Rep. Tom Price, a Georgia Republican, is President-elect Donald Trump’s pick for Secretary of Health and Human Services. He is currently chairman of the powerful House Budget Committee.

Price, an orthopedic surgeon for nearly 20 years before coming to Congress, has represented the northern Atlanta suburbs in the House of Representatives since 2005.

If confirmed by the Senate, Price would likely have a central role in the Republicans’ stated plans to dismantle the Affordable Care Act and design a replacement. He has repeatedly introduced legislation to repeal and replace the ACA and is one of hundreds of Republicans who have voted dozens of times to repeal the federal health care law since it was enacted in 2010. Those efforts either didn’t make it to President Obama’s desk or were vetoed by him.

As HHS secretary, Price would not only oversee Obamacare as it currently exists, but also run the government’s largest social programs, including Medicare, Medicaid and the Children’s Health Insurance Program. He would also have authority over the Food and Drug Administration, the Centers for Disease Control and Prevention, the National Institutes of Health and other major health agencies.

HHS employs nearly 80,000 people and is the largest source of funding for medical research in the world.

Politically, Price is conservative. He opposes abortion rights, receiving a 2016 rating of 0 by Planned Parenthood and 100 percent by National Right to Life. He has voted against legislation aimed at prohibiting job discrimination based on sexual orientation; for a constitutional amendment to define marriage as between one man and one woman; and against the bill that would’ve ended the don’t-ask-don’t-tell policy regarding disclosure of sexual orientation in the military.

He has also voted against:

• federal funding for abortion;
• funding for groups like Planned Parenthood;
• a law that now requires the FDA to regulate tobacco as a drug; and
• a bill that would have provided four weeks of parental leave for federal employees.

In 2007, Price voted in favor of a bill that would have granted the so-called pre-born equal protection under the 14th Amendment.

In 2015, Price wrote the language for a bill that is now seen as one of the main paths forward to repeal portions of the ACA. It would employ the same budget reconciliation rules Democrats used to originally pass the law in 2010, but instead the GOP plan would defund Obamacare.

This reconciliation option would leave in place the basic structure of the ACA, including the insurance exchanges and rules that require insurers to cover existing conditions and permit young adults to stay on their parents’ insurance policies until age 26.

But without funding, the exchanges are likely to see an exodus of insurance companies, particularly if expensive requirements are kept in place.

Price, 62, lives in Roswell, Ga., with his wife Betty. He received his medical degree from the University of Michigan.

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Hospitals have long been reluctant to share with patients their assessments of which nursing homes are best because of a Medicare requirement that patients’ choices can’t be restricted.

For years, many hospitals simply have given patients a list of all the skilled nursing facilities near where they live and told them which ones have room for a new patient. Patients have rarely been told which homes have poor quality ratings from Medicare or a history of public health violations, according to researchers and patient advocates.

“Hospitals are not sure enough that it would be seen as appropriate and so they don’t want to take the chance that some surveyor will come around to cite them” for violating Medicare’s rules, said Nancy Foster, vice president for quality and patient safety at the American Hospital Association.

As a result, patients can unknowingly end up in a nursing home where they suffer bed sores, infections, insufficient staffing or other types of substandard care.

But hospitals’ tight-lipped approach to sharing quality information may soon be changed. The Obama administration is rewriting those rules, not just for patients going to nursing homes but also those headed home or to another type of health facility.

Hospitals will still have to provide patients with all nearby options, but the new rule says hospitals “must assist the patients, their families, or the patient’s representative in selecting a post-acute care provider by using and sharing data” about quality that is relevant to a particular patient’s needs for recovery. The rule was drafted in October 2015.

The administration hasn’t said when it will be finalized. Should it not be enacted before the end of President Obama’s term, its fate becomes uncertain. President-elect Donald Trump has pledged not to approve new regulations unless two existing ones are eliminated.

The quality requirement might have made a difference for Elizabeth Fee, an 88-year-old San Francisco woman who had been hospitalized for a broken hip. Her hospital, California Pacific Medical Center, told her family about its own nursing home but did not tell them that Medicare had given it one star, its lowest quality rating, Fee’s family asserts in court papers.

“I feel we were misled because we believed that Mom was going to a facility that would have given her excellent care,” her daughter Laura Rees said. “And what she got was not even close to that, it was like night and day.”

At the nursing home, Ms. Fee developed a bowel blockage that went undiagnosed until the morning of the day she died in January 2012. The nursing home and hospital have denied that they provided substandard care and declined to comment. The nursing home closed last year.

Some health systems haven’t waited for Medicare’s rule change to increase the information they provide patients about prospective nursing homes. In Massachusetts, Partners Healthcare, which runs Massachusetts General and Brigham and Women’s hospitals — two teaching hospitals for Harvard University Medical School — endorses 67 nursing homes around the state based on a host of criteria, including state inspections, readmission rates, location and how frequently a doctor or nurse practitioner is at the facility.

Partners believes it doesn’t violate Medicare’s rules because it gives departing patients a complete list of nursing homes while noting on the list which ones are part of Partner’s quality network, said Dr. Chuck Pu, a medical director at Partners. This fall, Partners dropped one of its own nursing homes from its preferred list after it got a poor inspection. “There’s no free pass,” Pu said.

More careful attention to nursing home quality has been encouraged by existing financial incentives created by the Affordable Care Act that cut payments to hospitals if too many patients are readmitted within a month. “The whole idea of preferred provider networks is really going to escalate in the future,” said Brian Fuller, an executive with NaviHealth, a consulting company for hospitals that focuses on patient care after discharge.

Foster, the hospital association executive, said the proposed Medicare rule should make hospitals less wary about giving more detailed guidance. “This signals that it’s okay for knowledgeable folks to really engage in that conversation with patients and their families,” Foster said.

Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation. You can follow Jordan Rau on Twitter: @jordanrau.

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President-elect Donald Trump and House Speaker Paul Ryan agree that repealing the Affordable Care Act and replacing it with some other health insurance system is a top priority.

But they disagree on whether overhauling Medicare should be part of that plan. Medicare is the government-run health system for people aged 65 and older and the disabled.

Trump said little about Medicare during his campaign, other than to promise that he wouldn’t cut it.

Ryan, on the other hand, has Medicare in his sights.

“Because of Obamacare, Medicare is going broke,” Ryan said in an interview on Fox News on Nov. 10. “So you have to deal with those issues if you’re going to repeal and replace Obamacare.”

In fact, the opposite appears to be true — Obamacare may actually have extended the life of Medicare.

This year’s Medicare trustees report says the program would now be able to pay all its bills through 2028, a full 11 years longer than a 2009 forecast — an improvement Medicare’s trustees attribute, in part, to changes in Medicare called for in the Affordable Care Act and other economic factors.

And the irony of the Ryan Medicare plan, say some health policy analysts, is that it would turn the government program into something that looks very much like the structure created for insurance plans sold under the ACA.

“The way it works is comparable to Obamacare,” says physician and conservative policy analyst Avik Roy, founder of the Foundation for Research on Equal Opportunity.

Ryan’s plan would set up “Medicare exchanges” where private insurance companies would compete with traditional government-run Medicare for customers. Obamacare exchanges sell only private insurance plans.

People would get “premium support” from the government to pay for their insurance under the Ryan Medicare plan.

The subsidy would be tied to the price of a specific plan offered by an insurer on the exchange, much like the Affordable Care Act subsidy is tied to the second-cheapest “silver” plans.

And the payment would be linked to a recipient’s income, so lower-income people would get a bigger subsidy. The subsidy would rise as beneficiaries get sicker, to ensure access to insurance. Like in Obamacare, people who choose plans that cost more than the government subsidy would have to pay the balance.

Insurers would have to agree to issue policies to any Medicare beneficiary, to “avoid cherry-picking,” and to ensure that “Medicare’s sickest and highest-cost beneficiaries receive coverage.”

The changes would start in 2024, when people who are now about 57 become Medicare eligible.

Roy agrees with Ryan that Medicare is going broke and that a program structured in this way would save money through “the magic of competition.”

“If you have 10 insurers competing for that business, you’re going to negotiate a better deal,” he said.

Medicare is already a dual public-private program. Most seniors today are enrolled in what’s known as traditional Medicare, where the government pays for medical appointments, tests and hospital stays on a fee-for-service basis.

Alongside that program is Medicare Advantage, an insurance plan provided by a private insurer which may offer seniors additional services like dental care at the same price.

The government pays a fixed monthly fee to the insurer for each Medicare Advantage patient, rather than paying for every service separately, as it does in traditional Medicare.

About half of Medicare’s new enrollees choose Medicare Advantage plans, says Henry Aaron, a health care economist at the Brookings Institution.

Aaron says Ryan’s proposal aims to move almost all seniors into Medicare Advantage-style insurance by making traditional Medicare too expensive for the consumer.

But, he says, there are risks to that approach.

“The real question here is whether the requisite safeguards are in place to ensure that the elderly and people with disabilities would be able to maneuver in such a system,” he says.

That’s because the health care and health insurance systems are very complex. Doctors move in and out of networks, copayments can vary and plans can change.

Millions of people on Medicare are also eligible for Medicaid, meaning they are poor and vulnerable, Aaron says. And at least 8 million Social Security beneficiaries have been declared financially incompetent and are assigned a representative to manage their money.

“What you’ve got here is a group of people who are very sick, poor, and often cognitively impaired one way or the other,” Aaron says. “Tossing people like that into a health care marketplace and saying, ‘Here, go buy some insurance,’ is a recipe for problems.”

Seniors may feel the same way. Researchers at Brown University last year found that as people get older and sicker, they tend to drop Medicare Advantage and opt for traditional Medicare.

Ryan has been working on his plan to change Medicare for many years. A version of his “premium support” plan was included in several budget proposals he put forth when he was chairman of the House Budget Committee.

The Congressional Budget Office says the proposals would reduce federal spending on Medicare.

At this point it’s unclear whether Trump shares Ryan’s ambitions to upend the current Medicare system. Trump didn’t include Medicare reform on his campaign web site. But since his election, “modernize Medicare” has been included on the list of health care priorities on his transition web site.

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Chris Cunningham was so thrilled with Indiana Gov. Mike Pence’s Medicaid expansion under the Affordable Care Act that she readily accepted his invitation to an event celebrating its first anniversary in January.

After eight years without health insurance, Medicaid coverage paid for treatment of her thyroid problem and lung disease and prescription drugs to help both. “It was a game changer for me,” the Indianapolis woman said.

Election Day’s results are on her mind now.

Indiana Gov. Mike Pence was one of 10 Republican governors to expand Medicaid under Obamacare, but as President-elect Donald Trump’s running mate, Pence is now calling for the health law’s repeal and replacement.

If that happens, millions of low-income people around the country added to the state-federal insurance program since 2014 under the health law are at risk of losing their health insurance. Thirty-one states and the District of Columbia have expanded Medicaid, extending coverage to at least 10 million Americans.

“I don’t see how a compassionate human being can rip health care away from millions of people,” Cunningham said.

What Pence did with Indiana’s Medicaid program may place him in the middle ground of political battles to come over Obamacare’s future. He called for the law’s repeal even before joining Trump, but also pushed Medicaid’s expansion in a conservative direction by advocating for stricter eligibility requirements on low-income people receiving government-paid health care.

Neither Trump nor any other top Republican has spelled out what a replacement would look like. Trump has said he supports Medicaid block grants to states — a way of stabilizing federal funding that could ultimately raise states’ costs and force them to cut benefits or eligibility.

The health law allowed states to open Medicaid to all adults with incomes at or below 138 percent of the federal poverty level, with all the extra costs paid by the government for the first three years, 2014 through 2016.

Pence took the federal money but won the Obama administration’s approval to add features that set Indiana apart from other expansion states. For example, recipients are required to pay money — $1 a month for many — into special accounts that Pence contends will make them more conscious of the costs associated with health care.

Healthy Indiana Plan 2.0 pushed Medicaid’s traditional boundaries, which is why it has captured attention in conservative states. The plan demands something from all enrollees, even those below the poverty level. Individuals who fail to keep up their contributions lose dental and vision coverage and face copayments. Those above the poverty level can temporarily lose all coverage if they fall behind on contributions.

Proponents, including Pence, have said the strategy makes Medicaid recipients share financial responsibility for their care and that it will save Indiana money by reducing unnecessary services and inappropriate emergency room use.

Pence has said Indiana’s program has lowered ER use, led to recruitment of more physicians by paying them more and succeeded in getting most recipients to contribute monthly payments.

“This is an innovative, fiscally responsible program,” Pence said at the expansion’s first anniversary event that Cunningham attended in Indianapolis. “We are improving outcomes, improving lives and improving the fortunes of Hoosiers.”

Cunningham said last week she remembers that day well and the personal connection Pence made with her and other new enrollees.

“It does give me hope that Gov. Pence started Medicaid expansion here and talked highly of it,” she said. “When I met him that day, it gave me a sense that even though I didn’t agree with 75 percent of what he stood for, I found him to be a really good man [who] really wanted to improve the health situation for people of Indiana.”

Indiana hospitals are also hoping Pence will be an advocate for preserving the expansion.

The expanded Medicaid program pumped millions of dollars into the state’s hospital industry by providing them more paying patients and increasing their Medicaid reimbursements.

Brian Tabor, executive vice president of the Indiana Hospital Association, said the election results have him worried about the future of Medicaid and Obamacare. But knowing Pence will have Trump’s ear could make a difference.

Pence “understands that with some flexibility, states can be successful at expanding coverage and that bodes well for states like Indiana,” he said. “He is passionate about the health and security that Medicaid provides to Hoosiers. I am confident that he will have a significant policy role in the White House and will use that in a way to preserve what we have in Indiana.”

Tabor said that while block grants or a per capita limit for Medicaid would give states more autonomy in running the program, he worries it would mean cuts in federal funding that would hurt recipients and providers.

Medicaid’s expansion in Indiana has provided vital funding to hospitals, particularly those in rural areas that have struggled to stay open. “It’s been a lifeline to many rural providers,” he said.

Susan Jo Thomas, executive director of Covering Kids & Families of Indiana, an advocacy group, seems less hopeful for the future of Medicaid expansion and the program overall even with Pence as vice president.

“It’s scary to us,” she said of the prospect of losing Obamacare and Medicaid becoming a block grant program. While Republicans have proposed the block grant idea since the 1980s, she noted it could find stronger support because Congress has turned more conservative and most states have conservative governors.

For Cunningham, Medicaid expansion in 2015 came at the right time. She had been managing several group homes for the disabled in 2008 when she ended her career to care for her own disabled husband.

“I was in a desperate situation and I’ve been very grateful for the help,” she said.

For her at least, worries about not having insurance will fade next May.

That’s when she will turn 65 and enroll in Medicare.

This story was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health care policy research organization. You can follow Phil Galewitz on Twitter: @philgalewitz.

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In the Florida Keys on Election Day, along with the presidential race, one of the most controversial items on the ballot dealt with Zika. In a nonbinding vote countywide, residents in the Florida Keys approved a measure allowing a British company to begin a trial release of genetically modified mosquitoes. Armed with that approval, local officials voted Saturday to try out what they hope will be a new tool in the fight against Zika.

For months now, state and local authorities in Florida have struggled to control the spread of Zika. But although there have been more than 200 cases of locally transmitted Zika statewide, none have been reported in the Keys. And that’s one reason why residents like Megan Hall oppose the new technology. At a meeting of the Florida Keys Mosquito Control District board in Marathon on Saturday, Hall made a personal appeal to the board. “I am going to ask you, beg you, plead with you,” she said, “not to go forward with this.”

For five years now, the district has been working with the British company Oxitec to get federal approval for a trial release of the mosquitoes in the Keys. The company releases genetically modified male Aedes aegypti mosquitoes into the wild. When they mate with female Aedes aegypti, their offspring die.

In trials in Brazil, the Cayman Islands and other countries, Oxitec has shown its GM mosquitoes can reduce the population of Aedes Aegypti by 90 percent or more. But after five years, a small but vocal group of residents is not convinced the mosquitoes are safe. Opponent Dina Schoneck told the board, there are still too many unanswered questions about the new technology. She said, “I believe there are a lot of risks that are not being considered.”

Although it doesn’t have any cases of local Zika transmission yet, Monroe County, which includes the Keys, has had big problems in the past with dengue, another disease carried by the same mosquito. The head of the county’s health department, Bob Eadie, supports the trials. Just because the county hasn’t had any local Zika cases yet doesn’t mean the disease isn’t a threat, he said. Eadie went on, “There is a tool available for the people of Monroe County that can help control mosquitoes that carry a very, very, very serious disease.”

In August, the Food and Drug Administration gave its approval for the trial, saying it found no potential adverse impact on human health or the environment. Because of the vocal opposition, the Mosquito Control District’s Board of Commissioners decided to submit the trial to the voters in the form of two nonbinding resolutions. One was for the residents of Key Haven, the community where the trials were proposed. The other referendum went before voters in the rest of the county.

Because Key Haven voters rejected it, commissioners say trials won’t be conducted there. But in Saturday’s meeting, the board approved trials elsewhere in the Keys at a location still to be determined. Jill Cranney-Gage is a commissioner who represents Key West. “This is a tool mosquito control needs. When you’re sworn into office,” Cranney-Gage said,”your main goal is to kill mosquitoes and to protect the residents and the county.”

Officials in the Keys say the announcement by the World Health Organization that Zika is no longer a “public health emergency” is in no way an indication the threat is lessening but that instead, it’s a disease that’s here to stay

Florida Keys Mosquito Control District staff and Oxitec are now working now to identify a new neighborhood to conduct trials. Derric Nimmo with Oxitec is hopeful that identifying a new location and receiving federal approval will be a matter of a few months, and releases could start next year. Nimmo says he’s encouraged that the GM mosquito technology gained the approval of a large majority — 58 percent of county residents. “So there is very strong support for use of this technology in Monroe County,” he says. “And hopefully, they’ll move forward with this trial.”

After months of struggling with Zika, health officials and mosquito control authorities elsewhere in Florida are eager to begin their own trials of the GM mosquitoes. Oxitec says if things go well in the Keys, it could begin trials next year in Miami.

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For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America’s poorest places, the Affordable Care Act was life altering.

The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years.

“It’s been a godsend to me,” said the former Ohio school custodian who moved to Kentucky a decade ago.

Lockaby finally got treated for a thyroid disorder that had left her so exhausted she’d almost taken root in her living room chair. Cataract surgery let her see clearly again. A carpal tunnel operation on her left hand eased her pain and helped her sleep better. Daily medications brought her high blood pressure and elevated cholesterol level under control.

But Lockaby is worried her good fortune could soon end. Her future access to health care now hinges on a controversial proposal to revamp the program that her state’s Republican governor has submitted to the Obama administration.

Next year will likely bring more uncertainty when a Trump administration and a GOP-controlled Congress promise to consider Obamacare’s repeal, including a potential reduction in the associated Medicaid expansion in 31 states and the District of Columbia that has led to health coverage for an estimated 10 million people.

Kentucky Gov. Matt Bevin, who was elected in 2015, has argued his state can’t afford Medicaid in its current form. Obamacare permitted states to use federal funds to broaden Medicaid eligibility to all adults with incomes at or below 138 percent of the federal poverty level, now $11,880 for individuals. Kentucky’s enrollment has doubled since late 2013 and today almost a third of its residents are in the program. The Medicaid expansion under Obamacare in Kentucky has led to one of the sharpest drops in any state’s uninsured rate, to 7.5 percent in 2015 from 20 percent two years earlier.

Kentucky’s achievement owed much to the success of its state-run exchange, Kynect, in promoting new coverage options under the health law. Kynect was launched under Bevin’s Democratic predecessor, Steve Beshear, and dismantled by Bevin this year.

Bevin has threatened to roll back the expansion if the Obama administration doesn’t allow him to make major changes, such as requiring Kentucky’s beneficiaries to pay monthly premiums of $1 to $37.50 and require nondisabled recipients to work or do community service for free dental and vision care.

Budget pressures are set to rise next year in the 31 states and the District of Columbia where Medicaid was expanded as the federal government reduces its share of those costs. States will pick up 5 percent next year and that will rise gradually to 10 percent by 2020. Under the health law, the federal government paid the full cost of the Medicaid expansion population for 2014-2016.

In a state as cash-strapped as Kentucky, the increased expenses ahead for Medicaid will be significant in Bevin’s view — $1.2 billion from 2017 to 2021, according to the waiver request he’s made to the Obama administration to change how Medicaid works in his state.

Trump’s unexpected victory may help Bevin’s chances of winning approval. Before the election, many analysts expected federal officials to reject the governor’s plan by the end of the year on the grounds that it would roll back gains in expected coverage.

A Trump administration could decide the matter differently, said Emily Beauregard, executive director of Kentucky Voice for Health, an advocacy group that opposes most waiver changes because they could reduce access to care.

“I think it’s much more likely that a waiver could be approved under the Trump administration,” she said. “On the other hand, I wonder if the waiver will be a moot point under a Trump administration, assuming that major pieces of the [Affordable Care Act] are repealed.”

Lockaby is watching with alarm: “I am worried to death about it.”

Life already is hard in her part of Kentucky’s coal country, where once-dependable mining jobs are mostly gone.

In Clay County where Lockaby lives, 38 percent of the population live in poverty. A fifth of the residents are disabled. Life expectancy is eight years below the nation’s average.

Clay’s location places it inside an area familiar to public health specialists as the South’s diabetes and stroke belt. It’s also in the so-called “Coronary Valley” encompassing the 10-state Ohio/Mississippi valley region.

About 60 percent of Clay County’s 21,000 residents are covered by Medicaid, up from about a third before the expansion. The counties uninsured rate for nonelderly adults has fallen from 29 percent to 10 percent.

Still, the increase in insurance coverage hasn’t made Clay’s people healthier yet. Local health officials here say achieving that will take a decade or more. Instead, they cite progress in smaller steps: more cancer screenings, more visits to mental health professionals and more prescriptions getting filled. Harder lifestyle changes that are still ahead — such as eating better, quitting smoking and regular exercise — will take more than a couple years to happen, said Aaron Yelowitz, associate professor of economics at the University of Kentucky.

One hopeful spot is the Grace Community Health Center in downtown Manchester, where patient visits are up more than 20 percent since 2014. Those without insurance pay on a sliding scale, which can mean a visit costs $50 or more.

That was too much for Ramiro Salazar, 47, who lives with his wife and two children on a $733 monthly income. With Medicaid, he sees a doctor for his foot and ankle pain, meets regularly with a psychologist for anxiety and gets medications — all free to him. Medicaid even covers his transportation costs to doctors, vital because a specialist can be 40 miles away.

Salazar is worried about Bevin’s plans, especially the additional costs. “I probably couldn’t afford it as I’m unemployed,” he said. “It would hurt me pretty bad.”

Any development that could take away health coverage from people with mental health issues worries Joan Nantz, a psychologist who works part time at Grace and whose appointment calendar is booked three weeks out because of patient demand. More than 90 percent of her clients are on Medicaid.

“If something happens to this program, I can’t begin to think what impact it would have on society,” she said. Without counseling, people with mental health issues will resort to illegal drugs and be more likely to commit crimes and domestic violence, Nantz said.

Just five primary care doctors in Manchester treat adults in Clay and surrounding counties. Manchester Memorial Hospital has tried to recruit more without success.

“We had a painful primary care shortage here five years ago and now it’s worse,” said Dr. Jeffrey Newswanger, an emergency room physician and chief medical officer at the hospital. “Just because they have a Medicaid card doesn’t mean they have doctors.”

The emergency room is busier than ever seeing patients for primary care needs, he said.

Newswanger sees both sides to the debate over Medicaid. The hospital gained because more patients are now covered by insurance, and the ER’s uninsured rate dropped to 2 percent from 10 percent in 2013.

“Eliminating the expansion altogether would be painful for the hospital and a disaster for the community,” he said.

But, Newswanger also appreciates some of Bevin’s proposals.

“No one values something that they get for free,” he said, and incentives are needed to make people seek care in doctors’ offices instead of expensive ERs.

Christie Green, public health director of the Cumberland Valley District Health Department that covers Clay County, said making the poor pay more or scrapping Medicaid’s expansion would be a setback to improving people’s health.

Last year, Green helped Manchester build a three-mile trail along a park and install a swinging bridge across a small creek. Both additions were intended to promote physical fitness in a place where more than a third smoke — both far above national averages.

Progress is slow. The path is used regularly. But drug addicts congregate daily by the bridge and it rarely gets traffic.

“There is a lot to overcome here,” Green said.

This story was produced through collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health care policy research organization. You can follow Phil Galewitz on Twitter: @philgalewitz.

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The World Health Organization announced Friday that it no longer considers the Zika epidemic a public health emergency of international concern.

But Zika’s threat to pregnant women and babies is not going away anytime soon, the agency says. Instead, the virus is now a chronic problem, says the WHO’s Dr. Pete Salama.

“It is really important that we communicate this very clearly: We are not downgrading the importance of Zika,” Salama says. “In fact, by placing this as a longer term program of work, we’re sending the message that Zika is here to stay. And WHO’s response is here to stay, in a robust manner.”

One thing is clear: Zika is still spreading. And microcephaly cases are still growing. Argentina reported its first potential case this week. And Florida continues to find people who caught Zika inside the state.

For these reasons, pregnant women — and their partners — still need to pay attention to where they travel, says Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

“Regardless of how WHO defines Zika, [the disease] is unprecedented, and it’s an extraordinary risk for pregnant women,” Frieden says. “That’s why it’s important that pregnant women not travel to places where Zika is spreading.”

Right now, those places include countries across Latin America, the Caribbean, parts of Southeast Asia — and neighborhoods in Miami.

WHO first declared Zika a public health emergency back in February. Back then, the situation looked dire.

Brazil was investigating more than 4,000 cases of microcephaly — a horrible birth defect where babies have brain damage and small heads. And health officials were predicting thousands of more cases, as Zika spread across the Western Hemisphere.

“If this pattern is confirmed beyond Latin America and the Caribbean, the world will face a severe public health crisis,” WHO’s director-general, Dr. Margaret Chan, said in February.

But so far, that pattern hasn’t repeated itself. Brazil has confirmed the most Zika-linked microcephaly cases, about 2,100. Other counties in Latin America have reported far fewer. Colombia has the second highest with 57 confirmed cases and the U.S. is third with 31, WHO said Thursday.

Such a vast difference between the situation in Brazil versus other countries has raised some eyebrows. Could some other factor in Brazil be increasing the risk of microcephaly there? Perhaps a pesticide or another virus?

“I think it’s too early to draw conclusions,” says Alessandro Vespignani, who models the spread of Zika virus at Northeastern University in Boston.

Colombia is still investigating more than 300 microcephaly cases to see if they’re linked to Zika. Several countries, such as Venezuela and Haiti, have not been vigilant about reporting cases. And countries that are on top of reporting, such as Mexico and Puerto Rico, aren’t expected to have microcephaly cases until next year — it takes around 9 months after a Zika outbreak strikes for the bulk of microcephaly cases to appear.

“We can’t rule out the possibility that something unique is happening in Brazil,” Vespignani says. “But, right now, we have to wait and see what happens elsewhere.”

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