The Brief

For two decades, Washington, D.C., pediatrician Lanre Falusi has counseled parents about vaccine safety, side effects and timing. But this year, she said, the conversations have changed.

"For the first time, I'm having parents of newborns ask me if their baby will still be able to get vaccines," Falusi said.

Throughout the U.S., pediatricians say anxious parents are concerned about access to routine childhood immunizations.

That's especially true for those with children covered by Medicaid, the government insurance program for low-income families and people with disabilities. Medicaid covers 4 in 10 children in the United States.

"It really became an issue when RFK Jr. stepped into the role of HHS secretary," said Deborah Greenhouse, a pediatrician in South Carolina.

The concern accelerated after the shake-up of a key Centers for Disease Control and Prevention vaccine advisory body in June, raising fears that millions of American families could soon have to pay out of pocket for shots now covered by their health insurance.

Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist, removed all 17 members of the CDC's Advisory Committee on Immunization Practices (ACIP), the panel responsible for recommending which shots are included in the nation's adult and childhood immunization schedules.

Kennedy replaced the panelists with new members aligned with his views, prompting alarm among medical professionals and public health experts.

Insurance uncertainty worries parents

"People should be worried about what's going to happen to the availability of vaccines for children," said Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF, a national health information nonprofit that includes KFF Health News.

Under the Affordable Care Act, health insurers are required to cover all ACIP-recommended vaccines.

States and other jurisdictions use the childhood vaccine schedule to set immunization requirements for schoolchildren.

ACIP's recommendations also determine which vaccines get covered by the Vaccines for Children Program, a CDC-funded initiative that provides free immunizations to low-income and uninsured children. Half of children in the U.S. are eligible for the VFC Program.

If the new ACIP members withdraw support for a particular vaccine and the CDC director agrees, Tolbert said, the consequences would be immediate.

"It would automatically affect what is covered and therefore which vaccines are available to children on Medicaid," she said.

Health insurance companies have not yet said how they would alter coverage, but Tolbert said such a move would open the door for private insurers to refuse to cover the vaccine.

Pediatricians worry about a future where parents might have to choose: pay hundreds of dollars out of pocket for shots or leave their kids unprotected.

The health insurance industry group AHIP said that health plans "continue to follow federal requirements related to coverage of ACIP-recommended vaccines and will continue to support broad access to critical preventive services, including immunizations."

Pediatricians say news about President Donald Trump's new budget law, which is expected to reduce Medicaid spending by about $1 trillion over the next decade, has also prompted questions from parents.

While parents may be worried about losing their Medicaid, the law doesn't mention vaccines or change eligibility or benefits for children's Medicaid, Tolbert said.

But less federal funding means states will have to make decisions about who is covered and which services are offered.

To raise the revenue needed to pay for Medicaid, states could raise taxes; move money earmarked for other spending, such as education or corrections; or, more likely, reduce Medicaid spending.

"And they may do that by cutting eligibility for optional populations or by cutting services that are optional, or by reducing payments to providers in the form of provider rates," Tolbert said. "It's unclear how this will play out, and it will likely look different across all states."

In May, Kennedy announced in a post on X that the CDC is no longer recommending the COVID-19 vaccine for healthy children and pregnant women. The move prompted a lawsuit by the American Academy of Pediatrics and other physician groups that seeks to freeze Kennedy's directive.

And in June, the new ACIP members appointed by Kennedy voted to recommend that adults and children no longer receive flu vaccines with thimerosal, a preservative rarely used in some flu vaccines. Anti-vaccine activists, including Kennedy, have rallied against thimerosal for decades, alleging links to autism despite no evidence of any association.

"There is no cause for concern," Department of Health and Human Services spokesperson Emily Hilliard said in a statement. "As Secretary Kennedy has stated, no one will be denied access to a licensed vaccine if they choose to receive one."

"When the ACIP committee met last month, they reaffirmed that flu vaccines will remain accessible and covered, and they emphasized safety by ensuring these vaccines are mercury-free," Hilliard wrote.

"The Vaccines for Children (VFC) program continues to provide COVID-19 vaccines at no cost for eligible children when the parent, provider, and patient decide vaccination is appropriate. Medicaid will continue to reimburse the administration fee."

But the possibility that a vaccine could be restricted or no longer covered by insurance is already changing how parents approach immunization.

In Falusi's practice, parents are scheduling appointments to coincide precisely with their child's eligibility, sometimes making appointments the same week as their birthdays.

Doctors warn that fewer kids may get shots if cost shifts to families

Melissa Mason, a pediatrician in Albuquerque, N.M., has treated some patients who got measles during the multistate outbreak that started in neighboring Texas.

She's concerned that any new limitations on access or reimbursement for childhood vaccines could lead to even more preventable illnesses and deaths.

Nationally, there have been more than 1,300 measles cases since January, including three deaths, according to the CDC. "We're seeing this outbreak because vaccination rates are too low and it allows measles to spread in the community," Mason said.

Children and teens account for 66% of national measles cases. Mason has begun offering the measles vaccine to infants as young as 6 months old, a full six months earlier than standard practice, though still within federal guidelines.

Last year, overall kindergarten vaccination rates fell in the United States. At the same time, the number of children with a school vaccination exemption continued to rise.

Pertussis, or whooping cough — another disease that can be deadly to young children — is spreading. As of July 5, more than 15,100 cases had been identified in U.S. residents this year, according to the CDC.

Mason said pertussis is especially dangerous to babies too young to receive the vaccine.

For now, pediatricians are trying to maintain a sense of urgency without inciting panic.

In Columbia, S.C., Greenhouse used to offer families a flexible age range for routine vaccinations.

"I'm not saying that anymore," the pediatrician said.

She now urges parents to get their children vaccinated as soon as they are eligible.

She described anxious parents asking whether the HPV vaccine, which helps prevent cervical cancer, can be administered to children younger than the recommended age of 9.

"I actually had two parents today ask if their 7- or 8-year-olds could get the HPV shot," Greenhouse said. "I had to tell them it's not allowed."

With the vaccine requiring multiple doses months apart, Greenhouse fears time may run out for families to get the series covered by insurance. If they have to pay out of pocket, she's afraid some families may choose not to get the second dose. A second dose could cost about $300 if no longer covered by insurance.

"I cannot be 100% sure what the future looks like for some of these vaccines," Greenhouse said. "I can tell you it's a very scary place to be."

Kennedy's newly appointed vaccine advisory committee is expected to hold its next public meeting as soon as August.

This story comes from NPR's health reporting partnership KFF Health News, a national newsroom that produces in-depth journalism about health issues. It's one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Copyright 2025 KFF Health News

You may know the sounds of parrots screeching pretty well. They’re now definitely part of L.A.'s soundscape, even though they're not native to Southern California and only started multiplying a few decades ago, thriving in our urban jungle.

Researchers at Occidental College, with the Free Flying Los Angeles Parrot Project, have been studying one species in particular to see how they’re adapting to life in the L.A. basin.

The standout parrot

About nine species of parrots, native to South and Central America, fly around the region, according to John McCormack, who’s the director and curator of the Moore Laboratory of Zoology at Occidental College.

He says it’s not clear how they got here. Urban legends say these birds are descendants of parrots that escaped the pet trade, or broke free from homes and aviaries. Regardless, they’ve stuck around.

One of those species is the nanday parakeet, which are known for their rich green bodies, with blue-tinged tails and wings, and dark heads. They showed up in the 1980s and roost in our native Sycamore trees. McCormack says over the years they’ve acted differently from other species.

Nanday parakeets eat fuzzy Sycamore balls instead of local fruits, like the loquats that other parrots love. They also don’t fly as far as nandays would typically do in their native habitats, which includes Brazil and Argentina, or as far as other parrots do here.

“ The nandays had not spread all over the city,” he said. “They’d remained pretty confined to the canyons around Malibu.”

McCormack says the conditions here are different than back home, so that left them with a question:  If they were able to make that switch to L.A. County, why have they not spread beyond Malibu? Only a small portion of their habitat was impacted by the Palisades Fire.

(Russell Campbell/Courtesy Free-Flying Los Angeles Parrot Project)

Flapping to new frontiers

One of the ideas the team investigated was whether the nanday parakeets stayed put because there weren’t any suitable habitats around.

At the time of their analysis, the team found multiple areas where nandays could potentially thrive but hadn’t been spotted in yet. That included a coastal-facing canyon near Fillmore, next to Thousand Oaks, with sycamores.

John McCormack's lab has multiple parrot study specimens.

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Cato Hernández

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LAist

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Then, during their research, they noticed something had changed in that area.

“Lo and behold, we see on iNaturalist that, in fact, there has been this little persisting block of them in the canyon,” he said.

A small group of nanday parakeets have been there for about six months — the first stable population above the 101. Brenda Ramirez, a  research technician on the project, says the community science observations on iNaturalist is what makes their work possible.

“People always get so excited about these birds, and so it’s really wonderful that they get included in our research,” she said.

It’s not clear how the nandays got to these canyons. There’s a possibility it could be a repeat of the past — the birds may have escaped or been released from somewhere nearby.

Or, it could be a sign of changing behavior. Historically, nandays have been reluctant to cross infrastructure like the 101 Freeway. (Maybe they took a page from L.A.’s departed legend, the mountain lion P-22?)

McCormack says it goes to show that if given enough time in the parrot world, interesting things can happen. Next, his team will look into the birds’ DNA to see if there are other signs parrots are adapting to urban life.

It must have been about 10 years ago when I was running in the L.A. Marathon and had worked my way through the early miles along Sunset Boulevard, through downtown L.A. and up Temple Street.

On crossing the 101 Freeway into historic residential Echo Park, I see them: the hand-painted signs, lined up one after another: “Super Sloppy,” “Chili Cheese Dogz.” Then “BAD IDEA?” … “Maybe, Maybe not!”

Then I hear the music, and cheering from the neighbors who’ve come out to see who will tempt gastric disaster for some spicy, drippy chili and yellow American cheese atop nitrate-laced tube steaks.

Did I grab a chili cheese dog? No. I have never dared to take anything more than photos at the stand, given that I still have, at about Mile 5, 21 more miles to run, and running with the “runs” is not my thing.

But Marvin Suntonvipart did in 2016, he said, because he was undertrained and going at a slow jog. He figured it wouldn’t hurt.

“Digestive speed,” he called it. And the roadside snack? “It was good, highly recommended.”

The chili cheese dogs, free to marathon participants, have been the brainchild of artist and puppeteer Julianna Parr and her friend Alex Kenefick since 2011

“He ran up to me breathlessly and said I have this idea where we serve super sloppy chili cheese dogs to marathon runners. And I said to him 'That's a terrible idea. When do we start?'" Parr said.

This will be their 13th year serving marathoners, having skipped a few during the pandemic.

“It’s a happening,” Parr said, adding that she still gets a kick thinking about the runners’ reactions when they turn the corner off the freeway and see the signs leading them to free chili cheese dogs.

“We know that you're expecting to make choices about how you'll run, how fast you'll run, how slow you'll run, how you're going to pace, you've been doing this maybe for months to train, but we know that you have one choice that you probably did not bank on and that would be whether you're going to eat a super sloppy chili cheese dog,” she said.

The food is prepped outdoors on site starting at 5 a.m. Marathon Sunday using camp stoves and heated chafing dishes to keep everything at a safe temperature. Then, the group waits for the athletes to come through. The race starts at Dodger Stadium before 7 a.m. First to pass their stand are the wheelchair racers, then the pro men and women runners and then amateur elites, who are too fast to try to stop.

Soon, by about 8 a.m., there is a trickle of takers. And then the masses arrive.

David Winslow of Culver City partakes of a free chili cheese dog in the fifth mile of the L.A. Marathon in March 2020.

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Courtesy David Winslow

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“We just get mobbed,” she said. “People will try to grab them out of the hot vat. And I go, ‘Back, back!’ Like that's when they get wild, and they don't have common sense anymore and that's [just] at Mile 5."

The stunt costs about $700 each year to put together, which Parr and friends have footed. But this year, for the first time, she has put up a website to sell merch, including stickers, hats, tote bags and mugs. I think it will be a very “locals only” statement to be walking around with a Super Sloppy Chili Cheese Dog tote bag.

Runner Diana Kitching said she picks up a free dog almost every year when she passes by. In fact, in 2024, as a breastfeeding mom whose marathon pace was slowed with a few breaks to pump, she had two!

Unsurprisingly, the chili cheese dogs are most attractive to runners on a more relaxed and fun pace, those who are not taking their marathon times too seriously.

That was the case for David Winslow one year, when he was running with a group of cancer survivors and living kidney and liver organ donors.

“Each time you see the chili guys it’s like, ‘Who would be that crazy and stupid?’ You see guys grab them and go for it, and you shake your head," Winslow said.

But in 2019 and 2020, as he and his survivor and donor friends rounded the turn over the freeway, something changed.

“We just said, ‘Hey, we HAVE to do this!’ And I do not regret it. One of the craziest things to do during a race," Winslow said.

Playwright and performance artist Kristina Wong has eaten bagel and lox and baklava while taking on the L.A. Marathon, but she draws the line at a chili cheese dog.

“These hot dog portions look downright diarrhea-sized,” Wong said.

And runner O. Gary Pealer said he’d eat one at Mile 5 if they also served beer to wash it down.

But in my experience, the people pouring free beer are usually at Mile 20.

Jubilations to the sky! Have you heard the news? Costco is now selling Heinz baked beans. Thank you Costco! And not just that… the British kind!

(Ask any Brit you know who has tried American baked beans. They just taste .... different. Much too sweet. We don’t tend to show much emotion generally but a disappointment like that is not easily gotten over. I’ve seen weeping in the streets.)

And if there are now easily accessed British baked beans in L.A., that means there will be beans on toast at my house. I know that Americans generally don’t get it. As someone once said to me, "you can have beans. You can have toast. But why would you put the beans on the toast?" Because, dear American, you did not grow up in a country where you can put pretty much anything on toast.

Baked beans are now being sold at Costco!

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Suzanne Levy

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You see, we got used to putting things on toast during World War II — rationing and making do and all that. Bread was cheap and available, so why not make it the base of some delicious dishes? Mashed banana on toast? Yummy. Sardines? With a bit of vinegar, lovely. And how about spaghetti hoops? That one really blows American minds. "Wait, you put pasta on toast? Carb on carb?" Yes sir, and it tastes heavenly. The tomato sauce slowly seeps into the toast below, making for a wonderfully gooey texture. It is a work of art.

(There’s also cheese on toast, also known as Welsh rabbit, which I always thought was odd given we were not in Wales and there was no long-eared animal involved, but apparently it’s a corruption of the word rarebit. In case you were wondering).

Like mac and cheese

Beaked beans on toast. Yum

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Suzanne Levy

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LAist

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But for us beans on toast is the most loved option. We all grow up on it, an affordable go-to for weary mums. In many ways, beans on toast is our mac and cheese. Bland yet tasty, the perfect comfort food. For years as an adult, when I went back home for a visit from America, I’d ask my mum to have beans on toast waiting for me when I walked in.

I’m happy to say I’ve got my daughter into baked beans on toast. She resisted at first but now loves it. My American husband has never really developed a taste but understands its centrality in my life. Early on when we were dating, I asked him for egg, beans and toast. As in scrambled eggs, baked beans and toast, a classic breakfast combo.

When he’d made it he walked in and asked if it should be toast, egg and then the beans on top, or toast, beans and then the egg. I almost sputtered. Of course the beans have to go on top of the egg! What are we, peasants? The heavy egg would squash the beans and unbalance the whole precarious structure! He’s never made that mistake again. And has become an expert in making a lovely cup of tea.

So if you see me, feel free to join me in celebrating this major baked bean news. I may have baked beans on toast every night for dinner this week. Just because! It brings a little bit of Britain to my home. There is a New Yorker cartoon which has a man asking a waiter for baked beans on toast. “I’m not British,” he says. “I’m just crazy.” That cartoon is now on my wall.

California community college districts are spending millions of dollars on artificial intelligence-powered chatbots intended to help students navigate admissions, financial aid and campus services.

However, they struggle to consistently provide clear and accurate answers, leaving students frustrated and seeking help from others on unofficial social media channels.

In testing by CalMatters, they often answered general questions correctly but struggled with more specific ones. East Los Angeles College's bot couldn't even correctly name its own president.

Contracts for these chatbots can be pricey and last for years. Three community college districts that responded to a CalMatters survey reported annual costs ranging from about $151,000 to nearly half a million dollars. At the Los Angeles Community College District, the state's largest community college system, contracts and amendments approved since 2021 total about $3.8 million through 2029, according to district board documents.

Community college districts that responded to CalMatters have contracted with chatbot platforms such as Gravyty and Gecko, which district officials say handle thousands of conversations each month, many outside regular office hours, helping to reduce calls and save students unnecessary trips to campus.

Some of these chatbot platforms rely on manually maintained libraries of frequently asked questions and campus websites to answer questions, which can lead to errors when information is outdated or questions fall outside the system's database.

However, officials are working to improve them. Districts like the Santa Monica Community College District have moved to ChatGPT-integrated AI systems that scrape the college's website to generate answers, which officials say seem more reliable. In the Los Angeles district, officials say they plan to transition to a new AI chatbot platform as early as late spring.

Looking for answers

Improvements to the chatbot couldn't come soon enough for students like Pablo Aguirre, a computer science major at East Los Angeles College and an information technology intern at the Los Angeles college district office.

Aguirre mostly avoids the chatbot himself because, he said, it might provide unreliable or outdated information. He recalled using the bot to find financial aid information, but said he gave up after it kept asking him questions instead of giving him a clear answer.

"I just didn't find it as useful," Aguirre said. He usually turns to Google, social media platforms like Reddit and the college's website when looking for answers.

"Online, some pages don't work," Aguirre said, recalling a 404 error message on the college's website. Even when pages load, he said, it can be difficult to find the right one, such as when he was trying to figure out where to sign up for Extended Opportunity Programs and Services, a state-funded program that supports disadvantaged students. "That's where I just jump on Reddit," he said.

Students walk through the Fresno State campus on Feb. 9, 2022.

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Larry Valenzuela

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Aguirre's experience isn't unique. Reanna Carlson, a commercial music major at Fresno City College and student government vice president, said her college's chatbot, dubbed Sam the Ram after its mascot, repeatedly gave her unclear or incorrect answers to basic questions about campus services. Her district, the State Center Community College District, has a nearly $870,000, three-year contract for Gravyty, formerly Ocelot, through June 20, 2026, according to district board documents. Officials pointed out that the contract comes with other services, including tools that let staff engage in live chats or send text messages to students.

"I think the chatbot is outdated and can't navigate the services we provide on campus effectively," Carlson said. "I don't think it's the most beneficial option when it comes to asking questions."

Oddly, Carlson got accurate information on the availability of free food at her campus' Ram Pantry only when accidentally adding a typo to her query. Repeated CalMatters testing confirmed the same outcome, though the bot sometimes lists links that include the food pantry after clicking an adjacent "sources" button.

"If it weren't for the amazing staff on campus that constantly remind students of our services, I'd be lost," Carlson said.

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Screenshots via Fresno City College website

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Testing chatbots

When CalMatters tested community college chatbots, they generally returned quick, accurate responses to common questions but were less consistent with more specific ones.

For example, when asked, "Who is the current president of ELAC?" East Los Angeles College's chatbot incorrectly named Alberto Román, who left the position last year to become the district's chancellor. In another test, when asked, "What is the financial aid office's current schedule?" the bot provided incorrect hours and dates.

East Los Angeles College in Monterey Park on March 14, 2024. Photo by Jules Hotz for CalMatters

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Jules Hotz

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CalMatters

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East Los Angeles College in Monterey Park on March 14, 2024. Photo by Jules Hotz for CalMatters East Los Angeles College's chatbot claims to support several languages, including English, Spanish, Chinese and Vietnamese. But CalMatters found inconsistencies when asking it in Spanish, "Do I need a Social Security number to enroll?" Instead of answering the question, the system directed users to visit the registrar's office to update their Social Security number. When asked the same question in English, the bot pivoted to discussing financial aid.

Fresno City College's chatbot, powered by the same AI provider as East Los Angeles College's system, Gravyty, showed similar problems when asked whether a Social Security number is required to enroll. It also often failed to direct students to the correct offices and, in some cases, listed incorrect locations and hours.

Concerns with chatbots have surfaced elsewhere. In New York City, reporting by The Markup and THE CITY found that a city-run AI chatbot provided guidance that could lead to illegal behavior, prompting Mayor Zohran Mamdani to terminate it in February.

'Good answers with fewer errors'

Santa Monica College's chatbot, powered by Gecko, was more successful in answering most questions. The single-college district uses a ChatGPT-integrated chatbot that scans the college's website, which staff regularly update and monitor. The district has contracted with Gecko since 2019 and renewed its annual contract for the tool late last year for $57,000, according to district board documents. It initially showed a major hiccup: when asked about mental health counseling, the bot did not mention the campus' Center for Wellness and Wellbeing. It does now.

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Screenshots via Santa Monica College website

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District officials say chatbots' problems stem from how the tools are configured and the information they draw from, rather than the technology itself.

The Los Angeles district originally adopted its chatbot through Ocelot, which later merged with Gravyty The same chatbot platform is also used on the California Student Aid Commission website.

Betsy Regalado, one of the district's associate vice chancellors, said the current system relies on a manually maintained library of frequently asked questions that staff at each of the district's nine colleges help maintain and review at least once or twice a year for accuracy. She added that chatbots are primarily geared for the public rather than enrolled students, who can access more detailed personal information through their campus portal.

"The current chatbot that we have uses a library of questions. If you don't have that question in that library, then those poor people don't get an answer or they won't get an accurate answer," Regalado said.

She said the district plans to transition all nine colleges to Gravyty's platform as early as late spring at no additional cost under its existing contract, which runs through 2029. The new system will use AI to scrape college and external websites to generate responses.

"We're ready for the modernization of (the chatbot) and the change to generative AI. That is the new world out there," Regalado said.

Santa Monica College is one of 116 campuses in the California community college system.

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Courtesy Santa Monica College

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Santa Monica College's chatbot similarly initially relied on a manually loaded library of common questions and answers before transitioning to its fully AI system, according to Esau Tovar, the college's dean of enrollment services. In an email, he said the bot "was never designed to address all aspects of the student journey," but to answer general questions from students.

Tovar said the bot draws responses from the college's website, meaning accuracy depends on how current and complete that information is. As a result, the college prioritizes keeping its website up to date so the bot provides "good answers with fewer errors" rather than "great answers with potentially more errors."

Widely used, cautiously trusted

Acknowledging limitations, community college districts justify the costs by pointing to heavy student use, which would cost significantly more if performed by call center staff around the clock.

Regalado said the Los Angeles district colleges average 5,000 to 7,000 interactions per month. Other districts reported similar monthly use, including 5,000 interactions at the State Center Community College District, which includes campuses in Fresno and nearby counties, and 4,000 conversations at Santa Monica College. Regalado said that as long as the chatbot remains heavily used, her district would continue to support it.

Tovar said the chatbot provides 24-hour support regardless of time zone or location, which he said is helpful for international students when they are out of the country. He said that answering the tens of thousands of questions the chatbots receive around the clock would cost significantly more if handled by staff.

"Every technology has a cost. We would simply not be able to assist all students if they could only reach us using traditional methods," Tovar said.

But high usage and expanded access do not always translate into trust, especially when students need precise answers to delicate topics.

Bryan Hartanto, a civil engineering major at Santa Monica College from Indonesia, said the college's newer chatbot system is smoother and can be a useful starting point, especially for students more comfortable communicating in languages other than English. But as an international student he worries that following inaccurate guidance could jeopardize his visa status.

"Maintaining status as an international student right now is very, very sensitive," Hartanto said. "I would still rely on human or email communication."

Martin Romero is a contributor with the College Journalism Network, a collaboration between CalMatters and student journalists from across California. CalMatters higher education coverage is supported by a grant from the College Futures Foundation.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.