JOHN YANG: Tonight on PBS News Weekend, high stakes talks between the United States and Iran begin as they discuss sanctions and the future of Iran's advancing nuclear program.

Then, we investigate why more and more patients are getting hit with unexpected fees when they go to the doctor's office and the joys and challenges of raising children.

As a parent with disabilities, admitting that.

WOMAN: Disabled people exist and that we make good parents is also admitting that none of this is promised and all bodies are fragile and all bodies have needs.

(BREAK) JOHN YANG: Good evening.

I'm John Yang.

In Oman today, the United States and Iran appear to have taken the first steps that could lead to a new agreement to limit Iran's nuclear activities and lift U.S. Economic sanctions.

On social media, the Omani foreign minister who mediated today's indirect talks said they took place in a friendly atmosphere conducive to bridging viewpoints.

The White House described the meeting as very positive and constructive.

And the Iranian foreign minister said the two sides briefly interacted when their paths crossed at the end of today's session and that they will meet again next Saturday.

Karim Sadjadpour is a Senior Fellow at the Carnegie Endowment for International Peace.

He focuses on Iran and US Middle east policy.

Karim, a little brief encounter, it sounds like in a hallway agreement to meet again.

Is this about as much as one could hope out of this meeting?

KARIM SADJADPOUR, Carnegie Endowment for International Peace: The fact that they've agreed on a second meeting I think is as much anyone could have hoped for.

But our expectations should be realistic.

This is not a negotiation about a U S.-Iran rapprochement, a Nixon to China moments.

You know, normalization.

This is really whether the two sides can agree on something which limits Iran's nuclear program.

And that's going to be a tall order.

JOHN YANG: President Trump says he wants a stronger agreement than the one President Obama got.

Is that possible?

KARIM SADJADPOUR: I think that's going to be very difficult for President Trump because when he pulled out of the deal in 2018, Iran essentially put his foot on the gas.

And if you think of getting a nuclear bomb is a 26 mile marathon.

Iran is in mile 25 right now.

And so the big challenge President Trump is going to have is reversing Iran's program significantly.

And if he's not able to do that, he's going to have to answer to two constituencies.

One are congressional Republicans and the other Israel.

And you know whether those two constituencies will accept Trump signing off on a nuclear deal that was weaker than the Obama deal, which he abrogated.

JOHN YANG: The Iranian foreign minister, Abbas Araghchi, talked a little bit about the end of this meeting, about another of Mr. Trump's goals, and let's listen to a bit of that.

ABBAS ARAGHCHI, Foreign Minister, Iran (through translator): The American side also said their aim is to reach an agreement in the shortest possible time.

But of course, this won't be easy and will require necessary will from both sides.

JOHN YANG: The first agreement took a while to negotiate.

Is there a potential pitfall in making speed a priority?

KARIM SADJADPOUR: These negotiations are not going to be about the art of the deal.

They're going to be about the science of verification.

These are not theatrical discussions.

These are very technical discussions.

And here there is a huge imbalance between the Iranian side and the American side.

And that the Iranian side, you have several Iranian diplomats who have been thinking deeply and negotiating these issues for two decades.

And, and on the U.S. side, you have President Trump's friend Steve Witkoff, who's been thinking about this for perhaps two months.

And so it's true that America obviously has far more leverage over Iran than they have.

But there's an imbalance in terms of expertise when it comes to the negotiating teams.

JOHN YANG: Why now?

What's motivating each side to come to the table now?

KARIM SADJADPOUR: Well, Iran is one of the most sanctioned nations in the world.

It's a very deeply unpopular regime domestically.

It's been humiliated over the last several months in the region.

Israel is, has taken out several of Iran's proxies and Israel took out Iran's military air defense systems.

So militarily, Iran is very vulnerable.

On the U.S. side, Trump has always made clear that he's keen on reaching a deal.

And the fact that Iran is kind of inching towards nuclear weaponization has obviously given him a much greater sense of urgency.

JOHN YANG: You mentioned the economy, Iran's economy, the sort of the verge of Iran getting a nuclear weapon.

What else is at stake here?

KARIM SADJADPOUR: If you really break this down, you have two countries ruled by very different leaders.

Right.

President Trump likes theatrics of negotiations and doing deals and actually has been clear about the fact that he wants to resolve U S.-Iran relations.

On the Iranian side, you have Ayatollah Ali Khamenei, arguably the longest serving dictator in the world at age 85.

If he wrote a book, it wouldn't be the Art of the Deal, it's the Art of Resistance.

That's something he's prided himself on for four decades as being hostile to the United States.

The identity of the Islamic Republic of Iran is contingent on death to America.

Right.

So for him, it's swallowing a lot of pride for his diplomats to sit down directly and negotiate with the United States.

And I think there's really an imbalance of expectations here because as I mentioned, even President Trump's statement today made clear that he wants to see these negotiations lead to a resumption of relations between America and Iran, whereas Ayatollah Khamenei has much more narrow goals.

A temporary tactical compromise in order for him to get sanctions relief and avert an Israeli strike on Iran.

JOHN YANG: You mentioned Israel.

They are not at the table.

They see a nuclear powered Iran as a existential threat.

They say they want a total elimination of their nuclear program.

What role are they going to play even though they're not at the table?

KARIM SADJADPOUR: Well, I think Israel obviously is.

Has a very close relationship with President Trump.

They're going to make their concerns very well known, not only to the White House, but to Congress and the U.S. media.

And we've already seen statements from people within the Trump administration like his national security adviser, Mike Waltz, saying that the outcome here should be the so called Libya model, which is a total dismantlement of Iran's program.

And so it already appears that within the Trump administration there's different views about what the end game should be.

And Israel is obviously going to be putting the thumb on the scale for a much more hawkish outcome.

JOHN YANG: Karim Sadjadpour, thank you very much.

KARIM SADJADPOUR: Thank you, John.

JOHN YANG: Also in the Middle East, Israeli forces said they have now completely encircled Rafah in southern Gaza.

For days the military has warned hundreds of thousands of people in the area to evacuate.

The IDF is expanding activities in Gaza, where military operations resumed nearly a month ago.

Israel says it won't stop fighting there until the remaining 59 hostages are freed.

But Hamas has said it can't guarantee their safety while operations are ongoing.

The Trump administration is excluding smartphones, laptops and other electronics from tariffs.

The move caps a week of ratcheting up tariffs on products from China as part of the widening trade war.

Chinese tariffs now total 145 percent.

The exemptions were in guidance that Customs and Border Patrol issued last night.

It didn't give a reason for the change.

Among the items retroactively excluded memory chips, flat panel displays and hard drives.

It spares U.S. tech companies like Apple and Dell from import duties that threaten to upend their businesses and raise prices for consumers.

President Trump says he's in good shape and feeling well after getting his annual physical at Walter Reed Medical Center.

At 78, Mr. Trump was the oldest in U.S. history to be sworn in as president.

He spent five hours at the medical center on Friday.

Later, he gave reporters aboard Air Force One his self-assessment and took a swipe at his predecessor.

DONALD TRUMP, U.S. President: Overall, I think I'm in very.

I felt I was in very good shape.

Good heart, a good soul, very good soul.

And I took - - I wanted to be a little different than Biden.

I took a cognitive test and I don't know when to tell you whether that I got every answer right.

JOHN YANG: Despite multiple promises during the campaign to release medical records, the official report from this visit will provide the first detailed look at Mr. Trump's health since 2018 and the first information of any kind since an assassination attempt last year.

The CDC says there are confirmed cases of measles in half the country, more than 700 in 25 states.

That's more than double all of last year's reported cases.

Since January, the vast majority of people with measles have been in Texas, 541.

The CDC says there may be more infections nationwide since it doesn't count cases that are under investigation.

Still to come on PBS News Weekend, why a growing number of patients are finding extra fees on their doctor's bills and how the disabled community can provide valuable lessons about parenting.

(BREAK) JOHN YANG: The next time you go to the doctor's office, you may not know whether or not they're affiliated with a hospital system.

If they are, your bill for a routine visit may include some surprising extra charges fees that go to the hospital even if you never stepped a foot inside it.

Special correspondent Megan Thompson has our report.

MEGAN THOMPSON (voice-over): In 2016, Jess Ayers and her family moved from New Jersey back to her home state of Minnesota.

Ayres set about making appointments with new doctors for her three children, especially her daughter, who needed regular eye exams.

JESS AYERS: She was diagnosed with strabismus, which is essentially a lazy eye.

MEGAN THOMPSON (voice-over): So they took her to an ophthalmology practice at this clinic in Minneapolis that had been recommended by their old doctor in New Jersey.

After the checkup, Ayres was surprised to receive two bills, one for the physician's fee and one for hospital charges totaling $176 AERs.

JESS AYERS: It was very puzzling and frustrating.

MEGAN THOMPSON: Had you gone to a hospital?

JESS AYERS: No, we had not gone to a hospital.

Right.

This was a doctor's office.

MEGA THOMPSON (voice-over): Ayres discovered the doctor's office was part of a hospital system called M Health Fairview, one of the largest health systems in the state.

So Ayres, who works in healthcare communications, had to pay something called a facility fee.

JESS AYERS: I was dumbfounded because I'd never heard of it, and having worked in health care for a long time, I was taken aback.

MEGAN THOMPSON (voice-over): She's not alone, says Christine Monahan, an expert on facility fees at Georgetown University's center on Health Insurance Reforms.

CHRISTINE MONAHAN, Georgetown University: Facility fees are particularly pernicious because there are these high, often surprising bills that are not really adequately covered by our insurance.

MEGAN THOMPSON (voice-over): Monahan says hospitals have traditionally charged facility fees to help cover their overhead costs.

But more and more they're charging the fees for routine outpatient care.

CHRISTINE MONAHAN: Two things are at play.

One is that hospitals are increasingly acquiring physician practices.

More and more places you go to will be affiliated with the hospital.

MEGAN THOMPSON (voice-over): In fact, between 2012 and 2024, the percentage of doctors employed by hospitals or health systems more than doubled to 55 percent, which helps explain why it seems more Americans are being charged.

CHRISTINE MONAHAN: But we're also seeing them more.

Consumers are feeling them more because we're seeing deductibles increase in our insurance coverage.

And so more and more you might be directly responsible.

MEGAN THOMPSON (voice-over): Nationwide, insurance deductibles have increased by nearly 50 percent in the last decade.

Jess Ayers current insurance plan has a high deductible of $10,000 for her family of five.

JESS AYERS: You know, there's a lot of those types of bills.

They come in every which way and it's a little bit like death by a thousand.

Paper cuts.

MEGAN THOMPSON (voice-over): Kaitlin Johnson of Minneapolis says she was prepared for a facility fee when she took her eight-year-old daughter for a panel of 40 allergy tests last summer at this M Health Fairview clinic.

But she was not prepared for how much the actual tests would cost.

KAITLIN JOHNSON: The total they charged to insurance was $24,400.

MEGAN THOMPSON: $24,000.

KAITLIN JOHNSON: Yes.

MEGAN THOMPSON (voice-over): Insurance paid almost $19,000, and Johnson was left to pay more than 5,400.

MEGAN THOMPSON: I mean, what went through your head when you saw that bill?

KAITLIN JOHNSON: Shocked and really confused because, you know, part of me felt like, how did I not know that this was such an expensive test?

MEGAN THOMPSON (voice-over): It turns out it's actually not.

KAITLIN JOHNSON: I'm just calling to see if I can get some pricing information.

MEGAN THOMPSON: Johnson called around to allergy clinics not affiliated with hospitals and asked about a panel of tests similar to what her daughter had.

WOMAN: Testing typically runs about $1,827.

WOMAN: Could run anywhere from 800 to 1.800.

MEGAN THOMPSON (voice-over): And that's the price before insurance kicks in.

Johnson thought her clinic had made a mistake, but they assured her they had not.

Saying there is a big difference between hospital pricing and freestanding clinic pricing.

So now she's fighting the bill.

KAITLIN JOHNSON: This test was outrageously expensive and seemed extremely out of line.

MEGAN THOMPSON: High prices, Christine Monahan says, are another consequence of hospitals consolidating and buying up independent practices.

The larger they are, the more negotiating power they have with insurance companies.

CHRISTINE MONAHAN: The greater the market power that a hospital has, the higher prices they charge for their services.

MEGAN THOMPSON (voice-over): High procedure prices and facility fees are helping drive up the cost of hospital care, which has been growing about twice as fast as inflation and outpacing physician services and prescription drugs.

What do they pay for?

MEGAN THOMPSON (voice-over): To understand what's behind the surging prices, we spoke to Molly Smith of the American Hospital Association.

MOLLY SMITH, American Hospital Association: First and foremost, there is no place in the healthcare system like a hospital.

We uniquely provide the highest level of care.

MEGAN THOMPSON (voice-over): Smith says operating hospitals is expensive with their round the clock emergency departments, top of the line medical equipment and highly trained specialists.

MEGAN THOMPSON: A patient walks into a doctor's office for routine care and they're not using any of those hospital resources.

So you can kind of understand why they would say, why am I paying for them?

I'm not getting anything.

MOLLY SMITH: But I do think everyone needs to understand what it takes for hospitals and health systems to maintain access to care in their communities 24 hours a day.

When you need your emergency department in the middle of the night, you need it to be open and available.

MEGAN THOMPSON (voice-over): Smith says inflation has made it all the more expensive, and hospitals are not being reimbursed enough by insurers to cover all the costs.

MOLLY SMITH: Insurers payers are squeezing providers to the point where they are no longer financially stable.

For every dollar that a hospital spends on staff on medical supplies, Medicare only reimburses them $0.82.

They have to make up that other $0.18 somewhere else.

MEGAN THOMPSON (voice-over): But state legislatures are increasingly cracking down, saying that gap shouldn't be made up by raising costs for routine care.

CHRISTINE MONAHAN: We've seen 20 states nationwide take some type of action to regulate facility fee billing.

MEGAN THOMPSON: And when it comes to reining in prices for procedures, a bill proposed in New York state would be the first to cap prices at hospital outpatient clinics for people with commercial insurance, people like Kaitlin Johnson with her daughter's $24,000 allergy test.

In a statement to PBS News Weekend, M Health Fairview said, we understand that health care billing can be complex, and we recognize that the cost of care a significant concern for many individuals and families.

After eight months of Johnson fighting her bill and after inquiries from PBS News Weekend, M Health Fairview finally agreed to waive her balance.

They also told her they've decided to reduce their price for allergy tests by more than 80 percent.

As for Jess Ayers, she found she could avoid the facility fee by driving her daughter to a different clinic 40 minutes away in a far off suburb.

Even though it's the same doctors and health system.

JESS AYERS: You almost like had to shake your head and be like, what?

MEGAN THOMPSON (voice-over): Luckily, Ayers could afford to pay her bill, but she still worries about those who are less well-off and about people like her parents who live in rural northern Minnesota, a two hour drive from their doctors.

JESS AYERS: And there's a lot of country out there and there are a lot of people who are further from care.

And if they only have a choice to go to a facility that does charge a hospital fee, what then?

How is that fair?

MEGAN THOMPSON (voice-over): For PBS News Weekend, I'm Megan Thompson in Edina, Minnesota.

JOHN YANG: Last year, the surgeon general warned that parents in the United States are overwhelmed and burned out.

One group of parents is often overlooked.

The 1 in 15 with disabilities.

Jessica Slice became disabled years before becoming a mother.

The experience, she says, prepared her for parenthood.

Ali Rogin spoke with her about her new book, "Unfit Parent: A Disabled Mother Challenges an Inaccessible World."

It's part of our series Disabilities Reframed.

ALI ROGIN: Jessica Slice, thank you so much for being here.

You write in the very introduction of your book, disabled parents have something powerful and transformative to offer.

Tell me about that.

JESSICA SLICE, Author, "Unfit Parent": Yeah, I think that disabled parents have been rejected by the systems that govern parenting for everyone.

And from that place of rejection, we formed our own way of parenting.

And I think actually that way that we formed can be an off ramp for all parents from consumeristic parenting, from perfection driven parenting, from this sense that we should be able to willpower our kids into safety and ultimate happiness.

ALI ROGIN: You spent much of your adult life, your young adult life as a non-disabled person.

And you write about that transition and what it was like for you in the book.

But what wisdom and tools do you think you bring to parenting as a disabled parent, as somebody who became a parent while disabled that you wouldn't have been equipped to hold if you were not disabled?

JESSICA SLICE: Yeah, so when I was in my 20s, I had this sense that happiness or perfection was just around the corner, that if I could just do things a little bit better, then I would really enjoy my life and disability pride that perfectionism from my hands.

And since becoming disabled, I'm much better at just taking my days as they are.

And I know that many days will be hard for many people and I'm able to accept that.

And then I also think that being disabled taught me how to be bored.

I'm very good at just sitting around all day.

And I think under acknowledged requirement for being a parent to young kids is the ability tolerate boredom.

ALI ROGIN: That is, as the parent of a toddler myself, that is very true.

On a serious note, there are studies, there are books that you talk about, countless testimonies, many of which you write about in the book.

Disabled people facing staggering discrimination when trying to become pregnant, when having a baby.

And then certainly it continues once they have a baby.

Can you take us through the ways that the system is designed that often fails disabled parents in this way?

JESSICA SLICE: Sure.

I mean, you know, this could be its own book and I hope it is one day.

But reproductive care is often inaccessible.

There's many obstetricians who are unable to help physically disabled people.

Many fertility clinics aren't able or unwilling to help disabled people get pregnant in the hospital.

Child protective services is often called after giving birth.

I mean, it kind of goes on and on.

ALI ROGIN: And what assumptions underlie that dynamic in the system?

You talk a lot about this in your book.

JESSICA SLICE: Yeah, I think really at the bottom of that is this sense that if you need care, if you have a needy body, if you can't be completely independent, then unable to care for others or unable to care for a baby.

And I just think that's fundamentally untrue.

And I think it really hurts all parents because I think it gives non-disabled people this false perception that they should be able to parent without help.

And so non-disabled people crumble under this unsustainable pressure, and then disabled people are kept out of the whole thing.

I think we all want so desperately for our kids to be okay and for our families to be okay, and we parent with this idea that we are invincible if we only work hard enough.

And admitting that disabled people exist and that we make good parents is also admitting that none of this is promised and all bodies are fragile and all bodies have needs.

ALI ROGIN: You write about a discrepancy in the book that disabled people routinely report being happy at rates equal to or greater than non-disabled people.

And yet most doctors who have been surveyed on this believe that disabled people have a quality of life that is less than a non-disabled person.

Why is it so common for society to consider disability in this way?

JESSICA SLICE: It's actually called the disabled paradox.

It's a philosophical phenomenon that disabled people are just far happier than anyone think.

I actually joke in the book that statistically, you're much more likely to be happy if you're disabled than if you're a doctor, which, you know is unfortunately true.

And they have their own rates of moral injury.

But I think what's underneath it goes back to this fear of fragility and fear of mortality that for many people, disability is a reminder that nothing is promised and very little is actually in our control.

And we think, oh, we don't want to get anywhere close to fragility, because that is terrifying.

But I think once we kind of look it in the face and live with it, then we actually can live very fulfilling lives.

ALI ROGIN: You write in the book about how the challenges that disabled people experience on a daily basis that really equip them with tools to be constantly creative and calm and able to adapt to change, really equips them well, especially in the earliest days of parenting when things just feel completely out of one's control.

Tell me more about that.

JESSICA SLICE: So I think there's two parts of this.

One, we're afraid of disability.

And in many ways, having a baby and caring for a baby is confronting disability.

You know, if you labor and are recovering, you're nearly in a weak and unpredictable body, and a baby is very weak and unpredictable.

And then on top of that, in my experience, being disabled and dealing with the daily and hourly problem solving of living in my very painful and unpredictable body primed me and prepared me to not be totally overwhelmed caring for both my babies when they were newborn and incredibly unpredictable and incredibly needy.

ALI ROGIN: Jessica Slice, author of "Unfit Parent: A Disabled Mother Challenges an Inaccessible World."

Thank you so much for joining us.

JESSICA SLICE: Thank you for having me.

This was wonderful.

JOHN YANG: And that is PBS News Weekend for this Saturday.

I'm John Yang.

For all of my colleagues, thanks for joining us.

Happy Passover.

See you tomorrow.