President Trump speaks Thursday at a press conference with members of the GOP in the Rose Garden of the White House. Photo by Cheriss May/NurPhoto via Getty Images

BRANCHBURG, N.J. — President Donald Trump urged Senate Republicans on Sunday to “not let the American people down,” as the contentious debate over overhauling the U.S. health care systems shifts to Congress’ upper chamber, where a vote is potentially weeks, if not months, away.

Some senators have already voiced displeasure with the health care bill that cleared the House last week, with Republicans providing all the “yes” votes in the 217-214 count. They cited concerns about potential higher costs for older people and those with pre-existing conditions, along with cuts to Medicaid.

Sen. Susan Collins of Maine, a moderate Republican whose vote will be critical to getting a bill to Trump’s desk and who voiced similar concerns, said the Senate would not take up the House bill.

“The Senate is starting from scratch. We’re going to draft our bill, and I’m convinced we will take the time to do it right,” she said.

Mick Mulvaney, Trump’s budget director, also said the version that gets to the president will likely differ from the House measure. Such a scenario would then force the House and Senate to work together to forge a compromise bill that both houses can support.

Collins also complained that the House rushed a vote before the Congressional Budget Office could complete its cost-benefit analysis.

Eager to check off a top campaign promise, Trump sought Sunday to pressure Senate Republicans on the issue.

“Republican senators will not let the American people down!” Trump tweeted from his private golf course in central New Jersey, where he has stayed since late Thursday. “ObamaCare premiums and deductibles are way up — it was a lie and it is dead!”

Trump has said the current system is failing as insurers pull out of markets, forcing costs and deductibles to rise.

The White House on Sunday scoffed at Democratic claims that voters will punish the GOP in the 2018 elections for upending former President Barack Obama’s law. “I think that the Republican Party will be rewarded,” said Reince Priebus, Trump’s chief of staff. House Democratic leader Nancy Pelosi of California has threatened that GOP lawmakers will “glow in the dark” over their vote.

The House bill would end the health care law’s fines on people who don’t buy policies and erase its taxes on health industry businesses and higher earners. It would dilute consumer-friendly insurance coverage requirements, like prohibiting higher premiums for customers with pre-existing medical conditions and watering down the subsidies that help consumers afford health insurance.

Major medical and other groups, including the American Medical Association, opposed the House bill. Democrats are also refusing to participate in any effort to dismantle Obama’s law, while some Republican senators — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska — object to cutting Medicaid, the federal-state health care program for the poor and disabled.

The ACA expanded Medicaid with extra payments to 31 states to cover more people. The House bill halts the expansion, in addition to cutting federal spending on the program, which Trump’s health chief argued is flawed and dictates too much from Washington.

Health and Human Services Secretary Tom Price argued that states will get more freedom to experiment with the program and make sure that people who rely on Medicaid get the care and coverage they need.

“There are no cuts to the Medicaid program,” Price insisted Sunday, adding that resources are being doled out to allow states greater flexibility.

Gov. John Kasich of Ohio questioned what would happen to the mentally ill, drug addicts and people with chronic illnesses under the changes proposed for Medicaid.

“They are going to be living in the emergency rooms again,” potentially driving up health care costs,” Kasich predicted.

Senate Majority Leader Mitch McConnell, R-Ky., plans to move forward under special procedures that allow legislation to pass with a simple majority vote, instead of the 60 usually required for major bills in the Senate. That means McConnell can afford to lose just two senators; Vice President Mike Pence would vote to break a 50-50 tie in his constitutional role as vice president of the Senate.

House Speaker Paul Ryan, R-Wis., appeared resigned to the legislative reality that the bill he unveiled with great fanfare, after years of Republican pledges to replace what’s become known as “Obamacare,” will be altered as part of a “multistage process.”

“We think we need to do even more support for people who are older and also more support for people with pre-existing conditions,” Ryan acknowledged. “The Senate will complete the job.”

Some House lawmakers have been challenged by the public over the House vote.

Conservative Rep. Raul Labrador, R-Idaho, drew boos Friday at a public meeting for his response to a constituent who said the House bill tells people on Medicaid to “accept dying.

Labrador responded: “That line is so indefensible. Nobody dies because they don’t have access to health care.” The comment traveled quickly on social media.

Collins and Ryan appeared on ABC’s “This Week,” Price was on NBC’s “Meet the Press” and on CNN’s “State of the Union” with Kasich, while Mulvaney was interviewed on CBS’ “Face the Nation.” Priebus was on “Fox News Sunday.”

Associated Press writer Hope Yen in Washington contributed to this report.

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KIRA KAY: When Chally Dang was growing up in Philadelphia, he dreamed of playing professional basketball.

CHALLY DANG: We’d just shoot hoops and dream of one day making it big in the NBA. So it’s part of being American.

KIRA KAY: But America is just a memory for Dang. He plays his Sunday pick-up game 9-thousand miles from Philadelphia, in Phnom Penh, the Capital of Cambodia, where his parents were born.

Dang is not here by choice. He grew up in the U.S. as a legal permanent resident, a child of war refugees. But in 2011, he was deported to a country he never knew.

CHALLY DANG: Everything was different, it was like a culture shock. The environment is different, the people are different, the language is different.

KIRA KAY: His crime was firing a gun in the air during a gang standoff when he was 15-years-old. He served five years, and upon release, the government ordered him deported, but didn’t act on it. He got a job and had five kids. But deportation orders never expire, and eight years later, when Dang went for a routine immigration check-in, he was detained and put on a plane to Cambodia. He says there’s a stigma to being a deportee.

CHALLY DANG: We are in our own category, because the Cambodian community look at us as foreigners who decided to come back, and those that know we were deported look at us like we are criminals that got rejected from another country so why are we back in Cambodia?

KIRA KAY: Dang is one of 550 deportees from America now living in Cambodia. They began arriving in 2002, when this country signed a repatriation agreement with the U.S. to accept green card holders of Cambodian descent who had committed aggravated felonies — even nonviolent offenses that carried short sentences.

The “Cool Lounge,” a bar run by deportees, is home away from home for these people who went to American schools, listened to American music, ate American food.

Chandara Tep is from Modesto, California.

CHANDARA TEP: I grew up 4th of July, you know, fireworks, BBQ, Spring breaks. I shed tears when 9/11 happened, because I felt like I was American too.

KIRA KAY: Tep was deported six years ago, following his conviction for assaulting a police officer. Sophea Phea and Bobby Orn also arrived in 2011, Kalvin Heng, in 2004.

Heng and Phea weren’t born in Cambodia. Like many deportees they were born in refugee camps in Thailand, after their parents fled war and the genocidal Khmer Rouge regime that ruled Cambodia in the 1970s and killed two million people. The American bombing of Cambodia during its war in Vietnam added to the chaos. The U.S. eventually granted asylum to 150-thousand Cambodian refugees between 1975 and 1994.

CHANDARA TEP: You come from a jungle to a concrete jungle. You are over here in Cambodia, you know, you dodging bullets. Over there you’re living in the project, you’re dodging muggers and robbers and thieves.

SOPHEA PHEA: In the states, being in bad neighborhoods, sometimes we make mistakes, and sometimes we go on a wrong path, and not knowing what the bigger consequences are.

KIRA KAY: These children of refugees say they had no idea their brushes with the law made them vulnerable to deportation. Kalvin Heng says he didn’t fight his assault with a deadly weapon charge and accepted a one-year sentence, not knowing that made him deportable.

KALVIN HENG: We weren’t informed about taking a plea bargain, or anything like that. If we take a plea bargain we could be, you know we could face deportation, and so on and so on. We didn’t know any of that until like now, when we started doing our research.

KIRA KAY: American immigration judges have no leeway to consider how potential deportees have rehabilitated their lives. Tep had been out of prison for 13 years when he was deported, leaving a wife and three kids behind.

CHANDARA TEP: We changed our lives. We had families, you know. We bought a home, you know, we did all that stuff already, and then knock-knock, you know, ‘You’ve got to go, because you’re not a citizen.’

KIRA KAY: By the time they land in Cambodia, deportees have been stripped of all American identification. Cambodian immigration officials give them a single document with their name, birth date, and photo. Their lives start over from scratch.

SOPHEA PHEA: I had no luggage. I had about $150 in my pocket. No possessions at all.

CHANDARA TEP: Everything’s in Cambodian and you don’t even know how to write your name in Cambodian.

KIRA KAY: Local officials wouldn’t even recognize Heng’s immigration document. So he got creative.

KALVIN HENG: My uncle had to play my dad. And then I had to be put into his family book and use the identity of my cousin that passed away the year before I came. So I was under a whole new identity for 12, 13 years.

KIRA KAY: What do you say to the comment that I’m sure you guys get a lot, ‘Tough luck, you guys had an opportunity in the states, you blew it?’

CHANDARA TEP: What I say? My answer’s always like this: yes, I messed up, I confess to it, you know what I mean, but you are not seeing where we’re coming from, You know, we’re refugees of the war and I lost my rights, of course, because I’m not a citizen. But my kids has rights, my mom has rights, a right to be a family member, a right to be with one another, you know what I mean.

SOPHEA PHEA: I do believe that you do the crime you do the time, and you know for most of us, or all of us, we’ve done our time.

BILL HEROD: These are not illegal immigrants. They didn’t sneak into the U.S.

KIRA KAY: American Bill Herod was living in Cambodia when the deportees began arriving in 2002. He says back in the U.S., officials had left refugees to fend for themselves.

BILL HEROD: Because of the failure of the refugee resettlement program, no case officer came around and knocked on the door and said, ‘You need to fill out these papers to get citizenship.’

KIRA KAY: Herod’s charity, the “Returnee Integration Support Center,” or “RISC,” is staffed by deportees and helps newcomers through the difficult adjustment.

BILL HEROD: They actually live here in this building if they don’t have any place else to go, or we pay to put them in a guest house. And just help them get on their feet. And then we find out what their interests are, what their work experience is, and try to help them find jobs.

KIRA KAY: RISC has helped 50 American deportees train for and obtain jobs teaching English and keeps tabs on them as they assimilate into Cambodian society. Despite many success stories, some deportees succumb to drug use, mental health problems, and crime. Herod lost an eye when grabbing drano out of the hands of a despondent deportee.

BILL HEROD: And some don’t make it. We’ve had suicides. And it’s heartbreaking when we realize that maybe if we’d made another field visit or another phone call or taken him out for pizza one more time, we might have been able to help them get across that blockage.

KIRA KAY: Deportees struggle with whether or not to reveal their criminal records. Heng works as an advertising manager at a local English-language newspaper and was candid with his employer.

KALVIN HENG: I’ve made a mistake in the past. I’ve did my time for it. I’ve rehabilitated. So please don’t look at what I’ve done in the past affect what I can contribute. And they’ve been very good to me about it.

KIRA KAY: But Phea, who was deported for credit card fraud, needed three years to open up to others about her past.

SOPHEA PHEA: I was lonely. I was depressed, I kind of was lost.

KIRA KAY: She now teaches Cambodian children in a Phnom Penh school, but she isn’t raising her own 13-year-old son, who remains in California with his father.

SOPHEA PHEA: I’m angry that this has fractured my relationship with my son. We don’t have that communication anymore. I don’t know if he’s going to turn out to be angry at me or just holding grudges against me or just feeling lonely that I’m not there.

KIRA KAY: He visited her last year for the first time. She hopes it won’t be the last.

SOPHEA PHEA: And he didn’t know how to call me ‘mom’ anymore, and that hurts.

KIRA KAY: In the U.S., deportee families and Cambodian-American community leaders have lobbied American officials for changes in immigration policy with few results. Last year, Kalvin Heng had a realization.

KALVIN HENG: I just blurted it out, you know, ‘Let’s take it to the Cambodian government.’

KIRA KAY: Heng recruited his deportee friends and formed a political action group, “One Love Cambodia.” They are pushing to amend the repatriation agreement from the Cambodian side. Most crucially, they want the Cambodian Government to refuse to accept anyone who was once a refugee. To their surprise, this group of ex-convicts was granted a meeting with high level officials at Cambodia’s Interior Ministry.

SOPHEA PHEA: They sat there and listened to each of our stories and seeing what we struggle here.

KALVIN HENG: No one had gone up to them and officially filed for a grievance and, you know, really let them know that you know this is really really messing up our communities and our families across the U.S.

KIRA KAY: Only days after that meeting, the Cambodian Government sent a letter to the American Embassy, requesting to amend the current repatriation agreement and “suspend temporarily the implementation” until a new deal is struck. The U.S. rejected Cambodia’s request to suspend deportations and has sometimes withheld visas and economic aid from countries that refuse to accept deportees. U.S. Officials have agreed to a first discussion with Cambodia, expected to take place soon.

Just 10 days ago, Cambodia’s Prime Minister publicly demanded to renegotiate the agreement, calling the deportations “a sad separation” of families.

CHANDARA TEP: Nobody ever stepped up to them and told them. ‘This is what’s happening…’

KIRA KAY: The “One Love Cambodia” team is assisting the Cambodian Government in preparation for the talks — talks they hope will yield changes that might come too late for them, but could stop others from following in their footsteps.

Produced in partnership with New York University’s GlobalBeat journalism program.

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HARI SREENIVASAN, PBS NEWSHOUR WEEKEND ANCHOR: On questions of Russian meddling and hacking in the U.S. presidential election, congressional committees are probing ties and communications between Trump campaign operatives and Russia. Tomorrow, former deputy and acting Attorney General Sally Yates is scheduled to testify in public about what she knew about ousted national security adviser Michael Flynn, as well her conversations with the Trump White House about him.

“Associated Press” reporter Eric Tucker is covering this story and joins me now from Washington.

What’s the discrepancy likely to be?

ERIC TUCKER, ASSOCIATED PRESS REPORTER: So, we are going to hear Sally Yates for the first time publicly describe a conversation that she had in January with the White House counsel. And she’s likely going to say that she warned the White House that there was a major discrepancy between what they were saying publicly about Michael Flynn’s communications with Sergey Kislyak, who was the Russian ambassador to the United States, and what actually happened, and that discrepancy is significant because from the perspective of the Obama administration and from Sally Yates, in particular, it was enough to leave Michael Flynn in a compromised position.

SREENIVASAN: And that’s a different narrative than what the Trump administration has been saying about all this.

TUCKER: Correct. So, the White House initially had said, look, Sally Yates did indeed come to us on January 26th, but mostly it was to give us a head’s up that there was a discrepancy and she wanted us to just know that. But what we expect based on what our sources are telling us, we expect Sally Yates to testify that this was not just a heads up, that this indeed was an actual alarm and a warning that you guys keep saying based on what Michael Flynn is telling you, that he didn’t discuss sanctions with Mr. Kislyak, but we know that not to be true, and that’s important.

SREENIVASAN: This was at the point — I mean, to kind of just taking us back in time a few months, to a point where the Obama administration was not actually giving information to the incoming Trump administration because they didn’t trust that this information wasn’t going to get back to the Russians.

TUCKER: That’s correct. So, my colleague Julie Pace wrote a big story on Friday suggesting that there were already these alarms that were surfacing within the Obama administration based on questions and information that the Trump transition team was asking, particularly as it related to Sergey Kislyak. So, already, you’re seeing this area of distrust developed.

SREENIVASN: Who is likely from the White House to be called up in any way, shape or form to try to rebut or clarify the testimony that Sally Yates will give tomorrow?

TUCKER: Well, the sort of point people back in February about the conversations that occurred were Reince Priebus and Sean Spicer. They were sort of out there kind of characterizing the conversations. So, we’ll see what they have to say tomorrow. The actual January 26th conversation that Sally Yates had at the White House involved White House counsel Don McGahn. So, it’s not clear if Mr. McGahn will have anything himself to say either in response.

SREENIVASAN: You know, one of the things that the White House has pointed is say, hey, listen, James Clapper, the former DNI, he said back in March when he was leaving, I haven’t seen any evidence of any conclusion?

TUCKER: That’s right. And Republicans really seem to seize on that statement as some sort of vindication. However, Clapper at the time did have a sort of important caveat when he said that, which he said, at the time I left the administration, which would have been January, and when we know from what FBI Director Jim Comey said this week, this investigation is really ongoing, and new intelligence is being reviewed, new information is being processed and assessed. So, it’s not clear how significant it is if in January, no collusion existed. That doesn’t necessarily — it’s not dispositive of anything necessarily.

SREENIVASAN: Sally Yates testimony begins tomorrow at 2:30. You can expect the “NewsHour” to cover it tomorrow night.

“Associated Press” reporter Eric Tucker — thanks for joining us.

TUCKER: Great to be here. Thank you.

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HARI SREENIVASAN, PBS NEWSHOUR WEEKEND ANCHOR: Joining me now from Paris, with the Macron campaign is “NewsHour Weekend” special correspondent Malcolm Brabant.

Malcolm, how much of a victory was this for him as we heard from people who were at the polls here? Some of them said this was not a vote for him. It was a vote against the opposition.

MALCOLM BRABANT, NEWSHOUR WEEKEND SPECIAL CORRESPONDENT: Well, this is — if you look at the numbers, it looks like a really substantial victory, 65 percent against 35 percent. But when you actually look at the real numbers that actually voted for Macron, it’s really not as big. So, he cannot really regard this as being a complete mandate, a popular mandate because there were so many people who abstained and overall, there were only about some 20 million French voters who actually voted for him, and that’s less than a third of the country.

And so, many of the people who voted for him were not necessarily voting for him, they were voting tactically. What they wanted to do more than anything else was to prevent Marine Le Pen from getting into the Elysee Palace, and they managed to do that.

SREENIVASAN: All right. So, there is the joy of campaigning versus the difficulty of governing now.

BRABANT: Very much so. I mean, the president has the ability to appoint a prime minister and various other ministers. But what he needs to do is very much like the U.S. president. He needs to have the French parliament with him and French parliamentary elections are coming up in June. And the thing is, he doesn’t actually have any kind of real, sort of party formation, any sort of party history. And he’s somehow got to get around, about 270 people into parliament if he’s to have his movement in the majority there.

And I think that what we are really going to see is not so the other parties doing their utmost to be able to stymie him. So, for the next five years, he may find it very difficult to get his policies through, especially if he gets a parliament that doesn’t support him.

SREENIVASAN: One of the key issues between — that was very clear cut between these two candidates was their relationship or what they would like relationship be with to the E.U. Should the E.U. take some comfort and that Le Pen did not win, or should they still be concerned that Macron does not have that mandate yet?

BRABANT: You know what, any independent observer would say to the bureaucrats in Brussels is that, you know, there’s an awful lot of people in Europe who are very unhappy with the way that the E.U. is being run and those are the people that need to be listened to. I mean, otherwise, the right wing nationalist movement in Europe is going to continue.

But what possibly happened here tonight is this movement is that this being — this movement, this wave which lots of people were hoping was going to sweep across Europe seems to have come to another dead halt here, although Marine Le Pen is saying that she is now the leader of a great opposition. Perhaps, that’s what the destiny for the right wing in Europe, is that it’s going to be opposition rather than government.

SREENIVASAN: All right. Malcolm Brabant, joining us from Paris tonight — thanks so much.

BRABANT: You’re very welcome.

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Former President Barack Obama has arrived in Boston to be honored with the John F. Kennedy Profile in Courage Award.

The ceremony at the John F. Kennedy Presidential Library and Museum is among Obama’s first public appearances since leaving office. His speech Sunday will come just days after U.S. House Republicans passed a bill that would dismantle much of his signature health care law.

A long line of guests made their way down the red carpet into the library, including members of the Kennedy family, members of Congress, former Obama staffers and celebrities including former late-night talk show host David Letterman.

The annual award is named for JFK’s 1957 Pulitzer Prize-winning book Profiles in Courage and is presented to political figures who have taken courageous stances in public life.

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This file photo shows schoolchildren walking in the rebel held besieged Douma neighbourhood of Damascus, Syria. Defense Secretary Jim Mattis said the U.S. owes it to the people of Syria to take a close look at the Russian proposal to create several “safe zones” in Syria. Photo by REUTERS/Bassam Khabieh.

COPENHAGEN, Denmark — Defense Secretary Jim Mattis said the U.S. owes it to the people of Syria to take a close look at the Russian proposal to create several “safe zones” in Syria. But Mattis also said the plan poses many unanswered questions, including whether it would be effective.

Speaking to reporters traveling with him to Copenhagen, Mattis said the borders of the proposed cease-fire areas are still being worked out, although the general locations are “well understood.” And he suggested that it’s still not yet clear what impact the plan could have on the U.S.-led fight against Islamic State militants.

“It’s all in process right now,” said Mattis, who was offering some of the first extensive public U.S. comments on the agreement reached Friday by Russia, Turkey and Iran. “Who is going to be ensuring they’re safe? Who is signing up for it? Who is specifically to be kept out of them? All these details are to be worked out and we’re engaged.”

READ MORE: Who is fighting in Syria’s civil war?

Secretary of State Rex Tillerson will be meeting with his Russian counterpart, Foreign Minister Sergey Lavrov, about the Syria crisis on Wednesday. The U.S. State Department said in a statement that Tillerson plans to discuss with Lavrov “efforts to de-escalate violence, provide humanitarian assistance to the Syrian people, and set the stage for a political settlement of the conflict.”

According to activists in Syria, there already have been skirmishes on the edge of a large cease-fire zone in the northwest portion of the country. Russia, Turkey and Iran agreed to enforce a cease-fire between Syrian government and opposition forces in four locations, but Russia says map details won’t be published until early June.

The U.S. is not part of the agreement, and the Syrian government and the opposition haven’t signed on to the deal. The plan, however, does not cover areas controlled by Islamic State group militants and U.S.-backed Kurdish groups.

That leaves the U.S. and its allies free to continue the campaign to retake IS-held territory. It doesn’t, however, prevent frictions between Turkish troops and their Syrian allies from clashing or going after the U.S.-backed Syrian Kurds.

READ MORE: Trump, Putin signal new effort to cooperate on Syria

“We’ll look at the proposal, see if it can work,” said Mattis, who will attend a meeting of the anti-ISIS coalition in Copenhagen, and also travel to Lithuania and to a conference in London this week. “Will it affect the fight against ISIS? I think the international community is united in the sense of wanting to see ISIS put on its back foot.”

Mattis was circumspect when asked if the plan had any hope of ending the brutal civil war that has killed some 400,000 people and displaced nearly half of the country’s population since 2011.

“The devil is always in the details, right? So we have to look at the details, see if we can work them out, see if we think they’re going to be effective,” he said.

The U.S. owes it “to the situation there, the people there to at least examine it very, very carefully,” Mattis added. “All wars eventually come to an end. And we’ve been looking, for a long time, how to bring this one to an end.”

READ MORE: U.S. ‘too important’ to pull back in today’s world, U.N. chief says

The cease-fire is an effort to allow humanitarian aid to access hard-to-reach and besieged areas in Syria, were at least 4.5 million people in need reside. The deal also calls for refugees to be allowed to return to the safe zones and services and infrastructure to be restored.

The results so far have been mixed. There was a reported drop in fighting in the four areas designated by the de-escalation agreement: the Idlib province, north Homs province, the Ghouta suburbs of Damascus and parts of Syria’s southern provinces.

The inclusion of Idlib presents a concern for the U.S., because the province near the Turkish border is held by the U.S.-backed opposition.

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The White House says former President Barack Obama made it clear to Donald Trump that he “wasn’t exactly a fan” of Michael Flynn.

White House spokesman Sean Spicer said Monday that Flynn was an outspoken critic of Obama’s “lack of strategies.” Spicer said that if Obama “was seriously concerned” about Flynn’s connections to Russia or other foreign countries, he should have withheld Flynn’s security clearance. Flynn served under Obama as defense intelligence chief but was later dismissed.

Responding to a question over whether Obama voiced concerns over Trump’s choice of Flynn for his national security adviser, Spicer said he would not disclose the details of the meeting.

Flynn was asked to resign in early February after it became clear Flynn misled senior members of Trump’s administration about his communications with Russian government officials.

Sally Yates, former deputy attorney general, is expected to testify before a Senate subcommittee Monday that she had warned the White House about contacts between Flynn and Russia before being fired by Trump.

WATCH LIVE: Former acting AG Sally Yates to testify in Russia probe

Trump tweeted Monday that Flynn was “given the highest security clearance by the Obama Administration – but the Fake News seldom likes talking about that.”

In a second tweet, Trump said Yates should be asked under oath “if she knows how classified information got into the newspapers” soon after she raised concerns about Flynn.

READ MORE: Trump distances himself from Flynn as Russia probe continues

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President Donald Trump’s revised travel ban is back in the courtroom Monday, this time before a federal appeals court in Richmond that will hear arguments on whether the executive order — which sought to temporarily suspend the entry of those from six Muslim-majority countries — violates the constitution.

The hearing is scheduled to begin at 2:30 p.m. EST. Listen live in the player above.

In March, refugee resettlement agencies represented by the National Immigration Law Center and the ACLU challenged the revised ban in a Maryland court, arguing it discriminated against Muslims.

U.S. District Court Judge Theodore Chuang agreed, ruling against the revised ban’s 90-day hold on those entering the country from Iran, Libya, Somalia, Sudan, Syria and Yemen.

READ MORE: Trump’s Muslim rhetoric key issue in travel ban rulings

The Depart of Justice appealed Chuang’s ruling later that month, sending it to Monday’s hearing before the 4th Circuit Court of Appeals in Richmond.

Typically, an appeal of this nature would be heard by a randomly selected panel of three judges — similar to the panel from California’s 9th Circuit Court of Appeals that heard arguments on Trump’s original travel ban in February. But Monday’s arguments will be heard by 13 of the 4th circuit’s slate of 15 judges, 10 of whom were appointed under former Presidents Bill Clinton and Barack Obama.

Trump’s original travel ban, which sought to temporarily suspend the entry of those from seven Muslim majority countries and end the U.S. refugee program entirely, sparked protests nationwide when it was first issued in January. The executive order was blocked by a number of judges in the days that followed.

READ MORE: A Hawaii judge extended a ruling to block Trump’s travel ban. What’s next?

After the 9th Circuit Court of Appeals upheld a suspension of the ban in February, the Trump administration declined to appeal the ruling, instead issuing a revised order that removed Iraq from the list of countries and exempts dual citizens and visa and green card holders.

The justice department is also appealing a separate ruling on that revised ban by a judge in Hawaii, which blocked the 90-day ban in question Monday as well as a proposed 120-day ban on all refugees entering the country. Washington, along with a number of other states, is also challenging the revised ban in court.

PBS NewsHour will update this story as it develops.

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A new working paper finds that the arrival of one new industrial robot in a local labor market coincides with an employment drop of 5.6 workers. Photo by Echo via Getty Images.

Each month, the NBER Digest summarizes several recent NBER working papers. These papers have not been peer-reviewed, but are circulated by their authors for comment and discussion. With the NBER’s blessing, Making Sen$e is pleased to feature these summaries regularly on our page.

The following summary was written by the NBER and doesn’t necessarily reflect the views of Making Sen$e.

With America’s workers already squeezed by forces ranging from international competition to offshoring to new information technologies, concern is growing about the impact of robots on jobs and wages.

In “Robots and Jobs: Evidence from U.S. Labor Markets,”  Daron Acemoglu and Pascual Restrepo find that deployment of robots reduces employment and wages, but caution that it is difficult to measure net labor market effects.

Since at least the start of the Industrial Revolution, economists and policy makers have pondered how relentless technological advances might impact labor markets. John Maynard Keynes warned in 1929 of coming “technological unemployment,” and Wassily Leontief predicted several decades later that “labor will become less and less important.” In recent years, a range of studies has estimated that nearly half of all U.S. workers’ jobs will be at risk of being automated over the next two decades and noted that this risk extends beyond laborers to include many white-collar occupations with substantial routine components.

READ MORE: Smart robots will take over a third of jobs by 2025, Gartner says

The researchers note that automation has several effects on the labor market. It may displace the workers performing a particular job in a particular industry, leading to reduced employment opportunities and wages for workers who historically held such positions. However, other sectors and occupations may expand to soak up labor freed from the tasks performed by machines, and it is even possible that productivity gains due to new automation technologies may expand employment possibilities in the industries in which they are deployed.

The researchers focus on how the adoption of a specific type of automation technology — industrial robots — affects local labor markets. They use the International Federation of Robotics’s definition of robots as autonomous, reprogrammable, multipurpose machines. (This excludes single-purpose automated machinery and artificial intelligence technologies.) By combining data from the International Federation of Robotics, the U.S. Bureau of the Census and other sources, the researchers analyze the effect that increases in industrial robot usage in 19 industries between 1990 and 2007 have on labor markets. They measure the within-industry rate of robot adoption in countries other than the U.S. and pair that with information on the location of industrial employment across commuting zones to construct a measure of potential exposure to robots for each local labor market.

READ MORE: Will your job get outsourced to a robot?

The researchers find large and robust negative effects of robots on employment and wages. They estimate that one more robot per 1,000 workers reduces the employment-to-population ratio by between 0.18 and 0.34 percentage points and is associated with a wage decline of between 0.25 and 0.5 percent. The effects are most pronounced on industries most exposed to robots, on workers with less than a college degree and on routine manual, blue-collar, assembly work and other related occupations.

Robots appear to have a more negative impact on the employment of men than of women.

Noting that there have been several other significant shocks to the U.S. labor market during their sample period, the researchers investigate whether growing imports from China and Mexico, offshoring, access to other computer technology or changes in other components of the capital stock might confound their results. Their results are robust to all of these controls.

— Jay Fitzgerald, National Bureau of Economic Research

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A billboard in Frederick, Maryland, displays the number of opioid overdoses and deaths in 2017. As the deadly illicit opioid fentanyl spreads, state and local governments are accelerating their public health and law enforcement responses. Photo by the Pew Charitable Trusts

FREDERICK, Md. — A billboard on a main highway tallies the number of residents in this mostly rural county who have overdosed on prescription painkillers, heroin and other illicit opioids this year: 96 overdoses, 15 of them fatal.

What the sign doesn’t say is that a large and growing number of those deaths are the result of fentanyl, a fast-acting drug that is 50 times stronger than heroin and can kill users within seconds. Cheap and easy to produce, it is used by drug dealers to intensify the effects of heroin and other illicit drugs, often without the users’ knowledge.

The presence of fentanyl in the illicit drug supply has put law enforcement officials and the medical community on high alert in more than a dozen states, accelerating the battle against opioids on all fronts.

States, counties and cities are responding to this latest crisis by doing more of what they already were doing: stockpiling the overdose reversal drug naloxone, funding more drug treatment, and ramping up police surveillance of drug trafficking. In addition, a handful of states are stiffening penalties for selling the lethal drug.

But even in hard hit states that have been battling fentanyl for more than three years, the death toll continues to spike. Connecticut, Illinois, Maine, Massachusetts, New Hampshire, New York, Ohio, Tennessee, West Virginia and Rhode Island were among the states hit hard by fentanyl as early as 2013.

In 2014, the powerful drug killed more than 5,000 Americans, according to the Centers for Disease Control and Prevention. The next year, nearly 10,000 Americans died of fentanyl-related overdoses. All opioids, including heroin and prescription painkillers, killed more than 33,000 people in 2015, the most recent year for which numbers are available.

Early death reports from states indicate that national data, to be released in January, will show an even steeper rise in deaths in 2016, said Matthew Gladden, an opioid investigator at the CDC.

This year and last, the deadly drug began spreading to more states. “We no longer have a situation of isolated outbreaks, but a major sustained public health challenge with the supply of fentanyl,” he said.

The sharpest spike is in Maryland, according to Gladden. “The trends there are extremely disturbing.” Other emerging hotspots include Florida, New York City and Virginia, he said.

Sounding alarms

Public health messages like the billboard in Frederick, as well as radio and TV alerts, are increasingly common. And standardized approaches to detecting the presence of the deadly drug and communicating its dangers — to drug users, people in treatment or recently released from prison or jail, and their friends, family and advocates — also are beginning to emerge.

In Maryland, the state health department in April issued an alert about carfentanil, a related drug that is even more potent than fentanyl and is used as a tranquilizer for elephants and other large animals. The warning to community advocates across the state came after one person in Frederick County and two in Anne Arundel County died of overdoses involving the drug.

Maryland and other states also are developing policies for detecting the deadly drug as quickly as possible and targeting public health messages to affected communities.

In Massachusetts, for example, the health department in January asked all hospitals and treatment centers to routinely screen for fentanyl in patients who have overdosed or are seeking treatment for addiction.

Medical examiners there and in Maryland are also attempting to shorten the weekslong process of reporting the results of toxicology tests performed on people who have died of drug overdoses. And in Maryland, Massachusetts, New York and Rhode Island, law enforcement and public health officials are sharing their data to keep better track of which drugs are killing people and where.

“What’s so concerning is that in Massachusetts, where, probably more than any other state, we’ve implemented all of the recommended strategies to address the opioid epidemic, overdose deaths are still surging, largely driven by fentanyl,” said Dr. Alex Walley, director of an addiction medicine fellowship at Boston Medical Center.

In general, the U.S. Department of Health and Human Services has recommended that states take three major steps to stem opioid overdose deaths: reduce unsafe prescribing of prescription painkillers, widely distribute the overdose rescue drug naloxone, and provide greater access to opioid addiction treatment using medications approved by the U.S. Food and Drug Administration.

Fast-acting

With the advent of fentanyl and other highly potent synthetic drugs, many states are amplifying those policies and adding new programs to protect drug users from deadly contaminants in heroin, cocaine and other illicit drugs.

Most important, Walley said, is to make sure that people don’t use these drugs while they’re alone.

Because fentanyl works much faster than heroin, the window of time to save a person who has overdosed on the drug is only a few minutes, compared to an hour or more with heroin. In most cases, unless a person with the rescue drug naloxone is in the same room as the drug user, rescue is not possible, he said.

In Frederick, Maj. Tim Clarke of the County Sheriff’s Office said officers routinely find fentanyl overdose victims who still have the syringe in their arm because they passed out before they had time to remove it.

An informal survey of drug users by the Massachusetts Department of Public Health revealed the same thing. This is how one Massachusetts drug user who witnessed a fentanyl overdose described it:

“A person overdosing on regular dope leans back and drops and then suddenly stops talking in the middle of a conversation and you look over and realize that they’re overdosing. Not like with fentanyl. I would say you notice it as soon as they are done. They don’t even have time to pull the needle out and they’re on the ground.”

Another difference between heroin and fentanyl and related drugs such as carfentanil is that overdose victims usually require multiple doses of naloxone to be revived. That means rescue workers and bystanders need to have at least two doses of the rescue drug on hand and call 911 immediately, even if the victim appears to be revived.

In Frederick, Clarke said, his department had just started talking about equipping officers with multiple doses of naloxone, although it’s expensive and hard to buy in bulk because of its short shelf life.

So far, however, he said rescuers have been able to use multiple doses when needed because two officers are assigned to each overdose call and each officer carries one dose. In addition, emergency medical service professionals usually arrive on the scene with one or more doses of the overdose antidote, and, in many cases, a bystander has already administered the lifesaving drug by the time officers arrive, he said.

Extraordinary measures

As the number of overdose victims who visit hospital emergency departments skyrockets and overdose deaths mount, addiction experts are suggesting unusual initiatives to protect the lives of drug users.

Last week, the Massachusetts Medical Society recommended that the state create a first-in-the-nation “safe injection” clinic where people can use drugs and be observed by medical professionals who can rescue them if they overdose.

State Del. Dan Morhaim, a Democrat who represents Baltimore, this year proposed a bill that would create similar clinics in Maryland. Such sites have proven successful at reducing overdose deaths in other countries. But they run counter to federal drug laws, and are not expected to be widely used in the U.S. any time soon, although safe drug consumption sites are under discussion in Seattle and in several cities in New York, including Albany, Ithaca, New York City and Syracuse.

In March, Maryland Republican Gov. Larry Hogan declared the opioid crisis a state of emergency with the goal of promoting communication among state agencies and between state and local officials. The state also dedicated another $50 million to fighting the epidemic.

Clay Stamp, the head of the state’s new Opioid Operational Command Center, said the battle against fentanyl and other opioids is challenging because overdose deaths are increasing at lightning speed while the coordination process takes time. “We’re just now starting to mobilize,” he said.

In Maryland, there were fewer than 200 deaths related to fentanyl in the first nine months of 2015. But in the same period of 2016, fentanyl-related deaths had nearly quadrupled, to 738, accounting for more than half of overdose fatalities in the state, 1,468, according to the Maryland Department of Health and Mental Hygiene.

In Frederick County, only two overdose deaths were attributed to fentanyl in the first nine months of 2015. A year later, 28 people had died of a fentanyl overdose in the same time period.

For Stamp, the goal is simple: reduce the number of fatalities. To do that, he said, his team will start by expediting an opioid prevention, treatment and law enforcement plan released by Hogan and Lt. Gov. Boyd Rutherford in January.

Stamp said his team also will work to spread innovative programs across the state. One such program, Safe Stations, is in Anne Arundel County, home to Maryland’s state Capitol. Started in April, it allows anyone with an addiction to walk into a local fire station and get a medical assessment and help finding treatment. Any drug-related legal issues they may have will be suspended while they seek treatment.

In Frederick County, a successful but underfunded program connects health care professionals who are recovering from an addiction — “peers” — with people who have overdosed. “The dream is to expand that program with more funding so that a peer can meet every person face-to-face in that moment right after an overdose,” said Andrea Walker, county director of behavioral health services.

“If death were a deterrent to drug use, we wouldn’t be in this situation,” she said. But that’s not the way addiction works. The disease reprograms the brain to seek more drugs, even in the face of death, she said.

This story was produced by Stateline, an initiative of The Pew Charitable Trusts. You can view the original report on its website.

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A woman demonstrates at a protest rally in 2012 in Sanford, FL, supporting slain teenager Trayvon Martin. Photo by Mario Tama/Getty Images

Order of Events
By Simone John

We started talking about the All-Star Game,
him tellin me to go check for him if it’s on.
It wasn’t. The game started at 7:30PM.
In perfect pitch Mary J. Blige asked,
Does that star spangled banner yet wave?
The crowd clapped in response.
Ne-Yo closed the half-time show:
For all we know, we might not get tomorrow
Let’s do it tonight

But the call dropped at 7:16. Then: sirens.
Windows washed in red light. Occupants
peering through parted curtains, watching
EMTs lift the limp wrist of a stranger
in the street. Elsewhere, brown boys
sat around the screen, waiting
for the game to begin.

Trayvon Martin. Sandra Bland. Elisha Walker. Shade Schuler. Some names we know well, while others are unfamiliar. The Black Lives Matter movement asks us to say the names of the black men and women who have died in encounters with police. Poet and educator Simone John wants us to also understand their stories, through her debut collection of poetry, “Testify.”

Simone John. Credit: Stephanie Lamb

In “Testify,” John weaves together her own lyricism with primary sources and official documents. There’s the dashboard audio recording from 2015 when a police officer stopped Sandra Bland, a black woman who was found hanged in a jail cell after that confrontation. And there’s court testimony of the death of Trayvon Martin, a black teenager who was shot in 2012 while walking to the corner store by a neighborhood watch volunteer.

The poem “Order of Events” opens with two lines of court testimony from Rachel Jeantel, who had been on the phone with Martin moments before he was killed. When Martin’s lawyer asks Jeantel to set the scene, she tells him that she and Martin had been talking about a basketball game.

“One of the things most difficult for me to process [about this case] was the mundanity, that it was just an ordinary day, that he was walking to the corner store,” John said. “And there is something so mundane about these two people having a conversation about the All-Star Game.”

The case had a powerful impact on John, who wasn’t much older than Martin at the time of the shooting. She is 25 now.

“It stirred up feelings for me about how the United States does not value black life — and that even your youth won’t save you,” she said.

[READ MORE: After viral story on D.C. girls, understanding the real perils for missing children of color]

In addition to court documents, “Order of Events” weaves in lyrics by the singer Ne-Yo and details from news stories about the moments after Martin was shot.

John calls this approach “documentary poetry,” using her art form to chronicle real-life events.

“With documentary poetry, you are documenting first, by creating a record of something that happened,” John said. “It’s also sometimes a counter narrative to what the larger conversation is.”

In “Testify,” John often zooms in and out of the courtroom, or between different perspectives, like from Bland to the police officer, layering over all of these with a razor-sharp, often first-person voice of the narrator.

Testify. Credit: Octopus Books

John says she was inspired by the prose poetry book “Jane: A Murder,” by Maggie Nelson, which is about the unsolved murder of Nelson’s aunt, and which similarly uses different layers and lenses to document and examine violence.

In her poem “Elegy for Black Women #4,” John writes of 21 black trans women who have been killed in the United States over the last few years. Many of these deaths were not well-covered in the media. This poem — as well as many of the poems in “Testify” — is a critique of race- and gender-based violence, as well as how these victims are remembered.

“When they hunt you with / abandon and misname you,” she writes. “I will / call you queen, call you / cousin, homegirl or / sister-friend” — and then she lists all 21 women’s names.

It troubled John that because of the frequency of these events and the speed of the news cycle, some names “become immortalized and become chants,” while others quickly fade away. “Testify” was her effort to counteract that.

“I want to know how many more people can be brought into the conversation,” she said. “Like civic journalism… it’s a way to record and for people to talk about, reflect and witness what we’re seeing.”

[READ MORE: Using poetry to uncover the moments that lead to racism]

Below, listen to John read her poem “Order of Events”:

There should be an embedded item here. Please visit the original post to view it.

Simone John is a poet, educator and freelance writer based in Boston, Massachusetts. She received an MFA in creative writing from Goddard College with an emphasis on documentary poetics. Her poetry and essays have appeared in “Wildness,” “The Pitkin Review,” “Public Pool,” and the “Writer in the World.” She is a contributing editor at Gramma Poetry. Find her online at simonejohn.com and on twitter @simoneivory.

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Former Acting Attorney General Sally Yates testifies about potential Russian interference in the presidential election before the Senate Judiciary Committee in Washington, D.C. Photo by Aaron P. Bernstein/Reuters

WASHINGTON — Former acting Attorney General Sally Yates, speaking publicly for the first time about concerns she brought to the Trump White House on Russia, told Congress on Monday she warned that National Security Adviser Michael Flynn “essentially could be blackmailed” because he apparently had lied to his bosses about his contacts with the Russian ambassador.

The statements from Yates, an Obama administration holdover, offered by far the most detailed account of the chain of events that led to Flynn’s ouster from government in the first weeks of the Trump administration.

Yates, appearing before a Senate panel investigating Russian interference in the 2016 presidential election, described discussions with Trump White House Counsel Don McGahn in late January in which she warned that Flynn apparently had misled the administration about his communications with Sergey Kislyak, the Russian ambassador.

White House officials had insisted that Flynn had not discussed U.S.-imposed sanctions with Kislyak during the presidential transition period, but asked Flynn to resign after news reports indicated he had misled them about the nature of the calls.

“We felt like it was critical that we get this information to the White House, in part because the vice president was making false statements to the public and because we believed that Gen. Flynn was possibly compromised,” Yates said.

“We knew that was not a good situation, which is why we wanted to let the White House know about it.”

The highly anticipated hearing — it is Yates’s first appearance on Capitol Hill since her firing in January — filled in details in the chain of events that led to the ouster of Michael Flynn, President Donald Trump’s first national security adviser, in the early weeks of the administration.

The Jan. 26 conversation took place two days after the FBI interviewed Flynn about those contacts. McGahn asked Yates how Flynn did in the interview, but Yates said she could not answer.

She was fired four days later by the Trump administration. James Clapper, director of national intelligence under President Barack Obama, testified as well. He retired when Trump took office.

The hearing came hours after former Obama administration officials revealed that Obama had warned Trump against hiring Flynn as national security adviser during an Oval Office meeting after the 2016 election.

The highly anticipated hearing — it was Yates’ first appearance on Capitol Hill since her firing — before a Senate panel investigating Russian interference in the presidential election was expected to fill in basic details in the chain of events that led to Flynn’s ouster. Word that Obama directly warned Trump suggests that concern over Flynn’s possible appointment spread to the highest level of government months before Flynn’s departure.

The Obama-Trump discussion was first reported Monday by NBC-TV.

Flynn’s forced February resignation followed media reports that he had discussed U.S.-imposed sanctions on Russia with Ambassador Kislyak, which was contrary to the public representations of the Trump White House.

Earlier Monday, former officials said Obama had raised general concerns about Flynn with Trump and told the incoming president there were better people for the national security post. Trump’s White House press secretary Sean Spicer said in response Monday that if Obama “was seriously concerned” about Flynn’s connections to Russia or other foreign countries, he should have withheld Flynn’s security clearance. Flynn served under Obama as defense intelligence chief before Obama dismissed him from that post.

Trump moved to distance himself from his former adviser’s troubles Monday, tweeting that it was the Obama administration that gave Flynn “the highest security clearance” when he worked at the Pentagon. Trump made no mention of the fact that Flynn had been fired by the Obama administration in 2014.

In a second tweet, Trump said Yates should be asked under oath “if she knows how classified information got into the newspapers” soon after she raised concerns about Flynn with McGahn.

She said Monday she did not — and that she had revealed no classified information herself.

Trump has said he has no ties to Russia and isn’t aware of any involvement by his aides in Moscow’s interference in the election. He’s dismissed FBI and congressional investigations into his campaign’s possible ties to the election meddling as a “hoax” driven by Democrats bitter over losing the White House.

The Associated Press meanwhile reported last week that one sign taken as a warning by Obama administration officials about Flynn’s contacts with Kislyak was a request by a member of Trump’s own transition team made to national security officials in the Obama White House for the classified CIA profile of Kislyak. The revelation came after interviews with a host of former U.S. officials, most of whom spoke on the condition of anonymity in order to discuss sensitive national security information.

Marshall Billingslea, a former Pentagon and NATO official, wanted the information for Flynn, his boss. Billingslea knew Flynn would be speaking to Kislyak, according to two former Obama administration officials, and seemed concerned Flynn did not fully understand he was dealing with a man rumored to have ties to Russian intelligence agencies. When reached by the AP last week, Billingslea refused to comment. Last month, Trump announced his intention to nominate Billingslea to serve as assistant secretary for terrorist financing at the Treasury Department.

Yates’ warning about Flynn in January capped weeks of building concern among top Obama officials, former officials told the AP. President Obama himself that month told one of his closest advisers that the FBI, which by then had been investigating Trump associates’ possible ties to Russia for about six months, seemed particularly focused on Flynn.

Yates, a longtime federal prosecutor and Obama administration holdover, was fired Jan. 30 by Trump after refusing to defend the administration’s travel ban. She had been scheduled to appear in March before the House intelligence committee, but that hearing was canceled.

The subcommittee meeting Monday is one of three congressional probes into the Russia interference, along with House and Senate intelligence panels. All the committees are led by Republicans.

White House Correspondent Julie Pace contributed to this report.

READ MORE: Yates testifying on ousted national security adviser Flynn

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“Many patients with the greatest unmet needs are therefore marginalized, with only glancing interactions with the health system – or none at all, in the most wrenching cases of suicide, drug overdose and other chronic illnesses that end in catastrophe.” Photo by pongmoji/via Adobe

In medicine, we speak of “seeing patients” when we are rounding in the hospital or caring for those who come to our clinics. But what about those people who may be sick but do not seek care? What is our responsibility to the patients we do not see?

This question takes on greater urgency in the current political climate, as patients face the threat of losing health insurance. Renewed efforts to repeal and replace the Affordable Care Act leave millions wondering whether they will be covered.

For me, as a physician practicing in the safety net, abstract numbers evoke the very real stories of my uninsured patients. One of my patients, whom I’ll call Elsa, had not seen a doctor since immigrating to the United States 15 years ago. That abruptly changed one morning: She awoke to find the room spinning around her and, terrifyingly, she could not articulate the words to explain to her husband what was going on. She was having a stroke.

There are many reasons that patients like Elsa may not seek care – until they have no choice. Although she felt no symptoms before her stroke, Elsa was one of about 13 million U.S. adults with undiagnosed high blood pressure. I wondered if making her aware of her blood pressure would have been enough to avoid her suffering.

But even if high blood pressure may sit atop the list of problems I write out, from his or her perspective it may not crack the top five. Food security, job stability, child care and affordable housing understandably feel more urgent. Time and again, I have learned that taking care of my patients starts by trying to walk a mile in their shoes.

Why patients may not seek care

Sometimes, forgoing care is a symptom of social isolation. I asked another patient of mine – whom I had recently diagnosed with uncontrolled, likely longstanding diabetes – about his eating habits. I learned that in his routine, he would go for days at a time without interacting with another person; he did not have any family nearby and worked from his home computer.

Aside from deterring access to care, loneliness and social isolation have direct effects on health. One review of 148 studies showed that the influence of social relationships on the risk of death was comparable with risk factors such as obesity and alcohol use.

In other cases, the health care system must take responsibility for barriers to patients that we ourselves erect. Beyond costs, structural barriers include inadequate language interpretation services and the assumption of health literacy when conveying information. Meanwhile, historical inequities often underlie wary attitudes toward health care.

Dr. Mary Bassett, the health commissioner of New York City, has spoken plainly about this: “We must explicitly and unapologetically name racism in our work to protect and promote health…We must deepen our analysis of racial oppression, which means remembering some uncomfortable truths about our shared history.”

In the same vein, new immigration policies may have a chilling effect on the willingness of people like Elsa to see a doctor, if they perceive negative repercussions for themselves or their families.

Many patients with the greatest unmet needs are therefore marginalized, with only glancing interactions with the health system – or none at all, in the most wrenching cases of suicide, drug overdose and other chronic illnesses that end in catastrophe.

When they do seek care, it is sporadic. They may show up in the ER, but not to a primary care follow-up appointment. If an ensuing phone call goes unanswered, or their phone is out of service, we label them as “lost to follow-up” and move on to the next patient on the list.

What needs to change

Doing better by these patients will require moving the locus of accountability for health further into communities. It means bringing more of a public health mindset to health care; that is, not reflexively restricting our purview to those who happen to cross our clinic’s threshold.

Hospitals and health systems must have the humility to reach across boundaries and partner with local institutions that are sometimes more trusted, and often more relevant, in people’s daily lives, including churches, schools, food pantries and parks.

In one recent example, the 54 branches of the Free Library of Philadelphia were shown to be vital community nodes for health-related services like literacy programs, healthy eating initiatives, job fairs and food preparation courses. Public libraries are particular safe havens for those experiencing mental illness, substance use disorders and homelessness – as well as youth and recent immigrants. We should consider how the these locations are therefore already a part of our health ecosystem.

Doctors and other clinicians may balk at trying to take care of the patients we do not see. After all, with the harried pace set by the 15-minute office visit, it is hard enough to keep up with the patients we do see. But the goal is not to schedule doctor’s appointments for all library-goers, but rather to equip them to be better stewards of their own health, which sometimes involves health care providers, sometimes not. While physicians can’t do it alone, we can lend our voices to those calling for greater outreach, less stigma and protection of the most vulnerable.

Prevention, not regression

In Elsa’s case, when she had her stroke, she was rushed to the ER and received excellent care from the hospital team. Neurologists treated the blocked vessels in her brain and diagnosed her with a narrowed heart valve and high blood pressure.

As a doctor in a system that accepts all patients, regardless of ability to pay, I was proud to be a part of her follow-up care. She underwent heart valve surgery, and we put her on blood thinners and blood pressure medicines to reduce her risk of another stroke. Her rehabilitation, all things considered, was going well. The health care system had reacted to Elsa’s crisis with swift competence.

At our last clinic visit, my mind turned to what could have been done to prevent her stroke. But the chances to intervene were too few. She and her husband made a living as bottle-pickers; they spent hours every day sifting through trash for bottles to recycle. Elsa told me they made enough money to get by, since they lived with her nephew. But visiting me in clinic, not to mention a cardiologist, neurologist and physical therapist, cost her time and thus cash.

And so for every Elsa who walks into our clinic I know there is another patient we do not see.

With health coverage for millions of Americans in limbo, we must speak out and organize just to keep seeing the many patients who have been newly brought into care. And at the same time, we must develop better ways to find and support people like Elsa – even before we see them as patients.

Dr. Chokshi is a physician and health system executive at New York City Health + Hospitals. This article was originally published on The Conversation. Read the original article.

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Protesters march in the streets outside the Texas State Capitol. Austin’s status as a sanctuary city has put it at odds with state and federal efforts to clamp down on undocumented immigrants. Photo by Drew Anthony Smith/Getty Images.

AUSTIN, Texas — The Mexican government, San Antonio’s police chief and others slammed Texas’ new “sanctuary cities” law on Monday, saying that requiring local law enforcement to help enforce U.S. immigration law could lead to racial profiling and will fan distrust of the police by the state’s many Hispanics.

The law, which takes effect in September and which critics say is the most anti-immigrant since a 2010 Arizona law, will allow police officers to ask about the immigration status of anyone they detain, including during routine traffic stops. Republican Gov. Greg Abbott signed the law Sunday evening on Facebook Live with no advanced warning. A few dozen people protested outside his mansion in Austin on Monday.

San Antonio police chief William McManus, whose burgeoning city is estimated to have more than 1 million residents who aren’t in the country legally, ripped into the Republicans who pushed the law through despite the objections of every big-city police chief in the state.

He and the other police chiefs, including those in Dallas and Houston, say it will create a chilling effect that will cause immigrant families to not report crimes or come forward as witnesses over fears that talking to local police could lead to deportation. Critics also fear it will lead to the racial profiling of Hispanics and put officers in an untenable position.

“It’s either skin color or language. What else does someone have to base it on?” McManus said, referring to an officer’s reason for inquiring about a person’s immigration status. “That leads to profiling. Profiling leads to lawsuits. In my opinion, there is nothing positive this bill does in the community or law enforcement.”

Nevertheless, McManus said his department will abandon a policy that prohibits officers from asking about a person’s immigration status.

“We’re going to have to take it off the books,” said McManus, adding that it will probably have to spend a year now training his roughly 2,400 officers on immigration law.

The law also drew rebuke from Mexico, which is Texas’ largest trading partner and shares close ties to the state. The country’s foreign ministry said in a news release that the law could trample on the rights of Mexican citizens who choose to live just across the border and promised to “closely follow” the situation after the law takes effect.

“These types of actions criminalizes even more the topic of immigration, foments racial discriminatory acts and reduces collaboration between the immigrant community and local authorities,” the ministry said.

The law also requires police chiefs and sheriffs — under the threat of jail and removal from office — to comply with federal requests to hold criminal suspects in jail for possible deportation. Republicans have a strong majority in the Legislature and shoved aside Democratic objections, even as President Donald Trump’s efforts to withhold federal funding for sanctuary cities have hit roadblocks in federal courts.

“Isn’t this quasi-insane that we have to pass a law to force law enforcement officers to comply with the law?” Abbott said Monday on “Fox and Friends.”

Terri Burke, executive director of the ACLU of Texas, said the group is committed to fighting the law. But it remained unclear Monday when it might file a lawsuit.

The term “sanctuary cities” has no legal definition, but Republicans want local police to help federal immigration agents crack down on criminal suspects in the U.S. illegally.

Opponents blast the Texas bill as a version of Arizona’s immigration crackdown law, SB 1070, which sparked protests and led to legal challenges in 2010. But the Texas and Arizona bills are not identical. Whereas the Arizona law originally required police to try to determine the immigration status of people during routine stops, the Texas bill doesn’t instruct officers to ask.

Texas doesn’t currently have any cities which have formally declared themselves sanctuaries for immigrants.

But Sally Hernandez, the sheriff of Travis County, which includes liberal Austin, has refused to honor federal requests to detain immigrants if the suspects weren’t arrested for immigration offenses or serious crimes such as murder. Hernandez softened her policy after Abbott cut funding to the county, saying decisions would be made on a case-by-case basis. She said before Abbott signed it that she would conform to the ban if it became law.

Associated Press writer Will Weissert contributed to this report.

READ MORE: Under sanctuary city ban, Texas officials face penalties for not complying with immigration laws

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Social studies teacher Tim Smyth, Wissahickon High School in Ambler, Pennsylvania, gearing up for Teacher Appreciation Week. Photo taken by Donovan Kennedy with editing by Gordy Michie

Most teachers would agree that teaching is one of the most exhausting jobs to love. Between meeting the individual needs of our students, keeping up with the latest initiatives and completing the day-to-day tasks required for keeping a classroom productive and positive, the job can be overwhelming and sometimes discouraging.

In my 15th year of teaching, these feelings only intensified for me. Facing burnout, I realized that I needed a way to regroup and re-energize. If I didn’t, I feared that like so many others, I might have to leave the classroom. I decided to go back to the basics.

Every introductory education class declares that bringing our personal passions into our classroom is fun for us and fun for our students. It was this premise that gave me the permission to finally do what I had been deliberating ever since completing my reading specialist studies: I committed myself to bringing my passion — comics — into the classroom.

Student in Tim Smyth’s social studies class using comics to study history at Wissahickon High School in Ambler, Pa. Photo by Tim Smyth

I said ‘yes’ to being excited and to broadening my approach to teaching social studies. I said ‘yes’ to utilizing social media to exchange ideas with people who share my passion. I said ‘yes’ to new approaches, new experiences and stepping out of my comfort zone. But most of all, I gave myself permission to use my strengths to bring to life the core concepts of my curriculum, and it has made all the difference in my lessons, in my perspective and in my ability to connect with my students.

I wrote about this journey, still in its beginning stages, in a blog one year ago. The reaction was swift. My students responded positively, validating that the approach worked for them. Educators, artists and writers in the industry reached out to me over Twitter. I was asked to present a program about comic books in the classroom at Philadelphia Wizard World. I was terrified, but it was so well-received that it was clear other educators want to know how to do this as well.

Through social media, I received a multitude of requests. I helped college professors develop curriculum materials. I previewed possible educational comic books for publishers. I ran Twitter chats for teachers discussing how to integrate pop culture in the classroom. I was chosen as “Geek of the Week” on Philly.com.

For every opportunity, I stayed committed to saying ‘yes,’ which led me to the Super Bowl of all nerdom–I was asked to present on a panel at the San Diego Comic Con about my experiences in the classroom. And it was awesome. I found my people.

In August, having just returned from my San Diego trip, I began my 16th year of teaching, feeling energized and excited. Despite having two new courses, I began looking for ways to integrate these new ideas into classroom life. I still have a curriculum, data points, special schedules and lesson plans. But now I look for opportunities for broadening my student’s experiences.

This year we used “March,” a graphic novel by Rep. John Lewis, Andrew Aydin and Nate Powell, to explore the civil rights movement. At the same time, a teacher whom I had met over Twitter and I arranged to have our students work together, discussing the historical and modern implications of the story. It just so happened that the teacher and her class were in Norway.

This forced my students to look at the topic differently, to explain their ideas more clearly and more globally. And it is this more worldly perspective that I think I was missing before.

In another instance, while talking about various atrocities in history, we used the comic book “Madaya Mom” which chronicles the real-life experiences of a mom in Syria. This comic was put together by Marvel Comics and ABC News. We discussed the historical and social implications of the panels and applied them to the human experience of groups facing persecution. My students had many questions. They were drawn in by the emotional panels; they had questions I didn’t have answers for.

Students at Wissahickon High School in Ambler, Pa. in social studies teacher Tim Smyth’s class. Students used Rep. John Lewis, Andrew Aydin and Nate Powell’s graphic novel “March” (Top Shelf Productions/IDW Publishing) to learn about the civil rights movement. Photo by Tim Smyth

Through Twitter, we contacted the ABC news correspondent who had interviewed the real life “Madaya Mom” in Syria. My class then Skyped with the two news correspondents, one in New York and one in Paris, to ask their questions, learning about Syria in a way I never would have been able to convey. Several students took the comic books to their after-school organizations, hoping to develop service projects so that they can help the people suffering from the war in Syria. Seeing their reaction made it the single most rewarding day of my teaching career.

And yet some days teaching is still stressful and overwhelming. The grading, the planning, the expectations still overwhelm me. But over the course of the last two years, I have learned to share more and to celebrate my successes more. I have learned to reach out to other educators, writers, artists, publishers, and not to be afraid to use social media. We need to overcome the self-imposed stigma of boasting about our successes – we need to celebrate the awesome things that happen in our classrooms every day.

I have given myself permission to use what I know and what I love in order to bring new experiences and connections to my students. At my most recent Comic Con experience in Chicago, as I was seated on a panel of teachers, authors and a rapper, I said that we must give ourselves permission to use comics, music and pop culture in our classrooms, because we know it works for our students.

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The Bears Ears buttes, located in Utah. The Bears Ears National Monument in Utah is one of two designations President Barack Obama made at the end of his term, granting protection to land considered to be sacred. Photo by Witold Skrypczak/Getty Images

BLANDING, Utah — U.S. Interior Secretary Ryan Zinke took an aerial tour Monday of one of America’s newest and most hotly contested monuments — one of 27 he’s been ordered to review by President Donald Trump to determine if they were properly established.

Zinke’s tour guide for the helicopter ride over the 1.3-million acre (5,300 square kilometers) swath of southern Utah with red rock plateaus, cliffs and canyons was Gov. Gary Herbert, one of several prominent Republican leaders in the state who oppose Bears Ears National Monument.

Herbert, U.S. Sen. Orrin Hatch and the rest of the all-GOP congressional delegation consider the monument creation by former President Barack Obama an unnecessary layer of federal control that will hurt local economies by closing the area to new energy development. They also say it isn’t the best way to protect the land.

“The only way to truly learn about and understand a place is with boots on the ground,” Zinke posted to Twitter after landing in Blanding for the second day of his four-day trip to see Bears Ears and the Grand Staircase-Escalante.

Zinke and Herbert were expected to hold a news conference later in the day before taking a hike to one of the ancient ruins within the Bears Ears site.

The monument review is rooted in the belief of Trump and other critics that a law signed by President Theodore Roosevelt allowing presidents to declare monuments has been improperly used to protect wide expanses of lands instead of places with particular historical or archaeological value.

Interior Secretary Ryan Zinke speaks prior to President Donald Trump signing an executive order reviewing previous National Monument designations made under the Antiquities Act, at the Interior Department in Washington, D.C. Photo by Kevin Lamarque/Reuters

Conservation groups contend that the monument review puts in limbo protections on areas that are home to ancient cliff dwellings, towering Sequoias, deep canyons and ocean habitats where seals, whales and sea turtles roam.

In Blanding, with a population of 3,400 people, two large banners read, “#RescindBearsEars,” reflecting the popular sentiment among residents.

Those who want Zinke to leave Bears Ears alone to preserve lands considered sacred by tribes made their voices heard, too. Tara Benally, a member of Navajo Nation, was standing just outside the Blanding airport wearing a shirt commemorating the December declaration of Bears Ears National Monument.

“We want it left as is. We have history going through there,” said Benally, who lives in the nearby town of Bluff. “That was basically my mom’s playground as she was growing up.”

After his arrival Sunday in Salt Lake City, Zinke was met by about 500 protesters who chanted, “Save our monuments, stand with Bears Ears.”

He held a closed-door meeting with a coalition of tribal leaders who pushed for the monument then spoke of his admiration for Roosevelt,

Zinke, a Montana Republican, said “it is undisputed the monuments have been an effective tool to save, preserve our greatest cultural treasures.”

He insisted there is no predetermined outcome of his review, saying he may not recommend the monuments be made smaller or rescinded, and he might even recommend an addition.

Zinke has been tasked with making a recommendation on the Bears Ears monument by June 10, about 2½ months before a final report about all the monuments.

“I’m coming in this thing as a Montanan, a former congressman and now the secretary of the Interior without any predispositions of outcome,” Zinke said. “I want to make sure that the public has a voice, that the elected officials have a voice.”

The two monuments he’s reviewing in Utah are quite large. Created in 1996, Grand Staircase-Escalante is 1.9 million acres (7,700 square kilometers), about the size of Delaware. Bears Ears is a bit smaller at 1.3 million acres.

Environmental groups have vowed to file lawsuits if Trump attempts to rescind monuments — a move that would be unprecedented.

On Tuesday, Zinke plans to tour the Bears Ears area on horseback.

“I think, sometimes, the best way to see things is slow and easy with a horse,” Zinke said, referring to his commute ride through the streets of Washington, D.C., on his first day as Interior secretary.

READ MORE: From Bears Ears to Gold Butte, here are the 27 national monuments being reviewed by the Trump administration

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Love candy? Well then, your liver may make relatively less of a hormone called FGF21, according to a new study. Photo by Carl Court/Getty Images

Believe it or not, some people don’t like candy. (Writer raises hand.) These people have been known to balk when friends offer jellybeans or leave the room as co-workers paw at the annual bowl of Halloween candy corn. If you’re one of these candy deniers, you may want to blame your hormones — or at least, a hormone made by the liver called FGF21.

This hormone controls your sweet tooth, according to a study published May 2 in the journal Cell Metabolism, making some folks much more likely to snack on candy and sweets, such as gum drops, ice cream, milk chocolate, Sweet Tarts and Skittles.

“It’s really specific to sweet tooth,” said Matthew Gillum, a metabolism researcher at the University of Copenhagen’s Novo Nordisk Foundation Center for Basic Metabolic Research who co-led the study. “We don’t see an effect on intake of complex carbs,” namely their preferences for fatty-sweets (cakes and pastries) and salty treats are just like everyone else’s.

While the neuroscience behind what drives overall hunger is well-understood, surprisingly little is known about why our brains and bodies gravitate toward specific foods. Parents pass along food preferences for fruits and veggies or meat, to their kids. But scientists like Gillum want to know why people make those decisions.

FGF21 had cropped up in the scientific world of sugar consumption in the past. Boosting FGF21 hormone levels in lab rodents or non-human primates triggers an aversion to sugar and artificial sweeteners, but not to proteins, fats or overall food intake.

Meanwhile, genome-wide association studies — which look at human mutations and how they correlate with health behaviors — pinpointed two genetic tweaks in the FGF21 gene that associated with increased carbohydrate consumption. But these prior studies did not quantify how much extra sugar was consumed by these individuals.

So to explore how these FGF21 mutations influence the day-to-day diets of humans, Gillum and his colleagues examined the genetic profiles of subjects from the Inter99 study — a huge survey in Denmark that tracked the cardiovascular health of 13,000 random adults between the ages of 30 and 60. From 1999 to 2006, subjects filled out questionnaires about their daily diets, while doctors collected blood samples to track things like cholesterol and insulin levels. A subset of 6,500 individuals volunteered their blood samples for future genetic analysis, such as by teams like Gillum’s.

Gillum and company found people from the Inter99 study who had one of the two FGF21 mutations were 20 percent more likely to consume candy and sweets on a day-to-day basis.

“It’s a small change in behavior — about 3 grams in added sugar consumption per day,” Gillum said. “It doesn’t seem to do anything to your bodyweight. The effect on BMI [body mass index] is not large.”

“Liking sweets is a somewhat addictive behavior,” said Terry Maratos-Flier, a professor of medicine at Harvard University who studies how diet alters the programming of our minds and bodies. Photo by Sarah Lawrence/via Getty Images

Going further, the team recruited a separate group of 100 college students and asked if they liked or disliked sweets. Those with the strongest preferences for sweets had 50 percent less FGF21 circulating in their blood.

Stated otherwise, FGF21 hormone acts like a brake. If you have lower levels of it or if your version is mutated, then you tend to consume more sugar.

Though FGF21 levels did not correlate with obesity in this random selection, it may still influence weight gain through its ability to temper cravings.

“Liking sweets is a somewhat addictive behavior,” said Terry Maratos-Flier, a professor of medicine at Harvard University who studies how diet alters the programming of our minds and bodies. “It’s a motivation behavior. You get a lot of pleasure out of it.”

Maratos-Flier, who wasn’t involved with Gillum’s research, found it interesting that people with FGF21 mutations who liked sweets were more likely to drink alcohol and smoke. Prior work has shown genetics tweaks to FGF21 pathways increase alcohol intake in mice and humans.

“It suggests that FGF21 might fit into these highly motivated behaviors,” Maratos-Flier said, adding that the hormone may push multiple hedonic behaviors. Gillum’s group plans to dig into the alcohol question in the immediate future.

Meanwhile, a clinical trial conducted by Pfizer found a drug that mimics FGF21 can reduce body weight in Type 2 diabetes patients by lowering their food intake. But many metabolic pathways influence diet choices, and likely sugar consumption too, so both Gillum and Maratos-Flier said more research is needed to clarify how FGF21 factors into disorders like obesity.

“The surprising takeaway is that appetite might be regulated by the liver, which isn’t thought to be a hormonal regulator of feeding behavior,” Gillum said. But right now, “we think these natural rewards may just be going through the same craving pathway that sugar does.”

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Activists protest against the Republican plan to repeal Obamacare during a rally in Freedom Plaza in Washington, March 23, 2017. Photo by Kevin Lamarque/REUTERS

Under the Republican health bill, it’s up to states whether to dismantle key parts of the Affordable Care Act.

Red, or GOP-leaning, states are sure to be interested in rolling back the law’s coverage requirements and freeing insurers to charge people more when they have preexisting conditions.

As strange as it sounds, deep-blue, heavily Democratic states supportive of Obamacare, including California and New York, may be forced to do the same, according to experts, regulators and consumer advocates.

The American Health Care Act, which narrowly passed the House on Thursday and now heads to the Senate, would significantly cut the federal subsidies on which many Americans rely to buy coverage. Unless the legislation fails or changes substantially, many consumers across the country could see the amount they pay every year for premiums increase by thousands of dollars, making coverage effectively unaffordable.

Few, if any, states would be able to fund subsidies on their own. To keep insurers in the market and bring costs down, state leaders might feel compelled to seek exemptions from rules that require health plans to provide 10 “essential health benefits” and prohibit them from charging higher rates for sicker consumers. The new GOP health care bill would allow such waivers.

“With the skimpier subsidies, states are going to be under enormous pressure to apply for these waivers,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.

These opt-out provisions could accelerate the unraveling of Obamacare, even in places that fully embraced the landmark law.

“Certainly the Californias and New Yorks of the world will do what they can to hold onto the ACA protections. But when confronted with insurer exits and big price hikes, many states with the best of intentions may feel they have little choice but to get a waiver,” Corlette said.

The idea of opting out is unfathomable to many liberals who fought so hard to win the consumer protections in the Affordable Care Act. They’re hoping the Senate will dump the bill or, in its quest for more moderate votes, at least make the premium tax credits more generous or eliminate the waivers.

Republican leaders insist the current health law isn’t worth saving because it has left consumers with double-digit rate hikes, onerous deductibles and little or no competition in some states, as insurers exit the marketplaces.

Rep. Kevin Brady (R-Texas), chairman of the House Ways and Means committee, said the GOP health bill grants states the flexibility they need to remove the “crushing mandates” that have led to “Obamacare plans you don’t want and can’t afford.”

House Speaker Paul Ryan (R-Wis.) struck a similar note in urging his colleagues to pass the bill. “Let’s make it easier for people to afford their insurance. … Let’s return power from Washington to the states,” he said on the House floor Thursday.

Consumer advocates in North Carolina, Colorado and other states are taking the threat of waivers seriously.

“No state is safe from such a waiver,” said Brendan Riley, a health policy analyst at the North Carolina Justice Center, an advocacy group focused on economic and social issues.

North Carolina would be one of the states hit hardest by the House bill, according to an analysis by the left-leaning Center on Budget and Policy Priorities. The state’s average premiums and out-of-pocket costs would rise by $7,549 annually.

Nationally, the average tax credit for enrollees in the online marketplaces would be 41 percent lower under the American Health Care Act by 2022, according to a study by the Kaiser Family Foundation. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.)

The GOP bill also ends the penalty for not having coverage, which experts say might increase premiums as fewer healthy people sign up, leaving health plans with a higher proportion of  sick patients.

All this could put the focus back on which benefits are deemed essential in health insurance — an all-too-familiar battle in statehouses before the ACA set a nationwide standard.

The health law now requires all plans sold on the individual and small-group markets to cover the 10 essential health benefits, including hospitalization, prescription drugs and mental health treatment. It has made coverage more comprehensive and prevented insurers from selling bare-bones plans that had cheaper premiums but often exposed consumers to huge medical bills after they sought care.

Before the ACA, coverage for maternity care, prescription drugs and substance abuse treatment often wasn’t available. State lawmakers were hesitant to approve new benefit mandates for fear of raising premiums.

Washington state Insurance Commissioner Mike Kreidler, a Democrat, said he sees a political fight over benefits on the horizon if the GOP bill advances.

“I certainly think there’s going to be political pressure applied to make adjustments [in essential health benefits],” he said. “I’d be vociferously and violently opposed to those changes.”

Adela Flores-Brennan, executive director of the Colorado Consumer Health Initiative, said she too has faith that her state’s Democratic governor and insurance commissioner would uphold essential benefits and protections for people with preexisting conditions.

But she and other patient advocates said that resolve may be tested by the lack of competition in some areas, which insurers could use as a bargaining chip for more leeway on regulations.

For instance, Flores-Brennan noted that industry giant Anthem is the sole company on the state’s insurance exchange in 14 Colorado counties. She said she worries the company could threaten to pull out if the state doesn’t opt for weaker standards.

Even in California, a liberal bastion that enthusiastically implemented Obamacare, the law’s supporters are bracing for a fight over the waivers.

“As premiums go higher, it will create pressure on us to undercut the standards we have,” said Beth Capell, a lobbyist for the consumer advocacy group Health Access California.

In California, premiums and out-of-pocket costs would rise by $2,779, on average, under the House bill, according to the analysis by the Center on Budget and Policy Priorities.

“California policymakers will once again hear what we heard year after year before the ACA: ‘Some coverage is better than no coverage. More limited benefits are better than nothing,’” Capell said.

John Baackes, the chief executive of L.A. Care Health Plan, with about 26,000 enrollees in the California exchange, said state leaders would exhaust every other option before slashing coverage.

“California would be loath to cut benefits,” Baackes said. “If you’re selling a policy to a young adult without maternity care, that’s nuts.”

No matter the state, red or blue, experts anticipate vigorous debate over these waivers because consumer protections under Obamacare have become more popular.

Wisconsin Gov. Scott Walker, a Republican, experienced that firsthand last week when he suggested his state may opt out of the ACA’s preexisting condition rules — and then immediately backtracked amid strong opposition.

Michael Miller, director of strategic policy for Community Catalyst, a Boston-based national consumer group, said waiver requests won’t necessarily proceed “quietly even in the red states. … People have heart disease and cancer and asthma in those states, too.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report on its website.

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Photo by Jason Lelchuk

While we were out filming our story on the growing movement to put teaching kitchens in primary care doctors’ offices to teach patients how to cook healthier meals, we picked up some great recipes and healthy food knowledge that didn’t make it into our broadcast story.

Below you see our intrepid cameraman, Jason Lelchuk, capturing Chef Lars Kronmark’s slicing skills at the Culinary Institute of America’s Napa Valley Campus. Chef Lars is preparing some salmon, which was one of my favorite recipes from the conference. The recipe for Salmon Tagine from the Healthy Kitchen’s Healthy Lives’ stockpile is just one of more than 300 recipes that were circulating as health care professionals learned how to make healthy, delicious meals from top notch chefs. The recipe below is easy to make, full of healthy veggies, fennel, onions, olive oil and more — and it’s absolutely delicious.

Tagine Of Salmon With Preserved Lemons And Caper Berries

Serves 8

Ingredients:
• 8 – salmon steaks 5 oz. each

For herb mixture:
• 1 cup parsley, flat leaf, coarsely chopped
• 1/2 cup cilantro, coarsely chopped
• 2 tablespoons garlic, finely chopped
• 1/2 cup extra virgin olive oil
• 1 tablespoon sea salt
• 1-1/2 teaspoon black pepper, coarsely ground
• 2 lemons, juiced
• 1-1/2 tablespoon hot paprika
• 1/8 teaspoon cayenne pepper
• 1 teaspoon cumin seed, freshly ground

For vegetable bed:
• 12 oz onion, very thinly sliced-
• 8 oz. fennel, very thinly sliced
• 4 ribs celery, very thinly sliced
• 2 pounds plum tomatoes, large chop no seeds
• 2 tablespoons garlic, finely chopped
• 1/3 cup caper berries
• 2 preserved lemons, rinsed
• black pepper, coarsely ground
• 1/3 cup extra virgin olive oil
• 3/4 cup water, saffron infused

Directions:
1. Prepare herb mixture (charmoula) by combining all ingredients. Rub mixture on fish and set aside to marinate for 1 to 2 hours.
2. Combine vegetables for bed, toss, season and toss again. Place veggies on bottom of casserole. Drizzle with olive oil and saffron infused water. Place fish on top of vegetable bed cover and cook at 425 degrees, until fish is cooked (about 25 minutes).
3. Allow to cool for 5 minutes, serve with the vegetables and resulting broth.

A graduate of Healthy Kitchen’s Healthy Lives, primary care doctor Nicole Farmer, in the picture below, showed patients how to build a more nutritious breakfast at the Casey Health Institute in Gaithersburg, Maryland. Farmer convinced Casey Health Institute to build the kitchen where she now teaches.

Dr. Nicole Farmer in the Physician’s Kitchen at the Casey Health Institute in Gaithersburg, Maryland.

Farmer brings her patients into the Physician’s Kitchen to teach them about healthy ingredients they can buy and cook. Farmer cooks with her patients and drills down on some of the science behind those healthy choices. When we were there, she was focusing on building a more nutritious breakfast.

The lesson of they day was swapping out highly processed grains, like the white flour that goes into pancakes for whole grains that are more nutritious alternatives, such as buckwheat and steel cut oats. Those whole grains contain far more nutrients than their highly processed cousin, white flour.

Farmer explained to her class why those whole grains are so much more beneficial. She said, “These are unrefined grains, just as they are in nature and nothings been stripped out of them. The refined grains have been stripped of quite a few nutrients.” Farmer went on to explain that whole grains have a protective outer coating that contains bran, endosperm and what’s called, a germ. These components are packed with minerals and vitamins in high concentrations. Minerals like magnesium, calcium, iron, zinc and other great nutrients. But, processed grains are stripped of the bran and the germ, leaving behind the “white” grain or endosperm and many of the whole grains nutrients.

The table shows you the consequences of processing a whole grain and what percentage of minerals and vitamins are lost when you take away the bran and germ in refined flour.

Besides the loss in nutrients that occurs when grains are highly processed, Farmer explained to her class that all the good things those grains do for your body go out the window too. Keeping your blood sugars in check is one. By keeping blood sugars lower, you also help regulate blood pressure. Farmer said,”The whole grains don’t spike your blood sugar, like processed grains do and because they don’t raise your blood sugar your blood is less sticky and travels through your heart easier, which keeps your blood pressure lower.” In essence, more sugar will make your bloody stickier and thicker making it harder for the heart to pump.

So at this point you might be saying, “Why am I eating all these carbs for breakfast when many diets tell you to avoid carbs all together? Farmer says you might want to think twice about eliminating carbs. She says, as long as you focus on eating good carbs or whole grains and not bad carbs or processed grains, you’ll be taking in nutrients like magnesium and Vitamin B2, that are hard to find in other foods. In addition you lose the regulating of blood sugar and blood pressure, without carbs. Going grain-free Farmer says, “…can actually cause nutritional deficiencies.”

The patients got to watch Farmer make some delicious breakfast dishes and they all feasted on buckwheat pancakes with toppings like yogurt and fresh fruits, a whole grain called millet that was combined with lemon curd. Below are the recipes.

Soaked Grain Pancakes

Makes 6-8 pancakes
Prep time: 15 minutes plus 8hrs soaking time
Cook time: 20 minutes

Ingredients
• 2/3 cup steel cut oats
• 1/3 cup toasted buckwheat groats
• 1 ¼ cups “milk” (cows milk, soy milk, rice milk, almond milk)
• 2 eggs
• 1/4 teaspoon sea salt
• 2 tablespoons sucanat or other minimally refined dry sugar
• 1 teaspoon baking powder
• 1/2 teaspoon grated nutmeg
• 2 tablespoons melted butter or coconut oil for the pan
Directions
Combine oats, buckwheat, and milk in medium sized bowl or blender (do not blend yet!). Cover and let soak, refrigerated, 8 hours or overnight.
Add eggs, salt, sucanat, baking powder, nutmeg, and blend until smooth. Preheat a griddle or frying pan over medium heat. Lightly grease with butter or coconut oil. Pour about 1/3rd cup batter onto pan and cook for about 2 minutes on either side (edges set, bubbles burst). Add butter or oil to pan in between pancakes if needed. Serve hot. Hold in 200 degree oven to keep warm if needed before serving.
To make vegan pancakes: use a non-dairy milk, omit eggs, add 1 tablespoon oil to batter, and add either 1 tablespoon arrowroot powder and ¼ cup of water OR ½ ripe banana. Blend and cook as above.
Recipe adapted by Ronit Gourarie from The Splendid Grain by Rebecca Wood.

•••

Millet Porridge with Lemon Curd and Sunflower Seeds

Prep time: 5 mins
Cook time: 30 mins
Total time: 35 mins

Ingredients
• 1/2 cup uncooked millet
• 1 1/2 cups water
• 1/2 teaspoon vanilla extract
• 1 tablespoon maple syrup
• 1/2 cup whole milk
• 1/4 cup lemon curd
• 2-3 tablespoons sunflower seeds

Directions
Add millet to a pot over medium heat. Swirl for 2-3 minutes, letting millet lightly toast. Add water, vanilla extract, and maple syrup. Bring to a boil, reduce to a simmer, and let millet cook until water is absorbed, 25-30 minutes*. Stir the millet occasionally as it cooks.

Once millet is done, remove from heat and stir in the milk. Add more or less milk depending on the texture you desire. Divide into 2 bowls (or eat as one large serving) and swirl in the lemon curd and sprinkle with sunflower seeds.
Notes: *While stirring, I always check the consistency starting after about 15 minutes and add water as needed. My “simmer” on my stove top isn’t always a simmer.

One more breakfast bonus from the Culinary Institute of America. Chef Ed Brown cooks what he calls a “plant forward” breakfast where veggies play a big role and the bacon is made from trumpet mushrooms. Chef Brown shared these two recipes: Lentil Pancakes with Oven Roasted Tomatoes and French Feta, Plus Green Onion and Cheddar Waffles with Spinach, Egg and Trumpet Royale “bacon”:

Greens, Grains, And Lentil Pancakes With Oven Roasted Tomatoes And French Feta

Makes 6 portions

Ingredients
• 9 Roasted Tomatoes
• 9 Roma tomatoes.
• 3 Tbsp. Extra-virgin olive oil
• 1 tsp. Garlic clove, minced
• 1 tsp. Shallot, minced
• 1 Tbsp. Basil, chopped
• 1 tsp.Thyme, chopped
• Salt as needed
• Ground black pepper as needed

Greens, Grains, and Lentil Pancakes
• 3 Tbsp. + additional Extra-virgin olive oil
• ½ lb. Spinach leaves, triple washed
• 1 cup All-purpose flour
• 1 Tbsp. Baking powder
• 1 tsp. Sugar
• 2 tsp. Salt
• ½ cup Plain Greek yogurt
• 2/3 cup Milk
• 2 ea. Eggs
• 1 bu. Green onions, chopped
• 1 bu. Dill, chopped
• ¾ cup. Farro, cooked
• ¼ cup Lentils, cooked
• ¼ bu. Parsley, chopped
• ½ bu. Tarragon, chopped
• 1 tsp. Lemon zest
• 8 oz. French feta
• Microgreens as needed
• Smoked or plain sea salt as needed

Directions:
1. For the Roasted Tomatoes: Preheat oven to 275°F.
2. Remove the cores from the tomatoes and cut into halves lengthwise.
3. In a mixing bowl, whisk together the olive oil, garlic, shallots, basil, and thyme.
4. Add the tomatoes to the bowl, toss gently to coat evenly, and season with salt and pepper.
5. Arrange in a single layer skin side down on a rack over a sheet pan.
6. Oven-dry the tomatoes in the preheated oven until the tomatoes are dried and lightly browned, 1 to 1 ½ hours.
7. For the Greens, Grains, and Lentil Pancakes: Heat a large sauté pan. Add 1 tablespoon of olive oil and spinach leaves, and toss for 30 seconds until the spinach wilts.
8. Remove to a colander and allow to drain for 5 minutes. Squeeze excess moisture from the spinach and chop.
9. In a mixing bowl whisk together the flour, baking powder, sugar, and salt.
10. In a separate bowl, mix the yogurt, milk, eggs, and 2 tablespoons of olive oil. Add the chopped spinach, green onions, dill, farro, lentils, parsley, tarragon, and lemon zest.
11. Mix together the wet and dry ingredients, and mix until just combined..
12. Heat a nonstick pan, and add a small amount of olive oil. Make the pancakes by scooping ¼ cup amounts into the pan and cooking on medium heat until bubbles appear on the surface. Flip and cook on the other side, about 3 minutes per side, so that both sides are a nice, even golden brown. Keep warm in a low oven until ready to serve.
13. To Serve: Place 2 warm Pancakes on each plate. Top with the Roasted Tomatoes and juice, crumbled French Feta and a good pinch of microgreens. Finish with a sprinkle of smoked or plain sea salt. Serve immediately. Source: Adam Busby, as presented at the Menus of Change® Leadership Summit. Copyright The Culinary Institute of America 2016. All rights reserved.

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Photographs are displayed for a memorial ceremony held for U.S. Army Spc. Hilda Clayton, at Forward Operating Base Gamberi, Afghanistan. Clayton died while taking photographs of Afghan National Army soldiers as they conducted a live-fire training exercise. Photo taken in July 2013. Photo by Sgt. Richard Jones

Military combat photographers will tell you that part of the job involves accepting that their next step may be the last.

This image is the last photo military photographer Specialist Hilda I. Clayton ever took. While photographing a live-fire training exercise, a mortar tube exploded, killing Clayton and the four Afghan National Army soldiers with her. The Pentagon released the photo in “Military Review” last week.

Clayton died, camera in hand, on June 2, 2013 in Laghman Province, Afghanistan. She is one of more than 2,200 U.S. troops killed in Afghanistan since the United States invaded in 2001, according to the Pentagon.

As a visual information specialist in the 55th Signal Company, Clayton photographed military missions and history. The military used her photos to gain a more complete understanding of how ground operations played out.

The picture sat in a file for nearly four years before one of Clayton’s fellow soldiers stationed in Afghanistan brought it to managing editor William Darley of the “Military Review.” Darley said after he deliberated with Clayton’s family and husband, all parties decided it would be a fitting tribute to her work and sacrifice.

The photo drew emotional reactions from soldiers across the military and civilians alike, most especially from military photographers and conflict photographers.

“Her last image will be a part of history,” Air Force combat photographer Staff Sergeant Ashley Brokop, who worked for more than three years in Iraq, told the NewsHour in an email. “ I feel her bravery when I see this image,” she wrote.

A mortar tube accidentally explodes, killing four Afghan soldiers and U.S. Army photographer who took the photo, Spc. Hilda I. Clayton, during an Afghan National Army (ANA) live-fire training exercise in Laghman Province, Afghanistan July 2, 2013. The 2013 photo was released for the May-June issue of the United States Army journal Military Review. U.S. Army/Spc. Hilda Clayton via Reuters

“My first reaction was, ‘My God, that exact situation could have happened to me a million times,’” said Lynsey Addario, a New York Times photographer who has spent many years of her career in Iraq and Afghanistan documenting the military and covering numerous conflicts.

Addario, who photographed the 173rd Airborne Brigade Combat Team for two months in the Korengal Valley in 2007, said she has often been at training exercises just like Clayton, where something could have gone wrong.

“It’s incredible she shot until the very end,” Addario told the NewsHour.

Combat photographers train extensively and understand death’s nearness at all times, said Sergeant Stacy Pearsall, a combat photographer in the Air Force for more than a decade.

Army combat photographer Spc. Hilda I. Clayton, who was killed in Afghanistan in 2013, is seen in an undated photo. Photo by U.S. Army/Handout via Reuters

“Every morning that I went to document combat, I accepted death as a possibility,” Pearsall, who served in Iraq and Afghanistan and traveled to dozens of countries while in the service, told the NewsHour. “Only then could I truly push aside all those other thoughts and just get down to business and do my job,” she said.

The military uses combat photographers’ work for a variety of purposes from forensics to documenting prisoner transactions and gathering intelligence.

Combat photographers also receive weapons training and they learn military strategy and lingo. “Combat Cameras” or “COMCAMs” in military lingo, are on the front lines, trained to work with the infantry.

With that assignment, comes a dedication to the mission and to the craft, Army combat photographer Sergeant Jacob Smith, who served in Afghanistan on and off between 2003 and 2009 said.

“I never placed personal safety into account when it came to getting the imagery needed to tell the story,” he wrote in an email to the NewsHour.

Combat photographers do not have the same flexibility as civilian journalists who have the ability to leave before a tour is finished. Military photographers are there for the duration of a tour.

“You’re not going home,” said Erin Kirk-Cuomo, a Marines photographer who served in Iraq from 2006 to 2008. “You’re there with your unit and you are an integral part of that mission,” she said.

Many military photographers, reflecting on Clayton’s death, said they were moved by what the photo represented to them.

“I’m honored to call myself a combat photographer given the caliber of the men and women who also call themselves combat photographers, because I think [Clayton’s] actions and her sacrifice show the best of who we are,” Pearsall said.

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