The MA industry is coming back, but 2027 will be the fourth year of retrenchment to get back to financial sustainability.

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 space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

In this episode, Marc discusses the fact that the Medicare Advantage industry is coming back, but 2027 will be the fourth year of retrenchment to get back to financial sustainability.

Key Takeaways:

2024 through 2026 were tough years for the industry and MA enrollees as a great number of benefit reductions and plan exits occurred.

This was needed to get the industry back to financial stability.

So far it is working. Q2 financials show a recovering MA industry.

But 2027 will be another year of retrenchment due to continued volatility in MA and high trends.

MA plans deploy numerous strategies to limit enrollment and better financial outcomes – from county exits down to benefit tweaks and withholding commissions.

Despite the retrenchment, MA remains popular compared with traditional Medicare and choice is strong.

2026 had the most impact on Medicare beneficiaries. I don't expect the impact to be quite as large in 2027 right now, but well over 1 million enrollees will have to find a new plan again.

Again, retrenchment does not mean MA is collapsing by any means.

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

CMS' recent audit report is well thought out and offers plans excellent advice in an increasingly complex compliance environment.

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 space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

In this episode, Marc discusses CMS' recent audit report. It is well thought out and offers plans excellent advice in an increasingly complex compliance environment.

Key Takeaways:

When I first started dealing with this stuff, CMS oversight could sometimes feel inconsistent. Standards weren't always as well developed. Enforcement could be uneven.

That has changed. CMS has built a much more sophisticated audit and enforcement machine. And the compliance bar is moving upward.

The 2025 program audit and enforcement report gives excellent advice for performing well in a complex compliance environment.

It is no longer good enough to have policies – execution is essential.

Much of non-compliance is tied to operational deficiencies across the plan enterprise.

Plans also do not make decisions based on complete information – even when it is available.

Vendor oversight is lacking and vendors fail to execute on plan requirements. They need better oversight.

Ongoing internal audits, disclosure, and transparency with CMS could be the difference. CMS wants you to find your own problems.

Prior authorization reforms and CMS' use of AI could up the stakes on compliance.

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

As usual in politics and public policy, the truth of the Exchange enrollment debate is somewhere in the middle.

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 space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

In this episode, Marc discusses the Exchange enrollment debate. As usual in politics and public policy, the truth is somewhere in the middle.

Key Takeaways:

When the Exchange enhanced premium subsidies expired, the political battle lines were drawn.

Democrats claim the expiration at the hands of the GOP is the reason for huge coverage losses on the Exchange.

According to KFF, effectuated ACA Marketplace enrollment fell from approximately 22.1 million people in 2025 to 19.2 million in February 2026.

KFF currently estimates that average effectuated enrollment could settle around 17.5 million in 2026, potentially several million below 2025 levels.

KFF found that average premium payments for Marketplace enrollees increased by approximately 58%, from $113 per month to $178.

Democrats trace the drop to clear inability for people to afford the premium hikes after the expiration of the enhanced subsidies.

The GOP and conservative think tanks argue that losses equal its calculation of improper and fraudulent enrollment in the public program.

Analyses suggest approximately 6.2 million 2026 Exchange sign-ups may have been improperly enrolled, representing about 27% of all Exchange sign-ups.

These enrollments could result in as much as $25 billion in improper federal subsidy payments.

And, as is so often the case in healthcare, the truth is somewhere in the middle.

Driving for affordable access while protecting the government program from improper enrollments should be the goal.

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

Good financial news for health plans coming out Q2, but caution is needed in terms of the future.

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 space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

In this episode, Marc discusses the good financial news for health plans coming out Q2, but argues caution is needed in terms of the future.

Key Takeaways:

Q2 financial results were positive overall for health plans.

Health plans have been meticulous and practiced surgical precision in getting back to margin.

Benefit cutbacks, exits, and reductions have dominated thinking in almost every line of business.

The bigger more diversified healthcare entities performed the best.

Medicare Advantage appears to be recovering well with financial discipline, but there are storm clouds ahead with tight rates, poor quality Star results, and a risk adjustment crackdown.

Medicaid and Exchanges appear more predictable right now as well, with similar peril in the future due to program reductions.

Employer coverage is generally the most stable, but passing on costs to employers and employees has limits.

The plan recovery will not be lasting unless we tackle the huge surge in costs and unaffordability.

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

There is little doubt that the time has come for a real fix to Medicare physician fees. The big stall is hurting healthcare.

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 space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

In this episode, Marc discusses the need for a real fix to Medicare physician fees.

There is little doubt that the big stall is hurting healthcare.

Key Takeaways:

For decades, Medicare docs have been riding what can only be described as a reimbursement roller coaster.

The payment formula had so many flaws that huge reductions were the reality, often only temporarily undone by lawmakers along the way.

Since 2001, real payments have gone down by about one-third.

This has led to a collapse in independent primary care.

Physicians have been taken over by health systems, health plans, and private equity.

Physician costs are higher now because health systems force their doctors to practice at much higher places of service.

In 2024 and 2025, Medicare docs saw reductions again.

In 2026, Medicare docs received a one-time 2.5% hike, temporarily undoing a 2.5% reduction.

In 2027, Medicare physicians would see yet another reduction because the 2.5% hike expires.

A new bipartisan bill would better tie physician rates to inflation moving forward. It would be costly, but it is an important reform that should pass.

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

The latest national health data show the healthcare crisis we are in.

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 space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

In this episode, the latest national health data show the healthcare crisis we are in. Reform is desperately needed.

Key Takeaways:

The latest National Health Expenditure Data from the CMS Office of the Actuary once again confirms what many of us in healthcare already know -- the system is growing faster than the economy can sustain.

Healthcare spending is estimated to be about $5.7 trillion in 2025, up 7.3% from about $5.3 trillion in 2024. This is the third year of 7% annual hikes.

The CMS Actuary now projects healthcare spending will approach $9 trillion by 2034. And healthcare spending is expected to represent 20.6% of gross domestic product (GDP).

The actuary projects average healthcare spending growth of about 5.4% annually.

The actuary projects real per capita healthcare spending growth of approximately 2.8% annually. That is about 0.9 percentage points higher than projected GDP growth.

The biggest driver is expected to be prescription drugs. Retail prescription drug spending is projected to grow approximately 5.7% annually from 2025 through 2034.

Administrative expense will also rise considerably.

Due to the affordability crisis, by 2034 the uninsured rate is expected to rise from 8.2% to approximately 9.5%.

The National Health Expenditure data is not just a collection of statistics. It is a warning.

We badly need healthcare reform – price reform, care management, and affordable universal 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

In episode 5 of my healthcare reform series, we sum up the series and explain the healthcare grand bargain again.

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 space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

In episode 5 of my healthcare reform series, we sum up the series and explain the healthcare grand bargain again.

Key Takeaways:

We are concluding the 5-part series on healthcare reform today, summing up the series and discussing the healthcare grand bargain that is needed again.

Healthcare reform is critically needed as the system is fragmented, costs continue to spiral, and the system is becoming unaffordable.

Incremental fixes have continually failed.

I have proposed three pillars of reform – price reform, a pivot to care management and primary care, and affordable universal access.

They all would work together and reinforce one another.

This is not socialized medicine or single payer. Private delivery and employer coverage would be preserved, with one social safety net plan for those falling through the cracks.

The proposal is apolitical, but politicians should like it. For the GOP, it makes us more competitive. For Democrats, it prioritizes access and coverage.

Trillions in savings could be used in various ways, including reinvesting some to retain on-demand and technology-driven healthcare.

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

In episode 4 of my healthcare reform series, I tell you about why we finally have to get to true affordable universal access.

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 space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

In episode 4 of his healthcare reform series, Marc tells you about why we finally have to get to true affordable universal access.

Key Takeaways:

One of the biggest misconceptions in American healthcare policy is the assumption that coverage equals access. Do people actually have affordable access to care when they need it?

These are individuals who have insurance on paper but face significant financial barriers when they attempt to use it.

Affordable universal access means: (1) Everyone has a defined pathway to coverage. (2) Financial protection is real, not theoretical. (3) Affordability is preserved across life transitions.

America's system is a patchwork one that does not safeguard tens of millions because the safety net is too fragmented.

The solution does not have the be socialized medicine or single payer.

Employer coverage should be maintained with one single safety net program. Medicare can be maintained for seniors.

Subsidies should follow people and be adequate for affordability based on income.

A solution like this would end the uninsured and underinsured crisis.

Richard Nixon proposed something similar in 1974.

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