john: tonight on pbs news weekend, a historic global deal to protect marine life on the high seas is reached in amatic, down-to-the-wire negotiations at the united nations. then, an insurance change for a type of breast reconstruction is leaving patients and doctors concerned about future access. wheaton: we need more people on board about is. this is very, very important because this is going to change people's body images. john: and, our hidden histories series continu with the story of the first hispanic woman in space. ♪ >> major funding for pbs news

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thank you. john: good evening, i'm john yang. delegates at the united nations have agreed on a historic international treaty to protect biodiversity in the ocean. it's been years in the making and only made it over the finish line after a marathon 36-hour negotiating session that ended late last night. >> even for people who don't live near it, the ocean is central to life on earth. it covers more than 70 percent of the earth's surface, is home to tens of thousands of species of fish, provides oxygen for the planet, and provides the livelihood for billions of people. but only 1.2% of the ocean has any legal protecti, leaving the high seas lawless and ripe for exploitation. overfishing threatens biodiversity. another threat, the ocean's

rising temperatures caused in part by climate change. the man-made scourge of plastic pollution poses an ever-growing problem. late last month, as the united nations kicked off a fifth round of negotiations to establish a treaty to protect more of the ocean, the cause gained some star power. jane fonda: we depend on the ocean. you know, even dogs don't poop in their kennel because they know that the kennel provides curity and a home for them. we're pooping in our kennel. we're supposed to be so smart. we're destroying things we don't even understand. >> the outcome is critical to reaching another un goal, protecting 30% of the ocean by 2030. over the past two weeks, delegates from 193 countries met to try to hammer out the final details. among the goals, creating a legal framework to establish a network of high sea marine protected areas, creating rules

for exploitation of resources, and confronting the issue of overfishing. >> the ship has reached the shore. [applause] >> late last night, after 36 straight hours of negotiation at the un, the president of the conference announced the historic agreement. earlier i spoke with liz karan who was at the un for the marathon negotiations as head of the pew charitable trusts' efforts to protect ocean life on the high seas. i asked her about the final push to get the deal done. >> it was truly incredible. the negotiations started before the official starting time of 10:00 a.m. on friday morning. and went all through the night into the next morning. it did not include until :00 p.m. the next day. it is not unusual for negotiations of this kind to go into a little bit of overtime.

this is an incredible situation where because of the complexity of the package of issues being dealt with, they needed the extra time to push it over the finish line. >> given the complexity and how long this has been in the works and how long thesfinal rounds of talks were, how much of the significance of the agreement is in the details and provisions and how much is it the fact that it exists? the countries were able to come to an agreement at all -- that countries were able to come to an agreement at all? >> an agreement of th scale that covers the high seas which covers two thirds of the world's ocean. it is also an incredibly detailed agreement that establishes heigh -- high seas.

it evaluates environmental impacts, activities in the high seas, and also sent out financial benefit sharing derived from resources. an important element is it ensures the transfer of marine technology to ensure the equitable implementation. >> what were the toughest hurdles to clear before the agreent was reached? >> i think two key issues, one is around the financial benefit sharing. it really is unprecedented. basically, it ensures that benefits are derived from comments and are shared globally. that means that developing countries that also benefit. those benefits will be in turn used for conservation.

>> it is some of the same splits that we have seen in climate change talks between the rich industrial nations and the poor nations who feel that they are being asked to pay for what the rich industrial nations have created. they are looking to get the benefits, is that right? >> i think financial benefit sharing is an important issue. it is an issue of equity and allowing for the effective implementation of the agreement. the agreement well has a mentioned set out a process for the establishment, large-scale protected areas in the high seas and that is important to protect areas and keep biodirsity in a changing climate. >> this has to be ratified by many of the participant nations, that is right? >> it does.

what occurred last night is about the president of the conference finalized the text that will be going through technical review and translation into all six you and official languages at which time countries will come back and officially adopt -- six u.n. official languages and which t which time countries will come back and officially adopted. high seas makeup 2/3rds's of the world's -- 2/3rds of the world's oceans. we want to ensure that the implementation of the target is hit rate without the treaty it would be hard to hit that target. >> thank you very much. john: president biden went to selma, alabama to mark the 58th anniversary of bloody sunday, when hundreds of protestors were violently attacked by police

during a voting rights march. today, president biden used the occasion to call for progress since the 1965 voting rights act. >> selma is a reckoning. the right to vote. the right to vote, to have your vote counted, is the threshold of democracy and liberty. with it, anything is possible. thout it. without that right, nothing is possible. john: president biden has pushed for two voting rights bills while in office, including one named for the late congressman john lewis of georgia who was badly beaten at the edmund pettus bridge in 1965. former maryland governor larry hogan ended speculation today, saying he will not run for the 2024 republican presidential nomination. hogan is a moderate republican who served two terms in heavily democratic maryland. he is also a longtime and vocal critic of donald trump. hogan said he wants to avoid a crowded republican field that could help the former president win the nomination.

in bangladesh, a rohingya refugee camp erupted in flames today. un and local officials said no one was killed, but that thousands are homeless. more than a million slim rohingya refugees have fled from myanmar to bangladesh over several decades to escape persecution. a trailblazing advocate for disability rights has died. judy "human's" lifelong activism fought discrimination and prejudice against people with disabilities. her work led to major legislation, including the americans with disabilities act. she was featured in the 2020 prize-winning documentary “crip camp", and was once a special advisor to president barack obama on international disability rights. in 2021, she spoke to the newshour about the movement. judy: i think having a disability really has allowed me to do anget in touch with so many things and opportunities that otherwise would not have happened. people look at us as the label of our disability.

and it is a part of who we are, but it is not who we are. john: judy "human" was 75 years old. still to come on "pbs news weekend", fears that an insurance change will limit access to a type of breast reconstruction surgery. and, the story of nasa's first female hispanic astronaut. ♪ >> this is pbs news weekend. home of the pbs newshour, weeknights on pbs. john: health insurance companies are changing the way they reimburse doctors for performing a complicated type of breast reconstruction surgery. doctors and patients fear the changes will make the procedure inaccessible to all but the wealthiest. ali rogin's report is part of our ongoing series "unequal treatment" looking at inequities in health care for women. >> the surgery is known as diep flap reconstruction.

it uses a person's own blood vessels, fat, and skin to reconstruct the breast. older, less complex reconstruction methods use abdominal muscles, but they often lead to complications like hernias and mule weakness. since 2006, doctors have billed insurance companies for diep flap reconstruction using a unique four-digit code. but now, that code is sunsetting over the next two years. instead, diep flap surgeries will be billed with a different code that also includes those older, less complex procedures, which are also cheaper to perform. doctors and patients worry that this will lead to insurance companies only reimbursing the value of the older, less complex procedures. and doctors might not be able to afford to perform diep flap surgery unless patients pay out of pocket. we spoke to some women who have received or are hoping to receive this surgery. diane heditsian: i'm diane hestian and i'm 68 yrs old. i was diagnosed with breast cancer and i had three different lumps.

kate getz: my name is kate getz and i am 30 years old. i was diagnosed in january of 2023 with breast cancer. latishia wheaton: my name is latishia wheaton. i'm 50 years old. i was diagnosed with triple negative breast cancer on march 11th, 2020. i had to do like 16 rounds of chemo. jenni osier: my name is jenni osier and i am 46 years old. i had a prophylactic mastectomy due to a genetic mutation and family history. i had originally planned to go with implants, but my body rejected the tissue expander, so diep is my only option now for reconstruction. jessica hezekiah: my name is jessica hezekiah. i am 37 ars old. my surgeon recommended the diep flap over having an implant because of radiation. having 33 treatments probably would not support the implant. wai-choo finch: my name is wai-choo finch, and i'm 65 years old. it just looked like natural breast. so it makes it makes it easier for you to move forward.

latishia wheaton: i'm just amazed how good of a job that my breasts, you cannot really tell i had reconstructive surgery. diane heditsian: i was extremely happy with the results. i just felt wholagain. jessica hezekiah: going through chemo and going through radiation, you don't look at yourself. you -- you're a you're a bystander. you don't know that person because you get put through chemo, radiaon. you become a number in a clinic. but to have your surgeon make subtle changes and have your insurance cover that for you, now i look at myself and i'm who i am before i had all my treatments done. diane heditsian: i see taking away the insurance code for this particular kind of surgery as an access issue. if we don't win our fight to get this reversed, it's going to end up that the diep flap and other flap surgeries are just not available to underserved women. latishia wheaton: we need more people on board about this. this is very, very important

because this is going to change people body images. kate getz: it is 2023. we have made surgical advances. we are doing better in health care than we ever have been, and women should be seeing the benefits of that. >> joining me now is elisabeth potter. she is a plastic surgeon who specializes in breast reconstruction and is a co-founder of the community breast reconstruction alliance, an advocacy group dedicated to preserving access to diep flap reconstruction. and a note, some of the women we just heard from are her patients. dr. potter, thank you so much for joining us. you are one of a relatively small handful of doctors who perform this type of procedure. and to give people a sense of where diep flap surgery fits into the broader breast reconstruction landscape. diep flap reconstruction constituted 17% of reconstructive surgeries in 2020. can you explain what goes into this surgery? dr. elisabeth potter: diep flap surgery is really the

culmination of many years of surgical refinement and a technique that we as reconstructive surgeons use to transfer a woman's own tissue to her chest to create a natural breast. during a diep flap surgery i remove skin and fat and blood vessels, no muscle from the abdomen area that is similar to the area that might be removed during a tummy tuck procedure. but instead of discarding that, we areble to carefully connect blood vessels in the chest so that that breast is then living on the chest. we can then mold that into the shape that's most natural for the patient, and then the patient moves forward with the breast that is there for their lifetime. very different from an implant. >> and why would somebody choose this surgery over a breast implant? dr. elisabeth potter: you know, patient choice is critical here. so someone might just prefer to not have a foreign body. there are a lot of issues that have come up around implant safety over the last several years.

the more we know, the more patients are informed about risks regarding implants. there's cancers associated with implants and other complications. there's also the fact that implants are not lifetime devices and have to be , maintained and potentially replaced several times over a patient's lifetime. importantly, though, there is a real clinical reason why many women need to have natural tissue reconstruction, and that's radiation. so radiation is an important part of the treatment for breast cancer and for women who have to have radiation, an implant is a less safe option. so for women with a more advanced cancer, with a younger age, a diagnosis or a more aggressive type who might need to have radiation, this is really the gold standard of reconstruction. >> doctor, access to this kind of surgery is also already very limited. lots of insance plans don't cover it. so how would these coding changes affect the access tt already exists?

dr. elisabeth potter: so actually, under the women's health and cancer rights act of 1998, access to reconstruction is really should be guaranteed at least coverage it. although it's difficult to talk about money in cancer, and especially to talk about payments for physicians, this is about patients. if we decrease the payment to surgeons, then quietly those procedures go away and the woman who finds herself needing to find a surgeon or a procedure will find that it doesn't exist in her community. >> and stakeholders like insurance companies and the feral government, they say that this change was always supposed to happen, that the unique code that previously was used for this surgery was always meant to be temporary, and that this change means that it's just a more mainstream surgery and can be identified using one of these existing codes. how do you respond to that? dr. elisabeth potter: i thin that that's a really important point to make. this is not the time to be taking this code away. patient outcomes weren't

considered in removal this code. and despite the fact that insurance companies could plan to change codes over time, we weren't allowed to have a discussion about patient impact and the implementation of this change. so absolutely. can we work together to work over time if codes need to be changed or addressed? yes, but a drastic change in coverage, a drastic change in access is what's happening now. and that's not okay. >> so who has the power to change this? dr. elisabeth potter: centers for medicaid and medicare have the ability to restore these codes. and they honestly have the power to do that pretty quickly because we're seeing right now that patients are being asked to pay cash for these surgeries and facing decreased access in their communities. >>nd dr. potter, there's a much broader conversation have

-- a much broader conversation being had right now about women's health access. o gets to make these decisions? is this surgery? and the changes to the way it's dealt with administratively? is that part of that larger conversation? dr. elisabeth potter: absolutely it is. this effort really highlights so many problems that we're facing in health care. right now, we need for women to have access to care that is best for them from the patient perspective. to me, that's the most important thing that we're seeing. we need to pivot away from just the dollars and cents of insurance companies and surgeons, and we need to look at patient outcomes and what patients need. >> dr. elisabeth potter, a breast reconstruction specialist and the co-founder of the community breast reconstruction alliance. thank you so much for your time. dr. elisabeth potter: thank you, ali. john: we asked the centers for medicare and medicaid services about the change. officials said the phasing in of the new code “allows more than two years for providers and payers to adjust" and that it will give doctors

and insurers ample time to consult with the american medical association, which administers the code. ♪ march is women's history month, so over the next few weeks we're highlighting stoes of women whose accomplishments have often not gotten widespread recognition. >> hello ellen. hello there, i'm up here taking some pictures to support the atlas experiment. >> ellen ochoa was the first hispanic woman in space. she logged nearly 1,000 hours in space over the course of 4 missions between 1993 and 2002. >> astronaut ellen ochoa is maneuvering the robotic arm into a position where it will be for the start of the spacewalk. >> an engineer, she directed her fellow astronauts on space walks from the international space station.

ellen: ok everybody. >> ochoa went on to become the first hispanic person to be head of the johnson space center. ellen: this is really an exciting and important mission for . we will in the future be putting our astronauts on board and we are testing some of the highest risks. >> today she's an advocate for stem education, and has written a bilingual children's book “we are all scientists”. njohn: now online this , instagram story on americans living with diabetes and the price of insulin. you can find this and other stories on our instagram, at

instagram.com/ newshour. and that is pbs news weekend for this sunday. i'm john yang. for all of my colleagues, thanks for joining us. have a good week. >> our service team can find a plan that fits you, to learn more visit consumercellular.tv. >> with the ongoing support of these individuals and institutions. ♪ this program was made possible by the corporation for public broadcasting about contributions your pbs station from viewers like you. -- and contributions to your pbs station from viewers like you. thank you. ♪

this program was made possible in part by contributions to your pbs station from viewers like you. thank you. ♪ what i do, for i know ♪ daniel: good evening, ladies and gentlemen, you're all very welcome to our show here at the theatre royal in castlebar in county mayo in ireland and we're absolutely thrilled to be back with you on public television. (audience cheers and applauds) announcer: so welcome, please, mr. daniel o'donnell. (audience cheers and applauds) daniel: good evening, everybody. lovely to see you all. great that you are able to be with us. are you ready, folks? no turning back now. ♪