From a government shutdown halting FDA approvals to the looming expiration of ACA subsidies threatening to raise insurance premiums for millions, the American healthcare system is facing a perfect storm. These mounting US healthcare policy challenges are creating unprecedented uncertainty for patients, providers, and innovators alike. In this episode, we're joined by healthcare regulation and policy expert Matt Wetzel, a partner at Goodwin Procter LLP, to dissect the interconnected crises plaguing Washington, D.C. and what they mean for the future of your healthcare.

We connect the dots between the federal shutdown, expiring ACA enhanced premium tax credits, clandestine pharmacy benefit manager (PBM) practices, and Medicare's latest payment cuts. Why can't Washington compromise, and who is feeling the most pain? We explore the real-world consequences, including delays for companies seeking approvals for new drugs and devices, the degradation of hospital payer mix due to rising uninsured rates, and the political maneuvering that leaves everyday Americans caught in the middle. This discussion on US healthcare policy challenges uncovers the systemic dysfunctions, from legislative gridlock to the "wrecking ball" approach to policymaking that prioritizes disruption over stability.

This episode provides a comprehensive breakdown of the most pressing issues in healthcare today. We uncover the truth behind Pharmacy Benefits Managers (PBMs) and the bipartisan push for PBM reform, exposing their fundamental conflicts of interest, the dirty tricks of "spread pricing" on generic drugs, and why their business model drives up costs for everyone. We also analyze the controversial Medicare efficiency adjustment included in the latest Medicare Physician Fee Schedule—a "lazy" blanket cut that penalizes specialists and creates further uncertainty in the medical technology market. If you want to understand the forces driving up your insurance costs and creating chaos in the US healthcare system, this is a must-watch conversation that unpacks the complex US healthcare policy challenges we all face.

About Our Guest:
Matt Wetzel is an attorney and Partner at Goodwin Procter LLP, based in Washington D.C. He is a leading expert in medical device and healthcare regulation, working with numerous biotech, medtech, and digital technology companies. As a seasoned health policy commentator, Matt provides deep insights into the administrative and regulatory hurdles impacting the healthcare industry, from the FDA and CMS to the NIH.

Timestamps:
(00:00) Introduction: A System in Crisis
(01:55) The Government Shutdown's Widespread Impact on Healthcare
(05:05) How the Shutdown Halts FDA Approvals for New Drugs & Devices
(09:25) The Crushing Weight of Uncertainty on the Healthcare Business Community
(11:34) The Looming Expiration of ACA Enhanced Premium Tax Credits
(14:28) Why Can't Congress Agree on Extending ACA Subsidies?
(20:09) The Hidden Bureaucracy Driving Up Health Insurance Costs
(26:15) Decoding PBM Reform: Conflicts of Interest and Hidden Costs
(33:24) The PBM Conflict of Interest: Serving Two Masters
(37:50) PBM Trick Explained: What is "Spread Pricing"?
(41:00) The "Halloween Surprise": Unpacking the Medicare Efficiency Adjustment
(49:09) What's Next? Biotech, National Security, and Future Healthcare Legislation

Learn More From Our Guest / Episode Resources:

• Learn more about Matt Wetzel's work at Goodwin Procter LLP

One of America's largest pharmacy benefit managers (PBMs) just announced they'll stop taking rebates from drug manufacturers. The Senate's response? "Not impressed."

Why? Because rebates are just one of five profit driving "tricks" PBMs use to quietly inflate your drug costs.

In this episode, Dr. Anthony Paravati breaks down the real money flow behind prescription drug pricing, how a system designed to reduce costs does the exact opposite

You'll learn:

• The 7-player money map that explains where every healthcare dollar really goes

• The 5 PBM "tricks" that turn generics into goldmines

• How "spread pricing" means employers (and ultimately you) pay huge markups on actual drug cost

• Why regulatory capture keeps this system legal

• And why this reform moment in Washington matters right now

If you're an employer, benefits consultant, or policymaker, this episode will change how you see pharmacy costs forever.

If you're a patient, you'll finally understand why your prescriptions keep getting more expensive.

Because every dollar diverted to middlemen is a dollar not going to care, wages, or innovation.

🎧 Listen now to understand the role PBMs have played to drive annual healthcare spend in the US to a ridiculous $4 trillion.

The 340B drug pricing program was created to help safety-net hospitals and clinics stretch their resources to care for low-income and uninsured patients. But has it spiraled out of control? Originally a modest plan, the program has exploded into a $130 billion market, leading to a fierce debate over who truly benefits from the massive discounts. Is it the patients, as intended, or are for-profit corporations, PBMs, and large hospital systems capturing the profits? In this episode, we unpack the controversy and explore the future of 340B.

Joined by two of the nation's leading experts on the topic, we dissect the complex mechanics of the 340B drug pricing program and the powerful financial incentives that drive it. We explore how the program has grown exponentially, fueled by rising drug costs and the explosion of 340B contract pharmacies. This discussion sheds light on the central question: who benefits from the 340B program? Our guests break down how pharmacy benefit managers (PBMs) and major chains like CVS and Walgreens have become major players, diverting funds that were meant for patient care. We provide a clear, step-by-step example of how the money flows for a single prescription, revealing the winners and losers in this system.

A significant focus of our conversation is on 340B in oncology, where high-cost drugs create enormous financial spreads for participating hospitals, often without any direct savings for the cancer patient. This raises critical questions about whether the program encourages the use of more expensive drugs and consolidates cancer care into large hospital systems. We also dive deep into the push for 340B program reform, covering the recent Senate hearings, the legal battles over state laws restricting manufacturers, and the debate over moving oversight from HRSA to CMS. We analyze proposals like a rebate model and increased transparency requirements to understand what the future may hold for this vital, yet deeply flawed, healthcare program.

About Our Guests:

Ted Okon: As the Executive Director of the Community Oncology Alliance (COA), Ted Okon is a nationally recognized voice on the policy and politics of cancer care. He is a frequent presence on Capitol Hill, advocating on critical issues like drug costs, Medicare reimbursement, and the changing economics of oncology.

Amanda Smith: Amanda is Counsel at K&L Gates in their healthcare and FDA practice, with a specialized focus on the federal 340B drug pricing program. She advises clients on complex regulatory, legislative, and litigation matters related to the program and previously served as a healthcare law clerk for the U.S. Senate Committee on Finance.

Timestamps / Chapters: (00:20) Understanding the 340B Drug Pricing Program (07:24) How the 340B Program Really Works (09:29) Who Truly Benefits from 340B Discounts? (12:03) The Financial Impact: How 340B Influences Drug Prices (16:33) Navigating the Regulatory Landscape: HRSA's Role and Limitations (22:03) The Rise of 340B Contract Pharmacies & PBM Influence (25:26) The Legal Battleground: State Laws and Lawsuits (30:21) FOLLOW THE MONEY: A $10,000 Drug Example (36:11) Hospital Eligibility and the Lack of Transparency (44:26) The Future of 340B Program Reform: Rebates, CMS Oversight & More (59:45) PREDICTIONS: What Will 340B Look Like in 2 Years?

Learn More From Our Guests / Episode Resources:

• Learn more about the Community Oncology Alliance (COA)
• Learn more about K&L Gates' Healthcare Practice
• Subscribe to our channel
• Follow us on TikTok
• Follow us on LinkedIn

How do we deliver high-quality cancer care in a system under pressure? Meagan O'Neill, Executive Director of the Association of Cancer Care Centers (ACCC), joins us to talk about workforce empowerment, technology as a multiplier, and building sustainable oncology systems for the future.

Meagan shares her journey from oncology business consulting to national advocacy, shaped by her own personal experience with cancer care. With two-thirds of U.S. cancer programs in its network, ACCC plays a pivotal role in driving change across the oncology landscape.

In this episode, we discuss:

• Why personal experience can reshape how we design cancer care

• Strategies to address workforce shortages through empowerment

• Using technology to amplify—not replace—clinical teams

• Building upstream cancer care capacity to improve community health

• Making value-based care real in oncology practices

• Interoperability and integrated models for better patient outcomes

• The role of diversity in improving adherence and patient engagement

Key Takeaways

• Workforce empowerment is essential to meet rising patient needs.

• Technology should act as a force multiplier for clinicians.

• Patient-centered care must be prioritized at every level.

• Interoperability and upstream investment are critical for sustainable oncology systems.

About the Guest Meagan O'Neill is the Executive Director of ACCC, which represents more than two-thirds of U.S. cancer programs. She previously worked in oncology business consulting and brings both professional and personal perspectives to driving systemic change in cancer care.

Chapters 00:00 – Introduction to ACCC and Meagan O'Neill 04:58 – A Personal Cancer Journey 12:11 – Workforce Empowerment in Oncology 20:19 – Building Capacity in Cancer Care 25:25 – Patient-Centered Care 26:12 – Data-Driven Approaches 28:10 – Expanding Capacity with Nursing and APPs 30:37 – Leveraging Technology 34:36 – Navigating Claims and Denials 37:18 – Interoperability and Integrated Care 39:02 – Tailoring Oncology Models 43:09 – Telehealth and E-Consults 45:39 – Designing Future Oncology Care 51:35 – Reflections on ACCC's 50th Anniversary

Keywords ACCC, cancer care, oncology, workforce empowerment, technology in healthcare, patient experience, healthcare systems, cancer treatment, healthcare innovation, patient-centered care, value-based care, interoperability, nursing, APPs, telehealth

Dr. Bobby Mukkamala, President of the American Medical Association and practicing ENT surgeon in Flint, Michigan, joins Value Health Voices to discuss the critical challenges facing American healthcare from both the physician and patient perspective.

As a solo practice physician treating cancer patients while leading the nation's largest physician organization, Dr. Mukkamala provides unique insights into the policy battles affecting healthcare delivery. The conversation covers prior authorization barriers that delay cancer care, the Medicare payment crisis with 25 years of declining physician reimbursement, and the collapse of independent medical practices due to site neutrality issues.

Dr. Mukkamala also addresses Medicare Advantage's aggressive denial tactics, the physician workforce shortage, and dangerous trends toward independent nurse practitioner practice without physician oversight. The discussion includes the AMA's role in CPT coding and RUC valuation, as well as Dr. Mukkamala's personal cancer journey and its impact on his advocacy for NIH research funding.

This episode reveals how physician advocacy organizations fight for both healthcare providers and patients as the system faces mounting pressures. Dr. Mukkamala's dual perspective as practicing physician and cancer patient offers invaluable insights into what's really happening in American healthcare.

About the Guest: Dr. Bobby Mukkamala is President of the American Medical Association, a practicing otolaryngologist in Flint, Michigan, and graduate of University of Michigan Medical School. He previously served on the AMA Council on Science and Public Health while maintaining his solo practice.

Value Health Voices makes healthcare policy and finance accessible through engaging discussions with industry leaders, policymakers, and practitioners working to transform care delivery.

The presidents of ASTRO and ACRO provide focused analysis of CMS's 2026 proposed rules and their specific implications for radiation oncology practice. This executive briefing examines key policy changes without background context, concentrating on immediate implementation concerns and the September 12 comment period.

Key Topics Covered:

• Critical APC "crosswalk" methodology issues affecting new treatment delivery codes
• CMS's new "efficiency adjustment" reducing procedural service payments by 2.5%
• Transition from survey-based valuations to hospital cost data methodology
• Image guidance and port film bundling into treatment delivery codes
• Surface radiation therapy coding updates and valuation changes
• RUC committee dynamics and specialty representation challenges
• Strategic considerations for the comment period ending September 12, 2025

Technical Analysis: Dr. Sameer Keole (ASTRO President) and Dr. Brian Lally (ACRO President) and Drs Paravati and Rewari explain how CMS may have assigned new radiation therapy codes to incorrect ambulatory payment classifications. The analysis suggests CMS deleted separate IMRT codes but may not have recognized that IMRT services are now bundled into new level 2 and level 3 treatment codes, potentially resulting in significant undervaluation.

Policy Context: The discussion examines how radiation oncology's 21% decline in relative value over 20 years, combined with these proposed changes, affects practice sustainability. Freestanding centers face particular challenges with a 32% reimbursement reduction since 2015.

About Our Guests: Dr. Sameer Keole serves as President of ASTRO and practices radiation oncology in Arizona. Dr. Brian Lally is President of ACRO and practices at an academic center in South Carolina. Both provide extensive expertise in healthcare policy and specialty society leadership.

This focused analysis provides healthcare leaders with essential technical information for participating in the rulemaking process.

Note: This is a condensed version of our full Episode 18 analysis, focusing specifically on radiation oncology implications.

Subscribe & Connect: Follow Value Health Voices Podcast for healthcare policy analysis. Find us on YouTube, LinkedIn, and all major podcast platforms.

Episode Tags: Medicare physician fee schedule, HOPPS, radiation oncology, ASTRO, ACRO, APC crosswalk, efficiency adjustment, CMS proposed rule, treatment delivery codes, comment period, healthcare policy analysis, specialty medicine, supercut

The presidents of ASTRO and ACRO join the VHV guys to provide expert analysis of CMS's newly released 2026 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS) proposed rules. Dr. Sameer Keole (ASTRO President) and Dr. Brian Lally (ACRO President) join us one week after the July 2025 release to examine the implications for radiation oncology and procedural specialties.

Key Topics Covered:

• CMS's new "efficiency adjustment"—a 2.5% reduction to work RVUs for procedural services
• New treatment delivery codes and potential APC "crosswalk" issues in radiation oncology
• Budget neutrality's role in specialty medicine reimbursement competition
• The shift from survey-based valuations to hospital cost data methodology
• Practice expense changes affecting technical component payments
• RUC committee dynamics and specialty representation challenges
• 34-year evolution of the RVU system and its impact on different specialties

Critical Policy Analysis: The episode examines how CMS assigned new radiation therapy codes to ambulatory payment classifications, potentially using incorrect methodologies that may not account for IMRT services bundled into new level 2 and level 3 codes. Our expert guests explain why radiation oncology has experienced a 21% decline in relative value over two decades while primary care increased 38%.

About Our Guests: Dr. Sameer Keole serves as President of the American Society for Radiation Oncology (ASTRO) and is a practicing radiation oncologist in Arizona. Dr. Brian Lally is President of the American College of Radiation Oncology (ACRO) and practices at an academic center in South Carolina. Both bring extensive experience in healthcare policy and specialty society leadership.

This executive briefing provides physicians and healthcare leaders essential context for the 60-day comment period ending September 12, 2025, and explores strategies for effective advocacy during the rulemaking process.

Subscribe & Connect: Follow Value Health Voices for comprehensive healthcare policy analysis. Find us on YouTube, LinkedIn, and all major podcast platforms.

Episode Tags: Medicare physician fee schedule, MPFS, HOPPS, efficiency adjustment, radiation oncology, ASTRO, ACRO, CMS proposed rule, RUC committee, budget neutrality, APC methodology, conversion factor, practice expense, healthcare policy analysis, specialty medicine, procedural services

Alice Ayres, President and CEO of the Association for Healthcare Philanthropy, reveals the critical funding lifeline that most people don't know exists. As Congress slashes healthcare budgets and millions face losing Medicaid coverage, Alice exposes how healthcare philanthropy returns $4.16 for every dollar invested and why it's becoming the difference between hospitals thriving and closing their doors.

This powerhouse leader, former Advisory Board Company executive who worked with 4,500+ healthcare organizations and 200,000+ leaders, breaks down the urgent shift happening in healthcare funding. With 10,000 baby boomers daily moving from private insurance to Medicare, operating margins are shrinking fast.

Key Topics Covered:

• Why "grateful patient" programs heal faster than traditional medicine
• How behavioral health donations surged 500% since COVID
• Why 100% leadership giving is non-negotiable for foundation success
• How AI is revolutionizing donor identification while respecting patient privacy
• Mobile clinics funded by donors serving vulnerable populations
• Alice's game-changing advice: "No doctor should ever ask for money—but opening gratitude conversations makes patients heal faster"

From her 20+ years leading healthcare transformation to guiding foundations that collectively raise $11 billion annually, Alice provides the roadmap hospitals need as federal funding disappears.

About Our Guest: Alice Ayres has served as President and CEO of AHP since 2018, recognized as one of Non-Profit Times Power and Influence Top 50 in 2024. She previously led strategic marketing for The Advisory Board Company, creating strategy sessions for 150+ leading healthcare providers worldwide. She holds an MBA from Northwestern Kellogg and brings deep healthcare industry knowledge to philanthropy leadership.

Subscribe & Connect: Follow Value Health Voices for insider healthcare finance strategies. Find us on YouTube, LinkedIn, and all major podcast platforms.

Episode Tags: healthcare philanthropy, hospital funding, grateful patient programs, healthcare finance, Alice Ayres, AHP, medical fundraising, healthcare donations, Medicaid cuts, hospital charity care, healthcare leadership, nonprofit management

Dr. Eric Bricker returns for Part 2 of our analysis of the "One Big Beautiful Bill" and the timing couldn't be more critical. Just as the Senate moves toward a final vote, the nonpartisan Congressional Budget Office reported Sunday (6/29/25) that the Senate version would add at least $3.3 trillion to the national debt over the next decade.

This internal medicine physician and founder of AHealthcareZ (400+ healthcare finance videos, 100,000+ subscribers) delivers his signature straight-talk analysis on what will be the most earth-shattering healthcare legislation in decades. Dr. Bricker exposes how this bill would strip Medicaid coverage from 11-16 million Americans while dismantling the state funding mechanisms that keep safety-net hospitals alive.

Dr. Bricker and the VHV guys discuss:

• How "provider tax safe harbors" being cut from 6% to 3% will trigger massive prior authorization increases
• Why hospital systems will face a "double squeeze": less Medicaid revenue AND higher debt refinancing costs
• The brutal politics behind using patient care as a "political pawn" to fund tax cuts
• How charity care programs could become the only lifeline for millions of Americans
• Why even Republican senators are questioning these Medicaid cuts

Dr. Bricker's urgent message to physicians: "The age of passivity is over. No one is coming to save you or your patients." He provides concrete actions healthcare professionals can take locally while this legislative earthquake unfolds in Washington.

From work requirements that target caregivers to state-directed payment caps that will bankrupt safety-net hospitals, this episode breaks down thousands of legislative pages into what every healthcare leader needs to know before the Senate votes.

Subscribe to Value Health Voices for critical healthcare policy analysis. Check out Dr. Bricker's AHealthcareZ YouTube channel for his complete healthcare finance education library.

Chapters:

00:00 The $3.3 Trillion Healthcare Bill: An Overview

02:05 GOP Budget Reconciliation Bill: Key Healthcare Proposals

03:45 The Human Cost: Real Stories from Safety-Net Hospitals

07:23 Work Requirements: Who Really Gets Hurt

10:53 The Great Medicaid Funding Squeeze: Provider Taxes Under Attack

18:03 State-Directed Payments: The End of Hospital "Scavenger Hunts"

23:33 Political Power and Healthcare: The Real Game Being Played

29:02 The Double Squeeze: Medicaid Cuts + Rising Interest Rates

31:35 Taking Action: What Physicians Can Do Right Now

37:27 Hospital Innovation: Learning from Ochsner's Success Model

44:49 The Future of Healthcare Finance: Reasons for Optimism

Keywords: #Medicaidcuts, #budgetreconcilation #Senatebill, #CongressionalBudgetOffice #Medicaid #providertaxes #statedirectedpayments #workrequirements, #safetynethospitals healthcare finance #DrEricBricker #AHealthcareZ

Dr. Eric Bricker, the powerhouse behind AHealthcareZ's 400+ healthcare finance videos with 100,000+ subscribers, joins Value Health Voices to decode the labyrinthine money flows that determine which hospitals succeed with Medicaid—and which avoid it entirely. This internal medicine physician and former co-founder of Compass Professional Health Services (which grew to 1.8M members across 2,000+ clients including T-Mobile and Southwest Airlines before being acquired) reveals the complex "scavenger hunt" that separates thriving hospital systems from struggling ones.

Discover why Medicaid isn't actually one program but 50+ different state systems with wildly different funding mechanisms. Dr. Bricker exposes how provider taxes, DSH payments, and state-directed payments create a $80 billion federal funding ecosystem—and why only sophisticated hospital systems with armies of consultants can navigate it successfully. You'll learn why California gets 50% federal matching while Mississippi receives 77%, how children's hospitals depend on Medicaid for half their revenue, and why some suburban systems can ignore Medicaid entirely while urban academic centers live or die by these payments.

Known for his viral whiteboard videos that deconstruct the US healthcare system, Dr. Bricker delivers essential insights every healthcare leader needs to understand the financial forces reshaping American healthcare. This eye-opening conversation explains why administrative complexity has become a competitive advantage—and what it means for patient care.

Subscribe to Value Health Voices for expert healthcare policy analysis. Check out Dr. Bricker's AHealthcareZ YouTube channel for his complete healthcare finance library.

Chapters:

00:00 Understanding Medicaid: A Complex Landscape

02:12 The Mechanics of Medicaid Funding

05:41 Provider Taxes and Their Impact

10:01 Disproportionate Share Hospital Payments

17:22 State-Directed Payments: Variability and Controversy

20:16 Expansion vs. Non-Expansion States

24:22 The Role of Managed Care Organizations

28:40 Challenges in Accessing Care for Medicaid Patients

32:35 Understanding the Complexities of Healthcare Funding

36:56 The Scavenger Hunt for Revenue in Healthcare

39:48 The Friction in Healthcare Administration

Keywords: Medicaid, healthcare finance, health policy, state funding, provider taxes, DSH payments, state-directed payments, expansion states, healthcare access, revenue generation