In the President’s 99-minute address to Congress last Tuesday, not a mention of healthcare. None. Nada. Go figure.
It’s not surprising but totally regrettable. Politicians on both sides of the aisle know it’s a vital industry to the population’s well-being and the economy’s overall stability. It accounts for a fourth of all job gains in monthly Bureau of Labor jobs reports. It also represents 28% of total federal spending (includes HHS + Veterans Health) with the CBO forecasting 5.5% annual growth through 2032. Thus, it’s not surprising it’s a target of ongoing DOGE federal spending cuts and prominent in this week’s budget reconciliation vote by Congress to avoid a shut down.
Two programs are initial targets: Medicaid and Veterans Affairs. Each is big and serves unique populations:
- Medicaid represents access to the health system for 72 million lower income and disabled adults and 7 million kids. (FY25 Budget Request: $1.3 trillion—up 8% from FY2024. Note: the federal portion is roughly half; states fund the rest).
- Veteran’s Affairs includes the lifeline for more than 9 million of the nation’s 18 million living vets who depend on its 170 hospitals and 1193 clinics for care. And Veterans make up a third of the 3 million employed in the federal workforce.
The reconciliation package (Full-Year Continuing 5 Appropriations and Extensions Act, 2025) includes cuts in a number of health programs including an 11% annual reduction in Medicaid achieved through enrollment cuts and federal FMAP contributions to states. Funding cuts in Veterans Affairs are achieved through lower appropriations and expansion of the “choice program” which replaces VA hospitals and clinics with private alternatives. And DOGE is expected to continue cuts to the federal workforce which employs 1 million vets. All these are part of the Trump Administration’s “flood the zone” strategy to reduce “fraud waste and abuse” in the federal government. Per DOGE, as much as $4 trillion can be taken out with healthcare programs like Medicaid and Veterans Affairs providing up to third.
The impact of proposed Medicaid and VA cuts will draw attention to the overall health system, prompting its critics to argue its wastefulness and its defenders to blame inadequate funding or ubfair regulation. The debate, like the recent attention given prior authorization and public animus toward insurers, will heighten public consciousness of operating practices that might be uncomfortable:
- How and why to privately insured employers and individuals pay more to offset underpayments by Medicaid?
- How and why are not-for-profit hospitals able to recoup Medicaid underpayments through by cost shifting while simultaneously getting credit for those adjustments as “community benefit” to maintain exemptions from state and federal taxes?
- How and why has the VA has struggled to implement its Cerner (Oracle) EHR platform to enable connectivity and coordination across its sprawling operations?
- Why is access to mental health services is neglected in both Medicaid and VA populations resulting in epidemic levels of depression, substance abuse and suicide?
- Why is affordability not taken seriously by healthcare providers, insurers and drub companies?
- How are coverage and denials determined?
- Why is access to the system dependent on an individual’s insurance and socioeconomic status?
- How are drugs, insurance premiums, physician and hospital services priced and why aren’t easily accessible?
- How does private equity ownership of a provider organization influence the safety and efficacy of care it provides patients?
And many more.
The public’s not happy with the health system: that’s well documented. But what to do about it is unclear to most. Exposing the public to how the system operates is a likely consequence of the DOGE’ effort. Importantly, key DOGE leaders (Gleason, Smith) came from operating roles in private healthcare companies and they know how the system operates. That means critics of DOGE cuts must be prepared to answer questions with more than soundbites. It means Medicaid enrollees and Veterans will be more vocal about the system–what it does well and not so well. And it means the public will be listening.
Paul
Resources
‘‘Full-Year Continuing 5 Appropriations and Extensions Act, 2025’’ https://rules.house.gov/sites/evo-subsites/rules.house.gov/files/documents/crfull_xml.pdf
Luigi Mangione pens jailhouse letter after mom’s story of daughter’s healthcare ‘made him tear up’
Deloitte and Accenture workers worry about losing their jobs as DOGE focuses on consulting contracts, Business Insider March 7, 2025 https://www.businessinsider.com/deloitte-accenture-job-fears-doge-consulting-contracts-trump-musk-2025-
ABA Gets Pressured By Pam Bondi — See Also Get Rid Of DEI Or We Get Rid Of Your Accrediting: Rough times for the ABA.
How health systems are faring in a high-cost environment Modern Healthcare March 7, 2025 https://www.modernhealthcare.com/finance/commonspirit-mayo-clinic-tenet-earnings-2024
Sections in today’s report
- Quotables
- Economy
- Hospitals
- Insurers
- Physicians
- Polling
- Population Health
- Prescription Drugs
Quotables
John Arnold, Arnold Ventures’ Co-Founder, on keys to healthcare reform to reduce costs and improve outcomes: “Three incremental reforms are necessary:
- Site neutral reform: loophole in Medicare billing allows hospitals to buy up doctors’ offices and charge higher hospital prices for routine medical services without changing anything in the office except for the logo on the door…
- Unchecked hospital consolidation: Corporate consolidation can lead to economies of scale, which means more efficient business practices and lower consumer costs. In health care markets, however, hospital consolidation has a record of leading to less competition and higher prices without improving the quality-of-care patients receive
- Reference pricing: In a functioning market, prices reflect supply and demand. But health care markets are overwhelmingly concentrated, allowing the biggest players to set their own prices.
Texas Business Hall of Fame Dinner March 5, 2025 Dallas Tx https://texasbusiness.org/event/creators-2025-john-arnold-x-mark-cuban/
Jindal on drug pricing policy: “Through a practice known as global freeloading, other wealthy countries leverage their socialized health care systems to negotiate steep discounts from drug manufacturers. On average, these countries pay just 24 cents for every dollar Americans pay for pharmaceutical treatments. In 2018 alone, price controls reduced drug sales in other wealthy countries by 77%, or $254 billion. This freeloading allows other countries to enjoy the benefits of American drug innovations, without paying the necessary costs to develop them.
While these sweetheart deals are politically popular abroad, they directly harm American health. Here’s why: Drug manufacturers care about market size. On average, every $2.5 billion increase in global drug sales to treat a specific disease incentivizes those manufacturers to develop an additional new drug for the same condition. When other countries systematically underpay for drugs, the global market shrinks. As a result, drug manufacturers develop fewer drugs, and chronically ill patients often languish as their conditions worsen.
America can fix this. If other countries pay market-based prices, drug manufacturers could invest more dollars to invent and produce new lifesaving drugs…
The Trump administration could leverage policies such as the International Price Index and Most Favored Nation pilot programs to encourage other countries’ investment in greater drug development. First proposed in Trump’s first term in office, these policies limit how much Medicare pays for the most expensive drugs based on their prices in similar wealthy countries. Once Medicare aligns America’s drug prices with those in other countries, drug manufacturers could no longer rely solely on Americans to finance drug development. The result: These companies would have to terminate sweetheart deals with low-paying countries and make sure they pay higher prices to support chronically ill patients.
The White House could also leverage the Office of the United States Trade Representative (USTR) to pressure other countries to abandon freeloading….”
Bobby Jindal was former Governor of LA and McKinsey consultant, “Global freeloading: Americans shouldn’t bear the brunt of drug development costs” StatNews March 5, 2025 https://www.statnews.com
On PR in healthcare: “Public relations—advertising, communications, crisis response—is an essential part of the American health care industry…Healthcare is an essential part of the PR economy, making up around 35% of large agency revenues. It spans pharmaceuticals, hospital systems, public health, medical devices, care providers, health technology, digital health and health equity…the PR industry needs the health care industry. And the health care industry needs good PR.
In 2023, according to one Harris Poll survey, more than 70% of U.S. adults reported feeling that the health care system was failing to meet their needs in at least one way. Health care spending has continued its expensive skyward climb: In 2000, total health expenditures in America reached $1.4 trillion; by 2023 that amount had more than tripled to $4.9 trillion, easily outrunning inflation. (In 1970 it was $74 billion.) There are the age-old indignities of premiums and copays and costs seemingly all going up all the time. And then there are the endless new pain points for Americans—the rejected claims, the surprise billing, the groveling for coverage in the face of capricious, error-plagued, and rejection-heavy A.I algorithms…”
I Went to the Health Industry’s PR Awards. Luigi Mangione Wasn’t the Only One Haunting the Night. Slate March 3, 2025 https://slate.com/business/2025/03/luigi-mangione-robert-f-kennedy-jr-united-healthcare-medicine-awards
Mark Cuban to Elon Musk on reducing health costs: “The key is the contracts CEOs of self-insured companies sign. The PBM contracts YOU have signed for Tesla, SpaceX, and X have more impact on healthcare costs than anything you can do with DOGE. 7 ways those contracts with PBMs and insurers keep drug prices high:
- Don’t control your claims data
- Don’t control your formulary
- Have to pay more for “Specialty Drugs” that have nothing special about them
- Get rebates that are paid for by your sickest and oldest employees and result in higher deductibles and co-pays that impact the wellness of your workers and their families.
- Cause independent pharmacies to be reimbursed for less than their costs for brand drug scripts for your employees and families, causing them to go out of business.
- Can’t talk to manufacturers to put together wellness programs for things like GLP1s.
- Signed a PBM contract with an NDA which prevents you from publicly discussing your PBM contract, resulting in an opaque, inefficient market, which leads to higher prices and lower quality of care for the entire country.
All of this allows the big PBMs to continue to distort the pharmacy market for literally EVERYONE.”
” Elon Musk Wants to Know Why Healthcare Costs So Much — Mark Cuban Gives Him 7 Brutal Reasons Why CEOs Like Him Are Making It Worse Benzinga March 6, 2025 https://www.benzinga.com/personal-finance
Economy
On potential stagflation: “Stagflation may be set for its first real return to the U.S. in about 50 years, as recent economic numbers point to a slowing labor market and continued stickiness in inflation. President Donald Trump’s new tariffs won’t help. This risks creating a very difficult environment for consumers. Unemployment may increase and wage gains may slow, even as the cost of living goes up…
Two trends in the current economy point to this problem: Jobs data that’s weakened and missed economists’ estimates, and inflation that’s picked up and come in hotter than predicted.
January consumer inflation came in hot. Employers added far fewer jobs in February than in January, unemployment claims were worse than expected, and the staffing measure in the ISM manufacturing survey also showed a big jump in prices paid. On March 7, payroll numbers for February will add another data point — and some economists also expect a big miss.
And the Atlanta fed is now projecting a 2.8% contraction in the U.S. economy this quarter — an outlier given most analysts are still projecting growth, but a troubling sign of potential trouble.”
What is stagflation and why does it matter for the economy?
CBO on Medicaid spending: “In CBO’s January 2025 baseline budget projections, mandatory outlays for the accounts you asked about total $8.8 trillion for the 2025–2034 period. Medicaid outlays account for $8.2 trillion, or 93%, of that amount… the largest programs other than Medicaid and CHIP are the risk adjustment program, in which health insurers make payments to the government or receive payments from it according to the health of their enrollees ($158 billion), and the Universal Service Fund ($87 billion). The risk adjustment program, however, is budget neutral with revenues offsetting spending. Spending from the Universal Service Fund is derived from fees that are classified as revenues on certain telecommunication services. Outlays for all other programs total $135 billion, on net, over the period, encompassing spending for a variety of federal activities.”
Congressional Budget Office March 5, 2025 www.cbo.gov
Urban Institute analysis: Medicaid funding cut impact on states: Per the analysis by the Urban Institute and Robert Wood Johnson Foundation: proposed cuts could shift $44.3B in costs to 41 expansion states hiking state spending by about 25.6% on average.
Urban Institute www.urban.org
ERI on softening labor market, “Actual compensation movement in the fourth quarter of 2024 saw a lower level of growth at 0.60%, which is consistent with October’s growth of 0.60%. These two quarters represent a decrease from July’s growth of 0.84% and April’s growth of 0.79%.
Annual growth in Q4 2024 slowed to 2.82% from the 3.31% growth reported in the October 2024 data release. This rate of growth has decreased from the high of 4.14% in 2022.
Current labor market data indicate a softer market than that reported in the first half of 2024, but one that has been largely unchanged since last quarter. An examination of the current number of job openings indicates a high number of open jobs in the United States, with an open job rate of 4.6%, which is lower than the 10-year average open job rate of 4.8%. It is also down significantly from the high of 7.3% in March 2022. The rate of hires is currently 3.3%, which has been slowly trending down since the high of 4.4% in March 2022”.
10 Year (2014-2024) compensation changes by occupational category: Professionals +30%, Clerical +30.2%, Healthcare +28.5%
NATIONAL COMPENSATION FORECAST, Economic Research Institute www.erieri.com
Commonwealth study: impact of premium tax credit suspension: “To help people afford plans sold in the health insurance marketplaces, the Affordable Care Act (ACA, also sometimes called Obamacare) provides low- and middle-income individuals with premium tax credits (PTCs). In 2021, Congress enhanced the generosity of these tax credits and made them available to more people. Authorized originally by the American Rescue Plan Act, the enhanced PTCs were later extended by the Inflation Reduction Act through December 2025. Together, these changes have made marketplace health insurance coverage more affordable.1 As of January 2025, 24 million Americans had selected a marketplace plan, about twice as many as in 2021.” Per the Commonwealth analysis, impact will be…
- Loss of financial support. Across states, the federal tax credits that individuals, health insurers, and, ultimately, health care providers receive would fall by $26.1 billion in 2026, compared to a baseline in which the enhanced PTCs were continued.
- Reduced economic activity and personal income. Ending enhanced PTCs would reduce state economies across the nation. Total state gross domestic products (GDPs) would fall by $34.1 billion and total economic output would fall by $57.0 billion. The net economic harm for states would therefore be much larger than the loss of federal funds ($26.1 billion) to states.
- Loss of jobs. Overall employment would decline by a total of 286,000 jobs nationwide in 2026. This includes 130,000 jobs lost because of direct reductions in the provision of hospital, physician, and other ambulatory care as well as reductions in pharmacy-related services. It also includes 156,000 jobs lost in non-health sectors like retail, real estate, and manufacturing as a result of the indirect or induced effects of health care funding losses. Rural communities in particular could be among the areas hardest hit.
- Reduced tax revenues. The reductions in income and economic activity will lead to losses of $2.1 billion in state and local tax revenues in 2026, as well as $5.4 billion in reduced federal tax revenues. The loss of state and local tax revenues would make it harder for state and local governments to balance their budgets and continue paying for crucial services like education.
“The estimates detailed above are similar, but somewhat larger, for 2027 and 2028, as the value of enhanced PTCs would grow if they were to be continued.”
The Cost of Eliminating the Enhanced Premium Tax Credits | Commonwealth Fund
CCIIO cuts: “Some 15% of those working at the federal Center for Consumer Information and Insurance Oversight, or CCIIO, were fired two weeks ago, according to the agency’s former deputy director in charge of operations, Jeff Grant.Bottom of Form The cuts, which affected 82 of the federal office’s employees, also risk delaying critical new rules designed to speed the process of adjudicating disputes over surprise bills between health plans and medical providers.”
Trump Vowed to End Surprise Medical Bills. The Office Working on That Just Got Slashed KFF Health News March 4,2025 https://kffhealthnews.org/news/article/trump-surprise-medical-bills-agency-responsible-job-cuts-doge
Hospitals
Fitch: Impact of Medicaid cuts on hospitals, not-for-profits hardest hit: Per the ratings agency’s report released last Tuesday: “Major cuts to Medicaid would negatively affect U.S. not-for-profit (NFP) hospital operating margins and revenues…Slower revenue growth or a revenue decline leading to sustained cash flow reduction could pressure ratings and potentially the sector outlook….
A decrease in Medicaid reimbursement and/or an increase in uninsured care would hinder hospitals’ nascent financial recovery from weak sector-wide post-pandemic performance due to higher labor costs and elevated inflation….NFP hospitals have limited ability to cut services, given operating constraints such as the obligation to serve all needing medical care…The effects of any Medicaid cuts on NFP hospitals would depend somewhat on state Medicaid policies and other healthcare options…A federal statute sets a FMAP floor of 50% for states with the highest per-capita income and a ceiling of 83%. The FMAP’s significance depends on each state’s total budget size and Medicaid spending, which vary based on factors like enrollee levels, composition, and reimbursement rates. States may choose to allocate more of their own resources to Medicaid funding to mitigate the effects of federal cuts, or reduce benefits, eligibility, or provider payment rates…”
Potential Medicaid Cuts Could Threaten Not-for-Profit Hospital Margins Fitch March 4,2025 https://www.fitchratings.com/research/us-public-finance/potential-medicaid-cuts-could-threaten-not-for-profit-hospital-margins-04-03-2025
Study: hospital ED access to SDOH information: Researchers analyzed barriers and facilitators to screening, documenting, and addressing adverse social determinants of health (SDOH) in hospitals by interviewing 27 ED leaders. Findings:
“Findings centered around heterogeneity in ED adverse SDOH screening and documentation practices; skepticism of utility of ED adverse SDOH screening and referral; drivers of ED adverse SDOH screening, such as regulatory mandates for the expansion of adverse SDOH screening; resource, staffing, and time constraints in adverse SDOH screening and linkage to services processes; and recommendations and suggestions for improving the implementation of ED adverse SDOH screening, such as tailoring validated tools to the ED context and ED stakeholder engagement in designing the screening process. Other suggestions included having additional dedicated screening staff, particularly social workers, and strengthening relationships with existing non-ED SDOH initiatives and community resources dedicated to addressing adverse SDOH.”
Loo et al “Implementing Social Determinants of Health Screening in US Emergency Departments” JAMA Network Open March 6, 2025;8(3):e250137. doi:10.1001/jamanetworkopen.2025.0137
KFF: Overview of relationship between Medicaid and hospitals: Per KFF:
- Medicaid covered 19% of all hospital spending in 2023, or $283 billion out of the $1.5 trillion spent on hospital care
- Hospital care accounted for 32% of total Medicaid spending in 2023, or $283 billion out of $872 billion in total Medicaid expenditures.
- Medicaid covered 1.5 million births in 2023—representing 41% of all U.S. births—and financed nearly half (47%) of births in rural areas
- Among the 10 states with the highest charity care costs as a percentage of operating expenses in 2023, 8 had not expanded Medicaid as of November of that year.
- Medicaid financing for hospitals is complex. Hospital FFS rates consist of base rates and supplemental payments. Base rates vary considerably across states and, on average, are belowhospitals’ costs of providing services to Medicaid enrollees. States may rely on supplemental payments – such as payments to hospitals that serve a disproportionate share of low-income patients – to help cover hospitals’ costs.
5 Key Facts About Medicaid and Hospitals | KFF
Insurers
Blue Cross NC joins Blues restructuring wave: Last Thursday, Blue Cross and Blue Shield of North Carolina has established a nonprofit holding company, CuraCor, to house its insurance subsidiary and other businesses, making it the latest Blues carrier to seek stronger footing against for-profit insurers. The insurer’s acquisition of 55 FastMed retail clinics last year is an example of the moves.
Blue Cross NC restructures operations with launch of holding company CuraCor Solutions March 7, 2025 https://www.fiercehealthcare.com/payers/blue-cross-nc-restructures-operations-launch-holding-company-curacor-solutions
BCBSA antitrust update: Last week, more than 100 providers filed new antitrust lawsuits against the Blue Cross Blue Shield Association and its 33 affiliated insurance companies alleging the carriers illegally conspired to suppress competition and lower hospital rates. The new lawsuits reiterate claims made in previous cases, alleging Blue Cross insurers violated the Sherman Antitrust Act of 1890 by dividing the country into specific sales areas, suppressing revenue generated from non-Blue Cross branded businesses, and using their collective size to negotiate rates with providers. Providers seek treble damages, pre-judgment interest and relief from future losses.
Note: Recently, numerous health systems have opted out of a $2.8 billion antitrust settlement with the Blue Cross Blue Shield Association (BCBSA) and filed new lawsuits
Health providers opt out of $2.8B BCBS antitrust settlement, file lawsuits March 5, 2025 https://insurancenewsnet.com/innarticle/providers-opt-out-of-2-8b-bcbs-antitrust-settlement-file-lawsuits
Stat on UnitedHealth Growth: As part of its ongoing investigation of UHG: “UnitedHealth Group, the largest health care company in the U.S., has clear ambitions of getting bigger. The sprawling conglomerate — which owns a major health insurance company, physician practices, a pharmacy benefit manager, and numerous other firms — acquired or created more than 250 subsidiaries in 2024. Pretty much all of those deals weren’t publicly announced, since the transactions are small relative to UnitedHealth’s size. And just like in 2023, UnitedHealth has prioritized outpatient surgery centers.
UnitedHealth acquired full or partial ownership stakes in more than 100 surgery centers in 2024… More than a dozen are part of a joint venture with Texas Health Resources, a nonprofit hospital system in the Dallas-Fort Worth area that generated $6 billion in revenue last year.
But UnitedHealth’s deal-making went beyond outpatient providers. It also acquired a physician management company in California, bought specialty pharmacies that dispense drugs for hospitals and nursing homes, and officially created its own company to distribute lower-cost biosimilar drugs…UnitedHealth’s most recent deals helped boost revenue by 8% from 2023 to 2024, hitting more than $400 billion. And with a goal of growing even more this year — reaching at least $450 billion of revenue, or a 12.5% jump — it’s a near certainty UnitedHealth is continuing to scoop up more companies right now, under the radar, amid antitrust inquiries and lawmaker criticisms.”
UnitedHealth continued aggressive, and stealthy, growth in 2024 | STAT
Physicians
Jackson Physician, APP Survey: Career satisfaction: Survey conducted in January 2025 with 1200 physicians and APPs. Results:
- 21% of physicians would recommend a medical career to young people, and just 32% would choose the profession again.
- 4 of 5 rated their ability to live out their purpose as a 3 or higher on a 5-point scale.
- 58% of physicians believe medicine was “definitely” a calling, while 70% cited a desire to help others as their primary motivation.
- 42% of physicians strongly agree that their role is an integral part of their identity, while 39% somewhat agree.
- APPs are more likely than physicians to say medicine was unquestionably a calling (72% vs. 58%) and are slightly more likely to report that this feeling has strengthened over time (29% vs. 20%). Additionally, APPs are more likely than physicians to cite helping others as a primary motivator (83% vs. 70%) and to rate their ability to fulfill their purpose at the highest level on a 5-point scale (30% vs. 18%)
New Study Finds Clinicians Who Consider Their Work a Calling Are Better Suited to Navigate Challenge and Change March 5, 2025 Physician Recruiting & Physician Job Search
Study: PE impact on physician turnover: “Consolidation of physician practices by private equity (PE) firms has accelerated, raising concerns that PE’s emphasis on short-term profitability may exacerbate physician turnover, with implications for care continuity. Despite their significance, evidence on how PE acquisitions affect physician turnover is limited. Using clinician-level data linked to practice acquisition data from the period 2014–21, we used a difference-in-differences design to examine changes to physician employment and turnover after PE acquisition of 200 ophthalmology practices with 1,980 clinicians. Relative to matched controls, PE-acquired practices increased the total number of clinicians by 46.8% through three years after acquisition. This growth was driven by increases in the numbers of both ophthalmologists and optometrists (30.7% and 36.2% respectively). PE acquisitions also increased physician turnover, with the share of physicians leaving PE-acquired practices from one year to another increasing by 13 percentage points, or 265 percent, after acquisition, relative to non-PE-acquired practices. Findings highlight how PE acquisitions of physician practices are reshaping physician employment and workforce stability. As PE expands its footprint, policy makers should monitor the long-term implications of PE ownership on physician employment and turnover to mitigate potential undesirable effects on patient health.”
Physician Turnover Increased in Private Equity–Acquired Physician Practices Health Affairs March 2025 www.healthaffairs.org
Polling
West Health Poll: Consumer borrowing to pay medical bills: The West Health-Gallup Survey was conducted via web Nov. 11-18, 2024, with a nationally representative sample of 3,583 U.S. adults aged 18 and older. Results:
31 million Americans (12%) report needing to borrow about $74 billion last year to pay for healthcare despite most having some form of health insurance.
- % who borrowed $$$ in the last 12 months to pay a medical bill by age: 18-29 (18%), 30-39 (17%), 40-49 (16%), 50-64% (9%), 65+ (2%).
- More than half (58%) borrowed $500 or more, 41% borrowed $1,000 and.14% borrowed $5,000 or more.
- Women between the ages of 50 and 64 were twice as likely as men in the same age group to say they had to borrow (12% vs. 6%). 2% of Medicare-eligible adults (those over the age of 65) reported having to borrow.
- Black (23%) and Hispanic adults (16%) were significantly more likely to report having borrowed money than White (9%) adults. The biggest disparities were found among adults under the age of 50. Black adults aged 18-49 (29%) were the biggest borrowers followed by Hispanic adults (19%) and White adults (14%) in the same age range. Americans with children under the age of 18 were twice as likely to report borrowing compared to households with no children (19% vs. 8%)
28% report being “very concerned” that a major health event could throw them into debt.
- “58% report being at least somewhat concerned that a major health event could land them in debt, including 28% who say they are “very concerned.” Concerns span income levels, with more than six in 10 households with annual incomes under $120,000 worried. Fewer higher earners were concerned, but 40% of households making over $180,000 report they too have concerns.
- Even with Medicare eligibility, more than half (52%) of people aged 65 or older say they are at least somewhat concerned they could go into medical debt if they suffered a major health event. Concerns also run high among Black adults (62%), Hispanic adults (63%) and women (62%). Only 14% of respondents say they are not concerned at all.”
Americans Borrowed $74 Billion Last Year to Cover Healthcare Costs West Health March 5, 2025 https://westhealth.org/news/americans-borrowed-74-billion-last-year-to-cover-healthcare-costs/
Generation Lab Poll: Opinions about DOGE: The GL poll was conducted Feb. 21-28 from a representative sample of 972 young people, ages 18 to 34-years-old nationwide.
- Do you approve or disapprove of the way Donald Trump is handling his job as president? strongly approve/approve (32%) vs. disapprove/strongly disapprove (69%)
- How much have you heard about DOGE (or the White House’s “Department of Government Efficiency”) led by Elon Musk? A lot (43%), A little (44%), Nothing at All (14%)
- Do you approve or disapprove of the work performed by D.O.G.E so far? Strongly approve/approve (28%) vs.71% disapprove/strongly disapprove
Generation Lab Poll February, 2025 www.generationlab.org
KFF: Opinions about Medicaid cuts: “As Congress considers changes to the Medicaid program as part of budget conversations, the latest KFF Health Tracking Poll finds that fewer than one in five adults (17%) want to see Medicaid funding decreased, and most think funding should either increase (42%) or be kept about the same (40%).” Additional findings
- 62% adults support work requirements, which would require nearly all adults to be working or looking for work in order to have health insurance through Medicaid, while 59% oppose eliminating the 90% federal match ratefor adults covered under the ACA Medicaid expansion.
- 62% of the public incorrectly believe that most working-age adults on Medicaid are unemployed, and some people change their views on imposing work requirements when they hear about the potential implications. Overall support for work requirements drops from 62% to 32% when those who initially support the proposal hear that most people on Medicaid are already working and many would risk losing coverage because of the burden of proving eligibility through paperwork.
- Views on eliminating the 90% federal match rate for the ACA Medicaid expansion are also somewhat malleable when more information is presented. When supporters of the proposal hear that most states wouldn’t be able to make up the funding and that 20 million people would likely become uninsured as a result, overall support drops from 40% to 24%. On the other hand, when opponents of the proposal hear that it would reduce federal spending by $600 billion over ten years, support increases somewhat from 40% to 49%, with 50% overall continuing to oppose the proposal.
- 47% of adults are either unsure or incorrectly believe undocumented immigrants are eligible for health insurance programs paid for the federal government.
KFF Health Tracking Poll February 2025: The Public’s Views on Potential Changes to Medicaid March 7, 2025 https://www.kff.org/medicaid/poll-finding/kff-health-tracking-poll-public-views-on-potential-changes-to-medicaid
Lotis Blue: Healthcare retention survey: The Lotis Blue survey of 1200* focused on factors impacting workforce retention and job-quitting. High level findings:
“19% of respondents reported quitting a job in the past 12 months. However, turnover rates are notably higher among those who had been with their employer for less than a year, with 45% of them having quit. Among those who had quit, 47% were driven by job-related factors, suggesting a significant opportunity for employers to improve controllable elements of the EVP to reduce turnover.
The reasons for staying in a job and quitting a job are entirely unique; however, some factors serve as triggers, pushing employees from considering leaving to the decision to quit. Feeling “the work is meaningful” is the top reason clinical professionals choose to stay and cite additional factors that support feelings of safety, stability, and community as critically important. Emotional stress” is the top reason for quitting and also a driver of considering leaving, making it the only factor predictive of more than one outcome.
Factors often expected to drive quit decisions, such as liking one’s immediate supervisor, were notably absent from the results.
*Sample stratification and projectability not provided.
The Science of Staying: 2025 Health Care Workforce Retention Study. https://lotisblueconsulting.com/insights/the-science-of-staying-2025-health-care-workforce-retention-study/
Survey: gun violence observers: Researchers surveyed 10,000 U.S. adults in January 2024. Findings:
“7% reported having been present on the scene where 4 or more people were shot, which was more common among younger generations, males, and Black respondents. 2% reported having been injured in a mass shooting—by being shot, trampled, or experiencing related injuries—which was more common among younger generations and males.
The findings from this survey study of US adults underscore the extensive and often overlooked regular exposure to mass shootings in this country. The demographic disparities in exposure highlight the need for targeted interventions and support for the most affected groups, particularly younger generations and males. Understanding these patterns is essential for addressing the broader impacts of gun violence on public health and community well-being.”
Pyrooz et al “Direct Exposure to Mass Shootings Among US Adults” JAMA Network Open. 2025;8(3):e250283. doi:10.1001/jamanetworkopen.2025.0283
Population Health
Study: Association between wealth and end-of-life health: The research team analyzed the association between wealth and end-of-life symptom burden using data from 8976 older adults from the Health and Retirement Study (HRS)–a nationally representative survey of older adults in the US, on decedents who died between January 1, 2000, and February 28, 2021, from proxy-reported exit interviews through February 28, 2021. Findings:
“In this cohort study, low wealth was significantly associated with higher end-of-life symptom burden (i.e., presence ≥7 of 12 symptoms). Decedents with low wealth were more likely to experience high symptom burden compared with those with medium or high wealth, with functional impairment, multimorbidity, and dementia mediating this association.”
Censer et al “Wealth Disparities in End-of-Life Symptom Burden Among Older Adults” JAMA Network Open March 6, 2025;8(3): e250201. doi:10.1001/jamanetworkopen.2025.0201
Study: depression, anxiety prevalence: This systematic review and meta-analysis identified 376 studies comprising 347,468 individuals with chronic pain from 50 countries. Findings:
Researchers found a pooled prevalence of 39.3% for depression and 40.2% for anxiety– highest among people with fibromyalgia, younger and predominantly female populations.
Aaron et al “Prevalence of Depression and Anxiety Among Adults with Chronic Pain a Systematic Review and Meta-Analysis” JAMA Network Open March 7, 2025;8(3): e250268. doi:10.1001/jamanetworkopen.2025.0268
NEJM on nutrition research need: “There are approximately 20 essential micronutrients, and deficiency in one or more has distinct effects on the metabolome, proteome, and genome. …In the United States, the prevalence of most micronutrient deficiencies is low. National surveys — namely, the National Health and Nutrition Examination Survey (NHANES), which assesses biochemical markers of nutritional status, as well as its interview component, What We Eat in America, which measures nutrient intakes — provide some data on micronutrient status in the general population. However, these measures are made cross-sectionally, so it is difficult both to infer causality between micronutrient deficiencies and chronic diseases and to assess the health benefits of interventions such as supplementation…
Multiomic analysis of the thousands of stored samples from randomized, controlled trials of single or multiple interventions, especially from low- and middle-income populations, could reveal underlying consequences of micronutrient deficiencies and the benefits of interventions.”
Prescription Drugs
On FDA accelerated approval process: “The pendulum has shifted too far in the direction of approving drugs and biologics when there’s not good evidence of effectiveness and there hasn’t been adequate time to prove the therapies are actually safe…The FDA should, whether it’s through accelerated approval or traditional approval, should have a higher bar for what it gives the green light to.”
Robert Steinbrook, the director of Public Citizen’s Health Research Group and an author of the report.
