A clinical trial of experimental drugs from Eli Lilly and Roche Holdings found the medications did not stunt the progression of a rare hereditary form of Alzheimer's disease, reports the Wall Street Journal . The trial assessed the two drugs' ability to decelerate worsening cognitive function in carriers of genetic mutations linked to dominantly inherited Alzheimer's. The subjects either had no symptoms or mild dementia at the outset, with some given Lilly's solanezumab, others administered Roche's gantenerumab, and still others receiving a placebo. Neither solanezumab nor gantenerumab, which are designed to reduce beta amyloid accumulations in the brain, effectively slowed cognitive declines. Lilly said it will not pursue an application for regulatory approval of its drug to treat dominantly inherited Alzheimer's, while Roche said it cannot make firm conclusions about gantenerumab's effect on people with the disorder.

President Trump is proposing major cuts to domestic spending in his budget for the next fiscal year, most notably Medicare and Medicaid, reports Politico Pro . The budget for fiscal year 2021 calls for $2 trillion in savings from mandatory programs over the next decade, including $130 billion in savings from drug pricing under Medicare and $292 billion from cuts to safety-net programs. The Trump administration has been promoting various ideas to bring down drug spending. However, bipartisan legislation has yet to make it through Congress and other White House-generated ideas have stalled. On Medicaid, for instance, the administration has advocated more limitations to the state-federal health care program for low-income people, such as work requirements. CMS recently announced it would permit states to switch to a block grant program for the Medicaid expansion population, which would slow spending. Trump had campaigned on safeguarding Medicare and Medicaid. However, in remarks in Switzerland last month, he expressed an openness to possible cuts to entitlements. The CDC would get a 9 percent cut, although the $4.3 billion for fighting infectious diseases such as coronavirus would be untouched. Finally, the Department of Veterans Affairs would see a 13 percent increase in funding, though that's not all for health care.

San Diego researchers will screen thousands of people worldwide to find candidates for an experimental drug designed to slow, and possibly halt, the progression of Alzheimer's disease, reports the San Diego Union Tribune . The University of Southern California's Alzheimer's Therapeutic Research Institute (ATRI) will lead the effort to find asymptomatic people with elevated levels of beta-amyloid on whom to test the drug BAN2401. "We believe the best benefit will come with the early administration of the drug, before there is substantial, irreversible damage," said ATRI Director Paul Aisen. The project will establish 100 test sites globally, where people can undergo a positron-emission tomography scan to identify elevated beta-amyloid levels. ATRI said the goal is to find "1,400 people who are clinically normal and have intermediate or elevated levels of amyloid in their brains. Researchers hope to screen the first participant by May 31 and complete enrollment in 18 to 30 months." A previous clinical trial showed that BAN2401 seems to have some ability to eliminate amyloid from the brain, but so far the drug has not demonstrated a major breakthrough.

One in three older adults is hospitalized after an emergency-department visit and one in five hospitalized persons is discharged to a nursing community — yet doctors seldom screen for dementia, writes Professor Elizabeth Goldberg at Brown University's Alpert Medical School in the Wall Street Journal . She says the United States is poorly equipped to meet the health and social needs of seniors 85 and older, and cases where loved ones are simply dumped at emergency departments is an all too common event. "Unlike younger adults with acute problems, older people tend to come to the emergency room for chronic problems and ambiguous symptoms like fatigue," Goldberg notes. "Those with cognitive impairment often can't articulate their concerns, which leads doctors to order tests and sometimes admit the person to the hospital. This increases healthcare costs." In addition to making dementia screening routine for emergency room arrivals, Goldberg suggests more preventive care, revised Medicare rehabilitation policies, new reimbursement schemes, and new success metrics would greatly improve outcomes. "Primary-care offices that offer same-day sick visits, home visits for bed-bound older adults, or at-home monitoring of conditions could reduce emergency department volumes," she adds.

A study in JAMA Network Open warns that almost half of older Americans are concerned about their ability to afford health insurance by retirement age, while 27 percent are unsure they will have insurance within a year's time, reports Gizmodo . Although any legal resident older than 65 in the United States is entitled to Medicare, many older Americans have historically struggled to pay for health insurance prior to that age — and Medicare programs still require people to pay premiums and deductibles, while more costly supplemental insurance is required for vision and dental care. A 2017 Senate report found the uninsured rate among Americans 50 to 64 had declined from 12 percent in 2013 to 6 percent in 2015, yet less attention is devoted to whether these citizens are still worried about their future medical costs, even if they currently have coverage. Forty-seven percent of study respondents had little to no confidence in being able to afford health insurance by the time they retire, and about two-thirds were at least a little worried about potential federal changes to their health insurance. Moreover, many respondents did not receive the medical help they needed because it was unaffordable. "Policy solutions are needed to enhance the stability of health insurance affordability and availability for adults in this age group," the authors concluded.

California Assembly members Cecilia Aguiar-Curry (D) and Monique Limón (D) have proposed two companion bills to promote greater awareness and earlier diagnosis of Alzheimer's and dementia, reports the Lake County Record-Bee . The package offers seniors, providers, and caregivers with tools for identifying and planning for a diagnosis, and a foundation for late-life treatment strategies. Aguiar-Curry's legislation instructs the Consortium of California Alzheimer's Disease Centers to widely disseminate and implement the "Assessment of Cognitive Complaints Toolkit" to healthcare providers. "If we fully deploy these tools, we can save families valuable time to find and access benefits and develop a plan for their loved ones' care," Aguiar-Curry said. Meanwhile, Limón's bill establishes an informational tool to help individuals with cognitive impairment and their caregivers in communicating with healthcare providers before and after receiving an Alzheimer's diagnosis. "Understanding the diagnosis, treatment options, and the disease would provide individuals better assurance when making decisions or asking questions," Limón declared.

Politico Pro is reporting that the House Ways and Means Committee late last week released its long-expected rival legislation to end surprise medical bills, which gives physicians greater leeway to contest payments than competing proposals. The Ways and Means bill differs in that it ditches a benchmark for what insurers would have to pay for an unexpected out-of-network bill. Instead, the legislators want to leave the payment particulars for the doctors and insurers to work out via an open negotiation. An independent arbiter would only be summoned if there's no agreement within 30 days. The legislation is expected to result in a fierce battle on Capitol Hill. Hospital and doctors' groups have been pushing for a bill with a robust arbitration process, arguing that a federal benchmark payment would reduce their pay rates and give insurers too much leverage. Insurers contend that the benchmark approach is the only way to end surprise bills without adding to the system's already high costs. The Ways and Means legislation, which is being championed by Chairman Richard Neal (D-Mass.) and ranking member Kevin Brady (R-Texas), breaks from a deal struck by bipartisan leaders of the House Energy and Commerce and Senate HELP Committees in late 2019. That plan, which allows arbitration in certain circumstances, relies on a federal benchmark payment.

A study in Occupational and Environmental Medicine yields insights that could help older adults who work night shifts sleep better, reports Bel Marra Health . The researchers learned that older people who work nights may feel more alert and sleep longer if they stay up longer after getting off work, then stay in bed for eight hours and wake up near the beginning of their shift. The authors enrolled two groups of nine adults, ranging in age from mid-50s to early 60s, who spent eight-hour simulated work shifts in a lab but slept at home. Subjects were required to "work" from 7 a.m. to 3 p.m., then took a day off and worked four-night shifts from 11 p.m. to 7 a.m. They could sleep when they wanted after day shifts, but after night shifts one cohort had to stay out of bed until at least 1 p.m. then stay in bed for eight hours, while the other group only had to postpone sleep until 1 p.m. Both groups spent about eight hours in bed and asleep before the study and during day shifts, but during night shifts, those told to stay in bed for eight hours got as much sleep as before — while those with no instructions spent less and less time every day in bed during night shifts. Participants told to sleep only in the afternoon and stay in bed for eight hours averaged two hours extra sleep each day than the comparison group.

Block grants are the latest chapter in an unfolding fight between the White House and Capitol Hill Democrats over the future of Medicaid, the Washington Post reports. Seema Verma, administrator of the Centers for Medicare and Medicaid Services, and Health and Human Services Secretary Alex Azar last week announced the "Healthy Adult Opportunity" program, in which states can agree to receive a lump-sum payment to finance care for adults who become eligible for Medicaid when the 2010 health-care law expanded it. As with many current health policy debates, the rhetoric around this issue has often been heated and emotional. Republican legislators have long complained that the safety-net program is not only overly burdensome to state budgets, but doesn't contain enough incentives for people to better their own lives. Verma contends that the block grants will give states greater control over their own spending and allow them to more nimbly respond to the needs of their enrollees.

All of the Democrats running for President currently have floated proposals that include a fix for the Social Security program's looming financial shortfall, notes the New York Times . The combined trust funds for Social Security's retirement and disability programs are on course to be depleted in 2035. Without changes, funding from payroll tax receipts will be sufficient to pay only 80 percent of the scheduled benefits. Sens. Bernie Sanders (Vt.) and Elizabeth Warren (Mass.) have been at the forefront of the expansion forces for much of the past decade. The former is the chief sponsor of current Senate expansion legislation, and the latter has published a detailed Social Security expansion plan as part of her campaign. A recent review of the candidates' positions on Social Security by the Center for Retirement Research at Boston College revealed no candidates — from either party — on record supporting Social Security benefit cuts. Among the Democrats, several back an across-the-board increase in benefits. And three favor shifting to a formula for the annual cost-of-living adjustment all beneficiaries receive that more accurately reflects the inflation experienced by seniors. Finally, all of the top-polling candidates support increasing Social Security's special minimum benefit, which aims to keep very low-income workers out of poverty in retirement. President Trump, meanwhile, campaigned in 2016 promising to oppose cuts to retirement benefits in a clear break with his party's orthodoxy. Although he reiterated that pledge in this week's State of the Union address, some Democrats were quick to argue that a recent statement of his signaled at least some openness to considering a reduction.