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The Hill
35 minutes ago
- The Hill
Hospitals across nation brace for Medicaid cuts under ‘big, beautiful' law
Hospitals are bracing for the impact from the Medicaid cuts in President Trump's sweeping spending and tax cut law. While most of the cuts won't happen immediately, rural facilities in particular say they likely will have to make difficult financial decisions about which services they can afford to keep and which may need to be cut. Hospitals loudly raised alarms about the legislation, but their warnings went unheeded, and now they say they will bear the brunt of the changes. The new law cuts about $1 trillion from Medicaid, primarily through stringent work requirements as well as reductions to how states can fund their Medicaid programs through provider taxes and state directed payments. Rural hospitals rely heavily on Medicaid funding because many of the patients they care for are low income. 'Restrictions on state directed payments and provider taxes cut off critical financial lifelines for hospitals,' Bruce Siegel, president and CEO of America's Essential Hospitals said in a statement. 'State directed payments are a critical source of support for hospitals, particularly in rural areas, and provider taxes help reduce the gap between Medicaid and other payers, ensuring that physicians can take Medicaid patients and hospitals can be adequately staffed. Cutting these lifelines is not sustainable, and it will harm patients.' More than 300 rural hospitals in the U.S. are at risk of closing down because of the bill, according to research conducted by the University of North Carolina's Sheps Center for Health Services Research and released last month by Democratic lawmakers. Rural hospitals already operate on thin margins. The law's Medicaid cuts will lead to more uninsured patients, meaning rural hospitals will not get paid for the services they are required by law to provide to patients, according to the report. In turn, they will face deeper financial strain. Medicaid-dependent services — like labor and delivery units, mental health care, and emergency rooms — are some of the least profitable, yet most essential, services that hospitals provide. But experts said those will likely be cut as hospitals try to stay afloat. In rural communities, Medicaid covers nearly half of all births and one-fifth of inpatient discharges, according to health research group KFF. Republicans pushed back the start date for the provider tax reductions until 2028, and they won't be fully phased in until 2031. The bill was only signed into law on July 4, so hospitals said it's too early for them to know specifics on which services they'll have to cut back on. But the discussions are underway because hospitals need to start planning. 'If they see a very negative outlook in terms of Medicaid revenue reductions, increases in uncompensated care costs, I think that will tip the scales towards cutting services, cutting staff, not hiring, not expanding,' said Edwin Park, a research professor at the McCourt School of Public Policy at Georgetown University. Mark Nantz, president and chief executive officer of Valley Health System, oversees a network that includes six hospitals in the Shenandoah Valley of Virginia and West Virginia, ranging from a 495-bed regional facility in Winchester to a 36-bed facility in Front Royal, about 70 miles outside of Washington. Nantz said Medicaid expansion and provider taxes have allowed the system to break even when taking care of Medicaid patients. Previously, they were losing about 25 cents on every dollar. Once the cuts are fully phased in, Nantz said Valley Health will lose about $50 million a year in revenue for Medicaid patients. The most likely casualty will be new construction and expansion plans, but he said it's too early to know more. 'We're not in a situation where we need to knee-jerk because we're a pretty stable healthcare system, but it's definitely going to change the way we look at expanding and the types of services that we offer in our six hospitals,' Nantz said. Valley Health was able to expand the services it offers because it was not losing money on Medicaid, but that may not be able to continue. While hospitals may not close, some types of specialty care may be moved from rural facilities and centralized at the regional facility. 'We've got, really, two and a half to three years to make those kinds of decisions and prepare for what we will do. So we're not threatening to cut jobs or hospitals or service locations or any of that right now,' Nantz said, 'but we have to look at whether or not we can continue' offering the same types of services. Republicans concerned about the impact of the provider tax reduction on rural hospitals inserted a $50 billion relief fund into the law. The law calls for the money to be distributed by the Centers for Medicare and Medicaid Services (CMS) over five years. The federal government will distribute half of the program's $50 billion allotment equally among all states with an approved application over the next five years. But experts said the money isn't nearly enough to make up for the impact of the cuts. According to a KFF analysis, federal Medicaid spending in rural areas is estimated to decline by $155 billion over a decade. The states and hospitals that will be hit the hardest will benefit the least, Park said. He noted the law gives the Trump administration a lot of discretion on how they divide up the funds, so there's potential for favoritism. Every state has until the end of 2025 at the latest to apply for funds by submitting a 'detailed rural health transformation plan' that addresses the program's aims, according to the legislation. But if CMS Administrator Mehmet Oz doesn't agree with how states are using their funds, the law says he then 'may withhold payments to, or reduce payments to, or recover previous payments from, the State.' 'It's a fig leaf,' Park said. 'The fund is temporary. These cuts are permanent.'
Los Angeles Times
an hour ago
- Los Angeles Times
U.S. aid cuts halt HIV vaccine research in South Africa, with global impact
JOHANNESBURG — Just a week had remained before scientists in South Africa were to begin clinical trials of an HIV vaccine, and hopes were high for another step toward limiting one of history's deadliest pandemics. Then the email arrived. Stop all work, it said. The United States under the Trump administration was withdrawing all its funding. The news devastated the researchers, who live and work in a region where more people live with HIV than anywhere else in the world. Their research project, called BRILLIANT, was meant to be the latest to draw on the region's genetic diversity and deep expertise in the hope of benefiting people everywhere. But the $46 million from the U.S. for the project was disappearing, part of the dismantling of foreign aid by the world's biggest donor earlier this year as President Trump announced a focus on priorities at home. South Africa has been hit especially hard because of Trump's baseless claims about the targeting of the country's white Afrikaner minority. The country had been receiving about $400 million a year via USAID and the HIV-focused PEPFAR. Now that's gone. Glenda Grey, who heads the Brilliant program, said the African continent has been vital to the development of HIV medication, and the U.S. cuts threaten its capability to do such work in the future. Significant advances have included clinical trials for lenacapavir, the world's only twice-a-year shot to prevent HIV, recently approved for use by the U.S. Food and Drug Administration. One study to show its efficacy involved young South Africans. 'We do the trials better, faster and cheaper than anywhere else in the world, and so without South Africa as part of these programs, the world, in my opinion, is much poorer,' Gray said. She noted that during the urgency of the COVID-19 pandemic, South Africa played a crucial role by testing the Johnson & Johnson and Novavax vaccines, and South African scientists' genomic surveillance led to the identification of an important variant. A team of researchers at the University of the Witwatersrand has been part of the unit developing the HIV vaccines for the trials. Inside the Wits laboratory, technician Nozipho Mlotshwa was among the young people in white gowns working on samples, but she may soon be out of a job. Her position is grant-funded. She uses her salary to support her family and fund her studies in a country where youth unemployment hovers around 46%. 'It's very sad and devastating, honestly,' she said of the U.S. cuts and overall uncertainty. 'We'll also miss out collaborating with other scientists across the continent.' Professor Abdullah Ely leads the team of researchers. He said the work had promising results indicating that the vaccines were producing an immune response. But now that momentum, he said, has 'all kind of had to come to a halt.' The BRILLIANT program is scrambling to find money to save the project. The purchase of key equipment has stopped. South Africa's health department says about 100 researchers for that program and others related to HIV have been laid off. Funding for postdoctoral students involved in experiments for the projects is at risk. South Africa's government has estimated that universities and science councils could lose about $107 million in U.S. research funding over the next five years due to the aid cuts, which affect not only work on HIV but also tuberculosis — another disease with a high number of cases in the country. South Africa's government has said it will be very difficult to find funding to replace the U.S. support. And now the number of HIV infections will grow. Medication is more difficult to obtain. At least 8,000 health workers in South Africa's HIV program have already been laid off, the government has said. Also gone are the data collectors who tracked patients and their care, as well as HIV counselors who could reach vulnerable patients in rural communities. For researchers, Universities South Africa, an umbrella body, has applied to the national treasury for over $110 million for projects at some of the largest schools. During a visit to South Africa in June, UNAIDS executive director Winnie Byanyima was well aware of the stakes, and the lives at risk, as research and health care struggle in South Africa and across Africa at large. Other countries that were highly dependent on U.S. funding including Zambia, Nigeria, Burundi and Ivory Coast are already increasing their own resources, she said. 'But let's be clear, what they are putting down will not be funding in the same way that the American resources were funding,' Byanyima said. Magome writes for the Associated Press. Associated Press writer Michelle Gumede in Johannesburg contributed to this report.
The Hill
4 hours ago
- The Hill
Promising technologies are not yet ready to replace animal research
A recent op-ed in The Hill praising the National Institutes of Health's new initiative to promote human-based technologies as a 'major victory for animal ethics in science' oversimplifies a far more complex research landscape. While the piece correctly identifies growing support and development of innovative, non-animal approaches, it is misleading in its framing and overstates what this federal initiative actually signals about the future of animal research. Animal studies remain essential to both basic and translational science. From mapping brain circuitry to developing life-saving vaccines, the use of animal models has helped scientists uncover core biological mechanisms and test therapies with a degree of whole-organism complexity that no alternative system can yet match. Research involving animals has been directly responsible for major advances in treating cancer, HIV/AIDS, diabetes and countless other diseases. To suggest that NIH is ready to 'leave outdated animal experiments behind' is to paint an unrealistic picture of the current scientific landscape. It implies that non-animal alternatives are fully capable of replacing animal studies across the board. In reality, these technologies — while exciting and valuable — are still evolving and have significant limitations. This kind of oversimplification does a disservice not only to the scientific community but also to public understanding. Non-animal research methods such as organ-on-a-chip platforms, computational models and 3D bioprinting hold great promise. They offer different ways to model disease, study mechanisms of action and even predict certain aspects of human physiology. But they are not yet equipped to serve as wholesale replacements for animal research. Instead, they are powerful complementary tools that can be used alongside traditional models to enrich our understanding and refine research methods. This oversimplification misleads people into believing that animal and non-animal model research is either-or, when in most cases, these models work together to address different angles of a research question. Consider Emulate's liver chip. This sophisticated model includes four types of human liver cells and has demonstrated promising applications in toxicology and disease modeling. However, the human liver contains at least seven essential cell types, and critical components are missing from the liver chip. This means the model currently lacks the complexity needed to reliably replicate diseases that affect the entire liver, let alone multiple systems. While the technology shows potential, a recent study demonstrates that there are clear limitations, including the inability to perform long-term studies due to challenges in sustaining human liver cells over time. This is just one example of how non-animal models, although deserving of federal support, still have considerable progress to make before they can completely replace animals — a concept acknowledged by the developers of these technologies. Public trust in science has declined in recent years, leaving the research community with a responsibility to communicate scientific issues with clarity, honesty and appropriate context. However, comparing funding levels for animal models versus non-animal models is an ineffective and misleading way to provide transparency. Funding levels fluctuate from year to year for various reasons, including shifting priorities, new projects and the start or natural conclusion of existing studies. Public reporting of these numbers without further context fails to reflect the true complexity, value and potential outcomes of research. Instead, scientists should take opportunities to discuss the goals of their research, the rationale behind the methods and study design and how funding supports the broader mission of improving human and animal health. Using a variety of models helps to ensure that the best research is being done to benefit patients and their families. While organ-on-a-chip and other non-animal technologies show promise, their limitations prevent them from being a full replacement for many animal models. The development of non-animal methods should not come at the expense of the existing established models that still require animals. To sustain scientific progress and drive the next wave of medical breakthroughs, agencies like NIH should focus on funding the best research possible with the most appropriate available models. Alissa Hatfield, MS, is a science policy manager for the American Physiological Society. Naomi Charalambakis, Ph.D., is the director of communications and science policy at Americans for Medical Progress.
