Physicians in North Carolina are warning that what they describe as Medicare's outdated payment system is putting patient care on the line, especially in rural communities.

For years, Dr. Sreejit Nair's practice, Sunrise Vascular, has provided specialized vascular treatments to patients who would otherwise need to travel hours for care. Now, because of ongoing Medicare cuts, Nair said he fears without immediate reform, his patients and many others in underserved areas could lose access to life-saving treatments.

"It's already too late for many practices," he said, "and there are a few of us that are still trying to hang on for dear life, trying to still provide these desperately needed services to areas of the country where there's no other option."

The problem stems from Medicare's Physician Fee Schedule, which has slashed payments to lower-cost private practices such as Dr. Nair's, while increasing them for higher-cost hospital-based services. The imbalance is pushing many private practices to the brink of closure, leaving patients with fewer options for affordable care.

The Office-Based Facility Association is advocating for reforms to pull high-cost supplies and equipment out of the fees currently covered, and create a new payment model for office-based providers.

Jason McKitrick, the association's executive director, said these changes would still reimburse for these supplies, and be the lifeline for these smaller medical practices.

"Over the last few decades, as the technology advances have allowed those services to move from the hospital to the office-based setting," he said, "the money hasn't gone with it."

He said Medicare's own data show what is reimbursed today doesn't cover the direct cost of care or doctor's salaries for at least 300 office-based services.

McKitrick stressed that without these reforms, the burden will also fall on patients, who'll have to seek more expensive care.

"When these centers shut down, they have to go to a higher-cost site of service - and in many states, the only other option is a hospital," he said, "and so, they're paying up to five times more for some services."

He said this affects patients who need all types of care, from physical therapy to oncology and even cardiac surgery. He suggested that prompt legislative action is critical.

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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A new study from Wayne State University showed breathing in air pollution, especially benzene, can raise the risk of developing type 2 diabetes.

Benzene is a pollutant found in common emissions such as car exhaust and tobacco smoke. The report found a strong link between benzene exposure and insulin resistance.

Marianna Sadagurski, associate professor of environmental health sciences at Wayne State University and the study's lead author, investigated how air pollution affects metabolism. She explained how long it takes for sugar levels to rise after being exposed to benzene.

"Within seven days you already have changes in blood glucose levels," Sadagurski reported. "It does not mean that you already developed type 2 diabetes immediately. But that indicates that your blood glucose levels continue to higher than normal. "

In mice, test results showed after exposure, male mice showed changes in energy balance, brain activity, insulin function and immune responses, which caused their blood sugar levels to rise.

The researchers also discovered even short-term exposure to benzene affects how the brain handles insulin and causes inflammation in certain brain cells. The inflammation is connected to a specific pathway in the body. When they blocked the process in the brain cells, it helped fix the metabolism problems caused by benzene in the mice.

Sadagurski emphasized the study was far-reaching.

"All the studies, not just from the U.S., all across China and Mexico and so on," Sadagurski outlined. "All the studies that were done, we collected."

Sadagurski explained they analyzed data from different groups of people, including young adults and the elderly.

The Episcopal Health Foundation wants Texas lawmakers to make health a priority during this legislative session.

The nonprofit focuses on the nonmedical drivers of a person's overall health, such as economic status, health behaviors and safe neighborhoods where people can exercise.

Ann Barnes, president and CEO of the foundation, said they would like to see legislation on maternal health, food security and diabetes prevention.

"These are health conditions that affect low-income populations and communities of color," Barnes pointed out. "We are looking for opportunities to support legislation that improves those outcomes."

Barnes noted during the last legislative session, lawmakers passed bills that approved Medicaid screenings for nonmedical factors that influence health and for doulas to serve as case managers for pregnant people. She looks forward to having those bills implemented.

A recent survey by the foundation found nearly half of adults in Texas say they live in a household experiencing diabetes or prediabetes.

Barnes argued not addressing the problem puts an economic strain on the entire state.

"Between $6 billion and $8 billion, that's billion with a B, is spent on the treatment of diabetes through the Medicaid program," Barnes emphasized. "That is about a quarter of all dollars spent on adults on Medicaid."

She added health care only affects about 20% of a person's overall health. The other 80% is determined by their environment.