As Florida seeks to end vaccine mandates, a behind-the-scenes debate in the medical community has been thrust into the public spotlight: Should doctors see young patients whose parents do not want them to get shots?

The decision has long rested with physicians, who say they weigh the needs of children who have no control over their families’ health care choices against their responsibility to protect their most vulnerable patients — including newborns — from potential exposure to highly contagious, preventable diseases. Many pediatricians opt to require vaccines, even posting such policies on their practice’s websites.

But doctors no longer will make the call if Florida leaders have their way. Gov. Ron DeSantis and Surgeon General Joseph Ladapo said on Sept. 3 they want to end vaccine requirements in public and private spaces, including doctors’ offices.

That announcement alarmed some Central Florida pediatricians, who view requiring vaccines for diseases such as measles, polio and whooping cough as critical public health measures even as the COVID-19 pandemic made parents increasingly distrustful of vaccines and government mandates.

Dr. Pamela Trout said she asks parents who refuse to vaccinate their children to look elsewhere for their health care because she feels she needs to protect children who are too young to get the shots or can’t get them for medical reasons. That means keeping unvaccinated kids out of her waiting room.

“It’s not fair to my other patients,” said the Winter Park doctor.

But DeSantis has decried this stance as a form of “discrimination” he wants to stop.

“That is limiting people’s freedom to do what they think is right for their kids by having these restrictions,” DeSantis said during a press conference last week.

Not all vaccines required by the state may make sense, DeSantis added, citing Hepatitis B, which is often transmitted through activities like sex and needle-sharing, as an infection he did not think young children would be likely to contract.

Under current state law, doctors can turn away patients who refuse vaccines, but legislators could change that, said Lars Noah, a law professor at the University of Florida whose areas of focus include public health.

And they may have ethical reasons for doing so, he said. “To say, ‘you do it my way or I’m not going to see you anymore,’ is fairly coercive,” Noah said. “Some of these patients may not have a whole lot of choices.”

Posts from parents searching for pediatricians who take a flexible stance on vaccines are common on local social media pages.

“I have multiple children but my youngest isn’t vaccinated yet and I’m not sure when or if I want to but I don’t want to constantly be pushed every time I take my baby to the doctor,” one mother wrote on Facebook recently.

Ladapo said last week the Florida Department of Health will end state rules that mandate certain vaccines first and then work with DeSantis and the Legislature to eliminate the rest of the required shots. It’s unclear whether lawmakers would support such a change or pass a new law requiring doctors to treat unvaccinated patients.

Earlier this year, legislators failed to pass a law that would have prohibited healthcare providers and facilities from declining to treat patients based solely on vaccination status. Some lawmakers worried that the provision exposed physicians to medical malpractice lawsuits. 

During the pandemic, Florida forbade businesses from asking for proof of COVID-19 vaccination from their customers and employers from requiring their workers to get the shots. That prohibition was narrowly focused on the COVID-19 vaccines, but Noah said it shows lawmakers can stomp out vaccine mandates and could extend such a ban to health care settings.

“Doctors are subject to all kinds of intrusive state mandates these days,” Noah said. “This one strikes me as one of the least controversial that you could pick.”

But local pediatricians say lawmakers need to consider that some patients can’t get the shots for medical reasons and depend on the immunity of others to protect them.

Pediatrician Dr. Jaime Candelori at her Maitland office, on Monday, Sept. 8, 2025. (Ricardo Ramirez Buxeda/Orlando Sentinel)

“The most vulnerable kids, the ones who can’t be vaccinated, are the ones at highest risk,” said Dr. Jaime Candelori, who is based in Maitland. “As a pediatrician, as a parent, I would not send them to a school knowing not all the kids are vaccinated.”

Candelori said she works with parents who are hesitant about shots but willing to discuss the benefits, but suggests that families who are adamantly opposed to vaccines pick a different doctor.

“If parents don’t trust you to say vaccines are safe, and they’re the best method we have in preventing serious illness in kids, how can you have a relationship?” Candelori said.

Pediatrician Dr. Jaime Candelori at her Maitland office, on Monday, Sept. 8, 2025. (Ricardo Ramirez Buxeda/Orlando Sentinel)

Jessica Tillmann, a Seminole County mother of four, believes parents have the “fundamental right” to decide whether their children receive shots. Tillmann said she decided not to vaccinate her two youngest children after her second oldest had an adverse reaction after receiving a shot.

She obtained a religious exemption for her unvaccinated children, who attend a private school. Her family has been “kicked out” of several doctors’ practices because of her stance on vaccines, she said.

“I think it’s almost disturbing a pediatrician would kick out a parent for asking questions about an invasive procedure,” said Tillmann, the chair of Seminole’s Moms for Liberty chapter, a conservative parents group that formed during the pandemic. “If that is their true concern, then I would suggest that they make time in their schedule to see those patients when they know they won’t be around other patients.”

Many parents, like Tillmann, are already declining the shots. Florida, which offers parents easy-to-get religious exemptions from its current vaccine rules, saw a 20-year low in the kindergarten vaccination rate during the 2024-25 school year.

Last school year, less than 89% of Florida kindergarteners were fully immunized. That rate is well below the 95% level, sometimes referred to as herd immunity, which makes it unlikely that a single infection will spark a disease cluster or outbreak.

The lower vaccination rate alarms experts, who note there was a measles outbreak at a Broward County elementary school last year, where 33 students lacked at least one required shot, and that two unvaccinated Texas school-age children died from measles a few months later.

If the mandates go away entirely, even fewer parents will vaccinate their kids, said Dr. David Carr, a pediatrician whose practice is just south of downtown Orlando.

Carr said he sees children whose parents refuse vaccines because many of his patients are covered by Medicaid insurance plans and the rules of that program generally forbid doctors from withholding care based on their vaccination status.

But as a physician for nearly four decades, Carr described vaccines as “one of the biggest medical marvels of modern history.”

Today’s parents haven’t seen most of the diseases that shots are intended to prevent and many don’t realize how seriously ill their children could become if they’re not protected, he said.

Carr said he fears diseases like diphtheria, a respiratory infection that’s particularly dangerous for young children and older adults, could make a comeback if vaccination rates dip too low. Because Central Florida draws tourists from around the world, this area is particularly vulnerable to an outbreak, he said.

“I think the vaccine program in the United States has been so successful it’s become a victim of its own success,” he said.

The American Medical Association said last week it “strongly opposes” Florida’s plan to end all vaccine mandates. “This unprecedented rollback would undermine decades of public health progress,” it said in a statement, and put children at risk of serious illness.

However, the organization previously has urged doctors not to turn away patients who decline shots. During the pandemic, it acknowledged that many doctors were frustrated with patients who forwent the COVID-19 vaccines but said they should see them anyway.

Dr. Pam Trout at her pediatrics practice near AdventHealth Winter Park hospital, Monday, Sept. 8, 2025. Like many pediatricians, Trout has concerns about state plans to remove school vaccine mandates. (Joe Burbank/Orlando Sentinel)

But Trout doesn’t budge on shots. She said she knows many of her peers will make exceptions, adding she’s “one of the stricter pediatricians in town.”

“I require all vaccines on schedule and if they choose not to, I just tell them, ‘It’s been great treating you and I would love to continue, but this is my policy and I would just ask you to find a practice that’s comfortable with kids that aren’t fully vaccinated being in their office,” she said.

If Florida laws change, Trout said, her office policies “will be what is best for my patients.”

She added she thinks some parents resist vaccines because of notions about personal freedom or feelings that they should only look out for their own families.

“I don’t even think people are willing to consider the community or the greater good,” Trout said.

anmartin@orlandosentinel.com

A correction to an earlier version of this article has been appended to the end of the article.

Health insurance giant Anthem wanted $1,800 from Lauren Gonzalves for hospital nursery services after the birth of her son. But it had been two years since the Concord mother gave birth, she had already paid her out-of-pocket maximum and she believed her policy covered the care for which Anthem repeatedly sought payment.

The situation may be unsurprising for many of those with health insurance. Health care consultancy Premier pegged the national medical claims denial rate at 15% in 2023, while independent research group KFF found insurers that sell policies under the Affordable Care Act denied one in five claims that year.

Gonzalves, however, had an advantage over many policyholders: She has a doctorate in a medical field and has worked for large health care companies for years as a clinician and scientist.

Still, she spent almost two years working to get the bill canceled, and in the end, only found rescue in an AI bot.

In a statement, Anthem said it could not comment on Gonzalves’ billing for privacy reasons.

The free conversational bot Gonzalves, 39, used for help in defending the insurance coverage for her son’s care in the hospital nursery identified a federal law and other information that supported her claim. It’s one of two primary offerings from Counterforce Health, a North Carolina-based company running an AI-based platform for challenging health-coverage denials.

Counterforce Health’s flagship product, also free, produces AI-generated letters of appeal, to be sent to insurance companies by patients fighting denials.

The platform was co-founded by Neal Shah after insurance companies denied everything from an oncologist-prescribed MRI to a life-saving drug for his 34-year-old wife as she fought cancer, he said.

“It’s absurd how many people are fighting insurance denials,” Shah said.

It appears that it’s getting worse. In a survey of 200 executives and managers at health care providers — which are reimbursed by insurers for authorized patient care claims — consumer-credit and data company Experian found that in 2024, more than three-quarters said denials were rising. Fewer than half gave that response in 2022.

Insurance companies increase profits by refusing to pay initial claims, under a “Let’s deny, and see what you do” approach, Shah said.

In California, health plans approve the vast majority of the hundreds of millions of claims received every year, according to the California Association of Health Plans, which represents insurers,

“In fact, over 85 percent of medical services and 75 percent of pharmacy services are approved immediately,” the group said this week. “When a claim is denied, it’s most often due to incomplete information that needs clarification. Most denied claims are quickly resolved.”

Shah, who works as a principal investigator at the Johns Hopkins Artificial Intelligence Collaboratory for Aging Research in Baltimore, pointed to research from KFF showing that very few people appeal denied claims, but when they do, they often succeed.

Gonzalves gave birth to her son Grant in October 2021 at a local hospital. On the payment side, all went well, until more than two years later in December 2023, when she received a hospital bill of about $9,000, with her share at $1,800.

Anthem said she had failed to appeal within 180 days of receiving the medical care, although no bill had arrived during that time, she said. Further appeals went nowhere.

“It makes you want to pull your hair out,” Gonzalves said. “It’s so frustrating. It was so stressful.”

Meanwhile, she’d had twins, Fiona and Lucas, now 2.

Lauren Gonzalves, a cancer care social worker, is seen at her home in Concord, Calif., on Tuesday, Sept. 9, 2025. Gonzalves uses the Counterforce website, which works with AI to help individuals dispute medical bills. (Ray Chavez/Bay Area News Group)

“We had three under three and I’m literally having to fight this claim while I’m on maternity leave with my twins,” said Gonzalves, a medical social worker at Sutter Solano Cancer Care Center in Vallejo.

Then, earlier this year, a nurse friend who was doing consulting work for Counterforce Health suggested the app, and Gonzalves tried out its AI assistant, Maxwell.

The bot identified issues related to timing of billings and denials, and highlighted a federal statute concerning newborns’ coverage under mothers’ policies, essentially telling her, “These are all the reasons you should keep fighting this,” Gonzalves said.

Gonzalves also used ChatGPT, asking the chatbot how to escalate a grievance with Anthem, and receiving email addresses for people at a company handling complaints for the insurer. Within days, she was connected to an analyst — who easily found the claim Anthem had told her was inaccessibly archived — and a week later, last month, her $1,800 bill was dismissed, she said.

Insurance company denials, Shah said, should be taken as the starting point of a negotiation.

“The vast majority of the time the person is thinking, ‘I don’t have options now,’” Shah said. “Most people view it as a finality.”

Patients using the Counterforce Health appeal-letter generator upload the denial letter from their insurer, their policy documents, and any other relevant materials. The app’s AI — trained on thousands of successful appeal letters, plus insurance billing codes, and information from peer-reviewed medical journals, clinical guidelines, and state and federal regulations — scans relevant medical literature, insurance policy language, and appeal regulations, then produces an appeal letter the patient can send to the insurer, Shah said.

Because Counterforce Health doesn’t solicit results from users, Shah said he doesn’t know its success rate. But a rheumatology clinic that uses the app dozens of times a week reported success nearly three-quarters of the time, he said.

Stanford University health policy professor Maria Polyakova noted that insurance isn’t the only area with complicated, paperwork-based appeals — think the IRS or property taxes. But often, she said, “it’s just a really bad mismatch of getting into a bureaucratic nightmare in the middle of having a sickness.”

It remains to be seen whether Counterforce Health could boost the number of successful appeals, but such technology could help patients understand insurance processes that are, Polyakova said, “not particularly user friendly, in fact maybe the opposite.”

By Holden Lewis, NerdWallet

A Hemingway character was asked how he went bankrupt. “Two ways,” he replied: “Gradually, then suddenly.” That’s a fine description of how I sold a house in a buyer’s market this summer.

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How it happened gradually: I inherited the house in October 2021, fixed it up bit by bit, and finally listed it for sale in June 2025.

How it happened suddenly: The house sold in 18 days.

So how did I manage that? First, some context: The house is in a desirable location on the west side of Fort Worth. Mom bought it when I was a high school sophomore, and she lived alone for decades after I left for college.

Now I live in South Florida. For years, I considered selling my Florida house and moving into the Fort Worth house. I made upgrades and repairs, but ultimately my wife and I decided not to move to Cowtown. I reluctantly said adios to El Tacorriendo (my favorite food truck) and Billy Bob’s (the legendary honky tonk), and listed the house for sale.

I didn’t expect to sell it in less than three weeks. Metroplex homes usually linger longer — a typical July sale took 53 days. The analysts at Realtor.com call it a balanced market, but it feels like a buyer’s market to me.

And yes, luck was a big factor in selling so quickly. That said, let me tell you what I did right and what I would do differently.

I interviewed three agents

I wanted to hire a real estate agent who had represented sellers and buyers in the neighborhood — someone I’d feel comfortable with, who also had years of experience. I interviewed three, asking, among other things, what improvements I should make to the house. I wanted an agent who would answer forthrightly instead of telling me what I wanted to hear.

I hired the agent who had the strongest background. She specialized in my neighborhood and had the brisk demeanor of a C-suite corporate executive who wants to sell efficiently.

What I did right: I chose an experienced, perceptive agent. She knew to be blunt with me and tactful with my wife, which was a sign that she would adopt the proper tone when talking with buyers and their agents.

And she priced the house right.

I shelled out for some updates

My $350,000 asking price was low for the neighborhood. There’s a good reason: Mom had Alzheimer’s, so the house suffered from some deferred maintenance. It took a full five minutes to get hot water from the kitchen tap, and the walls reeked of cigarette smoke.

On the outside, the hail-damaged roof needed replacement, the 75-year-old casement windows were caulked shut, and the siding consisted of unsightly, brown-painted cedar shingles.

Ah, those shingles. I remember catching a ride home from high school one day. As my friend pulled up to my place, someone in the backseat shrieked, “Look at that ugly brown house!” When I sold the house 46 years later, it still wore the same brown shingles…and I still felt kinda mortified.

Renovations I did and didn’t do

But my time and money were limited. I could spend them making the exterior look great, or I could prioritize making the interior function well. So I fixed up the interior — because what’s the use of having a house that’s pretty on the outside, if you have to wait forever to get hot water at the kitchen sink?

Overall, I paid more than $60,000 to upgrade the electrical, plumbing, and HVAC systems, replace the roof, and repaint the interior (to eliminate the cigarette smell). By leaving the exterior mostly as-is, I let the buyer choose their own siding and windows.

What I did right: I focused on updating major systems and completed only must-do interior work. The buyer wanted to spend their money refining the aesthetics, not replacing the A/C.

I kept my cool

To reassure potential buyers, I made a spreadsheet of renovations, how much they cost, and when they were done. However, there was sometimes a gap between the date of a contractor’s initial estimate and the date work was completed — and the buyer used this information to strong-arm me.

“It is clear to see that these repairs dates are incongruent to your marketing materials and seller’s disclosure making them obsolete,” the buyer’s agent emailed after the inspection. “Furthermore, this would be considered Deceptive Marketing Practices.” They reduced their offer by $33,000. I felt furious one second, and panicked the next. Would this sale go through?

My impulse was to teach them a lesson and insist on the price we had agreed to. That afternoon, I floated in my Florida pool while angrily mimicking Michael Corleone saying, “My offer is this: Nothing.”

But then I reminded myself that this was my only offer. I had paid attention to stats from Realtor.com, the Case-Shiller price indexes, and my agent — I knew home prices in Fort Worth were falling while inventory was rising. I made a counteroffer for $326,000, the lowest price I would have accepted. The buyer took it.

What I did wrong: Being specific about dates and dollar amounts of renovations opened up another round of negotiation that I didn’t want. I would have been better off providing general information about the upgrades.

And I didn’t recognize the accusatory email and lower offer as a hardball negotiation tactic. That was the judgment of my attorney, which brings me to the last thing I did right.

I hired an attorney

Candidly, that agent’s email wigged me out. I forwarded it to the lawyer who had represented me three years earlier in Mom’s estate. He laughed off the email and calmed me down.

Lawyers close real estate transactions in some states, but Texas isn’t one of them. So even though I didn’t technically need an attorney, I hired him because the buyer’s agent had intimidated me.

What I did right: My attorney’s services were well worth the cost. He helped me through the negotiation, and he prevented a potential delay by spotting an error in the closing paperwork. Instead of listing Mom’s estate as the seller, the document listed Mom herself as the seller — as if she would materialize from her urn, like a genie from a bottle, to sign the papers. My attorney fixed that, and we closed at the scheduled time.

What I’ll do next time

Eventually, I want to get away from the hurricanes, rising seas and high home insurance costs of South Florida. When I sell this house and move to the mountains of western North Carolina, I’ll do a lot of things the same and a few things differently:

I will employ a real estate attorney from the outset, starting with reviewing the contract with the agent.

I will keep mum about specific costs and dates of work done on the house. Anything I say can and will be used against me.

I’ll choose, hire and pay a photographer, and have final say over the photos. (My agent chose the photographer, and I wish the pictures had been better.)

And I’ll rejoice that I’m not selling a house with brown shingle siding.

Holden Lewis writes for NerdWallet. Email: hlewis@nerdwallet.com.

The article I’m a Real Estate Writer Who Sold a House in a Buyer’s Market. Here’s What I Learned originally appeared on NerdWallet.

ROME (AP) — Pope Leo XIV said in his first interview as history’s first American pope that he has no intention of getting involved in U.S. politics but will raise his voice on issues of concern to the Catholic Church, including on immigration.

Leo spoke on a range of topics — from the Trump administration to the clergy sexual abuse crisis, welcoming LGBTQ+ Catholics and Vatican-China relations — in the interview, published Thursday. It was conducted by Vatican correspondent Elise Ann Allen of the news site Crux for a biography of Leo that was published Thursday in Peru, where Leo was bishop for many years.

Pope Leo XIV delivers his message in St. Peter’s Square on the occasion of the weekly general audience at the Vatican, Wednesday, Sept. 17, 2025. (AP Photo/Gregorio Borgia)

Here are some highlights:

Welcoming the LGBTQ+ community

Leo embraced Pope Francis’ message for LGBTQ+ Catholics that “todos, todos, todos” are welcome in the Catholic Church but said that he found “it highly unlikely” the church’s core doctrine about sexuality would change anytime soon.

The Catholic Church teaches that homosexual people must be treated with dignity and respect, but that homosexual activity is “intrinsically disordered.” It opposes same-sex marriage, saying marriage is a union between a man and woman.

Pope Leo XIV arrives in St. Peter’s Square on the occasion of the weekly general audience at the Vatican, Wednesday, Sept. 17, 2025. (AP Photo/Gregorio Borgia)

“I think we have to change attitudes before we even think about changing what the church says about any given question,” he said.

Earlier this month, the Vatican hosted a Holy Year pilgrimage that included several LGBTQ+ Catholic groups. On Thursday, traditionalist Catholic groups announced a petition asking Leo to “confirm and reaffirm the perennial teaching of the church” on sexuality “in the face of the brazen offensive of those who demand the moral legitimization of homosexual relationships and unions.”

Ties with China

Leo said he didn’t foresee any short-term changes in the Vatican’s controversial 2018 agreement with Beijing over bishop nominations.

The Vatican under Pope Francis had inked the accord hoping it would help unite China’s estimated 12 million Catholics, long divided between those belonging to an official, state-sanctioned church and an underground church loyal to Rome.

“I in no way pretend to be wiser or more experienced than all those who have come before me,” Leo said, adding he was studying the issue and speaking with Chinese people “on both sides” about it.

The Vatican has defended the 2018 accord against criticism that Francis sold out the underground faithful, who endured decades of persecution by the Beijing authorities. The Vatican has said the deal was necessary to prevent an even worse schism in the Chinese church after China named bishops without the pope’s consent.

Sex abuse scandals

Leo said the sex abuse crisis is “a real crisis” that has not yet been solved, and that the church still hasn’t found a way to help victims heal. But he also said the rights of priests must be respected.

“Statistics show that well over 90% of people who come forward and make accusations, they are authentically victims. They are telling the truth. They are not making this up,” he said. “But there have also been proven cases of some kind of false accusation. There have been priests whose lives have been destroyed because of that.”

The pope also said the scandal “cannot become the center focus of the church.”

Leo was instrumental in helping victims of an abusive Peruvian group find justice but he has been accused by a U.S. victim advocacy group of not doing enough to help other Peruvian victims.

Trump and US politics

Leo said he recognized the influence of the United States on world affairs and mentioned migration as one of the issue important to the Catholic Church.

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He recalled a letter Francis sent to U.S. bishops earlier this year rebuking the Trump administration’s plans for mass deportations of migrants. The letter took direct aim at Vice President JD Vance’s defense of the deportation program on theological grounds.

Leo praised Francis’ initiative and said U.S. bishops showed “courage” in confronting the administration, expressing hopes they would continue to take the lead on such issues.

“One of the last conversations I had with the vice president of the United States – I have not had direct conversations with or have not met the president – I talked about human dignity and how important that is for all people, wherever you’re born, and hopefully to find ways to respect human beings and the way we treat them in the policies and choices we make,” Leo said.

Leo made clear he is not a Trump supporter, adding that he and his brother Luis Prevost, a self-described “MAGA-type,” who has met the U.S. president are in “different places.”

“The United States is a power player on the world level, we have to recognize that, and sometimes decisions are made more based on economics than on human dignity and human support, but (we have to) continue to challenge and to raise some questions and to see the best way to do that,” Leo said.

Women’s voices

Leo vowed to continue appointing women to leadership positions in the church, but tamped down any hopes of ordaining women as deacons or as priests. He pointed to an ongoing study by the Vatican’s doctrine office on the issue.

“I at the moment don’t have an intention of changing the teaching of the church on the topic,” he said. “I am certainly willing to continue to listen to people.”

Vatican finances

Leo inherited a longstanding financial crunch at the Vatican, which has been running a $57 million to $68 million structural deficit, a $1.14 billion pension fund shortfall and declining donations.

The crisis hit hardest during the pandemic when the Holy See’s main source of revenue, the Vatican Museums, closed down.

But things are improving and “it is not the crisis that people have been led to believe,” Leo said.

“I’m not saying we can relax,” he said. “I don’t think the crisis is over, I think we have to continue to work on this, but I’m not losing sleep over it, and I think that it’s important that we communicate a different message.”

Associated Press religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.