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Cutting Medicaid?

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Cutting Medicaid?

Republican leaders in Congress have directed the committee that oversees Medicaid to cut $880 billion from the next budget. They say these cuts aren’t necessarily aimed at Medicaid, the insurance program for 72 million poor and disabled Americans. The cuts could come from Medicare, for instance. But Trump has vowed not to touch that very popular program. And a sum this large can’t come from anywhere else.

The Republican process is just getting started, and we don’t yet know how lawmakers will change the program. Most Medicaid money goes to states, so the best way to think about the proposal is as a cut to state budgets. State lawmakers could react by dropping coverage, raising taxes or slashing other parts of their budget. In today’s newsletter, I’ll explain a few possible scenarios.

Medicaid was designed to divide a patient’s medical bills: the federal government and the state would each pay a set share. (A state’s contribution depends on how poor it is.)

The law is precise about what Medicaid must cover — cancer screenings and kidney transplants, for instance, but not prosthetic legs — and Republicans can’t change that with a budget bill. Every state has to cover certain populations, including poor children, pregnant women, people with disabilities and patients in nursing homes who run out of money.

Most states also choose to cover an optional group that was added as part of Obamacare in 2014: anyone who earns less than a certain income (around $21,000 for a single person). Republicans want to impose a work requirement on this group for people who aren’t disabled. That idea is popular with the public but would save the federal government only around $100 billion, not enough to meet the G.O.P. target.

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Anything more to lower the federal government’s share would put the burden on states. And lawmakers there could deal with the problem in their own ways. They could cut optional populations like the Obamacare group. Twelve states have laws that will automatically do this if federal funding drops. If they don’t want to drop people, states can drop optional benefits, such as prescription drug coverage.

After those cuts, states face tough choices.

They could pay doctors, hospitals and nursing homes less for care. But there is a limit. If Mississippi suddenly started paying $50 for an echocardiogram instead of around $160, cardiologists might stop seeing Medicaid patients. (Many Medicaid patients already struggle to find care because the program pays doctors so little.) Cuts like these could also put some nursing homes or rural hospitals out of business.

Even so, states would still need a lot more money for Medicaid, usually their second-largest expense after education.

Where could they get it? They’d have to sacrifice other priorities. One option is to cut education. Another is to raise taxes. None of these would be required by federal legislation; it’s up to the states how they cope. That allows Republicans in Congress to say they are not cutting Medicaid benefits or eligibility, even if that is the inevitable effect in most places.

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Republicans point out that the original pact between Washington and the states has frayed, and feds are covering more than their share. That’s true. Through various accounting gimmicks, states have lowered their Medicaid contributions and now pay about a third of the bill, on average. Plus, Washington assumed almost the whole cost of the 2014 Obamacare expansion.

But that expansion has made Medicaid popular. More than half of Americans say someone in their family has used the program, and only 17 percent support cutting its budget. Local lawmakers also probably won’t win over voters by chopping education or raising taxes to save Medicaid. That’s why Democrats have settled on Medicaid as their top talking point about the G.O.P. budget plan.

Republicans tried to cut Medicaid’s budget in 2017, too. Grassroots opposition helped defeat the effort, as did extensive lobbying by Republican governors, who urged senators not to leave them with a huge fiscal hole.

The unpopularity of that bill — and its failure — helped Democrats retake the House the next year.

Related: Cutting Medicaid, taxing scholarships and killing invasive plants: A guide to the Republican wish list.

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In India, young people are driving a boom in book festivals big and small. These readers are increasingly consuming books in their native tongues and in English. They are learning in ways that India’s higher education system — with its focus on exams — often does not encourage.

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Brain Health Challenge: Try the MIND Diet

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Brain Health Challenge: Try the MIND Diet

Welcome to Day 2 of the Brain Health Challenge. Today, we’re talking about food.

Your brain is an energy hog. Despite comprising about 2 percent of the average person’s body mass, it consumes roughly 20 percent of the body’s energy. In other words, what you use to fuel yourself matters for brain health.

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So what foods are best for your brain?

In a nine-year study of nearly 1,000 older adults, researchers at Rush University in Chicago found that people who ate more of nine particular types of food — berries, leafy greens, other vegetables, whole grains, beans, nuts, fish, poultry and olive oil — and who ate less red meat, butter and margarine, cheese, sweet treats and fried food had slower cognitive decline.

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Based on these findings, the researchers developed the MIND diet.

Large studies encompassing thousands of people have since shown that following the MIND diet corresponds with better cognitive functioning, a lower risk of dementia and slower disease progression in people with Alzheimer’s. People benefit from the diet regardless of whether they start it in midlife or late life.

Experts think the foods included in the MIND diet are especially good for the brain because they contain certain macro and micronutrients.

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Berries and leafy greens, for example, are rich in polyphenols and other antioxidants, said Jennifer Ventrelle, a dietitian at Rush and a co-author of “The Official Mind Diet.” Many of these compounds can cross the blood-brain barrier and help to fight inflammation and oxidative stress, both of which can damage cells and are linked to dementia.

Nuts and fatty fishes, like salmon and sardines, contain omega-3 fatty acids, which are important for building the insulating sheaths that surround the nerve fibers that carry information from one brain cell to another.

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Whole grains and beans both contain a hefty dose of fiber, which feeds the good microbes in the gut. Those microbes produce byproducts called short-chain fatty acids that experts think can influence brain health via the gut-brain axis.

You don’t have to revamp your whole diet to get these nutrients. Instead, think about “MIND-ifying” whatever you already tend to eat, said Dr. Joel Salinas, a neurologist at NYU Langone Health and the founder and chief medical officer of the telehealth platform Isaac Health. For instance, add a handful of nuts or berries to your breakfast.

Today’s activity will help you MIND-ify your own meals. Share your choices with your accountability partner and in the comments, and I’ll discuss the ways I’m adjusting my diet, too. For added inspiration, check out these MIND-approved recipes from New York Times Cooking.

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Measles outbreak explodes in South Carolina; multiple people hospitalized as cases surpass 200

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Measles outbreak explodes in South Carolina; multiple people hospitalized as cases surpass 200

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The South Carolina Department of Public Health (DPH) is sounding the alarm after 26 new measles cases were reported since Friday, bringing the total number of cases in the state’s latest outbreak to 211.

DPH first reported a measles outbreak Oct. 2 in the Upstate region. As of Tuesday, 144 people are in quarantine and seven people are in isolation.

Of the 211 cases, 45 involve children under 5, 143 cases involve children ages 5 to 17, 17 cases involve adults and six cases involve minors whose ages weren’t disclosed.

DPH said 196 of the 211 infected individuals were unvaccinated, four were partially vaccinated, one was vaccinated and 10 are either still being investigated or have an unknown vaccination status.

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MEASLES CASES CONFIRMED AT FOUR MAJOR US AIRPORTS ACROSS COUNTRY AMID PEAK HOLIDAY TRAVEL

Hundreds of people in South Carolina have contracted the measles, and a few have been hospitalized. (Jan Sonnenmair/Getty Images)

Officials said 19 of the new cases were associated with “exposures in known households and previously reported school exposures,” and four resulted from church exposures.

DPH identified public exposures at Sugar Ridge Elementary and Boiling Springs Elementary and began notifying potentially exposed students, faculty and staff Dec. 31. 

There are nine students in quarantine from the two schools.

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Of the 211 cases, 45 involve children under 5 years old. (iStock)

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Exposures also happened at the Tabernacle of Salvation Church, Unitarian Universalist Church of Spartanburg, Slavic Pentecostal Church of Spartanburg and Ark of Salvation Church.

The source of one case is unknown, while two others are still being investigated.

Although complications from measles are not reportable, officials said four people, including adults and children, required hospitalization for complications from the disease.

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Officials recommend all children be vaccinated against measles. (Raquel Natalicchio/Houston Chronicle via Getty Images)

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Additional cases required medical care, but the infected individuals were not hospitalized.

Those infected with measles are contagious from four days before the rash appears and may be unaware they can spread measles before they know they have the disease, according to DPH.

DPH said it is important for those with a mild illness or those who are in quarantine to stay home to protect others.

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“We encourage employers to support workers in following DPH recommendations to stay out of work while ill or in quarantine, which also protects businesses, other workers and clients,” officials wrote in a statement.

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DPH said vaccinations continue to be the best way to prevent measles and stop the outbreak.

Though the CDC recently released new vaccine recommendations under Health and Human Services Secretary Robert F. Kennedy Jr., its guidelines still dictate all children should be immunized for measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV) and chickenpox.

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Common pain relievers may raise heart disease and stroke risk, doctors warn

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Common pain relievers may raise heart disease and stroke risk, doctors warn

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Many might assume that over-the-counter (OTC) medications are generally safer than stronger prescription drugs, but research shows they can still present risks for some.

Certain common OTC painkillers have been linked to an increased risk of high blood pressure, stroke and heart attacks.

Potential risk of NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) — which are used to reduce pain, fever and inflammation — have been pinpointed as the class of medicines most linked to elevated cardiovascular risk.

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“This is because they reduce the production of certain chemicals called prostaglandins,” Maryam Jowza, M.D., an anesthesiologist at UNC Health in North Carolina, told Fox News Digital. “These chemicals are involved in inflammation, but they are also involved in other body functions, such as influencing the tone of blood vessels.”

Certain common OTC painkillers have been linked to an increased risk of high blood pressure, stroke and heart attacks. (iStock)

Dr. Marc Siegel, Fox News senior medical analyst, echoed the potential risk of NSAIDs. 

“They can lead to high blood pressure, heart attack and stroke via fluid retention and salt retention,” he told Fox News Digital. “This increases volume, puts a strain on the heart and raises blood pressure.”

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Common examples of NSAIDs include ibuprofen, naproxen, aspirin, diclofenac, indomethacin and celecoxib.

Randomized trials found that ibuprofen caused the biggest spikes in blood pressure, followed by naproxen and then celecoxib. 

“In general, the increase in blood pressure is more likely with higher doses and longer duration of treatment,” said Jowza, who is also an associate professor in the Department of Anesthesiology at the UNC School of Medicine.

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NSAIDs can also increase stroke risk, especially at high doses and with long-term use, the doctor added. 

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Diclofenac was linked to the highest cardiovascular risk, the doctor cautioned. Ibuprofen can also raise blood pressure and has been associated with a higher heart attack and stroke risk, but not as high as diclofenac. Naproxen carries a lower cardiovascular risk than ibuprofen or diclofenac, but is not entirely risk-free.

NSAIDs have been pinpointed as the class of medicines most linked to elevated cardiovascular risk. (iStock)

“The practical takeaway is that diclofenac is generally the least favorable choice in patients with elevated cardiovascular risk, and all NSAIDs should be used at the lowest effective dose for the shortest duration,” Dr. Nayan Patel, pharmacist and founder of Auro Wellness in Southern California, told Fox News Digital.

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Aspirin is an exception — although it is an NSAID, it actually reduces the risk of clots when taken at a low dose for prevention, under a doctor’s guidance. However, it can increase bleeding risk and blood pressure at high doses.

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Non-NSAIDs safer, but not risk-free

Non-NSAID pain relievers are commonly used for everyday aches, headaches and fever, but not swelling. They act mainly on the brain’s pain signals, not inflammation, according to medical experts.

Acetaminophen, the most common non-NSAID pain reliever, is also linked to an increase in blood pressure, although to a lesser extent, according to Jowza. 

“All NSAIDs should be used at the lowest effective dose for the shortest duration.”

“Acetaminophen was once thought to have little to no cardiovascular effects, but more recent evidence suggests it can increase blood pressure, especially with higher doses used in the long term,” she said, emphasizing the importance of blood pressure monitoring. “Its effect on stroke risk is less clear.”

Which groups are most vulnerable?

The groups at greatest risk, according to doctors, are those with existing health conditions, such as high blood pressure, prior stroke or heart disease, diabetes or kidney problems.

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“These groups are also more likely to experience NSAID-related fluid retention and destabilization of blood pressure control,” Patel said.

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Cardiovascular risk is generally higher for people 75 and older, the doctors agreed.

“Age amplifies risk largely because baseline cardiovascular risk increases with age, and kidney function reserve tends to decline,” Patel said. “Older adults are also more likely to be on antihypertensives, diuretics, antiplatelets or anticoagulants, so NSAIDs can destabilize blood pressure control and add safety complexity.”

Warning signs

Anyone experiencing chest pain, shortness of breath, sudden weakness or numbness, severe headache, confusion, slurred speech or vision changes should see a doctor immediately, Jowza advised.

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“These symptoms can point to a heart attack or stroke,” she warned. “Other symptoms of concern that may not develop as rapidly, like new swelling in the legs, should also prompt medical attention.”

Anyone experiencing chest pain, shortness of breath, sudden weakness or numbness, severe headache, confusion, slurred speech or vision changes should see a doctor immediately, a doctor advised. (iStock)

“Patients should also seek medical advice if they notice signs of fluid retention or kidney stress, such as rapidly rising blood pressure, swelling in the legs, sudden weight gain over a few days, reduced urine output or worsening shortness of breath,” Patel added.

Safer alternatives

For those at higher risk, Patel recommends non-NSAID approaches whenever possible. 

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“For many patients, this means starting with non-drug strategies such as heat or ice, physical therapy and activity modification,” he told Fox News Digital. “If medication is needed, acetaminophen is generally preferred over oral NSAIDs from a cardiovascular standpoint, although regular use should still be monitored in people with hypertension.”

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For localized joint or muscle pain, the doctor said topical NSAIDs can offer “meaningful relief” with “far lower” risk.

“Overall, pain management in high-risk patients should emphasize targeted therapy, conservative dosing and close blood pressure monitoring.”

Bottom line

The doctors emphasized that the overall risk is “very low” for people taking OTC pain relievers on a short-term basis, but it rises with long-term, high-dose use.

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“I would not hesitate to use an occasional dose if it were a low-risk individual with no prior history of heart attack or stroke,” Jowza said. “I also think short-term use in diabetics and hypertensives who are well-controlled is acceptable.”

Although aspirin is an NSAID, it actually reduces the risk of clots when taken at a low dose for prevention, under a doctor’s guidance. (iStock)

For those taking NSAIDs, the doctor suggested using “guard rails” — such as regularly testing blood pressure and kidney function, and setting limits on dosing — to make treatment as safe as possible.

Patel agreed that for most healthy individuals, occasional NSAID use “does not carry a meaningful cardiovascular risk.”

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“The concern is primarily with repeated or chronic use, higher doses, and use in people with underlying cardiovascular, kidney or blood pressure conditions,” he confirmed to Fox News Digital.

“That said, large population studies show that cardiovascular events can occur early after starting NSAIDs, particularly at higher doses, which is why even short-term use should be approached cautiously in higher-risk patients.”  

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