL GAIMAN: I suppose I think about them as if I’m taking old folk songs and then perhaps orchestrating them, arranging them for modern ears.

I’m going back to the Icelandic versions of these stories that remain to us written in a post-Christian world, picking the versions of the stories that I like, not changing things, not creating, in the sense of retelling, retelling as if you were telling a joke that you love, but telling it for modern ears.

JEFFREY BROWN: So, you had some fun with this?

NEIL GAIMAN: I had a lot of fun with it.

JEFFREY BROWN: Yes.

NEIL GAIMAN: But what I didn’t do was invent stories.

JEFFREY BROWN: You write about these gods as though they are still with us to some degree. And, of course, in your writing, that’s a motif.

NEIL GAIMAN: Yes.

JEFFREY BROWN: Do you feel that, that the gods are with us in …

NEIL GAIMAN: I feel like the gods are ours. And we are allowed — we created them. Human beings get to create gods, and human beings get to tell stories with gods.

We carry our cultures around with us. We carry our background around with us. We carry our histories and our families’ histories and our ancestors histories around with us.

JEFFREY BROWN: Gaiman himself has long been a kind of cult hero to his fans, who follow him and his work in progress on his blog and on Twitter.

He’s reached broader audiences with adaptations, a film version of his novel “Coraline,” an upcoming television series based on “American Gods,” and much more to come.

NEIL GAIMAN: For me, it’s all part of the giant, same thing, which is storytelling.

What fascinates me, what drives me is the urge to tell stories. What then drives you is going, where is this story best told? How can you tell this story as one thing? How can — sometimes, how can you move this story from one medium into another?

JEFFREY BROWN: You wrote about when you achieve some success, the fear that you will be uncovered as a kind, what your wife called the fraud police, right? And you refer to it as the impostor syndrome, where this is all too good to be true.

NEIL GAIMAN: Absolutely, fearing that it will be taken away from you at any moment when people notice that you are simply making it up.

And I guess it’s worse for a writer because you are simply making it up.

JEFFREY BROWN: Yes, you really are.

NEIL GAIMAN: You know, you look around, and you go, well, doctors, they have at least learned things. And, you know, architects must know how to architect.

But I’m just a guy who makes stuff up, and people happen to like it. And, maybe tomorrow, they won’t like it. Maybe there will be that knock on the door, and there will be that guy in a suit with a clipboard saying, right, we’re onto you. You have to go and get a real job now.

JEFFREY BROWN: In the meantime, look out. The “Norse Mythology” ends with Ragnarok, the apocalyptic end of the world.

NEIL GAIMAN: One of the things that I love about Ragnarok is, yes, it’s the end of all times, it’s terrible, all the people are killed. Everything is destroyed.

And yet, even as Ragnarok finishes, you’re told, but there are two human beings whose names are Life and Life’s Yearning who are still hiding successfully, and they will repopulate the world. And, yes, the sun is destroyed, but a new sun will come up fresher and brighter than the old one.

JEFFREY BROWN: Until then, from New York, I’m Jeffrey Brown for the PBS NewsHour.

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JUDY WOODRUFF: And to the analysis of Shields and Brooks. That’s syndicated columnist Mark Shields and New York Times columnist David Brooks.

Welcome, gentleman.

So, let’s pick up with the conversation, David, that Jeffrey Brown was just having with the head of the American Medical Association.

President Trump is saying again today the health care overhaul is moving along very well, it’s going to move through the House.

What do you see as the prospects?

DAVID BROOKS, The New York Times: It has no critics.

No. I’m first all amazed that they did it first. Of all the issues to tackle, health care is probably the hardest one. And so every four or eight years, some president decides, you know, let’s do health care first. And it hurts them every single time.

Whether the prospects of this bill are good, I tend to doubt. It has very few fans in the Senate. And it has two wings of opposition which are in contradiction, what we call the coverage caucus, who want a little more expensive bill that will cover more people, and the Freedom Caucus wants a less expensive bill to cover less.

You can’t — they have to win both of these groups. And how do you do this, when they are mutually contradictory? And so the Senate is very daunting. So, therefore, you’re asking the House members to vote for something that will take away coverage that already exists for a bill that probably doesn’t have great prospects in the long run.

I personally bet they get through the House, just because it’s so hard to go against the sitting president in his first major thing. But I wouldn’t want to bet on the eventual passage of this.

JUDY WOODRUFF: And, Mark, what we hear is the main argument they are using now in the House as it gets closer to the vote is the political vote, you can’t go against your president.

MARK SHIELDS, Syndicated Columnist: Yes.

It’s an argument that used, used in 1993 for the Democrats and Bill Clinton on his major budget and tax increase, which, by the way, per what David was talking about, included a BTU tax that House members voted on. It passed the House in a very difficult vote and died in the Senate.

Several moderate to conservative Democrats walked away from it. And it left those House members with a vote that they really couldn’t — it became politically mortal — fatal in several instances. I think the same thing is true here, and for good reasons, Judy.

I mean, the Republicans — part of David’s answer — they pledged in 2010, they pledged in 2012, they pledged in 2016. That was the one pledge they had: repeal Obamacare. It was an applause line.

So, it really did take on almost a moral imperative, or at least a political imperative. But, Judy, this is going to radically overhaul the Affordable Care Act. It going to radically overhaul Medicaid. You heard Dr. Gurman in his interview with Jeff.

The reality is, providers are not going to provide coverage. They’re not going to take on as patients people under Medicaid, because they are not going to have the money to pay for it. They are talking — one figure that jumps out, beyond all the questions of deductibles and everything else, 24 million Americans. That’s what the Congressional Budget Office estimates.

And Republicans just kind of recoiled. That is the number that has hung around — are going to lose coverage. Lose coverage. That just is — that is truly unforgivable. It’s morally indefensible. And I think, in this case, it will be politically indefensible.

JUDY WOODRUFF: But we’re talking — you’re talking, Mark, about the bill as it sits in the House. In the Senate, we may — we’re almost certain to see changes.

DAVID BROOKS: Yes, but which direction?

First, on the 24 million, it’s a neat trick to do that, because simply repealing Obamacare would have only taken coverage from 23 million. So, somehow, the replacement subtracts a million, which is an interesting trick.

The Republican Party just hasn’t figured out where it sits on this issue. I think you could have a very good free market system, sort of modeled on Switzerland, where there are a lot of individual markets, people actually pay for their health care, and there’s some cost and demand — supply and demand pressures to get costs down.

But you would have to spend more to get it — make it universal. You business have to make it universal using a free market system. But the Republican Party hasn’t gotten there, because they don’t want to make it universal, because it probably would be extensive.

And so some of them want to go sort of in that direction, but a lot, Ted Cruz, Rand Paul, they want to go in the other direction. And they just don’t think it’s the government’s job to be in the field of distribution, redistribution.

And this ACA was very redistributionist. The Republican Party hasn’t figured it out. And what is interesting to me is that Donald Trump hasn’t figured it out. He campaigned partially as a populist. And if I was a populist, I would be handing things to my people.

And what this bill does is, it takes things from the Trump voters. The middle-aged people, 50 to 64, get hammered in this bill, the people just above the Medicaid threshold. The working class, they get hammered.

And so what is the one piece of the bill that has been there from the beginning to end in all the versions, is the tax cut for people making over $250,000. And so it’s a weirdly anti-Trumpian bill that he has sort of gone along with because, I guess, the House Republicans led the way.

MARK SHIELDS: I think — I can’t argue with any point that David made.

I would just say, it’s inconceivable to me. Donald Trump changed the face of the Republican Party, whatever anyone thinks of this election. He carried 403 counties that had voted for Barack Obama.

The counties he carried, Judy, were considerably more white than the country is, and they were considerably less educated. They were struggling working class. And he has turned his back, not simply on the health care, this bill does, but on the budget.

It takes from the have-nots. It takes from the have-nots and the have-lesses, and gives to the have-mores. It is absolutely a Robin-Hood-in-reverse budget.

And I just don’t understand it. It really, to use David’s word, hammers the very people who voted for him, especially in rural areas in America.

JUDY WOODRUFF: David, what about the budget proposal?

DAVID BROOKS: Yes, just some things are mystifying.

Why they eliminated the Appalachian regional development, the thing that — why they severely cut the Great Lakes regions, Michigan, Wisconsin, why they had to put those specific cuts in the budget, let alone — fine, Republicans are going to try to get rid of CPB, our beloved CPB, Corporation for Public Broadcasting.

But why they put those things, it’s mystifying. And it seems to go in direct contradiction to everything he stood for in the course of the campaign.

And there’s a theory going around in political science which has some resonance for me today, which is that you have moments where you get a political party knows what they believe and they are all on board. Then there’s periods of disruption, where they are internally divided.

And the argument is, Jimmy Carter was an example was this. The Democrats had shifted away from some old-style liberalism. They hadn’t got to Bill Clinton’s style. And they were internally divided, and that Donald Trump is like Jimmy Carter.

He comes at a time when the Republican Party does not know what it wants, and that he himself is internally divided. And you get these weird contradictions of campaigning one way, and then governing in a very opposite way.

JUDY WOODRUFF: And both of you are saying the same thing, then, Mark, about the budget.

MARK SHIELDS: I hope not. Well, I hope not.

(LAUGHTER)

MARK SHIELDS: There’s no point in watching.

JUDY WOODRUFF: At least on this point.

(LAUGHTER)

MARK SHIELDS: No, but, Judy, just to add to that, David Rogers, a peerless congressional reporter, wrote in Politico, these — they are turning their backs on Republican-endorsed programs.

It was President Jerry Ford who pitched community development grants. It was Bob Dole who pushed and was the champion of food aid overseas. They’re going to cut that. It was Ronald Reagan who found the money for heating assistance for poor people. It’s just — it’s amazing.

And it’s the same budget that Paul Ryan passed in 2013. But then he was negotiating with a Democratic president, because he wanted to get cuts in entitlement growth towards his dream of taming the budget deficits.

But now he’s got Republican president, and they’re passing the same budget with the same cuts. And I just — I don’t know where the pickup is.

DAVID BROOKS: Yes. I’m — was looking for the political philosophy that might be inherent in a budget.

And some of them are just weird, even for Republicans, as Mark said, $6 million — $6 billion off the National Institutes of Health. That is an investment in scientific advance and economic growth. And why would you do that? That doesn’t even seem particularly Republican.

But, basically, what you’re doing, they are investing in everything that is hard power. They’re investing in the military, in homeland security, everything that is about threat and fear.

And they are disinvesting in everything that has to do with compassion, with care, thinking, innovation. And it’s almost like emotionally consistent. It’s just hardness and toughness and fear. And everything else just has to go.

JUDY WOODRUFF: Well, even some Republicans are saying, well, this is just the first shot from the White House, and we will have our own crack at it.

In the few minutes that we have left, Mark, let’s talk about the president continuing to double down on his contention that he was wiretapped by former President Obama. He’s said it. He said it again today. His spokesman, Sean Spicer, has come up with evidence, they say, or at least cited news stories. And, of course, the British government pressed back on, pushed back on one of that — one of the claims that Sean Spicer made yesterday.

What does this say that this is something the president won’t let go of, in the face of almost universal lack of evidence?

MARK SHIELDS: It is universal. When you let — when lose Devin Nunes, who is the chairman of the House Intelligence Committee …

JUDY WOODRUFF: Republican.

MARK SHIELDS: Republican, who has been Donald Trump’s apologist, I mean, explained that Donald Trump was actually a political neophyte, and you could take things literally, this is a man who ran as, you might disagree with him, Judy, but you know what he says. He stands — he says what he believes and he believes what he says, and he tells it like it is.

And now we’re down to literally and figuratively. Literally and figuratively, I don’t care about quotation marks. He said this about the president of the United States. He accused the president of the United States. He said it was a fact that the president of the United States had done this. It was wrong.

It was unfounded. It was unfair. It was unjust. It was as unjust as it was when he charged that is principal opponent Ted Cruz’s father had been involved in the assassination of President Kennedy, when he charged that the first African-American president wasn’t an American, was African, Barack Obama.

But now he’s president. Now he’s president. This isn’t a matter of his macho or his vanity or his toughness. This is a question, when a president of the United States says anything, it reassures allies, it confounds the world, or it reassures the world, or it alarms people.

And I said last week, I do not believe, when the crisis comes, that there’s going to be credibility for this man.

JUDY WOODRUFF: How do you explain it?

DAVID BROOKS: Yes, there’s some fear.

One of the things that struck me this week is, Donald Trump is the most talked-about American in the history of our country. Wherever you go around the world, people are talking about Donald Trump. And every — people who go abroad, that’s all — anywhere you go in the world, people want to talk about that.

And he does it in part through this, through saying things that make him criticized and — but he is the center.

And the second thing he demonstrates through this — and, again, I’m just trying to illustrate why — A, why he got elected president, and why these things don’t seem to kill him. So, he’s first center of attention.

JUDY WOODRUFF: Figuratively speaking.

DAVID BROOKS: Yes, right. Right, exactly.

And the second is that force. He shows force. I was listening to a lot of talk radio today. And there is a lot of support for Donald Trump is that that guy is tough enough to stand against everybody and be forceful. And he never withdraws, he never backs down. It’s just force, force, force.

If you remember when Jeff Sessions recused himself from that investigation on the Russia thing, Trump reportedly blew his top, because it was a withdrawal. And it was a perfectly legitimate step back, but it was a partial withdrawal. And Trump is always forward, forward, forward.

JUDY WOODRUFF: And no sign of any change on that one.

All right, David Brooks, Mark Shields, thank you both. Have a great weekend.

MARK SHIELDS: Thank you, Judy.

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JUDY WOODRUFF: President Trump and the Republican leadership in the House are working to pass a health care bill later next week. But there’s still criticism and concern about the impact of this bill, including among lawmakers, governors and, of course, among voters.

There are also a number of powerful interest groups who are directly involved in health care and they are expressing reservations.

Tonight, Jeffrey Brown hears one of those perspectives.

JEFFREY BROWN: In 2010, the American Medical Association, the largest physicians group in the country, lobbied for the passage of the Affordable Care Act.

Fast-forward to today, the group is publicly opposing the proposed House Republican health plan.

Dr. Andrew Gurman is its president, and joins me now.

Welcome to you.

DR. ANDREW GURMAN, President, American Medical Association: Thank you. Delighted to be here.

JEFFREY BROWN: Can you boil down the essence of the opposition? What is wrong with this plan?

DR. ANDREW GURMAN: Sure.

We know that people who don’t have health insurance live sicker and die younger. So, it is a basic principle of ours that people who have insurance shouldn’t lose it, and people don’t have health insurance should get it. And we’re afraid that, under this bill, that wouldn’t happen.

JEFFREY BROWN: So, take parts of it.

The tax credit part, emphasis of this, why wouldn’t that work, or who would that not work for?

DR. ANDREW GURMAN: Well, we’re concerned that the poorest and sickest among us would be the ones most affected.

And I will give you an example. These are numbers from the Kaiser Family Foundation. Someone who is 60 years old under the Affordable Care Act might get subsidies of up to between $9,000 and $13,000 to buy insurance, depending on where he or she lived.

Under the proposed legislation, that subsidy would be $4,000 flat, across the board. It doesn’t know where you live. It is virtually impossible to purchase insurance at that age for $4,000.

JEFFREY BROWN: Do you see an impact on your own patients? You’re already hearing the worries?

DR. ANDREW GURMAN: The worries that my patients have, have to do with high deductibles and availability of insurance.

And I can give you example of someone I saw last week in my office, self-employed carpenter, probably makes somewhere between $20,000 and $30,000 in a good year. He needs to have surgery on his hand. He has a $6,000 deductible. That’s a big problem for him.

JEFFREY BROWN: So, to push back a little bit on you here, many doctors have also, of course, complained about the ACA, right, about the — too many regulations, gets in the way of the doctor-patient relationship, takes away choices from patients.

You are also getting some pushback from the White House about that you and other interest groups are opposed because it hits you financially, you doctors financially. What do you respond?

DR. ANDREW GURMAN: Well, there is no question that there are things in the Affordable Care Act that need to be fixed.

There are various ways that that could be done. Repeal and replace is one of them, but we don’t know what the replacement is. So, the AMA has clearly stated that we think that the American people should see what the proposed replacement is, so that we can have a thoughtful discussion regarding whether it’s better or worse than what we have now.

There are many things in the Affordable Care Act that could be fixed, rather than replaced.

JEFFREY BROWN: The repeated claim behind all this, of course, is that Obamacare is collapsing. Do you see that?

DR. ANDREW GURMAN: Well, there’s no question that the markets which were created under the Affordable Care Act need to be stabilized. There are lots of ways to do that.

JEFFREY BROWN: And, finally, the president says we’re going to get through all this, we’re going to get a new health plan.

Do you think that will happen? What will it take to get the AMA on board?

DR. ANDREW GURMAN: Well, the AMA stands ready, willing and eager to work with Congress in order to get this right and to make it work for all Americans.

JEFFREY BROWN: And, again, do you think it will happen?

DR. ANDREW GURMAN: I hope so.

JEFFREY BROWN: You do hope so, even though you oppose what is on the table right now?

DR. ANDREW GURMAN: Oh, I hope that, at the end of this process, that we have a health care system that works for everybody in America.

JEFFREY BROWN: All right.

DR. ANDREW GURMAN: It’s already the envy of the world. We just need to make it work for us.

JEFFREY BROWN: Dr. Andrew Gurman, president of the AMA, thank you.

DR. ANDREW GURMAN: My pleasure. Thank you for having me.

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JUDY WOODRUFF: Secretary of State Rex Tillerson at one of the most tense places on the planet, the border between North and South Korea, it’s the second of his stops on an important, three-country, whirlwind tour of Asia, where allies and adversaries are both close at hand.

Hari Sreenivasan has that.

REX TILLERSON, U.S. Secretary of State: Let me be very clear: The policy of strategic patience has ended.

HARI SREENIVASAN: From South Korea, Secretary of State Rex Tillerson signaled a tougher line on dealing with North Korea, including the possibility of a preemptive military strike.

REX TILLERSON: Certainly, we do not want to — for things to get to a military conflict. If they elevate the threat of their weapons program to a level that we believe that requires action, that option is on the table.

HARI SREENIVASAN: Tillerson spoke in Seoul after visiting the demilitarized zone that separates the two countries, and the truce village of Panmunjom. North Korean soldiers looked on, snapping pictures.

The secretary arrived at a time of mounting tensions. North Korea has test-fired ballistic missiles twice in the last three weeks, as U.S. and South Korean troops conduct elaborate, annual joint exercises. The North also carried out two nuclear tests last year.

Yesterday in Japan, the secretary said 20 years of attempts to curb Pyongyang’s nuclear ambitions have failed.

REX TILLERSON: In the face of this ever-escalating threat, it is clear that a different approach is required. The purpose of — part of the purpose of my visit to the region is to exchange views on a new approach.

HARI SREENIVASAN: This morning, President Trump weighed in via Twitter. He wrote: “North Korea is behaving very badly. They have been playing the United States for years. China has done little to help.”

The Chinese have condemned North Korea’s nuclear and missile tests. But they also oppose deployment of the U.S. ballistic missile defense system, known as THAAD, to South Korea.

Tillerson answered today in Seoul, before heading to Beijing tomorrow.

REX TILLERSON: While we acknowledge China’s opposition, its economic retaliation against South Korea is inappropriate and troubling. We ask China to refrain from such action.

HARI SREENIVASAN: The South Korean foreign minister underscored the U.S. argument that the missile defense system is not aimed at China. But the recent ouster of South Korea’s president, in a corruption scandal, could change the landscape. The liberal candidate favored to win the presidency in May says he will review the THAAD deployment, and consult with China.

For more on the secretary’s trip to Asia, and the significance of what Tillerson had to say in South Korea, we turn to veteran diplomat Kathleen Stephens. She was U.S. ambassador to South Korea during the Obama administration. She’s now at Stanford University.

How significant were the secretary’s remarks?

KATHLEEN STEPHENS, Former U.S. Ambassador to South Korea: Well, I think they were very significant, and closely listened to and heard throughout the region, as well as here.

In fact, I think it’s first somewhat extensive press conferences as secretary of state. It was indeed a very tough message, but I also think he picked his words pretty carefully. And a lot of what he had to say was a reinforcement of what had been the Obama administration policy, but I think an indication that he wants to toughen it up even more.

HARI SREENIVASAN: Is this our chief diplomat saying diplomacy hasn’t been working, the talking hasn’t been working?

KATHLEEN STEPHENS: Well, in fact, there hasn’t been much talking with North Korea over the eight years.

And one thing that did strike me about Secretary Tillerson’s remarks was that he was quite specific and categorical in saying now is not the time for talks. I actually would have liked to have seen him keep the door a little bit ajar on that, because I think, when you do have a new administration in Washington, there will soon be a new administration in Seoul, there’s a good argument for trying to climb that mountain one more time and seeing what’s possible diplomatically, because at the very least, it helps you build coalitions you need to increase the pressure if the diplomatic approach doesn’t work.

HARI SREENIVASAN: He’s advocating tougher sanctions. Will tougher sanctions work against North Korea?

KATHLEEN STEPHENS: Well, sanctions are a very blunt instrument.

And sanctions have been — against North Korea have been progressively tightened and broadened through Security Council resolutions, through bilateral action by the United States, by actions by South Korea and Japan.

China has also participated, although, of course, there’s never been satisfaction, I think, with China doing or a sense that China is doing as much as it possibly could.

But will sanctions work? I think they can bring pressure on the regime, and they are bringing pressure. Will they lead Kim Jong-un to make a strategic choice that he’s ready to trade his nuclear and missile program for a lessening of sanctions and for other benefits?

I think that the chances of that working are far less promising perhaps than they ever have been. But it doesn’t mean you give up on sanctions. But I think it means it has to be only one part of your approach.

HARI SREENIVASAN: Given what we know and we don’t know about North Korea’s leader, is this the type of thing that prods him to come to the table, or does it just anger him more? And, at times, his actions have not been predictable.

KATHLEEN STEPHENS: Well, I think what we know about Kim Jong-un, who has now been in power for five years, is that a priority, his priority has been to accelerate and consolidate his nuclear weapon and ballistic missile capability.

And to date, the sanctions, the isolation, the — and, for that matter, the carrots that have been offered to him to do otherwise have not been sufficient. So, I am pessimistic about them. But I think that continued pressure is important, because you don’t know what the timeline is for getting somebody to the table.

And I think Secretary Tillerson is right. Indeed, it was something that the Obama administration emphasized, that China also plays a very important role. But I think sanctions have to be combined with some kind of exit ramp. And the ramp has to be into something that allows him to start to make some adjustments.

And given where he is in the program, we may have to lower our sights about what he needs to do to get into talks. And this was one part of Mr. Tillerson’s presentation that concerned me a bit. He stated, perhaps for tactical reasons, a kind of a maximalist approach, which has long been an approach which has — that basically North Korea needs to give up everything before we get into a diplomatic process.

I do think it is going to have to be a process, probably a slow process, but certainly the principle which was held by Obama administration, which Mr. Tillerson reinforced, that there needs to be a readiness on the part of North Korea to say they are prepared to move toward denuclearization, is an important prerequisite.

And that is one that the Chinese have also agreed to and need to reinforce.

HARI SREENIVASAN: Something that has been of interest in South Korea is not who Mr. Tillerson met with, but who he didn’t meet with. He didn’t seem to meet with any of the opposition leaders. And he kind of talked to an administration that is a lame-duck.

How significant are things — or how much is it likely to change after South Korea has a new election?

KATHLEEN STEPHENS: Right.

It’s always a tricky question in the middle of an election campaign is how you can manage those meetings. So, I have some sympathy with the diplomatic nuances of trying to do that.

But, certainly, I mean, less than two months’ time, South Korea will have a new president. The election is on May 9. And that new president will take power, I guess, immediately.

And it looks now that it’s going to be most likely a president from the part of the political spectrum that has tended to lean towards trying a little harder on the engagement angle with North Korea.

In any event, I think any new South Korean will want to look at the options for that. And I think it will be very important not to close off too many options before that new government gets in place, and then to see with Seoul, as well as with Beijing, what, along with deepened pressure, deepened sanctions, more countries participating and pressuring North Korea, what might be possible in terms of a fresh diplomatic approach, some kind of grand bargain that addresses our core interest in seeing all of the Korean Peninsula denuclearize — and that means no nuclear weapons in North Korea — but finds a way to get into some kind of talks on that basis.

HARI SREENIVASAN: All right, Kathleen Stephens, thanks so much.

KATHLEEN STEPHENS: My pleasure.

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JUDY WOODRUFF: Meanwhile, the Justice Department said today that it has complied with congressional requests for any information on surveillance during the campaign. It gave no details.

There’s new trouble tonight for the Secret Service. The agency has confirmed today that someone stole a laptop from an agent’s car in New York yesterday. It was parked near her Brooklyn home. The Secret Service says the laptop has multiple security layers and doesn’t contain classified information.

Agency officials also confirmed this evening that a man who jumped a White House fence a week ago was on the grounds or 16 minutes before being arrested. He didn’t enter the building, but he got close.

President Trump today ramped up his push for the Obamacare replacement bill. He met with conservative Republicans, and said he’s — quote — “100 percent” behind the measure. Later, he predicted it will pass pretty quickly. Other lawmakers said changes to the bill are in the works, and House Speaker Paul Ryan said the process is going well.

REP. PAUL RYAN, R-Wis., Speaker of the House: There are people from middle and from the right who have various concerns. And we’re trying to make sure that we address as many of these concerns as possible without destroying the bill and without losing votes, but adding votes. And we’re getting — we’re really doing well. We feel very good.

JUDY WOODRUFF: In the Senate, four Republicans have already come out against the bill, leaving it short there of a majority.

In Yemen, 42 Somali refugees were killed last night when they came under attack at sea. Survivors said they were trying to flee Yemen to Sudan, when a naval vessel and a helicopter gunship opened fire. Shiite rebels in Yemen blamed a Saudi-led coalition. The coalition had no immediate comment.

The Pentagon denied today that a U.S. airstrike targeted a mosque in Syria’s Aleppo province. Activists and a powerful rebel group said the attack killed nearly 50 people, mostly civilians who had gathered for prayers. But a U.S. military photograph showed the mosque still standing, while a building across the street was destroyed. A Pentagon spokesman said the strike killed dozens of al-Qaida fighters, not civilians.

The International Energy Agency reports that worldwide carbon emissions remained flat in 2016. Emissions fell in the United States and China, the two largest emitters, thanks to greater use of renewable, nuclear and gas power. Still, the agency says it’s not enough to prevent the continued rise of global temperatures.

And Wall Street finished the week on a so-so note. The Dow Jones industrial average lost nearly 20 points to close at 20914. The Nasdaq rose a quarter-point, and the S&P 500 gave up three. For the week, all three indexes gained a fraction of a percent.

And Nobel-winning poet Derek Walcott died today at his home on the island of Saint Lucia. His work focused on the Caribbean and earned him renown as one of the greatest writers of the second half of the 20th century. He won the Nobel Prize for literature in 1992. Derek Walcott was 87 years old.

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JUDY WOODRUFF: The veteran leader of Germany and the new American chief executive, Chancellor Angela Merkel and President Trump met today at the White House in what many thought would be a moment to smooth relations after a rocky start. Whether that was the outcome is far from clear.

Chief foreign affairs correspondent Margaret Warner has our report.

MARGARET WARNER: Chancellor Merkel got a warm presidential welcome at the West Wing this morning, yet minutes later, an odd scene in the Oval Office, Merkel offering to shake hands, but getting no response.

ANGELA MERKEL, German Chancellor (through interpreter): Do you want to have a handshake?

PRESIDENT DONALD TRUMP: Thank you very much.

MARGARET WARNER: At a joint news conference later, the two did exchange compliments in prepared statements.

PRESIDENT DONALD TRUMP: Our alliance is a symbol of strength and cooperation to the world. It is the foundation of a very, very hopeful future.

ANGELA MERKEL (through interpreter): We had a very good first exchange of views, so I’m very much looking forward to the talks we will have over lunch.

MARGARET WARNER: But the body language of their first meeting wasn’t warm, perhaps reflecting the two leaders’ sharply different styles and viewpoints, Mr. Trump, the businessman-turned-politician who campaigned on America first, and Merkel, political veteran, now Europe’s most vocal defender. It’s been a touchy long-distance relationship up to today.

Last year, candidate Trump accused Merkel of ruining Germany by accepting hundreds of thousands of Syrian refugees.

PRESIDENT DONALD TRUMP: I don’t know what went wrong with her. I don’t know what went wrong. Angela, what happened? What happened, Angela?

MARGARET WARNER: Today, the chancellor was asked whether she had any reservations about the president’s combative style.

ANGELA MERKEL (through interpreter): People have different abilities, different characteristics, traits of character, have different origins, have found their way into politics along different pathways. Well, that’s diversity, which is good. Sometimes, it’s difficult to find compromises, but that’s what we have been elected for.

MARGARET WARNER: Two of those areas of difficulty, NATO, and the European Union. Mr. Trump has repeatedly criticized NATO states for not paying their share of the common defense. He said today he had pressed Merkel to boost defense spending to 2 percent of economic output, the alliance’s stated goal.

PRESIDENT DONALD TRUMP: Many nations owe vast sums of money from past years. And it is very unfair to the United States. These nations must pay what they owe.

MARGARET WARNER: Merkel repeated Germany’s pledge to get to 2 percent of GDP within the next seven years.

ANGELA MERKEL (through interpreter): NATO is of prime importance to us. It wasn’t without very good reason that we said during our summit meeting in Wales that also Germany needs to increase expenditure. We committed to this 2 percent goal until 2024.

MARGARET WARNER: The president has also criticized Germany for running a huge manufacturing trade surplus with the U.S.

Today, he said:

PRESIDENT DONALD TRUMP: The United States has been treated very, very unfairly by many countries over the years. and that’s going to stop. But I’m not an isolationist. I’m a free trader. But I’m also a fair trader. Germany has done very well with its trade deals with the United States. And I give them credit for it.

MARGARET WARNER: Merkel noted that any trade agreement has to between the U.S. and the E.U.

ANGELA MERKEL (through interpreter): It will be of benefit to both countries. Let me be very honest and very candid. A free trade agreement with the United States of America has not been all that popular with Germany either.

MARGARET WARNER: Merkel’s dealings with President Trump may affect her own popularity at a critical moment. She’s seeking a fourth term as chancellor in elections later this year, and faces challenges both from the left and the right.

For the PBS NewsHour, I’m Margaret Warner.

JUDY WOODRUFF: In the day’s other news: President Trump defended the White House’s handling of his claim that President Obama had him wiretapped. His press secretary, Sean Spicer, had quoted a FOX News analyst who suggested British intelligence handled the wiretapping. The British flatly denied it and complained to the White House.

But at his news conference today, the president dismissed the furor.

PRESIDENT DONALD TRUMP: All we did was quote a certain very talented legal mind who was the one responsible for saying that on television.

I didn’t make an opinion on it. That was a statement made by a very talented lawyer on FOX. And so you shouldn’t be talking to me. You should be talking to FOX.

JUDY WOODRUFF: FOX News issued a statement today saying that it has — quote — “no evidence of any kind that Mr. Trump was surveilled at any time in any way.”

But with German Chancellor Merkel looking on, the president then connected his own claim to allegations back in 2013 that the Obama administration monitored her phone calls.

PRESIDENT DONALD TRUMP: As far as wiretapping, I guess, by this past administration, at least we have something in common, perhaps.

(LAUGHTER)

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(L-R)U.S. House Majority Leader Kevin McCarthy, U.S. House Speaker Paul Ryan, and U.S. Representative Greg Walden hold a news conference on the American Health Care Act on Capitol Hill in Washington, U.S. March 7, 2017. Photo by Eric Thayer/Reuters

WASHINGTON — The House GOP health care bill has competition from other Republicans, a group of governors who’ve made their own proposal about how to overhaul Medicaid for low-income people. They’re hoping GOP senators will find their ideas more persuasive.

It’s a gradual approach, with additional options for states. It’s likely to involve more federal spending than the House bill, but also keep more people covered. In the end, though, the governors are still talking about fundamental change.

Four GOP governors are pushing the plan, saying they represent most of the 33 Republican state chief executives. There’s no inkling of any involvement by Democratic governors, and it’s hard to conceive of such major changes without them.

Medicaid is a federal-state program that covers more than 70 million low-income people, about 1 in 5 Americans. Beneficiaries range from elderly nursing home residents to newborns. Former President Barack Obama expanded the program in his health care law, to mainly help low-income adults with no children living at home. About half the 31 states that accepted the expansion have Republican governors.

The House Republican bill would start by repealing Obama’s Medicaid expansion. More significantly, it would limit overall federal spending on Medicaid going forward. The nonpartisan Congressional Budget Office says the proposal would result in a cut of $880 billion from projected Medicaid spending from 2017 to 2026. By that year, 14 million fewer people would have Medicaid coverage, and program spending would be about 25 percent lower than what’s currently projected.

The House approach “provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to states,” Republican Govs. John Kasich of Ohio, Rick Snyder of Michigan, Brian Sandoval of Nevada, and Asa Hutchinson of Arkansas said in a recent letter to congressional leaders.

The future of Medicaid could become a pivotal issue as the health care debate moves to the Senate. Kevin Smith, a spokesman for Sen. Rob Portman, R-Ohio, said his boss “shares (governors’) concerns about the need to protect the Medicaid expansion population and give governors more flexibility to ensure they can design programs that meet the needs of their states.”

Differences between the House bill and the governors’ approach would have an impact on millions of people. Here’s a look:

Medicaid expansion

Current law: States can expand Medicaid to cover people making up to 138 percent of the federal poverty level, or about $16,640 for an individual. The federal government picks up almost all of the cost, gradually phasing down to a 90 percent share.

House bill: Ends Medicaid expansion. States can continue to receive the higher federal rate only for those enrolled by Dec. 31, 2019.

Governors: States that expanded Medicaid can also keep receiving the higher federal rate for new enrollees into the future if they agree to make other changes to their programs.

Medicaid spending limits

Current law: Medicaid is an open-ended entitlement program. The federal government pays a share of each state’s cost of providing care for beneficiaries. That share varies among states, but the national average is nearly 60 percent.

House bill: Federal Medicaid funds would be limited under a per-beneficiary cap that takes into account what a state has spent traditionally, adjusted for inflation. House leaders are also expected to introduce an option for states to choose a block grant.

Governors: States could pick a per-beneficiary cap, a block grant or the current system. If they choose the current system, they would lose the more generous matching funds for new beneficiaries covered by expanded Medicaid.

If states choose a per-beneficiary cap or a block grant, they would not have to take a complete plunge.

Initially such limits would apply only to spending for able-bodied adults, including people covered through expanded Medicaid. It would be up to each state to decide whether to accept caps or block grants for sensitive groups of beneficiaries, including children, pregnant women, and elderly and disabled adults.

Prescription drugs

Current law: State Medicaid programs must cover FDA-approved drugs for medically accepted uses. Pharmaceutical companies pay Medicaid rebates to states under a complex formula. A costly new drug like recent ones for hepatitis C can cause havoc with state budgets.

House bill: Not addressed.

Governors: States would be able to exclude coverage for a given medication. The option to exclude a drug would give them leverage in price negotiations with drug companies.

Eligibility and benefits

Current law: Federal government sets threshold for eligibility. States must cover certain basic benefits, including hospitalization, doctor visits, nursing home care and health screenings.

House bill: Not addressed.

Governors: States that accept spending caps would be able to freeze or reduce enrollment, with exceptions. States could impose work requirements for able-bodied adults. States would also gain authority to redesign benefits and require beneficiaries to pay modest amounts for their care.

“The Medicaid program is complex and different (beneficiary) populations have different needs,” said Trish Riley, executive director of the nonpartisan National Academy for State Health Policy, which advises state policymakers. The governors “recognize that you can’t have a hard cap on a program that has a lot of unpredictable costs.”

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A drug succeeded in lowering cardiovascular risks in a clinical trial, but questions remain over whether insurers will cover it. Photo by RunPhoto via Getty Images

A cholesterol-cutting drug from Amgen succeeded in lowering patients’ risk of cardiovascular trouble in a huge clinical trial — but the results, announced Friday, may not be good enough to prompt insurers to cover the expensive drug for millions of patients.

Amgen’s treatment, called Repatha, met its goals in a two-year trial on more than 27,000 patients with heart disease who were already taking a maximum dose of statins like Lipitor and yet still had stubbornly high cholesterol. Those who got Amgen’s drug were 15 percent less likely to suffer a bad outcome, defined as heart attack, stroke, hospitalization for chest pain, placement of a stent, or death.

However, looking at death rates alone, there was no significant difference between the two groups.

Cardiologists said the result is profound, but it will likely be a disappointment to investors, who widely expected Repatha to cut that bundle of cardiovascular problems by 20 percent.

Amgen’s stock fell about 7 percent after the data became public.

It remains to be seen how the trial results will affect Amgen’s contentious discussion with payers and pharmacy benefit managers, who have balked at the drug’s roughly $14,000-a-year list price.

READ NEXT: These pricey cholesterol drugs aren’t selling. And that has the biotech industry sweating

Before the new data came out — when the drug was known to reduce cholesterol, but when it wasn’t clear it could reduce hospitalizations — insurers and benefit managers rejected more than three-fourths of prescriptions that physicians wrote for Repatha. The question now is whether the new data will persuade them the drug is worth covering.

“We think we’re really at the beginning of a new era in how to further treat cardiovascular patients,” said Dr. Jeffrey Kuvin, a cardiologist at Dartmouth-Hitchcock not involved in the Amgen study. “The real test now will be how we can actually implement this science into daily practice.”

A money-back guarantee

Repatha, like a rival drug from Sanofi and Regeneron, is approved to lower LDL, or “bad,” cholesterol by blocking a bodily protein called PCSK9. The new class of treatment arrived on the market about a year and a half ago with blockbuster sales projections; Amgen was expected to ring up annual sales of around $3 billion. But a combination of unconvinced physicians, wary payers, and pugilistic pharmacy benefit managers has limited revenue to but a fraction of that figure.

Amgen says its latest data, presented at the American College of Cardiology Conference, firmly answers the question of whether dramatically lowering LDL can improve patients’ lives — more than what’s been possible with inexpensive statins. And the company believes Repatha’s performance more than justifies expanded use of the drug.

“The barriers that have been thrown up by the payers have been around, ‘You don’t have outcomes data,’” said Dr. Sean Harper, Amgen’s head of R&D. “Well, that’s off the table.”

The company hopes to persuade insurers to cover it in part by offering a sort of money-back guarantee: Amgen will refund the cost of Repatha if patients suffer a heart attack or stroke while taking the drug, said Dr. Joshua Ofman, Amgen’s senior vice president of value, access, and policy.

“We want to put our money where our mouth is,” Ofman said. “We stand by our product, and we’re willing to take risks around outcomes.”

Repatha’s $14,000 price tag is the list price. It doesn’t account for the customary discounts and rebates offered to payers, which average around 30 percent across the industry, Harper said. In pure dollar terms, he argued, Repatha’s ability to reduce patients’ risk of costly hospitalization more than justifies its price.

But the industry’s gatekeepers may not agree. In a survey of payers conducted by analysts at Leerink, about half of the respondents said they expected to approve more PCSK9 prescriptions if Amgen’s study was a success, but they expected a median improvement of 20 percent on the trial’s primary endpoint, well above the 15 percent Amgen demonstrated.

READ NEXT: Testing cholesterol in toddlers and babies? Study says it could help

Express Scripts, the nation’s largest PBM, is now preparing for spike in Repatha prescriptions. The company has streamlined its process for reviewing scripts, Chief Medical Officer Dr. Steve Miller said, but Amgen’s data — and its offer of a refund program — haven’t changed Express Script’s concerns about Repatha’s price tag.

“These are incremental gains in the right direction, and it’s an improvement for patients,” Miller said. “The big question is going to be, at $14,000, is the improvement enough?”

Repatha’s numbers look better in the trial’s secondary endpoint, which looks at data from the same patients, but leaves out two adverse outcomes: hospitalization for chest pain and stenting. By that measure, Repatha led to a 20 percent risk reduction for heart attack, stroke, and death.

But looking at death alone, Repatha had no effect, and it wasn’t meaningfully better than placebo at keeping patients out of the hospital with chest pains.

On the safety side, Amgen spotted no new risks of taking the drug.

A chilling effect on further research?

If Amgen’s data don’t move the needle and Repatha remains a blockbuster interrupted, there could be a chilling effect on cardiovascular R&D in the drug industry. The Medicines Company, Esperion Therapeutics, and others are spending millions of dollars to prove their drugs can safely lower LDL levels. But as the bar for profitability gets higher and higher, the odds of recouping such investments only lengthen.

“As a former colleague of mine, Jack Scannell, once called it, this is the ‘better than the Beatles’ problem,” said Geoffrey Porges, a biotech analyst at Leerink.

“The challenge for this industry is if the predecessor medicines are really good, and are now available for pennies, and are ubiquitous, it’s really hard to come up with something that has sufficient incremental benefit and appeal to justify a price that is hundreds of times higher,” Porges said.

Amgen has long complained that insurers are rejecting prescriptions for Repatha for no rhyme or reason, and there’s some evidence now to back that up.

A study to be presented at the cardiology conference on Saturday looked at more than 44,000 PCSK9 prescriptions over the course of a year and found no major differences between the 83 percent of patients who got rejected and the 17 percent who were approved.

“The experience is frustrating,” Kuvin said. Doctors have to submit pages of documentation to prove that patients’ high cholesterol has persisted despite two rounds of statin therapy, or that they have an inherited disorder that leads to dangerously high LDL levels.

“Now, with strong outcomes data, I’m hopeful that the marketplace will appreciate these data and allow practitioners to prescribe these drugs in an economically favorable way,” Kuvin said.

A bitter patent fight continues

Meanwhile, the famously litigious Amgen is fighting in court with its sole PCSK9 rival.

READ NEXT: Why a drug that lowers cholesterol doesn’t save lives

In January, a federal judge ruled that Sanofi and Regeneron’s treatment, Praluent, infringed Amgen’s patents. The judge took the unexpected step of barring the drug from the market. Sanofi and Regeneron got a stay on that ruling and are now in the midst of an appeals process that analysts believe will end with a settlement between the parties.

Regardless of the legal dispute, Amgen maintains that it is the clear leader in the field. And Harper doesn’t think Repatha’s outcomes data should be seen as a boon to the whole class of medicines — just Amgen’s.

“People would like to make that kind of simplified assessment, but look at what happened with the Pfizer molecule,” Harper said, referring to an erstwhile PCSK9 competitor that dropped out of development when investigators found that patients’ bodies were rebelling against the drug. “You could go ask Pfizer that question,” he added.

This article is reproduced with permission from STAT. It was first published on March 17, 2017. Find the original story here.

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U.S. Health and Human Services Secretary Tom Price speaks about efforts to repeal and replace Obamacare and the advancement of the American Health Care Act on Capitol Hill in Washington, D.C., on March 17, 2017. Photo by Joshua Roberts/Reuters

WASHINGTON — Republicans intent on scrapping Barack Obama’s Affordable Care Act have a budget problem.

As it turns out, repealing and replacing the law they hate so much won’t save nearly as much money as getting rid of it entirely, the goal they’ve been campaigning on for seven years. That means trouble for the federal deficit and for Congress’ fiscal conservatives who repeatedly warn about leaving their children and grandchildren worse off financially.

President Donald Trump and other GOP leaders know they can’t just get rid of the law; instead they’ve vowed to “repeal and replace” it. So they’ve come up with a bill that would fix Obama’s “disaster” and insist it would give Americans more choices on health coverage.

But it only reduces the deficit by $337 billion over a decade and doesn’t move the federal budget much closer to being balanced, if at all. That’s one big reason many budget-conscious Republicans have joined Democrats in opposing the repeal-and-replace version pushed by the White House and House Speaker Paul Ryan, R-Wis.

In proposing his 2018 budget on Thursday, Trump called for spending billions more on defense while slashing domestic programs. He vowed during the campaign to leave the costly mandatory programs such as Medicare and Social Security untouched, and he won’t raise taxes. That budget plan guarantees large deficits.

READ NEXT: Wheels spinning as GOP looks for traction on health bill

“Our military is more important to me than a balanced budget,” Trump said in a Fox News interview in January.

The initial Republican plan to completely scuttle the 2010 health care law promised a cut of more than $2 trillion from the deficit over 10 years.

The GOP health care bill cuts the deficit by much less.

“Now that (health care repeal) is actually going to happen, they’ve changed their priorities greatly so that they’re not actually trying to generate any significant savings,” said Maya MacGuineas, president of Committee for a Responsible Federal Budget, a Washington-based advocacy group for budget discipline. “And there’s no sign what they can fill it in with.”

A senior member of the House Budget Committee, Rep. Tom Cole, R-Okla., says: “Oh yeah, there’s no question. It’s much tougher, much tougher” to balance the budget after repealing and replacing the health care law.

What would be left behind, according to the Congressional Budget Office, is $9 trillion in projected deficits over the coming decade and fewer ways for Trump and Republicans controlling Congress to cut.

The worsening deficit creates a huge problem for other critical pieces of Trump’s agenda, including tax reform, a big infusion of infrastructure spending or helping people with the costs of child care.

First, swelling deficits mean less money for such legislation.

The deepening debt hole also means problems when Republicans try to pass a budget outline this spring, since some tea party Republicans and deficit hard-liners will insist on promising to balance the budget even though the math no longer works. More realistic lawmakers will resist that.

Under the arcane congressional budget process, the yearly budget blueprint doesn’t by itself make any changes to government programs, but it makes it easier to enact follow-up legislation like tax reform, which is the top GOP priority after dealing with health care.

But if they can’t pass a budget, Republicans can’t pass tax reform — at least without help from Senate Democrats — because of Senate rules.

The fiscal picture, meanwhile, has another complication. If Republicans can successfully pass their health care repeal and replacement they will have used up their opportunity to cut Medicaid to generate savings toward a balanced budget. The health measure promises an enormous $880 billion cut from Medicaid over 10 years and it’s not credible to say Republicans could claim more in subsequent legislation.

“They’ve taken (Medicaid) off the table,” said Douglas Holtz-Eakin, a conservative economist and former Congressional Budget Office director.

“The math doesn’t work,” said Sen. Chris Van Hollen, D-Md. “Just nothing that they’re doing adds up right now.”

How big is the problem? According to calculations by the Committee for a Responsible Federal Budget, if House Republicans were to simply plug their health repeal and replace bill into last year’s budget resolution, they would fall $350 billion short of balance by the end of their 10-year goal. And if further Medicaid savings are taken off the table, the gap is more like $500 billion.

“It’s going to be extremely difficult,” admitted budget panel member Cole.

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A Donald Trump for President campaign sticker is attached to a U.S. Customs sign hanging on the border fence between Mexico and the United States near Calexico, California. Photo by Mike Blake/Reuters

WASHINGTON — The Trump administration wants to build a 30-foot-high border wall that looks good from the north side and is difficult to climb or cut through, according to a pair of contract notices posted to a government website further detailing President Donald Trump’s promise to build a “big, beautiful wall” at the Mexican border.

The notices were made public late Friday by Customs and Border Protection, the Homeland Security Department agency that will oversee the project and eventually patrol and maintain the wall. The proposals are due to the government by March 29.

One of the CBP contract requests calls for a solid concrete wall, while the other asks for proposals for a see-through structure. Both require the wall to sunk at least six feet into the ground and include 25- and 50-foot automated gates for pedestrians and vehicles. The proposed wall must also be built in a such a way that it would take at least an hour to cut through it with a “sledgehammer, car jack, pick axe, chisel, battery operated impact tools, battery operated cutting tools, Oxy/acetylene torch or other similar hand-held tools.”

The government will award a contract based on 30-foot-wide sample walls that are to be built in San Diego.

This is the second time the Trump administration has asked for private companies to bid on building the wall. Last month CPB put out a call for “concept papers” to design and build prototypes by March 10.

Trump has bragged in recent days that the wall is ahead of schedule, though it’s unclear from the latest contract notices if any firms have submitted wall proposals or if any such submissions have been rejected.

READ NEXT: Here’s what the Mexico border wall looks like now

The government has not said where the wall will be built, though the contract notices suggest some pieces of a new wall could replace existing fencing that stretches over about 700 miles of the roughly 2,000-mile border. The current fencing of mixed construction, including 15-foot steel posts set inches apart that are designed to keep people from crossing and shorter posts that are intended to block cars. Border Patrol agents are constantly repairing holes in the structure.

Trump has long promised that Mexico would pay for the wall, which he has said is necessary to stop the flow of immigrants crossing the border illegally and drug smugglers.

This week the president sent a budget proposal to Congress that included a $2.6 billion down payment for the wall. The total cost for the project is unclear, but the Government Accountability Office estimates it would cost about $6.5 million a mile for fence to keep pedestrians from crossing the border and about $1.8 million a mile for a vehicle barrier.

Congressional Republicans have said Trump’s wall would cost between $12 billion and $15 billion and Trump has suggested $12 billion.

An internal report prepared for Homeland Security Secretary John Kelly estimated the cost of building a wall along the entire U.S.-Mexico border at about $21 billion, according to a U.S. government official who is involved in border issues. The official spoke on condition of anonymity because the report has not been made public.

That report proposed an initial phase that would extend fences 26 miles and a second wave that would add 151 miles, plus 272 “replacement” miles where fences are already installed, according to the official. Those two phases would cost $5 billion.

It is unclear how soon Congress might act on that request or how much money lawmakers will ultimately approve for the wall. Democrats and some Republicans have said a border-long wall is unnecessary.

The Department of Homeland Security reported earlier this month that the number of border arrests dropped about 44 percent from January to February, the lowest monthly tallies since at the least the start of the 2012 budget year.

Associated Press reporter Elliot Spagat in San Diego contributed to this report.

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The Jackson Women’s Health Organization is pictured in Jackson, Mississippi, on July 11, 2012. Photo by Emily Le Coz/Reuters

A federal court in Mississippi on Friday ruled against a state law that would have shut down the state’s lone abortion clinic in the capital city of Jackson.

Mississippi Gov. Phil Bryant in 2012 signed a bill into law that would have required abortion clinic doctors to secure special privileges to admit patients into local hospitals.

A lawsuit was filed soon after by the legal group Center for Reproductive Rights on behalf of the Jackson Women’s Health Organization challenged the law.

A federal court judge allowed the law to move forward but stopped the state from closing the clinic.

Friday’s ruling follows a successful legal challenge last year against a Texas state law similar to Mississippi’s. In June, the U.S. Supreme Court overturned a Texas law requiring abortion clinics in the state to have surgical facilities and hospital admitting privileges.

Nancy Northup, president and CEO of the Center for Reproductive Rights, called Friday’s ruling “the latest victory for women’s health and rights.”

“And it will not be the last,” Northup said in a statement. “Our landmark win at the Supreme Court last summer continues to reverberate across the nation. Any politician trying to roll back women’s constitutional rights should take notice and remember the law is on our side.”

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Germany’s Chancellor Angela Merkel and U.S. President Donald Trump hold a joint news conference in the East Room of the White House in Washington, U.S., March 17, 2017. Photo by Jonathan Ernst/Reuters

WASHINGTON — President Donald Trump said Saturday that Germany owes “vast sums of money” to NATO and the U.S. “must be paid more” for providing defense, reiterating his stance that European allies need to meet their end of the bargain if they are to continue benefiting from the military alliance.

Trump’s tweet from his Florida resort, where he is spending the weekend, came the day after his first meeting with Germany’s leader.

“Despite what you have heard from the FAKE NEWS, I had a GREAT meeting with German Chancellor Angela Merkel,” the president wrote. “Nevertheless, Germany owes … vast sums of money to NATO & the United States must be paid more for the powerful, and very expensive, defense it provides to Germany!”

Trump and Merkel tried to sidestep their differences in their meeting at the White House on Friday, but it was punctuated by some awkward moments.

During a photo op in the Oval Office, the two did not shake hands before reporters. Later, during a joint news conference, Trump pushed back against the notion in Europe that his “America First” agenda means he’s an isolationist, calling such a suggestion “another example of, as you say, fake news.” And he referred to the United States as “a very powerful company,” before quickly correcting that to “country.”

When a German reporter asked Trump if he regrets any of his commentary on Twitter, Trump said, “Very seldom.”

The new president reaffirmed the United States’ “strong support” for NATO, but reiterated his stance that NATO allies need to “pay their fair share” for the cost of defense. Trump said at the press conference that many countries owe “vast sums of money” — but he declined to identify Germany, at the time, as one of those nations.

Prior to his inauguration, Trump declared NATO “obsolete” but has since modified his stance, telling European leaders the alliance remains of strategic importance. Only the U.S. and four other members currently reach the benchmark of spending 2 percent of GDP on defense. Germany currently spends 1.23 percent of its GDP on defense, but it is being increased.

When the topic moved to trade, Trump said the U.S. would do “fantastically well” in its trade relations with Germany. The president has been deeply critical of foreign trade and national security agreements but suggested he was only trying to revise trade deals to better serve U.S. interests, rather than pull back from the world entirely.

Trump said trade agreements have led to greater trade deficits. The U.S. trade deficit with Germany was $64.9 billion last year, the lowest since 2009, according to the Commerce Department.

Merkel maintained her composure when Trump repeated his contention that former President Barack Obama may have tapped his phones in Trump Tower. He sought to turn the explosive charge into a light joke when asked about concerns raised by the British government that the White House is now citing a debunked claim that U.K. spies snooped on Trump.

“At least we have something in common, perhaps,” Trump said casually, referring to 2013 reports that the U.S. was monitoring Merkel’s cellphone conversations. As for the most recent report, Trump said he shouldn’t be blamed for quoting a Fox News analyst who had accused British intelligence of helping Obama spy on him.

On economic issues, Merkel attempted to project a conciliatory approach. She said the “success of Germans has always been one where the German success is one side of the coin and the other side of the coin has been European unity and European integration. That’s something of which I’m deeply convinced.”

Those comments appeared aimed at making a case to Trump on the benefits of the European Union. Trump backed Britain’s departure from the EU and has expressed skepticism of multilateral trade agreements.

The two leaders tried to express their common bonds but showed minimal rapport in their first encounter, a departure from Merkel’s warm relations with Obama during his eight years as president. At the start of the news conference, Merkel sought to break the ice, saying that it was “much better to talk to one another than about one another.”

Merkel said delicately that while she represents German interests, Trump “stands up for, as is right, American interests. That is our task respectively.” She said they were “trying to address also those areas where we disagree but tried to bring people together.”

“We need to be fair with each other,” Merkel said, saying both countries were expecting “that something good comes out of it for their own people.”

The meetings at the White House included discussions on fighting the Islamic State group, the conflict in Afghanistan and resolving Ukraine’s conflict, all matters that require close cooperation between the U.S. and Germany.

The talks aimed to represent a restart of a relationship complicated by Trump’s rhetoric on the campaign trail. As a candidate, Trump frequently accused the chancellor of “ruining” Germany for allowing an influx of refugees and other migrants from Syria and accused his campaign rival, Hillary Clinton, of wanting to be “America’s Angela Merkel.”

Associated Press writer Vivian Salama contributed to this report from Palm Beach, Florida.

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