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WILLIAM BRANGHAM: The U.S. State Department recently convened its first oceans conference, bringing scientists and political leaders from around the world to address the many threats to the world’s oceans, including pollution, climate change, and overfishing.

SECRETARY KERRY: “The protection of our oceans is a vital international security issue.”

WILLIAM BRANGHAM: Secretary of State John Kerry said that protecting the oceans was an obvious concern both for the U.S., and for all nations.

SECRETARY KERRY: “Protecting our ocean is also a great necessity for global food security … The connection between a healthy ocean and life itself for every single person on earth cannot be overstated.”

WILLIAM BRANGHAM: Kerry then introduced President Anote Tong, of the Pacific island nation of Kiribati, a man Kerry called “one of the world’s greatest advocates for the world’s oceans.”

Tong’s country is nearly 7,000 miles away — far out in the middle of the Pacific Ocean. You may have heard of Kiribati because its approximately 100,00 residents are extremely vulnerable to sea-level rise caused by climate change. In fact, Kiribati recently purchased land in Fiji as a refuge for its people in anticipation of when rising seas may make it too dangerous to continue living there.

But President Tong’s most recent concern has been overfishing. He’s working with the environmental group Conservation International to protect the marine life that lives along the rich coral reefs that ring his country’s islands. The area is home to a huge array of species, most importantly tuna.

Tong went to that State Department conference to announce that in order to protect those tuna, he was banning commercial fishing in what’s called the Phoenix Islands Protected Area. It’s over 150,000 square miles of Kiribati’s territorial waters — an area roughly the size of California.

Some critics claim Kiribati has promised to close these waters before, but only closed a small portion, but President Tong says, soon, the entire area will be protected.

PRESIDENT ANOTE TONG: “Kiribati has taken the decision to fully close all commercial fishing activities within the Phoenix Islands Protected Area with the effect from the first of January 2015.”

WILLIAM BRANGHAM: Because of overfishing, many of the worlds tuna stocks are depleted or in jeopardy. The tuna that come from the Central Pacific are now one of the last remaining relatively healthy stocks of this lucrative, crucial fish.

Tuna are known as a ‘pelagic’ species – which means they migrate huge distances across the Pacific during their lifespan. So while Kiribati’s closure protects just one small part of the tuna habitat, it’s considered an important – if symbolic – step in protecting the entire fishery.

I talked with President Tong the day before he announced the closure.

WILLIAM BRANGHAM: President Tong, why did you decide that this was the right time to close these fishing grounds?

PRESIDENT ANOTE TONG: For far too often in the past, we stand by and watch what goes on. And we have theories, we postulate theories as to how to deal with it, but I think we want to do more than that. I think it’s the same case in terms of climate change. I think we know what’s wrong, we believe we know what should be done, but we continue not to do it. We continue to wait for the next country to do it.

And definitely the case is that many Americans eat tuna, either sashimi or canned, but what we see on the table, what we see around our daily lives, we don’t always associate it with something else beyond. But the reality is that this has to come from somewhere. And at the moment the most viable tuna fishing grounds that remain viable are those in the Western and Central Pacific, in our waters. And so leadership has got to be taken.

WILLIAM BRANGHAM: How will this be enforced though? As you know, there are many protected marine fisheries around the world where illegal fishing is still rampant. So how will Kiribati, with really no navy and few resources be able to protect this protected area?

PRESIDENT ANOTE TONG: We do have measures in place. We do have agreements in place where we have agreed to look after each other’s exclusive zone, particularly for illegal activities. We also have arrangements with our developed partners including the United States, whereby the U.S. Coast Guard vessels go into our waters and they do provide surveillance and they have in the past actually caught and we have prosecuted illegal fishing vessels.

But I believe that it’s got to be done as a collaborative effort. We cannot do it alone; we should not have to do it alone, because we are doing this for the rest of humanity as a food security issue, global food security issue. And so our partners, our neighbors should be willing, if they are able, to contribute.

WILLIAM BRANGHAM: As you know, tuna spend — they cross an enormous amount of the Pacific Ocean, and so while you may be able to protect them in the short time when they are in your waters, isn’t there a concern that they’re going to eventually migrate somewhere else and might be unprotected and snatched up once they’ve left your neighborhood?

PRESIDENT ANOTE TONG: There’s no doubt that this is, the tuna are renowned for being a ‘pelagic’ species. That’s absolutely correct. But at least somewhere where they know that, we’ll we know that they will be able to find refuge. I hope the tuna learn that in time, but I think it’s better than doing nothing at all.

And hopefully by doing this, other neighboring countries will do the same and so on. Hopefully, in time, we will have something much more effective to ensure that the tuna fisheries in our part of the world doesn’t suffer the same fate as other tuna, fisheries in different parts of the world in the Atlantic, the salmon, the cod and whatever, the bluefin in the Atlantic, that’s all gone. We don’t want to repeat the same experience.

WILLIAM BRANGHAM: You’ve obviously spent a great deal of your time trying to draw the world’s attention to climate change and to sea-level rise and to the very real threat to your nation. Is there a concern that, as sea levels continue to rise and the territorial size of your own country is threatened, that it becomes harder and harder to protect the fisheries around them?

PRESIDENT ANOTE TONG: Well, a lot of things are going to need protecting, and I think the first animals that would need protecting are our people, okay? Secondly, of course the question that arises as to what happens to our exclusive economic zone. Does it disappear with the submergence of our islands? We believe not. I’ve looked and I’ve been seeking advice on this, and there’s no legal precedent. In other words –

WILLIAM BRANGHAM: If a nation goes under the water, does it still have jurisdiction around it?

PRESIDENT ANOTE TONG: Yes. Definitely. We believe that it is ours, it remains ours. Whether our islands go underwater or not. But of course let me make the point that we are committed to ensuring that whatever happens, whatever the sea level rise might be, we will build them up so that to ensure that our nation continues to exist, even if only a small piece of it. Because it’s symbolic. It’s a statement to everybody not to allow things like that to happen.

WILLIAM BRANGHAM: President Anote Tong of Kiribati, thank you very much.

PRESIDENT ANOTE TONG: You’re very welcome and thank you for giving me this opportunity to comment on this very significant challenge.

The post To protect oceans, Kiribati bans commercial fishing appeared first on PBS NewsHour.

Americans are a small step closer to accessing less-expensive specialty drugs known as biologics.

The Food and Drug Administration for the first time accepted an application for the approval of a copycat “generic” version of the brand name drug Neupogen, which treats patients with low white blood cell counts.

Sandoz, the generics company that submitted the application for filgrastim, already sells the cheaper biosimilar drug in more than 40 countries outside the U.S.

Biologics are a class of injectable drugs that are made from living cells, which makes them more complex to produce than traditional pills that are made by mixing chemicals.

Some popular biologics include Humira or Enbrel, used to treat rheumatoid arthritis, and Lucentis for macular degeneration.

Americans have been paying more for these injectable biologic drugs compared to patients in Europe or Asia because not a single “generic” version of these drugs – also known as biosimilars – has hit the U.S. market.

Biosimilars have been available abroad for nearly eight years and at a much lower price, often 30 percent less than the brand name version.

Earlier this year, we spoke to a patient from New York whose single injection of the biologic drug Procrit, which boosts red blood cells, cost $1,500. He needed the shot each week and that meant under his insurance plan his co-pay ended up being nearly $800 a month.

Despite the increasingly popular use of biologics in the country, the FDA does not yet have a regulatory system set up to approve lower priced “generic” biosimilars. However, the passage of the Affordable Care Act in 2009 aimed to change that by authorizing the FDA to set up that approval process.

And so the FDA’s review of this first application has been nearly five years in the making. The delay stems from concerns that biosimilars – because they’re more complex to produce – should be approached with a different regulatory system than the one in place for traditional chemical pills.

The post FDA will consider approval of biosimilar drug for first time appeared first on PBS NewsHour.

In July of 2012, coronal mass ejections (CMEs) came close to hitting Earth, which could have left millions without power and trillions in damage. Credit: NOAA

Two years ago, the worst solar storm in almost two centuries tore through Earth’s orbit. Luckily, the storm’s path just missed Earth.

Now, scientists are shedding new light on the solar event, which didn’t make headlines but could have had a “catastrophic effect.” 

“If it had hit, we would still be picking up the pieces,” Daniel Baker of the University of Colorado said in a statement released by NASA this week.

The storm occured on July 23, 2012. If it had taken place a week earlier, when the storm site was directly facing Earth, billions of tons of highly-charged particles would have rained down on the planet, scientists said.

These particles, which travel in clouds of plasma called coronal mass ejections (CMEs), would have reached Earth in about one day.

The resulting firestorm could have knocked out power for millions for months or years and caused more than $2 trillion in damage, scientists said.

While the 2012 storm didn’t strike Earth, it did come into contact with the spacecraft, STEREO-A, NASA said. Since then, scientists have been researching whether a future galactic storm of the same magnitude is merely science fiction.

It’s not.

Physicist Pete Riley in a paper published in “Space Weather” in February puts the odds of a solar storm hitting earth in the next 10 years at 12 percent. 

The last solar storm that made a serious impact blacked out Quebec’s power grid in 1989, and storms in October and November in 2003 caused transformer failures in North America and Europe.

The worst solar storm on record happened in 1859 and was observed by amateur astronomer Richard Carrington. Because the so-called “Carrington event” occurred before the electrical age, there wasn’t significant damage on Earth.

A 2009 report by the National Academy of Sciences said another Carrington event today would be utterly debilitating.

“The loss of electricity would ripple across the social infrastructure with water distribution affected within several hours; perishable foods and medications lost in 12-24 hours; loss of heating/air conditioning, sewage disposal, phone service, fuel re-supply and so on,” the report said.

“We need to be prepared,” Baker said.

The post Solar ‘superstorm’ missed Earth in 2012 — but another could strike appeared first on PBS NewsHour.

Pro-Palestinians in France clashed with riot police Saturday, after they defied a protest ban imposed by the government. Credit: Mustafa Yalcin/Anadolu Agency/Getty Images

About five thousand pro-Palestinian demonstrators gathered in Paris on Saturday, defying a French government ban against protesting Israel’s military actions in Gaza.

Around 2,000 police officers surrounded the Place de la Republique in Paris, where the protest took place. Clashes began when protestors threw stones and other projectiles at shopfronts and police officers, who responded with tear gas.

The police made about 50 arrests, according to France 24.

French authorities say they started to ban protests two weeks ago after several Pro-Palestinian marches targeted Jewish shops and synagogues.

“Anti-Semitic violence exists: we must face it head on,” French Minister of the Interior, Bernard Cazeneuve, said in a television address.

Protest organizers deny that their actions are anti-Semitic.

“Our goal is not to attack the Jews, it is to condemn the policies of a government,” Tarek Ben Hiba, an organizer of Saturday’s protest, told Reuters.

In response to recent violence and tensions in France, Jewish residents are moving out of the country in increasing numbers. This year, over 2,000 have left, which is up from 580 who had left by this time last year, according to an NPR report.

In the past two weeks, French authorities say there have been 300 pro-Palestinian protests throughout France.

The post Thousands stage protest in Paris, defying authorities appeared first on PBS NewsHour.

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HARI SREENIVASAN: So Nicholas you’ve been in Gaza through this temporary cease-fire. What’s life been like?

NICHOLAS CASEY: Well dozens went outside today. For many people this was the first time that they had seen their homes after they fled and we as their reporters also got the chance to get out and see what just had gone on. I think what we all learned, was that large parts of Gaza are completely destroyed right now.

I myself haven’t seen anything that was this bad since I was in Haiti after the earthquake in 2010, and I would say that there’s only a few parts of the world right now that have gotten to this level of destruction. Syria being the first one that comes to mind. There were entire areas where the buildings were barely standing. I saw a mosque that had been basically blown to pieces. There were animals that were dead out in the street.

There were people trying to take people out of the rubble and get their bodies so they could be buried. One woman showed me a Quran, copy of the Quran that she said her husband had been reading was covered in blood and flies and in the cemeteries there weren’t enough places to bury people. They were literally having to try to bury people in graves of other people where there was some room because there were no room in the grave yards.

HARI SREENIVASAN: Was this an opportunity for people to re-stock supplies, food, water?

NICHOLAS CASEY: It was, they were trying to do a lot of things at the same time. I think the first thing was to just satisfy the curiosity of what had happened to their homes and then the second priority was also to try to get some supplies because they think the fighting might be coming again, really soon. I saw a lot of people who were carrying mattresses. Mattresses seemed to be the thing that people needed most.

They would go back to their house and get as many of them as they could, others were trying to get water and some food. About 95 percent of Gazan water is undrinkable, it’s salty actually, so water has to be drank out of bottles and you have to find it and a lot of people were struggling to do that today.

HARI SREENIVASAN: What about the refugee population? Where hearing now numbers up to 140,000 people have been displaced that’s almost 10% of the population.

NICHOLAS CASEY: It is, it’s actually higher than that figure you said. It’s about 165,000 people right now and that’s a huge number. That was about three times as much as during the 2008 war, which was the only war that had sort of gotten to this level that were at.

So it’s a huge number of people in Gaza that aren’t in their homes right now. They are staying in schools but even the schools have become places that aren’t safe. Just a few day s ago an U.N shelter which was in a school was attacked and this was an attack that killed 16 people and this is what Gazans are learning. The fact they may be getting some warnings that there may be an attack that’s going to happen in their neighborhood.

From Israel there’s not a place for them to go to right now this is a very small strip of land about 36 miles long and there’s no way out of here right now. So as long as the fighting is going on the people here are trapped in the fighting, they are going to be in the fight. The talk of the refugee here is a bit silly because there’s no way no place to take refuge from here you can’t leave.

HARI SREENIVASAN: Alright, Nicholas Casey of the Wall Street Journal joining us by phone from Gaza, thanks so much.

NICHOLAS CASEY: Thanks.

The post Amid temporary cease-fire, Gaza residents survey level of destruction appeared first on PBS NewsHour.

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HARI SREENIVASAN: What’s the public opinion on the street now about what’s been happening?

JODI RUDOREN: Yeah, people here are really behind this operation. They are terrified of these tunnels, they feel that this is a war of no choice. They feel they were attacked and some people are really kind of a little bit blind to the death toll on the other side, others I think are quite sympathetic to it. But they really, really blame Hamas for those deaths.

They think that Hamas has caused or was complicit in those deaths by not allowing people to leave, by hiding ammunitions in civilian neighborhoods, etc., and the fact that Israel is increasingly kind of isolated around the world and there’ve been all these demonstrations and calls for a cease fire. I think it has had a backlash here. People are getting angrier than ever and really, you know just feel that nobody understands them and they want to get the job done.

HARI SREENIVASAN: What about the recent protest in the West Bank that we’ve seen in the past few days. Is there increasing concern?

JODI RUDOREN: I mean, absolutely. The West Bank, is, you know, closer to most Israelis than Gaza is, and people have been talking and worrying about a third intifada here for as long as I’ve been here, which is two years. However, I think that Israelis are pretty confident and have a reason to be that their security forces are also well deployed in the West Bank,and they basically kind of stopped the security threat from the West Bank with the separation barrier.

I mean, I think you know some people really want and believe in a solution with the Palestinians and therefore I think feel awful about especially the unrest in the West Bank and the killings in the West Bank. I think a lot of people, though, are quite hopeless about it.

HARI SREENIVASAN: Just to give us a snapshot, if you can, what’s it like in different parts of Israel? Is life different closer to the border with Gaza than other cities?

JODI RUDOREN: Absolutely. The rockets have gone to quite a bit of Israel, and I think you’ll hear Israeli leaders talk about 70 percent or something. But, you know it’s one or two or three a day sirens in lots of the country, and then in the South it‘ll be dozens and dozens a day. So in the South around Gaza a lot of the small community’s people have evacuated. They’ve moved to relatives in other parts of the country or to hotels. Otherwise, they basically stay at home. Most of the stores are closed. Today people have left and went during the pause down to the beach or to the cafes that had been closed and they were kind of cautiously venturing out.

But in the rest of Israel and Jerusalem where I’m based life is mostly as normal, it’s a little slower a little less traffic and people are certainly on the edge. It’s kind of all anyone talks about and a lot, a lot of people here have soldiers or reservist who are In Gaza or about to go in. So everybody kind of carrying their phones around at every minute. Some people are afraid to leave their houses lest someone comes and tells them that someone has been killed. People are canceling their vacations. None of that compares to what’s happening in Gaza where people are getting killed by the hundreds.

But it is not life as normal here by any means, but it is certainly better here than in the south and better in the south than in Gaza.

HARI SREENIVASAN: Jodi Rudoren of the New York Times, thanks so much.

JODI RUDOREN: Thank you.

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Certified nurse practitioner Myra Tilson conducts a check-up on a patient at a Community Clinic Inc. health center in Takoma Park, Maryland, U.S., on Tuesday, Oct. 1, 2013. Health insurance experts say customers who opt for convenience by automatically renewing their coverage for 2015 are likely to receive dated and inaccurate financial aid amounts.

WASHINGTON — If you have health insurance on your job, you probably don’t give much thought to each year’s renewal. But make the same assumption in one of the new health law plans, and it could lead to costly surprises.

Insurance exchange customers who opt for convenience by automatically renewing their coverage for 2015 are likely to receive dated and inaccurate financial aid amounts from the government, say industry officials, advocates and other experts.

If those amounts are too low, consumers could get sticker shock over their new premiums. Too high, and they’ll owe the tax man later.

Automatic renewal was supposed to make the next open-enrollment under President Barack Obama’s health care overhaul smooth for consumers.

But unless the administration changes its 2015 approach, “they’re setting people up for large and avoidable premium increases,” said researcher Caroline Pearson, who follows the health law for the market analysis firm Avalere Health.

It could be a new twist on an old public relations headache for the White House: You keep the health plan you like but get billed way more.

“It was our preference for (the administration) to have the capacity to update people’s subsidy information, but they haven’t been able to get that built,” said Brendan Buck, a spokesman for the industry trade group America’s Health Insurance Plans.

Here’s the issue, in a nutshell:

To streamline next year’s open enrollment season, the Health and Human Services Department recently proposed offering automatic renewal to 8 million consumers who are already signed up.

But the fine print of the HHS announcement said consumers who auto enroll will get the “the exact dollar amount” of financial aid they are receiving this year.

That’s likely to be a problem for a couple of reasons, not to mention inflation.

First, financial aid is partly based on premiums for a current benchmark plan in the community where the consumer lives. Because more plans are joining the market and insurers are submitting entirely new bids for 2015, the benchmark in many communities will be different.

Second, financial aid is also based on household income. If your income goes down, you are entitled to a bigger health insurance tax credit. If it goes up, you get less. The 2014 amounts could well be out of date and incorrect for many people. Financial assistance is also affected by age, family size and where people live.

And that doesn’t get into another motivation for consumers to shop around: Premiums and choices for 2015 are changing, so your current plan may no longer be a good deal.

“Just continuing in the same plan with the same credit is not going to be the optimal outcome for most people,” said Judy Solomon of the Center on Budget and Policy Priorities, which advocates for low-income people. “Your 2014 credit is going to be lower in most cases, and in some cases it could be too high.”

About 8 in 10 of those who signed up for private coverage under the health care law are getting financial aid. In the 36 states served by the federal insurance exchange, the tax credits average $264 a month, reducing the average monthly premium of $346 to just $82.

Even with such generous subsidies, about 4 in 10 who bought a health law plan say they have trouble paying their premiums, according to a poll by the nonpartisan Kaiser Family Foundation.

Open enrollment starts Nov. 15, and consumers who already have a policy will have just about a month to renew or make changes to avoid a break in coverage Jan. 1. Millions of new customers are also expected to try to sign up for the first time.

New Health and Human Services Secretary Sylvia Mathews Burwell is hoping that auto renewal will simplify things, a welcome change from this year’s website problems.

But the subsidy scheme created by Congress to keep premiums affordable has so many moving parts that it’s turning out to be difficult for the government to administer.

Administration spokesman Aaron Albright says all consumers are encouraged to contact their health insurance exchange to update any changes in personal and financial details. You can do that at any time, before the open-enrollment crunch.

However, you will have to wait until the fall to change to a new plan for next year.

Even if the financial aid amounts are off the mark, some advocates say auto renewal is still a safeguard to keep some people from falling through the cracks.

“It is not a perfect solution, but I’m not sure that there is a better solution in terms of protecting people so they don’t lose health coverage,” said Ron Pollack, executive director of Families USA, an advocacy group supporting the overhaul.

The post Why automatic renewal of 2015 health coverage may backfire appeared first on PBS NewsHour.

National Tidal Centre of Australia estimates that the Pacific island nation of Kiribati sinks further into the ocean 3.7 millimeters every year. Credit: Lisa Overton/NewsHour Weekend

Venice isn’t the only piece of land sinking today.

The nation of Kiribati, made up of 33 tiny islands far out in the Pacific Ocean, is getting smaller as rising sea levels continue to swallow the land by an average of 3.7 millimeters a year, according to the National Tidal Centre of Australia.

“Never in history has a state disappeared because of a physical problem,” said Michael Gerrard, Director of the Center for Climate Change Law at Columbia Law School.

To deal with the country’s uncertain future, Kiribati President Anote Tong announced in June the purchase of nearly 6,000 acres of land on a Fijian island 1,240 miles away to potentially serve as a refuge for citizens who are forced to relocate as their homes eventually go under.

But if a nation drowns, is it still a nation?

Gerrard said a country must meet four standards to be recognized as a state: Land, population, government and recognition from other countries.

“If you have everything but land – if you have a population that is displaced – whether that allows you to be a state is a novel question,” Gerrard said. “It would really be up to the United Nations whether they still wanted to recognize the entity as a state.”

The future of Kiribati’s nationhood may very well rely on Fiji, Gerrard said.

“If Fiji were to cede the land and give it up and say it’s no longer within their jurisdiction, then it became the new Kiribati, then it would probably work,” Gerrard said.

Kiribati has just over 100,000 residents. The island nation’s highest point of elevation is only 81 meters above sea level, making it highly vulnerable to ocean changes. 

And as sea levels rise, citizens of Kiribati will need a new place to call home.

In neighboring New Zealand, 75 people from Kiribati are allowed to relocate every year if they meet certain visa requirements.

But in 2013, a New Zealand court ruled against a man from Kiribati who sought refugee status because of the effects of climate change on his home.

“The problem is that the definition of refugee does not fit this situation,” Gerrard said. “There is also talk of creating a new classification of people — climate-displaced persons. But they wouldn’t be considered refugees under existing law.“

The post Planning to sink: What happens if Kiribati drowns? appeared first on PBS NewsHour.

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RACHEL TUTERA: My gender identity is really based in both my experiences as a woman– and also it’s just deeply rooted in the f– the fact that I’m masculine…

IVETTE FELICIANO: Rachel Tutera says it wasn’t until she started wearing boy’s clothes as a pre-teen, that she started to feel like the most authentic version of herself. Yet the 29-year-old says shopping for clothes in the men’s department left her feeling insecure and self-conscious. Nothing ever fit her proportions. So she was resigned to thinking that’s just the way it was.

RACHEL TUTERA: I got used to wearing clothes that hid me. I thought I would just end up being someone who would prefer to be overlooked, or not worth sort of a second glance.

RACHEL TUTERA: “Typically you show a little bit of cuff …”

IVETTE FELICIANO: After years of frustration shopping off the rack, Tutera decided to purchase her first tailored men’s suit…and she says the way she felt when she tried it on changed her life.

RACHEL TUTERA: Having something custom-made for my body basically reintroduced me to my body and I have felt, like, incredibly visible in a way that’s not just causing people to take a second look at me, but I think people see me in a way that may actually be aligned with how I see myself. And that has been the most, like, powerful, mind-blowing thing.

IVETTE FELICIANO: The experience made Tutera want to pass that feeling on to others. So she approached the New York based made-to-order-men’s suit company, “Bindle and Keep” convincing the owner that he was overlooking an under-served market…Not only masculine women, but also transgender men and other gender non-conforming people who want well-fitting, men’s suits. She soon became the company’s LGBTQ liaison, serving hundreds of people all over the country who sometimes spend up to 1,500 dollars for their custom made suit.

RACHEL TUTERA: This is not just a need that is being recognized in progressive cities.

IVETTE FELICIANO: Has it been emotional for any of your clients?

RACHEL TUTERA: Yes it has been emotional for sure. Shopping or wearing clothes seems like a really mundane thing. But actually it’s, like, incredibly meaningful and incredibly powerful and it can really, like, make or break an identity.

ANN PELLEGRINI: There are so many different ways to be gender nonconforming. And there’s an explosion of new vocabularies– to talk about it.

IVETTE FELICIANO: Ann Pellegrini is the Director of the Center for Gender and Sexuality at New York University.

ANN PELLEGRINI: Many gender non-conforming people don’t experience themselves as having been born into the wrong body. But– they might find themselves deeply uncomfortable with the kinds of straightjackets of gender. The ways in which, you know, you’re supposed to sort of present, again, this very narrow notion of femininity if you have a female body, a very narrow notion of masculinity if you have a male body.

IVETTE FELICIANO: She says recently there’s been an explosion of gender non-conforming people in mainstream media, challenging conventional gender roles.

KATIE COURIC: This is the first time an openly transgender person has appeared on the cover of Time Magazine…Why now do you think, Laverne?

LAVERNE COX: Because of the internet and because of social media trans people we our voices now, and we are letting our voice be heard.

JANET MOCK: I think that we are born and we’re assigned a sex at birth. That is a matter none of us have control over. But we do have control over our destinies and over our identities — and we should be respected.

IVETTE FELICIANO: Professor Ann Pellegrini believes that the growing visibility of gender-non-conforming people and the legalization of same-sex marriage in 19 states, has forced the fashion world to acknowledge the presence and buying power of the LGBTQ community.

ANN PELLEGRINI: The really short answer would be capitalism. At the end of the day it’s about seeing that there’s a market.

RACHEL TUTERA: I’ve met a lot of people who say things like they’ve been putting off getting married for ten years because they couldn’t fathom what they would wear.

IVETTE FELICIANO: Pew Research estimates that there have been more than 70,000 same-sex marriages since 2004, when Massachusetts became the first U.S. state to legalize them.

CRYSTAL GONZALEZ-ALE: So it’s our first full collection where we did shirts blazers pants, bathing suits, we did it all…

IVETTE FELICIANO: And that has meant new clients for start-up companies like Marimacho, a Brooklyn-based clothing line that designs classic menswear for the “unconventionally masculine.”

CRYSTAL GONZALEZ-ALE: I think there’s a stereotype of masculine women existing outside of fashion. It– it– sort of– takes them as, you know, perpetual teenagers that are always gonna be awkward and dressed in ill-fitting clothing.

IVETTE FELICIANO: Owners Ivette and Crystal Gonzalez-Ale, who are married, say investors laughed at their business idea at entrepreneurial mixers back in 2010. Yet the overwhelming support from their LGBTQ community allowed them to fund their project entirely without investors.

IVETTE GONZALEZ-ALE: From the moment we put up our website– folks have been pouring in emails about how important it is for them to have– clothing that’s appropriate for their gender.

IVETTE FELICIANO: And now many mainstream labels are following suit. In 2012, Ford Models chose female Olympic swimmer and New York artist, Casey Legler, as its newest menswear model. In the same year, Yves Saint Laurent chose a female model as the face of its Spring/Summer menswear collection. And just this year, luxury retailer Barneys New York featured 17 transgender models in its spring campaign.

ANN PELLEGRINI: None of these designers would be sort of trying to produce clothes that would appeal to masculine women if they didn’t think there were people who could walk in with a wallet and pull out a credit card.

IVETTE FELICIANO: Though mainstream designers are starting to cater to the needs of the LGBTQ community, some shoppers say that sort of acceptance hasn’t trickled down to their stores.

IVETTE GONZALEZ-ALE: Most of our customers have tried department stores where the dressing rooms are typically gendered and that is a really violent experience– to be removed from a dressing room or to be told that you don’t belong there because of your perceived gender.

IVETTE FELICIANO: What was surprising to you when just trying to shop at a store– and going into a fitting room?

RACHEL TUTERA: There’s a weird tendency in people to panic when they can’t tell if you’re a man or a woman, or how you or how you may identify.

IVETTE FELICIANO: Rachel Tutera says discrimination and judgment directed at people like her is often inevitable. That’s why two years ago she started a fashion blog called “The Handsome Butch”. The site hopes to empower readers with a simple message, which is that they too have “the right to be handsome.”

RACHEL TUTERA: It was almost like a meditation I had for myself when I was first shopping. It was, “I have the right to be here”. I think I just had to say over and over to myself, “you have the right to be handsome. You have the right to be handsome–” until it actually felt like a right instead of, like– like, a meditation I was trying to convince myself was true.

IVETTE FELICIANO: Tutera’s work will be featured in an upcoming documentary produced by Lena Dunham of the hit HBO series “Girls”. She says the one thing she won’t be tailoring in the coming months is her message.

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Nissan will recall more than 226,326  additional vehicles due to faulty air bags, the National Highway Traffic Safety Administration announced Saturday, expanding on a March recall of nearly one million vehicles.

The recall involves certain models released between 2002 and 2004, including Infiniti, Maxima, Pathfinder and Sentra cars, the company said in a statement.

The vehicles in the expanded recall have defective airbags manufactured by Japanese auto-parts supplier Takata, which have been known to break upon inflation, shooting metal fragments into the car, the company statement said.

A Nissan spokesman said the company is not aware of any injuries caused by the airbags and that the recall is a preventative measure, the Associated Press reports.

The Nissan vehicles in March were recalled after some airbags failed to deploy during a collision. The company said in a report to regulators that sensors were unable to detect an adult in the front passenger seat.

The recall, set to begin on August 11, will include both airbags that were installed in the cars at the factory and replacement models, the NHTSA said.

Nissan models from 2002 to 2004 in the expanded recall include:

Infiniti JX35 SUV 2013
Infiniti FX35, 2003
Infiniti FX45, 2003
Infiniti I35, 2002-2003
Infiniti QX42, 2002-2003
Maxima, 2002-2003
Pathfinder, 2002-2003
Sentra, 2002-2004

The 2013-14 recalled Nissan models from March include:

Altima 2013-2014
Leaf 2013-2014
Pathfinder 2013-2014
Serra 2013-2014
Taxi Van NV 2013

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Researchers on the Pacific Storm, a research vessel operated by Oregon State University, tagged blue whales near the Channel Islands of California in 2006. Credit: Craig Hayslip, courtesy of OSU Marine Mammal Institute, via Flickr

A new study says that changing shipping lanes may help prevent the injury or death of blue whales that accidentally collide with commercial ships in popular feeding areas.

In a 15-year study published in the journal PLOS ONE, marine biologists at Oregon State University’s Marine Mammal Institute studied the migration patterns of 171 blue whales using satellite technology. About one-quarter of the world’s 10,000 blue whales migrate in the Pacific Ocean off the West Coast.

To learn more, scientists attached satellite tags to the whales from 1993 to 2008. They discovered two areas off Los Angeles’ Channel Islands and San Francisco’s Gulf of the Farollones where whales and ships were likely to collide. The two “high-risk” areas are home to krill, or small shrimp-like food that blue whales depend on for their diet, as well as major shipping lanes.

“While the whales in this study generally occupied a wide region, most of the areas of highest concentration were close to large human population centers and busy port terminals,” the study said.

In September 2007, the National Oceanic Atmospheric Administration (NOAA) reported that ships had struck and killed three blue whales in the Santa Barbara Channel off the coast of Southern California.

Despite protections put in place by the International Whaling Commission in 1966, the report said the number of blue whales were not increasing at a significant enough rate for the species to sustain itself.

According to the report, “…the lack of evidence of substantial population growth during the past decades may indicate their recovery is being impeded, possibly by human impacts either indirectly through food chain interactions, or directly from physical interactions such as noise, or ship strikes.”

To reduce the likelihood of ship strikes, scientists suggest moving shipping routes southward, particularly during heavy feeding months from July to October. One suggestion included closing the northern shipping lane in and out of the ports in San Francisco Bay from August to November.

In 2003, Canadian authorities changed shipping lanes off of Nova Scotia, which led to a 90 percent reduction in collisions between the North Atlantic right whale and ships. In 2007, NOAA and the U.S. Coast Guard worked to enact the first regulations on shipping lanes in U.S. history, in order to protect the animal in waters around Boston Harbor.

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HARI SREENIVASAN: For more about the situation on the ground in Gaza, we’re joined once again tonight via Skype by Nicholas Casey of The Wall Street Journal. So, we’ve heard basically that all signs of the truce are off, that there is continued rockets being hurled at Israel from Hamas, and that the shelling continues from Israel on Gaza.

NICHOLAS CASEY: Basically, that’s what’s happening, unfortunately. I saw just right outside my hotel window three rockets from Hamas, or one of the affiliated groups, going out toward Israel. And most of the morning, we were getting bombarded really heavily right around this hotel.

We have no idea what the Israelis were trying to hit, but they were trying to hit it multiple times. So the sounds of the booms were so loud that it was shaking the windows, scaring everybody out of the rooms. And I’ve no idea what the situation was like just a couple of blocks away where these targets are getting hit.

HARI SREENIVASAN: There seem to be different motivations for both sides on whether to agree to a cease-fire or not.

NICHOLAS CASEY: There are. I think agreeing to these temporary cease-fires is most within Israel’s interest, because when the firing stops, Israel generally continues to go after the Hamas tunnels and have its troops still stationed within the Gaza strip for the promise from Hamas, that Hamas will attack it. Whereas for Hamas, its infrastructure, its weapons facilities and its tunnels continue to be destroyed by Israel as the people of Gaza get a small, brief break to get food and water. Whereas the troops from Israel remain in the Gaza strip, and it is unable to attack them by its own agreement.

HARI SREENIVASAN: We also received information today about a Red Cross building that was damaged. What happened there?

NICHOLAS CASEY: The Red Cross building a bit south of here that was torched. It’s not clear why people came after the Red Cross building, but the fact is what’s going on in Gaza now is that there’s a foreign army who’s attacking it. There are a lot of foreigners here who are trying to photograph, document and also help Gazans and there’s a tremendous feeling of frustration and entrapment here.

The other thing that had gone on was that there was a bit of anger toward the Red Cross based on some rumors that had gone around before the evacuation – or the attempted evacuation – of a U.N. shelter in the North of here in Beit Hanoun. I don’t know if this had anything to do with it, but what had happened was that there was a rumor going around that there were Red Cross vehicles that were going to get people out of the shelter. Then, as people were gathering, there was an attack on the shelter that killed 16 people.

One of the days that I was in the hospital where these people were being treated, there were people yelling at the Red Cross, saying ‘Why didn’t you come to rescue us?’ And the driver from the Red Cross was trying to explain that he himself couldn’t get into the area because it was too dangerous that day.

HARI SREENIVASAN: Alright, Nicholas Casey of The Wall Street Journal joining us via Skype from Gaza, thanks so much.

NICHOLAS CASEY: Thanks.

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Staff of the international aid organization, Samaritan’s Purse, put on protective gear at the ELWA hospital in Monrovia, Liberia. Dr. Kent Brantly, an American who was recently infected by Ebola, is currently being treated at that hospital’s isolation center. Credit: AFP Photo/Zoom Dosso via Getty Images

A second American citizen working to treat Ebola patients in Liberia has tested positive for the deadly virus, an international aid organization reported Sunday, amid the outbreak that has ravaged West Africa since March. 

Nancy Writebol, a North Carolina woman and an employee of the Christian humanitarian group, Serving in Mission, contracted the disease while working at a hospital in Monrovia, Liberia. She has been working in the region since March.

On Saturday, the North Carolina-based Samaritan’s Purse said that Dr. Kent Brantley, 33, a Texas doctor working at the same hospital, also tested positive for Ebola and was undergoing treatment at the isolation center in Monrovia where he worked.

The center will continue to remain open, the aid organization said in a press release.

The organization’s website says Writebol has two children and Brantly has worked as a family practice physician in Forth Worth, Texas, and is married with two children.

Earlier this week, Sheik Umar Khan, a leading Ebola doctor in Sierra Leone, was also infected with the virus. 

Occurrences of aid workers contracting the diseases they were trying to treat are common — something Dr. Brantly spoke out about earlier this year.

“In past Ebola outbreaks, many of the casualties have been healthcare workers who contracted the disease through their work caring for infected individuals,” Brantly said.

West Africa’s Ebola epidemic is now the deadliest on record, according to the World Health Organization, which said the virus has a mortality rate of about 60 percent and has lead to more than 660 deaths.

Responding to the outbreak has been particularly challenging for international relief organizations, as they routinely encounter violence and mistrust among West African communities.

Earlier this month PBS NewsHour’s Jeffrey Brown spoke with Laurie Garrett of the Council on Foreign Relations about the buildup of resentment against health workers trying to contain the Ebola outbreak. 

“It is a general fearfulness from the population,” Garrett said. “Widespread crazy rumors, such as the doctors are infecting people … and you have to stay away because they are ruining hospitals. All of this is making the problem absolutely catastrophic.”

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U.S. State Department releases satellite images it claims prove Russia fired artillery into Ukraine. Credit: U.S. State Department

WASHINGTON — Stepping up pressure on Moscow, the U.S. on Sunday released satellite images it says show that rockets have been fired from Russia into neighboring eastern Ukraine and that heavy artillery for separatists also has crossed the border.

The images, which came from the U.S. Director of National Intelligence and could not be independently verified by The Associated Press, show blast marks where rockets were launched and craters where they landed. Officials said the images show heavy weapons fired between July 21 and July 26 – after the July 17 downing of Malaysia Airlines Flight 17.

The four-page memo is part of the Obama administration’s push to hold Russia accountable for its activities in neighboring Ukraine and the release could help to persuade the United States’ European allies to apply harsher sanctions on Russia.

The timing of the memo also could be aimed at dissuading Russia from further military posturing. The Pentagon said just days ago that the movement of Russian heavy-caliber artillery systems across its border into Ukraine was “imminent.”

Russian officials have denied allegations of Russia’s involvement in eastern Ukraine. Secretary of State John Kerry spoke on Sunday with Russian Foreign Minister Sergei Lavrov, but details about their discussion have not yet been released by the State Department.

The U.S. images claim to show multiple rocket launchers fired at Ukrainian forces from within Ukraine and from Russian soil. One image shows dozens of craters around a Ukrainian military unit and rockets that can travel more than seven miles.

The memo said one image provides evidence that Russian forces have “fired across the border at Ukrainian military forces and that Russian-backed separatists have used heavy artillery provided by Russia in attacks on Ukrainian forces from inside Ukraine.”

Another satellite image depicted in the memo shows “ground scarring at multiple rocket launch sites on the Russian side of the border oriented in the direction of Ukraine military units within Ukraine.”

“The wide areas of impact near the Ukrainian military units indicates fire from multiple rocket launchers,” the memo said.

Moreover, the memo included a satellite image that it stated is evidence of self-propelled artillery only found in Russian military units “on the Russian side of the border oriented in the direction of a Ukrainian military unit within Ukraine.”

Tensions have run high in that region since Russia seized Crimea in March and Washington has been highly critical of Russian President Vladimir Putin’s behavior.

More recently, U.S. intelligence officials have said they have what they call a solid circumstantial case that Russian-backed separatists in Eastern Ukraine are responsible for downing the Malaysia Airlines plane. Citing satellite imagery, intercepted conversations and social media postings, officials say a Russian-made SA-11 surface-to-air missile hit the plane on July 17.

Moscow angrily denies any involvement in the attack.

U.S. officials said they still don’t know who fired the missile or whether Russian military officers were present when it happened. But until Sunday, they were unwilling to share evidence that the separatists had the technology to down a plane.

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HARI SREENIVASAN: For the latest from Israel we’re joined tonight from Jerusalem via Skype by Ruth Eglash of the Washington Post. So, what’s the latest?

RUTH EGLASH: Yeah, well it’s been a very up and down and day. This morning it looked like there was a ceasefire and it was holding for a little bit, even though there was still rocket fire coming from Gaza into Israel.

The Israeli government had ordered the military not to respond up until mid-morning and at that point the rockets just kept on coming and the government decided to instruct the military to continue on pounding Gaza with its airstrikes and from the sea. And also to continue searching and destroying tunnels that had been discovered under the ground between Israel and Gaza.

At around two o’clock today there was some word that Hamas was seeking a ceasefire and that proposal by Hamas was rejected by Israel. And then, overall the ceasefire attempts by the US—US Secretary of State John Kerry—has been as far as I know rejected, flatly rejected by the Israeli government here.

HARI SREENIVASAN: We’ve also heard that there have been attempts at infiltration along the border with Gaza

RUTH EGLASH: That’s been ongoing for the last three weeks. There has been—pretty much every few days—infiltration attempts, soldiers discovering tunnels inside the Gaza Strip, and militants managing to go through those tunnels and come out into Israel. That’s been pretty much constant for the last three weeks.

HARI SREENIVASAN: We’ve also heard that there was an attempted infiltration into Israel from the West Bank today.

RUTH EGLASH: Yes, I received around midday an update from the army that said a car carrying explosives had been stopped at a checkpoint near Jerusalem. The suspect was apprehended and the car was taken in for further investigation.

I don’t have any more details on that incident at this time but there has been large amounts of protests in the West Bank over the last few days and at least nine Palestinians killed during clashes with the Israeli security forces in the West Bank.

HARI SREENIVASAN: We’ve seen a couple of clips and images and videos of peace rallies in cities like Tel Aviv—is this gaining any traction? We also see social media campaigns as well.

RUTH EGLASH: Yeah, these have been happening since the beginning. There was always a small number of people in Israel who were speaking out against the war, saying that it wasn’t going to achieve anything.

Last night possibly was the biggest rally in Tel Aviv, roughly 3,000 people attended, and that rally was cut short when Hamas fired rockets towards Tel Aviv and the sirens went off in Tel Aviv forcing people to go into bomb shelters. But there is a consistent voice here but it’s very very small.

HARI SREENIVASAN: Ruth Eglash of the Washington Post joining us via Skype from Jerusalem this evening. Thanks so much.

RUTH EGLASH: You’re welcome.

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HARI SREENIVASAN: And now, Viewers Like You, your feedback about some of our recent work. Our signature story last Sunday about web-based incentive programs devised by behavioral economists and used by big financial institutions to try to boost savings prompted many skeptical comments.

Panayiotis Terzis wrote us on Facebook.

“Developing willpower on your own is probably a better idea than becoming even more dependent on the digital grid.”

Anthony who wrote us on our website added this:

“First you have to convince people to live within their means, create a realistic household budge, and stick with it.”

But most of the responses we got expressed distrust of, even disdain for other big financial institutions.

Debora Godden wrote us on Facebook.

“Good idea on the face of it, but with the track record of these monsters, I would advocate ‘trust but verify.’ And look at it from the standpoint of what these big financial guys figure they’ll get out of it.”

And we heard this from Marie Dixon:

“Hey! You first on that responsible fiscal practice, big banks!”

Others commented about the difficulty of saving in the first place.

A person identified as, Ransom O’Shields wrote: “What is this save money…did um we fix the problems of living hand to mouth for 100 million Americans?”

M K added this: “Perhaps personal savings are 1/2 of what they were a generation ago because the interest rate on savings accounts and bonds is about 0% now compared to 7% a generation ago. No amount of self-incentivizing gimmickry will change that.”

And Peter Piper shared a similar view on Facebook.

“Save what? Between low wages and high prices, what is there to save?”

As always, let us know what you think of our stories on Twitter, Facebook or at newshour.pbs.org.

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WASHINGTON — President Barack Obama and European leaders are conferring about next steps for dealing with the crisis in Ukraine.

The White House says Obama held a joint call Monday with German Chancellor Angela Merkel, French President Francois Hollande (frahn-SWAH’ oh-LAWND’), British Prime Minister David Cameron and Italian Prime Minister Matteo Renzi.

The call comes as the U.S. and European Union weigh tougher sanctions against Russia. The West accuses separatists in eastern Ukraine of shooting down a passenger jet earlier this month and blames Russia for supplying the rebels with equipment that can take down a plane.

Tougher U.S. sanctions are expected this week. The EU also reached a preliminary deal last week on sanctions that would target Russia’s access to European capital markets and trade in the defense sector and sensitive technologies.

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President Barack Obama walks with his wife Michelle Obama (R) and two daughters Malia Obama (L) and Sasha Obama (2R) through Lafayette Park to St John’s Church to attend service October 27, 2013 in Washington, DC. Photo by Shawn Thew-Pool/Getty Images

Malia barely reached up to her father’s shoulders when they moved to the White House nearly six years ago with her mother, little sister and grandmother. At 16, she stands nearly as tall as her 6-foot-1 dad and is visiting college campuses in preparation for that bittersweet day in the fall of 2016 when she trades her White House bedroom for a dorm.

She has been seen touring the University of California at Berkeley and the Palo Alto, California, campus of Stanford, where another president’s daughter, Chelsea Clinton, attended college.

In a commencement address to high school graduates in Worcester, Massachusetts, Obama said he’s practicing for what’s coming in two years. “So I’m trying to get used to not choking up and crying and embarrassing her. So this is sort of my trial run here.”

Obama said during a question-and-answer session with the chief executive of Tumblr, a social media site, that his daughter, like young people in general, should shop around for a college.

Malia goes into the 11th grade this fall at the private Sidwell Friends School in Washington. The Sidwell parent’s guide to college counseling suggests that juniors take the PSAT test in October, visit colleges as time allows, take the SAT exam in March and set up a family meeting with a college counselor in late spring, among other steps.

Michelle Obama is also thinking about her daughter’s departure. In a commencement-eve address to Topeka, Kansas, high school seniors, the first lady said: “Days like this make me think of my own daughters, so forgive me if I get a little teary.”

Chelsea Clinton and her mother, Hillary Rodham Clinton, toured some colleges together, at times attracting a horde and at other times going unnoticed. Then-President Bill Clinton never joined them, mainly because of the disruption that would have been caused by the large entourage that follows a president in public.

The prevalence of social media and cellphone cameras practically guarantees that Malia’s college search will be even more documented than Chelsea Clinton’s 17 years ago. In September 1997, more than 200 journalists showed up to cover her first day at Stanford.

Bill Clinton and his wife, who was Obama’s first secretary of state, were shocked when their only child chose to attend college some 3,000 miles away. Her parents were educated at East Coast universities — Georgetown for him and Wellesley for her — before they met at Yale Law School. And they thought Chelsea would follow their path.

In her syndicated newspaper column, Hillary Clinton wrote about her dread at having to say goodbye to Chelsea.

Malia’s journey into the next phase of her life will be a similarly emotional time for Obama, who grew up without his dad. He talks about his desire to be a “present” father for Malia and Sasha, 13, and how living in the White House enabled the family to spend more time together than ever before. The Obamas lived in Chicago when the girls were born, but he was often away in Springfield, Illinois, when he was a state senator, or in Washington representing Illinois as a U.S. senator.

Children already seem to grow up too fast, but it “happens more suddenly for a president and a president can feel cheated,” said Doug Wead, who interviewed 19 children of presidents for his book, “All the Presidents’ Children.” ”The president is feeling some angst over this, and rightly so.”

Already this summer, Malia has worked in Los Angeles as a production assistant on the set of “Extant,” a new CBS sci-fi thriller starring Halle Berry and produced by Democratic Party donor Steven Spielberg. She’s also learning how to drive.

Perhaps compounding emotions for the Obamas is that they, too, will follow Malia out of the White House shortly after she starts college.

His presidency ends in January 2017, a few months after she departs.

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Hisham Uadadeh enrolls in a health insurance plan under the Affordable Care Act at Leading Insurance Agency in Miami, Florida. Photo by Joe Raedle/Getty Images

“They said, ‘We take the old plan, but not the new one,’” says Perez, an attorney in Palo Alto, California.

In Plymouth, Indiana, Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.

Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect.

“It’s totally different,” said Pippenger, 57, whose new Anthem Blue Cross plan doesn’t pay for any care outside its network, although the job-based Anthem plan she had last year did cover some of those costs. “To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.”

Nationally, regulators and insurance agents are inundated with complaints, while state lawmakers are considering rules to ensure consumers’ access to doctors. For 2015 plans which will be on sale beginning in November, the federal Department of Health and Human Services said it will more closely scrutinize whether networks are adequate.

Insurers say they are simply trying to provide low-cost plans in a challenging environment. The new federal health law doesn’t let them reject enrollees with health problems or charge them more just because they are sick. So they are using the few tools left to them — contracting with smaller groups of hospitals and doctors willing to accept lower reimbursements; requiring referrals for specialty care and limiting coverage outside those networks.

“Obamacare products have lower prices than they would have if they had had [larger] commercial networks,” said Robert Laszewski, an industry consultant and former insurance executive. “They’re one-size-fits-all networks designed for low-income people accessing insurance for the first time.”

Lower Prices, Limited Choice
Lower monthly premiums made such plans attractive to many consumers on the new exchanges. Some chose tightly managed plans — often called health maintenance organizations (HMOS) or exclusive provider organizations (EPOS) – specifically because of their cost, in some cases, without realizing the tradeoffs.

Others had no choice.

Anthem, one of the biggest sellers of individual insurance, offers only HMO-like plans through the new markets in six of the 14 states it serves, including New Hampshire, where it is the only insurer. In California, where the insurer is the target of two class-action lawsuits, it offers plans with no out-of-network benefits in Los Angeles, San Diego and San Francisco, although another type of plan is available in other counties.

Anthem spokeswoman Kristin Binns said the insurer decided to move heavily into managed care in many of its markets after research showed most consumers, especially those who were uninsured, cared about price first and foremost.

“HMOs give them much more access than they were afforded before,” Binns said.

Still, she said Anthem expects to roll out plans with out-of-network coverage in 2015 in some areas where it does not offer them. She would not specify the regions.

Other insurers made similar decisions, offering managed care plans as the only choice for residents buying through the new marketplaces in entire counties in Indiana, Georgia, South Carolina, Virginia, Florida, Wisconsin and Mississippi, according to government data analyzed by Kaiser Health News. Nationally, 43 percent of mid-level “silver” plans offered in California, New York and 34 states using the federal marketplace have no coverage outside their networks, a study by the American Cancer Society Cancer Action Network found.

“They’re all doing it,” says Wall Street analyst Ana Gupte of Leerink Swann, an investment bank. “Obamacare is putting pressure on their margins, so they’re on the hook to moderate costs.”

But along with consumers, lawmakers and regulators have begun to push back.

In California, managed care regulators are investigating Anthem and another insurer, Blue Shield of California, after receiving numerous complaints about access to doctors and hospitals.

Lawmakers in 22 states debated laws this year and last related to network adequacy, although the vast majority failed to pass, according to the National Conference of State Legislatures. In Washington state, administrative rules announced this spring require insurers to provide enough primary care doctors so enrollees can get an appointment within 10 days and 30 miles of their home or workplace. Directories of participating providers must be updated monthly.

“I have heard from many consumers … who were upset to find their health plan no longer included their trusted doctor or hospital … and some discovered this only after they enrolled,” Washington Insurance Commissioner Mike Kreidler said in an announcement of the rules in April.

Scrambling To Find Doctors

Brian Liechty of TCU Insurance in Plymouth, Indiana, said he has helped “hundreds” of clients sign up for tightly managed plans – including Pippenger, when her work-based plan was discontinued.

“For the right person who is willing to go where they must and live with rules, it allows them to buy a health insurance policy they could never touch before,” he said.

Patient advocates agree that managed care can be done well but caution that some policies could leave patients scrambling to find doctors – and on the hook for thousands of dollars if they go out of network.

“If highly specialized care — an academic medical center or a cancer center — is not available in a plan’s network … some plans will send you to an out-of-network provider, but it’s not required,” said Laura Skopec, senior policy analyst at the cancer action network.

Going out of a managed care plan’s network often means patients foot the entire bill, which can be financially devastating in cases of serious illness. In other types of insurance plans, a portion of the out-of-network bill might be covered, but consumers still face sharply higher costs than if they see a network provider.

Pippenger said that because she was in pain and knew she might need surgery, she checked the provider directory for her new plan, looking for an orthopedic surgeon within 30 miles. She found five who specialized in hips and knees, but felt anxious because she knew nothing about them.

“I want to go back to the doctor who did my other knee,” she said.

She paid for an initial consultation with him, but realized she couldn’t afford the cost of having him fix her second knee.

Adding to the problem this year were some plans’ incomplete or inaccurate lists of participating doctors and hospitals.

Perez, 46, bought her insurance through California’s state-run website. Before enrolling, the immigration attorney says she was assured by the plan and her doctors that they were in Anthem’s network. Only later did she find out that none of those affiliated with her local hospital, Stanford Medical Center, are in it.

Perez said she was unable to find a doctor affiliated with Stanford or another nearby hospital, so she filed a complaint with state regulators and was granted a waiver to switch plans.

“I’ve been paying a premium since March for medical care that I’ve never been able to access,” she said.

The post Marketplace shoppers discover new health plans have many limitations appeared first on PBS NewsHour.

Illustration by Getty Images

Scientists at Aberystwyth University in the United Kingdom tested the germ-exchange rates of handshakes, fist-bumps and high-fives to determine which mode of mano-to-mano contact spreads the most bacteria. In the study, one participant wore a sterile glove and exchanged various types of hand contact with other study participants. The sterile glove was analyzed and the number of bacteria present were counted.

The results showed that fist-bumps transferred a tiny fraction of the germs handed off during a handshake. High-fives transfer about half as many germs as a firm shake.

“Adoption of the fist-bump as a greeting could substantially reduce the transmission of infectious diseases between individuals,” said co-author, David Whitworth, PhD.

The handshake has been under fire by the medical research community as of late, with an article in JAMA calling for a ban on hand-to-hand greetings published in June.

Hand-hygiene in hospitals is a topic of intense study due to the emergence of more types of antibiotic-resistant bacteria, the negative environmental effects of antibacterial soaps and the realization that simple cultural changes could help to reduce the risks of infection in the first place.

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