DC EKG

Stay On Course Studios
  • 5.0 (221)
  • Government
  • Updated Weekly

Join former White House policy expert Joe Grogan as he cuts through the complexities of healthcare legislation and its real-world implications. Each episode of DC EKG aims to demystify the policies shaping our healthcare system, uncovering how these changes impact patients, providers, and payers across the country.

  1. 6d ago

    REFILL | Naomi Lopez on Healthcare AI, ACCESS, TEMPO, and the Future of Care (Originally Aired: January 23, 2026)

    This is a legacy episode recorded in January 2026. At the time of recording, Naomi Lopez was founder of Nexus Policy Consulting and a leading voice in healthcare policy, healthcare AI, and state health reform. Joe Grogan sits down with Naomi Lopez from Nexus Policy Consulting to recap the first Healthcare AI Policy Summit held in December 2025 in Washington, DC. They discuss big themes shaping healthcare AI, HHS approaches to AI adoption, and what regulatory clarity could look like. The conversation covers new federal initiatives like ACCESS and TEMPO that may reshape chronic disease management for Medicare patients. They unpack HHS Deputy Secretary Jim O'Neill's vision for AI in government, including using large models to improve physician productivity, payment integrity, and care coordination. They dig into ACCESS Medicare payment model and FDA TEMPO initiative, explaining how these pilots test AI tools in real-world chronic disease management for hypertension, diabetes, musculoskeletal pain, and depression. The discussion widens to physician burnout, interoperability, rural care, states and federal preemption, and what tech companies becoming Medicare Part B providers could mean for healthcare innovation. Key Timestamps 0:00 Intro and why the Healthcare AI Policy Summit matters 2:00 Summit recap: big themes and regulatory pressure points 6:00 Jim O'Neill at HHS: regulatory clarity and adoption inside government 12:00 ACCESS explained: Medicare chronic disease management payment model 18:00 TEMPO explained: FDA's risk-based approach for chronic care tools 24:00 Wearables, remote patient monitoring, and virtual ICU models 30:00 Privacy, de-identification, and re-identification risk 35:00 AI inside HHS and FDA: productivity, payment integrity, care coordination 41:00 Reducing admin burden and physician burnout 47:00 Rural healthcare: scaling diagnostics and access with AI 52:00 Interoperability and data sharing: APIs, friction, and incentives 58:00 State AI laws versus federal preemption 1:04:00 2026 outlook: tech companies as Medicare Part B providers 1:09:00 Wrap-up and what to watch next Key Topics Healthcare AI, ACCESS payment model, TEMPO initiative, FDA regulation, Medicare reimbursement, chronic disease management, AI in government, physician productivity, care coordination, wearables, remote patient monitoring, privacy and de-identification, rural healthcare, interoperability, state AI regulation, federal preemption, healthcare innovation, payment integrity About the Guest (at time of recording, January 2026) Naomi Lopez is the founder of Nexus Policy Consulting and a leading voice in healthcare policy, healthcare AI, and state health reform. She co-founded a healthcare AI working group and co-hosted the inaugural Healthcare AI Policy Summit in December 2025 in Washington, DC. Her work focuses on how regulation, Medicare and Medicaid policy, and state law shape healthcare innovation, access, and affordability. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Naomi Lopez Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

  2. Aug 17

    REFILL | Jackson Hammond on NHE, CMS Reform, and Making Insurance Almost Obsolete (Originally Aired: January 22, 2026)

    In this "REFILL" episode, Joe Grogan sits down with Jackson Hammond from Paragon Health Institute to unpack what the latest CMS National Health Expenditure data says about where U.S. healthcare is headed. They break down spending trends from $5.2 trillion to projections of $8.6 trillion, explaining what changed, what didn't, and what it means for affordability, Medicare, Medicaid, and long-run fiscal pressure. The conversation connects spending outlook to Jackson's work on CMS Innovation Center reform and debates whether CMMI is bending the cost curve or adding bureaucracy without accountability. Jackson argues we should aim for healthcare so affordable you barely need insurance, exploring how choice and competition could reshape the system. Key Timestamps 0:55 Jackson's background and how he got into health policy 3:39 Focus areas: Medicare, hospitals, drug pricing, PBMs, and 340B 5:14 What the NHE report is showing 6:14 Healthcare spending trajectory: $5.2T to $8.6T and why it matters 8:00 Why health spending is not really optional 10:11 Where the money goes: payer mix and per-enrollee costs 12:23 Medicaid costs, provider taxes, and state financing tactics 15:58 Medicare spending pressure and fiscal risk 21:06 Misconception: coverage equals care 26:18 Why provider payments keep rising after COVID demand and consolidation 33:01 Rural care, consolidation, and rural emergency hospital models 40:08 Drug pricing: retrospective versus prospective MFN approaches 49:20 2026 outlook and closing thoughts Key Topics National Health Expenditure, healthcare spending, CMS reform, CMS Innovation Center, Medicare spending, Medicaid costs, hospital consolidation, rural healthcare, drug pricing, PBMs, 340B program, provider payments, patient-centered care, healthcare affordability, choice and competition, fiscal policy About the Guest (at time of recording, January 2026) Jackson Hammond is a Senior Policy Analyst at the Paragon Health Institute focused on health spending, CMS policy, and reforms centered on choice, competition, and patient-centered care. He authors Paragon's Paragon Prognosis analyses and has written extensively on CMS Innovation Center reform and strategies for making healthcare more affordable through competitive market approaches. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Jackson Hammond Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

  3. Aug 10

    REFILL | Michael Cannon on STLDI and ACA Coverage: Costs, Choice, and Tradeoffs (Originally Aired: January 27, 2026)

    This is a legacy episode recorded in January 2026. At the time of recording, Michael Cannon was Director of Health Policy Studies at the Cato Institute, a leading voice on healthcare reform, the Affordable Care Act, and market-based health policy solutions. Episode Description Joe Grogan sits down with Michael Cannon from the Cato Institute to discuss short-term, limited-duration insurance (STLDI), also known as "Obamacare-exempt" plans, and why they can be significantly cheaper than ACA exchange coverage. Cannon explains how renewal guarantees work and why allowing more consumer choice can reduce pressure on exchange risk pools. The conversation covers the politics of pre-existing conditions, how ACA rules change insurers' incentives, and why coverage debates often miss the real drivers of cost, access, and quality. They also discuss public trust in healthcare following the Brian Thompson murder and explore how policy choices shape what insurers can and cannot do. Key Timestamps 0:23 Michael Cannon joins and what STLDI is 2:27 STLDI explained: Obamacare-exempt plans, renewal guarantees, and lower premiums 6:00 ACA history: why STLDI was restricted 7:46 International comparisons and pre-existing conditions incentives 12:10 Why healthcare stays broken: regulation, lobbying, and government-designed systems 16:59 Subsidies and the politics of pre-existing conditions 22:22 Renewal guarantees, employer tax exclusion, and Medicare history 30:37 Public trust after Brian Thompson's murder and Cannon's letter 41:56 Wrap-up and key takeaways Key Topics STLDI insurance, short-term limited-duration plans, ACA coverage, renewal guarantees, risk pools, pre-existing conditions, insurance regulation, healthcare costs, consumer choice, affordability, public trust, healthcare policy, market-based reform, junk insurance debate, employer-based coverage, Medicare policy About the Guest (at time of recording, January 2026) Michael Cannon is the Director of Health Policy Studies at the Cato Institute and a leading voice on healthcare reform, the Affordable Care Act, health insurance regulation, and market-based health policy solutions. He is a policy expert focused on expanding consumer choice and reducing the regulatory barriers that limit access to affordable coverage options. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Michael Cannon Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

  4. Aug 3

    REFILL | Ryan Long on 340B Drug Pricing, Enhanced ACA Tax Credits, and Medicare Part D (Originally Aired: September 24, 2025)

    Joe Grogan sits down with Ryan Long, healthcare policy expert and senior research fellow at Paragon, to discuss three critical healthcare policy issues facing Congress. First, the Congressional Budget Office's landmark analysis of the 340B drug pricing program, which revealed the program increases federal spending, drives up premiums, and channels most benefits to wealthy hospitals rather than those serving low-income patients. Second, the enhanced premium tax credits set to expire at the end of 2025, which have been plagued by fraud and fraudulent enrollment. Long explains how unscrupulous brokers have exploited the system, enrolling people without their knowledge, with billions in improper payments going to insurance companies. Third, the Inflation Reduction Act's devastating impact on Medicare Part D, including premium increases from thirty to sixty dollars monthly, coinsurance replacing copays, and seniors paying higher out-of-pocket costs despite the legislation's promise to lower drug costs. Key Timestamps 1:20 Welcome to DC EKG and introduction of Ryan Long 2:15 Congressional Budget Office analysis of 340B program 4:06 Why CBO conducted the 340B study 4:25 How 340B increases federal spending and premiums 4:58 Studies showing 340B drives higher-cost drug utilization 5:30 Will CBO analysis lead to legislative reform efforts 6:15 Program expansion from 90 to 2,600 participating hospitals 8:06 Timeline for 340B reform legislation 10:43 340B program growth from two billion to sixty-six billion annually 11:52 Why insurance companies support limiting 340B 12:20 Enhanced premium tax credits and ACA credits expiring 14:22 Difference between baseline and enhanced ACA credits 16:34 Zero-dollar plans and fraud mechanisms 18:19 Broker fraud and fraudulent enrollment schemes 21:09 How fraudulent brokers exploit free plans and commission structure 22:53 Paragon study showing four times over-enrollment in Florida 25:30 Misleading polling about ACA credits expiring 28:18 Groups pushing misleading messaging on enhanced credits 29:31 Political dynamics and Republican position on credits 33:17 Government shutdown politics and Democrat strategy 36:09 Elevance exiting standalone Medicare Part D plans 38:03 Migration from Part D to Medicare Advantage due to IRA 39:15 How IRA's out-of-pocket cap restructuring increased premiums 40:34 Coinsurance replacing copays and cost shift to seniors 42:20 IRA using fictitious list price to calculate negotiated savings 44:47 Multiple factors causing Medicare Part D premium increases Key Topics 340B program, Congressional Budget Office, drug pricing, hospital consolidation, enhanced premium tax credits, ACA fraud, fraudulent enrollment, broker fraud, government subsidies, Medicare Part D, out-of-pocket costs, coinsurance, Inflation Reduction Act, pharmaceutical pricing, program integrity About the Guest (at time of recording, September 2025) Ryan Long is a Senior Research Fellow at the Paragon Health Institute and affiliated with the USC Schaefer Center for Health Policy and Economics. He is a healthcare policy expert with extensive experience on Capitol Hill, including service as a staffer on the House Energy and Commerce Committee and chief health policy advisor to Speaker Kevin McCarthy. Long specializes in healthcare reform, pharmaceutical pricing policy, Medicare and Medicaid issues, and legislative strategy. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Ryan Long Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

  5. Jul 27

    "REFILL" | Dutch Rojas on Healthcare Economics, Direct Contracting, and Tax-Exempt Health Systems (Originally Aired: September 15, 2025)

    This is a "REFILL" episode recorded in September 2025. At the time of recording, Dutch Rojas was a healthcare entrepreneur, founder of multiple direct contracting companies, and board member of Physician Led Healthcare for America, with a growing following on social media advocating for market-based healthcare solutions. Joe Grogan sits down with Dutch Rojas, healthcare entrepreneur and social media advocate, to discuss his journey from accounting to building direct contracting companies that revolutionize employer healthcare. Rojas explains how direct contracting allows employers to negotiate directly with physicians, bypassing insurance middlemen. The conversation covers his experience building ambulatory surgery centers, certificate of need laws, self-funded employer plans, and his critique of not-for-profit health systems. Rojas argues that academic medical centers masquerade as not-for-profit organizations while receiving seventy-four subsidies annually from taxpayers, acquiring massive real estate holdings, and avoiding property and federal taxes. He advocates for policy changes on not-for-profit tax status and site-neutral payments, arguing these represent unfair advantages that harm independent physicians and patients. Key Timestamps 0:18 Joe introduces Dutch Rojas and asks who is Dutch Rojas 1:32 Dutch's background, career path, and journey to social media 2:22 Physician-led Healthcare for America and PHA board 4:32 Starting in accounting, real estate investment trust, and ambulatory surgery centers 5:14 150 ambulatory surgery center deals and certificate of need experience 7:34 Building a practice in Scottsdale and expanding to 16 states 9:30 First direct contracting company in 2009 and how direct contracting works 12:45 Self-funded employer plans and 106 million Americans not covered by insurance 15:22 Deals with banks and large employers in New York City 18:09 The difference between clinical medicine and business in medicine 22:15 Building insurance products on top of physician-led care 28:30 How direct contracting saves employers money 32:18 The three companies Dutch has started and sold 38:45 Healthcare as a percentage of GDP and rising costs 42:10 Regulatory hurdles and state-level barriers 46:54 Not-for-profit tax status and academic health systems 48:07 How health systems receive subsidies but claim non-profit status 48:22 Academic medical centers owning four to five percent of city real estate 49:21 Site-neutral payments and payment disparities between settings 50:28 Dutch's social media reach and audience impact Key Topics Direct contracting, healthcare economics, physician-led care, ambulatory surgery centers, certificate of need, self-funded employer plans, not-for-profit health systems, tax exemptions, site-neutral payments, healthcare regulation, real estate holdings, academic medical centers, employer negotiations, insurance reform, market-based healthcare About the Guest (at time of recording, September 2025) Dutch Rojas is a healthcare entrepreneur with over 25 years of experience in healthcare economics and business. He started in accounting and real estate investment, then moved into healthcare, developing over 150 ambulatory surgery centers. Rojas founded multiple direct contracting companies that help employers negotiate directly with physicians, bypassing traditional insurance intermediaries. He serves on the board of Physician Led Healthcare for America. He has built a significant social media following on X (formerly Twitter), sharing his analysis of healthcare policy and economics. Rojas is the author of the Rojas Report and hosts a YouTube channel and Substack focused on healthcare reform and market-based solutions. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Dutch Rojas Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

  6. Jul 20

    "REFILL" | Dr. Brian Miller on FDA Regulatory Reform and the Valley of Death in Medical Innovation (Originally Aired: March 21, 2025)

    In this "Refill" episode, Joe Grogan sits down with Dr. Brian Miller to discuss the "Valley of Death" - the gap between FDA approval and CMS coverage - and how regulatory reform can accelerate medical innovation. Miller explains how FDA product review can be made more efficient through automation and algorithmic analysis of routine tasks, allowing highly trained reviewers to focus on clinical interpretation rather than data processing. The conversation covers clinical trial reform, device review modernization, third-party review programs, and CMS coverage decision processes. Miller argues that these are operational challenges that can be fixed with executive leadership, and that transforming FDA and CMS procedures is critical to bringing new medicines and devices to patients faster. Key Timestamps 1:23  Brian Miller background and AEI role 2:47  The Valley of Death - gap between FDA approval and CMS coverage 5:06  Making FDA and CMS review processes more synergistic 7:43  Example of hypertension drug review and routine tasks 8:26  Data overload in FDA review process 10:40  Supplemental applications and unnecessary information 12:01  FDA reviewer burnout and middle management proliferation 15:30  Automating routine tasks at FDA 17:33  Clinical trial reform discussion and regulatory risk 20:03  Practical approach for new FDA commissioner and DOGE 21:22  Operational changes needed at FDA 22:48  Tobacco regulation at FDA and resource allocation 25:10  Device world getting short shrift in FDA priorities 27:33  Third-party 510k review program and third-party organizations 29:09  COVID diagnostic tests and pandemic review process 30:51  Reforming CDRH through third-party reviews 31:36  70-year comparison of heart attack treatment advances 32:46  CMS coverage decisions and Coverage with Evidence Development 36:02  Medicare Administrative Contractors (MACs) and local coverage decisions 38:12  Practical market-based approach to MAC appeals 39:54  National vs local coverage decisions and reasonable and necessary standard 42:28  Defining reasonable and necessary through algorithms and guidance Key Topics FDA regulatory reform, Valley of Death, clinical trial reform, FDA product review automation, CMS coverage decisions, Medicare Administrative Contractors, third-party device review, drug development costs, medical innovation, device regulation, regulatory science, operational efficiency About the Guest (at time of recording, March 2025) Dr. Brian Miller is a physician and non-resident fellow at the American Enterprise Institute (AEI) focusing on FDA regulatory policy and Medicare payment policy. He practices medicine at Johns Hopkins Hospital and serves as an associate professor of medicine and business at Johns Hopkins University. His research and policy work emphasize making regulatory systems more efficient to accelerate the development and approval of innovative medicines and medical devices. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Dr. Brian Miller Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

  7. Jul 13

    "REFILL" | Peter Pitt on FDA Advisory Committees, Make America Healthy Again, and Drug Pricing (Originally Aired: May 23, 2025)

    Joe Grogan sits down with Peter Pitt, FDA veteran and expert on healthcare regulation, to discuss FDA advisory committees, the Make America Healthy Again initiative, and critical gaps in pharmaceutical labeling. Pitt addresses why obesity-related drug dosing information is missing from labels, the importance of vaccine safety, food regulation reform, and strategies for lowering drug prices through generic drug reviews and supply chain diversification. He also discusses the need for FDA and CMS to work together and warns against mission creep at CMS. Key Timestamps 0:44 Background: East Coast native, McGill University, from New York City 1:07 How he got a professorship at University of Paris School of Medicine 2:35 Mark McClellan connection and FDA career start 5:19 Conflicts of interest versus interests in FDA advisory committees 7:07 Why people need to be dismissed from advisory committees 9:13 Three basic reasons FDA holds advisory committee meetings 11:08 Why Canada keeps advisory committees secret versus FDA transparency 14:08 Advisory committees for CYA, new science, and lack of consensus 19:44 Op-ed on vaccines and nutrition under Make America Healthy Again 22:44 Cancer drug dosing for obese patients and missing label information 27:15 Learning about drug dosing outside of clinical trials 30:42 Food regulation and FDA's second-class treatment of food safety 32:02 MAHA moment and removing red food dyes from food supply 34:00 Dietary supplements regulation under DSHEA 35:21 Nutrition labeling updates and soda bottle serving sizes 38:21 PDUFA reauthorization and user fees 40:32 User fees about predictability not speed 42:54 CMS mission creep and encroaching on FDA authority Key Topics FDA advisory committees, transparency, vaccine safety, Make America Healthy Again, pharmaceutical labeling, obesity and drug dosing, food regulation, dietary supplements, generic drug review, PDUFA reauthorization, user fees, CMS mission creep, drug pricing About the Guest (at time of recording, May 2025) Peter Pitt is President and Co-Founder of the Center for Medicine in the Public Interest and a visiting professor at the University of Paris School of Medicine. He is a former associate commissioner at the FDA where he oversaw advisory committees and served as a senior policy and communications advisor. Pitt is a native of New York City, a McGill University graduate, and speaks fluent French. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Peter Pitt Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

  8. Jul 6

    "REFILL" - Ryan Long on the ACA Subsidy Fight, Phantom Enrollees, and Reforming 340B

    Podcast TitleDC EKG with Joe Grogan: A Healthcare Policy Podcast This is a REFILL of Episode124 - (Original air date: January 27, 2026) Episode Title - Ryan Long on the ACA Subsidy Fight, Phantom Enrollees, and Reforming 340B Episode Description - Joe Grogan is joined by Ryan Long of Paragon Health Institute and the University of Southern California to break down two fights shaping health policy right now: a California wealth tax pitch framed as a health care fix, and the battle over extending enhanced Affordable Care Act subsidies. They unpack how enhanced subsidies changed who qualifies, why zero-premium plans opened the door to broker-driven enrollment and fraud, and why the medical loss ratio creates perverse incentives that can push premiums higher. They also explain how silver loading and cost-sharing reduction policy distort the exchange market, and what reforms could lower costs without writing a blank check. The episode closes with Ryan's latest work on the 340B program, including why drug arbitrage rewards hospitals with a stronger commercial mix and can fuel consolidation, and why direct, targeted assistance could better support hospitals that truly serve low-income and rural patients. Chapters and Timestamps 00:01 Intro 00:23 Welcome, and what is on the agenda 01:25 California wealth tax and structural deficits 11:20 Enhanced ACA subsidies and the shutdown fight 16:54 Income caps, zero premium plans, and phantom enrollees 21:50 Fraud, Medicaid exposure, and public trust 30:39 Medical loss ratio incentives and ACA market fixes 38:41 340B: how arbitrage works and why it drives consolidation 44:51 What reform could look like 47:20 Closing SEO Keywords | Affordable Care Act, ACA subsidies, enhanced subsidies, premium tax credits, exchange plans, zero premium plans, phantom enrollees, medical loss ratio, cost sharing reduction, silver loading, Medicaid fraud, Minnesota fraud, California wealth tax, 340B program, drug arbitrage, hospital consolidation, site neutral payments, commercial mix, Medicare Trust Fund About Our Guest | Ryan Long is a health policy expert with experience on Capitol Hill, including years in the Speaker's office and on the House Energy and Commerce Committee. He is affiliated with Paragon Health Institute and the University of Southern California. CreditsSponsor: Survivors for SolutionsExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Julie Riga, Stay on Course Studios, https://www.stayoncourse.studio

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About

Join former White House policy expert Joe Grogan as he cuts through the complexities of healthcare legislation and its real-world implications. Each episode of DC EKG aims to demystify the policies shaping our healthcare system, uncovering how these changes impact patients, providers, and payers across the country.

Information

  • Creator
    Stay On Course Studios
  • Years Active
    2023 - 2026
  • Episodes
    148
  • Rating
    Clean
  • Copyright
    All Rights Reserved ©2026
  • Show Website
    DC EKG

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