The Healthcare Labyrinth

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

87. 2024 Medicare Advantage and Part D Program Audit Enforcement Report Out: What Does It Tell Us? 08/08/2025

87. 2024 Medicare Advantage and Part D Program Audit Enforcement Report Out: What Does It Tell Us? CMS’ Medicare Advantage (MA) program audits are getting tougher and more detailed every year. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses Medicare Advantage compliance. CMS’ program audits are getting tougher and more detailed every year. Key Takeaways: Overall, CMS’ program audit protocols are fair and reasonable. They hold plans accountable for the delivery of care to Medicare beneficiaries. There are four core audit protocols and a fifth for Special Needs Plans. The 2023 and 2024 program audit report shows MA audits are getting tougher and more detailed. Compliance Program Effectiveness is closely being scrutinized due to concerns about oversight of delegated vendors. Formulary Administration is also an active area due to concerns on correct prior auth edits, claims configuration, cost-sharing, and transition fills. Scrutiny of medical service and drug authorizations and appeals remain very detailed, with clinicians digging deep into cases and determination of medical necessity. On Special Needs Plans, CMS is always concerned about health risk assessments but is now going beyond that to determining if care plans are addressing all of the identified needs of individuals. CMS says plans are implementing and carrying out the new utilization management rules, but scrutiny should increase in the future. Financial audits are also increasingly rigorous and focused on no beneficiary harm. Record civil monetary penalties were levied in 2024. Connect with Marc: Resources: /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/37648465

86. Will The New 100% RADV Audits Be Fair To Medicare Advantage Plans? 08/01/2025

86. Will The New 100% RADV Audits Be Fair To Medicare Advantage Plans? While justified, there is some question about whether the new RADV audits will be fair to MA plans. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the new 100% RADV audits. While justified, there is some question about whether the new RADV audits will be fair to MA plans. Key Takeaways: CMS announced it will audit all Medicare Advantage (MA) contracts for each payment year. How it will ramp up staff and technology to hit the aggressive announcement is another question. Opponents of MA call out dubious numbers on the magnitude of overpayments, but there is some risk adjustment abuse by a small number of plans that disproportionately benefit. About half of contracts have been noticed for RADV audits in payment year 2019. The 2023 RADV rule is controversial and being challenged by plans. The new audit process adds to the controversy. CMS will use a suspect approach and target diagnosis codes for HCC risk adjustment clusters most at risk of abuse. Fewer records can now be submitted, which ups the ante on accuracy, timeliness, and completeness during the submission period. The suspect sample audit approach and extrapolation of penalties should be a major concern. Will the industry end up worse off with the suspect approach than a more comprehensive one? Does the government now conduct RADV audits in an Elon Musk, “DOGE-like” approach, storm-trooping for maximum recoupment to hit lower spending targets rather than a fair and transparent process rooted in real program integrity? Other reforms could also be implemented. Connect with Marc: Resources: /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/37526035

85. Healthcare Developments Beyond The One Big Beautiful Bill 07/25/2025

85. Healthcare Developments Beyond The One Big Beautiful Bill The Big Beautiful Bill buried some other important healthcare developments. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the other major healthcare developments that got buried by the One Big Beautiful Bill the past two months. Key Takeaways: The Big Beautiful Bill buried some other important healthcare developments. Health plans committed to significant prior authorization reforms. CMS will not propose further reforms right now as it monitors health plan implementation. Plans will reduce the number of PAs required and pursue electronic processing, some in real time. Numerous state and federal restrictions are already in place and the new commitments will hurt plans’ ability to control medical expense. CMS Administrator Dr. Mehmet Oz wants pharmacy benefits managers (PBMs) to end the complicated system of drug rebates, or the government will step in to change it. Oz also hinted that the Trump administration could issue a rule that is focused on drug price transparency. The Supreme Court ruled 6-3 in favor of allowing preventive services to continue under the Affordable Care Act (ACA). Last, CMS announced that it will have a 100% Risk Adjustment Data Validation audit for every payment year for every contract. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/37448405

84. The One Big Beautiful Bill Passes 07/18/2025

84. The One Big Beautiful Bill Passes The one big beautiful bill has passed. Listen in to learn about how it happened and the impact of healthcare reductions. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the one big beautiful bill passing. Listen in to learn about how it happened and the impact of healthcare reductions. Key Takeaways: The one big beautiful budget reconciliation bill passed on tight votes in each chamber of Congress. Trump and GOP leaders are given a great deal of credit for getting the controversial bill through and satisfying both moderates and conservatives in the caucus. The GOP tried to be very stealthy in terms of cuts, but major impacts will occur. Cuts are wide-ranging in Medicaid, the Exchanges, and even Medicare. Most notable are cuts to state provider taxes funding Medicaid, new Medicaid nationwide work requirements, and tighter eligibility in Medicaid and the Exchanges. About $1.1 trillion is cut over ten years in healthcare and almost 17 million could lose coverage when you count the expiration of the enhanced Exchange subsidies. The reductions are certain to destabilize the financial recovery of the health insurance industry. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/37428015

83. Are There Smarter Healthcare Cuts? 07/11/2025

83. Are There Smarter Healthcare Cuts? There are smarter healthcare cuts and sensible reforms that could be made and spare major impacts to coverage. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the budget reconciliation bill. There are smarter healthcare cuts and sensible reforms that could be made and spare major impacts to coverage. Key Takeaways: The problem with the Republican healthcare budget reduction proposals is that these are clear and deliberate reductions to Medicaid and Exchange coverage. The GOP is being quite stealthy, but nonetheless Republican lawmakers get to the same place as more explicit coverage termination initiatives. About 16 million could lose coverage and the bill would decrease spending by $321 billion to hospitals, $81 billion to physicians and $191 billion for drugs. If the Exchange premium tax credits expire, spending would decline by an additional $262 billion. There are smarter cuts that can be made. A case can be made that provider cuts are needed to attack the high-cost and inflation problem we have in healthcare. High costs are driving premiums and creating a situation where we are priced out of healthcare. Done right, price reform brings inflation down and bends the cost curve. Over time, it could mean a real reduction in prices and costs. Done over a reasonable period of time, it would force provider reform, especially at hospitals. We need site-neutral policies. There is no reason that hospital-owned settings (outside of inpatient) should be paid more for the same services provided at independent free-standing facilities or a physician’s office. Reforming the 340B drug discount program may not save major government spending, but reforms would reduce costs to employers and beneficiaries. President Trump has proposed most-favored-nation (MHN) pricing across the entire healthcare system. Several possible changes could be made to Medicare Advantage risk adjustment over time. The healthcare system could be transformed to the benefit of plans, providers, employers, and consumers. It is far superior to how each party thinks about it – the GOP’s chopping at coverage and the Democrats’ fixation with driving more and more coverage and benefits without a thought to efficiency. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/37262930

82. Will Health Plan Pain Continue? 07/04/2025

82. Will Health Plan Pain Continue? As bad as health plans have had it the past few years, trends seem to show the pain continuing. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the financial state of health plans. As bad as health plans have had it the past few years, trends seem to show the pain continuing. Key Takeaways: Last week we discussed how every health plan is undergoing financial strain, but Big Healthcare was especially hurting right now. Compound Annual Growth Rate EBITDA for health insurers dropped by 1.2% from 2019 to 2024. So, will all these struggles continue for the foreseeable future, despite most big health insurers seemingly beginning to dig themselves out of their financial mess? Healthcare trends as well as government actions will most assuredly mean continuing bumpy times in all lines of business. A return to pre-pandemic utilization demand and cost growth of weight-loss, specialty, and medical drugs are creating major medical expense challenges for plans. On the employer front, businesses will continue to demand greater accountability from their healthcare entities. Millions (over 8 million) could leave the Exchanges, which brings back the prospect of fewer plans, skyrocketing premiums, and higher risk. Plans have complained that Medicaid rate hikes are not keeping up with the costs from rising risk. We could see the same phenomenon as more leave the Medicaid rolls. Utilization trends and the threat of major risk adjustment revenue recoupment in Medicare Advantage could lead to greater retrenchment than expected. Plans will need to further adjust their recovery assumptions as they seek to turn around margins. Downsizing, administrative reductions, and moving from a prior authorization focus to intervention and care management are essential. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/37227420

81. How Mighty Big Healthcare Has Fallen 06/27/2025

81. How Mighty Big Healthcare Has Fallen The mighty big healthcare companies have fallen, in this case a victim of their own financial mismanagement and shenanigans. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses how the mighty big healthcare companies have fallen, in this case a victim of their own financial mismanagement and shenanigans. Key Takeaways: A number of external forces contributed to problems in the health insurance industry. Margins have collapsed. McKinsey finds that the EBITDA Compound Annual Growth Rate for insurers was -1.2% from 2019 to 2024. Big Healthcare has been vertically integrating a great deal over the past two decades. This has usually powered their growth and investors flocked to their sticks. But a number of large health plans have suffered major financial problems and some of the problems are impacting their non-insurance entities as well. Big Healthcare has tended to have it better financially than other insurers, but that has changed recently. Big healthcare has relied too much on suspect practices, such as risk adjustment maximization, robust prior authorization, marketing deals with brokers, and intercompany arrangements derived from vertical integration. While regional players have been hit by a financial downturn too, their greater focus on member care and relationships have put them in better shape right now. Big healthcare had bigger hits on underwriting margin and medical loss ratio (MLR) in 2024 in Medicare Advantage (MA). Regional players also did better than Big Healthcare on MA enrollment for 2025. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/37081530

80. Republicans Are In Stealth Mode On Healthcare Coverage Cuts, But The Impact Is Real 06/20/2025

80. Republicans Are In Stealth Mode On Healthcare Coverage Cuts, But The Impact Is Real The GOP is not following the same overt repeal of healthcare coverage as it did in 2017, but the stealth approach still has real impact. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the budget reconciliation bill’s impact on healthcare coverage. The GOP is not following the same overt repeal of healthcare coverage as it did in 2017, but the stealth approach still has real impact. Key Takeaways: In 2017, the GOP attempted an overt repeal of the Affordable Care Act (ACA) and suffered defeat in the 2018 midterms. This year, the GOP is attempting a stealth approach to Medicaid and Exchange spending reductions in the budget reconciliation bill. Still, the impact to coverage and the uninsured rate will be huge. Major Medicaid cuts include work requirements, limitations on state provider taxes to generate the state matching contribution, and various enrollment changes and restrictions. Medicaid savings are about $864 billion over ten years. The Congressional Budget Office (CBO) says about 7.8 million lose Medicaid due to the bill’s provisions. Exchange coverage reductions include changes to premium tax credits for migrants, increased recoupment of premium subsidies paid out at levels that are too high from income, and increased eligibility checks. The ACA changes save about $230 billion over ten years. About 3.1 million lose coverage due to the bill’s ACA provisions and some other provisions. The CBO says that about 4.2 million will exit the Exchanges and remain uninsured due to the expiration of the enhanced premium subsidies at the end of 2025. An additional approximate 900,000 would lose Exchange coverage as a result of a proposed Trump administration rule dealing with eligibility and enrollment periods. This brings the total increase in the number of uninsured to 16 million by 2034. More than a third of the ACA coverage gains would evaporate. Those losing eligibility due to the Medicaid work requirement mandate will lose coverage largely due to administrative snafus and a broken enrollment and eligibility process. Many of the eligibility proposals put unreasonable barriers to enrollment in place and are very expensive. Medicaid and the ACA are both popular programs among Americans. A good share of Republicans also supports healthcare programs. There are other ways to tackle our deficit and debt problems than to fundamentally pare back healthcare coverage, but the parties lack the political will to come together. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/37028700

79. Managed Care Enters New Cycle; Medicare Advantage Needs To Pivot To Thrive 06/13/2025

79. Managed Care Enters New Cycle; Medicare Advantage Needs To Pivot To Thrive Managed care is entering a new conversion cycle just as Medicare Advantage plans have to pivot to thrive. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses two major trends in healthcare. Managed care is entering a new conversion cycle. And Medicare Advantage needs to pivot to thrive. Key Takeaways: We are entering a fourth conversion cycle for managed care in America. The first cycle was the birth of managed care to eliminate the transactional indemnity system. The second cycle was a managed care backlash due to the huge utilization clampdown and too little choice. The third cycle involved governments pursuing compliance, accountability, and quality reforms. The current cycle involves the advent of value-based care and digital healthcare. Medicare Advantage is facing a sea change, with governments restricting prior authorization, making quality programs more complex, and reining in liberal risk adjustment revenue practices. The above along with surging utilization and healthcare trends mean Medicare Advantage (MA) plans are in a financial crisis. MA plans need to pivot from upfront gatekeeping using utilization management to a focus on wellness, prevention, and care management. MA plans need to invest in technology and personnel to assess quality outcomes, member risk and cost trends, and member satisfaction. A mature data analytics platform deriving real-time assessment of factors as well as leveraging artificial intelligence (AI), machine learning and agentic AI engagement could be how all plans rise to the occasion and pivot their enterprises for financial success in MA. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/36852460

78. The Budget Reconciliation Saga 06/06/2025

78. The Budget Reconciliation Saga The House has passed the budget reconciliation bill, but the Senate intends to put its mark on the bill and there are competing forces as in the House. Final passage is some time off still. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the status of budget reconciliation. The House has passed the budget reconciliation bill, but the Senate intends to put its mark on the bill and there are competing forces as in the House. Final passage is some time off still. Key Takeaways: The House passed the budget reconciliation bill on a very tight vote. The House vote was contentious, with both conservatives and moderates winning concessions in order to get the bill passed. To partially pay for tax cuts and extension, the bill includes $1.8 trillion in spending cuts over ten years, largely in healthcare and nutrition. The Medicaid and other healthcare cuts will mean millions lose coverage. They will have major impact on state budgets and providers. There is also a chance that sequestration rules cut Medicare spending by $500 billion over ten years. The Senate says it will make its mark on the bill and make some fairly major changes. The Senate has both moderates and conservative arguing their points as with the House. Right now, enough moderates and conservatives are off the bill to sink the House version. If too many changes occur in the Senate, that could complicate re-passage in the House. Final passage of a budget reconciliation bill will likely go into the summer. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/36816050

77. Donald Trump Goes All In On Drug Price Reform 05/30/2025

77. Donald Trump Goes All In On Drug Price Reform While his proposals seem to go against the GOP’s pro-Big Pharma drug policies, populist Donald Trump is right to go all in on drug price reform. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses how Donald Trump is going all in on drug price reform. While his proposals seem to go against the GOP’s pro-Big Pharma drug policies, our populist president is right. Key Takeaways: Donald Trump has now issued two executive orders on drug price reform. His first was well thought out and comprehensive. It promises to hit all areas in need of reform. His second order seeks to establish most favored nation (MFN) pricing across all lines of business. This could be a seminal event in drug price reform and healthcare reform overall. It is a populist move. The Medicare drug price law was a good start but savings were small and Americans would have to wait many years for real relief. MFN pricing would give Americans the lowest price of any other developed nation. Right now Americans pay manyfold more. There is some doubt that Trump alone has the authority to implement this. And there are other challenges as well. Congress likely will act on his other drug reform measures, but implementing MFN is unknown because GOP lawmakers traditionally have been lap dogs for Big Pharma. But populist and anti-corporate-greed sentiment is taking hold in the party. Regardless of major roadblocks, the public policy debate is critical and I think Trump can build some legislative and other consensus on the issue. There is no reason why private healthcare in America could not leverage a national drug net price list across lines of business. I think we can craft a middle ground that ensures reasonable access to innovator drugs and affordability. The status quo means America will continue to have higher morbidity and mortality. I like the no-holds-barred, mixed-martial-arts Donald Trump on drug price reform and he should press on. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/36670075

76. Diving Into The 2026 Final Announcement And 2026 Rule For Medicare Advantage and Part D 05/23/2025

76. Diving Into The 2026 Final Announcement And 2026 Rule For Medicare Advantage and Part D The Trump administration finalized two key documents for 2026 for Medicare Advantage and Part D – the annual rule and announcement. Learn about the changes in this podcast. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses that the Trump administration finalized two key documents for 2026 for Medicare Advantage and Part D – the annual rule and announcement. These outline key policy changes. Key Takeaways: Medicare Advantage (MA) and Part D plans are governed by two key documents – the annual announcement and annual rule. The Biden administration proposed drafts of each and it was up to the Trump administration to finalize these policies for 2026. The announcement largely governs rate setting. The final rate hike for MA was 5.06% -- a major jump from the proposed 2.23%. Largely, utilization increased in more recent claims to produce the higher hike. This will help MA plans in 2026, but the road is still rocky and there could be additional contraction of benefits and offerings. The Trump administration threw out much of the MA and Part D rule and finalized a very small subset of Biden’s proposals. The Trump administration finalized largely technical things in the final 2026 rule for Part D. The Trump administration finalized some Part C policy recommendations, including prior authorization protections, supplemental benefit reforms, and special needs plans streamlining. The Trump administration kept the Health Equity Index in the Star program but changed its name to the Excellent Health Outcome for All reward. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/36624680

75. Tariffs Could Have An Ugly Impact On Healthcare Costs And Access 05/16/2025

75. Tariffs Could Have An Ugly Impact On Healthcare Costs And Access The imposition of tariffs on healthcare supplies, devices, equipment, and drugs could further increase runaway costs in the healthcare system and have a major impact on access and quality. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the imposition of tariffs on healthcare supplies, devices, equipment, and drugs. The tariffs could further increase runaway costs in the healthcare system and have a major impact on access and quality. Key Takeaways: America is heavily reliant on imports for healthcare. The main components imported include medical equipment, supplies, devices, finished pharmaceuticals, and active pharmaceutical ingredients (APIs) used to manufacture pharmaceuticals. The U.S. imported over $300 billion of medical devices and pharmaceutical products in 2024. China, Mexico, Canada, and India all are important in terms of supporting U.S. healthcare’s supplies, devices, and drugs. The EU is a major exporter to the U.S. of brand medications. So far, the tariffs from the Trump administration clearly impact medical supplies, devices, and some active pharmaceutical ingredients. Trump plans on tariffs for all drugs and ingredients. Generic prices and supplies could be heavily impacted. Hospitals could see increases over time of as much as 15%. Drug costs nationwide could increase by as much as 15% as well. Even if the current annual trends relax a bit, we could see healthcare percentage increases well into the double digits in 2026 or 2027 due to tariffs. We could see shortages and access issues. Onshoring is commendable but complicated and long term. Trump’s tariffs will be a disaster for the healthcare system and coverage. He should exclude healthcare imports and work to create domestic production in other ways. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/36486745

74. Medicaid "Outlier" States And Their "Over-Expansion" Stuck In The Craw Of Conservatives 05/09/2025

74. Medicaid "Outlier" States And Their "Over-Expansion" Stuck In The Craw Of Conservatives Medicaid cuts are being hotly contested between moderates and conservatives in the GOP caucuses, but Medicaid outlier states and their over-expansion of the program are certainly stuck in the craw of the conservatives. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the fact that Medicaid cuts are being hotly contested between moderates and conservatives in the GOP caucuses. But Medicaid outlier states and their over-expansion of the program are certainly stuck in the craw of the conservatives. Key Takeaways: The GOP’s annoyance regarding benefit and coverage-rich states could drive some budget reconciliation cuts. Trump and GOP leaders have ruled out coverage reductions to Medicaid. The Senate is seeking to limit overall budget reductions, especially in healthcare. But House conservatives continue to want deeper cuts, including on healthcare. The House is looking at Medicaid reductions in part to rein in progressive states and the size of their Medicaid programs. Changes here would be featured as reforming waste and abuse in the system. Conservatives criticize these states’ expansions of both eligibility and benefits. As the budget debate rolls out, the GOP may make the case that it is all about reasonable expansions vs. excessive ones. Conservatives argue these states find all sorts of questionable ways to fund their state matches, leverage increased federal dollars, and then expand Medicaid to more and people and additional services. In addition to traditional approaches to attacking fraud and abuse, conservative budgeteers could curb provider taxes and other practices states use to generate federal match as part of the so-called abuse bucket. Could moderates get on board for some of these changes? Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/36437815

73. Donald Trump Comes Out Strong On Drug Price Reform 05/02/2025

73. Donald Trump Comes Out Strong On Drug Price Reform In an odd twist, Donald Trump has come out strong on drug price reform. An executive order he issued on the topic is populist, comprehensive, and good policy. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses Donald Trump’s executive order on drug price reform. He has come out strong on the issue. The ideas are populist, comprehensive, and good policy. Key Takeaways: Donald Trump issued an executive order on drug price reform. It is populist, comprehensive, and good policy. He wants to go deeper on price reductions than Biden did. Trump may offer a concession on small molecule drugs. He is targeting 340B reform to force hospitals and community health centers to lower overall prices. Trump is opening the door to site neutral payments, first on drug administration. He wants to reform all aspects of the drug supply channel. Trump will promote biosimilars and generics and get them to the market quicker. Some of the proposals could make it into the budget reconciliation bill, but others may take more time. Could he extend drug price reform to the commercial world? Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/36309575

72. Fetterman Is Right On GLP-1s, But Now Is Not The Time To Expand In Medicare 04/25/2025

72. Fetterman Is Right On GLP-1s, But Now Is Not The Time To Expand In Medicare Sen. John Fetterman wants the Trump administration to change its mind and extend further GLP-1 weight-loss coverage in Medicare Part D. But now is not the time. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses how Sen. John Fetterman wants the Trump administration to change its mind and extend further GLP-1 weight-loss coverage in Medicare Part D. But now is not the time. Key Takeaways: Sen. John Fetterman was much-maligned during his 2022 Senate run but has emerged as a thoughtful and sober senator. In a recent opinion piece in The New York Times, Fetterman urges the Trump administration to reconsider and expand GLP-1 access in Medicare. The Biden administration had proposed expanding GLP-1 access to those with obesity. Now it is only available for those with another underlying disease state like diabetes or cardiovascular disease. Both Fetterman and I are on the same drug and he is right that being on a GLP-1 can transform your life. As he says, it does promise to reduce chronic disease costs in the future. The problem with expansion is that costs for such drugs are surging already for disease states alone and adding obesity as a diagnosis would accelerate that. Already, Medicare Advantage (MA) and the standalone Part D (PDP) program saw huge cost surges because of an unwise Part D cost-sharing reduction in the Inflation Reduction Act (IRA). The PDP program’s financial viability is precarious. Drug price negotiations may help but a 22% average reduction as we have seen will not be enough. We should wait to expand GLP-1 coverage in Medicare until prices come down dramatically for these drugs and more analysis can be done. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/36270005

71. All About Special Needs Plans And Their Recent Growth 04/18/2025

71. All About Special Needs Plans And Their Recent Growth Medicare Advantage (MA) plans are investing heavily in Special Needs Plans (SNPs). Learn all about SNPs and their recent growth. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses how Medicare Advantage (MA) plans are investing heavily in Special Needs Plans (SNPs). Learn all about SNPs and their recent growth. Key Takeaways: While Medicare Advantage (MA) plans are struggling, they are investing heavily in Special Needs Plans (SNPs). Investments are driven by CMS efforts to integrate Medicare and Medicaid as well as the margin opportunity with these high-revenue enrollees and the ability to reduce excessive cost of care. There are three types of SNPs – institutional (I-SNPs), chronic condition (C-SNPs), and dual eligible (D-SNPs). There are three subtypes of D-SNPs – coordination, highly integrated and fully integrated. SNPs almost went extinct, but CMS has reinvested and laid down robust regulatory and clinical requirements. SNPs have grown to almost 7.6 million lives -- that is a 106% growth since January 2020. SNPs now represent about 21.6% of all MA enrollment. D-SNPs account for 6.060 million as of March 2025, or about 80% of all SNP lives. C-SNPs have seen robust growth recently. CMS says in 2025 the number of MA plan offerings overall decreased by 2.8%, including a 6.5% decrease in individual MA plans but an 8.5% increase in SNPs. Due to the financial crisis, SNP benefits eroded in 2025. Given the financial crisis, some major national plans lost SNP lives, while others gained. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/36088015

70. With The Cigna-HCSC Sale, Who Is Right About Medicare Advantage? 04/11/2025

70. With The Cigna-HCSC Sale, Who Is Right About Medicare Advantage? With the recent sale of Cigna’s Medicare business to Big Blue HCSC, there is a noticeable split in the Medicare Advantage (MA) industry. Who is right about MA’s future? About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the recent sale of Cigna’s Medicare business to Big Blue HCSC. There is a noticeable split in the Medicare Advantage (MA) industry. Who is right about MA’s future? Key Takeaways: Cigna sold its Medicare assets, including 700K Medicare Advantage lives, to HCSC, a Midwest Big Blue. HCSC now has about 950,000 MA lives and has a national footprint. It now is the 7th largest MA plan. Cigna was frustrated with MA and did not want to stay in the line. It is investing in its services business, Evernorth, and its commercial insurance line. The industry is split between MA doubters and MA cheerleaders. Cigna and some Blues plans doubt the ongoing viability of MA. Most large national plans, despite some financial woes, believe in staying in MA. This is the case with other Blues’ plans too. MA has been hit with some poor rates, over-zealous regulation, reining in of risk adjustment, and major utilization hikes. Some of the financial woes were caused by plans’ bad management, poor Star scores, and over-expansion when there were clear warning signs. HCSC actually had a rating downgrade after the sale. Both sides have points, but MA has always bounced back from periodic financial issues. Plans realign financially. MA will be bolstered by the ongoing value proposition against the traditional program as well as aging in America. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/36044755

69. 2025 Medicare Advantage Enrollment Shows Struggle Of Industry 04/04/2025

69. 2025 Medicare Advantage Enrollment Shows Struggle Of Industry While Medicare Advantage grew from 2024 to 2025, the lackluster performance during the 2025 enrollment season shows the financial woes of the industry. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the 2025 Medicare Advantage enrollment season. While MA grew from 2024 to 2025, the lackluster performance during the 2025 enrollment season shows the financial woes of the industry. Key Takeaways: 2025 Medicare Advantage enrollment season results were delayed due to issues at CMS and the new administration. While MA grew from 2024 to 2025, the statistics show the financial woes of the industry. Growth year over year was just 4.4%, about half of the average of the last 4 years. Benefit and footprint contractions by Big MA players caused the lower growth. MA remains attractive, however, due to the great value proposition compared with the traditional program. As of March, over 35 million are now in MA. Non-Big MA plan enrollment grew at a healthy pace year over year – about 688K or 8.7% from January 2024 to February 2025. This compares to just 3.1% for Big MA plans. Some Big MA plans shed lives to financially realign. Special Needs Plans continued to see huge growth, up over 9% from 2024 to 2025. This is about half of the growth from 2023 to 2024. Plans contracted benefit offerings for both HMOs and PPOs. After PPOs grew in prior years more than HMOs, HMOs beat PPOs in growth from 2024 to 2025. Many plans shed PPO enrollment due to their financial pictures with the more expensive product. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/35887405

68. Lessons From Oz: What Does The Future CMS Head Tell Us About Trump Healthcare Policy? 03/28/2025

68. Lessons From Oz: What Does The Future CMS Head Tell Us About Trump Healthcare Policy? At Dr. Oz’s confirmation hearing, we learned a great deal about the Trump administration’s views on Medicare drug price reform and Medicare Advantage. Spoiler: it is not what you might expect. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses Dr. Mehmet Oz’s confirmation hearing. We learned a great deal from the future CMS leader about the Trump administration’s views on Medicare drug price reform and Medicare Advantage. Spoiler: it is not what you might expect. Key Takeaways: Dr. Oz’s confirmation hearing most assuredly means he will be the next CMS leader. Because the Trump administration closely controls the process, what is said is a good indication of what policy may be. On Medicaid, Oz toed the Trump line and did not commit to fighting Medicaid cuts. He did say he wants to focus on waste and work requirements rather than more extensive coverage reductions. Oz was silent on his view of extending enhanced premium subsidies in the Exchanges. Oz did endorse Medicare drug price reform and the current law and said he would defend it in court from Big Pharma suits. He also said he was open to international reference pricing. Oz endorsed pharmacy benefits manager reform as well. Oz has been an ardent supporter of Medicare Advantage but now says it needs reform. He committed to tackling risk adjustment abuse and overpayments. He criticized prior authorizations and denials and wants radical reform and restrictions here. He also wants marketing reform and to return more of the rate rebate to the government rather than additional benefits. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/35794880

67. In Budget Reconciliation, GOP Lawmakers Seek To Thread The Needle on Healthcare Cuts 03/21/2025

67. In Budget Reconciliation, GOP Lawmakers Seek To Thread The Needle on Healthcare Cuts Given commitments to safeguard healthcare, GOP lawmakers will seek to thread the needle as they consider making spending reductions to healthcare programs. It will take a lot of finesse! About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses how, given commitments to safeguard healthcare, GOP lawmakers will seek to thread the needle as they consider making spending reductions to healthcare programs. It will take a lot of finesse! Key Takeaways: Both President Trump and GOP lawmakers have made commitments not to impact Medicare and Medicaid coverage. The current budget reconciliation framework calls for $880 billion in healthcare cuts over ten years. Given such a big bogey, the Congressional Budget Office says Medicaid and perhaps Medicare would have to be impacted. Lawmakers want to focus on fraud and waste as well as work requirements in Medicaid. The amount of overpayments, fraud and waste is big. But is that enough? Trump and lawmakers will have to thread the needle on healthcare cuts. It will take a lot of finesse. Lawmakers likely will stay away from radical healthcare program changes and overt reimbursement reductions to states in Medicaid. They may seek to reform certain provider payments and ways that states raise revenue to pay for their share in Medicaid. Possible cuts include site neutral payments and other provider reforms, certain drug reforms, a focus on Medicare Advantage overpayments, and reining in the provider taxes in Medicaid. There are trillions in cuts over time here, but there would be impacts to coverage for sure. Will the GOP’s plan eventually pass the no-coverage-impact litmus test? We shall see. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/35675975

66. Time For Medical Price Reform To Help Employers 03/14/2025

66. Time For Medical Price Reform To Help Employers American healthcare is in dire need of price reform. Without it, employers are significantly disadvantaged. Two fixes would help American competitiveness a great deal. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses how American healthcare is in dire need of price reform. Without it, employers are significantly disadvantaged. Two fixes would help American competitiveness a great deal. Key Takeaways: America has the only employer-driven healthcare system in the developed world. This puts American companies at a significant disadvantage in terms of competitiveness as they pay the lion’s share of healthcare even with tax deductibility of healthcare expenses. No one really wants to abandon that system right now. Most people like it and our productivity helps close the competitiveness gap. But rising healthcare costs are hurting our competitiveness. Two things could be done. While providers could be more efficient there is some evidence that government programs tend to under-reimburse. So first, adopting uniform pricing across lines of business would stop a cost-shift to the employer world. The cost-shift is actually encouraged both by providers as well as health plans given how most employer coverage is funded in the nation. This would mean some additional spending on the part of government programs, but overall costs would be more rationale and come down over time. Second, site neutral payments should also be adopted in Medicare as this would lower costs in the employer and commercial world as well. Commercial payments are primarily based on Medicare. Both of these moves would encourage efficiency in the system and change providers’ and health plans’ behavior. No longer would they concentrate on gaming price across lines of businesses. They would have to focus on efficiency. Without these changes, employer coverage will become more and more expensive, business will become less competitive, and more of the burden will be shifted to Americans who will increasingly be unable to afford healthcare and to access the system. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/35558410

65. Is Trump Stretching Article 2 Of The Constitution? 03/07/2025

65. Is Trump Stretching Article 2 Of The Constitution? President Donald Trump is blazing a trail to strengthen executive power in the federal government. But is he stretching Article 2 of the Constitution along the way? About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses how President Donald Trump is blazing a trail to strengthen executive power in the federal government. But is he stretching Article 2 of the Constitution along the way? Key Takeaways: The founders did not intend co-equal branches of government. While they wanted a powerful executive, they wanted Congress to hold the most power. Over time, Congress has ceded power to the executive branch. A bureaucracy has emerged over the years as well that holds great sway over decisions. Trump believes the executive branch has become too weak and is controlled by agency bureaucracies. He believes in the unitary executive theory. In his first two months he has sought to assert executive power in many areas. FDR and Nixon also asserted executive power with some success and some failure. They are parallels here to what Trump is doing. What Trump is trying to do is not entirely unreasonable, but how he is doing it and how quickly he is proceeding is cause for worry. Courts have increasingly sided against agencies’ power and been open to some aspects of Trump’s arguments on executive power. He will win some court battles. But courts likely will also strike down some of the more adventurous aspects of Trump’s efforts, especially impoundment or reducing/zeroing out congressional appropriations. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/35520895

64. Trump's Populism Could Spell Trouble For Big Pharma 02/28/2025

64. Trump's Populism Could Spell Trouble For Big Pharma After a recent comment on the cost of GLP-1 weight-loss drugs, it appears Trumps’ populism is ramping up to cause problems for Big Pharma. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses Donald Trump’s recent comments on the high cost of GLP-1 weight-loss drugs. His populist views could spell trouble for Big Pharma and he would be right to pursue further drug price reforms. Key Takeaways: While Donald Trump has been inconsistent on drug price reform, two recent developments show he may pursue serious changes. His CMS says it will continue with Medicare drug price negotiations. In an interview Trump bemoaned the high prices of GLP-1 weight-loss drugs. He noted that such drugs are at least ten times more in the U.S. compared with other developed countries. He thinks this is inequitable and needs to change. His comments are a significant development and tie into Trump’s views that other nations are taking Americans for a ride. His populism could spell trouble for Big Pharma and signals a change for a Republican. The drug market is not a free market and prices should be reformed. All drug makers take advantage of the American public, but this is especially true of foreign firms – more than half of the top 50 drug makers. Americans’ life expectancy is lower and health is poorer in part due to the disparities in drug prices. As well, Americans essentially subsidize other developed countries’ healthcare systems through high American drug prices. Trump should seize the initiative on drug price reform and make it part of his Make America Healthy Again agenda. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/35444160

63. Round 2 of Medicare Drug Negotiations Has Begun. What Will Trump Do? 02/21/2025

63. Round 2 of Medicare Drug Negotiations Has Begun. What Will Trump Do? The second year of Medicare drug negotiations has kicked off with a list of the next 15 brand drugs subject to negotiations. What will Trump do now that he is back in office? About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the second year of Medicare drug negotiations, which has just kicked off with a list of the next 15 drugs subject to negotiations. What will Trump do now that he is back in office? Key Takeaways: President Biden announced the next 15 drugs early while he was still in office. 10 drugs were negotiated in 2024 for 1/1/2026. These 15 drugs’ negotiated prices will take effect on 1/1/2027. The combination of round 1 and round 2 drugs means over a third of total gross covered prescription drug costs under Medicare Part D will already have been subject to negotiation. Round 2 drugs cover many major disease states seen in Medicare. Round 1 saw drug costs drop on average 22%. This is better than other government program prices, but prices remain well above other developed nations. The program needs to mature over time. Trump has been sympathetic on drug prices and proposed price reduction proposals as Trump 45. In the election he went back and forth on what he would do if he won again. In a blow to brand drug makers, he has announced the process will continue with stakeholder input and more transparency. Trump has a great opportunity to further Medicare drug price negotiations by expanding and applying it to commercial and employer coverage as well. Trump’s populism will likely prevail over his somewhat friendlier relationship with Big Pharma. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/35277285

62. Some Signs Healthcare Cuts May Be Tempered 02/14/2025

62. Some Signs Healthcare Cuts May Be Tempered As the Trump administration and GOP Congress settle in, there are some signs that any healthcare cuts may be tempered. But don’t take it to the bank just yet. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses that there are some signs that any healthcare cuts may be tempered as the Trump administration and GOP Congress settle in. But don’t take it to the bank just yet. Key Takeaways: There are some signs from the administration and Congress that healthcare cuts could be tempered for a number of reasons. GOP control in each chamber is narrow. Moderate lawmakers will hold sway in each chamber. Swing district lawmakers are worried about the 2026 election. There are prominent GOP lawmakers who are doctors and are influenced by provider lobbies, which oppose deep coverage cuts. States will also ask their delegations to stop funding cuts to Medicaid. Trump himself appears to have softened his stances on coverage issues. But don’t take this to the bank just yet. A reconciliation bill with major healthcare cuts could still be forced through Congress. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/35182055

61. What Are The Possible Healthcare Cost Reductions in 2025? 02/07/2025

61. What Are The Possible Healthcare Cost Reductions in 2025? With Trump and the GOP in Congress pursuing extension of the 2017 tax cuts, what are the possible cuts throughout healthcare that could occur in a master budget reconciliation bill? About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the possible cuts throughout healthcare that could occur in a master budget reconciliation bill as Trump and the GOP in Congress pursue an extension of the 2017 tax cuts. Key Takeaways: President Trump and the GOP want to extend the 2017 tax cuts and will pass a budget reconciliation bill with major healthcare cuts. While Trump has said he will not cut Medicare, there are likely reductions that will be adopted in Medicare. While Trump is friendly to Medicare Advantage, expect some cuts here too. Medicaid and the Exchanges may see major cuts to pay for the tax cuts. Other cuts could be taken across healthcare and for employer and commercial coverage. The Healthcare Labyrinth Podcast has assembled a list of possible reductions and the podcast goes through them. While we predict that major healthcare restructuring will be avoided, we could be wrong on this. At the same time, the reductions will have a major impact on coverage, affordability, and out-of-pocket costs. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/35128650

60. The Torch Has Been Passed At The White House: A Republican's Reflection On Biden's Healthcare Accomplishments 01/31/2025

60. The Torch Has Been Passed At The White House: A Republican's Reflection On Biden's Healthcare Accomplishments President Biden has left office. He deserves credit for expanding healthcare coverage and bringing drug price negotiations to Medicare. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses how former President Biden deserves credit for expanding healthcare coverage and bringing drug price negotiations to Medicare. Key Takeaways: On January 20, the presidential torch was passed from Joe Biden to Donald Trump. Trump is only the second person to serve non-consecutive presidential terms. America is in dire need of healthcare reform. Main reform tenets should be access to affordable coverage, a focus on primary care and disease management, and price reform. Now former President Joe Biden deserves credit for expanding healthcare coverage and bringing drug price negotiations to Medicare. Affordable universal healthcare coverage is both a moral and economic imperative. Biden embraced Medicaid and Exchange enrollment after Trump 45 sought to reduce commitment to and enrollment in each program. Biden also is the first to bring price reform to a major government program. It could pay huge dividends over time. The Trump 47 years could have major impact on the progress made on both fronts. We expect major spending reductions that could contract coverage. Whether Medicare drug price negotiations will continue is unknown. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/35005130

59. 2026 Rate and Policy Changes For Medicare Advantage and Part D 01/24/2025

59. 2026 Rate and Policy Changes For Medicare Advantage and Part D The latest Healthcare Labyrinth podcast outlines the 2026 rate and policy changes for Medicare Advantage and Part D plans. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc covers the recently released Advance Notice, which outlines the 2026 rate and policy changes for Medicare Advantage and Part D plans. Key Takeaways: The 2026 Advance Notice was released by CMS outlining 2026 rate and policy changes for Medicare Advantage (MA) and Part D plans. The notice will be finalized in April. CMS says MA rates will increase by 4.33%, but plans will likely say they will be up more like 2.23% due to a debate over risk scoring trends year-to-year. While this is positive compared with 2024 and 2025, the rates are inadequate and could lead to further benefit reductions and plan contractions in 2026. The growth rate for rates was almost 6%. But this was substantially offset by lower Star rating revenue and the final phase-in of a risk model change. A phase-in of medical education costs changes also hurt rates. CMS said it may begin transitioning to setting rates by encounter data submitted by plans. MA plans hope that the incoming Trump administration will offer some rate relief. But Trump is busy assembling spending reductions to pay for the extension of 2017 tax cuts. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/34880135

58. What Could The First 100 Days Of Trump 47 Look Like From A Budget Perspective? 01/17/2025

58. What Could The First 100 Days Of Trump 47 Look Like From A Budget Perspective? The latest Healthcare Labyrinth podcast outlines what the first 100 days or so of Trump 47 could look like from a budget perspective. The activities are hugely complex and will require delicate political negotiations. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc outlines what the first 100 days or so of Trump 47 could look like from a budget perspective. The activities are hugely complex and will require delicate political negotiations. Key Takeaways: Confirmations will dominate a great deal and most if not all of Trump’s picks should be approved. Congress will have to pass a spending bill for FFY 2025 since the current continuing resolution expires on March 14. Will the overall budget approach be ready? Congress also has to tackle the debt limit. Technically, the cap is back as of 1/1 and moving the cap will be imperative I the next several months. Trump and a GOP Congress are likely to use one or two budget reconciliation bills to reduce spending and extend Trump’s 2017 tax cuts. But moving them could be complex. Trump’s proposal for major spending cuts via a Department of Government Efficiency commission has won endorsement by most Republicans, who want to collaborate. Trump is expected to overturn a great deal of Biden’s regulatory environment. Trump could pursue what he thinks is executive impoundment authority. Congress and courts may see it another way. Connect with Marc Resources /episode/index/show/8ba9f16c-af31-4c5f-9f19-782d8eef5991/id/34786635

The Healthcare Labyrinth

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