The Conversation

Taxpayers spend 22% more per patient to support Medicare Advantage – the private alternative to Medicare that promised to cost less

Published

9 months ago

November 26, 2024

theconversation.com – Grace McCormack, Postdoctoral researcher of Health Policy and Economics, University of Southern California – 2024-11-26 07:38:00

Grace McCormack, University of Southern California and Erin Duffy, University of Southern California

Medicare Advantage – the commercial alternative to traditional Medicare – is drawing down federal health care funds, costing taxpayers an extra 22% per enrollee to the tune of US$83 billion a year.

Medicare Advantage, also known as Part C, was supposed to save the government money. The competition among private insurance companies, and with traditional Medicare, to manage patient care was meant to give insurance companies an incentive to find efficiencies. Instead, the program’s payment rules overpay insurance companies on the taxpayer’s dime.

We are health care policy experts who study Medicare, including how the structure of the Medicare payment system is, in the case of Medicare Advantage, working against taxpayers.

Medicare beneficiaries choose an insurance plan when they turn 65. Younger people can also become eligible for Medicare due to chronic conditions or disabilities. Beneficiaries have a variety of options, including the traditional Medicare program administered by the U.S. government, Medigap supplements to that program administered by private companies, and all-in-one Medicare Advantage plans administered by private companies.

Commercial Medicare Advantage plans are increasingly popular – over half of Medicare beneficiaries are enrolled in them, and this share continues to grow. People are attracted to these plans for their extra benefits and out-of-pocket spending limits. But due to a loophole in most states, enrolling in or switching to Medicare Advantage is effectively a one-way street. The Senate Finance Committee has also found that some plans have used deceptive, aggressive and potentially harmful sales and marketing tactics to increase enrollment.

Baked into the plan

Researchers have found that the overpayment to Medicare Advantage companies, which has grown over time, was, intentionally or not, baked into the Medicare Advantage payment system. Medicare Advantage plans are paid more for enrolling people who seem sicker, because these people typically use more care and so would be more expensive to cover in traditional Medicare.

However, differences in how people’s illnesses are recorded by Medicare Advantage plans causes enrollees to seem sicker and costlier on paper than they are in real life. This issue, alongside other adjustments to payments, leads to overpayment with taxpayer dollars to insurance companies.

Some of this extra money is spent to lower cost sharing, lower prescription drug premiums and increase supplemental benefits like vision and dental care. Though Medicare Advantage enrollees may like these benefits, funding them this way is expensive. For every extra dollar that taxpayers pay to Medicare Advantage companies, only roughly 50 to 60 cents goes to beneficiaries in the form of lower premiums or extra benefits.

As Medicare Advantage becomes increasingly expensive, the Medicare program continues to face funding challenges.

In our view, in order for Medicare to survive long term, Medicare Advantage reform is needed. The way the government pays the private insurers who administer Medicare Advantage plans, which may seem like a black box, is key to why the government overpays Medicare Advantage plans relative to traditional Medicare.

Paying Medicare Advantage

Private plans have been a part of the Medicare system since 1966 and have been paid through several different systems. They garnered only a very small share of enrollment until 2006.

The current Medicare Advantage payment system, implemented in 2006 and heavily reformed by the Affordable Care Act in 2010, had two policy goals. It was designed to encourage private plans to offer the same or better coverage than traditional Medicare at equal or lesser cost. And, to make sure beneficiaries would have multiple Medicare Advantage plans to choose from, the system was also designed to be profitable enough for insurers to entice them to offer multiple plans throughout the country.

To accomplish this, Medicare established benchmark estimates for each county. This benchmark calculation begins with an estimate of what the government-administered traditional Medicare plan would spend on the average county resident. This value is adjusted based on several factors, including enrollee location and plan quality ratings, to give each plan its own benchmark.

Medicare Advantage plans then submit bids, or estimates, of what they expect their plans to spend on the average county enrollee. If a plan’s spending estimate is above the benchmark, enrollees pay the difference as a Part C premium.

Most plans’ spending estimates are below the benchmark, however, meaning they project that the plans will provide coverage that is equivalent to traditional Medicare at a lower cost than the benchmark. These plans don’t charge patients a Part C premium. Instead, they receive a portion of the difference between their spending estimate and the benchmark as a rebate that they are supposed to pass on to their enrollees as extras, like reductions in cost-sharing, lower prescription drug premiums and supplemental benefits.

Finally, in a process known as risk adjustment, Medicare payments to Medicare Advantage health plans are adjusted based on the health of their enrollees. The plans are paid more for enrollees who seem sicker.

Two sets of stacked boxes sit below a vertical bar labeled Risk-Adjusted Benchmark. A vertical line bisecting the boxes is labelled what Medicare would actually spend on an enrollee in traditional Medicare — The government pays Medicare Advantage plans based on Medicare’s cost estimates for a given county. The benchmark is an estimate from the Centers for Medicare & Medicaid Services of what it would cost to cover an average county enrollee in traditional Medicare, plus adjustments including quartile payments and quality bonuses. The risk-adjusted benchmark also takes into consideration an enrollee’s health.

Samantha Randall at USC, CC BY-ND

Theory versus reality

In theory, this payment system should save the Medicare system money because the risk-adjusted benchmark that Medicare estimates for each plan should run, on average, equal to what Medicare would actually spend on a plan’s enrollees if they had enrolled in traditional Medicare instead.

In reality, the risk-adjusted benchmark estimates are far above traditional Medicare costs. This causes Medicare – really, taxpayers – to spend more for each person who is enrolled in Medicare Advantage than if that person had enrolled in traditional Medicare.

Why are payment estimates so high? There are two main culprits: benchmark modifications designed to encourage Medicare Advantage plan availability, and risk adjustments that overestimate how sick Medicare Advantage enrollees are.

Two sets of stacked boxes with dotted arrows on the left side of each labeled Medicare Advantage Plan Bid sit below vertical bars labeled Benchmark and Risk-Adjusted Benchmark. — High risk-adjusted benchmarks lead to overpayments from the government to the private companies that administer Medicare Advantage plans.

Samantha Randall at USC, CC BY-ND

Benchmark modifications

Since the current Medicare Advantage payment system started in 2006, policymaker modifications have made Medicare’s benchmark estimates less tied to what the plan spends on each enrollee.

In 2012, as part of the Affordable Care Act, Medicare Advantage benchmark estimates received another layer: “quartile adjustments.” These made the benchmark estimates, and therefore payments to Medicare Advantage companies, higher in areas with low traditional Medicare spending and lower in areas with high traditional Medicare spending. This benchmark adjustment was meant to encourage more equitable access to Medicare Advantage options.

In that same year, Medicare Advantage plans started receiving “quality bonus payments” with plans that have higher “star ratings” based on quality factors such as enrollee health outcomes and care for chronic conditions receiving higher bonuses.

However, research shows that ratings have not necessarily improved quality and may have exacerbated racial inequality.

Even before fully taking into account risk adjustment, recent estimates peg the benchmarks, on average, as 8% higher than average traditional Medicare spending. This means that a Medicare Advantage plan’s spending estimate could be below the benchmark and the plan would still get paid more for its enrollees than it would have cost the government to cover those same enrollees in traditional Medicare.

Overestimating enrollee sickness

The second major source of overpayment is health risk adjustment, which tends to overestimate how sick Medicare Advantage enrollees are.

Each year, Medicare studies traditional Medicare diagnoses, such as diabetes, depression and arthritis, to understand which have higher treatment costs. Medicare uses this information to adjust its payments for Medicare Advantage plans. Payments are lowered for plans with lower predicted costs based on diagnoses and raised for plans with higher predicted costs. This process is known as risk adjustment.

But there is a critical bias baked into risk adjustment. Medicare Advantage companies know that they’re paid more if their enrollees seem more sick, so they diligently make sure each enrollee has as many diagnoses recorded as possible.

This can include legal activities like reviewing enrollee charts to ensure that diagnoses are recorded accurately. It can also occasionally entail outright fraud, where charts are “upcoded” to include diagnoses that patients don’t actually have.

In traditional Medicare, most providers – the exception being Accountable Care Organizations – are not paid more for recording diagnoses. This difference means that the same beneficiary is likely to have fewer recorded diagnoses if they are enrolled in traditional Medicare rather than a private insurer’s Medicare Advantage plan. Policy experts refer to this phenomenon as a difference in “coding intensity” between Medicare Advantage and traditional Medicare.

Human figure with arrows to two boxes. Left box has two plus symbols labelled recorded diagnoses and one dollar sign. Right box has five symbols and three dollar signs. — The same person is likely to be documented with more illnesses if they enroll in Medicare Advantage rather than traditional Medicare – and cost taxpayers more money.

Samantha Randall at USC, CC BY-ND

In addition, Medicare Advantage plans often try to recruit beneficiaries whose health care costs will be lower than their diagnoses would predict, such as someone with a very mild form of arthritis. This is known as “favorable selection.”

The differences in coding and favorable selection make beneficiaries look sicker when they enroll in Medicare Advantage instead of traditional Medicare. This makes cost estimates higher than they should be. Research shows that this mismatch – and resulting overpayment – is likely only going to get worse as Medicare Advantage grows.

Where the money goes

Some of the excess payments to Medicare Advantage are returned to enrollees through extra benefits, funded by rebates. Extra benefits include cost-sharing reductions for medical care and prescription drugs, lower Part B and D premiums, and extra “supplemental benefits” like hearing aids and dental care that traditional Medicare doesn’t cover.

Medicare Advantage enrollees may enjoy these benefits, which could be considered a reward for enrolling in Medicare Advantage, which, unlike traditional Medicare, has prior authorization requirements and limited provider networks.

However, according to some policy experts, the current means of funding these extra benefits is unnecessarily expensive and inequitable.

It also makes it difficult for traditional Medicare to compete with Medicare Advantage.

Traditional Medicare, which tends to cost the Medicare program less per enrollee, is only allowed to provide the standard Medicare benefits package. If its enrollees want dental coverage or hearing aids, they have to purchase these separately, alongside a Part D plan for prescription drugs and a Medigap plan to lower their deductibles and co-payments.

Page from text document — Medicare Advantage plans offer extras, but at a high cost to the Medicare system – and taxpayers. Only 50-60 cents of a dollar spent is returned to enrollees as decreased costs or increased benefits.

AP Photo/Pablo Martinez Monsivais

The system sets up Medicare Advantage plans to not only be overpaid but also be increasingly popular, all on the taxpayers’ dime. Plans heavily advertise to prospective enrollees who, once enrolled in Medicare Advantage, will likely have difficulty switching into traditional Medicare, even if they decide the extra benefits are not worth the prior authorization hassles and the limited provider networks. In contrast, traditional Medicare typically does not engage in as much direct advertising. The federal government only accounts for 7% of Medicare-related ads.

At the same time, some people who need more health care and are having trouble getting it through their Medicare Advantage plan – and are able to switch back to traditional Medicare – are doing so, according to an investigation by The Wall Street Journal. This leaves taxpayers to pick up care for these patients just as their needs rise.

Where do we go from here?

Many researchers have proposed ways to reduce excess government spending on Medicare Advantage, including expanding risk adjustment audits, reducing or eliminating quality bonus payments or using more data to improve benchmark estimates of enrollee costs. Others have proposed even more fundamental reforms to the Medicare Advantage payment system, including changing the basis of plan payments so that Medicare Advantage plans will compete more with each other.

Reducing payments to plans may have to be traded off with reductions in plan benefits, though projections suggest the reductions would be modest.

There is a long-running debate over what type of coverage should be required under both traditional Medicare and Medicare Advantage. Recently, policy experts have advocated for introducing an out-of-pocket maximum to traditional Medicare. There have also been multiple unsuccessful efforts to make dental, vision, and hearing services part of the standard Medicare benefits package.

Although all older people require regular dental care and many of them require hearing aids, providing these benefits to everyone enrolled in traditional Medicare would not be cheap. One approach to providing these important benefits without significantly raising costs is to make these benefits means-tested. This would allow people with lower incomes to purchase them at a lower price than higher-income people. However, means-testing in Medicare can be controversial.

There is also debate over how much Medicare Advantage plans should be allowed to vary. The average Medicare beneficiary has over 40 Medicare Advantage plans to choose from, making it overwhelming to compare plans. For instance, right now, the average person eligible for Medicare would have to sift through the fine print of dozens of different plans to compare important factors, such as out-of-pocket maximums for medical care, coverage for dental cleanings, cost-sharing for inpatient stays, and provider networks.

Although millions of people are in suboptimal plans, 70% of people don’t even compare plans, let alone switch plans, during the annual enrollment period at the end of the year, likely because the process of comparing plans and switching is difficult, especially for older Americans.

MedPAC, a congressional advising committee, suggests that limiting variation in certain important benefits, like out-of-pocket maximums and dental, vision and hearing benefits, could help the plan selection process work better, while still allowing for flexibility in other benefits. The challenge is figuring out how to standardize without unduly reducing consumers’ options.

The Medicare Advantage program enrolls over half of Medicare beneficiaries. However, the $83-billion-per-year overpayment of plans, which amounts to more than 8% of Medicare’s total budget, is unsustainable. We believe the Medicare Advantage payment system needs a broad reform that aligns insurers’ incentives with the needs of Medicare beneficiaries and American taxpayers.

This article is part of an occasional series examining the U.S. Medicare system.

Past articles in the series:

Medicare vs. Medicare Advantage: sales pitches are often from biased sources, the choices can be overwhelming and impartial help is not equally available to all

Grace McCormack, Postdoctoral researcher of Health Policy and Economics, University of Southern California and Erin Duffy, Research Scientist and Director of Research Training in Health Policy and Economics, University of Southern California

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

The post Taxpayers spend 22% more per patient to support Medicare Advantage – the private alternative to Medicare that promised to cost less appeared first on theconversation.com

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Chaos gardening – wild beauty, or just a mess? A sustainable landscape specialist explains the trend

Published

2 days ago

August 19, 2025

Staff Editor

theconversation.com – Deryn Davidson, Sustainable Landscape State Specialist, Extension, Colorado State University – 2025-08-19 07:35:00

A mix of annuals and perennials can look colorful and carefree.
Deryn Davidson

Deryn Davidson, Colorado State University

If you’ve spent any time in the gardening corners of social media lately, you’ve likely come across a trend called “chaos gardening.”

The name alone is eye-catching – equal parts fun, rebellious and slightly alarming. Picture someone tossing random seeds into bare soil, watering once or twice, and ending up with a backyard jungle of blooms. No rows, no color coordination, no spacing charts. Just sprinkle and hope for the best.

As a sustainable landscape specialist at Colorado State University Extension, I think a lot about how to help people make designed landscapes more sustainable. Occasionally, a new trend like this one crops up claiming to be the silver bullet of gardening – supposedly it saves water, saves the bees and requires no maintenance.

But what is chaos gardening, really? And does it work? As with most viral trends, the answer is: sometimes.

What chaos gardening is and isn’t

At its core, chaos gardening is the practice of mixing a wide variety of seeds, often including leftover packets, wildflower mixes, or cut flower favorites, and scattering them over a planting area with minimal planning.

The goal is to create a dense, colorful garden that surprises you with its variety. For many, it’s a low-pressure, joyful way to experiment.

But chaos gardening isn’t the same as ecological restoration, pollinator meadow planting or native prairie establishment. Unlike chaos gardening, all of these techniques rely on careful species selection, site prep and long-term management.

Chaos gardening is a bit like making soup from everything in your pantry – it might be delicious, but there are no guarantees.

Chaos gardening’s appeal

One reason chaos gardening may be catching on is because it sidesteps the rules of garden design. A traditional landscape design approach is effective and appropriate for many settings, but it is a time investment and can feel intimidating. Design elements and principles, and matching color schemes, don’t fit everyone’s style or skill set.

A flower bed with a curved border, and curved rows of white and pink flowers, with equally spaced hedges and bushes — Organized and manicured home gardens such as this can be stressful to maintain.
Elenathewise/iStock via Getty Images Plus

Even the apparently relaxed layers of blooms and informal charm of an English cottage garden actually result from careful planning. Chaos gardening, by contrast, lets go of control. It offers a playful, forgiving entry point into growing things. In a way, chaos gardening is an antidote to the pressure of perfection, especially the kind found in highly curated, formal landscapes.

There’s also the allure of ease. People want gardening to be simple. If chaos gardening brings more people into the joy and mess of growing things, I consider that a win in itself. Broader research has found that emotional connection and accessibility are major motivators for gardening, often more than environmental impact.

When does chaos gardening work?

The best outcomes from chaos gardening happen when the chaos has a few guardrails:

Choose plants with similar needs. Most successful chaos gardens rely on sun-loving annuals that grow quickly and bloom prolifically, like zinnias, cosmos, marigolds, snapdragons and sunflowers. These are also excellent cut flowers to use in bouquets, which makes them doubly rewarding.
Consider your region. A chaos garden that thrives in Colorado might flop in North Carolina. It is beneficial to select seed mixes or individual varieties suited to your area since factors like soil type and growing season length matter. Different plants have unique needs beyond just sun and water; soil pH, cold hardiness and other conditions can make a big difference.
Think about pollinators. Mixing in nectar- and pollen-rich flowers native to North America, such as black-eyed Susans, bee balm or coneflowers, provides valuable resources for native bees, butterflies, moths and other local pollinators. These species benefit even more if you plan your garden with phenology – that is, nature’s calendar – in mind. By maintaining blooms from early spring through late fall, you ensure a steady food supply throughout the growing season. Plus, a diverse plant palette supports greater pollinator abundance and diversity.
Prep your site. Even “chaos” needs a little order. Removing weeds, loosening the top layer of soil and watering regularly, especially during germination when seeds are sprouting, will dramatically improve your results. Successful seed germination requires direct seed-to-soil contact and consistent moisture; if seeds begin to grow and then dry out, many species will not survive.

When does chaos gardening not work?

There are a few key pitfalls to chaos gardening that often get left out of the online hype:

Wrong plant, wrong place. If your mix includes shade-loving plants and your garden is in full sun, or drought-tolerant plants whose seeds end up in a soggy low spot, they’ll struggle to grow.
Invasive species and misidentified natives. Some wildflower mixes, especially inexpensive or mass-market ones, claim to be native but actually contain non-native species that can spread beyond your garden and become invasive. While many non-natives are harmless, some spread quickly and disrupt natural ecosystems. Check seed labels carefully and choose regionally appropriate native or adapted species whenever possible.
Soil, sun and water still matter. Gardening is always a dialogue with place. Even if you’re embracing chaos, taking notes, observing how light moves through your space, and understanding your soil type will help you know your site better, and choose appropriate plants.
Maintenance is still a thing. Despite the “toss and walk away” aesthetic, chaos gardens still require care. Watering, weeding and eventually cutting back or removing spent annuals are all part of the cycle.

Beyond the hashtag

Beneath the chaos gardening memes, there’s something real happening: a growing interest in a freer, more intuitive way of gardening. And that’s worth paying attention to.

Once someone has success with a zinnia or cosmos, they may be inspired to try more gardening. They might start noticing which flowers the bees are visiting in their garden. They may discover native plants and pay attention to the soil they are tending, seeing how both are part of a larger, living system. A chaotic beginning can become something deeper.

An orange and black butterfly perched on top of a flowerhead with small, pink flowers — Choosing nectar-rich flowers such as milkweed for your seed mix can help local pollinators.
Brian Woolman/iStock via Getty Images Plus

Chaos gardening might not replace the structured borders of a manicured garden or a carefully curated pollinator patch, but it might get someone new into the garden. It might lower the stakes, invite experimentation and help people see beauty in abundance rather than control.

If that’s the entry point someone needs, then let the chaos begin.

Deryn Davidson, Sustainable Landscape State Specialist, Extension, Colorado State University

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

Organized and manicured home gardens such as this can be stressful to maintain.
Elenathewise/iStock via Getty Images Plus

When does chaos gardening work?

The best outcomes from chaos gardening happen when the chaos has a few guardrails:

Choose plants with similar needs. Most successful chaos gardens rely on sun-loving annuals that grow quickly and bloom prolifically, like zinnias, cosmos, marigolds, snapdragons and sunflowers. These are also excellent cut flowers to use in bouquets, which makes them doubly rewarding.
Consider your region. A chaos garden that thrives in Colorado might flop in North Carolina. It is beneficial to select seed mixes or individual varieties suited to your area since factors like soil type and growing season length matter. Different plants have unique needs beyond just sun and water; soil pH, cold hardiness and other conditions can make a big difference.
Think about pollinators. Mixing in nectar- and pollen-rich flowers native to North America, such as black-eyed Susans, bee balm or coneflowers, provides valuable resources for native bees, butterflies, moths and other local pollinators. These species benefit even more if you plan your garden with phenology – that is, nature’s calendar – in mind. By maintaining blooms from early spring through late fall, you ensure a steady food supply throughout the growing season. Plus, a diverse plant palette supports greater pollinator abundance and diversity.
Prep your site. Even “chaos” needs a little order. Removing weeds, loosening the top layer of soil and watering regularly, especially during germination when seeds are sprouting, will dramatically improve your results. Successful seed germination requires direct seed-to-soil contact and consistent moisture; if seeds begin to grow and then dry out, many species will not survive.

When does chaos gardening not work?

There are a few key pitfalls to chaos gardening that often get left out of the online hype:

Wrong plant, wrong place. If your mix includes shade-loving plants and your garden is in full sun, or drought-tolerant plants whose seeds end up in a soggy low spot, they’ll struggle to grow.
Invasive species and misidentified natives. Some wildflower mixes, especially inexpensive or mass-market ones, claim to be native but actually contain non-native species that can spread beyond your garden and become invasive. While many non-natives are harmless, some spread quickly and disrupt natural ecosystems. Check seed labels carefully and choose regionally appropriate native or adapted species whenever possible.
Soil, sun and water still matter. Gardening is always a dialogue with place. Even if you’re embracing chaos, taking notes, observing how light moves through your space, and understanding your soil type will help you know your site better, and choose appropriate plants.
Maintenance is still a thing. Despite the “toss and walk away” aesthetic, chaos gardens still require care. Watering, weeding and eventually cutting back or removing spent annuals are all part of the cycle.

Beyond the hashtag

Beneath the chaos gardening memes, there’s something real happening: a growing interest in a freer, more intuitive way of gardening. And that’s worth paying attention to.

If that’s the entry point someone needs, then let the chaos begin.

The post Chaos gardening – wild beauty, or just a mess? A sustainable landscape specialist explains the trend appeared first on theconversation.com

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Centrist

This content focuses on gardening practices and environmental awareness without promoting any particular political ideology. It presents information in a balanced, informative manner, emphasizing sustainability and ecological considerations while avoiding partisan language or viewpoints. The article encourages accessibility and experimentation in gardening, appealing broadly without aligning with left- or right-leaning political perspectives.

The Conversation

RFK Jr.’s plans to overhaul ‘vaccine court’ system would face legal and scientific challenges

Published

6 days ago

August 15, 2025

Staff Editor

theconversation.com – Anna Kirkland, Professor of Women’s and Gender Studies, University of Michigan – 2025-08-15 07:39:00

The Vaccine Injury Compensation Program was established in 1986 by an act of Congress.
MarsBars/iStock via Getty Images Plus

Anna Kirkland, University of Michigan

For almost 40 years, people who suspect they’ve been harmed by a vaccine have been able to turn to a little-known system called the Vaccine Injury Compensation Program – often simply called the vaccine court.

Health and Human Services Secretary Robert F. Kennedy Jr. has long been a critic of the vaccine court, calling it “biased” against compensating people, slow and unfair. He has said that he wants to “revolutionize” or “fix” this system.

I’m a scholar of law, health and medicine. I investigated the history, politics and debates about the Vaccine Injury Compensation Program in my book “Vaccine Court: The Law and Politics of Injury.”

Although vaccines are extensively tested and monitored, and are both overwhelmingly safe for the vast majority of people and extremely cost-effective, some people will experience a harmful reaction to a vaccine. The vaccine court establishes a way to figure out who those people are and to provide justice to them.

Having studied the vaccine court for 15 years, I agree that it could use some fixing. But changing it dramatically will be difficult and potentially damaging to public health.

Deciphering vaccine injuries

The Vaccine Injury Compensation Program is essentially a process that enables doctors, lawyers, patients, parents and government officials to determine who deserves compensation for a legitimate vaccine injury.

It was established in 1986 by an act of Congress to solve a specific social problem: possible vaccine injuries to children from the whole-cell pertussis vaccine. That vaccine, which was discontinued in the U.S. in the 1990s, could cause alarming side effects like prolonged crying and convulsions. Parents sued vaccine manufacturers, and some stopped producing vaccines.

Congress was worried that lawsuits would collapse the country’s vaccine supply, allowing diseases to make a comeback. The National Childhood Vaccine Injury Act of 1986 created the vaccine court process and shielded vaccine manufacturers from these lawsuits.

Here’s how it works: A person who feels they have experienced a vaccine-related injury files a claim to be heard by a legal official called a special master in the U.S. Court of Federal Claims. The Health and Human Services secretary is named as the defendant and is represented by Department of Justice attorneys.

A syringe leaning against a gavel on a white background — Many experts agree that the vaccine compensation program could use some updates.
t_kimura via iStock / Getty Images Plus

Doctors who work for HHS evaluate the medical records and make a recommendation about whether they think the vaccine caused the person’s medical problem. Some agreed-upon vaccine injuries are listed for automatic compensation, while other outcomes that are scientifically contested go through a hearing to determine if the vaccine caused the problem.

Awards come from a trust fund, built up through a 75-cent excise tax on each dose of covered vaccine sold. Petitioners’ attorneys who specialize in vaccine injury claims are paid by the trust fund, whether they win or lose.

Some updates are needed

Much has changed in the decades since Congress wrote the law, but Congress has not enacted updates to keep up.

For instance, the law supplies only eight special masters to hear all the cases, but the caseload has risen dramatically as more vaccines have been covered by the law. It set a damages cap of US$250,000 in 1986 but did not account for inflation. The statute of limitations for an injury is three years, but in my research, I found many people file too late and miss their chance.

When the law was written, it only covered vaccines recommended for children. In 2023, the program expanded to include vaccines for pregnant women. Vaccines just for adults, like shingles, are not covered. COVID-19 vaccine claims go to another system for emergency countermeasures vaccines that has been widely criticized. These vaccines could be added to the program, as lawyers who bring claims there have advocated.

These reform ideas are “friendly amendments” with bipartisan support. Kennedy has mentioned some of them, too.

A complex system is hard to revolutionize

Kennedy hasn’t publicly stated enough details about his plan for the vaccine court to reveal the changes he intends to make. The first and least disruptive course of action would be to ask Congress to pass the bipartisan reforms noted above.

But some of his comments suggest he may seek to dismantle it, not fix it. None of his options are straightforward, however, and consequences are hard to predict.

Robert F. Kennedy Jr., Secretary of the Department of Health and Human Services, testifying in Congress — HHS Secretary Robert Kennedy Jr. has said he plans to revolutionize the vaccine court.
Kayla Bartkowski / Staff, Getty Images News

Straight up changing the vaccine court’s structure would probably be the most difficult path. It requires Congress to amend the 1986 law that set it up and President Donald Trump to sign the legislation. Passing the bill to dismantle it requires the same process. Either direction involves all the difficulties of getting a contentious bill through Congress. Even the “friendly amendments” are hard – a 2021 bill to fix the vaccine court was introduced but failed to advance.

However, there are several less direct possibilities.

Adding autism to the injuries list

Kennedy has long supported discredited claims about harms from vaccines, but the vaccine court has been a bulwark against claims that lack mainstream scientific support. For example, the vaccine court held a yearslong court process from 2002 to 2010 and found that autism was not a vaccine injury. The autism trials drew on 50 expert reports, 939 medical articles and 28 experts testifying on the record. The special masters deciding the cases found that none of the causation hypotheses put forward to connect autism and vaccines were reliable as medical or scientific theories.

Much of Kennedy’s ire is directed at the special masters, who he claims “prioritize the solvency” of the system “over their duty to compensate victims.” But the special masters do not work for him. Rather, they are appointed by a majority of the judges in the Court of Federal Claims for four-year terms – and those judges themselves have 15-year terms. Kennedy cannot legally remove any of them in the middle of their service to install new judges who share his views.

Given that, he may seek to put conditions like autism on the list of presumed vaccine injuries, in effect overturning the special masters’ decisions. Revising the list of recognized injuries to add ones without medical evidence is within Kennedy’s powers, but it would still be difficult. It requires a long administrative process with feedback from an advisory committee and the public. Such revisions have historically been controversial, and are usually linked to major scientific reviews of their validity.

Public health and medical groups are already mobilized against Kennedy’s vaccine policy moves. If he failed to follow legally required procedures while adding new injuries to the list, he could be sued to stop the changes.

Targeting vaccine manufacturers

Kennedy could also lean on his newly reconstituted Advisory Committee on Immunization Practices to withdraw recommendations for certain vaccines, which would also remove them from eligibility in the vaccine compensation court. Lawsuits against manufacturers could then go straight to regular courts. On Aug. 14, 2025, the Department of Health and Human Services may have taken a step in this direction by announcing the revival of a childhood vaccine safety task force in response to a lawsuit by anti-vaccine activists.

Kennedy has also supported legislation that would allow claims currently heard in vaccine court to go to regular courts. These drastic reforms could essentially dismantle the vaccine court.

People claiming vaccine injuries could hope to win damages through personal injury lawsuits in the civil justice system instead of vaccine court, perhaps by convincing a jury or getting a settlement. These types of settlements were what prompted the creation of the vaccine court in the first place. But these lawsuits could be hard to win. There is a higher bar for scientific evidence in regular courts than in vaccine court, and plaintiffs would have to sue large corporations rather than file a government claim.

Raising the idea of reforming the vaccine court has provoked strong reactions across the many groups with a stake in the program. It is a complex system with multiple constituents, and Kennedy’s approaches so far pull in different directions. The push to revolutionize it will test the strength of its complex design, but the vaccine court may yet hold up.

Anna Kirkland, Professor of Women’s and Gender Studies, University of Michigan

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

The post RFK Jr.’s plans to overhaul ‘vaccine court’ system would face legal and scientific challenges appeared first on theconversation.com

Political Bias Rating: Center-Left

The content presents a fact-based, nuanced analysis of the Vaccine Injury Compensation Program and Robert F. Kennedy Jr.’s criticisms and proposed reforms. It acknowledges the safety and effectiveness of vaccines, aligns with mainstream scientific consensus, and highlights bipartisan efforts for reform. While it critiques Kennedy’s more controversial positions, especially regarding discredited vaccine-autism links, it does so with measured language and provides context on legal and public health complexities. Overall, the article leans slightly left by supporting established science and public health perspectives but remains balanced and informative without strong partisan rhetoric.

The Conversation

Genomics can help insect farmers avoid pitfalls of domestication

Published

1 week ago

August 14, 2025

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theconversation.com – Christine Picard, Professor of Biology, Indiana University – 2025-08-14 07:29:00

A biologist maintains a large population of black soldier flies for protein farming.
picture alliance/Contributer via Getty Images

Christine Picard, Indiana University and Hector Rosche-Flores, Indiana University

Insects are becoming increasingly popular to grow on farms as feed for other animals, pet food and potentially as food for people. The process of bringing a wild animal into an artificial environment, known as domestication, comes with unique challenges. Luckily, there are important lessons to be learned from all the other animals people have domesticated over millennia.

As researchers who study how domesticating animals changes their genes, we believe that recognizing the vulnerabilities that come with domestication is important. Today’s powerful biotechnology tools can help researchers anticipate and head off issues early on.

Domestication is nothing new

From grain domestication starting as far back as 12,000 years ago to today’s high-tech, genome-based breeding strategies, humans have long bent nature to suit their purposes. By selectively breeding individual plants or animals that have desirable traits – be it appearance, size or behavior – humans have domesticated a whole host of species.

The same principle underlies all domestication attempts, from dogs to crops. A breeder identifies an individual with a desired trait – whether that’s a dog’s talent for tracking or a plant’s ability to withstand pests. Then they breed it to confirm that the desired trait can be passed down to offspring. If it works, the breeder can grow lots of descendants in a lineage with the genomic advantage.

People have made crops resilient to disease and environmental challenges, docile cows that yield more milk or meat, large-breasted poultry and cute dogs.

A long history of insects working for people

Insect domestication is also far from new. People have reared silkworms (Bombyx mori) to produce silk for over 5,000 years. But selective breeding and isolation from wild relatives have led to their inability to fly, dependence on one food source and need for assistance to reproduce. As a result, silkworms are wholly reliant on humans for survival, and the original species doesn’t exist anymore.

A white moth sitting on a white cocoon on top of a leaf — Silk moths have lost their ability to fly and are completely dependent on humans for survival.
baobao ou/Moment Open via Getty Images

Similarly, people have maintained colonies of the western honeybee (Apis mellifera) for pollination and honey production for centuries. But bees are at risk due to colony collapse disorder, a phenomenon where worker bees disappear from seemingly healthy hives. The causes of colony collapse disorder are unknown; researchers are investigating disease and pesticides as possible factors.

Now the insect agriculture industry has set its sights on domesticating some other insects as a source of sustainably farmed protein for other animals or people.

Insects such as the black soldier fly (Hermetia illucens) and the mealworm (Tenebrio molitor) can grow on existing organic waste streams. Rearing them on organic farm and food waste circularizes the agricultural system and reduces the environmental footprint of growing proteins.

But these insects will need to be grown at scale. Modern agriculture relies on monocultures of species that allow for uniformity in size and synchronized growth and harvest. Domesticating wild insects will be necessary to turn them into farmed animals.

A large number of white larvae in a dry food medium — Black soldier fly larvae feed on a mixture of wheat bran, corn and alfalfa when reared in labs and farms.
Christine Picard

Domestication has an immunity downside

Chickens today grow faster and bigger than ever. But factory-farmed animals are genetically very homogeneous. Moreover, people take care of everything for these domesticated animals. They have easy access to food and are given antibiotics and vaccines for their health and safety.

Consequently, industrially-farmed chickens have lost a lot of their immune abilities. Building these strong disease-fighting proteins requires a lot of energy. Since their spotless, controlled environments protect them, those immune genes are just not needed. The energy their bodies would typically use to protect themselves can instead be used to grow bigger.

In the wild, individuals with faulty immune genes would likely be killed by pathogens, quickly wiping these bad genes out from the population. But in a domesticated environment, such individuals can survive and pass on potentially terrible genes.

The H5N1 bird flu provides a recent example of what can go wrong when a homogeneous population of domesticated animals encounters a dangerous pathogen. When disease broke out, the poor immune systems of domesticated chickens cracked under the pressure. The disease can spread quickly through large facilities, and eventually all chickens there must be euthanized.

Hundreds of brown chickens with red crowns being reared in an indoor facility — Industrially-farmed chickens are genetically homogenous and have lost much of their immune defenses.
pidjoe/E+ via Getty Images

Domestication and the risks of monoculture

Weak immune systems aren’t the only reason the bird flu spread like it did.

Domestication often involves growing large numbers of a single species in small concentrated areas, referred to as a monoculture. All the individuals in a monoculture are roughly the same, both physically and in their genes, so they all have the same susceptibilities.

Banana cultivars are one example. Banana plants grown in the early 1900s were all descendants of a single clone, named Gros Michel. But when the deadly Panama disease fungus swept through, the plants had no defenses and the cultivar was decimated.

Banana growers turned to the Cavendish variety, grown in the largest banana farms today. The banana industry remains vulnerable to the same kind of risk that took down Gros Michel. A new fungal strain is on the rise, and scientists are rushing to head off a global Cavendish banana collapse.

Lessons about weaknesses that come with domestication are important to the relatively new industry advancing insects as the future of sustainable protein production and organic waste recycling.

How genomics can help correct course

Modern genomics can give insect agriculture a new approach to quality control. Technological tools can help researchers learn how an organism’s genes relate to its physical traits. With this knowledge, scientists can help organisms undergoing domestication bypass potential downsides of the process.

For instance, scientists combined data from hundreds of different domesticated tomato genomes, as well as their wild counterparts. They discovered something you’ve probably experienced – while selecting for longer shelf life, tomato flavor genes were unintentionally bred out.

A similar approach of screening genomes has allowed scientists to discover the combination of genes that enhances milk production in dairy cows. Farmers can intentionally breed individuals with the right combinations of milk-producing genes while keeping an eye on what other genes the animals have or lack. This process ensures that breeders don’t lose valuable traits, such as robust immune systems or high fertility rates, while selecting for economically valuable traits during domestication.

Insect breeders can take advantage of these genetic tools from the outset. Tracking an animal population’s genetic markers is like monitoring patients’ vital signs in the hospital. Insect breeders can look at genes to assess colony health and the need for interventions. With regular genetic monitoring of the farmed population, if they begin to see individuals with markers for some “bad” genes, they can intervene right away, instead of waiting for a disaster.

Mechanisms to remedy an emerging disaster include bringing in a new brood from the wild or another colony whose genes can refresh the domesticated population’s inbred and homogeneous genome. Additionally, researchers could use gene-editing techniques such as CRISPR-Cas9 to replicate healthy and productive combinations of genes in a whole new generation of domesticated insects.

Genomics-assisted breeding is a supplement to standard practices and not a replacement. It can help breeders see which traits are at risk, which ones are evolving, and where natural reservoirs of genetic diversity might be found. It allows breeders to make more informed decisions, identify genetic problems and be proactive rather than reactive.

By harnessing the power of genomics, the insect agriculture industry can avoid setting itself up for an accidental future collapse while continuing to make inroads on sustainable protein production and circularizing the agricultural ecosystem.

Christine Picard, Professor of Biology, Indiana University and Hector Rosche-Flores, Ph.D. Student in Biology, Indiana University

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

The post Genomics can help insect farmers avoid pitfalls of domestication appeared first on theconversation.com

Political Bias Rating: Centrist

The content presents a factual, science-based discussion on insect domestication and sustainable agricultural practices without promoting a specific political agenda. It focuses on the benefits and risks of domestication and biotechnology, highlighting both challenges and technological solutions in a balanced manner. The article underscores environmental sustainability and advances in genomics while maintaining an objective tone, characteristic of centrist perspectives that weigh multiple facets pragmatically.