From the New York Times, it's the

headlines. I'm Tracy Mumpford. Today's

Thursday, April 23rd. Here's what we're

covering.

One of the key questions swirling as the

US attempts to negotiate an end to the

war in Iran is who is really running

Iran?

The new supreme leader, Ayatollah Mosh

Baham, was wounded in air strikes at the

start of the war, which killed his

father, the previous Supreme Leader, and

he's been in hiding while he recovers.

He still has not been seen in public

since he took over, and that has fed

into uncertainty about the country's

leadership. To try and trace Iran's new

power structure, The Times spoke with

senior Iranian officials, members of the

Islamic Revolutionary Guards Corps, and

others familiar with the country's inner

workings.

Several officials told the Times that

Homine's injuries are severe. He's had

surgery on his hand and leg, and his

face and lips were badly burned, making

it difficult for him to speak. They say

he's sharp and engaged, but he hasn't

released a video or audio message

because he doesn't want to appear weak

in his first public address. Also,

because of fears he could be targeted

again, messages to him are handwritten,

sealed in envelopes, and relayed via a

human chain from one courier to the

next. They travel on highways and back

roads, in cars, and on motorcycles until

they reach his hideout. His responses go

back the same way. That combination of

his injuries and the challenge of

reaching him has led hommin to delegate

decision-making to commanders in the

revolutionary guards corps. It's

essentially left the hardline military

calling the shots. Those generals were

the ones who came up with the strategy

of closing the straight of Hormuz and of

striking neighboring countries in the

Gulf. They were the ones who agreed to

the temporary ceasefire and who decided

to pull the plug on more peace talks

this week because they felt President

Trump was trying to pressure Iran to

surrender. Overall, Iranian officials

tell the Times the generals are feeling

confident in this moment, like they've

been able to prevent the US and Israel

from toppling the regime and that the

country still has leverage in the

conflict.

I can confirm that there was an attack

against the Creek cargo ship.

Yesterday, there were reports that Iran

fired on and seized two ships in the

straight of Hormuz as it tightens its

strangle hold on the waterway. Before

the war, more than 130 vessels went

through the straight every day, and

there was hope the ceasefire would get

those numbers back up. But with Iran

renewing its attacks, traffic in the

straight has pretty much come to a halt.

Also,

I was approached by more than 10 of the

most vulnerable and poorest countries in

terms of energy, and they asked us to

extend that sanction.

Treasury Secretary Scott Bessant doubled

down yesterday on the Trump

administration's decision to extend a

sanctions exemption on Russian oil as a

way of trying to ease the energy crisis

sparked by the war. Russian oil had

previously been blacklisted because of

the war in Ukraine, but the Treasury

Department said it wants to ensure quote

all oil is available to those who need

it. Bessant first paused the sanctions

in March, saying it was temporary.

According to one analysis, that move

caused Russian oil revenues to surge,

nearly doubling last month and providing

a financial lifeline for the Kremlin.

And last update on the war. President

Trump is staring down a looming deadline

for US military operations in Iran. By

law, the president can wage war for 60

days without getting congressional

approval. But at that point, lawmakers

need to authorize it to continue. For

Trump, that date is May 1st, next

Friday. While Republicans in Congress

have largely backed his campaign so far,

some have signaled they won't continue

that support after that deadline. If

lawmakers don't authorize the war, Trump

will either have to pull back

immediately or give himself a one-time

30-day extension that would be used to

safely withdraw US forces. There's also

a chance he could push past the deadline

altogether, though, which would not be

unprecedented. In 2011, President Obama

continued military operations in Libya

past 60 days, which prompted bipartisan

backlash.

A couple of years ago, Republican and

Democratic lawmakers banded together to

take on one of the most costly and

frustrating parts of medical care,

surprise billing. Every year, millions

of Americans who unexpectedly saw a

doctor out of network, often in

emergency rooms, would be hit with far

higher bills than what their health

plans normally covered. So, Congress

passed the No Surprises Act, which

barred out of network doctors from

billing patients directly. Instead,

physicians can take their claim to a

government approved arbitrator to try

and make a case for how much they think

the patients insurance company should

pay them. This new law by all accounts

did do a lot to solve the problem of

surprise medical bills. So patients are

no longer in the middle of these billing

disputes between insurers and doctors.

But what we found is that doctors have

been flooding this new arbitration

system with millions of claims and

getting paid rates much much higher than

they did in the past. Sarah Cliff is an

investigative health reporter at the

Times who's been looking into how the

new system works. Each side submits what

they think is a fair price for the

medical care rendered. They submit some

arguments and then the arbitrator

selects one of them. There is no middle

ground. Somebody is going to win. And

once the arbitrator picks someone, that

is the final decision. There is no route

to appeal. Sometimes the numbers that

insurers and doctors bring to the table

are wildly different.

There was one case that we looked at

where the insurance company offered

$2,600 for a test of blood flow to the

brain. The doctor asked for $330,000

and they won that dispute and got that

money. We saw this happening repeatedly

in this massive data set that had

millions of claims. We saw gynecologists

who were getting 600 times the normal

rates for placing a contraceptive called

an IUD. And the doctors are

overwhelmingly winning these disputes.

We found that in 88% of the cases, they

win and they're often winning hundreds

of times of what they used to get paid

before this law passed.

One of the mysteries is why the results

are so lopsided. It surprised the

lawmakers who wrote this law when we

asked them about it. There are a few

theories. One is that the arbitrators

are paid on a per case basis. So they

have an incentive to render decisions

favorable to doctors to have doctors

continue bringing them disputes. Another

is that doctors are just viewed more

positively by the public than insurance

plans are. And maybe arbitrators have

those same kind of biases that the

general public does.

Sarah says, "As a result of the huge new

payouts doctors are getting, some

insurance companies say they're having

to raise premiums for patients,

essentially passing along the cost of

this new arbitration system.

A study out this week found that after a

national suicide prevention effort went

into effect a few years ago, the rate of

youth suicides in the US dropped. Three

numbers helped me find the help I

needed.

988, suicide and crisis lifeline.

The idea was to basically create the 911

of mental health, taking a 10-digit

hotline number and simplifying it to

just 988.

Lawmakers also put more than a billion

dollars towards supporting crisis

centers. Now, researchers have found

that in the first two and a half years

after the hotline launched, the rate of

suicides among young people was 11%

below projections. There could be other

factors driving the drop. For one thing,

the hotline launched right as the

country was coming out of the depths of

the pandemic. But to try and get a true

sense of the hotline's impact, the study

compared suicide rates between states.

It found that in places that had the

biggest surge in calls to 988, youth

suicide rates dropped significantly more

than places that saw a smaller uptick in

calls. Overall, since 988 launched, it's

fielded more than 25 million calls,

texts, and online chats. According to

the Department of Health and Human

Services, the agency has asked Congress

for another half billion dollars to fund

the program for next year.

I feel like I see them everywhere I

look.

It's so fun to say, too, right?

The Laboo craze over the last few years

has meant that the furry little monster

dolls have been everywhere, from

backpack keychains to high fashion

runways.

We're talking lines through the mall,

wrapped around the block, no sleep, no

shame.

People have waited hours to buy them.

Some of them go for thousands and

thousands of dollars. But now, some of

the toys have been found to contain

cotton that's actually banned in the US

because of concerns about forced labor.

The US government has restricted imports

of cotton from the Shing Jang region of

China, citing human rights violations

after China carried out a vast crackdown

on ethnic minorities there, including

detaining people in camps. A nonprofit

group that advocates on behalf of

weaguers, one of those minority groups,

commissioned a test of a liaboo last

year and found the sample contained

cotton grown in Shing Jang. The Times

then commissioned its own testing which

confirmed that some Labubus have cotton

from that region. There could be serious

consequences for PopMart, the Chinese

company that sells Laboos. Companies

found to have violated the US import

restrictions could have all their

products banned. A spokeswoman for

PopMart told the Times it would conduct

an investigation into its supply chains

and that the company held itself and its

suppliers to the highest standards.

One US lawmaker who co-chairs a

Congressional Commission on China said,

quote, "Popmark should prove that all of

its dolls in the United States are slave

labor free."