Health Wanted: Health Insurance

The Episode

Health insurance: It seems like a straightforward concept. Every month you put money into an account so that when you need to pay health care costs, that account will cover it. If you’re laughing at the idea of using that description for this country, that’s probably because it’s a ridiculous oversimplification. 

This week on Health Wanted, host Laurel Bristow gives you an abridged explanation of health insurance in the U.S. She also talks to Rachel Nuzum of The Commonwealth Fund about what we could do to fix our health insurance system.

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The Listener Questions

Can the COVID-19 vaccine change my menstrual cycle?

Changes in periods after vaccination and infection have been reported since pretty early on in the COVID-19 pandemic. There is not much research on it, because we simply don’t research issues that predominantly affect women.

Even though it was noted from early on, it doesn’t seem like many people decided to look into it in the intervening five years.

There are a lot of theories for why an infection or vaccination could have an impact on someone’s menstrual cycle, but the one that fits best with the vaccine’s impact is this: Your endometrial lining is part of your immune system, and when it gets inflamed due to an immune response it can disrupt how your period happens. The immune response can also impact hormone levels, which has the potential to mess with things as well.

It’s hard to disentangle what the vaccine or infection does from what the stress of living through unprecedented times does, because stress is also something that messes with periods. But there have been other studies that show a temporary change in cycle length after the typhoid vaccine or HPV vaccine.

Whatever impact the vaccine has, it appears to be short-lived and doesn’t impact fertility. If changes last more than a few cycles, it’s a good idea to talk to a doctor.

Does melatonin  cause heart failure?

The research on this is going to be presented at the American Heart Association Scientific Sessions. It’s not a paper people can read, and it’s not peer reviewed. 

It’s a review of the medical records of 130,000 adults with a diagnosis of insomnia over a period of five years. it found that people who had a record of using melatonin for a year or more had an increased risk of heart failure over five years compared to people who had no record of melatonin use. The incidence of heart failure was about 4.6% in the melatonin group vs 2.7% in the control.

The research also found that people who used melatonin long term had a 3.5 times higher risk of hospitalization due to heart failure.

The study can only prove an association, not that melatonin use causes these outcomes, and it has some pretty big limitations. For one, it uses electronic medical records for multiple countries, some of which require a prescription for melatonin use. So in places like the U.S., someone who is taking over-the-counter melatonin supplements would likely be classified as a “non-melatonin user,” because it’s not a documented prescription they have. 

Also, there’s no information about the severity of insomnia someones has or other psychiatric conditions which could impact health. Sleep is incredibly important, and if someone has insomnia and additional conditions that could impact sleep, they might be at greater risk from those other conditions, but it seems like melatonin is the problem.

It’s important to note that we don’t have data about the risks of long-term melatonin use. It’s just been considered safe without the data to back that up. So while it’s a good idea to look into safety data, there are a lot of questions this report is leaving unanswered.

I heard that America lost it’s measles elimination status. Does that mean we no longer have herd immunity?

The U.S. has not lost it’s elimination status, though that’s likely to happen in January of 2026 because the outbreak that started in West Texas at the beginning of this year and is still causing cases in other states.

The region of the Americas has lost its measles elimination status as a result of Canada losing its elimination status.

In order to get elimination status, a region has to go 12 months without sustained transmission of measles. So this means you could have a few sporadic cases of measles in travelers who got infected abroad, and those travelers might infect someone here, but as long as that transmission is interrupted and doesn’t spread continuously for a year, you keep your status.

Canada had an outbreak that started in New Brunswick and spread in Ontario and Alberta for over a year, so they lost that status in November of 2025.

The WHO divides the world into six regions: African region, region of the Americas, Eastern Mediterranean region, Europe region, South-East Asian region, and Western Pacific region. Because Canada is part of the region of the Americas, losing their status means the whole region lost status.

The Americas have lost and regained measles elimination status before. We lost it because of measles transmission in Venezuela in 2018 and Brazil in 2019, but then we tightened up and got status back in 2024. So we could get it back again, but the U.S. and Mexico both have ongoing outbreaks currently.

As for herd immunity, that’s different than elimination status. Herd immunity is the amount of people that have immunity, which helps stop transmission. Because there are different levels of vaccine uptake throughout the country, some places still have herd immunity, meaning the risk of transmission is much lower. Other places have a much higher risk of transmission.

People, particularly children, who are fully vaccinated are still at a significantly lower risk of getting infected, even if they are in an area with no herd immunity. We like herd immunity to cover the gaps in protection, because nothing is 100%.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

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