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The Healthcare Labyrinth

The Healthcare Labyrinth

By: Marc S. Ryan
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 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.2023 Hygiene & Healthy Living Social Sciences
Episodes
  • 82. Will Health Plan Pain Continue?

    82. Will Health Plan Pain Continue?
    Jul 4 2025
    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 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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    13 mins
  • 81. How Mighty Big Healthcare Has Fallen

    81. How Mighty Big Healthcare Has Fallen
    Jun 27 2025
    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

    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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    31 mins
  • 80. Republicans Are In Stealth Mode On Healthcare Coverage Cuts, But The Impact Is Real

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

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