(CNN)Just hours before it was due to go into effect, US President Donald Trump’s revised executive order banning travelers from six Muslim-majority nations had been struck down by a federal court in Hawaii late Wednesday.
GRAND RAPIDS – It’s hard to imagine, but a horrible case of strep throat will soon cost a west Michigan man his hands and feet.
Doctors at Spectrum Hospital in Grand Rapids are studying the extremely rare case. They said the man is one of only two men in the world with a case this bad.
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Kevin Breen’s son had strep throat and fought it off with no problem, but for some reason, Breen nearly died from the illness.
The amputations are happening on Wednesday. Breen’s hands and feet have turned black and have lost almost all movement.
“This one I can move a little,” he said.
He now relies on his wife, Julie, to do pretty much everything.
“I never thought going in for a stomach ache and coming out a totally different person, and life changing,” he said.
It all started when he started feeling sick on Christmas Day. Days later, his stomach pain was so unbearable he went to the emergency room. Doctors found his stomach was filling with puss, but they didn’t know why.
At one point, his wife was told to gather family and prepare for the worst.
“That moment was terrifying,” she said. “I just kind of lost it and stopped and prayed.”
Doctors said a rash on Breen’s upper torso was a clue — a common sign of strep in his belly. It’s assumed he got it from his son. The strep traveled from his throat to his stomach and his body couldn’t fight it.
“So basically he just had a very strong strain of it, and he was very susceptible to it,” a doctor said.
Despite that storm, changing Breen’s life forever, he’s the first to admit he’s glad to still be alive.
“Life is forever going to be different, but different doesn’t necessarily have to be bad,” Breen said. “It’s just going to be what we make it and we just have to figure it out, figure it our for our kids. Dad’s going to have cool hands. Dad’s going to have cool feet. We have to be positive.”
His doctors said they’ve only found 32 cases of strep traveling to the abdomen. Most are from the urinary track in women. Breen is one of two men in the world who have had this happen.
When people hear that something like strep throat leads to amputations, it raises concerns, but Dr. Frank McGeorge said this obviously isn’t common.
“It’s certainly not common with strep, and the situation in this case was probably more complex,” McGeorge said. “The strep he had may have also been producing a toxin that made the complications worse, and it’s likely that the damage to his hands and feet were also part of the larger picture of an overwhelming infection that affected his circulation. So it wasn’t quite as simple as strep throat leading to amputations. I do want to point out, strep can cause many complications, including kidney damage, rheumatic fever, toxic shook syndrome and even behave as a flesh-eating bacteria.”
Three women suffered severe, permanent eye damage after stem cells were injected into their eyes, in an unproven treatment at a loosely regulated clinic in Florida, doctors reported in an article published Wednesday in The New England Journal of Medicine.
One, 72, went completely blind from the injections, and the others, 78 and 88, lost much of their eyesight. Before the procedure, all had some visual impairment but could see well enough to drive.
The cases expose gaps in the ability of government health agencies to protect consumers from unproven treatments offered by entrepreneurs who promote the supposed healing power of stem cells.
The women had macular degeneration, an eye disease that causes vision loss, and they paid $5,000 each to receive stem-cell injections in 2015 at a private clinic in Sunrise, Fla. The clinic was part of a company then called Bioheart, now called U.S. Stem Cell. Staff members there used liposuction to suck fat out of the women’s bellies, and then extracted stem cells from the fat to inject into the women’s eyes.
The disastrous results were described in detail in the journal article, by doctors who were not connected to U.S. Stem Cell and treated the patients within days of the injections. An accompanying article by scientists from the Food and Drug Administration warned that stem cells from fat “are being used in practice on the basis of minimal clinical evidence of safety or efficacy, sometimes with the claims that they constitute revolutionary treatments for various conditions.”
Kristin C. Comella, the chief science officer of U.S. Stem Cell, said in an interview that the clinic did not need F.D.A. approval because it was treating patients with their own cells, which are not a drug. She said the stem-cell treatments were comparable to patients’ receiving grafts of their own skin — a procedure not a drug.
Two of the eye patients sued the clinic and settled, but it has faced no other penalties. Ms. Comella said it no longer treats eyes, but continues to treat five to 20 patients a week for other problems like torn knee cartilage and degenerating spinal discs.
All three women found U.S. Stem Cell because it had listed a study on a government website, clinicaltrials.gov — provided by the National Institutes of Health. Two later told doctors they thought they were participating in government-approved research. But no study ever took place, and the proposed study on the site had no government endorsement. Clinical trials do not need government approval to be listed on the website.
Legitimate research rarely, if ever, charges patients to participate, scientists say, so the fees should have been a red flag. But many people do not know that.
Promising stem-cell research in eye disease and other conditions is taking place. But researchers and health officials have been warning for years that patients are at risk from hundreds of private clinics that have sprung up around the United States and overseas, offering stem-cell treatments for all manner of ailments, like injured knees, damaged spinal discs, neurological diseases and heart failure. Businesses promising “regenerative medicine” have multiplied, with little or no regulation.
Stem cells, which can develop into many different types of cells, are thought to have tremendous potential to repair or replace tissue damaged by disease, injury or aging. But so far, the F.D.A. has approved only a few stem-cell products to treat certain blood disorders.
The women in Florida suffered detached retinas, in which the thin layer of light-sensing cells that send signals to the optic nerve pulls away from the back of the eye — a condition that usually needs prompt surgery to prevent blindness. Doctors who examined the patients said they suspected that the stem cells had grown onto the retina and then contracted, pulling it off the eyeball.
One woman had such high pressure inside her eyes — about three times the normal level — that it may have damaged her optic nerves. Doctors operated quickly to relieve the pressure, but she became blind.
“The really horrible thing about this is that you would never, nobody practicing good medicine would ever do an experimental procedure on a patient on both eyes on the same day,” said Dr. Thomas A. Albini, an author of the article who saw two of the patients, at the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine.
Standard practice, he said, is to treat one eye at a time, usually the worse eye first, so that if something goes wrong at least the patient still has one eye left with some vision.
Dr. Albini said his team alerted the F.D.A. after the second patient showed up.
“They did send an investigator who took statements from us,” he said. “They apparently wrote up a report, which as far as I know is still not finished or available for public consumption.”
Andrea Fischer, a spokeswoman for the F.D.A. said the agency could not comment on whether an investigation had been conducted.
Two of the women were not available for interviews because their lawsuit settlements in 2016 included nondisclosure agreements, according to their lawyer, Andrew B. Yaffa, of Coral Gables, Fla. He also was barred from discussing the case, but a publicly available complaint he filed in July 2016 details one patient’s story, and states that the injections were performed by a nurse practitioner who was introduced as a physician.
The third patient did not sue, but did not respond to a request for an interview made through her doctor. (The patients were not named in the journal article.)
Ms. Comella, from U.S. Stem Cell, said that an independent review board had approved the proposed eye study, including the plan to treat both eyes at once. She said a total of three patients ever received eye injections at the clinic, and were not part of a trial. She declined to confirm that they were the same three patients described in the journal article, but the article links the women to the clinic.
Ms. Comella said a trial never did begin, because the first three cases “ended the way they ended, so we decided not to go forward with any additional patients.”
She declined to discuss the cases further, citing the nondisclosure agreement. But she said that U.S. Stem Cell had successfully treated thousands of patients for other conditions, and that it was misleading to draw attention to “a handful of adverse events.”
U.S. Stem Cell also makes money by training doctors to extract stem cells from fat. And in a blog post on Tuesday its chief executive, Mike Tomás, said the company expected to open clinics throughout the Middle East, in Kuwait, Dubai and Qatar.
But the company, which is a penny stock, is struggling financially, and as recently as last fall warned investors that its poor financial situation put it at risk of going out of business.
Clinics like U.S. Stem Cell that extract stem cells from fat fall into a gray zone. Regulations say stem cells do not have to be F.D.A. approved if they are the patient’s own and are “minimally manipulated” — but some clinics may stretch that term to suit their own purposes.
The F.D.A. website has a page that warns “the hope that patients have for cures not yet available may leave them vulnerable to unscrupulous providers of stem-cell treatments that are illegal and potentially harmful.”
The F.D.A. article in The New England Journal of Medicine suggested that adverse events from stem-cell treatments “are probably much more common than is appreciated, because there is no reporting requirement when these therapies are administered outside clinical investigations.”
Like the Florida patients, people who consult clinicaltrials.gov may assume that the studies listed there have been approved by the F.D.A. or the National Institutes of Health, but that is not necessarily the case, Renate Myles, an N.I.H. spokeswoman, said.
In an email, Ms. Myles said, “The information on ClinicalTrials.gov is provided by the study sponsor or principal investigator and posting on ClinicalTrials.gov does not necessarily reflect endorsement by the N.I.H. ClinicalTrials.gov does not independently verify the scientific validity or relevance of the trial itself beyond a limited quality control review.”
Ms. Myles said that the site urges patients to consult their own doctors about joining studies and includes caveats in multiple places.
“However, we agree that such caveats need to be clearer to all users and will be adding a more prominent disclaimer in the near future,” she added.
One morning in July 2011, Samantha Ahdoot’s 9-year-old son, Isaac, grabbed his clarinet, trekked up the hilly road to the bus stop and set off for another day at the band camp near his home in the suburbs of Washington, D.C.
Within an hour, Ahdoot’s phone rang: Isaac had collapsed and was en route to the emergency room on a stretcher. Her otherwise healthy son suffered heat exhaustion and dehydration from the blistering heat of a summer that regularly broke temperature records. July alone shattered two daytime high temperature records in just the D.C. area. Concerned, Ahdoot, a pediatrician, volunteered to be camp physician. As temperatures soared, she was forced to cut soccer games short and limit campers to swimming and indoor activities.
“That was the experience that first got me thinking about how our summers are getting hotter and what does that mean for children, their health and their safety,” Ahdoot, a doctor at Pediatric Associates of Alexandria, told The Huffington Post by phone on Tuesday. “Climate change isn’t about our grandchildren or great-grandchildren, just as it’s not about polar bears and penguins. Climate change is about people and their health today in 2017.”
On Wednesday, Ahdoot joined more than 434,000 physicians ― more than half the doctors in the U.S. ― in a newly formed medical consortium warning the public about the effects climate change is already having on health. The Consortium on Climate & Health includes a dozen top medical associations covering fields ranging from allergies and asthma to internal medicine to psychiatry. In one of its first moves, the nonprofit coalition plans to lobby governors, mayors, manufacturers, Fortune 500 chief executives, the U.S. Chamber of Commerce and the Trump administration to invest in renewable energy and slash greenhouse gas emissions.
The group faces an uphill battle. President Donald Trump has made axing environmental regulations a top priority as the White House seeks to boost the economy. Already, his administration has lifted regulations to protect streams and waterways from toxic pollution, scrapped a rule requiring oil and gas drillers to report methane leaks and proposed gutting the Environmental Protection Agency’s budget. In January, the Centers for Disease Control and Prevention abruptly canceled a climate change summit just days before Trump was sworn in. Last week, EPA Administrator Scott Pruitt ignited a firestorm when he said on CNBC that he doesn’t believe carbon dioxide emissions cause global warming.
Even in red states, the vast majority of Americans disagree with the White House. Nearly 70 percent of Americans believe global warming is happening, and 53 percent understand that humans are to blame, according to 2016 survey data from the Yale Program on Climate Change Communication. Yet despite 71 percent of those surveyed saying they trust scientists’ conclusions on global warming, less than half realized that most scientists believe climate change is real.
That’s a problem. For years, oil companies, particularly Exxon Mobil Corporation, have funded groups that reject the overwhelming scientific consensus on the causes of climate change as part of disinformation campaigns modeled on efforts by tobacco companies and automakers to hide the health effects of smoking and leaded gasoline. In fact, study after study shows 97 percent or more of climate scientists who actively publish in peer-reviewed journals agree that increased greenhouse gases in the atmosphere are warming the planet. The surge in greenhouse gases such as carbon dioxide and methane irrefutably mirrors the dramatic upswing in industrial emissions, both of which track rising temperatures.
“At this point, physicians are really trying to speak out about their own observations and let everyone know it isn’t just climate scientists,” Mona Sarfaty, director of the new consortium and a professor at George Mason University, told HuffPost by phone. “Physicians ― who have a closer relationship with the public than scientists, generally ― are seeing this, and they feel concerned and feel a responsibility to speak directly to the American public.”
“To get 12 different major medical organizations coming together like this is rare,” she added. “It doesn’t happen often. It only happens when the stakes are really high.”
Just 1 in 4 Americans can name even one way in which climate change poses a risk to health, according to a 2014 poll. A report released Wednesday in conjunction with the consortium’s launch announcement outlines three types of maladies linked to global warming:
- Direct harms, such as injuries and deaths due to increasingly violent weather, and asthma and other lung diseases exacerbated by extremely hot weather, wildfires or longer allergy seasons.
- Diseases spread through insects such as ticks and mosquitoes that carry infections like Lyme disease or Zika virus, and through contaminated water and food.
- Mental health effects, such as increases in depression and anxiety resulting from the damage climate change can do to society.
Stories of such ailments abound. One anecdote featured in the report detailed the spike in lung disease, asthma and pneumonia diagnoses after the 2008 Evans Road wildfire ripped through North Carolina during the state’s worst drought on record. Another described the medical chaos that followed the evacuation of Baton Rouge, Louisiana, last year as people fled their homes without medications after two days of torrential rains caused a “1,000-year” flood.
Last year, Ahdoot treated a 6-year-old boy for Lyme disease he caught while riding his bike in Chicago in November, when the city is typically too cold for ticks to survive.
It’s difficult to draw a direct line from manmade global warming to individual diagnoses or weather events. But refusing to cut greenhouse gases until evidence is as conclusive as the sky is blue is like waiting until a patient is on a ventilator to begin treatment, Ahdoot said.
“If doctors waited for absolute certainty, they’d never treat a single patient because there’s nothing that we do that’s based on certainty,” Ahdoot said. “There’s only best available evidence. That’s what doctors use to care for patients.”
“The best available information today, as determined by over 97 percent of climatologists and every legitimate scientific organization in the world,” she added, “is that rising greenhouse gases are warming our planet.”
Fifty-six million years ago, about 10 million years after the dinosaurs went extinct, something strange happened to our planet.
It got hot.
Hotter than it had ever been since the Earth formed a few billion years earlier.
Carbon signatures in the geological record show that global temperature surged 5 to 8 degrees Celsius within 10,000 years.
They also indicate that the planet’s temperature remained elevated for an additional 170,000 years before returning to normal.
Scientists describe this (relatively) rapid rise in temperature as a “hyperthermal event,” and it is not the only one that has ever occurred.
About 2 million years later, the Earth experienced another surge in temperature that was about half the magnitude of its predecessor.
Over the course of Earth’s history there have been other, smaller hyperthermal events as well. Most scientists would agree that we are in the midst of one right now.
Abigail D’Ambrosia, a graduate student at the University of New Hampshire, is interested in what happens to living things when the global temperature jumps.
Do they go extinct? Do they adapt? Do they change?
Her research, published Wednesday in the journal Science Advances, shows that at least in the case of some mammals, they shrink.
And it turns out that the amount they shrink is directly related to how hot the planet gets.
The findings are based on a new analysis of fossilized teeth and jaw fragments collected from the Bighorn Basin in northwestern Wyoming, about 80 miles east of Yellowstone National Park.
“For adult mammals, measuring teeth is a great proxy for body size,” D’Ambrosia said.
By comparing the change in tooth size of the same species over time, researchers have already shown that mammal dwarfing occurred during the largest ancient warming event, approximately 56 million years ago.
Specifically, they showed that the earliest equid, Sifrhippus, shrank by at least 30% during the first 130,000 years of the warming event. As the global temperature slowly returned to normal, its body size rebounded by 76%.
D’Ambrosia, whose Twitter handle is @ClimateDentist, wondered whether similar dwarfing had occurred during the smaller warming event roughly 54 million years ago.
To find out, she set to work gathering and measuring teeth of four mammals that lived before and during it.
Included in her research was Arenahippus pernix (an early horse about the size of a small dog), Diacodexis metsiacus (a rabbit-sized predecessor of pigs and deer), Hyopsodus simplex (a weasel-sized herbivore) and Cantius abditus (an early primate similar to modern lemurs).
D’Ambrosia said that especially for the little horse, the difference in tooth size between individuals that lived before the warming event and those that lived during it was obvious.
“That was the coolest thing,” she said. “When I first started taking measurements my advisor started randomly grabbing teeth and guessing which came from the hyperthermal. Just visually, he could pick them out.”
(You can probably pick them out too. If you look at the picture at the top of this story, you will see D’Ambrosia holding two teeth from the same species. Can you guess which one lived during the warming event? The answer is in the caption.)
A scientific analysis of the data revealed that during the second warming event, Arenahippus shrank in size by an average of 14% — the equivalent of going from dog-sized to cat-sized, D’Ambrosia said.
This finding suggests that at least for equids, the dwarfing response to an increase in climate change scales proportionately with the magnitude of the warming. During the first warming event, the small horse decreased in size by 30%. In the second warming event, which was about half as intense, a different small horse dwarfed by 14%.
D’Ambrosia had fewer teeth from the other three species included in the study, but she was still able to report that Diacodexis, the deer predecessor, exhibited dwarfing of 15%. The change in size of the weasel-sized herbivore Hyopsodus was an insignificant 4%, and the primate Cantius bucked the trend by appearing to grow 2%. However, neither of these last two findings were significant.
“It’s hard to say what is going on in detail without collecting more samples,” D’Ambrosia said.
Although shrinking in the face of climate change may seem like a strange response, it is well known in scientific communities that mammals get smaller in warmer climates. For example, red foxes that live in higher, cooler latitudes are larger than those that live closer to the equator. This phenomenon even has its own name — Bergmann’s rule.
“The idea behind it is that it is more efficient to cool off if you have a small body size because you have a larger surface-area-to-volume ratio,” D’Ambrosia said.
This ratio allows smaller animals let off more heat, while having a larger body size in a cooler environment helps an animal retain heat.
But she added that it is also possible that animals living through ancient hyperthermal events may have shrunk for other reasons, including not being able to get enough water or food.
As the planet continues to warm today, scientists may be able to see for themselves what drives the mammal dwarf response.
“Unfortunately, today is a really great experiment,” D’Ambrosia said.
OKLAHOMA CITY — Charges could be filed Thursday against an Oklahoma state senator who police say was found with a teenage boy in a motel room in the Oklahoma City suburb of Moore, according to a local prosecutor.
Cleveland County District Attorney Greg Mashburn said Wednesday that he could not say what charges might be filed against Republican Sen. Ralph Shortey of Oklahoma City, but told The Associated Press that police have presented a report to his office.
“She (the first assistant district attorney) could send it back for more work or file it as is,” Mashburn said.
Police in Moore have said they’re still investigating the circumstances surrounding a March 9 incident involving Shortey and a teenager. Police did not immediately return a phone call for further comment.
Police on Wednesday released a heavily redacted report that said a juvenile boy was found in a motel room with an adult male on March 9.
The names of those in the room and the boy’s age are redacted in the report.
Meanwhile, the Oklahoma Senate imposed sanctions Wednesday on Shortey, voting 43-0 for a resolution that accuses him of “disorderly behavior.” Among other things, it removes Shortey from membership and leadership of various Senate committees, bars him from occupying his office and reserved parking spot at the Capitol, blocks his expense allowances and authorship of bills, and revokes his right to have an executive assistant.
Senate officials said Shortey will still receive his $38,400 annual salary as a senator and will be allowed to vote.
Shortey, who was not present in the Senate chamber when the resolution was adopted without opposition, was also not in his Capitol office Wednesday and has not responded to requests for comment.
The resolution by Senate President Pro Tem Mike Schulz, a Republican from Altus, was co-sponsored by 44 of the Senate’s 48 senators. In a statement following its passage, Schulz said it was not intended to be “a presumption of guilt or innocence.”
“The Oklahoma Senate has full faith that the judicial system will play out appropriately and bring this matter to a lawful conclusion,” Schulz said. “This resolution reserves the right of the Oklahoma Senate to pursue further action if more facts come to light.”
The chair of the Oklahoma Republican Party, Pam Pollard, released a statement Wednesday condemning Shortey and alleging he is being investigated for a sex crime.
“No person, particularly a child, should be subjected to sex crimes,” Pollard’s statement said. “While we believe in the right to a fair trial and that all people deserve their day in court, the accusations against Ralph Shortey are in no way in line with the principles of the Oklahoma Republican Party.”
CLEVELAND — A 911 dispatcher who took a call that led to a white police officer’s fatal shooting of a 12-year-old black boy outside a recreation center has been suspended for eight days.
Police Chief Calvin Williams found in a disciplinary letter dated March 10 that Constance Hollinger violated protocol the day of the shooting of Tamir Rice, who had been playing with a pellet gun.
Cleveland safety director Michael McGrath also handed down a two-day suspension for police officer William Cunningham, who was working off duty without permission at the Cleveland rec center where Rice was shot.
Tamir was shot within seconds of a police cruiser skidding to a stop just a few feet away from him in November 2014 outside the rec center. The city’s internal disciplinary charges accused Hollinger of failing to tell the dispatcher who sent the officers to the rec center that the man who called 911 about “a guy” pointing a gun at people had also said the person could be a juvenile and the gun might be a “fake.”
McGinty said the shooting might have been avoided if the information from the 911 caller had been properly relayed to the officers.
The omission was also cited by former Cuyahoga County prosecutor Timothy J. McGinty as a crucial mistake that impacted how officers Timothy Loehmann and Frank Garmback responded. Disciplinary action against Garmback, who was driving the patrol car that pulled up to the scene, and Loehmann, who fired the fatal shots, has not yet been determined, CBS affiliate WOIO reports.
Loehmann and Garmback face possible discipline that could result in them being dismissed from the Cleveland police department.
Tamir’s mother, Samaria Rice, said in a statement issued Tuesday by her attorney that Hollinger’s eight-day suspension was “unacceptable.”
“Eight days for gross negligence resulting in the death of a 12-year-old boy,” Rice’s attorney, Subodh Chandra, said in the statement. “How pathetic is that?”
Chandra said that if that is the best “that system can offer, then the system is broken.”
Loehmann’s disciplinary letter cites his failure to disclose in an application that the Independence Police Department, where he worked for six months, had placed a letter in his personnel file saying he had an “inability to emotionally function.” Garmback’s disciplinary letter accuses him of driving too close to Tamir and failing to report the time of arrival at the recreation center.
Cleveland Police Patrolmen’s Association president Steve Loomis has said the officers did nothing wrong the day Tamir was shot. Investigators said the boy was handling a pellet gun that officers believed was a real firearm.
Samaria Rice has called for the two officers to be fired.
The city agreed last April to pay Tamir’s family $6 million to settle a federal civil rights lawsuit.
President Trump’s supporters are increasingly agitating for him to ditch the Republican healthcare plan, and are tying it to House Speaker Paul Ryan, R-Wis., to make their point.
Breitbart, the conservative news site formerly run by top Trump strategist and former campaign chairman Stephen Bannon, consistently calls the bill “Ryancare” rather than “Trumpcare,” and does not intend the moniker as a compliment.
Trump confidante Christopher Ruddy of Newsmax Media published a column urging the president to abandon both the bill and its conservative detractors by reverting to his more government-friendly vision of healthcare reform.
“Speaker Paul Ryan and the establishment GOP have pulled a fast one on President Trump,” Trump-friendly Fox News pundit Eric Bolling argued in an op-ed.
When Breitbart published audio of Ryan all but disavowing Trump ahead of the presidential election, the accompanying story was largely about the healthcare bill.
“Now, Ryan — still the Speaker — has pushed now President Donald Trump to believe his healthcare legislation the American Health Care Act would repeal and replace Obamacare when it does not repeal Obamacare,” wrote Matthew Boyle.
Even conservatives who aren’t necessarily aligned with Trump are starting to think Ryan and other House Republicans are trying to pull a fast one on the president.
“I think that Paul Ryan’s selling him a bill of goods that he didn’t explain to the president, and the grassroots doesn’t want what Paul Ryan is selling,” Sen. Rand Paul, R-Ky., said Wednesday.
Publicly, the White House has said Trump is still working with Republicans to make the bill work, and turn it into something that can pass the House and Senate and can be presented as a victory. But conservatives find themselves in the unlikely position of hoping that Trump, a past supporter of single-payer healthcare, will rescue them from a bill pushed by Ryan, the foremost proponent of free-market reform of the American welfare state over the past decade.
Heritage Action CEO Mike Needham told reporters on a conference call Monday that Trump was “still in a listening mode” on healthcare reform, “extremely open-minded” and “looking for good ideas.”
“I’m worried the attitude coming from the other end of Pennsylvania Avenue is ‘take it or leave it,'” Needham said, citing Ryan’s comment that Republicans face a “binary choice” between the House bill and failing to fulfill a campaign promise on Obamacare.
“Ryancare is in a precarious position in the House and it is not even close to having enough votes to pass in the Senate,” Needham added. He praised Vice President Pence for standing up to a Republican president and “arm-twisting” GOP congressional leaders by voting against the deficit-funded Medicare Part D while a member of the House.
But the campaign provided examples that indicate Trump is not ready to run toward conservatives who are urging him to take a tougher stance. Trump has never shared Pence’s convictions on controlling entitlement spending, and even the vice president came under fire for accepting a modified version of Obamacare’s Medicaid expansion while governor of Indiana.
“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid,” Trump told the Daily Signal, a conservative news site created by the Heritage Foundation, in 2015.
“Everybody’s got to be covered,” Trump said of his preferred Obamacare replacement in an interview with “60 Minutes” that same year.
“We’re gonna come up with a new plan that’s going to be better healthcare for more people at a lesser cost,” Trump remarked to ABC News in January.
When Sen. Ted Cruz, R-Texas, pressed Trump on his healthcare views during a GOP presidential debate last year, Trump replied, “We’ll have private health care, but I will not allow people to die on the sidewalks and the streets of our country if I’m president.”
All this would seem to imply that Trump would be more interested in having a healthcare bill that is more competitive with Obamacare when it comes to the total number of people covered — and perhaps more in tune with moderate Republicans in the Senate who are wary of Medicaid cuts than House Freedom Caucus members worried about “Obamacare lite.”
That theory seemed to be confirmed when the Congressional Budget Office projected that the GOP’s American Health Care Act would cover 14 million fewer people than Obamacare in 2018 and 24 million fewer by 2026, and the White House pushed back.
“As far as their numbers go and the number of people they predicted back then they were off by more than half,” press secretary Sean Spicer said during his press briefing Monday.
Moreover, conservative lawmakers and activists have frequently come away from meetings with the administration believing Trump was more sympathetic to making changes to the bill than Ryan or congressional leaders.
On Wednesday, Ryan said the bill is a group effort that has involved input from Republicans in the House, Senate and White House, a sign that Trump has not given up yet despite the growing pressure on his administration to cut bait. He said it was “insulting” for Sen. Paul to suggest that GOP lawmakers were looking to dupe Trump.
“Obviously the major components are staying intact, because this is something we wrote with President Trump, this is something we wrote with the Senate committees,” Ryan told Fox Business. “This is the plan we ran on all of last year, this is the plan that we’ve been working — House, Senate, White House — together on.”
But conservatives are getting antsy, and are wondering when Trump will insist on tougher language. Conservative commentator Laura Ingraham, who was linked late last year to potential jobs in the administration, complained on Fox News that the House bill at this point is still lacking the “Trumpiest” parts of healthcare reform.
The Justice Department will encourage cities to revive decades-old strategies to fight violent crime, focusing on sending certain gun crimes to federal court, where they carry longer sentences in far-away prisons, Attorney General Jeff Sessions said Wednesday.
Sessions continued to push his tough-on-crime agenda to law enforcement officials in Richmond, where one such effort had its origins.
Sessions credited that program, known as Project Exile, for slowing the murder rate through aggressive prosecution of gun offenses under federal laws, instead of the weaker state statutes. Conviction on a federal gun charge carries a minimum, mandatory prison sentence of five years, bond is less available and defendants are sent out of state to serve their sentences.
“I will promote that nationwide,” he said, calling the effort “a very discreet effective policy against violent crime.”
The comments further underscored Sessions’ repeated promise to make fighting street violence a top mission of the Justice Department. That is a radical departure for a department that has focused more on prevention of cyberattacks from foreign criminals, counterterrorism and the threat of homegrown violent extremism.
Still, in his first month in office, Sessions has spoken more frequently about the need for federal involvement in ordinary crime-fighting, citing the need for harsh sentences for the most violent criminals. Last week, he urged the nation’s federal prosecutors to devote more resources to prosecuting the worst offenders, lamenting a rise in murders as federal prosecutions declined.
Law enforcement officials, including FBI Director James Comey, credit Project Exile for a drop in murders in Richmond. But critics have said the program that began in the 1990s was racially biased and point to other reasons for declines in crime. Federal judges at the time expressed concerns about the wisdom of having federal agencies take over functions historically reserved for state and local law enforcement.
Photo by Mario Tama/Getty Images
On racial disparities, Sessions said law enforcement has “to be so sensitive to those issues,” but added, “When you fight crime you have to fight it where it is. You may have at some point an impact of a racial nature that you hate to see, but if … it’s focused fairly and objectively on dangerous criminals, then you’re doing the right thing.”
Sessions said he helped orchestrate a similar program called Project Trigger Lock when he was a federal prosecutor in Mobile, Alabama, during the height of the drug war in the 1980s and ’90s. Investigators would seek ways to move certain traditional violent crime and gang cases to federal court.
“When I met in my communities, the people in those communities pleaded with us to have more police and do a better job of getting thugs off the street,” he said. “I still go through there 30 years later and see the progress that was made.”
NASHVILLE — President Trump made a plea on Wednesday for his supporters to unite behind the Republican plan to overhaul Americans’ health care as the only way to squelch Democratic attempts to scuttle the plan. At the same time, facing resistance to the bill from within his own party, House Speaker Paul D. Ryan said it would be refined and improved.
“We want Americans to be able to purchase the health insurance plans they want, not the plans forced on them by our government,” Mr. Trump told about 10,000 supporters at the Municipal Auditorium in downtown Nashville. He spoke against the backdrop of a giant American flag to a crowd dotted with red trucker caps bearing his signature slogan, “Make America Great Again.”
“We’re going to all get together, we’re going to get something done,” Mr. Trump said. “Remember this: If we didn’t do it the way we’re doing it, we’d need 60 votes, so we’d have to get the Democrats involved. So we’re doing it a different way, a complex way.”
“It’s going to be fine,” Mr. Trump added.
The remarks were a nod to the complicated and politically risky approach Republicans have taken in pushing through legislation to repeal the health care law. The House plan championed by Mr. Ryan is coming under strain amid resistance, both from conservative Republicans concerned it is too close to Obamacare and from moderates who fear it will provide insufficient coverage for Americans who lack health insurance.
Mr. Ryan, fighting to keep the measure on track, said Wednesday that he was making “some necessary improvements and refinements” to the package to answer the concerns, which intensified this week after the Congressional Budget Office released a report estimating that the legislation would increase the number of people without health insurance by 24 million by 2026.
“Now that we have a score, we can incorporate feedback to improve this bill, to refine this bill, and those kinds of conversations are occurring between the White House, the House and the Senate, and our members,” Mr. Ryan said.
Previously, the speaker had referred to the measure as a “binary choice,” suggesting that Republicans must accept what many of them see as a flawed bill or lose the opportunity to enact a health care overhaul.
Mr. Trump has thrown his full support behind the legislation but is plainly concerned that the arcane legislative process will prompt a backlash that could undermine his presidency.
“If we’re not going to take care of the people, I’m not signing anything,” Mr. Trump said Wednesday evening in an interview with Fox News. “I’m not going to be doing it, just so you understand.”
He said he considered himself “an arbitrator” for Republican factions warring over the bill, and, asked whether the measure was the best his party could offer, said, “I think we’re going to have negotiation.”
Mr. Trump made his case on health care as he prepared to unveil a budget on Thursday that is expected to slash scores of domestic programs and illuminate his vision for radically scaling back the government.
“We have proposed a budget that will shrink the bloated federal bureaucracy — and I mean bloated — while protecting our national security,” Mr. Trump said, to cheers from his audience.
But even as he sought to focus on his own agenda during the second campaign rally of his young presidency, Mr. Trump was being drawn into yet another controversy over his travel ban on predominantly Muslim countries. Just before he was scheduled to take the stage in Nashville, Mr. Trump learned that a district judge in Hawaii had blocked the second iteration of his executive order, and the president took the stage fuming about the setback.
“This is, in the opinion of many, an unprecedented judicial overreach,” Mr. Trump said during his speech. “We’re going to fight this terrible ruling. We’re going to take our case as far as it needs to go, including all the way up to the Supreme Court. We’re going to win.”
Wednesday was supposed to provide a respite for Mr. Trump from the questions and controversies that have consumed him in Washington in recent days. He left behind a capital astir over his allegation that President Barack Obama tapped his phone during the fall campaign, after a top Republican said there was no evidence to back up the claim.
As he strode to Marine One in the morning, he ignored questions shouted by reporters about the leak on Tuesday of a portion of his 2005 tax return, which returned the spotlight to his refusal, unprecedented among recent presidents, to release any portion of his tax returns.
Mr. Trump traveled to Detroit for a speech to automakers highlighting his move to halt Obama-era fuel efficiency standards, arguing that stripping away regulations would allow the manufacture of more cars in the United States.
His decision to hold a rally in Nashville suggested a desire to reach beyond his core supporters. While he won the state of Tennessee handily — claiming 61 percent in the state to Hillary Clinton’s 35 percent — he was deeply unpopular in Nashville, the seat of a largely urban county where he won only one-third of the vote.
But the event contained no glimmer of outreach. It was a raucous re-enactment of the fiery and hyperpartisan rallies that powered his 2016 campaign, complete with Mr. Trump vowing repeatedly to “build that wall” on the southern border — a refrain his supporters chanted loudly in response — and a dig at Mrs. Clinton. He also paused for several moments to allow shouts of “Lock her up! Lock her up!” to echo throughout the hall.
Before the rally, Mr. Trump paid homage to a former American president whom he has often invoked as a kindred spirit, stopping to lay a wreath at the tomb of Andrew Jackson at his home, the Hermitage, to honor Mr. Jackson’s 250th birthday. Mr. Trump, who has styled himself a populist even thought he advocates many policies sought by corporate interests, has often mentioned his admiration for Jackson, who is also considered a fighter for the working man.
“It was during the Revolution that Jackson first confronted and defied an arrogant elite. Does that sound familiar?” Trump told a crowd gathered in front of the Hermitage.