Medicaid cuts in the "One Big Beautiful Bill Act" could undermine the coverage, financial well-being, medical care, and health of low-income Americans, and lead to more than 16,500 medically-preventable deaths

Embargoed for release until 5:00 p.m. ET on Monday 16 June 2025   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. Medicaid cuts in the "One Big Beautiful Bill Act" could undermine the coverage, financial well-being, medical care, and health of low-income Americans, and lead to more than 16,500 medically-preventable deaths

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00716

URL goes live when the embargo lifts             

A new study published in Annals of Internal Medicine estimates the potential effects on Medicaid enrollment, uninsurance, financial strain, health care access, and health outcomes from potential Medicaid budget cuts being considered in Congress, including the House reconciliation bill advanced in May. Adam Gaffney, MD, MPH and colleagues identified six potential Medicaid cuts that the House of Representatives’ Budget Committee estimates would each reduce the Federal government’s Medicaid outlays by at least $100 billion over ten years: reduction of the Medicaid matching floor; reduced funding of the ACA Medicaid Expansion; Medicaid per capita caps; Medicaid work requirements; reduced Medicaid provider taxes; and repeal of the Biden-era Medicaid eligibility rule. They also assessed the overall effects of the current House bill, which includes three of the six options along with multiple smaller policy changes, such as shortening the duration of Medicaid’s retroactive coverage and increasing cost-sharing for some Medicaid enrollees. The researchers project that individually, these six Medicaid cuts would lead to an annual increase of between 651 and 12,626 medically preventable deaths. These cuts would increase the number of uninsured by between 600,000 and 3,900,000, and the annual number of persons foregoing needed medical care by 129,060 to 838,890. If the current House bill is enacted, the number of uninsured would rise by 7.6 million. It could lead to 1.9 million people losing their personal doctor, 1.3 million foregoing needed medications, 380,270 women going without a mammogram, and 16,642 preventable deaths. The authors warn that although these cuts are intended to offset tax cuts, they would also strip care from millions of low-income Americans and possibly lead to thousands of medically preventable deaths. They assert that policy makers should weigh the likely health and financial harms to patients and providers of reducing Medicaid expenditures against the desirability of tax reductions, which would benefit mostly wealthy Americans.   

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Adam Gaffney, MD, MPH, please email agaffney@challiance.org.      

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2. Semaglutide more effective at lowering risk for stroke and other cardiovascular outcomes compared to empagliflozin

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00775

Summary for Patients: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00775-PS

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Two target trial emulation studies compared mortality and cardiovascular risks in adult patients treated with semaglutide or dulaglutide versus empagliflozin. The study found that semaglutide moderately lowers risk for death, myocardial infarction (MI), and stroke compared to empagliflozin; however, dulaglutide does not have a clinical treatment advantage over empagliflozin. The results are published in Annals of Internal Medicine.

Researchers from the University of Pittsburgh studied data from a retrospective observational cohort of patients 45 years or older with type 2 diabetes, comorbid conditions and a prescription for semaglutide, dulaglutide, or empagliflozin between 1 January 2019 and 31 December 2024. The researchers emulated two target trials of initial treatment with either semaglutide (primary trial) or dulaglutide (secondary trial) versus empagliflozin. The primary outcome was risk for the composite outcome of death, MI, or stroke. Secondary outcomes included all-cause death, MI, stroke, heart failure (HF), and atrial fibrillation. The researchers matched empagliflozin-treated patients to either semaglutide- or dulaglutide-treated patients using propensity score (PS) methods. In the primary trial analysis, 7,899 patients treated with semaglutide were matched to 7,899 patients treated with empagliflozin, with all patients having similar baseline characteristics except a higher body mass index among patients treated with semaglutide. In the secondary trial, 6093 patients treated with dulaglutide were matched with 6,093 patients treated with empagliflozin and baseline characteristics were similar. The researchers found a nominally lower cumulative incidence of death, MI, or stroke in patients using semaglutide versus empagliflozin starting at one-year of follow-up. This was largely driven by a clear lower risk of stroke when using semaglutide versus empagliflozin. All risk estimates favored the use of semaglutide versus empagliflozin for secondary outcomes. In a subgroup analysis, patients younger than 65 years and those with an HbA1C below 7% had a lower risk for death, MI, or stroke when using semaglutide. In the secondary trial, the risk for death, MI, or stroke over follow-up was similar for patients treated with dulaglutide versus empagliflozin.  

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Anum Saeed, MD, please email Allison Hydzik at hydzikam@upmc.edu.   

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3. Phase 3 trial suggests fecal transplant is as effective as antibiotics for treating c. diff infection

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03285

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01868

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A phase 3 randomized controlled trial evaluated the efficacy and safety of fecal microbiota transplantation (FMT) versus the antibiotic vancomycin for adult patients with primary Clostridioides difficile infection (CDI). The trial found that FMT showed a 5.4% numerical superiority to vancomycin, indicating that it is noninferior to vancomycin. Given the potential for side effects with vancomycin, the study results suggest that FMT could be considered as a first-line treatment for primary CDI, representing a change to current practice. The results are published in Annals of Internal Medicine. 

The current recommended therapy for primary CDI is antibiotic treatment; however, some patients experience antibiotic-associated colitis due to CDI. Researchers from the University of Oslo and colleagues conducted a randomized, open-label, noninferiority, multi-center trial at hospitals and primary care facilities in Norway between 1 June 2019 to 15 March 2024 to determine whether FMT without antibiotic pretreatment is an effective and safe treatment for CDI. Eligible patients were 18 years or older, had primary CDI, a positive stool test result for toxin-producing C difficile, and no diagnosis of CDI in the year prior to enrollment. 104 eligible patients were randomly assigned in a 1:1 ratio to either one FMT enema administered within 24 hours of randomization or standard-of-care treatment with 125 mg of oral vancomycin four times daily for 10 days. The primary end point was clinical cure at day 14 after the start of treatment with only the assigned treatment and no recurrent CDI in the 60 days after the start of treatment. The researchers found that 66.7% of patients in the FMT group and 61.2% of patients in the vancomycin group achieved the primary end point. Subgroup analyses did not show significant differences by sex, age or CDI severity. There were no significant differences in adverse events between treatment groups.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Frederik Emil Juul, MD, PhD, please email f.e.juul@medisin.uio.no.

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4. Screening for anal cancer most cost-effective when initiated at age 35

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01426

URL goes live when the embargo lifts             

A microsimulation model was used to perform a benefits, harms and cost-effectiveness analysis of different anal cancer screening strategies among men who have sex with men (MSM) with HIV—individuals with 45-fold greater anal cancer risk than men without HIV. The researchers found that anal cancer screening among MSM with HIV aged 35 years or older could reduce anal cancer mortality by up to 65% and is cost-effective, with cost-effectiveness and harm-to-benefit ratios varying across a range of intervals and approaches. The results suggest value-based prioritization of anal cancer screening is needed to optimize screening use. The study is published in Annals of Internal Medicine. 

Researchers from the Medical University of South Carolina Hollings Cancer Center and colleagues developed a microsimulation model to simulate the life course of MSM with HIV using data from the ANCHOR (Anal Cancer–HSIL Outcomes Research) trial and other published literature. The researchers conducted the study to address the significant knowledge gap of data on long-term clinical outcomes and cost-effectiveness of screening for anal cancer. The model examined age-based anal cancer screening strategies among MSM with HIV aged 35 years or older in 2019 in the base-case analysis. Tests for primary screening and triage included anal cytology, hrHPV testing and cytology, and HPV co-testing. The researchers used the model to compare 52 different screening strategies which considered screening of persons aged 35 years or older, 40 years or older, or 45 years or older and annual, biennial, triennial, or quadrennial screening intervals. The researchers found that compared with no screening, cytology screening among MSM with HIV aged 35 years and older could reduce anal cancer mortality by up to 65%, with the greatest reductions seen in those initiating screening at an earlier age and more frequent rescreening intervals. These findings were consistent in the harm-to-benefit analysis. In the comparative analysis, anal cancer mortality reduction ranged from 25.8% for quadrennial cytology with HPV16 triage to 63.1% for annual cytology with hrHPV co-testing. HPV-based screening, specifically triennial testing for HPV16/18, was the most efficient. Cost effectiveness improved among newly eligible 35-year-olds, with biennial cytology screening being the most cost-effective. The researchers conclude that screening MSM with HIV aged 35 years or older using cytology provides greater value than initiating screening among those aged 40 or 45 years or older, in line with clinical guidelines recommending screening to start at 35. 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Ashish A. Deshmukh, PhD, MPH, please email Leslie Cantu at cantul@musc.edu.    

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