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
    Show More Show Less
    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
    Show More Show Less
    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
    Show More Show Less
    23 mins
  • 79. Managed Care Enters New Cycle; Medicare Advantage Needs To Pivot To Thrive

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

    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
    29 mins
  • 78. The Budget Reconciliation Saga

    78. The Budget Reconciliation Saga
    Jun 6 2025
    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

    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
    23 mins
  • 77. Donald Trump Goes All In On Drug Price Reform

    77. Donald Trump Goes All In On Drug Price Reform
    May 30 2025
    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 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 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 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
    32 mins
  • 76. Diving Into The 2026 Final Announcement And 2026 Rule For Medicare Advantage and Part D

    76. Diving Into The 2026 Final Announcement And 2026 Rule For Medicare Advantage and Part D
    May 23 2025
    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 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 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 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
    36 mins
  • 75. Tariffs Could Have An Ugly Impact On Healthcare Costs And Access

    75. Tariffs Could Have An Ugly Impact On Healthcare Costs And Access
    May 16 2025
    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 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 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 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
    20 mins