Dr. Mehmet Oz, President Donald Trump’s pick to lead the agency in charge of massive government-run health insurance programs, on Friday declined to commit to opposing future cuts to Medicaid when directly asked if he would do so.

Instead, the nominee for administrator of the Centers for Medicare & Medicaid Services said that the way to protect Medicaid is “making sure that it’s viable at every level.”

The exchange during Oz’s Senate confirmation hearing raises fresh questions about the fate of Medicaid under a Republican-led Congress and White House, despite Trump’s promises to preserve it and other federal safety-net programs.

The nonpartisan Congressional Budget Office said last week that House Republicans’ current budget cannot meet its spending-cut goals without significantly cutting Medicare or Medicaid coverage.

Sen. Ron Wyden, D-Ore., the ranking member of the Senate Finance Committee, asked Oz on Friday, “Since you cherish Medicaid, will you agree to oppose cuts in the Medicaid program?”

“I cherish Medicaid, and I’ve worked within the Medicaid environment quite extensively, as I highlighted, practicing at Columbia University,” Oz said.

Wyden replied, “That’s not that question, doctor. The question is, will you oppose cuts to this program you say you cherish?”

Oz again declined to say that he would.

“I want to make sure that patients today and in the future have resources to protect them if they get ill,” he said.

“The way you protect Medicaid is by making sure that it’s viable at every level, which includes having enough practitioners to afford the services, paying them enough to do what you request of them, and making sure that patients are able to use Medicaid.”

Epidemiologists evaluate the potential cancer-protective effects of red wine by comparing its associated cancer risks to those of white wine.

Not all alcoholic beverages are perceived equally, with red wine often considered a healthier option. This belief stems from its high resveratrol content—an antioxidant with anti-inflammatory properties—thought to offer cancer protection.

However, researchers from Brown University’s School of Public Health have tested this assumption. In a new study, they analyzed data from 42 observational studies involving nearly 96,000 participants to compare cancer risks associated with red and white wine. The research, co-led by Eunyoung Cho, an associate professor of epidemiology and dermatology, found no clear evidence that red wine reduces cancer risk. Additionally, the study found no overall increase in cancer risk from wine consumption, regardless of type.

“We conducted a comprehensive meta-analysis to assess whether red wine is truly a healthier choice than white wine,” Cho said “Our analysis included as many published epidemiological studies as possible that separately explored the relationship between red and white wine consumption and cancer risk. The results revealed no significant difference in cancer risk between red and white wine overall. However, we did observe a distinction when it came to skin cancer risk. Specifically, the consumption of white wine, but not red wine, was associated with an increased risk of skin cancer.”

White Wine and Increased Skin Cancer Risk

In fact, the researchers calculated a 22% increased risk of skin cancer associated with white wine compared to red wine. The reasons for this remain unclear. Researchers suggest that heavy consumption of wine may correlate to high-risk behaviors, such as indoor tanning and inadequate sunscreen use. However, it is unclear why white wine, in particular, is the culprit.

The study also found a stronger association between white wine intake and increased overall cancer risk among women. This finding warrants further investigations into potential underlying mechanisms.

The meta-analysis done by the team is the first study of its kind and challenges the belief that red wine is healthier than white. It also points to the need for further study into the association between white wine consumption and cancer risk, particularly in women.

Alcohol — specifically, the ethanol in alcoholic beverages — metabolizes into compounds that damage DNA and proteins, contributing to cancer risk. In 2020, excessive alcohol consumption was linked to more than 740,000 cancer cases worldwide, accounting for 4.1% of all cases.

The U.S. Food and Drug Administration on Thursday made recommendations to vaccine manufacturers for the virus strains to be used in influenza vaccines for the 2025-2026 flu season in the United States.

Traditionally the recommendations have been voted on by an advisory committee, but the agency made the decision on its own this year. The regulator said it does not anticipate any impact on timing or availability of vaccines for the public.

The move comes after Robert F. Kennedy Jr. was confirmed as the secretary of Health and Human Services in February despite his criticism of agencies under his supervision, including the Centers for Disease Control and Prevention.

Kennedy has denied being “anti-vaccine” and has said he would not prevent Americans from getting vaccinated.

The flu vaccine recommendation from the agency comes on the same day that its Vaccine and Related Biological Products Advisory Committee had been scheduled to meet, before being canceled.

The U.S. influenza rate is at or near its highest level in at least 15 years and is still on the rise.

The National Institutes of Health will cancel or cut back dozens of grants for research on why some people are reluctant to be vaccinated and how to increase acceptance of vaccines, according to an internal email obtained by The Washington Post on Monday.

The email, titled “required terminations – 3/10/25,” shows that on Monday morning, the agency “received a new list … of awards that need to be terminated, today. It has been determined they do not align with NIH funding priorities related to vaccine hesitancy and/or uptake.”

Robert F. Kennedy Jr., the new secretary of NIH’s parent agency, the Department of Health and Human Services, has disparaged vaccines for years. He gained national notoriety over the past two decades by promoting misinformation about vaccines and a conjectured link to autism, drawing widespread condemnation from the scientific community.

It is unclear if Kennedy had a role, directly or indirectly, in the move to cancel these grants. But his ascendancy to HHS leadership has caused a stir in the research community. Last week, the Centers for Disease Control and Prevention, another part of HHS, was asked by the Trump administration to launch a study into a possible connection between vaccines and autism, despite repeated research that shows no link between the two.

Spokespeople at NIH and HHS did not immediately respond to requests for comment.

Monday’s email was sent by Michelle Bulls, director of the Office of Policy for Extramural Research Administration. It instructed NIH officials who dispense money to researchers around the country to send termination letters by the close of business Monday. It did not specify where the order originated.

For some studies that are partly about vaccine hesitancy and uptake, officials can offer the option of defunding only those activities, the email shows.

The termination notice should include the following language, according to the email: “It is the policy of NIH not to prioritize research activities that focuses gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment. … Therefore, the award is terminated.”

The email flagged more than 40 grants, according to two people familiar with the matter, who spoke on the condition of anonymity because they were not authorized to speak about the new order.

It is an especially fraught time to be canceling research into vaccine hesitancy, some experts argued, with more than 200 cases of measles in 12 states and two deaths from the disease. Measles vaccination rates have declined among kindergartners in the United States since 2019. All states and the District require measles vaccinations for schoolchildren, but more parents are requesting exemptions, citing medical, religious or philosophical reasons.

“There is an urgent need to enhance vaccine acceptance behavior, especially due to the potential resurgence of measles and covid-19 still looming,” said Manoj Sharma, a professor of social and behavioral health at the University of Nevada at Las Vegas, who had a CDC grant that ended last year to evaluate vaccine hesitancy.

Delesha Carpenter, a professor at the Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill, has had an NIH grant to focus on coronavirus vaccine hesitancy for three years, along with partners at the University of Arkansas for Medical Sciences and the University of South Carolina.

She has been bracing for the work to be upended, but she had not heard Monday afternoon whether her funding has been terminated.

“If we take away research on vaccine hesitancy, we’re also going to be taking away the ability to provide people with the best information about whether the vaccine is in their best interest,” Carpenter said. “They still have the decision to make.”

Michael Bronstein, an assistant professor in the department of psychiatry and behavioral sciences at the University of Minnesota Medical School, said his grant from the National Institute of Mental Health has not been affected, as far as he knows.

“From a public health perspective, preventing people from dying should be a government goal,” he said. “Vaccine hesitancy is one barrier to that.”

NIH, the world’s largest sponsor of biomedical research, has terminated more than a dozen grants related to China and transgender research, according to social media posts by Elon Musk’s U.S. DOGE Service, which is leading government efforts to sharply cut spending and the size of the federal workforce.

Documents obtained by The Washington Post showed that last week, grants management staff were given guidance on how to terminate funding related to diversity, equity and inclusion. That guidance included “language provided to NIH by HHS providing examples for research activities that NIH no longer supports.”

Those topics included funding to Chinese universities; for diversity, equity and inclusion; and for transgender issues. The language used in the notices created anguish within NIH, according to several people familiar with the notices.

There are two active grants to Chinese universities listed in an NIH database.

You may have noticed some headlines in recent weeks about butter and cheese taking days and even weeks off our lives if they’re eaten too often.

Now, let me be the first to say, a life without cheese is not one I particularly fancy living and restricting — or entirely cutting out — food is something that you should discuss with your GP, as it’s often not advised.

However, is there any weight to these stories? Should we start to consider a life without these delicious sources of fat?

Well, the most recent stories come from a study published in JAMA which looks at butter and plant based oils intake and mortality. According to the study, higher butter intake was associated with increased total and cancer mortality, while higher intake of plant-based oils was associated with lower total, cancer, and cardiovascular disease mortality.

Basically: plant-based oils such as olive oils are much better for your body than saturated fats such as butter.

The National Institutes of Health (NIH) is abruptly terminating at least 33 research grants for projects studying why some people are hesitant to receive vaccines or evaluating strategies that could encourage vaccine uptake, Science has learned. An additional nine grants may be modified or cut back. Scientists who received these grants began to receive termination letters this evening.

A person with direct knowledge of the situation says NIH has also requested lists of projects involving messenger RNA (mRNA) vaccines, which some vaccine skeptics think are unsafe because they believe, without evidence, that the vaccines could modify DNA or cause various health issues. The agency is also seeking a list of collaborations between NIH researchers and international partners on any topic. The terminations appear to be part of the agency’s efforts to defund research that does not align with policies backed by President Donald Trump and Department of Health and Human Services Secretary Robert F. Kennedy Jr.—a noted vaccine skeptic.

Last week, on behalf of interim Director Matthew Memoli, NIH asked each of its institutes to supply a list of current and future grants involving vaccine hesitancy. This morning, officials at the institutes sent a list of grants to be terminated to program officers, along with a template letter notifying awardees their grant was being terminated as of 11 March.

The letter, which Science has seen, will inform investigators that their award “no longer effectuates agency priorities. It is the policy of NIH not to prioritize research activities that focus on gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment.”

Like letters sent last week to dozens of researchers studying transgender health, the new termination letter says researchers should not try to alter their projects to conform to the new policy because “the premise of Project Number [INSERT] is incompatible with agency priorities, and no modification of the project could align the project with agency priorities.”

Fourteen of the awards are funded by the National Institute of Allergy and Infectious Diseases and involve vaccines for diseases such as mpox, human papillomavirus, chickenpox, and COVID-19. One involves a hypothetical gonorrhea vaccine. The project appeared on the list because one of its aims “is to evaluate health care worker’s [sic] and potential patient’s attitudes towards acceptance of a gonorrhea vaccine if one is developed.”

The list also names grants from the National Institute of Child Health and Human Development, National Institute of Mental Health, and National Institute of General Medical Sciences. Many of these involve promoting vaccine uptake among racial minority groups or understanding why some parents are reluctant to accept childhood and adolescent vaccines. In several grants, which fund efforts to model disease outbreaks, “vaccine hesitancy” is just one of several variables driving a model. It’s unclear whether these grants will be terminated in their entirety or modified so they no longer consider vaccine hesitancy. Other grants, including one that studies HIV in adolescents, will not be cut in their entirety, but subprojects involving vaccine hesitancy will be terminated.

Denis Nash, an epidemiologist at the City University of New York whose grant is on the list but who has not yet received a termination letter, says it will affect his work testing vaccine messaging strategies for people with mental health disorders and studying barriers such as misinformation and disinformation. “Ceasing to support research on the uptake of safe and effective vaccines does not eliminate the underlying challenges related to low vaccine uptake—it exacerbates them,” he says.

Another $548,002 project that has been terminated is analyzing electronic health records and infant developmental screening data to study whether the COVID-19 vaccine is safe in people who are pregnant or breastfeeding. The grant’s primary investigator, perinatal epidemiologist Kristin Palmsten at the HealthPartners Institute, says she was “stunned” by the 10 March termination notice. “The grant does not study vaccine hesitancy or uptake,” Palmsten says. “I originally wrote this grant because I was breastfeeding my daughter around the time of COVID-19 vaccine rollout, and there was no available human data on the safety of COVID-19 vaccination during breastfeeding.”

Palmsten says one reason for the project was to identify potential harms that would be important for patients’ decision-making. “I know how terrible it feels to have zero safety data available,” she says.

Thomas Carpino, an epidemiology graduate student at Johns Hopkins University, learned that the $48,974 training grant supporting his Ph.D. work on mpox among men who have sex with men is being canceled. Carpino had already defended his thesis and has a postdoc position lined up, but he will need alternative funding to finish his study. The grant was “to train the next generation of public health scientists,” he says. “They’re sending a very strong message to anyone who’s interested in pursuing these research topics.”

A second memo sent to the institutes on 6 March and seen by Science said Memoli “has requested information on NIH’s investment in mRNA vaccines research” including current or planned grants and contracts. A third asked the institutes to provide “information on each current substantive collaboration between your [Institute or Center] or [Intramural Research] program and international partners (nongovernmental organizations, research institutions, governments).” Collaboration could mean sharing data, providing technical assistance or training, or participating in working groups and advisory groups. NIH institutes and programs must respond by next week.

Measles outbreaks in West Texas and New Mexico are now up to more than 250 cases, and two unvaccinated people have died from measles-related causes.

Measles is caused by a highly contagious virus that’s airborne and spreads easily when an infected person breathes, sneezes or coughs. It is preventable through vaccines, and has been considered eliminated from the U.S. since 2000.

Here’s what you need to know about measles in the U.S.

How many measles cases are there in Texas and New Mexico?

Texas state health officials said Tuesday there were 25 new cases of measles since the end of last week, bringing Texas’ total to 223. Twenty-nine people in Texas are hospitalized.

New Mexico health officials announced three new cases Tuesday, bringing the state’s total to 33. The outbreak has spread from Lea County, which neighbors the West Texas communities at the epicenter of the outbreak, to include one case in Eddy County.

Oklahoma’s state health department reported two probable cases of measles Tuesday, saying they are “associated” with the West Texas and New Mexico outbreaks.

A school-age child died of measles in Texas last month, and New Mexico reported its first measles-related death in an adult last week.

Where else i

s measles showing up in the U.S.?

Measles cases have been reported in Alaska, California, Florida, Georgia, Kentucky, Maryland, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.

The U.S. Centers for Disease Control and Prevention defines an outbreak as three or more related cases — and there have been three clusters that qualified as outbreaks in 2025.

In the U.S., cases and outbreaks are generally traced to someone who caught the disease abroad. It can then spread, especially in communities with low vaccination rates.

Do you need an MMR booster?

The best way to avoid measles is to get the measles, mumps and rubella (MMR) vaccine. The first shot is recommended for children between 12 and 15 months old and the second between 4 and 6 years old.

People at high risk for infection who got the shots many years ago may want to consider getting a booster if they live in an area with an outbreak, said Scott Weaver with the Global Virus Network, an international coalition. Those may include family members living with someone who has measles or those especially vulnerable to respiratory diseases because of underlying medical conditions.

Adults with “presumptive evidence of immunity” generally don’t need measles shots now, the CDC said. Criteria include written documentation of adequate vaccination earlier in life, lab confirmation of past infection or being born before 1957, when most people were likely to be infected naturally.

A doctor can order a lab test called an MMR titer to check your levels of measles antibodies, but health experts don’t always recommend this route and insurance coverage can vary.

Getting another MMR shot is harmless if there are concerns about waning immunity, the CDC says.

People who have documentation of receiving a live measles vaccine in the 1960s don’t need to be revaccinated, but people who were immunized before 1968 with an ineffective measles vaccine made from “killed” virus should be revaccinated with at least one dose, the agency said. That also includes people who don’t know which type they got.

What are the symptoms of measles?

Measles first infects the respiratory tract, then spreads throughout the body, causing a high fever, runny nose, cough, red, watery eyes and a rash.

The rash generally appears three to five days after the first symptoms, beginning as flat red spots on the face and then spreading downward to the neck, trunk, arms, legs and feet. When the rash appears, the fever may spike over 104 degrees Fahrenheit, according to the CDC.

How can you treat measles?

There’s no specific treatment for measles, so doctors generally try to alleviate symptoms, prevent complications and keep patients comfortable.

Why do vaccination rates matter?

In communities with high vaccination rates — above 95% — diseases like measles have a harder time spreading through communities. This is called “herd immunity.”

But childhood vaccination rates have declined nationwide since the pandemic and more parents are claiming religious or personal conscience waivers to exempt their kids from required shots.

The U.S. saw a rise in measles cases in 2024, including an outbreak in Chicago that sickened more than 60. Five years earlier, measles cases were the worst in almost three decades in 2019.

Pharmacy benefits managers, or PBMs, are meant to lower drug prices by acting as a middleman between drug manufacturers and either insurance companies or employers who sponsor health plans. Advocates said employers and consumers often don’t understand what PBMs are and how they work.

Prescription Benefits Matter is a new educational campaign looking to change that.

Joey Fox has testified on behalf of the Association of Health Plans and the Pharmaceutical Care Management Association. He also directs the campaign, which he said is designed for people to better understand the role PBMs play in the price they pay at the pharmacy counter.

“It’s a part of the health care system that consumers don’t necessarily interact with on a personal level every day,” Fox said. “We want them to know that we are involved. And we are advocating for them and want them to have a better understanding of the value that they’re getting.”

By taking over that role in the negotiating process, Fox said PBMs can provide expertise to employers who cover their employee’s health insurance.

“If you are an employer in Indiana and you decide that you want to cover prescription drugs for your employees, you don’t have the expertise to call every single drug company, all the pharmacies to figure out which drugs to cover, which ones to maybe not, how much to pay for them, how much to reimburse a pharmacy,” Fox said. “The expertise within these organizations are what they’re offering to employers and to consumers to health plans.”

In addition to negotiating for drug prices, PBMs also play a role in how pharmacies actually run.

“They also are the technological backbone of the transactions that happen when you go to the pharmacy counter and pick up your drugs,” Fox said. “All that technology in the background is supplied through a pharmacy benefit manager.”

Fox said PBMs are also behind concepts like getting prescriptions delivered through the mail.

He said there are a lot of things about PBMs that people don’t understand that this campaign is hoping to answer.

“When you sign up at your at your job for health benefits, you just know, ‘OK, I’ve got I’ve got health care coverage and I know they cover prescription drugs.’ But you don’t necessarily know what that entity that’s there has been doing on your behalf or what value they add,” Fox said.

Ultimately, Fox said the main function of PBMs is to negotiate for lower drug prices for consumers.

However, some Indiana lawmakers have questioned whether PBMs are effective at achieving lower prices. In fact, lawmaker skepticism led to some of the most “aggressive” reforms being approved by the Senate earlier this legislative session.

Senate Bill 140 implements a variety of reforms meant to address concerns about what’s known as vertical integration. Vertical integration refers to when one company owns multiple parts of a certain supply chain, such as a company owning all or part of a PBM, a pharmacy and a drug manufacturer.

Under the bill, PBMs would be prohibited from working with an insurance company that has ownership interest in the PBM. And PBMs would not be allowed to have an ownership interest in a pharmacy.

Fox said Prescription Benefits Matter is targeting consumers and employers — not members of the General Assembly.

“This is really about getting to Hoosier consumers and Hoosier employers so that they understand that the prescription benefit manager is in the room advocating for them,” Fox said. “Then, they can take actions that they might deem appropriate to ensure that those benefits are protected.”

That campaign will focus on connecting people to information that Fox said already shows Hoosiers are saving about $1,000 per year because of PBMs.

“We’ve launched PrescriptionBenefitsMatter.org and an affiliated blog with kind of PBM fast facts,” Fox said. “These are ways for consumers to learn what those PBMs are doing for them on a day-to-day basis and the value that they provide.”

Fox said the campaign will include digital, print and radio advertising aimed at helping people understand that having a PBM involved in the health care system saves people money.

Health insurers’ use of AI is bringing a new level of concern to the burdensome payer cost-control practice known as prior authorization. In a recently released AMA survey (PDF), 61% of physicians said they fear that payers’ use of unregulated AI is increasing prior authorization denials, a practice that will override good medical judgment and exacerbate patient harm.

“Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care,” said AMA President Bruce A. Scott, MD, reacting to the survey results.

Physicians should be able to make medical decisions with their patients without interference from unregulated and unsupervised AI technology, said Dr. Scott. The AMA is fighting by challenging insurance companies to eliminate care delays, patient harms and practice hassles.

Health plans use prior authorization to control costs, requiring advance approval to obtain a prescription medication or medical service for a patient. Physicians and patients alike view this as a burdensome practice that affects care delivery, clinical outcomes and productivity in physician offices. Spending rises under this practice due to additional office visits, unanticipated hospital stays, and out-of-pocket costs for treatment.

In this most recent nationwide survey of 1,000 practicing physicians—400 working in primary care, the remainder in other physician specialties—82% reported that prior authorization sometimes leads to patients abandoning treatment. Over 90% said prior authorization delays care.

AI tools have been accused of producing high rates of care denial, in some cases 16 times higher than is typical, according to figures from a 2024 Senate committee report cited in the AMA’s news release.

“Using AI-enabled tools to automatically deny more and more needed care is not the reform of prior authorization physicians and patients are calling for,” said Dr. Scott.

Other AMA surveys underscore physician concerns about some misuses of health care AI. Results released early in February (PDF) found that 49% of physicians ranked oversight of payers’ use of AI in medical necessity determinations among the top three priorities for regulatory action. To address these concerns, the AMA House of Delegates recently adopted policy supporting advocacy to help ensure that technology is an asset to physicians and not a burden. Based on this policy, the AMA has developed advocacy principles (PDF) that address the development, deployment and use of health care AI, with particular emphasis on:

• Health care AI oversight.
• When and what to disclose to advance AI transparency.
• Generative AI policies and governance.
• Physician liability for use of AI-enabled technologies.
• AI data privacy and cybersecurity.
• Payer use of AI and automated decision-making systems.

 

AI concerns notwithstanding, physicians continue to report that prior authorization impedes delivery of necessary medical treatments, jeopardizes quality care and harms patients. More than nine in 10 physicians—94%—reported that prior authorization had a negative impact on clinical outcomes.

Eighty percent of doctors surveyed said that prior authorization sometimesleads patients to pay out-of-pocket for a medication, and 31% said payers are rarely or never using evidence-based criteria to make coverage decisions.

More distressingly, 29% of physicians reported that prior authorization led to a serious adverse event for a patient in their care.

More specifically, these shares of physicians said that prior authorization led to:

• A patient’s hospitalization—23%.
• A life-threatening event, or one that required intervention to prevent permanent damage—18%.
• A patient’s disability, permanent bodily damage, congenital anomaly, birth defect or death—8%.

Physicians also feel the administrative burden of prior authorization, which reduces their time with patients and negatively affects their practices. On average, physicians and their staff spend 13 hours a week completing the prior authorization workload for a single physician. Forty percent of physicians employ staff whose primary job is to work on this task.

These shares of physician respondents also revealed that prior authorization:

• Somewhat or significantly increases physician burnout—89%.
• Has increased somewhat or significantly over the last five years—75%.
• Is often or always denied—31%.

In cases of adverse payer decisions on prior authorization requests, 20% of physicians will always appeal. Physicians report various reasons for not appealing health-plan denials, with 67% reported doubts about an appeal’s success based on their past experiences. Over half said patient care could not wait for the health plan’s approval process, and 55% said they had insufficient resources to file an appeal.

The survey also revealed that prior authorization adds significant costs to the U.S. health system, forcing patients to try ineffective treatments and schedule additional office visits.

A strong majority of physicians—88%—reported that prior authorization leads to higher overall utilization of health care resources. These shares of physicians reported that prior authorization increases utilization in the following ways:

• Led to ineffective initial treatment—77%.
• Additional office visits—73%.
• Immediate care or emergency department visits—47%.
• Hospitalizations—33%.

Prior authorization can also affect productivity in the workplace, if employees are missing work due to delays in care leading to prolonged illness or attending rescheduled appointments. Nearly 60% of physicians with patients in the workforce said prior authorization has affected work performance among their patients.

Back in 2018, the AMA joined the American Hospital Association, American Pharmacists Association, Medical Group Management Association, America’s Health Insurance Plans, and Blue Cross Blue Shield Association in releasing a consensus statement (PDF) on how to improve prior authorization.

Seven years later, surveyed physicians reported that health plans have made little progress honoring their commitments as outlined in that document. Major payers such as UnitedHealthcare and Cigna pledged to reduce services requiring prior authorization in 2023. But just 16% of physicians who work with UnitedHealthcare and Cigna, respectively, reported that the changes led to a reduction in prior authorization requirements.

There has been some momentum to fix prior authorization at the state and federal levels. States enacted 13 prior authorization reform bills last year to cut the volume of prior authorization requirements, reduce patient care delays, improve transparency surrounding prior authorization rules and increase prior authorization data reporting.

At the federal level, the Centers for Medicare & Medicaid Services last year issued a final rule that included prior authorization reforms designed to cut patient-care delays and electronically streamline the process for physicians.

However, the continuing resolution that Congress passed in late 2024 to keep the federal government operating into 2025 failed to include prior authorization reform in the final package—a reform with vast bipartisan support in both chambers. The AMA and others are calling for five critical reforms, including speeding up response times and maintaining continuity of care.

Patients, doctors and employers can learn more about reform efforts and share their personal experiences with prior authorization at FixPriorAuth.org.

The House Republican drive to significantly reduce federal spending on medical care has placed the party on a collision course with the health needs of its own constituents.

The House GOP is advancing a budget that could impose major cuts in the Medicaid program that now provides health services to more than 72 million Americans.

But dozens of House Republicans represent districts where the share of residents receiving health coverage through Medicaid is greater than in the average district nationwide. And far more House Republicans than House Democrats now hold seats in districts where the share of residents confronting serious health challenges — including diabetes, high blood pressure, obesity, breast cancer deaths, cardiovascular problems and a lack of health insurance of any kind — exceeds the average.

Those are among the major findings of an exclusive CNN analysis of data collected by the Congressional District Health Dashboard, a partnership between the New York University Grossman School of Medicine and the Robert Wood Johnson Foundation.

The concentration of chronic health problems in Republican-held districts underscores the treacherous cross-pressures confronting the House majority as it advances its budget blueprint. Medicaid looms as the biggest single source of potential cuts available to Republicans as they seek to satisfy House conservatives demanding to offset the huge cost of extending the tax cuts passed in 2017, during President Donald Trump’s first term.

But areas facing the clustering of chronic health problems now common in Republican House districts are especially vulnerable to the loss of health insurance that big Medicaid cutbacks would likely trigger, many experts agree.

“As you begin to make access to basic health care resources more sparse, in an area where there is a high prevalence of those conditions, the impact of that is necessarily greater,” said Marc Gourevitch, a professor of population health at the NYU medical school and the principal investigator for the Health Dashboards Initiative.

Given the substantial number of their own constituents who now rely on Medicaid, House Republicans are visibly more uneasy about cutting Medicaid than they were when approving major reductions in the program during their attempt to repeal the Affordable Care Act in 2017 — much less when they voted to block grant (i.e., limit to a fixed sum) and slash Medicaid during their 1995-96 budget showdown with then-President Bill Clinton.

But despite those hesitations, all but one House Republican still voted for the budget resolution that almost all analysts agree makes major reductions in Medicaid spending unavoidable. The struggle over Medicaid cuts — especially as part of a GOP budget plan that also cuts taxes primarily for the wealthy and corporations — could emerge as the central legislative battlefield of 2025 and the foundation of Democratic plans to retake the House majority in 2026.

“Republicans in Congress are betraying their own voters by gutting Medicaid,” says Leslie Dach, chair of the liberal health care group Protect Our Care, in a preview of what may be a core Democratic argument in next year’s midterm elections.

The new politics of health care

To produce the Congressional District Health Dashboard, the NYU School of Medicine uses federal data from the Census Bureau; the Centers for Disease Control and Prevention; the National Center for Health Statistics; and other sources to calculate whether each congressional district ranks above or below the average for all districts nationwide on 40 different metrics of health status. These indicators are wide-ranging and include, among many others, access to health insurance; teen births; the presence of various kinds of chronic illness; and life expectancy. CNN senior producer Edward Wu analyzed the data to produce a comparison of the health status of House districts held by Republicans and Democrats.

That exercise showed how the electoral realignment of the two parties over the past generation has intersected with the growing reach of Medicaid to reconfigure the politics of health care.

Over the past generation, the House Democratic Caucus has become a kind of upstairs-downstairs coalition centered on two distinct groups of districts: lower-income, heavily minority urban seats, and more affluent white-collar suburban seats with larger White (though still often racially diverse) populations.

The health dashboard data show that 118 of the 215* House Democrats, primarily from that first group of seats, represent districts where the share of the total population (including children and seniors) on Medicaid exceeds the nationwide average of 22.7% as of spring 2024. (*Note: These data were compiled before the death this week of Democratic Rep. Sylvester Turner, who represented Texas’ heavily Democratic 18th Congressional District.)

Traditionally, Republicans have felt comfortable pursuing significant reductions in Medicaid because they have viewed it primarily as a program for the urban poor. But GOP representatives now hold dozens of seats in districts heavily reliant on Medicaid.

The CNN analysis found that 64 of the 218 House Republicans (not counting two previously Republican-held seats that are currently vacant) represent districts where the number of people on Medicaid exceeds the average share. Those include 17 districts where at least 30% of residents are on Medicaid. At the top of the list are the districts represented by Reps. David Valadao of California (with 60.7% of district residents on Medicaid); Jay Obernolte of California (44.1%); Hal Rogers of Kentucky (44%); Doug LaMalfa of California (39.1%); Dan Newhouse of Washington (35.9%); and Cliff Bentz of Oregon (35%).

Beyond the 64 Republicans with more Medicaid recipients than the average district, another 43 represent districts where at least one-fifth of residents, or just slightly less than the national average, rely on Medicaid.

The substantial number of Republicans representing big Medicaid populations largely reflects the shift in the party’s center of gravity from suburban seats in earlier decades toward predominantly white, mostly lower-income and lower-education districts outside of major metropolitan areas — the kind of small-town and rural seats once held by centrist Democratic House “blue dogs.” Medicaid has become more important to the health care system in such areas as Congress has expanded the populations eligible for it, most dramatically when the Affordable Care Act extended eligibility for Medicaid to working adults making up to 138% of the federal poverty level, which works out to about $22,000 for an individual this year. Rural hospitals and health care providers are especially reliant on Medicaid because fewer people in those areas receive health insurance through their jobs.

“There’s this conventional wisdom that Medicaid is a welfare program for the urban poor, and it’s just not the case anymore,” said Larry Levitt, executive vice president for health policy at KFF, a nonpartisan health care thinktank. “Given how Medicaid has been expanded over time, and how political bases have realigned, there are a lot of people in Republican districts who rely on Medicaid.”

The number of Republican districts with large Medicaid populations is smaller than it would be otherwise because the 10 states that have refused to expand Medicaid eligibility under the ACA are generally red states that mostly send GOP legislators to Congress.

Eighty-four House Republicans represent districts in the states that have rejected the Medicaid expansion, and only Rep. Russell Fry of South Carolina among them represents a district where the share of residents receiving care through the program exceeds the average for districts nationwide. By contrast, in the expansion states, nearly half of all House Republicans represent seats where more people receive care through Medicaid than in the average district. Those are the GOP members feeling the tightest squeeze as the spending and tax debate proceeds.

The shifting class basis of the two parties’ electoral coalitions has also produced a clear pattern in the health outcomes tracked by the NYU dashboard. Across nearly every significant measure, more Republicans than Democrats represent districts facing onerous burdens from chronic disease and diminished access to health care, CNN’s analysis found.

Most House Republicans now represent districts where the death rate from cardiovascular disease exceeds the average for districts nationwide. Most of them also represent seats where the death rate from breast and colorectal cancer is higher than in the typical district — as is the incidence of obesity, diabetes and high blood pressure.

Most House Democrats represent seats where fewer people than in the average district suffer from those health problems. On many of these measures, the two parties present almost precisely mirror images. Three-fifths of Republicans, for instance, represent districts where the prevalence of diabetes is greater than in the average district; almost exactly the same share of Democratic districts see less diabetes than the average district.

Measures tracking access to health care show the same kind of gulf. The share of people without health insurance of any kind is less than average in two-thirds of the seats held by Democrats. But the uninsured population exceeds that of the average district in more than half of the Republican-held seats, in large part because of the states that have refused to expand Medicaid coverage. And far more House Republicans than Democrats represent seats facing a greater than average shortfall in the availability of primary care physicians, according to federal statistics.

One measure best captures the cumulative impact of all these disparities. Nearly three-fifths of House Republicans now represent districts where life expectancy at birth is below the average for districts nationwide; nearly two-thirds of Democrats hold seats where life expectancy exceeds the national average. Of the 100 districts where life expectancy is the longest in the country, 76 are represented by Democrats. Of the 100 districts where life expectancy is the shortest, 60 are represented by Republicans.

“The way I see it when I look at the maps on our website is that health problems don’t respect geographic boundaries; they don’t discriminate by place,” said Ben Spoer, program director of the Health Dashboards Initiative at NYU. “That’s why these insurance programs are so important: because they serve lots and lots of people everywhere.”

The GOP districts that embody the new dynamic

The negative health indicators are especially common in the Republican-held districts with heavy Medicaid dependence. Of the 64 Republican districts where a larger than average share of residents rely on Medicaid, roughly 50 also exceed the national average in the rates of cardiovascular deaths, diabetes, high blood pressure, obesity and deaths from colorectal cancer. In 48 of those 64 districts, life expectancy at birth trails the national average.

The districts of two of the House Republicans at the center of the GOP budget plans encapsulate these broader trends.

The northwest Louisiana district of House Speaker Mike Johnson ranks near the top of the list among Republicans for reliance on Medicaid, with nearly 31% of people there depending on the program. The rates of diabetes, high blood pressure, obesity and breast cancer deaths in Johnson’s district are all about 20% greater than in the average district; the rate of cardiovascular deaths and low-birthweight births are each nearly 40% greater. The teen birthrate in Johnson’s district is double the national average. More than five times as many residents in his district as in the average one live in an area with a shortfall of primary care physicians. The average lifespan at birth in Johnson’s district is 2.3 years shorter than in the average district nationwide, NYU has calculated.