One Clock Isn't Enough, and Other Reckonings · Morning Gist
Friday, October 235 stories · 16 min
One Clock Isn't Enough, and Other Reckonings
Anti-aging claims that rest on a single epigenetic clock fall apart, insurance costs go up again, and Washington uses grant money to loosen hospital rules.
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An Aging Cell study retested anti-aging findings that had relied on a single epigenetic clock, using other clocks, and none held up. It proposes three tests for trusting a clock result. story 1 ↓
Family premiums from employers rose 9%, so workers now pay $7,471 a year. Meanwhile 11.2% of working-age adults have no coverage at all. story 2 ↓
Trump is tying rural health grants to states loosening hospital approval laws. Tennessee is phasing out most of its rules, and five more states may follow. story 3 ↓
In fruit fly eggs, ribosomes from old oocytes made protein about 50% less actively, which may help explain early fertility decline. It's a preprint in flies and mice. story 4 ↓
Dana Goldman, an economist who backed the ACA, says it failed to curb costs. He wants a cost-effectiveness research body with no power over prices. story 5 ↓
1/5Fight Aging!· Reason· Oct 22
Retesting single-clock anti-aging findings with more epigenetic clocks: none held up
Researchers re-ran published anti-aging studies that had reported a result on one epigenetic clock, using other clocks. None of the added clocks showed a significant effect. They propose three checks before trusting such results.
Why it matters · Claims that a drug, diet or supplement "reversed biological age" often rest on a single clock, and this study suggests many such claims may not survive scrutiny.
Know this first
Context from the editor, not the article · 26 sec
1 · What an aging clock is
A machine-learning model that combines many biological measurements into one estimate of age or mortality risk. The most common kind, epigenetic clocks, read DNA methylation: chemical tags on DNA whose patterns shift predictably with age.
2 · Clock generations
First-generation clocks (Horvath, Hannum) predict chronological age. Later ones are trained on mortality or health outcomes (GrimAge) or on the rate of decline over time (DunedinPACE). Dozens now exist, and they often disagree.
3 · Why trials use them
Testing whether a therapy extends human lifespan takes decades. A clock that reliably tracked aging could serve as a quick surrogate endpoint, much as blood pressure stands in for strokes in heart trials.
2/5STAT· O. Rose Broderick and Elizabeth Cooney· Oct 22
Workers' family insurance premiums rise 9% as more adults go uninsured
KFF found workers' share of family health premiums rose 9% in 2026, to $7,471. A separate Commonwealth Fund survey found the uninsured rate among working-age adults climbed from 8.9% to 11.2% since 2024.
Why it matters · Whether people have coverage, and what it costs them, shapes whether they get care at all. Half of uninsured adults say they skipped needed care because of cost.
Know this first
Context from the editor, not the article · 31 sec
1 · How Americans get insured
Most working-age Americans get insurance through an employer, who pays most of the premium while the worker pays the rest. Others buy plans on Affordable Care Act marketplaces or qualify for Medicaid, the joint federal-state program for low-income people.
2 · Two subsidies that ended
During the pandemic, states had to keep people enrolled in Medicaid, and Congress expanded the tax credits that lower marketplace premiums. The enrollment protection ended in 2023 and the expanded credits ran out after 2025. Both had pushed the uninsured rate to record lows.
3 · The surveys behind the numbers
3/5KFF Health News· Andrew Jones· Oct 22
Trump ties rural health grants to states loosening hospital approval laws
The Trump administration is giving higher scores for part of a $50 billion rural health fund to states that weaken "certificate of need" laws. These laws make hospitals prove local need before they build or expand. Six states have signaled they will.
Why it matters · Whether hospitals can build freely shapes rural access, prices and consolidation, and this shift is happening fast, driven by grant money rather than new evidence.
Know this first
Context from the editor, not the article · 30 sec
1 · What certificate of need is
Certificate of need (CON) laws make a hospital or clinic get state approval, by proving community need, before it builds, expands, or sometimes buys costly equipment. The goal was to stop duplicated facilities and rising costs.
2 · A long-running fight
Many states adopted CON laws in the 1970s, partly because of a federal mandate that was repealed in 1987. Since then, administrations of both parties have questioned them. Studies of their effects on cost and access have produced mixed results.
3 · The rural health fund
The Rural Health Transformation Program is a five-year, $50 billion fund created in Trump's 2025 One Big Beautiful Bill Act. The Centers for Medicare & Medicaid Services runs it, and states apply for grants to modernize care in remote areas.
4/5Fight Aging!· Reason· Oct 22
Aging egg cells lose protein-making power as their old ribosomes wear out
In a preprint, researchers report that egg cells in flies and mice slowly lose their ability to make proteins as old ribosomes wear out. Cutting ribosome numbers early made eggs show aging-like defects sooner.
Why it matters · It offers a testable, cell-level explanation for why fertility declines decades before the rest of the body ages, though so far the evidence comes only from animals.
Know this first
Context from the editor, not the article · 27 sec
1 · Egg cells are made once
Female mammals are born with a fixed pool of oocytes, the immature egg cells. No new ones are made in adulthood, so each surviving oocyte may have to stay functional for decades before ovulation.
2 · What ribosomes do
Ribosomes are the cell's protein factories. They read messenger RNA and build proteins from it. Most cells keep making fresh ribosomes, but oocytes mostly rely on a stock built while they were growing.
3 · Egg quality and age
Fertility falls steeply from a woman's mid-30s. A main cause is the rising rate of meiotic errors, mistakes in how chromosomes are split when the egg matures, which lead to miscarriage and conditions like Down syndrome.
5/5STAT· Dana P. Goldman· Oct 22
Economist who backed the Affordable Care Act says it failed to curb costs
USC health economist Dana Goldman signed a 2009 letter backing the Affordable Care Act. He now says it never slowed spending. He wants an independent body to judge which treatments are worth their cost.
Why it matters · Whether US health policy can openly weigh benefit against price decides which treatments get paid for. It sits under every reform debate, from drug pricing to Medicare for All.
Know this first
Context from the editor, not the article · 27 sec
1 · The 2010 health law
The Affordable Care Act (ACA), passed in 2010, expanded insurance through Medicaid and subsidized marketplaces called exchanges. Supporters also promised it would "bend the cost curve", meaning it would slow the growth of US health spending.
2 · Fee-for-service payment
Most US care has been paid fee-for-service: every visit, test or procedure is billed on its own. Critics say this pays for volume, not results. "Value-based" payment tries to tie money to outcomes instead.
3 · Health technology assessment
Many countries have agencies that judge whether treatments are worth their price, such as England's NICE. They often measure health gained in quality-adjusted life years (QALYs) and compare treatments by cost per QALY.
A study in Aging Cell took published anti-aging trials that had reported a benefit on a single 1 and re-ran the data on other clocks. In the authors' words, "no additional clocks reach statistical significance." They then propose three checks for deciding when a clock result deserves trust. The study was discussed by Reason at Fight Aging!, a longevity-advocacy blog. Neither the abstract nor the commentary gives effect sizes or names the trials involved.
Why clocks are tempting, and suspect
Epigenetic clocks are machine-learning models that estimate age or mortality risk from 2, chemical tags on DNA that shift with age. Testing a longevity therapy on real outcomes takes decades. A clock that changed within months would let researchers screen many candidates quickly.
Reason argues the catch is basic. A clock learns how people age naturally, and a new therapy may change the body in ways it never saw. It could overstate a benefit, understate it, or miss it. The only way to know which is to check the clock against long-term outcomes for that therapy, which defeats the purpose. A second problem is that dozens of clocks now exist. Testing several and reporting the one that moved invites false positives.
What the researchers did
After the failed re-analysis, the team looked at data from events already known to accelerate aging. They used these as 3 to see how real effects appear across clocks. A simulation suggested that more reliable clocks are more sensitive to true effects. Data following the same people over time showed that changes in reliable clocks track each other.
Three checks
According to the authors, a result is more believable when:
Principal-component (PC) clocks respond. These clocks are rebuilt from broad patterns across thousands of DNA sites rather than individual noisy ones, so repeat measurements agree far better.
Mortality-trained or pace-of-aging clocks respond. Examples are 4 and 5, which are tied to death or the rate of decline rather than calendar age.
Several clocks move the same way. One clock shifting alone looks like noise.
The authors say some interventions pass all three tests but don't name them in the abstract.
Caveats
These checks raise confidence. They don't solve Reason's core objection: clocks agreeing with each other is not proof of better health, and clocks built on similar data may share blind spots. For now, read "reversed biological age" claims based on a single clock skeptically. The authors themselves say such findings "may warrant reexamination."
A study in Aging Cell revisited published anti-aging trials that reported a benefit on a single 1. The researchers ran the same data through additional clocks. In their words, "no additional clocks reach statistical significance." The team then proposes a three-part test for deciding when a clock result deserves trust. The study was flagged and discussed by Reason at Fight Aging!, a longevity-advocacy blog. What follows is drawn from the paper's abstract and that commentary. Neither gives effect sizes or names the trials involved.
The problem clocks are meant to solve
An aging clock is a machine-learning model trained on a large dataset of some biological measure that changes with age. The model finds a weighted combination of measurements that tracks chronological age, remaining life expectancy or mortality risk. Epigenetic clocks are the most popular kind. They use 2, chemical tags at specific DNA sites (CpG sites) whose levels drift with age.
Reason argues that the real point of the technology is speed. If a clock could reliably show within months whether a therapy slows or reverses aging, researchers could screen candidates quickly and focus on the best ones, instead of waiting decades for outcomes like disease and death.
Why that's hard
Reason's core objection is that no clock can be trusted to read a new kind of intervention correctly. A clock learns correlations from how people age naturally. A therapy can change the body in ways those correlations never captured. The clock might then overstate the benefit, understate it, or miss a real effect entirely. You can't know which in advance. The only way to find out is to calibrate the clock against real outcomes for that therapy, which takes the long studies clocks were supposed to replace. That is a circular problem, and the new paper doesn't claim to escape it. It aims for something more modest: rules of thumb for how much confidence a given result deserves.
There is also a practical problem. As clocks multiply, researchers can test several and report the one that moved. Even when it's done innocently, choosing one clock out of many inflates the chance of a false positive.
What the study did
The work had four steps.
Re-analysis. The authors took published intervention studies that had reported a significant result on one clock and applied more clock models. None of the added clocks reached significance.
Positive controls. They examined datasets of events already known to accelerate aging (the abstract doesn't say which) to see how real age-related changes appear across clocks.
Simulation. They modelled why a genuine effect should show up on several clocks at once. In their simulation, more reliable clocks were more sensitive to true effects.
Longitudinal controls. Using repeated measurements from the same people over time, they found that changes in reliable clocks correlate with one another.
The three criteria
Based on this, the authors say confidence in a result rises when:
Reliable 3 respond. PC clocks are versions of standard clocks rebuilt on principal components, which are summary patterns across thousands of methylation sites. They don't rely on individual noisy sites. This makes them much more consistent when the same sample is measured twice. A small change on a noisy clock may be measurement error. The same change on a PC clock is harder to dismiss.
An illustrative comparison (not from the paper): imagine three bathroom scales that usually agree. If one shows you two kilos lighter and the other two show no change, you'd suspect that scale before you'd credit your diet. If all three drop, you'd believe it.
The authors say some interventions do meet all three criteria, but the abstract doesn't name them.
What this means for readers
The paper's own conclusion is that "some previously published single-clock findings may warrant reexamination." In practice, treat a headline saying that something "reversed biological age" with caution if it rests on one clock, especially a first-generation one. Ask whether the result showed up on PC clocks and outcome-trained clocks, and whether the clocks agreed.
What stays open
The criteria improve the odds but don't fix Reason's basic objection. A therapy could move every clock in agreement and still do little for health. Or it could help real aging through a route the clocks don't see. Agreement among clocks trained on similar data may also partly reflect shared blind spots. Only outcome data can settle whether a clock tracks a given therapy. The abstract also leaves out key details: which studies were re-analysed, how large the original effects were, and how many clocks were tested. Those details would show whether the null results reflect false positives or just underpowered trials.
Remember
Published single-clock anti-aging results didn't replicate when other clocks were applied to the same data.
Trust a clock result more when reliable PC clocks, outcome-trained clocks and several clocks agree.
No clock can be validated for a new therapy without long outcome studies, which is the circular problem.
KFF, a health policy nonprofit, runs an Employer Health Benefits Survey every year and is widely treated as the benchmark for employer coverage costs. The Commonwealth Fund runs a survey on insurance coverage every two years.
Image: STAT
Two new surveys show health coverage in the U.S. getting both more expensive and harder to get.
Workers pay more for family plans
1 is a health policy nonprofit whose annual Employer Health Benefits Survey is the standard reference for job-based coverage. Its 2026 survey found that workers' share of a family plan's premium rose 9% this year, to $7,471 on average. Employers pay the rest of the premium, and that portion is larger. Workers at small businesses saw bigger increases than average.
STAT's explanation is simple: health care costs keep rising. Employers have absorbed most of the increase so far, but small businesses are increasingly dropping coverage. Experts say employers are reaching a "breaking point," and next year's increases could be larger.
More adults uninsured
The 2 surveys insurance coverage every two years. Its latest survey found the uninsured rate among working-age adults rose from 8.9% in 2024 to 11.2% in 2026, about a quarter more uninsured people. Half of uninsured respondents said they had skipped needed care because of cost.
The Fund links the rise to two changes:
Expired subsidies: enhanced 3 tax credits, which lowered premiums for people buying their own plans, ran out.
4 rechecks: pandemic-era rules that kept people enrolled in Medicaid, the program for low-income people, ended. States then rechecked eligibility and removed many enrollees.
A survey can't prove these changes caused the rise, but the timing fits. The Fund expects more coverage losses in 2027, when major Medicaid cuts and new limits on the ACA marketplaces take effect.
Also in the newsletter
Liver transplant 5. Researchers at Northwestern and the University of Pittsburgh gave 355 patients waiting for a liver transplant a personalized home exercise and diet plan targeting 150 minutes of activity a week. About two-thirds improved on a 4.5-point frailty scale built from grip strength, chair stands and balance. Patients who came to at least three follow-up visits improved by at least 0.4 points, a change linked in earlier research to roughly 50% lower risk of dying on the waitlist. That figure is an association, not deaths counted in this study. Patients who return for follow-ups may also be healthier to begin with. A larger trial is planned.
6 for drinking. Telehealth companies are promoting GLP-1 obesity drugs, such as semaglutide, for alcohol use disorder without FDA approval for that use. Eli Lilly and Altimmune are running trials. Whether the drugs work for this is still unproven.
New York fraud probe. Federal officials sent letters to almost 100 providers in New York's Medicaid-funded adult day care program questioning their unusually high billing. Two people were arrested over alleged fraud of more than $500,000.
STAT's daily newsletter for October 22 led with two surveys that point the same way. Employer coverage is getting more expensive for workers, and a growing share of working-age adults have no insurance at all. The newsletter also covered a liver-transplant exercise study, telehealth companies promoting obesity drugs for addiction, and a federal fraud crackdown in New York.
Premiums: workers' family share up 9%
According to 1's 2026 Employer Health Benefits Survey, the amount workers pay toward a family health plan rose 9% this year, to $7,471 on average. KFF is a health policy nonprofit, and STAT calls its annual survey "gold-standard." The $7,471 is only the worker's contribution. The employer pays the larger part of the total premium, and the newsletter doesn't give that full figure. Workers at small businesses saw bigger increases than average, though the article doesn't say how much bigger.
STAT explains the rise simply: health care itself keeps getting more expensive. So far employers have absorbed most of the increase. That has a cost of its own. Small businesses are increasingly dropping coverage for their workers, and experts quoted by STAT say employers are reaching a "breaking point." Premiums could rise even faster next year.
A 9% jump in the worker's share is much faster than typical wage growth, so take-home pay effectively shrinks for families on employer plans. The newsletter summary doesn't break down where the cost growth comes from, such as hospital prices, drugs (including expensive 2 obesity drugs) or how often people use care. The full KFF report would be the place to look for that.
Coverage: the uninsured rate climbs
The 3's Biennial Health Insurance Survey, which it runs every two years, found that the uninsured rate among working-age U.S. adults rose from 8.9% in 2024 to 11.2% in 2026. That is 2.3 percentage points, roughly a quarter more uninsured adults than two years ago. Half of all uninsured people said they had skipped needed care because of cost.
The Fund links the rise to two policy changes:
Enhanced 4 tax credits ran out. These subsidies cut premiums for people buying their own plans on the ACA marketplaces. Congress expanded them during the pandemic, and when the expansion lapsed, many people's premiums went up sharply.
Pandemic 5 protections ended. For about three years, states couldn't remove people from Medicaid, the joint federal-state program for low-income people. After that rule ended, states rechecked everyone's eligibility, and many people lost coverage, some because of paperwork problems.
This explanation is the survey authors' reading of the timing. A survey can show the rate went up, but it can't prove what caused it. Still, both policies directly affected large numbers of enrollees, so the explanation is plausible.
The Fund expects things to get worse. In 2027, major Medicaid cuts and new limits on the ACA marketplaces take effect, and both will make coverage harder to get. The article doesn't list the specific provisions.
The two trends together
The surveys show pressure from two directions at once. Workers with job-based coverage pay more, and some small employers stop offering it. People without job-based coverage find marketplace plans and Medicaid harder to get or keep. For patients, the most important number is the share of uninsured who skip care. Delayed care tends to make chronic disease worse and push people toward emergency treatment.
Prehab before a liver transplant
A study in Clinical Gastroenterology and Hepatology tested "6": a personalized, home-based exercise and diet program for people waiting for a liver transplant. Many of these patients die before an organ becomes available, and frailty is a strong predictor of who does. Researchers at Northwestern Medicine and the University of Pittsburgh enrolled 355 patients. Each met with a physical therapist and a dietitian to build a plan aiming for 150 minutes of activity a week.
The results:
About two-thirds of patients improved their frailty score, a 4.5-point scale built from grip strength, chair stands and balance.
Patients who came to at least three follow-up visits improved by at least 0.4 points. In earlier research, a change that size goes with roughly 50% lower risk of dying on the waitlist.
The frailest patients often benefited most.
Some caution is needed. The newsletter doesn't describe a randomized control group. The 50% figure is a risk linked to a score change, not deaths counted in this trial. And patients who keep coming back for follow-ups may be healthier or more motivated to begin with. The authors want to confirm the results in a larger trial.
Other items
GLP-1 drugs for addiction. GLP-1 drugs are the popular obesity medications such as semaglutide and tirzepatide. Telehealth companies are advertising them on Facebook for alcohol use disorder without waiting for the Food and Drug Administration (FDA) to approve that use. The FDA hasn't approved a new drug for alcohol use disorder in about two decades. Eli Lilly and Altimmune are testing drugs for their effect on alcohol cravings. Whether they work is still unproven.
New York fraud crackdown. Federal officials have targeted New York's Social Adult Day Care program, which Medicaid pays for. It provides socializing, personal care and meals for adults with physical or cognitive disabilities. Mehmet Oz, head of the 7, called it "a plague to the state." Nearly 100 providers received letters saying their billing far exceeded their peers' and asking for documentation. Two providers were arrested on charges of defrauding Medicaid of more than $500,000. Critics say the administration's fraud campaign disproportionately targets Democratic-led states such as Minnesota and California.
Remember
The $7,471 is only the worker's share of a family premium; employers pay the larger part.
The uninsured rate rose 2.3 points in two years, and half of uninsured adults skipped care over cost.
The prehab study's 50% lower waitlist death risk is an inferred association, not a randomized result.
Construction of AdventHealth's hospital in Weaverville, North Carolina, which was held up for three years by a certificate of need court fight.
The Trump administration is using a $50 billion rural health fund to push states to weaken their 1 laws. These laws require a hospital or clinic to prove community need, and get state approval, before it builds or expands. Six states have signaled they will comply.
The lever
The 2 is a five-year fund created in Trump's 2025 One Big Beautiful Bill Act. Half the money, $25 billion, goes to every state in equal shares. The other half depends on other factors, including what policies a state commits to. The 3, the federal agency running the program, called CON laws "an additional expense and burden on rural facilities." It told states that fewer CON rules would mean higher scores.
Maureen Hensley-Quinn of the National Academy for State Health Policy calls this a "carrot," similar to the bonuses the Obama administration paid states that made children's insurance enrollment easier. She warns that in tight budget years, the money can tip states toward a policy they might not otherwise choose.
The case for and against
More than 30 states plus Washington, D.C., have some form of CON law. The laws were meant to prevent monopolies and duplicate facilities that raise costs. Critics from both parties say the laws raise prices, delay needed facilities and keep new technology from rural patients. In North Carolina, a hospital that had won approval spent three years in court before breaking ground in 2026. South Carolina voted in 2023 to end most of its rules. From January, only nursing homes there will need a certificate.
The article doesn't cite studies on what repeal actually does to prices or access.
Tennessee moves first
In April, Tennessee lawmakers passed a bipartisan bill to phase out most remaining CON rules over four years. Alaska, Connecticut, Delaware, Iowa and Mississippi say they may follow. Rural hospital leaders had opposed an earlier, narrower repeal in 2024. Martin Chaney of Maury Regional Health warned of "4," meaning new hospitals would go where patients are most profitable. A month later, a hospital owned by HCA Healthcare, the largest U.S. hospital company and a for-profit, won approval to build 20 minutes from his flagship hospital.
Williamson Health, an independent nonprofit, cited the state's CON plans in a 2025 letter about growing financial pressure. In July 2026, its board voted to sell itself, including a hospital of more than 330 beds, to Ascension St. Thomas for $900 million. The article doesn't show that the CON changes caused the sale.
A hidden cost
Hensley-Quinn adds that CON applications are one of the few records states have of who owns and runs their health facilities. After repeal, states may not know when, for example, 5 takes over hospital services.
The Trump administration has made part of a $50 billion rural health fund depend on states rolling back 1 laws. These laws require a hospital or clinic to get state approval, by proving community need, before it builds or expands. Six states said in their applications that they would revisit their laws. Tennessee has already passed a bill to phase most of its rules out.
How the funding lever works
The 2 was added to the One Big Beautiful Bill Act, Trump's main 2025 legislation, to modernize care in remote areas. It runs for five years. Half of the $50 billion goes to every state in equal shares. The other $25 billion depends on other factors, including what policies a state commits to.
In its notice to applicants, the 3, the federal agency that runs Medicare and Medicaid, called CON laws "an additional expense and burden on rural facilities." It said states with fewer CON rules would score higher. Nothing forces a state to change its law, but holding back would cost it competitive money.
Maureen Hensley-Quinn, a researcher at the National Academy for State Health Policy, calls this a federal "carrot" rather than a "stick." She notes the Obama administration did something similar when it paid performance bonuses to states that made it easier for children to enroll in federally funded health insurance. She says the incentive is a chance for states to ask whether CON rules are worth keeping. She also warns that states should weigh the trade-offs of a "voluntary" federal policy, because "additional federal financing, especially in tight state budget years, can tip the scale."
What the laws do and the case against them
More than 30 states plus Washington, D.C., have some form of CON law, according to the National Conference of State Legislatures. They were meant to curb monopolies and rising costs. The reasoning was that duplicate facilities raise overall spending, so a regulator should decide whether a new one is needed.
Critics say the laws have raised prices, held up needed facilities and kept new technology away from rural patients. Some states require approval for something as small as one expensive piece of equipment. Applications can also be contested. In Weaverville, North Carolina, a hospital that had won its certificate for a needed facility spent three years in a court battle before it broke ground in 2026.
Opposition crosses party lines. South Carolina state senator Wes Climer, a Republican, argued in 2021 that when Obama and Trump agree on something, "the idea probably has some merit." South Carolina voted in 2023 to end most of its rules. Starting in January, new hospital construction and expansion there will no longer need a certificate, and only nursing homes will.
The article doesn't cite studies on what repeal does to prices, access or quality. It presents the arguments on each side through the people making them, not through data.
Tennessee as the test case
Tennessee has done the most. In April, lawmakers passed a bipartisan bill that will unwind most of the state's remaining CON rules over four years. They had tried for years but only passed sweeping changes once federal money was at stake. Alaska, Connecticut, Delaware, Iowa and Mississippi have said they would consider ending or loosening their laws.
Rural hospitals in Tennessee had pushed back on earlier efforts. In 2024, 12 hospital and health system leaders signed a letter from the state hospital association opposing a narrower repeal, which passed anyway. One signer, Martin Chaney, CEO of Maury Regional Health in rural Middle Tennessee, argued that repeal would raise costs and spread staff thin. He also predicted "4": new entrants would build where patients are most profitable and have a range of insurers, leaving rural areas as healthcare deserts.
A month after that letter, TriStar Health applied for a certificate to build a hospital 20 minutes north of Maury Regional Medical Center. TriStar is owned by HCA Healthcare, the largest hospital company in the U.S. and a for-profit. The state approved it despite brief opposition from Maury Regional. HCA did not respond to KFF Health News.
Local officials disagree about the effect. Maury County Commissioner Kevin Markham said "competition is good" and patients should have choices. Judy Herbert, a Williamson County commissioner and board member of the independent nonprofit Williamson Health, predicted closures. Her argument: large systems will take over expensive procedures, and smaller hospitals that relied on that revenue will be forced to close or sell.
In July 2025, Williamson Health's leadership published an open letter citing growing pressure on independent nonprofits, including Tennessee's plans for CON. In July 2026, its board voted to sell its clinics, diagnostic centers and a hospital of more than 330 beds to Ascension St. Thomas, part of one of the country's largest health systems, for $900 million. The article places these events side by side but doesn't show that CON changes caused the sale.
A less obvious cost: losing visibility
Hensley-Quinn raises a side effect that gets less attention. CON applications are long and detailed, so they are one of the few ways states learn who owns and runs their health facilities. She says officials in states that repealed their laws have told her, years later, that even with licensing they can't see the finances or management of their systems. For example, they may not know when a health system contracts with 5 to provide hospital services. "Without CON, without ownership reporting, and without an entity that monitors transactions… there's no way for you to know," she said.
What remains open
The article doesn't say how many points the CMS scoring gives for CON changes or how much money a state risks by keeping its law. It also doesn't say whether states that only promised to "consider" changes will be held to them. The bigger question is whether repeal brings rural competition or speeds up consolidation into large systems. Tennessee's four-year phase-out should give the first real-world answer.
Remember
Only half of the $50 billion is split equally among states; CON rollbacks help a state compete for the rest.
Repealing CON laws also removes one of the few records states have of hospital ownership and finances.
The article reports arguments and anecdotes, not data, on whether repeal improves rural access or speeds consolidation.
A new 1, a study not yet peer reviewed, offers a specific reason why egg cells age faster than the rest of the body: their protein-making machinery wears out. The experiments were done in fruit flies and mice. The work was highlighted by Fight Aging!, a blog that advocates for longevity research.
The problem
Female fertility drops decades before most organs fail. Women are born with all their 2 (immature egg cells), and the eggs that remain become more prone to errors in 3, the cell division that halves the chromosome count. Exactly what goes wrong inside each aging egg is still unclear.
The authors focus on 4, the structures that read messenger RNA and build proteins. Most cells keep making new ribosomes. Oocytes build up a stock while they grow and then mostly stop making more, keeping the same ribosomes for long periods. The authors call this an "intrinsic vulnerability."
What they found
A 5 that tested many genes without a prior hypothesis found ribosome dosage to be a major factor in how long oocytes stay viable.
Lowering ribosome levels on purpose made eggs lose the ability to become viable embryos sooner. It also produced early versions of the meiotic defects normally seen with age, and the embryos developed abnormally.
The main point is that the ribosomes lose function more than they lose numbers. As an analogy, it is like a factory with nearly all its machines still in place, each running at half speed. The summary does not say what causes the damage.
Caveats
This is an animal study and has not yet been peer reviewed. Apart from the 50% figure, the article gives no effect sizes, sample sizes or screen details. The mouse data show a correlation. The evidence for cause comes from removing ribosomes, which is not the same as natural wear, and no experiment restoring ribosome function in old eggs is described. Other known drivers of egg aging, such as mitochondrial decline, still matter. The authors call ribosome decline "a contributor," not the cause. The evolutionary trade-off framing comes from the blogger, not from the study's data.
Nothing changes for patients yet. If human eggs show the same decline, protein-making capacity could become a measure of egg quality in 7 or a target for extending fertility. Both are a long way off.
Researchers have posted a 1, a study not yet peer reviewed, proposing a specific reason egg cells age early. The reason is 2, the cell's protein-making machinery. Oocytes, the immature egg cells, build their ribosomes while they grow and then keep them for long periods without replacing them. The researchers argue that as these old ribosomes lose function, the egg loses quality. The work was covered by Reason at Fight Aging!, a blog that advocates for longevity research. The experiments were done in fruit flies (Drosophila) and mice, not in humans.
The puzzle
Female reproduction ages faster than almost any other part of the body. In humans, fertility drops sharply in the late 30s, while most organs keep working for decades after that. The basic outline is well known. A woman is born with all the 3 she will ever have. The pool shrinks over time, and the eggs that remain become more likely to make errors in 4, the special cell division that halves the chromosome count. What has been less clear is what is going wrong inside each aging egg.
Protein synthesis is known to slow with age in many tissues. Whether that slowdown actually drives aging, or is just a side effect of it, is an open question. The authors argue oocytes are a strong test case. Most cells keep building new ribosomes as needed. Oocytes stock up during their growth phase and then mostly stop. Reason frames this as a trade-off: the germline protects cell quality very tightly, and not churning ribosomes may be part of that. The cost is a component that can't be renewed and eventually wears out.
What the researchers did
According to the abstract, there were four main lines of evidence:
How to read the result
The key finding is that ribosomes wear out in function, not mainly in number. One way to picture it, as an analogy: a factory keeps nearly the same number of machines, they all look fine, but each one is running at half speed. That points to subtle damage, such as chemical changes to ribosomal RNA or proteins, that a check of numbers or structure would miss. The abstract does not identify what that damage is.
The experiment of cutting ribosome numbers is what lets the authors claim cause rather than correlation. With fewer ribosomes, young eggs acted like old ones. This is consistent with lost translational capacity driving egg aging, but it is not quite proof that this happens naturally. Removing ribosomes is not the same as having them slowly lose function. A stronger test would be to restore ribosome function in old eggs and see whether quality recovers. The summary does not mention any such rescue experiment.
Caveats
It is a preprint. The study has not yet been through peer review.
Animals only. Flies and mice differ from humans in reproductive lifespan, which is weeks in flies and months in mice versus decades in women. The mouse evidence shown is a measurement of falling protein synthesis, which is a correlation. The experiment that tests cause is described in the context of the fly work.
Few numbers. Apart from the roughly 50% drop in activity, the article gives no effect sizes, sample sizes, or details about the genetic screen.
One factor among several. Other known contributors to egg aging include mitochondrial decline and the weakening of the cohesin proteins that hold chromosomes together. The authors call ribosome decline "a mechanistic contributor," not the only cause.
The framing is the blogger's. The evolutionary trade-off story comes from Reason's commentary, not from data in the study.
What it changes
For patients, nothing changes yet. No therapy or test is proposed. If the finding holds up in human eggs, translational capacity could become a measure of egg quality in 8 (in vitro fertilization). It could also become a target for efforts to extend fertility. Neither is close. The open questions are what damages ribosomes in aged eggs, whether human oocytes show the same decline, and whether ribosome function can be restored in old eggs.
Remember
Old fly egg ribosomes were about 50% less active, even though their numbers and structure were mostly intact.
Removing ribosomes from young eggs produced aging-like meiotic defects, which supports a causal role.
This is an unreviewed animal preprint with no human data and no rescue experiment yet.
In 2009, health economist Dana Goldman was one of 11 economists who urged Congress to pass the 1, the 2010 law that expanded US health insurance. In a STAT opinion piece he says he now wishes he hadn't. Goldman runs the USC Schaeffer Institute for Public Policy and Government Service. The piece is an argument, not a study.
The promise that failed
The ACA expanded coverage. Goldman says he signed mainly because it promised to "bend the cost curve," slowing how fast health spending grows. It didn't. A 2010 Institute of Medicine report found $750–765 billion of wasteful spending in 2009, about 30% of the total. He says current analyses put waste at up to $1.6 trillion a year, still about 30%. He doesn't name the source for that figure, and waste estimates depend on how waste is defined.
Why, in his view
Cost controls were removed. The 2, meant to force automatic Medicare cuts when spending passed set targets, was repealed in 2018 before it ever operated. The "3" on very generous employer health plans was repealed in 2019.
4. Goldman argues the law sped up mergers that raised prices. Its compliance costs favored large insurers. Exchange plans with 5 of doctors and hospitals pushed insurers to grow for bargaining power. Its "care coordination" goal gave hospitals a reason to buy doctors' practices. He gives no data showing how much the ACA caused versus trends already underway.
The "death panels" attack. After Sarah Palin used the phrase, Goldman says, economists became reluctant to ask whether expensive care was worth its cost.
A research agency that can't weigh cost
The ACA created 6, the Patient-Centered Outcomes Research Institute, which compares how well treatments work. It has funded more than 2,600 studies with more than $5 billion. Goldman's example is research showing that antibiotics could prevent half of appendectomies, an estimated 27,410 fewer surgeries over five years. But Congress barred PCORI from formal 7, meaning comparing what each unit of health benefit costs. PCORI can find that one treatment works slightly better. It can't say whether the extra benefit justifies a much higher price.
His fix
Goldman backs a 2021 USC Schaeffer–Aspen Institute proposal for an independent, publicly funded Institute of Health Technology Assessment. Scientists, economists, doctors and patients would judge the value of drugs, devices and procedures. It would have no power to set prices, only to inform decisions. He also wants PCORI's ban lifted.
The open question is whether advice with no enforcement power will change spending when Congress repealed the ACA's stronger cost tools. Goldman also doesn't address the main objection to cost-per-benefit measures: they can undervalue treatments for older or disabled patients.
Dana Goldman runs the USC Schaeffer Institute for Public Policy and Government Service. In November 2009 he was one of 11 economists who signed a letter urging Congress to pass what became the 1, the 2010 law that expanded US health insurance. In a STAT opinion piece he now says he wishes he hadn't signed it. This is an argument from one prominent economist, not a new study. Its numbers come from waste estimates and one research example.
What the ACA promised and what happened
The ACA did expand coverage, as promised. Goldman says he signed mainly for a different promise: that the law would "bend the cost curve," slowing how fast US health spending grows.
He uses waste as his yardstick. A 2010 Institute of Medicine report (the IOM is now the National Academy of Medicine) estimated $750–765 billion in wasteful health spending in 2009, about 30 cents of every health care dollar. He says similar analyses now put waste at up to $1.6 trillion a year, still about 30% of spending. He doesn't name the source for the newer figure. Waste estimates also depend heavily on how "waste" is defined, so treat the steady 30% as a rough indicator, not a precise measurement. His point is that total spending roughly doubled while the wasteful share stayed the same.
Cost controls that Congress removed
Goldman says he and his colleagues didn't foresee that Congress, with votes from both parties, would strip out or weaken the law's cost-control and financing provisions. He gives two examples:
The 2 (IPAB). This board was meant to trigger automatic Medicare cuts if spending grew faster than set targets. It was repealed in 2018 and never went into operation.
The "3." This was an excise tax on unusually generous employer health plans, meant to discourage coverage so rich that it encourages overuse. Goldman strongly supported it. Congress delayed it several times and repealed it in 2019.
He adds that efforts to move away from fee-for-service payment, where every visit and procedure is billed separately, had "mixed results at best."
His main criticism: consolidation
Goldman argues the bigger mistake was that the law paid little attention to prices. In his view the ACA did nothing to slow consolidation, the merging of hospitals, insurers and doctors' practices into larger systems, and probably sped it up. He names three ways this happened:
Compliance costs. The law's design and paperwork favored large insurers that could spread those costs over more members.
Narrow networks. Many exchange plans contract with a limited set of doctors and hospitals. That gave insurers a reason to grow, so they would have more bargaining power with providers.
Care coordination. The ACA's goal of better-coordinated care gave hospitals a justification for buying physician practices. That increased their market power and let them charge more.
These are Goldman's causal claims. The piece cites no data on how much of the post-2010 consolidation, or the price increases that followed, came from the ACA rather than from trends already underway.
The "death panel" effect
Goldman says many health economists became reluctant to study wasteful spending because of the "death panels" attack, a phrase popularized by former Alaska Governor Sarah Palin. It suggested that weighing the value of expensive end-of-life care would mean government experts deciding whose lives matter. Goldman's reply is that some treatments really are more valuable than others, and the health system already acts on that. He points to his 2009 New York Times essay, "I am a Death Panelist. I Am Not the Problem," which argued that cost control should favor high-value treatments over "endless, ineffective interventions." He says that essay has aged better than the letter.
The ban on cost-effectiveness research
The ACA created 4, the Patient-Centered Outcomes Research Institute, which funds studies comparing treatments. According to Goldman, it has awarded more than $5 billion to over 2,600 studies and projects. His example: research showing that antibiotics could prevent half of all appendectomies, an estimated 27,410 fewer surgeries over five years.
Because Congress feared PCORI could be used to ration care, it barred the institute from formal 5. In practice, PCORI can say whether treatment A works better than treatment B. It cannot put numbers on the health gained and compare treatments by what each unit of benefit costs. That is the step agencies such as England's NICE take, often using cost per quality-adjusted life year (6), a measure combining how much longer and how much better people live.
Here is an illustration with made-up numbers. Two drugs both slow a disease. Drug A costs $20,000 and adds 0.5 QALYs, so $40,000 per QALY. Drug B costs $150,000 and adds 0.6 QALYs. B helps a bit more, but each extra QALY it buys over A costs $1.3 million. A PCORI study could report that B works slightly better. It could not report that calculation. Goldman argues that without it, no one can see what treatments are worth "to patients and society in dollars over time."
What he proposes
Goldman backs a 2021 recommendation from the USC Schaeffer Center and the Aspen Institute: Congress should create an independent, publicly funded Institute of Health Technology Assessment. It would bring together scientists, economists, physicians and patients to judge the effectiveness and value of drugs, devices and procedures, both new and existing. It would have no regulatory power and could not set prices. Its role would be to inform payers, providers and patients. He also wants Congress to let PCORI do cost-benefit analysis. He says these steps could cut the roughly 30% of care that "does no good" without rationing or price controls. He calls the current administration's focus on fraud "a good start" and argues that plans like Medicare for All will fail without cost control.
Trade-offs and open questions
The proposal assumes that information alone will change behavior. A body that can't set prices or coverage rules relies on insurers, Medicare and doctors choosing to act on its findings. Goldman doesn't explain why they would when the ACA's stronger tools were repealed. He also leaves out the main objection to cost-per-QALY measures: they can rate treatments for disabled or older patients lower, because those patients start with fewer quality-adjusted years to gain. That concern sits behind the ACA's restrictions, and any new institute would face the same political fight that produced the PCORI ban.
Remember
By the estimates Goldman cites, about 30% of US health spending is wasteful, the same share in 2009 and today, while total waste roughly doubled.
Congress, with votes from both parties, repealed the ACA's main automatic cost controls in 2018 and 2019.
PCORI can compare how well treatments work but is legally barred from saying whether a treatment is worth its price.
Mortality-trained or pace-of-aging clocks respond. These include clocks like 4, trained to predict death, and 5, trained on how fast people decline over years. They are closer to the outcomes that matter than clocks trained only to guess a person's age.
Multiple clocks move in the same direction. One clock moving alone looks like noise. A shared signal across clocks looks like biology.
Ribosomes from old fly eggs were about 50% less active at making protein, even though there were only modestly fewer of them and they looked structurally normal. Both ribosome subunits contributed to the drop.
Aged mouse eggs at 6, an early meiotic stage, made markedly less protein.
A 5. An unbiased screen, meaning one that tested many genes without guessing in advance which would matter, found that ribosome dosage strongly affects how long oocytes stay viable. The article does not say which organism the screen used or how many genes it covered, though the context suggests flies.
Cutting ribosome numbers. When the researchers lowered ribosome levels on purpose, oocytes lost 6 (the ability to become a viable embryo) sooner. They also showed early versions of the meiotic defects that normally appear with age, and the embryos they produced developed abnormally.
Measuring old ribosomes directly. Ribosomes taken from aged fly oocytes were about 50% less active at translation, the step of turning messenger RNA into protein. Yet there were only modestly fewer of them, and their overall structure and makeup looked normal. Both halves of the ribosome, the large and small subunits, contributed to the drop.
A check in mammals. In aged mouse oocytes at 7, the stage when chromosomes first line up to separate during meiosis, protein synthesis was "markedly" lower.
