Each Wednesday at St. Francis Episcopal Church on the north side of San Antonio, dozens of refugees from all over the world come for free care at the Refugee Health Clinic.

Students and faculty at the University of Texas Health Science Center in San Antonio have teamed up to operate one of the only student-run refugee clinics in the country.

In the past six years, more refugees have resettled in Texas than in any other state. That was before the State of Texas pulled out of the refugee resettlement program in September, citing concerns over terrorism.

The refugees who come seeking care are from the Middle East, southern Africa and Asia. They have fled violence and persecution. An estimated 5,000 refugees live within three miles of San Antonio’s medical center.

Most who have resettled here receive temporary federal government health benefits that run out after six months or so.

“We really fill that gap before they can kind of get on their feet after they’ve lost their government benefits,” says Michael Tcheyan, a medical student who volunteers at the clinic. “We feel like it’s our duty, and it’s their right to get medical care and to be connected with services that are going to make their life better.”

Medical students from the Student Faculty Collaborative Practice of UT Health San Antonio help provide care along with students from the School of Nursing, the School of Dentistry and the School of Allied Health Professions, which includes physician assistants, physical therapy and respiratory care.

Layla Mohsin, 52, came to the clinic for dental care. She’s a teacher from Iraq who came to America with her family of seven to escape the violence.

“We left Iraq and came to the United States because there is safety here. There, there is no safety,” Mohsin says as her son, Karrar Al Gburi, interprets for her. “The main concern? The lethal explosive cars. You can get caught by an explosive car at any place, any time.”

Laxmi Adhikari, a 65-year-old old man who fled Bhutan to a refugee camp in Nepal, is being treated for an itchy stubborn rash. He sports a T-shirt with a local high school team logo, a gift from one of the many people in San Antonio who he says have welcomed him.

“It’s far better than the refugee camp,” Adhikari says through Nepalese interpreter Dal Gajmer. “I trust and believe all of the nurses and doctors. They treat me very well.”

Dental student Eduardo Vela is originally from another country, too. He understands his patients’ challenges. “If you don’t know the language, there are a lot of cultural differences. I myself grew up in Mexico, so I know a little bit of the feeling of being an outsider and then trying to fit in,” Vela says.

The refugee population has many unmet medical needs, says clinic Medical Director Browning Wayman. “They are in search of people to manage their high blood pressure, their diabetes, their high cholesterol, thyroid disease, mental health issues,” Wayman explains. “For a lot of us that went into medicine, we went into it to help people. This is a population that needs help, and so it’s really a joy.”

Funding for the Refugee Health Clinic is provided through the Kronkosky Charitable Foundation and St. Luke’s Lutheran Health Ministries, Inc., as well as the operations budget of the Center for Medical Humanities and Ethics, part of the School of Medicine of the University of Texas Health Science Center at San Antonio. Endowment funds, individual donors and the university pitch in to cover other costs.

Texas will continue to be home to new refugees. But instead of giving financial assistance to the state, the federal Office of Refugee Resettlement will be giving that money directly to nonprofits.

The refugees don’t use the free clinic forever. The staff helps them find more permanent care. If the patient needs a referral to a specialist, they may have to find a way to pay for that visit.

The students and faculty also work to connect patients to whatever health coverage they might be eligible for, such as CareLink, a financial assistance program for health care services through University Health System. It’s available for Bexar County residents who do not have public or private health insurance. The cost is based on family size and income.

Navigating the health care system can be difficult even for Americans, says one of the clinic’s founders, Dr. Andrew Muck, an associate professor of emergency medicine at UT Health Science Center, so he says it is hard to imagine the difficulty for these refugees.

“You don’t speak the language, may not have a job,” Muck says. “And even though you’re in the midst of this robust health system, you can’t get in the door, can’t get over those hurdles.”

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After more than a year of delays, Texas health officials are moving to block the women’s health provider Planned Parenthood from receiving Medicaid funds beginning next month.

In October 2015, Texas officials told Planned Parenthood that the state intended to bar the organization from the public insurance program. Planned Parenthood responded with a lawsuit seeking an injunction against the state.

For more than a year, nothing seemed to be happening. Texas didn’t follow through on its threat, and Planned Parenthood clinics — those that are still open after years of other budget cuts by the state Legislature — continued to provide services.

Then, on Tuesday, Texas Health and Human Services Inspector General Stuart Bowen sent a letter notifying Planned Parenthood that the state would cut off Medicaid funding in 30 days unless the organization requests an administrative hearing with the Texas Health and Human Services Commission in the next 15 days, The Texas Tribune reported.

The newspaper reported that Bowen’s letter referenced undercover videos recorded in Houston by anti-abortion activists who claimed they showed a Planned Parenthood executive improperly offering to sell fetal tissue. A grand jury found no evidence of wrongdoing by Planned Parenthood, and instead indicted two people who recorded the videos for tampering with a government record and illegally offering to purchase human organs, as The Two-Way has reported.

“Your misconduct is directly related to whether you are qualified to provide medical services in a professionally competent, safe, legal and ethical manner,” Bowen wrote in the letter, according to the Tribune.

As in past cases in which states attempted to block funding to women’s health providers, the final outcome of the state’s move will be decided by the federal courts.

On Tuesday night, Planned Parenthood filed a notice in federal court in Austin adding an attorney to its 2015 complaint against the state. Officials from the organization told The New York Times they would continue to provide care to Medicaid patients, and would seek an injunction in federal court to stop the state from blocking funds.

Earlier this month, the federal government finalized a regulation that “says states that award federally funded grants for women’s health programs can’t discriminate against Planned Parenthood,” as NPR’s Alison Kodjak reported. “The regulation doesn’t name Planned Parenthood, but it was clear the rule was written with the organization in mind.”

The organization says about 75 percent of the more than $500 million it receives each year from the U.S. government comes from Medicaid, as we have reported.

As NPR’s Wade Goodwyn has reported, it is already against state and federal law for clinics that perform abortions to receive taxpayer dollars. Clinics that provide other health services — for example, HIV testing, cancer screenings and contraception — largely rely on those funds.

Most Planned Parenthood clinics in Texas do not provide abortion services.

Federal courts in other states have struck down multiple laws that attempted to block Medicaid dollars from clinics associated with organizations that provide abortions.

In 2012, a federal judge found an Indiana law that prohibited abortion providers from any state contracts, including state-administered federal funds, violated the Medicaid Act, which requires state Medicaid plans to “provide that … any individual eligible for medical assistance … may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service.”

This September, a federal judge found a similar law in Arkansas also violated Medicaid statutes protecting the rights of patients. And in October, a federal judge in Mississippi came to the same conclusion about a law passed by that state’s Legislature, writing, “Essentially every court to consider similar laws has found that they violate § 1396a(a)(23) of Title 42 of the United States Code, the so-called “Free Choice-of-Provider Provision.”

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People who want to sign up for a policy on HealthCare.gov after the annual open enrollment period ends Jan. 31 may have to produce a paper trail proving that they qualify for a “special enrollment period,” before their coverage can begin, according to details of a pilot program described by federal officials.

But the verification measures, long sought by insurance companies, may deter the very consumers the marketplace needs to attract: healthy people who may not bother signing up if doing so is a hassle.

The insurance needs of many of the shoppers who use the health marketplaces don’t fit neatly into the three-month annual open enrollment period.

For example, nearly 30 million people — workers plus their families — lose employer-sponsored coverage every year outside of open enrollment, researchers at the Urban Institute found. But they estimated that only about 5 percent of those eligible for a special enrollment period signed up for marketplace coverage in 2015.

Everyone seems to agree that special enrollment periods are necessary to accommodate people who have major life changes such as the loss of job-based health insurance, birth of a child or divorce. But insurers maintain that customers have abused these periods, waiting to sign up until they’re sick and need pricey care.

A study commissioned by two insurance industry groups, America’s Health Insurance Plans and the Blue Cross Blue Shield Association, found that the monthly health insurance claims of individuals who enrolled in coverage under a special enrollment period in 2015 were 41 percent higher during the first three months of coverage than the claims of people who enrolled during regular open enrollment.

That’s not surprising, said Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities. Many consumers are not aware of the availability of special enrollment periods, and the people who are going to make signing up a priority when they lose their jobs or have another life change often are those who have health care needs.

“We reject the idea of widespread abuse [of special enrollment periods], and that the evidence of costs is evidence of abuse,” she said.

Until last February, the federal Centers for Medicare & Medicaid Services – which runs the federal marketplace used by three-quarters of the states – didn’t verify the eligibility of people signing up in a special enrollment period. In June CMS began to require that people who signed up through the HealthCare.gov website provide documentation for some of the most common special enrollment triggering events, including the loss of other insurance coverage, permanent relocation, marriage, birth or adoption. People could receive coverage while their documents were reviewed, however.

The pilot project described last week will tighten documentation requirements still further. Starting next June, half of customers who apply for certain types of special enrollment periods on HealthCare.gov will be required to submit documents verifying their eligibility before their coverage begins. (The specific enrollment categories that will be affected is unclear, except that the pilot will include applications based on the loss of other insurance coverage.) Individuals will have 30 days to submit their documents, after which the marketplace will forward their enrollment information to the insurer.

Neither AHIP nor the Blue Cross Blue Shield Association responded to a request for comment about the pilot program.

Policy analysts are concerned that the new requirements will discourage people, particularly healthy people, from applying. There is some evidence that this is already happening, they say. The fact sheet describing the upcoming pilot reported that sign-ups using special enrollment periods have dropped by 20 percent since the new verification process began in June compared with 2015. Particularly concerning is the finding that younger applicants were more likely to drop out of the verification process than older ones.

“We don’t know if the reason [for the decline] is that people are not eligible or that the process is now so onerous that they’re not completing it,” said Elizabeth Hagan, a senior policy analyst at Families USA, a consumer advocacy group.

The pilot program puts the burden on the consumer to upload or mail in copies of relevant documents. In the regular open enrollment process, the marketplace’s computer system electronically searches for the identification, income and other data necessary to determine eligibility for coverage.

Stan Dorn, a senior fellow at the Urban Institute who authored the report on special enrollment periods, suggested that there are better ways to address the issue than requiring consumers to provide documentation. He said the existing electronic system through which doctors query insurers to confirm patients’ insurance coverage could provide the basis for HealthCare.gov to confirm that applicants have lost their insurance and may be eligible for a special enrollment period.

“We have a lot of experience that eligible consumers faced with [documentation requirements] will drop out of the process,” Dorn said.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter: @mandrews110.

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It took a lot of convincing to get John Evard into rehab. He was reluctant to give up the medications that he was certain were keeping his pain at bay. But ultimately he agreed — and seven days into his stay at the Las Vegas Recovery Center, the nausea and aching muscles of opioid withdrawal are finally beginning to fade.

“Any sweats?” a nurse asks him as she adjusts his blood pressure cuff.

“Last night it was really bad,” he tells her, “but not since I got up.” Evard, who is 70, says he woke up several times in the night, his sheets drenched with sweat.

Evard says it is hard to understand, even for him, how he ended up 300 miles away from his home in Scottsdale, Ariz., at this bucolic facility in the suburbs of Las Vegas. “This is the absolute first time I ever had anything close to addiction,” he says. He prefers the term “complex dependence” to describe his situation.

“It was, shall we say, a big surprise when it happened to me,” he says.

As the nation grapples with a devastating opioid epidemic, concerns have primarily focused on young people buying drugs on the street. But many elderly people in America also have a drug problem. Over the past several decades, physicians have increasingly prescribed older patients medication to address chronic pain from arthritis, cancer, neurological diseases and other illnesses that become more common in later life. And sometimes those opioids hurt more than they help.

A recent study of Medicare recipients found that in 2011, about 15 percent were prescribed an opioid when they were discharged from the hospital; three months later, 42 percent were still taking the pain medicine.

It’s perhaps no surprise, then, that some, like Evard, end up addicted.

Evard spent his life working as a corporate tax attorney. He’s lively and agile, with a contagious grin. A few years ago he and his wife retired to Arizona with their eyes on the golf course. But the dream didn’t last long. Just months into retirement, a virus infected Evard’s left ear. Overnight, he lost half his hearing and was left with chronic pain. In January, he had surgery to fix the problem.

“From the surgeon’s standpoint, the operation was successful,” Evard recalls. “The problem was, the pain didn’t go down. It went up.”

His doctors prescribed opioids, including Oxycontin. “They decreased the pain, particularly at first,” says Evard. “As time went on, [the pills] had less and less effect, and I had to take more and more.”

As the doctors increased his dosage, in hopes of managing the pain, Evard’s once active life fell apart. He was confused, depressed, and still in pain.

“I was effectively housebound,” he says. “I couldn’t play golf anymore. I couldn’t go to social events with my friends or my wife.”

He couldn’t think of anything except the pills, focusing on when he’d be able to take the next one. He knew he was in trouble — despite having taken them exactly as his doctor instructed.

“I was a rule-follower,” he says. “And I still ended up in a mess!”

In 2009, the American Geriatric Society came out strongly in favor of opioids, updating its guidelines on pain management to urge doctors to consider using opioids for older patients who have moderate to severe pain. The panel cited evidence that seniors were less likely than others to become addicted.

Dr. Bruce Ferrell,a geriatrician and pain specialist at the University of California, Los Angeles, served as chairman of the panel that issued the AGS guidelines.

“You don’t see people in this age group stealing a car to get their next dose,” Ferrell told the New York Times at the time.

Dr. Mel Pohl, medical director of the Las Vegas Recovery Center, calls that conclusion a “horrible misconception.”

“There’s no factual, scientific basis for that,” he says. “The drug takes over in the brain. It doesn’t matter how old the brain is.”

The problem is that there aren’t many good options to treat chronic pain as people age. Even aspirin and ibuprofen carry bleeding risks that can be serious.

The 2009 AGS guidelines are no longer in use, but opioid medications remain a crucial tool to treat pain in older people. And most people are able to take opioids in small doses for short periods of time without a problem.

“We really don’t use opioids necessarily as the first line of treatment, because we understand what the risks are,” says Dr. Sharon Brangman, past president of the AGS. “But we also don’t want to see our patients suffering needlessly if we can provide them with relief.” The trick, she said, is to first try non-pharmacological options such as acupuncture, and to use the smallest effective opioid dose possible.

Nonetheless, in the past 20 years, the rate of hospitalization among seniors that is related to opioid overuse has quintupled.

It took John Evard about a week to get over the vomiting and flu-like symptoms of detox, which can be particularly hard on older patients. He still has some of the chronic pain that first led him to seek help from a doctor, he says, but he takes Tylenol to deal with it. He’s speaking out now about opioids because he doesn’t want other seniors to fall into the same trap.

“Don’t just take the prescription because it’s part of the checkout process from the hospital,” he cautions. “It’s your body. Take charge of it, and push for alternatives at all costs. And if you do go on, get off them as fast as you can.”

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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In a study that is sure to rile male doctors, Harvard researchers have found that female doctors who care for elderly hospitalized patients get better results. Patients cared for by women were less likely to die or return to the hospital after discharge.

Previous research has shown that female doctors are more likely to follow recommendations about prevention counseling and to order preventive tests like Pap smears and mammograms.

But the latest work, published Monday in JAMA Internal Medicine, is the first to show a big difference in the result that matters most to patients: life or death.

The study’s authors estimate “that approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year.”

“Of course! What did you expect?” replied the wife of Dr. Ashish Jha, the study’s senior author, when he shared his team’s findings with her. Jha said he expects a backlash over the study results. But his team’s methodology, successfully put through multiple analyses, makes this work noteworthy, he added.

But tens of thousands of fewer deaths per year if we just went with female doctors?

Whoa! To us, a man and woman who met as we were getting our start in medicine, them’s fightin’ words.

An editorial about the study urges doctors to remedy the gender disparities in care and the pay gap that favors male physicians over women.

Since half the patients we treat are women and girls, it makes sense that at least half the physician corps should reflect the population. We’ve achieved that in medical school rolls, but overall only a third of practicing doctors are female. And many specialties, including orthopedics, cardiology and neurosurgery, are still dominated by men.

So why is there a gender-based difference in physicians’ care? The authors admit that they are “unable to identify exactly why female physicians have better outcomes than male physicians.”

We don’t pretend to know for sure, but as married doctors, we have our hunches. We talked it over and here are our thoughts about the research.

Dr. Sarah-Anne Henning Schumann: The actual effect reported in the study is small, but multiplied over a huge population it does add up to something significant.

Dr. John Henning Schumann: I like the Big Data aspect of it. The authors said, “Let’s look at more than a million Medicare patients over several years and see how they fared based on the gender of their doctor.” While many people may want to tear this study apart, I think the findings make intuitive sense.

Sarah-Anne: I’m assuming the difference is because of the way that women, in general, communicate. It’s about being better listeners, more nurturing and having emotional intelligence.

John: There are plenty of men who are good communicators.

Sarah-Anne: Yes, just as there are plenty of women who don’t really have those qualities. For female doctors, having worked their way through pre-med, med school and residency, they can have some of that nurturing communication skill beaten out of them.

John: That happens to men, too!

Sarah-Anne: That’s true. But this study shows us — just possibly — that if female doctors, on average, communicate better, their style might be more effective in treating disease and preventing death.

John: It’s interesting to me because I think about some of my older patients, who much prefer that I tell them what to do rather than to discuss options and share decision-making.

Sarah-Anne: I think that traditionally men were the doctors. People often assume men are more intelligent and so would be more likely to take their advice.

John: That has to change, as we get closer to parity with women in the profession.

Sarah-Anne: My mother has had many experiences with male doctors where she feels they haven’t listened to her. They aren’t warm or kind, but she feels reassured anyway. She thinks they’re smart, and what’s most important to her is their knowledge and technical skill, not their bedside manner.

John: Mom always knows best, if that’s what she values.

Sarah-Anne: Even in our family, we’re both doctors. I’m a family doctor, trained to see adults and kids. You’re an internist, trained to only see adults. And in both of our families, most of the time, our family members will reach out to you with their questions — even about kids. And my family, who attended my Harvard Medical School graduation, I’ll remind you, seems to value your opinion more. They seem to be looking for opinions more from men. That’s kind of an interesting thing.

John: I never really thought about that. I can see how that’s totally male privilege. It has to be frustrating to be taken less seriously.

Sarah-Anne: I’m in a Facebook group of physicians who are moms. While it’s not every doctor-mom in the country, there are over 60,000 of us in it. So many tell stories of being mistaken for nurses — and taking great offense at that. We have worked so hard to get where we are and want to be treated as equals to our male colleagues.

But I see the mix-up as a compliment rather than an insult. To be compared [to] a nurse says that patients are seeing me as someone who is caring for them and nurturing.

John: That’s a smart way to reframe it. Our colleague Jill used to get angry when people assumed she was a nurse. Instead, she decided to embrace it and use it as a call to service. Now she asks patients if they need an extra blanket or something to drink. And she believes that she provides better, more empathic care.

Sarah-Anne: Everyone is going to want to know what is it about women that leads to these better outcomes. I think it’s going to be hard to figure out exactly.

John: Do you think people that read or hear about this study will take home the message that they need to choose female doctors?

Sarah-Anne: Some will no doubt oversimplify it to that. What I take away is that if communication is the key, as I suspect, then we need to better select and train medical students and residents to exhibit these qualities.

John: Amen to that. What about equal pay for equal (or better!) outcomes? Paging Lilly Ledbetter!

Sarah-Anne: You’re not really asking me that, are you?

Sarah-Anne Henning Schumann is a family doctor and serves as medical director of Community Health Connection, a federally qualified community health center in Tulsa, Okla.

John Henning Schumann is an internal medicine doctor and serves as president of the University of Oklahoma’s Tulsa campus. He also hosts Studio Tulsa: Medical Monday on KWGS Public Radio Tulsa. He’s on Twitter: @GlassHospital

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With more states legalizing recreational marijuana, parents are facing the question of whether they should smoke pot around their children.

“I have never smoked and would never smoke around my child,” says one mother who lives in San Francisco. California is one of eight states that allows recreational marijuana use for adults 21 and older.

This woman uses marijuana to treat her migraines and insomnia, but she never uses it around her 5-year-old son. (She asked that her name not be used because marijuana use remains a federal offense.) “I don’t want to impact his air quality by the decisions I’m making,” she says.

This is the right decision, according to research by Dr. Karen Wilson, a pediatrician and lead author of a study showing that children absorb chemicals from secondhand marijuana smoke.

“This is the first time we’ve been able to demonstrate that there are detectable marijuana metabolites in the urine of children who’ve been exposed to marijuana,” says Wilson, who is the Debra and Leon Black division chief of general pediatrics at Mount Sinai in New York.

It’s a small study, involving 43 young children in Colorado, another state where recreational marijuana use is legal. The children, ages 1 month to 2 years, were hospitalized for bronchiolitis. Their urine samples were sent to the Centers for Disease Control and Prevention, which used a new and highly sensitive test that can detect very low levels of marijuana metabolites. They found 16 percent of the overall samples tested positive. And for the children whose caregivers said they had been exposed to marijuana use, 75 percent had traces of marijuana in their urine.

“There is a strong association between those who said there was someone in the home who used marijuana or a caretaker who used marijuana and the child having detectable marijuana levels,” says Wilson.

There is very little scientific evidence to show the health risks of secondhand marijuana smoke or vapor, but there are clues that it could cause problems.

Some studies have shown that even low concentrations of THC — the psychoactive ingredient in marijuana — can cause developmental problems for babies whose mothers used marijuana while pregnant. Other research shows that marijuana use in adolescence can impact the developing teenage brain and cause problems with attention, motivation and memory.

“Our hypothesis is that it is not good for kids,” Wilson says. “We strongly believe that once we do the research to document secondhand marijuana exposure that we will see there is a negative effect on children.”

And this worries doctors, especially in states where marijuana use is legal — more than half of states now have laws legalizing medical marijuana. Dr. David Beuther, a pulmonologist and associate professor of medicine at National Jewish Health in Denver, says his patients frequently ask about the safety of marijuana smoke, and their perception tends to be that it is safer than cigarette smoke. Beuther says they are wrong.

“There is no reason to believe that it is any safer than tobacco smoke exposure,” he says, pointing to studies showing marijuana smoke in rats is just as bad as tobacco smoke or even worse. Beuther suspects that secondhand marijuana smoke or vaper will put children at risk for problems like increased risk of viral infections, asthma and other respiratory illnesses. It could even increase the risk of developing chronic conditions like heart disease and stroke later in life, he speculates.

“To a degree we suffer from lack of evidence,” Beuther says. “But without the federal OK it’s difficult to study it.” As marijuana is still illegal under federal law, it makes it very difficult for laboratories to get permission to conduct randomized clinical trials with it.

So until there is more science on the health risks, Beuther says, marijuana smokers and vapers should take the same precautions around children as tobacco smokers.

“Get it out of the house and away from your baby,” Beuther says. “Not in the car, not in the home. If someone wants to smoke marijuana, they need to do it outside, far away from your baby or your child, because at this point we believe the adverse health effects are probably as bad as secondhand cigarette smoke.”

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When Dominika Tamley chose “Isebelle,” her American Girl doll, she picked a toy whose hair and eye color matched her own. But the 10-year-old is quick to point out that’s not the only way the doll resembles the real child who plays with her.

“She’s like a mini-me,” Tamley explained with pride. “Because she has a hearing aid and I have a hearing aid.”

American Girl has for years offered a wide variety of accessories reflecting a range of disabilities. Arm crutches, leg braces, a sporty red wheelchair and allergy-free lunch sets. You can order a doll without hair — like a child with cancer — or one outfitted with a diabetes kit that includes insulin pumps, pens, glucose tablets and a blood sugar monitor.

“The designer who worked on that had Type 1 diabetes, and it was a really personal item for him to create,” said Stephanie Spanos, a public relations manager at American Girl. The designers developed the diabetes kit with the input of doctors, nurses and dietitians at American Family Children’s Hospital in Madison, Wis., Spanos added. “We introduced that at the very beginning of 2016 and it’s been in and out of stock all year.”

American Girl dolls, which can cost more than $100, often come with a built-in back story, such as Nellie, the Irish immigrant orphan, or Cécile, the Creole girl growing up in 1850s New Orleans. Some activists remain irked that no American Girl comes with a built-in back story related to a disability. (A petition to add one last year, during the 25^th anniversary of the Americans with Disabilities Act, was unsuccessful.)

Still, more and more mainstream companies are adding characters with disabilities to their roster of toys. Earlier this year, Lego introduced, for the first time, a figure of a little boy in a wheelchair. Significantly, he’s not in the hospital — instead, he’s part of a city park set, representing people with disabilities out in the world. And in 2013, Toys R Us added its Journey Girls line of dolls, with accessories including wheelchairs and crutches.

Is this good business? Or just good public relations?

“It’s not about PR for us,” said the chief merchandising officer of Toys R Us, Richard Barry. “Our job as a company is to make sure we have the best assortment for all kids.” Barry pointed out that Toys R Us catalog has also started including children with disabilities in its photos of kids playing with the company’s toys.

Representation of kids with disabilities was harder to find at a big-box store in the suburbs of Washington D.C., where Rebecca Cokley took me shopping. Cokley is executive director of the National Council on Disability, and the first female little person to have worked in the White House. She’s 4 feet 2 inches tall and white, with red hair and freckles. “My family is interracial and interspatial,” she said. “My husband’s average height and African American. And, so, our kids are biracial dwarf kids.”

There were all kinds of toys Cokely liked in the aisles — she’s a Lego nerd and a big fan of Batgirl, a character with her own deep connection to the disability community. But it was nearly impossible to find a single toy that represented disability. In the Barbie aisle, we found chef Barbies, vet Barbies and gymnast Barbies.

“Why can’t one of these come with a hearing aid?” Cokely wondered. And Mattel has stopped making Becky, Barbie’s friend who uses a wheelchair (although you can still find Becky dolls to buy on secondary retail sites online.)

“And look — there’s Barbie’s inaccessible dream house!” Cokely said. “It’s got a working garage, but the elevator is too small for a wheelchair.” It would be tough for Becky to come over for a visit.

We had more luck in the Star Wars aisle. Cokely noticed a Luke Skywalker doll that comes with a prosthetic arm. “That counts!” she exclaimed, with a wry aside: “People do tend to claim Vader, but I don’t know if that’s a good thing or a bad thing.”

Aside from Luke, only one other toy (among many hundreds) explicitly represented a disability: Nemo. The friendly orange clownfish from the Pixar movie has one shortened fin, and the store sold a stuffed plush version.

“Both Finding Nemo and Finding Dory have been phenomenal resources for parents with disabilities,” she said. “Not only in terms of showing good examples of kids with disabilities, but also the challenges of being that overprotective helicopter parent.” She pointed out that some toys – such as My Little Pony — have been embraced by some disability activists, but that so much of the toy section represented missed opportunities.

“Why don’t we have any GI Joes that are disabled vets?” Cokely asked. “Think about that, what that would mean to a young boy whose dad’s a vet or whose mom’s a vet. To see their parents’ experience reflected in the toys — that would be massive.”

Research by social psychologist Sian Jones of Goldsmith University of London, as well as that of others, shows that all children benefit from playing with toys representing disability — it heightens empathy.

And activist Rebecca Atkinson, who runs the Toy Like Me website in the United Kingdom, told me she’d love it if every toybox included a wheelchair and a seeing-eye dog for children to play with. (Atkinson’s website points consumers towards toys that represent disability, and also creates playful images meant to inspire manufacturers, such as princesses with eye patches and scars, and superheros with tracheostomies.

This isn’t a niche market, Cokely added. One in four people will experience a disability at some point in their lives. “Everyone has a family member with a disability,” she said. “Everyone knows someone with a disability.”

And playing with toys in an imagined world where, just like in real life, people walk or use wheelchairs or have hearing aids is a world where kids can imagine other kids — disabled and otherwise — as friends.

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Crowdfunding is a now a popular way to raise money for everything from birthday bashes to political protests. But on some of the big online fund raising sites, you’ll find public pleas for something far more personal — infertility treatments.

Greg and Julia Fry of Ithaca, N.Y., were in their early 30s when they got married three years ago and set out to start a family. But a year passed and they didn’t get pregnant. Six more months went by and, still, no baby.

So they consulted a medical specialist, Greg says. “And we wound up realizing that fertility treatments were what we would need.”

They began with a less costly and less invasive option: IUI or intrauterine insemination. That’s where sperm is inserted with a catheter directly into the woman’s uterus at the time of ovulation. The procedure costs, on average, just under $1,000 a try. The Frys have tried four times in the past year — with no luck.

“This, by far, is the hardest thing that we’ve ever been through together,” says Greg. “There is always hope going into every cycle. And that hope, sort of, gets dashed at the end of the cycle, and then we start again.”

The next step they took was to try in vitro fertilization, or IVF. This involves fertilizing eggs with sperm in a laboratory dish, then transferring the embryo into the woman’s uterus. It can cost $15,000 to $20,000 each try.

At first, Greg says, they thought about traveling overseas for more affordable treatments, but travel costs would have gobbled up any savings. So, they went online instead, to the crowdfunding site GiveForward. They posted a video in which they talk about their decision to ask for financial help.

“You know us as Julia and Greg,” Greg begins. “The couple with so much love to give,” Julia continues, and they alternate telling their story.

Asking for IVF assistance like this is one of the fastest growing crowdfunding categories, according to Josh Chapman, CEO of GiveForward. It’s outpaced all categories except adoption at his firm in 2016, Chapman says, adding, “we believe this trend will continue into 2017.”

Most health insurance doesn’t cover treatments for infertility. That was the case for Janet Carter and her wife Jackie. They live in Charleston, S.C., and both have job-based health insurance.

Janet says their insurance was helpful for the diagnostic part of the process, but that was the extent of the reimbursement. “[The insurance] will cover anything that is testing beforehand, like any underlying issues that are leading to the need for fertility treatment. They do not cover any of the actual procedures at all,” she says.

As their August, 2015 wedding approached, the couple asked their guests to consider giving them cash for fertility treatments.

“We not only had a regular registry for Target, but we also decided to have it be an option for our friends and family that wanted to be a part of us starting our little new family,” Janet says.

The wedding guests gave them about $3,000, which they used to help pay for nine failed IUI attempts. Janet wanted to try asking friends again for money, this time for help with IVF. But, initially, Jackie wasn’t so sure.

“Does it seem like we’re begging, or asking people for money,” she recalls wondering. “Am I ready to do that? Am I ready for people to be that involved?”

They asked friends for their opinions about crowdfunding, and the support was resounding, the women say, save for a wee bit of hesitation from Janet’s mom.

“I think that’s just a generational difference in opinion,” Janet says.

But, Jackie became convinced.

“I realized, ‘Hey, you know what? There are thousands of people out there using these crowdfunding sources for honeymoons and, you know, maybe things that aren’t as impactful as having a child,’ ” she says.

The couple went forward with a site called, YouCaring.com, that’s helped them raise about $5,000 so far.

Still, crowdfunding is hard for a lot of people, says Rachel Gurevich, who writes about fertility issues.

“I wouldn’t do it unless you have a lot of social connections,” she says. “A lot of people think that it’s automatic — they’re going to put it up and raise a bunch of money. And they’re not — and that can be really disappointing.”

Indeed, dozens of IVF campaigns on these sites show $0 raised. Both the Frys and the Carters received money from friends, family and some acquaintances, which is more typical for these crowdfunds, Gurevich says. Most donations range from $20 to $100.

Greg and Julia Fry’s crowdfunding page has earned about $1,200.

“It’s been very positive — everybody that I’ve worked with,” says Julia. “People come up to me. And they’ve come into my office and they hand me $20,” she says. “They say, ‘We love you guys. We think you will be such great parents — please take it.’ “

Their friend Jordanna Larish gave $50, even though she’s unemployed right now. “Julia and Greg are incredibly generous people, always helping others,” she writes in an email to NPR. “They’ve been trying for so long to have a baby, and they’ll be excellent parents.”

Jessie Simpson, who is friends with Jackie and Janet Carter, says she gave them $500 — “and a whole lot of prayers.” Simpson was moved by how easy it was for her to have her son and how difficult it has been for her friends.

“Watching their struggle for over a year, all while the medical bills rack up each month, it was heartbreaking,” Simpson writes to NPR. “That is the power of crowdfunding though — connect their story to your experiences and you want to melt in a puddle of tears and give them the shirt off your back.”

The Carters are using their fundraising to pay down a credit card bill for their IVF. And Janet is now pregnant — their baby is due in June, 2017.

This story is part of NPR’s reporting partnership with Kaiser Health News.

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As drug prices have spiraled upward, tens of millions of generally law-abiding Americans have committed an illegal act in response: They have bought prescriptions medicines outside the U.S. and imported them.

Take Debra Miller, of Collinston, La., who traveled to Mexico four times a year for 10 years to get diabetes and blood pressure medicine. She quit in 2011 after the border patrol caught her returning to the U.S. with a three-month supply that had cost her $40. The former truck driver drew a warning not to do it again, but she got to keep her pills.

“I didn’t know what I did wrong,” said Miller, 51, who now pays $120 a month at Wal-Mart for her five medicines while she waits to join Medicaid.

It’s no secret that some Americans regularly buy prescription drugs on the Internet or while traveling abroad. But the popularity of the approach is underscored by the results of a Kaiser Family Foundation poll conducted in November. (Kaiser Health News is an editorially independent program of the foundation.)

Eight percent of respondents said they or someone in their household had imported a drug at some point, a figure that would translate to about 19 million adults in the U.S. based on current Census population estimates.

Even the proportion found in the poll may be low, says Andrew Zullo, a clinical pharmacist and a doctoral student at the Brown University School of Public Health who has researched the subject. “People are uncomfortable talking about the cost of their own health care, and they don’t want to admit they are struggling to pay for their own meds,” he said. Some may also be reluctant to reveal they’ve broken the law.

Still, 8 percent is far higher than in surveys conducted by government interviewers, which suggested the number was about 2 percent in 2011 — though the government survey focused only on purchases in the previous 12 months. The Kaiser poll queried a nationally representative sample of 1,202 adults.

The Internet has made it easier for Americans to buy prescription drugs abroad, frequently from disreputable sources, according to Jaime Ruiz, a spokesman for U.S. Customs and Border Protection.

The Food and Drug Administration has cautioned that many online pharmacies aren’t what they seem to be. An international crackdown in 2014 found that many packages of medicines purportedly from Australia, Canada, New Zealand and the U.K. contained drugs from other countries, including India, China and Laos.

Zullo acknowledged that imported medications could be inferior or expired. Some could be counterfeits. But many medicines purchased from another country are the same as the ones patients buy in the U.S.

When purchased outside the country, many prescription medicines cost half or less than they do in the U.S.

According to the FDA’s website, it is generally illegal for Americans to import drugs into the U.S. for personal use. The law isn’t rigorously enforced, in part, because it is difficult to monitor the entry of medicine in suitcases and small packages. But in 2015 the FDA implemented a rule that would give government border inspectors expanded authority to destroy drugs imported for personal use at their point of entry.

In the poll, people who had imported medicines ranged from college students in their 20s to retirees in their 80s. They bought medications to treat chronic conditions — such as high blood pressure and thyroid problems — as well as acute problems such as sinus infections and acne.

Amanda Mazumder, a 27-year-old graphic designer in St. Paul, Minn., was stressed out by the murky legality of the situation when she tried buying birth control pills while in college five years ago. “That was the most difficult part, trying to be an honest citizen but also getting an affordable prescription,” she said. She couldn’t afford to pay $150 a month for her birth control, but found an online Canadian pharmacy that sold her a three-month supply for $60.

Bobby Grant, of Los Angeles, has relied on foreign pharmacies for seven years to get medicine for his partner’s severe asthma. Grant, 38, travels internationally for his job producing live shows. Each time he’s in Mexico or France, he buys 10-packs of inhalers and 20-packs of nebulizer solution for a fraction of what they would cost in the U.S.

His partner’s asthma would require inhalers costing $300 a month if she purchased them here. Grant estimates he saves at least $2,500 a year by buying the drugs overseas.

“I love her to death,” he said. “I’ll do whatever I can to take her stress away.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

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