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In the News
What happened in healthcare recently—and what we think about it.
- House passes 'One Big Beautiful Bill'; 8.6 million could lose health insurance coverage. The House of Representatives passed the 2025 budget reconciliation bill, also known as the One Big Beautiful Bill Act, early Thursday morning after overcoming resistance within the Republican caucus. The bill institutes Medicaid work requirements, bars new or higher state provider taxes to fund the program, and reduces federal Medicaid funding for states that use their own funds to offer Medicaid coverage to undocumented immigrants. The passage comes after the Congressional Budget Office (CBO) released a budgetary analysis of an earlier version of the bill on Tuesday. CBO estimates the bill would result in a $698 billion cut in Medicaid between 2026 and 2034 along with a net increase of $78 billion in state spending due to the changes in state contributions to the Supplemental Nutrition Assistance Program and Medicaid. In an earlier CBO report, the office estimated that an estimated 8.6 million people would lose health insurance coverage under changes to provider taxes that were akin to what ultimately passed.
- The Gist: The reconciliation bill has passed a key hurdle in the House but still faces an uphill battle. There are competing interests; moderate Republicans in swing districts are hesitant to drastically cut Medicaid, while fiscal hawks want more spending cuts. Several Republican senators have come out against the House’s version of the bill. Notably, Sen. Josh Hawley (R-MO) rejects the extent of the Medicaid cuts, a reminder of the Republicans’ transformed base. The bond market has initially reacted negatively to the projected deficits the bill would cause, which could further imperil the bill’s chances. The work requirement, an administrative burden that will likely reduce the number of people on Medicaid without reducing benefits, appears to be a solution that mends the intra-party debate. Work requirement programs at the state level demonstrate that the administrative burden is high even for those who meet the requirements, increasing the burden on health systems that are already struggling to serve safety-net populations.
- FDA to change Covid booster guidelines. In a New England Journal of Medicine article on Tuesday, the Food and Drug Administration (FDA) outlined a new approval approach for future Covid-19 boosters. Under the new guidelines, the FDA will recommend different standards of evidence depending on patients’ risk of severe disease. For adults 65 and older and people as young as 6 months with risk factors, immunogenicity data—the current standard for Covid boosters—will suffice. But for those with no risk factors who are older than 6 months and younger than 65, randomized controlled trials using placebos will be required.
- The Gist: The change could hinder the development of new boosters, given the added costs of running a randomized controlled trial. This could also increase infection rates and therefore long Covid rates. While there are risk factors for developing long Covid, anyone who had the illness can develop long Covid. An estimated 10-20% of people who had Covid experienced long Covid symptoms. Additionally, people get Covid boosters for reasons other than their own personal risk of developing severe disease; for example, they might live or work with someone who is immunocompromised. These people may now struggle to get boosters. Given the Trump administration’s skepticism toward vaccines, the requirement for new standards of evidence is not surprising but could further undermine waning trust in public health.
- Former President Biden diagnosed with aggressive prostate cancer. On Sunday, former President Joe Biden’s office announced that he has been diagnosed with prostate cancer. Biden, 82, was diagnosed last Friday, after reporting urinary symptoms. Biden was diagnosed with an aggressive form that has metastasized to the bone. Biden’s Gleason score, a gauge that measures prostate cancer’s aggressiveness, was 9, with 10 being the highest. His cancer appears to be hormone-sensitive, which could make treatment more manageable.
- The Gist: This case illustrates how population health recommendations do not always align with individual health needs and the challenges of cancer screening in older populations. Biden’s case is rare, as the average age of a prostate cancer diagnosis is 67 and most forms of prostate cancer are not this aggressive. The U.S. Preventive Services Task Force (UPSTF) does not recommend prostate-specific antigen (PSA) screenings, a common screening for prostate cancer, for men over 70, as the risks of testing are considered to outweigh potential benefits. USPSTF provides important recommendations for clinicians who usually do not see macro-level data. However, the Task Force’s work could be hindered by a Department of Health and Human Services restructuring that affects the Agency for Healthcare Research and Quality, which provides critical logistical support to USPSTF. The diagnosis is doubly wounding, as Biden’s support for cancer research was core to his presidency and the disease has already touched his life. Biden relaunched his “Cancer Moonshot” initiative in 2022 with the goal of halving the cancer death rate by 2047, and lost his 46-year-old son to brain cancer in 2015.
Plus—what we’ve been reading.
- CRISPR to the rescue with personalized cure for infant: Published in The New York Times last week, this article details a medical breakthrough: the first successful use of a personalized CRISPR-based gene-editing therapy in a human patient. This piece details the practical use of CRISPR, which it describes as “a molecular GPS,” to treat a 9-month-old infant named KJ with CPS1 deficiency at Children’s Hospital of Philadelphia. Physicians developed and administered the bespoke treatment in just 6 months—a process that would traditionally take a decade. After receiving only a few doses, the infant, who had spent nearly his entire first year hospitalized, is now nearly healthy enough to go home.
- The Gist: Personalized gene therapies are becoming increasingly possible with strong interdisciplinary collaboration. This case illustrates the potential of agile collaboration among hospitals, academic institutions and industry partners to accelerate the path from bench to bedside by overcoming cost, manufacturing and regulatory challenges. While this article describes a breakthrough treatment for only one rare disease, CRISPR technologies are capable of editing much more than just a single base. Unique gene editors could potentially be developed for more than 30 million people living with rare diseases in the United States today. The rapid evolution of these and other gene therapies require a proactive, streamlined approach to bridge clinical and research expertise with operational capacity, federal regulation and finance to ensure high-quality care. Notably, researchers in this case highlighted the role that decades of government funding for research played in the development of KJ’s treatment, a future that is under threat due to spending cuts.
Graphic of the Week
A key insight illustrated in infographic form.
Intersection of performance improvement and health access
This week’s graphic highlights Vizient Vulnerability Index (VVI) and procedure utilization data to show how utilization differs when certain socioeconomic factors are considered. Patients with higher VVI scores used less care across a variety of scheduled procedures. The differences in utilization between high and low VVIs and between high and average VVIs were particularly stark, 37% and 27% respectively for surgical valve procedures. Patients with higher VVI scores (i.e., those who were more vulnerable) had worse care outcomes. For transcatheter valve procedures and surgical valve procedures, patients with high VVI scores had a longer average length of stay and higher inpatient mortality rates. Addressing social determinants of health is not only good for health access but can also be a part of a well-rounded performance improvement strategy.
This Week at Kaufman Hall
What our experts are saying about key issues in healthcare.
Advanced practice providers (APPs) now comprise about 40% of the clinical workforce in the United States. With median salaries and fringe benefits for APPs now approaching $200,000 a year, health systems can no longer afford to think of APPs as “physician extenders” or expensive scribes.
In a new article, originally published with The Governance Institute, Bonnie Proulx discusses how hospitals and health systems must work to effectively integrate APPs across clinical settings and develop the operational and financial data points needed to monitor the efficacy and efficiency of that integration. Most importantly, they must ensure that APPs are being deployed in ways that enable the physicians they work with to operate at the top of their potential.
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Thanks for reading! We’ll see you next Friday with a new edition. In the meantime, check out our Gist Weekly archive if you’d like to peruse past editions. We also have all of our recent “Graphics of the Week” available here.
Best regards,
The Gist Weekly team at Kaufman Hall
