In Episode 130 of DC EKG, Joe Grogan sits down with Ryan Long to unpack two policy stories that are driving real-world drug costs and healthcare spending: the 340B program and the fallout from Medicare Part D changes under the Inflation Reduction Act. 

Ryan explains why the current 340B structure can incentivize higher costs, hospital consolidation, and contract pharmacy expansion, while often directing the biggest windfalls toward larger, wealthier systems rather than truly resource-constrained hospitals. They cover contract pharmacies, exposure to diversion and fraud, Medicare Part B reimbursement dynamics, and why reforms need to address the incentives baked into the program. 

They then turn to Medicare Part D, the shift from copays to coinsurance, premium pressure, the accelerated move into “catastrophic” coverage, and what happens when Washington promises savings that do not materialize. The episode closes with a broader look at fraud, program integrity, and why durable reform requires Congress to act. 

In This Conversation

Why does 340B incentivize higher costs and hospital consolidation 

Contract pharmacies, diversion risk, and fraud exposure 

Who really benefits from 340B and why rural hospitals can lose out 

Medicare Part D premium pressure and the IRA tradeoffs 

Copays vs coinsurance and what seniors experience at the pharmacy counter 

Fraud, program integrity, and why limited resources should go to patients who need them 

Timestamps0:00 Why the 340B structure drives higher costs and consolidation0:37 Ryan Long joins Joe1:13 What has changed in 340B, and why it is getting attention6:57 Payer mix, spreads, and why wealthier systems benefit more11:06 How 340B expanded post-2010 and contract pharmacies16:56 Why contract pharmacy reform alone does not fix the incentives22:11 Medicare Part D and what the IRA changed24:23 Explaining the donut hole28:54 Premium increases, catastrophic coverage, and cost shifting32:26 Copays to coinsurance and unexpected out-of-pocket changes40:37 Fraud exposure and program integrity52:09 Where to find Ryan’s work52:38 Outro

340B program, contract pharmacy, hospital consolidation, drug pricing, Medicare Part D, Medicaid rebate, Affordable Care Act, healthcare spending, healthcare costs, fraud exposure, policy impact, legislative reform, patient assistance

About Our GuestRyan Long is a Fellow at the Paragon Health Institute and a Scholar at the USC Schaeffer Center. He previously served as health policy lead for Speaker Kevin McCarthy and is a longtime Energy and Commerce veteran focused on drug pricing, Medicare, Medicaid, and healthcare spending reform. 

Podcast: DC EKG with Joe GroganEpisode: 130Guest: Ryan LongSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer:  Stay on Course Studios – https://www.stayoncourse.studio

In Episode 129 of DC EKG, Joe Grogan sits down with returning guest Adam Thierer, Resident Senior Fellow for Technology and Innovation at the R Street Institute, to break down the surge of state by state AI laws and why a patchwork approach could slow innovation, especially in healthcare.

Adam explains how more than a thousand state AI bills are flooding the zone, what types of “everything bills” are emerging, and why some states are trying to set national standards from Albany or Sacramento. Joe and Adam connect the federalism debate to real world health innovation, including mental health chatbots, algorithmic discrimination laws, and why compliance costs hit “little tech” hardest.

They also discuss Adam’s “AI Articles of Confederation” framing, the failed effort to create a federal moratorium on state AI rules, and what a better model could look like, such as regulatory inventories, learning labs, and sandbox style approaches that allow experimentation without shutting innovation down.

Key link: https://www.rstreet.org/commentary/congress-should-lead-on-ai-policy-not-the-states/

In This Conversation

Why state AI bills are accelerating and what is driving them

“Mega measures” that try to regulate frontier models, child safety, jobs, and copyright in one bill

New York and California style rulemaking with national spillover

The Micron example and how permitting and lawsuits can stop progress

Algorithmic discrimination laws and why healthcare gets hit hardest

Mental health chatbot bans and the access and workforce tradeoffs

Preemption and why Congress keeps punting

Alternative models: inventories, learning labs, sandboxes, and targeted gap fixes

Timestamps0:00 What is happening with state AI bills right now1:36 Adam’s background and how he got into AI policy5:55 The shift from federal regulation to state action10:27 What these state bills try to regulate13:29 Micron, permitting delays, and stopping progress20:00 Why some red states are pushing AI Bills of Rights26:24 “AI Articles of Confederation” and why it matters31:01 The attempted moratorium in the “big, beautiful bill”38:03 Preview of “The AI Terrible Ten” and worst state models39:43 Mental health chatbot bans and the mental health crisis44:25 What governors should do instead of rushing to regulate49:05 What Adam is tracking next51:48 What AI tools Adam uses52:42 Where to find Adam’s work

SEO Keywordsstate AI laws, AI policy, federal preemption, healthcare innovation, algorithmic discrimination, mental health chatbots, interoperability, AI regulation

About Our GuestAdam Thierer is a Resident Senior Fellow at the R Street Institute focused on technology and innovation policy. He writes and speaks widely on AI governance, federalism and preemption, and how regulatory models can either accelerate or stall innovation, including in healthcare.

Podcast: DC EKG with Joe GroganEpisode: 129Guest: Adam Thierer, Resident Senior Fellow, Technology and Innovation, R Street InstituteSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Julie Riga, Stay on Course Studios – https://www.stayoncourse.studio

In Episode 128 of DC EKG, Joe Grogan is joined by Kat McDavitt and Lisa Bari, co-hosts of the Health Tech Talk Show, for a practical conversation on what the next wave of health IT policy could unlock for patients and innovation.

They break down the proposed HTI 5 rule from ONC, why it is framed as deregulation, and how it aims to shift the market away from long EHR certification checklists toward one core goal: data that moves. The conversation digs into information blocking, TEFCA, patient access, and the reality of who controls health data in practice.

Joe presses a simple question: if it is “my data,” why do patients still struggle to pull a complete record? Kat and Lisa explain how HIPAA is often used as a barrier instead of a bridge, how secondary data use markets operate, and why privacy gets complicated in a world of apps, brokers, and advanced compute.

They also explore how HTI 5 connects to the AI wave, why state AI laws can create risk for innovation, and whether ideas like a Medicare app library help patients or end up picking winners too late.

In This Conversation

What HTI 5 is and why ONC is scaling back parts of EHR certification

Information blocking, TEFCA, and what real interoperability requires

Patient access vs business-to-business exchange and why complete records are still hard to get

HIPAA and the gap between intent and real-world data sharing

Screen scraping, automation, and why data access is becoming an AI issue

State AI regulation and federal direction on AI policy

,Timestamps0:36 Intro1:14 Welcome Kat McDavitt and Lisa Bari2:05 Lisa on her new role and what she is working on4:17 First reactions to HTI 5 and EHR deregulation7:34 HTI 5 in plain English11:27 Who controls health data and why this rule matters14:08 Why patients still cannot easily access complete records17:36 HIPAA and how it is used today22:24 Privacy outside HIPAA and secondary use25:50 How HTI 5 targets information blocking28:16 Screen scraping and why it is controversial36:09 How HTI 5 connects to healthcare AI47:28 Medicare app library concerns52:05 Closing and where to find Health Tech Talk Show

Health Tech Talk Show YouTube channel: https://www.youtube.com/@HealthTechTalkShow/streams

SEO Keywords (Megaphone)HTI 5, ONC, information blocking, TEFCA, interoperability, healthcare APIs, HIPAA, health data access, healthcare AI policy, data liquidity, screen scraping, Medicare app library

About Our GuestsKat McDavitt is co-host of the Health Tech Talk Show, President and Founding Partner of Innsena, and CEO and Founder of the Zorya Foundation.Lisa Bari is the Vice President of Policy and Partnerships at Innovaccer, where she leads health and AI policy, government relations, and global partnerships. She is the creator and host of the Policy Stack podcast, co-host of the Health Tech Talk Show, and a board member of the Zorya Foundation. Previously, she was the founding CEO of Civitas Networks for Health.
Podcast: DC EKG with Joe GroganEpisode: 128Guests: Kat McDavitt and Lisa BariSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Julie Riga, Stay on Course Studios – https://www.stayoncourse.studio

Episode 127

Rural Health on the Front Lines: Dr. Manny Sethi on Access, Private Equity, and Prevention

Dr. Sethi shares his story growing up in small town Tennessee as the son of immigrant physicians, then training as an orthopedic traumatologist and treating high-energy injuries that often collide with chronic disease and limited access to care.

The conversation centers on why rural communities struggle to find primary care and specialists, how administrative burden and electronic medical record requirements can crush independent practices, and why private equity and large systems buying clinics can reduce real access for patients.

Dr. Sethi also explains how Healthy Tennessee built a volunteer, community-based model of prevention through health fairs that screen hundreds to thousands of people, partner with food banks, and connect high-risk patients to follow-up care.

If you care about rural healthcare, access to care, private equity in medicine, physician shortages, preventative care, EHR burden, Medicaid, Medicare, and community health, this episode is a practical look at what is broken and what can be done.

In This Conversation

Timestamps (Audio platforms)

Key Takeaways

About Our Guest
Dr. Manny Sethi is an orthopedic traumatologist at Vanderbilt and co-founder of Healthy Tennessee, a nonprofit he launched with his wife in 2011 to bring prevention and screening to underserved communities through volunteer-driven health fairs and partnerships across the state.

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Show Sponsor: Survivors for Solutions – https://survivorsforsolutions.org

Executive Producer: John “CZ” Czwartacki, DC EKG Podcast

Producer: Julie Riga, Stay on Course Studios – https://www.stayoncourse.studio

In Episode 126 Joe speaks with Sue Peschin, President and CEO of the Alliance for Aging Research, about what Alzheimer’s and dementia look like in the real world and how policy determines who gets help and when. 

Sue explains the mission and 40–year history of the Alliance for Aging Research and lays out the scope of the Alzheimer’s crisis in plain language: who is affected, how dementia types differ, and why neuropsychiatric symptoms like agitation, psychosis, and depression are so often ignored in policy and practice.

They discuss why early detection matters more than ever now that disease-modifying therapies and amyloid inhibitors exist, and why so many cases are still missed in primary care. Sue walks through new blood biomarkers, digital cognitive assessments, and how Medicare coverage, CED restrictions, and the proposed ASAP Act will shape access to testing and treatment.

Joe and Sue also dig into Coverage with Evidence Development (CED) in Medicare, whether CMS is overstepping what Congress intended under Section 1801, and how restrictive coverage decisions have limited access to Alzheimer’s drugs to a tiny fraction of eligible patients. Finally, they talk about caregiver burden, stigma around behavioral symptoms, and what families and clinicians can realistically do today.

If you care about Alzheimer’s, dementia, early detection, blood biomarkers, Medicare coverage, CED, the ASAP Act, primary care, caregiver burden, vascular dementia, and aging research, this episode connects the science with the politics and the lived experience.

In This ConversationJoe and Sue cover:

What the Alliance for Aging Research is and why it focuses on “gap” aging and brain health issues

How many Americans are living with Alzheimer’s and dementia, including younger-onset cases

The difference between Alzheimer’s, vascular dementia, and other dementias, and why neuropsychiatric symptoms matter

Why early and accurate detection is critical, even before someone qualifies for a disease-modifying therapy

New tools: blood-based biomarkers, digital assessments, PET scans, and when they are used

How Medicare coverage, Coverage with Evidence Development (CED), and the ASAP Act affect access to diagnostics and treatments

The tension between FDA’s role on safety and effectiveness and CMS’s role on cost control and coverage

Timestamps (Audio platforms)

0:00 Intro and Sue’s background / Alliance for Aging Research

5:30 How big is the Alzheimer’s and dementia problem

10:30 Why early detection matters and why diagnoses are still missed

18:30 Neuropsychiatric symptoms, stigma, and caregiver burden

26:30 Blood biomarkers, digital tools, and primary care

33:30 The ASAP Act and Medicare coverage for biomarkers

38:30 Coverage with Evidence Development (CED) and Section 1801

45:00 How to get involved and where to find resources

Key Takeaways

Alzheimer’s is one of several dementias, and many patients have mixed dementia (Alzheimer’s plus vascular changes).

Early detection is vital, not only for disease-modifying therapies, but to rule out other treatable causes and to help families plan.

New blood biomarkers and digital assessments could make detection cheaper and easier, but coverage and adoption lag behind the science.

Medicare’s CED policy has sharply limited access to Alzheimer’s therapies despite FDA approval and labeled indications.

The ASAP Act aims to secure Medicare coverage for Alzheimer’s blood-based biomarkers without waiting on slow guideline processes.

About Our GuestSue Peschin is President and CEO of the Alliance for Aging Research, the leading nonprofit focused on advancing science, policy, and education to improve healthy aging and access to care. At the Alliance, Sue has driven national work on Alzheimer’s, dementia, neuropsychiatric symptoms, Medicare policy, CED reform, and aging research, empowering older adults and caregivers to advocate for better care.

"Obamacare Exempt" Plans - STLDI and ACA Coverage: Costs, Choice, and Tradeoffs

Joe Grogan is joined by Michael Cannon (Cato Institute) to break down short-term, limited-duration insurance (STLDI), also known as “Obamacare-exempt” plans. They explain why STLDI can be far cheaper than ACA exchange coverage, how renewal guarantees work, and why allowing more consumer choice can reduce pressure on exchange risk pools.

They also dig into the politics of pre-existing conditions, how ACA rules change insurers' incentives, and why coverage debates often miss the real drivers of cost, access, and quality. The conversation ends with a broader look at public trust, healthcare fear, and how policy choices shape what insurers can and cannot do.

Timestamps / Chapters00:01 – Intro00:23 – Michael Cannon joins + what STLDI is02:27 – STLDI explained: “Obamacare-exempt” plans, renewal guarantees, and lower premiums06:00 – ACA history: why STLDI was restricted07:46 – International comparisons + pre-existing conditions incentives and the Colette Briggs story12:10 – Why healthcare stays broken: regulation, lobbying, and “government-designed” systems16:59 – Subsidies and the politics of pre-existing conditions22:22 – Renewal guarantees, employer tax exclusion, and why Medicare entered the picture30:37 – Public trust after Brian Thompson’s murder and Cannon’s letter41:56 – Wrap-up

In This Conversation

What STLDI is and how it compares to ACA exchange plans

Why renewal guarantees matter for long-term protection

Risk pools, affordability, and why the “junk insurance” debate persists

Pre-existing conditions, politics, and how incentives affect networks and access

Why employer-based coverage and Medicare policy shaped today’s system

Key Takeaways

STLDI is a legal, consumer-driven coverage option that can reduce premiums and expand choice.

Renewal guarantees are a major consumer protection that changes the long-term risk story.

Pre-existing conditions policy is often debated emotionally, but incentives determine outcomes.

About Our GuestMichael Cannon is the Director of Health Policy Studies at the Cato Institute and a leading voice on the ACA, health insurance regulation, and market-based health reforms.

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

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:

Jim O’Neill’s vision for AI at HHS, including internal AI adoption and keeping a direct line open for small innovators.

ACCESS and TEMPO as new federal test beds for AI in chronic disease management and Medicare payment.

How wearables, remote monitoring, and “virtual ICU” models can support aging in place and reduce pressure on state budgets.

Ways AI can reduce documentation burden, support care coordination, and act as a first-line triage tool without replacing clinicians.

The emerging idea of personal AI agents that help patients navigate the system and share the right data with clinicians.

How AI-enabled diagnostics and tools can expand access in rural and underserved communities.

Why interoperability, ONC’s API rules, and the balance between state AI regulation and federal preemption will shape how quickly these tools scale.

The potential for tech companies to become Medicare Part B providers under ACCESS, and what that means for reimbursement and competition.

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.

Regulatory clarity and predictable routes from FDA clearance to Medicare reimbursement are essential for sustained AI adoption.

AI is currently most valuable as a force multiplier for physician productivity, taking on administrative and analytic work so clinicians can focus on patients.

Personal AI agents may become a primary interface between patients and the health system, coordinating data, benefits, and care.

Rural and underserved communities could benefit significantly if payment and regulatory rules support AI-enabled diagnostics and remote care.

Interoperability, state AI laws, and federal preemption will determine whether healthcare AI stays in pilots or reaches patients nationwide.

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.

 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.”

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.