The Conversation

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

Published

7 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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The Conversation

I’m a physician who has looked at hundreds of studies of vaccine safety, and here’s some of what RFK Jr. gets wrong

Published

2 days ago

June 28, 2025

Staff Editor

theconversation.com – Jake Scott, Clinical Associate Professor of Infectious Diseases, Stanford University – 2025-06-26 07:31:00

Public health experts worry that factually inaccurate statements by Robert F. Kennedy Jr. threaten the public’s confidence in vaccines.
Andrew HarnikGetty Images

Jake Scott, Stanford University

In the four months since he began serving as secretary of the Department of Health and Human Services, Robert F. Kennedy Jr. has made many public statements about vaccines that have cast doubt on their safety and on the objectivity of long-standing processes established to evaluate them.

Many of these statements are factually incorrect. For example, in a newscast aired on June 12, 2025, Kennedy told Fox News viewers that 97% of federal vaccine advisers are on the take. In the same interview, he also claimed that children receive 92 mandatory shots. He has also widely claimed that only COVID-19 vaccines, not other vaccines in use by both children and adults, were ever tested against placebos and that “nobody has any idea” how safe routine immunizations are.

As an infectious disease physician who curates an open database of hundreds of controlled vaccine trials involving over 6 million participants, I am intimately familiar with the decades of research on vaccine safety. I believe it is important to correct the record – especially because these statements come from the official who now oversees the agencies charged with protecting Americans’ health.

Do children really receive 92 mandatory shots?

In 1986, the childhood vaccine schedule contained about 11 doses protecting against seven diseases. Today, it includes roughly 50 injections covering 16 diseases. State school entry laws typically require 30 to 32 shots across 10 to 12 diseases. No state mandates COVID-19 vaccination. Where Kennedy’s “92 mandatory shots” figure comes from is unclear, but the actual number is significantly lower.

From a safety standpoint, the more important question is whether today’s schedule with additional vaccines might be too taxing for children’s immune systems. It isn’t, because as vaccine technology improved over the past several decades, the number of antigens in each vaccine dose is much lower than before.

Antigens are the molecules in vaccines that trigger a response from the immune system, training it to identify the specific pathogen. Some vaccines contain a minute amount of aluminum salt that serves as an adjuvant – a helper ingredient that improves the quality and staying power of the immune response, so each dose can protect with less antigen.

Those 11 doses in 1986 delivered more than 3,000 antigens and 1.5 milligrams of aluminum over 18 years. Today’s complete schedule delivers roughly 165 antigens – which is a 95% reduction – and 5-6 milligrams of aluminum in the same time frame. A single smallpox inoculation in 1900 exposed a child to more antigens than today’s complete series.

A black-and-white photo of a doctor in a white coat giving an injection to a boy who is held by a female nurse. — Jonas Salk, the inventor of the polio vaccine, administers a dose to a boy in 1954.
Underwood Archives via Getty Images

Since 1986, the United States has introduced vaccines against Haemophilus influenzae type b, hepatitis A and B, chickenpox, pneumococcal disease, rotavirus and human papillomavirus. Each addition represents a life-saving advance.

The incidence of Haemophilus influenzae type b, a bacterial infection that can cause pneumonia, meningitis and other severe diseases, has dropped by 99% in infants. Pediatric hepatitis infections are down more than 90%, and chickenpox hospitalizations are down about 90%. The Centers for Disease Control and Prevention estimates that vaccinating children born from 1994 to 2023 will avert 508 million illnesses and 1,129,000 premature deaths.

Placebo testing for vaccines

Kennedy has asserted that only COVID-19 vaccines have undergone rigorous safety trials in which they were tested against placebos. This is categorically wrong.

Of the 378 controlled trials in our database, 195 compared volunteers’ response to a vaccine with their response to a placebo. Of those, 159 gave volunteers only a salt water solution or another inert substance. Another 36 gave them just the adjuvant without any viral or bacterial material, as a way to see whether there were side effects from the antigen itself or the injection. Every routine childhood vaccine antigen appears in at least one such study.

The 1954 Salk polio trial, one of the largest clinical trials in medical history, enrolled more than 600,000 children and tested the vaccine by comparing it with a salt water control. Similar trials, which used a substance that has no biological effect as a control, were used to test Haemophilus influenzae type b, pneumococcal, rotavirus, influenza and HPV vaccines.

Once an effective vaccine exists, ethics boards require new versions be compared against that licensed standard because withholding proven protection from children would be unethical.

How unknown is the safety of widely used vaccines?

Kennedy has insisted on multiple occasions that “nobody has any idea” about vaccine safety profiles. Of the 378 trials in our database, the vast majority published detailed safety outcomes.

Beyond trials, the U.S. operates the Vaccine Adverse Event Reporting System, the Vaccine Safety Datalink and the PRISM network to monitor hundreds of millions of doses for rare problems. The Vaccine Adverse Event Reporting System works like an open mailbox where anyone – patients, parents, clinicians – can report a post-shot problem; the Vaccine Safety Datalink analyzes anonymized electronic health records from large health care systems to spot patterns; and PRISM scans billions of insurance claims in near-real time to confirm or rule out rare safety signals.

These systems led health officials to pull the first rotavirus vaccine in 1999 after it was linked to bowel obstruction, and to restrict the Johnson & Johnson COVID-19 vaccine in 2021 after rare clotting events. Few drug classes undergo such continuous surveillance and are subject to such swift corrective action when genuine risks emerge.

The conflicts of interest claim

On June 9, Kennedy took the unprecedented step of dissolving vetted members of the Advisory Committee on Immunization Practices, the expert body that advises the CDC on national vaccine policy. He has claimed repeatedly that the vast majority of serving members of the committee – 97% – had extensive conflicts of interest because of their entanglements with the pharmaceutical industry. Kennedy bases that number on a 2009 federal audit of conflict-of-interest paperwork, but that report looked at 17 CDC advisory committees, not specifically this vaccine committee. And it found no pervasive wrongdoing – 97% of disclosure forms only contained routine paperwork mistakes, such as information in the wrong box or a missing initial, and not hidden financial ties.

Reuters examined data from Open Payments, a government website that discloses health care providers’ relationships with industry, for all 17 voting members of the committee who were dismissed. Six received no more than US$80 from drugmakers over seven years, and four had no payments at all.

The remaining seven members accepted between $4,000 and $55,000 over seven years, mostly for modest consulting or travel. In other words, just 41% of the committee received anything more than pocket change from drugmakers. Committee members must divest vaccine company stock and recuse themselves from votes involving conflicts.

A term without a meaning

Kennedy has warned that vaccines cause “immune deregulation,” a term that has no basis in immunology. Vaccines train the immune system, and the diseases they prevent are the real threats to immune function.

Measles can wipe immune memory, leaving children vulnerable to other infections for years. COVID-19 can trigger multisystem inflammatory syndrome in children. Chronic hepatitis B can cause immune-mediated organ damage. Preventing these conditions protects people from immune system damage.

Today’s vaccine panel doesn’t just prevent infections; it deters doctor visits and thereby reduces unnecessary prescriptions for “just-in-case” antibiotics. It’s one of the rare places in medicine where physicians like me now do more good with less biological burden than we did 40 years ago.

The evidence is clear and publicly available: Vaccines have dramatically reduced childhood illness, disability and death on a historic scale.

Jake Scott, Clinical Associate Professor of Infectious Diseases, Stanford University

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

The post I’m a physician who has looked at hundreds of studies of vaccine safety, and here’s some of what RFK Jr. gets wrong 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: Center-Left

This content presents a science-based and fact-checked critique of Robert F. Kennedy Jr.’s statements on vaccines, emphasizing the importance of established public health measures and vaccine safety. It supports mainstream medical consensus and public health institutions like the CDC, while challenging anti-vaccine rhetoric associated with certain political or ideological positions. The tone is objective but leans toward defending regulatory agencies and vaccine advocacy, which aligns more closely with Center-Left perspectives favoring public health expertise and government intervention in health policy.

The Conversation

Cyberattacks shake voters’ trust in elections, regardless of party

Published

3 days ago

June 27, 2025

Staff Editor

theconversation.com – Ryan Shandler, Professor of Cybersecurity and International Relations, Georgia Institute of Technology – 2025-06-27 07:29:00

An election worker installs a touchscreen voting machine.
Ethan Miller/Getty Images

Ryan Shandler, Georgia Institute of Technology; Anthony J. DeMattee, Emory University, and Bruce Schneier, Harvard Kennedy School

American democracy runs on trust, and that trust is cracking.

Nearly half of Americans, both Democrats and Republicans, question whether elections are conducted fairly. Some voters accept election results only when their side wins. The problem isn’t just political polarization – it’s a creeping erosion of trust in the machinery of democracy itself.

Commentators blame ideological tribalism, misinformation campaigns and partisan echo chambers for this crisis of trust. But these explanations miss a critical piece of the puzzle: a growing unease with the digital infrastructure that now underpins nearly every aspect of how Americans vote.

The digital transformation of American elections has been swift and sweeping. Just two decades ago, most people voted using mechanical levers or punch cards. Today, over 95% of ballots are counted electronically. Digital systems have replaced poll books, taken over voter identity verification processes and are integrated into registration, counting, auditing and voting systems.

This technological leap has made voting more accessible and efficient, and sometimes more secure. But these new systems are also more complex. And that complexity plays into the hands of those looking to undermine democracy.

In recent years, authoritarian regimes have refined a chillingly effective strategy to chip away at Americans’ faith in democracy by relentlessly sowing doubt about the tools U.S. states use to conduct elections. It’s a sustained campaign to fracture civic faith and make Americans believe that democracy is rigged, especially when their side loses.

This is not cyberwar in the traditional sense. There’s no evidence that anyone has managed to break into voting machines and alter votes. But cyberattacks on election systems don’t need to succeed to have an effect. Even a single failed intrusion, magnified by sensational headlines and political echo chambers, is enough to shake public trust. By feeding into existing anxiety about the complexity and opacity of digital systems, adversaries create fertile ground for disinformation and conspiracy theories.

Just before the 2024 presidential election, Director of the Cybersecurity and Infrastructure Security Agency Jen Easterly explains how foreign influence campaigns erode trust in U.S. elections.

Testing cyber fears

To test this dynamic, we launched a study to uncover precisely how cyberattacks corroded trust in the vote during the 2024 U.S. presidential race. We surveyed more than 3,000 voters before and after election day, testing them using a series of fictional but highly realistic breaking news reports depicting cyberattacks against critical infrastructure. We randomly assigned participants to watch different types of news reports: some depicting cyberattacks on election systems, others on unrelated infrastructure such as the power grid, and a third, neutral control group.

The results, which are under peer review, were both striking and sobering. Mere exposure to reports of cyberattacks undermined trust in the electoral process – regardless of partisanship. Voters who supported the losing candidate experienced the greatest drop in trust, with two-thirds of Democratic voters showing heightened skepticism toward the election results.

But winners too showed diminished confidence. Even though most Republican voters, buoyed by their victory, accepted the overall security of the election, the majority of those who viewed news reports about cyberattacks remained suspicious.

The attacks didn’t even have to be related to the election. Even cyberattacks against critical infrastructure such as utilities had spillover effects. Voters seemed to extrapolate: “If the power grid can be hacked, why should I believe that voting machines are secure?”

Strikingly, voters who used digital machines to cast their ballots were the most rattled. For this group of people, belief in the accuracy of the vote count fell by nearly twice as much as that of voters who cast their ballots by mail and who didn’t use any technology. Their firsthand experience with the sorts of systems being portrayed as vulnerable personalized the threat.

It’s not hard to see why. When you’ve just used a touchscreen to vote, and then you see a news report about a digital system being breached, the leap in logic isn’t far.

Our data suggests that in a digital society, perceptions of trust – and distrust – are fluid, contagious and easily activated. The cyber domain isn’t just about networks and code. It’s also about emotions: fear, vulnerability and uncertainty.

Firewall of trust

Does this mean we should scrap electronic voting machines? Not necessarily.

Every election system, digital or analog, has flaws. And in many respects, today’s high-tech systems have solved the problems of the past with voter-verifiable paper ballots. Modern voting machines reduce human error, increase accessibility and speed up the vote count. No one misses the hanging chads of 2000.

But technology, no matter how advanced, cannot instill legitimacy on its own. It must be paired with something harder to code: public trust. In an environment where foreign adversaries amplify every flaw, cyberattacks can trigger spirals of suspicion. It is no longer enough for elections to be secure − voters must also perceive them to be secure.

That’s why public education surrounding elections is now as vital to election security as firewalls and encrypted networks. It’s vital that voters understand how elections are run, how they’re protected and how failures are caught and corrected. Election officials, civil society groups and researchers can teach how audits work, host open-source verification demonstrations and ensure that high-tech electoral processes are comprehensible to voters.

We believe this is an essential investment in democratic resilience. But it needs to be proactive, not reactive. By the time the doubt takes hold, it’s already too late.

Just as crucially, we are convinced that it’s time to rethink the very nature of cyber threats. People often imagine them in military terms. But that framework misses the true power of these threats. The danger of cyberattacks is not only that they can destroy infrastructure or steal classified secrets, but that they chip away at societal cohesion, sow anxiety and fray citizens’ confidence in democratic institutions. These attacks erode the very idea of truth itself by making people doubt that anything can be trusted.

If trust is the target, then we believe that elected officials should start to treat trust as a national asset: something to be built, renewed and defended. Because in the end, elections aren’t just about votes being counted – they’re about people believing that those votes count.

And in that belief lies the true firewall of democracy.

Ryan Shandler, Professor of Cybersecurity and International Relations, Georgia Institute of Technology; Anthony J. DeMattee, Data Scientist and Adjunct Instructor, Emory University, and Bruce Schneier, Adjunct Lecturer in Public Policy, Harvard Kennedy School

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

The post Cyberattacks shake voters’ trust in elections, regardless of party appeared first on theconversation.com

Political Bias Rating: Centrist

This article presents a balanced and fact-focused analysis of trust issues surrounding American elections, emphasizing concerns shared across the political spectrum. It highlights the complexity of digital voting infrastructure and the external threats posed by misinformation and foreign influence without promoting partisan viewpoints. The tone is neutral, grounded in data and research, avoiding ideological framing or advocacy. The piece calls for bipartisan solutions like public education and institutional trust-building, reflecting a centrist perspective that prioritizes democratic resilience over partisan blame.

The Conversation

Toxic algae blooms are lasting longer than before in Lake Erie − why that’s a worry for people and pets

Published

4 days ago

June 26, 2025

Staff Editor

theconversation.com – Gregory J. Dick, Professor of Biology, University of Michigan – 2025-06-26 14:38:00

A satellite image from Aug. 13, 2024, shows an algal bloom covering approximately 320 square miles (830 square km) of Lake Erie. By Aug. 22, it had nearly doubled in size.
NASA Earth Observatory

Gregory J. Dick, University of Michigan

Federal scientists released their annual forecast for Lake Erie’s harmful algal blooms on June 26, 2025, and they expect a mild to moderate season. However, anyone who comes in contact with toxic algae can face health risks. And 2014, when toxins from algae blooms contaminated the water supply in Toledo, Ohio, was a moderate year, too.

We asked Gregory J. Dick, who leads the Cooperative Institute for Great Lakes Research, a federally funded center at the University of Michigan that studies harmful algal blooms among other Great Lakes issues, why they’re such a concern.

A bar chart shows 2025's forecast to be more severe than 2023 but less than 2024. — The National Oceanic and Atmospheric Administration’s prediction for harmful algal bloom severity in Lake Erie compared with past years.
NOAA

1. What causes harmful algal blooms?

Harmful algal blooms are dense patches of excessive algae growth that can occur in any type of water body, including ponds, reservoirs, rivers, lakes and oceans. When you see them in freshwater, you’re typically seeing cyanobacteria, also known as blue-green algae.

These photosynthetic bacteria have inhabited our planet for billions of years. In fact, they were responsible for oxygenating Earth’s atmosphere, which enabled plant and animal life as we know it.

An illustration of algae bloom sources shows a farm field, city and large body of water. — The leading source of harmful algal blooms today is nutrient runoff from fertilized farm fields.
Michigan Sea Grant

Algae are natural components of ecosystems, but they cause trouble when they proliferate to high densities, creating what we call blooms.

Harmful algal blooms form scums at the water surface and produce toxins that can harm ecosystems, water quality and human health. They have been reported in all 50 U.S. states, all five Great Lakes and nearly every country around the world. Blue-green algae blooms are becoming more common in inland waters.

The main sources of harmful algal blooms are excess nutrients in the water, typically phosphorus and nitrogen.

Historically, these excess nutrients mainly came from sewage and phosphorus-based detergents used in laundry machines and dishwashers that ended up in waterways. U.S. environmental laws in the early 1970s addressed this by requiring sewage treatment and banning phosphorus detergents, with spectacular success.

How pollution affected Lake Erie in the 1960s, before clean water regulations.

Today, agriculture is the main source of excess nutrients from chemical fertilizer or manure applied to farm fields to grow crops. Rainstorms wash these nutrients into streams and rivers that deliver them to lakes and coastal areas, where they fertilize algal blooms. In the U.S., most of these nutrients come from industrial-scale corn production, which is largely used as animal feed or to produce ethanol for gasoline.

Climate change also exacerbates the problem in two ways. First, cyanobacteria grow faster at higher temperatures. Second, climate-driven increases in precipitation, especially large storms, cause more nutrient runoff that has led to record-setting blooms.

2. What does your team’s DNA testing tell us about Lake Erie’s harmful algal blooms?

Harmful algal blooms contain a mixture of cyanobacterial species that can produce an array of different toxins, many of which are still being discovered.

When my colleagues and I recently sequenced DNA from Lake Erie water, we found new types of microcystins, the notorious toxins that were responsible for contaminating Toledo’s drinking water supply in 2014.

These novel molecules cannot be detected with traditional methods and show some signs of causing toxicity, though further studies are needed to confirm their human health effects.

A young woman and dog walk along a shoreline with blue-green algae in the water. — Blue-green algae blooms in freshwater, like this one near Toledo in 2014, can be harmful to humans, causing gastrointestinal symptoms, headache, fever and skin irritation. They can be lethal for pets.
Ty Wright for The Washington Post via Getty Images

We also found organisms responsible for producing saxitoxin, a potent neurotoxin that is well known for causing paralytic shellfish poisoning on the Pacific Coast of North America and elsewhere.

Saxitoxins have been detected at low concentrations in the Great Lakes for some time, but the recent discovery of hot spots of genes that make the toxin makes them an emerging concern.

Our research suggests warmer water temperatures could boost its production, which raises concerns that saxitoxin will become more prevalent with climate change. However, the controls on toxin production are complex, and more research is needed to test this hypothesis. Federal monitoring programs are essential for tracking and understanding emerging threats.

3. Should people worry about these blooms?

Harmful algal blooms are unsightly and smelly, making them a concern for recreation, property values and businesses. They can disrupt food webs and harm aquatic life, though a recent study suggested that their effects on the Lake Erie food web so far are not substantial.

But the biggest impact is from the toxins these algae produce that are harmful to humans and lethal to pets.

The toxins can cause acute health problems such as gastrointestinal symptoms, headache, fever and skin irritation. Dogs can die from ingesting lake water with harmful algal blooms. Emerging science suggests that long-term exposure to harmful algal blooms, for example over months or years, can cause or exacerbate chronic respiratory, cardiovascular and gastrointestinal problems and may be linked to liver cancers, kidney disease and neurological issues.

A large round structure offshore is surrounded by blue-green algae. — The water intake system for the city of Toledo, Ohio, is surrounded by an algae bloom in 2014. Toxic algae got into the water system, resulting in residents being warned not to touch or drink their tap water for three days.
AP Photo/Haraz N. Ghanbari

In addition to exposure through direct ingestion or skin contact, recent research also indicates that inhaling toxins that get into the air may harm health, raising concerns for coastal residents and boaters, but more research is needed to understand the risks.

The Toledo drinking water crisis of 2014 illustrated the vast potential for algal blooms to cause harm in the Great Lakes. Toxins infiltrated the drinking water system and were detected in processed municipal water, resulting in a three-day “do not drink” advisory. The episode affected residents, hospitals and businesses, and it ultimately cost the city an estimated US$65 million.

4. Blooms seem to be starting earlier in the year and lasting longer – why is that happening?

Warmer waters are extending the duration of the blooms.

In 2025, NOAA detected these toxins in Lake Erie on April 28, earlier than ever before. The 2022 bloom in Lake Erie persisted into November, which is rare if not unprecedented.

Scientific studies of western Lake Erie show that the potential cyanobacterial growth rate has increased by up to 30% and the length of the bloom season has expanded by up to a month from 1995 to 2022, especially in warmer, shallow waters. These results are consistent with our understanding of cyanobacterial physiology: Blooms like it hot – cyanobacteria grow faster at higher temperatures.

5. What can be done to reduce the likelihood of algal blooms in the future?

The best and perhaps only hope of reducing the size and occurrence of harmful algal blooms is to reduce the amount of nutrients reaching the Great Lakes.

In Lake Erie, where nutrients come primarily from agriculture, that means improving agricultural practices and restoring wetlands to reduce the amount of nutrients flowing off of farm fields and into the lake. Early indications suggest that Ohio’s H2Ohio program, which works with farmers to reduce runoff, is making some gains in this regard, but future funding for H2Ohio is uncertain.

In places like Lake Superior, where harmful algal blooms appear to be driven by climate change, the solution likely requires halting and reversing the rapid human-driven increase in greenhouse gases in the atmosphere.

Gregory J. Dick, Professor of Biology, University of Michigan

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

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Political Bias Rating: Centrist

This article presents a neutral and factual overview of the harmful algal blooms in Lake Erie, relying on scientific data and expert analysis without promoting a political agenda. It references federal and academic research, explains causes like agricultural runoff and climate change, and discusses practical mitigation efforts such as agricultural practice improvements and wetland restoration. The tone is informative and balanced, avoiding partisan framing or ideological language. While it touches on environmental issues that can be politically charged, the article remains focused on evidence-based explanations and policy-neutral recommendations.