JOHN YANG: Tonight on PBS News Weekend, controversial return, elite women's tennis is back in China for the first time since the disappearance of Chinese tennis star Peng Shua.

Then the lack of regulation of the ink used in the billion dollar tattoo industry and what it means for the millions of Americans getting things.

MAN: Will unfortunately know very little about what's in the in the United States because it isn't regular, just absolutely anything.

There's actually no ink that is FDA approved for injection into the skin.

And I think that's the main problem.

JOHN YANG: The legal blind spot that results in unexpected big bills for medical emergency transportation.

(BREAK) JOHN YANG: Good evening, I'm John Yang.

Tonight as the maker break week reporting a government shutdown begins, House Republicans are still looking for a way out of their spending stalemate.

House Speaker Kevin McCarthy wants to pass a 45-day spending bill to fund the government beyond next Saturday.

But hardline Republicans are insistent on full year bills with big cuts.

This morning on Fox News, one of the hardliners Matt Gaetz of Florida blasted the speaker strategy.

REP. MATT GAETZ (R) Florida: We knew September 30 was coming all year.

And Kevin McCarthy has been dilatory, he's been fiddling like we (inaudible) burns.

WOMAN: As we understand it, they're doing this this upcoming week.

So we will -- MATT GAETZ: Right.

Because we are making them.

They're doing it with a political gun to their head and you are welcome America.

JOHN YANG: This week, McCarthy will try to pass four of bills needed to fund the government for a full year as well as a short term stopgap measure for the rest of the government.

French President Emmanuel Macron was ending his country's military presence in Niger and bringing the ambassador home as a result of July's military coup that deposed Niger's democratically elected president.

France, the West African nation's former colonizer has kept about 1,500 troops in Nigeria to combat terrorism in the region, but huge protests have called for the French to leave.

Macron says all French forces will be out of the country by the end of the year.

NASA got a special delivery from space this morning.

A capsule about the size of a car tire landed in the Utah desert, ending a seven year 4 billion mile round trip to collect the biggest haul of samples from an asteroid ever collected in space.

The material will be analyzed at the Johnson Space Center in Houston and eventually labs around the world.

Scientists hope what they find will help unlock the mysteries of the creation of the earth and our solar system.

It's the most extraterrestrial material to be brought back to Earth since the end of the Apollo lunar program.

And two milestones today for women in sports.

At the Berlin marathon Ethiopian runner Tigst Assefa shattered the women's world record by a full two minutes.

She covered the 26 mile course in two hours, 11 minutes and 53 seconds.

Assefa only started running marathons last year.

Before that she was a middle distance runner.

And tonight's US women's national soccer team match against South Africa will be Megan Rapinoe's final game with a team and her two decades on the national squad.

She helped with two World Cups and an Olympic gold medal.

She still has three more games and the National Women's Soccer League regular season before fully retiring.

After that, Rapinoe says she'll continue to fight for women's rights and equal pay.

Still come on PBS News Weekend, the unexpected high cost of emergency medical transportation, and the story of Lydia Mendoza, the first queen of Tejano music.

(BREAK) JOHN YANG: When Chinese tennis star Peng Shua disappeared from public view after accusing a high ranking Communist Party officials of sexual assault, the Women's Tennis Association declared and would not hold any more tournaments in China until Peng's whereabouts were known.

And there was a full uncensored investigation of allegations.

That was two years ago.

There's still no official word about Peng who hasn't been seen since a brief appearance at the 2022 Winter Olympics.

There's been no investigation.

But despite that, on Tuesday, in Beijing, the WTA's $8 million.

China Open begins.

Sophie Richardson is the China director of Human Rights Watch.

Sophie, first of all, let's -- I want to talk about Peng.

What do we know about her current situation?

Do we know anything?

SOPHIE RICHARDSON, China Director, Human Rights Watch: We know very little.

We don't know whether she has removed herself from public view or whether she is being kept out of sight by either sports officials or by agents of the government or the party.

JOHN YANG: The WTA says they've been in touch with people around her people know her well.

And they say that she' swell, she's living with her family and baby.

If any of that's true, SOPHIE RICHARDSON: There's no way to verify it independently.

And really, even if we could, we are talking about an independent adult who should be able to answer these questions herself directly in order for us to be confident that she really is free, secure, or any of the other characteristics that people are attributing to her.

JOHN YANG: I want to read the statement that the Women's Tennis Association released when they say they were going back to China, they said after 16 months of suspended tennis competition in China and sustained efforts at achieving our original request, the situation has shown no signs of changing.

We have concluded we will never fully secure those goals.

And it will be our players of tournaments, who will ultimately be paying an extraordinary price for the sacrifices.

What do you make of that?

SOPHIE RICHARDSON: Well, I think the WTA gets a lot of credit for having tried to take a principal position in the first place.

And then for having been honest about the ways in which it hasn't succeeded.

I would amend that statement, to be clear that what hasn't changed is the intransigence and the hostility of the Chinese government and Communist Party, you know, to being transparent to people letting speak their mind freely or to letting serious allegations of sexual assault be investigated by competent authorities.

That's what needs to change.

JOHN YANG: In wages.

This embolden them, they just helped hold out long enough things will they'll get what they want?

SOPHIE RICHARDSON: I think that's the story of the last 40 years, particularly with the business community as a whole.

Again, I think, you know, the WTA is being honest and saying that it tried and failed.

You know, a lot of companies and indeed sports organizations, and particularly a body like the International Olympic Committee, just continue to insist without any evidence that simply doing business there will bring improvements.

And I think recent history shows that that's not really the case.

JOHN YANG: Alize Cornet of France is one of the few top 100 players who was not going or says she's not going to China, because of Peng.

She said on her Instagram post staying true to my convictions and careful about my health, I decided I will not be playing in China this year.

Are the players doing enough to support their colleague?

SOPHIE RICHARDSON: I think in the immediate aftermath of Peng Shuai's allegations against Zhang Gaoli in November of 2021.

Number of athletes spoke up very I think movingly and strongly both in her defense but also concerned about her whereabouts and well-being and it's good to hear some of them follow through on those concerns.

But I think too often they are limited or have to stop and think about whether professional sports associations will in any way penalize them for trying to speak their minds or act on their own principles and that is unfair and should change to.

JOHN YANG: Peng is obviously a very high profile individual.

So a lot of attention.

A lot of people notice when she sort of disappeared.

But are there are people who are less known who just simply the similar things that are happening to them in China.

SOPHIE RICHARDSON: The Chinese government has a long track record of disappearing people and whether it's for example a journalist named Huang Xueqin who has just tried on Friday after being off the grid for two years.

She made her name actually writing about MeToo cases in China, or whether you're talking about until recently foreign minister, who disappeared off the grid in June.

The authorities have no trouble simply depriving people of their liberty.

There's no warrant, no arrests.

Nobody tells your family where you are, and you can't call a lawyer.

This is an alarmingly common problem for journalists, for activists and indeed for very senior government officials.

JOHN YANG: Sophie Richardson of Human Rights Watch, thank you very much.

SOPHIE RICHARDSON: Thank you.

JOHN YANG: Tattoos in early 20th century America were largely limited to sailors and circus performers.

But today, there's hardly a major celebrity who isn't inked.

And it's not just the famous.

When the Pew Research Center surveyed nearly 8,500 Americans this summer, 32 percent said they had at least one tattoo and 22 percent said they had more than one.

By one estimate, tattooing in America is a one and a half billion dollar industry.

But while all 50 states and the District of Columbia required tattoo artists to have a license, tattoo ink is totally unregulated in the United States, although the Food and Drug Administration has recently proposed guidelines.

Dr. Thomas Rohrer is a dermatologic surgeon and a private practice in the Boston suburbs and he's the former president of the American Society for Dermatologic Surgery.

Dr. Rohrer, how is tattooing done?

And what are the risks from that process?

DR. THOMAS ROHRER, Dermatologic Surgeon: Sure, well, tattooing can be done in a couple of different ways.

One very crudely, you can put anything into the skin with ink on it and create a little deposit and create some color there.

So an amateur tattoo.

But the professionals use a machine that has a whole bunch of needles in it kind of like a sewing machine that goes in and out of the skin and deposits ink of different colors at different depths to give you a more colorful picture.

So the risks for tattoos, I guess, start initially with infection.

All right, so since that tattoo needle or whatever device they're using to get into the skin has to penetrate the skin, you can potentially inject some bacteria or virus into the skin and then cause a problem.

So there have been certainly a number of cases of bacterial infections, or viral infections, including hepatitis.

And then down the road, what happens with the ink, there can also be problems, some of those inks, some people are allergic to in this country and around the world.

And they have these anything from a mild to a really massive allergic reaction to the ink that's gone into their skin, which causes burning, itching, sometimes ulceration and scarring with that.

One of the other issues we've been seeing with the tattoo, particularly when people get a big tattoo, like a sleeve covering a large area is they cover a good portion of their skin.

So if that patient were to develop melanoma in that area, it's very difficult for the patient to see that and for the physician to see it.

There also been cases of tattoos reacting when someone goes for an MRI, which can be an issue.

And lastly, there's some question about some of these tattoos potentially leading to cancer down the road.

JOHN YANG: In your practice, have you seen with the increase of the number of people who have tattoos?

Have you seen an increase in the number of people coming in with complications?

THOMAS ROHRER: Yeah, we have seen an increase in the complications, but is probably, you know, reflective of just the increase in the number of patients getting tattoos.

So overall, I don't know if the percentage of people getting complications has changed.

We've definitely seen an uptick over the last few years.

JOHN YANG: Then talk about the ink because as I say that it's not regulated in the United States, the EU, the European Union has banned some ingredients.

What do we know about what's in the ink in the United States?

THOMAS ROHRER: Well, unfortunately, you know very little about what's in the ink in the United States, because it isn't regulated.

Now they can use absolutely anything.

There's actually no ink that is FDA approved for injection into the skin.

And I think that's the main problem.

I think it'd be a lot better if they were able to standardize it and get rid of like the EU did some of the steps could potentially be harmful, and limited to a handful of them.

JOHN YANG: And the FDA is put out proposed guidelines.

Is that enough?

THOMAS ROHRER: Yeah.

I mean, I think some set of guidelines would be fine.

That should be a working base to start with, and then we can go down the road, but I do think that's would be very helpful to help regulate the tattoo industry.

JOHN YANG: And that Pew survey that we talked about at the in the introduction, about a quarter of the people who do have at least one tattoo said they regret it.

How is tattoo removal, but how does that work?

And have you seen a lot of people coming in asking for that?

THOMAS ROHRER: Well, sure, and that's where we see mostly, you know, patients coming in who do regret it and in the numbers vary from, you know, there's one study that showed 78 percent that people regretted it, some say 40, you know, and at NIH one (ph) and one by tattoo artists only showed 2 percent regretting.

So the numbers vary.

How we remove them is with lasers.

These days, we've got a lot of different lasers, the new picosecond lasers work much better than our older lasers.

And I think if someone's getting a tattoo removed, make sure they go to a board certified dermatologist who's got some of these high tech lasers, and not just some mom and pop shop that may have the millisecond lasers, which could actually cause some harm.

JOHN YANG: You said earlier that you tend to see the patients who have problems come in.

But if a patient were to come in and say and say to you, I'm thinking about getting a tattoo, what would be your advice?

THOMAS ROHRER: Yeah, I mean, I guess the same thing is like tell the my family members, be sure he wants a tattoo and know that there are some complications that can happen with it and also know that it's going to hurt a lot more and cost a lot more to remove that tattoo than it is to get the tattoo placed in first time.

JOHN YANG: Dermatologic surgeon Thomas Rohrer.

Thank you very much.

THOMAS ROHRER: My pleasure.

Thank you.

JOHN YANG: And a medical emergency you want to get to a hospital as quickly as possible.

But what happens when the cost of that transportation is hundreds or thousands of dollars even with insurance.

Ali Rogin has more on how a legal blind spot is creating a dangerous dilemma for families across the country.

ALI ROGIN: When Congress passed the No Surprises Act last year, it got rid of most unexpected billing for out of network emergency room visits.

But the legislation leaped out a crucial service ground ambulance rides.

Every year, roughly 3 million insured people ride in ambulances during medical emergencies.

But up to 85 percent of those transports are out of network.

That means many Americans are being slapped with surprise bills.

Joining me now is Laura Santhanam, NewsHour's digital health reporter.

Laura, thank you so much for joining us.

You spoke to many people who've been affected by this including one California mom, tell me about her experience.

LAURA SANTHANAM: Yeah, so California is one of the worst parts of the country when it comes to out of network billing, or what we call surprise bills.

So this one new mom who I talked to, you know, had a newborn son, her third child last September, shortly after he was born, he developed problems breathing.

And so the hospital worker said you need to take an ambulance, get him to a pediatric facility where they can take better care of him.

So you know, it's an emergency situation, seconds matter.

They did what the professionals told them to do.

After a few days, he recovered, they went home, everything is sort of clicking into place as far as newborns schedules go.

And then a few weeks later, a bill, you know, bills start to show up, right.

You know, the ambulance company is saying that she owes $4,400 for this ride, you know, that was 23 miles to save her son's life.

Presumably, the insurance company's not, you know, paying for it with payments company and the insurance company aren't talking to each other.

She's spending her parental leave when she's recovering and trying to take care of her youngest child, getting these companies to talk to each other so that she's not left with thousands of dollars of medical debt.

ALI ROGIN: And she ended up having to pay several $1,000.

Is that right?

LAURA SANTHANAM: That's right.

You know, so ultimately, after again, you know, like months on the phone, the insurance company agreed to pay for half.

But that left her on the hook for more than $2,000.

She's a teacher.

She didn't have paid leave.

So she ultimately had to cut short her parental leave, go back into the classroom, teach and teach summer school to pay down this debt, that she wasn't looking for her and had no real chance of anticipating in the first place.

ALI ROGIN: Why were ground ambulances not included in the No Surprises Act?

LAURA SANTHANAM: There were a lot of things that the no surprises act tackled, especially thinking about out of network billing.

But when it came to ground ambulance services, it was just a bridge too far, just in large part because the one universal truth it seems about ground ambulances in the U.S. is that it's a complex system.

And it took us decades to get here.

ALI ROGIN: For patients, there's often no way to calculate how much an ambulance ride costs.

Why does the price vary so much state to state?

LAURA SANTHANAM: Part of the complexity is that, you know, in some places, you may have fire departments operating this, you know, there's private equity firms.

And so others hospitals may be running these services, and then you layer on top of that state local taxes on top of that health insurance status and in and out network, and so all of those complications, make it to where it is it no reasonable person can anticipate some of these costs.

ALI ROGIN: I want to talk about something related here, which is a millions of Americans live in what are known as ambulance deserts in which the closest ambulance that they could call is 25 minutes away.

How is this affecting this problem that we're talking about?

LAURA SANTHANAM: It's a problem that came up with this family in California who I talked to, so you know, they had insurance, but in but they're insurance did not cover the one ambulance company that was in the county where they lived and where their son was.

you know, transported like between hospitals.

So that's part of the reason why, you know, when you see things like ambulance deserts, it directly implies that, you know, there are fewer choices.

And when you have fewer choices, you're forced to make decisions that might not be in your best interest.

ALI ROGIN: So in terms of solutions, there are 13 states that have protections against patients being slapped with these emergency ambulance bills.

But on the broader level, we have this committee now in place, what sort of protections are they looking into?

LAURA SANTHANAM: Right.

So they're looking at, you know, what is this, you know, Frankenstein system of ambulatory care that we have right now, and what can be done to fix it?

So, several states have already taken the initiative to protect consumers from some of these surprise bills.

But how sustainable are those solutions?

You know, right now, this committee is, you know, gathering, you know, all kinds of evidence and testimony and research, to try and put together a number of recommendations that they'll then share with lawmakers in Congress and state level and local levels of government to try and see what we can do.

How receptive policymakers will be to those suggestions time will tell but it's definitely a problem worth looking at.

ALI ROGIN: Absolutely.

Laura Santhanam, he's our digital health reporter.

Thank you so much.

LAURA SANTHANAM: Thanks for having me.

JOHN YANG: To read all of Laura's reporting on the high cost of emergency medical transportation, visit our website pbs.org/newshour.

And now for Hispanic Heritage Month, we look back on the life of a Mexican American musician, whose music bridge styles and cultures to tell the stories of the working class, it's part of our series Hidden Histories.

During her seven decades singing career Lydia Mendoza was known by many nicknames, the Luck of the Border, the Songstress of the Poor, the Glory of Texas.

Mendoza was the first queen of Tejano music, giving voice to the working class Texans and Mexican descent living along the border.

From the 1930s to the 1980s, she recorded hundreds of songs on more than 50 solo albums and public performances.

Her clothes reflected her cultural roots.

Her songs evokes generations of heritage.

LYDIA MENDOZA, Musician (through translator): Whether I'm singing okarito (ph), a waltz, a bolero, a Polka, or whatever it is, when I sing that song, it feels like I'm living that moment.

I feel when I'm singing.

If it's like a kurido (ph), I feel it.

It's my feeling for every song I sing.

JOHN YANG: Mendoza kept to the oral tradition of singing what audiences requested, drawing on her encyclopedic musical memory.

In a 1986 interview, renowned Tejano composer and music producer Salome Gutierrez recalled asking Mendoza to sing a song her mother had composed decades before.

SALOME GUTIERREZ, Composer and Producer (through translator): She told me I haven't sung this song and over 20 years, let me see if I remember the verses.

But she started singing it without reading.

She sang the 28 verses without making a mistake.

JOHN YANG: Mendoza was born in Houston in 1916 to Mexican parents who were part of the wave fleeing the revolution.

It was a musical family.

Her mother taught her guitar when she was seven.

She later took up the mandolin, the violin and eventually the iconic 12-string guitar.

Her family formed a band playing on street corners and restaurants wherever they could pass the hat.

They were playing at a San Antonio outdoor market when a Tejano broadcaster heard Mendoza sing.

He put her on his show as a guest.

Listeners phone the station demanding an encore.

The host made irregular paying her $3.50 a week.

We felt like millionaire she recalled years later.

While still a teenager, Mendoza auditioned for bluebird records then part of RCA Victor.

One of the songs she recorded that day, Mal Hombre became a hit on both sides of the border led to a record contract and was her signature tune for the rest of her career.

Mendoza continued performing into the 1980s.

Singing in 1977 at President Jimmy Carter's inauguration.

In 1999, a decade after a stroke entered her performing career, President Bill Clinton presented her with the National Medal of Arts.

BILL CLINTON, Former U.S. President: With the artistry of her voice and the gift of her songs she bridged the gap generations and culture.

Lydia Mendoza is a true American pioneer.

And she paved the way for a whole new generation of Latino performers, who today are making all Americans sings.

JOHN YANG: And in 2013, six years after she died at 91, she was honored with a postage stamp, a forever stamp, just as her contributions to Tejano culture will live on forever.

And that is PBS News Weekend for this Sunday.

I'm John Yang.

For all of my colleagues, thanks for joining us.

Have a good week.