DC EKG

Podcast TitleDC EKG with Joe Grogan: A Healthcare Policy Podcast Episode124 Episode TitleRyan Long on the ACA Subsidy Fight, Phantom Enrollees, and Reforming 340B Episode DescriptionJoe Grogan is joined by Ryan Long of Paragon Health Institute and the University of Southern California to break down two fights shaping health policy right now: a California wealth tax pitch framed as a health care fix, and the battle over extending enhanced Affordable Care Act subsidies. They unpack how enhanced subsidies changed who qualifies, why zero-premium plans opened the door to broker-driven enrollment and fraud, and why the medical loss ratio creates perverse incentives that can push premiums higher. They also explain how silver loading and cost-sharing reduction policy distort the exchange market, and what reforms could lower costs without writing a blank check. The episode closes with Ryan's latest work on the 340B program, including why drug arbitrage rewards hospitals with a stronger commercial mix and can fuel consolidation, and why direct, targeted assistance could better support hospitals that truly serve low-income and rural patients. Chapters and Timestamps00:01 Intro00:23 Welcome, and what is on the agenda01:25 California wealth tax and structural deficits11:20 Enhanced ACA subsidies and the shutdown fight16:54 Income caps, zero premium plans, and phantom enrollees21:50 Fraud, Medicaid exposure, and public trust30:39 Medical loss ratio incentives and ACA market fixes38:41 340B: how arbitrage works and why it drives consolidation44:51 What reform could look like47:20 Closing SEO KeywordsAffordable Care Act, ACA subsidies, enhanced subsidies, premium tax credits, exchange plans, zero premium plans, phantom enrollees, medical loss ratio, cost sharing reduction, silver loading, Medicaid fraud, Minnesota fraud, California wealth tax, 340B program, drug arbitrage, hospital consolidation, site neutral payments, commercial mix, Medicare Trust Fund About Our GuestRyan Long is a health policy expert with experience on Capitol Hill, including years in the Speaker's office and on the House Energy and Commerce Committee. He is affiliated with Paragon Health Institute and the University of Southern California. CreditsSponsor: Survivors for SolutionsExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Julie Riga, Stay on Course Studios, https://www.stayoncourse.studio

In this episode of DC EKG with Joe Grogan: A Healthcare Policy Podcast, Joe breaks down the first Healthcare AI Policy Summit, held on December 10th in Washington, DC, with his event co-host, Naomi Lopez, founder of Nexus Policy Consulting. The big themes shaping healthcare AI right now: how HHS is thinking about AI adoption, what real regulatory clarity might look like, and how new initiatives like ACCESS and TEMPO could reshape chronic disease management for Medicare patients. Joe and Naomi unpack HHS Deputy Secretary Jim O’Neill’s approach to AI: using tools like ChatGPT and other large models inside government to improve physician productivity, payment integrity, and care coordination, while staying mindful of privacy, re-identification risk, and data security. They also zoom in on the ACCESS Medicare payment model and the FDA TEMPO initiative, explaining how these pilots are designed to test AI and machine learning tools in real-world chronic disease management for conditions like high blood pressure, diabetes, musculoskeletal pain, and depression. If you care about the real-world impact of healthcare AI on policy, payment, and patients, this is a dense, practical walkthrough of what the summit revealed and what to watch next. In This Conversation Joe and Naomi cover: · Jim O’Neill’s vision for AI at HHS o Using AI to improve government operations and AI adoption inside agencies o Balancing innovation with privacy and re-identification risks when releasing federal health data o Why HHS wants small innovators to have a direct line in, without pay-to-play gatekeepers like the Coalition for Health AI Key Takeaways · Healthcare AI is being wired directly into policy through programs like ACCESS and TEMPO, linking AI tools to Medicare payment models, FDA initiatives, and real-world chronic disease management. · Real regulatory clarity and predictable pathways from FDA clearance to Medicare reimbursement are critical for sustained AI adoption. · AI is most powerful today as a force multiplier for physician productivity and care team. · Personal AI agents could become the primary interface between patients and the health system, coordinating data, benefits, and care. · Rural healthcare and underserved communities stand to benefit significantly if payment and regulatory frameworks allow AI-enabled diagnostics and remote care to scale. · Fights over interoperability, state AI regulation, and federal preemption will determine whether these tools stay as pilots or reach patients nationwide. Naomi Lopez is the founder of Nexus Policy Consulting and a leading voice in healthcare policy, healthcare AI, and state health reform. She co-founded a healthcare AI working group with Joe Grogan and co-hosted the inaugural Healthcare AI Policy Summit on December 10th in Washington, DC. Her work focuses on how regulation, Medicare and Medicaid policy, and state law shape healthcare innovation, access, and affordability for real patients.

In this episode of DC EKG with Joe Grogan: A Healthcare Policy Podcast, Joe sits down with health economist Tony LoSasso to dissect what serious, workable Obamacare reforms could look like without blowing up the Affordable Care Act entirely. They dig into the structure of healthcare subsidies, why current premium tax credits dull price sensitivity, and how that undermines insurance competition, drives up healthcare costs, and threatens the law's fiscal sustainability. Tony lays out a path to modernize the ACA with defined-contribution-style subsidies, patient-directed “health freedom” accounts, and targeted support for people with preexisting conditions through high-risk pools, rather than hiding transfer programs inside community-rated premiums. Along the way, they tackle essential health benefits, community rating, Medicare pricing, certificate-of-need laws, and growing hospital market concentration, and ask what a real bipartisan healthcare reform deal might look like in today’s political climate.

Joe Grogan sits down with James Gelfand, president and CEO of The ERISA Industry Committee (ERIC), to break down the future of employer-sponsored insurance and the challenges shaping healthcare policy. They discuss how rising healthcare costs affect both employers and employees, the evolution of health savings accounts, and why direct primary care and telehealth represent major shifts in employer benefits. The conversation highlights the growing crisis in mental health, the impact of hospital consolidation on costs and quality, and the political battles over healthcare reform. Gelfand explains why employer-sponsored insurance remains a critical safety net and what changes are needed to bring more transparency, value, and balance to the healthcare system.

In this episode of DC EKG, host Joe Grogan is joined by Ryan Long, Capitol Hill veteran and senior research fellow at the Paragon Institute, to unpack two big health policy debates: the 340B drug discount program and the enhanced ACA premium tax credits. Ryan explains how 340B drives higher drug spending, hospital consolidation, and rising premiums, while often benefiting wealthier hospitals over safety-net providers. He also breaks down why the temporary ACA subsidies are set to expire in 2025, the fraud and enrollment issues they’ve created, and what both parties are gearing up for as the fight continues.

In this episode of DC EKG, Joe Grogan sits down with healthcare entrepreneur and advocate Dutch Rojas to unpack some of the most pressing and misunderstood issues in American healthcare. From his unconventional path from accounting into healthcare to his outspoken advocacy for physician-owned hospitals, Rojas brings a fresh, unapologetic perspective to how we can break through the gridlock of consolidation and outdated policy. Rojas makes the case for why charity care is often used as a business strategy rather than genuine community support, and explains how site-neutral payments could dramatically lower costs for patients and employers alike. He also outlines how innovations like a healthcare commodities exchange could finally deliver the price transparency Americans deserve, and the competition the system desperately needs.

Join host Joe Grogan for an exclusive masterclass with Dr. Robert Burns, James Joo-Jin Kim Professor of Health Care Management at the Wharton School. A nationally recognized expert on the U.S. healthcare system, Dr. Burns unpacks the complex forces driving healthcare costs. With a background in sociology, anthropology, and decades of research, Dr. Burns reveals why so many healthcare reforms fail, what policymakers and business leaders get wrong, and how the U.S. healthcare ecosystem really works behind the headlines. If you’ve ever wondered why American healthcare is so expensive, and what can actually be done about it, this episode is a must-listen.

Critics have been quick to attack the One Big Beautiful Bill (OBBB), but how much of what you’ve heard is true? In this episode, Joe Grogan sits down with Brian Blase to set the record straight on the bill’s health policy reforms and why they matter. From Medicaid funding changes to the role of provider taxes, Brian and Joe break down the bill’s impact, debunk common myths, and explore what’s next for U.S. healthcare policy. They cover how work requirements, eligibility reviews, and a focus on value could transform the system. Paragon Institute Myth-Busting Series on OBBB: https://paragoninstitute.org/issue-library/obbb-myths-and-facts/ Brian Blase X: https://x.com/brian_blase?lang=en

In this episode of DC EKG, Joe Grogan sits down with Sean Spicer, former White House Press Secretary and host of The Sean Spicer Show. Spicer shares his experiences from working in various political roles, his thoughts on Republican strategies for the midterms, and the challenges of communicating healthcare policies. The discussion also delves into the differences between legacy media and new media, highlighting the need for self-reflection within traditional news outlets.

Stephen Parente, former White House Chief Economist for Health Policy and current Minnesota Insurance Industry Chair of Health Finance and Associate Dean at the Carlson School of Management, joins host Joe Grogan to discuss the state of healthcare transparency. They dive into the pros and cons of price transparency, the impact of the No Surprises Act, challenges for insurers and providers, and what transparency means for healthcare costs and future policy. Parente also hosts the On Background podcast, where he explores key issues in health finance and public policy.

In this episode of DC EKG, host Joe Grogan sits down with Dan Troy, former Chief Counsel of the FDA and a nationally recognized expert on healthcare law and the First Amendment. They explore Troy’s unique journey from free speech litigator to one of the FDA’s top legal voices, examining how the agency regulates what drugmakers, doctors, and companies are allowed to say—and what they’re not. The conversation dives into the legal boundaries of off-label promotion, the impact of direct-to-consumer advertising on patient care, and the growing tension between innovation and regulation in the pharmaceutical industry. Troy also offers his perspective on the Inflation Reduction Act and its potential chilling effect on drug development, underscoring the need for bipartisan support in shaping healthcare policy.

In this episode, Michael F. Cannon, the Cato Institute’s Director of Health Policy Studies, dives into the policy decisions that shaped Medicare and fundamentally distorted the U.S. health insurance market. From how tax incentives nudged Americans into employer-sponsored plans to the unintended consequences that left many seniors uninsured, Cannon breaks down the government’s role in creating systemic challenges in health care. He also explores how tax policy has long been used as a tool to mandate certain health behaviors, and what a less distorted, freer market might look like. If you want to understand the policy roots behind today’s health care complexities, this conversation is a must-listen.

In this conversation, Joe Grogan interviews Peter Pitts, a former FDA associate commissioner and current president of the Center for Medicine and the Public Interest. They discuss the role of FDA advisory committees, the importance of transparency in regulatory processes, and the intersection of vaccination and nutrition in public health. Pitts emphasizes the need for better dosing guidelines for obese patients and the significance of user fees in ensuring predictable FDA reviews. The conversation highlights the challenges and opportunities within the FDA and the broader healthcare landscape.

In this episode of DC EKG, host Joe Grogan interviews historian and political veteran Tevi Troy about the complex relationship between U.S. presidents and powerful industries. They discuss themes from his book The Power and the Money: The Epic Clashes Between Commanders in Chief and Titans of Industry and his op-ed In Defense of Big Pharma. The conversation explores why pharmaceutical companies are often political targets and the impact on innovation, how historical antitrust cases shape today’s tech and biotech battles, insights on Trump’s leadership and the future of the GOP, the importance of communication skills in politics and business, and behind-the-scenes stories from the Trump administration, offering valuable leadership lessons. This episode provides important insights for policymakers, investors, and anyone interested in the intersection of health, economics, and democracy.

Joe Grogan sits down with Dr. Anthony DiGiorgio, a neurosurgeon and health policy researcher, for a wide-ranging conversation on the challenges facing America’s healthcare system. Drawing on his experience at a safety net hospital, Dr. DiGiorgio discusses the realities of trauma care, including the treatment of traumatic brain and spinal cord injuries, and the systemic issues within Medicaid that hinder access and quality of care. The conversation also explores the misuse of the 340B program, the ethics and logistics of overlapping surgeries, and the growing crisis of physician burnout. Dr. DiGiorgio shares his advocacy for direct primary care and the promise of AI as tools to reduce administrative burdens and improve patient outcomes.

In this episode of DC EKG, policy expert Ryan Long unpacks the tangled evolution of the 340B program—from its origins in the early 1990s to its explosive, unintended role in today’s healthcare market. Originally designed to help hospitals serving the uninsured access affordable drugs, 340B has morphed into a tool for profit, driving hospital consolidation, inflating costs, and straining the biotech innovation ecosystem. Ryan explains how vague eligibility rules, lack of oversight, and policy loopholes have turned a small support program into a massive $54 billion industry—with no requirement that savings actually reach the patients it's meant to help. This is a must-listen for anyone interested in how drug pricing policy, hospital behavior, and innovation incentives are shaping the future of medicine in America.

In this episode of DC EKG, host Joe Grogan speaks with Kelly Cleary, a partner at Akin Law, about her career in healthcare regulatory law and her experience at HHS. They discuss the recent repeal of the Richardson waiver, its historical significance, and implications for healthcare policy and regulation. The conversation also touches on the end of Chevron deference and its potential impact on agency regulations, as well as personal reflections on the value of government service in shaping legal practice.

In this episode of DC EKG, host Joe Grogan sits down with Dr. Brian J. Miller to dissect the critical barriers slowing medical innovation in the United States. Together, they unpack the notorious "Valley of Death"—the daunting gap between FDA approval and Medicare coverage that delays patient access to groundbreaking treatments and technologies, often by an average of 5.7 years. Dr. Miller shares his insights on how outdated regulatory processes at both the FDA and CMS create unnecessary hurdles for life sciences and technology entrepreneurs. They explore how modernizing third-party reviews, streamlining clinical trials, and reforming coverage decisions could dramatically accelerate the journey from lab to patient.

In this episode, Joe Grogan and Brian Blase dive into the current state of Medicaid, exploring the urgent need for reforms to tackle inefficiencies, improper payments, and discriminatory reimbursement rates. Blase discusses the challenges stemming from the Medicaid expansion under the Affordable Care Act (ACA) and how it has impacted traditional enrollees. The conversation also uncovers the troubling issue of Medicaid money laundering, shedding light on the practice of state-directed payments that sometimes surpass Medicare rates. Together, they discuss the pressing need for a more effective and equitable healthcare system that better serves those in need while ensuring accountability in healthcare spending. This episode is a critical look at how the ACA and Medicaid policies are shaping the future of American healthcare.

In this episode, Joe Grogan and Sally Pipes dive into the future of U.S. healthcare policy, discussing potential reforms under a second Trump administration. They explore executive orders, Medicaid challenges, and the flaws in Canada’s healthcare system. The conversation also tackles a provocative question: Could Canada ever become the 51st state? Sally breaks down the political, economic, and healthcare implications of such a shift. Plus, they discuss California’s wildfire mismanagement and the urgent need for political change.