By Renuka Rayasam, Sam Whitehead, KFF Health News

Every time Ashton Alexander sees an ad for Georgia Pathways to Coverage, it feels like a “kick in the face.”

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Alexander tried signing up for Pathways, the state’s limited Medicaid expansion, multiple times and got denied each time, he said, even though he met the qualifying terms because he’s a full-time student.

Georgia is one of 10 states that haven’t expanded Medicaid health coverage to a broader pool of low-income adults. Instead, it offers coverage to those who can prove they’re working or completing 80 hours a month of other qualifying activities, like going to school or volunteering. And it is the only state currently doing so.

“Why is this marketing out here?” said the 20-year-old, who lives in Conyers, east of Atlanta. “It’s truly not accessible.”

Each denial used the same boilerplate language, Alexander said, and his calls to caseworkers were not returned. State offices couldn’t connect him with caseworkers assigned to him from the same state agency. And when he requested contact information for a supervisor to appeal his denial, he said, the number rang to a fax machine.

“It’s impenetrable,” Alexander said. “I’ve literally tried everything, and there’s no way.”

Millions of Americans trying to access Medicaid benefits could soon find themselves navigating similar byzantine state systems and work rules. Legislation signed into law by President Donald Trump on July 4 allocates $200 million to help states that expanded Medicaid create systems by the end of next year to verify whether some enrollees are meeting the requirements.

Conservative lawmakers have long argued that public benefits should go only to those actively working to get off of government assistance. But the nation’s only Medicaid work requirement program shows they can be costly for states to run, frustrating for enrollees to navigate, and disruptive to other public benefit systems. Georgia’s budget for marketing is nearly as much as it has spent on health benefits. Meanwhile, most enrollees under age 65 are already working or have a barrier that prevents them from doing so.

What Georgia shows is “just how costly setting up these administrative systems of red tape can be,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families.

Over the past two years, KFF Health News has documented the issues riddling Georgia’s Pathways program, launched in July 2023. More than 100,000 Georgians have applied to the program through March. Just over 8,000 were enrolled at the end of June, though about 300,000 would be eligible if the state fully expanded Medicaid under the terms of the Affordable Care Act.

The program has cost more than $100 million, with only $26 million spent on health benefits and more than $20 million allocated to marketing contracts, according to a KFF Health News analysis of state reports.

“That was truly a pretty shocking waste of taxpayer dollars,” Alker said.

The Government Accountability Office is investigating the costs of the program after a group of Democratic senators — including both members of the Georgia delegation — asked the government watchdog to look into the program. Findings are expected this fall.

A state report to the federal government from March said Georgia couldn’t effectively determine if applicants meet the qualifying activities criteria. The report also said the state hadn’t suspended anyone for failing to work, a key philosophical pillar of the program. Meanwhile, as of March, more than 5,000 people were waiting to have their eligibility verified for Pathways.

The Pathways program has strained Georgia’s eligibility system for other public benefits, such as food stamps and cash assistance.

In April, the state applied to the federal government to renew Pathways. In its application, officials scaled back key elements, such as the requirement that enrollees document work every month. Critics of the program also say the red tape doesn’t help enrollees find jobs.

“Georgia’s experience shows that administrative complexity is the primary outcome, not job readiness,” said Natalie Crawford, executive director of Georgia First, which advocates for fiscal responsibility and access to affordable health care.

Despite the struggles, Garrison Douglas, a spokesperson for Georgia’s Republican governor, Brian Kemp, defended the program. “Georgia Pathways is doing what it was designed to do: provide free healthcare coverage to low-income, able-bodied Georgians who are willing to engage in one of our many qualifying activities,” he said in an emailed statement.

New federal requirements in the tax and spending legislation mean that the 40 states (plus Washington, D.C.) that expanded Medicaid will need to prepare technology to process the documentation some Medicaid recipients will now have to regularly file.

The federal law includes exemptions for people with disabilities, in addiction treatment, or caring for kids under 14, among others.

The Trump administration said other states won’t face a bumpy rollout like Georgia’s.

“We are fully confident that technology already exists that could enable all parties involved to implement work and community engagement requirements,” said Mehmet Oz, head of the Centers for Medicare & Medicaid Services, in an emailed statement.

In a written public comment on Georgia’s application to extend the program, Yvonne Taylor of Austell detailed the difficulties she faced trying to enroll.

She said she tried to sign up several times but that her application was not accepted. “Not once, not twice, but 3 times. With no response from customer service,” she wrote in February. “So now I am without coverage.”

Victoria Helmly of Marietta wrote in a January comment that she and her family members take care of their dad, but the state law doesn’t exempt caregivers of older adults.

“Georgia should recognize their sacrifices by supporting them with health insurance,” she wrote. “Let’s simplify this system and in the end, save money and lives.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

The combination of a recently approved blood test for detection of Alzheimer’s disease combined with two medications that slow progression of the disease is drastically improving outcomes for patients and their families, according to a neurologist and surgeon at Yale New Haven Health.

Dr. Ausim Azizi is among those seeing the overall early results, as Yale New Haven Hospital is in the forefront of research and clinical care, he said, calling it “tops in the country,” and home to a federally-funded Alzheimer’s Disease Research Center.

“We have started 350 people on these drugs,” he said. “Everybody I see feels better,” and feels, along with their families that they have “more control” of their lives.

With easy early detection and treatment patients may never reach the end stage of the disease, he said. The medication slows the disease progression and maintains what patients have, longer, he said.

In terms of quality of life, someone 75 years old, retired with significant memory problems, can still have friends and, “a good life,” with early detection and treatment, Azizi said.

The debilitating, progressive condition robs sufferers of their memory and cognitive abilities.

Azizi said there is no cure for Alzheimer’s, but the disease can be “modified” with medications from two different companies.

The medications approved about two years ago are Lecanemab, also known as Leqembi and Kisunla, also known as Donanemab. The drugs are administered through an IV infusion that targets amyloid plaque in the brain.

Azizi said confirmation of Alzheimer’s, as opposed to other forms of dementia, is needed to treat with those medications and, until the blood test diagnosis, was complicated, stressful, and expensive, Azizi said.

The blood test, Lumipulse G, for Alzheimer’s Disease, approved in late May, can confirm the disease with 98 percent accuracy, he said.

Prior to the blood test, doctors confirmed the disease by drawing spinal fluid to test for chemicals or through a pet scan, Azizi said.

The blood test is not predictive and the test is for people 55 and older suffering cognitive issues, he said. Confirmation of Alzheimer’s is needed for the medication to be prescribed.

That early detection is key, he said, because while the medications don’t cure Alzheimer’s, they slow progression.

According to the Alzheimer’s Association, it is a progressive disease, “where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment.

“On average, a person with Alzheimer’s lives four to eight years after diagnosis but can live as long as 20 years, depending on other factors,” according to the association.

The association notes that its “2025 Alzheimer’s Disease Facts and Figures” report found that “nearly 4 in 5 Americans would want to know if they had Alzheimer’s disease before it impacted their lives,” which means “91% of Americans say they would want to take a simple test — such as a blood biomarker test — if it were available,” because that would then open access to early treatment.

Azizi said that, in Alzheimer’s, sticky proteins or plaques are found on the brain that he likened to rust on an engine.

“The wheels don’t turn, things are squeaky,” he said.

People with the plaques have trouble with cognition, sequencing events and their memory noticeably going, he said.

The new medications “clear the rust,” and slow progression, but the damage already done remains, he said.

Cognitive problems can develop with other forms of dementia, but the same medications don’t work for those. He said 70 percent of the time when there are cognitive problems, it’s Alzheimer’s.

“Before we treat we ask, do you have biologic evidence?,” Azizi said.

He said of early treatment, “It’s huge for the family.”

Simple lifestyle changes can also improve outcomes, he said.

He said 10 factors that boost the brain and help prevent dementia include:

Control blood pressure, low number should be below 80
Control blood sugar to around 100
Control cholesterol, total fasting less than 200
Adequate and restful sleep
Diet, eat mostly unprocessed plants
Maintain a healthy body weight
If you are smoking, stop
Reduce alcohol intake – maximum of 3 to 4 drinks per week
Increase physical activity, including daily aerobic exercise
Engage in enjoyable and healthy social and mental activities

Summer evening skies are the home of some classic constellations. One of them is Scorpius the Scorpion, the 10th-brightest constellation in the night sky and one of those few constellations that actually looks like what it’s supposed to be. Personally, I see Scorpius as a “giant fishhook” that trolls our low summer skies. You certainly won’t have to crane your neck to see it because it’s a low rider. Begin looking for Scorpius in the very low southern sky at the end of evening twilight.

Most of Scorpius is easy to find. The brightest star is Antares, a brick-red star, marking the heart of the beast. It’s the brightest star in that part of the sky. To the right of Antares, you’ll see three dimmer stars in a nearly vertical row that make up the Scorpion’s head. To the lower left of Antares, look for the long, curved tail of the beast. Unfortunately, here in Minnesota and Western Wisconsin, the lowest section of the tail never gets above our horizon. At the end of the tail, barely above our horizon, is the celestial scorpion’s stinger, made of two moderately bright stars very close together.

(Mike Lynch)

The stinger stars, also known as the “cat’s eyes,” can be a bit of a challenge to see. You have to have a low, flat, treeless southern horizon to see them. Part of the difficulty of seeing the stinger stars is that visibility is greatly hampered close to the horizon because you’re forced to look through a lot more of Earth’s blurring atmosphere. Moderate to heavy light pollution and high humidity in the air can also add to the challenge. If you’re ever in the southern U.S., Scorpius will be a lot higher above the horizon, and you can get a much better look at it.

Antares (Mike Lynch)

Getting back to Antares, its reddish hue, demonstrates that stars come in different colors. They are not just little white lights in the sky. A star’s color tells a lot about its nature. Bluish-white stars are the hottest, with some having surface temperatures exceeding 30,000 degrees Fahrenheit. Reddish stars like Antares are cooler. In fact, Antares is cooler than our own sun, with a surface temperature of approximately 6,000 degrees. A thermometer plopped on the sun’s photosphere would show close to 10,000 degrees. Antares’ reddish hue is also reflected in its name. Antares is derived from the Greek language and means “rival of Mars,” as it shares a similar reddish tone with the planet Mars. You can easily confuse Mars and Antares with each other if you’re new to stargazing.

There’s no confusion between Mars and Antares when it comes to size. Mars is only about 4,000 miles across, a far celestial cry from the over-600-million-mile diameter of Antares. That’s over 700 times the diameter of our sun. If Antares were at the center of our solar system instead of our sun, the planets Mercury, Venus, Earth and Mars would all be living inside Antares.

There are many stories about how Scorpius came to be a constellation. The one I like is the Greek mythology story about how Zeus, the king of the gods, sent a giant Scorpion to kill the mighty hunter Orion, to end an affair he was having with Zeus’ daughter Artemis, the goddess of the hunt. Orion hunted by night and slept by day, and while he was on his nocturnal hunting adventures, Orion was a hunk and caught the eye of Artemis. After watching Orion for a few weeks, she started to call down to the very manly hunter and have long-distance conversations with him every night. As time went on, Artemis eventually joined Orion in his hunting jaunts, ignoring her other duties.

Zeus learned of his daughter’s negligence and put a contract out on Orion. He had his staff send a giant scorpion to sting and kill Orion during his daytime slumber. When the fateful day arrived and the giant scorpion approached Orion, the ever-alert hunter awoke as the beast stirred the nearby brush with its approach. Orion shot up and valiantly fought the scorpion with all his might, but eventually he was stung by the steroid-enhanced scorpion and died instantly.

That night, Artemus discovered the body of her boyfriend and was filled with tremendous grief. She managed to compose herself and lift Orion’s body to the sky and transform it into the famous constellation we see during the winter evenings. As she looked back down to Earth, she saw the giant scorpion not far from where she had found Orion. She put two and two together and decided to get revenge. She dive-bombed the scorpion, picked it up, and flung it up into the opposite end of the sky from her dead boyfriend, where it transformed into a constellation. That’s why the constellations Orion and Scorpius are never seen in the sky at the same time. Orion prowls the winter skies and Scorpius trolls the summer heavens. Orion won’t get stung again.

Celestial happening this week

(Mike Lynch)

On Sunday and Monday, toward the end of evening twilight in the very low western sky, look for the new crescent moon hanging close by the faint planet Mars.

Mike Lynch is an amateur astronomer and retired broadcast meteorologist for WCCO Radio in Minneapolis/St. Paul. He is the author of “Stars: a Month by Month Tour of the Constellations,” published by Adventure Publications and available at bookstores and adventurepublications.net. Mike is available for private star parties. You can contact him at mikewlynch@comcast.net.

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White House budgets, generally speaking, aren’t serious governing documents. Even so, they’re a declaration of national priorities — and by that measure, the latest blueprint is deeply troubling. What sort of administration aspires to shrink its budget for scientific discovery by 40%?

Health and Human Services Secretary Robert F. Kennedy Jr. recently testified before a House committee to defend cuts at the National Institutes of Health, the world’s biggest funder of biomedical and behavioral research.

The agency going forward “will focus on essential research at a more practical cost,” the secretary said. His plan would end taxpayer support for “wasteful” academic areas, including certain gender-related topics.

It’s fair for the administration to set its own research priorities. But one would expect such cuts to free up (if not increase) funding for other urgent concerns, including chronic disease. Confoundingly, Kennedy appears intent on shrinking the entire research enterprise, thereby jeopardizing the White House’s stated goals of improving public health, maintaining global leadership in science and staying ahead of China, which is set on closing the gap.

His proposal also undermines the core principle that science is a vehicle for national progress. America’s explicit commitment to support scientific research began in 1945. Inspired by wartime innovations, President Franklin D. Roosevelt asked his top science adviser to develop a program that would advance medicine, boost the economy and develop a cadre of young researchers. The resulting framework established science as a “proper concern of government” and sought to reward academic inquiry with generous public funding.

For the better part of a century, this formula worked quite well. The NIH enthusiastically funded basic research — largely through universities — and innovation bloomed. NIH grants have supported countless lifesaving advances, from cancer treatments and gene therapies to vaccines and diagnostic equipment. Almost a fifth of Nobel Prizes have been awarded to NIH scientists or grantees.

Yet several factors have sown doubt about this model in recent years. Reports that the NIH supported Chinese research on coronaviruses, a type of which caused the COVID-19 pandemic, inflamed the public and increased scrutiny over grants writ large.

Some lawmakers started to question whether the current system overwhelmingly favors established insiders to the detriment of promising junior scientists. Others raised doubts that elite universities — with their swelling administrative costs, staggering tuition rates and contentious ideological fixations — are prudent stewards of taxpayer dollars.

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For these reasons, the White House isn’t wrong to scrutinize how universities spend federal money. A reassessment of the NIH’s decades-old grant framework would be salutary. The process undoubtedly would benefit from including reviewers with more diverse professional backgrounds by, say, offering stronger incentives to participate. (The tiny stipends involved hardly compensate for the work required.)

Ensuring more equitable distribution of grants among top applicants (for example, via lottery or “golden ticket” allocations) would make sense, as would more generous funding for high-risk, high-reward research.

Alas, such reforms don’t appear to be what Kennedy has in mind. Instead of limiting some costs to improve systems and expand funds for critical research, the health secretary is seeking to issue 15,000 fewer grants by next year. In so doing, he threatens to impede crucial medical studies, shrink the number of new drugs and put American scientists at a needless disadvantage — all while China lavishly invests in research facilities, improves clinical trials and streamlines regulatory approvals.

Congressional appropriations ultimately will determine what gets funded — and judging by recent hearings, lawmakers are deeply skeptical about Kennedy’s budget. By expanding support for science and encouraging careful oversight, Congress can do its part to redirect the secretary’s ambitions.

— The Bloomberg Opinion Editorial Board