Episodes

  • 97. Is Big Pharma Hoodwinking The President?

    97. Is Big Pharma Hoodwinking The President?
    Oct 17 2025

    Are President Trump and his healthcare policy advisors getting hoodwinked by Big Pharma 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 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 drug price reform and asks if President Trump and his healthcare policy advisors are getting hoodwinked by Big Pharma.

    Key Takeaways:

    Are President Trump and his healthcare policy advisors getting hoodwinked by Big Pharma on drug price reform?

    President Trump has come out swinging in Trump 47 on drug price reform and I applaud that.

    He has shown a good understanding of the drug price system and what needs to be done to reform it.

    He is using all sorts of ways to cajole and even extort concessions from Big Pharma. It is admirable.

    He has proposed the most favored nation form of drug pricing, where America would adopt the lowest price on each brand drug anywhere in the developed world.

    But Trump could back off aggressive reforms based on proposed concession deals from brand drug companies.

    These deals do not amount to fundamental drug price reform, but window-dressing and efforts by Big Pharma at self-preservation.

    The targeted reforms do not fundamentally change price for the vast majority of consumers or the system as a whole.

    Trump should stick to his game plan and truly reform drug price.

    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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    27 mins
  • 96. Special Needs Plan Growth and Operational Risks

    96. Special Needs Plan Growth and Operational Risks
    Oct 10 2025
    Special Needs Plans are growing explosively in Medicare Advantage, but understanding the operational risks is key. 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 explosive growth of Special Needs Plans in Medicare Advantage. Health plans need to understand the operational risks as well as the opportunities. Key Takeaways: Plans have been investing heavily in SNPs for several years now and this occurred even with the financial woes many saw in 2024 that led to a massive retrenchment in terms of geographies, products, and benefits in 2025. While individual MA plan offerings declined by 6.54% in 2025, SNP offerings increased 8.5% in 2025. From January 2020 to September 2025, SNPs grew from 3.687M to 7.909M, a growth of 4.222M or 114.51%. About half of the growth noted above has come since January 2023. Dual-Eligible or D-SNPs have dominated the numbers, capturing 3.351 of the 4.222 growth, or 79% of all growth. They grew 118% in the timeframe. Chronic Care or C-SNPs grew the most from a percentage standpoint in the timeframe, growing by 1M or 271%. Plans are investing due to the CMS Medicare-Medicaid integration strategy, synergies plans see between the two lines of business, and the potential for greater revenue and margin with SNPs. But there are risks as well, including the current rate and risk adjustment environment, immature clinical oversight, greater integration, challenges with Star performance for dual eligibles, and the robust audit environment. Program audits look at both SNP regulations and a plan’s Model of Care compliance as well. Audits no longer limit their focus to health risk assessments and care plan issuance, but go deep into clinical practices, engagement of members with care teams, and how identified problems have been addressed. CMS sees the increased use of technology as a dynamic and cost-effective way to identify problems and risks as well as undertake intervention strategies. 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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    24 mins
  • 95. Healthcare Price Disparity and Health Plan Landscape

    95. Healthcare Price Disparity and Health Plan Landscape
    Oct 3 2025
    We are covering two topics in this edition – healthcare price disparity between the U.S. and other developed countries as well as the current health plan landscape. 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 covers two topics – healthcare price disparity between the U.S. and other developed countries as well as the current health plan landscape. Key Takeaways: Part 1: Price Disparity The Peterson-KFF Health System tracker looked at price and utilization in the U.S. and 11 other developed nations. It finds that the U.S. has higher prices for many healthcare services and that we spend more than any other large, developed country on healthcare. However, utilization of many services is lower than in many comparable countries. The study says this has been the case for some time. Costs ultimately are driven by price and utilization. In this case, the study says price in America is the big culprit for higher costs than in other nations. The U.S. spends nearly twice as much on healthcare per person as the average of peer nations. Part 2: Health Plan Landscape There is an ongoing financial meltdown at health plans and the One Big Beautiful Bill will not help matters in terms of recovery. There are a number of different unsettling things on Medicare Advantage, including poor Star performance, risk adjustment revenue scrutiny, and prior authorization limits. Expect more benefit and other contraction in MA in 2026. Plans will need to pivot to real-time data analysis and engagement to reduce costs due to restrictions on prior authorization across all business lines. Plans will also look at agentic AI to help reduce administrative costs and enhance member and provider outreach. Ultimately, we need healthcare reform focusing on price reform, wellness and care management, and affordable access. 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
  • 94. The No Surprise Act Needs Reform

    94. The No Surprise Act Needs Reform
    Sep 26 2025
    While the No Surprises Act has saved Americans from huge surprise bills, the law is fundamentally flawed and needs to be reformed. 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 No Surprises Act. It has saved Americans from huge surprise bills, but the law is fundamentally flawed and needs to be reformed. Key Takeaways: The No Surprises Act has saved millions of Americans from huge surprise bills. The Blue Cross Blue Shield Association projected in early 2024 that the NSA averted 10 million surprise bills in the first nine months of 2023 alone. Another study finds that there was a $567 decrease in out-of-pocket (OOP) spending related to surprise billing for people living in states that did not have protections before the national law. The study finds that the NSA appears to be generating more savings to Americans than other coverage measures or cost reductions and protections. But the baseball-style arbitration process in the law is heavily stacked against health plans and favors providers. In baseball-style arbitration, an arbiter decides between one or the other last best offers from the sides and cannot craft a middle ground. A new study by Georgetown University researchers and published in Health Affairs, show that providers have won 85% of disputes since the fourth quarter of 2023. In these cases, the median payments were three to four times higher than average median in-network rates. There has been over $5 billion in total costs through the end of 2024 due to the law. Additional payments were about $2.24 billion, with additional administrative costs and fees totaling $2.78 billion. Annually, this totals $2 to $2.5 billion a year in increased costs. The study also finds that the majority of the disputes are filed by a small number of providers that are backed by private equity firms. At least three major insurers have now sued various providers over their abuse of the dispute resolution process. The bill has and will continue to increase costs in the healthcare marketplace. Reform is absolutely needed. 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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    21 mins
  • 93. We Do Need Accountability: Not All Big Beautiful Bill Cuts Were Bad Policy

    93. We Do Need Accountability: Not All Big Beautiful Bill Cuts Were Bad Policy
    Sep 19 2025
    Notwithstanding my opposition to most of what is in the One Big Beautiful Bill, not everything in it was bad policy. After all, we do need accountability in government programs. 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 not every healthcare reduction in the One Big Beautiful Bill was unreasonable. We do need accountability in government programs. Key Takeaways: I have taken the position that most of the reductions to healthcare in the One Big Beautiful Bill Act (OBBBA) were simply bad policy. As a former state budget director and management secretary, I do believe in accountability of government healthcare programs. Areas I see in the OBBBA that promote accountability include certain provider tax reforms, some state directed payment changes, and verification of eligibility reforms. Democrats support universal access but have rarely asked if their policies do or do not promote accountability, real reform, efficiency in the system, and creating cost-effective coverage options. Their unfettered policy positions ignite massive spending growth to the detriment of long-term stability of the system as a whole. Case Study 1: Democrats passed a series of cost-sharing reductions on Part D, largely to score political points in the 2024 election. The changes have destabilized the standalone Part D program, leading to premium and cost-sharing hikes, benefit reductions, and less choice and access. Case Study 2: Democrats also fostered huge opportunities for Exchange enrollment fraud because enhanced premium subsidies became so generous and eligibility and enrollment so liberal. This led to phantom enrollees. The number of Exchange individual market enrollees with no medical claims more than tripled from 2021 to 2024. The percentage of individual market enrollees with no claims jumped from fewer than 20 percent in 2021 to 35 percent in 2024—an increase of nearly 80 percent in three years. Democrats ignore such issues in favor of expansive and unaccountable healthcare. The GOP has become so suspicious of healthcare expansion due to the lack of accountability. Unless we solve this issue, healthcare reform in Congress will be a long way off. 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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    16 mins
  • 92. My Biggest Worry … Erosion of Coverage

    92. My Biggest Worry … Erosion of Coverage
    Sep 12 2025
    A combination of events come together to create a worrisome erosion of coverage in the next decade, driving up both the uninsured and underinsured counts. 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 a worrisome erosion of coverage in the next decade, driving up both the uninsured and underinsured counts. Key Takeaways: Two forces are coming together to further erode coverage in America. They are surging utilization and the OBBBA. Some of the surging utilization can be explained – a return to normal post pandemic utilization, increased expensive drug introductions, aging and more. But some of it cannot. While healthcare actuaries anticipate a slowing of annual healthcare growth in a few years, I think we could be in a new era of even more robust annual growth. When utilization spikes, as much as employers try to protect employees, more costs are foisted upon them or coverage evaporates. While the GOP says no one will lose coverage unless it is fraudulent or they want to be tossed, we know this is far from the truth. With the expiration of Exchange premium enhancements, 15 million will lose coverage in Medicaid and the Exchanges. We have seen very low uninsured rates due to coverage expansion. That will increase dramatically through 2034. The bigger problem could be the rise in the underinsured rate. Surging utilization, costs, and the fallout from the OBBBA will mean more and more fall into the ranks of the underinsured. Latest statistics say about 8% to 9% of adults are uninsured, 12% had a gap in coverage over the past year, and 23% were underinsured (they had coverage for a full year that didn’t provide them with affordable access.) We are in a crisis. It is clear that the uninsured and underinsured rates will rise because of misguided policies and the lack of true healthcare reform. 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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    15 mins
  • 91. What Will Happen to Medicare Advantage in 2026?

    91. What Will Happen to Medicare Advantage in 2026?
    Sep 5 2025
    Given the major MA retrenchment in 2025, many are asking what will happen to offerings, geographies, and growth in 2026. I tell you. 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 what will happen to offerings, geographies, and growth in Medicare Advantage in 2026. Key Takeaways: Since January 2020, MA enrollment has grown from 23.93 million to 35.44 in July 2025, a growth of 11.51 million. From January 2020 to January 2024, average growth was 10%, ranging from 6% to 11%. Growth from January 2024 to February 2025 did come down considerably to 4.4%. Since February, MA continues to grow at a healthy pace overall. Between February and July, almost 500,000 lives were added to the MA rolls. We are likely in store for a rate of growth from 2025 to 2026 that is similar to 2024 to 2025. It is clear that the major retrenchment by MA plans in 2025 impacted overall growth. But a great value proposition compared with the traditional program sustains growth. 2025 brought a reduction in some added benefits, a major contraction of the Preferred Provider Organization (PPO) product, and geographic contraction. While many plans pulled back, national MA plans struggled the most in terms of benefit cuts, contraction, and growth. While Individual MA plan offerings declined by 6.54% in 2025, SNP offerings increased 8.5% in 2025. And SNPs have grown considerably since January 2024. In the end, robust competition remained, $0 premiums prevailed, and most enrollees could find very favorable plans. Some analysts are speculating that contraction of benefits, products, and geographies could be robust again this year. But will it be as big as 2025? I do not expect the enrollee impacts to reach what we saw in 2025. But based on recent announcements from United and Aetna, we can say the contraction in benefits, products, and footprint could again be sizeable in 2026. 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
  • 90. What Explains The Insurer Meltdown?

    90. What Explains The Insurer Meltdown?
    Aug 29 2025

    While outside forces contributed, health plans, especially the big ones, can blame their own mismanagement on the insurer meltdown.

    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 crisis of health plans. While outside forces contributed, health plans, especially the big ones, can blame their own mismanagement on the insurer meltdown.

    Key Takeaways:

    Outside forces contributing to the meltdown were high utilization and government actions that reduced rates and revenue and limited cost-savings opportunities.

    But health plans generally and the big plans specifically missed the financial mark.

    Big plans were over-zealous and had a severe lack of financial discipline.

    In Medicare Advantage, health plans ignored lower rates, lower Star performance, risk adjustment reform demands, and prior authorization limits.

    In Medicaid, plans grew too much, ushered on by what were temporary rules expanding growth and reimbursement.

    In the Exchanges, insurers did not plan for the eventual phaseout of enhanced premium subsidies.

    In the employer and commercial world, health plans did not respond to demands for cost-savings and greater transparency by insurers.

    The current trends, including the budget reconciliation bill, likely would have meant further retrenchment in all lines of business.

    But it is equally true that the lack of financial discipline by most of these plans in the last several years complicates their recovery.

    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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    23 mins