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**DC EKG**

Join former White House policy expert Joe Grogan as he cuts through the complexities of healthcare legislation and its real-world implications. Each episode of DC EKG aims to demystify the policies shaping our healthcare system, uncovering how these changes impact patients, providers, and payers across the country.

Latest Episodes:

Ryan Long on the ACA Subsidy Fight, Phantom Enrollees, and Reforming 340B Jan 27, 2026

Show notes

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

Healthcare AI Gets Real: Naomi Lopez on ACCESS, TEMPO, and the Future of Care Jan 23, 2026

Show notes

DC EKG with Joe Grogan: A Healthcare Policy Podcast

Ep. 122

In this episode of DC EKG with Joe Grogan: A Healthcare Policy Podcast, Joe recaps the first Healthcare AI Policy Summit, held on December 10th in Washington, DC, with his co-host for the event, Naomi Lopez, founder of Nexus Policy Consulting.

They walk through the big themes shaping healthcare AI right now: how HHS is approaching AI adoption, what real regulatory clarity could look like, and how new federal initiatives like ACCESS and TEMPO may reshape chronic disease management for Medicare patients.

Joe and Naomi unpack HHS Deputy Secretary Jim O’Neill’s view of AI in government, from using large models to improve physician productivity, payment integrity, and care coordination to managing privacy and re-identification risk when working with federal health data.

They dig into the ACCESS Medicare payment model and the FDA TEMPO initiative, explaining how these pilots test AI and machine learning tools in real-world chronic disease management (hypertension, diabetes, musculoskeletal pain, and depression), and what that means for Medicare payment models, FDA oversight, and healthcare innovation.

The conversation then widens to physician burnout, interoperability, rural care, and the role of states and federal preemption in setting the rules for healthcare AI. If you care about the real-world impact of healthcare AI on policy, payment, and patients, this episode offers a clear, practical summary of what the summit revealed and what to watch next.

Today Joe and Naomi cover:

Key Takeaways:

Healthcare AI is being built into policy through programs like ACCESS and TEMPO, tying AI tools to Medicare payment and FDA pathways in chronic disease management.

Joe's guest, 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.

Are We Getting Our Money’s Worth? Jackson Hammond on NHE, CMS Reform & Making Insurance Almost Obsolete Jan 23, 2026

Show notes

In Episode 123 of DC EKG, Joe Grogan sits down with Jackson Hammond (Senior Policy Analyst, Paragon Health Institute) to unpack what the latest CMS National Health Expenditure (NHE) data says about where U.S. health care is headed.

They break down the June 2025 NHE release, compare it to Jackson’s earlier “Paragon Prognosis” analysis, and explain what changed, what didn’t, and what it means for affordability, Medicare, Medicaid, and long-run fiscal pressure.

They also connect the spending outlook to Jackson’s paper, “How to Reform the CMS Innovation Center with a Choice and Competition Approach,” and debate whether CMMI is bending the cost curve or just adding bureaucracy without accountability. Jackson argues we should aim for health care so affordable you barely need insurance.

Chapters / Timestamps 00:00 – Intro + welcome 00:55 – Jackson’s background: how he got into health policy 03:39 – Focus areas: Medicare, hospitals, drug pricing, PBMs, 340B 05:14 – What the NHE report is showing 06:14 – $5.2T → $5.6T → $8.6T: why the trajectory matters 08:00 – Why health spending isn’t really “optional” 10:11 – Where the money is going: payer mix + per-enrollee costs 12:23 – Medicaid costs, provider taxes, and state financing tactics 15:58 – Medicare spending pressure and fiscal risk 21:06 – Misconception: “coverage = care” 26:18 – Why provider payments keep rising (post-COVID demand + consolidation) 33:01 – Rural care, consolidation, and the REH / hub-and-spoke model 40:08 – Drug pricing: retrospective vs prospective MFN 49:20 – 2026 outlook + closing thanks

In This Conversation • NHE 2025: what the June 2025 data confirms about spending growth and the federal share. • Rising prices, flat health: why prices climb while outcomes lag. • Medicare and Medicaid: why they remain major budget drivers. • Coverage vs access: why an insurance card doesn’t guarantee care or better health. • Hospitals and consolidation: what’s driving higher payments and fewer choices. • Rural vs urban: why patients bypass local hospitals and what a better model could look like. • Drug pricing: what MFN approaches might mean for costs and innovation. • 2026: what Jackson expects next and what reform could realistically look like.

Key Takeaways • NHE data points to continued, unsustainable spending growth. • Medicare and Medicaid drive long-term budget pressure. • Consolidation and payment incentives shape prices as much as utilization. • CMMI reform hinges on accountability, choice, and competition. • Smarter drug pricing policy should lower costs without undermining innovation.

About Our Guest Jackson Hammond is a Senior Policy Analyst at the Paragon Health Institute focused on health spending, CMS policy, and reforms centered on choice, competition, and patient-centered care. He authors Paragon’s “Paragon Prognosis” analyses and wrote “How to Reform the CMS Innovation Center with a Choice and Competition Approach.”

Fixing Obamacare Without Repeal: Tony LoSasso on Competition, Subsidies & Fiscal Reality Dec 10, 2025

Show notes

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.

Ryan Long on The Hidden Costs of 340B and ACA Subsidies—and Why Reform Matters Sep 24, 2025

Show notes

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.

Dutch Rojas on Physician-Owned Hospitals, Transparency, and Ending Healthcare Monopolies Sep 15, 2025

Show notes

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.

Inside the Business of American Healthcare with Wharton’s Dr. Lawton Burns Aug 24, 2025

Show notes

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.

Debunking the Myths of the One Big Beautiful Bill with Brian Blase Aug 13, 2025

Show notes

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

Sean Spicer on Why Legacy Media Is Failing, Trump’s Impact & the Future of GOP Messaging Aug 04, 2025

Show notes

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 on How Transparency Can Fix U.S. Healthcare Costs Aug 04, 2025

Show notes

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.

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