Health
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.
Who’s covered
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.
Bigger targets
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.
Too big to fail
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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Trump’s Tariffs
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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Journalist Katie Couric is sharing a scary medical episode that she experienced on June 27.
In a post on Substack titled “The Day I’ll Never Remember,” she detailed a sudden episode that left her unable to recall the current month, year and president.
“I thought it was 2024. And I believed Joe Biden was president,” she wrote.
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The event occurred while Couric was attending the Aspen Ideas Festival in Colorado, during which she participated in two public panels — one on AI and one on journalism — both of which she cannot remember at all.
“I have no idea what we talked about, or of what occurred when the panels ended,” she said.
Journalist Katie Couric is sharing a scary medical episode that she experienced on June 27. (Getty Images)
John Molner — Couric’s husband, who was in attendance at the festival and the two panels — also shared his account.
After the event, someone told Molner that Katie wasn’t feeling well. When he reached her, an EMT and a doctor were tending to her. “I could tell something was off,” he wrote. “It could have been altitude sickness, but Katie was definitely not all there.”
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At the hospital, when Couric struggled to recall the year, the president and her grandchildren’s names, doctors began checking for a stroke.
An MRI revealed no signs of stroke, which was a relief, but “Katie’s ‘fog’ became a lot more apparent,” Molner wrote.
John Molner, Couric’s husband, who was in attendance at the festival and the two panels, also shared his account. (Getty Images)
“She repeatedly asked me the same questions: ‘What was I doing before we got to the hospital?’ ‘Why am I at the hospital?’”
Couric was ultimately diagnosed with transient global amnesia, a sudden, temporary episode of memory loss that prevents a person from forming new memories and may also erase some recent memories, according to Mayo Clinic.
“The cause seems to be as mysterious as the brain itself.”
It is not caused by a stroke, seizure or head injury, and it usually resolves completely within 24 hours.
“[It’s] just a very weird neural episode that’s pretty uncommon and, at least in most cases, is a ‘one and done’ experience,” Molner said.
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Couric said she finally began feeling “like herself” again around 9 p.m. and went to sleep at 2 a.m.
As TGA leaves a “permanent gap in memory” for the duration of the episode and for hours beforehand, Couric said that from around noon on that day until at least 7 p.m. will remain a “big, black hole.”
As TGA leaves a “permanent gap in memory” for the duration of the episode and for hours beforehand, Couric said that from around noon on that day until at least 7 p.m. will remain a “big, black hole.” (Getty Images)
Data shows that approximately three to eight people per 100,000 will have an episode of transient global amnesia, with people 50 years of age and older at higher risk.
The specific cause of TGA is not known, but some experts believe it stems from a “temporary dysfunction in the brain’s hippocampus — the area responsible for creating new memories,” Couric shared.
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“Doctors believe this is driven by brief interruptions in blood or oxygen flow, or microscopic spasm in the blood vessels.”
Episodes could potentially be triggered by intense physical exertion, emotional distress, extreme temperature changes or migraines, experts say.
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Approximately 15% of patients will have a recurrence 10 years later.
“Why did this happen to me? Was the altitude an issue? Was I dehydrated? Tired? Stressed? The literature doesn’t seem to indicate that these are contributing factors, but the cause seems to be as mysterious as the brain itself,” Couric wrote.
Anyone who experiences sudden memory loss, confusion, difficulty speaking, weakness, numbness, vision changes, severe headache or other stroke-like symptoms should seek immediate medical attention or call 911, doctors advise. (iStock)
“All I know is that those hours will be forever lost. Someone described it as my brain failing to hit the ‘record button.’”
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“While this was a freaky occurrence, it could have been much more serious. So ultimately, I’m relieved — even though several hours of a Saturday in June will always be missing for me.”
Anyone who experiences sudden memory loss, confusion, difficulty speaking, weakness, numbness, vision changes, severe headache or other stroke-like symptoms should seek immediate medical attention or call 911, doctors advise.
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Older adults identified as “super movers” are about half as likely to develop cognitive impairment than their peers.
That’s according to a recent study led by Stony Brook Medicine in New York, which evaluated the cognitive function of 4,000 adults 80 and over who participated in multiple aging and longevity studies over several years.
Among this group, 6% to 10% were classified as super movers, which means they walk at a much faster pace than others of the same age and gender — at speeds comparable to people three decades younger.
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The super movers were found to have about half the risk of cognitive decline compared to seniors with typical gait speed.
The findings were published in the journal Neurology on June 16.
Older adults identified as “super movers” are about half as likely to develop cognitive impairment than their peers. (iStock)
“The study reinforces that mobility and brain health are closely connected,” lead study author Dr. Joe Verghese, MD, neurologist at Stony Brook Medicine, told Fox News Digital. “This suggests that preserving mobility may be an important marker of healthy brain aging and resilience.”
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The most intriguing finding, according to Verghese, was that super movers maintained cognitive function despite having similar dementia-related brain changes as their peers.
In postmortem brain analysis, there was no difference in dementia-related pathologies between the super movers and the slower walkers, the study stated.
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“This suggests they may possess resilience mechanisms that help preserve brain function even in the presence of age-related changes,” he said. “Understanding these resilience factors could lead to new strategies for promoting healthy brain aging.”
As the study was observational, there were some limitations, and it does not prove that walking faster prevents dementia, the researchers noted.
Super movers were found to have about half the risk of cognitive decline compared to seniors with typical gait speed. (iStock)
“Other factors, such as cardiovascular health, physical fitness or genetics, may also contribute to both faster walking and better cognitive outcomes,” Verghese said.
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This study adds to growing evidence that what’s good for the heart and muscles also benefits the brain, he noted, adding that “staying physically active remains one of the most effective, evidence-based ways to support healthy aging.”
“Walking speed is best viewed as a marker of overall health, not a treatment.”
“The broader message is that physical activity is important at any age,” Verghese said. “Walking is an easy step-up point because you don’t need any special equipment. You can do it inside or outdoors, and you can do it on a regular basis. You can walk with a dog, you can walk with a friend.”
Any activity is beneficial if it’s done regularly and with the right intensity, he added.
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Rather than just trying to walk faster, the neurologist recommends that seniors focus on maintaining mobility through regular physical activity, strength training, balance exercises and good cardiovascular health.
“Walking speed is best viewed as a marker of overall health, not a treatment,” Verghese noted.
Major public health guidelines from the CDC and U.S. Physical Activity Guidelines recommend at least 150 minutes of moderate-intensity aerobic activity each week, such as brisk walking.
Major public health guidelines from the CDC and U.S. Physical Activity Guidelines recommend at least 150 minutes of moderate-intensity aerobic activity each week, such as brisk walking. (iStock)
This can be achieved by walking 30 minutes a day, five days a week, or about 20 to 25 minutes most days. Another option is to engage in shorter sessions that add up over the day.
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“You have to do it within your health limitations and medical conditions,” Verghese advised. “So if there are any medical concerns, I would get your physician to clear you before starting exercise.” The good thing about walking, he added, is that you can start at a slow pace and then gradually build up to a brisker pace.
“And then adding on strength and balance training, whatever age you are, I think is also important.”
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