Pre-march photo! #womensMarchAntarctica ❤️🐧 pic.twitter.com/NaRyZaIvsM

— linda zunas (@lindazunas) January 21, 2017

The Women’s March has reached Antarctica — specifically, on a ship of about 100 travelers who are on an expedition to the continent. Linda Zunas, who organized their participation, told the PBS NewsHour in an email that she was on her third visit to the continent but still wanted to take part in the day of demonstrations.

“We can’t invite the public, but welcome all ship-board guests and staff to join us,” Zunas said on a website dedicated to their event. She added in an email to the NewsHour that while the group is primarily focused on environmental issues, they did not want their isolation to impede on their ability to march. “I spent a month after the election mourning the impending damage to the earth that will be done. I felt like I needed to do something to be part of the global movement.”

The group made about 50 signs on Wednesday and plans to march on land in solidarity with organizers in Washington, D.C. Zunas said their contingent ranges in age, from 24- to 87-years-old, and come from more than six countries.

Marches and demonstrations are planned for Saturday in all 50 states, in more than 60 countries and on every continent.

Follow the NewsHour’s live blog here.

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Dr. Sean Mackey oversees Stanford University’s pain management program. Photo by Elizabeth D. Herman for STAT News

PALO ALTO, Calif. — For Thomas P. Yacoe, the word is “terrifying.”

Leah Hemberry describes it as “constant fear.”

For Michael Tausig Jr., the terror is “beyond description.”

All three are patients struggling with chronic pain, but what they are describing is not physical agony but a war inside the medical community that is threatening their access to painkillers — and, by extension, their work, their relationships, and their sanity.

Two years after the United States saw a record 27,000 deaths involving prescription opioid medications and heroin, doctors and regulators are sharply restricting access to drugs like Oxycontin and Vicodin. But as the pendulum swings in the other direction, many patients who genuinely need drugs to manage their pain say they are being left behind.

Doctors can’t agree on how to help them.

“There’s a civil war in the pain community,” said Dr. Daniel B. Carr, president of the American Academy of Pain Medicine. “One group believes the primary goal of pain treatment is curtailing opioid prescribing. The other group looks at the disability, the human suffering, the expense of chronic pain.”

Pain specialists say there is little civil about this war.

“There’s almost a McCarthyism on this, that’s silencing so many people who are simply scared,” said Dr. Sean Mackey, who oversees Stanford University’s pain management program.

“The thing is, we all want black and white. We don’t do well with nuance. And this is an incredibly nuanced issue.”

READ NEXT: How do we decrease addiction to opioids but still treat millions with chronic pain?

Nuance does not matter to people like Tausig, 43, who has been unable to work or socialize since 2008, when the last of his five spinal reconstruction surgeries left him in constant pain.

He last got a taste of life without opioids a few years ago, when his pharmacy’s corporate parent imposed opioid-distribution limits, forcing him to find a new one.

“Those three days were among the worst of my life,” he said. “I wandered the house at night, legs shaking like a whirling mass of putty, sleepless and without respite from the pain.”

Now, with regulators and health industry leaders continuing to bear down on opioids, and the arrival of a new president whose statements indicate that he might further restrict opioid distribution, Tausig’s worries have deepened.

“It’s put the fear of God in me.”

Michael Tausig has been unable to work or socialize since 2008, when the last of his five spinal reconstruction surgeries left him in constant pain. Photo by Elizabeth D. Herman for STAT News

The medical community’s battle over painkillers burst out into the open in late 2015, when the New England Journal of Medicine published a commentary in which two doctors argued that chronic pain patients should focus not on reducing the intensity of their pain, but on their emotional reactions to it.

The authors, Dr. Jane C. Ballantyne, the president of Physicians for Responsible Opioid Prescribing, and Dr. Mark D. Sullivan, argued patients should pursue “coping and acceptance strategies that primarily reduce the suffering associated with pain and only secondarily reduce pain intensity.”

The pair argued that patients who mainly focus on pain intensity tend to escalate their doses of opioids and worsen their quality of life.

On NEJM’s website, the comments section devolved to a flame war more suited to YouTube than the staid pages of the nation’s top medical journal, with some accusing the authors of a lack of compassion, and others lauding them for a sane approach to public health and addiction prevention.

READ NEXT: Treating chronic pain: When ‘How much does it hurt?’ isn’t enough

But the comments also laid bare a fundamental problem in the debate over opioid treatments: Neither side has much evidence about the benefits or consequences of long-term use because almost no such studies exist.

A few studies have identified a litany of side effects beyond addiction. One survey, by palliative care doctors Mellar P. Davis and Zankhana Mehta, pointed to symptoms including increased risk of depression, anxiety, cognitive impairment, and sleep apnea, among other issues. Patients with lung disease were also more likely to die when their treatment included opioids, according to the survey’s authors, who practice at Geisinger Health System.

Stanford’s Mackey said those risks are important to recognize. But, he said, nearly 15,000 people die a year from anti-inflammatory medications like ibuprofen. “People aren’t talking about that,” he said.

Mackey says doctors being trained at Stanford’s pain center have grown increasingly fearful about prescribing opioids. Photo by Elizabeth D. Herman for STAT News

On a Monday morning last month, Mackey entered an exam room to greet one of his patients who uses opioids: an 81-year-old physician with a bad back.

The doctor, who agreed to be interviewed on condition of anonymity, said he’d routinely cycled to work until relatively recently, when a degenerative spinal condition worsened. Surgery in October failed to help, and now, he told Mackey, he can only get out of bed if he takes five opioid pills at dawn and sleeps another half-hour before rising.

The doctor wanted to find a way to address his back problem without the painkillers, which, he said, cloud his thinking.

Mackey spent nearly 30 minutes with him, talking about scans, symptoms, and previous treatments. He planned a follow-up consult in January, when another set of test results would arrive.

READ NEXT: For some chronic pain patients, ‘without opioids, life would be torture’

Over lunch, Mackey reviewed the case.

“Do you get any sense from him of drug-seeking behavior?” he asked. “Is he selling this stuff on the street or trying to score some synthetic fentanyl or heroin? No. All he wants to do is be more functional so he can see patients and be relevant and have a life.”

Mackey also wasn’t sure the opioids were causing the cloudiness. The patient’s cognitive issues could be the result of non-opioid medications he takes before sleeping, so dialing down the opioids without first exploring other options might harm him more. Without them, his pain would be so severe he would be relegated to bed.

“If you’re 81 and you stop getting out of bed, it’s a slippery slope,” he said.

Mackey, a past president of the American Academy of Pain Medicine, has built Stanford’s pain center into one of the nation’s most comprehensive and well-funded pain research operations. But he said doctors being trained there have grown increasingly fearful about prescribing opioids.

“In many cases that can be healthy, but I’d like to see a thoughtful, balanced approach,” he said. “Opioids are a tool — they’re more often a fourth- or fifth-line option for me.”

Mackey recalled the case of a patient who had crushed his foot in an accident and undergone 10 surgeries that failed to diminish his “burning, terrible pain.” The patient now relies on opioids.

“People will say, ‘This guy’s on way, way too much opioid medication, you have to take him off,’” Mackey said. “But guess what: He gets up every morning and goes to work and does his job, and he’s been on the same regimen for years and years and tried everything else first.”

Even some of Mackey’s colleagues have issues with that kind of thinking.

Dr. Anna Lembke, who practices alongside Mackey at Stanford’s pain clinic and is chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, published a book about the opioid crisis last year. It was titled: “Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop.”

Lembke believes that long-term opioid use can cause patients to perceive pain even after the original cause of pain has cleared. Some patients, she said, find themselves free of pain only once they have endured the often agonizing effects of opioid withdrawal.

“That’s what we’re seeing again and again,” she said.

Lembke believes people with chronic pain who have taken opioids daily for long periods may never be able to break their dependence on the drugs, and may need permanent doses of medications like Suboxone, which is commonly given to people with opioid addictions.

But chronic pain patients who have not yet started on opioids, she said, should only take them intermittently — “like every three days or so” — to avoid addiction.

The American culture has grown too intolerant of pain, Lembke said.

“Whether it’s surgery or women going into childbirth, there’s an alarmist reaction to pain, and it’s contagious and makes more people anxious, which makes the pain worse,” she said. “We’re terrified to experience pain.”

Mackey has built Stanford’s pain center into one of the nation’s most comprehensive and well-funded pain research operations.
Photo by Elizabeth D. Herman for STAT News

Those who experience chronic pain say these views embolden clinicians, pharmacists, and others to treat them like addicts and criminals.

Hemberry, a 36-year-old multimedia specialist in Leavenworth, Wash., suffers from a connective-tissue disorder called Ehlers-Danlos syndrome and trigeminal neuralgia, an often-excruciating nerve condition for which she occasionally takes opioids.

She heard Lembke interviewed on NPR recently and was bereft. “Every pain patient is now an addict and a failure,” Hemberry said.

Last March, the Centers for Disease Control and Prevention issued guidelines for opioid prescriptions. Those guidelines focused on addiction prevention, opioid trafficking, and medication diversion, and included stern cautions against using the drugs for chronic pain.

To Hemberry, the guidelines seemed reasonable. “But many doctors and administrators have taken a hard-line ‘no opiate’ stance,” she said, and go to absurd lengths to enforce it.

Earlier this winter, Hemberry recalled, she went to the emergency room with a migraine headache, a frequent symptom of her medical conditions. She was seeking a saline drip — one of the few treatments that has helped her pain — and said she wasn’t seeking opioids.

The nursing staff nonetheless grilled her on her medications and chided her for taking too many pills, even though her daily medications are non-narcotic. She turned her head at one point and started sobbing.

Others report a similar lack of empathy.

“What people forget is, those who end up on opioid pain management have usually tried everything else unsuccessfully,” said Yacoe, 61, who suffers from chronic migraines. “I stayed away from opioids for decades. It was really and truly a last resort.”

A patient room at the Stanford University Center for Back Pain.
Photo by Elizabeth D. Herman for STAT News

Some clinicians trace the early roots of the opioid crisis not to the pharmaceutical industry’s marketing of controlled-release morphine pills, but to a 1986 study of 38 non-cancer patients performed by palliative care doctors at Memorial Sloan Kettering Cancer Center.

Most were treated with oxycodone, methadone, or levorphanol in small daily doses — less than half the surgeon general’s current recommended starting dose — and 24 reported acceptable or adequate pain relief, while two patients developed “management” problems with the drugs. (Both had histories of substance abuse.)

According to Carr, of the American Academy of Pain Medicine, the conservative opioid treatment approach used in the study, and the modest benefits reported, reflect the current practices and expectations of many doctors.

But a growing number, he said, are being pressured into a zero-tolerance policy.

“Because if one isn’t anti-opioid enough, there’ll be protests,” said Carr, who is also founding director of Tufts University’s Pain Research, Education, and Policy Program.

Other experts note that, as opioid restrictions tighten, the medical system and insurance industry have done little to support opioid-withdrawal efforts, help more physicians learn how to help patients manage pain, or enable access to alternative therapies.

In some cases, patients seeking to treat their pain have turned to street drugs like heroin or synthetic fentanyl, while others have instead chosen suicide. (In one high-profile case recently, a man who committed suicide left behind notes saying he could find no help for his chronic pain; at least two of the roughly 20 patients interviewed for this article said they had considered suicide because of their pain.)

Everyone wants the number of opioid overdoses to fall. But patients like Tausig don’t want to be made to suffer.

Tausig, a single father of two teens, said that every month he needs to fill a prescription, he’s fearful it will be denied.

Whenever he thinks he might meet with a new pharmacist or clinician, he dresses neatly to hide his tattoos. He said he thinks they can cause people to rush to judgment or even stigmatize him as an addict.

“You’ve got the wars on the medical side, but then you’ve got the governmental people stepping in, who have no idea,” Tausig said. “All they know is drugs: bad.

“They don’t see a struggling single dad in the most expensive place in the US who’s just trying to get through the day.”

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

The post A ‘civil war’ over painkillers rips apart the medical community appeared first on PBS NewsHour.

U.S. Vice President-elect Mike Pence arrives for the Presidential Inauguration of Donald Trump at the US Capitol in Washington, D.C., U.S., January 20, 2017. Photo By Saul Loeb/Pool via Reuters

INDIANAPOLIS — When Fort Wayne needed expensive airport improvements, its mayor contacted an influential Indiana native — then-Vice President Dan Quayle — to help secure federal funding.

Now that former Indiana Gov. Mike Pence is the new vice president, residents are hopeful his home state could again reap some benefits.

However, much has changed in the nearly 25 years since Quayle served under President George H.W. Bush. Republicans, who control both chambers of Congress, swore off earmarks under former President Barack Obama. And federal laws and regulations forbid many officials who oversee the awarding of contracts and grants from considering undue White House influence.

“They don’t have as much power as they used to have. They do have some, but it’s at the margins,” said Elaine Kamarck, senior fellow at the Brookings Institute who also served as an aide to former Democratic Vice President Al Gore. “Most federal grants are given according to a formula and it’s hard, if you don’t meet the requirements, to have a politician intervene and get a grant — often it’s downright illegal.”

Paul Helmke, the former Fort Wayne Mayor and current public affairs professor at Indiana University, recadlls getting federal funding for the city airport after Quayle “put in a word” He says Quayle also smoothed the way for a flood abatement project in the city.

Former aides say Quayle secured funding for a state park interpretive center along the Ohio River and helped land a massive railroad bypass in Lafayette.

While new President Donald Trump has promised to spend big on federal infrastructure, it’s not clear whether Pence’s role in the administration will have much influence on what projects Indiana lands.

Still, some Indiana GOP leaders who recently proposed a tax increase to pay for infrastructure projects are hoping Pence might help nab a larger-than-usual share of federal funding for roads.

“Dan Quayle never forgot Indiana and never forgot his Hoosier friends,” said former aide Bill Neale, who served as a campaign treasurer for both Quayle and Pence. “I think everybody has that same hope now that there will be a favorable ear in the White House.”

Pence, who was not only Indiana’s chief executive but also served six terms in the U.S. House, is poised to wield considerable influence under Trump, who had never held public office and has openly feuded with members of his own party. Quayle, who served in both the U.S. House and U.S. Senate but never as governor, worked under a president with a longer resume of public service.

But while Indiana officials may already be looking to D.C. for help, there’s still no guarantee that it will come. John Nance Garner, one of Franklin D. Roosevelt’s vice presidents, famously said the office was “not worth a bucket of warm spit.”

Historically, the duties of the vice president have included overseeing the Senate, where they can provide a tie-breaking vote if the chamber is deadlocked. But the job also involves international travel and meeting with foreign dignitaries.

The power of the office has grown in recent years as the last two vice presidents, Dick Cheney and Joe Biden, have taken on key advisory roles under the commander-in-chief.

Pence has said that he wants to model his term after Cheney, who as George W. Bush’s vice president was extremely influential in the administration’s foreign policy decisions. Pence’s spokesman, Marc Lotter, declined comment on the new vice president’s plans for his home state.

Leslie Lenkowsky, who led an agency under President George W. Bush, cautioned that just because the White House wants something doesn’t mean professional government service workers will comply. He recalled fielding a phone call from Laura Bush’s chief of staff after turning down a grant application from an organization favored by the first lady.

“It’s not that easy for the president, and certainly not the vice president, to get in the middle of awarding a grant or contract,” Lenkowsky said.

Former Indiana Attorney General Greg Zoeller, a one-time Quayle staffer, said the former vice president was able to steer some funding home for projects. But the benefits aren’t always easy to quantify, he said.

“Access to government is always something that people pay a lot of money for,” said Zoeller, who added that a well-placed call from the White House will certainly be noted by members of Congress and executive agency heads.

But, he added, it cuts both ways, because “the more people you know, the more people are going to be contacting you.”

The post Indiana residents wonder whether Pence will benefit state appeared first on PBS NewsHour.

U.S. President Donald Trump arrives for a prayer service at Washington National Cathedral the morning after his inauguration, in Washington, U.S., January 21, 2017. Photo By Carlos Barria/Reuters

WASHINGTON — President Donald Trump opened his first full day as president Saturday at a national prayer service, the final piece of transition business for the nation’s new chief executive before a promised full-on shift into governing.

Trump and his wife, Melania, and Vice President Mike Pence and his wife, Karen, sat in a front pew at Washington National Cathedral for the morning service after a day of pomp, pageantry and protests that accompanied his Friday inauguration.

The interfaith service is a tradition for new presidents and is hosted by the Episcopal parish, but the decision to hold a prayer session for Trump sparked debate among Episcopalians opposed to his policies.

The service took place as throngs of women, many of them wearing bright pink, pointy-eared hats, descended on the nation’s capital and other cities around the world Saturday for marches organized to push back against the new president.

Trump had no speaking role at the service.

Bishop Harry Jackson of Hope Christian Church in Beltsville, Maryland, asked God to grant the president, vice president and Cabinet members “wisdom and grace in the exercise of their duties.” Jackson also asked that Trump and Pence “serve all people of this nation and promote the dignity and freedom of every person.”

After church, Trump planned to visit the CIA for a meeting with members of the nation’s intelligence community that could be fraught with tension.

Trump has sharply criticized top U.S. intelligence officials over their conclusions that Russia interfered in the 2016 election on his behalf, as well as over leaks about classified briefings he received in the weeks before his he was sworn into office on Friday.

Trump has signaled an intention to make a quick and clean break from the Obama administration.

Before dancing with the new first lady at three inaugural balls Friday night, Trump signed an executive order aimed at former President Barack Obama’s health care law. The order notes that Trump plans to seek the law’s “prompt repeal.” It allows the Health and Human Services Department and other federal agencies to delay implementing parts of the law that might impose a “fiscal burden” on states, health care providers, families or individuals.

Trump also cleared the way for members of his national security team to take their places.

He signed legislation granting James Mattis, his pick for defense secretary, a one-time exception from federal law barring former U.S. service members who have been out of uniform for less than seven years from holding the top Pentagon job. The restriction is meant to preserve civilian control of the military. Mattis, 66, retired from the Marine Corps in 2013.

Hours later, the Senate confirmed Mattis, and retired Gen. John Kelly to lead the Homeland Security Department. Both were sworn into office late Friday by Vice President Mike Pence.

Separately, White House chief of staff Reince Priebus issued a memo aimed at freezing some new regulations and halting ones the Obama administration had started.
Trump, his wife, children and grandchildren spent Friday night at the White House. His daughter, Ivanka, and her husband, senior White House adviser Jared Kushner, were seen snapping photos Saturday on the Truman balcony with a young girl who appeared to be their daughter.

The Justice Department released a memo concluding the president’s “special hiring authority” allows the New York real estate mogul to appoint Kushner to the administration and the move does not contravene federal anti-nepotism laws.

Trump, a Presbyterian, is not a regular churchgoer. He does not attend weekly services in New York, but worships every Christmas at a church near his estate in Palm Beach, Florida. Trump courted evangelical voters during the presidential campaign and infused his inaugural address with references to God and quoted from the Bible’s book of Psalms during a call for national unity.

Trump shook hands with guests who attended the invitation-only church service as he departed.

The service included readings and prayers from Protestant, Jewish, Sikh, Mormon, Buddhist, Roman Catholic, Baha’i, Episcopal, Hindu and Native American leaders. But the program was remarkable for the large number of evangelicals participating, including two former presidents of the Southern Baptist Convention, the country’s largest evangelical denomination. Several speakers had served as Trump advisers and supporters who spoke at the Republican National Convention.

The dustup over the service marked another example of the backlash against Trump by religious leaders, artists, celebrities and others.

But Bishop Mariann Budde of the Episcopal Diocese of Washington wrote in a blog post that while she shared “a sense of outrage at some of the president-elect’s words and actions” she felt an obligation to welcome all people without qualification, especially those who disagree and need to find a way to work together.

AP Religion Writer Rachel Zoll in New York and Associated Press writers Jill Colvin, Jonathan Lemire and Darlene Superville contributed to this report.

The post Trump begins first day as president in church appeared first on PBS NewsHour.

LANGLEY, Va. — President Donald Trump moved to mend his tumultuous relationship with America’s spy agencies Saturday, traveling to CIA headquarters on his first full day in office and assuring officials, “I am so behind you.”

But the president quickly shifted from praise for the CIA to criticism of media coverage of Inauguration Day, in an unscripted address that overstated the size of the crowd that gathered on the National Mall as he took the oath of office. Trump said throngs “went all the way back to the Washington monument,” despite photos and live video showing the crowd stopping well short of the landmark.

The president’s media criticism came as he stood in front of a memorial honoring CIA officers killed while serving the United States.

READ NEXT: Comparison: Donald Trump and Barack Obama’s inauguration crowds

Trump’s decision to visit CIA headquarters just outside of Washington was aimed at making a public gesture to the intelligence officials he disparaged during the transition. He had repeatedly challenged the agencies’ assessment that Russia meddled in the presidential race to help him win and suggested intelligence officials were behind the leak of an unverified dossier that claimed Russia had collected compromising financial or personal information about him.

During remarks to about 400 CIA officials, Trump denied that he had a feud with the intelligence community, saying it was “exactly the opposite.” He again blamed the media for creating that impression, despite the fact that he made numerous public statements critical of intelligence officials.

“There is nobody that feels stronger about the intelligence community and CIA than Donald Trump,” he said. “There’s nobody.”

The 45th president’s inauguration has been shadowed by news reports that the CIA and other federal agencies are investigating Russian interference in the presidential election on behalf of Trump. The New York Times, citing anonymous officials, said agencies were examining intercepted communications and financial transactions between Russian officials and Trump’s associates.

FBI Director James Comey has declined to confirm or describe the nature of the government’s investigation, both during a congressional hearing and in closed-door meetings with members of Congress.

Saturday marked the end of three days of inaugural celebrations, with Trump and his family attending a national prayer service traditionally held for the new president. The president and his wife, Melania, and Vice President Mike Pence and his wife, Karen, sat in a front pew at Washington National Cathedral for the morning service.

The interfaith service is a tradition for new presidents and is hosted by the Episcopal parish. But the decision to hold a prayer session for Trump sparked debate among Episcopalians opposed to his policies.

Bishop Mariann Budde of the Episcopal Diocese of Washington wrote in a blog post that while she shared “a sense of outrage at some of the president-elect’s words and actions,” she felt an obligation to welcome all people without qualification, especially those who disagree and need to find a way to work together.

The service took place as throngs of women, many of them wearing bright pink, pointy-eared hats, descended on the nation’s capital and other cities around the world Saturday for marches organized to push back against the new president. The presidential motorcade sped past the protesters.

Officials said the crowd in Washington for the women’s march could be more than half a million people, more than double expectations. The event appeared to have attracted more people than Trump’s inauguration, based on figures from transportation officials.

Trump arrived at the cathedral mid-morning. The service included readings and prayers from Protestant, Jewish, Sikh, Mormon, Buddhist, Roman Catholic, Baha’i, Episcopal, Hindu and Native American leaders. But the program was remarkable for the large number of evangelicals participating, including two former presidents of the Southern Baptist Convention, the country’s largest evangelical denomination. Several speakers had served as Trump advisers and supporters who spoke at the Republican National Convention.

Trump, a Presbyterian, is not a regular churchgoer. He does not attend weekly services in New York, but worships every Christmas at a church near his estate in Palm Beach, Florida. Trump courted evangelical voters during the presidential campaign and infused his inaugural address with references to God and quoted from the Bible’s book of Psalms during a call for national unity.

The president’s family joined him at the White House for his first weekend in office. His daughter Ivanka and her husband, senior White House adviser Jared Kushner, were seen snapping photos Saturday on the Truman balcony with a young girl who appeared to be their daughter.

The Justice Department released a memo concluding the president’s “special hiring authority” allows the New York real estate mogul to appoint Kushner to the administration and the move does not contravene federal anti-nepotism laws.

AP Religion Writer Rachel Zoll in New York and Associated Press writers Jonathan Lemire and Darlene Superville contributed to this report.

The post ‘I am so behind you,’ Trump tells CIA appeared first on PBS NewsHour.

President-elect Donald Trump arrives for the inauguration ceremonies swearing him in as the 45th president of the United States on the West front of the U.S. Capitol in Washington, D.C., on Jan. 20, 2017. Photo by Lucy Nicholson/Reuters

WASHINGTON — President Donald Trump’s first executive order targets the sweeping “Obamacare” law by giving federal agencies broad leeway to chip away at the measure. But Trump still needs Congress to do away with the law for good.

Trump signed the executive order in the Oval Office Friday, hours after being sworn in as the 45th president of the United States.

The one-page directive gives agencies authority to grant waivers, exemptions and delays of provisions in the Affordable Care Act. But until it becomes clear what steps federal agencies take as a result, its full impact on Americans and their health insurance is uncertain.

Here’s a look at Trump’s executive order:

___

Q: What does the order do?

A: Trump’s order states that federal agencies can grant waivers, exemptions and delays of “Obamacare” provisions that would impose costs on states or individuals. That language appears to be aimed squarely at undoing the law’s unpopular requirement that individuals carry health insurance or face fines — a key provision of the measure former President Barack Obama signed in 2010.

It’s not spelled out whether the IRS could waive the fines for failing to secure coverage and the White House has not explained how it wants agencies to respond to the order.

The measure also directs agencies to stop issuing regulations that would expand the health care law’s reach. And it says the federal government must allow states greater flexibility in carrying out health care programs.

“It’s a sign that the Trump administration is looking to unwind the law in every way it can administratively,” said Larry Levitt of the Kaiser Family Foundation, a nonpartisan clearinghouse for information and analysis about the health care system.

___

Q: Will people who get insurance under “Obamacare” lose their coverage as a result of Trump’s order?

A: The order doesn’t directly target the insurance marketplace at the center of the health care law. But some experts say that if the directive leads to broad exemptions from the law’s coverage requirement, it could scare off insurers.

Insurers see the coverage requirement, or so-called individual mandate, as an essential tool to nudge healthy people into the coverage pool. Without it, the companies and most independent experts believe premiums would spike, making HealthCare.gov’s insurance markets unsustainable.

Leslie Dach, campaign director of the Protect Our Care Coalition, issued a statement saying, “While President Trump may have promised a smooth transition, the executive order does the opposite, threatening disruption for health providers and patients.” He called the executive order “irresponsible.”

___

Q: How quickly will any changes take effect?

A: The executive order may not have much impact for 2017, since government rules for this year have already been incorporated into contracts signed with insurance companies.

Departments like Health and Human Services and Treasury will have to issue policies that embody the new president’s wishes.

The Trump administration can rewrite regulations carrying out the legislation. New regulations cannot be issued overnight, but would have to follow a legally established process that requires public notice and an opportunity for interested parties to comment on the administration’s changes.

___

Q: What is Congress’ plan for the Affordable Care Act?

A: With Republicans in control of both the White House and Congress, undoing Obama’s health care law is at the top of the party’s agenda for 2017.

There’s broad agreement among Republicans that the law should be repealed. But lawmakers are far less unified about what should take its place and how quickly a new measure should take effect.

Shortly before taking office, Trump said he wanted Congress to pass repeal and replace measures “essentially simultaneously.” That put some Republicans on edge, given the complexities of unwinding the current law.

Trump has also been vague about what he wants included in a replacement package, saying his administration will have a plan after the Senate confirms his nominee to lead the Department of Health and Human Services, Rep. Tom Price.

The president has said he wants to keep some of the measure’s more popular elements, including allowing young people to stay on their parents’ insurance until age 26 and preventing insurance companies from denying coverage to people with pre-exiting conditions.

The post How Trump’s executive order impacts future of the Affordable Care Act appeared first on PBS NewsHour.

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MEGAN THOMPSON: Democrat Steve Israel served in Congress from 2001 to 2016, representing a politically centrist district on Long Island.  A few years into his tenure, he co-founded the “center aisle caucus.”  The effort to foster bipartisanship regularly drew around 25 Democrats and 25 Republicans to a Chinese restaurant near Capitol Hill.

STEVE ISRAEL:  We had a kitchen timer. Five minutes to state your disagreements, and then 55 minutes to figure out where you could agree. It was sublime. It was so liberating. You know what I learned from that experience at center aisle caucus? Democrats and Republicans are going to disagree 75 percent of the time, and that’s okay. The problem with Washington is that we’re so busy beating each other up on 75 percent that we will never agree to that we forget that there’s 25 percent waiting to be passed. And that can be passed quickly.

MEGAN THOMPSON: Back in the capitol Israel found those agreements behind the scenes rarely became policy. One example – infrastructure.

STEVE ISRAEL:  So I’d have conversations with colleagues on the other side of the aisle who would say, “Yeah, we’re spending the lowest level of financing on infrastructure in recent history. We need to do more. We need to generate those investments.”  But they couldn’t say that in public because they would be tarred as tax and spenders. And they just couldn’t withstand that label.

CANDICE MILLER: Both parties are very, very partisan.

MEGAN THOMPSON: For 14 years, Republican Candice Miller represented Macomb County, Michigan, just north of Detroit, a swing area of a swing state, won twice by Barack Obama and then won by Donald trump. She was Michigan’s secretary of state before serving in Congress.

CANDICE MILLER: I’ve been used to reaching out across the aisle and working with Democrats. And we worked pretty well in Macomb County because of that. But then, of course, when I went to Congress I found it was a much more partisan environment.

MEGAN THOMPSON: She agrees with Israel — partisanship impedes progress on big issues.

CANDICE MILLER:  Whether that’s dealing with entitlements, or dealing with national defense, or dealing with so many things that face us, we need to come together in some ways on some of these huge issues..

MEGAN THOMPSON: With its Tea Party wing insurgent in 2010, Republicans picked up 63 seats and regained control of the House.

CANDICE MILLER: Well, I think that the Tea Party was a result of people around the country who were just absolutely fed up with the way that Washington was operating, particularly, I think in that case, of course, because the way that President Obama was really operating with all of the executive orders, with Obamacare. So many governmental overreaches. I think there was a huge pushback.

MEGAN THOMPSON: But, Miller says, the party’s shift to the right affected its own ability to get things done. In 2015, some of the most conservative house members formed the Freedom Caucus, which voted “no” as a bloc on many issues.

CANDICE MILLER: It really hindered, I think, the ability for the Republican conference when I was there even though we were in the majority we couldn’t get the optimal kind of bills that we were looking for done.

MEGAN THOMPSON: Israel says the polarization in Congress has grown because of partisan redistricting — the way states redrew House district lines following the 2010 Census.

STEVE ISRAEL: Too many Congressional districts are drawn to protect a Republican incumbent or a Democratic incumbent. And if they’re drawn to protect a Democratic or Republican incumbent, that incumbent necessarily has to cut further and further to the left or the right. If you had less partisan redistricting where districts were kind of drawn more towards the middle, you would have more meeting in the middle by members of Congress.

MEGAN THOMPSON: Israel supports taking the redistricting power away from state legislators and putting independent commissions in charge.  Miller says that’s not so simple.

CANDICE MILLER:  You’re never gonna take politics out of politics; it’s just impossible. So when they say, “Well, we’re gonna get a non-political group that’s gonna draw these lines.” Uh, Okay. (laugh) I don’t know if anyone believes that.  I don’t know who these nonpolitical people are, they’re gonna draw political lines that have no interest in politics?  Maybe.

MEGAN THOMPSON: Israel – who will now chair an institute on global issues at Long Island University –  left Congress in part because he came to dread the fundraising.

Not just for his own campaigns, but for fellow Democrats when he chaired the Democratic Congressional Campaign Committee.

STEVE ISRAEL: I actually calculated the amount of time that I spent raising money for my re-elections over 16 years: 4,200 hours on the phone asking people for money, dialing for dollars. 1600 separate cocktail parties. That’s 4,200 hours that I wasn’t spending trying to figure out how we’re gonna strengthen Medicare, trying to figure out how we’re gonna make sure that the middle class grows their paychecks.

MEGAN THOMPSON: The need for infrastructure improvements is one area where Israel and Miller see common ground.  In her new job as Macomb County public works commissioner, Miller has had to deal with a massive sinkhole caused by a broken sewer line.

CANDICE MILLER: That’s a very vivid demonstration of how our immediate area and quite frankly this could happen in lots of places in our country because we have not addressed infrastructure. We’ve not invested enough infrastructure. And so I’m very hopeful President Trump will be able to get a very good transportation and infrastructure investment bill through.

MEGAN THOMPSON: As Congress gets down to business under the new president, Miller and Israel have this advice for new members.

CANDICE MILLER: You might only be there for one session of Congress. You might be there for a much longer time. But be bold, don’t be afraid to be bold. Do the right thing, be bold. Never forget who you actually are representing, though. These are your bosses. And so always remember your constituents before you think about your party.

STEVE ISRAEL: Number one, find a friend with whom you disagree. Understand there are no absolutes in Washington. Most of the issues that you’re gonna be dealing with are actually in a gray area. And so find somebody who you like but somebody who you disagree with and start to learn from one another.

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IVETTE FELICIANO, PBS NEWSHOUR CORRESPONDENT: The first marchers began arriving near the Capitol building before dawn. There were women and men of all ages from all over the country, a mix of ethnic, religious, and class backgrounds. Among the many first-time demonstrators was Janet Chen (ph), who brought her eight-year-old daughter, Molly. They’re worried about the Republican rollback of Affordable Care Act, or Obamacare.

MOLLY CHEN, EIGHT-YEAR-OLD: I have a heart defect, and I want to get health insurance when I’m older, but I might not be able to.

JANET CHEN, DEMONSTRATOR: I think it’s important that the next generation of little girls stand up for women’s rights and realize there’s a real threat to women’s rights in this country right now with the incoming administration.

IVETTE FELICIANO: Debbie Snowdon (ph) came from North Carolina to support abortion rights and funding for Planned Parenthood.

DEBBIE SNOWDON, DEMONSTRATOR: It’s really important to me that they’re going to probably reverse Roe v. Wade, take away abortion rights in this country. I’m very concerned. I’m at an age when I can remember us fighting for those rights, and it’s really hard to believe we’re in danger of losing them.

IVETTE FELICIANO: While the overriding message we heard from people here was anti-Trump, the issues motivating marchers were as diverse as the crowds here.

Anjum Khan (ph), from Maryland, said she’s concerned about Muslim rights and Trump’s promise to ban Muslims from entering the country.

ANJUM KHAN, DEMONSTRATOR: When he said he’s going to eradicate Islamic terrorism, that’s wonderful! Like, yes, please do that. But in doing that, don’t trample on my rights.

IVETTE FELICIANO: Rohima Miah (ph) has marched on Washington before for civil rights and was among the protestors at the inauguration yesterday.

ROHIMA MIAH, DEMONSTRATOR: As a black woman with a 30-year-old black son that lives in New York City, it should be an issue for all people — that our children are safe.

IVETTE FELICIANO: Judy Ames (ph), a gay rights activist since the AIDS epidemic started in the 1980s, was here with a group of gay musicians.

JUDY AMES, DEMONSTRATOR: We just don’t think that women’s rights and civil rights and everybody’s rights should be just trampled on and thrown away. It’s ridiculous.

IVETTE FELICIANO: The march’s wide-ranging policy platform advocated for economic justice for women, keeping abortion access safe and legal, immigration reform, police accountability, union rights, sex worker rights, and environmental protection.

RHEA SUH, NRDC: Women matter.

(CHEERS AND APPLAUSE)

And we will not be shy about standing up to what matters to us.

(CHEERS AND APPLAUSE)

And here’s what matters to me: that my daughter inherits a world where a healthy environment is a basic right for all of us.

IVETTE FELICIANO: March leaders, like actress America Ferrera, whose parents are from Honduras, said their rights are under attack.

AMERICA FERRERA, ACTRESS: We are America!

(CHEERS AND APPLAUSE)

And we are here to stay. We will not go from being a nation of immigrants to a nation of ignorance.

IVETTE FELICIANO: Long-time political activist Gloria Steinem called on the crowd to use their “people power” to keep a close eye on the new president.

GLORIA STEINEM, POLITICAL ACTIVIST: Trump and his handlers have found a fox for every chicken coop in Washington. And his Twitter finger must not become a trigger finger.

IVETTE FELICIANO: Kristin Rowe-Finkbeiner, the head of the group, Moms Rising, called for equal pay for equal work.

KRISTIN ROWE-FINKBEINER, MOMS RISING: Women make 80 cents to a man’s dollar. Moms earn only 71 cents to a man’s dollar, and moms of color earn as low as 46 cents to a man’s dollar.

IVETTE FELICIANO: And activist filmmaker Michael Moore had this word of advice for the assembled women.

MICHAEL MOORE, ACTIVIST FILMMAKER: You have to run for office! You! Yes, you!

SEN. KAMALA HARRIS (D), CALIFORNIA: Even if you’re not sitting in the White House, even if you’re not a member of the United States Congress, even if you don’t run a big corporate super PAC, you have the power! And we the people have the power.

IVETTE FELICIANO: After the speeches, the protesters intended to march about two and a half miles from near the Capitol, along the National Mall, to the White House. But they were unable to do that due to the size of their crowd.

The same thing happened in Chicago, where 150,000 people turned up for a rally in Chicago’s Grant Park — so many more than expected. In New York, some 200,000 people rallied outside the United Nations before marching through Manhattan in support of human and civil rights. In Los Angeles, tens of thousands of demonstrators converged on downtown’s Pershing Square.

Overseas, thousands of Trump protesters took to the streets of London. In Paris, thousands marched near the Eiffel Tower carrying signs saying: “We have our eyes on you, Mr. Trump.” Among the thousands of trump protesters in Sydney, Australia, one woman said, “We want to send the sign to the women in the U.S. that we are all in this together.”

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ALISON STEWART, PBS NEWSHOUR WEEKEND ANCHOR: The only cabinet level Trump appointees confirmed by the U.S. Senate so far are Defense Secretary James Mattis and Homeland Security Secretary John Kelly, both former Marine Corps generals. Also on the job is Trump national security adviser, Michael Flynn, who did not require confirmation. But many vacancies in the administration’s national security team remain.

Joining me now from Washington to discuss it is “Politico” correspondent Michael Crowley.

Michael, so President Trump visited the CIA today and he was very complimentary. But as we know through most of the transition, he’s basically derided the agency.

So, how does that relationship moved forward and what should be looking for — looking at as it moves forward?

MICHAEL CROWLEY, POLITICO: Well, I think as Trump himself said at the CIA today, he’s going to have his own director. His nominee is Mike Pompeo, who’s a Republican congressman. Now, Democrats are putting up a little more of a fight that had been expected a couple of days ago. It’s not guaranteed that Pompeo is going to go through.

But I think the Trump team’s view is that the heads of the intelligence community at the top levels were Obama appointees and at the CIA, you have John Brennan, who has already resigned, and also, likewise, the Director of National Intelligence Jim Clapper has also resigned. And I think there was, you know, not a good relationship between Trump and either of those men. So, he’s going to have Pompeo coming in at the CIA, and probably former Republican Senator Dan Coats coming as Director of National Intelligence.

And I think the hope on his team is that that will be a fresh start. You won’t have, you know, kind of mistrust — you know, a poisoned well that you might have with those guys who are on their way out.

But the last thing I’ll say about that is I don’t think that solves the problem. I mean, among the rank and file, I think there’s a lot of confusion, distrust and even anger at the way Trump has talked about the intelligence community the last several weeks. So, just changing the leadership isn’t going to solve the problem. And I don’t know how he fixes it. It’s really going to depend on I think whether he takes their advice, seems to take them seriously, listens to them, and whether his new senior leadership can kind of repair the relationship moving downward.

ALISON STEWART: So far, what has Mr. Trump signaled as his national security priorities?

MICHAEL CROWLEY: Well, I think that he has made clear that possibly, his top priority — I mean, he — you know, make America great again, of course. And as he said in his inaugural speech, “America first”. So, he is saying that he wants to reorient our foreign policy in a way that — you know, the way I hear it — spends less money and blood and treasure overseas defending allies, building out the militaries of our allies so they can protect themselves. It’s a little bit more of you’re on your own attitude toward our global alliances, including the NATO alliance, for instance. That has left our allies very unsettled.

I think when you kind of get in to policy issues, really, fighting ISIS and Islamic radicalism are at the top of his list. He seems to think that there’s almost nothing that’s worth using our military in diplomacy for beyond crushing ISIS and crushing it’s, you know, kind of similar organizations like al Qaeda. But he has not really spelled out in policy terms how that would work, what he would do that’s so different from the Obama administration.

Last thing very quickly, of course, he’s made clear that he wants to have a new relationship with Russia, which is going to be a very tricky and controversial thing to do, given the cloud, frankly, over his inauguration related to reports that Russia interfered in the U.S. election to Trump’s benefit.

ALISON STEWART: Michael Crowley from “POLITICO” — thanks so much.

MICHAEL CROWLEY: Thanks for having me.

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ALISON STEWART, PBS NEWSHOUR WEEKEND ANCHOR:  Joining me here in the studio to discuss the start of the Trump presidency is “NewsHour Weekend’s” Jeff Greenfield.

Jeff, you were a speechwriter for Senator Robert F. Kennedy.  So, what struck you about the Trump inaugural speech?

JEFF GREENFIELD, NEWSHOUR WEEKEND:  How much it was consistent with the most forceful arguments of his campaign.  There was very little give in saying, “OK, now that I’m president, I’ve got to be a little different.”  Yes, there were touches about “we have to be together and we’ll be unified.”

But the central arguments of his campaign, that the big shots in Washington have betrayed you, have gotten rich and powerful at your expense, and all those countries overseas have prospered at your expense, was front and center in the speech.  And I did not expect the speech — actually, I was wondering before, would he be as forceful and blunt and tough about that as he was in the campaign?  And the answer was yes.

ALISON STEWART:  One of the phrase that jumped out to a lot of people was “America first”, because it has a fraught past.  And it also gives us a signal to what he might be thinking about going forward, the way he’s going to steer policy.

JEFF GREENFIELD:  Right, the history is that that the end of the 1930s, people who were opposed to helping the Great Britain resists Hitler didn’t want us to have any possibility of entering that war formed the America First Committee, and it was actually a fairly distinguish committee for a while.  You know, people like Norman Thomas, a socialist leader, the publishers of powerful newspapers, Gerry Ford, John Kennedy, both contributed to it.  But Charles Lindbergh, the famous aviator, who was their principal spokesperson, gave a speech where he suggests that American Jews, with all their power in the media, were going to drag us into that war.  So, it has a very bad, you know, context.

The broader context that we’re going to put America’s interest first, that’s much more traditional, at least in the years before World War II and the more international aspect of American life.

But it certainly suggests that, you know, once again, what he said he would do in the campaign is something that he thinks he can do.  If I were a foreign leader or an analyst abroad, I’d be very, very concerned with what the real implications of that are.

ALISON STEWART:  Well, from that speech, what should we be looking for in terms of policy?

JEFF GREENFIELD:One of the things that if I were a Republican leader in Congress would give me a little bit of agita is that when he says the establishment has betrayed middle-class and working class people.  He’s talking about both parties.  It’s another reminder, in effect, he is a third-party candidate who happened to get control of one of the two major parties.

So, on issues like big infrastructure program, for instance, which is not part of the Republican playbook —

ALISON STEWART:  They’re not going to be so happy about spending money on infrastructure.

JEFF GREENFIELD: That’s part of it.  Free trade has been part and parcel of the Republican playbook for 60 years or more.  He is clearly not a free trader.

And then when he says, “We’re going to have insurance for everybody”, which is at least something he said in one of his interviews — well, how does that square with the Republican congressional agenda which no matter what plan you look at, looks to be a lot more cost effective, is one way to put it, or penurious in terms of coverage.

So, there are some signals there from the inaugural, to the shock of some people in Washington, that he apparently means to try to do what he said he was going to try to do.

ALISON STEWART: Mr. Trump’s speech had a phrase in it, “American carnage”.

JEFF GREENFIELD:  Yes.

ALISON STEWART:  Now, the fact checkers jumped right on top of this, saying, by all economic indicators, we are in a much better position than we were, say, eight years ago.  So, what is he trying to do there?  What is he getting at with American carnage?

JEFF GREENFIELD:   It’s almost the same message he had in his acceptance speech.  He sees — Reagan once called it “Morning in America”, he sees midnight in America.  And what he sees are people who’ve been left behind and defines that as a country as a whole.  So, the fact checkers are right in terms of, you know, 4.7 percent unemployment, real wages are actually rising.  But he’s talking about the people who formed the core of his support who have been left behind by globalization, by new technologies, and who are not as well off as they were.

Now, you know, defining that group of Americans as the country as a whole seems to be kind of myopic.  But it is the precise reason why those people who are for him in those real areas in the Rust Belt were so passionate for him.

ALISON STEWART:  Jeff, let’s talk about today’s events, the huge protests that are happening in major cities, and in smaller cities all across the country.  It’s the Women’s March in Washington.  And if you go to their website, this is their stated purpose: for the protection of our rights, our safety, our health and our families, recognizing that our vibrant and diverse communities are the strength of our country.

Given the size of these marches and the — and how far spread they are around the globe, it seems like it’s more than that.

JEFF GREENFIELD:  I think it is really almost a primal expression of fear, anger, determination to push back on Donald Trump.  Whether it’s what he’s had to say about women, the actions that he’s boasted of, his positions on things like abortion and Planned Parenthood.  But I think it would be a mistake to look at this march as a singular march.  The definition that you gave us, that’s pretty broad.  That can mean everything from affordable health care to pay equity to, you know, abortion to gay rights to —

ALISON STEWART:  Climate.

JEFF GREENFIELD:  Yes.  So I don’t — I think it’s different from, for instance, the marches about Vietnam or the right-to-life march that will happen in a few weeks.  We know what those marches are about and you can be very specific.  I just think in this case, it’s much more of a very wide coalition of people who just still are in a state of almost shock that Donald Trump is the president of the United States.

ALISON STEWART:  Jeff Greenfield, thanks so much.

JEFF GREENFIELD:  Pleasure.

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U.S. President Donald Trump delivers remarks during a visit to the Central Intelligence Agency (CIA) in Langley, Virginia U.S. January 21, 2017. Photo by Carlos Barria/Reuters

WASHINGTON — President Donald Trump, who spent his first full day in office berating the media over their coverage of his inauguration, will spend Sunday engaged in more routine matters, like overseeing the swearing in of high-level staffers.

On the second full day of his administration, Trump will see the “assistants to the president” sworn in, according to his press secretary, Sean Spicer. He’ll also hold a reception for law enforcement officers and first responders who helped with his inauguration as he celebrates his 12th wedding anniversary.

White House staff are scheduled to have a briefing on ethics and another on the proper use and handling of classified information as they begin to make themselves comfortable in their new White House offices.

While Trump has said that he’ll consider Monday his first real day in office, he is already making clear that sparring with the press will be a defining aspect of his administration.

Trump turned a bridge-building first visit to CIA headquarters on Saturday into an airing of grievances about “dishonest” journalists, while wildly overstating the size of the crowd that gathered on the National Mall as he took the oath of office. Trump said throngs “went all the way back to the Washington monument,” despite photos and live video showing the crowd stopping well short of the landmark.

Comparison: Donald Trump and Barack Obama’s inauguration crowds

Standing in front of a memorial for fallen CIA agents, Trump assured intelligence officials, “I am so behind you.” He made no mention of his repeated criticism of the intelligence agencies following the election, including his public challenges of their high-confidence assessment that Russia meddled in the White House race to help him win.

“There is nobody that feels stronger about the intelligence community and CIA than Donald Trump,” he said, blaming any suggestion of a “feud” on the media.

Trump’s visit took place as throngs of women, many of them wearing bright pink, pointy-eared hats, descended on the nation’s capital and other cities around the world for marches organized to push back against the new president. Hundreds of protesters lined the motorcade route as Trump sped back to the White House, many screaming and chanting at the president.

The Washington rally alone attracted more than 500,000 people by the unofficial estimate of city officials. It appeared to be more people than attended Trump’s inauguration on Friday, but there were no comparable numbers. The city did not release an estimate for the inauguration. The National Park Service does not provide crowd counts.

Suggestions of weak enthusiasm for his inauguration clearly irked the new president. Shortly after his remarks, Trump dispatched Spicer to aggressively reinforce the message.

“There’s been a lot of talk in the media about holding Donald Trump accountable. And I’m here to tell you that it goes two ways. We’re going to hold the press accountable as well,” Spicer said in his first appearance in the White House briefing room.

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Participants demonstrate in front of Trump International Hotel during the Women’s March on Washington, following the inauguration of U.S. President Donald Trump, in Washington, D.C., on Jan. 21, 2017. Photo by Brian Snyder/Reuters

WASHINGTON — Red, white and blue balloons rained down over crystal chandeliers in the soaring atrium of the Trump International Hotel at midnight in “a new inaugural tradition,” its social media account promised.

But while President Donald Trump’s hotel in Washington did serve as a hub of Friday’s inaugural activities, it also stands as ground zero for what top Democrats and some ethics advisers see as his unique web of conflicts of interest.

Trump’s lease with the federal government to develop and operate a hotel inside the historic Old Post Office building expressly prohibits any elected official from benefiting from the property, yet Trump has not divested from his company or this particular project.

The government’s General Services Administration previously said it would refrain from commenting on the apparent contract violation until Trump took office, which he did at noon Friday. The agency did not respond to requests for comment.

“I think it’s a simple matter of amending the lease,” said Patrick Keogh, a real estate investor in Austin, Texas, who has developed projects for the GSA and other federal agencies. He said Ivanka Trump, the president’s daughter and chief negotiator on the hotel, should ask the GSA to exempt her father from that provision of the contract. The GSA should make the process public and transparent, Keogh said.

Others say Trump must relinquish ownership of the hotel. More broadly, they argue, Trump should sell off his company and put the cash into a blind trust as previous presidents have done. He is not legally required to do so, but it’s become common for presidents to separate themselves from their personal finances to avoid any possible conflicts with national policy.

The liberal-funded watchdog group Citizens for Responsibility and Ethics in Washington complained to the GSA that it should terminate its deal or take legal action because the president had violated the conditions of the lease. The American Civil Liberties Union said it had filed a Freedom of Information Act request for documents about Trump’s conflicts of interest, including any recent memos, emails and other private communications on the issue with his transition team.

The Washington hotel also attracted protesters on Friday and Saturday. People participating in the women’s march Saturday booed in unison as they walked by, and many left their protest signs in front of the building.

Trump handed control of his international real estate development, property management and licensing company to his two adult sons. To help ease the appearance of conflicts of interest, the company said it would not enter into any new international deals, promised to hire a compliance officer and ethics adviser to vet domestic deals, donate foreign profit from its hotels and refrain from doing anything that could be perceived as exploiting the office of the presidency.

“The Trump Organization has directed that no communications of the organization, including social media accounts, will reference or otherwise be tied to President-elect Trump’s role as president of the United States or the office of the presidency,” a company attorney wrote in a briefing released earlier this month.

Trump has voluntarily taken these measures, since few conflict laws apply to the president or vice president. That means people will have to trust that the president and his company are following through.

“We are waiting for you Mr. President! Thank you!” Trump’s Washington hotel wrote on its Twitter account shortly before the president was scheduled to roll past the Pennsylvania Avenue property as part of the inaugural parade. Indeed, Trump hopped out of his motorcade to walk and wave in front of the hotel.

The tweet would appear to violate the company’s no-reference-to-the-president policy.

Trump Organization representatives did not respond to requests for comment.

Patricia Tang, the Washington hotel’s director of sales and marketing — who said she was responsible for social media — did not directly answer a questions about the possible violation. But she said, “We have nothing to do with the administration. We have nothing to do with the presidency. We just want to be the best possible luxury hotel that we can be.”

The new White House raised eyebrows on its first day by posting on its official website a biography of first lady Melania Trump that included an explicit reference to her jewelry collection, which it noted was sold on the home-shopping channel QVC. By Saturday, that line had been edited and simplified to say that she had “launched her own jewelry collection.”

A spokeswoman for the first lady said the website was updated out of “an abundance of caution” and that the jewelry line is no longer available in any case.

There have also been questions about what the Trump Organization means by no “new” foreign deals.

Earlier this week, the company confirmed it wanted to expand at one of its Scottish resorts, including plans to add a golf course. A spokeswoman for the resort said the expansion is just another “phase” of a project outlined in a planning document approved by the local government years ago, and so did not break any Trump promise.

But Richard Painter, chief ethics lawyer under former President George W. Bush, said every phase of a real estate project is like a new deal, requiring financing and government permits, and allowing foreigners to hold something back that the president might want in hopes he will shape public policy in their favor.

Trump’s administration addressed one potential conflict when the Justice Department on Saturday said federal anti-nepotism laws do not prevent the president from appointing his son-in-law to his administration. That clears the way for Jared Kushner, Ivanka Trump’s husband, to take a post as a senior adviser.

Federal anti-nepotism laws prevent relatives from being appointed to government positions. The Trump transition team argued, and a career Justice attorney agreed, the laws apply to jobs in federal agencies, not White House posts.

Associated Press writers Bernard Condon in New York and Darlene Superville in Washington contributed to this report.

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Paul Rooks, left, 49, his wife Ester, center, and son Damon chat in their home while waiting to depart for the clinic on the Pine Ridge Indian Reservation in South Dakota on June 25, 2001. A member of the Oglala Lakota tribe, Mr. Rooks has kidney failure brought on by diabetes. According to the American Diabetes Association, Native American diabetics are six times more likely to suffer renal failure than others who have the disease. Photo via Reuters

Native American populations, heavily afflicted by diabetes during the last several decades, have seen a dramatic decrease in kidney failures often related to the disease, the Centers for Disease Control and Prevention disclosed earlier this month.

The CDC announced that between 1996 and 2013 there was a 54 percent reduction in the number of diabetes-related kidney failures, called end-stage renal disease.

The data in the CDC report stated that Type-2 Diabetes still causes two out of three kidney failures in Native Americans.

Native American communities have the highest proportion of diabetes among all U.S. populations. About 16 percent of adult Native American people have diabetes, compared with the national average for all adults of 9.3 percent, or 29 million people, according to 2014 statistics from the CDC.

According to the Indian Health Service, a federal agency charged with improving the health of an estimated 2.2 million Native Americans (AI) and Alaska Natives (AN), an aggressive campaign to educate and treat diabetes, bolstered by the support of $150 million in annual federal funding through the Special Diabetes Program for Indians (SDPI), played a large part in the reductions. “We’re very rural … Our patients don’t have access like the rest of the country. It’s getting out to those people, identifying them and getting the resources.” — Jared Eagle, director of the Ft. Berthold Diabetes Program

“This decline is especially remarkable given the well-documented health and socioeconomic disparities in the AI/AN population, including poverty, limited health care resources and disproportionate burden of many health problems,” the CDC report stated.

The CDC told the NewsHour that in 1996, 673 Native Americans started treatment for kidney failure and in 2013 that number rose to 705. However, while the number of new incidents increased, the overall Native American population also went up considerably resulting in a decrease in the overall percentage of cases.

Dr. Ann Bullock, director of the Division of Diabetes Treatment and Prevention for IHS, said the program targets both rural and urban populations with efforts beginning in the 1980s.

Since 1997, the program has provided grants for diabetes prevention and treatment to more than 400 Indian Health Service locations, tribal committees and urban centers — allowing more people to have access to diabetes clinical teams, to adult weight management programs, to medicines that protect kidneys and to strategies that catch at-risk patients before diabetes begins.

In a 2014 report to Congress, IHS stated diabetes prevention and healthy living programs helped decreases in kidney disease in Native American communities, where high rates of obesity are common and access to healthy food options and medical facilities are often scant.

Nancy Haugen, a diabetes consultant for the IHS, said her outfit covers approximately 130,000 Native Americans and 17 tribes in North Dakota, South Dakota, Iowa and Nebraska. Many of the on-the-ground practices used to decrease the number of kidney failures related to diabetes were also used in those states.

She said many people live far away from medical care, don’t have sick leave or access to food or gas money.

“You’re not just treating the people who darken your door,” Haugen said. “Public health workers get out and check on some of these people.”

She said that early intervention is key in reducing kidney-related diseases, one of the factors that created a heft of diabetes in Native communities. Such tactics include screening activities, health fairs and fitness challenges at schools.

Depending on the location and the involvement, things like community gardens, canning and preserving classes, programs on traditional foods and the creation of health centers can also be a part of the process.

“Some of the programs started out in the beginning with 10 participants in 2008,” Haugen said. “And now have 400 people showing up.”

The Ft. Berthold Diabetes Program in North Dakota holds regular fitness classes as part of a Indian Health Service program to address high numbers of diabetes and kidney failures in Native American communities. Shown here are participants in a Zumba class. Photo Courtesy of Indian Health Service.

Jared Eagle runs one of those localized efforts as director of the Ft. Berthold Diabetes Program on the Fort Berthold Indian Reservation in North Dakota. He said the rural area he represents covers 250 square miles — including the Mandan, Hidatsa and Sahnish Nation and six communities — with much of the population living on the reservation. Many lack easy access to healthy foods.

“We definitely do live in a food desert,” Eagle said.

The community is made up of about 7,000 people, with a 13 percent rate of diabetes. At least 21 people have kidney disease. The nearest hospital is approximately 80 miles away, and those who need specialized care for diabetes or kidney disease sometimes have to travel 150 miles, or roughly two hours by vehicle, to Bismarck.

“We’re very rural,” he said. “Our patients don’t have access like the rest of the country. It’s getting out to those people, identifying them and getting the resources.”

Ft. Berthold has one main health center and several satellite clinics, some of them no bigger than a single room. A diabetes specialist travels to the region once a month to examine patients. Eagle said part of the program helps patients navigate the healthcare process or travel to appointments that can be hours away.

The area also has one main pharmacy and a small laboratory for basic work. The program has helped fund fitness centers in various parts of the reservation but many of the people who live in the community are overweight, Eagle said.

“The thought process is that if you’re not overweight, you’re kind of out of the norm,” he said.

Much of the SDPI funding in Eagle’s district has gone to preventative measures targeting the 1,300 hundred school children in the community. This includes regular blood tests that look for signs of diabetes, screenings for height and weight and a range of programs that urge healthier lifestyles.

Eagle said some of those lessons are spilling over into the community at large, including among adults, with people over 40 having significantly higher rates of diabetes and kidney disease.

“We’re getting the promotion out and the people are starting to recognize it and look forward to it,” Eagle said. “We’re starting to see the effects of that.”

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Thousands of people participate in a Women’s March to protest against President Donald Trump in New York City on Jan. 21, 2017. Photo by Stephanie Keith/Reuters

WASHINGTON — President Donald Trump on Sunday offered a scattershot response to the sweeping post-inauguration protests against his new administration, sarcastically undermining the public opposition and then defending demonstrators’ rights a short time later.

“Watched protests yesterday but was under the impression that we just had an election! Why didn’t these people vote? Celebs hurt cause badly,” tweeted Trump, at 7:51 a.m.

Ninety-five minutes later, he struck a more conciliatory tone.

“Peaceful protests are a hallmark of our democracy. Even if I don’t always agree, I recognize the rights of people to express their views,” the president tweeted at 9:26 am.

While Trump has said that he considers Monday his first real day in office, his discordant reaction underscored that the new president has little intention of changing the defiant approach that defined his campaign — particularly when it comes to the media and those who oppose him.

The dueling tweets marked his administration’s first response to the more than 1 million people who rallied at women’s marches in Washington and cities across the world. Hundreds of protesters lined the street as Trump’s motorcade drove past on Saturday afternoon, with many screaming and chanting.

The Washington rally appeared to attract more people than attended Trump’s inauguration on Friday, but there were no completely comparable numbers. Regional transportation officials tweeted on Sunday that 1,001,616 trips were taken on the rail system on Saturday. Metro spokesman Dan Stessel had said that on Friday, the day of Donald Trump’s inauguration, just over 570,000 trips were taken on the rail system.

Even suggestions of weak enthusiasm for his inauguration clearly irked the new president.

Trump spent his first full day in office berating the media over their coverage of his inauguration, using a bridge-building visit to CIA headquarters to air grievances about “dishonest” journalists and wildly overstating the size of the crowd that gathered on the National Mall as he took the oath of office.

Trump said throngs “went all the way back to the Washington monument,” despite photos and live video showing the crowd stopping well short of the landmark.

READ NEXT: Comparison: Donald Trump and Barack Obama’s inauguration crowds

In talk show interviews Sunday, advisers defended Trump’s anger at journalists for correctly reporting that his inauguration drew a smaller crowd President Barack Obama did eight years ago, saying the Trump administration was supplying “alternative facts.”

“There’s no way to really quantify crowds. We all know that. You can laugh at me all you want,” Kellyanne Conway told NBC’s “Meet The Press.” She added: “I think it’s actually symbolic of the way we’re treated by the press.”

Aides also made clear that Trump will not release his tax returns now that he’s taken office, breaking with a decades-long tradition of transparency. Every president since 1976 has released the information.

Throughout the campaign, Trump refused to make his filings public, saying they’re under audit by the Internal Revenue Service and he’d release them only once that review is complete. Tax experts and IRS Commissioner John Koskinen said such audits don’t bar taxpayers from releasing returns.

“He’s not going to release his tax returns. We litigated this all through the election. People didn’t care,” Conway said on ABC’s “This Week.”

Trump’s Sunday plans were to include a telephone conversation with Israeli Prime Minister Benjamin Netanyahu, who told his Cabinet that the call would cover the Israeli-Palestinian conflict, Syria, Iran and other issues.

Also on tap: the swearing-in of presidential assistants and a reception for law enforcement officers and first responders who helped with his inauguration.

Sunday also was his 12th wedding anniversary.

His chief of staff, Reince Priebus, said on “Fox News Sunday” that Trump would spend his first full week in office undoing some of his predecessor’s agenda and planned to sign executive orders on immigration and trade.

Priebus did not provide specifics but during the campaign, Trump pledged to scuttle trade deals such as a pending Asia-Pacific agreement and overturn Obama’s executive order deferring deportations for 700,000 people who were brought into the country illegally as minors.

Later in the week, he’ll address congressional Republicans at their retreat in Philadelphia and meet with British Prime Minister Theresa May.

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BREAKING: Gov. Deal declares state of emergency for seven South Central Georgia counties | We'll have LIVE at Noon pic.twitter.com/SSHS56H7W4

— WSB-TV (@wsbtv) January 22, 2017

Severe weather killed at least 11 people and injured 23 others overnight in portions of southern Georgia, the state’s Emergency Management Agency said on Sunday.

Catherine Howden, a spokesperson for the agency, told the Associated Press the deaths took place in Cook, Brooks and Berrien counties. Tornado warnings had been issued for the region on Saturday, though Howden did not specify whether they caused the deaths.

Seven South Central Georgia Counties impacted by severe weather are under a SOE issued by @GovernorDeal. More here: https://t.co/xBovZWDL5w pic.twitter.com/viLVjRmtCZ

— Georgia EM&HS (@GeorgiaEMA) January 22, 2017

Of the 11 confirmed fatalities, seven took place in Cook County, where injured patients were transferred from the cities of Adel and Tifton to area hospitals.

Calls for comment on Sunday from the Georgia Emergency Management Agency were not immediately returned. But Cook County Coroner Tim Purvis told the BBC that more than half of 40 mobile homes were destroyed in Adel. Brooks County Coroner Michael Miller said two people were killed when a mobile home there was destroyed by a tornado.

The National Weather Service said on Saturday that “a severe thunderstorm and tornado outbreak” were expected to strike north Florida and south Georgia. On Sunday, damaging winds and isolated tornadoes continued across portions of the south, including Florida and South Carolina. Reports of downed trees, damaged homes and flooding were prevalent.

Four more people were killed early on Saturday in Mississippi after a 25-mile-wide tornado with winds of more than 136 mph barreled through parts of the state. At least 50 people were reported injured.

Saturday’s storm also hit Texas, Alabama, Louisiana and South Carolina, causing flooding, power outages and damaged homes.

“The total debris clean-up will be weeks at this point,” said Lee Smithson, of the Mississippi Emergency Management Agency.

The post At least 11 dead in Georgia storm appeared first on PBS NewsHour.

U.S. President-elect Donald Trump greets outgoing President Barack Obama before Trump is inaugurated during ceremonies on the Capitol in Washington, D.C., on Jan. 20, 2017. Photo by Carlos Barria/Reuters

WASHINGTON — Donald Trump has promised to change Washington, and he surely will. Yet while he may play some wild cards in the realms of medicine, science, and public health, you can also look for some surprising continuity with President Obama’s administration.

Here’s our preview of what to expect.

DISEASE OUTBREAKS

The H1N1 flu pandemic broke out within Obama’s first few months in office, and nearly 61 million Americans eventually contracted it. He later had to contend with the worst outbreak of Ebola in history, which left thousands dead in Africa and led to some hysteria stateside, and the unexpected rise of Zika.

The White House and Congress were stalled for months trying to reach agreement to fund the Zika response, a precedent that worries many outside groups. Ambitious efforts to shore up the international infrastructure to stop epidemics before they come to the United States are at risk as a result.

Still, the general verdict is that the president handled these crises calmly and with scientific rigor. Most recently, the administration spearheaded an effort that could lead to a Zika vaccine being produced in record time.

Trump could not be more different. Where Obama was calm, perhaps a little aloof in his critics’ eyes, the president-elect was often sensationalist.

“A single Ebola carrier infects 2 others at a minimum,” Trump tweeted in November 2014. “STOP THE FLIGHTS! NO VISAS FROM EBOLA STRICKEN COUNTRIES!”

He even became conspiratorial at times, casting doubt on the scientific consensus.

“Ebola is much easier to transmit than the CDC and government representatives are admitting,” he said that October. “Spreading all over Africa-and fast. Stop flights[.]”

As for the Zika outbreak, which unfolded during the presidential campaign, Trump never expressed much interest in the issue. In one notable interview, he largely deferred to Florida Governor Rick Scott on what should be done to stop the global health crisis.

Our verdict: Things are going to change.

OPIOID CRISIS

Perhaps no issue has attracted as much bipartisan consensus as the heroin and painkiller epidemic, which is now killing more than 30,000 Americans a year.

In his last months in office, Obama signed the first major legislation to address the crisis and another bill that provided $1 billion in funding for those programs. His surgeon general produced a landmark report explaining the origins of the crisis and outlining a comprehensive vision to stop it.

Trump, too, takes the crisis seriously. He said repeatedly on the campaign trail how much he had heard about it from supporters in states like Ohio and Pennsylvania.

“The incoming administration has acknowledged the issue,” Dave Zook, who lobbies on behalf of the Collaborative for Effective Prescription Opioid Policies, told STAT after the election. “Obviously a lot of the impact is in the red areas of the map.”

In the final weeks of the campaign, Trump laid out a detailed plan for addressing the crisis. He emphasized the need for better addiction treatment and reiterated policies supported by Obama, such as raising the cap on how many patients doctors can treat for opioid addiction.

Trump could focus more on law enforcement than Obama did — he liked to say on the trail that his proposed wall on the Mexican border would keep out heroin along with undocumented immigrants. But unless the president-elect departs dramatically from his campaign rhetoric, he will largely build on what Obama has started.

Our verdict: More of the same.

MEDICAL RESEARCH

Obama’s tenure will be remembered for its big ideas: the cancer moonshot, the Precision Medicine Initiative, the BRAIN Initiative.

They weren’t always popular — critics of the National Institutes of Health under Obama would say it was too enamored with these headline-grabbing projects — but nobody doubted the president felt strongly that the federal government should be devoted to medical research.

Nobody can be sure if Trump feels the same way.

He and his family do have relationships with renowned medical institutions such as the Dana-Farber Cancer Institute and St. Jude Children’s Research Hospital. One of his advisers over the last year has been Newt Gingrich, the former House speaker who initiated the doubling of NIH’s budget in the 1990s and wants to see it doubled again. Gingrich told STAT that Trump is seriously considering keeping Obama’s NIH director, Dr. Francis Collins, which would allow those big projects to continue.

But the rest of Trump’s record worries many scientists and advocacy groups. He has flirted with anti-vaccination rhetoric, to the point that anti-vaccine groups think they will now have an ally in the White House. He told a conservative radio host that he had heard “terrible” things about NIH, though he wasn’t any more specific.

His vice president and health secretary nominee are opponents of embryonic stem cell research. His pick to head the Office of Management and Budget questioned whether there should be any government funding of research. One of his top White House health policy aides has linked some forms of birth control to abortion.

Then there is Peter Thiel. The Silicon Valley billionaire is said to be wielding tremendous influence over science-related personnel in the new administration. He has been in touch with former NIH director Elias Zerhouni about a top science post in the Trump White House.

“Thiel is the only silver lining I see in the administration,” one scientist who has been affiliated with Thiel told STAT. “He’s pro-science, anti-regulation.”

But others are wary. Thiel is known to have an interest in what many consider fringe science, such as anti-aging projects.

Trump’s personnel decisions should ultimately provide some clarity on how his administration will approach medical research. Until then, it’s hard to know.

Our verdict: Unclear.

PRESCRIPTION DRUGS

Though skyrocketing drug prices became a major news story in the last years of Obama’s presidency, he was never really at the forefront of the efforts to crack down on the cost of medicine.

It may have been in part a tactical decision. Drug makers were big boosters of the president’s health care plan in 2009, and they struck a deal with the White House that allowed them to avoid more direct price controls.

When the administration did move to address drug costs, with an ambitious Medicare experiment under an office created by the health care law, pharma fought back and the administration eventually backed off.

Trump, meanwhile, is unorthodox (to say the least) for a Republican when it comes to drug pricing. During the campaign, he endorsed allowing Medicare to directly negotiate the prices it pays for medications.

After his win, biotech stocks initially jumped, amid industry relief that they’d been spared from Hillary Clinton — who had promised a much more aggressive pricing crackdown. That didn’t last long, though. Trump told TIME magazine he wanted to bring down drug prices, and stocks fell. The bully pulpit will loom large in the Trump era; a single tweet can erase millions of dollars on Wall Street.

But, in the end, many people in Washington are skeptical much will change for drug companies. While Trump has his idiosyncrasies, the underlying facts that make the industry so influential with lawmakers — its sizable coffers and strong support among lawmakers of both parties — have not changed.

“The Republicans in Congress have no stomach for doing a regulatory scheme on drug pricing. It’s not their bag,” Ira Loss, senior health care analyst at Washington Analysis, said. “They don’t want to bother the people in R&D. In all honesty, Obama doesn’t want to bother those people either.”

Our verdict: More of the same.

OBAMACARE AND MEDICARE

The Affordable Care Act is a major piece of Obama’s legacy. It has insured upward of 20 million people and brought the US uninsured rate to historic lows. It has been the catalyst for major changes in how health care is paid for and delivered, while providing many benefits (such as free preventive services) that many Americans may not have understood.

However, the law’s marketplaces have struggled to stabilize and insurers have dropped out of the market at an alarming rate. Many people have faced high deductibles and narrow networks in the plans they’ve purchased through these exchanges.

The law is still highly divisive and Republicans, including Trump, have campaigned for years on the promise to repeal it. Now they’ll have their chance. It won’t be an easy task and many details must be hashed out, but there seems to be general GOP unity about largely dismantling the ACA.

But on Medicare, Trump could find himself at odds with Republican leaders — and more in line with Obama.

House Speaker Paul Ryan and Congressman Tom Price, Trump’s nominee for health secretary, have supported a major overhaul of the program. Trump, on the other hand, has said repeatedly that he would not support cuts to Medicare and that he wants to save it.

As he often said on the campaign trail: “We’re going to protect our Medicare.”

Our verdict: Unclear.

This article is reproduced with permission from STAT. It was first published on Jan. 9, 2017. Find the original story here.

The post A guide to Obama and Trump’s differences on health policy appeared first on PBS NewsHour.

Rex Tillerson, chairman and CEO of ExxonMobil, testifies about the company’s acquisition of XTO Energy before the House Energy and Environment Subcommittee on Capitol Hill in Washington, D.C., in 2010. Photo by Joshua Roberts/Reuters

WASHINGTON — Rex Tillerson, the former Exxon Mobil executive with close business ties to Russia, saw his prospects of becoming secretary of state brighten Sunday after gaining the support of two influential Republican senators who had wavered on the nomination.

“Though we still have concerns about his past dealings with the Russian government and President Vladimir Putin, we believe that Mr. Tillerson can be an effective advocate for U.S. interests,” Sens. John McCain, R-Ariz., and Lindsey Graham, R-S.C., said in a statement.

Many Democrats and Republicans McCain, Graham and Sen. Marco Rubio of Florida have questioned whether Tillerson has too many conflicts of interests to champion U.S. policy abroad, especially in Russia.

As CEO of Exxon Mobil, Tillerson spoke out against U.S. sanctions levied on Moscow following its annexation of Ukraine’s Crimean Peninsula in 2014. The penalties cost the energy giant hundreds of millions of dollars.

Further roiling the debate is U.S. intelligence’s assessment that Russia meddled in the presidential election to help Donald Trump defeat Democrat Hillary Clinton in the White House race.

McCain and Graham announced their decision before a vote Monday on Tillerson by the Senate Foreign Relations Committee. While McCain and Graham aren’t committee members — McCain leads the committee that oversees military policy, while Graham oversees a subcommittee on military personnel — their signal of support could make it tougher for Rubio to remain a holdout.

Their support also would make it tough for Democrats to peel off enough Republican votes to oppose his nomination. The Senate is divided by 52 Republicans and 48 Democrats.

Graham told CBS’ “Face the Nation” that he was persuaded to back Tillerson after a private meeting with the nominee. According to Graham, Tillerson told him “when America doesn’t lead, other people will, and the vacuum is always filled by bad actors. He said that we have to have a foreign policy that engages the world. We need to lead from the front.”

McCain said on ABC’s “This Week” that he talked to Tillerson about his views on Russia and his duty heading a major corporation.

“Listen, this wasn’t an easy call,” said McCain. “But I also believe that, when there’s doubt, the president, the incoming president, gets the benefit of the doubt.”

Rubio, who challenged Trump for the GOP nomination last year, clashed with Tillerson at a hearing his month. Rubio bridled at Tillerson’s refusal to label Putin a “war criminal” or condemn human rights violations in Saudi Arabia and the Philippines in strong enough terms. He chided Tillerson over the need for “moral clarity.”

Hours after Trump was sworn in on Friday, Rubio was tight-lipped, saying he would make his decision “certainly before the vote” Monday and that Tillerson’s responses to written questions had addressed “some of” his concerns.

The committee is narrowly split between 11 Republicans and 10 Democrats so Republicans must all hold together to vote Tillerson out favorably, unless he gets some Democratic backing.

Still, a “no” vote from Rubio would not doom Tillerson’s confirmation, because the nomination could go directly to the Senate floor even without a positive committee recommendation. But it would be an embarrassing rebuke to Trump just as his presidency gets under way, with questions swirling about his ties to Russia.

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CHRIS LIVESAY, PBS NEWSHOUR WEEKEND: In the port city of Bremerhaven on Germany’s North Sea coast, approximately 4-thousand American troops and 25-hundred vehicles began arriving in early January. Known as the Iron Brigade, they’re from the Army’s 3rd Armored Brigade Combat Team of the 4th Infantry Division, based in Fort Carson, Colorado.

This is the largest deployment of U-S forces in Europe since the end of the Cold War 25 years ago. It’s part of the European Reassurance Initiative and Operation Atlantic Resolve — a three-and-a-half billion dollar effort paid for by the United States to reinforce NATO.

MAJ. GEN. TIMOTHY MCGUIRE: I am very proud that we’re a member of NATO.

CHRIS LIVESAY: At the start of the deployment, Army Major General Tim McGuire joked by rushing to meet the deadline set by the Obama Administration, his units weren’t able to change their vehicle camouflage.

MAJ. GEN. TIMOTHY MCGUIRE: To get them here as scheduled in January, just do not have time to paint them green.

CHRIS LIVESAY: But the Army is anxious to deliver a serious message: to demonstrate to allies and adversaries alike the U.S. is determined to assist NATO in defending Eastern Europe from potential aggression from Russia.

MAJ. GEN. TIMOTHY MCGUIRE: The combat power here is a tangible sign of the continued commitment of the United States of America. It is one that enables us to work with our allies and send a message that we remain committed.

BRIGADE COMMANDER COLONEL CHRISTOPHER NORRIE: You’ve got tanks here…

CHRIS LIVESAY: Brigade commander Colonel Christopher Norrie describes his unit as “lethal.”

BRIGADE COMMANDER COLONEL CHRISTOPHER NORRIE: So we’re an armored brigade combat team. So as part of that team we have tanks, Bradleys, we have indirect fire systems, Paladins, we have a whole range of vehicles that make up our team here.

BRIGADE COMMANDER COLONEL CHRISTOPHER NORRIE: You can see now, you’ve got one ship here, one ship there, both offloading all of our equipment in preparation for onward movement.

CHRIS LIVESAY: Norrie’s troops spent the past year training for this mission.

BRIGADE COMMANDER COLONEL CHRISTOPHER NORRIE: What’s up iron strong!

CHRIS LIVESAY: Algenon Lewis and Thomas Rodriguez are Army mechanics.

PVT THOMAS RODRIGUEZ, U.S. ARMY: This is my first time in Europe, pretty excited to be here. Going to miss home, but it’s also nice to be here helping out our NATO allies.

CHRIS LIVESAY: These soldiers concede outside of their families few folks back home may know about their assignment.

PVT THOMAS RODRIGUEZ, U.S. ARMY: Probably not. Probably not, honestly. I don’t think they do.

SGT. ALGENON LEWIS, U.S. ARMY: I don’t think a lot of them know what NATO actually does.

CHRIS LIVESAY: Under NATO, the U.S., Canada, and 26 other nations pledge to defend each other in case of attack. In 2014, Russia annexed Crimea from Ukraine, which is not a NATO member. But that sent jitters across Europe, especially in the five NATO countries bordering Russian territory, Poland, Finland, and the former Soviet Republics of Estonia, Latvia, and Lithuania.

CHRIS LIVESAY: After international sanctions were imposed on Russia, then-President Obama pledged to beef up American military presence in Europe which had shrunk from its Cold War level, over 300-thousand troops to 120-thousand in 2000 and 65-thousand in 2015.

CHRIS LIVESAY: Six days after arriving in Germany, Colonel Norrie’s military convoy reached the first of those nervous border states, Poland, where U-S troops will begin the first of their nine month rotations planned for the next seven years. This is the first large-scale continuous presence of U.S. troops in Poland.

CHRIS LIVESAY: This army video shows the symbolic moment a Polish flag was added to the lead U.S. vehicle. Colonel Norrie was officially welcomed by Polish Major General Jaroslaw Mika.

MAJOR GENERAL JAROSLAW MIKA: It is important for security not only for Poland, for Europe, and for all the world.

CHRIS LIVESAY: Why should the U.S. care about what is happening so far away here in Poland?

MAJOR GENERAL JAROSLAW MIKA: Common cooperation, common training, and all these things provide more security for all countries. You have to be prepared for a war, yeah?

CHRIS LIVESAY: Prepared for a war?

MAJOR GENERAL JAROSLAW MIKA: You would like to avoid any war, but you have to do a lot of training to be prepared.
CHRIS LIVESAY: Training is what these troops will be doing. Their Bradley Fighting vehicles transported from Bremerhaven by train were positioned in the snowy fields of Poland in temperatures close to zero degrees.

TROOPS: It’s cold! It’s beautiful, though.

CHRIS LIVESAY: Some American troops will remain in Poland. Others will be sent farther East for training and war exercises in Estonia, Latvia, Lithuania, Romania, Bulgaria, and Hungary. Pre-positioning equipment and ammunition in Eastern Europe can reduce the time needed for additional troops to deploy, if ever needed. Other NATO members like the U.K., France, and Denmark, are deploying more troops to Eastern Europe as well.

CHRIS LIVESAY: Many NATO member states are boosting their military spending, but only five countries, including the U.S., the U.K., and Poland, meet the target of spending two percent of their Gross Domestic Product on defense. The rest, including France, Germany, the Netherlands, and Italy, spend less.

CHRIS LIVESAY: Overall, the U.S. accounts for three-quarters of NATO’s military expenditures.

CHRIS LIVESAY: In a formal ceremony in the western Polish city of Zagan, where some of the new American troops will be based, Poland’s prime minister and defense minister welcomed the military help, saying it would help ensure freedom, independence, and peace.

CHRIS LIVESAY: While Operation Atlantic Resolve might reassure leaders in Eastern Europe, it is angering Russia, which has repeatedly denounced the buildup along its borders as a provocation that demands countermeasures. “We consider this a threat to us,” a Kremlin spokesman said as the troops arrived.

CHRIS LIVESAY: The Russian military has been conducting military exercises of its own and last October, near the borders of Poland and Lithuania, Russia placed missiles that could be armed with nuclear warheads and reach the German Capital of Berlin.

CHRIS LIVESAY: Russia has called this build up a provocation. Is this a provocation?

BRIGADE COMMANDER COLONEL CHRISTOPHER NORRIE: We are here to deter, and a part of that deterrence is putting this formation together as part of a really exceptionally strong team of teams. I would view it as a deterrent, and if I was looking at it through the lens of a potential aggressor, I would say it’s an exceptionally capable deterrent.

CHRIS LIVESAY: Russia has even recently aligned missiles that are capable of being mounted with nuclear warheads along the border. What are you doing to prepare for that?

BRIGADE COMMANDER COLONEL CHRISTOPHER NORRIE: We’ve trained for every eventuality. I mean, the soldiers that we have in this formation, the capability by battalion here throughout the brigade, they’re ready for the full range of any kind of a threat. Our commitment to our allies is very very important. Right now we are continuing to build combat power here in Western Poland to rapidly mass our formation and then demonstrate that we are ready to fight.

CHRIS LIVESAY: In the towns and countryside of Poland, we found mixed feelings about what Operation Atlantic Resolve would mean. This Polish truck driver says he’s already comfortable with the American presence. After all, Poland is used to less friendly foreign troops dating back to the Germans who invaded in World War Two or the Soviets who occupied and oppressed Poland for decades after that.

TRUCKER: Deutschland, Ruskies.

CHRIS LIVESAY: “First it was the Germans, then the Russians, and now the Americans are in Poland,” he says.

CHRIS LIVESAY: And is that okay? Is that a good thing?

TRUCKER: “It is good,” he says. “We need protection.”

CHRIS LIVESAY: But other Poles worry the deterrent force might too easily be drawn into a fight.

TRUCKER: “The troops are for war. They didn’t come here to fish, right?”

CHRIS LIVESAY: This man works for a small communications company in Zagan.

WORKER: “Maybe it’s politics? I suppose it’s politics. Ordinary people, we are afraid. We are afraid.”

CHRIS LIVESAY: Another element of uncertainty in all of this: These American troops now have a new Commander-In-Chief, President Trump, who has voiced skepticism about NATO and has signaled he wants closer ties with Russia.

CHRIS LIVESAY: In an interview with British and German reporters a few days before his inauguration, President Trump said “NATO is very important to me,” but again called it “obsolete, because it wasn’t taking care of terror,” and said that “a lot of these countries aren’t paying what they’re supposed to be paying, which I think is very unfair.”

CHRIS LIVESAY: At a press conference before the Trump inauguration, Colonel Norrie was asked whether he expects orders to turn around and go home.

BRIGADE COMMANDER COLONEL CHRISTOPHER NORRIE: We’ve been training for this operation, for this mission for a very, very long time. And our arrival here just demonstrates how fully committed our nation and our army is to providing that credible deterrent force here and enabling security in a vital part of the world.

The post U.S. NATO troops surge in Europe after Russian aggression appeared first on PBS NewsHour.

Left: M., who told her mom she was transgender when she was three years old, appears in a matching outfit with her doll at age five. Right: A self-portrait M. drew when she was in preschool and still living as a boy. Photos by Marlo Mack

On a recent drive to elementary school, M. told her mom: “I can’t have a baby.”

Her mother, Marlo Mack, pulled over — she had been expecting this conversation for awhile. Six years ago, M. told Mack that she is transgender and then socially transitioned to living as a girl shortly afterward — a journey Marlo Mack documented in the podcast “How to Be a Girl.” (“Marlo Mack” and “M.” are pseudonyms, the same ones used in the podcast to protect M.’s privacy.)

While the transition left M. happier and healthier, Mack had long worried about M.’s ability to reproduce as an adult and wanted to tell her daughter that scientists are working on fertility research for trans kids. But Mack also wanted to keep it light. After all, M. is only nine years old.

“From early on I’ve been kind of cringing when she’ll say, ‘When I’m a mom,’ or, ‘I‘m going to have this many babies,’ or ‘When I’m pregnant,’ those kinds of things,” Mack said. “As a parent, you don’t want your child who’s only five to have a whole aspect of human experience already shut to them.”

There are an estimated 1.4 million trans Americans, and physicians told the PBS NewsHour Weekend that demand is increasing for health care specific to them. Many doctors are confronting the issue of fertility among trans communities, especially as children start to feel more comfortable voicing their identity at earlier ages.

Gender dysphoria — the feeling that an individual’s gender is different from the one assigned at birth — can cause distress in children who fear the physical changes that come with puberty. M. was alarmed as a toddler when she learned about the possibility of someday growing a beard like her father, according to Mack.

“There was this look of shock on her face,” Mack said. “It goes to show how deeply felt and experienced gender is for these kids.”

Before that happens, some trans youth, under the care of a doctor and with the permission of a guardian, decide to take puberty blockers to halt the production of estrogen and testosterone. These drugs pause puberty while they decide how to move forward. And during adolescence, some transition with hormone therapy, taking estrogen and testosterone to develop the secondary sex characteristics of their gender.

READ NEXT: NY will soon make it easier for trans youths to delay puberty

At this point, doctors may recommend that their trans patients preserve eggs or sperm for later use, according to Dr. Courtney Finlayson, a pediatric endocrinologist at the Ann & Robert H. Lurie Children’s Hospital of Chicago. But it’s a tricky time. If the patients haven’t gone through puberty, then their bodies have not made mature eggs or sperm yet, leaving their fertility prospects uncertain.

“You don’t have that mature biological material for reproduction,” Finlayson said. She added that fertility actions were poorly understood and rarely addressed in the past for trans people.

Drawing inspiration from cancer treatment

Twelve years ago, a group of doctors who treat cancer patients started a conversation about reproduction. Its effects are rippling through the trans community today.

The Oncofertility Consortium brought together oncologists and fertility specialists from around the country who wanted to improve fertility options for cancer survivors — including young kids whose fertility was affected by chemotherapy.

Both groups — young cancer patients and trans kids hoping to transition early — have a demand for fertility preservation at an age where it has not usually been possible. But researchers say they are drawing closer to a solution with new techniques to freeze, or cryopreserve, immature reproductive cells.

So far, scientists can take a piece of ovarian tissue, freeze it and then re-implant it into a patient to produce mature eggs. That process has resulted in at least 100 births so far, mostly by adult patients who were treated for cancer, said Dr. Teresa Woodruff, a reproductive endocrinologist researching the issue at Northwestern’s Feinberg School of Medicine in Chicago.

Yet this process does not work for all patients, and researchers say that it is unlikely to work for trans people who transition with hormone therapy. So they started to look for ways to grow that tissue in a petri dish, so it can develop into a mature egg. “We’ve had to borrow knowledge from other disciplines and sort of figure out how that applies to trans people … What can be frustrating sometimes is having to adapt and extrapolate all of this information from work that is not done for trans people.” — Zil Goldstein, Mount Sinai

In November, Woodruff co-authored a study in the journal Nature that did just that.

“We can continue to develop that technology and eventually, hopefully, this will transfer to all the individuals who are looking for fertility intervention,” Woodruff said.

The research is not as far along for people with testes, said Dr. Kyle Orwig, whose lab studies fertility at the Magee-Womens Research Institute and Magee-Womens Hospital of the University of Pittsburgh. In several animal models, researchers can preserve testicular tissue outside the body and then re-implant that tissue to produce sperm. A study published by Scientific Reports this month showed that researchers could develop sperm from mouse tissue in a petri dish over the course of 6 months, producing healthy offspring. But this technique has never been replicated in humans.

In recent years, doctors treating trans people have paid close attention to this cancer research, Finlayson said. “We have taken a lot of our inspiration and our information from the world of oncofertility,” she said.

Several years ago, Woodruff and others decided to start a committee that would focus on trans patients within the Oncofertility Consortium, as she and others were approached by doctors and trans patients who had heard about the research.

“There were trans people that were kind of finding their way to our program. And it seemed to me that this was an obvious next step for the development of fertility management,” Woodruff said. “I think for the transgender community, the more they know this is out there, the more they will take advantage of these opportunities.”

These treatments are not fully developed or available yet, and will likely not be for decades, Finlayson said. But “there is a lot of progress in that area,” she said. “We hope that 20 or 30 years from now, that this technology will exist.”

For trans patients, a taxing trade-off

Even for trans people who have gone through puberty and can preserve mature eggs or sperm, the process isn’t always straightforward. Doctors will often advise their patients to stop taking hormones during fertility treatments, which can last weeks or months.

But doctors say that even a temporary disruption in their hormone therapy can cause symptoms of anxiety or depression in their patients.

Some who decide to move forward anyway are discouraged by staff and doctors who treat them “like an alien,” said Zil Goldstein, program director at the Center for Transgender Medicine and Surgery at Mount Sinai Hospital in New York.

“A lot of adults that I see choose not to preserve fertility because it is such an anxiety-inducing experience to go in and receive what is essentially ‘women’s health care’ when you are a man,” Goldstein said. “Even staff who are aware of issues around cultural sensitivity say things like, ‘We’ve never done this with a trans person before,’ or, “This is such an interesting case, let me bring in the resident.’”

For others, the procedures required to extract sperm or eggs can cause additional distress and dysphoria. People who produce sperm may not feel comfortable masturbating to give a sperm sample, and people with ovaries may not want to undergo the procedure of obtaining eggs, which can feel invasive, Finlayson said.

“If you have to have a transvaginal ultrasound or procedure to harvest eggs, that might be something that trans males say, ‘I can’t do that,’” she said.

But Finlayson said that with more trans people seeking these procedures, doctors are learning more about how to treat them. “Fertility preservation is a major decision for everyone,” Finlayson said. “I think that we have a lot to learn about how it’s different for trans individuals.”

In general, the trans community has always relied on a medical system that was not built for them, Goldstein said.

“Traditionally in transgender health, we’ve had to borrow knowledge from other disciplines and sort of figure out how that applies to trans people,” Goldstein said. “What can be frustrating sometimes is having to adapt and extrapolate all of this information from work that is not done for trans people.”

Mack’s daughter gives advice for other trans children in this video that Mack animated.

Cost is an additional concern. Fertility preservation is rarely covered by insurance, for trans people or anyone else. And with a high rate of economic instability among trans people, many simply cannot afford it.

Orwig said the process of freezing testicular tissue can cost between $2,000 and $4,000, whereas preserving ovarian tissue costs approximately $5,000. But that estimate is “probably on the lower end,” since it applies to an experimental treatment, and would be higher in a typical clinic, he said.

“We’ve asked insurance companies, if this wasn’t research, would you cover it? And across the board, the answer was no,” Dr. Jill Ginsberg, a pediatric oncologist at the Children’s Hospital of Philadelphia, said.

Insurance coverage for trans-related care is spotty across the nation, with a wide range of laws on whether insurance must cover it. Eighteen states and Washington, D.C. prohibit insurers from discriminating against trans people, and Medicaid covers transition-related care in 12 states and the district. But concerns over trans health were magnified recently, as a federal judge in Texas blocked Section 1557 of the Affordable Care Act — which would have prohibited discrimination on the basis of gender identity — just before the regulation was set to take effect.

Mack worries about obtaining insurance coverage for her daughter — and fears the eventual cost of fertility treatments could be out of reach. “I’m worried about even just getting her coverage for basic treatment,” Mack said. “I don’t really know what I’m going to do.”

When it comes to fertility, Mack was quick to highlight that adoption is a valid path to parenthood — but she also struggles with the thought of her daughter missing out on the opportunity to be a biological parent.

“I think, well, what do I do if someday she says, ‘Mom, this was available, and you didn’t do it?’ I don’t want that conversation,” Mack said. “If this becomes available, a lot of trans people who are able to stretch to make it work are going to have a hard decision to make, and for most people it will be absolutely out of reach.”

Sitting with her daughter in the car, Mack told her she saw hope in the research progress.

“I can’t promise her that this is an option, but I can say that it’s a maybe,” Mack said.

The post Trans patients, looking for fertility options, turn to cancer research appeared first on PBS NewsHour.

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ALISON STEWART, PBS NEWSHOUR WEEKEND ANCHOR: To discuss the security situation in Europe, I am joined from Warsaw by Paul Jones, the American ambassador to Poland. He’s a career foreign service officer appointed by President Obama in 2015 and is staying on with the Trump administration.

Ambassador, what is your reaction to the Kremlin calling Operation Atlantic Resolve a provocation and, quote, “a threat”?

PAUL JONES, U.S. AMBASSADOR TO POLAND: Well, Alison, you know, these decisions have been taken over a course of time, and especially after Russian’s invasion of Ukraine and its occupation of Ukrainian territory, which led to a deterioration of the security environment here, and a lot of anxiety from some of our allies.

And so, our military together with our allied militaries took some prudent, took — made some prudent recommendations to political leadership. And that includes this deployment of a U.S. armored brigade combat team first to Poland and then to the region.

STEWART: Ambassador, why commit troops specifically to Poland?

JONES: Well, Poland is really the hub of this deployment. So, these forces, about 3,500, 4,000 soldiers with heavy armor will — are deploying from Poland because of Poland’s geographic location. And they will be headquartered here in Poland. But they will also be in the Baltic States. They’ll be in Hungary, they’ll be in Romania and Bulgaria. All of those countries have requested this support.

STEWART: Will other NATO members bordering Russia add deterrent forces?

JONES: You know, this is a bilateral deployment, this particular deployment that is happening right now. Later in the spring, we will have the NATO contingents come in, a U.S. battalion will come to Poland, British, German and Canadian battalions will go to the Baltic countries, but this is really supported by all 28 allies one way or the other. And even within this region, Poland, for example, is contributing to the security of other countries along this side of NATO because it’s the largest country and the one with the most capable military itself.

STEWART: We have a new president in the United States, one who has questioned the United States role within NATO. Is there any concern there that the U.S. troops will be asked to come home — to return home by the Trump administration?

JONES: Well, I think the government and the president of Poland are looking forward to having a detailed — there’s been some contact already. But they’re looking forward to having a detailed conversation about the security in this region and about how the United States and Poland — I mean, Poland sees the United States as its, you know, primary strategic ally. But the whole alliance can ensure security in this region.

STEWART: One of Mr. Trump’s criticisms of NATO is that all the member nations are supposed to devote 2 percent to their GDP to defense. Only five nations do that. The United States and Poland being two of the five.

Is it — is there anything that you and other diplomats can do to create more equity in that situation? And does it ever cause tensions between the member nations?

JONES: You know, as you say, Poland is contributing its 2 percent and actually is involved in a broader military modernization program, which includes very significant purchases of military equipment, and weaponry from the United States as part of that. So — but I think you see over all, a growing sense within the alliance that we have to pick up the pace of every ally reaching that 2 percent and every ally contributing.

And we see that, really, in what’s happening in this part of the alliance. And as I say, Poland is a big contributor to that and frankly, you know, wants to be part of not only the contributions militarily but the policy discussion going forward in — you know, with the new administration in Washington and also in the future meetings of the alliance.

STEWART: Ambassador Paul Jones from Warsaw, Poland — thank you for being with us.

JONES: Thank you. It’s been a pleasure, Alison.

The post Eastern European countries back NATO support against Russia appeared first on PBS NewsHour.