By GEOFF MULVIHILL and DAVID A. LIEB

The U.S. social safety net would be jolted if the budget bill backed by President Donald Trump and passed Thursday by the House of Representatives becomes law.

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It would impose work requirements for low-income adults to receive Medicaid health insurance and increase them for food assistance as well as cut funding for services like birth control to the nation’s biggest abortion provider.

Supporters of the bill say the moves will save money, root out waste and encourage personal responsibility.

A preliminary estimate from the nonpartisan Congressional Budget Office said the proposals would reduce the number of people with health care by 8.6 million over a decade.

The measure, which also includes tax cuts, passed the House by one vote and could have provisions reworked again as it heads to the Senate.

Here’s a look at the potential impact.

Work would be required for most people to get Medicaid health insurance

Starting next year, many able-bodied Medicaid enrollees under 65 would be required to show that they work, volunteer or go to school in exchange for the health insurance coverage.

Some people who receive Medicaid were worried Thursday that they could see their coverage end, even if it is not immediately clear whether they might be covered by an exception.

Raquel Vasquez, a former cook who is battling two types of cancer and has diabetes, said she believes she could be affected because she has not been able to qualify for Social Security disability benefits. “I cannot even afford this life now because of my disabilities,” said the 41-year-old Bakersfield, California, resident. “But my country won’t even help me.”

About 92% of people enrolled in Medicaid are already working, caregiving, attending school or disabled. That leaves about 8% of 71 million adult enrollees who would need to meet the new requirement. An estimated 5 million people are likely to lose coverage altogether, according to previous estimates of the bill from the Congressional Budget Office.

Only Arkansas has had a work requirement that kicks people off for noncompliance. More than 18,000 lost coverage after it kicked in 2018, and the program was later blocked by federal courts.

FILE – In this Sept. 12, 2018, file photo, Arkansas Gov. Asa Hutchinson, center, talks at a news conference at the State Capitol in Little Rock, Ark., about the state’s work requirement for its expanded Medicaid program. (AP Photo/Andrew DeMillo, File)

“The people of Arkansas are generous and we want to help those who cannot help themselves, but we have no interest in helping those who are unwilling to help themselves,” said Arkansas Senate President Pro Tempore Bart Hester, a Republican. “I’m glad the federal government is starting to align with our thinking.”

Work requirement could hit harder in rural areas

Increased eligibility checks and red tape related to work requirements may result in some people wrongly getting booted off, said Eduardo Conrado, the president of Ascension, a health care system that operates hospitals across 10 states.

That could spell trouble for rural hospitals, in particular, who will see their small pool of patients go from paying for their emergency care with Medicaid coverage to not paying anything at all. Hospitals could have to eat their costs.

“Adding work requirements is not just a policy change, it’s a shift away from the purpose of the program,” Conrado said of the rule.

That is also a concern for Sandy Heller, of Marion, Massachusetts.

Her 37-year-old son, Craig, has Down syndrome and other complicated medical needs.

She worries the changes would make it harder for hospitals in out-of-the-way places like hers to stay afloat and offer the services he could need.

If they don’t, he would have to travel about 90 minutes for care.

“It could mean life and death for my son if he needed that medical care,” Heller said.

More people would be required to have jobs to receive food assistance

The Supplemental Nutrition Assistance Program, formerly known as food stamps, already requires work for some of its roughly 42 million recipients. Adults ages 18-54 who are physically and mentally able and don’t have dependents must work, volunteer or participate in training programs for at least 80 hours a month, or else be limited to just three months of benefits in a three-year period.

The legislation passed by the House would raise the work requirement to age 65 and also extend it to parents without children younger than age 7. The bill also would limit the ability to waive work requirements in areas with high unemployment rates.

The combination of those changes could put 6 million adults at risk of losing SNAP benefits, according to the liberal-leaning Center on Budget and Policy Priorities.

Like work requirements for Medicaid, those for SNAP tend to cause a decrease in participation without increasing employment, according to an April report by the Brookings Institution’s Hamilton Project.

States that cover immigrants lacking legal status would lose federal funds

Under the bill, the federal government would punish states that use their own state dollars to provide Medicaid-covered services to immigrants lacking legal status or to provide subsidies to help them buy health insurance.

Some states that provide that sort of coverage extend it only to children.

Those states would see federal funding for the Medicaid expansion population — typically low-income adults — drop from 90% to 80%.

That could mean states pull back that Medicaid coverage to avoid the federal penalty, said Joan Alker, executive director of Georgetown University’s Center for Children and Families.

KFF said the provision could affect 14 states that cover children regardless of their immigration status.

This month the Democratic governor of one of them — California’s Gavin Newsom — announced a plan to freeze new enrollments of adults in state-funded health care for immigrants who do not have legal status as a budget-balancing measure.

The bill could curtail abortion access by barring money for Planned Parenthood

Planned Parenthood says a provision barring it from receiving Medicaid funds could lead to about one-third of its health centers closing.

FILE – Security personnel stand outside a recently opened Planned Parenthood clinic, Sept. 10, 2024, in Pittsburg, Kan. (AP Photo/Charlie Riedel)

The group said about 200 centers are at risk — most of them in states where abortion is legal. In those states, the number of Planned Parenthood centers could be cut in half.

Planned Parenthood, the nation’s largest abortion provider, also offers other health services, including birth control and cancer screening.

Federal money was already barred from paying for abortion, but state Medicaid funds in some states now cover it.

“We’re in a fight for survival — not just for Planned Parenthood, but for the ability of everyone to get high-quality, non-judgmental health care,” Planned Parenthood President and CEO Alexis McGill Johnson said in a statement.

Susan B. Anthony Pro-Life America celebrated the provision, saying “Congress took a big step toward stopping taxpayer funding of the Big Abortion industry.”

Health services for transgender people would be cut

Medicaid would stop covering gender-affirming care for people of all ages in 2027 under one provision.

Further, coverage of the treatments could not be required on insurance plans sold through the exchanges under the Affordable Care Act.

Trump has targeted transgender people, who make up around 1% of the U.S. population, since returning to office, including declaring that the U.S. won’t spend taxpayer money on gender-affirming medical care for transgender people under 19. The care includes puberty blockers, hormone therapy and surgeries.

The bill would expand that to all ages, at least when it comes to Medicaid.

Some states already block the coverage, and some require it. It’s unclear how much Medicaid has spent on providing gender-affirming care, which has only been recently added to some coverage plans in some states.

Associated Press reporters Devna Bose in Jackson, Mississippi; Andrew DeMillo in Little Rock, Arkansas; Susan Haigh in Hartford, Connecticut; Marc Levy in Harrisburg, Pennsylvania; Amanda Seitz in Washington; and Leah Willingham in Boston contributed to this article.

By ALAN SUDERMAN

It’s not an official holiday – yet – but for many cryptocurrency enthusiasts “Bitcoin Pizza Day” is still special. Thursday marks the 15th anniversary of the first known use of cryptocurrency to buy real-world goods.

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The 10,000 bitcoin that software developer Laszlo Hanyecz paid for two Papa John’s pizzas delivered to his Florida home on May 22, 2010, were worth about $41 at the time. Today they’re worth $1.1 billion, as bitcoin hits record high prices.

Several cryptocurrency companies are announcing promotions and other celebrations to mark Bitcoin Pizza Day. Bitget, a cryptocurrency exchange, announced that it’s giving away pizzas to more than 2,000 people at gatherings held around the world.

Here’s the backstory of Bitcoin Pizza Day:

Humble Beginnings

The first bitcoin was created in early 2009 by the digital currency’s still unknown creator, Satoshi Nakamoto. It started as a passion project for libertarian-minded computer nerds who wanted to create a digital payment system that didn’t rely on a third party – like a government or financial institution – for transactions.

Hanyecz was an early enthusiast and became active on an early bitcoin internet message board, offering technical advice on how to “mine” bitcoin more effectively.

Central to bitcoin’s technology is the process through which transactions are verified and then recorded on what’s known as the blockchain. Computers connected to the bitcoin network race to solve complex mathematical calculations that verify the transactions, with the winner earning newly minted bitcoins as a reward in a process known as mining.

In the early days, enthusiasts could mine bitcoin through their home computers and Hanyecz accumulated thousands of the new digital asset. Nowadays, mining bitcoin has become a highly competitive field with multi-billion-dollar companies using specialized computers in entire data centers to acquire new bitcoins.

‘No weird fish topping’

No one quite knew what to do with the bitcoin they were mining at first. On May 18, 2010, Hanyecz tried an experiment and posted a message offering 10,000 bitcoins for pizza.

“I like things like onions, peppers, sausage, mushrooms, tomatoes, pepperoni, etc.. just standard stuff no weird fish topping or anything like that,” Hanyecz wrote.

Three days later, Hanyecz wondered if he needed to up the price.

“So nobody wants to buy me pizza? Is the bitcoin amount I’m offering too low?” he wrote.

But the next day, Hanyecz said he’d successfully traded his bitcoin for pizza. Another bitcoin enthusiast from California had paid for the Papa John’s pizza in exchange for the cryptocurrency, according to a book about bitcoin’s early history, “Digital Gold.”

“A great milestone reached,” said another early bitcoin enthusiast on the message board congratulating Hanyecz.

Tremendous growth

It did not take long for bitcoin to take off after the first pizza deal. Bitcoin started getting more publicity and grew, thanks in part to the popularity of an online black-market site, Silk Road, which only accepted bitcoin.

By February 2014, with bitcoin trading at around $600, Hanyecz marveled at what the digital currency had become.

“I mean people can say I’m stupid, but it was a great deal at the time,” Hanyecz wrote on the bitcoin message board. “I don’t think anyone could have known it would take off like this.”

Five years later, when bitcoin was trading as high as $11,000, Hanyecz reflected on what buying that first pizza meant for bitcoin.

“It made it real for some people, I mean it certainly did for me,” Hanyecz said on the television show “60 minutes.”

Hanyecz has largely stayed out of the public spotlight in recent years and efforts to contact him by The Associated Press were unsuccessful.

All-time highs

After many years of fits and starts, bitcoin now appears firmly entrenched in the mainstream financial system. While it hasn’t taken off as a way to pay for everyday items like pizza, bitcoin has found popularity as a kind of “digital gold,” or a way to store value.

Retirement accounts can buy bitcoin ETFs, more and more companies buy bitcoin as corporate treasuries, and President Donald Trump recently signed an executive order establishing a government reserve of bitcoin.

Bitcoin was trading at about $111,000 on Thursday morning — a new record. That price gives it a market cap of more than $2 trillion, or about the same as Amazon.

By CARLA K. JOHNSON

Excess body weight can raise the risk of certain cancers, leading researchers to wonder whether blockbuster drugs like Wegovy, Ozempic and Zepbound could play a role in cancer prevention.

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Now, a study of 170,000 patient records suggests there’s a slightly lower risk of obesity-related cancers in U.S. adults with diabetes who took these popular medications compared to those who took another class of diabetes drug not associated with weight loss.

This type of study can’t prove cause and effect, but the findings hint at a connection worth exploring. More than a dozen cancers are associated with obesity.

“This is a call to scientists and clinical investigators to do more work in this area to really prove or disprove this,” said Dr. Ernest Hawk of MD Anderson Cancer Center in Houston, who was not involved in the study.

The findings were released Thursday by the American Society of Clinical Oncology and will be discussed at its annual meeting in Chicago. The study, funded by the National Institutes of Health, was led by Lucas Mavromatis, a medical student at New York University’s Grossman School of Medicine.

“Chronic disease and chronic disease prevention are some of my passions,” said Mavromatis, a former research fellow with an NIH training program.

GLP-1 receptor agonists are injections used to treat diabetes, and some are also approved to treat obesity. They work by mimicking hormones in the gut and the brain to regulate appetite and feelings of fullness. They don’t work for everyone and can produce side effects that include nausea and stomach pain.

In the study, researchers analyzed data from 43 U.S. health systems to compare two groups: people with obesity and diabetes who took GLP-1 drugs and other people with the same conditions who took diabetes drugs like sitagliptin. The two groups were equal in size and matched for other characteristics.

FILE – The injectable drug Ozempic is shown, July 1, 2023, in Houston. (AP Photo/David J. Phillip, File)

After four years, those who took GLP-1 drugs had a 7% lower risk of developing an obesity-related cancer and an 8% lower risk of death from any cause compared to those who took the other type of diabetes drug. There were 2,501 new cases of obesity-related cancer in the GLP-1 group compared to 2,671 cases in the other group.

The effect was evident in women, but not statistically significant in men. The study couldn’t explain that difference, but Mavromatis noted that differences in blood drug concentration, weight loss, metabolism or hormones could be at play.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

Saving the world often enough has a way of inflating any superstar’s ego. Early in “Mission: Impossible – The Final Reckoning,” the bulky, sentimental, slightly pious but nonetheless satisfying capper to an eight-film franchise, the U.S. president (Angela Bassett, returning to the role) refers to espionage all-star Ethan Hunt as “the best of men,” and by inference the first man you call when you need someone to run an errand in a Tom Cruise hurry.

Later in the movie, another character sneers that Hunt is way past ordinary greatness; he’s now “the Chosen One.” Not just a world saver, but a world savior! By this point in the sanctification of our hero, “Final Reckoning” has made it relentlessly clear that only these two superstars — Cruise (real, and a proven industry savior thanks to the pandemic-era “Top Gun: Maverick”) and Hunt (fictional) — can prevent the “truth-eating digital parasite” and next-generation artificial intelligence troublemaker known as The Entity from destroying the world. Its mission, clearly accepted, is to redesign Earth according to its own controversial notions of progress and preferred sentient AI-to-human ratio.

The Entity emerged two summers ago in “Mission: Impossible – Dead Reckoning Part One,” with Hunt’s rogue Impossible Mission Force scrambling after the literal and metaphoric key to vanquishing its renovation plans. The AI source code, we learned from the earlier outing, lies at the bottom of the Bering Sea, stashed in a sunken Russian submarine. Much of the new picture concerns the retrieval of that plot device. In one of “Final Reckoning’s” most compelling sequences, finessed nicely for maximum intentional audience breath-holding, Hunt risks the bends and death itself to complete this piece of the mission, as he rolls around amid massive cylindrical nukes in the hulk of the sub rolling around and upside down on the ocean floor. A little “Inception,” a little “Poseidon Adventure.”

In league with its sniveling human colleague Gabriel (Esai Morales, cackling with evil intent as if being paid by the cackle), The Entity conducts a good deal of digital foreplay in the new movie, co-written and directed by “M:I” franchise veteran Christopher McQuarrie. This means the AI monster is hacking into the world’s nuclear defense systems and taking control of the missiles, one paralyzed and panicking nation at a time. Meanwhile Hunt’s team, back in reasonably good graces with the U.S. government despite Henry Czerny’s welcome, born-to-distrust return to the franchise as CIA director Kittridge, follows a travel itinerary spanning the U.K., the U.S., Norway (subbing for St. Matthew Island in the Bering Sea off Alaska) and South Africa.

Tom Cruise as Ethan Hunt in “Mission: Impossible – The Final Reckoning.” (Paramount Pictures and Skydance/TNS)

McQuarrie’s script, written with Eric Jendresen, manages to stretch a fairly simple, easily summarized plot into the longest of the eight “M:I” films. At 169 minutes, it’s about an hour longer than director Brian De Palma’s 1996 swank, cynical, quite beautiful diversion based on the hit TV series. The grandiosity and solemnity of the stakes in “Final Reckoning” test the very limits of what some of us want from an “M:I” movie. Maybe it’s a matter of real-world confidence in some of our leaders; watching a film about what might happen in a case of uncertain nuclear intentions, and wondering how your own leaders would handle it, well, it’s basically the opposite of escapism.

The dialogue scenes all have two or three too many reiterations of the mission’s importance per hour of running time. Elsewhere, “Final Reckoning” becomes a festival of callbacks and flashbacks to the entire series, with dozens of Easter eggs for the superfans, including the release date of the De Palma movie. Just in time, for my taste, the climax goes old-school for old times’ sake, per the producer and star’s wishes, featuring Gabriel’s biplane winging its way through narrow gorges while Cruise dangles off the wing, making sure we see that it’s him there, not a stunt double. In “Dead Reckoning” two years ago, the big wow was the motorcycle plummet and parachute routine, pretty amazing, and nicely compact in its duration and impact. The climax of “Final Reckoning” is likewise impressive and scenic, but also what you might call lengthy. Show-offy. Paced and edited less for the good of the overall movie and more for risk-verification purposes.

That said, this franchise has class. Always has. Plus, it has the virtue, taken as a 29-year entity, of having had a striking variety of directors at the helm. McQuarrie’s ideal in many ways, devoted to both traditional ’60s-derived “exotic” locations and spy games, and to star maintenance and ever-higher threat levels. Stalwart regulars from Ving Rhames and Simon Pegg to more recent series ringers Hayley Atwell and Pom Klementieff act as grounding points for this purported wrap-up, which may be more at home in the air or underwater but there it is.

And there’s this, a small thing in theory, but a huge bonus in practice. It’s not a spoiler, since he’s foregrounded, conspicuously, in the “Final Reckoning” trailer, but the movie boasts a real dinger of a callback: the very minor role of CIA analyst William Donloe. He’s the fellow who failed to notice Cruise hanging from wires in that vault in the bowels of Langley in the first film. Last we heard, 29 years ago, then-IMF head Kittridge promised to exile Donloe to a radar tower near the Arctic Circle.

He’s back, in a happily expanded role, and from my perspective, “Final Reckoning” exists primarily to allow the actor playing Donloe, Rolf Saxon, an opportunity most character actors never get in this lifetime. He’s not just there for nostalgia’s sake, but for real scenes, in which Saxon’s nearly forgotten minor player performs with an equally welcome series newbie, Inuk actor Lucy Tulugarjuk, who plays Donloe’s resourceful wife. In a franchise built on extremes, and the grandiosity that tends to come with a near-$400 million dollar production budget, Saxon’s own personal mission appears simply to have been: Play this material nice and easy, not like a callback or a punchline, but a relatable human being in unusual circumstances. He may not hang off a biplane, but the year’s unlikeliest franchise MVP makes “Final Reckoning” something better than superhuman: human.

‘Mission: Impossible – The Final Reckoning’

3 stars (out of 4)

MPA rating: PG-13 (for sequences of strong violence and action, bloody images, and brief language)

Running time: 2:49

How to watch: In theaters May 23

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