NIH Grant Terminations Disproportionately Impact Minority Researchers

Today’s issue explores billing code scrutiny, vitamin K refusals, NIH grant cuts, prior authorization rollbacks, and FDA leadership changes.

In this edition of AcademyHealth’s Situation Report, we examine new research showing that recent NIH grant terminations disproportionately affected minority and equity-focused researchers, alongside UnitedHealthcare’s plan to scale back prior authorization requirements and what the evidence says about their effects on care and costs. We also explore growing congressional scrutiny of medical billing code complexity and concerns about improper payments, rising refusal rates of newborn vitamin K injections and the resulting implications for preventable infant harm, and ongoing uncertainty surrounding FDA leadership as political and industry pressures continue to shape federal health policy.

In today’s issue:

• Study Finds NIH Grant Terminations Disproportionately Impacted Minority Researchers

• UnitedHealthcare’s Removal of 30 Percent of its Prior Authorization Requirements

• Lawmakers Question Whether CPT Coding Complexity Drives Improper Billing

• Rising Refusal of Vitamin K Shot Linked to Preventable Infant Bleeding and Deaths

• Makary Continues Leading FDA as Questions Persist About His Future

Study Finds NIH Grant Terminations Disproportionately Impacted Minority Researchers

A new study published in The Lancet Regional Health Americas found that the Trump administration’s 2025 NIH grant terminations disproportionately affected BIPOC and LGBTQ+ researchers, particularly those conducting equity-related and gender-focused research. Researchers surveyed investigators whose grants were terminated and found that minority scientists were significantly more likely to experience funding cuts.

The findings are important because NIH funding plays a major role in determining what research moves forward, who advances into leadership roles, and which perspectives shape future scientific priorities. The study raises concerns that the loss of funding for minority researchers could have long-term effects on mentorship pipelines, community partnerships, and the types of health issues prioritized in future research.

For researchers, the study signals increasing uncertainty around federal funding priorities, especially for work focused on equity, underserved populations, and minority health. The authors warn that some researchers may feel pressure to shift or narrow their work to align with changing political and funding landscapes, potentially reshaping the direction of health research for years to come.

UnitedHealthcare’s Removal of 30 Percent of its Prior Authorization Requirements

Earlier this month, UnitedHealthcare announced its plan to eliminate prior authorization requirements for 30 percent of its health care services by the end of 2026. This will cover services for certain outpatient surgeries, chiropractic care, certain outpatient therapies, and some diagnostic tests like echocardiograms. The leading health care company announced that a full list of services that will no longer need prior authorizations will be available on UHCProvider.com. This shift strengthens UnitedHealthcare’s pledge from June 2025 to reduce delays and streamline paperwork for both their providers and patients. UnitedHealthcare announced that an average of 92 percent of their prior authorizations are approved within 24 hours of receipt.

It was previously understood by the health insurance industry that prior authorizations save money for health plans by reducing unnecessary utilization and enforcing the use of lower cost alternatives like generics. Research has found the opposite, as prior authorization delays care and ultimately increases health care costs. The 2024 American Medical Association Prior Authorization Physician Survey found that nearly 90 percent of the 1,000 physicians surveyed reported that prior authorizations contributed to higher overall health care resource utilization. A majority (69 percent) reported ineffective initial treatments due to step-therapy requirements by the health insurance company. The survey also found that prior authorizations lead to substantial administrative burden for physicians, with 89 percent of respondents feeling “somewhat” or “significant increases” in burnout. As health insurers such as UnitedHealthcare make strides toward cutting the red tape that delays access to care by removing prior authorizations, the field of health services research is waiting to evaluate the impact.

AcademyHealth’s recent Decisionmaker’s Guide to the CAP health cost proposal identified prior authorization reform as an area where the harm is well-documented but the replacement model is largely untested — making UnitedHealthcare’s announcement a significant real-world test case for the field.

Lawmakers Question Whether CPT Coding Complexity Drives Improper Billing

House Oversight and Government Reform Committee Chair James Comer has asked the Centers for Medicare & Medicaid Services (CMS) to assess whether the growing complexity of the Current Procedural Terminology (CPT) coding system is contributing to improper billing practices such as upcoding and unbundling. Upcoding is when a provider bills for a more complex or expensive service than was actually provided. Unbundling is when services that should be billed together as a single package are instead billed separately to increase total payment. In a letter to CMS, Comer requested information on the scale of coding errors, steps the agency is taking to prevent misuse, and whether statutory or operational constraints limit CMS’s ability to modify or move away from its reliance on CPT codes.

The inquiry comes amid broader congressional scrutiny of the CPT system, which contains thousands of highly granular codes and is updated annually through a process led by external stakeholders. Lawmakers have raised concerns about transparency, cost control, and the federal government’s reliance on a privately owned coding system embedded across Medicare, Medicaid, and commercial insurance. The issue has drawn attention to how billing complexity may create administrative burden for providers while also enabling inaccuracies that drive improper payments.

Billing and coding systems shape provider behavior, administrative workload, and program integrity across the health system. Researchers can help examine how coding complexity affects billing accuracy, compliance costs, and access to care. This moment also raises broader questions about whether simplification, alternative coding frameworks, or stronger oversight could reduce waste without increasing barriers to appropriate reimbursement or care delivery.

Rising Refusal of Vitamin K Shot Linked to Preventable Infant Bleeding and Deaths

New reporting shows that rising refusal of the routine vitamin K shot at birth is contributing to preventable cases of severe bleeding, brain injury, and death among newborns. Vitamin K deficiency bleeding is rare but potentially fatal, and decades of evidence show the injection dramatically reduces risk. Recent data indicate that more than 5 percent of U.S. newborns did not receive vitamin K in 2024, a sharp increase over the past decade, as refusals have risen alongside broader declines in trust in medical interventions.

Clinicians report seeing more infants present weeks after birth with sudden, catastrophic bleeding, often without warning, and medical experts note that many of these cases could have been prevented with the injection. Despite the severity of outcomes, there is no comprehensive state or federal system to track vitamin K refusals or related complications, making it difficult to quantify the full scope of harm or identify trends. Some hospitals have begun tracking refusals internally, but data remain fragmented and largely unavailable for broader public health surveillance.

The rise in vitamin K refusal underscores the intersection of misinformation, trust in health systems, and gaps in public health data infrastructure. Researchers can help evaluate how refusal patterns vary by setting, how clinician counseling and hospital policies influence uptake, and whether improved surveillance and reporting could prevent avoidable harm. The issue also raises broader questions about how health systems monitor the consequences of declining standard preventive care, and how evidence can be used to support informed decision‑making for parents and providers.

Makary Continues Leading FDA as Questions Persist About His Future

FDA Commissioner Marty Makary has continued performing his duties despite growing uncertainty about his job security following internal disputes within HHS leadership. According to reports late last week, senior HHS leaders drove the push to oust Makary. In his yearlong tenure at the helm of the FDA, Makary has conflicted with a range of HHS officials and interest groups, including anti-abortion activities, opponents of vaping regulation, and various drug manufacturers. Despite the ongoing uncertainty, Makary remains the acting FDA commissioner and is slated to testify on Wednesday to the Senate Committee on Appropriations on the Trump Administration’s fiscal 2027 budget proposal for the FDA. While reports indicate the Trump Administration is consulting former HHS officials on potential acting leadership for the FDA, the situation is complicated by the difficulty of identifying a nominee who would be confirmed by the Senate Committee on Health, Education, Labor, and Pensions. For health services researchers, the situation underscores how competing political and industry pressures can affect regulatory decision‑making and the consistency of federal health policy.