New peer-reviewed study reveals severe health and economic consequences of 2025 Medicaid policy changes

Research published in JAMA Health Forum projects 13-14 excess deaths and over 800 preventable hospitalizations annually per 100,000 people losing Medicaid coverage

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Waymark, a public benefit company dedicated to improving access and quality of care in Medicaid, today published peer-reviewed research in JAMA Health Forum examining the projected health system and economic impacts of 2025 Medicaid policy changes. The study, conducted in collaboration with researchers at the University of North Carolina at Chapel Hill, reveals that H.R. 1, the "One Big Beautiful Bill Act" recently passed by Congress, could result in devastating consequences for vulnerable populations, rural communities, and local economies nationwide.

Numerous studies from multiple organizations, including the nonpartisan Congressional Budget Office (CBO), estimate that Medicaid changes including eligibility restrictions, work requirements, and reduced federal matching rates would result in between 7.6 million and 14.4 million Americans becoming uninsured by 2034. Unlike previous analyses focused on enrollment projections, this study quantifies how changes in federal spending and coverage could impact population-level health outcomes and create economic ripple effects for communities across the country — particularly in rural areas already struggling with healthcare access. 

Key findings: 

The study projects that for every 100,000 people who lose Medicaid coverage, communities can expect substantial consequences for health outcomes and economic stability:

Health and Economic Impacts (Per 100,000 People Losing Coverage):

• 13-14 excess deaths annually

• 810-924 preventable hospitalizations annually

• ~2,582 jobs lost annually

• ~$1.2 billion in reduced economic output annually

Healthcare System Impacts (National Scale):

• Rural hospitals face heightened risk of closure, with impact disproportionate to coverage losses due to the high concentration of patients on Medicaid in rural areas

• Federally qualified health centers (FQHCs) experience revenue reductions of 18.7-26.1% depending on coverage loss magnitude and the degree to which patients losing Medicaid would be able to gain other forms of insurance (e.g., Exchange plans)

The study analyzed both base case and higher coverage loss scenarios, with per-capita health and economic consequences remaining consistent across both scenarios. These projected ratios can be applied regardless of the final number of people affected by the policy changes, as uncertainty remains regarding the scale of coverage losses due to administrative burdens of renewal and work requirement verification processes. The study is based on a comprehensive microsimulation model incorporating empirically derived parameters from peer-reviewed literature on health outcomes, healthcare systems, and local economies.

"This analysis demonstrates that Medicaid policy changes in H.R. 1 could have far-reaching consequences extending well beyond federal budget considerations," said Dr. Sanjay Basu MD PhD, lead author of the study and Co-Founder and Head of Clinical for Waymark. "The data shows that rural and underserved communities would bear a disproportionate burden of these policy changes, with implications for people’s lives and livelihoods that state and local policymakers must carefully consider."

With H.R. 1 now signed into law, these findings provide critical insights into what communities can expect as the legislation's provisions take effect. The law includes 80-hour monthly work requirements for able-bodied adults, enhanced eligibility verification every six months, and reduced federal matching rates for expansion populations—representing the most significant restructuring of Medicaid since the program's creation.

“Medicaid affects many different aspects of people’s lives,” said Dr. Seth A. Berkowitz MD MPH, co-author of the study and Associate Professor of Medicine at the University of North Carolina School of Medicine. “When Medicaid gets cut, there are of course health impacts to the people who lose coverage. But there are also important impacts to the broader community, and policymakers need to consider those impacts as well.”

Recognizing the importance of tracking implementation impacts, the research team has made their microsimulation model open source to enable updated estimates as implementation details are finalized. This approach ensures that policymakers and stakeholders have access to the most current projections as states develop their implementation plans.

"This research demonstrates the critical importance of understanding the full consequences of proposed Medicaid changes beyond federal budget numbers,” said Dr. Sadiq Y. Patel MSW PhD, an author for the study and VP of Data Science and Artificial Intelligence for Waymark. “Our model reveals that coverage losses would cascade through communities in ways that profoundly impact public health, healthcare delivery systems, and local economies. These findings should inform policymakers about the real-world trade-offs inherent in these policy decisions."

The research letter titled "Projected Health System and Economic Impacts of 2025 Medicaid Policy Proposals" was published in JAMA Health Forum. The study was conducted by Dr. Sanjay Basu (Waymark, University of California San Francisco), Dr. Sadiq Y. Patel (Waymark, University of Pennsylvania), and Dr. Seth A. Berkowitz (University of North Carolina at Chapel Hill). 
 

About Waymark

Waymark is a public benefit company dedicated to improving access and quality of care for people receiving Medicaid. We partner with health plans and primary care providers—including health systems, community health centers, and independent practices—to improve outcomes through community-based care. Our local teams of community health workers, pharmacists, therapists and care coordinators use proprietary data science and machine learning technologies to deliver evidence-based interventions to hard-to-reach patient populations. Waymark's peer-reviewed research has been published in leading journals including the New England Journal of Medicine (NEJM) Catalyst, Nature Scientific Reports, and Journal of the American Medical Association (JAMA)—demonstrating measurable improvements in health outcomes and cost savings for Medicaid populations. For more information, visit www.waymarkcare.com.

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Journal

JAMA Health Forum

DOI

10.1001/jamahealthforum.2025.3187 

Article Title

Projected Health System and Economic Impacts of 2025 Medicaid Policy Proposals

Article Publication Date

16-Jul-2025

 

Faster, smarter, more open: a new way to accelerate AI models

Algorithms developed by Weizmann Institute and Intel Labs researchers enable AI developers around the world to combine the power of different AI models “thinking” as one

Weizmann Institute of Science

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Just as people from different countries speak different languages, AI models also create various internal “languages” – a unique set of tokens understood only by each model. Until recently, there was no way for models developed by different companies to communicate directly, collaborate or combine their strengths to improve performance. This week, at the International Conference on Machine Learning (ICML) in Vancouver, Canada, scientists from the Weizmann Institute of Science and Intel Labs are presenting a new set of algorithms that overcome this barrier, enabling users to benefit from combined computational power of AI models working together. The new algorithms, already available to millions of AI developers around the world, speed up the performance of large language models (LLMs) – today’s leading models of generative AI – by 1.5 times, on average.

LLMs, such as ChatGPT and Gemini, are powerful tools, but they come with significant drawbacks: They are slow and consume large amounts of computing power. In 2022, major tech companies realized that AI models, like people, could benefit from collaboration and division of labor. This led to the development of a method called speculative decoding, in which a small, fast model, possessing relatively limited knowledge, makes a first guess while answering a user’s query, and a larger, more powerful but slower model reviews and corrects the answer if needed. Speculative decoding was quickly adopted by tech giants because it maintains 100-percent accuracy – unlike most acceleration techniques, which reduce output quality. But it had one big limitation: Both models had to “speak” the exact same digital language, which meant that models developed by different companies could not be combined.

“Tech giants adopted speculative decoding, benefiting from faster performance and saving billions of dollars a year in cost of processing power, but they were the only ones to have access to small, faster models that speak the same language as larger models,” explains Nadav Timor, a PhD student in Prof. David Harel’s research team in Weizmann’s Computer Science and Applied Mathematics Department, who led the new development. “In contrast, a startup seeking to benefit from speculative decoding had to train its own small model that matched the language of the big one, and that takes a great deal of expertise and costly computational resources.”

The new algorithms developed by Weizmann and Intel researchers allow developers to pair any small model with any large model, causing them to work as a team. To overcome the language barrier, the researchers came up with two solutions.

First, they designed an algorithm that allows an LLM to translate its output from its internal token language into a shared format that all models can understand. Second, they created another algorithm that prompts such models to mainly rely in their collaborative work on tokens that have the same meaning across models, similarly to words like “banana” or “internet” that are nearly identical across human languages.

“At first, we worried that too much information would be ‘lost in translation’ and that different models wouldn’t be able to collaborate effectively,” says Timor. “But we were wrong. Our algorithms speed up the performance of LLMs by up to 2.8 times, leading to massive savings in spending on processing power.”

The significance of this research has been recognized by ICML organizers, who selected the study for public presentation – a distinction granted to only about 1 percent of the 15,000 submissions received this year. “We have solved a core inefficiency in generative AI,” says Oren Pereg, a senior researcher at Intel Labs and co-author of the study. “This isn’t just a theoretical improvement; these are practical tools that are already helping developers build faster and smarter applications.” 

In the past several months, the team released their algorithms on the open-source AI platform Hugging Face Transformers, making them freely available to developers around the world. The algorithms have since become part of standard tools for running efficient AI processes.

“This new development is especially important for edge devices, from phones and drones to autonomous cars, which must rely on limited computing power when not connected to the internet,” Timor adds. “Imagine, for example, a self-driving car that is guided by an AI model. In this case, a faster model can make the difference between a safe decision and a dangerous error.”

Also participating in the study were Dr. Jonathan Mamou, Daniel Korat, Moshe Berchansky and Moshe Wasserblat from Intel Labs and Gaurav Jain from d-Matrix.

 

Prof. David Harel is the incumbent of the William Sussman Professorial Chair of Mathematics.

 

Delicious but damaging invasive golden oyster mushrooms are decreasing fungal community richness

University of Wisconsin-Madison

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MADISON - A popular species of edible mushroom, golden oyster, has spread rapidly throughout the United States since escaping from cultivation into the wild. Now, a new study from researchers at the University of Wisconsin–Madison shows these mushrooms are spreading in every direction from their initial documented escapes in New York, Iowa, Wisconsin and Ohio. The study, published in the journal Current Biology, also found that ecosystems invaded by the golden oyster support less diversity of fungal species and smaller numbers of native fungal species.

“The same way that plants and animals can be invasive, mushrooms can also be invasive,” says Aishwarya Veerabahu, a doctoral student in the Department of Botany and lead author of the paper.

The study uses data collected from shavings of dead tree trunks in the UW–Madison Arboretum and Madison parks, allowing the researchers to determine what fungal species are present, both native and invasive. It also incorporates observational data from community scientists around the country.

Biodiversity loss is an ongoing problem across the globe, and loss of fungal biodiversity is a young, but growing, field of study. Without diversity in ecosystems, species have a smaller pool of genetics at their disposal to evolve and continue to survive. Since fungi provide ecosystem services in unique niches, loss of native species could dramatically alter how an ecosystem functions.

The study’s takeaways included:

• Golden oyster mushrooms are displacing other fungal species, decreasing biodiversity. Trees where golden oyster mushrooms were detected hosted about half as much diversity of fungal species as trees where the golden oyster mushroom was not detected. Loss of native fungal diversity could have implications for the rate of decomposition and carbon storage capacity in forests. It could also deplete fungal species with rich potential for pharmaceutical development.
• Climate models predict that the range of habitability for this mushroom will increase. As the planet continues to warm, golden oyster mushrooms will be able to invade more ecosystems and continue to spread across the country. That could mean more ecosystems will lose fungal biodiversity in the future. In future studies, Aishwarya hopes to explore what traits make the golden oyster mushroom a successful invasive, as there may be an overlap with traits that make it desirable for cultivation.
• Community scientists made tracking the rapid spread of golden oysters possible. The team used visual observations reported on iNaturalist and MushroomObserver to map out the range of the mushroom in the United States. They also used that data to predict where the mushroom might be able to continue its spread.
• Just because there are no visible mushrooms on a tree does not rule out the presence of the golden oyster mushroom. The most recognizable part of the golden oyster, the part people eat, is actually just the fungus’ fruiting body. The team tested wood shavings from trees to also look for the presence of golden oyster at a molecular level.

 

This research was made possible by the UW Arboretum’s Leopold Fellowship and the USDA Forest Service.

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Journal

Current Biology

Method of Research

Meta-analysis

Subject of Research

Not applicable

 

What does it cost an animal to fight?

Cell Press

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Lithobates catesbeianus

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Credit: Randy Dzenkiw

How do animals decide when to fight and when to walk, fly, slither, or swim away? Most research on animal conflict has focused on the short-term costs of single interactions, but a pair of behavioral ecologists argue that these one-time events might paint an incomplete picture. In an opinion paper publishing July 16 in the Cell Press journal Trends in Ecology & Evolution, the researchers say that to really understand the consequences of animal conflict, we need to also consider its long-term and cumulative impact on an individual’s longevity and reproduction. 

“By linking individual contests to lifetime reproductive success, we can understand how different contexts and environmental situations could favor the evolution of decision strategies in different species,” says author and ecologist Paulo Enrique Cardoso Peixoto of Universidade Federal de Minas Gerais in Brazil.  

Contests are ubiquitous across the animal kingdom, note the authors. In many cases, these fights are symbolic and may or may not involve physical contact, but they can deplete energy reserves, and in some cases result in physical injury and death. Usually, animals engage in contests when competing for a resource such as food, shelter, territory, or mating partners. Since contests have the potential to result in both benefits and costs, scientists have long thought that different species must have evolved strategies for deciding whether to fight, and if they do fight, when to quit.  

The researchers say that the optimal conflict strategy would vary depending on the species and situation. For example, the potential benefits might outweigh the risks for very valuable resources, but for less important resources, individuals might be better off abstaining, especially if they are unlikely to win. They also note that some costs carry more weight than others.  

“If snapping shrimp lose a claw during a fight, it can regrow, so it’s not a total loss because they can recover and fight subsequent contests,” says Peixoto. “But, if a beetle breaks a horn during a fight, it will not regrow, so that individual will be unable to fight again, and since they often fight for female access, this means they will be unable to reproduce anymore.” 

To examine how costs have been characterized and quantified previously, the researchers conducted a systematic review of field and laboratory studies. From 73 articles spanning 62 animal species, they identified 24 different types of cost, which they grouped into six categories: increased metabolism, increased stress and decreased immune response, increased risk of injury and mortality, decreased foraging opportunities, decreased predator awareness, and decreased investment in parental care.  

They found that researchers studying different types of animal tend to measure different types of cost, which makes it difficult to compare findings. For example, studies in crustaceans and fishes were more likely to measure metabolic costs, whereas studies in insects usually measured direct injuries.  

“There is huge variation in the measurements researchers take,” says Peixoto. “Variation is not a bad thing, but the lack of standardization in the way we do this precludes us from estimating whether there is an average cost between different species, or investigating the variation among species.” 

In many cases, the researchers argue, the costs measured are not the most relevant for understanding the consequences of contests. They also rarely extend beyond measuring the short-term consequences of isolated incidents.  

“We need to link the average cost in a single contest to the individual’s longevity or lifetime reproductive success,” says Peixoto. “For example, are there contexts that favor individuals that always fight and are more aggressive, and other situations that favor more cautious individuals that only fight weaker rivals to increase their chances of winning?” 

To link short- and long-term costs, the researchers propose a three-step process, starting with identifying the most important cost for the species they’re studying. The next step is measuring how this cost accumulates during a single contest, relative to the animal’s baseline. Finally, the team recommends linking this single-contest data to long-term data on how frequently different individuals fight, and how many offspring frequent and non-frequent fighters produce. 

“By knowing the average number of fights that different individuals are involved in and their lifespans, we can estimate whether individuals who fight more or less have better lifetime reproductive success,” says Peixoto. “This connection would allow us to gain deeper insights into the evolutionary dynamics of animal contests and the trade-offs individuals face.” 

Philaeus chrysops

Credit

Anatoly Ozernoy 

This research was supported by funding from Fundação de Amparo à Pesquisa do Estado de São Paulo and Conselho Nacional de Desenvolvimento Científico e Tecnológico. 

Trends in Ecology & Evolution, Peixoto et al., “What we (don’t) know about costs in animal contests” https://www.cell.com/trends/ecology-evolution/fulltext/S0169-5347(25)00153-3

Trends in Ecology & Evolution (@Trends_Ecol_Evo), published by Cell Press, is a monthly review journal that contains polished, concise, and readable reviews and opinion pieces in all areas of ecology and evolutionary science. It aims to keep scientists informed of new developments and ideas across the full range of ecology and evolutionary biology—from the pure to the applied, and from molecular to global. Visit http://www.cell.com/trends/ecology-evolution. To receive Cell Press media alerts, please contact press@cell.com. 

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Journal

Trends in Ecology & Evolution

DOI

10.1016/j.tree.2025.05.008 

Method of Research

Systematic review

Subject of Research

Animals

Article Title

What we (don’t) know about costs in animal contests

Article Publication Date

16-Jul-2025

 

Why some elephants take more risks around people than others

CUNY Graduate Center researchers found that wild elephants closer to farms are more curious around and attracted to new objects — insights that may help reduce human-elephant conflict

The Graduate Center, CUNY

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A Thai elephant checks out a cattle brush in an experiment showing that elephants living near farms are more interested in exploring unfamiliar objects — a curiosity that may put them in harm’s way.

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Credit: Sarah Jacobson

Elephants that live near farms are more daring than their deep-forest counterparts, and that behavior could be the key to helping people and elephants get along.

That’s the central finding of new research by CUNY Graduate Center alumna Sarah Jacobson (Ph.D. ’24, Psychology), published in Royal Society Open Science. Working with Professor Joshua Plotnik (GC/Hunter, Psychology), Jacobson found that wild elephants on the edge of agricultural land in Thailand were more curious and exploratory when presented with unfamiliar objects than elephants living in protected forests.

The paper is a chapter of Jacobson’s dissertation, completed under Plotnik’s mentorship. By showing how elephants’ behavior shifts across different landscapes, the study adds important insight into how wild animals adapt to human-dominated environments and why some may take more risks than others.

“Understanding why some elephants are more willing to take risks to engage with humans in habitats where they share food and other resources may help in the development of more effective conflict mitigation methods,” said Plotnik, who directs the Comparative Cognition for Conservation Lab at Hunter College.

“We conducted this study because we wanted to learn more about how individual elephants differ,” Jacobson said. “We were interested in the characteristics of those elephants who are leaving the forest to spend time close to people, which can cause a lot of problems.”

The study compared elephant responses to new objects — such as cattle brushes and firehoses — in two different settings: a remote forest sanctuary and a landscape adjacent to farmland. The elephants living near people were more likely to investigate and interact with the objects, showing higher levels of what researchers call neophilia, or attraction to novelty.

This behavior may give those elephants an edge in finding high-calorie resources like crops, but it also increases the risk of dangerous encounters with humans. As elephants lose habitat to development, they often seek food in villages and fields, leading to conflict with local communities.

Jacobson also explored whether curiosity and exploration were stable personality traits in elephants by comparing individual responses to multiple objects. But too few elephants encountered both objects to draw firm conclusions about consistency in behavior.

Still, the findings offer a powerful glimpse into how animal behavior is shaped by the environment. They suggest that individual differences in curiosity may help elephants adapt, but at a cost.

The research builds on Plotnik’s long-standing work at the intersection of animal cognition and conservation. His lab aims to translate scientific understanding of animal minds into practical tools for protecting endangered species like the Asian elephant. Work conducted by the lab was recently featured on CBS’s 60 Minutes in a segment about human-elephant conflict in Thailand.

“I feel fortunate to have been able to work on a research project that can help both people and elephants as part of my dissertation at the Graduate Center,” Jacobson said. “I look forward to seeing more results from the Comparative Cognition for Conservation Lab’s research about elephant personality traits and the current work to integrate this behavioral knowledge into novel ways to reduce negative interactions between elephants and people.”

This work was funded, in part, by the U.S. Fish and Wildlife Service’s Asian Elephant Conservation Fund, the Golden Triangle Asian Elephant Foundation, and the Research Foundation of CUNY.

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Journal

Royal Society Open Science

DOI

10.1098/rsos.250896 

Method of Research

Experimental study

Subject of Research

Animals

Article Title

Wild elephants vary in their attraction to novelty across an anthropogenic landscape gradient

Article Publication Date

16-Jul-2025

 

How a tiny gene ensures the survival of male birds

Researchers from Heidelberg and Edinburgh identify a mechanism that balances the genetic disparity between sex chromosomes

Heidelberg University

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Recent studies on the genetic differences between bird sex chromosomes reveal a tiny gene crucial for male survival.

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Credit: © Nils Trost, Sara Yousefi Taemeh

Birds have developed a unique evolutionary solution to ensure the survival of males – a powerful microRNA. This tiny gene allows male embryos to survive despite a genetic imbalance between the sexes by balancing the activity of the sex chromosomes. An international research team led by biologists from Heidelberg University and the University of Edinburgh (Scotland) has discovered this previously unknown mechanism, which differs significantly from the system that mammals have developed in the course of evolution to address the same biological challenge.

Sex chromosomes, which determine whether an individual is male or female, originated from an ordinary pair of chromosomes. In mammals, females carry two X chromosomes, while males have one X and one Y chromosome. In contrast, male birds have two Z chromosomes, and female birds have one Z and one W chromosome. Over time, the Y chromosome in mammals and the W in birds lost most of their genes due to their highly specialized sex-specific roles, meaning one sex retains two copies of most genes while the other has only one. Mammals compensate for this genetic imbalance by boosting the activity of the X chromosome in both sexes and “silencing” one of the two X chromosomes in females.

Using chickens as an example, the international research team has now demonstrated how birds resolve this issue. The loss of genetic material on the female-specific W chromosome is offset by increased activity of key genes on the Z chromosome. While this is vital for the survival of female birds, it leads to genetic overactivity in males with two Z chromosomes, resulting in growth defects if left unbalanced. The researchers, led by Prof. Dr Henrik Kaessmann (Heidelberg University) and Dr Mike McGrew (University of Edinburgh), suspected that a previously discovered microRNA – a short regulatory ribonucleic acid – plays a crucial role in this process.

“This microRNA is predominantly active in male birds, which led us to assume that it helps balance the activity of the Z chromosome,” explains Prof. Kaessmann, who conducts research at the Center for Molecular Biology of Heidelberg University (ZMBH). To test their hypothesis, the researchers used gene editing to remove the microRNA and studied the effects during early chicken development. While male embryos could not survive without the microRNA, females developed normally. According to the researchers, the same tiny gene is found in all bird species examined thus far, but not in other animals. “It is the only known microRNA that is essential for the survival of one sex, but not the other,” says Dr Amir Fallahshahroudi, former postdoc in Prof. Kaessmann’s team at the ZMBH and current group leader at Uppsala University in Sweden.

According to Dr McGrew, the mechanism of the male-specific microRNA works like a dimmer switch, dialing down the overactive genes on the two male Z chromosomes. “Our findings show that birds have developed a distinct evolutionary solution to offset the genetic imbalance between sex chromosomes and ensure the survival of male animals,” he emphasizes. They also highlight that evolution can arrive at different solutions for the same biological problem – and that tiny genes can have a dramatic impact on survival. “We now have to ask whether other animal species also use microRNAs to regulate their sex chromosomes, or whether they rely on different systems entirely,” adds Prof. Kaessmann.

Alongside the researchers from Heidelberg, Edinburgh and Uppsala, scientists from Abu Dhabi and China were also involved in the study. This research was funded by various organizations and foundations, including the European Research Council, the NOMIS Foundation, the Swedish Research Council and the Biotechnology and Biological Sciences Research Council (UK). The results have been published in the journal “Nature”.

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Journal

Nature

DOI

10.1038/s41586-025-09256-9 

Article Title

A male-essential miRNA is key for avian sex chromosome dosage compensation

Article Publication Date

16-Jul-2025