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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Health
Your bedroom temperature could be putting your heart in serious danger, study warns
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The temperature of the bedroom at night could affect heart health — particularly in older adults.
Heat places extra demands on the cardiovascular system, according to lead study author Dr. Fergus O’Connor from Griffith University in Queensland, Australia.
When the human body is exposed to heat, its reaction is to work harder to try and circulate blood to the skin surface for cooling, he noted.
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“However, when the heart works harder and for longer, it creates stress and limits our capacity to recover from the previous day’s heat exposure,” O’Connor stated in a press release.
Researchers aimed to understand how real-world bedroom temperatures affected older adults.
When the heart works harder and for longer, it creates stress and limits its capacity to recover from the previous day’s heat exposure. (iStock)
The team followed 47 adults living in southeast Queensland averaging 72 years of age.
While many sleep observations are conducted in special clinics, this was a “free-living” study, meaning the participants carried on with their normal activities and sleep schedules.
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Scientists monitored the participants throughout an entire Australian summer, from December to March. Each person wore a high-tech fitness tracker to monitor their heart rate from 9 p.m. to 7 a.m., according to the release.
While many sleep observations are conducted in special sleep clinics, this was a “free-living” study, meaning the group carried on with their normal activities and sleep schedules. (iStock)
Sensors were then placed directly in participants’ bedrooms to record the temperatures, monitoring over 14,000 nighttime hours of sleep in total.
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The temperature at which the heart began to show signs of disruption was a little more than 75 degrees Fahrenheit.
Between 75 and 79 degrees Fahrenheit, the odds of a “clinically relevant” drop in heart recovery rose by 40%, the researchers found.
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Between 79 and 82 degrees Fahrenheit, the odds doubled. Above 82, the risk was nearly triple compared to cooler rooms.
Between 75 and 79 degrees Fahrenheit, the odds of a “clinically relevant” drop in heart recovery rose by 40%. (iStock)
“For individuals aged 65 years and over, maintaining overnight bedroom temperatures at 24 C (75.2 F) reduced the likelihood of experiencing heightened stress responses during sleep,” O’Connor said.
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While the study shows a strong link between heat and heart stress, its observational design means that it doesn’t definitively prove heat is the only cause, the researchers acknowledged.
As the study only focused on older adults in Australia, it may not apply to other populations.
“When the heart works harder and for longer, it creates stress and limits our capacity to recover from the previous day’s heat exposure.”
Also, while the wearable devices are advanced, they are not as precise as the medical-grade ECGs used in clinical settings.
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O’Connor emphasized a gap in temperature guidance — while there are guidelines for maximum daytime indoor temperature, there are no equivalent recommendations for nighttime conditions.
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The study was published in the journal BMC Medicine.
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Health
Family pleads for kidney donor as teen’s health declines: ‘We need help’
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A New Jersey family is desperately seeking a living donor to save Thaddeus Giansanti, an eighth-grader who was born with kidney disease.
Thaddeus has had multiple surgeries throughout his 13 years, including one to remove a kidney as a baby.
Despite his struggles, he has remained positive and optimistic, his parents shared with Fox News Digital.
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“His remaining kidney is now failing,” said his father, Carlo Giansanti. “We are not a match, so now we’re asking for help from the community.”
The family first found out about their son’s kidney disease before he was born, when an ultrasound detected a potential issue.
Christa DeMark and Carlo Giansanti are pictured with their son Thaddeus, who has battled kidney disease his entire life. (Christa DeMark)
“It was nothing alarming at that point — it looked like he had extra fluid when he was born,” Thaddeus’ mother, Christa DeMark, told Fox News Digital. “Everything seemed normal, but right before we were leaving, they noticed an elevated creatinine number (a measure of kidney function in blood tests) that led to us being in touch with nephrology.”
She added, “There was something wrong with the ureters (tubes that carry urine from the kidneys to the bladder) and the formation of the kidneys.”
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Thaddeus spent an extended period of time in the NICU, where he had multiple procedures. Before he was even 5 months old, he underwent a left nephrectomy to remove his left kidney.
His remaining kidney was diagnosed with chronic kidney disease, which has required lifelong medications.
“He’s been with nephrology and nephrologists his entire life, and up until last year, everything’s been stable, but that’s been slowly changing,” DeMark said. “He’s getting bigger, and it’s been putting more stress on his remaining kidney.”
Thaddeus, now 13, has had multiple surgeries throughout his life, including one to remove his kidney as a baby. (Christa DeMark)
Doctors informed the family that their best course of action would be to find a living donor.
“Everything’s been sped up based on his bloodwork lately,” DeMark said. “So it’s looking like we need something quicker than we thought, which is why we’re looking for living donors.”
“It has pushed us to rely on faith in a way that’s very palpable — we are just coming together as a family and taking each day as it comes.”
If Thaddeus does not receive a kidney transplant within a couple of weeks, he will need to be put on dialysis, according to his doctors.
“It’s obviously been challenging for him,” DeMark said. “He’s dealing with it very well, but these are difficult situations we’re navigating.”
His parents describe Thaddeus as a smart, outgoing boy — a straight-A student who was recently awarded multiple scholarships for next year, when he will become a high-school freshman.
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Thaddeus is very athletic and enjoys playing soccer, golfing and fencing. He also plays piano and often volunteers in his community, including being an altar server and working with the local food pantry.
“He loves his family, and loves doing things with his family,” DeMark said. “He’s just a great kid.”
The boy’s remaining kidney is failing, and his family is asking the community to help find a life-saving donor. (Christa DeMark)
Thaddeus’ parents said they have not shared much about their son’s medical condition until now. “We wanted Thad to just be the bright, happy person that he is, so we’ve minimized it for years,” DeMark said.
But in the last couple of weeks, as their son’s condition has become more dire, they have started to speak out about their situation.
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“We never expected to have such an outpouring of people who cared or people trying to help — it’s been incredibly humbling,” DeMark said.
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“It has pushed us to rely on faith in a way that’s very palpable — we are just coming together as a family and taking each day as it comes,” she went on. “We are remaining hopeful because we know there’s a solution to this problem. We just need help.”
“The miracle Thad needs right now is people who have the ability to step up,” his mother said. “He is a great kid, a kind kid.” (Christa DeMark)
To be considered for the donation program, kidney donors must be 45 or younger, have a BMI under 30 and match Thaddeus’ O blood type.
For those who are considering becoming donors, DeMark emphasized that it entails a laparoscopic procedure with a “fairly quick” healing process that is covered by their insurance, not the donor’s.
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“The miracle Thad needs right now is people who have the ability to step up,” she added. “He is a great kid, a kind kid.”
Those interested in being considered as a donor can complete this Kidney Transplant Living Donor Questionnaire.
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