Top officials with the Obama administration said Wednesday that they’ll redirect $589 million toward the Zika virus response. Most of that money was to be used to deal with Ebola virus.

Almost two months ago, the Obama administration requested $1.9 billion from Congress to respond to the Zika threat.

“But Congress has yet to act,” Shaun Donovan, director of the Office of Management and Budget, said in a news conference. “In the absence of congressional action, we must scale up Zika preparedness and response activities right now.”

Over 600 people with Zika, including 64 pregnant women, have been reported in U.S. states and territories. In most cases, people contracted the virus while traveling.

But Sylvia Burwell, secretary of the U.S. Department of Health and Human Services, says she expects to see local Zika virus transmission in the continental U.S. in coming months.

The redirected funds will go to mosquito control and surveillance; education about how to prevent transmission; supporting states and territories in their own Zika virus responses; and developing vaccines and better diagnostic tests.

Burwell and Donovan reiterated that the administration’s earlier request for supplemental funding from Congress remains in place. And, they say, the administration will also ask for funds to replenish the amount currently being moved from the Ebola response to the Zika response.

Without the full supplemental funding, Burwell says, a number of crucial activities would be impacted.

“Mosquito control and surveillance might need to be delayed or stopped. Our ability to move to a subsequent phase of vaccine development could be jeopardized. And without more funding, the development of faster and more accurate diagnostics could be impaired,” says Burwell.

One reason for the haste is that public health officials want to get mosquito control and surveillance underway before the peak summer mosquito season in the U.S., and before the rainy season in Central America and the Caribbean.

Most of the redirected funding — $510 million — is coming from the Ebola response. That’s concerning, because while the public panic over Ebola has faded, the virus continues to flare up.

“We face two real global health challenges — Ebola and Zika — and we don’t have an option to set one aside in the name of the other,” says Burwell.

Last week, a woman in Liberia died of Ebola. And though Guinea was declared Ebola-free in December, last month World Health Organization officials put more than 1,000 people under medical watch because they may have come into contact with eight people who contracted Ebola.

It’s those kind of activities that could be shortchanged by diverting funds away from Ebola and toward Zika, administration officials say.

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Talking about money is never easy. But when doctors are reluctant to talk about medical costs, patients’ health can be undermined.

A study published Monday in the journal Health Affairs explores the opportunities that are often missed in the exam room.

Patients are increasingly responsible for more of their own health costs. In theory, financial incentives are supposed to make them sharper consumers and empower them to trim unnecessary health spending. But previous work has shown it often leads them to skimp on both valuable preventive care and superfluous testing.

Doctors could play a role in helping patients find appropriate and affordable care by talking with them about out-of-pocket costs.

But, a range of physician behaviors currently stand in the way, according to the study. “We need to prepare physicians to hold more productive conversations about health care expenses with their patients,” said Peter Ubel, a physician and behavioral scientist at Duke University.

The researchers analyzed transcripts of almost 2,000 physician-patient conversations regarding breast cancer, rheumatoid arthritis and depression treatment. They identified instances in which patients suggested the cost of care might be difficult for them to bear and assessed how doctors responded.

Overall, researchers noted two ways in which doctors dismissed patients’ financial concerns. They either didn’t acknowledge them or only addressed them halfway.

For instance, if a patient commented on how expensive a drug was, the doctor might ignore the comment entirely, or might suggest a temporary solution – like a free trial – without exploring long-term strategies to address the issue.

Without a long-term plan, patients may eventually stop taking the medication, or take it irregularly. Either way, a patient would get less benefit from treatment and could getter sicker, perhaps even winding up in the hospital.

The study doesn’t measure how often doctors dismissed patient concerns – because, the researchers wrote, they didn’t know how often those dismissals led to people actually forgoing needed treatments.

Still, Ubel said, it’s clear doctors aren’t talking to patients about these expenses. He pointed to a separate analysis of those same conversations, which found that doctors discussed medical costs with patients about 30 percent of the time. And only in a minority of those discussions did doctors and patients brainstorm about ways to make medication more affordable.

“A majority of [physicians] – they don’t talk about costs,” he said. “When they do talk about it, they don’t talk about it productively.”

Why do physicians hesitate? For one thing, they aren’t used to discussing cost barriers, and many think it’s inappropriate to bring up money at all, Ubel said. When he lectures on the subject, he always encounters people who worry that discussing finances will “contaminate the doctor-patient relationship.”

Plus, doctors haven’t been taught to listen for patients’ pocketbook concerns. If a patient comes in with heartburn and indigestion, a good internist will start probing for signs of coronary disease, Ubel said. By contrast, physicians aren’t primed to pick up on cues that patients may face financial strains.

“If we had that on our list to be aware of, we’d pick up the cues. If we don’t, it’ll be right in front of our eyes, and we’ll miss it,” he added.

The idea of patients acting as consumers – weighing cost and shopping for the best health care deal – is still relatively new, the study notes. As it becomes more commonplace, patients may push doctors for more help in making cost-based decisions, Ubel said.

That said, navigating a patient’s financial circumstances and medical needs in the course of a 15-minute visit is tricky, said Jonathan Kolstad, an assistant professor of economic analysis and policy at the University of California, Berkeley. Kolstad wasn’t involved in the Health Affairs study but has researched how medical costs affect people’s decision-making.

“It’s not as though, ‘Oh, it’s just consumers can’t figure it out.’ Doctors don’t know,” he said. When it comes to figuring out what a drug will cost, doctors are in the same boat.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Shefali Luthra is on Twitter: @shefalil.

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