In a wide-ranging discussion on the Health Policy Podcast, Mike Smith, President Emeritus at The Brokerage Inc., outlines how the Affordable Care Act expanded coverage to millions of previously uninsured Americans but failed to deliver on long-term affordability. Smith explains that while subsidies helped drive enrollment and improve access to care, rising base premiums and the expiration of enhanced tax credits in late 2025 have led many consumers to drop coverage.

He describes a market now marked by instability, limited private-sector solutions, and growing reliance on government funding, warning that current trends could push the U.S. closer to a national healthcare system if sustainable reforms are not found

Ross Marchand, executive director of the Taxpayers Protection Alliance, discusses his organization's report Blocking Breakthroughs, which examines FDA drug rejection rates. He said that regulatory barriers, shifting standards, and excessive risk aversion are delaying patient access to potentially life-saving treatments, even as other developed countries approve the same drugs.

Nurse practitioner and author Cynthia Thurlow discusses her transition from traditional allopathic medicine to a lifestyle-focused practice centered on perimenopause and menopause care. She explains the evolving role of nurse practitioners in the U.S. healthcare system, including their training, scope of practice, and ability to help fill gaps created by physician shortages.

Thurlow highlights key systemic challenges shaping modern healthcare, including insurance-driven decision-making, declining reimbursement rates, consolidation of private practices, and the growing administrative burden on clinicians. She also addresses the rise of concierge medicine and the tension between efficiency and patient-centered care, particularly as technology and electronic medical records reshape doctor-patient interactions.

The conversation also explores the potential and risks of artificial intelligence in medicine, with Thurlow emphasizing the importance of maintaining human judgment and connection in clinical care. She warns against overreliance on AI while acknowledging its usefulness in streamlining certain tasks.

Finally, Thurlow introduces her book The Menopause Gut, which focuses on the role of the gut microbiome in women's health during midlife. She outlines how hormonal changes impact gut health and presents a holistic framework involving lifestyle, nutrition, and targeted therapies to support long-term wellness.