House Republicans last year were the least unified party bloc on legislation in more than four decades, CQ Roll Call’s annual Vote Studies analysis of congressional data found.

And that’s the case even without the multiple ballots it took to pick a speaker at two different points in the year, though those fights were certainly symptomatic.

The data show Republicans had only a 63.7 percent success rate on “party unity votes” or roll calls on bills, amendments and resolutions in which majorities of the two parties were on opposite sides of roll call votes. The metric ignores votes where both parties were overwhelmingly for or against a bill to identify cases where a member’s vote had the most potential to tip the scales one way or another.

The last time a majority party lost more unity votes was when Democrats presided in 1982, the second year of President Ronald Reagan’s first term, and prevailed just 63.5 percent of the time.

‘Stymied’ by hard-liners

There are parallels between 1982 and 2023, notes Princeton University politics professor Frances Lee. In both cases, the House was controlled by the party that did not control the Senate and the White House.

But, Lee explained, “A key difference between the 1982 Democrats and the 2023 Republicans is that the 2023 Republicans have been repeatedly stymied by a hard-line bloc, whereas the 1982 Democrats had to contend with a swing moderate/conservative contingent who wanted to work with the Reagan White House.”

In this Congress, spending fights have been an ongoing flashpoint within the GOP majority, and divisions reached a head with the historic Oct. 3 ouster of California’s Kevin McCarthy from the speaker’s chair after a faction moved to punish him for calling a vote on a short-term spending extension to prevent a government shutdown.

In 2023, many of the party unity votes that drove down the GOP’s success rate came on floor amendments to appropriations bills. Those votes included a slew of salary reduction amendments aimed at individual executive branch employees, as well as broader efforts to reduce funding for federal programs.

Of the 515 House party unity votes, 54 of them (more than 10 percent) were on measures to reduce salaries for officials ranging from the White House press secretary to the acting administrator of the National Highway Traffic Safety Administration.

Those votes tended to follow a pattern, with all Democrats present voting “no” and between 45 and 75 Republicans crossing over to join the opposition.

“The American people should not be forced to pay the salary of an individual who dispenses bold-faced lies to the American people,” Rep. Claudia Tenney, R-N.Y., said during floor debate in November after seeking to reduce the salary of White House Press Secretary Karine Jean-Pierre to $1.

Like others, that amendment was not adopted, with the final tally being 165-257.

Seven of the votes came on amendments to reduce appropriations for regional commissions funded through the Energy and Water Development spending bill.

The commissions, like the Denali Commission in Alaska and the Appalachian Regional Commission, are favorite agencies of some lawmakers who see them as providing economic development funding and services to their constituents.

Rep. Scott Perry, R-Pa., offered separate amendments to reduce funding for several of the commissions and faced similar defeats in each case, running up the score in terms of party unity votes. All told, the House took seven roll call votes on amendments to reduce commission funding that all proved unsuccessful for the GOP position.

The data show, therefore, that one concession McCarthy made to the most conservative faction in the caucus helped drive down the unity rate.

Leaders usually do not call for votes they know will not pass, but McCarthy agreed to a much more robust amendment process on spending bills than Democrats and even some of his GOP predecessors allowed when they had the majority. The change led to conservative members being able to force amendment votes that had no chance of success.

Speakers of the recent past, in contrast, would routinely consider appropriations measures under more restrictive rules and closed processes.

Rules defeated

Arguably, the most significant losses for Republicans, however, came on rules themselves. Rules votes, which set the framework for how long debate can take and what amendments are allowed, effectively give the majority its power to set the agenda. They traditionally get near-unanimous support from the ruling party, even if members plan to vote later against the underlying legislation. Until July 2023, no rule had been defeated on the House floor since November of 2002.

Two of the year’s most significant successful House votes completely divided the majority party, with Republican unity rates slightly above 50 percent against the December measure that expelled Rep. George Santos, R-N.Y., and a September vote on Ukraine security assistance.

Republicans started the year with a 222-213 majority, meaning leaders could afford to lose only four GOP votes and still prevail if every Democrat voted “no.” That was the same split then-Speaker Nancy Pelosi had in 2022, however, when Democrats won 91.4 percent of party unity votes that year, their lowest majority win rate since 2010.

“House Republicans have contended with similar difficulties under other recent leaders dating back at least to Boehner,” Lee said in an email, referring to GOP Speaker John Boehner who held the gavel from 2011 through 2015. “Their problems were more severe in 2023 given the party’s narrow margin of control and hard-liners’ newfound willingness to withhold support for the party’s procedural control of the House.”

Senate trend continues

Senate unity rates for 2023 were more in line with recent trends. Roughly 81 percent of the roll call votes cast in 2023 were unity votes, with the majority Democrats prevailing 91.5 percent of the time. Most of the unity votes were on nominations or on procedural votes to set them up, meaning essentially duplicate votes boosted the average. All told, 208 of the 284 Senate unity votes in 2023 were on nominations.

Sens. Susan Collins of Maine, Lisa Murkowski of Alaska and Lindsey Graham of South Carolina were the only three Republicans to vote the opposite way from most their GOP colleagues more than 100 times, with Collins leading the way at 186.

All three are senior appropriators, but the bulk of the votes in question were nominations. For instance, of the 124 times that Graham broke, 119 (96 percent) were on nominations.

The results have been basically the same since Senate Majority Leader Charles E. Schumer of New York started setting the agenda in 2021, operating with the narrowest of margins.

Twelve of the 24 times that Senate Republicans prevailed on party unity votes came on votes related to overturning regulations adopted by the executive branch or the District of Columbia municipal government. These measures were able to get up-or-down votes because they were not subject to the 60-vote threshold normally needed to end debate on legislation. But they were also subject to President Joe Biden’s veto, which he used nine times and was not overriden.

©2024 CQ-Roll Call, Inc. Visit at rollcall.com. Distributed by Tribune Content Agency, LLC.

Physician groups and other advocates for overhauling the Medicare payment system will lose three of their biggest Capitol Hill supporters to retirement next year, raising questions about next steps for long-term changes to the Medicare payment program.

Republican Reps. Larry Bucshon of Indiana, Michael C. Burgess of Texas and Brad Wenstrup of Ohio, all members of the GOP Doctors Caucus, have been vocal in pushing for changes to the way Medicare pays physicians.

The current system has been fraught with controversy, with doctors complaining their rates don’t keep up with inflation and with requirements that payments be budget-neutral, resulting in cuts to doctor pay. Meanwhile, a near decadelong push to embrace value-based care has not panned out.

Burgess, Bucshon and Wenstrup, who are all doctors, have become well-known on Capitol Hill for translating wonky Medicare policies and communicating the needs of fellow physicians to their colleagues, carving out a particular niche issue in Medicare physician payments. Burgess and Wenstrup co-chair the GOP Doctors Caucus with Rep. Greg Murphy, R-N.C.

“They’ll really be missed,” said Margaret C. Tracci, chair of the advocacy council at the Society for Vascular Surgery.

Burgess, who came to Congress in 2003, is a former chair of the House Energy and Commerce Health Subcommittee, and Bucshon currently is the vice chair. They, along with Wenstrup, who came to Congress in 2013, owned or worked in private practice and came to the job with experience of not just treating patients but running small businesses and working with Medicare.

Tracci said their experience helped them translate the “very complex issue” of Medicare payment, easing the burden for doctors pressed to explain the complications of the payment system to laymen. “It really creates a lot more work for physicians and for physician advocacy groups to climb that hill again of trying to translate what the needs are,” Tracci said.

But now, the lawmakers’ retirements might leave a long-term overhaul unfinished, with Congress instead pursuing other priorities and distracted by an election year.

“It’s going to be hard, but I think we’re just going to try and lay some of the groundwork,” Bucshon said, referring to hoped-for changes to the Medicare Access and CHIP Reauthorization Act of 2015, commonly called MACRA, which aimed to stabilize physician payments and reward quality instead of volume.

The road to MACRA

Bucshon came to Congress in 2011, when doctors were fighting a similar Medicare payment problem: the sustainable growth rate, which also resulted in cuts to physician pay year after year, with Congress stepping in on an ad hoc basis to avert those cuts.

Viewing those short-term fixes as ultimately unworkable, Burgess led the effort to get Congress to pass MACRA, which repealed the sustainable growth rate formula while providing new frameworks to shift payments toward value instead of volume.

But it hasn’t quite worked out that way, doctors say.

The new law’s budget neutrality requirement has typically meant that pay increases for one specialty, like primary care doctors, have resulted in cuts to others.

Since 2020, Congress has stepped in to avert cuts triggered by the law’s budget neutrality requirements. But lawmakers haven’t acted on the issue this year, and cuts took effect Jan. 1.

“MACRA, in many respects, has outlived its usefulness,” said Susan Dentzer, president and CEO of America’s Physician Groups. “It was very important at the time and got us out of a rut that the system was in around a prior formula for setting payments. But it [MACRA] was enacted in 2015 and it’s been 10 years.”

While Bucshon, Burgess and Wenstrup are pushing for short-term fixes to the most recent cuts in the next spending package, the prospects for long-term change are murky.

Other options

One bill, sponsored by Rep. Mariannette Miller-Meeks, R-Iowa, and co-sponsored by Burgess, Wenstrup and Bucshon, would lift the budget neutrality threshold from $20 million to $53 million per year.

Currently, if the fee schedule increases spending by more than $20 million, cuts are triggered. Raising the threshold would provide more breathing room in the fee schedule, but the American Medical Association has pushed for a $100 million at least, paired with other changes.

“These are significant steps and the urgency cannot be overstated,” Burgess said on the House floor last month, referring to the legislation.

But floor action is unclear at this point. Negotiators are working on including some kind of “doc fix” in the spending package due in March. Broader, long-term changes will take time.

“It’s clear that we need to do some reforms to MACRA, and we clearly need to change the physician fee schedule, but it’ll be hard,” Bucshon said.

Bucshon also co-sponsors a bill, sponsored by Rep. Raul Ruiz, D-Calif., that would require that physician payment updates be tied to inflation, a concept also supported by AMA and other physician groups. That bill hasn’t received committee consideration.

“There used to be a greater opportunity for them [retiring members] to get something on their way out the door,” said Rodney Whitlock, vice president at McDermott+Consulting and a former GOP aide. “I’m not too certain that I’m as big of a believer in that as I used to be, but once you decide you won’t be here, you fight like hell to get something done on the way out, and I wouldn’t expect any less of these guys.”

Other problems

Also among disappointing aspects of the 2015 law, doctors say, are the pathways it set up for doctors to be graded and paid for delivering value-based care.

Nearly 10 years after the bill’s passage, the committee that advises Congress on Medicare policy has recommended that one of those pathways, the Merit-based Incentive Payment System, should be eliminated because it imposes a significant reporting burden on providers, exempts more physicians than will participate and results in small bonuses for those who do.

Meanwhile, participation in the other pathway, alternative payment models, and the savings it was intended to generate haven’t been as high as was originally hoped.

Physician practices had complained that the models available were not applicable to them. One of the main types of models, accountable care organizations, worked best for integrated health systems and not small independent practices, doctors say.

Those problems are harder to fix. And the loss of institutional knowledge from lawmakers like Burgess, who helped draft the law and knows in depth how it works and what was intended, is not a small thing, said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association.

“The comprehensive fix to what we’re dealing with — the aftermath of MACRA reform — would be helped by many of the physicians in Congress that unfortunately are retiring this year,” he said.

©2024 CQ-Roll Call, Inc. Visit at rollcall.com. Distributed by Tribune Content Agency, LLC.

WASHINGTON — Vice President Kamala Harris on Friday slammed the report by a Justice Department special counsel into Joe Biden’s mishandling of classified documents that raised questions about the president’s memory, calling it “politically motivated” and “gratuitous.”

The report from Robert Hur, the former Maryland U.S. Attorney selected by Attorney General Merrick Garland to investigate Biden found evidence that Biden willfully held onto and shared with a ghostwriter highly classified information, but laid out why he did not believe the evidence met the standard for criminal charges, including a high probability that the Justice Department would not be able to prove Biden’s intent beyond a reasonable doubt.

The report described the 81-year-old Democrat’s memory as “hazy,” “fuzzy,” “faulty,” “poor” and having “significant limitations.” It noted that Biden could not recall defining milestones in his own life such as when his son Beau died or when he served as vice president.

Taking a question from a reporter at the conclusion of a gun violence prevention event at the White House, Harris said that as a former prosecutor, she considered Hur’s comments “gratuitous, inaccurate, and inappropriate.”

She noted that Biden’s two-day sit-down with Hur occurred just after the Oct. 7 attack by Hamas on Israel, where more than 1,200 people were killed and about 250 were taken hostage — including many Americans.

“It was an intense moment for the commander in chief of the United States of America,” Harris said, saying she spent countless hours with Biden and other officials in the days that followed and he was “on top of it all.”

She added that “the way that the president’s demeanor in that report was characterized could not be more wrong on the facts and clearly politically motivated, gratuitous.”

Harris concluded saying a special counsel should have a “higher level of integrity than what we saw.”

Her comments came a day after Biden insisted that his “memory is fine.” and grew visibly angry at the White House, as he denied forgetting when his son died. Beau Biden died of brain cancer in 2015 at the age of 46.

ANNAPOLIS, Md. — Former Maryland Gov. Larry Hogan announced Friday that he will run for U.S. Senate, giving Republicans a prominent candidate who is well-positioned to run a competitive campaign for the GOP in a state that hasn’t had a Republican U.S. senator in 37 years.

The decision marks a surprise turnaround for Hogan, a moderate who had considered a presidential bid. During Hogan’s tenure as governor, he became a national figure as one of the rare Republicans willing to criticize Donald Trump. Last month, Hogan stepped down from the leadership of the third-party movement No Labels.

“My fellow Marylanders: you know me,” Hogan begins in a video released by his Senate campaign. “For eight years, we proved that the toxic politics that divide our nation need not divide our state.”

The former governor added that he made the decision to run for Senate “not to serve one party, but to try to be part of the solution: to fix our nation’s broken politics and fight for Maryland.”

“That is what I did as your governor and it’s exactly how I’ll serve you in the United States Senate,” Hogan said.

GOP leaders are eager to pick up the seat as they try to wrest control of the Senate from Democrats, who hold a slim majority and are defending more seats than Republicans in 2024.

In 2022, Hogan rebuffed an aggressive push from Senate Minority Leader Mitch McConnell and other Republicans to run against Democratic Sen. Chris Van Hollen.

When he announced his decision not to run for Senate two years ago, Hogan expressed confidence he could win. “But just because you can win a race, doesn’t mean that’s the job you should do if your heart’s not in it. And I just didn’t see myself being a U.S. senator,” he said then.

The former two-term governor who left office early last year will be running for an open seat due to the retirement of Sen. Ben Cardin. Hogan made his Senate bid known just hours before Maryland’s filing deadline.

Hogan announced in March that he would not challenge Trump for the GOP’s White House nomination. Last month, he squelched speculation of a third-party presidential run and endorsed former United Nations ambassador and South Carolina Gov. Nikki Haley for the Republican nomination for president.

The rarely open Maryland Senate seat already has drawn U.S. Rep. David Trone into the Democratic primary, as well as Angela Alsobrooks, the county executive of Prince George’s County in the suburbs of the nation’s capital. Trone, the wealthy founder of a chain of liquor stores called Total Wine & More, has poured $23 million of his own money into his campaign so far.

Seven Republicans have filed to enter the GOP primary, but none is as well known as the former governor. Hogan was only the second Republican governor to ever win reelection in Maryland, a state where Democrats outnumber Republicans 2-1.

He won his first term as governor in 2014 in an upset, using public campaign financing against a better-funded candidate. Running on fiscal concerns as a moderate Republican businessman, Hogan tapped into voter frustration over a series of tax and fee increases to defeat then-Lt. Gov. Anthony Brown.

Hogan, who had never held elected office before, focused on pocketbook issues from the outset. He lowered tolls, an action he could take without approval from the General Assembly, long controlled by Democrats. But he also faced challenges, including unrest in Baltimore following the death of Freddie Gray in police custody in 2015. Hogan sent the National Guard to help restore order.

In June of that year, Hogan was diagnosed with stage 3 non-Hodgkin’s lymphoma but continued working while receiving treatment. He has been in remission since November 2015.

Maryland’s last Republican U.S. senator was Charles Mathias, who served in the Senate from 1969 to 1987. Mathias was known as a liberal Republican who often clashed with his party over issues such as the Vietnam War and civil rights.

SAN DIEGO — The pop-pop-pop of gunfire cracked just as the rain started to fall in grisly synchronicity. Then the screams began.

Within moments, civilians lay strewn across the ground, some lifeless, others writhing in pain. Blood flowed in streams that pooled with the rainwater on the muddying ground littered with shell casings.

Three gunmen quickly opened fire on a San Diego County Sheriff’s Department armored BearCat truck arriving in response. It crawled along an alleyway. Half a dozen SWAT members pointed rifles into open doorways or fired back from behind corners.

One assailant, wearing black gloves and a graying black beard, stood on a third-floor apartment balcony and, as deputies came closer, threw a Molotov cocktail at two white cars parked below. The explosion sent a blast of heat and sound, its boom punctuated by the gunman’s AK-47.

“Help me!” bellowed a man rolling on the ground, blood shooting from his severed leg. Another man groaned next to him, hidden by smoke billowing around the cars.

It seemed like something out of an action movie. And, in a way, it was.

The rounds were blanks, the Molotov cocktail wasn’t lit, the smoke came from a machine. The explosion was controlled, the victims and gunmen were actors, and the blood was fake. However, the deputies, firefighters and doctors from across the region were real.

They were in the middle of a simulation on a Saturday afternoon in mid-January in a commercial lot on the north end of San Diego, conducted by Strategic Operations, a local company run by former Hollywood producers and military combat veterans.

First responders and law enforcement agents have for decades used simulations to train for mass casualty events such as shootings or natural disasters, especially after the Columbine school shooting in 1999. But in recent years, as mass shootings have become increasingly common in the United States, the simulations have become more and more realistic. Now they feature visceral sound effects, trained actors, pyrotechnics and even virtual reality. The trainings also have become more and more expensive for public agencies.

But hyper-realistic simulations are essential for learning how to respond to an active shooter, triage mass casualties and coordinate among departments in a chaotic environment, said Sgt. Colin Hebeler, who works in the Infrastructure Security Group within the San Diego County Sheriff’s Department. The department has two facilities where deputies go through similar simulation training.

“If we can provide these trainings that are as close to the real-life event as possible, you will actually induce that same kind of stress and the reaction that you might have during a real-life incident,” he told Stateline.

Stop the killing, stop the dying

Training has evolved in Hebeler’s 16 years in the department, expanding well beyond both the classroom and limited simulations that involved plastic pieces that looked like guns and shouts of “Bang, bang.” Although expensive, simulated mass shootings are far more intense, realistic and frequent now, he said.

“If it does happen, we’re going to be prepared,” Hebeler added. “We don’t want this to be one of those catastrophic events that comes out on the news, and everyone says, ‘Well, the law enforcement messed up.’”

Law enforcement agencies continue to face public scrutiny over how they respond to mass shooting events — highlighted by last month’s scathing report from the U.S. Department of Justice on the response to the 2022 school shooting in Uvalde, Texas, that left 21 people dead, all but two of them elementary school children.

First responders are trained to focus on two things in a mass shooting event: Stop the killing and stop the dying. By waiting 77 minutes outside the fourth grade classrooms where the active shooter was before confronting and killing him, Uvalde law enforcement failed to follow protocols and that cost lives, the federal report found.

Uvalde showed “layer upon layer upon layer of failures,” said Jaclyn Schildkraut, executive director of the Regional Gun Violence Research Consortium at New York’s Rockefeller Institute of Government. Simulations highlight the sights, sounds and smells of an active shooter event in a controlled environment so the failures seen in Uvalde don’t occur, she said.

“It doesn’t matter if you’re the first officer or by yourself or there’s 20 of you, you go in and you stop the shooter, and then you start trying to help the people who’ve been injured,” she said.

“Simulations are really about acclimating you to what you might encounter on that given day, so that you are able to maintain that focus and subsequently your safety as best as possible.”

But she wanted to be clear about one point: This kind of training should never be used in schools among children. It is far too traumatic.

Simulation’s increased use

Seventeen miles east of downtown Raleigh, North Carolina, Wake Technical Community College is building a 60,000-square-foot facility with an 8-acre driving pad that is dedicated to reality-based simulation training for police, fire and emergency medical workers.

From the outside, observers wouldn’t realize the massive gray complex is full of buildings and streets, with spaces designed to mimic the commercial, jail, residential and school spaces first responders would experience in their communities. Trainees can drive into the facility, pull up to a specific location inside and respond to the simulated event — a school shooting, for example, or a fire inside a supermarket.

During mass shooting simulations, trainees will experience the disaster through all their senses: It could smell like smoke, there might be flashing lights and sirens, role players may act as screaming victims or use simulated munitions filled with paint. The $60 million facility, which is slated to open this spring, was funded by a bond that Wake County voters approved in 2018.

For officers, simulation training is much more effective than shooting at a line of paper targets, or simply going over shoot/don’t-shoot scenarios, said Jamie Wicker, provost of public safety education at Wake Tech. Training for mass shooting events has developed over many years with the help of veterans who served in Afghanistan and Iraq, she added.

“It’s one thing to describe chaos. It’s completely different to experience chaos,” said Wicker, who has been in law enforcement for more than 20 years, in part as a trainer. “This is managed chaos.”

This approach has been backed up by researchers who have studied the effectiveness of simulation training for first responders.

When officers respond to a mass shooting, they’re running, maybe up a flight of stairs or while carrying people. They will see victims who are injured or dead. They will be worried about the shooter’s location. Meanwhile, parents may be rushing to the scene, along with additional first responders from agencies across the region who might not have interacted with one another before.

While an increased heart rate can produce positive reactions such as adrenaline and sharpened senses, it can quickly turn negative, leading to tunnel vision, auditory exclusion or impaired judgment, Dolly said.

“You want to, at some level, induce that in a training environment,” he said. “It conditions the officer to inoculate them from being overwhelmed by all that when the time comes.”

For the past decade, federal law enforcement has viewed the Advanced Law Enforcement Rapid Response Training Center, known commonly as the ALERRT Center, as the national standard for active shooting simulation training. Hundreds of thousands of police officers have received training from the center, which was formed in the wake of Columbine and has been housed at Texas State University since 2002.

Funded by a line item in the Texas state budget and federal grants, ALERRT is mandated to train 80,000 Texas officers every two years at its facility in San Marcos — a city between Austin and San Antonio. But center experts also go to all 50 states to spread their training, going to schools during breaks and to businesses, at no cost to trainees or their agencies.

Sometimes they use local drama students to play victims, wearing makeup and moulage, simulating a wound. “They love it,” said Larry Balding, external resources director with the center.

For the training, ALERRT likes long hallways and T intersections — stress points for law enforcement responding to an active shooter. Beyond learning how to stop the shooter, trainees focus on getting victims to an operating table. Gunshot victims only have around 30 minutes before it’s too late, said Balding, who used to be in the fire service.

“Nobody will ever be 100% ready,” he said. “But if you can get a new officer, get him trained, trying to get the mindset right, that’s what we want to do.”

When asked where simulation training is heading in the field of first responders, Balding didn’t hesitate: virtual reality.

Training in the virtual world

The floor of the San Diego Convention Center was filled with lifelike mannequins — bleeding, blinking, moving and able to be poked and prodded and to respond to questions. Some were even pregnant, with a baby ready to squirm out when prompted.

Among the 140 health care presenters last month at a conference organized by the Society for Simulation in Healthcare, a membership nonprofit that seeks to promote simulation training to reduce errors in medical care, were companies that want to take the industry in a whole new direction with virtual reality.

Whether first responders use Oculus headsets to learn how to interact with patients in an emergency room or use lifesaving tools at the scene of a shooting, localities are turning more to virtual reality training for first responders, said Dr. Barry Issenberg, president of the society.

“It’s the reduction of errors, safer care, safer way of training,” said Issenberg, who is also the director of the Gordon Center for Simulation and Innovation in Medical Education at the University of Miami. “What we’re doing is not just a cool idea, but ultimately going to make an impact for their constituents.”

The society worked with the Hollywood-style facility, which organized the simulation for the San Diego County Sheriff’s Department and other local first responders who participated the day before. Around 100 visiting academics and health care workers in town for a conference were among the onlookers.

While researchers have found in several studies that virtual reality can add some benefits to health care training, there is still some skepticism.

Dolly, at the National Policing Institute, sees “some promise” with virtual reality for training police officers. It can be a cost-effective alternative to in-person simulations and can help officers train in shoot/don’t-shoot scenarios.

However, he does see limitations with not being able to run around and experience viscerally the confusion of a mass shooting, which can be fully felt with an in-person simulation.

Back at the San Diego shooting simulation, screams still pierced the air.

Gunfire continued for another minute, as the seven deputies dashed from room to room in the complex of buildings. They killed the shooters, then carried some of the wounded down flights of stairs.

After the shots finally stopped, the screams of victims were nearly drowned out by the wail of ambulance sirens.

Firefighters and emergency medical technicians rushed bloodied victims in stretchers to nearby pop-up emergency and operating rooms, where Navy doctors tried to keep their footing on floors slippery with blood and worked to close victims’ wounds.

Wearing blue scrubs and shoe coverings, doctors turned victims on their side and searched for exit wounds. One demanded O negative blood.

An hour after the first shots rang out, the simulation ended. The first responders gathered in the ER in a semicircle. An instructor quieted the room, asked for the beeping heart monitors to be shut off and turned to the participants.

“So, what did we learn?”

Stateline is part of States Newsroom, a national nonprofit news organization focused on state policy.

©2024 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

A federal judge formally ordered Donald Trump to pay $83.3 million to E. Jean Carroll, endorsing the jury’s verdict from the defamation trial last month.

The judgment was made in a one-page order on Thursday.

The issuance of the judgment takes Carroll one step closer to obtaining her award, but it is only the beginning of a process that can take months or longer to play out, in part depending on how long the appeals process lasts.

This will be the second judgment Carroll has won against Trump. Last year a jury awarded her $5 million in damages after finding Trump liable for sexual abuse and defamation for denying Carroll’s rape allegation, saying she wasn’t his type, and suggesting she made up the story to sell copies of a book.

Trump set aside $5.5 million in an account that is controlled by the court. That money will not be released until all appeals, including potentially to the Supreme Court, are exhausted. Last May, Trump appealed the verdict to the 2nd US Circuit Court of Appeals, which has not yet heard arguments.

In the current case, a jury found Carroll should receive $83.3 million in damages to repair her reputation, to compensate her, and to punish Trump. The judge found that the prior verdict should carry over to statements at issue in the last trial since they were similar.

Trump will likely post a bond that will stay the enforcement of the judgment for the duration of the appeal.

A spokesman for Carroll had no comment. An attorney for Trump could not immediately be reached.

This story has been updated with additional details.

WASHINGTON — Overcoming a week of setbacks, the Senate on Thursday voted to begin work on a package of wartime funding for Ukraine, Israel and other U.S. allies. But doubts remained about support from Republicans who earlier rejected a carefully negotiated compromise that also included border enforcement policies.

Senate Majority Leader Chuck Schumer called the latest vote a “good first step” and pledged that the Senate would “keep working on this bill — until the job is done.”

The 67-32 vote was the first meaningful step Congress has taken in months to approve Ukraine aid, but it still faces a difficult path through Congress. Support from GOP senators for final passage is not guaranteed, and even if the legislation passes the Senate, it is expected to be more difficult to win approval in the Republican-controlled House, where Speaker Mike Johnson, R-La., has been noncommittal on the aid.

The Senate prepared for a days-long slog to reach a final vote, and leaders had not agreed to a process to limit the debate time for the bill as Republicans remained divided on how to approach the legislation.

The $95 billion package is intended to show American strength at a time when U.S. military troops have been attacked and killed in Jordan, allies like Ukraine and Israel are deep in war and unrest threatens to shake the global order. It is also the best chance for Congress to replenish completely depleted military aid for Ukraine — a goal shared by President Joe Biden, Schumer and Senate Republican leader Mitch McConnell.

After the collapse this week of a bipartisan agreement to include border policy changes in the package, Schumer salvaged $60 billion in aid for Ukraine, as well as roughly $35 billion for Israel, other allies and national security priorities in the current legislation.

But Senate Republicans were fractured and frustrated as they huddled Thursday morning to discuss their approach to the legislation and struggled to coalesce behind a plan to assert their priorities. Still, Schumer forged ahead to the noon-hour vote, essentially daring the Ukraine supporters within the GOP to vote against the aid.

Schumer’s push worked as the vote to begin debate on the new package cleared with 17 Republicans along with Democrats voting to move forward. Sen. Bernie Sanders, an independent from Vermont who opposes much of the aid for Israel, voted against it.

Some in the Senate vowed to do everything they could to delay final action.

“I’ll object to anything speeding up this rotten foreign spending bill’s passage,” said Sen. Rand Paul, a Kentucky Republican, on X.

The U.S. is already out of money to send missiles and ammunition to Kyiv, just as the nearly two-year-old war reaches a crucial juncture. Ukraine supporters say the drop-off in U.S. support is already being felt on the battlefield and by civilians. Russia has renewed its commitment to the invasion with relentless attacks.

“There are people in Ukraine right now, in the height of their winter, in trenches, being bombed and being killed,” said Sen. Thom Tillis, R-N.C.

While military support for Ukraine once enjoyed wide bipartisan support in Congress, an increasing number of Republicans in the House and Senate have expressed serious reservations about supporting a new round of funding for Ukraine. Following the lead of Donald Trump, the likely GOP presidential nominee, they see the funding as wasteful and argue that an end to the conflict should be negotiated.

Biden has made halting Russian President Vladimir Putin’s invasion a top foreign policy priority and last year requested a sweeping funding proposal to replenish aid for Ukraine and Israel, as well as to invest more in domestic defense manufacturing, humanitarian assistance and managing the influx of migrants at the U.S.-Mexico border.

The $95 billion package package proposed by Democrats this week would send $14 billion in military aid to Israel, provide further funding for allies in Asia, and allot $10 billion for humanitarian efforts in Ukraine, Israel, Gaza and other places.

The revamped package includes legislation to authorize sanctions and anti-money laundering tools against criminal enterprises that traffic fentanyl into the U.S.

Supporters of the national security package have cast it as a history-turning initiative that would rebuff both Russia’s incursion in Europe and Chinese president Xi Jinping’s ambitions in Taiwan and Asia.

“Failure to pass this bill would only embolden autocrats like Putin and Xi who want nothing more than America’s decline,” Schumer said.

Republicans had initially demanded that the package also include border policy changes, arguing that they would not support other countries’ security when the U.S. border was seeing rampant illegal crossings. But after months of round-the-clock negotiations on a bipartisan compromise intended to overhaul the asylum system with faster and tougher enforcement, Republicans rejected it as insufficient.

Still, some senators said they would continue to insist on tying border measures — this time even more strict — to the foreign aid.

“My priority is border security. It’s always been border security. I think we need a new bill,” said Sen. Roger Marshall, R-Kan.

WASHINGTON — A special counsel report released Thursday found evidence that President Joe Biden willfully retained and shared highly classified information when he was a private citizen, including about military and foreign policy in Afghanistan, but concluded that criminal charges were not warranted.

The report from special counsel Robert Hur resolves a criminal investigation that had shadowed Biden’s presidency for the last year. But its bitingly critical assessment of his handling of sensitive government records and unflattering characterizations of his memory will spark fresh questions about his competency and age that cut at voters’ most deep-seated concerns about his candidacy for re-election.

In remarks at the White House Thursday evening, Biden denied that he improperly shared classified information and angrily lashed out at Hur for questioning his mental acuity, particularly his recollection of the timing of his late son Beau’s death from cancer.

The searing findings will almost certainly blunt his efforts to draw contrast with Donald Trump, Biden’s likely opponent in November’s presidential election, over a criminal indictment charging the former president with illegally hoarding classified records at his Mar-a-Lago estate in Florida and refusing to return them to the government. Despite abundant differences between the cases, Trump immediately seized on the special counsel report to portray himself as a victim of a “two-tiered system of justice.”

Yet even as Hur found evidence that Biden willfully held onto and shared with a ghostwriter highly classified information, the special counsel devoted much of his report to explaining why he did not believe the evidence met the standard for criminal charges, including a high probability that the Justice Department would not be able to prove Biden’s intent beyond a reasonable doubt, citing among other things an advanced age that they said made him forgetful and the possibility of “innocent explanations” for the records that they could not refute.

“I did not share classified information,” Biden insisted. “I did not share it with my ghostwriter.” He added he wasn’t aware how the boxes containing classified documents ended up in his garage.

And in response to Hur’s portrayal of him, Biden insisted to reporters that “My memory is fine,” and said he believes he remains the most qualified person to serve as president.

“How in the hell dare he raise that?” Biden asked, about Hur’s comments regarding his son’s death, saying he didn’t believe it was any of Hur’s business.

Biden’s lawyers blasted the report for what they said were inaccuracies and gratuitous swipes at the president. In a statement, Biden said he was “pleased” Hur had “reached the conclusion I believed all along they would reach — that there would be no charges brought in this case and the matter is now closed.”

He pointedly noted that he had sat for five hours of in-person interviews in the immediate aftermath of Hamas’s October attack on Israel, when “I was in the middle of handling an international crisis.”

“I just believed that’s what I owed the American people so they could know no charges would be brought and the matter closed,” Biden said.

The investigation into Biden is separate from special counsel Jack Smith’s inquiry into the handling of classified documents by Trump after Trump left the White House. Smith’s team has charged Trump with illegally retaining top secret records at his Mar-a-Lago home and then obstructing government efforts to get them back. Trump has said he did nothing wrong.

Hur, in his report, said there were “several material distinctions” between the Trump and Biden cases, noting that Trump refused to return classified documents to the government and allegedly obstructed the investigation, while Biden willfully handed them over.

Hur, a former U.S. Attorney in the Trump administration, was appointed by Attorney General Merrick Garland as special counsel in January 2023 following an initial discovery by Biden staff of classified records in Washington office space. Subsequent property searches by the FBI, all coordinated voluntarily by Biden staff, that turned up additional sensitive documents from his time as vice president and senator.

Hur’s report said many of the documents recovered at the Penn Biden Center in Washington, in parts of Biden’s Delaware home and in his Senate papers at the University of Delaware were retained by “mistake.”

Biden could not have been prosecuted as a sitting president, but Hur’s report states that he would not recommend charges against Biden regardless.

“We would reach the same conclusion even if Department of Justice policy did not foreclose criminal charges against a sitting president,” the report said.

But investigators did find evidence of willful retention and disclosure of a subset of records found in Biden’s Wilmington, Delaware house, including in a garage, office and basement den. The files pertain to a troop surge in Afghanistan during the Obama administration that Biden had vigorously opposed. He kept records that documented his position, including a classified letter to Obama during the 2009 Thanksgiving holiday.

Documents found in a box in Biden’s Delaware garage have classification markings up to the Top Secret/Sensitive Compartmented Information Level and “other materials of great significance to him and that he appears to have personally used and accessed.” Hur, though, wrote that there was a “shortage of evidence” to prove that Biden placed the documents in the box and knew they were there.

Some of the classified information related to Afghanistan was shared with a ghostwriter with whom he published memoirs in 2007 and 2017. As part of the probe, investigators reviewed a recording of a February 2017 conversation between Biden and his ghostwriter in which Biden can be heard saying that he had “just found all the classified stuff downstairs.”

Prosecutors believe Biden’s comment, made at a time he was renting a home in Virginia, referred to the same documents FBI agents later found in his Delaware house. Though Biden sometimes skipped over presumptively classified material while reading notebook entries to his ghostwriter, the report says, at other times he read aloud classified entries “verbatim.”

The report said there was some evidence to suggest that Biden knew he could not keep classified handwritten notes at home after leaving office, citing his deep familiarity “with the measures taken to safeguard classified information and the need for those measures to prevent harm to national security.” Yet, prosecutors say, he kept notebooks containing classified information in unlocked drawers at home.

“He had strong motivations to do so and to ignore the rules for properly handing the classified information in his notebooks,” the report said. “He consulted the notebooks liberally during hours of discussions with his ghostwriter and viewed them as highly private and valued possessions with which he was unwilling to part.”

While the report removes legal jeopardy for the president, it is nonetheless an embarrassment for Biden, who placed competency and experience at the core of his rationale to voters to send him to the Oval Office. It says that Biden was known to remove and keep classified material from his briefing books for future use and that his staff struggled and sometimes failed to get those records back.

Even so, Hur took pains to note the multiple reasons why prosecutors did not believe they could prove a criminal case beyond a reasonable doubt.

Those include Biden’s “limited memory” both during his 2017 recorded conversations with the ghostwriter and in an interview with investigators last year in which, prosecutors say, he could not immediately remember the years in which he served as vice president. Hur said it was possible Biden could have found those records at his Virginia home in 2017 and then forgotten about them soon after.

“Given Mr. Biden’s limited precision and recall during his interviews with his ghostwriter and with our office, jurors may hesitate to place too much evidentiary weight on a single eight-word utterance to his ghostwriter about finding classified documents in Virginia, in the absence of other, more direct evidence,” the report says.

“We have also considered that, at trial, Mr. Biden would likely present himself to a jury, as he did during our interview of him, as a sympathetic, well-meaning, elderly man with a poor memory,” investigators wrote.

In addition, prosecutors say, Biden could have plausibly believed that the notebooks were his personal property and belonged to him, even if they contained classified information.

In an interview with prosecutors, the report said, Biden was emphatic with investigators that the notebooks were “my property” and that “every president before me has done the exact same thing.”

Special counsels are required under Justice Department regulations to submit confidential reports to the attorney general at the conclusion of their work. Such reports are then typically made public. The dual appointments in the Biden and Trump cases were seen as a way to insulate the Justice Department from claims of bias and conflict by placing the probes in the hands of specially named prosecutors.

Garland has worked assiduously to challenge Republican claims of a politicized Justice Department. He has named special counsels to investigate not only the president but also his son, Hunter, in a separate tax-and-gun prosecution that has resulted in criminal charges.

But in this case, Biden’s personal and White House lawyers strongly objected to the characterizations of Biden in the report and to the fact that so much derogatory information was released about an uncharged subject like the president.

Biden’s personal attorney Bob Bauer accused the special counsel of violating “well-established’ norms and “trashing” the president.

“The special counsel could not refrain from investigative excess, perhaps unsurprising given the intense pressures of the current political environment. Whatever the impact of those pressures on the final report, it flouts department regulations and norms,” he said in a statement.

But a public outcome was basically sealed once Garland appointed a special counsel.

Regulations require special counsels to produce confidential reports to the attorney general at the conclusion of their work. Those documents are then generally made public, even if they contain unflattering assessments of people not criminally charged.

NEW YORK — The Federal Communications Commission on Thursday outlawed robocalls that contain voices generated by artificial intelligence, a decision that sends a clear message that exploiting the technology to scam people and mislead voters won’t be tolerated.

The unanimous ruling targets robocalls made with AI voice-cloning tools under the Telephone Consumer Protection Act, a 1991 law restricting junk calls that use artificial and prerecorded voice messages.

The announcement comes as New Hampshire authorities are advancing their investigation into AI-generated robocalls that mimicked President Joe Biden’s voice to discourage people from voting in the state’s first-in-the-nation primary last month.

Effective immediately, the regulation empowers the FCC to fine companies that use AI voices in their calls or block the service providers that carry them. It also opens the door for call recipients to file lawsuits and gives state attorneys general a new mechanism to crack down on violators, according to the FCC.

The agency’s chairwoman, Jessica Rosenworcel, said bad actors have been using AI-generated voices in robocalls to misinform voters, impersonate celebrities and extort family members.

RELATED: Fake Biden robocalls in New Hampshire traced to Texas company, criminal investigation underway

“It seems like something from the far-off future, but this threat is already here,” Rosenworcel told The Associated Press on Wednesday as the commission was considering the regulations. “All of us could be on the receiving end of these faked calls, so that’s why we felt the time to act was now.”

Under the consumer protection law, telemarketers generally cannot use automated dialers or artificial or prerecorded voice messages to call cellphones, and they cannot make such calls to landlines without prior written consent from the call recipient.

The new ruling classifies AI-generated voices in robocalls as “artificial” and thus enforceable by the same standards, the FCC said.

Those who break the law can face steep fines, with a maximum of more than $23,000 per call, the FCC said. The agency has previously used the consumer law to clamp down on robocallers interfering in elections, including imposing a $5 million fine on two conservative hoaxers for falsely warning people in predominantly Black areas that voting by mail could heighten their risk of arrest, debt collection and forced vaccination.

The law also gives call recipients the right to take legal action and potentially recover up to $1,500 in damages for each unwanted call.

Josh Lawson, director of AI and democracy at the Aspen Institute, said even with the FCC’s ruling, voters should prepare themselves for personalized spam to target them by phone, text and social media.

“The true dark hats tend to disregard the stakes and they know what they’re doing is unlawful,” he said. “We have to understand that bad actors are going to continue to rattle the cages and push the limits.”

Kathleen Carley, a Carnegie Mellon professor who specializes in computational disinformation, said that in order to detect AI abuse of voice technology, one needs to be able to clearly identify that the audio was AI generated.

That is possible now, she said, “because the technology for generating these calls has existed for awhile. It’s well understood and it makes standard mistakes. But that technology will get better.”

Sophisticated generative AI tools, from voice-cloning software to image generators, already are in use in elections in the U.S. and around the world.

Last year, as the U.S. presidential race got underway, several campaign advertisements used AI-generated audio or imagery, and some candidates experimented with using AI chatbots to communicate with voters.

Bipartisan efforts in Congress have sought to regulate AI in political campaigns, but no federal legislation has passed, with the general election nine months away.

Rep. Yvette Clarke, who introduced legislation to regulate AI in politics, lauded the FCC for its ruling but said now Congress needs to act.

“I believe Democrats and Republicans can agree that AI-generated content used to deceive people is a bad thing, and we need to work together to help folks have the tools necessary to help discern what’s real and what isn’t,” said Clarke, D-N.Y.

The AI-generated robocalls that sought to influence New Hampshire’s Jan. 23 primary election used a voice similar to Biden’s, employed his often-used phrase, “What a bunch of malarkey” and falsely suggested that voting in the primary would preclude voters from casting a ballot in November.

“New Hampshire had a taste of how AI can be used inappropriately in the election process,” New Hampshire Secretary of State David Scanlan said. “It is certainly appropriate to try and get our arms around the use and the enforcement so that we’re not misleading the voting population in a way that could harm our elections.”

The state’s attorney general, John Formella, said Tuesday that investigators had identified the Texas-based Life Corp. and its owner, Walter Monk as the source of the calls, which went to thousands of state residents, mostly registered Democrats. He said the calls were transmitted by another Texas-based company, Lingo Telecom.

According to the FCC, both Lingo Telecom and Life Corp. have been investigated for illegal robocalls in the past.

Lingo Telecom said in a statement Tuesday that it “acted immediately” to help with the investigation into the robocalls impersonating Biden. The company said it “had no involvement whatsoever in the production of the call content.”

A man who answered the business line for Life Corp. declined to comment Thursday.

Associated Press writers Christina A. Cassidy in Washington and Frank Bajak in Boston contributed to this report.

The Associated Press receives support from several private foundations to enhance its explanatory coverage of elections and democracy. See more about AP’s democracy initiative here. The AP is solely responsible for all content.

LAS VEGAS (AP) — Former President Donald Trump won Nevada’s Republican presidential caucuses Thursday after he was the only major candidate to compete, winning his third straight state as he tries to secure his party’s nomination.

Former U.N. Ambassador Nikki Haley, his last major rival still in the race, skipped the caucuses even though they are the only contest in Nevada that counts toward the GOP nomination. Haley cited what she considered an unfair process favoring Trump and instead ran in Nevada’s symbolic state-run presidential primary on Tuesday, when she finished behind the “none of these candidates” option.

Trump’s win in Nevada gives him all 26 of the state’s delegates. He needs to accrue 1,215 delegates to formally clinch the party’s nomination and could reach that number in March.

From Nevada, the GOP contest pivots to the South Carolina primary in Haley’s home state on Feb. 24. Trump remains popular in the deeply conservative state but Haley, who won two elections as South Carolina’s governor, is hoping her local roots give her an edge. Trump is eyeing a massive delegate haul during the March 5 Super Tuesday contests, which would move him closer to becoming the GOP’s presumptive nominee.

Though Trump has been the front-runner, Nevada’s caucuses were seen as especially skewed in his favor due to the intense grassroots support caucuses require candidates to harness around a state in order to win. Nevada’s state party gave him a greater edge last year when it barred candidates from running both in the primary and caucuses and also restricted the role of super PACs like the groups that were key to Florida Gov. Ron DeSantis’ campaign before he dropped out.

Caucuses typically require voters to show up for an in-person meeting at a certain day or time, while elections can offer more flexibility to participate, with polls open for most of the day on Election Day along with absentee or early voting. Nevada Republicans said they wanted certain rules in place like a requirement that participants show a government-issued ID.

Trump’s supporters waited in long lines Thursday. At one caucus site at a Reno-area elementary school, a line of nearly 1,000 people stretched around the corner and down the street 20 minutes after the caucuses opened.

Voters in line, some of whom were wearing Trump hats and shirts, said they came out to back the former president in a contest that would give him a third straight win in the Republican presidential race.

“I think it’s about backing Trump up and giving him the support that he needs. And to let people know that we’re supporting him,” said Heather Kirkwood, 47.

Trump has long been immensely popular among Nevada Republicans, but he had other perceived advantages among the party’s key figures. Nevada GOP Party Chair Michael McDonald and the state’s Republican National Committeeman Jim DeGraffenreid were among six Republicans in the state indicted on felony charges that they were so-called fake electors who sent certificates to Congress falsely claiming Trump won Nevada in 2020. The chairman of the Republican Party in Clark County — the largest county, which is home to Las Vegas — was another of the six so-called fake electors.

Republicans are increasingly converging behind Trump while he faces a deluge of legal problems, including 91 criminal charges in four separate cases. Trump is flexing his influence both in Congress — where Republicans rejected a border security deal after he pushed against it — and at the Republican National Committee, as chairwoman Ronna McDaniel could resign in the coming weeks after he publicly questioned whether she should stay in the job.

Trump still faces unprecedented jeopardy for a major candidate. A federal appeals panel ruled this week that Trump can face trial on charges that he plotted to overturn the results of the 2020 election, rejecting his claims that he is immune from prosecution. The U.S. Supreme Court on Thursday heard arguments in a case trying to keep Trump from the 2024 presidential ballot over his efforts to overturn his 2020 election loss. The justices sounded broadly skeptical of the effort.