AMNA NAWAZ: Good evening.

I'm Amna Nawaz.

GEOFF BENNETT: And I'm Geoff Bennett.

On the "News Hour" tonight: President Trump announces sweeping new tariffs that could shake up the U.S. and global economies.

AMNA NAWAZ: Republicans hold on to two key seats in Congress, but Democrats beat Elon Musk's chosen candidate for the Wisconsin Supreme Court.

What the elections say about voter sentiment.

GEOFF BENNETT: And how private equity's increasing role in health care is affecting patients.

ROSEMARY BATT, Cornell University: This has happened in many industries, but it is particularly serious when it has moved into social goods such as health care, where people's lives are at stake.

(BREAK) GEOFF BENNETT: Welcome to the "News Hour."

President Trump announced major new global tariffs today, 10 percent on all imported goods into the U.S., and he escalated trade wars with a second set of sweeping tariffs for about 60 countries.

AMNA NAWAZ: During a speech in the Rose Garden, he also issued retaliatory tariffs against many countries in response to what he called unfair trade practices involving trade barriers and other policies.

The rates varied considerably, but were quite high in some cases, including a 34 percent tariff on China, 20 percent for the European Union, 24 percent for Japan, and 46 percent for Vietnam.

The president called it an historic day and said the tariffs would revitalize manufacturing in the U.S. DONALD TRUMP, President of the United States: It's our declaration of economic independence.

For years, hardworking American citizens were forced to sit on the sidelines as other nations got rich and powerful, much of it at our expense.

But now it's our turn to prosper.

Jobs and factories will come roaring back into our country, and you see it happening already.

We will supercharge our domestic industrial base.

We will pry open foreign markets and break down foreign trade barriers.

AMNA NAWAZ: As part of today's announcement, the president declared a national economic emergency, which the White House says gives him the authority to impose the tariffs.

To help us understand more about all of this, I'm joined again by Roben Farzad, economic analyst and host of public radio's "Full Disclosure."

Great to see you here, Roben.

ROBEN FARZAD, Host, "Full Disclosure": Thank you.

AMNA NAWAZ: So let's just get your reaction to these announcements.

Big picture, is this better or worse than what folks were anticipating?

ROBEN FARZAD: It's slightly better than what people were expecting, but the headlines have been so volatile, and he's been shucking and jiving and changing directions and being positive about it and being bearish about it on other days.

So a lot was building up to April 2, so it could have been a lot worse.

AMNA NAWAZ: So the president held up that chart that we saw that was handed out to journalists as well.

It listed all the tariffs that have been imposed on the U.S. by each country and then the tariff that the U.S. would Levy in response.

What stood out to you about this when it comes to the president's approach to these tariffs?

ROBEN FARZAD: You know, I'm reminded of a tableau.

It was Bill Clinton, President Bill Clinton, I believe, in 1993, signing NAFTA.

And he was surrounded by Bob Dole, Al Gore, I think George Bush Sr.

There was so much unanimity over this new world order.

And we were approaching the other -- China entering the World Trade Organization, and the gains from trade that used to be something that a moderate Democrat and left-wingers and right-wingers could nominally agree on.

And here you have Trump, really with gusto, shattering that idea of new world economic order that's been building for the past 40 years.

And he did it in one fell swoop.

So there's no real playbook for this.

We could look back to the Depression and the Hawley-Smoot tariff and various other things that happened.

But we have never had anything just line up in one day just in staccato fashion like this.

And I'd be very curious to see what the reaction is from finance ministers across the planet and multinationals over the coming week.

AMNA NAWAZ: Yes.

Do you get a sense from what we know so far about what industries could be hardest hit and also what consumers should anticipate?

ROBEN FARZAD: Well, look at cars already, right?

I mean, everybody has been anticipating something coming down the pike.

We have already seen, as you and I have discussed before, significant inflation through the pandemic in car prices, what $40,000 or $50,000 can tell you.

And so much of this is perception and self-fulfilling prophecy.

If you're a car dealership or a chain of dealerships and you have only so many things on the lot and various things on a CSX rail car and other things on tankers coming over, you're going to covet that supply.

And there are going to be many people that are afraid and maybe want to pull forward a car purchase.

Again, what is an American car?

What is a Japanese car?

Many great Subarus are made in Indiana, right?

Volkswagen, Mercedes, Toyota, they have plants here in the United States.

There will be a tremendous amount of confusion and it might be like kind of buy first, ask questions later.

AMNA NAWAZ: So that baseline 10 percent tariff goes into effect pretty soon, midnight on April the 5th.

The other additional retaliatory tariffs go into effect about a week from now.

It's a pretty short timeline.

What does this mean for the countries and the companies impacted here in terms of what they can do to get ready?

ROBEN FARZAD: Well, a little bit nefariously, it provides some cloud cover to companies who want to hike prices.

We saw that.

They called it greedflation disdainfully during the pandemic.

But if you're in there and saying, well, we're more uncertain about our supply chain than we were last week, so we have an interest with our shareholders to hike the price.

I mean, any car dealership, if you're an American car manufacturer, you can hike prices in reaction to the expected hike.

And, indeed, the president himself said, let them hike.

Let the Big Three hike.

And you saw the head of the AFL-CIO said it's not so bad if he hikes.

So I'm worried about that echo chamber, that reaction.

But this has hit -- it's going to hit places like pharmaceuticals, shampoos, everyday products, certain produce items that you took for granted, or textile items and towels.

It's not easy to just turn around and reshore these jobs and these factories over the course of six months.

It takes years.

AMNA NAWAZ: We saw the president also mention in his remarks that his policies are bringing down inflation.

We should point out, in fact, that inflation has picked up in the first few weeks of the Trump administration.

But when you look at the tariffs and as they go into effect, what could be the impact on inflation ahead?

ROBEN FARZAD: Why wouldn't it add to inflation?

I don't understand.

It could become deflationary if everybody panics and stops spending.

And the Fed's like, OK, we got rid of inflation.

But that's a pretty blood-eyed move.

I mean, it's a roundabout way of destroying the economy.

There are easier ways of destroying the economy and getting interest rates down.

So that could arrest inflation.

But I have never seen that playbook before.

AMNA NAWAZ: There's also the underlying argument by the Trump administration here that there could be short-term pain, but this is for long-term gain, that this will spur domestic manufacturing in the United States.

Have you seen evidence of that anywhere?

Could it have that impact?

ROBEN FARZAD: You know, we did see since -- even in -- look at all the companies that have onshored here, especially in auto manufacturing, I'm not convinced that in lower-value added things such as textiles - - there used to be towel towns.

There used to be sofa towns in North Carolina.

It is brutally hard to bring those things back.

When you source the fiber and the labor and the railroad tracks that have been left abandoned for several years -- you go down the Eastern Seaboard and see these abandoned facilities.

It's not like you can just light them up over the course of two weeks.

I mean, this is a play that takes decades.

AMNA NAWAZ: Roben Farzad, host of public radio's "Full Disclosure," thank you so much for being here.

Great to have you here.

ROBEN FARZAD: My pleasure.

Thank you.

GEOFF BENNETT: We start today's other headlines in Myanmar, where the death toll from the devastating earthquake last week has now surpassed 3,000, and as relief efforts have been hampered by that country's civil war.

Today, the ruling military took to state television to call a temporary cease-fire to aid in the recovery.

It will last until late April, though the sides still reserved the right to fight in self-defense.

That's as survivors were still being pulled from the rubble today, five days after Friday's 7.7-magnitude quake.

Neighboring and competing powers like China and India have stepped in with rescue teams, even as hope fades.

KAVITA SINGH, Indian Rescuer (through translator): There is zero possibility of finding survivors.

It is the fifth or sixth day after the earthquake and the weather is extremely hot.

We have only recovered bodies so far.

GEOFF BENNETT: The U.S. has sent a three-person team to Myanmar and pledged $2 million in emergency aid.

A group of Democratic senators sent a letter to the Trump administration criticizing what they called the paltry U.S. aid response.

Israeli leaders say their military will establish a new security corridor across Gaza and would be, in their words, seizing large areas to add to the security zones.

Israeli Prime Minister Benjamin Netanyahu is calling it the Morag Corridor, invoking the name of a Jewish settlement that used to sit between the southern cities of Rafah and Khan Yunis, suggesting the corridor would run between them.

Meantime, local hospitals say more Israeli strikes overnight killed at least 40 Palestinians, including nearly a dozen children.

The U.N. says Israeli evacuation orders since fighting resumed have rendered more than 60 percent of Gaza inaccessible to its people.

Denmark's prime minister spoke out against President Trump's ambition to take control of Greenland today during a visit to its capital, Nuuk.

She also pledged to stand with the semiautonomous territory, saying that it belongs to Greenlanders, not the U.S.

It comes after Vice President J.D.

Vance visited a U.S. air base there last week.

He criticized Denmark for underinvesting in the territory and failing to keep the island safe.

Back in this country, a U.S. official confirmed to the "PBS News Hour" that senior Russian negotiator Kirill Dmitriev was at the White House today.

He's the top economic and investment envoy in Moscow, the chief of Russia's sovereign wealth fund, and a close adviser to Russian President Vladimir Putin.

Dmitriev met with U.S. special envoy Steve Witkoff about the ongoing cease-fire effort in Ukraine.

He's the most senior Russian official to visit the White House since Russia invaded Ukraine back in 2022.

The administration has not said what came out of the meeting.

A federal judge officially and permanently dismissed the corruption charges against New York City Mayor Eric Adams today.

Judge Dale Ho did so with prejudice, meaning the charges cannot be refiled.

Still, the judge blasted the Trump Justice Department for what he called its troubling rationale in dropping the case so the Democratic mayor could help with the Trump administration's immigration crackdown.

Adams for his part celebrated the decision outside the mayoral mansion this afternoon.

ERIC ADAMS (D), Mayor of New York: This case should have never been brought.

And I did nothing wrong.

I'm now happy that our city can finally close the book on this and focus solely on the future of our great city.

GEOFF BENNETT: Adams also said he will run for reelection against a crowded field that also includes former New York Governor Andrew Cuomo.

That Democratic primary is a little less than three months away.

The head of Boeing told lawmakers his company made what he called serious missteps in recent years amid heightened scrutiny after a door panel blew off a 737 MAX jet last year.

After the incident, the FAA imposed a manufacturing cap on the model of just 38 planes per month.

Boeing says it has yet to hit that ceiling this year.

At a Senate hearing today, Boeing CEO insisted that improving safety, not production rates, is the company's main focus.

KELLY ORTBERG, CEO, Boeing: We can't just fix the defects.

We have to get to root cause and make sure the defects go away.

I'm not pressuring the team to go fast.

I'm pressuring the team to do it right.

WOMAN: Thank you.

KELLY ORTBERG: That's the most important thing we can do at this point.

GEOFF BENNETT: Boeing recently won the contract to build the Air Force's future stealth fighter jet, the F-47, but its timetable to build two new Air Force One planes is running behind schedule.

And its Starliner spacecraft suffered technical issues last year, failing to safely return two astronauts from the International Space Station.

On Wall Street today, stocks swung higher ahead of President Trump's announcement on tariffs.

The Dow Jones industrial average climbed by more than 230 points.

The Nasdaq gained 150 points, or nearly 1 percent.

The S&P 500 rebounded from an early loss to finish up on the day.

And a passing of note tonight.

Val Kilmer has died.

The gifted actor was once the youngest ever accepted to the prestigious Juilliard School, and those who worked with him marveled at his range.

VAL KILMER, Actor: I don't like you because you're unsafe.

TOM CRUISE, Actor: That's right.

GEOFF BENNETT: Often playing the brooding antihero, he was Iceman, the hotshot pilot opposite Tom Cruise in the "Top Gun" movies.

NICOLE KIDMAN, Actress: What is it about the wrong kind of man?

VAL KILMER: It's the car, right?

Chicks love the car.

GEOFF BENNETT: And at the height of his career in the 1990s, he played the Dark Knight in "Batman Forever.'

Known to immerse himself in his roles, Kilmer blasted the psychedelic music of "The Doors" for a whole year when he portrayed the band's front man, Jim Morrison.

Kilmer survived a 2014 throat cancer diagnosis and underwent two tracheotomies.

The actor's family said he died from pneumonia at his home in Los Angeles.

Val Kilmer was 65 years old.

Still to come on the "News Hour": former Secretary of Health and Human Services Kathleen Sebelius on the Trump administration's cuts to the agency; the Supreme Court hears a case that could change access to reproductive care through Medicaid; and West Philadelphia works to address neighborhood problems and threats to democracy through art.

AMNA NAWAZ: A trio of off-cycle election results show the president and his party losing political ground, even as they won two of the three races.

GEOFF BENNETT: Political correspondent Lisa Desjardins has a look now at the message sent by voters in Wisconsin and Florida.

LISA DESJARDINS: The most expensive judicial race ever for a pivotal but technically nonpartisan seat on Wisconsin's Supreme Court ends in a victory lap for Judge Susan Crawford and Democrats nationwide.

SUSAN CRAWFORD, Wisconsin Supreme Court Justice-Elect: As a little girl, growing up in Chippewa Falls, I never could have imagined that I'd be taking on the richest man in the world.

(LAUGHTER) SUSAN CRAWFORD: And we won.

LISA DESJARDINS: That richest man reference is not about her actual opponent, Judge Brad Schimel, but Elon Musk.

The billionaire sunk more than $20 million of his personal wealth into the race, as out-of-state money poured in from both sides of the aisle.

Ultimately, voters clearly chose Crawford 55 percent to 45.

BRAD SCHIMEL, Wisconsin Supreme Court Candidate: I have called judge and conceded.

MAN: No, no.

WOMAN: No.

BRAD SCHIMEL: No, no, no.

You have got to accept the results.

SANDY BAKA, Wisconsin Resident: We have a lot of people who need to get a little bit more in the game on the Republican side.

They tend to vote every four years in a presidential election.

And we need people to stay tuned in.

LISA DESJARDINS: In Wisconsin, the race is likely to influence the future of abortion access there, as well as redistricting for and possibly the balance of power in Congress.

Zac Schultz covers politics for PBS Wisconsin.

ZAC SCHULTZ, PBS Wisconsin: I think everyone expects to see some challenges make their way up to the court that will look to redraw what is currently a 6-2 majority for Republicans in our congressional seats.

LISA DESJARDINS: The race is also another salvo in the role big outside money plays up and down the ballot.

ZAC SCHULTZ: Elon Musk can attract attention and he can bring out voters, but he does it for both sides of the aisle.

I don't think there's any doubt he juiced conservative turnout for Brad Schimel's campaign, but speaking to a number of liberals and Democrats over the last few days, he juiced turnout on the liberal side as well.

LISA DESJARDINS: Musk downplayed the loss, posting that the most important thing was a ballot measure cementing the state's voter I.D.

requirement.

On that, the state voted by an even larger margin, 62 percent to 37 percent, to amend the state's constitution and require photo I.D.

at the polls.

That's something conservatives see as a win, along with two wins from voters in Florida.

RANDY FINE (R), Florida Representative-Elect: People don't know me that well.

President Trump asked you to vote for me, but now it's incumbent upon me over the next two years to show you that I am worthy of that trust.

LISA DESJARDINS: Businessman and state lawmaker Randy Fine won a special election to fill a vacancy left by now-National Security Adviser Michael Waltz.

That was in one of two special elections held in Florida congressional districts, where Trump won by 30 and 37 points less than five months ago.

But Republicans won last night by half that or less.

RANDY FINE: I won, last time we looked, by 14 points, so I think it's hard to say that's an underperformance.

LISA DESJARDINS: Joining Fine will be Florida's chief financial officer, Jimmy Patronis, filling the seat vacated by former Congressman Matt Gaetz.

Those wins give Speaker Mike Johnson a bit more wiggle room, but a still historically tight margin in the House.

GEOFF BENNETT: And Lisa Desjardins joins us now from Capitol Hill.

So, Lisa, what do these special elections for Congress?

LISA DESJARDINS: I think there are two important ways to think about these elections, first what they mean for the chamber right now.

And I mean right now.

This is video of something that happened moments ago, the two Florida winners, Republicans, being sworn in to fill those vacant seats.

Now, that changes the margins in the House right away.

So let's look at what that does specifically.

Before today, the Republicans had just a two-vote margin in the House.

They had 218 votes.

Now they have got a three-vote margin.

That might not sound like a big deal to us, but that's a huge deal to Speaker Johnson.

They have 220 votes.

Now, I will caution people, this is going to change again.

There are two Democratic-leaning seats that are vacant.

Those special elections will change things.

But this is likely the largest majority that House Republicans will see, at least for the foreseeable future.

Now, that brings us to the next most important point, which is what this says about the House Republicans' ability to hold on to the chamber after the next midterm elections.

Democrats see a real opportunity from what happened, especially in Wisconsin, because they note that Trump was not on the ballot there or in Florida.

And, in fact, those margins for Republicans either were not what they wanted or smaller than they wanted.

Democrats think then, with Trump not on the ballot again in the midterm, his voters won't come out and they have got a real opportunity to reclaim the chamber.

GEOFF BENNETT: Well, tell me more about that.

Big picture, what lessons are the national parties taking away from the House from this?

LISA DESJARDINS: Republicans will say the lessons is that Democrats have kind of gone too far on issues like voter I.D.

They point to that in Wisconsin as a real win for them, but really it's Democrats who seem to have found the biggest lessons from what happened, especially in Wisconsin.

It was interesting.

I talked to one left-leaning group who works on elections, works in kind of that campaign field.

They had their biggest day in history because of this Wisconsin vote.

And they said the lesson is that voters are rejecting the idea that Elon Musk, billionaires can buy their way into the election.

That's something Democrats think they can run on.

This is a Democratic Party that's been struggling to respond to Trump.

They feel like maybe they're getting their footing.

Another part of that, of course, is Senator Cory Booker of New Jersey taking to the Senate floor, speaking for more than 25 hours, setting a record.

The Democrats and those opposing Trump have wanted action.

They're seeing the first beginnings of that, maybe a framework going ahead, so say Democrats.

GEOFF BENNETT: Meantime, Lisa, Senate Republicans are taking steps toward passing key parts of the Trump agenda.

Bring us up to speed.

What's happening?

LISA DESJARDINS: Right.

OK.

So to pass all of the Trump agenda, especially those tax cuts, you have to get a budget resolution through Congress.

And today Senate Budget Chairman Lindsey Graham put out his compromise version.

This is a very big deal.

He told me exactly what is in it.

So let me go through this.

This is a version that would extend the current Trump tax cuts, make them permanent.

It would expand those tax cuts as well.

They haven't said exactly how yet, but it would raise the national debt ceiling $5 trillion.

We know that something conservatives generally don't like, but that would be part of this.

Now this is something we're going to watch closely the next two days.

This could pass as quickly as this weekend, but, meanwhile, to do this, Republicans say they may ignore the cost of extending the Trump tax cuts altogether.

That is an unprecedented budget move.

It is untested.

And it would be kind of a nuclear type of option, that from the same Republicans who in the past have really decried when Democrats have threatened to change the rules in similar ways.

GEOFF BENNETT: Yes, more to come on that.

But you have Senate Democrats who are poised to pass this bill that is a rare vote of disapproval on the Trump tariffs on Canada, and the Democrats have some support from Republicans on this?

Tell me more about that.

LISA DESJARDINS: Yes, let's go through this.

We're giving folks a lot of news tonight, but this is on the tariff news of today.

The Congress has the power to pull back an emergency declaration from the president.

And that's what the Senate will vote on today, whether to object to or reverse the emergency declaration involving Canada.

Now, this does require a majority vote.

And look at this.

There are four Republicans who have said they are in fact against what Trump is doing with Canada.

You can see their names there.

These are folks that have voted against some Trump policies in the past.

So if this passes the Senate, it is symbolic, however, because the House is not expected to take this up.

This move would end the Trump tariffs on Canada, but because the House won't take it off, it's symbolic.

It shows there is some Republican opposition to these tariffs, but it also shows it is a small group of Republicans saying that publicly.

GEOFF BENNETT: Lisa Desjardins tracking it all for us tonight from Capitol Hill, thanks, as always.

LISA DESJARDINS: You're welcome.

AMNA NAWAZ: There's growing concern over massive cuts to the Department of Health and Human Services, as Secretary Robert F. Kennedy Jr. works to reduce the agency work force by 25 percent.

The "News Hour" has invited Secretary Kennedy multiple times to join us on the show.

His office has not yet responded.

But among the cuts are 3,500 jobs at the FDA, which regulates food and medicine safety, 2,400 at the CDC, the national public health agency, and 300 jobs at the Centers for Medicare and Medicaid Services, which oversees those programs and the health insurance marketplaces.

For one view on all of this, we turn now to Kathleen Sebelius, the HHS secretary during the Obama administration.

Secretary Sebelius, welcome to the "News Hour."

Thanks for joining us.

KATHLEEN SEBELIUS, Former U.S. Health and Human Services Secretary: Well, thanks for having me, Amna.

AMNA NAWAZ: So, as you have probably heard, Secretary Kennedy says that he can lose 20,000 workers, that's about 10,000 through cuts, another 10,000 through retirements and buyouts, without affecting the services that the agency provides.

This is an agency you have run.

Do you think that can be done?

KATHLEEN SEBELIUS: Well, unfortunately, Amna, to me, it's another indication of how little Senator -- Secretary Kennedy understands about this massive agency.

HHS is intertwined with state governments, with local governments, with tribal governments.

And it's not just about losing some nameless, faceless bureaucrat in Washington, D.C. What the massive layoff will mean is that you lose expertise, you lose timeliness, you lose an opportunity to get not only the best products to market in a very fast manner, but a food outbreak that could occur anywhere in the country.

That's part of the FDA's job, is that they work with industry to quickly get those foods off the market, so my kid doesn't get harmed by the peanut butter.

Here in the heartland, in Kansas, we're going to lose health employees from the CDC who have been working closely with our local health offices to monitor outbreaks, to keep vaccines up to date, to make sure that data is shared from state to state.

Those employees are all over the country.

They will suddenly be gone.

We're going to go into hurricane and tornado season very shortly.

The first people on the ground when a disaster hits are from the CDC.

They make sure the water is safe, so people can go back and relocate.

We're talking about real impact at every point in the country.

And, unfortunately, after six weeks, my guess is Kennedy has not only not visited the 13 divisions, but he really doesn't know or doesn't care what the people do.

AMNA NAWAZ: We should note that these cuts will now downsize the agency to some 62,000 positions that would remain.

Secretary Kennedy has also made an economic argument for these cuts.

He has said that HHS is the biggest agency in the government.

He said it's twice the size of the Pentagon with $1.9 trillion, suggesting that these job cuts could help to tame the budget.

Could they?

Do you see that point?

KATHLEEN SEBELIUS: Most of the money that is in the HHS budget goes out the door.

It's the largest transfer of federal funds to states through Medicaid, childcare grants, mental health block grants, Agency on Aging, help and support, home health services.

So, this is not money that's hiring people inside of D.C. offices.

It's money that really is essential to health services in every state in the country and in tribal governments throughout our land.

So, cutting the budget really is not about people, as much as it's about really harming the services that go out to American folks.

If the personnel isn't there to make sure that Medicare payments go out on time, to make sure that people can enroll and get the health insurance that they're entitled, to make sure that the block grants go out on childcare and mental health services, those services grind to a halt.

And it hurts everyday Americans who desperately need the health services that HHS helps to deliver.

AMNA NAWAZ: We have also heard a top adviser to Secretary Kennedy make an argument that he says the agency has basically been failing in its mission to the American public.

He points to rising rates of chronic disease, to lower life expectancy in recent years, and also a culture that he claims is too quick to medicate patients without addressing underlying causes for the disease.

What's your response to that argument?

KATHLEEN SEBELIUS: Well, I don't think there's any question America spends more and in some ways has a lower return on investment than most of our competitive Western European nations.

We have a very expensive health care system, again, not because of HHS.

Private insurers have a lot more overhead and a lot less return on the dollar.

There's been a real pivot since the passage of the Affordable Care Act in 2010 to preventive services, to look at the underlying causes of obesity and heart disease, to invest in healthier foods, more exercise programs, programs that actually do diabetes prevention, instead of waiting and treating the disease.

I think those efforts are really important.

I'd love to see us double down on prevention services and pay more to keep people healthy than treat them when they're sick.

That's great.

But you can't tell the measles that is now breaking out throughout the country -- we have our first measles cases in 15 years in Kansas, and it's an alarming rate of spread.

You can't tell an infectious disease just to stop because we're going to focus on diabetes.

We have to be able to walk and chew gum at the same time.

We have to be able to do multiple things.

Infectious diseases will come.

Disasters will come.

And chronic disease is here to stay.

So all those efforts are critically important.

He is clearing out of agencies, from what I can read and ascertain, the top tier of expertise, not people who came in as politicals with one or another administration, but people who had been working in these fields for a long time.

AMNA NAWAZ: As you know, this is all part of the Trump administration's plan and agenda to try to cut what they call bloat in the federal government work force.

You have led this agency, so I have to ask, if there were changes you would suggest that need to be made at HHS, what would those be?

What should change?

KATHLEEN SEBELIUS: Well, I think any good CEO, private or public company or government, looks constantly at ways to be more efficient.

Can -- are there redundant jobs?

Can you put people together?

I was amused by some of the suggestions that agencies work more closely together that are in very different locations.

Some are in Washington, D.C.

Some are in Atlanta.

And while that's an interesting theory, it's very difficult to conduct that mission.

But constantly reviewing what can we do better and really keeping the consumer front and center, the patient front and center, what services can we deliver more timely and more effective to the American public, not where my grudges, where I want to dispute old and long-term scientifically proven vaccines, safety and effectiveness.

I mean, I think this agency is quickly, unfortunately, going off the rails with leadership who has a very clear agenda, doesn't know really what happens throughout the breadth of this organization, and is likely to do a lot of unintended harm by slashing expertise, slowing down approvals of vaccines and cosmetics and food and drugs, not being able to respond in a timely fashion to food outbreaks or natural disasters.

We're going to be in a very vulnerable situation.

AMNA NAWAZ: That is the former Secretary of Health and Human Services Kathleen Sebelius us tonight.

Secretary Sebelius, thank you for your time.

Really appreciate it.

KATHLEEN SEBELIUS: Thank you.

GEOFF BENNETT: The U.S. Supreme Court heard arguments today in a case that could dramatically change how Medicaid recipients can choose their own medical providers.

The case went before the court after South Carolina attempted to remove Planned Parenthood clinics from the state's Medicaid program since it also provides abortions.

Special correspondent Sarah Varney joins us now.

Sarah, it's good to see you.

So, the technical legal issue before the justices deals with whether people who use Medicaid, the low-income assistance program, can choose their providers.

But tell us about this case, which tests whether South Carolina is legally allowed to cut off Medicaid funding for Planned Parenthood.

SARAH VARNEY: So, this case actually goes back to 2018, when the Republican governor then signed an executive order terminating Planned Parenthood's participation in the state's Medicaid program because it separately funded abortions.

The clinics challenged this executive order.

They won at the lower courts.

And it's been appealed and appealed, and it finally made it to the Supreme Court.

GEOFF BENNETT: The conservative justices at one point seemed to question whether they should weigh in on this case, arguing that it's not the justices place to rule on funding arguments.

We spoke with our Supreme Court analyst, Marcia Coyle, earlier today.

Here's what she said.

MARCIA COYLE: They're concerned because this is what we call spending clause legislation, Medicaid, the Medicaid Act.

And it's Congress, as Justice Alito pointed out, that creates rights and remedies, not the courts, which is why they're kind of stingy about finding these private rights of action and have been for a very long time.

GEOFF BENNETT: Was there any indication as to how the justices might rule in this case?

SARAH VARNEY: I think it was very difficult to understand or to discern how the court is going to rule in this particular case.

You did hear a lot of questioning from the liberal justices about this idea that Congress was trying to solve a problem when it created this law, that many states were actually limiting their Medicaid networks.

They were saying Medicaid beneficiaries could only go to state-run facilities or creating a very small network, and that this law was actually put into place to expand that network.

So why would -- if you're trying to understand Congress' motivations, why would you say that a stake then could jettison a provider outside of the network if it was in fact willing to participate?

GEOFF BENNETT: And this isn't the only reason why Planned Parenthood is in the spotlight this week.

As you well know, the Trump administration is withholding tens of millions of dollars from Planned Parenthood clinics that provide contraception, STI testing, other health services to low-income Americans.

How does this play into the broader GOP push against Planned Parenthood?

SARAH VARNEY: So this effort to defund Planned Parenthood, which is a phrase you will see across Christian conservative media, has been really going on for decades.

In the first Trump administration, they actually changed the rules to the Title X program that were really, in a sense, specifically targeted towards Planned Parenthood.

They said that if you wanted to participate in the title X program, you could not offer abortion services, nor could you refer patients to abortion services.

Of course, federal dollars are not allowed to be used for abortion services, with very limited exceptions for rape and incest and if the pregnant woman's life is in danger.

But, nonetheless, when these rules were put into place by the Trump administration in its first term, in 2019, the entire Planned Parenthood network left Title X, along with many, many other Title X clinics.

When the Biden administration came in, they actually reversed those rules.

And, so, many people -- many clinics came back in.

They reconstituted the Title X clinic.

I think it's clear from these letters that went to Planned Parenthood, everyone from the organization that runs the program in California, in Mississippi, in Maine, that they didn't want to necessarily take that amount of time that was going to take to do all the rulemaking.

So this was a way to say, we are holding up your funding, we're going to do an investigation, we expect some remedies.

But I think there's a real sense among these beneficiaries, among these providers that this is just a first step into dismantling the network.

GEOFF BENNETT: And if the Supreme Court rules against Planned Parenthood, what effect might that have on the people who rely on their services?

SARAH VARNEY: Well, I think the direct effect actually right now is from the withholding of this money.

So, right now, if you are a Planned Parenthood or you are one of the people or one of the organizations in, say, the California network or the Maine network, and you have a patient that comes in and they want birth control, or they want an STI test, you now can't charge that service against the Title X grant.

So already, right now, I mean, this is happening here.

I'm in California right now.

It's happening here.

And I think, when these clinics start running out of supplies, and they have to start reordering birth control pills, STI tests, all these sorts of things, they're going to be in a real bind.

So if -- eventually, if the court rules against Planned Parenthood in the South Carolina case, it could certainly mean that other states -- and we have already seen other states exclude Planned Parenthood from their Medicaid networks, but we could see a stepping up of Planned Parenthood being excluded from the Medicaid network, in addition to the Title X network.

GEOFF BENNETT: Special correspondent Sarah Varney.

Sarah, thanks again.

SARAH VARNEY: Oh, thank you, Geoff.

AMNA NAWAZ: Last night, economics correspondent Paul Solman reported on the impact in Massachusetts after a private equity firm bought several struggling hospitals there.

Tonight, Paul looks at the bigger picture, the effect of private equity investments on Americans' health care.

ELLEN MACINNIS, Nurse, St. Elizabeth's Medical Center: There's a bereavement box.

And some items are placed with the baby.

PAUL SOLMAN: Nurse Ellen MacInnis.

ELLEN MACINNIS: And the baby's remains, and that eventually goes to the morgue.

PAUL SOLMAN: She's talking about what happened at her hospital after purchase by a private equity firm Cerberus, which created a subsidiary, Steward Health Care, to run eight struggling Massachusetts hospitals.

ELLEN MACINNIS: Steward didn't have any bereavement boxes.

They didn't the vendor, so they weren't any.

So nurses were having to put babies' remains in banker's boxes and cardboard shipping boxes.

It only happened once or twice, and then nurses went out and bought the bereavement boxes themselves.

PAUL SOLMAN: Plus, 15 deaths were attributed to the care, or lack of it, in the hospitals, two now completely shut in the wake of the private equity purchase.

Moreover, it wasn't just in Massachusetts.

Steward bought 37 hospitals around the country.

And more than 450 hospitals nationwide have been taken over by private equity, as well as nursing homes, emergency rooms, doctor's practices, and air ambulances.

One analysis finds that private equity investors spent more than $200 billion on health care acquisitions in 2021 alone, and $1 trillion over the past decade.

STATE SEN. CINDY FRIEDMAN (D-MA): It's a real problem.

PAUL SOLMAN: And that problem says Cindy Friedman: STATE SEN. CINDY FRIEDMAN: Private equity is the complete opposite of the delivery of health care.

PAUL SOLMAN: State Senator Friedman has been trying to rein in private equity in Massachusetts through legislation.

STATE SEN. CINDY FRIEDMAN: Make money, leave, make it however you want, make it for people who are invested in making money, and then you have got health care, which is all about delivering care to people.

The cost is not the first thing.

The delivery care is the first thing.

And those two things do not mesh.

PAUL SOLMAN: But they are now joined at the hip, says economist Rosemary Batt.

ROSEMARY BATT, Cornell University: We're seeing a rise in financialization and the role of unregulated financial actors in Main Street companies because of the deregulation of the financial industry that took place over decades.

PAUL SOLMAN: And thus privatization, a lot of it by private equity.

ROSEMARY BATT: This has happened in many industries, but it is particularly serious when it has moved into social goods such as health care, where people's lives are at stake.

PAUL SOLMAN: So, an economic disaster?

Really?

RYAN MCDEVITT, Duke University: It was a struggling hospital system.

PAUL SOLMAN: Economist Ryan McDevitt, who's presented his work at private equity events, says health care in general and the Steward hospitals in particular were failing long before private equity got involved.

RYAN MCDEVITT: They were poorly performing.

Private equity tried to salvage it, didn't quite work, but I wouldn't say that's specific to private equity.

PAUL SOLMAN: As usual, private equity promised to invest to improve its purchases.

RYAN MCDEVITT: Health care is dysfunctional.

It's broken.

There's a lot of waste in the system.

If private equity can come in, reduce costs, increase profits, that should be a good thing.

PAUL SOLMAN: Should be, but is it?

Before I try to answer, here's a shot at explaining what private equity is, first, private, because, as with so-called hedge funds, there are few enough investors that the SEC doesn't regulate private equity firms.

What investors?

DR. ZIRUI SONG, Harvard Medical School: Well-known entities in our society, including pension funds, institutional endowments, as well as the wealthy individuals.

PAUL SOLMAN: MD Zirui Song of Harvard Medical School studies the industry.

He notes that most of the purchase price of a hospital or other health care entity is provided by debt owed to the lender like a bank.

That debt and the interest on it is then paid by the hospital or medical practice.

When this model first came in, in the 1980s, the idea was that it was the discipline of debt, force the acquired company to become more efficient, no?

DR. ZIRUI SONG: Indeed.

And not only that, it's also the addition of managerial expertise that private equity firms bring in to health care settings that may have lacked it.

PAUL SOLMAN: But as with hedge funds, private equity's main appeal to investors is the industry's outsized return rate, estimated at 13 percent a year for the past 25 years, by comparison, the stock market, as measured by the S&P 500, 8.6 percent a year.

Now, debt and expertise might result in more efficiency and profits, but so might cutting corners, supplies, staff, and using a tactic at the heart of almost every hospital buyout, selling off the real estate.

Again, economist Batt: ROSEMARY BATT: The private equity firm can buy out a hospital, quickly divide it into a property company and an operating company, sell off the property for millions, and immediately turn that into cash, which it gives back to itself and to its investors.

The hospitals are left not only with the debt from the buyout, but with these high rents that increase every year.

PAUL SOLMAN: So, now the key question, the results of private equity in health care.

Well, Dr. Song and associates have studied Medicare data of more than half-a-million patients in hospitals after private equity takeovers.

Their findings?

DR. ZIRUI SONG: On average, across the country, private equity acquisitions of hospitals have led to a roughly 25 percent increase in patient adverse events.

PAUL SOLMAN: Really?

Like what?

DR. ZIRUI SONG: This was driven by an increase in central line-associated bloodstream infections and an increase in patient falls, as well as doubling roughly of surgical side infections relative to a control group or comparison group of hospitals that looked like the private equity hospitals, but were not acquired by private equity firms.

PAUL SOLMAN: Meanwhile, in the Steward buyouts, CEO Ralph de la Torre himself took out at least $250 million, according to a Wall Street Journal investigation.

Cerberus, the initial private equity buyer, blames de la Torre, but it earned $800 million in profit on a $246 million investment when it sold at stake 11 years after purchase.

So isn't this an overall indictment of private equity's involvement in health care?

RYAN MCDEVITT: Absolutely, these antidotes are concerning.

PAUL SOLMAN: Again, researcher Ryan McDevitt of Duke.

RYAN MCDEVITT: But what I'm trying to convey as an economist and academic is that we have to move beyond these anecdotes.

Is this happening systematically because of private equity?

I don't think that's clear at all.

What stood out to me is, in that same study, what was buried was that death rates actually fell more than the adverse events went up.

PAUL SOLMAN: He's referring to Dr. Song's study, but, reading it, the death rates only fell for the first 30 days, not after.

And, crucially, Song's study compared private equity hospitals to random equivalents.

The outcomes at the private equity hospitals were noticeably worse.

Dr. Song's takeaway?

DR. ZIRUI SONG: Although it remains true that in certain instances, private equity financing can turn around a struggling health care provider, to date, on average, that is an exception, rather than the rule.

PAUL SOLMAN: And that would jibe with the complaint we heard time and again.

As nurse Ellen MacInnis put it: ELLEN MACINNIS: It has to do with what happens to the money.

Whether it goes to an account in the Caymans or it goes into Ralph de la Torre's pocket, it doesn't matter.

The money that should be there to take care of these patients is not.

PAUL SOLMAN: Not much of the time, it would seem.

For the "PBS News Hour," Paul Solman.

GEOFF BENNETT: Local arts organizations have the power to play a role in everything from community challenges to the vibrancy of national democracy by expanding access to both creating and experiencing art.

That mission drives one of the country's most vigorous and diverse artistic hubs in West Philadelphia.

Senior arts correspondent Jeffrey Brown visited for our series Art in Action, exploring the intersection of art and democracy, and our Canvas coverage.

JEFFREY BROWN: It was a gathering of gentle movement, some laughs, and plenty of concern... MAN: Never in my lifetime has democracy been more under threat.

JEFFREY BROWN: ... over how small arts organizations here in West Philadelphia and beyond can meet the moment.

Andrew Zitcer, professor of urban strategy at Drexel University, was one of the organizers of the event titled "Democracy in the Making" with an emphasis on the creative act itself.

ANDREW ZITCER, Drexel University: For us, it means that democracy is not something that is either an abstraction or an assumption.

It's not something that's just out there that's always been and will forever be and it's not something that we receive.

It's something that we make together.

JEFFREY BROWN: Public Trust, where this group met, is one of a number of small West Philly nonprofit spaces based around a simple, but to Zitcer and others, profound idea about the role artists and arts organizations can play in their local communities.

ANDREW ZITCER: The artist as embedded facilitator and storyteller and reflector of community experience is as old as it comes.

And so this culture of democracy is reclaiming a very old paradigm for today's reality.

JEFFREY BROWN: One such organization, Writers Room, established by Drexel in 2014 with an unusual goal for a university, to serve as a place for students and community members to write, share and publish their stories together.

RACHEL WENRICK, Founding Director, Drexel Writers Room: Think of a time from your past when you experienced a moment of discovery.

JEFFREY BROWN: Rachel Wenrick is founding director of Writers Room.

RACHEL WENRICK: We're unique in that we were founded with our students and faculty and our neighbors together.

JEFFREY BROWN: Students and community members.

RACHEL WENRICK: Yes.

There's not a lot of rooms that you walk into where you're going to see someone 18, someone 84 who is going to greet each other, know each other, know their histories.

CAROL RICHARDSON MCCULLOUGH, Founding Member, Drexel Writers Room: And when we got the grades back... JEFFREY BROWN: Local resident Carol McCullough is a founding member of the workshop and now adjunct faculty at Drexel.

CAROL RICHARDSON MCCULLOUGH: When you get people together to talk about what it feels like and maybe preserve that talk in the form of writing... RACHEL WENRICK: Yes.

CAROL RICHARDSON MCCULLOUGH: ... then you have got good stuff going on.

JEFFREY BROWN: It's one effort to address a history of divisions in an ever-changing community, a 19th century suburban-like setting, an economically depressed 20th century neighborhood, largely African American, major universities, Drexel and the University of Pennsylvania that in this century have continued to expand and buy up properties, helping spur a gentrification that priced or pushed many older residents out of their homes.

It was something Carol McCullough experienced firsthand in 2015, even as the Writers Room was celebrating its successful first year.

RACHEL WENRICK: Carol sent me the e-mail that said, "A developer has bought my building and I have to move."

It was the moment where we understood we are implicated in each other's stories, right?

JEFFREY BROWN: And so the arts-centered, community-driven, affordable housing project Second Story Collective was born, first matching students as renters in local residents' homes to help with high housing costs, then raising money through state grants to pay for renovations of existing homes so older residents can age in place, and now working with community organizer De'Wayne Drummond and local developer Charles Lomax on the building of 18 homes to be owned by residents, but shared with and rented to students.

The idea, build more affordable housing, generational wealth and a diverse neighborhood, work that's grown out of an arts project.

CAROL RICHARDSON MCCULLOUGH: Artists do challenge the ways that things are, so they will look for how they can twist that plot and turn it into something positive.

BRUJO DE LA MANCHA, Artist: Thank you so much.

This is PhillyCAM.org, 106.5 FM's in the city Philadelphia.

JEFFREY BROWN: Another example of hyperlocal art in action here, the work of an artist, educator and activist who goes by the name Brujo De la Mancha.

He produces a weekly radio show from low-frequency FM community radio station PhillyCAM.

And in a wide variety of ways, including Aztec dance exhibitions, plays and other kinds of arts, celebrates indigenous life in the Americas.

BRUJO DE LA MANCHA: I don't know if you heard about it, but there's a new petition.

They came out with these topics we are now with immigration.

JEFFREY BROWN: He uses his various platforms in different ways, including advocating for migrant rights.

BRUJO DE LA MANCHA: People can say, yes, he's a real activist.

He's doing something like that.

And I say, no, I'm just an artist.

Like, I'm an artist.

You can't categorize my art in any box.

JEFFREY BROWN: Today, Brujo says many in his community are in hiding, afraid even to come out to his public performances.

But he intends to continue his work.

BRUJO DE LA MANCHA: We have to show to people who we are, but there's many ways to show it.

I'm not going to be screaming.

It doesn't get me nowhere.

But I can show you the beauty of who we are.

JEFFREY BROWN: All of this is now going on in a new political environment, of course, in which universities and arts organizations face challenges, even threats, for diversity and other programs.

And that brings new challenges to Zitcer and other scholars and practitioners of the connection between arts and democracy at the local level.

ANDREW ZITCER: It creates a new kind of urgency.

It creates a context where mutual aid and solidarity, especially at the local level, is our superpower.

JEFFREY BROWN: Are there limits to being so hyperlocal?

ANDREW ZITCER: That question of scale is a fundamental question.

So, yes, what we're doing here in West Philadelphia is hyperlocal.

And what's happening in Chapel Hill or in Detroit is also hyperlocal.

But can we create a federated movement of people talking about arts, culture, cities and democracy that gains strength in its networks?

JEFFREY BROWN: A big question and a continuing vision that will be refined and refocused as the political times change.

For the "PBS News Hour," I'm Jeffrey Brown in Philadelphia.

AMNA NAWAZ: And that is the "News Hour" for tonight.

I'm Amna Nawaz.

GEOFF BENNETT: And I'm Geoff Bennett.

For all of us here at the "PBS News Hour," thanks for spending part of your evening with us.