Health Affairs This Week

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Pharmacy Benefit Manager Reforms Are (Finally) Afoot Feb 06, 2026

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This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Health Affairs' Jeff Byers welcomes Senior Editor Kathleen Haddad back to the pod to discuss the recently passed $1.2 trillion spending appropriations bill, its included reforms for pharmacy benefit managers, the latest round of drugs slated for the Medicare Drug Negotiation program, TrumpRx, the upcoming flat rate for Medicare Advantage plan rates, and more recent health policy news.

Related Articles:

Congress Reins In Drug Middlemen In Effort to Lower Prescription Prices (The New York Times)
Analyzing The Drugs Selected For The 2028 Medicare Drug Price Negotiation Cycle (Health Affairs Forefront)
The No UPCODE Act: Considering A Simple Start To A Complex Problem (Health Affairs Forefront)
PRESS RELEASE: CMS Announces Selection of Drugs for Third Cycle of Medicare Drug Price Negotiation Program, Including First-Ever Part B Drugs

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What Health Policy Katie Keith Is Watching In 2026 Jan 30, 2026

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This episode is brought to you by Semafor Healthcare.

Health Affairs' Jeff Byers welcomes Katie Keith of Georgetown Law and Deputy Editor Chris Fleming to the pod to discuss what to watch out for in 2026 for health policy. The conversation touches on Affordable Care Act subsidies, Medicaid eligibility, guidance for pharmacy benefit managers, drug price negotiations, and more.

This week, we announced that Health Affairs has become Health Affairs Publishing, LLC, a single-member limited liability company wholly owned by Project HOPE. To find out more about this exciting new chapter, check out this Forefront piece.

Join us for the following events:

2/17: The FDA and Its Changing Relationship to Industry
2/25: What Excites Insiders About Health Care in 2026?

Become an Insider today to get access to these exclusive events.

Related Links:

Health Policy At A Crossroads: What To Watch In 2026 (Health Affairs Forefront)
Prescription Drug Policy, 2025 And 2026: The Year In Review And The Year Ahead (Health Affairs Forefront)

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Behind Epic's Latest Antitrust Lawsuit (Gabriel Perna) Jan 23, 2026

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This episode is brought to you by Semafor Healthcare.

Health Affairs' Jeff Byers welcomes Gabriel Perna, Deputy Editor of Digital Health Business & Technology at Modern Healthcare, to the pod to discuss Epic Systems, how they became one of the leading American health care EHR companies, a recent antitrust lawsuit filed by Texas Attorney General Ken Paxton against Epic Systems, and even touch on ChatGPT's entrance into health care.

Related Articles:

Texas files antitrust suit against Epic over health data (Modern Healthcare)
Texas hits Epic with an antitrust suit: Here’s what to know (Modern Healthcare)

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It's Not the Prices, Stupid. Michael Chernew on US Health Expenditures Jan 16, 2026

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This episode is brought to you by Semafor Healthcare.

Health Affairs' Jeff Byers is joined by Michael Chernew from Harvard Medical School to explore the recent 2024 health care spending report from the Centers for Medicare and Medicaid Services (CMS).

To kick off the new year, we are offering podcast videos of A Health Podyssey. Subscribe to our YouTube channel to watch those episodes. Let us know what you think about the videos by emailing us at communications@healthaffairs.org.

Join us on January 21 for an exclusive Insider virtual event exploring the latest drug policies with the University of Utah’s Joey Mattingly. Become an Insider to get access to this event.

National Health Care Spending Increased 7.2 Percent In 2024 As Utilization Remained Elevated (Health Affairs)
Growth In National Health Expenditures: It’s Not The Prices, Stupid (Health Affairs Forefront)

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BEST OF: Power and Its Impact on Medicaid w/ Jamila Michener Jan 07, 2026

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This episode is brought to you by Semafor Healthcare.

In the wake of Medicare and Medicaid's 60th anniversary, Health Affairs' Jeff Byers welcomes Jamila Michener of Cornell University to the pod to discuss her recent Forefront article on organized power and its impact on the future of Medicaid.

Also, join us for these upcoming events:

8/26: Provider Prices in the Commercial Sector: Independent Dispute Resolution (FREE TO ALL)
9/3: Theme Issue Briefing: Insights About The Opioid Crisis (FREE TO ALL)
9/23: Prior Authorization: Current State and Potential Reform (INSIDER EXCLUSIVE)

Become an Insider today to get access to exclusive events like the ones highlighted above.

Related Articles:

Order Fragmented Democracy: Medicaid, Federalism, and Unequal Politics (Cambridge University Press)
Medicare and Medicaid at 60 Forefront Series

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BEST OF: What's Happening with Value-Based Insurance Design? w/ Mark Fendrick Dec 24, 2025

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This episode is brought to you by Semafor Healthcare.

Health Affairs' Jeff Byers welcomes Mark Fendrick of The University of Michigan's Center for Value-Based Insurance Design (VBID) to discuss the recent announcement from CMS that the Medicare Advantage VBID model would be ending after 2025, and what the future holds for VBID moving forward with the new Trump administration.

Check out a recently released Health Policy brief from Nathaniel Tran and Gilbert Gonzales exploring LGBTQI+ policies.

Join Health Affairs on February 25 for an exclusive Insider virtual event featuring Stacie Dusetzina and Laura Tollen discussing HHS’s announcement of the 15 additional drugs selected for Medicare drug price negotiations, including weight-loss drugs such as Ozempic and Wegovy.

Also, join a live recording of A Health Podyssey on March 12 featuring Rob Lott and Yashaswini Singh discussing her recent paper on the effect of private equity on physician turnover. Register for the live taping here.

Related Articles:

The End Of The MA Value-Based Insurance Design Model: What Next? (Health Affairs Forefront)
V-BID X: Creating A Value-Based Insurance Design Plan For The Exchange Market (Health Affairs Forefront)
Medicare Advantage Value-Based Insurance Design (VBID) Model to End after Calendar Year 2025 (CMS)

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BEST OF: Medicare Physicians Are Getting a Raise...But At What Cost? Dec 17, 2025

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This episode is brought to you by Semafor Healthcare.

Health Affairs' Jeff Byers welcomes Senior Editor Leslie Erdelack back to the pod to discuss the proposed rule change to the Medicare Physician Fee Schedule for 2026, which includes payment conversion factors for doctors, alternative payment models, add-on codes for Advanced Primary Care Management services, a new mandatory value-based payment model, and more.

Order the August 2025 issue of Health Affairs.

Join us for a live taping of A Health Podyssey on Tuesday August 12 where Rob Lott will discuss recent findings about changes in clinician's participation across Medicare value-based payment models with Kenton Johnston.

Upcoming Events include:

8/20: 340B w/ Sayeh Nikpay (INSIDER EXCLUSIVE)
8/26: Provider Prices in the Commercial Sector: Independent Dispute Resolution (FREE TO ALL)
9/23: Prior Authorization: Current State and Potential Reform (INSIDER EXCLUSIVE)

View all Upcoming Events.

Become an Insider today to get access to exclusive events like the ones highlighted above.

Related Articles:

PRESS RELEASE: Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule (CMS-1832-P)
CMS proposes rule aligning Medicare physician payment with ‘Big Beautiful Bill,’ MACRA (Healthcare Dive)
CMS proposes 3.6% pay bump for docs, takes aim at chronic conditions in physician fee schedule (Fierce Healthcare)
Physicians will see Medicare payments rise in 2026 (AMA)
Medicare proposes ‘efficiency’ pay cuts that would hit highly paid specialists the most (STAT News)

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BEST OF: US Health Spending Projections Back on the Rise w/ Michael Chernew Dec 10, 2025

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This episode is brought to you by Semafor Healthcare.

Health Affairs' Jeff Byers is joined by Michael Chernew from Harvard Medical School to discuss the recently released National Health Expenditures Projections for 2024–33 from the Office of the Actuary (OACT) at the Centers for Medicare and Medicaid Services (CMS).

Related Articles:

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BEST OF: The Big Beautiful Bill: A New Era for Health Policy? w/ Katie Keith Dec 03, 2025

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This episode is brought to you by Semafor Healthcare.

Health Affairs' Jeff Byers welcomes Katie Keith of Georgetown Law and Deputy Editor Chris Fleming to the pod to discuss Trump administration's One Big Beautiful Bill and how this will affect Medicaid, Medicare, health savings accounts, rural hospitals, and more.

Become an Insider today to get access to our trend reports, events, and exclusive newsletters.

Related Links:

The 'One Big Beautiful Bill,' Now Law, Does Not Protect Rural Hospitals (Health Affairs Forefront)
Rural Health Transformation Program Won’t Shield Hospitals And Other Rural Providers From OBBBA’s Fallout (Health Affairs Forefront)
With Budget Reconciliation Bill Enacted, Health Care Changes Loom (Health Affairs Forefront)
Congress Should Remove The Rare Disease Carve-Out From Medicare Drug Price Negotiation, Not Expand It (Health Affairs Forefront)
Recent Experience Shows National Medicaid Work Requirements Would Create Enormous Administrative Inefficiencies (Health Affairs Forefront)

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Keeping ACO Models Accountable Nov 21, 2025

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This episode is brought to you by Semafor Healthcare.

Health Affairs' Jeff Byers welcomes Rachel Bonesteel of Duke-Margolis Center for Health Policy to the pod to discuss her recent Forefront article focused on how ACO REACH enabled ACOs to participate in an advanced, global-risk, population-based payment model.

Related Articles:

ACO REACH 2023 Performance Results Indicate A Pathway To Sustainable Accountable Care (Health Affairs Forefront)
Opportunities To Enhance Design And Implementation Of ACO REACH’s Core Payment Model Design Elements (Health Affairs Forefront)
Enhancing Design And Implementation Of ACO REACH’s Equity-Focused And Beneficiary Engagement Design Elements (Health Affairs Forefront)
Future Of Accountable Care: Lessons Learned And Potential Paths Forward During A Time Of Transition (Health Affairs Forefront)
Medicare Accountable Care Organizations In 2023: Large Savings With Increasing Value-Based Programmatic Competition (Health Affairs Forefront)
Medicare ACOs In 2024: Increased Participation And Evolving Policy Impacts (Health Affairs Forefront)

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