Medicare Sticker Shock and Election-Night Heartbeats · Morning Gist
Saturday, October 315 stories · 16 min
Medicare Sticker Shock and Election-Night Heartbeats
Medicare drug plan premiums jump, Florida considers dropping school vaccine requirements, a mouse study finds liver cancer without driver mutations, and evidence that elections strain hearts.
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Stand-alone Medicare drug plan premiums rise about 50% in 2027 and zero-premium plans disappear. Comparing plans before December 7 could save hundreds. story 1 ↓
Florida may drop school requirements for Hib, chickenpox, pneumococcal and hepatitis B shots. Kindergarten measles coverage there is already down to 88.9%. story 2 ↓
Switching on YAP1 in mouse liver cells caused cancer by removing DNA methylation, with no driver mutations. Blocking the TET1 enzyme reduced tumours. story 3 ↓
Implanted heart devices recorded 77% more irregular heartbeats around the 2016 election. The studies are observational, but the finding is timely before Tuesday's midterms. story 4 ↓
A judge blocked a narrow Medicaid frailty exemption from work rules, and hybrid clinics are billing urgent-care visits as ER visits. story 5 ↓
Nearly two in three teens and tweens use AI chatbots, often when stressed or lonely. The survey can't show cause and effect.
1/5KFF Health News· Phil Galewitz· Oct 30
Stand-alone Medicare drug plan premiums set to rise 50% in 2027
A KFF analysis finds the average premium for stand-alone Medicare drug plans will jump from $34 to $51 a month in 2027. Deductibles rise too. Enrollees can switch to cheaper plans until December 7.
Why it matters · For 25 million people in stand-alone Medicare drug plans, or anyone helping an older parent, shopping before December 7 could save hundreds of dollars or more in 2027.
Know this first
Context from the editor, not the article · 28 sec
1 · Two ways to get Medicare drugs
Medicare Part D drug coverage is sold by private insurers. People in traditional Medicare buy a stand-alone drug plan. People in Medicare Advantage, a private alternative to traditional Medicare, usually get drug coverage bundled into that plan.
2 · Open enrollment
Every fall, from October 15 to December 7, Medicare enrollees can switch plans for the next year. Plans can change their premiums, deductibles and covered drugs every year, so last year's good deal may not still be one.
3 · Why premiums are under pressure
The 2022 Inflation Reduction Act capped yearly out-of-pocket drug spending starting in 2025 and moved more catastrophic-cost liability onto insurers. To soften the effect on premiums, Medicare launched a temporary subsidy for stand-alone plans.
2/5The Conversation: Health· Katrine L. Wallace, Assistant Professor of Epidemiology and Biostatistics, University of Illinois Chicago· Oct 30
Florida weighs ending school requirements for four childhood vaccines
At an October 2026 hearing, Florida's health department considered dropping school-entry requirements for four vaccines. An epidemiologist uses US case counts from before and after each vaccine to show what fewer vaccinated children could bring back.
Why it matters · Whether removing a school mandate actually lowers uptake, and by how much, will be tested in real time in a state of 23 million people, with measles already circulating.
Know this first
Context from the editor, not the article · 32 sec
1 · How school mandates work
US states, not the federal government, decide which vaccines children need to enter school or daycare. Most allow medical exemptions, and many also allow religious or personal ones. Mandates mainly push coverage up by making vaccination the default.
2 · Herd immunity thresholds
When enough people are immune, an infection can't find enough new hosts to keep spreading. That protects babies too young for their shots and people whose immune systems can't respond. For measles, the very contagious benchmark is about 95% coverage.
3 · Florida's earlier push
3/5Fight Aging!· Reason· Oct 30
Mouse liver cancer formed through gene-regulation changes, without driver mutations
In mice, researchers switched on a growth signal in a few liver cells. The cells became liver cancers with no known cancer-causing mutations. Instead, lost chemical tags on DNA switched on cancer-promoting genes.
Why it matters · If some cancers come from changes in how genes are controlled rather than from mutations, ageing's role in cancer and the targets for treating those cancers may differ from the usual picture.
Know this first
Context from the editor, not the article · 28 sec
1 · The usual cancer story
Most cancers carry 'driver' mutations, DNA changes in genes such as TP53 or KRAS that push cells to grow out of control. Sequencing projects have catalogued these drivers. A minority of tumours, however, carry none of the recognised ones.
2 · Epigenetics and methylation
Cells also control genes without changing the DNA sequence. One method is DNA methylation: small methyl tags on DNA usually keep a gene silent. TET enzymes remove these tags, which can switch genes back on.
3 · YAP1 and TEAD
YAP1 is a protein that drives organ growth and is normally kept in check by the Hippo signalling pathway. It works by binding TEAD proteins, which sit on DNA and turn on growth-related genes.
4/5STAT· Elizabeth Cooney· Oct 30
Studies link the 2016 and 2020 elections to more heart rhythm problems and heart attacks
Two US studies found more irregular heartbeats around the 2016 election and more heart-attack hospitalizations right after the 2020 vote. Both are observational, so neither proves that election stress caused the heart events.
Why it matters · Nearly half of US adults have some form of cardiovascular disease, and a predictable stress spike is one cardiac trigger people can partly plan around.
Know this first
Context from the editor, not the article · 27 sec
1 · Acute stress as a trigger
Cardiologists have long seen short-term bursts of heart attacks and cardiac events after shocks such as 9/11, earthquakes and big World Cup matches. Researchers use these events as natural experiments to study emotional triggers.
2 · Implanted devices as recorders
Many people with heart rhythm disorders carry implanted pacemakers or defibrillators. These devices log every abnormal rhythm with a timestamp, which gives researchers a continuous, objective record without asking patients to report symptoms.
3 · Why observational data is limited
Comparing event rates in an exposed period with a control period can show an association. It cannot rule out other causes that happened at the same time, such as weather, seasonal illness or changes in behavior.
5/5STAT· Annalisa Merelli· Oct 30
Judge blocks narrow Medicaid frailty rule; hybrid clinics bill urgent visits as ER
A federal judge struck down a narrow federal definition of "medically frail" that limited exemptions from Medicaid work requirements. STAT also found patients at hybrid clinics paying ER prices for routine urgent-care visits.
Why it matters · Who counts as exempt from Medicaid work rules, and how a visit gets billed, decide whether people get care. Both moved this week.
Know this first
Context from the editor, not the article · 26 sec
1 · Medicaid work requirements
A 2025 federal law requires many adults covered through Medicaid expansion to show about 80 hours a month of work or similar activity, starting by 2027. Some groups are exempt, including people deemed "medically frail."
2 · Urgent care versus ER billing
Emergency departments charge large facility fees that urgent care clinics don't. A clinic that can bill a visit either way has a financial reason to choose the more expensive category.
3 · Young-onset colorectal cancer
Colorectal cancer has been rising for decades in adults under 50, and younger patients are often diagnosed at later stages. The causes are still unexplained, and earlier studies may have been skewed by confounding factors.
A new analysis from KFF, a health policy nonprofit, finds the average monthly premium for 1 Medicare prescription drug plans will rise 50% in 2027, from $34 to $51. Nearly 25 million people have these plans. Anyone can switch to a cheaper one during 2, which ends December 7.
The rise is concentrated in stand-alone plans. People in 3, the private-plan alternative to traditional Medicare, usually get drug coverage bundled in. About 31 million people get coverage that way, and the drug part of their premium averages $9 a month in 2027, up by less than $2.
Staying put will cost most people more
KFF counted stand-alone enrollees who don't get the 4, which pays most premiums for people with limited means. Of that group, 76% (10.4 million people) will pay more if they keep their current plan. That includes 4.1 million people now paying no premium at all. No zero-premium plans will be offered in 2027.
Individual cases can be much worse than the average. Robert Travis Scott of Virginia saw his plan's premium set to go from $39.60 to $121.90 a month. With a quick search online, he switched to a similar Humana plan for $19.30 and expects to save about $1,000.
Other costs are rising too
Deductibles: what you pay before coverage starts. They average $643 for stand-alone plans (up from $540) and $489 for Medicare Advantage drug coverage (up from $360).
Coinsurance: most enrollees will pay a percentage of each drug's price instead of a fixed copay. That makes their costs harder to predict, since a pricier drug means a bigger bill.
Why
KFF links the premium jump partly to a July decision by the 5 (CMS), the agency that runs Medicare. CMS ended a three-year pilot a year early. The pilot had paid subsidies to keep stand-alone premiums down in 2025 and 2026. CMS Administrator Mehmet Oz called it an insurance industry bailout. The article calls this a possible cause and doesn't say how much of the increase it explains.
The government's competing figure
CMS projects the average premium will barely move, from $35 to $36. KFF says CMS didn't explain its method and may have assumed people will switch to cheaper plans. KFF's 50% figure describes people who stay where they are.
The analysis landed days before the November 3 midterms. President Trump says his administration has secured "the lowest drug prices anywhere in the world." The article doesn't test that claim. It notes that what people actually pay depends on which drugs they take and how they're covered.
The finding
The average monthly premium for 1 Medicare prescription drug plans will rise from $34 in 2027 to $51, an increase of 50%. That figure comes from an analysis by KFF, a health policy nonprofit that also runs KFF Health News, which published the story. About 25 million people are in these plans. Medicare's 2 period, when people can switch, runs through December 7.
The increase falls mostly on one group. 3 is the private-plan alternative to traditional Medicare, and more than half of beneficiaries now use it. Its plans usually bundle drug coverage in, and about 31 million people get drug coverage this way. For them, KFF puts the drug portion of the monthly premium at an average of $9 in 2027, up by less than $2.
Who pays more by staying put
KFF's most practical number concerns people who don't switch. Leave out enrollees who get the 4, which covers most premium costs for people with limited means. Of everyone else in stand-alone plans, 10.4 million people, or 76%, will pay a higher premium in 2027 if they keep the plan they have.
That group includes 4.1 million people now in plans with no premium at all. They have no zero-premium plan to fall back on, because KFF found that none will be offered in 2027.
For any one person the change can be far larger than the average. Robert Travis Scott of Abingdon, Virginia, was told his AARP-UnitedHealthcare plan would go from $39.60 a month to $121.90, roughly triple. After a short search online he found a Humana plan with similar benefits for $19.30. He estimates he will save about $1,000 next year. He worried that other seniors won't shop around. KFF's Juliette Cubanski said the stakes of "sitting on the sidelines" are higher this year than usual.
Premiums aren't the only cost going up
Most people with Part D coverage will also have a drug 5 in 2027, meaning they pay the full price of their drugs until they've spent that amount. KFF's averages:
Stand-alone plans: $643, up from $540 in 2026 (about 19%)
Medicare Advantage drug coverage: $489, up from $360 (about 36%)
So deductibles in Medicare Advantage are rising faster in percentage terms, even though its premiums are barely moving.
Most enrollees will also pay 6 rather than copayments. A copayment is a fixed fee, such as $10 a prescription. Coinsurance is a percentage of the drug's price, such as 25%. As an illustration: at 25% coinsurance, a drug priced at $40 costs the patient $10, but one priced at $400 costs $100. When the price changes, so does the bill, which is why KFF says coinsurance makes out-of-pocket costs harder to predict.
Why premiums are rising
KFF points to one likely cause. In July, the 7 (CMS), the federal agency that runs Medicare, ended a three-year pilot program a year early. The pilot paid subsidies to stand-alone drug plans in 2025 and 2026 to hold down their premiums. It had been set up as plans adjusted to the Inflation Reduction Act's redesign of Part D. That redesign capped what enrollees pay out of pocket each year and made insurers cover more of the costs above the cap. CMS Administrator Mehmet Oz has called the pilot an insurance industry bailout. With the subsidy gone, plans have more of their own costs to recover through premiums.
The article treats this as a "possible" cause, not a proven one. It doesn't break down how much of the increase comes from the lost subsidy and how much from plans' rising drug costs or other changes.
KFF's estimate versus CMS's
CMS projects something very different: the national average premium going from $35 to just $36, based on September 2026 enrollment. KFF says CMS didn't explain how it calculated that. One possible reason for the gap is that CMS assumed many people would move to cheaper plans. If so, the two estimates answer different questions. KFF's figure shows what people face if they stay where they are. CMS's may show what happens if enough people switch. CMS did not respond to a request for comment before publication.
That difference matters for how to read the 50% figure. It is a forecast of what people will pay if they don't act, not a measure of what they will actually pay.
The political backdrop
The analysis came out days before the November 3 midterm elections. Drug costs are among the affordability issues voters care about. At an October 28 rally in Ohio, President Trump said his administration had won "hundreds of billions" in pharmaceutical savings and that the US now has "the lowest drug prices anywhere in the world" through "favored nations" pricing. That refers to his push to tie US drug prices to the lowest prices paid in other wealthy countries.
The article doesn't check that claim directly. It notes that what people actually pay depends heavily on which drugs they take and how they're insured. It also doesn't explain why lower negotiated drug prices, if real, aren't showing up in lower premiums. Premiums reflect a plan's total expected costs, subsidies and pricing strategy, not only the list prices of drugs.
What's left open
How much the lost subsidy explains. The article names it as a possible cause but doesn't separate it from other pressures on plans.
Real-world switching. The gap between KFF's and CMS's estimates depends on how many enrollees shop around. Historically, many don't.
Total costs, not just premiums. Higher deductibles and the move to coinsurance could matter as much as premiums for people on expensive drugs. The article gives no estimate of total out-of-pocket spending.
What to do
If you or a relative has a stand-alone Part D plan, check the plan's annual notice of change and compare options on Medicare's online Plan Finder before December 7. Look at the premium, the deductible and whether each of your drugs is covered by a copay or by coinsurance.
Remember
KFF's 50% figure assumes people keep their current plan. CMS's estimate of a $1 rise may assume they switch.
None of the 2027 stand-alone drug plans will have a zero premium. 4.1 million people currently in one will pay more.
Higher deductibles and the move to coinsurance may hit people on expensive drugs harder than the premium increase.
In September 2025, Florida's Surgeon General Joseph Ladapo said the state should end all vaccine mandates. Some requirements are written into state law and need the legislature to change them. These four are set by health-department rule, so the department can drop them itself.
Image: The Conversation: Health
Florida's Department of Health held a hearing in October 2026 on dropping four vaccines from its school and childcare entry requirements. They are 1 type b (Hib), chickenpox, 2 and hepatitis B. The vaccines would stay available and recommended, but parents would no longer need proof of them to enrol a child. Measles, mumps and rubella (3) and other requirements are not part of this proposal.
Katrine Wallace, an epidemiologist at the University of Illinois Chicago, argues against the change in The Conversation. She does it by setting out how much harm each disease did in the US before vaccines. Her point is that lower coverage puts at risk not only children whose parents opt out, but also infants too young to be fully vaccinated and children who can't mount an immune response.
What the vaccines prevented
Florida's starting point
Measles shows the risk. The US declared it eliminated in 2000, yet Florida had 162 cases in 2026 as of October 17, at least 62 of them from an outbreak at Ave Maria University. Only 88.9% of the state's kindergartners had MMR in 2025-26, against 92.4% nationally and the roughly 95% needed for 6. Tracking is patchy. The state has no measles dashboard, and public counts disagree.
The caveat
The national figures before and after each vaccine are solid. The article doesn't estimate how much uptake would drop without the mandates, and that will decide how much disease comes back. It also doesn't give the department's reasons for the proposal.
In October 2026 the Florida Department of Health held a hearing on a proposal to stop requiring four vaccines for entry to school and childcare. They are 1 type b (Hib), chickenpox (varicella), 2 and hepatitis B. Other requirements, including measles, mumps and rubella (3), are not part of this proposal. The vaccines would still be available and recommended. Families just would no longer need proof of them to enrol a child.
Katrine Wallace, an epidemiologist at the University of Illinois Chicago who studies vaccine-preventable disease, wrote the piece for The Conversation. It argues against the change. Her method is to set out how much harm each disease did in the US before its vaccine arrived. She argues that parents who never saw these illnesses may underrate them. She also stresses that the risk goes beyond families who opt out, because lower coverage exposes infants too young to be fully vaccinated and children who can't mount an immune response.
The article does not give the department's stated reasons for the proposal. It also doesn't estimate how much coverage might fall without a mandate. That is the key unknown, and Wallace herself concedes that ending a requirement "would not mean that every family would stop using them."
Hib: 4 without outbreaks
Before 5 Hib vaccines came into wide use in the late 1980s, Hib was the leading cause of bacterial meningitis in American children. Conjugate vaccines link a bacterial sugar coat to a protein so that infants' immune systems can recognise it. In the early 1980s there were about 20,000 invasive Hib infections a year in children under 5, and 12,000 of them were meningitis. Between 3% and 6% of those children died. Between 15% and 30% of survivors were left deaf or with brain damage.
Hib didn't cause dramatic outbreaks. Healthy children carried the bacterium silently, and a few became seriously ill without warning. Vaccination cut cases in young children by 99%. The US reported 13 cases in children under 5 in 2023, and 28 so far in 2026. The article doesn't say what caused that rise, and with numbers this small it can't on its own show a trend.
Chickenpox: not as harmless as remembered
In the early 1990s the US had more than 4 million chickenpox cases a year. Between 10,500 and 13,500 people were hospitalised and 100 to 150 died. Children made up more than 90% of cases, about 70% of hospitalisations and roughly half the deaths. Anyone who has had chickenpox also carries the dormant virus and can develop shingles later in life.
The way the disease spreads helps explain why it disrupts schools. Children are contagious before the rash appears, and the incubation period runs up to three weeks. So one case can move through a school or daycare in waves for a month or more. Since the vaccine arrived in 1995, chickenpox deaths in people under 20 have been almost eliminated.
Pneumococcus: from ear infections to meningitis
Pneumococcal bacteria often live harmlessly in a child's nose. They cause serious disease when they reach the blood or organs. Before the childhood vaccine came in 2000, they caused about 17,000 invasive infections a year in US children under 5. That included about 700 cases of meningitis and 200 deaths, plus around 5 million ear infections.
Hepatitis B: infection early in life is the danger
Hepatitis B passes from mother to baby during birth and through infected blood. Infected adults and young children often have no symptoms, so the virus can spread within households without anyone knowing. Age at infection matters most. An infected infant has about a 90% chance of developing chronic hepatitis B, which over decades can cause 6 and liver cancer. That risk falls sharply in older children and adults, which is why prevention targets infancy.
Before the vaccine became available in 1982, about 20,000 American children were infected each year. The CDC recommended vaccinating all infants in 1991. By its estimate, hepatitis B infections passed on at birth fell 75% between 1987 and 2000.
Florida's starting point
Florida's own historical data are thin. The state didn't start tracking chickenpox until late 2006, so its pre-vaccine burden can't be rebuilt from state records. All the figures above are national.
Wallace points to measles as a live example of what happens when coverage slips. The US declared measles eliminated in 2000, meaning it no longer spread continuously within the country. Imported cases can still start outbreaks where enough people are unvaccinated. Florida reported 162 cases in 2026 as of October 17, including at least 62 linked to an outbreak at Ave Maria University near Naples. In the 2025-26 school year, 88.9% of Florida kindergartners had received MMR. That is below the national average of 92.4% and the roughly 95% needed for 7.
Tracking has become harder too. In May 2026 the department took county-level disease data off its website. The data are back, but there is no measles dashboard, 2026 counts are often delayed, and public trackers disagree on the state total.
How to weigh the argument
The pre-vaccine numbers come from established national surveillance and are solid. So is the scale of the drop after each vaccine was introduced. The piece is weaker on what happens next. It shows that these diseases were serious and that vaccines cut them sharply. It does not show how much uptake would fall in Florida if the mandates ended, and that determines whether disease returns.
The diseases would also return in different ways. Chickenpox spreads easily and would show up quickly as school outbreaks. Hib and pneumococcal disease come from bacteria children carry, so a rise would probably appear as scattered severe cases. Hepatitis B depends partly on screening during pregnancy and vaccination at birth, which a school mandate doesn't control. The article doesn't separate these differences. Florida's falling MMR coverage does suggest that, in this state, the habit of vaccinating is already weakening.
Remember
How harmful hepatitis B is depends on age at infection: infected infants have about a 90% chance of chronic disease.
Hib and pneumococcus cause scattered severe cases rather than outbreaks, so a resurgence could be noticed late.
Florida's kindergarten MMR coverage is 88.9%, well below the roughly 95% needed for herd immunity.
A mouse study in Communications Biology shows a liver cancer forming through changes in gene regulation, with none of the DNA mutations usually blamed for cancer. Reason, who writes the longevity blog Fight Aging!, highlighted it. The source is only Reason's short comment and the paper's abstract, so no effect sizes are available.
The puzzle
Most cancers carry 1, recurring DNA changes that push cells to grow uncontrollably. A small share of tumours have none of the recognised drivers. The researchers suspected 2, a growth-promoting protein that works by pairing with 3 proteins on DNA. Their idea was that persistent YAP1 activity could change the cell's 4 marks, the chemical tags that switch genes on or off without changing the DNA sequence.
What they found
In a 5, the team switched on YAP1–TEAD in just a few scattered liver cells. Those cells went on to form 6 (HCC), the main type of primary liver cancer.
7, which reads the protein-coding DNA, found no known driver mutations in the tumours.
8, which maps the silencing methyl tags on DNA, showed widespread loss of those tags. Several cancer-promoting genes had switched on as a result.
The proposed chain: YAP1 binds TEAD, TET1 rises, methyl tags come off oncogenes, the oncogenes switch on, and cancer follows.
In people with 10, liver damage that follows a heart surgery for children born with a single working ventricle, liver cells showed raised YAP1–TEAD–TET1 activity signatures. Liver cancers in these patients carry driver mutations less often than usual.
Caveats
The trigger was forced artificially in mice. The study shows this route can cause cancer, not how often it does in humans.
Whole-exome sequencing misses non-coding DNA, so unknown genetic contributors can't be fully ruled out.
The abstract says Tet1 knockdown "attenuated" tumours but gives no size for the effect.
The human evidence is correlational and comes from one uncommon condition.
Why ageing comes into it
Reason asks how much of ageing's cancer risk comes from piling-up mutations versus piling-up epigenetic drift. He expects the answer to vary by tissue. This study doesn't test that question. It only shows that an epigenetic route to cancer exists in mice.
A mouse study in Communications Biology reports that a liver cancer can develop through changes in gene regulation, with none of the DNA mutations normally thought to drive cancer. Reason, who writes the longevity blog Fight Aging!, flagged the paper. The source here is short: Reason's comment plus the paper's abstract. Many details, including effect sizes, are not given.
The puzzle
Large sequencing projects have found 1 (DGMs) in most cancers. These are recurring DNA changes that push cells toward uncontrolled growth, and in many cases researchers know how they do it. A small share of tumours carry none of the recognised drivers, and how those tumours form has been unclear. The authors proposed that some of them are driven by 2, a transcriptional coactivator: a protein that boosts the activity of genes rather than binding DNA itself. YAP1 drives organ growth and does its job by pairing with 3 proteins, which sit on DNA. The team suspected that persistent YAP1 activity could change the cell's 4 state, meaning the chemical marks that decide which genes are on or off without altering the DNA sequence.
What they did
The team built a 5 of 6 (HCC), the most common primary liver cancer. "Mosaic" means only a few scattered liver cells (hepatocytes) were engineered to have YAP1–TEAD switched on. The rest of the liver was normal. This resembles how a tumour starts in one rogue cell surrounded by healthy tissue.
Tumours formed. The researchers then tested them in four ways:
The proposed chain runs: YAP1 binds TEAD, activity of the TET1 demethylase rises, methyl tags are removed from oncogenes, those oncogenes switch on, and cancer develops, all without a mutation doing the initiating. As an analogy (ours, not the authors'): a driver mutation is like rewriting a line in the instruction manual, while this route peels sticky notes off pages that say "skip this section".
The human link
The authors looked at liver tissue from people with 10 (FALD). The Fontan procedure is surgery for children born with only one working heart ventricle. It reroutes blood flow, and over decades the resulting high venous pressure congests and scars the liver. HCCs that arise in FALD carry canonical driver mutations less often than typical liver cancers. Hepatocytes from FALD patients showed raised YAP1–TEAD–TET1 gene-activity signatures. That fits the mouse mechanism, but it is a correlation in gene-expression patterns, not proof that the same chain causes human tumours.
Caveats
It is a mouse model with a forced trigger. YAP1–TEAD was switched on artificially. The study shows that this route can produce cancer, not how often it does in people.
"No driver mutations" has limits. Whole-exome sequencing skips non-coding DNA and structural changes, and "canonical" means only the drivers already catalogued. Unknown or non-coding genetic contributors cannot be fully excluded from the abstract alone.
No effect sizes are given. The abstract says Tet1 knockdown "attenuated" tumour formation. How much it did so is not reported in the source.
The human evidence is indirect. It consists of expression signatures in one uncommon disease.
The scope is narrow. The authors frame this as an explanation for the small fraction of HCCs that lack drivers, not for liver cancer in general.
The ageing question
Reason uses the result to raise a broader question. Ageing raises cancer risk, but how much of that comes from accumulating mutations, and how much from accumulating epigenetic drift that changes the activity of oncogenes? He expects the answer to differ by tissue and cancer type. The study does not test that question. It shows only that an epigenetic route to one cancer exists in mice. If such routes matter in human ageing, they could in principle be targeted differently from mutations, because methylation marks are reversible and enzymes such as TET1 can be drugged. That remains speculation for now.
Remember
Forcing YAP1 on in mouse liver cells caused tumours with no known driver mutations, only widespread DNA demethylation.
Reducing the demethylating enzyme TET1 cut tumour formation, which points to the epigenetic change as a cause.
Human support is indirect: expression signatures in Fontan liver disease, a rare condition with fewer driver mutations.
Ahead of Tuesday's US midterms, STAT's Elizabeth Cooney pulls together research suggesting that divisive elections show up in cardiac data. In the weeks around a vote, irregular heartbeats become more common, and heart-attack hospitalizations rise just after it.
The 2016 study: implanted devices
Lindsey Rosman, now a cardiologist-researcher at Northwestern University, studied North Carolina patients who already had a heart rhythm disorder. Their implanted cardiac devices, such as pacemakers and defibrillators, automatically record each 1 (an abnormal heart rhythm). In the six weeks around the 2016 presidential election, her team found a 77% higher rate of irregular heartbeats than in a comparison period.
The pattern held across age, sex, race and other health conditions, and Democrats and Republicans had similar risk. North Carolina was a swing state that year, so residents saw an especially heavy load of ads and campaign events.
The 2020 study: hospital admissions
Matthew Mefford, an epidemiologist at Kaiser Permanente Southern California, asked whether admissions for acute cardiovascular disease jumped right after Election Day, the way they do after natural disasters. They did. Heart attacks were significantly more frequent in the five days after the 2020 vote than in the same five-day window two weeks earlier. His study included people with and without a history of heart disease. The article doesn't give the size of the increase.
The caveats
Both studies are 2. They show that heart events and the campaign period happened together, not that one caused the other. Mefford also notes that people differ in how strongly stress affects them.
The proposed mechanism
Rosman's explanation is that anger and anxiety set off a fight-or-flight response. Adrenaline rises, the 3 speeds up, and the calming pull of the 4 weakens. Those shifts change the heart's electrical activity and make abnormal rhythms more likely in people already prone to them. Cortisol, inflammation and stress behaviors may add to this: poor sleep, missed medications, salty or fatty food, and extra alcohol or caffeine.
Rosman says the findings apply most directly to people at high cardiac risk. But nearly half of US adults have some cardiovascular disease, counting high blood pressure. She is planning studies that use wearables, plus a larger nationwide analysis of the 2020 and 2024 elections.
Practical advice
The advice is ordinary but reasonable, especially for people with uncontrolled hypertension or coronary disease:
Limit news and social media, particularly before bed.
Protect your sleep and stay active.
Take your medications.
Walk, exercise, or try yoga or meditation.
With US midterm elections on Tuesday, STAT's Elizabeth Cooney reports on a small body of research suggesting that divisive elections can strain the heart. Two studies, one on the 2016 presidential election and one on 2020, found more irregular heartbeats in the weeks around voting day and more heart-attack hospitalizations right after it. Both are observational. They show that the two things happened together, not that one caused the other.
Why elections are worth studying
Doctors have long known that sudden emotional shocks can bring on cardiac events. Lindsey Rosman, an assistant professor of cardiology at Northwestern University, points to reported rises in heart attacks and other cardiac events after 9/11, earthquakes and World Cup matches. Elections are a useful version of this kind of natural experiment. Their date is known in advance, they reach almost everyone, and the stress they cause builds over weeks. That lets researchers compare a defined exposure window with a control period in the same population.
The hard part is attribution. Early November differs from other times of year in weather, respiratory illness and daily routine, and observational designs can't fully separate those factors from political stress.
2016: what the devices recorded
Rosman did the first study while at the University of North Carolina. She focused on patients who already had a heart rhythm disorder and had implanted cardiac devices. These devices, such as pacemakers and implantable defibrillators, continuously monitor the heart and log abnormal rhythms with timestamps. The data is therefore objective and doesn't rely on patients noticing or reporting symptoms.
Her team found a 77% higher rate of 1 (abnormal heart rhythms) in the six weeks around the 2016 election than in a control period. The article doesn't say exactly which period served as the control or how many patients were included. The increase was similar across age, sex, race and other health conditions, and Democrats and Republicans had similar risk. "Your political party doesn't matter to your heart; stress does," Rosman told STAT.
The setting may have mattered. North Carolina was a swing state in 2016, so residents were exposed to an unusually heavy volume of political ads and campaign events. The result may not carry over directly to places with less intense campaigns.
2020: hospital admissions
Matthew Mefford, a cardiovascular epidemiologist at Kaiser Permanente Southern California, took a different approach after the 2020 election. He treated Election Day the way researchers treat natural disasters and asked whether admissions for acute cardiovascular disease rose immediately afterward. His 2 included people with and without a known history of heart disease. Heart attacks were significantly more frequent in the five days after the election than in the same five-day window two weeks earlier. STAT doesn't report the size of the increase.
Mefford frames elections as one stressor among many. Stress "comes in many forms, including both positive and negative," he said, and people differ: "Not everyone responds to stress in the same way or to the same magnitude that triggers a heart event."
How stress could reach the heart
Rosman describes a chain of steps. Bad news and anger set off the fight-or-flight response. Adrenaline rises, the 3 (the body's accelerator) ramps up, and the 4, which normally slows the heart, has less influence. Together these changes alter the heart's electrical activity. In someone whose heart is already prone to misfiring, that makes an abnormal rhythm more likely.
Other pathways may contribute too. These include the stress hormone 5, inflammation, and stress-driven behavior: sleeping badly, skipping medications, eating saltier or fattier food, and drinking more alcohol or caffeine. Some of these behaviors could produce an election-time signal on their own, without any direct effect of emotion on the heart, and the studies as described can't tell these routes apart.
Rosman suggests that heavy social media use may make exposure greater now than it was in 2016, though the article presents this as her view rather than a finding.
Who should care
Rosman says her results apply most directly to people at higher cardiac risk, but that group is large. Nearly half of US adults have some form of cardiovascular disease once high blood pressure is counted. For people with uncontrolled hypertension or coronary disease, a short-term rise in heart rate and blood pressure adds strain to a system that is already stressed. She also notes that emotionally triggered events can happen in people with no diagnosed heart disease. Chronic stress, apart from these short spikes, is an established long-term risk factor.
How strong is the evidence?
It is suggestive but limited. The two studies cover two elections in two regions, use different outcomes (device-recorded arrhythmias versus hospital admissions) and different comparison windows, and neither can establish causation. The 77% figure is a relative increase among patients who already have rhythm disorders. The article doesn't give the absolute event rates, which would show how many extra events that means. Agreement between two different designs counts for something. Replication at larger scale counts for more.
That replication is what Rosman is planning: a larger nationwide study of the 2020 and 2024 elections, which she hopes to finish before the next presidential race. She also plans to use wearables to capture acute stress events as they happen.
Practical advice
The recommendations are low-cost and sensible whatever the size of the election effect:
Set limits on news and social media, especially before bedtime.
Prioritize sleep and physical activity.
Keep taking prescribed medications.
Try walking, hiking, exercise, yoga or meditation.
"Listen to your body," Mefford said.
Remember
The 77% rise in arrhythmias was a relative increase in patients with existing rhythm disorders; the article gives no absolute rates.
Risk was similar for Democrats and Republicans, which points to stress in general rather than which side wins.
A larger nationwide study of the 2020 and 2024 elections is planned to test whether the signal holds up.
STAT's Morning Rounds newsletter this week covers several unrelated stories. Two of them change things for patients right now.
Medicaid's "1" exemption widened by court
Under a 2025 federal law, many adults covered through Medicaid expansion must show work or similar activity to keep their coverage, starting in early 2027. People deemed "medically frail" are exempt. 2, the Centers for Medicare & Medicaid Services, issued an 3 that narrowed the exemption. People had to prove their condition stopped them from working, and no conditions qualified automatically.
States sued. They argued that CMS had no authority to narrow the definition and that the rule would pile paperwork on both beneficiaries and state staff. A federal judge in Massachusetts overturned the rule, saying states hadn't had enough time to assess eligibility. The ruling could delay the work requirements past the start of 2027. The newsletter doesn't say whether the government will appeal.
Urgent care visits billed as ER visits
Intuitive Health is a private equity-backed company running about 50 clinics that combine urgent care and an emergency room in one building. It promised a cheaper alternative to the hospital. STAT's Tara Bannow found that patients with simple problems were often billed at ER rates, which include large 4. One patient paid $211 for a urinary tract infection visit and was then billed another $1,756. Another was charged $7,000 for a cough and congestion ($2,100 after insurance). The company says patients should sign a form before any "upgrade," but Bannow found this often didn't happen.
Young-onset colorectal cancer atlas
Patients diagnosed with colorectal cancer young, especially under 35, often have worse outcomes. Kimmie Ng of 5 led a team that built an "atlas" of 189 tumors from patients in their 20s to their 90s. It is designed to compare tumors across ages while controlling for factors that muddied earlier studies. The newsletter doesn't report any findings yet, and with 189 tumors spread across all ages, each age group is small.
Men's health as a gender question
A three-paper Lancet series asks why men have worse health than women despite holding more social privilege. It frames the answer in terms of gender roles and power rather than biology. The papers offer a conceptual framework, a review of life-expectancy and disability data, and a policy strategy. The authors admit the data review is limited because few studies look at how gender combines with factors such as race or class. They argue that attention to men's health "is not a zero-sum game" with women's health. This is an argument, not new trial evidence.
This week's STAT Morning Rounds newsletter, written by Annalisa Merelli, collects several separate reports. Two matter most for patients: a court ruling on Medicaid work requirements and an investigation into how hybrid ER-urgent care clinics bill patients. The newsletter also covers a new tumor database for colorectal cancer in young adults and a Lancet series on men's health. Each item is a short summary of longer STAT reporting or outside work, so the details below stop where the newsletter's do.
A court rejects a narrow definition of "1"
Under a 2025 federal law, many adults who qualify for Medicaid through expansion must document work or similar activity to keep their coverage. The requirements are due to begin at the start of 2027. People classed as "medically frail" are exempt, so the way that term is defined decides how many people the rules reach.
2, the Centers for Medicare & Medicaid Services, issued an 3 that narrowed the definition in two ways. People had to show that their condition actually stopped them from working, not just that they had a serious condition. The rule also gave no list of conditions that would qualify someone automatically. With no such list, every claim has to be argued case by case.
A group of states sued. They argued that CMS had no authority to narrow the definition, that the rule would bury beneficiaries in paperwork proving their status, and that it would add work for already stretched state staff. A federal judge in Massachusetts rejected the government's definition and overturned the interim rule. The judge's stated reason was that states had not been given enough time to assess who is eligible.
In practice, the work requirements were already tangled, and the ruling may push their rollout past early 2027. The newsletter doesn't say whether the government will appeal, what definition states should use for now, or how many people the narrower rule would have affected.
Hybrid clinics that "upgrade" visits to ER prices
Intuitive Health is a private equity-backed company that runs about 50 hybrid clinics. Each one houses an urgent care clinic and an emergency room under the same roof. The company pitched this as a way to keep simple problems out of costly hospital ERs.
STAT reporter Tara Bannow found that many patients got the reverse. They came in with problems that urgent care could handle and were billed as ER patients. In one case, a patient with a urinary tract infection paid $211 at the clinic and then received a separate bill for $1,756. In another, a visit for congestion and a cough was billed at $7,000, which came to $2,100 after insurance. Company officials say every patient should sign a form before being moved to ER-level care, but Bannow found this often didn't happen.
The mechanism is simple. ER visits carry 4 that urgent care visits don't. When one building can bill either way, the patient may not know which category they're in until the bill arrives. The newsletter doesn't say how often visits get upgraded or how the company responded beyond its policy on consent forms.
A tumor atlas for young-onset colorectal cancer
Patients diagnosed with colorectal cancer young, especially before age 35, often fare worse than older patients. Researchers led by Kimmie Ng, who directs the Young-Onset Colorectal Cancer Center at 5, built an "atlas" of 189 colorectal tumors from patients ranging from their 20s to their 90s. The goal is to compare tumors across ages while controlling for variables that may have confounded earlier studies.
The newsletter doesn't report any findings. It doesn't say which molecular features were measured or what differences turned up. It presents the atlas as a resource that "could help explain" why the disease behaves differently in younger patients. With 189 tumors spread across seven decades of age, any one age group is likely small. Expect the atlas to generate hypotheses rather than settle questions. Ng describes the rising rate in young people as "one of the biggest questions facing our scientific community today."
Men's health, framed as gender rather than sex
A new three-paper series in The Lancet takes on what its authors call a paradox: men have worse health outcomes than women despite holding more social privilege. The authors frame men's health around gender, meaning the culturally defined roles, responsibilities, entitlements and power relations attached to being a man. They set this against a frame of biological sex.
Paper one offers a framework that is 6, meaning it looks at how gender combines with factors such as class or race. It focuses on structural determinants of health.
Paper two reviews data on men's life expectancy and disability. The authors acknowledge that most existing studies don't take an intersectional view, which limits how far they can separate causes from risk factors.
Paper three lays out a political strategy that presents men's health as part of the shared public good.
The authors expect the objection that attention to men takes something away from women. Their reply: "A gendered approach to health is not a zero-sum game." This is a framework and policy argument, not a trial. The empirical paper says outright that the data it can draw on is limited.
Also noted
Health Secretary Robert F. Kennedy Jr. campaigned in Iowa for Republican governor candidate Zach Lahn. He called Lahn's opposition to large-scale agriculture a "spiritual battle" and linked farming practices to cancer and the gut microbiome, without citing evidence. Ahead of the midterms, his main themes are fraud, vaccine "medical freedom," and his 7 (Make America Healthy Again) agenda. STAT also marked a posthumous award to its infectious-disease reporter Helen Branswell: the Kovler Prize for Trust in Life Science Journalism.
Remember
The court's reason was procedural: states had too little time to assess eligibility. It didn't rule on the substance of the definition.
At hybrid clinics, billing depends on which door you're counted through. Ask before treatment whether you're being seen as urgent care or ER.
The colorectal atlas and the Lancet series are resources and arguments, not new results that change care.
Hib, a bacterium that was once the leading cause of bacterial 4 in children. In the early 1980s it caused about 20,000 serious infections a year in children under 5, including 12,000 meningitis cases. Between 3% and 6% of those children died, and 15% to 30% of survivors were left deaf or brain-damaged. Vaccines cut cases by 99%. The US had 13 cases in young children in 2023 and 28 so far in 2026. The article doesn't explain the rise.
Chickenpox. In the early 1990s it caused more than 4 million cases a year, 10,500 to 13,500 hospitalisations and 100 to 150 deaths, about half of them in children. Children are contagious before the rash appears, so outbreaks can move through a school for a month or more.
Pneumococcus. Before the 2000 vaccine, it caused about 17,000 serious infections a year in children under 5, including 700 meningitis cases and 200 deaths, plus around 5 million ear infections.
Hepatitis B. Infected infants have about a 90% chance of chronic infection, which can lead to 5 and liver cancer. The CDC estimates infections passed from mother to baby at birth fell 75% between 1987 and 2000.
Knocking down 9, which makes an enzyme that removes methyl tags, reduced tumour formation. That suggests the demethylation helps cause the cancer.
Single-cell mapping of gene activity found a Tet1-high group of tumour cells that interacted with neighbouring liver cells.
7, which reads the protein-coding portion of the genome, found no canonical driver mutations in the tumours.
8, which maps where DNA carries methyl tags, showed widespread demethylation: many of those silencing tags had been removed. Several oncogenes (genes that promote cancer when active) had been switched on as a result.
Knocking down 9 reduced tumour formation. Tet1 makes an enzyme that removes methyl tags, so this points to demethylation as a cause of the tumours and not just a side effect.
Single-cell spatial transcriptomics, which measures which genes are active in individual cells while recording where those cells sit in the tissue, found a subgroup of tumour cells with high Tet1 that interacted with other liver cell types.
