WASHINGTON (AP) — In this time of war overseas, more Americans think foreign policy should be a top focus for the U.S. government in 2024, with a new poll showing international concerns and immigration rising in importance with the public.

About 4 in 10 U.S. adults named foreign policy topics in an open-ended question that asked people to share up to five issues for the government to work on in the next year, according to a December poll from The Associated Press-NORC Center for Public Affairs Research.

That’s about twice as many who mentioned the topic in the AP-NORC poll conducted last year.

Long-standing economic worries still overshadow other issues. But the new poll’s findings point to increased concern about U.S. involvement overseas — 20% voiced that sentiment in the poll, versus 5% a year ago.

It also shows that the Israeli-Hamas war is feeding public anxiety. The conflict was mentioned by 5%, while almost no one cited it a year ago. The issue has dominated geopolitics since Israel declared war on Hamas in Gaza after that group’s Oct. 7 attack on Israeli soil.

Four percent of U.S. adults mentioned the conflict between Russia and Ukraine as something for their government to focus on this year. That’s similar to the 6% who mentioned it at the end of 2022.

Foreign policy has gained importance among respondents from both parties. Some 46% of Republicans named it, up from 23% last year. And 34% of Democrats list foreign policy as a focal point, compared with 16% a year ago.

Warren E. Capito, a Republican from Gordonsville, Virginia, worries China could soon invade Taiwan, creating a third major potential source of global conflict for the U.S. “They would love to have us split three ways,” he said of China, and “we’re already spread so thin.”

Immigration is also a rising bipartisan concern.

Overall, the poll found that concerns about immigration climbed to 35% from 27% last year. Most Republicans, 55%, say the government needs to focus on immigration in 2024, while 22% of Democrats listed immigration as a priority. That’s up from 45% and 14%, respectively, compared with December 2022.

Janet Brewer has lived all her life in San Diego, across from Tijuana, Mexico, and said the situation on the border has deteriorated in recent years.

“It’s a disaster,” said Brewer, 69, who works part time after running a secretarial and legal and medical transcription small business. “It’s crazy.”

The politics of foreign military aid and immigration policy are entangled, with President Joe Biden ‘s administration promoting a $110 billion package that includes aid for Ukraine and Israel that remains stalled in Congress while Republicans push for a deal allowing major changes in immigration policy and stricter enforcement along the U.S.-Mexico border.

Brewer said she wouldn’t vote for Biden or a Republican for president in 2024, and may opt for independent Robert F. Kennedy Jr. But she also questions whether a change in the White House would necessarily improve immigration policy.

As for foreign aid, she said: “I know that we need to help. But come on. We’ve done enough.”

Even as immigration and foreign policy rose as concerns, those issues were no match for worries about the economy. Inflation has fallen, unemployment is low and the U.S. has repeatedly defied predictions of a recession — yet this poll adds to a string of them showing a gloomy outlook on the economy.

Some 76% of U.S. adults said this time that they want the government to work on issues related to the economy in 2024, nearly the same as the 75% who said so at this point in 2022.

About 85% of Republicans and 65% of Democrats name the economy as a top issue. But Republicans are more likely than Democrats to want the government to address some specific economic issues: on inflation 41% vs. 22% and on government spending or debt, 22% vs. 7%.

Meanwhile, 3 in 10 U.S. adults listed inflation as an issue that the government should focus on, unchanged from 2022.

The economy is a top issue mentioned by 18- to 29-year-olds (84%), followed by inflation specifically (39%), personal finances issues (38%) and foreign policy (34%). In the same age bracket, 32% mentioned education or school loans as something for the government to address in 2024. That’s despite the Biden administration trying new, more modest efforts to cancel debts after the Supreme Court struck down its larger original push.

Among those 30 and older, only 19% mention student loans. But Travis Brown, a 32-year-old forklift operator in Las Vegas, noted that he’s back to getting calls seeking payment of his student loans.

“Right now, with the economy, wages are not matching,” Brown said. “Blue collar’s going away and I don’t see how that’s going to boost an economy. An economy thrives off the working class. Not off the rich.”

Brown also suggested that the U.S. is too focused on shipping aid to its overseas allies.

“I care about others, I do,” he said. “But when you sit here and say, ‘I just sent $50 million over to Israel’ and then I go outside and I see half a neighborhood rundown … you’ve got to take care of home.”

One possible sign that larger sentiments on the economy could be improving slightly is that overall mentions of personal financial issues declined some, with 30% mentioning them now compared with 37% last year. Drops occurred for Democrats, 27% vs. 33%, and among Republicans, falling to 30% compared with 37% in 2022.

One-quarter of U.S. adults say 2024 will be a better year than 2023 for them personally, and 24% expect it will be a worse year. Some 37% of Republicans expect it’ll be a worse year for them, compared with 20% of independents and 13% of Democrats.

Just 5% of U.S. adults are “extremely” or “very” confident that the federal government can make progress on the important problems and issues facing the country in 2024, with 7% of Democrats and 11% of independents being optimistic, compared with 1% of Republicans.

Brown is a Democrat but said he was disillusioned enough to perhaps sit out the presidential election — especially if it proves to be a 2020 rematch between Biden and former President Donald Trump, who has built a commanding early lead in the 2024 Republican primary.

“I don’t think I will participate and maybe that’s bad,” Brown said. “But, it’s like, you’re losing faith.”

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WASHINGTON (AP) — New obesity drugs are showing promising results in helping some people shed pounds but the injections will remain out of reach for millions of older Americans because Medicare is forbidden to cover such medications.

Drugmakers and a wide-ranging and growing bipartisan coalition of lawmakers are gearing up to push for that to change next year.

As obesity rates rise among older adults, some lawmakers say the United States cannot afford to keep a decades-old law that prohibits Medicare from paying for new weight loss drugs, including Wegovy and Zepbound. But research shows the initial price tag of covering those drugs is so steep it could drain Medicare’s already shaky bank account.

A look at the debate around if — and how — Medicare should cover obesity drugs:

WHAT OBESITY DRUGS ARE ON THE MARKET AND HOW DO THEY WORK?

The Food and Drug Administration has in recent years approved a new class of weekly injectables, Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound, to treat obesity.

People can lose as much as 15% to 25% of their body weight on the drugs, which imitate the hormones that regulate appetites by communicating fullness between the gut and brain when people eat.

The cost of the drugs, beloved by celebrities, has largely limited them to the wealthy. A monthly supply of Wegovy rings up at $1,300 and Zepbound will put you out $1,000. Shortages for the drugs have also limited the supplies. Private insurers often do not cover the medications or place strict restrictions on who can access them.

Last month, a large, international study found a 20% reduced risk of serious heart problems such as heart attacks in patients who took Wegovy.

WHY DOESN’T MEDICARE COVER THE DRUGS?

Long before Oprah Winfrey and TikTok influencers alike gushed about the benefits of these weight loss drugs, Congress made a rule: Medicare Part D, the health insurance plan for older Americans to get prescriptions, could not cover medications used to help gain or lose weight. Medicare will cover obesity screening and behavioral treatment if a person has a body mass index over 30. People with BMIs over 30 are considered obese.

The rule was tacked onto legislation passed by Congress in 2003 that overhauled Medicare’s prescription drug benefits.

Lawmakers balked at paying high costs for drugs to treat a condition that was historically regarded as cosmetic. Safety problems in the 1990s with the anti-obesity treatment known as fen-phen, which had to be withdrawn from the market, were also fresh in their minds.

Medicaid, the state and federal partnership program for low-income people, does cover the drugs in some areas, but access is fragmented.

THE CONVERSATION IS SHIFTING

New studies are showing the drugs do more than help patients slim down.

Rep. Brad Wenstrup, R-Ohio, introduced legislation with Rep. Raul Ruiz, D-Calif., this year that would allow Medicare to cover the now-forbidden anti-obesity drugs, therapy, nutritionists and dietitians.

“For years there was a stigma against these people, then there was a stigma about talking about obesity,” Wenstrup said in an interview with The Associated Press. “Now we’re in a place where we’re saying this is a health problem we need to deal with this.”

He believes the intervention could alleviate all sorts of ailments associated with obesity that cost the system money.

“The problem is so prevalent,” Wenstrup said. “People are starting to realize you have to take into consideration the savings that comes with better health.”

Last year, about 40% of the nearly 66 million people enrolled in Medicare had obesity. That roughly mirrors the larger U.S. population, where 42% of adults struggle with obesity, according to the Centers for Disease Control and Prevention.

Notably, Medicare does cover certain surgical procedures to treat medical complications of obesity in people with a BMI of 35 and at least one related condition. Congress approved the exception in 2006, noted Mark McClellan, a former head of the Centers for Medicare and Medicaid Services and the FDA.

The 17-year-old law may provide a blueprint for expanding coverage of the new drugs, which mirror the results of bariatric surgery in some cases, McClellan said. Evidence showed that the surgery reduced the risks of death and serious illness from conditions related to obesity.

“And that’s been the basis for coverage all this time,” McClellan said.

COST IS NOW THE ISSUE

Still, the upfront price tag for lifting the rule remains a challenge.

Some research shows offering weight loss drugs would assure Medicare’s impending bankruptcy. A Vanderbilt University analysis this year put an annual price of about $26 billion on anti-obesity drugs for Medicare if just 10% of the system’s enrollees were prescribed the medication.

Other research, however, shows it could also save the government billions, even trillions over many years, because it would reduce some of the chronic conditions and problems that stem from obesity.

An analysis this year from the University of Southern California’s Schaeffer Center estimated the government could save as much as $245 billion in a decade, with the majority of savings coming from reducing hospitalizations and other care.

“What we did is we looked at the long-term health consequences of treating obesity in the Medicare population,” said the study’s co-author, Darius Lakdawalla, the director of research at the center. The Schaeffer Center receives funding from pharmaceutical companies, including Eli Lilly.

Lakdawalla said it’s nearly impossible to put a cost on covering the drugs because no one knows how many people will end up taking them or what the drugs will be priced at.

The Congressional Budget Office, which is tasked with pricing out legislative proposals, acknowledged this difficulty in an October blog post, with the director calling for more research on the topic.

Overall, the agency “expects that the drug’s net cost to the Medicare program would be significant over the next 10 years.”

The cost of the legislation is the biggest hang up in getting support, Ruiz said.

“When we talk about the initial cost, I often have to educate the members that the CBO does not take into account cost savings in their cost benefit analysis,” Ruiz told the AP. “Taking that number in isolation, one does not get the full picture of the full economies of reducing obesity and all of its comorbidities in our patients.”

WHO WANTS MEDICARE TO COVER THE DRUGS?

Doctors say weight loss drugs are only a part of the most effective strategies to treat a patient with obesity.

When Dr. Andrew Kraftson develops a plan with his patients at the University of Michigan’s Weight Navigator program, it involves a “perfect marriage” of behavioral intervention, health and diet education, and possibly anti-obesity medication.

But with Medicare patients, he is limited in what he can prescribe.

“A blanket prohibition for use of anti-obesity medication is an antiquated way of thinking and does not recognize obesity as a disease and is perpetuating health disparities,” Kraftson said. “I’m not so ignorant to think that Medicare should just start covering expensive treatments for everyone. But there is something between all or nothing.”

Lawmakers have introduced some variation of legislation that would permit Medicare coverage of weight loss drugs over the last decade. But this year’s bill has garnered interest from more than 60 lawmakers, from self-proclaimed budget hawk Rep. David Schweikert, R-Ariz., to progressive Rep. Judy Chu, D-Calif.

Passage is a top priority for two lawmakers, Wenstrup and Sen. Tom Carper, D-Del., before they retire next year.

Pharmaceutical companies also are readying for a lobbying blitz next year with the drugs getting the OK from the FDA to be used for weight loss.

“Americans should have access to the medicines that their doctors believe they should have,” Stephen Ubl, the president of the lobbying group, Pharmaceutical Research and Manufacturers of America, said on a call with reporters last week. “We would call on Medicare to cover these medicines.”

Already, Novo Nordisk has employed eight separate firms and spent nearly $20 million on lobbying the federal government on issues, including the Treat & Reduce Obesity Act, since 2020, disclosures show. Eli Lilly has spent roughly $2.4 million lobbying since 2021.

Advocates for groups such as the Obesity Society have been pushing for Medicare coverage of the medications for years. But the momentum may be shifting, thanks to the growing evidence that the obesity drugs can prevent strokes, heart attacks, even death, said Ted Kyle, a policy advisor.

“The conversation has shifted from debating whether obesity treatment is worthwhile to figuring out how to make the economics work,” he said. “This is why I now believe the change is inevitable.”

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WASHINGTON (AP) — As lawmakers in Washington weigh sending billions more in federal support to Kyiv to help fight off Russian aggression, close to half of the U.S. public thinks the country is spending too much on aid to Ukraine, according to polling from The Associated Press-NORC Center for Public Affairs Research.

Those sentiments, driven primarily by Republicans, help explain the hardening opposition among conservative GOP lawmakers on Capitol Hill who are rebuffing efforts from President Joe Biden to approve a new tranche of Ukraine aid, arguing that the money would be better spent for domestic priorities.

Yet opposition to aid is down slightly from where it was a month ago in another AP-NORC poll. Now, 45% say the U.S. government is spending too much on aid to Ukraine in the war against Russia, compared with 52% in October. That shift appears to come mostly from Republicans: 59% now say too much is spent on Ukraine aid, but that’s down from 69% in October.

Nonetheless, the Republican resistance to continued Ukraine aid remains strong.

“I understand the citizens need help, but I feel like we’re spending way too much money on Ukraine when we have our issues here, on our own soil, that we need to deal with,” said Eric Mondello, 40, from Fountain, Colorado. Pointing to needs such as health care for veterans and homelessness in communities, Mondello added: “I understand the U.S. has been an ally to others, but I feel like, let’s take care of our people first.”

More than one-third (38%) of U.S. adults say that current spending is “about the right amount,” which is up slightly from last month (31%). Among Republicans, nearly 3 in 10 (29%) say the current spending is about right, up from 20% last month.

Paula Graves, 69, is among those who says the amount of spending for Ukraine is the right amount.

“Putin, he’s straight up evil. I don’t think there should be any question in anyone’s mind,” said Graves, of Clovis, California. “He’s a dictator. He’s infringed on human rights, he’s a very scary person and if Ukraine falls to him, who’s next? What country’s next?”

Graves, who says she is not affiliated with a political party but leans more conservative, said she believes the U.S. has a leadership role on the global stage and added: “I think we definitely need to put America first, but I don’t think that needs to be first and only.”

The White House has been repeatedly pressing lawmakers to pass Biden’s nearly $106 billion emergency spending package that he proposed in October, which includes more than $61 billion specifically for the war in Ukraine. The rest of Biden’s request has aid for Israel as it battles Hamas, money for various priorities in the Indo-Pacific region and additional resources to help manage migration at the southern border.

On Ukraine, the Biden administration is increasingly warning that the well of aid is running dry. In an unannounced visit to Kyiv on Monday, Defense Secretary Lloyd Austin said Ukraine’s effort to defeat Russian forces “matters to the rest of the world” and pledged that U.S. support would continue “for the long haul.”

That message was reinforced at the White House.

“As President Biden has said, when aggressors don’t pay a price for their aggression, they’ll cause more chaos and death and destruction,” John Kirby, spokesman for the National Security Council, told the White House press briefing Monday. “They just keep on going, and the cost and the threats to America and to the world will keep rising.”

But Congress has rebuffed the White House efforts at bolstering Ukraine support at least twice in recent months. First, it ignored a roughly $40 billion supplemental request before a Sept. 30 funding deadline. Then last week, it passed a stopgap funding measure that keeps the government operating through early next year, but with no additional Ukraine aid.

In the Senate, a small bipartisan group is working on legislation that would combine fresh Ukraine assistance with stricter border measures to address concerns from Republicans that the U.S. was focused on needs abroad at the expense of issues closer to home. A broad majority of senators remains supportive of Ukraine aid, with Senate Minority Leader Mitch McConnell, R-Ky., being one of the most stalwart supporters despite the isolationist strain in his party.

South Dakota Sen. John Thune, the No. 2 Republican in the Senate, said lawmakers will continue to work on the Ukraine-border package over the Thanksgiving break and won’t wait until mid-January — when Congress faces another government funding deadline — to act on Ukraine.

The big question mark is in the House, where still-new Speaker Mike Johnson — who had voted against Ukraine aid as a rank-and-file conservative — has spoken broadly of the need to counter Russian aggression yet faces unruly GOP lawmakers who have shown more hostility to continued support for Kyiv.

Johnson, too, is insisting that additional Ukraine aid be paired with tougher border measures, although it is far from certain that any immigration agreement that clears the Democratic-led Senate could pass the GOP-controlled House.

Half of U.S. adults are extremely or very concerned that Russia’s influence poses a direct threat to the United States. Democrats (53%) and Republicans (51%) are similarly concerned about Russian power – but Democrats are more likely than Republicans to see Ukraine as a nation of shared values to the U.S. and to support more aid for Ukraine.

About half of the public (48%) endorses providing weapons to Ukraine (57% among Democrats, 42% among Republicans). About 4 in 10 favor sending government funds directly to Ukraine (54% for Democrats, 24% for Republicans).

Americans have grown slightly more likely to say the U.S. should take “a less active role” in solving the world’s problems, compared with a September poll from AP-NORC and Pearson. Slightly fewer than half (45%) now say the U.S. should be less involved, up from 33% in September. Just 16% of Democrats now say the U.S. should take a more active role, down from 29% in September.

Peter Einsig, a Republican from Tulsa, Oklahoma, said he still believes the U.S. has a role to play abroad, but that he remains concerned about excessive government spending and federal debt.

Yet Einsig said he would be more inclined to support aid to Ukraine if there were more oversight into how the money was being used abroad, as well as a timeline of how much longer the U.S. would be providing support.

“We don’t have transparency on where the money is really, really going,” said Einsig, 40. “It’s a big lump sum.”

Four in 10 U.S. adults say Ukraine is an ally that shares U.S. interests and values. That view is most common among Democrats (53%), who are much more likely than independents (28%), Republicans (29%) and Americans overall to see Ukraine as a nation with similar values and needs. About half of Republicans say Ukraine is a partner that the U.S. should cooperate with, but say it is not a nation that shares U.S. values.

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A new federal rule that goes into effect next month could make it easier for millions of workers to form unions at big companies like McDonald’s. But it’s already facing significant pushback from businesses and some members of Congress.

The rule — announced late last month by the National Labor Relations Board –- sets new standards for determining when two companies should be considered “joint employers” under the National Labor Relations Act.

It sounds wonky. But essentially, the rule could widen the number of companies that must participate in labor negotiations alongside their franchisees or independent contractors. For example, it might require Burger King to bargain with workers even though most of its U.S. restaurants are owned by franchisees. Or it could require Amazon to negotiate with delivery drivers who are employed by independent contractors.

“It’s trying to take in the realities of today’s workforce, when many employers subcontract out work and say, ‘Oh, we’re not the employer,’” said Cathy Creighton, director of the Buffalo Co-Lab at Cornell University’s School of Industrial and Labor Relations. “It’s the employer who is really calling the shots and has the money.”

The NLRB says the new rule changes a 2020 rule that made it too easy for joint employers to avoid their responsibility to negotiate with workers. The 88-year-old National Labor Relations Act guarantees the right of U.S. workers to form or join unions.

But critics say the new rule is an overreach by the labor-friendly Biden administration that undermines independent business owners. Some — including the American Hotel and Lodging Association — have already sued to block it.

“The franchise business model is a really great American innovation. It’s created wealth for thousands, particularly underrepresented minorities and women,” said McDonald’s President and CEO Chris Kempczinski during a recent conference call with investors. “This is something we think needs to be supported, not attacked.”

U.S. Sens. Joe Manchin, a West Virginia Democrat, and Bill Cassidy, a Louisiana Republican, have introduced a Congressional Review Act resolution that would overturn the rule. The resolution must pass both houses of Congress and be signed by President Joe Biden.

Biden hasn’t said whether he supports the new joint employer rule, but he has cast himself as the most pro-union president in history. The new rule is scheduled to go into effect Dec. 26.

Richard Eiker, 54, has worked in fast food for 25 years and now works at a McDonald’s in Kansas City, Missouri. He said McDonald’s clearly controls its franchised stores and is sidestepping its responsibilities to workers.

Eiker, a leader in the pro-union group Stand Up KC, said unionizing could improve his pay, benefits and working conditions. Eiker has foot pain and high blood pressure, but said his job doesn’t offer affordable health care or paid time off to see a doctor. He often cuts his prescription medicines in half because he can’t afford to refill them.

“McDonald’s made almost $15 billion in profits over the last two years. They can certainly afford to treat us better, and with a union we could make them do right by us,” he said.

The new joint employer rule had its origins in the Obama administration. In 2015, the NLRB ruled that Browning-Ferris Industries, a waste management company, should be considered the joint employer of contract workers who were sorting its recycling because it had authority over their working conditions. A federal court upheld the NLRB’s decision in 2018.

But during the Trump administration, the Republican-controlled labor board narrowed the definition of a joint employer. Under the 2020 rule, companies could be considered a joint employer only if they had “substantial direct and immediate control” over employment conditions.

The latest rule – passed by a board now controlled by Democrats — more closely resembles the Browning-Ferris ruling from 2015. It says companies may be considered joint employers if they have the authority to control – directly or indirectly – at least one condition of employment. Conditions include wages and benefits, hours and scheduling, the assignment of duties, work rules and hiring.

The rule only applies to labor relations. The Department of Labor sets its own joint employment standards for issues like meeting minimum wage requirements.

Still, the new rule could have a major impact. Local franchise owners employ more than 8 million people in the U.S., according to the International Franchise Association. Millions more work for subcontractors or temporary agencies.

John Motta, who owns 32 Dunkin’ locations in New Hampshire and Virginia, said franchisees must meet certain brand standards and use Dunkin’ uniforms and signage. But beyond that, they want to run their businesses independently.

“We don’t want our corporate partners to be telling us, ‘You have to pay this much per hour,’” he said. “That’s not why I came into this business. I wanted to make all those decisions by myself.”

Motta leads the Coalition of Franchisee Associations, which represents around 46,000 franchisees. He’s worried the rule will prompt Dunkin’ and other companies to stop working with franchisees and run stores themselves so they won’t be held responsible if a franchisee commits labor violations.

Michael Kaufman, an attorney who represents companies in labor disputes, said the rule has other potential complications. If a business hires temporary workers through a contractor but then asks the contractor to fire a temporary worker for harassing someone, the new rule might allow the temporary worker to bring unfair labor charges against the business, Kaufman said.

“The NLRB thinks they are holding more people accountable, but they’re holding the wrong people accountable,” he said.

Labor unions say the NLRB will consider such circumstances on a case-by-case basis, but the rule is still necessary to ensure all workers can negotiate wages and working conditions.

“Workers’ right to collectively bargain cannot be realized if the entity that has the power to change terms and conditions of employment is absent from the bargaining table,” the AFL-CIO, the Teamsters and the Service Employees International Union wrote in a letter sent this month to members of Congress.

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This year marks the 50th Anniversary of America’s withdrawal from Vietnam. This year and every year, we remember the 58,220 American patriots who were killed or are still missing from that war. And we honor the 9 million Americans who raised their right hands and committed to serve and defend our Constitution as members of the Armed Forces during that tumultuous period in our country’s history. 

One Veteran, Everett Alvarez, ejected from his A-4 Skyhawk on August 5th, 1964, shot down over North Vietnam. He landed in the water, among a small fleet of Vietnamese fishing boats, where he was quickly taken captive and became the first of 766 American Prisoners of War in Vietnam. Lieutenant Alvarez endured over eight years of captivity in the infamous Hanoi Hilton, marking the passage of time on the walls, and celebrating his own Catholic Mass every Sunday. He chose to hang on to every motivation he could muster—thoughts of home, the strength of faith, trust in his country, and a deep sense of duty to his fellow POWs. On February 12th, 1973—shortly after the US signed the Paris Peace Accords—Lieutenant Alvarez was finally freed.

His service didn’t end when he came back home. He remained in the Navy, retired as a Commander, and continued serving the Nation out of uniform—as Deputy Administrator at the VA, and as an advocate for his fellow Vets and their families. But my favorite part of Commander Alvarez’s story is what happened while he was recuperating after coming home. He met a wonderful woman, Tammy, and asked her on a date. That date—their first date—was at the White House, at an event honoring Commander Alvarez and his fellow Vietnam War POWs. Just a few months later, on October 27th, 1973, they married. And just last week, they celebrated their 50th year of marriage. Commander Everett Alvarez and Tammy are on another date—here this afternoon. Congratulations, and thank you for your courageous service to the Nation, your enormous sacrifice, and the high example of duty to country.

Veterans Day is Saturday. It’s a day we remember the millions of brave men and women—just like Everett Alvarez—who fought our nation’s wars and stood guard over our country during the periods of restless peace in between. It’s a day to reflect on what Veterans and their families have done and on what they’ve sacrificed for our country, for all of us. Because here’s the thing. When someone signs up to serve our country in the military, we make them a promise. If you fight for us, we will fight for you. If you serve us, we will serve you. If you take care of us, we will take care of you when you come home. Our country as a whole makes that promise. At VA, it’s our privilege and our honor to keep that promise.

So I’ll start with an update on what we at VA are doing to keep our promise to Veterans.

Since President Biden took office, VA has delivered more care and more benefits to more Veterans than ever before. When it comes to the benefits Vets have earned and deserve, we’re processing their claims faster than ever before.

Here’s an example. Just over a year ago, President Biden signed his historic legislation designed to care for Veterans who were exposed to toxins in Vietnam and in thirty years of war in Central Command. The PACT Act. Sergeant Major Kenneth Erickson is one of those Vets. Sergeant Major Erickson served in the Army for nearly 30 years, with combat tours spanning from the jungles of Vietnam to the deserts of Operation Desert Storm. Last May, the Sergeant Major was diagnosed with esophageal cancer, and he filed for those new toxic exposure benefits. Our VA benefits team expedited the review of his claim. In less than a week, Sergeant Major Erickson was granted 100% service connection. And his benefits were backdated to August 10th, 2022, the day President Biden signed that bill into law. Because of that law, Sergeant Major Erickson has one less thing to worry about during the toughest battle of his life.

That’s what we mean when we talk about keeping the promise. Altogether, VA processed nearly 2 million claims in 2023—shattering last year’s record by 16%. That meant 1.5 million Veterans and their survivors received over $163 billion in earned benefits. We’re also providing more care to Veterans. This year VA delivered more than 116 million health care appointments to Veterans, exceeding last year’s numbers by more than 3 million appointments. And it’s not just more care, it’s better, world-class health care. Study after study shows we’re delivering better health outcomes for Veterans than the private sector, which is a big reason nearly 90% of Vets who come to VA now trust us to deliver their outpatient care. 5.4 million people—including 4.1 million Veterans—are taking their final rest in VA national cemeteries. And we’ve doubled our online Veterans Legacy Memorial program to nearly 10 million Veterans—a digital platform keeping Veterans’ stories alive long after they’re gone.

Now look, behind all those statistics are Veterans like Commander Everett Alvarez and Sergeant Major Kenneth Erickson. They are our neighbors. They’re our friends. They’re teachers, civic leaders, coaches, and loved ones. They’re continuing to serve America, to defend and strengthen our democracy, long after they take off the uniform. And all our work at VA adds up to the single statistic that matters most: Veterans lives saved, or improved, by the work we do, together.

That’s what we’ve done. Now a bit about how we’ve done it, and who does it.  The VA workforce has been delivering for Vets during a period of rapid change, teaching us vivid lessons that have forever altered the way VA does business.

First, while the COVID-19 public health emergency came to an end six months ago, let’s not forget that VA’s clinicians and frontline staff provided world-class care through what has been a devastating, once-in-a-century health crisis. From the moment the pandemic hit, VA’s public servants mobilized around one core mission—saving and improving the lives of Veterans, their families, caregivers, and survivors. They worked long hours. They sacrificed precious time with their families. They risked their own lives—and by extension the lives of their loved ones—to serve Veterans. Because, you see, that’s our promise. And there are Veterans at home with their families right now, happy and healthy, all because of the best workforce in federal government. I am incredibly grateful to every one of them.

Second, today’s servicemembers and Vets represent the most deployed force in our history. And our thoughts are with the brave men and women serving in uniform in this period of heightened readiness and urgent security challenges in the Middle East and around the world. Through this thirty-year, intense period since September 11th, 2001, many have experienced multiple deployments and came home gripped by both the visible and the invisible scars of battle and moral injury. All of them were exposed to particulate matter and toxic fumes from burn pits and other sources. Months or years later, some have developed—and others might yet still develop—conditions that followed them home from war, and impact their lives long after the guns fell silent. And it’s our job as a nation to provide those Vets, their families, and their survivors with benefits and care for those conditions. Because that’s our promise. And that’s exactly what we’re doing. 

These important developments—the pandemic and our national commitment to recognize the need to care for burn pit exposures—have catalyzed a dramatic period of change and reform at VA, revolutionizing the way we do business. But one thing hasn’t changed: keeping Vets at the center of everything we do. So let me share four lessons we’ve learned during VA’s new, Veteran-centric era.

First lesson: we are fitting our care and service into Veterans’ lives, not expecting Veterans to build their lives around us. If we’re going to keep our promise to Vets, we need to meet them where they are, when they need us, without exception. So we’ve reached out to Vets and listened to what they wanted. And using a Veteran-centered design approach, we developed tools to ensure Veterans and their caregivers have positive, productive experiences when engaging with VA. We overhauled VA dot gov to make it the digital front door for all the services VA offers Vets. Medical appointments, filing a claim, applying for education benefits all go through that same front door. And the new VA Health and Benefits Mobile App gives Vets access to that digital front door, meaning Vets with a smart phone can have all their VA services right in the palm of their hands, wherever they are. So, while a Vet’s waiting to pick kids up from school, out on a lunch break, or watching a football game, they can refill a prescription, send a secure message to their doctor, take a quick telehealth appointment, access their travel reimbursement, and more.

It’s working. Not perfectly, but it’s working. We’ve seen a staggering 3000% jump in Vets’ virtual home visits since 2020—nearly 28 million total in that time span. By offering care that’s built into the lives of Vets at VA, in the community, via telehealth, and alongside focused processes and technological advances, we’ve decreased average wait times in nearly 60% of our facilities while still delivering the very best health outcomes for Vets. The same is true at VBA, where we reduced our average time to complete a claim by 15 days. And at the Board of Veterans Appeals, where using tele-appeals helped us set a single-year record of 103,000 claims decisions over the last year. As a result, Vets’ trust in VA has grown stronger. Here’s the point: we at VA are about shaping solutions for Vets that meet them where they are, that are adapted to them and their needs, rather than expecting Vets to adapt to us.

…

Second lesson, VA’s people—not machines, not buildings, not computers—keep our promise to Vets. From ending Veteran homelessness, to delivering toxic exposure benefits, none of it happens without the best workforce in the federal government. They’re the most passionate, highest-performing public servants in the country. They’re folks who want to make real differences in the lives of Veterans. I’m proud and I’m privileged that they’d consider me their colleague and teammate. We owe it to them to have a workforce sized to meet the mission, that can ensure we operate to ensure Veteran patient safety and high-quality claims decisions. So, this has been a year of hiring at a record pace while retaining our experienced staff. This year, we strengthened our partnerships with our unions and both the Veterans Health Administration and the Veterans Benefits Administration grew at their fastest rates in 15 years. VHA now has more than 400,000 employees for the first time in history. And with 32,000 employees, VBA’s bigger than it’s ever been. We’ve also increased employee retention, even in one of the hottest labor markets in decades—a market with profound health care provider shortages. Why are we able to grow our workforce in this context? Because people want to work for our nation’s heroes.

People like Chelbie Long, a VA Nurse Aide. For her, serving Veterans at the Bay Pines VA is a family affair. Her brother’s a surgical nurse at Bay Pines VA, and they’re both following in mom’s footsteps—a nurse in the Bay Pines Community Living Center. And Navy Vet Crishawn Lloyd, a Veterans Service Representative—or V-S-R—at the Chicago Regional Office. Crishawn was inspired to work at VA because of the thorough, responsive care his VSR gave him when he was transitioning out of the Navy. Then there’s Hector Rodriguez, a Marine Corps Vet. Hector went from being homeless on the streets of San Diego to working as a caretaker at Miramar National Cemetery, thanks to VA’s Compensated Work Therapy program. Hector regularly returns to his former homeless camp, hoping to inspire and support other Vets in crisis. Veterans helping Veterans. There is nothing better.

Third, this work takes all of us. VA can’t—and doesn’t—keep the promise to Vets alone. From the White House to the Hill, from faith-based and community groups to Veteran Service Organizations, from private sector to universities, we all play a critical role. These partnerships are helping us tackle some of our most pressing priorities on preventing Veteran suicide, ending Veteran homelessness, improving health care access, and more.

We just launched the second round of grants under the Staff Sergeant Parker Gordon Fox Suicide Prevention Program. These grants go to local organizations implementing innovative new suicide prevention services where Veterans live and work, meaning that we fund local people who know their Veterans best. Organizations like Nation’s Finest, which provides transitional and permanent supportive housing for Vets in rural communities across California, Arizona, and Nevada. This team recently helped a pregnant Vet fleeing domestic violence. They enrolled her in prenatal care at VA, connected her to Veteran resources, and provided her with temporary housing. She is just one Veteran of hundreds they help every year.

And working with state, local, and community partners, we are providing more housing and wraparound services to more homeless and at-risk Veterans than ever before. As we did last year, we are on pace again this year to exceed our goal of permanently housing 38,000 homeless Vets.

Part of the way we provided more care to more Veterans than ever before is through the community care program. Succeeding in the community means scheduling appointments faster. We’re doing that. It means paying our bills more quickly. We’re doing that, too. And it means incorporating the records of that care in the community into the Veteran’s record so that we recognize the full promise of VA’s integrated health care system, allowing providers and Vets to work together to build joint plans of treatment and medical interventions. A psychiatrist seeing a Vet for PTSD and TBI can see their Vet’s neurological records. Then, the team can huddle up with the Vet and their loved ones to discuss coordinated care plans along with the neurologist, social workers, clinical pharmacists, primary care providers, and any other team member involved in that Vet’s care. This kind of integrated treatment improves outcomes. It saves Vets’ lives. But if we are not getting the records of the Veterans care in the community, we decrease efficiency, increase costs, and reduce effectiveness. So, we have to see our community partners as just that—partners in our quest to provide integrated, Veteran-centric care that leads to high-quality outcomes.

Now, as I stand before you in the National Press Club I have to underscore our partnership with the press. We cannot keep our promise to Vets without you, the journalists who tell Veterans’ stories—journalists like Patricia Kime. You know, Patricia’s stories make VA better. Because they trust Patricia’s reporting, Veterans, VA employees, and other stakeholders talk to her when something is not working the way it should or the way we are telling you it is working. So her reporting and her stories help us better understand what Veterans experienced in war, what they’re going through here at home, and how we can better help them, oftentimes bringing something to our attention that we did not know was happening. For example, a couple months ago, Patricia noticed a software issue on the VA.gov website that was preventing some Vets from submitting claims appeals. She asked us for comment. Alerted to the problem by Patricia, we were able to immediately fix the bug, reach out to Veterans who were impacted, alert Congress to the issue that this important reporting identified, and prevent similar issues from happening again in the future. Patricia’s here today, so I’ll speak to her directly. Your work’s having a direct and positive impact on the lives of Vets. You make us better able to serve Vets by holding us to account.

You and so many great journalists—people like Leo Shane, Quil Lawrence, Ellen Milhiser, Ben Kesling, Eric Katz, Courtney Kube, Jory Heckman, and Orion Donovan Smith—are helping us serve Veterans far better than we ever could alone.

And just yesterday, investigative reporting from Dave Philipps in the New York Times uncovered the unseen TBI risks faced by Soldiers and Marines who operated heavy artillery weapons in the fight against ISIL. Because of his reporting, VA will be reaching out to those Vets who served in field artillery units to ensure they’re receiving the care they need. Those Vets served in Syria and Iraq, making them eligible for toxic exposure care under the PACT Act. Several of the Vets profiled in Dave’s piece are characterized as receiving less than honorable discharges. While VA cannot change a Vets’ character of discharge, Vets are not automatically disqualified from VA services because of discharge status. In fact, over the past 10 years VA has granted benefits or care to 73% of Vets with Other Than Honorable discharges. So to those Vets in that heartbreaking story and any Vets watching today, we want to serve you. Please, apply now. And re-apply if you’ve been denied before. And we need everyone’s help—every single person in this room’s help—communicating with Vets, so they get the care they need, and the benefits they deserve.

Fourth and finally, we’ve seen again and again that earning Veterans’ trust is critical to everything we do. Trust means many things for Vets. It means making it easier for Veterans to get care and benefits, ensuring that their VA services are effective, and that they feel respected when they come to VA. There’s no greater privilege than having that trust, and there’s no higher bar to meet. Since VA began measuring trust in 2016 through something we call the “V-Signal,” those three measures of trust and the Veteran experience—ease, effectiveness, and emotion—have increased. VA currently has 174 active surveys bringing in over 12 million responses over the life of V-Signal, allowing us to hear directly from Veterans about their experiences at VA. All of this information is released to the public through our quarterly VA Trust Reports and at va.gov/trust, tying trust metrics with our performance at VA.

Three of the VA teammates who help manage this intensive survey process that helps us ensure the Veteran experience and trust in VA’s care and benefits joined me at lunch here today. They all work in front-line Veteran Experience roles, helping VA measure and learn how to build trust better with Veterans. Let me tell you about them.

• Brianna Camera went into health care because her dad was sick when she was in high school. Her grandpa was an Army Vet, but he didn’t trust VA care when he left the military. And that’s her passion—making damn sure other Vets have a good experience with VA.
• Lynn Thiem comes from a long tradition of naval service. While she didn’t serve, she often says that there’s “seawater in her family’s blood.” Well, when her son joined the Navy as a rescue swimmer, Lynn was working on digitizing VA’s old paper records. She went on to lead the very first Veterans Experience project on machine learning, and today she brings her expertise to help VA make data-driven decisions to our benefits processes.
• And Richard Barbato served as an Army officer in the 82nd Airborne Division—All the Way! He fought in the initial invasion in Iraq. And in the years after, we’ve lost 40 of the Paratroopers he served with to suicide—including a best friend. Many of them rest today across the river in Section 60 of Arlington National Cemetery. Richard came to VA to honor them. And, he says, “This has never felt like work. It’s a mission. I wake up every morning because of this mission.”

Now you see why I’m so excited and humbled to be a part of this team. They each share the same deep devotion to keeping our promise to Vets that characterizes all of VA’s people. Our mission is far from over. There are enormous challenges ahead, not least meeting the demand of the millions of veterans who have filed claims under the Pact Act and who will qualify to be enrolled in VA health care. But I know that with my VA teammates leading the way—public servants like Brianna, Lynn, and Richard—VA will continue serving Vets every bit as well as they have served all of us. And as we look to the future, we’re not trying to build a VA that goes back to the old normal. Instead, we’re going to continue to do better for Vets. We’re going to continue to be better for Vets.

And this future at VA isn’t because of me. It’s because of the 450,000 VA employees—in your communities and neighborhoods across the country—who keep Vets at the heart of their care. And it’s because of you, too.

So, again, to all the Veterans here today, and watching, thank you—for everything.

And, to the Press Club, my thanks for all that you do holding us accountable to Vets, and telling their stories in the powerful ways that you do. God bless you all. And God bless our nation’s servicemembers, our Veterans, their families, caregivers, and survivors. Now, Eileen, let’s go to questions.

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The House has a new speaker, and now attention returns to whether a government “shutdown” can be averted before November 17. If only the American people could place the federal government in lockdown just as the unaccountable bureaucracy did to them during COVID’s oppressive hysteria. (So much for the people being in charge, eh?) In response to our unmanageable debt problem, there is an online meme that is spreading faster than Biden’s human trafficking business at the border: Government Shutdown — Fifteen Days to Flatten the Curve. Sounds like a good plan.

Shut ’er down, and we’ll see where we are in a couple weeks. If the debt and deficit haven’t improved, we’ll just have to keep the federal government in lockdown until our unsustainable spending problem is finally under control. For all those highly paid, partisan bureaucrats worried about their sinecures, stop being so selfish! We’re all in this together, after all. The experts are working at the speed of economics! Edward Holman says it best: “Had we merely refused to raise the debt ceiling one day forty years ago, the following morning Congress would have been forced to pay the debt service because we have always collected FAR more in tax revenue than needed to service the debt.”

Americans should call the government’s “bluff that we would all drown in a lake of fire” if the Leviathan doesn’t get everything it demands. In other words, until the federal government gains basic arithmetic and accounting skills and learns to live within a budget, shut ’er down! But how would the war hawks continue funding death and mayhem in Europe if they can no longer use American tax dollars to pay Ukraine’s government workforce and public sector pensions? Military strategist Larry Johnson has a good idea: President Volodymyr Zelenskyy should “make the rounds in Hollywood pitching a new soap opera — As the War Turns. It would be the story of a beleaguered Jewish comedian thrust into the seat of power, backed up by Nazi hordes, acquiescing to be the sock puppet of a malevolent Uncle Sam in exchange for a steady supply of Colombian cocaine and bags of cash.”

Hollywood could fund WWIII all by itself! Seriously, should American taxpayers be funding Ukrainian retirements when pension plans in the United States have been so mismanaged and dangerously underfunded that the next stock market quake will likely wipe out half of Americans’ own retirement nest eggs? Tucker Carlson, one of the few national figures willing to speak plainly about the threats to and concerns of the American people, said some remarkable things in a speech last Tuesday. He warned that “abrupt change” is heading our way. He argued that the United States may very well be on the “brink of collapse.” And he concluded that Americans, “regardless of political affiliation, can feel that something bad’s coming.” Meanwhile, our dishonest and incompetent ruling class is either asleep at the switch or actively rolling large boulders onto the tracks that lie ahead.

Rigged elections, rampant censorship, political persecution, an economic death spiral, and the growing prospect of this century’s first truly global war — yes, bad things are either here or quickly coming. Yet the media’s brainwashed minions prattle about “climate change,” “colonialism,” “diversity,” “equity,” Taylor Swift, and other false, foolish, or frivolous blather. It is also true that America’s leadership class has been found sorely wanting. It consists of frauds and thieves, murderers and misfits. Its butcher’s bill includes every victim of the experimental COVID “vaccine,” every casualty of the Uniparty’s open borders, every service-member sacrificed during Biden’s disastrous Afghanistan retreat, and the gone-but-never-forgotten veteran, Ashli Babbitt. Its allegiance belongs to central bank oligarchs and a royal clique of international elites who call no country home.

Americans-in-name-only run the U.S. government today. The only political leader in the last forty years who actually fought for Americans (instead of against them) is being railroaded in one courtroom after the next, gagged from speaking honestly, and threatened with life in prison for daring to honor his constitutional oath. The Fascist Bureau of Intimidation and Department of (in)Justice commit crimes against the American people but face no consequences.

The Department of Homeland Security has no interest in securing the homeland. The federal bureaucracy’s primary work product is disinformation, and its primary skill is accusing everyone outside of its Borg Collective of spreading disinformation. The same apparatchiks who take a knee in solidarity with Antifa and Black Lives Matter domestic terrorists have spent three years destroying families for protesting at the U.S. Capitol. The same conmen who framed Donald Trump as a Russian spy now frame the presumptive Republican nominee as a common criminal.

The same misanthropes who have drowned this country in debt, drugs, illegal aliens, and violent crime pretend to care about Americans’ health, security, and prosperity. They do not. They despise this country. They despise its foundations in liberty. They despise its history. They despise its heroes. They despise what its people have accomplished in the past and could so easily accomplish in the future, if only given the chance. Like some Marxist Globalist Bizarro World where the permanent ruling class engages in endless whack-a-mole to destroy everything good, reasonable, and sound, those helming the American ship today seek nothing less than to scuttle her deep into the sea.

Darkness is the Deep State’s friend. In the many battles that lie ahead, most of America’s “leaders” will continue taking a knee. They will play no part in protecting this nation from further harm. As agents of foreign powers, they have no interest in ameliorating Americans’ suffering. If unconstitutional surveillance, censorship, and “green”-energy-induced inflation had not already made that point crystal clear, COVID’s epidemic of rank totalitarianism really drove it home for good. Make no mistake, when the Doomsday Clock strikes midnight, We the People will be on our own. That’s okay.

America is much more than its government, and Americans are much more capable than those who insist on ruling over us. I’ll tell you now what I know to be true — we will get through what’s coming. The American government is corrupt, dangerous, and quasi-insane, but the American people still possess a unique and indomitable spirit. One of my favorite depictions of that spirit is retold in Stephen Ambrose’s Band of Brothers. Easy Company is heading for the Ardennes Forest near Bastogne to face the Germans in what would be known as the Battle of the Bulge. Without food, winter clothing, or ammunition, the young soldiers have no support but each other.

A horrified lieutenant tells Captain Winters that his guys will be completely surrounded, but the captain responds assuredly, “We’re paratroopers, Lieutenant. We’re supposed to be surrounded.” An anonymous quote attributed to the 506th Parachute Infantry Regiment then appears on a black screen: “Farthest from your mind is the thought of falling back; in fact, it isn’t there at all. And so you dig your hole carefully and deep, and wait.” I have always felt that we Americans were meant to be surrounded. Throw any manner of hardship our way, and we’ll somehow survive.

Send evil in our direction, and we’ll fight it tooth and nail. Just because the “woke” tyrants make all the noise, don’t underestimate those Americans who have carefully dug their holes and now patiently wait. For too many Americans, “falling back” will never be an option. “What one man can do, another can do,” Sir Anthony Hopkins memorably averred. What one generation of Americans can do, another can, too. Without help from a bloated government bureaucracy or a corrupt and worthless “ruling class,” Americans will endure. Sometimes, it is only when we are surrounded by danger that we find the courage and fellowship to stare down evil and prevail.

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CHICAGO (AP) — More than one-third of the food produced in the U.S. is never eaten. Much of it ends up in landfills, where it generates tons of methane that hastens climate change. That’s why more than 50 local officials signed onto a letter Tuesday calling on the Environmental Protection Agency to help municipal governments cut food waste in their communities.

The letter came on the heels of two recent reports from the EPA on the scope of America’s food waste problem and the damage that results from it. The local officials pressed the agency to expand grant funding and technical help for landfill alternatives. They also urged the agency to update landfill standards to require better prevention, detection and reduction of methane emissions, something scientists already have the technology to do but which can be challenging to implement since food waste breaks down and starts generating methane quickly.

Tackling food waste is a daunting challenge that the U.S. has taken on before. In 2015, the U.S. Department of Agriculture and the EPA set a goal of cutting food waste in half by 2030, but the country has made little progress, said Claudia Fabiano, who works on food waste management for the EPA.

“We’ve got a long way to go,” Fabiano said.

Researchers say the EPA reports provide sorely needed information. One report found that 58% of methane emissions from landfills come from food waste, a major issue because methane is responsible for about a quarter of global warming and has significantly more warming potential than carbon dioxide.

With the extent of the problem clearly defined, some elected leaders and researchers alike hope to take action. But they say it will take not just investment of resources but also a major mindset shift from the public. Farmers may need to change some practices, manufacturers will need to rethink how they package and market goods, and individuals need to find ways to keep food from going to waste.

So for the first time since the 1990s, the EPA updated its ranking of preferred strategies for waste reduction, ranging from preventing wasted food altogether (by not producing or buying it in the first place) to composting or anaerobic digestion, a process by which food waste can be turned into biogas inside a reactor. Prevention remains the top strategy, but the new ranking includes more nuances comparing the options so communities can decide how to prioritize their investments.

But reducing waste requires a big psychological change and lifestyle shift from individuals no matter what. Researchers say households are responsible for at least 40% of food waste in the U.S.

It’s a more urgent problem than ever, said Weslynne Ashton, a professor of environmental management and sustainability at the Illinois Institute of Technology who was not involved with the EPA reports. Americans have been conditioned to expect abundance at grocery stores and on their plates, and it’s expensive to pull all that food out of the waste stream.

“I think it is possible to get zero organic waste into landfills,” Ashton said. “But it means that we need an infrastructure to enable that in different locations within cities and more rural regions. It means we need incentives both for households as well as for commercial institutions.”

With the problem clearly defined and quantified, it remains to be seen whether communities and states will get extra help or guidance from the federal level — and how much change they can make either way. The EPA has recently channeled some money from the Inflation Reduction Act toward supporting recycling, which did include some funding for organics waste, but those are relatively new programs.

Some local governments have been working on this issue for a while. California began requiring every jurisdiction to provide organic waste collection services starting in 2022. But others don’t have as much of a head start. Chicago, for instance, just launched a city-wide composting pilot program two weeks ago that set up free food waste drop-off points around the city. But prospective users have to transport their food scraps themselves.

Ning Ai, an associate professor of urban planning and policy at the University of Illinois Chicago, said the report could be bolstered by more specific information about how different communities can adopt localized solutions, since preventing food waste might look different in rural and urban areas or in different parts of the country. But she was also impressed that the report highlighted tradeoffs of environmental impacts between air, water and land, something she said is not often as aggressively documented.

“These two reports, as well as some of the older ones, that definitely shows up as a boost to the national momentum to waste reduction,” said Ai, who was not involved with the EPA’s research.

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WASHINGTON (AP) — For many Americans, the Republican dysfunction that has ground business in the U.S. House to a halt as two wars rage abroad and a budget crisis looms at home is feeding into a longer-term pessimism about the country’s core institutions.

The lack of faith extends beyond Congress, with recent polling conducted both before and after the leadership meltdown finding a mistrust in everything from the courts to organized religion. The GOP internal bickering that for nearly three weeks has left open the speaker’s position — second in line to the presidency — is widely seen as the latest indication of deep problems with the nation’s bedrock institutions.

“They’re holding up the people’s business because they’re so dysfunctional,” said Christopher Lauff, 57, of Fargo, North Dakota.

Part of that business, he said, is approving money for Ukraine to continue its fight against Russia’s invasion, something he says ultimately helps the U.S. — a point President Joe Biden stressed Thursday during an Oval Office address.

“We’re usually the knight in shining armor, but we can’t be that now,” said Lauff, a Democrat.

The disdain for Congress is just one area where Americans say they are losing faith. Various polls say the negative feelings include a loss of confidence or interest in institutions such as organized religion, policing, the Supreme Court, even banking.

“Trust in institutions has deteriorated substantially,” said Kay Schlozman, professor of political science at Boston College. Schlozman said she believes in government and the things it provides, such as national defense and access to health care, but “I also can very much understand why the American people can be cynical about government.”

The turmoil in the House and the federal case against Democratic Sen. Robert Menendez of New Jersey, who is facing charges for bribery, show that both major parties are contributing to the dour outlook.

The House has been without a permanent leader since early October after a small cadre of right-wing Republicans pushed out a member of their own party, then-Speaker Kevin McCarthy. Subsequent attempts to replace him have failed.

“That is an example of exactly the kind of thing that I would say can’t foster trust of government among the American people — the multiple votes, the fractiousness within parties, of people being personally ambitious and not being willing to compromise” Schlozman said.

About half of adults (53%) say they have “hardly any confidence at all” in the people running Congress, according to a poll from The Associated Press-NORC Center for Public Affairs Research that was conducted in October. That’s in line with 49% who said that in March. Just 3% have a great deal of confidence in Congress, virtually unchanged from March.

About 4 in 10 adults (39%) have hardly any confidence in the executive branch of the federal government, compared with 44% in March. Most Republicans (56%) have low levels of confidence in the executive branch — which is overseen by a member of the opposing party, Democrat Joe Biden — compared with just 20% of Democrats.

About a third of adults (36%) say they have hardly any confidence in the conservative-majority Supreme Court, a figure that has remained steady in recent months. The polling reinforces that Democrats are more likely than Republicans to say their confidence in the Supreme Court is low. Black Americans are more likely than Americans overall, as well as more likely than white or Hispanic adults, to have hardly any confidence in the nation’s highest court.

One-third of U.S. adults (33%) continue to have low levels of confidence in the Justice Department, with Republicans having less confidence than Democrats. This comes as former President Donald Trump rails against the department after being charged with mishandling classified documents and attempts to overturn the 2020 election results.

Rick Cartelli, 63, a health care worker in Rocky Hill, Connecticut, who identifies as an independent, said he is happy with his local and state government but the current environment, especially the chaos on Capitol Hill, has wiped out what little confidence he had in that institution.

“What is happening now is not good for the country at all,” he said.

Cartelli also said he has little confidence in the executive branch, citing what he says are “mental lapses” by Biden that “are only probably going to become more and more pronounced.”

Multiple AP-NORC polls from earlier this year find that the dearth of confidence is pervasive, spreading to organized religion, the government’s intelligence gathering and diplomatic agencies, as well as financial institutions. Slightly fewer than half (45%) in a study from AP-NORC and Robert F. Kennedy Human Rights said they have little or no confidence that the news media is reporting news fully, accurately and fairly.

Views on the military were best, with just 17% saying they have hardly any confidence in it.

Kathleen Kersey, a 32-year-old health care worker in Brunswick, Georgia, who is a Republican, said she has little confidence in any of the federal entities, including Congress, but has more for the institutions closer to home. She also is a fan of Gov. Brian Kemp, a Republican, who she said is a moral man.

“There’s only so much one person can do, and just with all the evil, it’s hard to have confidence in anything really, even the churches because everything works together as one,” she said.

Confidence in the country’s foundational institutions has ebbed and flowed historically, though there’s been a long-term downward trend since at least the 1970s. Trust in government waned in the era of Watergate and the Pentagon Papers before making a slight recovery during Ronald Reagan’s presidency in the 1980s — despite Reagan’s famous declaration that the nine most terrifying words in the English language were: “I’m from the government, and I’m here to help.”

David Bateman, an associate professor of government at Cornell University, said the tea party movement during former President Barack Obama’s term was the beginning of a steadier decline in confidence, as noted in polling from Gallup. But Bateman believes the most acute problem in recent years has been Trump’s lies about the 2020 election, despite dozens of courts rejecting his claims and multiple audits and reviews in the swing states where he disputed his loss.

“The biggest threat to trust in institutions was the Trump campaign’s refusal to concede the election and insistence that they had won,” along with a large segment of the Republicans in Congress going along with the claim in the certification process, Bateman said.

“That validated the idea that the whole institutional system is rigged, which it isn’t,” he said.

He said an example of the fallout is the Republican attack on the Justice Department, including the FBI. The “weaponization” of the FBI has been a battle cry for Republicans who maintain it has targeted conservatives and who are incensed at the various investigations of Trump. Candidates vying against Trump for the Republican presidential nomination have said they would fire FBI Director Chris Wray.

Distrust of the FBI had long been the purview of Democrats, especially those aware of civil rights-era monitoring.

“If you told me in 2000 that Republicans are going to be saying you can’t trust the FBI, I would have been shocked,” Bateman said. “Going after the FBI has been a real ratcheting up of distrust.”

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WASHINGTON (AP) — President Joe Biden on Tuesday confirmed that U.S. citizens are among the hostages captured by Hamas as he condemned the militant group for the “sheer evil” of its shocking weekend assault on Israel.

“Our hearts may be broken but our resolve is clear,” said Biden, who compared the brutality of the Hamas militants to that of the Islamic State terrorist group. He added: “Let there be no doubt. The United States has Israel’s back. We’ll make sure the Jewish and democratic state of Israel can defend itself today, tomorrow as we always have.”

The president coupled his unflinching defense for Israel with only a glancing reference to the suffering that innocent Palestinians are enduring from Israel’s barrage of retaliatory fire on the Gaza Strip, where the Hamas attack was launched. That hardline approach could prove more difficult to sustain going forward if, as expected, the humanitarian crisis for the Palestinians worsens as Israel expands its military operation to root out Hamas.

Biden took note of the impact on Americans as well. He said the number of U.S. citizens confirmed to have been killed in the fighting has reached 14, up from 11 reported previously. U.S. officials said that death toll could increase further as some 20 Americans remain unaccounted for.

“There’s no justification for terrorism. There’s no excuse,” Biden said. “Hamas does not stand for the Palestinian people’s right to dignity and self-determination. Their stated purpose is the annihilation of the state of Israel and the murder of Jewish people. They use Palestinian civilians as human shields.”

Hamas responded to Biden’s remarks with a statement defending its actions, saying they were fighting against an occupation and defending Palestinians’ right to self-determination. Hamas called on Biden to “move away from the policy of double standards” when it comes to Israel.

Biden and Vice President Kamala Harris spoke by phone earlier Tuesday with Israeli Prime Minister Benjamin Netanyahu to discuss the unfolding situation. Biden outlined the actions he and other allies have taken to support Israel in the aftermath of the attack and expressed his horror about “sickening” reports of torture inflicted by militants on civilians.

Biden, in his public remarks and statements since Hamas launched its attacks, has repeatedly emphasized his shock over the breadth and brutality of the Hamas assault — a blitz by land, sea and air that surprised Israeli and U.S. intelligence and that has killed hundreds Israelis and left even more wounded.

Retaliatory strikes by Israel on the Gaza Strip have also left hundreds of dead and wounded Palestinians in the blockaded 141-square-mile area, one the poorest places in the world. The death toll was expected to grow as Israel pummeled Gaza with airstrikes and sent tens of thousands of Palestinians fleeing into U.N. shelters.

Biden said he has directed his team to share intelligence and military experts to consult and advise Israelis.

He renewed his warnings to adversaries who might want to exploit the turmoil. “Let me say again to any country, any organization, anyone thinking of taking advantage of the situation,” Biden said. “I have one word: Don’t.”

White House national security adviser Jake Sullivan said the U.S. does not know the precise number of Americans taken hostage. He said that the U.S., at the moment, has no plans of putting U.S. troops on the ground.

“As president I have no higher priority than the safety of Americans being held hostage around the world,” Biden said.

Biden is also dispatching his top diplomat to Israel to show U.S. support after the attacks, the State Department said Tuesday.

State Department spokesman Matthew Miller said Secretary of State Antony Blinken would travel in the coming days to deliver a message of solidarity and support. He said Blinken will also “talk about what additional resources we can give them.”

Blinken will leave Wednesday and is expected to arrive Thursday.

The White House on Monday confirmed that it has already begun delivering critically needed munitions and military equipment to Israel, and the Pentagon was reviewing its inventories to see what else can be sent quickly to boost its ally in the war against Hamas.

The Ford carrier strike group has arrived in the far Eastern Mediterranean, within range to provide a host of air support or long-range strike options for Israel if requested, but also to surge U.S. military presence there to prevent the war from spilling over into a more dangerous regional conflict, officials said.

The Pentagon has said that the U.S. warplanes, destroyers and cruisers that sailed with the Ford will conduct maritime and air operations which could include intelligence collection, interdictions and long-range strikes.

Along with the Ford, the U.S. is sending the cruiser USS Normandy and destroyers USS Thomas Hudner, USS Ramage, USS Carney and USS Roosevelt, and the U.S. is augmenting Air Force F-35, F-15, F-16, and A-10 fighter aircraft squadrons in the region.

Sullivan said the U.S. has already replenishing munitions for Israel’s Iron Dome missile defense system from U.S. stock that was already staged in country. The U.S. was in the process of sending additional interceptors and the administration was looking at additional ways it can help augment Israel air defense capabilities, Sullivan said.

Defense Secretary Lloyd Austin told reporters traveling with him Tuesday to a Ukraine contact group meeting in Brussels that a small group of U.S. special operations forces is also working with the Israelis to help with planning and intelligence.

Americans have had a gloomy outlook on Biden’s performance on the Israeli-Palestinian issue. Six in 10 Americans (61%) disapproved of how Biden was handling the conflict between the Israelis and Palestinians, according to an August poll from The Associated Press-NORC Center for Public Affairs Research. About one-third (35%) of U.S. adults approved, which was slightly lower than Biden’s overall approval rating of 42% in the same poll.

Four in 10 Americans (44%) said the U.S. gives about the right amount of support to Israel in the conflict between the Israelis and the Palestinians. Republicans were more likely than Democrats to say the U.S. should offer more support to Israel. Four in 10 Americans (42%) said the correct amount of support is given to the Palestinians. Democrats and Independents were more likely than Republicans to say the Palestinians should receive more support.

The current crisis seems certain to further test public sentiment about Biden’s Mideast foreign policy approach.

The Biden White House has pointed to its handling of the last conflict between Israel and Gaza in 2021 as playing a crucial part in limiting the length and loss of life in a war that stretched over 11 days and killed at least 250 people in Gaza and 13 in Israel.

During the 2021 conflict, Biden limited his public commentary while pressing Netanyahu in private to end it. His behind-the-scenes effort played out even as some of the president’s fellow Democrats pressured him to speak out against the Israelis as the death toll climbed in Gaza and as tens of thousands of Palestinians were displaced by the aerial bombardment, White House officials said at the time.

But this conflict is unlikely to end so quickly. Domestic and international pressure could quickly mount on Biden to pressure Netanyahu to wind down operations to prevent the suffering of innocent Gazans.

Netanyahu said Saturday that civilians in Gaza should leave areas near where Hamas is operating as the Israeli military planned to take defining action against the the militant group.

Sullivan said U.S. government officials have discussed details with Israel and Egyptian officials about where people in Gaza should go.

But Biden seemed to make clear that he’s not asking Netanyahu to show restraint.

“Like every nation in the world, Israel has the right to respond, indeed has a duty to respond to these vicious attacks.” Biden said.

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Most Americans should get an updated COVID-19 vaccine, health officials said Tuesday.

Advisers to the Centers for Disease Control and Prevention endorsed the new shots for everyone 6 months and older and the agency’s director quickly signed off Tuesday on the panel’s recommendation. That means doses should be available this week, some as early as Wednesday.

The severity of the COVID-19 pandemic has faded, but there are still thousands of hospitalizations and hundreds of deaths in the U.S. each week. Hospitalizations have been increasing since late summer, though the latest data indicate infections may be starting to level off, particularly in the South.

Still, experts worry that immunity from previous vaccinations and infections is fading in many people, and a new shot would save many lives.

According to a survey last month that CDC cited, about 42% said they would definitely or probably get the new vaccine. Yet only about 20% of adults got an updated booster when it was offered a year ago.

Doctors hope enough people get vaccinated to help avert another “tripledemic” like last year when hospitals were overwhelmed with an early flu season, an onslaught of RSV, or respiratory syncytial virus, and yet another winter coronavirus surge.

Here is what you need to know about the new COVID-19 shots:

WHO SHOULD GET THE UPDA

TED VACCINE?

The Food and Drug Administration approved the updated shot s from Pfizer and Moderna for adults and children as young as age 6 months. FDA said starting at age 5, most people can get a single dose even if they’ve never had a prior COVID-19 shot. Younger children might need additional doses depending on their history of COVID-19 infections and vaccinations.

The CDC decides how best to use vaccines and makes recommendations for U.S. doctors and the general public. The agency’s panel of outside exerts recommended the updated COVID-19 shots by a vote of 13-1. The no vote came from a panel member who had argued that the new shots should initially be recommended only for older people and others at greatest risk of severe illness. But other panel members said all ages could — and should — benefit.

“We need to make vaccination recommendations as clear as possible,” said one panel member, Dr. Camille Kotton, an infectious diseases doctor at Massachusetts General Hospital.

WHERE CAN I GET A SHOT?

The new vaccine will be available at pharmacies, health centers and some doctor offices. Locations will be listed on the government’s vaccines.gov website. The list price of a dose of each shot is $120 to $130, according to the manufacturers. But federal officials said the new COVID-19 shots still will be free to most Americans through private insurance, Medicare or Medicaid. For the uninsured or underinsured, the CDC is working with health departments, clinics and certain pharmacies to temporarily provide free shots.

On Tuesday, a Pfizer official said his company expected to have doses available at some U.S. locations as early as Wednesday.

WHY MORE COVID-19 SHOTS?

Similar to how flu shots are updated each year, the FDA gave COVID-19 vaccine makers a new recipe for this fall. The updated shots have a single target, an omicron descendant named XBB.1.5. It’s a big change. The COVID-19 vaccines offered since last year are combination shots targeting the original coronavirus strain and a much earlier omicron version, making them very outdated.

Pfizer, Moderna and Novavax all have brewed new supplies, and the FDA on Monday approved shots from Pfizer and Moderna. Novavax’s updated vaccine is still under review.

WILL THEY BE EFFECTIVE ENOUGH?

Health officials are optimistic, barring a new mutant. As expected, XBB.1.5 has faded away in the months it took to tweak the vaccine. Today, there is a soup of different coronavirus variants causing illness and the most common ones are fairly close relatives. Recent lab testing from vaccine makers and other research groups suggest the updated shots will offer crossover protection.

Earlier vaccinations or infections have continued to help prevent severe disease and death but protection wanes over time, especially against milder infections as the virus continually evolves. The FDA did allow seniors and others at high risk to get an extra booster dose last spring. But most Americans haven’t had a vaccination in about a year.

CAN I GET A FLU SHOT AND COVID-19 SHOT AT THE SAME TIME?

Yes. The CDC says there is no difference in effectiveness or side effects if people get those vaccines simultaneously, although one in each arm might be more comfortable. The CDC urges a yearly flu shot for pretty much everyone ages 6 months and up. The best time is by the end of October.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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