During February, Americans are urged to pay closer attention to their heart health. Experts say new findings suggest it can keep your brain in better shape, and South Dakota has an opportunity to help with prevention.
With American Heart Month underway, the American Heart Association's statistics update said in the past decade, global death rates from Alzheimer's and other forms of dementia have grown at a faster pace than heart-disease death rates.
Mitchell Elkind, neurology professor at Columbia University and immediate past president of the American Heart Association, said it coincides with research connecting heart disease risk factors and the likelihood of dementia.
"That boundary that we used to draw between vascular diseases of the brain, like stroke, and degenerative problems, like Alzheimer's disease, is beginning to fade away," Elkind explained.
The report showed efforts like keeping blood pressure low can reduce the risk of dementia later in life.
Meanwhile, groups supporting Medicaid expansion in South Dakota emphasized covering more people could go a long way toward keeping them healthier. Expansion is on the fall ballot, but is opposed by some leaders, including Gov. Kristi Noem.
Lindsey Karlson, director of quality improvement for the Community HealthCare Association of the Dakotas, said the clients they work with fall into the coverage gap; they make too much money to qualify for Medicaid, but can't afford other health insurance plans.
Community health centers will see them for primary care, but Karlson pointed out having insurance gives them more options.
"Medicaid expansion helps that patient get access to additional specialty care that they might need, so we're talking heart disease," Karlson explained.
South Dakota is among the last states holding out on Medicaid expansion, which is largely funded by the federal government under the Affordable Care Act.
Elkind added there is real concern with many people not having health care access or forgoing preventive care in the pandemic, the situation will only get worse.
"We are seeing an increase in cardiovascular disease and strokes, and that might lead to an increase down the line in people with not just dementia, but all sorts of long-term, chronic health issues," Elkind cautioned.
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As Mississippi lawmakers move forward with a potential Medicaid expansion, advocates said the state cannot afford further delays while thousands remain without health care.
Two so-called "dummy bills" are advancing through the House and Senate Medicaid committees, but the policy remains in limbo as legislators wait for clarity from Washington, D.C.
Kimberly Campbell, state director for AARP Mississippi, has been working on Medicaid expansion for several years and said the fight is far from over.
"There still needs to be some more discussions to figure out how can we get something that moves the state forward as far as access to health care," Campbell emphasized. "Access to quality health care for more individuals than we have now that are covered under any type of health program."
Mississippi is one of 10 states to have not expanded Medicaid under the Affordable Care Act, leaving an estimated 125,000 Mississippians without access to affordable health care. While last year's legislative session saw historic movement, expansion failed in the final hours as House and Senate leaders clashed over the details.
Advocates like Campbell argue expanding Medicaid would have far-reaching effects, including boosting the state's economy, strengthening rural hospitals and improving public health.
"Mississippi, unfortunately, we have some of the worst health outcomes here in the state," Campbell pointed out. "That would change a lot of those things. That would change our life span, and not only just the years of life but the quality of the years of life."
Gov. Tate Reeves remains firmly opposed to expanding Medicaid in Mississippi. In his recent State of the State address, he reaffirmed his stance against broadening coverage, citing concerns potential federal policy changes under President Donald Trump's administration could increase state costs for expanded welfare programs.
Reeves has consistently referred to Medicaid expansion as "welfare" and has resisted efforts to increase enrollment, despite growing support from key Republican legislative leaders.
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Florida residents who depend on Medicaid said they fear for their futures as lawmakers consider $2.3 trillion in federal cuts, which could force states to reduce services, cut eligibility or lower provider payments.
The proposal, first reported by Politico, has drawn opposition from health advocates who said the reductions would hit hardest among children, seniors and people with disabilities.
During a news conference organized by the Florida Policy Institute, Virginia, a Medicaid recipient in Alachua County, shared how the program has given her independence despite living with a disability.
"If Congress was to cut Medicaid or government was to cut Medicaid. I don't know how I would live," she said. "I have no family to go to. Both my parents are low-income housing. My father is pretty much disabled. He cannot help me at all. My mother is not in the picture."
The potential cuts include $9.8 billion in per capita reductions to cap how much funding Florida could receive. Proponents have suggested reducing federal Medicaid funding would compel states to make more prudent decisions regarding their health care budgets.
Joan Alker, executive director of the Georgetown University Center for Children and Families, warned these cuts would leave states with difficult choices.
"Cuts of this magnitude would force states to make very painful choices about cutting services, cutting benefits, reducing payments to providers, cutting eligibility," she said.
For the Rev. Latifah Griffin, whose 10-year-old son has cerebral palsy, Medicaid makes it possible for him to access specialized care, mobility devices and a pediatric extended care facility.
"I would literally struggle to take care of him," Griffin said. "I would likely need to quit my job because I would need to stay home due to being able, unable to afford the services for him without Medicaid. Then, I too will become a burden on an already broken system."
Medicaid serves 2.4 million Floridians, covering two of every five children in the state. A nationwide outage in government payment processing systems temporarily froze Medicaid funding to states, causing widespread confusion. The crisis followed President Donald Trump's recent executive orders, which briefly paused federal spending on various programs, excluding Medicare and Social Security.
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Changes could be coming for Arkansans who are on Medicaid.
Gov. Sarah Huckabee Sanders is proposing to add work requirements for some Medicaid recipients. Similar rules were imposed in the state in 2018 but later struck down by the Biden administration.
Neil Sealy, senior organizer for Arkansas Community Organizations, said more than 18,000 people lost coverage seven years ago although they were working or had been granted exemptions.
"We reached out to people to speak with them about their experience," Sealy explained. "There was a reporting requirement, and if after three months if you had not reported, then you would be taken off. "
He noted some recipients were unaware they did not have coverage until they tried to go to the doctor. Sanders is hopeful the requirements will remain in place under the new Trump administration.
According to a report in Forbes Magazine, Arkansas is the fourth-least healthy state in the country. Around 820,000 Arkansans are on Medicaid.
Specific details about Sanders' proposal have not been released but she said she wants a broader requirement to cover able-bodied adults. Sealy noted their volunteers are already mobilizing.
"We get ready," Sealy emphasized. "We are reaching out to people in the community. We are going to be on the doors, talking in churches, getting ready. We don't sit down and take it. "
A Harvard study showed in 2018 the work requirements did not decrease unemployment and red tape and paperwork created serious hurdles for people who were eligible for coverage.
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