BAGHDAD — The American-led military coalition in Iraq said Friday that it was investigating reports that scores of civilians — perhaps as many as 200, residents said — had been killed in recent American airstrikes in Mosul, the northern Iraqi city at the center of an offensive to drive out the Islamic State.
If confirmed, the series of airstrikes would rank among the highest civilian death tolls in an American air mission since the United States went to war in Iraq in 2003. And the reports of civilian deaths in Mosul came immediately after two recent incidents in Syria, where the coalition is also battling the Islamic State from the air, in which activists and local residents said dozens of civilians had been killed.
Taken together, the surge of reported civilian deaths raised questions about whether once-strict rules of engagement meant to minimize civilian casualties were being relaxed under the Trump administration, which has vowed to fight the Islamic State more aggressively.
American military officials insisted on Friday that the rules of engagement had not changed. They acknowledged, however, that American airstrikes in Syria and Iraq had been heavier in an effort to press the Islamic State on multiple fronts.
For Republicans Friday wasn't just bad. It was a disaster. Here are five reasons why.
A busted dealmaker
Donald Trump staked his reputation as a dealmaker - as a "closer" in the words of press secretary Sean Spicer - on getting the healthcare bill through the House of Representatives.
The president sang the bill's praises on Twitter, in press events and at campaign-style rallies.
On Friday Spicer told reporters the president had gone through "extraordinary feats" to try to get the bill approved.
"Has he pulled out every stop, has he called every member, has he tweaked every tweak, has he done every single thing he can possibly and used every minute of every day that's possible to get this thing through, then the answer is yes," Spicer said.
The reality, whether or not the president tried his absolute best-est, is that the bill went down in flames. Not only that, but all the threats and promises he made in the process were proven to be hollow.
He guaranteed a vote on Thursday that didn't happen. Then guaranteed a vote on Friday, and that didn't happen either. He warned his party of the dire consequences of a failure to act, and they ignored him.
Just over two months into his presidency, and Mr Trump's poll numbers are sagging, his agenda is on the ropes and his power is greatly diminished.
A powerless speaker
If it was a bad day for the president, it was a terrible day for Speaker of the House Paul Ryan, whose inability to control his congressional cohort was exposed for all to see.
As he stood before the cameras explaining the defeat, he looked and sounded like the coach of a team that had just lost a big game it had been favoured to win.
"We came really close," he said, "but we came up short."
The speaker of the House has considerable power to wield over individual members. He sets the rules of debate. He controls choice committee assignments, determines key legislative priorities and can direct party funds to his supporters.
All of that wasn't enough to prevent wholesale desertion on this bill from the left and right flanks of his party.
The conservative House Freedom Caucus may only be 29 members strong, but it proved it could go toe-to-toe with Mr Ryan and prevail, even squeezing a number of major concessions in the last few frenetic days.
Now that they have a taste of victory, they will be an even more potent thorn in Mr Ryan's side in future legislative battles.
An agenda derailed
The New York Times recently reported that the president has been grousing privately that he never should have agreed to take on healthcare reform as his first legislative priority.
Although he mentioned the topic repeatedly on the campaign trail, it always felt like a throw-away line offered to the Republican base - a bit of conservative gospel that party stalwarts expected to be repeated.
Policies like trade, infrastructure spending, tax reform and that "big, beautiful" wall on the US-Mexico border were always nearer and dearer to the Mr Trump's heart.
Those agenda items, however, are now at risk, as healthcare reform sinks beneath the waves. Tax cuts, for instance, are made considerably more complicated as long as the tax aspects of Obamacare remain on the books.
Wall Street investors are already expressing their growing pessimism over any serious tax-policy efforts, with stock prices sagging as the prospect of Republican healthcare reform's success dimmed, for instance.
There will still likely be members of Congress who want to keep plugging away on Obamacare repeal, seeing as how they campaigned on it for the past seven years. It will be difficult to agree on where to go next, and not everyone will be keen to listen to a president who botched his first big legislative test.
Healthcare in flux
"I don't know what else to say other than Obamacare is the law of the land," Mr Ryan said in his afternoon press conference conceding defeat. "We're going to be living with Obamacare for the foreseeable future."
Mr Obama's healthcare reform may remain in place, but its future is still murky. Although Congress has failed in its attempt to dismantle the law, the Trump administration can still do a great deal to undermine it through executive action - in fact, it already has.
The mandate that all Americans purchase health insurance aren't being enforced. Efforts to encourage enrolment through the healthcare marketplaces are being curtailed. More states will be given leeway to alter and adjust how they implement their components of the law. All of this could significantly affect how Obamacare looks and operates across the US.
Mr Trump has repeatedly said that it was the wiser political move for Republicans to let the Obamacare systems collapse on their own and then blame the resulting chaos on the Democrats. While the political wisdom of this strategy is uncertain, the fact remains that Mr Trump and his administration could go a long way toward causing the works to "implode and then explode", in the president's words.
The law as it's currently constituted does have some self-correcting measures to prevent total collapse, however. If insurance rates increase, the size of the government price supports will grow accordingly. The basic regulations - such as "essential coverage" guarantees and price controls - will remain.
The bottom line is Obamacare lives to see another day - and, perhaps, another Democratic rise to power, when it can be more fully revived.
An angry base
For seven years Republicans have been promising that they will tear up the Obamacare "root and branch", in the words of Senate Majority Leader Mitch McConnell. Success, they've said, is just an election away.
In 2010 Republicans won control of the House of Representatives. In 2014 they won control of the Senate. In 2016 they won the presidency. At last, Republican grass-roots activists were told, victory was in their grasp.
Only victory, at least for now, has slipped through conservative fingers once again.
At some point, the Republican base may start to wonder whether Obamacare is ever going to go away. And at some point if it doesn't, they may start to wonder why.
It's worth remembering that the reason the effort to pass the American Health Care Act failed was because the Republican Party itself was torn asunder on what to do about healthcare. Moderates feared that the proposed legislation would leave too many of their constituents without healthcare. Conservatives, on the other hand, thought the repeal efforts didn't go far enough.
Those problems aren't going to disappear anytime soon. While in the minority, it's been easy for Republican politicians to promise their voters "action" and "change". Now that they're in power, it has proven difficult to translate those words into policy.
When the next election rolls around, the Republican Party may face a Democratic Party that has been stirred into action and a Republican base disillusioned by their party's failure to perform. That, needless to say, is a recipe for electoral disaster.
"...child pornography was being planted into our facebook groups..." 12:50 in video
"We were very close," he told reporters Friday afternoon after the health care vote was pulled. The lack of bipartisan support made passing the legislation difficult, Trump conceded, saying that with no Democrat support, the health care overhaul couldn't pass."
Were you under some illusion that it passed by straight votes in Congress and ended up on Obama's desk?
So now there are different rules than in 2009/2010?
Have you ????
Your old age is ******* with your memory.
Read the mission statement and history of the Commonwealth Fund.
The Commonwealth Fund—among the first private foundations started by a woman philanthropist, Anna M. Harkness—was established in 1918 with the broad charge to enhance the common good.
The mission of The Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.
The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries.
I don't need to do anything.
I happen to know a great deal about mathematics and statistical analysis.