“Proposed Medicaid Cuts Could Lead to Thousands of Preventable Deaths Annually” & Personal Message

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6/17/25 Healio, E Bascom: Proposed Medicaid cuts could lead to thousands of preventable deaths annually

An excerpt:

Congress passing the controversial One Big Beautiful Bill Act could leave millions without insurance and lead to at least 16,000 annual preventable deaths, according to research published in Annals of Internal Medicine…

Arthur L. Caplan, PhD, a professor and founding head of the division of medical ethics at NYU Grossman School of Medicine, told Healio that the authors’ “warnings about what will happen should the Big Beautiful Bill go through have to be taken very seriously.”

“I think the fallout in terms of impact on Medicaid populations … people losing coverage who would then lose access [to health care] is morally staggering and unacceptable,” he said. “We are taking some of the most vulnerable people in society … and cutting back what is often somewhat meager benefits to begin with…”

A brief recently published by the Robert Wood Johnson Foundation also examined the potential impact of Medicaid cuts. Researchers revealed that, if the bill passes, national health care spending would drop by $797 billion over the next 10 years… They found that physicians would see an $81 billion cut, but hospitals would see the biggest decline in spending, at $321 billion.

Cited Study: A Gafney et al. Annals of Internal Medicine 2025; https://doi.org/10.7326/ANNALS-25-00716 Open Access! Projected Effects of Proposed Cuts in Federal Medicaid Expenditures on Medicaid Enrollment, Uninsurance, Health Care, and Health

An excerpt:

Enactment of the House bill advanced in May would increase the number of uninsured persons by 7.6 million and the number of deaths by 16 642 annually, according to a mid-range estimate…These estimates may be conservative. They rely on CBO’s assumption that states would replace half of the federal funding shortfall…Medicaid cuts would likely also increase uncompensated care, stressing hospitals and safety-net clinics and causing spillover effects on other patients…

ACA boosted enrollment to more than 90 million. Today, despite its many shortcomings, Medicaid enjoys wide support from the electorate and serves as the foundation of the nation’s health care safety net. The cuts under consideration, intended to offset the cost of tax cuts that would predominantly benefit wealthier Americans, would strip care from millions and likely lead to thousands of medically preventable deaths.

My take: Yogi Berra is attributed with the saying, “It’s tough to make predictions, especially about the future.” While this is true, it is highly likely that huge cuts in Medicaid funding will result in huge numbers who lose health insurance with subsequent increases in mortality and other adverse outcomes.

Related article: M Mineiro and M Sanger-Katz, NY Times 6/19/25: ‘Little Lobbyists’ Urge Senators to Oppose Trump’s Bill Cutting Medicaid

Related blog posts:

Personal Message:

Atlanta Botanical Gardens

Treatment Guidelines for Pediatric Irritable Bowel Syndrome

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J Green et al. JPGN 2025; Open Access! ESPGHAN/NASPGHAN guidelines for treatment of irritable bowel syndrome and functional abdominal pain-not otherwise specified in children aged 4–18 years

Overall, this article notes that the evidence based for most treatments for pediatric irritable bowel (IBS) is often lacking.

Specific recommendations:

Executive summary of Best Practice Statements‐ The Guideline Development Group (GDG) notes that a crucial emphasis should be placed on education regarding the abdominal pain‐related disorders of gut–brain interaction.

My take: This is a helpful guideline and likely to influence practice.

Related blog posts:

Budesonide Tablet vs Off-Label Corticosteroids in Eosinophilic Esophagitis

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G Pellegatta et al. Clin Gastroenterol Hepatol 2025; 23: 1058-1060. Open Access! Switch From Off-Label Swallowed Topical Corticosteroids to Budesonide Orodispersible Tablets in Eosinophilic Esophagitis Patients

Methods: This was a single center, prospective, observational study with adult patients previously diagnosed with EoE. Thirty EoE patients, receiving off-label swallowed topical corticosteroids (STCs), were consecutively enrolled. “This is the first study to evaluate the clinical, histological, and endoscopic efficacy of the switch from STCs to BOT [Budesonide Orodispersible Tablet]”

Key findings:

  • The median Dysphagia Symptoms Score decreased from 5 (range 0–9) under STCs therapy to 0 (range 0–6) under BOT therapy (P < .0001)
  • After switching to BOT, there was a significant increase in the number of patients in histological remission (STCs: n = 19 of 30 [63.3%] vs BOT: n = 27 of 30 [90%]; P = .030) and histological deep remission (STCs: n = 17 of 30 [56.6%] vs BOT: n = 25 of 30 [83.3%]; P = .047) 
  • Another important improvement following the switch was the improved patient satisfaction with the therapy in terms of a faster and easier modality of assumption…favors a better compliance to BOT
  • There was a “slight increase in oral Candida infection after BOT”

The authors did not include any cost information regarding the switch. In U.S., BOT is not an available treatment option. However, Eohilia, which is a budesonide suspension with a 12-week FDA approval period, costs ~$2100 per month (for 600 mL =30 day supply), whereas budesonide ampules at same dosage cost ~$300 per month (60 1 mg ampules).

My take: BOT therapy, which was targeted for esophageal delivery, was associated with better response rates. However, the cost of targeted FDA approved budesonide therapy in U.S, is exorbitant.

Related blog posts:

Understanding the Prevalence and Burden of Pediatric Inflammatory Bowel Disease in U.S.

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 From editorial (which is more expansive than the study):

Kappelman et al4 report the US prevalence of pediatric-onset IBD (diagnosed before the age of 20 years by a physician) as well as rates of disease based on race and ethnic background. To ensure that a representative population was captured, they combined multiple health administrative databases…

The authors report that the US currently has a pediatric IBD prevalence of 125 per 100,000 population, increased from 110 per 100,000 in 2011. This is higher than previously reported in Canada (82 per 100,000 in 2023)6 and Sweden (75 per 100,000 in 2010).7 These differences may be due to the older age cutoff used in the US data, <20 years vs <18 years in the Canadian and Swedish studies. However, misclassification bias may also play a role...

Nevertheless, understanding the approximate prevalence of pediatric IBD in the US allows for adequate human and financial resource planning for this important population of children with an impactful chronic disease. The high prevalence should raise concerns among health care practitioners and policy makers that we have under-resourced IBD care in children, especially considering the high rate of use of biologics and the growing direct health costs incurred in the treatment of this population.11

The burden of IBD in pediatrics goes beyond that of the child. Compared with adult IBD, it disproportionately affects caregivers and families (owing to missed work for appointments, hospitalizations, and home care), mental health of both the patient and the parents, and the health system...

They report that pediatric IBD is more frequent among White children and adolescents (145 per 100,000) compared with Black (91 per 100,000) and Hispanic (88 per 100,000) children, whereas children of Asian origin have markedly lower rates (52 per 100,000).“

My take: The updated prevalence data helps understand the increasing frequency of pediatric IBD. The associated commentary reminds us of the broader burden the disease has for families and for our communities.

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Constipation Preceding a New Diagnosis of Inflammatory Bowel Disease

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S Cenni et al. J Pediatr Gastroenterol Nutr. 2025;80:799–806. The prevalence of constipation in children with new diagnosis of inflammatory bowel disease: A retrospective study

This was a cross-sectional observational study in pediatric IBD-patients (n=238) with 104 (43.6%) with Crohn disease (CD), 130 (54.6%) with ulcerative colitis (UC) and 4 (1.6%). Only patients who filled out the Rome IV questionnaire for FC, through dedicated symptom recall at the next clinic appointment or telephone recall, were finally enrolled in the study for subsequent analysis.

Key findings:

  • Forty-seven out of 238 (19.7%) had a functional constipation history before the IBD diagnosis. In the CD children the prevalence of constipation before the IBD diagnosis was 19/104 (18.2%) and in the UC patients was 28/130 (21.5%).
  • The difference in terms of endoscopic localization was statistically significant in UC patients presenting FC (p = 0.026) with a prevalence of proctitis and left side colitis (30% and 15%, respectively)
  • There was a delay in the diagnosis of patients with preceding constipation

Discussion Points:

  • The main limitations of the present study are certainly related to the retrospective nature and, therefore, the possibility of recall biases must be taken into account.
  • Rectal bleeding that persists despite stool softener therapy should be investigated

My take: While this study shows that constipation is fairly common prior to a diagnosis of IBD, many times a parent is told that their child is constipated on the basis of an xray or simply because the child complained of stomach pain. This likely increases the risk of recall bias. My guess is that a prospective study involving careful questioning at the time of the initial colonoscopy would yield a lower number of children who had constipation at the time of diagnosis.

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Set of Shucked! at The Fox Theater. Really enjoyed this ‘corny’ musical.

Excellent Review of H Pylori in Children Plus One on Healthy Aging

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Congratulations to my partner Ben Gold and coauthors on their recent publication –an excellent review of H pylori infection in children:

DL Mebuge, RJ Noel, BD Gold. Current Treatment Options in Pediatrics 2025; 11:13. doi.org/10/1007/s40746-025-00328-6. Open Access: Helicobacter pylori in Children: An Individualized Approach to a Worldwide Disease

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For those interested in healthy aging/healthspan, Eric Topol had a recent interview with Katie Couric (54 minutes): On the State of US Life Science and Extending Healthspan

MMR Vaccination Safety in Immunocompromised Kids with IBD and Liver Transplant

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A Keutler et al. Vaccine 2025; 59: 127288. Open Access! Safety and immunogenicity of the measles-mumps-rubella vaccine in immunocompromised children with inflammatory bowel disease, or after liver transplantation: An observational study

Background: “Measles is a highly contagious disease and, despite the availability of a safe and effective vaccine, remains still an important cause of childhood death worldwide [1,2]. The risk of severe illness in measles-naive individuals is particularly high in immunocompromised patients with inflammatory bowel disease (IBD) or after liver transplantation (LT) [3]…Ideally, vaccination with live attenuated vaccines (LAVVs) should be completed four weeks before organ transplantation or the initiation of immunosuppressive therapy (IST) to allow for the live vaccine’s incubation period and minimize the risk of vaccine-associated disease…LAVVs are considered contraindicated during IST due to safety concerns and limited experience.”

Methods: “In this prospective multicenter observational study (DRKS00014569) 22 children and adolescents with incomplete MMR vaccination status were identified… with stable immunosuppressive therapy in the last three months with no evidence of underlying disease activity…Sixteen patients were vaccinated against MMR, eleven after liver transplantation and five with inflammatory bowel disease. At the time of vaccination, four patients were receiving moderate (e.g., tacrolimus drug level below 5 ng/ml), eleven were receiving high-intensity immunosuppression (e.g. anti-tumor-necrosis factor agents, mycophenolate mofetil) and one child had previously discontinued immunosuppressive treatment.”

Immediately prior to the references, the authors provide a downloadable document detailing how they chose to categorize the degree of immunosuppression and their precise protocol, including immunologic pretesting and drug contraindications as noted below.

Key findings:

  • There were no serious adverse events or complications related to the vaccination
  • In children receiving immunosuppressive medications, the seroconversion rate for measles after the first MMR vaccination was 73.3 % (11/15) and after the second vaccination 80 % (12/15)

My take: In carefully-selected immunocompromised pediatric patients, the MMR vaccine may be safe. However, given the small numbers receiving vaccination in this study, the absolute safety is unclear. Even infrequent adverse effects would be problematic. This study’s protocol could be helpful for those considering vaccination in immunocompromised populations with a measles epidemic. For now, the most important approach is improving vaccination rates in those (especially family members) without contraindications.

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Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

Personal Quest Update: The Beginning of the End for the Penny & World Button Battery Day

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As I noted in a blog in 2012, I had advocated for removal of the penny due to frequent ingestions (starting more than 20 years ago) (link: “Watch for change in the stools”). Now it appears I will finally get my wish.

RP Jones, Reuters, 5/22/25: US Treasury unveils plan to end production of penny coin

An excerpt:

In recent weeks, Republican and Democratic lawmakers introduced separate bills in the House of Representatives and the Senate calling for an end to penny production. The change means that businesses will have to start rounding the prices of cash transactions up or down to the nearest five-cent nickel as the number of pennies in circulation dwindles.

The Treasury’s penny phase-out plan was first reported by the Wall Street Journal…The cost of producing the penny has risen from 1.3 cents per coin to 3.69 cents over the past 10 years, according to the Treasury. It said stopping production will lead to immediate annual savings of $56 million. The penny was first issued by the government in 1793

Related article:

K Bucholtz, Statista 6/11/20: The Most Commonly Swallowed Objects in America

The following statistic will delight fans of obscure facts and overbearing bureaucracy: According to the U.S. Consumer Product Safety Commission, more than 850,000 accidental ingestions of everyday objects were recorded in the U.S. between 2010 and 2019. ..Coins topped the list of accidental ingestions, with around 33,000 being recorded each year (more might go unreported).

*According to the U.S. Consumer Product Safety Commission, 

My take: While this is a step in the right direction, there are still 114 billion pennies currently in circulation in the U.S. according to the Reuters article. Perhaps, other coins will be ingested less in the coming years too as so many business transactions are via smartphones and credit cards.

Button batteries are a much more serious ingestion than a coin. For World Button Battery Day, here’s a link to a 3 minute video from FISPGHAN. FISPGHAN Button Battery Video

The video provides a simple explanation of the problem though at times it is not certain who the target audience is. Particularly the first part feels like a video for kids rather than for parents. Thanks to Ben Gold for sharing this link.

Aso, Link: FISPGHAN Button Battery Website

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Missing Opportunities to Cure Pediatric Hepatitis C Infection

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MR Curtis et al. Pediatrics (2025) 155 (5): e2024068565. Disparities in Linkage to Care Among Children With Hepatitis C Virus in the United States

Background: “Current guidelines recommend treating all children aged 3 years or older with DAAs (direct-acting antivirals). These treatments achieve cure in more than 98% of HCV cases and reduce risks for cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality. Despite availability of DAAs, only 62% of adults with HCV have linked to care, 39% initiated treatment, and 26% attained cure (sustained virologic response) as of 2023.”

Methods: This retrospective cohort analysis included children born between 2000 and 2018 who were diagnosed with HCV between the ages of 0 and 18 years. The study analyzed TriNetX Research Network data, a US national electronic health records network with more than 87 million individuals within the U.S.

Key findings:

  • Among 928 children with HCV, 297 (32.0%) linked to HCV care and 111 (12.0%) were prescribed a DAA (direct-acting antiviral). Thus only 1 in 8 children with HCV were prescribed DAAs
  • Of 928 children with HCV, 35.9% of children were diagnosed with HCV perinatally (by 3 years old), 44.5% during childhood (between 4 and 12 years old), and 19.6% in adolescence (between 13 and 18 years old)
  • White and Hispanic/Latinx children were much more likely than black children to receive a DAA prescription with OR of 3.44 and 2.20 respectively
  • Children in Midwest, North, and West had higher rights of DAA prescription compared to the South with OR of 2.40, 1.50, and 4.19 respectively

Discussion points:

Potential barriers to treatment:

  • DAAs were only approved for children aged 3 years or older in 2019 for some genotypes and not until 2021 for all genotypes.
  • Some parents choose to wait to treat young children because of difficulty administering medications at the ages of 3 and 4 years old
  • Insurance: “The cause of low uptake of treatment is likely multifactorial: Medicaid and commercial insurers implemented restrictions based on degree of liver fibrosis, active or recent substance use, or specialty prescribing because of the very high initial cost of DAAs. Although most of these restrictions have now been removed, some still remain, and some insurance plans have varying criteria for pregnant or pediatric members.”

New CDC Recommendations: “In light of the new Centers for Disease Control and Prevention perinatal HCV testing recommendations and universal HCV screening recommended in pregnancy, more young children with HCV will be identified”

Limitations: Retrospective study relies on data from a database

My take: Being able to cure HCV with DAAs has been an incredible medical achievement. However, efforts to eradicate HCV have not gotten very far and had a severe setback with the opioid epidemic which increased rates of HCV. This study shows that very few children with HCV actually receive curative treatment. Advancing the goal of HCV elimination will require sustained efforts to get those identified with HCV to treatment, both in children and adults.

Related summary article in GI Hep News (5/21/25): Clinicians Can Prescribe the Cure for Hepatitis C: Most Kids Never Get It. Two other points:

  • “The prevalence of HCV in pregnant people jumped 16-fold between 1998 and 2018 to 5.3 cases per every 1000 pregnancies, and these patients can transmit the disease perinatally. Many people are unaware they are infected.”
  • “More than half of children clear the infection on their own by age 3, the age at which treatment can also begin”

Related blog posts:

Useful website:: HCVguidelines.org (living online reference of HCV therapies for all populations, including children)

RFK Jr. Ousts Entire CDC Vaccine Advisory Committee

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AP News 6/09/25: RFK Jr. ousts entire CDC vaccine advisory committee

An excerpt:

Health Secretary Robert F. Kennedy Jr. on Monday removed every member of a scientific committee that advises the Centers for Disease Control and Prevention on how to use vaccines and pledged to replace them with his own picks.

Major physicians and public health groups criticized the move to oust all 17 members of the Advisory Committee on Immunization Practices… Kennedy wrote in a Wall Street Journal opinion piece. “A clean sweep is needed to re-establish public confidence in vaccine science…”

Kennedy is going against what he told lawmakers and the public…Kennedy’s move, coupled with declining vaccination rates across the country, will help drive an increase in vaccine-preventable diseases…

Republican Sen. Bill Cassidy of Louisiana, a doctor who had expressed reservations about Kennedy’s nomination but voted to install him as the nation’s health secretary nonetheless, said he had spoken with Kennedy moments after the announcement.

“Of course, now the fear is that the ACIP will be filled up with people who know nothing about vaccines except suspicion,” Cassidy said in a social media post. “I’ve just spoken with Secretary Kennedy, and I’ll continue to talk with him to ensure this is not the case.”

RFK Jr alleges ACIP committee members are laden with conflicts of interest as the rationale for this move; however, his editorial lists little evidence of this. Just last month, HHS leaders announced that COVID vaccination was no longer recommend for pregnant women; these women and their infants in the first 6 months of life are at increased risk of COIVD deaths and complications. The pattern of undermining expertise in utilizing vaccines will have far-reaching repercussions. Unfortunately, the trajectory for public health is even more worrisome. It is likely that there will be more measures to limit vaccine availability. Though, it will be a while until the full body count will be determined.

My take: Senator Cassidy, a physician, allowed RFK Jr to lead HHS despite misgivings; this was due to political considerations rather than qualifications. This decision and his lack of action to hold him accountable are a true betrayal of his constituents and to the principle of ‘Do No Harm.’

Link to AAP Statement: AAP Statement on Changes to Advisory Committee on Immunization Practices

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It is funny that the city of Roswell highlights an award for excellence in park and recreation management on a trashcan. This type of honor, though, could be replicated for the work of the current HHS secretary.