HARI SREENIVASAN: Good evening.
I'm Hari Sreenivasan.
Judy Woodruff is away.
On tonight's "PBS NewsHour": Puerto Rico in bankruptcy.
We talk to the territory's governor about the island's troubles and what can be done to save its economy.
Also ahead this Friday: It's the final push for votes in France's presidential election, a look at the race that's upended French politics.
How an innovative program in San Diego is cutting costs of diabetes management by looking at the big picture of health.
DR. ATHENA PHILIS-TSIMIKAS, Scripps Whittier Diabetes Institute: It's not that easy to expect someone to remember to test their blood sugar, take their pill, to go out and take that walk, to have exactly the right meal on the table all the time to take care of this.
HARI SREENIVASAN: And it's Friday.
Mark Shields and Michael Gerson are here to talk about what's next for the Republicans' health care bill and the political stories this week.
All that and more on tonight's "PBS NewsHour."
(BREAK) HARI SREENIVASAN: The U.S. economy is showing signs of rebounding, after a lackluster first quarter.
The Labor Department reports that employers added a net of 211,000 jobs in April, up sharply from the month of March.
The unemployment rate for April fell to 4.4 percent, a nearly 10-year low.
The strong showing could increase odds that the Federal Reserve will raise interest rates again next month.
In Somalia, a U.S. Navy SEAL has been killed in a raid on the Islamist militant group Al-Shabaab.
It's the first American combat death there since 1993, when two helicopters were shot down in Mogadishu.
U.S. officials say the SEAL died on a mission supporting Somali forces yesterday.
Two other Americans were also wounded.
Thousands of Afghans turned out today to hail the return of a former warlord to Kabul.
Gulbuddin Hekmatyar responded with a demand that U.S. and other outside forces leave Afghanistan.
He rallied the crowd with a call for peace with the Taliban, and he criticized the Afghan government for its cooperation with the U.S. GULBUDDIN HEKMATYAR, Afghan Warlord (through translator): Let's all end this war together in our country first, and tell the foreign forces that Afghans are able to sort out their issues themselves, and that we want them to leave Afghanistan.
No one has any justification for the presence of foreign troops.
HARI SREENIVASAN: The U.S. now has about 8,000 troops in Afghanistan.
Next week, the Pentagon is widely expected to recommend sending more troops.
Russia's Defense Ministry announced today that four newly declared safe zones in Syria will be closed to U.S. coalition aircraft.
It's part of a deal that Russia, Turkey and Iran signed yesterday.
It took effect tonight.
Syrian military planes will also be banned from the restricted areas.
The U.N. Human Rights Office is condemning China for an ongoing crackdown of activists and their defense lawyers.
The agency said today there's been a continued pattern or harassment.
Within recent days, a prominent defense lawyer and his family were seized by police.
Back in this country, President Trump signed the omnibus bill to fund the government through September.
It totals some $1.2 trillion.
Now the focus shifts to the fate of the Republican health care bill that passed the House yesterday.
At the White House, Deputy Spokeswoman Sarah Huckabee Sanders said the president understands there are calls to revise the measure.
®MD-BSARAH HUCKABEE SANDERS, Deputy White House Press Secretary: He's committed to reforming our health care system.
You're going to see that process take place.
We're not going to get ahead of the legislative process.
We expect there to be some changes, but we expect the principles and main pillars of the health care bill as it exists to remain the same.
HARI SREENIVASAN: Several key Republican senators said today they probably cannot support the House bill.
President Trump has lost his second nominee for Army secretary.
Mark Green withdrew today, saying -- quote - - "false and misleading attacks" made his nomination a distraction.
He drew fire for saying that being transgender is a disease, and deploring -- quote -- "the indoctrination of Islam in public schools."
The president's initial nominee, Vincent Viola, withdrew because of financial entanglements.
And Wall Street closed out the week on the higher note.
The Dow Jones industrial average gained 55 points to close near 21007, the Nasdaq rose 25 points, and the S&P 500 added nine.
For the week, all three indexes gained less than 1 percent.
Still to come on the "NewsHour": Puerto Rico in bankruptcy -- we talk to the territory's governor; candidates make their last appeals ahead of a French election with global consequences; can South Sudan find a way out of its brutal civil war?
; and much more.
Puerto Rico went over the financial cliff this week.
The U.S. territory home to more than three million people essentially filed for bankruptcy so it can restructure more than $120 billion in debt and pension obligations.
It would be the largest municipal bankruptcy in U.S. history.
It owes $72 billion to creditors, many of whom are angry they will have to eat big losses in bankruptcy court.
Thousands of protesters took to the streets this week as the pain spreads throughout the island.
The government is reducing public services, pensions are likely to be cut, and, today, it announced it will close 184 schools, forcing 27,000 students to find another school.
Its economy remains mired in a slump, while more than 45 percent of the people there below the poverty line.
Its governor, Ricardo Rossello, joins me now from San Juan.
Governor, thank for being with us.
What is the argument that you're going to be making in court on why you should be allowed to restructure your financial obligations?
GOV.
RICARDO ROSSELLO, Puerto Rico: Well, what we asked, Hari, was essentially to have the courts' protection, so that we wouldn't be attacked by some -- what we feel are frivolous lawsuits.
But we have ensued a conversation with different creditors, and our hope is that we can find a consensual renegotiation route based on the fiscal plan that we have implemented and that's been certified for Puerto Rico.
HARI SREENIVASAN: Well, how much worse is it going to get?
This is just a day after the announcement and you're already talking about cutting back on schools.
What other public services are you going to have to tighten your belt on?
GOV.
RICARDO ROSSELLO: Well, the schools initiative was one that was established for a couple of months.
We have just announced today which schools are the ones that were going to be closed now.
This initiative, of course, has some fiscal relief, but the objective is for our children to actually consolidate and that we can get more human resource to give a better service to the kids, to the children of Puerto Rico.
HARI SREENIVASAN: What about the $49 billion in pension payments?
And that's the people of Puerto Rico that have been paying into this.
What are they likely to see?
GOV.
RICARDO ROSSELLO: Well, we're working on a budget right now, and part of the strategy that we have ensued on the fiscal plan is a pay-go system, so that we're going to make sure those pension recipients get the funding.
Now, there's still a discussion with the fiscal oversight plan on how those cuts are going to ensue.
Our proposal was that it's supposed to be on a progressive scale, so that those that are most vulnerable, those that receive less than $2,000 in pensions, will actually not get a cut, and those that receive higher will start getting a progressive cut on their pension.
HARI SREENIVASAN: Governor, I know Puerto Rico is home to you and it's home to the people who live there.
But I have got to ask, how can you keep your people from leaving the island?
Right now, you have unemployment at 12 percent.
You have lost 10 percent of your population in the last 10 years.
You have lost 20 percent of the jobs that are on the island.
If I was a resident of Puerto Rico, why wouldn't I just pick up and move to Florida or Texas or anywhere on the mainland?
GOV.
RICARDO ROSSELLO: That's been happening so far because we haven't made the proper changes.
We haven't made the changes to government.
Expenditures have gone rampant in Puerto Rico, lack of accountability, total lack of accountability.
And what we're proposing right now is a complete change in that direction now.
I know there are going to be some challenges during these cuts and the right-sizing of government.
The truth of the matter is that we are being very aggressive, so that we can lay the foundations for investors to come to Puerto Rico, for jobs to be created, and for opportunities to ensue.
And our objective, again, is for Puerto Rico, for the people of Puerto Rico who want to stay here, for them to have the opportunity to stay here.
Now, there's one last thing we need to point out.
And it is a fact that Puerto Rico is a colonial territory of the United States.
This puts us in a very significant disadvantage to all of the other states and to all of the other American citizens.
As a matter of comparative, the U.S. citizens, the Puerto Ricans that live in the United States have much better incomes, more than twice as much, participate in the labor force of greater scales, have better results in the education system and so forth.
And the one key difference is that Puerto Rico is a colonial territory.
We don't have representation.
We have a difficult time getting funding from the federal government.
So, this is another critical component that we need to change.
HARI SREENIVASAN: So, in the meantime, as your population continues to move to the mainland, your tax base shrinks, which only compounds this problem.
GOV.
RICARDO ROSSELLO: Right.
I agree.
But we're trying our best to develop sort of strategies.
We have already turned into law a labor reform law that will allow for more opportunities to ensue.
We have also established a permits law that will facilitate permits in Puerto Rico.
We are about to roll out a comprehensive tax reform that will enhance the base and will reduce the rates in Puerto Rico.
And energy has been a big challenge in Puerto Rico.
We are pushing very aggressively with a comprehensive agenda, so that we can collaborate with the private sector and reduce a lot of the costs.
HARI SREENIVASAN: Your debt has been tax-free, which made it very, very sought after for municipal bond funds, 401(k) funds.
What do you say to U.S. taxpayers who have helped -- they kind of put their faith in your future.
What happens if their retirement funds suffer because of this?
GOV.
RICARDO ROSSELLO: Listen, I just arrived to this position a little over a hundred days ago.
I am 38 years old, and I want to live in Puerto Rico and I want to create a path forward for growth.
I realize that have come at the most challenging times to become governor, but I want to push things forward.
I know that, with clear leadership, with a clear path forward, understanding that the times are tough and that there are great challenges, if we put a step in the right direction, I think we can push forward for a better Puerto Rico and, of course, renegotiation efforts with different creditors, so that it is something that is reasonable for them and something that is reasonable for us.
HARI SREENIVASAN: What's been your most recent conversation with the Trump administration?
Just recently, the president tweeted out.
It didn't seem very supportive of a bailout for Puerto Rico.
I know you met with the treasury secretary in February.
What's been the last thing that you agree on?
GOV.
RICARDO ROSSELLO: So, we met with the secretary of health and human services.
We met with the administrator of CMS, and we actually got a letter supporting what our claim was for Puerto Rico.
The secretary stated that Puerto Rico needed $900 million to have a path forward, to have some runway.
It's not a bailout.
It's actually the moneys that were assigned to Puerto Rico and that we need to have a system that actually works.
We're already cutting, mind you, over $300 million in health care expenditures over the coming years.
So we're putting our part.
If the health care system over here collapses because we have a lack of funding, the cost to the U.S. taxpayer base is much higher.
For every dollar that is spent here in Puerto Rico for a patient, all of the states and the federal government would have to pay $4 for that.
So this is not a bailout by any means.
It's reasonable ask.
It's what's fair for Puerto Rico, and we're doing so in a context where we're already making changes, we're already cutting costs, and we would prevent much more costs on the state level and on the federal level if we do this.
HARI SREENIVASAN: All right, Governor of Puerto Rico Ricardo Rossello, thank you for joining us.
GOV.
RICARDO ROSSELLO: Thank you so much.
HARI SREENIVASAN: In the most closely watched presidential election in France in decades, voters head to the polls this Sunday.
It's the second round run-off between centrist Emmanuel Macron and far-right leader Marine Le Pen.
Special correspondent Malcolm Brabant is there.
MALCOLM BRABANT: The candidates spent their final day of campaigning in vastly different places.
Centrist and heavy favorite Emmanuel Macron strolled around the small town of Rodez in the southwest of France.
But he told a local radio station he's not relaxing.
EMMANUEL MACRON, French Presidential Candidate (through translator): I know the French men and women, and you don't dictate their choices.
So until the last minute, they can decide, react, change.
So one must remain concentrated.
MALCOLM BRABANT: To the north, far-right candidate Marine Le Pen got a hostile reception outside the famed Reims Cathedral.
Later, she tweeted: "Monsieur Macron's supporters act with violence everywhere, even in a symbolic and sacred place.
No dignity."
And in an interview in Paris, she took aim at her rival.
MARINE LE PEN, French Presidential Candidate (through translator): Mr. Macron is the candidate of the elites, he is the candidate of the oligarchy, he is the candidate of the big private interests.
MALCOLM BRABANT: Macron has been buoyed this week by an endorsement from former President Obama and a solid performance in Wednesday's bruising debate.
But Le Pen's anti-immigrant National Front has kept pressing its case in places like the Yonne Valley.
Here, the Front is preaching to the converted.
Former soldier Pascal Roi supports Le Pen's pledge to crack down on Islamist militants.
PASCAL ROI, France (through translator): Regarding terrorism, she's promised to expel people flagged as threats to national security and dual nationals as well.
This is going to remove a burden so we can keep a better eye on the rest of the population.
MALCOLM BRABANT: Most of those attending this final campaign gathering were either seniors or middle-aged.
There were no people of color.
The youngest voter was student nurse Marie Buzetti, who favors Le Pen's plan to follow Britain out of the European Union.
MARIE BUZETTI, France (through translator): Today, we need to regain our independence.
Today, we are the puppets of the European Union and it needs to change.
MALCOLM BRABANT: The National Front has been accused of preying on fears and whipping up hatred.
Parliamentary candidate Ludovic Vigreux didn't hold back, warning that Sharia law might one day rule France forcing his daughters to buy burkas.
"We need Marine," he said.
France needs Marine.
And Marine needs you."
As you can hear, they're chanting "Marine for president."
And here in the countryside, she may do very well.
But nationally it's not looking good for her at all.
All the opinion polls suggest that Emmanuel Macron is going to win by a majority of 60 percent to 40 percent.
The Yonne Valley is one of the poorest districts of rural France.
The lack of job prospects have forced many residents to move away.
Le Pen's Frexit plans worry marketing executive David De Silva, and so he will vote for the pro-European candidate Emmanuel Macron.
DAVID DE SILVA, France (through translator): We have access to everything, a great marketplace, and it would be a shame to lose that.
Today, we obviously can't live without Europe.
MALCOLM BRABANT: One of the most important factors in this election is the large number of undecided voters.
If millions abstain, it could benefit Marine Le Pen.
Restaurant worker Joanna Thurloy voted for left-winger Jean-Luc Melenchon in the first round and now faces a major dilemma.
JOANNA THURLOY, France (through translator): I don't feel understood by either side, because, with Emmanuel Macron, it's all about capitalism and speculation.
And Marine Le Pen, it's her family history of being on the extreme right.
We have already been through this.
MALCOLM BRABANT: There's an undertone of defiance and maybe even desperation amongst the Front supporters as they chant, "We will win."
In order for Le Pen to enter the presidential palace, there will have to be a political surprise of Brexit or Donald Trump proportions.
And that's the mantra to which parliamentary candidate Julien Odoul is clinging.
JULIEN ODOUL, Parliamentary Candidate (through translator): Because she's the only one who speaks to the French, the only one who speaks to the forgotten ones, all those French who've been abandoned for decades.
MALCOLM BRABANT: France's national anthem, written in the 18th century, is all about conflict.
If Marine Le Pen upsets the odds and wins on Sunday, France and the European Union will face a major upheaval.
But the pollsters believe French voters want stability and will follow the Dutch in rejecting right-wing nationalism.
For the "PBS NewsHour," I'm Malcolm Brabant in the Yonne Valley.
HARI SREENIVASAN: Late today, Emmanuel Macron's campaign said they have been hacked and the internal documents have been posted online just hours before voters head to the polls.
It issued a statement saying it won't tolerate the undermining of democracy's vital interests.
Stay with us.
Coming up on the "NewsHour": empowering diabetes patients to control their own health; Mark Shields and Michael Gerson weigh in on the GOP health care plan; and a college president's plea for protecting free speech.
But first: All this week, we have brought you reports from South Sudan on the roots of its conflict, the famine there, and the use of rape as a weapon of war.
And from neighboring Uganda, we met South Sudanese refugees fleeing for a better life.
Tonight, we ask, what will it take to end the violence?
And we turn to Nii Akuetteh.
He has led a number of nonprofit organizations that promoted democracy and good governance in Africa.
He is now an independent analyst.
And Brian Adeba, he is the associate director for policy at The Enough Project, which advocates for accountability for genocide and atrocities in Africa.
So, Nii Akuetteh, the world's youngest country, how did we get here so fast?
NII AKUETTEH, Independent Analyst: I think it's because, in their fight for independence, the rest of the world focused on who they were fighting, Khartoum, and I think we didn't pay enough attention to the rivalries and the dissensions and the fault lines within the South Sudanese leadership.
And also, while they took control of the new country with the rules to be written and resources and rivalries, I also do think that the death of John Garang, who everything says was an outstanding leader, his death in a helicopter crash also led to that.
Finally, I think the world needs to pay more attention to what's going on.
HARI SREENIVASAN: Anything to add?
BRIAN ADEBA, The Enough Project: Well, indeed what he said is true.
At independence, a small group of people in the ruling party, a small group of elites hijacked government and all its institutions, and ensued on a corruption spree that created a lot of dissension within the party.
Ultimately, in the end, rivalries started appearing in the party because of this corruption.
The state became the most prized asset that everyone was vying for control of.
Unfortunately, for the ruling party itself, because it had incapacitated the ability of institutions to mitigate this conflict, in the end, the conflict began to be expressed in violent terms.
And that's where we are right now.
HARI SREENIVASAN: So, stopping the conflict is the first priority for everyone.
Why hasn't worked?
Why hasn't it worked so far, whatever we have tried?
NII AKUETTEH: I think one of the methods, one of the measures that people have talked about that have not actually implemented is stopping the flow of arms into the country.
It's like pouring gasoline on fire.
And various international players behind the scenes are reluctant, both in the region and then globally.
I think that's one of the things.
But the other thing is that not enough pressure.
I mean, the people who are doing -- the leadership doing the fighting, they have not suffered from it.
And I think one other aspect of the fighting that needs to be stressed is, heartbreakingly, it has become ethnicized, so that ordinary people are being killed.
There are ethnic militias.
So I think stopping it will be -- is going to be quite a challenge.
BRIAN ADEBA: It's true.
The missing element here is leverage, what can be done to exert leverage, so that the parties in the conflict change their calculations towards peace.
That's been missing.
And we have suggested that targeted pressures, targeted sanctions are essential, an arms embargo.
Targeted sanctions are essential because most of these transactions happen in the U.S. dollars.
And that gives the U.S. jurisdiction to act within the toolkit here, the precious toolkit available to policy-makers in the U.S.
There are measures that can be enacted to trace these assets, to seize these assets in some aspects, and to send a message to the perpetrators of this conflict that there is a price to pay for war.
HARI SREENIVASAN: Is that the most effective way to do it, because the U.S. dollar is the sort of currency of the day?
NII AKUETTEH: Oh, I agree totally, because also ,on the global stage, the U.S. looms large.
And the U.S. was a leader in supporting the independence of South Sudan.
But even if you take a more narrow view of U.S.' own national interests, it's always been said that ungoverned spaces breed terrorism, which eventually can come to affect the U.S.
So, frankly, when I look down the road, this is an American issue.
Now, the fighters are South Sudanese, the victims are South Sudanese.
But it should concern Americans.
And I think, for one, think that Congress needs to make its voice strong and push the State Department to work with various organizations, because, otherwise, it will get worse, and that -- we will then see that it's beginning to affect the American interests in ways that cannot be missed.
HARI SREENIVASAN: Brian, as he points out, the U.S. was instrumental in trying to birth this nation.
But is this administration going to -- are there any indications that they're going to pay as close attention to this?
BRIAN ADEBA: Well, I'm quite optimistic.
If we look back at the statements -- the statement that the U.S. ambassador to the United Nations, Nikki Haley, uttered a few weeks ago, it was the very first time that a member of the Trump administration had come out very strongly on South Sudan.
She chided how her counterparts in the Security Council for inaction on South Sudan and suggested that perhaps it's time now to broach or examine the possibility of an arms embargo to stop the carnage that is going on.
She also called out the president of South Sudan for continuing to perpetuate the conflict and also the other political elements involved in this conflict.
So, that's encouraging.
From a multilateral perspective, an arms embargo is very, very essential, and the U.S. has a lot of room and opportunity to use that.
HARI SREENIVASAN: Is that the best way for us to move forward?
Is it through a body like the United Nations?
Is there something the United States should be doing independent?
NII AKUETTEH: I think so.
The region original organization IGAD, Sudan, Uganda, Kenya, Ethiopia, all of them have played a great role.
And, in fact, up until some time ago, they played a positive role.
But now, in fact, the reason that there has been no push on the leadership in South Sudan is because IGAD itself is divided.
And within IGAD, what I'm saying is, the U.S., apart from pressure like Brian has said, on the Sudanese leaders, South Sudanese leaders, to also put pressure on the countries in the region.
I mean, U.S. relations with Khartoum is warming up.
It has good relations with Uganda.
It has good relations with Ethiopia.
It has good relations with Kenya.
So, I, for one, think the U.S. should also put pressure on these countries to come to a meeting of the minds, because they are backing different sides.
HARI SREENIVASAN: All right, Nii Akuetteh, Brian Adeba, thank you both.
NII AKUETTEH: Thank you for having us.
HARI SREENIVASAN: More than eight million Americans suffer from diabetes, and more than $320 billion are spent every year treating the disease.
But an innovative program in San Diego is trying to improve health and reduce those costs by encouraging better self-management of the disease.
Special correspondent Cat Wise has our report.
CAT WISE: Fifty-one year old Alma Ayala is not a doctor or a nurse, but she is on the front lines of the diabetes epidemic in her community.
She's a peer educator for a program called Project Dulce, which works with people who have diabetes or are at risk of developing the chronic illness.
Her classes are part informational, part support group.
Ayala says the goal of the program, which has been held up as a national model, is for people to feel empowered about changing their health.
That's something she didn't feel 30 years ago when she was first diagnosed with the disease.
ALMA AYALA, Project Dulce: I was devastated.
I didn't want to hear the word diabetes.
I felt that my life was done, that I was signing a certificate of death.
CAT WISE: Here in San Diego County, nearly half the adult population has pre-diabetes and about 8 percent have diabetes.
It's a disease that affects all socioeconomic groups and races, but the Latino community has been disproportionately impacted.
And that's the population Project Dulce has been targeting for the past 20 years.
ALMA AYALA: There are lots of barriers for the Latino community, language, insurance.
Sometimes, doctors don't have the time to spend with them.
So the classes that we provide is that extra support, working together with a clinical team to help our participants stay healthy.
CAT WISE: The program is scattered throughout 12 clinics in Latino neighborhoods throughout San Diego County and was designed by several local health care organizations, including the Scripps Whittier Diabetes Institute.
Dr. Athena Philis-Tsimikas is an endocrinologist who oversees the program.
DR. ATHENA PHILIS-TSIMIKAS, Scripps Whittier Diabetes Institute: This is a disease in which you have to do a number of management components, not only every day, but many times a day.
And it's not that easy to expect someone to remember to test their blood sugar, take their pill, to go out and take that walk, to have exactly the right meal on the table all the time to take care of this.
I don't see any lows there, so I don't think we have to worry that you might dip down too low.
CAT WISE: To help patients, a team is set up at each clinic with a physician, nurse practitioner, a dietitian and multiple peer counselors like Ayala who come from the communities they serve and also have the disease.
DR. ATHENA PHILIS-TSIMIKAS: If you can train these other people and professionals to help you do the other components that take longer, but are still absolutely necessary, then you're using your team to work very synergistically to deliver everything that patient needs in order to improve their care.
CAT WISE: The program is now adding another layer, technology.
Last year, Tsimikas conducted a study to see if patients receiving daily text messages could manage their disease even better.
Artist Gloria Favela-Rocha was one of the participants.
She's a muralist who does large scale works for hospitals, schools and private clients.
She says, before the study, she often forgot to regularly check her glucose levels.
Project Dulce changed that.
GLORIA FAVELA-ROCHA, Diabetes Patient: The text message would come every day at the same time, so if I would lose track of where I was during my day, I would hear it ring, and so I would start checking my blood sugars, send in my result right away.
It would send me back a message according to whatever my result was, like good job, or maybe you need to eat something that has a little more protein today.
So, it was just very -- it was very convenient.
CAT WISE: Dr. Tsimikas' team has also been studying the effects of continuous glucose monitoring, which uses Bluetooth technology to send results to the patient and physician in real time.
MAGDALENA HERNANDEZ, Diabetes Patient: This device is reading my sugar levels.
CAT WISE: Magdalena Hernandez wears a small monitor on her stomach.
MAGDALENA HERNANDEZ: I love it.
I love it because I don't have to prick my finger many times during the day, and it alerts me when my blood sugar goes high or goes low.
CAT WISE: And what happens if your levels go above 200?
What do you do?
MAGDALENA HERNANDEZ: I grab a bottle of water, and I get up and walk for five minutes.
CAT WISE: Thirty miles away, Dr. Tsimikas is also able to keep tabs on Hernandez's levels.
DR. ATHENA PHILIS-TSIMIKAS: This is just over the last three hours, that she probably ate breakfast here, it went up, and is now declining.
CAT WISE: This technology has been on the market for several years, but has not been widely used because of cost and a somewhat complicated user interface.
But Tsimikas says those barriers are being reduced and she predicts it will have a big impact on health.
DR. ATHENA PHILIS-TSIMIKAS: It is reinforcement to both the patient and to the provider that's helping to make recommendations on whether this is working or not.
I think it's really going to revolutionize the way we can take care of patients.
CAT WISE: Dr. Tsimikas says the objective is to prevent the serious complications that can accompany diabetes, including blindness, kidney failure, amputations or heart failure.
MAGDALENA HERNANDEZ: I really love the black beans and all the vegetables in here.
CAT WISE: According to studies conducted by the University of California, San Diego, and elsewhere, Project Dulce has helped lower patients' blood sugar and cholesterol levels, while at the same time reduced the number of costly hospitalizations and emergency room visits.
While some elements of the program are being used in other communities, Project Dulce stands out for its comprehensive approach.
So, why aren't similar initiatives being rolled out in every neighborhood in America?
DR. ATHENA PHILIS-TSIMIKAS: It's probably the way we reimburse for each of these components.
That's probably the biggest hurdle.
We traditionally have reimbursed only for physician visits.
If we could find a way to actually reimburse for each of these components, it may be more sustainable for the future.
Or maybe we simply reimburse based on our success.
If you are successful in achieving better outcomes, maybe then you pay for what led to those better outcomes.
CAT WISE: In the coming weeks, Project Dulce will begin a new study of patients that combines text messaging with continuous glucose monitoring and a wireless pill box that will alert a nurse if a patient isn't taking his or her medication.
From San Diego, I'm Cat Wise for the "PBS NewsHour."
HARI SREENIVASAN: Now to the analysis of Shields and Gerson.
That's syndicated columnist Mark Shields and Washington Post columnist Michael Gerson.
David Brooks is away.
Let's start with this little party that was on the Rose Garden yesterday.
The beer cases were brought in.
There was a celebratory atmosphere.
President Trump rightfully brought the House Republicans there after they pushed their health care repeal and replace bill through the House.
How did they manage to do this?
MARK SHIELDS: Well, first of all, the event itself, the only thing more -- or as unseemly as the self-congratulatory bus trip to the White House -- it was like after you had won an office softball game and you break out the beer -- were the Democrats on the House floor taunting bye, bye, bye to Republicans.
This is trivializing a moral issue.
And this -- to me, that's what health care is, whether in fact it is a right of a citizen in this country to health care.
And I think it's a serious question, whether we share our benefits and share our burdens, or whether in fact we're all in this alone.
And what the House passed yesterday was something that just had to be done.
I mean, otherwise, you're staring into the abyss of total political failure.
Republicans had gone through four elections where the one unanimous position they had all taken as a party was the repeal of Barack Obama's Affordable Care Act.
Sixty-two times, they courageously and boldly voted to do, knowing it didn't count, knowing it wasn't going to go anywhere.
The 63rd time was tougher, because what they passed yesterday has serious implications for them politically and certainly for the people of the country.
MICHAEL GERSON: It's a great moral issue.
But this passed because Paul Ryan got granular.
He identified who he needed and what they wanted and essentially gave it to them.
So, moderates get the high-risk fund.
The Freedom Caucus gets the waivers.
He just put on the table what he needed to get across the finish line.
Now, that doesn't make it a good bill or even a coherent bill.
But I think the trust here is that Ryan will hand this off to McConnell, McConnell has some rational process that the House can no longer produce, because of its own internal dynamics, and that they might get an improved product at the end.
The other thing that's worth noting that is really fascinating is the almost absence of presidential leadership in producing this victory.
He was really not very engaged or involved.
Paul Ryan is learning to live without the normal role of the president in the legislative process.
But it is unique, his absence.
HARI SREENIVASAN: So, what happens by the time it gets to the Senate?
Nancy Pelosi has already said, listen, this is the vote that's going to be tattooed on you come reelection time.
But more important, the Senate's going to change it in some way shape or form, if they move forward at all.
MARK SHIELDS: Yes, they are.
Just one quick point to Michael's point.
And that is the $8 billion fig leaf -- and it was a fig leaf -- that they're going to cover people with a preexisting condition, which was the price to get Billy Long and Fred Upton, represents less than one-fifth of 1 percent of the cost of Medicaid.
It's not going to last beyond a couple of months.
It was just something that they could go back and sell to their own constituencies and for their own purposes.
It's meaningless.
But what's going to happen in the Senate?
I will say this.
We have just seen the high watermark for this legislation.
Every Republican in the House who voted for it will have to answer for it.
And this is a stand-alone piece of it, whatever happens in the Senate.
And nobody really knows.
There are 11 Republican governors, don't forget - - and this is where this starts to count - - who expanded, accepted the Medicaid expansion, and who have covered people in their state, and from John Kasich, to Rick Snyder in Michigan, to Gary Herbert in Utah, to Brian Sandoval in Nevada, across the country.
And so it's a different dynamic in the Senate.
They have got states represented by senators like Rob Portman, a traditional conservative, who is going to fight for the preservation of Medicaid expansion.
MICHAEL GERSON: The Senate is acting pretty much from scratch.
They're not going to the House bill and building on it.
They're taking away.
Lamar Alexander has been charged to produce their own approach.
There's a small group of senators that is kind of diverse, at least within the caucus, that is working on this.
And Senator McConnell has promised them some time for deliberation, unlike the way the House passed this.
So, the probably -- is exactly what you're talking about.
Senator Collins has already announced she will not support a bill that doesn't include Planned Parenthood funding, OK?
The bill will not include Planned Parenthood funding.
That means that Republicans need 51 votes.
They have got a margin of one in producing this piece of legislation.
There's no margin of error for them here.
HARI SREENIVASAN: All right, let's talk about another Rose Garden event that happened yesterday, really kind of talking about religion in politics, and the Trump administration bringing that to the fore.
He signed an executive order easing an IRS rule limiting political activity by houses of worship.
This was also on day that President Trump proclaimed a national day of prayer and had a statement saying -- quote -- "All human beings have the right to practice their faith in private and in the public square."
The public square portion, does that raise any concerns?
MARK SHIELDS: It doesn't to me, and it apparently didn't to the American Civil Liberties Union either.
I happen to believe that this was a strict political payoff, in symbolic terms, that evangelical white Christians had been his most supporters; 81 percent of them voted for him.
And I, for one, will break with liberal ranks and make the case that America's original sin existed until organized religion, namely, the American Methodists, the Anglican evangelicals, and Quakers led the fight to abolish slavery.
There wouldn't have been a civil rights bill, legislation in this country without the active involvement of Jewish, Catholic and Protestant, particularly black Protestant leadership, so -- as well as peace movement.
So, I'm not as concerned about the involvement in the public square.
Donald Trump's religiosity has always been rather elusive to me.
(CROSSTALK) HARI SREENIVASAN: Sorry.
Is this a backdoor option or a possibility where this could be sort of Citizens United 2.0?
Let's just today build the church of Mark and Michael, totally tax-exempt organizations, raise as much money as you want, donate to whatever political party you would like?
MICHAEL GERSON: Well, I don't know if it even accomplishes that.
I mean, the Johnson amendment, you know, I have never seen anywhere, encountered someone complaining about rigorous enforcement of the Johnson amendment.
I have been around this a long time.
It's a nonexistent issue.
It's a solution in search of a problem.
And it is a sop.
It is an empty symbol.
The problem here that we're seeing more recently is not that religion is hurting the public square too much.
It's that politics is undermining and invading the credibility of religion itself.
People who support Donald Trump, many of them were people who said that Bill Clinton's character mattered more than anything else.
And now they're embracing Trump.
And people are looking at this and saying that this is a joke.
This is hypocrisy.
And so I think the risk here is actually to religion.
HARI SREENIVASAN: To that point, I mean... MARK SHIELDS: It's a good point.
On your point, yes, I am deeply concerned, and have been, and especially now that we have got a smokescreen of charitable religious institutions being formed basically for political ends, and for partisan political purpose.
And what it amounts to in public policy terms is, I'm making a donation, a tax-deducted donation, for a political purpose to support my political cause or your political cause, which I think is absolutely wrong, and it's a corruption.
MICHAEL GERSON: I just haven't seen much evidence of it.
HARI SREENIVASAN: I don't know... MARK SHIELDS: We have certainly seen -- we have seen phony, bogus charitable foundations created for that purpose.
HARI SREENIVASAN: I don't socially if this happens already, but do you end up picking your church a little bit more because you know how that church is going to vote?
I'm going to reveal my Hindu roots here, but I thought Jesus was an independent, not a Democrat or a Republican.
MICHAEL GERSON: Well, I think that's true.
Whenever a pastor makes a political statement, they're at risk of alienating a portion of their congregation on issues that have nothing to do with religion, or at least their judgment is not particularly sanctified on these issues.
I mean, I would rather go to the average bartender for political advice than the average priest or minister.
(LAUGHTER) MICHAEL GERSON: So, you know, I think that they don't have an expertise in many of these issues.
And that's up to laymen in the church and that, from the pulpit, there needs to be fairness.
HARI SREENIVASAN: Yes, all right, Michael Gerson, Mark Shields.
MARK SHIELDS: It's a good point you make.
HARI SREENIVASAN: All right, thank you.
(CROSSTALK) HARI SREENIVASAN: Thank you very much.
MARK SHIELDS: Thank you, Hari.
HARI SREENIVASAN: All right.
Tomorrow night here in Washington, the prestigious PEN/Faulkner Award for Fiction will be given.
Jeffrey Brown talks with the winning author, the latest in our "NewsHour" Bookshelf series.
JEFFREY BROWN: An immigrant couple from West Africa working for a wealthy New York family as the great recession is about to hit in 2008.
The novel "Behold the Dreamers" is a story of the contemporary American dream through the lens of class, race and immigration.
Author Imbolo Mbue came to the U.S. from Cameroon in 1998 and became a citizen in 2014.
This is first nurse novel.
And because of that, even more congratulations to you.
IMBOLO MBUE, Author, "Behold the Dreamers": Thank you, Jeffrey.
JEFFREY BROWN: You're working here in a great American fiction tradition about immigration.
What did you want to bring to that story?
What did you want to tell?
IMBOLO MBUE: Well, when I start writing this novel, it wasn't very much about immigration.
It was about the financial crisis.
I was very interested in how the financial crisis affected the lives of New Yorkers from different economic statutes.
So I wanted to write about an immigrant from my country who gets a job as a chauffeur (INAUDIBLE) executive, but, of course, an immigrant coming here for the American dream and facing the financial crisis, I wanted to write about how that affected him and how -- and also explore like the dreams and hopes he has himself when he came to America.
So, I ended up writing about the immigrant experience, coming here, realizing what America really is like, and also deciding whether it is really worth staying here.
JEFFREY BROWN: So, these characters, the main characters, Jende and Neni, from Cameroon, they're experiencing both sides of the American dream.
They tell us that they see it as both wonderful and awful at the same time.
IMBOLO MBUE: Yes.
It's very complex, this idea of the American dream, because, on one hand, when we're back in our countries, we especially, when I was growing up in Cameroon, we had this image of American being the sort of promised land, and this country where you go to and you work hard and you get to achieve this life, a lot of material success, a house and nice cars and (INAUDIBLE) accounts.
And that is what they came for, Jende and Neni.
And then they got here, and they see the realities of social -- a lot of social issues, economic inequity, and racism and sexism, and all of those issues.
And they have to deal with it.
And they also have -- see what it's like for people who achieve the dream.
JEFFREY BROWN: But by doing that and by setting it in that period, you're also raising question of class, right?
IMBOLO MBUE: Right.
JEFFREY BROWN: But, as a writer, you have to see this couple -- you have to see everybody with some sympathy.
IMBOLO MBUE: Right, right, right.
JEFFREY BROWN: Right?
So, the Edwards family, which is wealthy... IMBOLO MBUE: Right.
JEFFREY BROWN: ... and the immigrant family, they get along.
They don't get along.
There are all kinds of clashes.
But for you, what?
What are they?
IMBOLO MBUE: Well, for me, it was, I had a lot of empathy for the immigrants, because I am an immigrant.
I am from the same town where Jende and Neni come from.
So I know those struggles.
The struggles of the Edwards, the 1 percent, people who have that amount of privilege, is not something that I have dealt with during my life.
So I had to push myself to think about, what are their struggles, and what does it take to hold this dream life together?
Because they do have the dream life.
They have a house in the Hamptons.
They live on the Upper East Side.
They have so many privileges.
And yet they have their own struggles.
So, on one hand, I had one family that was living the dream and that family growing after the dream.
And when the recession happened, both families had to deal with the consequences.
JEFFREY BROWN: You referred to your own background.
How much is this your story?
IMBOLO MBUE: In many ways, you know, I was like Jende and Neni, in the fact that, when I came here, I thought America would be a sort of promised land.
And I do believe that it is a wonderful country.
I think it's a country that offers a lot of immigrants.
But, at the same time, this American dream, what I have seen is that it's not accessible, and that somebody like Jende, a black man without a good education, and he's also dealing with not having papers, that somebody like that, the odds of moving out of poverty is very difficult.
JEFFREY BROWN: You're also dealing in this very difficult and divisive issue over illegal immigration, because they overstay what they're allowed to.
IMBOLO MBUE: Right, right, the visa.
JEFFREY BROWN: They want to stay in the country.
They're facing deportation.
So, you know there's a great debate in the country over this.
IMBOLO MBUE: Right.
JEFFREY BROWN: I mean, you portray them as sympathetic characters who want to work hard.
IMBOLO MBUE: Right.
Right.
JEFFREY BROWN: But you know that there are plenty of people who would say, well, I'm sorry, you're not playing by the rules.
IMBOLO MBUE: Right.
Right.
And it is a very, very complex issue.
I think that, for me, as a writer, that my job is to tell the story and let the reader decide: Should I empathize with people like Jende who don't have papers, or I should vilify them?
I don't -- this is not a moralizing story.
I think people can read my book and use it as pro-immigration or use it as anti-immigration argument.
My place is to tell the story honestly and completely.
But I think that it is important to understand each other's stories.
It's so easy to put people in a box and say, oh, people without any papers, but who are these people, what are their stories?
And I also am a citizen, right?
So, I also understand the citizen perspective.
I am an immigrant and I'm a citizen, and I know what it's like to be both and to understand that desire to come here and work hard, but also that desire to, like, think about America's future.
JEFFREY BROWN: Let me ask you finally, as I said, this is your first novel.
And you won a big award.
That's got to be a bit of a surprise, a welcome surprise, right, for a young writer.
IMBOLO MBUE: Yes.
Yes, it is a good privilege.
I started writing this book when I was unemployed.
I had lost my job at the end of the financial crisis.
JEFFREY BROWN: So, this hit -- that hit you personally?
IMBOLO MBUE: Yes.
Yes.
Yes.
And I thought that writing a story about people from my hometown and other New Yorkers who I have met in some ways and talk about their own struggles.
And then I got a novel, and it got published.
And to win an award like the PEN/Faulkner, it is a great honor.
JEFFREY BROWN: All right.
Well, the award-winning book is "Behold the Dreamers."
Imbolo Mbue, thank you very much.
IMBOLO MBUE: Thank you, Jeffrey.
HARI SREENIVASAN: Finally: We are headed into commencement season, and each week seems to bring a new fight over whose ideas should be heard.
Tonight, Trinity College President Joanne Berger-Sweeney shares her Humble Opinion that universities are exactly the place for these difficult conversations.
Have a listen.
JOANNE BERGER-SWEENEY, President, Trinity College: These days, you can't miss the criticism aimed at higher education.
We hear it: We're a bunch of intolerant elites.
Our students are precious snowflakes.
As educators, we're stifling speech and thought, and we're not preparing students for the real world.
Frankly, I get it.
Lately, some campus protests around the country have gone awry in truly ugly ways.
Now it's commencement season.
Are controversial speakers going to be uninvited and ceremonies halted by protests?
If so, all of us in higher education should be ashamed.
It's our job as educators to uphold free speech and to teach the responsibilities that come with that freedom.
And, yes, we must provide safe spaces, spaces that are safe for speech, not from it.
But it seems more than ever that we're just refusing to hear one another.
Maybe that's because listening to the other side can hurt.
Let me tell you, as an African-American woman, I have heard it all, and a lot of it has hurt.
I didn't have to agree with it, like when I was told a black girl couldn't be a scientist, but I didn't have the option of not hearing it.
And now I'm the first woman, the first person of color, the first neuroscientist to be president of Trinity College.
But guess what?
I'm not representing just African-Americans, or women, or neuroscientists.
I'm representing Trinity College, a community with a variety of points of view.
I have to be true to myself, but I can't be a responsible leader without teaching students this important lesson: Silencing voices and refusing to listen harms us all.
That's why, for my first commencement as president in 2015, I awarded honorary degrees to both a retired Air Force general and a renowned peace advocate.
And that's why, this year, we will hear a commencement speech from philosopher Daniel Dennett, a well-known atheist, beside the statue of our founding president, an Episcopalian bishop, exposing students to different perspectives and helping them bridge divides.
This work is deeply personal to me.
It may be the most important work I will do as president.
When we teach students how to analyze an opposing argument and sharpen their own, how to relate across differences, how to listen and be heard, we are preparing our students for the real world.
In fact, we're giving them the tools to make our world a lot better.
HARI SREENIVASAN: And before we go, as we reported earlier, French presidential candidate Emmanuel Macron's campaign said it was the victim of a massive hack.
It said hundreds of authentic and fake internal documents have been leaked hours before the vote.
Also, The Dallas Morning News reports a police officer in suburban Dallas has been charged with murder over the weekend killing of a teenager.
The officer fired a rifle into a car as it left a party.
On the "NewsHour" online right now: Read how a recent reporting trip to coal country in West Virginia inspired a journalist's 7-year-old son to turn water pollution in his own neighborhood into a science fair experiment.
All that and more is on our Web site, PBS.org/NewsHour.
And Robert Costa is gearing up for "Washington Week" this evening.
Robert, what do you got?
ROBERT COSTA: Tonight, we look at the policy and politics behind the House bill to replace Obamacare.
If it becomes law, how much of it will change who gets coverage and how much will it cost?
We will have some answers and analysis later tonight on "Washington Week" -- Hari.
HARI SREENIVASAN: Thank you, Robert.
On "PBS NewsHour Weekend" Saturday: how the youth vote could determine France's next president and what the two candidates are doing to win over the young.
Join me tomorrow.
And Judy Woodruff will be back here on Monday.
That's the "NewsHour" for tonight.
I'm Hari Sreenivasan.
Have a great weekend.
Thank you, and see you soon.