Stem Cells Signal, Medicare Writes Checks

Mesenchymal stem/stromal cell (MSC) therapies are now easy to get. Medical tourism clinics offer them, and so do clinics in more tightly regulated countries for a range of conditions. A new review in Science Bulletin (doi:10.1016/j.scib.2026.09.057), discussed by Reason at Fight Aging!, takes stock of what these treatments actually do and where the field should go next.

The mechanism turned out to be different

The original idea was engraftment: transplanted cells would settle into damaged tissue, turn into the right cell types and replace what was lost. The review says the evidence now points elsewhere. Most of the functional recovery comes from paracrine signaling, meaning the cells secrete molecules that change how the patient's own cells behave. Those molecules include cytokines, chemokines, growth factors and extracellular vesicles (EVs). The review lists what these signals do: they promote blood vessel growth (angiogenesis), stimulate regeneration, and modulate inflammation, cell death (apoptosis) and fibrosis.

Reason points out that the transplanted cells don't survive long. Whatever benefit patients get comes from signals released during that short window.

Consistent on inflammation, inconsistent on repair

Reason argues that one effect is "fairly reliable": suppression of chronic inflammation that lasts for months. The outcomes people actually hope for, such as more regeneration or a disease going into reverse, "remain highly unreliable."

The review agrees that results vary widely between disease models. Effects are especially inconsistent in complex organ regeneration and chronic inflammatory disease. The authors name four sources of variation:

Democrats running in the midterms are talking about bigger ACA subsidies, reversing Medicaid cuts and lowering the Medicare eligibility age. Several Democratic states want to go further and set up single-payer systems. Oregon is furthest along. A nine-member Universal Health Plan Governance Board, created by the legislature in 2023, will send lawmakers its proposal by Dec. 1. The plan would cover medical, vision, dental and mental health care for every resident starting in 2032, with no premiums, deductibles or copays. Lawmakers could vote on it in the 2027 session or send it to voters in 2028.

How the money would move

The board says the plan would not change total health spending by government, employers and consumers. It would replace premiums and out-of-pocket costs with new corporate and personal taxes, then combine that revenue with federal and state money in one fund that pays all providers. Board members expect savings from less administrative work, less fraud and drug-price negotiation.

The board's focus-group examples:

• A 30-year-old earning $55,000 on a benchmark ACA silver plan pays $5,478 a year now and would pay about $2,331 in taxes.
• A person earning $55,000 with employer coverage pays $3,063 in premiums and out-of-pocket costs now and could pay nothing.

Companies with payrolls over $500,000 would pay a payroll tax, and their workers would get a partial tax credit. The board estimates 31% to 60% of Oregonians would pay nothing. Higher earners could pay more than they do today. The actual numbers depend on the tax rates lawmakers choose.

President Trump announced on social media late Friday that more than 20 million seniors will each get a one-time $90 payment toward their Medicare premiums. The money goes out in October by direct deposit or check, a few weeks before the Nov. 3 midterm elections.

Where the money comes from and who gets it

The White House says the payments will come from the Medicare Improvement Fund, which Congress created in 2008 as flexible money for improving how the program runs and how it pays providers. Larry Levitt, KFF's executive vice president for health policy, says no previous administration has used the fund this way. Congress has drawn on it for other priorities before. For example, it took $20.74 billion from the fund to help create the Affordable Care Act in 2010. "The Medicare Improvement Fund language is quite broad and gives substantial discretion to the administration," Levitt said.

The payment applies to Medicare Part B, which covers doctor visits, ambulance services and lab tests. Monthly Part B costs start at about $200 and rise with income, so $90 covers less than half of one month at the lowest rate.

According to the Centers for Medicare and Medicaid Services, many people are excluded:

• Enrollees must live in the U.S.
• People who already get help with premiums through Medicaid don't qualify.
• Higher earners who pay income-adjusted premiums don't qualify.
• Medicare Advantage enrollees don't qualify. KFF says more than half of eligible beneficiaries are in these private plans.

Physician ownership has mostly disappeared. As of early 2026, about 82 percent of practicing physicians worked for a hospital or other corporate entity, up from roughly 25 percent in 2012. Private equity (PE) is the newest buyer, and its record in other parts of medicine is poor.

Meehir Dixit, a second-year medical student at the University of Chicago who did health services research at Brown, lists that record. A JAMA study found a 25.4 percent increase in hospital-acquired adverse events at PE-acquired hospitals compared with matched controls, mostly falls and central line infections. In procedural specialties, prices rise noticeably after PE enters a market. Physician turnover goes up after acquisition. Steward Health Care in Massachusetts sold hospital land and leased it back from a real estate investment trust. The money likely went to investors, and the rent burden helped push the hospitals into bankruptcy. A BMJ paper links REIT and PE hospital acquisitions to later bankruptcies.

What the primary care studies found

Dixit and colleagues at Brown asked whether that pattern holds in primary care, which PE investors treat as a different kind of business. All three studies used traditional Medicare data:

• Health Affairs: After acquisition, practices billed more services, and each physician saw more patients. A meaningful share of the increase was preventive care, especially the Medicare Annual Wellness Visit. Patients saw more distinct clinicians, and the number of advanced practice providers (APPs, such as nurse practitioners and physician assistants) grew faster than at control practices.

If you or someone you know may be in crisis, call or text 988 to reach the Suicide & Crisis Lifeline.

Kenney Blewett, of Kyle, Texas, had COPD tied to decades of smoking. He was diagnosed more than a decade ago, and this year his breathing flare-ups became more frequent. He had lost 45 pounds and was winded by small chores. On June 2 his pulmonologist prescribed a new liquid drug to be inhaled through a nebulizer. Two days later Walgreens emailed that the prescription was delayed by "an insurance issue." On June 7, hours after another flare-up, he died by suicide. His wife, Cindy, says he had struggled with his mental health for a long time and had attempted suicide years earlier. His note said his health was too poor to go on. KFF Health News reporter Lauren Sausser doesn't claim the delay caused his death. Cindy Blewett wonders whether getting the drug in time would have changed anything.

Where the prescription got stuck

Blewett had four layers of coverage: Medicare Parts A and B, a Wellcare Value Script Part D drug plan (owned by Centene), and a Blue Cross Blue Shield of Texas Medigap plan. Cindy assumed the Part D plan wanted prior authorization. But nebulizer drugs are among the few drugs covered under Part B's durable medical equipment benefit, not Part D. Medicare told her it had no record of the drug being billed to Part B. Medigap plans don't require prior authorization, so that plan wasn't the cause.