ANN ARBOR, Mich. -- Back-to-school preparations require more than just pencils and backpacks. Doctors are reminding parents and caregivers to have a conversation about vaccinations before school bells ring.

Dr. Pamela Rockwell is the medical director of Dominos Farms Family Medicine and an immunization expert who sits on two vaccine advisory committees for the Centers for Disease Control and Prevention. She said she knows these can be difficult decisions for parents, and that's why it's important to have a close relationship with a health expert who can help sort fact from fiction.

"Discussion is always in order, and your family physician can point you toward some information if you need some data,” Rockwell said. “But having that ongoing, trustworthy relationship over years is key."

Some parents don't immunize children for religious reasons; others because of concerns about potential health problems associated with some vaccines.

Michigan law now requires parents to meet personally with health officials before opting out of vaccinating children for philosophical reasons. Along with the required school shots, topics to bring up with doctors include teen vaccinations for HPV, and seasonal flu vaccines.

As kids head back to the classrooms, Rockwell said it's important to remind them how to prevent the spread of common germs through hand washing and proper hygiene. She added that when it comes to vaccines, the volume of information online and on social media can be overwhelming.

"I think that people just are frightened and that's what has happened for about a generation and a half,” she said; “and we've become complacent, because we really haven't seen these vaccine-preventable diseases."

She cited the measles as an example of a highly contagious disease that once was common and that can have serious and even fatal consequences for young children - particularly those with weakened immune systems or who can't be vaccinated for medical reasons.

"And it's for those kids who have medical contraindications, that we should all as a society be obligated to protect them, because if enough people are vaccinated around those that cannot get vaccinated, then they will be protected as well,” Rockwell said.

She said adults also have reasons to ask about vaccines, from tetanus shots to the shingles and pneumonia vaccines for those in their 60s and older. The nonprofit Immunization Action Coalition offers extensive information on vaccine risks.


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In rural Arkansas, access to healthcare can be a distant dream - literally - as almost 60 counties in the state do not have enough providers to serve their populations. A new initiative with the Health Resources and Services Administration is working to improve access in these areas, through telehealth.

Heather Dimeris, director, Office for the Advancement of Telehealth at the Health Resources and Services Administration, said delivering care remotely online fills a crucial gap. Arkansans can visit telehealth.hhs.gov to explore their options, including behavioral and mental-health services.

"You can look at anxiety or depression screening through telehealth," she said. "You can also receive treatment for your anxiety or depression and other mental health needs, through one-on-one therapy as well as group therapy. And telehealth has also been extremely helpful in treating patients with substance-use disorders."

Dimeris noted 40% of all behavioral healthcare is now done virtually, including therapy, addiction counseling, and mental-health screening. She adds HRSA also provides telehealth services for treatment of chronic diseases, like diabetes, and information for healthcare providers.

However, the growth of telehealth spotlights another challenge for rural Arkansas - the lack of reliable, affordable internet service. Dimeris added some people can use their cell phones for telehealth services. Or they can apply for discounted internet access through two programs offered by the Federal Communications Commission.

"The Affordable Connectivity Program, as well as the Lifeline Program," she continued. "Both of these programs have eligibility requirements. But if you meet them, you really are able to access either free or reduced cost for broadband services and cell phone services."

Lower-income households can get up to $30 a month off their internet service bill, or $75 a month if they live on tribal lands, according to the FCC.

California's medical aid-in-dying law is back in court. Three patients with disabilities and two doctors are asking to intervene in a lawsuit challenging the law - and they want the judge to dismiss the suit.

In April, a coalition of disability rights groups and people with disabilities sued to stop the End of Life Option Act, claiming it is discriminatory and "coerces" people with disabilities into using medical aid in dying.

Jess Pezley is the senior staff attorney with Compassion & Choices, which supports the bill.

"It's not discriminatory to offer an additional end-of-life option," said Pezley. "And there's a lot of safeguards built in within the act to make sure that this law is not being used by people who do not want it. The only people who qualify for it are terminally ill with a prognosis of six months to live, and who have the capacity to make the decision."

California is one of ten states - plus Washington, D.C. - that allow doctors to prescribe medication that would allow mentally capable, terminally ill adults to peacefully end their suffering if they choose to take it.

Peter Sussman is a retired journalist and author from the Bay Area who said he lives with constant and disabling pain after a series of spinal surgeries. He said he supports medical aid in dying, and has joined the motion to intervene in the lawsuit.

"When my time comes and I am certified by doctors to be dying within six months, I do not want to die suffering needlessly," said Sussman. "The government shouldn't be able to tell me the manner of my own death."

The State of California, the defendant in the lawsuit, has also filed a motion to dismiss.

Earlier this year, the same judge dismissed a different challenge to the suit brought by the Christian Medical and Dental Association - after it reached a settlement with the state that said doctors who have a religious objection don't have to record a patient's request for medical aid in dying on their chart.

Open enrollment begins soon for employer-sponsored health insurance for coverage starting Jan 1.

Most people will have multiple options to choose from. Some are complex, so now is the time to do your research. According to the website USA Facts.org, about 7.5% of Indiana residents do not have health insurance. Experts say it is important to shop for plans, see exactly what they offer, and if a choice fits a family's needs and budget.

Dr. Rhonda Randall, chief medical officer of Employer and Individual for UnitedHealthcare, said understanding some of the basic insurance jargon is a good place to start.

"Things like deductibles, copays, coinsurance, premiums, etc.," Randall outlined. "Be familiar with what those terms are and what the costs associated with each one is for the plans that you're offered and the plans that you're considering."

Randall advised paying close attention to out-of-pocket costs and monitoring changes which can occur within a plan each year. She suggested the online health insurance glossary Just Plain Clear, which UnitedHealthcare has compiled. In 2021, more than one-third of Indiana's population was covered by public health insurance funded by governments at the federal, state or local level.

Nearly 17% of Indiana's population is 65 or older and eligible for Medicare. But it does not cover everything, so most people also buy a supplemental policy for added coverage, and a prescription drug plan. The Medicare annual enrollment period starts Oct. 15 and ends Dec. 7, when people can get new coverage or change what they've had.

Randall noted UnitedHealthcare has also compiled an online guide to help people navigate those plans.

"Medicare beneficiaries want to make sure they're understanding and learning the difference between original Medicare -- Medicare Parts 'A' and 'B' -- and Medicare Advantage, Medicare Part 'C' and 'D,' the prescription drugs," Randall explained.

Randall encouraged Hoosiers to consider insurance plans including coverage for telehealth -- virtual 24-hours-a day, 7-days-a-week mental and behavioral health services, or management of chronic conditions, such as migraines, plus physical therapy and wellness visits.