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.

Emergency physician Dr. Colleen Smith discusses how government regulations and market distortions have contributed to the rise of large, vertically integrated healthcare corporations. In the interview, she explains how policies such as certificate-of-need laws, Stark regulations, and the structure of employer-based insurance have limited competition and consumer choice in healthcare.

Smith argues that simply breaking up large healthcare companies will not solve systemic problems unless policymakers also reform regulations, expand health savings options, and restore competition in the healthcare marketplace. Smith is an emergency medicine physician in New York City and a visiting fellow at the Center for Modern Health.

Peter Mihalick, health policy and advocacy director for the International Hearing Society and a former congressional staffer, discussed the federal 340B drug discount program on a recent episode of the Health Policy Podcast, highlighting concerns about its rapid expansion and lack of oversight.

Mihalick explained that the program was originally designed to help safety-net providers serve low-income patients by allowing them to purchase outpatient drugs at steep discounts. However, he said the structure does not require hospitals or clinics to pass those savings directly to patients, raising questions about whether the program is meeting its intended goals.

The discussion focused on how large hospital systems can generate significant revenue through the program, while patients may still face high out-of-pocket costs for medications. Mihalick also pointed to the growing role of contract pharmacies and the complexity of drug pricing flows as barriers to transparency and accountability.

He noted that recent policy efforts, including provisions tied to the Inflation Reduction Act and regulatory actions, aim to increase transparency, but may not address underlying structural issues. Mihalick said reforms such as clearer definitions, stronger guardrails, and mechanisms to ensure patients benefit directly from discounts could help realign the program with its original purpose.

Nathan Benefield, Chief Policy Officer of the Commonwealth Foundation, joins the Health Policy Podcast to examine whether the Affordable Care Act has achieved its core promise of lowering health care costs. Sixteen years after its passage, Benefield argues that rising premiums, expanded subsidies, and increased government spending have failed to reduce costs for families.

The conversation explores the impact of temporary COVID-era subsidy expansions, declining competition on insurance exchanges, and what Benefield describes as "perverse incentives" built into the subsidy structure. He discusses the difference between insurance coverage and actual access to care, the strain Medicaid places on providers, and how mandates and regulations shape pricing in the current system.

Benefield also outlines potential reforms, including expanded health savings accounts, interstate insurance competition, direct primary care models, scope-of-practice reforms, and greater price transparency. As debates continue in Congress over subsidies and federal spending, this episode examines whether meaningful reform is possible — and what a more patient-centered system might look like.

Susan Goldhaber, writer for the American Council on Science and Health and a former EPA researcher, joins the Health Policy Podcast to examine the renewed debate over fluoride in drinking water. With decades of experience studying fluoride standards, Goldhaber explains the history of fluoridation — from early 20th-century dental discoveries to its adoption as a major public health measure after World War II.

The conversation explores why the EPA is conducting a new toxicity assessment, the controversy surrounding recent National Toxicology Program findings linking higher fluoride levels to potential IQ effects, and the arguments from both sides of the debate. Goldhaber breaks down the science behind fluoride exposure levels, discusses how today's broader sources of fluoride complicate the issue, and weighs the growing influence of the "Make America Healthy Again" movement against the longstanding position of the American Dental Association.

As legal challenges and regulatory reviews unfold, this episode examines where the science stands — and where the battle over fluoridation may head next.

On this episode of the Health Policy Podcast, Brian Hyde speaks with Pete Sepp, President of the National Taxpayers Union, about the accelerating financial crisis facing Medicare and other federal healthcare programs

Sepp outlines how Medicare Part A is projected to become insolvent in 2033—just one year after Social Security's trust fund is expected to fall short—triggering an automatic 11% cut in hospital insurance benefits unless Congress acts.

He explains that healthcare spending now accounts for more than a quarter of federal expenditures and continues to grow, even after recent reforms to Medicaid.

A central focus of the conversation is the bipartisan "No Upcode Act," introduced by Senators Bill Cassidy and Jeff Merkley, which aims to curb an estimated $40 billion in annual Medicare Advantage overpayments caused by insurers overstating patient diagnoses

Sepp describes how the bill would require stronger verification of diagnoses—such as in-person doctor visits and multi-year data review—to protect both taxpayers and patients.

Beyond Medicare, Sepp warns that Social Security and even the Highway Trust Fund face similar fiscal countdowns, arguing that lawmakers elected this cycle will confront unavoidable funding cliffs during their terms

The episode explores the intersection of healthcare policy, federal spending, and economic freedom—and the urgent need for reform before automatic cuts or tax hikes become the only remaining options.