Israel Leal/ AP

Mexico's President Enrique Pena Nieto speaks during the opening of the 2017 General Assembly of the Organization of American States in Cancun, Mexico, on Monday, June 19, 2017.

Venezuelan President Nicolás Maduro announced this week that if his government’s “Bolivarian Revolution” were ever threatened, his supporters would turn to weapons.

“What we failed to achieve with votes, we would do with weapons,” he said at a rally drumming up support for his plan to rewrite the Constitution.

The statement was a further blow to Venezuela’s struggling democracy. But it also spotlighted the inability of regional neighbors to agree on a resolution condemning the Andean nation’s humanitarian emergency and human rights abuses. 

For several years, neighboring countries and international actors, even the pope, have tried to help stem Venezuela’s mounting crises. Most recently, Mexico has taken the reins, standing at the forefront of the Organization of American States (OAS) to call for a resolution.

“Mexico will not stop using all diplomatic channels, including the OAS, in order to have a constructive impact on achieving a peaceful solution to the restoration of democracy” in Venezuela, Foreign Minister Luis Videgaray said at the University of Miami last month. “We have a country that, in fact, is no longer a functional democracy.”

It’s a somewhat unusual position for Mexico to take on. Geographically closer countries like Brazil, Colombia, and Panama arguably have more at stake, with tens of thousands of Venezuelans fleeing across the border. For decades, the United States – often controversially – has been at the helm when it comes to managing regional unrest. And there’s an irony in Mexico calling out rights abuses elsewhere when its own human rights record is under scrutiny.

Mexico has its reasons, analysts say. They range from the desire to lower the rising levels of government-backed violence in this overwhelmingly democratic region to a hope to position itself as a stronger regional leader, at a moment when many Latin American countries are tied up in their own political and economic crises.

But there’s an added, more local, benefit: Mexico’s 2018 presidential race.

Perennial populist candidate Andrés Manuel López Obrador, who lost the 2006 presidential election by a hair and set up his own parallel government in protest, is considered a top contender. By highlighting Venezuela’s woes, and linking them to its leftist leadership, the ruling party in Mexico can send a message that it understands and knows how to fix “leftist errors,” analysts say. 

“Mexican government officials have been … forewarning of a López Obrador presidency,” says Armand Peschard-Sverdrup, senior fellow of the Mexico Project at the Center for Strategic and International Studies in Washington. “They have been blunt enough to say he would be Mexico’s Maduro; that this would be a Venezuela-like scenario unfolding.”

Anti-establishment threat

It’s not the first time Venezuela has been pulled into Mexico’s national politics. In 2005, when running for president and leading in the polls, López Obrador was compared to Venezuela’s then-President Hugo Chávez. “I see authoritarianism in them both,” said opponent Roberto Madrazo, candidate for the Institutional Revolutionary Party (PRI). (Both lost to Felipe Calderón, of the center-right National Action Party (PAN). 

Back then, López Obrador was accused of taking campaign funding from Chávez. More recently, he has been lampooned by public figures for not explicitly condemning the situation in Venezuela.

“It was definitely a scare tactic … a strategy [the two main political parties] used to instill fear in the electorate,” Mr. Peshard-Sverdrup says of the 2006 election. “López Obrador kind of played into that, with his [populist] discourse,” and by drawing attention to social benefits programming he implemented while mayor of Mexico City, such as stipends for single mothers, senior citizens, and people with disabilities.

But times have changed. Not only is López Obrador a different candidate, but the political environment has changed.

“He’s AMLO 2.0,” says Peshard-Sverdrup, using López Obrador’s nickname. “This is the AMLO that has tempered [himself], moderated his discourse, pacted with business elite by creating an advisory counsel, who’s been traveling to the US,” he says.

And the Mexican electorate, like many voters around the world, are showing anti-establishment preferences. There’s a sense that Mexicans are growing disenchanted with the country’s main parties, including the Party of the Democratic Revolution (PRD), PAN, and the ruling PRI.

The PRI, which was in power from 1929 until 2000, won the 2012 election on a promise that it had reinvented itself for modern Mexico. But it has been hit with multiple, high-profile corruption allegations over the past five years. It’s still reeling from a botched investigation into the disappearance of 43 teaching students in 2014, and the high-profile reforms passed early on in the administration, in areas like education and telecommunications, have largely fallen out of view. And a greater pall was cast by this month’s allegations that the government paid a private company for spyware that they used to illegally track the communications of individuals exposing corruption within the government or fighting for citizen rights. 

International criticism 

Mexico is not unique in using Venezuela as a local warning about the risks of voting for the left.

More “governments and more people [are] repudiating everything that’s happening in Venezuela,”says Dmitris Pantoulas, a political analyst and Venezuela expert. But many politicians in “countries where the left has a chance at winning elections” are attacking Venezuela “for internal reasons of the left versus the right,” he adds.

He points to Spain: During last year’s general elections, news stories and campaign messaging emphasized alleged links between Venezuela’s leadership and Spain’s new, leftist Podemos party. Similar stories have been published about López Obrador, with headlines like, “ ‘Messiah’ or ‘Mexican Hugo Chávez’: Andrés Manuel López Obrador closer than ever to the presidency.”

Regardless of the reasons for calling out Venezuela’s government, however, many say it’s the right thing to do.

“There is a genuine desire to see the Venezuelan crisis end, and to see a more favorable outcome for the Venezuelan people,” says Andrés Rozental, Mexico’s former deputy foreign minister and the founding president of the Mexican Council on Foreign Relations. “Every country has some issues regarding human rights, but that doesn’t disqualify them from looking at what’s going on around them.”

“It may be the opposite,” he says. Mexico “having a position on issues in the region or in the world strengthens, I think, the position of those who believe that things need to change in Mexico.”

J. Scott Applewhite/AP

For those wondering where Justice Neil Gorsuch – shown here during shown during a June 1 official group portrait session – will fit on the Supreme Court’s ideological spectrum, the best early clue might be to watch the company he keeps. Gorsuch has paired up eight times with Justice Clarence Thomas – the court’s most conservative member – in separate opinions that dissent from or take issue with the court’s majority rulings.

A general rule of thumb for the US Supreme Court is that rookie justices need a few years to get comfortable before they find their voice. Two-plus months into his tenure, Justice Neil Gorsuch appears to have ignored that rule.

Most court watchers agree it is too early to know what kind of justice the former federal appeals court judge will be. Nevertheless, his first months on the bench can be fairly summed up in two words: talkative and conservative.

Justice Gorsuch has become “a reliable member of the four-Justice conservative bloc” that has existed since 2006, writes Stephen Vladeck, a professor at the University of Texas Law School, in an email to the Monitor.

But “it’s surprising to me that he wrote so many separate opinions,” he adds, referring to concurring opinions that agree in part with the majority ruling.

The seven separate opinions Justice Gorsuch has written so far equals the number that Justice Elena Kagan wrote in her first two terms. But it is understandable that he may have a shorter bedding-in process than most rookie justices, experts say, given his 10 years on the Denver-based 10th Circuit Court of Appeals.

“Before, you used to sit silently for five years before you got used to the place,” says Lyle Denniston, a journalist who covered the court for almost 60 years.

“He’s an experienced lower court judge, I think he has a pretty substantial ego, and I think he wants to show that while he’s only been on court three months, he’s really good at it,” adds Mr. Denniston, who most recently covered the Supreme Court for the National Constitution Center.

What that portends for the high court as a whole – and whether there could be a “Gorsuch effect” – remains to be seen. It’s unlikely he will sway his colleagues' opinions on major issues, since the justices have formed and solidified their feelings on them over decades. His longer-term impact may be in how future courts interpret his separate opinions, experts say.

Gorsuch built a reputation on the 10th Circuit as a staunch conservative and originalist – someone who, like Justice Scalia, interprets the Constitution as he believes the Framers intended 200 years ago. It is still early days, but his writings as a justice thus far are consistent with that reputation. Moreover, contrary to the popular belief that he will be a “new Scalia,” some experts believe he may be more consistently conservative in his rulings, putting him to the right of Scalia and closer to Justice Clarence Thomas. 

“I think he’s going to be an energetic member of the court, but it’s really clear he’s in a position to push the court considerably further to the right,” says Denniston, who is retiring this week.

A chatty textualist

As a justice, Gorsuch came out firing, asking 22 questions on his first day at the court (a new record, besting the 15 Justice Sonia Sotomayor asked on her first day). And his opinions so far on the high court appear consistent with his lower court record, both in substance and in style.

His first dissent, for example, turned an opaque case about employment grievances among federal employees into a cheery, conversational treatise on textualism and judicial deference to the legislature.

“For every statutory ‘fix’ [lower courts] have offered, more problems have emerged, problems that have only led to more ‘fixes’ still. New challenges come up just as fast as the old ones can be gaveled down,” he writes.

“At the end of a long day,” he concludes, “I just cannot find anything preventing us from applying the statute as written – or heard any good reason for deviating from its terms.”

In more significant decisions, Gorsuch has made his conservative philosophy clear, including dissenting to a decision ruling in favor of a same-sex couple in Arkansas seeking to have both their names on their child’s birth certificate, and dissenting to a decision to not hear a challenge to a strict concealed-carry policy in San Diego, Calif.

Guidelines for future courts

Early in its history, there was a norm against writing separate opinions on the Supreme Court, with the justices preferring to speak as one as often as possible. That norm has gradually eroded in recent decades, and no justice better embodies the increasing popularity of separate opinions than Justice Thomas.

Gorsuch has already joined Thomas in a number of separate opinions during his first few months. On Monday alone the pair signed onto eight separate opinions and dissents together.

Dissents and separate opinions don’t carry much legal weight themselves in the moment, but they can be helpful in making the public aware of a justice’s thinking. Perhaps more significantly, those opinions can become useful sources to justify changing court precedent, signaling, “alternative possibilities that a future court may end up taking up,” says Ilya Somin, a professor at George Mason University’s Antonin Scalia Law School.

Thomas “knows that sometimes what was once just one justice’s view will become more influential over time,” adds Professor Somin.

Gorsuch may think similarly, judging by his separate opinion in Trinity Lutheran v. Comer this week. The 7-2 majority opinion, which Gorsuch joined, ruled that a policy denying a state grant to a Missouri church to resurface its preschool playground violates the church’s free exercise rights. But a footnote in that opinion limited its scope to “the express discrimination based on religious identity with respect to playground resurfacing.”

In a separate opinion, Gorsuch and Thomas wrote that they disagreed with the footnote and think the majority opinion shouldn’t have been so narrow.

“If you want to argue that Trinity Lutheran is a sweeping decision,” says Denniston, “all you have to say is the part of the opinion that is supposedly narrowing [its scope] doesn’t have the support of the majority, because Justices Thomas and Gorsuch don’t join it.”

Outlier or bridge-builder?

Gorsuch’s writing style and, by all accounts, personable manner could help him sway the opinions of some of his fellow justices, some experts say. At least more than Scalia, with whom Gorsuch is frequently compared, who would sometimes publicly criticize his colleagues in dissents.

“Supreme Court justices are people just like the rest of us. If someone seems aggressive or insulting in an opinion, that might annoy them,” says Somin. “If they’re nice to them, that may lead them to have a more favorable view of that person’s opinion.”

But that effect “is likely to be marginal,” he continues, and unlikely to have an effect when it comes to major issues where the justices generally already have firmly-formed opinions.

A few weeks ago, Canadians heard something from their country's foreign minister that rattled them: pointed criticism of the United States.

“Many of the [American] voters in last year's presidential election cast their ballots, animated in part by a desire to shrug off the burden of world leadership,” Chrystia Freeland told the House of Commons, before announcing an uptick in military spending.

"To put it plainly: Canadian diplomacy and development sometimes require the backing of hard power,” she said. “To rely solely on the US security umbrella would make us a client state.”

Such talk is not the sort that Canadians are used to hearing from their government. Canada has long seen itself as a middle power. Its $5 bill features the Canadarm, a mechanical arm affixed to the International Space Station to move around parts. It’s an apt – if perhaps humble – metaphor for how the country has built consensus on issues like the environment or aid, always through American-led multilateral institutions.

But as Canada gets ready to celebrate its 150th birthday on Saturday, it is taking a bolder stance on the world stage.

And although it may be distancing from its longtime ally, and even protector, to the south, it is doing so by doubling down on values it has long espoused, by anchoring itself to the global institutions it’s enthusiastically supported for decades, a decision the country made in similarly tumultuous times.

“[Ms. Freeland] went further than any Canadian official had ever gone in being critical of the America First approach,” says Roland Paris, a senior University of Ottawa research professor who helped craft the current government’s foreign policy. “But on the other hand, she emphasized the importance of working with the United States” – i.e. a cry for the status quo.

Adrian Wyld/The Canadian Press/AP

Britain's Prince Charles and Camilla, the Duchess of Cornwall, arrive at CFB in Trenton, Ontario on Friday June 30. Prince Charles and the Duchess of Cornwall are in a royal visit as Canada marks its 150th birthday.

Coaxed away from Britain

Unlike Americans’ rallying narrative of the War of Independence, Canadians see their history as a gradual, quiet set of negotiations – ones that took decades to iron out.

The Dominion of Canada was formed in 1867, after British and French settlers made peace with each other and most indigenous tribes. As an outpost of the British Empire, Canada didn’t control its own foreign policy until 1931 – but Americans began coaxing Canadians to be more independent early on, says Christopher Sands, a professor at the Johns Hopkins School of Advanced International Studies in Washington.

“It was in the US strategic interest to encourage Canadian nationalism, to be distinct from the British Empire,” Professor Sands says, “to get them to think of themselves as independent.” Successive American presidents saw Canada as a next-door neighbor that could align its economy and political views to the US, and take Britain down a notch from its global hegemony.

In 1909, Washington officials signed a treaty with Canada on mechanisms to solve water-boundary disputes – the first treaty Canada had signed on its own. In 1926, after Britain relinquished some control over its colonies, the US invited Canada to set up an embassy in central Washington. Sands says that the Americans believed giving Canada a taste of autonomy would leave them craving more.

That largely came true after World War I, when Canada fought for Britain under the Union Jack. In doing so, Canadian soldiers took heavy losses, but also often fought alongside each other – men from the Pacific coast, prairie, Quebec, Nova Scotia alike – in a way that they hadn't before, helping to build a sense of Canadian nationhood. The cost of war and the nascent national identity helped build enough pressure on Britain that it granted some of its colonies, including Canada, full sovereignty in 1931.

The Gray Lecture

A pivotal moment for Canada's foreign policy came in 1947, in a speech by Foreign Minister Louis St. Laurent at the University of Toronto. Known today as “The Gray Lecture,” the speech laid out key concepts in what would become Canada's performance on the world stage.

At that time Canadians were wary of international institutions. The United Nations faced political gridlock over regulating atomic energy. Canadians were sending millions of aid dollars to war-torn allies. A poll just weeks prior to St. Laurent’s speech showed 44 percent of Canadians doubting the UN could prevent another world war in the next quarter-century.

St. Laurent offered a different perspective. “The freedom of nations depends upon the rule of law between nations,” he told the audience of 2,000. St. Laurent positioned Canada as a bulwark of political freedom, that would co-operate with like-minded countries while maintaining dialogue with adversaries. “A country of our stature,” he said, would need to work with larger countries, own more than just a handful of embassies, and demonstrate a “willingness to accept international responsibilities.”

He also committed Canada to continue working in lockstep with the US, a “vastly more powerful, more self-confident, more wealthy” state “with purposes and ambitions parallel to ours.” Canada followed through by joining the US in fighting the 1950 Korean War and loudly opposing communism.

Sands says American presidents have long reciprocated that allegiance, by including Canada in the founding of the UN, International Monetary Fund, and North Atlantic Treaty Organization. Decades later, the US pushed to include Canada in what is now the Group of Seven. “[Americans] tried to create, in the major post-war institutions, a seat for Canada at every major group,” says Sands. Canada generally abided by that system until the 1970s, siding with the US in most UN decisions and housing American nuclear weapons.

Canada’s first major foreign policy achievement took place in 1956, in diffusing the volatile Suez Crisis. The conflict came after Egypt nationalized a key shipping canal, prompting Britain, France, and Israel to invade. Then Prime Minister Lester Pearson kept his criticism of Britain private, instead focusing on steering all sides toward a ceasefire, which was enforced by the UN’s first large-scale peacekeeping force. Canadians still identify peacekeeping as a landmark of their foreign policy, despite the practice’s rare use in modern conflicts.

Testing the waters

But as the cold war dragged on, Sands says Canada started challenging American policies abroad. “We’re often on the same page,” he says. “The most significant moments are the ones where Canada really stands out, and tests the waters of that independence, to see if Americans really mean it.”

The man primarily responsible for this rough patch was Canadian Prime Minister Pierre Trudeau, father of current Prime Minister Justin Trudeau. During his time in office from 1968 to 1984, the elder Trudeau visited with Cuban President Fidel Castro, made nice with China's communist leaders, and pushed back against the Vietnam War. Trudeau also had all US nuclear arms removed from Canada.

But even then, Trudeau’s government still kept close ties to the US, and Canada sheltered six American diplomats during the 1979 Iranian Revolution and issued passports to bring them to safety.

And Trudeau's successor, Brian Mulroney, quickly returned to close partnership with the US – with high emphasis on consensus-building.

He pioneered the 1987 Montreal Protocol on Substances That Deplete the Ozone Layer, and a year later persuaded the environmentally skeptical Reagan administration to sign on. In 1991, he convinced the first Bush administration to combat acid rain. Kim Richard Nossal, a political science professor at Queen's University in Kingston, Ontario, says it’s part of a pattern: “Canadian foreign ministers have long pursued little niches where they can find consensus in different corners.”

Outraged by South African apartheid, Mr. Mulroney used his close ties with then-US president Ronald Reagan and his British counterpart Margaret Thatcher to eventually push for a major boycott, which destabilized the regime.

Sands says that since then, Canadian governments have oscillated between Mulroney’s staunch support for US policy and Trudeau’s outreach to adversaries, while relying on the UN and other global bodies to decide on military interventions.

The country has also stuck to carving out small-scale accomplishments. When UN talks to ban landmines sputtered, Canada hosted two conferences and multiple negotiations that led to the 1997 Ottawa Treaty, which forbade their sale and use. Today, 162 countries have ratified the treaty (but not the US, which sought an exemption for Korea’s Demilitarized Zone).

The only Canadian leader to dismiss the UN was recent Conservative Prime Minister Stephen Harper — and even his objections were mild. And he also relied on international partners, pioneering a maternal-health fund with the help of the World Bank. His diplomats reportedly played a key role in the private talks leading up to the 2014 rapprochement between the US and Cuba.

A charm offensive

Today, with President Trump pulling back from the world stage, Canada has become more critical of its southern neighbor.

As refugee advocates picketed American airports during January’s first travel ban, Prime Minister Trudeau tweeted a message of hope: “To those fleeing persecution, terror & war, Canadians will welcome you, regardless of your faith. Diversity is our strength #WelcomeToCanada” Hundreds are now leaving the US to claim asylum in Canada – a phenomenon that started under Obama-era deportation campaigns but has increased under Mr. Trump.

But abroad, Trudeau is continuing the Canadian tradition of pushing neatly defined causes by garnering multilateral support. He’s launching what he calls a “feminist international assistance policy,” focused on women’s rights and gender equality. He’s leveraging the Commonwealth to push African and Asian countries to remove anti-LGBT laws. He calls the UN the “principal forum for pursuing Canada’s international objectives.”

Even in the US, Canada continues to push for consensus, if not always directly with the White House's current occupant. Trudeau's top staffers reportedly have almost-daily contact with daughter Ivanka Trump and her husband, Jared Kushner. Prior to last fall’s election, Trudeau demanded his entire caucus never publicly criticize Trump, according to media reports.

And together with Mr. Mulroney, his father's rival, Trudeau has arranged for members of his cabinet fly to the US to meet with mayors, business leaders, journalists, and unions on an almost-weekly basis. The idea is to shore up support for Canada in 11 key states, including Wisconsin (home to House Speaker Paul Ryan) and Indiana (where Vice President Mike Pence was governor). It’s yielded a New York State reversal on import tariffs, and climate talks about possible deals between provinces and states.

The recent speech by Freeland, the foreign minister, suggests it’s a way of grounding Americans in the principles they shared with Canadians.

“The fact that our friend and ally has come to question the very worth of its mantle of global leadership, puts into sharper focus the need for the rest of us to set our own clear and sovereign course,” Freeland said. “For Canada that course must be the renewal, indeed the strengthening, of the postwar multilateral order.”

As Paul Heinbecker, who wrote speeches for the elder Trudeau and advised Mulroney, puts it, “that speech went back to the Gray Lecture and updated it for the current world.” But he says it’s unclear whether an increasingly assertive Canada will thrive on the world stage without US leadership.

“It was a recognition that the world was changing, and Canada was going to change,” he said. “It said that when America steps back, the world has to step forward.”

As the chief medical officer at a downtown hospital, William Goodman has seen how opioid abuse can ravage a community. He’s also seen what a robust response to addiction looks like, from creating safe spaces for users to seek help to seeding a network of long-term treatment centers across the Granite State.

But this public-health response depends on federal health dollars. Until 2014, able-bodied adults living just above the poverty line in New Hampshire didn’t qualify for Medicaid. Now they do, and that expansion has undergirded a rollout of services for substance abuse and mental illness.

Under health-care legislation being crafted by Senate Republicans, the Congressional Budget Office has estimated that 15 million Americans would lose Medicaid coverage over the next decade. For Dr. Goodman, any retrenchment in coverage could be a body blow in New Hampshire’s battle against opioid abuse.

“We’re trying to catch up. If we lose this kind of support and we go back to standard Medicaid [eligibility] I think it would be devastating on many levels.... Programs would wither on the vine,” he says.

His worry, shared by others here including the Republican governor, is emblematic of how grass-roots concern about opioid addiction is altering national debate over health-care policy. Although pledges to repeal Obamacare helped Republicans win control of Congress, Senate efforts to follow through on that promise have faltered because of the politics of coverage cuts, including for addiction treatment.

New Hampshire is the kind of low-tax, small-government state that Republicans love to champion. Until the opioid crisis hit, it spent only a fifth per capita of the average of New England states on treating substance abuse. A surge in opioid deaths and related illnesses forced a rethink in spending priorities during the rollout of the Affordable Care Act (ACA), which mandates coverage for substance abuse as an “essential” benefit in private insurance plans. It led to a bipartisan law that expanded Medicaid to an additional 53,000 residents and added substance abuse to traditional Medicaid plans.

Republican governors push back

Gov. Chris Sununu has criticized the Senate bill, joining other Republican governors from states that accepted more Medicaid dollars under the ACA. In a letter to Senate majority leader Mitch McConnell, Governor Sununu said the bill would jeopardize the state’s investment in Medicaid coverage. “Taken as a whole, we believe that the changes proposed in the BCRA will lead to cuts in eligibility, loss of coverage or significant increases in state taxes,” he wrote. The letter was made public on June 27 after Senator McConnell delayed hearings on the controversial bill.

The initial Senate bill offered about $2 billion in extra money for states fighting opioid abuse. A revision, in the works as Congress heads out for a week-long recess, may offer more money to get moderate Republicans on board. But critics say even $45 billion for the next decade, sought by Republican senators from West Virginia and Ohio, wouldn’t compensate for deep cuts in subsidies for the poor at risk of opioid abuse.

“Slashing and burning Medicaid and saying the states will find the money is the most gargantuan case of buck-passing in the history of American politics, and one that will cripple Medicaid financing ... for people plagued by opioids” and for many others, says Alan Sager, a professor of health law, policy, and management at Boston University.

Drug abuse cuts across class lines; not all those seeking help are on Medicaid. But its expansion in New Hampshire has eased the financial strain on hospitals like Catholic Medical Center (CMC), where Goodman oversees an emergency room that can see multiple drug overdoses in a single night when a potent batch of fentanyl, a synthetic opioid, hits the streets.

A rise in coverage

On a recent weekend, four extended family members were driven to the emergency room by an unknown fifth person after overdosing on fentanyl. All survived. “We all know someone who’s suffered, and it’s usually someone very close to you,” says Goodman.

Today fewer patients arrive at CMC with no means to pay for care. In 2011, 16 percent of opioid-related admissions were uninsured. Last year that share fell to 3 percent. Statewide, the rate of uninsured is 6 percent, down from 11 percent in 2011 before the Affordable Care Act.

Just as important as hospital care, say health officials and policy experts, is the flow of public money to outpatient clinics and detox centers for recovering addicts.

“We are developing a substance use disorder treatment network that can actually care for people with addiction. This is the first time we’ve been able to do that and that’s due to the coverage requirements in the Affordable Care Act,” says Lucy Hodder, director of health law and policy at the University of New Hampshire.

When Goodman’s team saves an overdose patient, he wants to know that there’s a place to refer the patient for long-term rehabilitation. That wasn’t a given before, which only added to his frustrations when the same patient would show up again in the ER. “It’s much more cost-effective to keep them sober and prevent them from getting sick,” he says. 

Between 2009 and 2015, the number of non-residential mental health and substance abuse centers in New Hampshire grew from 52 to 70, according to New Futures, an advocacy group. It estimates that substance abuse cost the state $2.36 billion in 2014, of which lost productivity made up the largest share, following by medical care and law enforcement.

The uncertainty factor

The network of treatment centers still lags behind the rising demand in a state that saw 478 opioid-related deaths last year, up from 300 in 2014, the second-highest rate per capita behind West Virginia. But the uncertainty hanging over future Medicaid coverage puts operators in a bind, says Courtney Gray-Tanner, who heads an association of drug and alcohol treatment centers.

“These entities are hesitant to build up, because they’re not sure about the level of resources,” she says.

Should the Senate bill become law, states that expanded Medicaid could try to fill the gap in federal funding from their own budgets. In his letter to McConnell, Sununu said the state would receive $1.4 billion less over 10 years under the Senate’s Medicaid funding formula.  

New Hampshire’s Medicaid expansion program automatically ends if the federal matching changes, says Ms. Hodder, a former adviser on health policy to Maggie Hassan, the two-term Democratic governor who signed the expansion into law.

Like many here, she’s unsure if a low-tax state could muster the resources to maintain the Medicaid coverage. “New Hampshire just isn’t prepared for that kind of investment that quickly,” she says.

Staff writer Mark Trumbull contributed to this report from Washington.

Jeff Chiu/AP

Xavier Becerra, Attorney General of California, gestures at the Pride parade in San Francisco, Sunday, June 25.

When California announced last week that it was restricting state-funded travel to Texas, Shaun Harper faced a dilemma.

Should his organization hold its annual conference in November in Houston, as it had planned for months? Or should they relocate to a city that is not in a state that recently allowed faith-based adoption agencies to refuse to place children with same-sex couples?

“Some people were immediately like, ‘You’ve got to get out of Texas as soon as possible,’ ” says Mr. Harper, president of the Association for the Study of Higher Education (ASHE). “I respect those perspectives. My personal activist stance is you don't pull away from the site of injustice; you go to it.”

Harper’s predicament highlights the issues swirling around California’s implementation of Assembly Bill 1887. The law, passed in January, prohibits state employees from using tax money to travel to states with laws discriminating against lesbian, gay, bisexual, and transgender (LGBT) individuals and families. The first four on the list were Kansas, Mississippi, North Carolina, and Tennessee. Last week, state attorney general Xavier Becerra added Alabama, Kentucky, South Dakota, and Texas.

The strategy is essentially a boycott in line with the one that led North Carolina to repeal its maligned “bathroom bill.” Some business coalitions say the tactic works: It sows the kind of uncertainty businesses try to avoid and provides a disincentive to lawmakers looking to pass such laws.

But others, like Harper, say there are ways of fighting discrimination that don’t involve the hostile singling out of states. And some critics are skeptical the ban will lead to policy changes. The move, they say, appears to be at least as much about California and the Democratic Party employing a strategy that aligns with an increasingly left-leaning base as it is about advancing the cause of the LGBT community.

“It’s a symbolic gesture,” says John Pitney, Jr., professor of politics at Claremont McKenna College in Los Angeles. “There’s pressure on the party to be even bolder and more progressive. This is one small step that [Mr. Becerra] can take … that the progressive base of the Democratic Party will like very much.”

'A place where ideas are debated'

Harper, who is black and gay and teaches race and ethics at the University of Southern California, supports robust rights for the LGBT community. As an advocate, he says, he understands the strategy of effecting change by hurting a state’s economy and compelling its legislators to behave differently.

But as an educator, Harper says he can’t help but feel that boycotting Texas would mean abandoning students and families who don’t have the luxury to leave their home state. “We owe it to them to go to where they are suffering and to do all that we can with what we know to alleviate [that],” he says.

“[A university is] supposed to be a place where ideas are debated, contested, revised, where we grapple with ideas and understand that we’re not all going to always agree, but that learning happens in the space of disagreement,” Harper adds.

His position echoes that of Charles Moran, board member of the California Young Republican Federation and former chairman of the Log Cabin Republicans, a major conservative LGBT organization.

“Some of these states do have laws on the books that clearly don’t reflect what a modern family is,” says Mr. Moran, who for more than a decade has worked to advance LGBT rights within the Republican Party. “What I’ve learned is, the way to get around this is by telling your stories, doing the face-to-face interactions, changing hearts and minds one at a time.”

California's law, he says, prevents that kind of discourse from taking place. “Instead of other states getting to learn about what it means to be tolerant, all they’re seeing is a bunch of arrogant Californians telling them what their values should be,” Moran says.

The criticism cuts to what some analysts say is one of the Democratic Party’s biggest problems: a tendency toward public gestures meant to appeal to an increasingly vocal liberal base – sometimes at the cost of advancing policy goals.

“This shows again a Democratic Party that’s looking to find its bearings,” says Bill Whalen, senior fellow at Stanford University’s Hoover Institution. “When do we move away from outrage and get down to the business of ideas?”

Effect of sanctions

Still, some say the ban does have teeth. Since Becerra added Texas to California’s no-go list, Jessica Shortall says she’s received dozens of calls from concerned entrepreneurs and organizations wanting to know if they can – or should – still hold events in Houston or Austin or Dallas.

“One of the worst things you can introduce in a situation, when you’re looking at it from an economic development perspective, is uncertainty,”  says Ms. Shortall, managing director of Texas Competes, a group that promotes an LGBT-friendly business environment in the state. “Why would I spend my time considering Texas when we just don’t know what's going to happen there?”

In a survey by Meetings & Conventions, a research and analysis site for event planners, about half of respondents said laws around LGBT rights factored into their decision to choose a site. More than a fifth said they would be willing to incur fees to cancel a meeting in a state that passed a law that some attendees would consider discriminatory, while 34 percent said they would do so “in some instances.”

One report, released in April, estimated that the Texas economy stands to lose at least $1.04 billion if it passes Senate Bill 6, which would require transgender people to use the bathroom that corresponds with the sex on their birth certificate. (The Texas Legislature is set to vote on the bill during a special session that starts July 18.)

“It’s something that’s talked about a lot in the industry,” Shortall says.

Proponents say the numbers prove that boycotting states with discriminatory legislation is a crucial part of fighting discrimination everywhere.

“It is facilitating discourse and conversation,” says Rick Zbur, executive director of Equality California, which co-sponsored A.B. 1887. “If the LGBT community and allies and elected officials basically turn a blind eye as these states target our communities, then I doubt there will be any discourse that happens.”

“We want to demonstrate that in California, inclusion is not something to be feared,” he adds. “Having policies that embrace diversity and inclusion is good for everyone.”

One group's decision

Harper grappled for nearly a week over whether to relocate the ASHE conference. On Wednesday, he took the matter to his board members, who voted 8 to 1 to keep the event in Houston.

In a statement, Harper explained that they considered the legal and financial consequences of relocating. But more importantly, he wrote, “We agreed that ASHE members who are able to travel to Houston should strategically use our scholarship to bring about the change we wish to see there and elsewhere in our nation.”

“There’s some serious learning that can happen in Houston at our conference, even though we don’t agree with the politics of the place,” he says.

Adrian Wyld/The Canadian Press/AP

Prince Charles shakes hands with locals as he participates in an event in Iqaluit, Nunavut, Canada, June 29. Prince Charles and the Duchess of Cornwall visited the Canadian Arctic to kick off a royal visit that's scheduled to culminate in Ottawa July 1 as Canada marks its 150th birthday.

One can’t imagine Canadians getting too worked up about the 150th anniversary of their nation’s founding. That occurred July 1, 1867, when three provinces merged to form a “confederation,” the basis of modern Canada.

On the Fourth of July Americans might be moved to dance to “The Stars and Stripes Forever” as fireworks erupt overhead. On Canada Day on July 1 Canadians might just lean back on the chesterfield (that’s the sofa to Americans) and nod in agreement “pretty good, eh?”

Actually America’s northern neighbor is spending roughly a half-billion dollars (Canadian) this year on special events from coast to coast to mark the 150th. Its famed national parks are free to visitors. Prince Charles and his wife, Camilla, Duchess of Cornwall, are making a royal visit, a reminder of the close ties that remain with Britain.

While the American Colonies tore themselves from British control in the late 18th century, a violent and sudden separation, Canada quietly eased away in stages over many decades. Complete independence only came in 1982 with the passage of its Constitution Act.

Today Canada’s story is a multiethnic one; it’s a country that prides itself as a home to immigrants from around the world. Europe and the United States wrangle over setting limits on immigration. In Canada, taking in immigrants is widely seen as a good thing.

The country’s young, charismatic prime minister, Justin Trudeau, has called Canada “the first post-national state” – tied together not by a common ethnicity or race but by “shared values – openness, respect, compassion, willingness to work to be there for each other, to search for equality and justice.”

Not that the 150th celebrations have been without controversy. Canada’s indigenous peoples, the First Nation and Inuit, don’t see much to celebrate. They view the country’s history as much older – long before 1867 or the arrival of European settlers. They hope the anniversary will include a revised history lesson, one that reveals the abuses suffered by indigenous peoples at the hands of the Europeans.

“Asking me to celebrate Canada as being 150 years old is asking me to deny 14,000 years of indigenous history on this continent,” Alethea Arnaquq-Baril, an Inuit filmmaker, is quoted as saying in Britain’s The Guardian.

As much as Canadians are teased about being polite or saying “eh?” they don’t seem to agree on what defines them. Asked in a recent poll for a word to describe their country, the most popular answer was “freedom” or “liberty.” In part it could reflect the views of immigrants on what their new home offers them compared with what they left behind. (A third of Canadians even said they can’t stand ice hockey, the country’s national sport.)

Some Americans may see their neighbors as pretty much like them – except without as many guns and with government-provided health care. But Canadians are much more: They’re known for sending peacekeeping forces abroad, for being good stewards of a land of vast natural beauty, and for being a good friend and ally to the US.

Whatever flaws they’re still ironing out, Canadians still have plenty to celebrate this year.