Questionable Procedures
3 medical routines older people may not need
Paula Span
KFF Health News
The risks and benefits of common screenings, procedures and drugs add up differently at advanced ages, and research continues to point out fresh examples of some that may become unnecessary.
It’s hard to shift established medical norms. Efforts to “deprescribe” drugs can meet with opposition from both patients and healthcare professionals.
Recently, investigators have taken on questions about three medical situations where the risks may outweigh the benefits.
1 Rough skin lesions
The reddened or rough patches on the skin are called, in doctor-speak, actinic keratoses. Because they result from long-term sun exposure, they usually appear on faces, scalps, forearms and the backs of hands.
Such lesions appear most commonly on older patients. One large study of traditional Medicare beneficiaries found that over a five-year period, almost 30% were diagnosed with an actinic keratosis. Then what?
“The vast majority of the time, they’re removed,” says Allison Billi, a dermatologist at the University of Michigan. That typically involves cryosurgery (freezing with liquid nitrogen), topical creams or laser therapy.
“The treatment may be more burdensome than the condition itself,” she says. Removal “is actually extremely painful, both during and after.” It can cause swelling, irritation and lasting discoloration.
Billi instead proposes active surveillance. Primary care doctors could observe the lesions annually for warning signs like bleeding, pain or rapid growth, which might warrant removal. But “in many cases, it’s not necessary,” she says. “We don’t always need to do everything we can do.”
2 Thyroid treatment
Patients take levothyroxine, one of the world’s most frequently prescribed drugs, when their thyroid glands can’t produce sufficient thyroid hormone.
With this condition, called hypothyroidism, “people gain weight. They have less energy. Their hair and skin are dry,” explains Jacobijn Gussekloo, a primary care doctor and researcher at Leiden University Medical Center in the Netherlands. “Everything slows down.”
Doctors also increasingly prescribe it for a borderline condition called subclinical hypothyroidism, which usually causes no symptoms but can progress to hypothyroidism.
Most patients take the drug for life — but do they have to? Gussekloo’s team found that in many older adults with subclinical hypothyroidism, hormone levels normalize on their own.
The researchers also reported that, among older people with the condition, levothyroxine had no effect on symptoms and “no apparent benefit.”
Like any drug, it may interact with other medications older patients typically take. Moreover, “it requires frequent lab tests and follow-ups, more visits and expense,” says Maria Papaleontiou, an endocrinologist at the University of Michigan.
Patients shouldn’t stop levothyroxine on their own, Papaleontiou cautions.
Discontinuation requires tapering off gradually, with testing and monitoring. Some patients will always need the drug.
But “a select group of adults over 60 may not require this treatment lifelong,” Papaleontiou says.
3 A screening with risks
The question of when older patients can safely stop screening for colon cancer has prompted years of debate. The U.S. Preventive Services Task Force gives the screening a lukewarm “C” rating after age 76, calling the benefit “small.”
Yet almost 60% of older patients who have had previous colonoscopies and face limited life expectancies (less than five years) are advised to undergo another screening, a 2023 study found.
As a gastroenterologist at the University of California-San Diego, Samir Gupta regularly encounters this issue with older patients. “I know they really have a low risk of colon cancer, and I’m putting them through more risk,” he says.
Gupta is the lead author of a recent study of almost 92,000 Veterans Affairs patients over 75 who had previous colonoscopies. In about 28%, the procedure found an adenoma, a type of polyp that can become cancerous. Gastroenterologists generally remove them.
The researchers found that, after 10 years, veterans with a previous adenoma were more likely to develop colon cancer than those without one, though the rate was extremely low in both groups.
But just 0.5% of those with a previous adenoma died of colon cancer, compared with 0.4% of those without one. “A tiny difference,” Gupta says.
Both groups were dwarfed by the number of veterans — almost half — who died within the decade of other causes.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.
Vance’s Obamacare crackdown may raise costs
Amina Niasse
Reuters
NEW YORK — A crackdown on Obamacare health insurance could raise prices for U.S. consumers and insurers by removing healthy, low-cost enrollees, adding pressure to a shrinking marketplace.
The 2010 Affordable Care Act created income-based government-subsidized health plans for individuals, with 19 million people now enrolled. Millions have dropped out this year as extra COVID-19 pandemic subsidies expired.
The Trump administration now says fraud contributed to the growth. Vice President JD Vance said last week the government had removed 760,000 enrollees it believed did not exist or who had been fraudulently signed up by brokers and were unaware of their insurance coverage. Another 400,000 are under review.
The government is also banning hundreds of brokers and will not accept new brokers, saying new brokers — who were paid a monthly fee for each enrollee — are often the ones who committed fraud.
The changes could impact legitimate members who were simply not using their health plans because they were healthy, policy experts said.
As the number of low-medical-use enrollees drops, a sicker mix of patients could eat into profits for insurers like UnitedHealth and Centene in the remaining months of 2026 and 2027, investors and analysts said.
“The premium rates for 2027 have already been filed, and at this point, they’ve all been approved and locked down,” said Matt McGough, a policy expert at health policy research firm KFF.
UnitedHealth and Centene did not provide immediate comments.
A spokesperson for the Centers for Medicare and Medicaid Services said the plan cancellations were based on a longstanding verification process, focused on enrollees who were signed up by a broker and were missing key identification information, like a U.S. Social Security number. Legitimate enrollees can be reinstated after verifying their identity, the spokesperson said.
The news has weighed on health insurance shares. Centene, Molina and Elevance fell 1.5%, 6.5% and 4.2% in the week since the announcement, while UnitedHealth shares fell 2.6%.
Costs for patients and insurers were already on the rise in 2026 after the extra COVID-19 subsidies expired and medical costs rose.
Insurers in July requested a median premium increase of 15% for 2027, according to a KFF analysis of rate filings across all 50 states and Washington, D.C., marking a second consecutive year of double-digit increases. 2027 plans are available starting Nov. 1.
While insurers can adjust premiums when they anticipate healthcare cost increases, profits get squeezed by steep membership drop-offs after rates have been set.
“Insurers generally do a great job pricing for a sicker population when they have reliable information, but unexpected changes in enrollment or policy after premiums are set create earnings risk,” said Daniel Barasa, portfolio manager at Gabelli Funds.
Insurers will likely set prices even higher in 2028 to reflect the drop in enrollees, further exacerbating growth, three investors and two policy experts said.
Brokers bring in 75% of people enrolled in the marketplace, according to government data released in 2026.
Mike Smith, president emeritus at The Brokerage Inc., a brokerage agency in Flower Mound, Texas, said he thought consumers would be less likely to use brokers and sign up for plans because of the fraud announcement and ban on new brokers.
“People will think negatively of the ‘fraudulent insurance brokers’ and paint all of the good brokers with a wide brush,” Smith said.
Obamacare plans can be purchased directly through Healthcare.gov or through state-run exchanges. There are 84,000 brokers nationwide who can help individuals pick a plan this year, according to the Department of Health and Human Services.
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