Episodes

  • 119. Reports of Medicare Advantage's Death Are Greatly Exaggerated

    119. Reports of Medicare Advantage's Death Are Greatly Exaggerated
    Mar 20 2026

    Yes, Medicare Advantage is struggling, but it remains a key social safety net program. It just needs less biased assessments and better advocates.

    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 that Medicare Advantage is struggling, but it remains a key social safety net program. It just needs less biased assessments and better advocates.

    Key Takeaways:

    Medicare Advantage turned 25 recently and is facing great financial troubles.

    CMS has proposed tight rates, restrictions on prior authorizations, risk adjustment reforms, and Star rating changes.

    This has led to major retrenchment, with reduced benefits, products, and footprints.

    MA growth has slowed but it still grew year over year and during open enrollment.

    MedPAC has been arguing MA is overpaid for years but relies on outdated data and dubious assumptions. This has undermined MA.

    Some overpayments existed, but much of it went to the biggest health plans that used aggressive coding.

    A bipartisan duo of former HHS secretaries came to the defense of MA recently, saying CMS and Capitol Hill have gone too far.

    Let's hope the defense of MA messages sink in The MA program is an important safety net and its death is greatly exaggerated.

    Connect With Marc:

    Marc on LinkedIn

    Marc on Twitter

    THL Podcast

    Resources:

    THL's Newsfeed

    THL's Blog

    The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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    26 mins
  • 118. PBM Reform Explosion: What Just Happened — And What It Really Means

    118. PBM Reform Explosion: What Just Happened — And What It Really Means
    Mar 13 2026

    Trying to make sense of the recent PBM reforms and their significance? I map them in this podcast and what it really means? It is game-changing.

    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 maps all the recent PBM and drug price reforms and tells you about their significance? It is game-changing.

    Key Takeaways:

    The recent FFY 2026 Appropriations Bill had major PBM reforms.

    They included 100% rebate pass-through and transparency and reporting in the employer market.

    In Medicare Part D, PBMs must adopt flat-fee compensation that is de-linked from rebates and utilization.

    Important reporting and transparency in Part D as well.

    Group purchasing reform could be next on lawmakers' list.

    A Federal Trade Commission settlement with Cigna's Express Scripts PBM has many similar reforms.

    Express Scripts is also adopting a brand net pricing model that will run in parallel with a traditional rebate model.

    Various initiatives from the Trump administration will also dramatically impact drug price. These include reforms of the drug channel and most-favored nation pricing.

    The developments are game-changing, but it will take time for reforms to set in and impact every line of business.

    Connect With Marc:

    Marc on LinkedIn

    Marc on Twitter

    THL Podcast

    Resources:

    THL's Newsfeed

    THL's Blog

    The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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    17 mins
  • 117. The Medicare Advantage Open Season – Good News, Bad News And What The Numbers Really Say

    117. The Medicare Advantage Open Season – Good News, Bad News And What The Numbers Really Say
    Mar 6 2026

    Showing Medicare Advantage's value, the sky did not fall on MA, but the earth shifted on the program.

    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 2026 Medicare Advantage open enrollment. Showing Medicare Advantage's value, the sky did not fall on MA, but the earth shifted on the program.

    Key Takeaways:

    Many analysts predicted a major contraction during open enrollment, but the Medicare Advantage program still grew.

    It grew 874K year over year and about 115K during open enrollment.

    MA has grown almost 50% — 11.9 million lives – since 2020.

    This shows the overall value of MA compared with traditional Medicare fee-for-service (FFS).

    Still growth has come way down in 2025 and 2026, which shows the financial stress in the program.

    Big plans did not fare well in open enrollment, losing 328K lives. Except for Humana, which grew about 1.2M, most big MA plans wanted to contract.

    Non-Big MA plans added 443,000 lives during open enrollment, including the insurtechs by 320K lives.

    SNPs grew 647,000 lives year over year -- 259,000 of that during open enrollment.

    PPOs saw major contraction in terms of offerings and enrollment. PPOs were down year over year by 103K, while HMOs grew 937K.

    Connect With Marc:

    Marc on LinkedIn

    Marc on Twitter

    THL Podcast

    Resources:

    THL's Newsfeed

    THL's Blog

    The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
    Show More Show Less
    17 mins
  • 116. The 2027 ACA Exchange Rule – Structural Reset or Risky Gamble?

    116. The 2027 ACA Exchange Rule – Structural Reset or Risky Gamble?
    Feb 27 2026

    The 2027 ACA Exchange rule will create some seismic changes in healthcare. Is it a structural reset or risky gamble?

    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 2027 ACA Exchange rule. It will create some seismic changes in healthcare. Is it a structural reset or risky gamble?

    Key Takeaways:

    The 2027 ACA Exchanges build on the One Big Beautiful bill with more seismic changes to the Affordable Care Act and the Exchanges.

    The Obama and Biden administrations were hopelessly devoted to the rich benefit and subsidy program. The COVID enhanced subsidies made Democrats even more devoted.

    But with or without the enhanced subsides, while many became insured, high premiums, deductibles, and cost-sharing actually created an underinsured problem.

    Trump 45 began some changes, but Trump 47 is structurally resetting to and emphasis on skinner coverage.

    Existing changes promote ICHRAs, HSAs, and DPCs.

    The rule proposes to eliminate standardization and creates more benefit flexibility.

    The rule also allows for multi-year catastrophic coverage and expands the coverage to more people including those over 30.

    And Trump also wants to get back to what we think of as non-traditional coverage.

    There will be fallout in the Exchanges for sure, but it is hard to argue some experimentation is not need given huge premiums spikes and the underinsured problem.

    Younger generations are also looking for alternatives to traditional coverage.

    Some of these reforms could be implemented with real healthcare reform that tackles price, access, and primary care.

    Then we would be making real progress.

    Connect With Marc:

    Marc on LinkedIn

    Marc on Twitter

    THL Podcast

    Resources:

    THL's Newsfeed

    THL's Blog

    The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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    19 mins
  • 115. Is Value-Based Care Real … Or Just Healthcare's Favorite Myth?

    115. Is Value-Based Care Real … Or Just Healthcare's Favorite Myth?
    Feb 20 2026
    Value-based care has been around for a while. While it is a favorite buzzword in healthcare, some are questioning its effectiveness. Is that fair? 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 value-based care. It has been around for a while. While it is a favorite buzzword in healthcare, some are questioning its effectiveness. Is that fair? Key Takeaways: A recent Health Affairs Forefront blog lit a bit of a firestorm when it argued that value-based payments — and even managed care — are not going to solve healthcare affordability. They missed the fact that healthcare is in the middle of a long, messy, transformational journey — and transformation never looks impressive in the early chapters. Value-based payments are meant to move us away from the old fee-for-service system — the transactional payment model that has dominated healthcare for decades. That has driven utilization, price, and costs. And the current system does not prioritize long-term quality or outcomes. There are various value-based-care (VBC) and payment (VBP) models that have emerged, from ACOs to episodic payments to capitation to partial and global risk funds. Regions, lines of business, provider type and the size of providers all determine how penetrated VBC or VBP are. Somewhere between 35% and 45% of healthcare payments today are tied to some form of value-based model. But true risk-bearing arrangements might only account for about 20% of transactions. Critics of VBC say many pilots haven't generated dramatic savings, value-based models may be accelerating consolidation and empowering corporate intermediaries, and spending slowdowns don't appear strongly correlated with VBC adoption. But there is plenty of evidence that mature VBC models do save and drive outcomes and we just may not be there yet throughout our healthcare system. Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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    20 mins
  • 114. 2027 Rate Advance Notice Bad News For Medicare Advantage

    114. 2027 Rate Advance Notice Bad News For Medicare Advantage
    Feb 13 2026
    The Trump administration released the 2027 Advance Notice for Medicare Advantage and Part D, and the near-zero rate hike sent a shockwave through the MA 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 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 release of the 2027 Advance Notice for Medicare Advantage and Part D. The near-zero rate hike sent a shockwave through the MA industry. Key Takeaways: In a huge shock to the industry, the Trump administration proposed a near-zero rate hike for 2027 in Medicare Advantage (MA). While the Effective Growth Rate was almost 5%, it was nearly zeroed out by two new risk adjustment reform changes. The 2027 increase stands at just 0.09% right now. That means just $700M in additional revenue in 2027 compared with $25B in 2026. Plans got no breathing room in 2027 after the new v28 risk model was phased in from 2024 to 2026 and took out 7.62% from rates. The proposed risk adjustment changes updated the new v28 model for more recent data as well as eliminated any chart review or health risk assessment submissions with diagnoses that do not have a linked medical encounter. The unlinked chart change has major impact on the biggest plans that practice very aggressive risk coding. The industry receives as much as $7.5B annually now for unlinked charts. Last year, the effective growth rate grew by almost 3% from the Advance Notice to the Final Announcement. That could happen again and move the rate for 2027 to just below 3%. This is still far below the 5% from 2026. A Stars restructuring that will reduce ratings and quality bonuses in the future compounds the overall gloomy financial picture. The MA recovery will be complicated by the rate announcement and more benefit, product, and geographic contractions are likely in 2027. The era of free-wheeling rates and risk adjustment is over. Plans need to focus on clinical management, quality, and cost control. One silver lining: overpayments are coming down and it is tantamount that the industry ensures Congress knows this before lawmakers push through more reforms. Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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    19 mins
  • 113. Warning Signs: 2024 National Healthcare Data

    113. Warning Signs: 2024 National Healthcare Data
    Feb 6 2026
    The 2024 National Healthcare Expenditure Data are out and there are huge warning signs for the country. 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 releases of the 2024 National Healthcare Expenditure Data. There are huge warning signs for the country. Key Takeaways: The 2024 National Healthcare Expenditure Data were finally released after a delay due to the government shutdown. In 2024, healthcare spending in the United States rose to $5.279 trillion, a $353.3 billion or 7.2% increase. Healthcare expenditures as a percentage of gross domestic product went from 17.7% in 2023 to 18% in 2024. This was largely driven by heightened utilization (use and intensity) and a shift in the types of services consumed (4.7%) and less so for actual inflation (2.5%). Hospital care was 31% of expenditures, physician and clinical services 21%, and prescription drugs 9%. The insured share of the population was 91.8% in 2024— down slightly from an historic high of 92.5% in 2023. Private Health Insurance was 31% of spending and reached $1.6 trillion in 2024, an 8.8% increase. Medicare was 21% of spending and reached $1.1 trillion in 2024, a 7.8% increase. Medicaid was 18% of spending, increasing 6.6% to $931.7 billion in 2024. Out-of-pocket costs were 11% of total expenditures and increased 5.9% to $556.6 billion. The typical working family in the U.S. spent $3,960 on healthcare-related costs in 2024, including premiums and out-of-pocket expenses. The robust growth shows the challenges ahead for healthcare. It was the second consecutive year costs trended up more than 7%. The ongoing growth in NHED is clearly not sustainable. Without major reform, we are faced with a number of compounding problems – economic stagnation, more Americans will become uninsured and underinsured, and healthcare will become more and more unaffordable. Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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    22 mins
  • 112. Donald Trump's "Great Healthcare Plan" Falls Short

    112. Donald Trump's "Great Healthcare Plan" Falls Short
    Jan 30 2026

    Donald Trump's new healthcare plan falls short and does not truly make things affordable.

    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 Donald Trump's new healthcare plan. It falls short and does not truly make things affordable.

    Key Takeaways:

    Donald Trump announced his "Great Healthcare Plan" on TikTok recently.

    It is at best a skeletal framework and would need Congress to pass legislation.

    The two main tenets include drug price reform and expansion of Health Savings Accounts (HSAs) in lieu of some or all of the current Exchange subsidies.

    It is unclear just how far-reaching the HSA expansion would be.

    Other proposals include transparency at health plans.

    The proposal would need congressional action and Trump's views dovetail with many in Congress advocated by the GOP.

    Conservative House Republicans propose to pass a second budget reconciliation bill that includes replacing Exchange subsidies with HSAs, pharmacy benefits manager (PBM) reform, and more.

    The Senate framework for the Exchange subsidy compromise also includes HSA expansion, ICHRA expansion, and more alternative coverage expansion.

    Other Senate bills would replace Exchange subsidies in whole or part or offer options to use HSAs instead.

    The HSA expansions could undermine the Exchange market and lead to a rate death spiral as risk rises.

    In general, Trump's proposals do not get to the root cause of unaffordability – prices in the system.

    Connect With Marc:

    Marc on LinkedIn

    Marc on Twitter

    THL Podcast

    Resources:

    THL's Newsfeed

    THL's Blog

    The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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    17 mins