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Fadi El Abdallah, a spokesman, did not return tele- phone or email messages. Rights advocates, however, quickly responded. Bashir has two warrants against him issued by the court, in and He is facing seven counts of war crimes and crimes against humanity as well as three counts of genocide.

While Mr. Bashir has visited nu- merous nations since, he could be arrested if he visits member coun- tries of the International Criminal Court. He must also use caution in avoiding any flight plan that in- cludes the airspace of a court member.

Neither Russia nor the United States are members. But the longstanding American policy has been to isolate Mr. Bashir was nearly arrested at a African Union meeting in South Africa, a court member. He was unable to leave while South African judges pondered whether he should be arrested. Bashir to depart. Neil MacFarquhar contributed re- porting. But a local election in Tokyo has put Mr. The victory for Tomin First, the party Ms.

Koike established in January, was widely seen as a ref- erendum on Mr. Abe as much as a vote of confidence in Ms. For several months, Mr. Abe, who has been in office since , has been dogged by influence- peddling scandals, as well as re- peated bumbling by some mem- bers of his cabinet. He has also drawn criticism for pushing through a legislative vote on an anti-conspiracy bill that many said he had not sufficiently ex- plained.

Until recently, Mr. Abe and his party behaved with an air of invin- cibility, shored up by their two- thirds majority in both houses of Parliament. But public frustration with Mr. Abe has grown. He has repeatedly denied involvement in two corruption scandals, in which his administration is accused of providing preferential treatment to schools operated by allies of Mr.

Abe, and he has shielded his de- fense minister, Tomomi Inada, from criticism of her competence. Jiro Yamaguchi, a professor of political science at Hosei Univer- sity, said Mr. Nationally, the public is wary of the leading oppo- sition, the Democratic Party, which is seen as having failed to deliver during more than three years in power before Mr.

The party won just five seats in the Tokyo assembly election. But Ms. Mochizuki, who voted for a Tomin First candidate, suggested that problems like Mr. In the spring, the cabinet had a 60 percent approval rating in na- tional polls.

It is unclear whether public sen- timent in Tokyo will translate into national support for Ms. Koike was a member of the Liberal Democratic Party, but ran for gov- ernor as an independent after the party declined to back her; the party accepted her resignation on Monday. Abe as well. Most analysts said Ms. Koike did not expect to challenge Mr. Abe for his job, but perhaps hoped to be his successor. Abe may face big- ger challenges within his own party. But in March, the party voted to change its rules to let a leader serve three consecu- tive terms, setting the stage for Mr.

Abe to govern until If his popularity continues to erode, it would be an echo of Mr. He resigned in after just a year in office, as his administra- tion foundered on a series of blun- ders and scandals. Since returning to power in and holding on to it, Mr. Abe has been viewed as having learned lessons and become a much more savvy politician.

He could yet be saved by his skills in international diplomacy. He is the rare world leader who has managed to get most of what he wanted from President Trump. With a likely visit by Mr. Trump to Japan in the fall and various up- coming Asian summit meetings, Mr. Advisers to Mr. Abe have indi- cated that he is also likely to re- shuffle his cabinet later this sum- mer, as a way of defusing some of the criticism of his administration.

Until now, he has steadfastly sup- ported his most gaffe-prone cabinet minister, Ms. Inada, a longtime close ally whom he once was thought to be grooming as his successor. As recently as last week, Mr. Abe stood by Ms. Analysts say that kind of sup- port for his friends could be Mr. Cucek said. By defending Ms. Inada, as well as the school operators he is ac- cused of giving special favors, Mr.

Abe has alienated the public, Mr. The missile took off from the Banghyon airfield in the north- western town of Kusong and flew miles before landing in the sea between North Korea and Japan, the South Korean military said in a statement.

Military officials were still analyzing flight data to determine what type of missile had been used. It was the first missile test by the North since it launched land- to-sea cruise missiles off its east coast on June 8. Under a series of United Nations Security Council resolutions, North Korea is banned from developing or test- ing ballistic missiles. According to the Japanese gov- ernment, the missile flew for 40 minutes before landing in the so- Motoko Rich contributed report- ing from Tokyo.

The United States Pacific Command said it had tracked the intermediate range missile for 37 miles. In Seoul, Mr. Moon, who during his election campaign this year advocated talks with the North, called a meeting of senior security officials to discuss the lat- est provocation, his office said. The launch occurred hours be- fore Independence Day began in the United States.

In , as the July 4 holiday was still being cele- brated, North Korea test-fired six ballistic missiles. On Twitter late Monday, Mr. Does this guy have anything bet- ter to do with his life? Hard to be- lieve that South Korea and Japan will put up with this much longer. Perhaps China will put a heavy move on North Korea and end this nonsense once and for all! Trump has been trying, so far without success, to enlist China to pressure Pyongyang to curtail its nuclear and missile pro- grams.

North Korea last launched a ballistic missile from Kusong on May 14, when it tested what it called a new weapon that could carry a large, heavy nuclear war- head. The intermediate-range Hwasong, believed to have a longer range than any other North Korean missile tested until then, landed in the sea between the North and Japan.

It flew miles and soared to an altitude of 1, miles. At the time, North Korea said that the missile was launched at a deliberately high angle so it would not fall too close to a neigh- boring country, and that if launched at a normal trajectory, it could target American military bases in the Pacific. Some outside analysts have reached a similar conclusion. The missile, which was identified as a Pukguksong-2, flew miles.

North Korea has said Pukguksong-2 could carry a nuclear payload. The missile was also fired from a mobile-launch vehicle and used a solid-fuel tech- nology that missile experts said will make it easier to hide it and launch on short notice. The Pukguksong-2 test was conducted as Mr. In remarks to reporters, Mr. At the same time, it has vowed to de- velop the ability to attack the United States with nuclear war- heads, although it has never tested an intercontinental ballistic missile that could fly across the Pacific.

Missile experts say North Ko- rea may still be years away from mastering the technologies needed to build a reliable inter- continental ballistic missile. A go-it-alone approach by Mr. Trump would also further antago- nize China, since it would require blacklisting multiple Chinese banks and companies that do business with the North. The United States began doing so on a modest scale last week by desig- nating four Chinese entities and individuals. The precarious state of United States-China relations was cap- tured by the way the two sides characterized the call.

The White House said only that Mr. Trump and Mr. Xi established in April at a summit meeting in Palm Beach, Fla. Trump avoided any personal jabs at Mr. Xi; the Chinese government said tensions were to be expected in a relationship this complex. But each leader has learned a hard les- son about the other, according to officials and outside analysts. Xi, they said, miscalculated what China needed to do to satisfy Mr.

Trump, thinking he could buy him off with a few highly visible measures, like banning coal pur- chases from the North. Trump overvalued the personal touch by betting that a few hearty hand- shakes with Mr. It imposed sanctions on a Chinese bank, ac- cusing it of acting as a conduit for illicit North Korean financial ac- tivity, as well as on a Chinese com- pany and two Chinese citizens.

And it labeled China one of the worst offenders in an annual State Department report on hu- man trafficking. Iris Zhao contributed research from Beijing. It was only the second time since Mr. Trump requested the call on Sunday. But American officials said their Chinese coun- terparts signaled that they were eager to clear the air after a A go-it-alone approach by the U. Xi had agreed to the call. Trump and perhaps deter him from taking more extreme measures, such as military action.

Trump to turn to other nations, no- tably Japan and South Korea, for help in resolving the crisis. He had a warmer call with Prime Minister Shinzo Abe of Ja- pan, who praised his decision to penalize Chinese entities accused of doing illicit business with the North, according to Kyodo News, a Japanese news agency. Trump will host a dinner with Mr. Some former officials said the tensions between Mr. Xi were neither new nor par- ticularly troubling. Bader, a China ad- viser to President Barack Obama.

We operate in a nether zone with the Chinese. Six out of 10 Londoners, including Mrs. Bakkali, voted against Brexit. Walsh and most black-cab drivers interviewed for this article voted in favor. One year after that vote, Britain is on edge.

More divided than ever after an in- conclusive election, the country has lived through four terrorist attacks in re- cent months — three by British Muslims and one against them. Uber, meanwhile, has become its own symbol of excess. Bakkali, the daughter of Moroc- can farmers, and Mr.

Walsh, the son of a north London construction worker, are small players in these much bigger dra- Top, Zahra Bakkali, who immigrated from Morocco in and now drives for Uber, voted against Brexit. At right, Uber representatives talk with drivers at an Uber center in London.

Losing London This article is part of a series examining whether Brexit will sink a great global city. They want the same thing: to claw their way into the middle class and give their children a shot at a better life. Bakkali said of black cabs she had en- countered. The drivers give the middle finger, she said, and shout abuse.

Bakkali, black cabs have be- come a byword for populism and racism. For Mr. Walsh, Uber is shorthand for ev- erything he believes is wrong with glob- alization — and proof that successive governments have failed hard-working citizens like him. Grant Davis, chairman of the London Cab Drivers Club, recounted a meeting with a minister in the Conservative gov- ernment about a year ago.

Davis, who has driven a black cab in London for 29 years. Walsh said one morning in April. In other cities, the latest immigrant group to arrive takes up the taxi trade, Mr. Walsh said. Not here. Walsh proudly conforms to most stereotypes about London cabbies. There was vinegar on the table and spotted dick on the menu.

The place could not be more British. Except that the entire staff seemed to be Eastern Eu- ropean. A lot of Poles now live where Mr. Walsh grew up, in Harlesden, northwest Lon- don. Walsh, now His father worked in construction and his mother in a cookie factory, but they saved up and moved the family to Wemb- ley, a more middle-class area. Earning a taxi badge was a ticket to upward mobility, but it required master- ing the Knowledge. The dropout rate is 70 percent.

Six days a week, Mr. Walsh would crisscross London on a scooter memorizing roughly 2, miles of road. Walsh dreamed of Lon- don and woke up sweating. Texas Lega- tion to Union Chapel. Cumberland Mar- ket to Redhill Street. It had taken him nearly three years, one year less than the average, and he was as proud as he had ever been.

Bakkali dropped off her youngest child at school and then sat in her car, staring at the Uber app. She hesitated and finally turned it on. It was her first day on the job. She had come to London in , at age 18, unable to read or write or drive, with a new husband she barely knew. Her hus- band, the son of Moroccan immigrants who had arrived in London in the s, had escorted her from a village without electricity in the mountains behind Mar- rakesh to a new, unimaginable life.

To mark the occasion, her mother-in-law had paid for a black cab from Heathrow Airport back to East Street Market in southeast London, her new home. Bakkali had never left her coun- try before, never taken an airplane, never even owned a passport. Asked for her signature, she could make only a clumsy doodle.

Now 38, Mrs. Bakkali is hungry for ed- ucation. In , Mrs. Bakkali recalled. That night, she told her husband they needed to buy a car, and he needed to learn to drive, because she never wanted to take public transportation again. Afraid of driving, he refused. So she got her own license. Bakkali loved driving. About a year ago, over breakfast, she confessed her dream: to become a bus driver.

They went online and booked an ap- pointment for the next morning, a Sun- day. By lunchtime she had registered with Uber, heard a presentation, taken an online topography test, received a certificate from the company and ap- plied for the obligatory government background check. Walsh was navi- gating his cab around Parliament Square, past Westminster Abbey and into an alleyway leading to the head- quarters of the governing Conservative Party. Their signs and slogans blamed Uber for an array of wrongs, including pollution and rape — and the government for siding with Uber.

Rachel Whetstone, who was a senior executive at Uber until April, is married to Steve Hilton, a close friend of, and once an adviser to, former Prime Min- ister David Cameron. When Boris John- son, as mayor of London, considered clamping down on Uber in , for ex- ample by imposing a minimum waiting time of five minutes on riders, some , Londoners signed a petition in protest and he was reportedly told to back off.

Uber de- nied that Ms. Cameron campaigned to stay in the European Union, which is one reason that many cabbies voted to leave. Cabbies say that T. Walsh, who was back in his cab and now following the march by road. Walsh add- ed. The taxis represent the old guard, tracing their lineage to the 17th century. Sometimes when a customer cancels, Mrs. Bakkali worries that it is because she is Muslim. In her photograph on the Uber app, she wears a head scarf dis- creetly tied at the back of her neck.

There are several Muslim women on Mrs. They shared pastries and stories about the relentless hostility coming from cabbies. Take off that scarf! Bakkali recently had a polite ex- change with a cabby, a man from Somalia, who rolled down his window at a red light.

Small money? She dropped off her last customer in Wey- bridge, west of London, at 6 : 30 a. Last year, Uber raised its commission on every ride to 25 percent, from 20, for new drivers. The room was packed. Every- body had the same urgent plea: Could Uber cut its commission back to 20 per- cent?

The answer was no. Bakkali said. When she took two weeks off around Easter, she found that in the days after, few jobs were sent her way. Her earnings were halved. Uber denies that its algorithm de- liberately penalizes breaks, but all Uber drivers interviewed for this article be- lieve that it does.

One cabby recently sold his taxi be- cause there was not enough work. He is leasing one now but may quit altogether, he said. Walsh would have 20 fares a day. Now the number is closer to five. Bakkali shrugs at the idea. She grew up without running water or a phone. To visit her grandparents, she had to walk — for a day. If someday driving is no longer an option, she may start her own business, she said.

Embroidery, perhaps, or sewing. Walsh accepts that black cabs have been slow to adapt to change. Cred- it-card machines were made mandatory only last fall. Ride-hailing apps for black cabs remain fragmented. But he believes that his brain can beat a navigation sys- tem any day. Years ago, he took part in a research project at University College London that found that memorizing a map of the city resulted in an enlarged hippocampus.

Walsh said proudly. They cannot deal with incomplete addresses and do not know the best shortcuts when traffic is bad. And they cannot tell you where to buy the best salt beef bagels. Macron has said little since his election on May 7, cultivating something of an air of mystery about his exact intentions.

He broke that semisilence on Monday in a speech lasting well over an hour to a rare joint session of the French Parliament at Versailles. He gave a lofty outline of his five-year term, setting a tone but largely eschewing specifics. That relationship had been damaged, he suggested.

Macron was making a point: French citizens were de- manding change after years of stagnation, change was needed and he was the man to bring it about. Macron said. Then, he told the lawmakers that they had to legislate less.

That plea was consistent with the disdain Mr. Macron has shown from the beginning for the world of conventional French politics. He stunned the traditional par- ties on the right and the left, and he is now buoyed by the election last month of a big majority from his own political movement. Polls show the French are now more optimistic than they have been in some years.

Macron aimed to encourage this optimism about the future on Monday. However, Mr. He would probably not have been elected but for revelations in the news media about an embez- zlement scandal touching his leading rival, the center-right poli- tician Francois Fillon. The Versailles speech was boy- cotted by members of Parliament on the far left, already taking up arms against Mr. He touched only briefly on his labor overhaul plans on Monday. Macron has been criticized — most recently over the week- end — for slighting references to the less fortunate in French soci- ety, and to those who are not eco- nomically successful.

For decades, Iranian revolutionary families would work late into the night to make sock puppets, cartoons and effigies of every American president since Jimmy Carter, then proudly pa- rade them around during an anti-Amer- ican protest and burn them in a bonfire.

Some would dress up with Uncle Sam top hats, Bill Clinton imitators would always have a big cigar hanging from his puppet mouth, and George W. Bush would be decorated with stars of David, to highlight the special relationship with Israel. But as even the staunchest hard- liners would admit, the number of zeal- ous protesters had dwindled over the years. In recent times, most people have been content just to pick up posters given to them by the authori- ties. But in President Trump the United States has a new, colorful president who denounces Iran, and Iranian hard- line groups cannot believe their good luck.

This Monday, at a cartoon and caricature contest where the only goal was to make fun of President Trump, the zealots were back in force. Several winners received cash prizes in dollars for showing the president in the white robes of the Ku Klux Klan, sharing a Time magazine cover with Adolf Hitler, or as Captain America wielding the Statue of Liberty as a bludgeon.

Some of the cartoons were also hung across Tehran. One poster, featured prominently at a busy intersection, showed Mr. Trump doing something to the rear of an elephant, symbol of the Republican Party, while also wearing a swastika armband and with the decapi- tated head of Lady Liberty at its feet. The date of the exhibition, July 3, is the anniversary of the downing of an Iranian passenger plane by the United States Navy in that killed all people on board.

While the Pentagon has always insisted the incident was a tragic mistake, many Iranians are convinced the plane was shot down to pressure Iran into ending its eight-year war with Iraq. The winning caricature, of Mr. He has been organ- izing — or told to organize — cartoon contests for several years now. He started after European newspa- pers began publishing cartoons depict- ing the prophet of Islam, Muhammad.

In retaliation, Iran organized a Holo- caust cartoon contest. Shojaei-Tabataei said in a recent inter- view. Last year the competition focused on the Islamic State terror group, specifically how the group is an instru- ment of the West, as Iranian officials often say. There were lots of drawings of terrorists with American flags on their chests.

Trump was the real face of America. Before that, the Irani- an leadership had mostly not reacted openly to Mr. Trump, buying time while they tried to figure out what makes him tick. Babaei acknowledged that he would be upset if a similar contest in America made fun of Ayatollah Khamenei, but he said he had a good reason.

Trump is just a showman. Babaei said he would not take his protest to the streets. Much more effective. As Americans prepare to celebrate the Fourth, are they still feeling pride in a divided country? Even a divided country can come together to celebrate its birthday.

This Fourth of July weekend, we wanted to see how patriotic Americans were feeling as they hit the road to beach parties, mountain cabins and backyard barbecues across this frac- tious, fractured country. Are people still taking pride in a country rippling with waves of anger and resistance, riven by resentments and bitterly divided over issues like health care and immigration?

Can patriotism encompass both supporting the president and marching against him? Standing during the national anthem and taking a knee in protest? To find out, we headed to roadside restaurants, outlet stores and rest stops in Colorado, Georgia and New Hamp- shire and spoke with about three dozen people as they stopped for bathroom breaks and reheated hot dogs.

Some interviews have been condensed. Patriotism to me means appreciating the military, means appreciating our freedom and appreciating the fact that anyone really is free to express what they want to express. We can be kind, no matter what. I never would have thought of that prior to this elec- tion cycle. Sheldon served in the Navy and Robbie in the Air Force, which helps feed a friendly rivalry between the two.

Sheldon: This is a good country, regard- less of the current political air. Robbie: Fourth of July — I have mixed emotions. We actually elected a black man president eight years ago. The only reason you would want to keep something like that around is for hatred. Traffic gets so bad on the two-lane roads that he and his wife are spending the weekend close to home with friends and having a backyard hot-dog roast.

How was he planning to celebrate? Display the flag, honor it. Believe in country, God. Loyal to the government and the president. Roger, a teacher in Denver, said the holiday made him think back to his days working for the Peace Corps. In these divided times, what does patrio- tism mean to you?

Patriotism really means focusing on what is positive about this country. Our loyalty to our flag, and what it stands for. Our diversity, which is our greatest strength. How do you express that? Yes we do. We make sure everyone knows this is our country. Sveta: I adopted America as my country. I feel proud to be able to live here. There are so many more opportunities here than anywhere else. Health care costs are a financial stress, and David said he felt his family slipping to the lower rungs of the middle class.

Jonny: New life. I had a daughter not too long ago. Her first Fourth of July. George: Honoring our country, honoring our freedom. Supporting our president and realizing how good we have it. Real- izing that we can get on our bikes, ride up to Old Orchard and get back to work. Jonny: You can call that the American dream. I would say the holiday is more impor- tant this year.

Maybe it can bring a sense of unity after all of the police brutality and politics and elections. We can just sit back and be one. What does the Fourth mean to you? Kristy: It just means the freedom of our country and the lives people lost for our country, and the people fighting for everything now. Do you think people think about what you see as the true meaning of the Fourth?

Does that feeling stick around after the holiday? Kristy: People do sit around and think about these things for a short period of time, but then they go on about your life after that. He played with his month-old daughter, Arabella, as he spoke. It means to be free. You think about what is going on and what you have been doing. Jan: We need to be protective of our country.

We take it for granted, what we have, and maybe people are realizing that now. Jim: Our country is so divided, so peo- ple should be coming together instead of trying to be resistant and all that. Here is an assessment. Senator Patrick J. This would lead to 15 million fewer Medicaid enrollees and seven million fewer in the indi- vidual market within the next decade, the Congressional Budg- et Office estimated.

According to the Kaiser Family Foundation, a nonpartisan health research group, Pennsylvanians would see a 72 percent increase in out-of-pocket premium costs under the new bill, compared with a national average increase of 74 percent. The plan is separate from Re- publican efforts to repeal the health care law, and appears more likely to be adopted because it would be written into the annual spending bill for the Treasury and the I.

But it has a similar purpose: to weaken the health law that Presi- dent Trump and Republicans in Congress want to dismantle. That provision, known as the individual mandate, is widely disliked, according to opin- ion polls. In case that effort fails or bogs down, the House Committee on Appropriations has drafted a pro- vision to stop the I. The restric- tions, for the fiscal year that starts Oct. In , it pegs funding growth to the medical inflation rate for children and adults at 3.

In , growth for all groups would be tied to the Con- sumer Price Index. But Medicaid spending for adults and children under the current law is expected to grow faster, at 4. People at all income levels would see some of the money, but characterizing the cuts as a boon for the middle class is misleading. In contrast, a I. The government uses these reports to help admin- ister the individual mandate and other requirements. Representative Tom Graves, Republican of Georgia and chair- man of the subcommittee, said the A plan to erode the Affordable Care Acts individual mandate.

Garrett Hawkins, a spokesman for Mr. Trump later bemoaned a percent actually percent increase in Alaska specifically. As The Times explained in a fact-check of Mr. McConnell, the comparison is imperfect — and Mr. Trump compares two fundamentally different uni- verses of plans : all the plans on the individual market in and those only on the federal ex- change in The plans are different, with Affordable Care Act plans covering more and sicker people and offering more comprehensive benefits.

If they fail to do so, they too may be subject to penalties. Aides to the Senate majority leader, Mitch McConnell, Republi- can of Kentucky, were working Monday on his bill to repeal major provisions of the Affordable Care Act, with the hope that they could meet objections from about one- fifth of his member caucus. He has sent proposed revisions to the Congressional Budget Office for analysis. To mollify moderate Republi- cans, he is considering restoring some money to Medicaid or keep- ing a tax on the investment in- come of the most affluent Ameri- cans.

To satisfy conservatives, he is considering a proposal that would allow insurers to sidestep most federal insurance rules if they offer at least one health plan that complies with those standards. Burgess, Republican of Texas and a physician. Many supporters of the Afford- able Care Act, including Democrats in Congress, describe the individual mandate as an im- portant part of the law.

The law it- self said the mandate would in- — 93 percent in Alaska, accord- ing to a different Health and Human Services report — re- ceive to help blunt the cost of premiums. Senator Ron Johnson of Wisconsin suggested misleadingly that the A. An estimated 2. Blaming the health care law for the coverage gap distorts a chain of causality. It simultaneously increa- ses Medicaid eligibility for low- income individuals, to per- cent of the poverty level from the previous threshold of 44 percent.

But the Supreme Court ruled in that the federal govern- ment could not compel states to expand their programs, with 19 states then declining to do so. In those states, people making 44 to percent of the poverty level did not qualify for Medicaid or marketplace subsidies. Their pre- mium payments help defray the cost of care for less healthy people and thus lower premiums in gen- eral, Congress said in Using similar logic, the Con- gressional Budget Office said last week that repealing the individual mandate penalty, by itself, could lead to higher premiums.

And many insurers cite uncertainty about the mandate as a reason for seeking rate increases for The Obama administration went to the Supreme Court in a successful effort to defend the in- dividual mandate, but the Trump administration has indicated that it is not planning aggressive en- forcement. On his first day in of- fice, Mr. Less than a month later the I. The agency had planned to reject such returns. The I. Koskinen, said that 6.

In addi- tion, Republicans in Congress have made clear that they want to change that equa- tion for many, whether through the health bill struggling in the Senate or future legislation. It would offer tax credits toward premi- ums for private coverage, but those policies would come with thousands of dollars in new deductibles and other cost shar- ing. Despite the much higher out-of-pocket costs, some policy analysts and policy makers argue that low-income Ameri- cans would be better off.

It appears that proponents like Ms. Verma have looked at research and concluded that having Medicaid is often no better than being uninsured — and thus that any private insur- ance, even with enormous de- ductibles, must be better. But our examination of research in this field suggests this kind of think- ing is based on a classic misun- derstanding: confusing correla- tion for causation.

One such study that got considerable at- tention was done at the Univer- sity of Virginia Health System. For patients with different kinds of insurance — Medicaid, Medicare, private insurance and none — researchers examined the outcomes from almost , major operations, like coronary artery bypass grafts or organ removal. They found that Medicaid patients were more likely than any other type of patient to die in the hospital. They were also more likely to have certain kinds of complica- tions and infections.

Medicaid patients stayed in the hospital longer and cost more than any other type of patient. Private insurance outperformed Medic- aid by almost every measure. Other studies have also found that Medicaid patients have worse health outcomes than those with private coverage or even those with no insurance. If this means that Medicaid causes worse health, we would be justi- fied in canceling the program. Why spend more to get less? But that is not a proper inter- pretation of such studies.

There are many other, more plausible explanations for the findings. Medicaid enrollees are of lower socioeconomic status — even lower than the uninsured as a group — and so may have fewer community and family resources that promote good health.

They also tend to be sicker than other patients. In fact, some health care providers help the sickest and the neediest to enroll in Medicaid when they have no other option for coverage. Be- cause people can sign up for Medicaid retroactively, becoming ill often leads to Medicaid enroll- ment, not the opposite. Some of these differences can be measured and are controlled for in statistical analyses, includ- ing the Virginia study. But many other unmeasured differences can skew results, even in studies with such statistical controls.

Aaron E. Carroll, a professor of pediatrics, and Austin Frakt, a health economist, both blog on health research and policy at The Incidental Economist. The Upshot provides news, analysis and graphics about politics, policy and everyday life. They practically shout that the correlations they find are not evidence of causation.

Other approaches to studying Medicaid more credibly demon- strate its value. The most straightforward is a prospective randomized trial, which gets around the subtle biases that plague studies that use only statistical controls. There has been one randomized study of Medicaid, focused on an expan- sion of the program in Oregon.

Because demand for the pro- gram exceeded what Oregon could fund, in the state introduced a lottery for Medicaid eligibility. It did not detect improvements in mortality or measures of physi- cal health, but it did not have enough sick patients or enough time to detect differences we might have expected to see. In other words, it was not powered to detect changes in mortality or physical health.

Saying that this A classic confusion of correlation with causation. Regardless, there was nothing to indicate that having Medicaid worsened health. Another way to tease out the causal effect of Medicaid is to look at variations in Medicaid eligibility rules across states.

With respect to health outcomes, these state decisions are effec- tively random, so they act like a natural experiment. Older stud- ies based on this approach, using data from the s and s, have not found that Medicaid causes worse health. Findings from more recent studies looking at expansions in enrollment, in the s and then under the Affordable Care Act in , are consistent with older ones.

One can argue that Medic- aid can be improved upon, but the credible evidence to date is that Medicaid improves health. It is better than being uninsured. Some of the studies that associate Medicaid with worse health, as compared with private insurance, also find the same association with Medicare. No one argues that Medicare is making people sick. It also provides peo- ple with peace of mind — know- ing that they will be able to af- ford care when they get sick.

Research is clear on how peo- ple react when asked to pay more for their health care. As the Congressional Budget Office reported, many poor people would choose not to be covered, because even if they could afford the premiums with help from tax credits, deductibles and co-pay- ments would still be prohibitively expensive.

Congress Moves to Stop I. In the six months since Presi- dent Trump took office, he has visited Iowa. New York. South Carolina. Even New Jersey. Perhaps Mr. Trump is in no rush to visit the state that has emerged as the center of the resistance to his presidency.

He lost California by more than four million votes in November. The state is the big- gest Democratic stronghold in the nation, and its leaders have been challenging Mr. Trump and his policies at every turn. De- spite having the luxury of traveling on Air Force One — no taking off your shoes for a securi- ty line — Mr. Trump has stayed close to the East Coast since he took office, crossing the Missis- sippi River only once, briefly, for an Iowa rally last month.

Except for his foreign trip in May, Mr. As he prepares to head even far- ther east on Wednesday for a four- day trip to Poland and Germany, the president has left some Cali- fornians wondering whether he has any intention to visit at all. Shear from Washington. Bauman, the state Democratic leader. Since at least Jimmy Carter, ev- ery president has visited Califor- nia by about the six-month mark in his presidency, looking for po- litical support, campaign cash or perhaps just a few days of good weather.

In May , Mr. Ronald Reagan returned to his home state in June George Bush was in San Jose talking about taxes in April Bush was in Los Angeles in May Barack Obama visited Cali- fornia in March and October The list of states Mr. Trump has visited include ones he won last year, along with New York and Virginia, which have Trump- branded properties, and Connecti- cut, where he delivered the com- mencement address at the Coast Guard Academy. Schmidt said. Trump would not encounter in California the same kind of raptur- ous reception that he has drawn in other states.

When Mr. Trump made his one trip back to New York, his home city, he confined the visit to the Far West Side of Manhattan, avoiding his Midtown home at Trump Tower, which has been the site of loud demonstrations. Bau- man said of a Trump visit to Cali- fornia. Trump had not come here — and probably should not invest the time in coming here — be- cause the party was in so much trouble in Washington.

But right now, they are behind in their agenda. Trump might be missing an opportunity to be seen stand- ing up to anti-Trump sentiment. Stutzman said. Trump changed his mind, a choice spot for a presidential vis- it would be Sunnylands, the sprawling estate in Rancho Mi- rage, built in by the publisher Walter H. It has been a favorite of Republicans in the past. Bush hosted the Japanese prime minister for a state dinner at the estate.

After his death, Mr. Accordingly, the foundation sent Mr. Trump a letter of invi- tation soon after his election, an- nouncing that the estate was available for presidential business or pleasure. The Annenberg Foundation is still waiting for an R. Gorsuch, left, and Chief Justice John G. Roberts Jr. Justice Gorsuch has seemed to acclimate quickly to the court. From Page A1 another on chemical spills, are likely to receive close scrutiny from the courts. Pruitt had imposed a day moratorium, which he later ex- tended to two years, on enforce- ment of parts of the E.

He had also ar- gued that his action was not sub- ject to court review. Robert Wilkins wrote. The third member of the three-judge panel, Janice Rogers Brown, dissented. Critics say the Trump adminis- tration has improperly delayed other regulations as well, and have challenged a May E. In June, the Interior Depart- ment also delayed for two years a set of rules that would have limited the release of methane from wells on federal and tribal lands.

The E. Trump and his advisers consider an oppressive regulatory state. In a February executive order, Mr. After the E. And the effort to reverse the Clean Power Plan regulation on power plant carbon emissions — the rule at the heart of Mr.

Pruitt is ex- pected to publish the details of his plan to repeal the regulation in the coming weeks. David Doniger, director of the climate and clean air program at the Natural Resources Defense Council, said he believed the ad- ministration would be on the los- ing end of those battles.

The methane rule was part of a broad suite of climate regulations enacted by Mr. Methane is a potent greenhouse gas 25 times more powerful than carbon dioxide. Oil and gas companies have ar- gued that the rule requiring them to report and fix any methane leaks in their equipment is an un- necessary burden because many oil-producing states already have their own regulations. The court rejected that argument.

Reid Porter, a spokesman for the American Petroleum Insti- tute, said that standards set in were already reducing meth- ane emissions. For Justice Neil M. Gor- such, who joined the court in April, a couple of months seem to have sufficed. His early opin- ions were remark- ably self-assured. He tangled with his new colleagues, lectured them on the role of the institution he had just joined, and made broad jurisprudential pronouncements in minor cases. Other justices moved more slowly.

Breyer, who joined the court in , said in a interview. Justice Clarence Thomas, who joined the court in , said he had asked his new colleagues how long it would take to hit his stride. Brandeis, who sat on the court from to Justice Robert H. But his most forceful state- ments came in otherwise forget- table decisions.

Consider Perry v. Merit Sys- tems Protection Board, an excep- tionally complicated case about where Civil Service and discrimi- nation claims may be filed. When the case was argued in April, Justice Samuel A. Alito Jr. By that standard, Justice Gor- such is no ordinary lawyer. In dissent, he said the answer was plain, as some kinds of cases belong in one court and other kinds in another.

The seven- justice majority had gone astray, he said, in tweaking the statutory arrangement in the name of simplicity to arrive at the conclu- sion that the claims should all be brought in Federal District Court. Then he made a larger point. To be sure, the demands of bi- cameralism and presentment are real, and the process can be protracted. Louis, said on First Mondays, an entertaining podcast that ex- plores developments at the Su- preme Court. Santander Consumer USA.

It was about debt col- lection, and it was unanimous. Here, too, Justice Gorsuch was ready to swing for the fences. United States, a case about when naturalized citizens may be stripped of their citizenship, Justice Gorsuch said Justice Kagan, writing for the majority, had provided more guidance than was warranted and proper. The Supreme Court should announce general principles, he said, and let lower courts fill in the gaps.

And recently, they have been getting it — but not from the federal government. Instead, state and local lawmak- ers have been passing policies to address the needs of working families. Last week alone, state legisla- tures passed several major pieces of legislation that benefit families.

Wash- ington passed a paid leave law that gives workers 16 weeks to care for babies, family members or themselves. The flurry of policy making at the state level is a response to the void at the federal one, advocates and policy makers say. The policies acknowledge that 71 percent of women with chil- dren under 18 are in the labor force, and both parents work in 61 percent of married families with children, according to the Bureau of Labor Statistics. There is widespread support among voters for policies that help make those two roles possible.

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