Written By Unknown on Kamis, 16 April 2015 | 12.07
PhotoState Senators Richard Pan, left, Loni Hancock, center, and Ben Allen talked about a bill requiring California's schoolchildren to be vaccinated.Credit Rich Pedroncelli/Associated Press
SACRAMENTO — Several hundred Californians swarmed the State Capitol on Wednesday to oppose a bill that would eliminate their right not to vaccinate their children against contagious diseases like measles. They were able to help stall a committee vote on the legislation by a week.
The bill, introduced after a measles outbreak over the winter that originated at Disneyland, would require nearly all children to be vaccinated, eliminating the growing use of the so-called personal belief exemption that has contributed to the spread of preventable diseases. Parents who refused to immunize their children and did not have a medical exemption would be forced to teach their children at home.
The bill, which was passed by the State Senate's Health Committee, was up for a hearing on Wednesday before the Senate Education Committee. There, the small but vocal minority of parents who object to scientifically proven vaccinations showed up in force and helped stall the measure.
"I strongly oppose injection of questionable materials into the bodies of our children as a condition of education," said Steve Wall, an environmental engineer from Bay Point, who lined up with hundreds of others to denounce the bill before the Education Committee.
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Graphic
A map of counties where cases have been reported so far this year, and a chart showing how the number of cases compares to previous years.
State Senator Richard Pan, a physician and a Democrat, has been threatened on Facebook over his sponsorship of the bill. He told the committee that the growing use of the personal belief exemption had been identified as aiding the spread of measles from the Disneyland outbreak. "We are clearly at a point where our community immunity is dropping too low," he said. To believe otherwise, he said, is a "luxury."
Jay Hansen, a member of the Sacramento City Unified School District, said the measure was based on science, not emotion. "We should stand up for the scientific method we all learned in school," he said.
But after nearly two hours of opposition testimony, doubts among committee members emerged, from both Republicans and majority Democrats. One concern was that the bill did not address what would happen to children who now have exemptions from vaccines on Jan. 1, when the law would take effect. At the end of the hearing, Senator Carol Liu, the committee chairwoman and a Democrat, told Mr. Pan that his bill lacked the votes for passage and gave him a week to fix the measure.
If the bill passes, California will become the largest state by far to bar exemptions from vaccines for any reason other than medical necessity. Only two other states, Mississippi and West Virginia, have such rules.
Testifying for the bill, Romana Garcia, 77, who has used a wheelchair since childhood because of polio, tearfully declared, "I beg you, please prevent infectious diseases that are preventable."
Also supporting Mr. Pan's bill were groups like the California Medical Association, the March of Dimes, the California State PTA and the California School Boards Association.
The hearing drew one of the largest crowds seen in the Capitol in years. Some people waited for hours to speak their name, city and their opposition to the measure. Among them was Jeany Bowen of San Diego, with her sons, Colin, 7, and Ethan, 12. She described herself as the "mother of two unvaccinated, healthy boys."
She said one of her sons suffered a reaction to a vaccine when he was young, but her physician insisted that it was a virus. "I never saw a doctor who said it was the vaccine," she said.
She said that she taught the boys at home, but that Ethan would like to go to a public high school. "But he won't be able to if this bill passes," she said.
From December to mid-April, 134 people in California were reported by the state to have contracted measles. Attention focused on the growing number of unvaccinated children whose parents used the personal belief exemption. The state reports that 2.5 percent of kindergarten pupils in 2014 were excused from some vaccines because of the exemption, but in some areas the percentage ran much higher; in Nevada County, in the Mother Lode of the Sierra Nevada, it was 22 percent, or 184 pupils.
PhotoPresident Obama told female bloggers on Wednesday that he had fewer options left for using his power to bypass Congress.Credit Stephen Crowley/The New York Times
CHARLOTTE, N.C. — In his assertions of executive power to advance his agenda in an era of gridlock, President Obama has been largely on offense. But his latest battle with Congress not only left him on defense, it actually broke the gridlock. Against him.
Mr. Obama's abrupt decision to sign a compromise version of legislation on Iran that he had previously vowed to veto was a bruising retreat in his larger campaign to act without Congress's getting in his way. In this case, partisanship gave way to rare consensus on Capitol Hill: Both sides agreed that he was wrong to cut them out.
The White House tried to make the best of the setback, arguing that the bipartisan bill was less objectionable than the initial draft. But the president's concession in the face of potentially veto-proof majorities underscored that even his fellow Democrats believed he had overreached in trying to operate on his own. And it suggested that he may be approaching the outer boundaries of his authority with 21 months left in office.
The fight over whether Congress should be able to block any nuclear agreement with Iran was one more chapter in a fundamental struggle between the executive and legislative branches since the beginning of the republic. Over two centuries, presidents have increasingly played a larger role in shaping national and foreign affairs. Bill Clinton went to war in Kosovo without explicit congressional approval. George W. Bush negotiated an agreement for troops to stay in Iraq without a vote by lawmakers.
In Mr. Obama's case, the use of executive power has come to define his final years in office now that he has, in many instances, given up on working with what he considers to be recalcitrant Republicans who captured the House in 2010 and the Senate in 2014. Republicans argue that he has abused his power, and they saw the Iran bill as a victory in balancing the scales.
"This is perhaps a high point of challenging the White House's undisputed judgment on these matters," said Thomas Karako, a senior fellow at the Center for Strategic and International Studies, who has written on executive power in foreign policy. "But this is just the latest wrinkle in a many-decades-long struggle between the president and the Congress."
Mr. Obama has found himself stymied in using executive power on the domestic side, too. His action last year permitting millions of illegal immigrants to stay in the country and obtain work permits has been blocked in court pending further litigation.
And during an appearance here on Wednesday to talk about issues like pay equity, Mr. Obama acknowledged that he had fewer options left for using his power without congressional support. "We've probably exhausted what I can do through executive actions," he told a woman who asked if he could do more on his own to equalize pay between men and women.
Noting that he had already issued presidential orders governing workplace standards of the federal government and federal contractors, Mr. Obama said, "My executive actions don't apply automatically to the private sector who are not doing business with the federal government."
Mr. Obama made no comment on Iran during a town hall-style meeting where he took questions from a group of female bloggers about workplace issues. But aides argued that he could live with the legislation because it addressed some of his concerns.
"The principle that the foreign policy of the United States of America is the purview of the president of the United States is absolutely still intact," Eric Schultz, a White House spokesman, told reporters on Air Force One flying to North Carolina. "A lot of the details, as we discussed, that we found the most objectionable in the bill are ones that have been since removed."
That was not the view of Republicans, who saw Mr. Obama's decision to accept a congressional role as a capitulation in the face of overwhelming opposition. "Maybe they saw the handwriting on the wall," Speaker John A. Boehner told a small group of reporters Tuesday.
Still, as a practical matter, this bill is no more likely to actually stop the deal with Iran than the original version. Under either version, Congress could pass a resolution rejecting the Iran agreement, but Mr. Obama could veto it, meaning he needs to hold onto no more than 34 senators or 146 House members to prevent an override.
Congress is trying to insert itself into a negotiation in which it has played little direct role. Negotiators from six world powers reached a framework agreement with Iran this month to curb its nuclear program in exchange for relief from international sanctions, but key details, including when sanctions would be lifted, remain in dispute as the negotiators try to commit the deal to writing by June 30.
Mr. Obama frames it as a nonbinding executive agreement rather than a treaty that would require Senate approval; most agreements with foreign countries in recent decades have been negotiated similarly. But lawmakers argue that this one is too important to go through without their involvement.
As president, Mr. Obama can lift sanctions he imposed under his own authority and can suspend other sanctions imposed by Congress. If the congressionally enacted sanctions are to be lifted permanently at some stage, however, Congress would have to approve that.
Unwilling to wait for such a vote, lawmakers in both parties fashioned a bill to require the president from the start to submit the deal to Congress for a review and temporarily prevent him from suspending sanctions while they decide whether to block the agreement. Mr. Obama objected strenuously, vowing to veto legislation that would "encroach on traditional presidential prerogatives."
Senator Bob Corker of Tennessee, the Republican chairman of the Senate Foreign Relations Committee, gathered enough support in both parties to possibly override such a veto. But he agreed to make changes in the bill to win more Democratic support, such as shortening the initial review period from 60 days to 30 days and removing a provision blocking the deal unless Iran is certified not to be targeting Americans in terrorist attacks.
The changes gave the White House reason to say the bill was better from its point of view, but they did not change the broader principle underlying it, namely that Congress would have a chance to vote on the deal soon after it is reached.
Harold Hongju Koh, the former top lawyer in Mr. Obama's State Department, who is now at Yale Law School, said the president should have worked with Congress before the preliminary agreement with Iran to come up with a process for involving lawmakers, rather than have it forced on him afterward.
"It would have been better to get this kind of political accord in a legal form up front," he said. "But now that it's here, it seems to be a workable one." Because it still allows the president to proceed eventually if he can hang on to most Democrats in a veto override attempt, Mr. Koh said, "frankly, he made lemonade" out of lemons.
PhotoChris Christie was in Londonderry, N.H., on Wednesday as part of an effort to remind people of his 2016 presidential ambitions.Credit Cheryl Senter for The New York Times
LONDONDERRY, N.H. — Chris Christie's name has tumbled off the list of top-tier presidential candidates. He is sagging in the polls. And in the kind of indignity that creeps up on him with agonizing regularity, a stranger here wisecracked Wednesday morning that he and his wife had been stuck in the George Washington Bridge traffic jam engineered by the governor's allies — on their wedding anniversary, no less.
"Really?" Mr. Christie asked, seeming legitimately surprised when he met the man at a Manchester diner. "How'd it go? Not well, right?"
As his rivals declare their candidacies for the White House with flashy events from Florida to Virginia, Mr. Christie is pursuing a humbling and painful path of rehabilitation: huddling with aides to plot a comeback, churning through a thick reading list to burnish his shaky command of foreign policy and showing up at intimate venues to convey the message that he is still alive.
With the possibility of imminent and embarrassing indictments hanging over his administration, Mr. Christie is turning to a political format, the town hall meeting, that has propelled him through rough patches in the past, and to a state, New Hampshire, whose forgiving and independent-minded voters are known for reviving once-moribund presidential campaigns.
His plan, advisers said, is to climb out of this hole one town hall at a time.
On Wednesday, Mr. Christie showcased the new tone that he plans to strike: hyper-detailed and highly prepared; full of piercing wit, a Christie hallmark, but infused with a deeper level of compassion.
He was, by his own admission, "on my best behavior" here at a hall filled with folding chairs and a giant American flag. No bullying, less bluster, and, all things considered, it was a deft performance.
He held forth on Iran, Israel and the Islamic State; walked the audience through an elaborate plan to raise the retirement age to 69 and eliminate Social Security benefits for those earning $200,000 or more in retirement; and, in direct contrast to an ambiguous answer that invited scorn recently, he stated emphatically that he would not allow parents to opt out of giving vaccines to their children.
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"I cannot be somebody who supports voluntary vaccinations," he answered crisply when a woman asked if she could count on him to support her group's agenda. "We cannot let people put the public health at risk."
There were, of course, reminders of his flaws. Even as he tried to relate to a largely working-class crowd anxious about college tuition costs, Mr. Christie, often enamored of celebrity, indulged in an homage to a wealthy friend, Donald Trump.
"We've been out many times with Donald and his wife," Mr. Christie said. "I consider him a very good personal friend."
And he inevitably engaged in a favorite Christie pastime: self-celebration. He trumpeted his re-election total from two years ago (61 percent) and recited the words of praise that, in his telling, ordinary New Jersey residents heap on him.
"When you say you are going to do something, you do it," Mr. Christie recalled them saying.
He added, "I think that's what Americans are starving for."
But there were touches of tenderness and levity. Mr. Christie, a graduate of the University of Delaware, recalled the overwhelming pride he felt when his son was admitted to Princeton. And he drew laughs as he recalled opening a floridly written piece of mail recently from the University of Notre Dame, where his oldest daughter is now enrolled, notifying him that tuition would rise only 3.9 percent next year.
"They are proud to tell me that keeps total student cost to $61,750," he said. "I was less proud to have learned that."
For Mr. Christie, any path to the Republican presidential nomination runs through New Hampshire, a Northeast state much like his own that favors moderate Republicans like John McCain and Mitt Romney.
Interviews suggest that many voters remain intrigued but skeptical, their fascination with his brash personality dogged by questions about his judgment.
"Well, of course, there is Bridgegate," said Margaret Brady, 58, unprompted.
Ms. Brady, who came to the town hall, said she wanted to like Mr. Christie but was anxious about the unresolved investigations into the conduct of his former aides and allies in New Jersey.
"You want to trust your leaders," she said. Could she trust Mr. Christie? "I have to figure that out," she replied.
For Mr. Christie, the lane closures on the George Washington Bridge are a weight tethering his political ambitions to the ground. Federal prosecutors are expected to announce indictments this month, just as the governor tries to ramp up his national political activities under a potentially ill-timed new slogan: "Tell It Like It Is."
There was no refuge in New Hampshire. During Mr. Christie's brief stop at a diner in Manchester on Wednesday, a table full of retired regulars repeatedly teased him about the scandal.
"When they told me you were coming here, I went down to make sure, personally, that the bridges were going to be open," joked Buck Mercier.
The room erupted in laughter.
The normally prickly Mr. Christie held his tongue. "You know," he said, turning away, "I've heard there are a lot of wise guys at this diner this morning."
Jokes about the bridge were so irresistible that Mr. Mercier's tablemate, Dick Moquin, who had earlier told Mr. Christie that he was in the infamous traffic jam, later said he had been mistaken about the timing.
But by the end of the hour-and-40-minute town hall meeting, it was clear that Mr. Christie had persuaded a number of voters to re-evaluate him. "In the past, we've seen him so frequently in his bombastic role," said Bill McDermott, 76. "It created an impression of him as an ill-tempered, thoughtless person."
But the Christie he listened to in Londonderry, Mr. McDermott said, was "much more laid back, more thoughtful. He told his story in a way that was much more professional than I'd given him credit for."
Mr. Christie even disarmed the opponent of mandatory vaccinations, Laura Condon, whose request he had rejected. Moments after the town hall ended, he stood in the center of a small crowd, gently grasping Ms. Condon's hand as he listened to her make her case. She asked him if she could give him a brochure explaining her position. Mr. Christie agreed and thanked her for attending.
But for every glimpse of a sign of a future revival, there was a reminder of his current woes.
As the audience shuffled out of the room, a man who was not called on during the meeting announced within earshot of the assembled television cameras that he was disappointed.
"I didn't get a chance," he said, "to ask him about traffic on the George Washington Bridge."
PhotoThe NBC journalists Aziz Akyavas, left, Richard Engel and John Kooistra were held hostage.Credit via Associated Press
NBC News on Wednesday revised its account of the 2012 kidnapping of its chief foreign correspondent, Richard Engel, saying it was likely that Mr. Engel and his reporting team had been abducted by a Sunni militant group, not forces affiliated with the government of President Bashar al-Assad of Syria.
In a statement posted on the NBC News website Wednesday evening, Mr. Engel said that a review of the episode — prompted by reporting from The New York Times — had led him to conclude that "the group that kidnapped us was Sunni, not Shia." He also wrote that the abductors had "put on an elaborate ruse to convince us they were Shiite shabiha militiamen."
Mr. Engel and his team were kidnapped in December 2012 while reporting in Syria. They were held for five days. Just hours after emerging, they appeared on the "Today" show.
"This was a group known as the shabiha, this was the government militia, these are people who are loyal to President Bashar al-Assad," Mr. Engel said on "Today," citing information he had gathered from the group. In that and other appearances on NBC, and in a Vanity Fair magazine article, he said that he had been rescued by Sunni rebels. At least two people died during the course of the captivity, he said in some versions of the account.
Interviews by The Times with several dozen people — including many of those involved in the search for NBC's team, rebel fighters and activists in Syria and current and former NBC News employees — suggested that Mr. Engel's team was almost certainly taken by a Sunni criminal element affiliated with the Free Syrian Army, the loose alliance of rebels opposed to Mr. Assad.
The group, known as the North Idlib Falcons Brigade, was led by two men, Azzo Qassab and Shukri Ajouj, who had a history of smuggling and other crimes. The kidnapping ended, the people involved in the search said, when the team was freed by another rebel group, Ahrar al-Sham, which had a relationship with Mr. Qassab and Mr. Ajouj.
Mr. Engel and his team underwent a harrowing ordeal, and it is a common tactic for kidnappers in war zones to intentionally mislead hostages as to their identity.
NBC executives were informed of Mr. Ajouj and Mr. Qassab's possible involvement during and after Mr. Engels's captivity, according to current and former NBC employees and others who helped search for Mr. Engel, including political activists and security professionals. Still, the network moved quickly to put Mr. Engel on the air with an account blaming Shiite captors and did not present the other possible version of events.
An NBC News spokesman said the network would have no comment beyond the statement posted on its site. Vanity Fair said it had no immediate comment.
Just two months ago, NBC News suspended Brian Williams, its nightly news anchor, after he exaggerated an account of a helicopter episode in Iraq in 2003. The furor that surrounded Mr. Williams's suspension led to a management shake-up in the news division, and the installation of Andrew Lack, a former NBC News president, as head of the operation.
NBC's own assessment during the kidnapping had focused on Mr. Qassab and Mr. Ajouj, according to a half-dozen people involved in the recovery effort. NBC had received GPS data from the team's emergency beacon that showed it had been held early in the abduction at a chicken farm widely known by local residents and other rebels to be controlled by the Sunni criminal group.
NBC had sent an Arab envoy into Syria to drive past the farm, according to three people involved in the efforts to locate Mr. Engel, and engaged in outreach to local commanders for help in obtaining the team's release. These three people declined to be identified, citing safety considerations.
Ali Bakran, a rebel commander who assisted in the search, said in an interview that when he confronted Mr. Qassab and Mr. Ajouj with the GPS map, "Azzo and Shukri both acknowledged having the NBC reporters."
Several rebels and others with detailed knowledge of the episode said that the safe release of NBC's team was staged after consultation with rebel leaders when it became clear that holding them might imperil the rebel efforts to court Western support.
Abu Hassan, a local medic who is close to the rebel movement, and who was involved in seeking the team's release, said that when the kidnappers realized that all the other rebels in the area were working to get the captives out, they decided to create a ruse to free them and blame the kidnapping on the Assad regime. "It was there that the play was completed," he said, speaking of the section of road Mr. Engel and the team were freed on.
Thaer al-Sheib, another local man connected with the rebel movement who sought the NBC team, said that on the day of the release "we heard some random shots for less than a minute coming from the direction of the farm." He said that Abu Ayman, the rebel commander credited with freeing the team, is related by marriage to Mr. Ajouj, and that he staged the rescue.
Mr. Engel, in his statement, said he did not have a "definitive account of what happened that night." He acknowledged the group that freed him had ties to his captors, but said he had received conflicting information.
"We managed to reach a man, who, according to both Syrian and U.S. intelligence sources, was one of Abu Ayman's main fund-raisers," he wrote. "He insists that Abu Ayman's men shot and killed two of our kidnappers."
Mr. Engel said the kidnapping "became a sensitive issue" for Mr. Ayman. "Abu Ayman and his superiors were hoping to persuade the U.S. to provide arms to them," he wrote. "Having American journalists taken on what was known to be his turf could block that possibility."
In his Vanity Fair article, Mr. Engel described one of his captors lying dead. In his statement Wednesday, he acknowledged that he did not see bodies during the rescue.
He said that one of his producers, Aziz Akyavas, climbed out of the van through the driver-side door, stepping over a body. "I climbed out of the passenger-side door," he wrote. "A bearded gunman approached and said that we were safe now. That was our introduction to Abu Ayman. He said that he and his men had killed the two kidnappers. Under the circumstances, and especially since Aziz said that he had seen and stepped over a body, I didn't doubt it and later reported it as fact."
PhotoPrime Minister Haider al-Abadi of Iraq, center, on Capitol Hill on Wednesday. He is making his first official visit to Washington.Credit James Lawler Duggan/Reuters
WASHINGTON — A remarkable clash between two key American allies in the Middle East burst into the open here on Wednesday as the Iraqi prime minister publicly criticized the Saudi air campaign in Yemen and a top Saudi official retorted that there was "no logic to those remarks."
The exchange, driven by sharply opposing views of Iran in the region, reflected the challenges facing the Obama administration as it tries to hold together a diverse coalition, including Sunni Arab states and Shiite-dominated Iraq, in the fight against the Islamic State, also known as ISIS. Iran is a sometimes patron to Iraq but an ideological archrival to Saudi Arabia.
The United States remains caught in a difficult balancing act as it tries to keep the Saudi air campaign in Yemen on track against Iranian-backed Houthis. But in its fight against the Islamic State in Iraq, the Obama administration finds itself supporting an Iraqi military offensive that is also backed by Iran.
The dueling Iraqi and Saudi narratives began when Prime Minister Haider al-Abadi of Iraq, who this week is making his first official visit to Washington, spoke early in the day to a small group of reporters at Blair House, the White House guest residence for visiting dignitaries. He said the Saudi campaign and the fighting in Yemen had created huge humanitarian problems.
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Map: Mapping Chaos in Yemen
"There is no logic to the operation at all in the first place," Mr. Abadi said. "Mainly, the problem of Yemen is within Yemen."
Mr. Abadi, who is in Washington seeking American military help in the fight against the Islamic State as well as billions of dollars to shore up his sagging economy, then suggested that the Obama administration agreed with him in his concerns about the Saudi campaign.
"They want to stop this conflict as soon as possible," Mr. Abadi said. "What I understand from the administration, the Saudis are not helpful on this. They don't want a cease-fire now."
The administration swiftly denied that President Obama had expressed concern about the Saudi air campaign during a meeting with Mr. Abadi on Tuesday at the White House.
"The president did not criticize Saudi or G.C.C. actions in Yemen," said Alistair Baskey, a spokesman for the National Security Council, referring to the Gulf Cooperation Council. At the same time, Mr. Baskey said, Mr. Obama had conveyed his view to the Iraqi prime minister "that this not escalate into a broader conflict and that ultimately Yemen's conflict can only be settled through a political negotiation."
In his remarks to reporters, Mr. Abadi also said he was worried that Saudi airstrikes might be a precursor for a more assertive Saudi military role in neighboring states.
"The dangerous thing is we don't know what the Saudis want to do after this," Mr. Abadi said. "Is Iraq within their radar? That's very, very dangerous. The idea that you intervene in another state unprovoked just for regional ambition is wrong. Saddam has done it before. See what it has done to the country."
A few hours later, Adel al-Jubeir, the Saudi ambassador to Washington, held a news conference at the Saudi Embassy and made his remarks about Mr. Abadi in response to questions from reporters, some of whom had met with Mr. Abadi at Blair House.
In addition to saying that there was "no logic" to Mr. Abadi's remarks, Mr. Jubeir set forth a highly positive picture of the Saudi campaign in Yemen. He said that the bombing had destroyed attack planes, helicopters, ballistic missiles, air defenses and command elements. But he gave no precise figures.
Saudi officials have insisted that their airstrikes, which they named Operation Decisive Storm, have been effective in weakening the Houthi forces.
Mr. Jubeir rejected as "false" reports that Saudi bombers had accidentally killed numerous civilians in some of their airstrikes, and said Saudi Arabia had taken measures to minimize risks to Yemeni civilians.
The air campaign has also created fissures among the Houthis and loyalists to the former Yemeni president, Ali Abdullah Saleh. Mr. Jubeir said the bombing had prompted some senior Yemeni officers — he did not say how many — to abandon Mr. Saleh.
"We're beginning to see cracks in their leadership," Mr. Jubeir said.
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Graphic: Despite Tikrit Loss, ISIS Still Holds Large Swaths of Iraq
The ambassador dismissed Mr. Abadi's claim that United States officials were worried about the goals and conduct of the air campaign, saying that no American official had complained to him about it.
The United States is flying Predator and Reaper reconnaissance drones over Yemen and transmitting the information to a 20-person American military coordination team divided among Saudi Arabia, Qatar and Bahrain, overseen by Maj. Gen. Carl E. Mundy III, the deputy commander of Marines in the Middle East, said a senior American military official who wanted to remain anonymous because he was discussing targeting procedures.
Under the arrangement, Saudi Arabia gives lists of potential targets to the American analysts for vetting. "We are not choosing their targets, but upon request, we're providing intelligence to help Saudi Arabia with their precision, effectiveness and avoidance of collateral damage," the official said.
In other comments to reporters, Mr. Abadi played down Iran's role in military operations in his own country — he said that Iran had only 110 military advisers in Iraq, far fewer than American military estimates. And he said that Iran's role was understandable because some of the Islamic State attacks in Iraq were near Iran.
James F. Jeffrey, a former United States ambassador to Baghdad, said that Mr. Abadi's remarks reflected deep-seated Iraqi concerns that sectarian tensions in the region might escalate further with devastating consequences for Iraq.
"The underlying fear in the whole Middle East given the weak state system in most countries is this three-way tug of war between Iran, Sunni Arab states and the Sunni Islamist militant movements," Mr. Jeffrey said. "The Iraqis are openly angry with the Saudis and they are almost certainly quietly unhappy with the Iranians," he added. "They would be the first victims of a Sunni-Shia cataclysm and don't want to be a bigger version of Lebanon."
Later on Wednesday, Iraq's oil minister, Adel Abdul Mahdi, told reporters that the Islamic State had seized control of some of the towers surrounding the Baiji oil refinery in northern Iraq last Friday and had infiltrated part of the complex. The Islamic State militants, he said, are trying to mount a counterattack after their recent loss of the city of Tikrit. Mr. Mahdi said he was confident that the militants would eventually be defeated.
Also on Wednesday, Iraq's finance minister, Hoshyar Zebari, said that Iraq is planning to issue $5 billion in bonds to try to cover a large budget deficit, which he said was about $25 billion for 2015. Iraqi officials have been negotiating with Citibank and Deutsche Bank, which would underwrite the bonds.
Iraq is also hoping to receive about $400 million to $700 million from the International Monetary Fund, though the fund has been insisting that the country do more to cut public spending as a condition of receiving the funds, Mr. Zebari said. Iraq is also hoping to work out an arrangement with the Export-Import Bank of the United States to finance the purchase of Boeing commercial aircraft, which would provide Iraq with $500 million in short-term funds.
It has taken other steps to try to ease its budget squeeze, including deferring $4.2 billion in reparations to Kuwait for Saddam Hussein's 1990 invasion of the country.
Mr. Abadi said that the next step in military operations against Islamic State fighters was to try to roll them back in Iraq's western Anbar Province and north of Baghdad, toward the oil refinery at Baiji. A military push to retake the northern city of Mosul, he said, would not occur until after Ramadan, which ends in mid-July.
On Wednesday, the Islamic State launched a major offensive in Anbar, and by the end of the day, it had captured three villages on the outskirts of Ramadi, the provincial capital, officials said.
During the fighting, hundreds of people from the besieged villages fled their homes, many ending up in Ramadi. State television reported Wednesday that the Islamic State was burning homes and massacring civilians in the areas it had seized, although those reports could not be independently verified.
Anbar officials said that the army had fled the villages that were under attack, leaving tribal fighters and the local police, who they said were badly outgunned by the militants, to defend the areas. In recent days the American-led coalition struck several Islamic State targets near Ramadi, according to a Pentagon statement.
PhotoAngela Williamson, an elementary teacher, leaving court after being sentenced to seven years.Credit Pool photos by Kent D. Johnson
ATLANTA — In an unexpectedly harsh sentence after a polarizing six-year ordeal, eight of the 10 educators convicted of racketeering in one of the nation's largest public school cheating scandals were sentenced to prison terms of up to seven years Tuesday after they refused to take sentencing deals that were predicated on their acceptance of responsibility and a waiver of their right to appeal.
As a result, the sentences, meted out after a raucous court hearing, offered a conflicted, inconclusive coda to a scandal that has brought shame and soul-searching to Atlanta and its 50,000-student public school system. Some were furious with the sentences, and some were pleased.
And as some of the defendants vowed to appeal, it ensured that this city would continue to grapple with two harrowing and interrelated questions: How much mercy should be due a roster of educators with otherwise spotless records? And what kind of justice is due the thousands of students, most of them poor minorities, whose falsely inflated standardized test scores obscured their academic shortcomings?
PhotoTamara Cotman, a regional director, also got seven years.Credit Pool photo by Kent D. Johnson
Many here, amid widespread calls for leniency before the sentencing, were shocked at the severity of the sentences handed down by Judge Jerry W. Baxter, who had seemed to indicate on Monday that he wanted to avoid prison terms. But after the deals fell through, and while declaring the cheating scandal "the sickest thing that's ever happened in this town," he imposed sentences that appeared to be more harsh than those in similar cheating scandals elsewhere and that exceeded what criminals sometimes receive for violent crimes.
The racketeering charges carried a 20-year maximum sentence, and some defendants were also found guilty of lesser crimes. Prosecutors said the teachers had participated in a wide-ranging conspiracy to artificially inflate students' standardized test scores and give a false sense that struggling schools were improving, all within a system led by a superintendent, Beverly L. Hall, who demanded that administrators meet ambitious testing targets.
A 2013 grand jury indictment named 35 Atlanta Public Schools employees, including Dr. Hall. Prosecutors said the educators who engaged in the conspiracy did so to win bonuses, protect their jobs or please their superiors.
Most of the accused took plea deals and avoided trial, and two other defendants, including Dr. Hall, died before they could have a day in court.
Some Atlanta residents said Tuesday that they were shocked at the severity of the punishment.
"I know a lot of people who do illegal things every day, and maybe they get like a month," Malik Andrews, 19, said near the courthouse. "So I think they went overboard."
But the judge also ordered all of the educators released on bond from county jail, where they had been held since their April 1 conviction. Lawyers said that those ordered to prison would probably remain free unless their convictions were upheld in the appeals process, which could take months or years.
Episodes of misconduct by educators elsewhere in the United States previously led to short terms of incarceration. In Ohio, for instance, a former administrator in Columbus's public schools served 15 days in jail after pleading no contest to attempted tampering with records.
Erica O. Turner, an assistant professor of educational policy studies at the University of Wisconsin-Madison, called the Atlanta sentences "entirely unprecedented."
"In other places, I haven't seen quite the same resources and the same desire to prosecute educators for cheating," she said.
Along with pleas for lenience here, there was acknowledgment that the real victims were the children whose education was tainted by falsified test scores that misrepresented what they had learned.
Fani T. Willis, a trial prosecutor, said the outcome showed that the poor African-American children who were the real victims "have dignity, and they matter."
"That, I think," she said, "is what Atlanta should be proud of."
Among those declining deals were three higher-level administrators: Sharon Davis-Williams, Michael Pitts and Tamara Cotman, all regional directors at Atlanta Public Schools. Judge Baxter sentenced each of them to seven years in prison.
These sentences exceeded prosecutors' recommendations. Also sentenced after refusing a deal were Angela Williamson, an elementary teacher, and Tabeeka Jordan, an assistant principal, who each received two years in prison. Three other defendants received one year in prison each: Dana Evans, a principal; Diane Buckner-Webb, a teacher; and Theresia Copeland, a testing coordinator.
Two educators accepted sentencing deals: Donald Bullock, a testing coordinator, was ordered to spend six months of weekends in county jail and five years on probation, and Pamela Cleveland, a teacher, was sentenced to five years' probation and one year of home confinement in the evenings.
All 10 educators were also fined and sentenced to probation and hundreds of hours of community service, and in some cases directed to give remedial instruction to the students whose scores had been altered.
All of them were also sentenced under a "first offender" statute that allows them to have the convictions removed from their records once the terms of their sentences have been satisfied. But arriving at this and other terms of the sentences proved to be an ugly process Tuesday as defense lawyers sparred with an exasperated Judge Baxter, who bellowed at them numerous times and threatened to throw one lawyer in jail in an effort to quiet him.
Judge Baxter, who presided over the complex six-month trial, was angry that some of the defendants would not stand before the court and take responsibility for what they had done.
"She didn't need to apologize to me; she needed to apologize to this community and these children," the judge said to lawyers for Ms. Buckner-Webb, who had questioned the prosecutors' demand that she make such a statement. "I want the community to have the apology, and I want these children who were shortchanged and cheated to have the apology."
At a news conference after the hearing, the Fulton County district attorney, Paul Howard, was joined by the Rev. Bernice King, the daughter of the Rev. Dr. Martin Luther King Jr., who said she would serve on the board of an "Atlanta Redemption Academy" offering remedial help for students harmed by the inflated scores.
Mr. Howard introduced Colleen Banks, a woman whose daughter attended a school where cheating took place; the daughter later had to repeat seventh grade twice.
"I felt like justice was somewhat served," Ms. Banks said, adding: "I have no pity for what happened to them today, because it is what it is. I'm sorry."
Outside the courtroom, some family and other supporters of the defendants were livid over the outcome. Some said that the practice of granting a pass to struggling students had never been criminalized before.
"Social promotion has been around since we were children," said Barbara Holly-Lutalo, 53, a friend of Ms. Evans who had appeared as a character witness for her in court Monday. "So why is it that social promotion is on trial for these educators?"
Ms. Holly-Lutalo said she believed that racism played a role in the treatment of the educators, noting that all of the defendants were black. (Later, Mr. Howard, who is black, as are several members of his team, responded by simply saying, "Look around you.")
Shani Williams, an elementary teacher, was also found guilty of racketeering April 1, but she was not sentenced because she gave birth to a boy over the weekend. On Tuesday night, Patrice Williams, her sister, was spreading the word of a rally at a church to show support for the 11 defendants.
"We are thrilled that they're able to come home and they didn't fall into the trap of taking a plea deal and admit to something they didn't do," she said. "It has been a lot of coercion: Do what the D.A. says, or you might not go home."
PhotoMolly Horwitz, a Stanford student council candidate, said she was horrified by questions asked of her by a student coalition.Credit Jim Wilson/The New York Times
LOS ANGELES — The debate over what constitutes anti-Semitism has spilled into Stanford University's student government election, with a Jewish student claiming that she was asked how her Judaism affects her view of divestment from Israel, morphing what was a contest about campus issues into a fierce discussion on identity and loyalties.
Like other candidates, Molly Horwitz, a junior from Milwaukee, was eager to receive an endorsement from the Students of Color Coalition, an umbrella group that has helped dozens win seats in the student senate. Ms. Horwitz, who was adopted from Paraguay, wrote extensively in her application about navigating both Jewish and Latino circles. Like many other students, she had paid close attention to the campus debate over divestment earlier this year.
But Ms. Horwitz said that what happened in the interview with the student coalition left her shocked and horrified. After talking about issues such as student mental health services with the eight representatives, Ms. Horwitz said, the interview changed topic: "Given your Jewish identity, how would you vote on divestment?"
"I was really taken aback by the question, and it took me a minute to process it, so I asked for clarification to make sure I knew what they were really asking," Ms. Horwitz said in an interview. "They said they saw in my application that I had a strong Jewish identity, and how would that impact my decision?"
Ms. Horwitz said that she responded by explaining that while she was supportive of the process the student senate had used to vote in favor of urging Stanford to divest, she opposed divestment and found the ultimate outcome of the vote disappointing. "There was an awkward silence, and the interview ended a minute later," Ms. Horwitz said. Although she did not receive the group's endorsement, she is still a candidate in the election, which begins Thursday.
Tianay Pulphus, the president of the campus chapter of the N.A.A.C.P., said that Ms. Horwitz's charge was "baseless."
"At no point was she asked whether her Jewish identity impacted her view on divestment," said Ms. Pulphus, a senior who was one of the students who conducted the interview. "We ask all candidates how they would navigate issues that have come up in the previous year. We in no way singled out a candidate based on their ethnic or religious identity."
Ms. Horwitz, like others interviewed, was asked about a range of issues including sexual assault and mental health services, Ms. Pulphus said, and her view on divestment was not the basis of the coalition's decision.
Stanford officials are investigating the incident, as well as charges that the Students of Color Coalition, a group that unites six campus groups representing blacks, Latinos, Asians and Muslims and that supported the proposal for divestment, asked its endorsed candidates to sign a contract promising not to affiliate with Jewish groups on campus. The coalition denied both charges in an article in The Stanford Daily on Tuesday, which was published along with an account by Ms. Horwitz.
This is not the first time the roiling debate on college campuses over divestment from Israel has led to charges of anti-Semitism. Earlier this year, students at the University of California, Los Angeles, asked a Jewish student who was a candidate for a campus judicial committee whether her religion would influence her decision-making. While that incident was captured on film and in official minutes, the case at Stanford is far more murky, with no official record.
"Allegations that any of our endorsees are precluded from affiliating with or receiving endorsements from other groups are unfounded," the Students of Color Coalition wrote. "We reject the notion that religious or cultural identification might prevent someone from being an effective senator. Such a stance is in direct conflict with S.O.C.C. values."
Stanford's undergraduate senate voted in February to ask the university to divest from companies doing business in the West Bank as a way of punishing Israel, but the university's board of trustees said Tuesday that such a decision would be divisive and it would not take up the matter again.
After her interview with the coalition, Ms. Horwitz filed a complaint with university officials, who met with her and promised a swift investigation.
Lisa Lapin, a Stanford spokeswoman, said that officials had found "conflicting accounts of what occurred" and expanded the investigation after The Stanford Review, a student publication that has criticized the Students of Color Coalition in the past, published an article about Ms. Horwitz. The article also said that the student group had asked candidates it chose to endorse to sign a contract prohibiting affiliation with Jewish groups, and Ms. Lapin said university officials were investigating that as well.
"This is a particularly important teaching moment," said Vlad Khaykin, the associate director of the Central Pacific Region of the Anti-Defamation League. "Having aspersions cast on their ability to reflect the interest of the student body on the basis that they are Jewish is obviously very troubling to us. The university needs to make it clear to students and student groups that singling out identity and questioning on those kind of issues is discriminatory."
But several students interviewed on campus said they did not see it as problematic to connect a stance on divestment with Judaism.
Julia Duncan, a freshman from the Bay Area, said that Ms. Horwitz and other candidates should have expected such questions.
"It's not entirely discriminatory to know your take on divestment," she said. "It is their money, and they do have their political agenda. And if their stance is pro-Palestine, I think it's a fair question."
During the debate over divestment earlier this year, Ms. Horwitz wrote several posts on Facebook against it. Miriam Pollock, a friend and campaign manager for Ms. Horwitz, said in an interview Tuesday that before Ms. Horwitz started gathering signatures for her campaign, the two scrubbed her Facebook page to hide all posts indicating support for Israel, including a photograph of a pair of shoes decorated to look like the Israeli flag.
"We did it not because she isn't proud — she is — but the campus climate has been pretty hostile, and it would not be politically expedient to take a public stance," Ms. Pollock said. "She didn't want that to be a main facet of her platform. Of course she was going to be honest if she was asked about her stance on divestment."
Correction: April 14, 2015
An earlier version of this article misspelled the surname of Molly Horwitz's friend and campaign manager. She is Miriam Pollock, not Pollack.
PhotoDemonstrators protesting police violence crossing the Brooklyn Bridge on Tuesday. Dozens were arrested, several assaults on officers were reported and traffic was disrupted for several hours.Credit Michael Appleton for The New York Times
Dozens of participants in a march intended to protest police violence were arrested on Tuesday as the demonstration crossed the Brooklyn Bridge and caused major delays there during the evening rush.
Stephen Davis, the Police Department's chief spokesman, said 34 people had been arrested by 6:40 p.m. That number was expected to rise overnight as precincts in Brooklyn and Manhattan reported arrests, he said.
There were also reports of assaults on police officers, including one involving an off-duty police sergeant who was punched in the face when he got out of his car, Mr. Davis said. The officer was treated at Lower Manhattan Hospital, and the assailant has not been caught, Mr. Davis said.
The police said they were also investigating a report of an officer being struck in the head by a beer bottle.
In a statement, Mayor Bill de Blasio said the violence against the police officers was unacceptable.
"And any other person who might use the right to peaceful protest as cover to initiate violence, cause mayhem or incite disorder — whether against the police, the people or property of our great city — should consider themselves on notice that New York City will not stand for it."
Witnesses and accounts on social media described protesters being rounded up and put in police vans. There were also reports of objects being thrown at police officers and scuffles between officers and demonstrators.
The Stop Mass Incarceration Network organized the march, one of several across the country. About 400 people participated in the early part of the demonstration, which began at Union Square at 2 p.m. and wound down Broadway toward Police Department headquarters in Lower Manhattan.
Around 4:15 p.m., some of the protesters split off and went to the Brooklyn Bridge, where they broke through a police barricade. Some jumped over a fence and onto the westbound traffic lanes.
Traffic in those lanes was disrupted for several hours.
Some protesters continued on Flatbush Avenue toward the Barclays Center.
The demonstration follows the most recent in a string of fatal police encounters with unarmed black men.
Walter Scott, 50, of North Charleston, S.C., was shot and killed by a police officer on April 4. A cellphone video showed the officer, Michael Slager, firing eight shots as Mr. Scott ran away, and later dropping his service Taser next to the body. Mr. Slager was fired and was charged with murder.
Before the march, Cornel West, a prominent black scholar, spoke at Union Square about what he said was his frustration with black leaders' inability to produce charges and convictions against the officers involved in the shootings.
"Don't be confused by some black faces in high places," he said. "For seven years, there have been black and brown brothers and sisters shot down by the police."
He noted that the president, the attorney general and the secretary of homeland security were all black. "And not one policeman sent to jail," Mr. West said.
PhotoRecent indicators suggested that the economy of China could be slowing more rapidly than many observers expected.Credit Jianan Yu/Reuters
HONG KONG — China's economy grew in the first three months of 2015 at its slowest quarterly pace in six years, dragged down by an industrial slowdown and a weak housing market, the government announced Wednesday.
Gross domestic product rose 7 percent from a year earlier, in line with economists' forecasts. While the growth rate means China still ranks as one of the world's fastest growing major economies, it marked the country's slowest quarterly expansion since early 2009, when it was still feeling the effects of the global financial crisis.
China's Communist Party leadership has lowered its official growth target for this year to around 7 percent. This would be the nation's slowest annual expansion in 25 years, but leaders have said this is a price that needs to be paid in order to reduce the economy's reliance on credit-fueled growth and get everyday shoppers to spend more of their savings.
Recent indicators suggest that the economy could be slowing more rapidly than many observers expected. In March, industrial production rose 5.6 percent from a year ago, its slowest increase since late 2008. Land purchases by real estate developers plunged 32 percent by area in the first three months of the year.
Premier Li Keqiang told a forum of Chinese economists on Tuesday that economic performance in the first quarter "has a strong role as a weathervane," according to a report in the Beijing News newspaper.
The pace of growth in the first quarter "supported quite ample employment, and residents' incomes have also risen in step," the Beijing News said, summarizing Mr. Li's comments.
"But on the other hand we must see that downward economic pressure indeed continues to grow," Mr. Li said. "Some of our traditional sources of strength are receding, and at the same time there are newly emerging sources of growth, and some sunrise industries are experiencing explosive growth."
For example, retail sales in March rose 10.2 percent, the slowest increase in nearly a decade. But online merchandise sales increased 41 percent in the first quarter, and now account for about 9 percent of all sales of consumer goods in China.
Foreign trade, by contrast, has been buffeted by lackluster overseas shipments and signs of even weaker demand at home. Exports of goods by value rose only five percent in the first three months of the year, while imports slumped 17 percent, weighed down by lower global prices for oil and other commodities.
The housing market continues to struggle, with home prices falling and new construction starts declining. This has far-ranging effects at home and abroad, including on domestic steel production, pricing of imported iron ore from Australia and the employment of sales agents at property brokerages across China.
Sheng Laiyun, the spokesman for China's National Bureau of Statistics, said that "downward pressure" on the Chinese economy came from both external factors, including the tepid recovery of many economies, and also from domestic factors. New sources of growth were emerging, he said, "but in the short term it's difficult for them to make up for the subsiding of traditional drivers."
China's leaders have responded to the slowdown by easing monetary policy but have held off from introducing more aggressive stimulus measures. Since November, the central bank has cut interest rates twice and freed up banks to lend more. Most economists expect further cuts in the coming weeks or months.
These measures do appear to be having an effect, with key short-term borrowing rates in China's money market, an important indicator of the real cost of funding for smaller banks and other financial institutions, falling to around 3 percent in the past week, down from around 5 percent in February.
Despite this, there are still few signs that the government's efforts at weaning the country off of credit fueled growth are succeeding. Total credit growth has slowed in recent months, but it is still outpacing G.D.P. growth, meaning China as a whole is growing more indebted. The biggest factor here continues to be the increase in corporate borrowing.
In his remarks on Tuesday, Mr. Li emphasized that the government would persist with planned economic and financial overhauls despite slowing growth.
"Our toolbox still has many policy tools, and the biggest tool is reform," Mr. Li said. "There certainly is pressure now, and the pressure on some sectors is quite heavy. But there is also impetus, and many businesses take a positive long-term view of this market," he added.
PhotoHomaro Cantu in 2005.Credit Peter Thompson for The New York Times
Homaro Cantu, a Chicago chef who kept a Class IV laser as a cooking tool and dreamed of eradicating hunger with nutrient-soaked edible paper, was found dead Tuesday on the city's North Side. He was 38.
The police said Mr. Cantu appeared to have taken his own life. The Chicago Tribune reported that he appeared to have hanged himself inside a brewery he had been building.
His blend of science and dining put Mr. Cantu among a small vanguard of American chefs who used chemical-laboratory techniques to coax food into novel and sometimes peculiar new forms. After four years in the kitchen at the Chicago restaurant Charlie Trotter, he was hired for his first job as chef, having impressed the restaurant's owner by cooking fish at the table in a small polymer box, among other feats.
The restaurant, Moto, opened in 2004 and has held a Michelin star since 2012. Mr. Cantu eventually took over most of the ownership.
In his early days, when Moto served synthetic Champagne squirted into a glass by a large black medical syringe, Mr. Cantu sometimes seemed as if he was out to shock. As time went by, though, critics and diners began to pay more attention to the quality of his cooking as well. And as the number of his patent applications grew to six, he revealed a more serious purpose to his fascination with gadgets.
Customers may have giggled as they ate a picture of a cow that tasted like filet mignon, but Mr. Cantu said in interviews that his technology for flavoring and fortifying edible paper could help feed soldiers at war, astronauts in space and people in refugee camps.
"My goal with this is to deliver food to the masses that are starving," he said in an interview with the magazine Fast Company. "We give them something that's healthy, that has an indefinite shelf life, and that is supercheap to produce."
Born in Tacoma, Wash., in 1976, Mr. Cantu was homeless between ages 6 and 9. He traced his interest in helping people through technology and his skills as a chef to that experience.
More recently, his ideas about ending hunger shifted to the miracle fruit, a berry that temporarily makes sour or bitter foods taste sweet. He called this "flavor-tripping," and it was the inspiration for his second restaurant, iNG, now closed, as well as a coffee shop, Berrista.
Last month, Alexander Espalin, an investor in iNG and Moto, sued Mr. Cantu in Cook County Circuit Court. Mr. Espalin, who claimed that he had never received any share of Moto's profits, alleged that Mr. Cantu had misused restaurant funds to promote his own businesses, including a book he had published, "The Miracle Berry Diet Cookbook."
Mr. Cantu lived in the Old Irving Park neighborhood with his wife, Katie McGowan, and their two young daughters.
The Chicago police said an autopsy was scheduled for Wednesday.
Written By Unknown on Selasa, 14 April 2015 | 12.07
PhotoIn Miami, an ad for the Affordable Care Act. Expanded access to Medicaid led to a 25 percent rise in prescriptions in 2014.Credit Joe Raedle/Getty Images
People newly covered by Medicaid drove a significant increase in prescription drug use in 2014, even as those with private commercial coverage filled fewer prescriptions and, over all, patients did not visit the doctor as often, according to a new report by the IMS Institute for Healthcare Informatics, which tracks the health industry.
The report, released on Tuesday, offers a window into how consumers used their insurance in 2014, the first full year after millions of Americans gained coverage through the health care law, which expanded eligibility for Medicaid in many states and set up marketplaces where consumers could shop for insurance.
Patients with Medicaid in states that expanded access to the program filled 25.4 percent more prescriptions than in the previous year, before the expansion. In states that opted not to expand the program, the increase was much smaller at 2.8 percent.
Sabrina Corlette, a senior research fellow at the Center on Health Insurance Reforms at Georgetown University, described the difference as "stark," adding, "it suggests that in the Medicaid expansion states, people are accessing the health care system. They are seeing physicians and other prescribers and getting needed drugs."
The report also provided some new details on the overall growth of spending on prescription drugs, which, it said, rose substantially in 2014 — by 13.1 percent, to $373.9 billion. The increase is the highest since 2001 — mainly because of the arrival of expensive new drugs for conditions like hepatitis C, cancer and multiple sclerosis, at the same time that sales eroded less for brand-name drugs because of new competition with generic drugs. Spending on so-called specialty drugs — high-priced treatments that typically treat serious chronic diseases — accounted for one-third of drug spending in 2014, up from 23 percent five years ago.
Last year "was a remarkable year in terms of growth in spending on medicines," said Murray Aitken, executive director of the IMS Institute. But he added that while growth in specialty drug spending was expected to continue, the eye-popping increase in 2014 was unique and spending would most likely not rise as sharply in future years.
The report sheds some light on who enrolled in coverage through the new marketplaces. The IMS Institute found that 70 percent of people who used a marketplace plan to fill a prescription in 2014 had been covered by commercial insurance in 2013, either through an employer or through purchasing an individual plan. Nearly a quarter — 24 percent — paid cash in 2013, meaning they may have been uninsured. In all, the number of prescriptions paid in 2014 with cash declined by 5.5 percent compared to 2013.
Steven Jacobsohn, a retired financial analyst who lives in Manhattan, said his prescription drug coverage improved in 2014, when he switched from individual coverage through EmblemHealth to a less expensive marketplace plan sold by Health Republic. He said two common generic drugs to treat high cholesterol and blood pressure cost $10 a month under his old policy, but were free under the Health Republic plan. "It's a very good plan," said Mr. Jacobsohn, who is 57.
But even as some have seen their options improve, the report found that many are cutting back on prescription drug use and doctor visits. Many marketplace plans — and, increasingly, plans through employers — come with high deductibles and co-payments, forcing some patients to make tough choices.
Over all, patients made 3 percent fewer office visits and had 1.7 percent fewer hospital admissions. They filled slightly more prescriptions — 2.1 percent — but that was mainly driven by the large increases among Medicaid patients, the report found.
Researchers found that patients who took one type of diabetes drug were less likely to take the drug after their own costs reached $30, and even more so when their costs exceeded $125. Patients who had recently changed to a plan with a deductible took their drug for 25 fewer days, on average, compared to those with more comprehensive plans.
Gary Claxton, a vice president at the Kaiser Family Foundation, said it was difficult to generalize about consumers' coverage under high-deductible plans because they can vary widely in how they are set up. Still, he said, previous studies support the idea that "with more cost-sharing, you get less use."
Mr. Jacobsohn counts himself among patients who have let costs drive his health care decisions. Last year, he said, his doctor suggested that he switch from his generic atorvastatin prescription to Crestor, a more expensive brand-name drug, because his cholesterol was too high. When he learned that the Crestor prescription came with a $60 co-payment, Mr. Jacobsohn said he decided to wait six months to give the cheaper drug another chance to work. His cholesterol improved at the next visit and he never switched to Crestor.
"Not that I couldn't afford it," Mr. Jacobsohn said. "I just didn't know if I wanted to pay for it."
PhotoAryn Higgins at work at Gravity Payments in Seattle. She and her co-workers are going to receive significant pay raises.Credit Matthew Ryan Williams for The New York Times
The idea began percolating, said Dan Price, the founder of Gravity Payments, after he read an article on happiness. It showed that, for people who earn less than about $70,000, extra money makes a big difference in their lives.
His idea bubbled into reality on Monday afternoon, when Mr. Price surprised his 120-person staff by announcing that he planned over the next three years to raise the salary of even the lowest-paid clerk, customer service representative and salesman to a minimum of $70,000.
"Is anyone else freaking out right now?" Mr. Price asked after the clapping and whooping died down into a few moments of stunned silence. "I'm kind of freaking out."
If it's a publicity stunt, it's costly one. Mr. Price, who started the Seattle-based credit-card payment processing firm in 2004 at the age of 19, said he would pay for the wage increases by cutting his own salary from nearly $1 million to $70,000 and using 75 to 80 percent of the company's anticipated $2.2 million in profit this year.
The paychecks of about 70 employees will grow, with 30 ultimately doubling their salaries, according to Ryan Pirkle, a company spokesman. The average salary at Gravity is $48,000 year.
Mr. Price's small, privately owned company is by no means a bellwether, but his unusual proposal does speak to an economic issue that has captured national attention: The disparity between the soaring pay of chief executives and that of their employees.
The United States has one of the world's largest pay gaps, with chief executives earning nearly 300 times what the average worker makes, according to some economists' estimates. That is much higher than the 20-to-1 ratio recommended by Gilded Age magnates like J. Pierpont Morgan and the 20th century management visionary Peter Drucker.
"The market rate for me as a C.E.O. compared to a regular person is ridiculous, it's absurd," said Mr. Price, who said his main extravagances were snowboarding and picking up the bar bill. He drives a 12-year-old Audi, which he received in a barter for service from the local dealer.
"As much as I'm a capitalist, there is nothing in the market that is making me do it," he said, referring to paying wages that make it possible for his employees to go after the American dream, buy a house and pay for their children's education.
Under a financial overhaul passed by Congress in 2010, the Securities and Exchange Commission was supposed to require all publicly held companies to disclose the ratio of C.E.O. pay to the median pay of all other employees, but it has so far failed to put it in effect. Corporate executives have vigorously opposed the idea, complaining it would be cumbersome and costly to implement.
Mr. Price started the company, which processed $6.5 billion in transactions for more than 12,000 businesses last year, in his dorm room at Seattle Pacific University with seed money from his older brother. The idea struck him a few years earlier when he was playing in a rock band at a local coffee shop. The owner started having trouble with the company that was processing credit card payments and felt ground down by the large fees charged.
When Mr. Price looked into it for her, he realized he could do it more cheaply and efficiently with better customer service.
The entrepreneurial spirit was omnipresent where he grew up in rural southwestern Idaho, where his family lived 30 miles from the closest grocery store and he was home-schooled until the age of 12. When one of Mr. Price's four brothers started a make-your-own baseball card business, 9-year-old Dan went on a local radio station to make a pitch: "Hi. I'm Dan Price. I'd like to tell you about my brother's business, Personality Plus."
His father, Ron Price, is a consultant and motivational speaker who has written his own book on business leadership.
Dan Price came close to closing up shop himself in 2008 when the recession sent two of his biggest clients into bankruptcy, eliminating 20 percent of his revenue in the space of two weeks. He said the firm managed to struggle through without layoffs or raising prices. His staff, most of them young, stuck with him.
Mr. Price said he wasn't seeking to score political points with his plan. From his friends, he heard stories of how tough it was to make ends meet even on salaries that were still well-above the federal minimum of $7.25 an hour.
"They were walking me through the math of making 40 grand a year," he said, then describing a surprise rent increase or nagging credit card debt.
"I hear that every single week," he added. "That just eats at me inside."
Mr. Price said he wanted to do something to address the issue of inequality, although his proposal "made me really nervous" because he wanted to do it without raising prices for his customers or cutting back on service.
Of all the social issues that he felt he was in a position to do something about as a business leader, "that one seemed like a more worthy issue to go after."
He said he planned to keep his own salary low until the company earned back the profit it had before the new wage scale went into effect.
Hayley Vogt, a 24-year-old communications coordinator at Gravity who earns $45,000, said, "I'm completely blown away right now." She said has worried about covering rent increases and a recent emergency room bill.
"Everyone is talking about this $15 minimum wage in Seattle and it's nice to work someplace where someone is actually doing something about it and not just talking about it," she said.
The happiness research behind Mr. Price's announcement on Monday came from Angus Deaton and Daniel Kahneman, a Nobel Prize-winning psychologist. They found that what they called emotional well-being — defined as "the emotional quality of an individual's everyday experience, the frequency and intensity of experiences of joy, stress, sadness, anger, and affection that make one's life pleasant or unpleasant" — rises with income, but only to a point. And that point turns out to be about $75,000 a year.
Of course, money above that level brings pleasures — there's no denying the delights of a Caribbean cruise or a pair of diamond earrings — but no further gains on the emotional well-being scale.
As Mr. Kahneman has explained it, income above the threshold doesn't buy happiness, but a lack of money can deprive you of it.
Phillip Akhavan, 29, earns $43,000 working on the company's merchant relations team. "My jaw just dropped," he said. "This is going to make a difference to everyone around me."
At that moment, no Princeton researchers were needed to figure out he was feeling very happy.
PhotoRobert Charles Bates, reserve deputy with the Tulsa County Sheriff's Department, says he confused a Taser and a handgun, weapons similar to these, when he shot a suspect.Credit Cory Young/Tulsa World, via Associated Press
Prosecutors in Tulsa, Okla., on Monday filed homicide charges against a 73-year-old Sheriff's Department volunteer who fatally shot a suspect on April 2, apparently firing his handgun instead of a Taser by accident as other officers were subduing the man on the ground.
The volunteer, Robert C. Bates, was charged with second-degree manslaughter involving culpable negligence, punishable by up to four years in prison.
Mr. Bates, an insurance broker, had been a reserve deputy since 2008. He is among scores of civilian police enthusiasts, including wealthy donors to law enforcement, some of whom effectively act as an armed adjunct to the Tulsa County Sheriff's Department.
Sheriff's officials said he had intended to subdue the fleeing suspect, Eric C. Harris, with a Taser, but mistakenly fired his handgun instead. Mr. Harris was accused of trying to sell an illegal gun to an undercover officer.
Video shot by a body camera worn by another deputy showed the suspect being knocked to the ground and commanded to roll on his stomach as officers struggled for a few seconds to subdue him. A voice on the video could be heard saying "Taser, Taser," as if to warn other deputies to get out of the way of the device.
PhotoRobert C. BatesCredit Tulsa County Sheriff's Office, via Associated Press
A moment later, there was a single gunshot, and a voice saying, "Oh, I shot him. I'm sorry."
Mr. Harris, who is black, could be heard repeatedly shouting "He shot me," while a deputy knelt on the suspect's head and others yelled at him to stop struggling. The video showed Mr. Bates, who is white, dropping his pistol. Officials later said he dropped it because he was unprepared for the gun's recoil, and called it added proof that the shooting was an accident; a Taser has negligible recoil.
Mr. Bates's lawyer, Charles O. Brewster, said that his client would surrender to the authorities on Tuesday morning and that he intends to plead not guilty.
"Anyone that looked at the facts here would find that there was no crime committed," Mr. Brewster said. "It was a truly tragic incident."
Mr. Brewster expressed disappointment with the district attorney's decision to charge his client.
"I think it's kind of a response to the national fervor and media concerning police shootings," he said. "I think he just kind of capitulated to that. This truly is an event that was unintended and what I consider to be a justifiable homicide."
Mr. Bates was working with sworn officers in an undercover operation into illegal gun sales run by the Sheriff's Department's violent crimes task force.
PhotoEric C. HarrisCredit Tulsa County Sheriff's Office, via Associated Press
Mr. Bates acted as an unpaid member of the department's Reserve Deputy Program, in which about 130 volunteers receive training and are deployed part-time throughout the department. A Tulsa police officer for a year in 1964-65, he had received hundreds of hours of advanced training and "can do anything a full-time deputy can do," The Tulsa World quoted a Sheriff's Department spokesman, Shannon Clark, as saying.
In 2012, the department named Mr. Bates Reserve Deputy of the Year.
Mr. Clark did not return telephone calls seeking comment.
Sheriff Stanley Glanz of Tulsa County told The World that Mr. Bates was an old friend "who made an error."
Mr. Bates was the chairman of Mr. Glanz's 2012 re-election campaign and, with a $2,500 contribution, was its biggest donor. In recent years he also donated equipment to the sheriff's office, including automobiles and technical equipment, according to a list provided by the county clerk to radio station KRMG.
"He made an error," Sheriff Glanz said, according to The World. "How many errors are made in an operating room every week?"
Sheriff Glanz told The World that he had no plans to change the deputy reserve program but that it would be looked at as part of the Sheriff Department's routine review of operations.
Mr. Brewster, the lawyer for Mr. Bates, said his client was trying to do his duty as a citizen and a reservist. Mr. Bates made a mistake that law enforcement officers have made many times before, Mr. Brewster said, pointing to the 2009 shooting of Oscar Grant in Oakland, Calif., by a transit police officer, who said that he had mistaken his sidearm for a Taser. Prosecutors charged the transit officer, Johannes Mehserle, with murder, but a jury found him guilty of involuntary manslaughter.
"When you look at this man, his life's work, he's been nothing more than giving, trusting, and just trying to do the right thing," Mr. Brewster said.
Correction: April 14, 2015
An earlier version of this article misstated the day a Tulsa County Sheriff's Department volunteer fatally shot a suspect. It was April 2, not last Thursday.
