Jane Tavares, UMass Boston and Marc Cohen, UMass Boston

Republicans in Congress intend to cut about US$880 billion in federal health care spending.

One of their primary targets is Medicaid. That government program covers 82 million Americans with health insurance. Most of the people enrolled in the program are low income, have disabilities, or both.

Medicaid, jointly funded by the federal government and the states, is also the biggest funder in the U.S. of long-term care services, whether they are delivered in the patient’s home, another location where they spend part of their day or a nursing home. That makes it particularly important for older adults and those with disabilities. All states must meet the basic federal guidelines for Medicaid coverage. But 41 states have opted to take advantage of the Affordable Care Act provision that expanded eligibility to cover more people under the program.

We are gerontology researchers who study health and financial well-being in later life. We’ve been analyzing what the potential impacts of Medicaid cuts might be.

While the debate about how to reduce the budget focuses largely on dollars and cents, we believe that cutting federal spending on Medicaid would harm the health and well-being of millions of Americans by reducing their access to care. In our view, it’s also likely that any savings achieved in the short term would be smaller than the long-term increase in health care costs born by the federal government, the states and patients – including for many Americans who are 65 and older.

Weak track record

Wary of backlash from their constituents, Republicans have agreed on a strategy that would largely cut Medicaid spending in a roundabout way.

Previous efforts by the GOP in some states, such as imposing work requirements for some people to get Medicaid benefits, have not greatly reduced costs. That’s largely because there are relatively few people enrolled in the Medicaid program who are physically able to be employed and aren’t already in the workforce. Nor have past efforts to reduce fraud, waste and abuse led to significant savings.

According to widespread media reports, Republicans are considering changes that would cut the amount of money that the federal government reimburses states for what they spend on Medicaid.

In May 2025, the nonpartisan Congressional Budget Office estimated that 8.6 million Americans would lose their health insurance coverage should the GOP proposal become law.

Historically, states have dealt with budget cuts by reducing their payments to health care providers, limiting eligibility or restricting benefits. These reductions all particularly affected home- and community-based services that many disabled and older adults rely on.

About 3 in 4 of the people with Medicaid coverage who receive long-term care through the program get that care at home, in their communities or both, rather than residing in a nursing home. States save an estimated 26 cents for every dollar spent on those services delivered outside nursing homes.

Losing coverage can be harmful for your health

We recently analyzed data from a nationally representative study of approximately 6,000 people who had Medicaid coverage but lost it when they turned age 65 because their income exceeded 100% of the federal poverty level. In 2025, that cutoff is about $15,560 for a single person and $21,150 for a couple.

Medicaid income eligibility generally drops from 138% to 100% of the federal poverty level at age 65 once Medicare becomes a person’s primary health insurer.

The people who participated in the study had lost their Medicaid coverage upon turning 65 between 1998 and 2020. Our team followed the experiences of these participants over a 10-year period starting at age 65 to see how they fared compared with people who continue to be enrolled in Medicaid after their 65th birthday.

What we found was both surprising and disturbing.

Fewer activities of daily living

Over the decade following that milestone, the people who lost their Medicaid coverage had more chronic conditions and could perform fewer activities of daily living, such as bathing and getting dressed, without any assistance as compared with those who still had Medicaid coverage. In addition, they were twice as likely to experience depression and be in fair or poor health.

As people’s health worsened, they also went to the hospital more often and stayed there longer. They also used outpatient surgery services more frequently.

These services are particularly expensive for the health care system. Depending on the service, it may also be costly for patients. Unlike the comprehensive coverage of Medicaid, the Medicare program fully covers only inpatient hospitalizations, short-term nursing facility care, hospice, some short-term home care, annual wellness visits, vaccines and some basic preventive care. Beyond that, Medicare requires the payment of premiums to help with uncovered services that can also include deductibles and copays.

This arrangement can lead to significant out-of-pocket costs that make health care hard for low-income older adults to afford unless they have both Medicare and Medicaid coverage.

We also found that older people who lost Medicaid coverage were less likely to see their primary care physician for routine and follow-up care, despite being enrolled in Medicare. This explains in part why they are going to the hospital more often, likely avoiding routine health care that may incur out-of-pocket costs and eventually utilizing Medicare-covered hospital care when needed.

In short, we found that exiting the Medicaid program upon turning 65 actually leads to an increase in the use of some of the most expensive health care services, such as inpatient hospitalization and outpatient surgery. So although Medicaid may no longer pay for these costs, the rest of the health care system does.

Just under 90% of older adults enrolled in Medicare have some kind of supplemental coverage that helps them pay for services that the program doesn’t cover. For 16% of the people with Medicare coverage, Medicaid covers those additional health care costs. The rest of that nearly 90% obtain supplemental coverage from private insurance companies or are enrolled in a Medicare Advantage plan that’s run by a private company instead of the government.

However, 11% of Americans covered by Medicare don’t have any additional coverage. It is likely that those who lost Medicaid benefits at age 65 may not be able to afford any other supplemental coverage options and fall into this group.

People who lose Medicaid coverage may die sooner

One of our more troubling findings was that people who lost Medicaid coverage at age 65 were 14% more likely to die within the next 10 years than were those who kept their coverage in addition to gaining Medicare coverage. This was true even though the people who lost their Medicaid access tended to start out in better health.

Roughly 12 million Americans are enrolled in both Medicare and Medicaid today. Much is at stake for them and other low-income people as Congress considers making major changes to the program to cut federal spending on it.

For some Americans, it’s a matter of life and death. For others, it’s a matter of healthy versus unhealthy aging that leads to costlier health care not just for themselves but for the U.S. as a whole.

Jane Tavares, Senior Research Fellow and Lecturer of Gerontology, UMass Boston and Marc Cohen, Professor of Gerontology, UMass Boston

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Carol Mathews, University of Florida

Obsessive compulsive disorder has many unknowns, including what causes it, why symptoms can differ so much between people, how medication and therapy for it actually work, and why treatment is effective for some people and not for others. In our newly published research, my colleagues and I made a step toward unraveling some of these mysteries by shedding light on the genetics of OCD.

Obsessive compulsive disorder is one of the most impairing illnesses worldwide. Affecting about 1 in 50 people globally, OCD is among the top 10 causes of years lost to disability, leading to harmful effects on a person’s ability to work and function in the world and on their family.

Compared with people without OCD, a person with the condition has a 30% higher chance of dying prematurely from natural causes, such as infections or other illnesses, and a 300% higher chance of dying early from nonnatural causes, such as accidents or suicide.

People with OCD experience obsessions – disturbing, recurrent and unwanted thoughts, fears or mental images – and compulsions, such as repetitive behaviors and rituals performed to ease the anxiety usually caused by obsessions. For example, someone might wash their hands dozens of times or in a specific way to get rid of germs, even if they know it’s excessive or illogical. Avoiding certain places or situations to reduce anxiety or prevent triggering obsessions and compulsions is also common.

While the exact causes of OCD are unclear, researchers know that both genetic and environmental factors play a role in its development. OCD can run in families; studies attribute between 40% to 65% of OCD cases to genetic factors. OCD that begins in childhood has a stronger genetic influence than OCD that begins in adulthood.

But unlike some genetic diseases caused by a single faulty gene, such as cystic fibrosis or Huntington’s disease, OCD is influenced by hundreds to thousands of genes that each play a small part in disease risk.

My colleagues and I analyzed the DNA of over 53,000 people with OCD and over 2 million people without OCD, the largest study of this kind for this condition. We discovered hundreds of genetic markers potentially linked to OCD – data we hope will ultimately lead to improved ways of identifying people who are at risk for OCD and, down the line, to better treatments.

How scientists study OCD genetics

To find the genes involved in OCD risk, researchers use a method called a genome-wide association study, or GWAS. These studies compare the DNA of tens to hundreds of thousands of people with a disease of interest with the DNA of people without the disease, looking for tiny differences in the genetic material. These genetic markers may be linked to OCD or indicate the presence of other genes linked to the disease.

In a GWAS, scientists carefully test each of the millions of genetic markers across the genome to identify those found more often in people with OCD than in people without OCD. They then determine which genes those markers are associated with, where in the body they are active and how they might contribute to the condition.

We identified 30 areas in the genome linked to OCD, containing 249 genes of interest in total. Of those, 25 genes stood out as likely contributors to the development of OCD.

The top three genes we found are also linked to other brain disorders such as depression, epilepsy and schizophrenia. Several other genes of interest for OCD were found in a region of the genome that plays a role in adaptive immunity and has been associated with other psychiatric disorders.

Importantly, no single gene can predict or cause OCD on its own. Previous genetic studies have demonstrated that genes across all of the 23 pairs of chromosomes in people may contribute to OCD risk.

Genetic insights into OCD

Because the contribution of each genetic marker or gene to disease susceptibility is very small, GWAS are not useful for identifying genes that cause OCD for a given person. Rather, this kind of research helps scientists understand how the brain works in people with OCD and whether OCD shares genetic roots with conditions that commonly occur alongside it.

For example, the genetic markers we found to be associated with OCD were highly active in several brain regions known to play a role in development of the condition. These brain areas are collectively involved in planning, decision-making, motivation, error detection, emotion regulation, and fear and anxiety, all of which can malfunction in OCD.

We also found associations with a brain region called the hypothalamus, which converts emotions such as fear, anger, anxiety or excitement into physical responses. The hypothalamus has not been directly linked to OCD before, but it is part of a network of brain regions that may contribute to its symptoms.

Additionally, we found that certain types of brain cells – particularly medium spiny neurons in a brain region called the striatum – were strongly linked to the OCD genes we identified. Medium spiny neurons play an important role in habit formation, the process by which a behavior becomes automatic and habitual – think compulsions. Specific receptors on medium spiny neurons are common targets for medications that are sometimes used to help treat OCD.

The results of our study can help researchers better understand the relationships between OCD and other conditions. We found genetic links between OCD and several other psychiatric disorders, especially anxiety, depression, anorexia and Tourette syndrome. People with OCD also showed lower genetic risk for conditions such as alcohol dependence and risk-taking behavior, aligning with what doctors see in clinics: Many people with OCD tend to be cautious and avoid risks.

Surprisingly, we also found genetic overlaps between OCD immune-related conditions. While having OCD appears to be linked to an increased risk of asthma and migraines, it may also be linked to a reduced risk of inflammatory bowel disease. These findings may lead to new insights about the role the immune system and inflammation play in brain health.

More effective OCD treatment

OCD is a complex disorder that can look very different from person to person. Understanding the genetic and biological factors behind OCD helps researchers move closer to better diagnosis, treatment and possibly even prevention.

As a practicing psychiatrist and researcher, I have spent my career working to understand the causes of OCD and to improve the lives of those who live with the condition. With larger studies and continued research, my team and I hope to better match specific biological patterns to individual symptoms.

In time, this could lead to more personalized and effective treatments – improving the lives of millions of people living with OCD around the world.

Carol Mathews, Professor of Psychiatry, University of Florida

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Deidre Popovich, Texas Tech University

Knowing the calorie content of foods does not help people understand which foods are healthier, according to a study I recently co-authored in the Journal of Retailing. When study participants considered calorie information, they rated unhealthy food as less unhealthy and healthy food as less healthy. They were also less sure in their judgments.

In other words, calorie labeling didn’t help participants judge foods more accurately. It made them second-guess themselves.

Across nine experiments with over 2,000 participants, my colleague and I tested how people use calorie information to evaluate food. For example, participants viewed food items that are generally deemed healthier, such as a salad, or ones that tend to be less healthy, such as a cheeseburger, and were asked to rate how healthy each item was. When people did not consider calorie information, participants correctly saw a big gap between the healthy and unhealthy foods. But when they considered calorie information, those judgments became more moderate.

In another experiment in the study, we found that asking people to estimate the calorie content of food items reduced self-reported confidence in their ability to judge how healthy those foods were − and that drop in confidence is what led them to rate these food items more moderately. We observed this effect for calories but not for other nutrition metrics such as fat or carbohydrates, which consumers tend to view as less familiar.

This pattern repeated across our experiments. Instead of helping people sharpen their evaluations, calorie information seemed to create what researchers call metacognitive uncertainty, or a feeling of “I thought I understood this, but now I’m not so sure.” When people aren’t confident in their understanding, they tend to avoid extreme judgments.

Because people see calorie information so often, they believe they know how to use it effectively. But these findings suggest that the very familiarity of calorie counts can backfire, creating a false sense of understanding that leads to more confusion, not less. My co-author and I call this the illusion of calorie fluency. When people are asked to judge how healthy a food item is based on calorie data, that confidence quickly unravels and their healthiness judgments become less accurate.

Why it matters

These findings have important implications for public health and for the businesses that are investing in calorie transparency. Public health policies assume that providing calorie information will drive more informed choices. But our research suggests that visibility isn’t enough – and that calorie information alone may not help. In some cases, it might even lead people to make less healthy choices.

This does not mean that calorie information should be removed. Rather, it needs to be supported with more context and clarity. One possible approach is pairing calorie numbers with decision aids such as a traffic light indicator or an overall nutrition score, which both exist in some European countries. Alternatively, calorie information about an item could be accompanied by clear reference points explaining how much of a person’s recommended daily calories it contains – though this may be challenging because of how widely daily calorie needs vary.

Our study highlights a broader issue in health communication: Just because information is available doesn’t mean it’s useful. Realizing that calorie information can seem easier to understand than it actually is can help consumers make more informed, confident decisions about what they eat.

What still isn’t known

In our studies, we found that calorie information is especially prone to creating an illusion of understanding. But key questions remain.

For example, researchers don’t yet know how this illusion interacts with the growing use of health and wellness apps, personalized nutrition tools or AI-based food recommendations. Future research could look at whether these tools actually help people feel more sure of their choices – or just make them feel confident without truly understanding the information.

The Research Brief is a short take on interesting academic work.

Deidre Popovich, Associate Professor of Marketing, Texas Tech University

This article is republished from The Conversation under a Creative Commons license. Read the original article.