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- 03/01/13--13:08: _Assessing Impact of...
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- 03/01/13--13:33: _New Documentary Put...
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- 03/03/13--11:30: _First Child Cured o...
- 03/04/13--04:00: _Obama, Boehner Look...
- 03/04/13--05:00: _The Daily Frame
- 03/04/13--05:00: _Weekly Poem: 'Soul'
- 03/04/13--06:11: _How Unfair Is Socia...
- 03/04/13--06:56: _Struck By a Turtle?...
- 03/04/13--07:22: _Why Is It So Hard T...
- 03/04/13--09:35: _On the PBS NewsHour...
- 03/04/13--10:00: _This Week on the Hill
- 03/04/13--10:19: _Kenyans 'Determined...
- 03/04/13--10:25: _Remembering the Bus...
- 03/04/13--11:26: _Finding a Doctor Wh...
- 03/04/13--13:02: _Mississippi Doctors...
- 03/01/13--13:08: Assessing Impact of Sequester Cuts at Local and Federal Levels
- 03/01/13--13:16: Sequester Spotlight: Virginia's Military Region
- 03/01/13--13:24: Egypt's Economy in Dire Straits Two Years After Fall of Mubarak
- 03/01/13--13:33: New Documentary Puts Homegrown Issue of Hunger on the Table
- 03/01/13--14:23: Shields and Brooks on March Madness, Sequester
- 03/03/13--11:30: First Child Cured of HIV
- 03/04/13--04:00: Obama, Boehner Look Ahead to Next Budget Deadline
- 03/04/13--05:00: The Daily Frame
- 03/04/13--05:00: Weekly Poem: 'Soul'
- 03/04/13--06:11: How Unfair Is Social Security's Maximum Family Benefit?
- 03/04/13--07:22: Why Is It So Hard To Fix Pay for Doctors Taking Medicare Patients?
- 03/04/13--09:35: On the PBS NewsHour Tonight
- 03/04/13--10:00: This Week on the Hill
- 03/04/13--10:19: Kenyans 'Determined' to Move Beyond 2007 Election Violence
- 03/04/13--10:25: Remembering the Businessman Who Took a Chance on Ex-Cons
- 03/04/13--11:26: Finding a Doctor Who Accepts Medicare
JEFFREY BROWN: And we return to our look at the impact of the sequestration cuts.
For a sense of what will happen at the federal level, we're joined by Ed O'Keefe. He's congressional correspondent for The Washington Post and has spent years covering federal agencies. And for some local consequences, we're joined by two journalists from our public media partners. Karen Kasler is bureau chief for Ohio Public Television. Megan Verlee is state government reporter for Colorado Public Radio.
And, Ed, I want to start with you for an overview here in Washington. Where are we seeing or likely to see the most immediate impacts?
ED O'KEEFE, The Washington Post: Well, we have already gotten some indication from a few agencies this week that their furloughs will begin essentially within a month. We really won't see most of the effects until later in March.
And so people shouldn't wake up tomorrow morning thinking, oh, my gosh, the national parks are closed and the lines at the airports will grow long. We heard this week, for example, that the Justice Department, people who work for U.S. attorneys face furloughs of about 14 days, but not until late April. Folks at the National Labor Relations Board could face furloughs up to 22 days.
At the Pentagon, they have said that there are hundreds of thousands of civilian employees across the country could face furloughs also of 22 days. You might wonder why 22 days. Well, it's because after 22 days, you have to lay someone off, and it's actually more expensive to lay someone off than to just make them stay home for a few days.
JEFFREY BROWN: And is it your sense that all of these agencies and departments have a plan in place or that...
ED O’KEEFE: They do.
JEFFREY BROWN: They do?
ED O’KEEFE: In fact, they have had plans in place really now for almost two years. You will recall back in the spring of 2011, there was a possibility of a government shutdown.
Well, contingency plans were being drawn up then. And they have been adapted ever since. A few months ago, the White House Budget Office asked these agencies to start putting together plans based on what the cuts would be. They didn't take them too seriously, and only in the last few weeks have they really started to get down to the nitty-gritty of who might lose their job for how long and what services would be cut.
JEFFREY BROWN: Karen Kasler, what are you seeing in Ohio? Where -- where -- or how much is the state exposed? What particular areas?
KAREN KASLER, Ohio Public Radio: Well, Ohio is interesting, in that we're not going to be as heavily impacted as some states like Virginia and Maryland, because the federal spending as a percentage of state GDP is pretty low, only about three percent in Ohio, actually less than three percent.
And so we're talking about 26,000 civilians who work for military contractors, most of them based at our largest military installation, which is Wright-Patterson Air Force Base near Dayton. And then we have got some other state agencies that might see some impacts. For example, the Department of Education is reporting about $25 million dollars. The White House is actually saying this -- about $25 million dollars could be cut to education, about $22 million dollars could be cut to education for children with disabilities -- and those could be hundreds of teachers' jobs -- and also some Head Start positions, about 2,500, according to the White House, though our costs here are lower for Head Start.
So Head Start in Ohio is saying about 3,000 kids. And so those are the kind of impacts that we're looking at. It's a lot less than, though, than in some other states.
JEFFREY BROWN: And, Megan Verlee, well, what about in Colorado? You have got a lot going on there with federal spending, right?
MEGAN VERLEE, Colorado Public Broadcasting: Well, I think, by definition, we are some other states in comparison to Ohio.
MEGAN VERLEE: We -- Colorado has a greater exposure to these federal cuts on average than most states in the country, according to numbers from the Pew Center on the States. That's because we have a bunch of military bases, a lot of federal spending with a lot of research labs and a big federal center out here.
And then federal grants to our budget are a larger-than-average percentage. So, in Colorado, we're looking at about $85 to $90 million dollars over the coming year, I believe they're estimating. And then there are concerns about the multiplier effect, as a lot of those federal workers and defense workers become furloughed and aren't spending as much money in the state economy.
So I know that there's been ongoing concerns at the state level for what this is going to mean, both for revenue and for state programs down the line.
JEFFREY BROWN: And, Megan, do you see this -- or is it being seen as rolling out over time, the way Ed O'Keefe was talking about?
MEGAN VERLEE: It is, although there is a certain amount of urgency.
If our state government decides it wants to backfill any of the lost federal money to save education programs or to temporary aid to needy families, that has to go through a vote of our full state legislature. They are in session until mid-May, but I think there is going to be urgency on the part of lawmakers to make some decisions pretty quickly about how they are going to react to this.
JEFFREY BROWN: So, Ed O'Keefe, so it's interesting. It's not felt evenly, right, and it's not felt spread out across every program.
ED O’KEEFE: No, it's not at all.
They mentioned Maryland and Virginia, certainly here just on the outskirts of Washington, will be adversely affected.
JEFFREY BROWN: Federal workers.
ED O’KEEFE: Absolutely.
And you will see a lot of different programs exempt. For example, the entire Department of Veterans Affairs is exempt from this. Social Security checks will continue to go out. The IRS won't furlough its workers until tax returns have been processed in mid-April. So it is sort of spread out in ways that, originally, it was meant to be that these were so draconian that they would never happen. But now they're going to hit the military, low-income women and children, disabled children and big education programs.
JEFFREY BROWN: And is that -- does this also affect the politics, I mean, in terms of who speaks out from various states, because, as we are saying, some are hit, some are not hit?
ED O’KEEFE: Yes, I think we will begin to see lawmakers from states who are adversely affected speaking out a lot more.
For example, there's a bipartisan plan that was put forth today to avert all this from Mark Udall, the Democratic senator from Colorado, and then Susan Collins, the Republican of Maine, both of those states with large military operations, a lot of dependence on federal money and federal employment. And so I think next week, as we approach the continuing resolution, the need to renew the current federal spending plan, that you will see some try to step in and soften the blow.
JEFFREY BROWN: So -- well, Karen Kasler, so you are at a state where you have got a Republican governor. What has the reaction been there? How much attention are they paying to it? How vocal are they about it?
KAREN KASLER: And our Republican governor, John Kasich, often touts himself as a budget expert. He was the chair of the House Budget Committee back in the '90s. And so we hear an awful lot about federal budgets from our governor.
And, interestingly, he has been saying and his office has been saying that they don't expect to see significant effects on state programs from the sequester. And when I talked to state agencies such as the Department of Education and Job and Family Services, which will be dealing with job training money that might be cut, the attitude is very, well, let's wait and see. Let's see what happens here. We have time to adjust.
And, indeed, the school funding money, the education money, wouldn't even be affected until next school year that starts in August. So there is a feeling here in Ohio, a state run by Republicans, that there is plenty of time to absorb the sequester. While it might not be ideal, there's time to recover.
JEFFREY BROWN: And, Karen, do you think that also applies to the general population as well, a sense of sort of watching from outside a bit?
KAREN KASLER: I think it depends on where are you in the state. Certainly, we have got the two congressmen to deal with Wright-Patterson Air Force Base., Congressman Michael Turner, and then also Speaker John Boehner, who are obviously very involved in what's happening here with the sequester.
But in other parts of the state, you hear a little less chatter. We do have some Tea Party groups that are urging the sequester to go forward. We have other groups that are very concerned about it. So once you get out of the main area here in the state capital, it depends on where you are what are you’re hearing.
JEFFREY BROWN: And, Megan, you were saying -- well, you have a Democrat as a governor. You were talking about how the state is trying to make some decisions here about how to deal with this. Tell us a little bit more. How big a deal is it? What are you hearing?
MEGAN VERLEE: I think it's a pretty big deal certainly within the halls of the capitol.
We spoke with our governor yesterday, and he said that he is really weighing whether to backfill specifically in programs that would affect, as he put it, the last and least. One he cited was families, low-income families that might lose child care vouchers, and then hence might not be able to continue working. And does it make sense for the state to step in there?
But, like most states, Colorado has gone through years and years of budget cuts. And I think it's going to be a very hard political sell both within the capitol and then out to the people saying, hey, we want to put this money into state programs. Now we're actually using it to make up federal funding that we have lost.
I think, on the ground level, like in Ohio, it really depends on where you are. I know the universities are very concerned. There's a lot of research grant money that goes into our big research institutions. And they're looking at cuts, and trying to figure out where that is going to hit in the labs and what that will look like for their work going forward.
The average person -- it's funny. I saw a tweet this afternoon, somebody saying, oh, no, the effects of the sequester, and they had a picture of a screen shot of the wait time at DIA, our airport. It's 10 minutes. So, I think there's a little -- some sensation that there might be some crying wolf, because people expected an immediate chop to funding, and life looks like it will go on tomorrow.
JEFFREY BROWN: And, Ed, just in a word here, it sure didn't look like much was happening behind -- is there any -- your reporting show any behind-the-screens action in Washington?
ED O’KEEFE: The speaker is going home to Ohio. Nancy Pelosi is in San Francisco. Eric Cantor, the majority leader, will be in Selma for a civil rights march this weekend. Harry Reid is here in Washington.
JEFFREY BROWN: OK.
ED O’KEEFE: No work is expected.
JEFFREY BROWN: All right, that tells us.
Ed O'Keefe, Megan Verlee, and Karen Kasler, thank you, all three.
ED O’KEEFE: Great to be with you.
MEGAN VERLEE: Thank you.
JEFFREY BROWN: And, online, you can find out how the cuts will affect two more communities, Hampton Roads, Virginia, and Saint Louis, Missouri. We have compiled reporting from our public media partners there.
The self-imposed March 1 deadline to broker a deal to avert across-the-board budget cuts in discretionary spending known as sequestration has passed and lawmakers have left town for the weekend.
NewsHour is talking with our public media partner stations across the country to gain insight on how the threat and implementation of sequestration cuts affect their communities.
We'll showcase two of those communities on Friday's broadcast in a segment featuring Karen Kasler of Ohio Public Television and Megan Verlee of Colorado Public Radio. Tune in at 6 p.m. ET.
Meanwhile, Cathy Lewis, host of WHRO's "HearSay," says the cuts will have a dramatic effect on the the labor force in the military-rich Hampton Roads region, where on Tuesday President Barack Obama called on lawmakers to compromise.
The NewsHour spoke with her this week.
How large is the military presence in Hampton Roads?
We have all the branches of the military represented here. It's the largest concentration of military assets in the United States. It's the largest harbor--so it's the largest naval presence without a doubt. One out of every two dollars in this economy is absolutely dependent on the defense industry. So that's why I think people are very concerned about it. And you know the big shipyards,Newport News shipyard will be fine. It's our major employer, It's the largest manufacturing employer in Virginia. And they have long-term contracts for carriers on the books. They are going to survive but some of their work will be certainly affected by it.
What kind of jobs might be lost if the cuts are implemented?
They could be all kinds of things. For example, you could have engineers associated with ship repair, specialty engineers who are brought in for certain ship systems. This can also be---these are janitorial firms that clean these companies and clean bases. These are companies that make uniforms for soldier, sailors and airmen. They are every kind of supporting organization you think would be needed to support an industry that is as large as the defense industry in Hampton Roads--food service grounds keeping operations. It is certainly the technical capability. There's no question about that but, I think what sometimes gets lost in the equation is the trickle down of these support businesses that exist to support an industry.
How has the region's employers prepared for the cuts?
In the last couple of months what's become clear is they are pretty shocked at what's happening and they are also making plans for it. So while the effects are supposed to happen next month, workers in this community are already being warned that they will get layoff notices. A major ship repair facility issued what they call, I believe "intent to layoff" notices. They basically already let people know--look if nothing changes on this end we will be laying off. And they are significant layoffs. They are very, very significant layoffs in the community. In one case a ship repair company with 1,100 workers probably will be laying off more than 600 of them. Everybody is sort of on pins and needles. They are waiting to see whether the Navy will cancel upcoming ship repairs. If there's no ship to repair, they basically have to lay them off or turn them loose.
How will this impact the military readiness?
If you lose that labor force into other industries it's really hard to rebuild it when the crisis is over. So that's what I think the ship building industry is really trying to make sure and certainly the Navy knows that because they've been down this road before. They know exactly what the implications of these kinds of draconian steps are, but I think they are really trying to hard to say "Congress look. You are going to lose more in the long-term if you do not do these ship repairs on schedule because the equipment gets degraded. The workforce capacity we lose to other industries and then the assets itself gets degraded over time and the repairs are more expensive to make down the road."
How might the sequester impact the large defense industry firms in Hampton Roads?
Newport News shipyard is one of only two shipyards in the country that builds and maintains nuclear power aircraft carriers. But even with that, they are absolutely impacted.They are they may have to stop two carrier overhauls that are on the books right now. They may delay construction on a third carrier. So on even on a big yard, it's having an effect.
How about smaller businesses?
I was talking to someone the other day who is a family business owner of one of these defense subcontractors--these are often service maintenance, that kind of thing, suppliers that kind of thing. And she was telling me they've had this family business for sixty something years and they will absolutely have to close if these defense cuts come because the way they are being made leaves the services very few options of where to go to get the money.
What affect has the uncertainty had on your community?
What I keep hearing from people is that the uncertainty is killing them. In fact before we got to this point they were saying, let's just try to figure out something. Now we are getting to the point where these cuts, since they haven't been announced yet and there's not a deal, these cuts it looks like are going to have to be compressed into an April to October time frame, which is going to be pretty devastating.
What are Virginia's local leaders saying about the cuts?
Gov. Bob McDonnell sent a letter to the president that said please do something about this because the state will go into recession and Virginia usually tops the list of best places to do business. That is something that is really coveted in the state and they don't want to see anything mess with the state's business reputation across the country so they are definitely concerned about it. Certainly Sen. Warner has also I hear behind the scenes is working with his gang of eight, which is good news they are working very quietly behind the scenes to try and come up with something that could work. Sen. Warner also has said that there are smart ways to make these cuts and there are stupid ways to make these cuts and his effort in the shortest turn around is trying to get the services permission to make the cuts in a way to they need to as opposed to arbitrary across the board way. So there's been a lot of discussion about this.
*What would people like to see happen? *
I think that there's an impression that military people and the defense industry doesn't want any cuts at all. I don't think anyone wants cuts in their business but these are bright capable and intelligent people who understand that when you draw down a war in Afghanistan and a war in Iraq that you of necessity draw down the defense. I think that they get that. I think what they want is--"We get that this is going to happen. Let's do this in a thoughtful way that will allow us to make the changes that need to be made. In ways that won't effect our presence and our readiness around the world." I think our federal lawmakers are really and the Navy and the other services as well have said, "Look, these cuts are not ideal in any circumstances, but if we have to make them, give us a break, don't make us make them 10 percent across the board. Give us the option to move the money around.
JUDY WOODRUFF: And it turns out local governments in the U.S. are facing their own budget woes. One in especially big trouble is Detroit.
The city faces a budget deficit of more than $300 million dollars, and has lost a quarter-million residents in the past decade. Today, Michigan's governor, Rick Snyder, announced plans to appoint an emergency manager to oversee the city's finances and operations. That would make it the largest U.S. city under state control.
Snyder spoke at a community forum today.
GOV. RICK SNYDER, R-Mich.: It's time to say we should stop going downhill. It is time to say we need to start moving upward with the city of Detroit.
There have been many good people that have had many plans, many attempts to turn this around. They haven't worked. The way I view it, today is a day to call all hands on deck, to say there's been too much fighting, too much blame, not enough resources, not enough people working together, to say, let's resolve these issues.
JUDY WOODRUFF: Detroit's mayor, Dave Bing, said in a statement that he remains opposed to the move, but would look at all options.
Christy McDonald has been covering the story for Detroit Public Television, and she was at today's forum. She joins us now.
Welcome to the NewsHour.
Christy McDonald, my first question is, how did things get to this state in the city -- to this condition in the city of Detroit?
CHRISTY MCDONALD, Detroit Public Television: Well, Judy, it didn't happen overnight. This has been years in the making. And when I say years in the making, it has been decades in the making. So they know that they can't turn this around overnight, but they know that they finally have to put an end to it and get actually a plan in place that is going to work for the finances and the financial mess that the city of Detroit has found itself in.
JUDY WOODRUFF: Is the governor intervening because he has to by law or because he wants to, feels he should?
CHRISTY MCDONALD: Well, there is an emergency financial manager law that is in place right now in the state of Michigan that compels him to take a look at the finances.
And, again, this isn't anything new. The city has been under a consent agreement with the state for the past year or so, just under a year. And so what happened is about two months ago, it triggered another financial review. So the financial review team went into the city, took a look at the books over two months, and finally came out last week with their findings for the governor and said, you have got to take a look at this. We think the city is in a financial emergency. Now you have to take a look and see if that is indeed -- you agree with that.
JUDY WOODRUFF: And what is it that the state taking over the city, what would the state be able to accomplish that the mayor and local officials can't do on their own?
CHRISTY MCDONALD: Well, there had to have been a lot of agreement with the mayor and with the city council. And that's been a bit of a problem for the last couple years.
What the emergency financial manager is going to be able to do in the state is, they have a wide range of powers where they don't have to have a lot of agreement. They don't have to have agreement from the city council. They don't have to have agreement with the mayor. They can come in and start to take a look at some city contracts. They can come in and start to take a look at some city departments that have to be reformed.
And they can come in and take a look at the finances at that long-term debt that you talked about and see how they can start chopping it.
JUDY WOODRUFF: And help us understand, Christy McDonald, why is the mayor opposed? I mean, if this is a way to come in and cut through what I hear you saying is some of the local politics, disagreements, why is the mayor so opposed?
CHRISTY MCDONALD: Well, an emergency financial manager is pretty much going to take his job, Judy. It moves the mayor to the side a bit. And it moves the city council to the side.
The mayor's not totally opposed. He says he wants to continue to work with the state. And I think if the mayor and city council had their way, they would like another consent agreement that would maybe have some more stringent milestones that they could meet.
But, essentially, that emergency financial manager, they're the ones that are going to be in charge, that person, he or she, whoever that is. And they're the ones that are going to be making those big decisions. And it's going to marginalize the positions of the administration.
JUDY WOODRUFF: We know the demographics of the city of Detroit, the whole state of Michigan, very different, the state largely white majority population, Republican governor. The city is heavily Democratic, a large African-American population.
What role is politics and race playing in all this, if any?
CHRISTY MCDONALD: Well, there is a racial divide in Detroit and in the Detroit area, Judy. And that's no secret.
And I can't tell you that this city, which is largely African-American, is 100 percent joyful that a white Republican governor is going to be coming in and exerting some control over the city finances. But there is a growing majority of people that says, look, bottom line is, we want to make sure that our trash gets picked up. We want to make sure that the abandoned building that's on our block or right next door to our house gets knocked down. We want to make sure that, when we call police, police come.
And those are the services that they need to restore to the city of Detroit and to the residents. So, at this point in time, people are starting to put a race conversation aside. And, in actuality, there is a viable candidate for mayor -- we are in an election year right now -- who is white. And he has a very good chance. He's very popular right now.
And so that has really changed the discussion in this area. But the bottom line is, people really want services. And they say, look, if this can get us the services that we need, that we should be paying for, then that's what we want to see.
JUDY WOODRUFF: So what happens now? The mayor has, what, is it just a matter of days to take another look at this, to see if he can do something before the state does step in?
CHRISTY MCDONALD: It's a 10-day appeals process, Judy. And so the mayor then can come forward and say, well, this is maybe why, Gov. Snyder, you should change your decision.
There has been one or two members of the Detroit City Council who has talked about perhaps that they should get some kind of legal representation to legally challenge that. I'm not quite clear sure how far that's going to go. And I'm not quite sure how much the governor -- he will listen to an appeal, but he seems pretty straightforward that he wants to go forward with this emergency financial manager.
Again, he hasn't named he or she, but seems pretty firm in who he has in mind.
JUDY WOODRUFF: Christy McDonald with Detroit Public Television, thank you.
CHRISTY MCDONALD: Thanks, Judy.
JEFFREY BROWN: And now to Egypt, where John Kerry arrives tomorrow for the first Mideast stop on his maiden trip abroad as secretary of state.
As the most populous nation in the Arab world, Egypt's success or failure carries enormous stakes for its own people and for all the countries caught up in the Arab spring.
But, as Margaret Warner reports, the nation faces mounting economic woes.
MARGARET WARNER: More than two years after the fireworks, after Egyptians celebrated the ouster of longtime ruling President Hosni Mubarak, and voiced hopes their revolution would bring a brighter future for them all, Egypt is teetering on the brink of economic collapse.
WALEED SAAD, Cab Driver: Every day, we say tomorrow's better. Be patient, tomorrow's better. Tomorrow not come yet.
MARGARET WARNER: On the streets of Cairo, some of those who cheered Mubarak's fall, like cab driver Waleed Saad, have grown tired of waiting.
WALEED SAAD: I think it's five months, six months, and then everything will be OK after the revolution. OK, we can wait, no problem. But it's two years, maybe more. Nobody know.
MARGARET WARNER: Ongoing political battles among Islamists, secularists and the security forces continue to spill out into the streets. The unrest has crippled Egypt's tourism industry. The one-time hordes of visitors at the ancient Pyramids of Giza are but a memory now.
In Cairo, construction projects idle, as foreign and domestic investors stay away. The ranks of the unemployed swell, especially among the young, while Cairo's aging infrastructure goes untended and frustration mounts over the frequent gas shortages. For Saad, the most painful part of this economic limbo is being unable to provide for his children.
WALEED SAAD: What can I do? I have no money. What can I do?
MARGARET WARNER: He's not alone. The Egyptian government itself is running low on funds, announcing in February it had only enough foreign currency reserves to cover three months of food and fuel imports.
As fuel subsidies gobble up a fifth of government revenues, the budget deficit widens. And the Egyptian pound continues to tumble against the dollar. It's fallen another eight percent since the start of the year, spawning a black market in foreign currency.
URI DADUSH, Carnegie Endowment for International Peace: The Egyptian economy is in dire straits.
MARGARET WARNER: Former World Bank officer Uri Dadush directs the economics program at the Carnegie Endowment for International Peace in Washington.
URI DADUSH: Egypt is not a basket case. It's an economy that was one of the most dynamic of the world during the five years or so preceding the revolution. So, this is a huge contrast in terms of the economic performance compared to where we were a few years ago.
MARGARET WARNER: Egypt's economic breakdown is partially driven by the country's broken politics. Since the Muslim Brotherhood won parliamentary elections last year, and elected their man, Mohammed Morsi, as president, the country has careened from outburst to outburst.
The past few months have seen wave after wave of clashes in the streets, as demonstrators protested a perceived power grab by Morsi, the new constitution, and their sense of an overall lack of progress more than two years after Mubarak's fall.
MICHELE DUNNE, Atlantic Council's Rafik Hariri Center for the Middle East: Capital is a coward. You know, investors don't like to invest in a situation that they feel is unsafe.
MARGARET WARNER: Michele Dunne, formerly with the National Security Council and State Department, heads the Middle East program at the Atlantic Council in Washington.
MICHELE DUNNE: Everyone's afraid to invest. There's political instability. There's widespread feeling of insecurity. And so Egyptian investors are taking their money elsewhere. And, of course, in that kind of climate, then foreign investors are not coming in with their money.
MAN: May I help you here? What about scarf? It's made of cashmere. Want to spend some money here?
MARGARET WARNER: At this souk in central Cairo, vendors are paying the price as they try to hawk the necessities of life to locals, and hookahs, shawls and mementos of Egypt's ancient past to tourists.
MAN: No business. There is no business because we -- like all world know and all world watching TV, we have a lot of problems. But we can't make this -- control this problem right now, because we don't have security.
MAN: After revolution, everything in Egypt below, below in economy, in tourists, in the work, in the money. Everything will be down, below. It's no good time now.
MARGARET WARNER: There's one prospect of hope on the horizon, a $4.8 billion dollar loan from the International Monetary Fund, in exchange for economic reforms in Egypt, like reducing those costly fuel subsidies and raising tax collections. But the loan has been under negotiation for more than a year, without a deal.
Securing the IMF loan is crucial for Egypt's future, says the Carnegie Endowment's Dadush, not only for the money itself, but for the reassuring signal it will send to investors.
URI DADUSH: The loan is vital because it comes with a package of economic reforms that are designed to stabilize the public finance of Egypt, reduce the deficit and enact a series of reforms that will be investor-friendly on the one hand, but hopefully also not socially disruptive, not too socially disruptive on the other.
MARGARET WARNER: Michele Dunne agrees, but fears the Morsi government will flinch from enacting tough measures, just as it backed off in December from its plan to curtail fuel subsidies.
MICHELE DUNNE: They have been afraid to put it into place because they are afraid of creating unrest. It's very difficult for Morsi to take difficult steps that might be unpopular with the public and might generate opposition from the street. It's difficult for him to take these steps without political allies who will support him in this process.
MARGARET WARNER: The divisions deepened this week. At the urging of opposition leader Mohamed ElBaradei, the main opposition alliance, the National Salvation Front, announced it would boycott parliamentary elections in April. Morsi insists he wants to bridge the political impasse.
PRESIDENT MOHAMMED MORSI, Egyptian: I tell everyone from all colors of the spectrum, my brothers in the different political parties to come, to sit and put in place guarantees that we agree on together to ensure the fairness of the upcoming elections.
MARGARET WARNER: But Michele Dunne doubts Morsi sees the connection between Egypt's political problems and its economic ones.
Do you see any signs that President Morsi understands this?
MICHELE DUNNE: He continues to say to the opposition, come to a political dialogue, but he doesn't show any signs of being willing to compromise with them.
So far, he's just trying to move forward, move forward to elections, with the idea that, after that, they will be able to institute economic reforms and get the IMF package. But I want to note this has been going on for two years now.
MARGARET WARNER: All this was reported to have been the subject of a phone call President Obama made to President Morsi this week, paving the way for new Secretary of State John Kerry's arrival in Egypt this weekend.
Dunne says Secretary Kerry needs to connect the dots for President Morsi between the economic assistance he wants and the political bridge-building he needs to do at home.
MICHELE DUNNE: It's important that Secretary Kerry tells President Morsi, we want to help you economically, but we think you need to compromise with other political forces and keep a democratic political process on track.
MARGARET WARNER: Back in the souk, among the tales of woe are also signs of the famed Egyptian patience.
MAN: Morsi, he can't change what's happened in 30 years in six months or seven months. He do what he do in politics. And us, we must -- people, we must work. We must look for future.
MARGARET WARNER: The question is how long that patience will hold out if the country's political leadership doesn't do the hard work that needs to be done.
JUDY WOODRUFF: The Cairo cab driver in Margaret's story had more to say about his frustrations with the economy and his hopes for his children. Find his story on our website.
JEFFREY BROWN: Next, we turn to a problem plaguing one in four children in the United States today: hunger.
A film opening nationwide today profiles some of the hardest-hit.
Ray Suarez has our conversation.
RAY SUAREZ: It's a bitter paradox. The United States produces more food per person than any other country in the world, but still has a major problem with hunger, a hardship that only grew worse during the recession and its aftermath.
The government estimates some 50 million people are living with food insecurity, meaning they don't always have adequate nutrition for an active and healthy life. A new documentary called "A Place at the Table" challenges the viewers' assumptions about who is hungry and why.
Here's an excerpt.
WOMAN: Hunger definitely impacts my classroom. I have had students come to me upset. And it's definitely a huge issue in our small community.
One student in particular, Rosie, I just really felt she wasn't really applying herself in the classroom, and I couldn't figure out where that attitude was coming from. So I felt that she just really didn't care about what I wanted her to learn or that school wasn't that important. And what I realized when I brought her in one day was the main issue was that she was hungry.
ROSIE: I struggle a lot. And most of the time, it was because my stomach is really hurting. And my teacher tells me to get focused. And she told me to write -- focus on my little sticker. And every time I look at it, I'm like, oh, I'm supposed to be focusing.
I start yawning. And then I just don't -- and so I'm just looking at the teacher, and I look at her, and all I think about is food.
RAY SUAREZ: Joining me now is the film's co-director, Lori Silverbush.
A baby can't tell you what's wrong with them. They know something's wrong, but they don't know what it is. An adult can sometimes pull up their socks and do something about their predicament.
LORI SILVERBUSH, Co-Director, "A Place at the Table": Sometimes.
RAY SUAREZ: Rosie was old enough to know what was wrong, but too young to do much about it. And when she was talking about being hungry at school, that was awful.
LORI SILVERBUSH: It's pretty awful.
And you have to ask yourself -- you know, we're in a nation where 17 million children face food insecurity, which means that at any given time, their families don't know where their next meal is coming from. We're investing all of this money and energy into teachers.
And yet we're setting up our kids for failure if they show up to school too hungry or too malnourished, even if they are not feeling hunger pangs. But if all their family can afford is the empty calories from a pack of ramen noodles or some chips, or whatever the cheapest calories are that they give their kids to eat, because that is, sadly, what many, many millions of Americans can afford, what are we saying about our aspirations for our nation's kids putting them in front of teachers, but unable to learn, and then frankly also blaming them for the situation?
A hungry kid isn't always easy to recognize. It could be a kid who looks like everybody else, but is acting out or isn't able to sit still or isn't listening or isn't absorbing. And that could even become a social and a behavioral problem and a disciplinary problem.
So we're really not serving our kids well by not paying attention to this. And, quite frankly we're being, I think, a little irresponsible with our taxpayers dollars by spending money on schools, but not giving them -- delivering children who can learn.
RAY SUAREZ: We meet families that are working hard and working a lot, and still not making ends meet, and the gruesome story of Barbara Izquierdo in Philadelphia, who after a long spell of unemployment, gets back to work and automatically loses a lot of the programs that were helping her keep her -- keep food on the table.
LORI SILVERBUSH: Yes.
I mean, Barbie was an amazing character, because she was simultaneously dramatic and interesting to watch, but also super articulate. And despite her struggles and despite how hard she was working to be a good role model to her children and to provide healthy food for them, she was also an activist on a national level around this, as part of the Witnesses to Hunger, which were 40 women in the North Philly area who had documented the struggle to put food on the table.
And they were taking their photographs around the country and showing people. And through her activism, Barbie got a job after many, many months of unemployment, through no fault of her own. She ended up getting a job. It was counseling other people and helping them get food benefits. And she got so much -- there was so much satisfaction and so much self-worth and she was so excited.
But the truth is that the salary that she got paid put her just above the level of qualification for SNAP, which is what -- food stamps, what we call food stamps today. And she was cut off immediately. And her children, as a consequence of her working, were cut off from a state-subsidized day care, where they received healthy meals.
And, ironically, after going to work and sort of fulfilling her side of the social contract, as we like to think of it, her children were hungrier than before.
RAY SUAREZ: You take us to visit working poor families around the country in a rural area, right in the heart of a big American city, and in a small town.
LORI SILVERBUSH: Yes.
RAY SUAREZ: Were they glad to you have there?
LORI SILVERBUSH: At times.
RAY SUAREZ: Did they find it an intrusion?
LORI SILVERBUSH: Well, I think we worked very hard to establish trust and to develop relationships. We didn't just show up with a camera and say, oh, let us in and shoot.
We cast a really wide net. We learned in our research that every single county in the United States is grappling with this issue. That meant that we wanted to represent the wide variety of people that are facing food insecurity. And there were a number of groups that are very active working on this. And they were able to introduce us to people that you meet in our film, like Pastor Bob, who introduced us to the community of Collbran in Colorado.
He was able to show us a town where every single member of the town was impacted in one way or another by food insecurity. And these are people who are quite proud, quite private, and were not necessarily looking to talk about something that quite -- some of them felt some shame around. This is an issue that carries a good deal of stigma. It shouldn't, but it does.
And over time, we were able to sort of get people to understand that we were on their side and that they were not to blame -- at least we didn't think they were to blame -- for the situation they found themselves in. And they opened up quite courageously in most cases.
RAY SUAREZ: So you watch the movie, and these beautifully drawn portraits and gorgeous photography.
LORI SILVERBUSH: Thank you.
RAY SUAREZ: You sympathize. You empathize. And then what?
LORI SILVERBUSH: Well, everybody has a stake in fixing this. One of the great things is that at this same time as this movie launches, on March 1 -- and it's coming into theaters. It will be on iTunes the same day. It will be on demand the same day, so that people all over the country can see it, whether they are near a movie theater playing it or not.
On the same day, we're launching a national action center, the first of its kind, around hunger, where all of the major national hunger groups are getting together, also, with state groups and with local groups. You can plug in your zip code and find out exactly what you can do at any given moment to affect the policies that are being decided right now on the Hill, to affect what's happening in your own backyard, to engage on any level of activism that you want.
And the truth is that, if we engage as citizens on this, and we let our representatives know that it's time to fix this, they will fix it. But we can't expect government to do the right thing unless we have told them that it matters to us. So, hopefully, this film is going to give people the awareness, the engagement and excitement around it, wants to activate them, and then gives them -- will give them very clear and accessible tools to do that.
RAY SUAREZ: The film is "A Place at the Table."
Lori Silverbush, thanks a lot.
LORI SILVERBUSH: My pleasure. Thank you for having me.
JEFFREY BROWN: We have more from Ray's interview, plus selected clips from "A Place at the Table." That's on our website.
JUDY WOODRUFF: And to the analysis of Shields and Brooks. That is syndicated columnist Mark Shields and New York Times columnist David Brooks.
JUDY WOODRUFF: Welcome back to the program.
MARK SHIELDS: Thank you, Judy.
JUDY WOODRUFF: So here we are, March the 1st, Mark, on the verge, on the cusp of yet another fiscal showdown. The president says it's not the apocalypse.
What is it then?
MARK SHIELDS: For people who care about politics and believe that government can be a force for good, it's been a very tough month, because I think every time we come to one more of these showdowns, gridlocks, whatever you want to call them, that you can feel a further erosion of public trust, public confidence in our ability to act positively for the common good.
And I just -- I think that's where we are right now. I mean, in a political sense, Judy, the Republicans are worse off than the Democrats. I mean, they are -- the latest Wall Street Journal/NBC poll, only a full-third of Republicans think that the Republicans in Congress are arguing -- or are operating just for partisan advantage and not to unify the country. I mean, by a 3-1 margin, overall, voters feel that about Republicans.
But the Democrats are not that much better off. It's just -- it's a dreary, dismal and I think disappointing time.
JUDY WOODRUFF: How do you see what -- here we go again.
DAVID BROOKS: Yes, just dysfunction as normal.
And I am of a view that it is possible that government could do a little trimming over the next couple years. We have seen this tremendous expansion in government spending over the last five years. All you have to do is live in Washington to see the just office parks, the contractors springing up.
But we have had a very rich five or six years here in Washington. So I do think it's possible to do the trimming. But to do it the way we're doing is just an insult to the idea of governments. You just take a simple statistic. What does government do that most people like? Most of it we call discretionary spending on education, Head Start, grants for universities.
That's like 14 percent of the budget. It's taking almost half the cuts, so all the big programs that actually lead to the debt are getting almost excluded from the cuts. All the little programs, they are getting savaged. And so it's just a mindless exercise.
JUDY WOODRUFF: Well, that's the way it was designed, though, wasn't it, to across the board, to be the kind of thing that neither side ...
DAVID BROOKS: That's right. It was, yes.
Right, but I would say that now both parties seem to have gotten used to it. I think it's now likely that this will all just happen, and it won't get repealed in a few weeks, and we will just be living with this. And so it's -- you know, they have come to love it.
JUDY WOODRUFF: Does one -- Mark, is one side or another more to blame for this, and does that question even matter anymore?
MARK SHIELDS: Yes, I think, I think the Republicans are locked into a position right now.
I mean, virtually every -- every study involving Republican economists, Democratic economists, nonpartisan economists has concluded it's going to require both to be done, to require tax, new revenues, as well as the cuts, but -- and that the Republicans have locked in that they will not support any new revenues. So I think, in that sense, they have put themselves in a position which is a minority position in the country as well.
And I think they're playing a very difficult hand. They have given themselves a very difficult hand.
JUDY WOODRUFF: Do you agree, that the Republicans ...
DAVID BROOKS: I think they will take more of the blame, and with some justice.
I do think they have to give on revenues. I would say a couple things in their defense, and a little criticism of the Democratic side. First, we have -- they have given a lot on revenue already. We can't continue to raise taxes again and again on the top two percent, because once you push people above where more than 50 or 60 percent of their income is going to tax, they start behaving in counterproductive ways.
So we can't just tax the top two percent. We got to have more revenue, but I think you have got to widen it down, a little down the income scale. The second thing I would blame the administration for is not sort of going bigger and saying, here is the big problem, which is entitlements. If we want to save these domestic programs, we do have to have Medicare reform.
Now, to be fair, the president does have some, some of that. But I wish he would go out into the country and sell it, because one of the fundamental problems we have is that 80 percent of Americans said don't touch a cent of Medicare. And somebody has to explain to them that's just not a tenable position.
JUDY WOODRUFF: Well, I get ...
MARK SHIELDS: Yes.
No, I mean, I don't absolve the Democrats completely from this, Judy, by any means. But I think the Republicans have put themselves in an indefensible position. And I think it's not only substantively, but politically.
But, I mean, there are very few Democrats -- they come up with a tax bill. Democrats talk about, we have got to get rid of this private jet loophole, we got to get rid of carried interest. Well, if you look -- which allows people on Wall Street to pay at income, their income at a rate of 15 percent on the private equity. And it wasn't included in neither of the Democratic proposals to eliminate the private jet coverage.
You know, I would like to see -- I would like to see them go big. We had that chance in August of 2011. I hate to think that that was the only time, when Speaker Boehner and the president were close to coming up what looked to be a grand bargain.
DAVID BROOKS: If I could take a quick whack at the Republicans, just because I think their political strategy is just insane.
If you are going to be serious about the deficits and the debt, which they claim to be, you can't just pick out the most trivial programs and demand cuts in those. And then, because you know you are going to demand cuts in those, and then when the public comes down on you, you are going to cave in and surrender anyway. So, why don't they have a long-term to fix -- to focus on the real problem, instead of some politically, for them, easy problem that is going to be politically untenable in the long run anyway?
JUDY WOODRUFF: There are those out there who are saying the two sides are really not all that far apart, that the president is prepared to do entitlement reform. The Republicans want entitlement reform. The president says he wants tax changes. The Republicans don't want those tax changes, but they have said in the past they were willing to close loopholes.
Is it -- is it theater? Is there that deep a philosophical difference between the two sides?
MARK SHIELDS: I'm not sure that there is the will right now.
I don't know the gulf, because an awful lot of it is posing and posturing on both sides. I'm not sure what the non-negotiable -- the really non-negotiable parts that are dividing them are. But I don't think that there is that sense of political will that we can do it.
And let's be very blunt about it. The Wall Street Journal/NBC poll asks, who do you think is better on 12 different issues? The Democrats are seen as better on everything from taxation, to the economy, to health care, to Medicare, I mean, across -- immigration. I mean, the Republicans are left with what have been their whole cards all these years. That's cutting the deficit, national defense. I mean, that's it.
DAVID BROOKS: Yes. And people think the Republicans are fanatically anti-government, and they don't make discrimination between good government and bad government.
MARK SHIELDS: Yes.
DAVID BROOKS: And so here they are sort of supporting something that is exactly that, this mindless thing that doesn't discriminate between the two.
And what does the country need? It needs just a sign that Washington can function. The housing market is beginning to turn around. There's some sign of green shoots -- just a sign they can function. Not going to happen.
JUDY WOODRUFF: And, meanwhile, you still have a sideshow squabble over whether the White House or the Congress first suggested this.
Bob Woodward was at the center of this back and forth this week over whether he got a ...
MARK SHIELDS: Well, what's fascinating about ...
JUDY WOODRUFF: Tough language in an e-mail from the White ...
MARK SHIELDS: Yes, from Gene Sperling.
JUDY WOODRUFF: From Gene Sperling.
MARK SHIELDS: You know, the real -- the godfather of 1600 Pennsylvania Avenue.
For those who don't know Gene Sperling, Gene is not a terribly intimidating public figure, I think, or personal figure. But the irony of this is how Bob Woodward has become now, who is blamed, blamed by two generations of conservatives and Republicans for bringing, with the possible exception of Richard Nixon, having more to do with Richard Nixon's impeachment than any other living human being -- I mean, he was obviously a liberal agent, an agent provocateur.
Now he is embraced by conservatives because he has exposed or allegedly exposed the White House.
JUDY WOODRUFF: Saying it's the president who ...
MARK SHIELDS: That it's the paternity.
JUDY WOODRUFF: ... is behind this.
MARK SHIELDS: Who has the paternity of this? I mean, it is Gramm-Rudman revisited 25 years later. That is what it is.
JUDY WOODRUFF: So, the Voting Rights Act, David, arguments between the Supreme Court this week, what did you make of this? This is a much-anticipated case.
DAVID BROOKS: Yes.
Well, Antonin Scalia said something obnoxious about voting...
JUDY WOODRUFF: Racial ...
DAVID BROOKS: ... being a racial -- I forget the phrase.
JUDY WOODRUFF: Entitlement.
DAVID BROOKS: Entitlement -- which is ridiculous.
But I do have to say I was sort of surprised reading through the arguments that I was a little more persuaded that some of the skeptics have some point, have a much stronger argument than I thought, and that their core argument is that, in 1964 or '65, the voting right abuses was localized in some of these states which are under this provision which is under discussion.
Now, if you look at the map of where the abuses are, they're nationalized. It's not 1964 anymore. And in some cases, states like Mississippi, African-American voting rates are higher than white voting rates. And so it's the idea that we are just going to punish the five or the number of states that were punished in 1964, that's sort of becoming a little more obsolete.
I thought they made a reasonably strong case about that just on the merits. Whether we want the court to step in and make that determination is a separate issue.
MARK SHIELDS: Judy, every election, there is one thing we could rely upon. Republicans are against taxes. Democrats are Social Security and Medicare. And every Republican was going to appoint judges who were strict constructionists, who would abide by the law, wouldn't write the law. These damn liberals are writing the law.
MARK SHIELDS: Now, we had, if I'm not mistaken -- the legislative process worked its will in 2006. We had 15,000 pages of testimony. We had 90 witnesses.
By a 390-33 vote in the House and a 98-0 vote in the Senate, they extended the law. And what has changed since then? The only thing I can see that has changed is that David Souter left the court, and Sam Alito joined the court. And so now we have got these activist conservative judges.
David is right in the sense that the real efforts to make it tougher to vote were in places like Pennsylvania, where, unfortunately for the Republican Senate leader in Pennsylvania, was caught on tape saying, this is how we're going to carry Pennsylvania for Mitt Romney, is to keep people from voting.
We had a 102-year-old woman in Florida who voted -- waited three-and-a-half-hours to vote. I mean, there is a need to -- and I would say nationalizing the standards is probably ...
JUDY WOODRUFF: But that's not -- that wasn't the question.
DAVID BROOKS: Right.
Well, the administration was asked about this specifically, and they said, no, we don't want to do that.
MARK SHIELDS: No, that's right.
DAVID BROOKS: These are states' obligations. This is a state matter. And so it becomes a little hard to nationalize it.
But I do think either you trust people or you don't. And the one thing I will say, which is just an interesting empirical point, these efforts in places like Pennsylvania to try to restrict voting were so completely counterproductive, I have to think that one of the reasons minority participation was so phenomenally high this time was because it was in a reaction against these things.
I think any party, especially the Republican Party, would be phenomenally stupid, let alone the fairness issue, phenomenally stupid to ever try this again.
JUDY WOODRUFF: Well?
MARK SHIELDS: Well, I mean, invincible stupidity ...
MARK SHIELDS: ... is not a stranger in American politics.
JUDY WOODRUFF: Well, there is everything invincible about the two of you.
JUDY WOODRUFF: Mark Shields, David Brooks, thank you.
And Mark and David keep up the talk on The Doubleheader, recorded in our newsroom. That will be posted at the top of the Rundown later tonight.
The Doubleheader is back with the politics of sports and the sport of politics. Syndicated columnist Mark Shields, New York Times columnist David Brooks and I tackle March Madness allegiances, the Oscar picks from last week (that I should have bet these guys money on) and whether POTUS is making friends and influencing people.
The "I am Khaled Said" reference is to a conversation I took part in Thursday at the United States Institutes for Peace.
Enjoy your weekend.
The first baby has been cured of HIV, researchers announced Sunday. The case was publicly unveiled at the 2013 Conference on Retroviruses and Opportunistic Infections in Atlanta.
The infant, who is now two and a half years old, was born to a "high-risk" mother in Mississippi. The mother was not diagnosed with HIV (human immunodeficiency virus) until delivery, and therefore did not receive prenatal treatment for the disease that could have prevented transmission to the baby.
The pediatrician, Dr. Hannah Gay of the University of Mississippi, began treating the baby with a stronger-than-usual cocktail of drugs within hours of birth.
Around 18 months, the child's mother stopped treatment and follow-up visits for the baby. But five months later, the child returned to care and was found to have an "undetectable viral load" -- the baby was no longer considered HIV-positive.
When HIV is diagnosed before or during pregnancy, prenatal transmission can be reduced to less than 1 percent with proper care. Since the mid-1990s, the number of infants born with HIV has dropped by 90 percent.
The only other documented case of an HIV cure to date remains that of Timothy Brown, the so-called "Berlin patient." In 2006, while on treatment for HIV, Brown was diagnosed with leukemia. He was treated with a stem cell transplant from someone who was born with the genetic mutation that causes immunity to HIV infection. After the transplant, Brown appeared to be completely free of the virus. While test results have caused some skepticism in recent months about whether trace amounts remain in his tissue, Brown says any remnants of the virus still in his body are dead and can't replicate.
Regardless, Brown's treatment would be too complex, high-risk and expensive to 'cure' the millions living with HIV/AIDS worldwide. That's why the researchers involved say this new case holds so much promise: the baby was cured through a relatively inexpensive course of antiretroviral therapy.
Dr. Luzuriaga worked with Dr. Deborah Persaud of Johns Hopkins University. They established a research collaboratory, funded by amfAR, The Foundation for AIDS Research, that included Drs. Stephen Spector and Doug Richman at the University of California, San Diego; Dr. Frank Maldarelli at the National Cancer Institute; and Dr. Tae-Wook Chun at the National Institute of Allergy and Infectious Diseases.
"This case is a startling reminder that a cure for HIV could come in ways we never anticipated," amfAR's CEO Kevin Robert Frost said in a statement. "We hope this is the first of many children cured of HIV in the months and years to come."
We spoke to Dr. Luzuriaga about the team's research on Friday afternoon.
NEWSHOUR: Thank you so much for joining us, Dr. Luzuriaga.
DR. KATHERINE LUZURIAGA: Thank you. I'm glad to be here.
NEWSHOUR: First of all, how big is this news? Would you classify it as a major breakthrough in treating AIDS?
DR. LUZURIAGA: Well, it's one case. But often a single case can tell you a lot, mostly because it stimulates intense interest, you develop hypotheses, conduct laboratory studies or further clinical trials to test those hypotheses. And that's where the real breakthroughs and confirmation come in. So I think this is an exciting case.
In that way, it's somewhat similar to the "Berlin patient," which was the first case of a functional cure in an adult. What it did was to provide some proof of concept that this may be achievable. So one case is interesting but clearly more work needs to be done to really understand why this happened and to better understand whether and how this can be replicated in other children.
NEWSHOUR: Let's dive a little deeper into the specifics of this case. What happened here?
DR. LUZURIAGA: This baby was born to a very high-risk mother who was not diagnosed as HIV-infected until she presented in labor. So she had no prenatal care, which put the baby at risk for HIV infection. Customarily, if you've got a mom that's HIV-positive, antiretroviral drugs during pregnancy are recommended and then you treat the baby for a period of time afterward to prevent mother-to-child transmission.
Because this baby was at risk, Dr. Gay decided to begin treatment very early and to treat the baby with three drugs. The baby had blood drawn at 30 hours and then was started on antiretrovirals without knowledge of what that baby's status was. Both turned up positive.
The baby remained on treatment for anywhere between 15 to 18 months. There was a little bit of uncertainty there because the baby did not engage in routine care for a time and then reappeared at 23 months. And when the baby reappeared at 23 months, Dr. Gay prepared to test the baby to get the baby back on treatment. And she was incredibly surprised when that first viral load came back negative. It's almost unheard of. Babies need almost constant therapy. They suppress the virus when you put them on treatment, but if you take them off, the virus comes back. And in this case, it didn't.
So then she repeated testing, thinking something was wrong with the lab test. And it was negative again. At that point in time, she called me because we've worked together as colleagues intermittently since the mid-1990s, caring for HIV-positive kids and doing clinical trials through the NIH-sponsored clinical trials group. When she told me about this, we thought this was quite unusual and so we assembled a team of individuals and went on to do some very specialized research to see exactly how much virus there was in the baby's system and what form it was in. Using those very sensitive tests, we were able to detect occasionally very, very low levels of the viral nucleic acids.
One of the doctors developed a very sensitive culture technique to see whether she can actually grow virus from people's cells. She tried to do that from the baby but she was unable to recover the virus. Then I did immunologic studies, and the kind of the immune repercussions that we usually see in HIV-positive individuals were not there. We retested the baby through 28 months, and the baby has continued to control the virus. In other words, we do not see the viral load coming back in the absence of treatment.
NEWSHOUR: But there are still low levels of the virus in the baby's system?
DR. LUZURIAGA: Yes, but we're not quite sure what it means. These are very low levels of virus that are around and we don't know whether these are false positives or whether they truly constitute viral load but it's just so low that it's tough to detect.
NEWSHOUR: So what was done differently with this infant compared to other HIV-positive infants. Was the therapy stronger?
DR. LUZURIAGA: Well, I think it was the timing of initiation. this child received three medications to prevent transmission and those three medications were continued when the child was diagnosed as infected. As a result, this baby received treatment much earlier than has been customary in the past, which we think contributed to the outcome.
NEWSHOUR: Could this be something specific in this child's genes that could have caused it to respond in this way?
DR. LUZURIAGA: Whenever something like this happens, we always say, 'Is this the virus? Or is it the host?' And studying those things can tell us a lot. For example, we know there are certain genetic types that are associated with individuals who control the virus better. You might have heard of individuals called "elite controllers," people who are associated with particularly good T-cell responses that help control the infection. But we have looked at the baby's [genetic] type, we've looked to see if the baby makes HIV-specific immune responses, and we have not detected any. The baby does not appear to have other genetic types that are associated with good control of infection.
NEWSHOUR: Do you foresee any specific implications for HIV treatment?
DR. LUZURIAGA: I think this is most relevant for babies who are born with HIV. We have pretty effective ways that can prevent mother-to-child transmission. And that is always our goal: to prevent babies from getting infected in the first place. Unfortunately, there are some children who still acquire infection, mostly because the mothers did not get prenatal care and were not identified as HIV-infected. So we need to redouble our efforts in that area.
But kids still get infected, and the guidelines recommend treatment during the first year of life. I think what this suggests to us is that if we treat earlier -- even earlier -- within the first several days to week of infection perhaps (though we don't know what that window would be) that we may be able to markedly curtail the amount of virus and the extent of viral reservoirs that are set up in the body. By doing so, and by treating for a period of time, we may get to a point where we could allow children to safely discontinue therapy. That is the hypothesis that this particular case raises, and now we're constructing the clinical trials to look exactly at that.
NEWSHOUR: Any things we can learn from this case for treating adult HIV cases?
DR. LUZURIAGA: I think there may be some, but because the infant - children are different than adults. Their immune systems are different, so we're not sure yet.
NEWSHOUR: Dr. Luzuriaga, thank you so much for being with us.
DR. LUZURIAGA: Thank you.
This conversation was lightly edited for clarity. Top photo coursesy of Flickr Creative Commons/raham. Photo of Dr. Luzuriaga courtesy of University of Massachusetts Medical School.
House Speaker John Boehner departs from the White House following a meeting with President Barack Obama and congressional leaders on Friday.The House is expected to vote Thursday on legislation to fund the government for the rest of the fiscal year. Photo by Pete Marovich/Bloomberg via Getty Images
The next budget deadline is now a little more than three weeks away, but President Barack Obama and congressional Republicans appear no closer to resolving their differences over fiscal policy that produced a stalemate over $85 billion in automatic spending cuts that started to kick in last week.
The first move in that battle will come Thursday when the House is expected to vote on a spending measure to keep the government running past March 27, the day current funding is set to expire. The stopgap plan put forward by Republicans would fund operations through the end of the fiscal year in September, but would do so at the lower spending levels of the sequester. The GOP proposal also would give the Pentagon greater flexibility when it comes to implementing reductions to the defense budget.
House Speaker John Boehner, R-Ohio, said in an interview with NBC's "Meet the Press" taped Friday, following the visit by congressional leaders to the White House, that he had discussed with the president the need to avert a government shutdown. "The president this morning agreed that we should not have any talk of a government shutdown. So I'm hopeful that the House and Senate will be able to work through this," Boehner said.
The speaker said he favored closing tax loopholes to streamline the tax code and lower rates for Americans. But he rejected the president's approach of using additional revenues to help reduce the deficit.
"The president got $650 billion of higher taxes on the American people on January the first," Boehner said. "How much more does he want? When is the president going to address the spending side of this?"
When asked Friday if he would support a measure to keep the government funded at sequester levels, the president refused to give a firm answer, but hinted strongly that he would do so.
"I never want to make myself 100 percent clear with you guys," the president told reporters at the White House. "But I think it's fair to say that I made a deal for a certain budget, certain numbers. There's no reason why that deal needs to be reopened."
The president suggested that allowing a government shutdown on top of the automatic spending cuts that just took effect would likely compound the country's economic problems.
"By law, until Congress takes the sequester away, we'd have to abide by those additional cuts. But there's no reason why we should have another crisis by shutting the government down in addition to these arbitrary spending cuts," Mr. Obama said.
The president added that he hoped Republicans would be willing to compromise on revenues going forward as the two sides seek a broader deal to reduce the deficit.
"Speaker Boehner, just a couple months ago, identified these tax loopholes and tax breaks and said we should close them and raise revenue. So it's not as if it's not possible to do," Mr. Obama said. "It may be that because of the politics within the Republican Party, they can't do it right now. I understand that. My hope is, is that they can do it later."
The split over taxes was also part of Kwame Holman's blog post on Friday looking at the failure to reach an agreement on averting the sequester.
The Washington Post's Ed O'Keefe, Megan Verlee of Colorado Public Radio and Karen Kasler of Ohio Public Television joined PBS NewsHour correspondent Jeffrey Brown on Friday to detail how the deal (or lack thereof) would impact the federal government as well as localities and states.
Watch the segment here or below:Watch Video
Reporter-Producer Cassie M. Chew talked with a handful of other public media reporters about what they are seeing back home. In Missouri, the research community stands to see big cuts, notes Jim Kirchherr of KETC in St. Louis. And WHRO's Cathy Lewis detailed how military-rich Hampton Roads will be impacted in a Q-and-A here.
President Obama will nominate Sylvia Mathews Burwell as director of the Office of Management and Budget on Monday. She's currently head of the Wal-Mart Foundation, and previously worked for the Bill and Melinda Gates Foundation. Burwell also served as the deputy budget director and deputy White House chief of staff in the Clinton administration.
To replace Lisa Jackson at the EPA, Mr. Obama has chosen Gina McCarthy, the agency's assistant administrator for air and radiation. He'll nominate MIT physicist Ernest Moniz as energy secretary.
And just as McCarthy's nomination surfaces, Coral Davenport of the National Journal details how deep cuts to the EPA budget handicap the agency.
A 229-page report from the Department of Homeland Security's inspector general, obtained through a Freedom of Information Act request, tracks allegations against Secret Service personnel over the past eight years, including assault, frequenting prostitutes and wiretapping. The Secret Service has called the list "an intake log," whose allegations are not verified.
The Homeland Security Department released 2,000 illegal immigrants ahead of sequestration, with plans to release 3,000 more who are facing deportation in March. That's many more than the "few hundred" the Obama administration originally admitted to releasing.
Obama pardoned 17 people Friday. Among them was a man convicted on firearms charges.
The Obama administration is taking the "maximum legal position," Talking Points Memo says, in support of same-sex marriage in an amicus brief filed with the Supreme Court. The court will hear two cases challenging the federal Defense of Marriage Act and California's Proposition 8 in late March.
If you haven't been following the Virginia transportation bill sagas or the recent politics of Virginia Gov. Bob McDonnell, read this story from the Washington Post. It casts the governor as in the midst of an "identity crisis," not unlike his party.
CBN talks to Mr. Obama's outgoing faith director Joshua Dubois about how the president views his religion's effect on his service.
Syria thinkers over at Syria Deeply respond to a reader's question about what should be next for the country, pointing to the need for the current regime to withdraw, the opposition to make concessions and the importance of a deal between the U.S. and Russia to break intransigence on the U.N. Security Council.
Duke Energy won't see a return on the $10 million line of credit it loaned to Charlotte for the Democratic National Convention last year. The company's shareholders will take a $6 million hit, the Charlotte Observer reports.
New York Magazine looks into former South Carolina Gov. Mark Sanford's political reincarnation. "The Sanfords have barely been on speaking terms; when they do talk, it's usually about the boys. But Mark went to meet with Jenny at her house this past December to discuss the congressional race," Jason Zengerle writes.
Connecticut state Rep. Ernest Hewett had an inappropriate response to a 17-year-old girl testifying about her experience overcoming shyness and a fear of snakes.
Former presidential candidate Mitt Romney said on Fox News that Republicans shouldn't blame New Jersey Gov. Chris Christie for his loss.
Jeffrey Toobin profiles Supreme Court Justice Ruth Bader Ginsburg in the New Yorker this week.
The president saddened nerds everywhere by mixing his Star Wars and Star Trek references when saying he can't do a "Jedi mind meld." But the White House owned up to it and even pushed the meme on its own.
Yeah, but was the fasten seatbelt sign on?
NEWSHOUR ROUNDUPAnalysts Mark Shields and David Brooks agree that the Republicans are mostly to blame for the sequester. Watch their segment here or below: Watch Video And Shields and Brooks prepare for March Madness in this week's Doubleheader: Watch Video Judy Woodruff spoke with Detroit Public Television's Christy McDonald about the city's budget emergency. "I can't tell you that this city, which is largely African-American, is 100 percent joyful that a white Republican governor is going to be coming in and exerting some control over the city finances," McDonald said. "But there is a growing majority of people that says, look, bottom line is, we want to make sure that our trash gets picked up. We want to make sure that the abandoned building that's on our block or right next door to our house gets knocked down. We want to make sure that, when we call police, police come." The full segment is here or below: Watch Video
The NewsHour discusses "food insecurity" with a documentary filmmaker who's examining the issue in the U.S. The film is "A Place at the Table," and you can read the conversation and view excerpts of the film here.
Last week's installment of "Lunch in the Lab" looked at the saltiness of sea water as seen from space.
Today's pardons bring to 39 the number of pardons granted by Pres. Obama - fewest of any pres since James Garfield in 1881.— Mark Knoller (@markknoller) March 1, 2013
FIRST TRIP: Secretary of State John Kerry says goodbye Saudi Foreign Minister Prince Saud al-Faisal in Riyadh today. twitter.com/globeglen/stat...— Glen Johnson (@globeglen) March 4, 2013
GWU clean up crew member with a laugh after Ashley Judd event: "Hey does anybody want Naomi Judd's tissue?"— Joshua Miller (@jm_dc) March 1, 2013
Any chance we could get North Korea to keep Dennis Rodman?— Karen Tumulty(@ktumulty) March 1, 2013
Christina Bellantoni and Simone Pathe contributed to this report.
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Artists from 11 of India's states participate at an art festival in Ghaziabad, India. One of the paintings portrays the recent deadly Delhi gang rape that inspired mass protests against violence against women. Photo by Sakib Ali/Hindustan Times via Getty Images.
By David FerryWatch Video
What am I doing inside this old man's body? I feel like I'm the insides of a lobster, All thought, and all digestion, and pornographic Inquiry, and getting about, and bewilderment, And fear, avoidance of trouble, belief in what, God knows, vague memories of friends, and what They said last night, and seeing, outside of myself, From here inside myself, my waving claws Inconsequential, wavering, and my feelers Preternatural, trembling, with their amazing Troubling sensitivity to threat; And I'm aware of and embarrassed by my ways Of getting around, and my protective shell. Where is it that she I loved has gone to, as This cold sea water's washing over my back? David Ferry is the author of several books of poetry and translations. His collection "Bewilderment" won last year's National Book Award for poetry. A profile of Ferry will air soon on the NewsHour. Read more about him here.
When you take your retirement benefit and whether you are a high, moderate or low wage earner can dramatically affect how much your family can get in Social Security auxiliary benefits. Photo by Mike Kemp/Getty Images.
Larry Kotlikoff's Social Security original 34 "secrets", his additional secrets, his Social Security "mistakes" and his Social Security gotchas have prompted so many of you to write in that we now feature "Ask Larry" every week.
We are determined to continue it until the queries stop or we run through the particular problems of all 78 million Baby Boomers, whichever comes first. Kotlikoff's state-of-the-art retirement software is available, for free, in its "basic" version. His considerable and often very useful output is available on his website.
Larry Kotlikoff: A question I asked myself this week: how unfair is Social Security's maximum family benefit?
You might think that Social Security's family benefit maximum is what it sounds like, a straightforward dollar ceiling on the total amount that you, your spouse, and your children can receive on your earnings record and that the same ceiling would apply to everyone. But you'd be wrong.
For starters, there's a rather weird and arguably unfair formula for calculating the family benefit maximum (FBM). Your own full retirement benefit, called your primary insurance amount (PIA), is what you can begin to take when you reach the age of full retirement -- 66 years old these days, but rising to 67 for those born in 1960 or later.
The problem is, if your PIA is very low, your total family benefit maximum will be only 150 percent higher. With a somewhat larger PIA, however, the maximum rises to 187 percent of your PIA. It then ebbs, ending up at 175 percent of your PIA. So 175 percent is the family maximum for those with the highest full benefits for themselves, a considerably higher multiple of PIA than for workers with the lowest personal benefits.
These family benefits -- spousal benefits, survivor, mother/father, and children benefits -- are called auxiliary benefits. The total family maximum is the wage earner's personal maximum plus the maximum of auxiliary benefits for family members. What makes the system both arbitrary and regressive is that the maximum auxiliary benefits are just 50 percent of a very low-income worker's full or "primary" retirement benefit (PIA), 87 percent of the moderate income worker's PIA, and 75 percent of the high earner's PIA.
A second kink in the rules and regulations: the most the family, including the worker, can receive also depends on when the worker takes retirement benefits.
Say you're a low-income worker and you take your benefits as early as possible, at 62, because you need the money in order to live. Your retirement benefit will then be reduced permanently to 75 percent of what you would get at your full retirement age. So the maximum you and your family can receive is 75 percent of your PIA (your reduced retirement benefit) plus 50 percent of your PIA in auxiliary benefits. In this case, your family maximum is only 125 percent -- 75 percent plus 50 percent -- of your full retirement benefit.
Contrast this to a moderate earner who waits until full retirement age. She would have a family benefit maximum equal to 187 percent of her full retirement amount. Now look at what happens if this worker can afford to wait until 70 to collect her retirement benefit. In this case her own retirement benefit is 1.32 times her PIA thanks to the "delayed retirement credit" and the maximum auxiliary benefits are 87 percent of her PIA. (The delayed retirement credit compensates workers who wait to collect Social Security with higher benefits once they start collecting.)
Hence, the largest amount the moderate earner family, including the earner herself, can receive is 219 percent of what she would receive at normal retirement age.
You would not quite know all this by reading Social Security's 30,000-foot description of the family benefit maximum, which states, "The maximum family benefit is the maximum monthly amount that can be paid on a worker's earnings record."
In other words, the maximum is the maximum and good luck figuring out what we mean by the maximum!
Carol -- Marblehead, Mass.: I am 64 years, single/divorced and currently not employed but trying. My former spouse took his Social Security benefits early at 62, and collects around $16,000 a year.
If I collected early, my benefits would have been $11,000 a year. My goal is to wait until 70 to collect.
We were married for 30 years before divorcing. He has remarried. What is the best way to maximize benefits? Should I file when I'm 66 on his benefits and then when I'm 70 file on my own? Is that allowed?
Larry Kotlikoff: The best way is to do exactly what you propose. File at 66 years old for a spousal benefit and then at 70 for your own retirement benefit.
Molly Cruz -- Santa Cruz, Calif.: Why not give early retirement to laborers, without penalty, say at 60 years old? This could make room for new workers and unleash a generation of spending, travelling, charitable working, and re-educating retirees -- a two-pronged aid to the economy.
Larry Kotlikoff: Social Security already permits early retirement at 62. It permits widows to take benefits at 60. But taking benefits early leads them to be reduced. If you are advocating full retirement benefits starting at 60, my reaction is the system is already 31 percent underfinanced and can not afford what it's now doing, let alone such a policy change.
Jim Gilchrist -- Costa Mesa, Calif.: I'm 66 years old. If my wife dies before she's 62, would I be eligible for survivor benefits?
Larry Kotlikoff: Yes, if she worked in covered employment and if you have been married for nine months or more.
Lorraine -- Los Angeles: My 66-year-old husband is collecting Social Security. I'm 66 also, but I'm going to work until 67 or 68. I have a government job so my husband receives the higher Social Security. Can I delay my Social Security benefit and seek a spousal benefit instead?
Larry Kotlikoff: You can and should do this. It's effectively free money.
Robert Forsythe -- Plainwell, Mich.: My family's only source of income is Social Security Disability. My wife has kidney cancer and we are told we make 27 dollars too much to get Medicaid. Why is the state of Michigan refusing to give her care? We pay cash for any care she gets and this prevents us from paying things like electric and gas bills.
Larry Kotlikoff: This is just outrageous. I hope the new health care exchanges created under the Affordable Care Act will provide some help.
Jacklyn Clark -- Buffalo, N.Y.: I am presently receiving Social Security and am recently divorced. If one of us died before the other, would we be able to receive our survivor benefit and receive our own benefit?
Larry Kotlikoff: Yes, assuming you were married 10 or more years and don't remarry before age 60. Also, if you take your retirement benefit at the same time as your survivor benefit, you will get the larger of the two.
A better strategy is to either: A. Take the retirement benefit earlier than the survivor benefit, where R is the retirement benefit and S is the survivor benefit; or B. Take the survivor benefit (S) before the retirement benefit (R). If you take R before S, you'd want to take your retirement benefit as soon as possible and then at full retirement age switch to your non-reduced survivor benefit. If you take S before R, you'd want to take your survivor benefit before or at full retirement age and wait until 70 to take your retirement benefit.
What's best for you or your ex as survivors would depend on both of your earnings histories. Also, if the survivor's maximum age of life is pretty short, some modification of these two strategies may be optimal.
Social Security makes these decisions as difficult as possible. You might benefit from one of the software tools on the market or consult an advisor to help you figure out how to maximize your lifetime benefits.
Angie -- Charlotte, N.C.: I am 60 and currently retired, but I may be taking an opportunity to rejoin the workforce. My husband is 58 and currently working. Should I take Social Security at 62 or wait?
Larry Kotlikoff: Go back to work if you can. Retirement is a waste of time. The economy needs you! You should NOT take Social Security at 62 unless you want to have permanently reduced benefits. It would be better to wait until 70 to take your retirement benefit when it will be as much as 76 percent higher than at age 62, depending on what day of the month you were born, I kid you not.
When your husband reaches 64, it might be worth having him apply for his retirement benefit and then have him suspend it at 66, when he reaches full retirement age. He can then start it up again at 70 at a 32 percent larger value than when he suspends it. This will enable you, at age 66, to apply for a spousal benefit, which will equal half of his full retirement benefit. You'll be able to collect this "free" spousal benefit from 66 to 70.
Struck by a turtle lately?
No? Then surely you've been smacked by a raccoon, chicken ... or at the very least, a nonvenomous lizard.
Well, regardless, starting in 2014, your doctor will be prepared when animals, lightning, or even unpowered watercraft strike, burn, bite or injure you in just about any other way.
The U.S. health care system is ramping up to implement a massive new coding system called ICD-10. It's a bland name for a system capable of coding thousands of colorful injuries. A full 68,000 to be exact, as opposed to the 13,000 under the current ICD-9. The codes are intended to help health care providers keep track of what happened to you, how much it should cost and what follow-up care you need.
Take these, straight from ICD-10:
Hurt at the opera: Y92253
Stabbed while crocheting: Y93D1
Walked into a lamppost: W2202XA
Walked into a lamppost, subsequent encounter: W2202XD
Submersion due to falling or jumping from crushed water skis: V9037XA
Even with the new descriptive phrases at their disposal, many health care providers strongly oppose the coding system. In December, the American Medical Association, 42 state medical organizations and 40 medical specialty groups, wrote a letter to the Centers for Medicare & Medicaid Services to cancel implementation of the ICD-10 code set.
Not only do they say it will "create significant burdens on the practice of medicine with no direct benefit to individual patient care," they also say ICD-10 will distract from other upcoming health information initiatives, including major ones tied to the health care reform law.
The complaints about the new coding system are just the latest in a mounting list of gripes doctors have with the federal government these days -- particularly the Centers for Medicare and Medicaid Services. On Monday's PBS NewsHour broadcast, senior correspondent Ray Suarez takes an in-depth look at why the largest health care groups in central Texas decided to drop all new Medicare patients. Tune in.
In the meantime, let's delve a little deeper into the intrigues of ICD-10 -- including how often the medical profession is likely use the code "Burn due to water-skis on fire, subsequent encounter" -- with someone on the front lines of its implementation. Holly Cassano is the CEO of a Florida-based medical coding consulting company ACCUCODE Consulting and blogs regularly on the upcoming ICD-10 changes for MedicalBillingandCoding.org.
NEWSHOUR: Holly, thank you so much for joining us. Let's start with the basics. Why should a normal patient care about the coding system and this change?
HOLLY CASSANO: This system is much more specific, which can be good. Let's say you're in some kind of accident that involves an insurance claim -- whether it's a vehicle or boating accident, or even if you've been bitten by an animal. It's not enough to say, "I was hit by a car" or "an animal bit me." The insurance company needs to know exactly how that injury occurred so when they go back and look at how to pay out a claim, it helps the patient have their story told properly and allows for potentially better benefits and care.
NEWSHOUR: Speaking of being bitten by an animal, some of these codes are so specific they're funny.
HOLLY CASSANO: I live in Florida and there's a lot of wildlife here - all great to see from a distance. But some people kind of take it to the next level and they want to have a more tactile encounter. That's where these codes come into play. You'll find codes for alligator attacks, which are easy to imagine. But let's look at some of the others. "Struck by a pig, initial encounter" or "struck by a dolphin" -- things that seem hardly feasible but you'd be amazed how often crazy things happen. That being said, when I worked in an ER, I never saw anything like a dolphin bite or someone struck by an orca or turtle or parrot, but bites while fleeing from river otters, panther and bear encounters along with mild shark bites, were a frequent occurrence and there are codes for all of those things just in case.
NEWSHOUR: Flaming water skis. That's another colorful one. When would that ever come into play?
HOLLY CASSANO: Well let's think. Flaming water skis might occur if someone was trying to do some kind of a stunt in Hollywood (the movie "Yogi Bear" comes to mind). maybe they're putting some kind of ignition fluid onto the water skis for a movie. If I was a coder in an emergency room in Los Angeles, it's quite possible I'd see something like that.
NEWSHOUR: They may be funny, but the hope is that these hyper-specific codes can also be very helpful. How?
HOLLY CASSANO: Absolutely. Living in Florida here, we get a lot of people from up north that come down and so they're seeing different physicians while they're here. But part of health care reform is making it possible to access a patient's electronic medical records nationally. By utilizing ICD-10 and being more specific about what has gone on with that patient, a doctor in Florida can help someone who was bitten by a rattlesnake out west a few months before. The patient is probably suffering some ongoing issues from the venom, so when another provider goes into their records, they can see: "OK, they were bitten by a rattlesnake, here was the severity of that injury, and let me see what I can do to treat them more specifically," -- which is a lot more helpful than dealing with the unknown.
NEWSHOUR: This is a big change for doctors, hospitals and especially professional coders. Just how big is the lift here to implement this new system?
HOLLY CASSANO: It is a very big undertaking but I feel at this point it's more from an IT (information-technology) standpoint, and it's more or less of a challenge depending upon what type of office system a provider currently has. There actually are some providers out there who are still on paper, believe it or not. For those individuals, it's going to be a huge undertaking because they not only have to convert all of that paper into an electronic health record system, they then also have to find one that can handle ICD-10. There are also vendors who you can outsource your coding to, if say, you feel you need assistance during the transition. There are companies that specialize in assisting providers, hospitals and other health care organizations with streamlining their coding operations. For organizations that have an electronic health record system of some sort -- which is most -- they need to assess and review the vendor's ICD-10 implementation plan in order to determine if that vendor can handle transitioning ICD-10 into their current system.
NEWSHOUR: There's been quite a bit of backlash against switching to ICD-10. Why?
HOLLY CASSANO: I think initially there was a lot of fear, as with anything new, and a lot of it is because people don't fully understand how it's going to work. But honestly, on the physician side, for coders and for health care providers in those settings, it's really more simplified due to programs that help you "crosswalk" to ICD-10. It may, prove to some degree, during the initial transition to have some hiccups on the provider side of things. But if they are armed with the proper coding tools out there, it should be somewhat seamless. Coding is not done from memory, so they will utilize the same types of coding tools they do now for ICD-9. If you have a tool like that, which is what I currently use, it's not going to be that difficult. You just have to plug in "injured in opera house" and the code will pop up.
NEWSHOUR: Is there any part of you that thinks this may be going overboard, like distinguishing between an injury in a mobile home's bathroom vs. the garden or foyer?
HOLLY CASSANO: Well, yeah (laughing). I think that some of these codes really may or may not be necessary. But part of the problem with ICD-9 is annually, due to various strange incidents or new disease processes, the governing bodies and decision-makers in health care -- the Centers for Medicare and Medicaid Services, the American Medical Association, the American Hospital Association and others -- are tasked with looking to create new codes from providers and others requests in the health care community in order to report these strange and/or new incidents and diseases. Which is one of the areas ICD-10 will assist with and cover more of the bases.
NEWSHOUR: Is there a takeaway here?
HOLLY CASSANO: The takeaway for coders and providers is to continue to educate yourselves. Don't wait for your facility or office to take the lead -- lead with both feet and embrace this as any other changes in health care reporting requirements. Look at how it will affect your specific specialty, not the entire health care community, and it makes it more palatable and easier to digest. It's like the age old question: "How do you eat an elephant? One piece at a time." And they will probably have a code for that too in the near future. So be careful out there and watch out for those charging river otters.
Holly Cassano is a Certified Professional Coder (CPC) and the CEO of ACCUCODE Consulting in Leesburg, Fla. She has worked in the health care industry since 1993 and currently serves as the blog host for Medical Billing and Coding.
Photo by Joe Raedle/Getty Images
While physicians have sidestepped drastic Medicare payment cuts for 2013, doctors' groups and lawmakers are gearing up for yet another battle to scrap the formula that forces Congress to consider the "doc fix" on a yearly basis.
For doctors, the nail-biter has become a familiar but frustrating rite. Lawmakers invariably defer the cuts prescribed by a 1997 reimbursement formula, which everyone agrees is broken beyond repair. But the deferrals are always temporary due to the difficulty of finding offsetting cuts to pay for a permanent fix. In 2010, Congress delayed scheduled cuts five times, with the longest patch lasting one year.
While Democratic and Republican leaders say they do not want Medicare physicians' payments to be cut, there is often disagreement about how to offset the costs of a fix. But proponents of a change were buoyed by the recent report from the Congressional Budget Office showing the price tag is now lower than past estimates due to slower growth in Medicare costs over recent years. "Cutting scores in half is certainly helpful," House Ways and Means Chairman Dave Camp told reporters in late February, noting, "that's still a very large number."
Two House initiatives to get rid of the payment formula have been announced already in this Congress: a plan unveiled by key GOP committee leaders and, separately, a bill offered by a Democrat and a Republican. "For far too long, the only thing certain about the Medicare physician payment system has been uncertainty about the future," House Energy and Commerce Chairman Fred Upton and Ways and Health Subcommittee Chairman Joe Pitts wrote in a statement about the Republicans' efforts. "As a result, the complexity of the problem and financial burden on taxpayers has snowballed."
Here are some answers to frequently-asked questions about the doc fix.
How did this become an issue?
Today's problem is a result of yesterday's efforts to control federal spending - a 1997 deficit reduction law that called for setting Medicare physician payment rates through a formula based on economic growth and known as the "sustainable growth rate" (SGR). For the first few years, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors reacted with fury when they came in for a 4.8 percent pay cut. Every year since, Congress has staved off the scheduled cuts. But each deferral just increased the size - and price tag - of the fix needed the next time.
The formula also reinforces what many experts say are some of the worst aspects of the current fee-for-service system - rewarding doctors for providing more tests, more procedures and more visits, rather than for better, more effective care. In an Oct. 14, 2011, letter to lawmakers, the Medicare Payment Advisory Commission (MedPAC), which advises lawmakers on Medicare payments, called the formula "fundamentally flawed" and said it "has failed to restrain volume growth and, in fact, may have exacerbated it."
Why don't lawmakers simply eliminate the formula?
Money is the biggest problem. While a Feb. 5 Congressional Budget Office estimate lowered the cost of the doc fix over the next decade to $138 billion due to lower Medicare spending on physician services over the last three years, that's still a lot of money, and so far Congress can't agree on where to find that kind of cash. Last January CBO estimated the cost of the doc fix at $316 billion, which it reduced to $245 billion last August.
For physicians, the prospect of facing big payment cuts is a source of mounting frustration. Some say the uncertainty has led them to quit the program, while others are threatening to do so. Still, defections have not been significant to date, according to MedPAC. In a March 2012 report the panel stated that while beneficiaries' access to care was good, for some "finding a new primary care physician continues to be more difficult than finding a new specialist."
Physician groups continue to lobby Congress to repeal the SGR and to enact a permanent payment fix. The deal Congress passed Jan. 1 to avoid the fiscal cliff by raising some taxes and putting off automatic budget cuts also stopped a 26.5 percent doctor pay cut but did not raise the level of Medicare reimbursement to physicians.
What do experts recommend?
In October, 2011, MedPAC recommended eliminating the formula without increasing the deficit by cutting fees for specialists and imposing a 10-year freeze on rates for primary care physicians. That proposal was strongly opposed by health industry groups, as well as the American Medical Association (AMA).
The AMA has recommended a five-year transition fee scale that allows time to test new payment approaches, including several being tested as part of the 2010 health care law.
Other options to fix the reimbursement formula include a bill introduced Feb. 5 by Rep. Allyson Schwartz, D-Pa., and Rep. Joe Heck, R-Nev., an osteopathic physician. Among its provisions, the measure would repeal the SGR, increase payments to physicians for four years and test new payment and delivery models.
Some key House Republicans also have a plan as well. The chairmen of the Energy and Commerce and the Ways and Means committees, as well as subcommittee leaders, unveiled an SGR repeal plan that would freeze physician payment rates at their current levels for the next 10 years with future increased based individual physicians' quality of care and efficiency. The have promised any fix "will not add a dime to the deficit." They are seeking comments on the proposal.
What happens next?
The current fix expires on Dec. 31, but a permanent fix would likely have to be melded into larger financial reforms.
Meanwhile, doctors face a more moderate Medicare pay cut this year. A series of automatic cuts in federal spending, called sequestration, went into effect March 1. By law, the Medicare cuts don't begin until April 1. They include a 2 percent reduction to physicians and other Medicare providers - including hospitals.
Kaiser Health News. is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente. Carol Eisenberg and Lexie Verdon contributed to this report.
On Monday's NewsHour:
The first baby cured of HIV
President Obama fills out his energy and environment team
Some doctors opting out of Medicare
And, more warning words to Iran from Vice President Joe Biden
While the above promo is written for the radio in the morning, it is a tentative snapshot of what we're covering on the show. With the ebb and flow of news headlines, chances are segments will be added, scrapped or moved to another night.
Tune in to the broadcast at 6 p.m. ET, online and on-air.
President Barack Obama and Congressional leaders gathered on Wednesday to unveil a new statue of Rosa Parks. Photo by Alyssa Gourd/NewsHour.
As members of Congress return to Washington amid post-sequester uncertainty, we pause to reflect on some of the non-fiscal matters faced on Capitol Hill last week.
Lew Confirmed as Treasury Secretary
Traveling a much easier road than some of President Barack Obama's other cabinet nominees, former Chief of Staff Jack Lew was confirmed as Treasury Secretary on Wednesday by a 71-26 Senate vote. The only major hiccup Lew faced during his confirmation hearing was his position as Chief Operating Officer of Citigroup's alternative investment unit and the $1 million bonus he accepted just before the bank received federal bailout money.
Sen. Orrin Hatch, R-Utah, the ranking Republican on the Finance Committee, suggested Lew's banking past would preclude him from honestly enforcing the Volcker rule, which limits banks' investments in private equity funds as part of the Dodd-Frank Act. "You would be, in effect, saying to financial firms, 'Do as I say, not as I did,'" Hatch said.
Despite his objections, Hatch -- and 19 other Republicans -- voted to confirm Lew. "I hope he and the president take note that I am bending over backwards to display deference," Hatch noted.
Before serving as Mr. Obama's chief of staff, Lew served as director of the Office of Management and Budget in the Obama and Clinton White Houses. The media, and even Mr. Obama, have poked fun at his signature; signing the nation's currency will be one of his first tasks as secretary. Lew replaces Tim Geithner, who has joined the Council on Foreign Relations as a senior fellow.
Jack Lew wasn't the only successful cabinet confirmation for the president this week. After a lengthy battle with Senate Republicans, former Republican Sen. Chuck Hagel was confirmed in a 58-41 senate vote on Tuesday to be Defense Secretary.
Congress Passes VAWA, Extending Access to New Groups
The House voted 286-138 on Thursday to pass the Senate's version of the Violence Against Women Act, which adds protections for immigrants, Native Americans and members of the LGBT community. The legislation, originally passed in 1994 to help victims of domestic violence, lapsed in 2011. House Republicans had been resistant to extend the services to more groups, but after discussion on the floor from both sides, members ultimately voted down the House bill in favor of the Senate's.
On the Path to the Capitol
The Hill is one step closer to welcoming a new member of Congress to Washington. Tuesday Illinois' 2nd district held a special primary to fill Jesse Jackson Jr.'s congressional seat. Democrat Robin Kelly, a former state representative, won with more than 50 percent of the vote, defeating former Rep. Debbie Halvorson and more than ten other candidates. Since the Chicago-area district is strongly Democratic, Kelly's primary win almost certainly will translate to a victory in April's special election against Republican candidate Paul McKinley. In the week leading up to the special primary, Jackson pled guilty to fraud for using campaign funds to buy personal items. PBS NewsHour spoke to Paris Schutz, political reporter with WTTW's Chicago Tonight, about the effect of the former congressman's legal troubles on the race.
Listen to that interview here:
Rose Parks Statue Makes Debut at the Capitol
As the Supreme Court was listening to arguments on the constitutionality of Section 5 of the Voting Rights Act on Wednesday, across the street at the Capitol members of Congress, their guests, staff employees of the House and Senate and even a couple of Hollywood celebrities attended a ceremony to unveil a statue dedicated to the memory of civil rights icon Rosa L. Parks. The 9-foot, 2,700-pound bronze statue honoring the woman who Mr. Obama called small in stature but big in courage, was placed in Statuary Hall.
In a rare moment of bipartisanship, congressional leaders from both parties and chambers praised Parks and acknowledged her as the first woman to lie in honor in the Capitol Rotunda. Parks is also the first African-American woman with a full-sized statue at the Capitol.
"Parks reminds us that this is how change happens," Mr. Obama said. "Rosa Parks' singular act of disobedience launched a movement. The tired feet of those who walked the dusty roads of Montgomery helped a nation see that to which it had once been blind. It is because of these men and women that I stand here today."
Senate Republican Leader Mitch McConnell had similar comments. "We have had humility as a nation to recognize past mistakes, and we've had the strength to confront those mistakes. But it has always taken people like Rosa Parks to help get us there," he said. "Because of the changes she helped set in motion entire generations of Americans have grown up in a nation where segregated buses only exist in museums ... where children of every race are free to fulfill their God-given potential and where this simple carpenter's daughter from Tuskegee is honored as a national hero."
Photo above: Jack Lew listens to President Obama at the White House on January 10. Photo by Roger L. Wollenberg/Getty Images. Photo above: The new Rosa Parks statue sits in Statuary Hall.
Coordinating Producer Linda J. Scott contributed to this report.
Kenyans wait in line to vote in Maasailand on Monday. Photo by Carl de Souza/AFP/Getty Images.
Millions of Kenyans voted in general elections Monday, and though there were some incidents of violence, the worst many experienced were lengthy lines and long wait times, international election monitors reported.
Early Monday morning, members of a separatist group attacked police with machetes in the coastal city of Mombasa, killing at least 19. Gunmen also reportedly overran two polling sites near the border of Somalia as night fell, according to the Associated Press.
But throughout the day, voting took place in a generally peaceful and orderly manner, said John Stremlau, vice president for Peace Programs at the Atlanta-based Carter Center. He spoke to us by phone after visiting polling stations at schools, hospitals and other sites in Kenya's capital Nairobi.
"We were impressed by the turnout and the patience of voters who had been standing in the hot sun since 8:30 this morning in order to cast their votes at 3:30 p.m.," he said. "In all the elections I've done for the Carter Center, I haven't seen lines that long."
Before the March 4 elections for president, legislators, governors and local offices, Kenyans were concerned about a repeat of the violence that engulfed the country after presidential elections in December 2007.
That winter, disputed election results sparked longstanding tensions among tribes, and more than 1,000 people died in the ensuing violence, which included the igniting of a church where people were hiding near Eldoret in western Kenya. NewsHour special correspondent Kira Kay recently returned to the area to see how its residents were faring:Watch Video
"It's hard to know whether or not people are motivated by fear or hope -- I think by hope -- but there is certainly a determination to move beyond the catastrophe of 2007," said Stremlau.
This time, Kenyans had prepared for the nationwide vote by holding practice elections to help train workers, and implementing reforms aimed at making the election process more transparent.
Voter identification at polling sites included a new system of checking people's fingerprints. And political parties were allowed to have two agents at each of the 33,000 polling sites to watch for any problems, said Stremlau.
Churches held prayer days and the business community offered the use of mediators in case of disagreements.
The candidates issued statements of support for whoever wins or loses. Polls leading up to the election showed a tight race between the two main candidates vying for President Mwai Kibaki's seat: Prime Minister Raila Odinga and Deputy Prime Minister Uhuru Kenyatta. Kenyatta is accused by the International Criminal Court of crimes against humanity for allegedly coordinating the 2007-8 postelection violence.
The winner must have more than 50 percent of the vote, which might be difficult with eight candidates, so a runoff -- if needed -- would take place April 11 if there are no challenges, said Stremlau.
International election monitoring groups are announcing their findings on Wednesday, and "if we conclude [the election was] credible, then it raises the pressure on the contestants to accept the results," he said. If there are any allegations of fraud, however, the Electoral Commission has pledged to investigate them.
The independent commission also promised to start posting preliminary election results a day or two after the vote, and final results within a week.
View more of our World coverage and follow us on Twitter:
Remembering John Neu, a businessman who took chances on convicted criminals by hiring them at his recycling company, WeRecycle. John Neu, chairman of Hugo Neu Corp., passed away Feb. 27.
Paul Solman: John Neu, a major figure in the scrap metal industry, died suddenly last week at age 74. A tireless, eager do-gooder of a businessman, he and his wife Wendy are long-time supporters of PBS NewsHour. Their support of the NewsHour was among a myriad of other causes they supported, including, most recently, serving food to victims of superstorm Sandy.
I knew none of that when I first heard about what Neu's work with long-term felons at Woodbourne Prison in upstate New York. He was hiring them as managers at a plant for his recycling company WeRecyle in Mount Vernon, N.Y. We wound up producing a first and then a second story about these prison degree programs.
In reading about John Neu's death, I remembered the interview we'd done with this extremely unusual businessman in the summer of 2011. It began by asking him for an introduction to WeRecyle.Watch Video
This story originally aired on PBS NewsHour July 27, 2011. Read the full transcript.
John Neu: [At WeRecycle,] we have a highly automated, fairly high-tech plant where we take electronics which have been discarded or obsolete. And we are processing them in a way where we get clean commodities, which can be sold to steel mills, copper refineries, aluminum refineries ... Plastic is being recycled and turned into plastic, and we eventually hope to recover the gold and silver from these electronics.
Paul Solman: Were you initially skeptical about the idea of hiring people out of prison?
John Neu: No. I was not. Wendy and I went to the first graduation ceremony for women graduating from the college in prison at a women's prison in Manhattan. It was done by the Bard Prison Initiative, and the president of Bard College came and the whole board of trustees. The senior judge of the Court of Appeals in New York was the graduation speaker. It was one of the most emotional experiences that I've had in my life.
Wendy talked to a couple of the graduates. And when the Bard graduate who ran the program, Max Kenner, said "I have somebody who's graduating who I want to recommend to you," we didn't have any hesitation about interviewing her.
Paul Solman: How did that first hire work out?
John Neu: Fabulously. I think this is the first job she's ever done and she's just improved her skills week by week, taking on more and more responsibility. She's running our HR program, and she's phenomenal.
Paul Solman: Compared to other college graduates?
John Neu: At one time we had over 1,000 employees. We've had a lot of HR people. We've had some very good ones, but nobody who's increased their skills as much as she has.
Paul Solman: How many employees have you had in your career?
John Neu: I can't imagine. It could be many, many thousands.
Paul Solman: How do these Bard prison graduates rank?
John Neu: Two of them rank as high as anybody we've ever had working for us.
Paul Solman: Of all the thousands of people?
John Neu: Of all the thousands.
Paul Solman: This is not affirmative action?
John Neu: Nothing to do with affirmative action. We do try to have a diverse workforce and we hire people from all levels, nationalities, colors, creeds and religions, but our hiring practice is hire good people. And the people we've hired from the Bard Prison Initiative have been fabulous.
Paul Solman: When you were at the Bard graduation and were so moved by it, wasn't a lot of the impulse to hire the woman that Max suggested to do something good?
John Neu: Yeah, there was an impulse to do something good, but we trusted Max's judgment that this was going to be a very extraordinary employee who would do a good job.
Paul Solman: You're a small business. How many of these people can you possibly hire? Since there's got to be some kind of limit, can you convince other businesses to do the same?
John Neu: I'm not going around convincing other businesses. We're looking for good employees all over the place and this is one of the places where you can get them, and I think it may be an example to other people.
Paul Solman: Is this a competitive advantage for you?
John Neu: Business is all about the people who are working with you and for you. That's what business is about. You might have the right equipment, you might have a good business plan, but if you don't have good people working for you to execute the plan everything else is going to fail.
So getting good employees, good associates, good officers, good people working for you is the key to business today in the world. It might not have been 50 or 100 years ago, but it certainly is today.
Paul Solman: Are you tapping an unexploited resource here?
John Neu: I think the Bard Prison Initiative is going to become well known to other people and we won't have the competitive advantage of getting the best people out of Bard Prison, but I hope we will for a while.
Paul Solman: But you won't be terribly upset if you lose this particular competitive edge?
John Neu: No. I am very concerned about global competitiveness for the United States. I think better education, better training, and more commitment from employees is a significant issue in the competitiveness of American businesses. I don't think this is even a small part of the answer for business in America, but any business that hires the best people coming out of a program like this, it's going to be that company's advantage.
Two key protagonists in NewsHour's original report on the Bard Prison program, Anthony Cardenales and Carlos Rosado, are still at WeRecyle and thriving, as is the Bard prison grad being considered for a job at the end of our second story, George Perez.
John Neu's Pet Project: From Ball and Chain to Cap and Gown: Getting a B.A. Behind Bars
Endless searching. Repeated rejection. Trips to the emergency room when all else fails. The horror stories are familiar to seniors who can't find a new primary care doctor willing to accept their Medicare coverage.
But just how widespread is the problem? And why are doctors opting out of the program in the first place?
To find out, the PBS NewsHour health unit traveled to Austin, where the Texas Medical Association -- one of the few state medical societies tracking the problem -- recently found that the number of Texas physicians accepting Medicare patients dropped from 78 percent in 2000 to 58 percent in 2012..
"Patients are having a much harder time finding a doctor who will accept Medicare, in particular primary care physicians," said the organization's CEO Lou Goodman. "In Texas, about four million patients are Medicare, and that number is growing because of the baby boomer generation aging into Medicare."
Seventy eight-year-old Nancy Martin is one of the seniors who had a tough time finding a physician.
"I felt frustration, disappointment and I would say despair. A lot of days I would get to the point where I would think, 'I'm never going to find a doctor in Austin,'" she told the NewsHour. It took a full two years for Martin to find one.
But nationally, seniors with Medicare have roughly the same problem finding a new doctor as their counterparts who are privately insured.
"Our recent survey showed very few seniors have trouble finding a doctor will take Medicare," according to Tricia Neuman, the director of the Kaiser Family Foundation's program on Medicare policy. "When we ask seniors in our survey that question, only 3 percent said they had trouble finding a doctor who would take their insurance."
Our full report will air Monday night on the PBS NewsHour broadcast. Watch a sneak preview above.
RAY SUAREZ: Researchers confirmed a two-year-old girl born with HIV has been functionally cured and remains virus-free even after treatment months ago.
It marks the first time HIV has been essentially eradicated in a child, making her just the second person ever said to be cured of HIV. Doctors at a Mississippi hospital say they gave the girl an especially intensive three-drug regimen within 30 hours of birth, before tests confirmed she was infected and wasn't merely at higher risk from her mother.
The findings were announced at a major AIDS conference in Atlanta and are stirring much discussion about what it could mean for more than 300,000 babies born with HIV each year, mostly in Africa.
We talk to two experts now watching this closely, Dr. Anthony Fauci of the National Institutes of Health, and Rowena Johnston, vice president and director of research at the American Foundation for AIDS Research, amfAR.
Dr. Fauci, few babies are now born HIV-infected in the United States because their mothers are usually already on antiretroviral medicine. But when it does happen, what's the normal protocol? What usually happens?
DR. ANTHONY FAUCI, National Institute of Allergy and Infectious Diseases: What happens, that if you get good prenatal care, the mother if she's infected during the pregnancy would be treated just like you would treat any other infected person, both for her own health as well as for the fact that it would dramatically diminish the likelihood that that mother would transmit the virus to their baby during the period of perinatal or during the birth period.
To be extra-specially sure that that doesn't happen, what you do is you then prophylax, not fully robustly treat, but prophylax the baby with one or usually two drugs, which is not enough for a full treatment, but enough for prevention. And you do that for six weeks. If the baby turns out to not be infected, then you stop that prophylaxis.
If the baby turns out to be infected, then you add the extra drug or two, which will give a triple combination. And that in fact would be the regular treatment for an infected baby. One of the problems is, is that if the baby is infected and you waited six weeks or so -- or a few weeks at least to determine definitively if the baby is infected, then the virus could have the opportunity to form what we call reservoirs, and take a full hold into the baby.
And that makes it more difficult to eradicate. What the pediatricians did in this case was something -- what was a gutsy call, but the right call. They felt that the baby was at such risk because the mother wasn't treated that they started right off from the get-go with the triple combination within 30 hours of the baby being infected, i.e., born.
And that seemed to have, what we're seeing now, essentially cured the baby.
RAY SUAREZ: Rowena Johnston, why was that decision made and how was the effect monitored? When they started this drug regimen right away, what were the special circumstances?
ROWENA JOHNSTON, American Foundation for AIDS Research: Well, this was a mother who came into medical care -- well, she presented during labor. And she had not been in medical care.
And a rapid HIV test was administered during labor. And she was determined to be HIV-positive. And the pediatricians recognized that, under those circumstances, because the mother had not been taking prophylaxis, there was really a fairly high risk that she might transmit HIV to her baby. And, as Dr. Fauci mentioned, they decided to take that gutsy decision to administer a full treatment dose of antiretroviral therapy at 30 hours after birth.
I mean, a baby might not normally get a full treatment dosage of antiretroviral therapy until even as several weeks, six weeks after birth. And so what was different in this case is that this regimen was started actually at about 30 or 31 hours after birth. And as Dr. Fauci had also mentioned, what might be critical here is that because that therapy was administered so early, they may have beat the virus to the punch.
And that is, they may have administered the therapy early enough that these viral reservoirs were not able to establish themselves. And what we do know when -- those of us who are interested in finding a cure for HIV infection, we know that the major impediment to curing HIV infection is the establishment and the maintenance of those reservoirs.
The fact that we have those reservoirs and the antiretroviral therapy cannot eradicate those reservoirs, that's really the barrier that stands between us and an HIV cure. And so what these researchers did here, what the hypothesis is, is that perhaps they actually disrupted this process early enough that those reservoirs never had a chance to establish themselves.
RAY SUAREZ: And, Rowena Johnston, to follow up, how was it realized that the baby was essentially HIV-free? And did it take a while before that was understood?
ROWENA JOHNSTON: Well, there were several things that happened in this case.
This child was in regular medical care until roughly 18 months of age and had been taking antiretroviral therapy, as recommended, but at about that 18 months of age point, both the mother and the child disappeared and didn't visit their doctor. And when they came back into medical care, the mother did confess at that time that the child had not been taking antiretroviral therapy for at least five months.
And so one of the first thing that the pediatrician in charge of the case did was to administer a viral load test, because she of course wanted to determine how much virus outgrowth there had been and how one should most appropriately treat the baby at that point. And she was astonished to find that there was no virus. And so she thought that actually this must be a mistake. And so she readministered that viral load test. Lo and behold, yet again, there was no virus to be detected.
RAY SUAREZ: Dr. Fauci, what can you learn from a case like this that could be applied in those countries where many people are born HIV-infected?
DR. ANTHONY FAUCI: Well, in the countries that you're talking about, the problem is enormous. Globally, even though we only have about 100 to 200, which is 100 to 200 too many, infections in infants from their mothers in the United States per year, there are about 1,000 infections per day mostly in the developing world, particularly in sub-Saharan Africa, so it's a huge problem.
What we can learn from this case, Ray, is that the first and most important thing is to try to prevent infection, mainly, get mothers in treatment during pregnancy and then do the same sort of prophylaxis on the infant to prevent infection in the first place. However, that doesn't always happen at all in the developing world.
And, not infrequently, a mother will present in exactly the same way as this mother presented in Mississippi here in the United States, namely walking into a clinic or an emergency room with no prior therapy. Having this index case now of showing at least the possibility of, with aggressive early therapy, curing an individual, then you might want to ask the question, when you're in that situation, is the risk-benefit ratio much more favoring towards the benefit of being very aggressive from the very beginning and not waiting that period of time until you have proven that the person, the baby in this case, is infected?
And those are things that are now being discussed. For clinical trials, it could be done under the appropriate conditions and with the appropriate ethical considerations that you might be able to, if you fail to prevent the infection in a situation such as a mother who has not been treated, can you then actually cure the baby if you start the treatment aggressively and early enough?
So, that's the critical question that now looms that will really be answered by saying, is this more broadly applicable than just an individual case in an unusual situation like we saw here in the United States and Mississippi? We hope the latter is true.
RAY SUAREZ: Anthony Fauci of the NIH, Rowena Johnston of amfAR, thank you both.
DR. ANTHONY FAUCI: Thank you.
ROWENA JOHNSTON: Thank you very much.
GWEN IFILL: On our website, you can find an interview with one of the doctors who conducted the research.