DC EKG

Podcast TitleDC EKG with Joe Grogan: A Healthcare Policy Podcast

This is a REFILL of Episode124 - (Original air date: January 27, 2026)

Episode Title - Ryan Long on the ACA Subsidy Fight, Phantom Enrollees, and Reforming 340B

Episode Description - Joe Grogan is joined by Ryan Long of Paragon Health Institute and the University of Southern California to break down two fights shaping health policy right now: a California wealth tax pitch framed as a health care fix, and the battle over extending enhanced Affordable Care Act subsidies.

They unpack how enhanced subsidies changed who qualifies, why zero-premium plans opened the door to broker-driven enrollment and fraud, and why the medical loss ratio creates perverse incentives that can push premiums higher. They also explain how silver loading and cost-sharing reduction policy distort the exchange market, and what reforms could lower costs without writing a blank check.

The episode closes with Ryan's latest work on the 340B program, including why drug arbitrage rewards hospitals with a stronger commercial mix and can fuel consolidation, and why direct, targeted assistance could better support hospitals that truly serve low-income and rural patients.

Chapters and Timestamps
00:01 Intro
00:23 Welcome, and what is on the agenda
01:25 California wealth tax and structural deficits
11:20 Enhanced ACA subsidies and the shutdown fight
16:54 Income caps, zero premium plans, and phantom enrollees
21:50 Fraud, Medicaid exposure, and public trust
30:39 Medical loss ratio incentives and ACA market fixes
38:41 340B: how arbitrage works and why it drives consolidation
44:51 What reform could look like
47:20 Closing

SEO Keywords | Affordable Care Act, ACA subsidies, enhanced subsidies, premium tax credits, exchange plans, zero premium plans, phantom enrollees, medical loss ratio, cost sharing reduction, silver loading, Medicaid fraud, Minnesota fraud, California wealth tax, 340B program, drug arbitrage, hospital consolidation, site neutral payments, commercial mix, Medicare Trust Fund

About Our Guest | Ryan Long is a health policy expert with experience on Capitol Hill, including years in the Speaker's office and on the House Energy and Commerce Committee. He is affiliated with Paragon Health Institute and the University of Southern California.

CreditsSponsor: Survivors for SolutionsExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Julie Riga, Stay on Course Studios, https://www.stayoncourse.studio

An episode pulled from the archives, Joe Grogan and Eric Ueland welcome Dr. Tevi Troy, former Deputy Secretary of Health and Human Services, presidential historian, and best selling author of Fight House: Rivalries in the White House from Truman to Trump. First aired in February 2023 at the midpoint of the Biden administration, this conversation diagnoses how White House infighting actually works, why the Biden team leaked so much less than its predecessors, and what discipline does and does not buy a president.
From there the conversation turns to the machinery of the State of the Union, why the speech always collapses into a laundry list, and how Ronald Reagan invented the pageantry that every president has copied since. Troy then makes the bipartisan case for reforming the Centers for Disease Control, arguing for a congressional charter and a sharper pandemic mission separate from behavioral health. Along the way Joe, Eric, and Tevi cover Lyndon Johnson and Vietnam, Ed Koch and the art of criticizing opponents without alienating voters, the real origin of the Bull Connor line in Biden speeches, and why Troy believes the Republican party has a brighter future after Trump than the Democrats have after Biden.

TIMESTAMPS
0:00 Tevi Troy on a brighter Republican future after Trump
0:47 DC EKG intro
1:10 Joe and Eric welcome Tevi Troy, refill context from February 2023
3:00 Why the Biden White House leaks far less than Trump's did
6:15 Neera Tanden, Afghanistan, and where the grumbling did surface
9:30 Is the press softer on Democratic administrations
12:10 Lessons from the hyper disciplined Bush 43 operation
15:00 Friction as a feature: Johnson, Ford, and creative tension
18:20 Johnson, Vietnam, and the limits of dominating Congress
21:00 Biden faces a Republican House and a debt ceiling fight
24:15 How a State of the Union actually gets built
27:30 Why every State of the Union becomes a laundry list
30:45 Reagan, Lenny Skutnik, and the birth of pageantry
33:50 The case for reforming the CDC with a congressional charter
36:20 Behavioral health versus the pandemic mission
39:10 Ed Koch, Carter, and criticizing without alienating voters
41:40 Where Meacham's Bull Connor line came from
44:30 Troy's path to DC: AEI, Ben Wattenberg, and the PhD
47:15 The conservative movement in flux and the future of the parties
48:33 Wrap up

ABOUT OUR GUEST
Dr. Tevi Troy is a presidential historian, best selling author, and former Deputy Secretary of the Department of Health and Human Services. An insider's insider in Washington, he warned of US vulnerability to coronavirus in 2016 and has since written widely on the failures at the CDC. He began his career at the American Enterprise Institute working for Ben Wattenberg, earned a PhD from the University of Texas at Austin, and served in a range of roles in the George W. Bush administration, including at the Domestic Policy Council. He is the author of Fight House: Rivalries in the White House from Truman to Trump, What Jefferson Read, Ike Watched, and Obama Tweeted, and Intellectuals and the American Presidency, along with more than four hundred articles.

CREDITS
Podcast: DC EKG with Joe Grogan
Episode: 137b
Guest: Dr. Tevi Troy, former Deputy Secretary of Health and Human Services
Sponsor: Survivors for Solutions, https://survivorsforsolutions.org
Executive Producer: John “CZ” Czwartacki, DC EKG Podcast
Producer: Stay on Course Studios, https://www.stayoncourse.studio

Dr. Jay Bhattacharya on COVID-19 Seroprevalence, Natural Immunity, and the Great Barrington Declaration (Originally Aired July 20, 2023)

This episode originally aired on July 20, 2023, the same day Stanford University President Tessier-Levine was forced to resign. Dr. Jay offers detailed commentary on the hostile work environment at Stanford and how government, big tech, and academia conspired to suppress scientific voices.

Episode Description
In this wide-ranging conversation, Joe Grogan and Eric Ueland sit down with Dr. Jay Bhattacharya to discuss his groundbreaking work on COVID-19 seroprevalence studies, the suppression of natural immunity data, and the origins of the Great Barrington Declaration.

Dr. Bhattacharya shares his immigrant family story and early recognition that COVID-19 was far more widespread than official counts indicated. He conducted one of the first seroprevalence studies in April 2020 in Santa Clara and Los Angeles Counties, using antibody test kits provided by Major League Baseball, and found that the disease was 40 to 50 times more common than reported cases.

The episode covers the intense backlash Dr. Bhattacharya faced for publishing these findings, including death threats, racist attacks, and institutional pressure from Stanford to suppress the research. He discusses how public health authorities suppressed evidence of natural immunity, the unethical decision-making by officials like Tony Fauci and Debbie Birx, and the formation of the Great Barrington Declaration.

Dr. Bhattacharya details the coordinated campaign against him, censorship on social media, including Twitter blacklisting, federal government threats to ensure censorship, and the terrible price paid that will echo through generations. He reflects on the failures of scientific institutions and the reforms needed to restore public trust in science.

Key Timestamps

4:27 Background: born in India, immigrant family, father was a rocket scientist
14:07 COVID enters consciousness: late December 2019, early January 2020
16:47 Wall Street Journal op-ed calling for seroprevalence studies
19:06 Major League Baseball provides 10,000 antibody test kits
20:30 Study results: 3 percent of Santa Clara had COVID by April 2020
26:12 Death threats, racist attacks, and pressure from Stanford
34:51 Evidence of natural immunity being suppressed by Fauci and Birx
39:52 Genesis of Great Barrington Declaration, October 2020
50:10 Hostile work environment at Stanford and Tessier-Levine impact
56:44 FOIA requests revealing government targeting
1:00:16 Twitter blocklist discovery and Elon Musk's Twitter Files
1:05:00 Reform is needed in the scientific community to restore public trust

About the Guest (at time of recording, July 2023)
Dr. Jayanta Jay Bhattacharya is a Professor of Health Policy at Stanford University's School of Medicine and a Senior Fellow at the Hoover Institution. He holds an MD and a PhD in Economics from Stanford. Born in Kolkata, India, he immigrated to the US at age four. His research focuses on the health and well-being of vulnerable populations. He has published over 160 peer-reviewed articles and is the author of a leading textbook on health economics. Dr. Bhattacharya co-authored the Great Barrington Declaration and is a co-founder of the Academy of Science and Freedom.

Dr. Jay's Current Role (June 2026)
Since this episode was recorded in July 2023, Dr. Bhattacharya has assumed significant leadership roles in the federal government. He is the 18th Director of the National Institutes of Health (NIH), confirmed March 25, 2025, and took office April 1, 2025. As of February 18, 2026, he also serves as Acting Director of the Centers for Disease Control and Prevention (CDC), bringing his emphasis on scientific integrity and evidence-based policy to these critical positions.

Podcast: DC EKG with Joe Grogan
Guest: Dr. Jay Bhattacharya
Host: Joe Grogan and Eric Ueland

Sponsor: Survivors for Solutions
Executive Producer: John CZ

DC EKG with Joe Grogan

Episode 137: Tax Expenditures, 340 B Drug Pricing, and Kidney Donation Reform

Air Date: June 15, 2026

Episode Description
In this episode, Joe Grogan sits down with Dr. Ike Brannon, President of Capital Policy Analytics and Senior Fellow at the Jack Kemp Foundation, to discuss hidden tax expenditures, the 340 B drug pricing program, and innovative solutions to the kidney shortage crisis.

Dr. Brannon brings decades of Capitol Hill experience, including roles as chief economist of the House Energy and Commerce Committee and senior advisor to Senator Orrin Hatch. He and co-author Tony LoSasso recently published groundbreaking research in Health Affairs Forefront arguing that the 340 B drug pricing program should be classified as a hidden tax expenditure costing the federal government 15 to 20 billion dollars annually.

The conversation covers how the 340 B program evolved from providing discounted drugs to uninsured patients into a massive subsidy for nonprofit institutions with little benefit to poor patients. Dr. Brannon explains how the same drug acquired at a 340 B discount often results in full commercial copays for patients.

Joe and Dr. Brannon explore other problematic tax expenditures including the mortgage interest deduction, employer health insurance exclusion, and credit union tax breaks. The episode pivots to Dr. Branons passionate work on kidney donation reform. Forty-five thousand Americans die annually from end stage renal failure due to kidney shortage, disproportionately affecting African Americans. Dr. Brannon advocates for fully reimbursing kidney donors for all expenses.

Key Topics
340 B drug pricing program, tax expenditures, pharmaceutical discounts, nonprofit hospitals, mortgage interest deduction, kidney donation, end stage renal failure, organ shortage, entitlement reform, social security, Medicare, federal deficit, health economics

Key Timestamps

0:00 Opening: What should be in a reconciliation bill?
4:38 The 340 B drug pricing program explained
13:54 How the 340 B discount does not reach patients
20:13 Mortgage interest deduction: the most irritating tax break
31:00 Prospects for reconciliation under Trump administration
34:57 The kidney donation crisis: 45,000 deaths per year
39:02 How kidney donation reimbursement would work
40:00 Would you allow kidney sales? The ethical debate
45:13 Final thoughts

About the Guest
Dr. Ike Brannon is President of Capital Policy Analytics and Senior Fellow at the Jack Kemp Foundation. He holds a PhD in Economics from Indiana University. Dr. Brannon served as chief economist of the House Energy and Commerce Committee, senior advisor to Senator Orrin Hatch on tax and trade policy, and has worked at the Congressional Joint Economic Committee, Treasury Department, and for the McCain presidential campaign. He is founder of the Prosperity Caucus and focuses on growth-oriented economic policy and healthcare innovation.

Featured Research
The 340 B Drug Pricing Program is a Hidden Tax Expenditure
Health Affairs Forefront, April 24, 2026
Co-authored by Ike Brannon and Tony LoSasso
https://www.healthaffairs.org/content/forefront/340b-drug-pricing-program-hidden-tax-expenditure

Podcast: DC EKG with Joe Grogan
Episode: 137
Guest: Dr. Ike Brannon

Sponsor: Survivors for Solutions
Producer: Stay on Course Studios
Executive Producer: John CZ Czwartacki, DC EKG Podcast

DC EKG with Joe Grogan
The Economics of Ozempic and Other Weight Loss Drugs
Episode 136.5 (“Prescription Refill” – A replay from the archives)
Original Air Date: May 2024

In this episode, Joe Grogan welcomes Ben Ippolito, Senior Fellow in Economic Policy Studies at the American Enterprise Institute, to discuss the rapidly evolving economics of GLP-1 weight loss drugs like Ozempic and Wegovy.

Ben explains the two main competitors in this market—Novo Nordisk's Ozempic and Wegovy versus Eli Lilly's Mounjaro and Zepbound. Revealing how insurance coverage decisions drive pharmaceutical marketing strategy.

The conversation reveals a critical irrationality in Medicare policy: the statutory prohibition on covering weight loss drugs despite their profound clinical and quality-of-life benefits. Yet these same drugs are covered for diabetes and cardiovascular risk reduction.

Ben explores the surprising economics of drug pricing through gross-to-net pricing—the massive gap between list prices and what insurers actually pay through rebates and discounts.

The episode examines critical implications of the Inflation Reduction Act's price negotiation provisions. Once Medicare negotiates Ozempic's price, that same price applies to all products using the same active ingredient. This creates cascading market effects: competitors must match those prices to remain on formularies, new entrants face lower pricing power even if clinically superior, and pharmaceutical companies may abandon promising programs due to regulatory uncertainty.

Ben argues Congress doesn't need to act immediately to expand Medicare coverage, but likely will within a few years.

Joe and Ben discuss unintended consequences of government price regulation, including effects on innovation and drug development pipelines. They explore how price controls announced before elections affect pharmaceutical strategy and development timelines.

Concluding with Ben's research on Medicare Advantage and why both Democrats and Republicans scrutinize this private alternative to traditional Medicare. With over 50 percent of seniors enrolled in Medicare Advantage plans, bipartisan interest in reform is reshaping healthcare policy conversations on Capitol Hill.

Key Topics
GLP-1 drugs, Ozempic, Wegovy, Mounjaro, Zepbound, weight loss medications, obesity treatment, Medicare coverage, drug pricing, Inflation Reduction Act, pharmaceutical competition, rebates, gross-to-net pricing, health economics, cardiovascular benefits, diabetes treatment, Medicare Advantage, healthcare policy, innovation incentives

Key Timestamps
00:00 Cold Open: "Turned Up to 11"
00:24 Welcome to DC EKG
00:46 Meet Ben Ippolito (AEI)
03:48 The GLP-1 Landscape: Ozempic, Wegovy, and the Field
05:04 One Drug, Two Names
06:45 Medicare's Weight-Loss Coverage Ban
07:21 Blockbusters and Big Effect Sizes
09:32 Why Isn't Congress Acting?
10:17 Why It Costs Less Than You Think
12:34 The Coverage Irrationality
14:05 Quality of Life as a Real Benefit
15:17 Beyond Weight: Cravings and Addiction
18:21 Devil's Advocate: Why Cover It At All?
19:48 Gross-to-Net and the Rebate Problem
22:41 Why Can't You Just Pay Cash?
25:43 The IRA and the Ozempic Price Cut
27:32 One Ingredient, One Price
30:10 Unintended Consequences in Part D
34:01 New Competitors and Killed Programs
38:03 What's Next: Medicare Advantage
42:04 Wrap-Up and Credits

About the Guest
(As of May 2024) Ben Ippolito is a Senior Fellow in Economic Policy Studies at the American Enterprise Institute. He holds a PhD and Master's degree in Economics from the University of Wisconsin-Madison and a Bachelor's degree in Mathematics and Economics from Emory University. Ben examines drug pricing policy, Medicare Advantage, and healthcare innovation economics with regular engagement with Congress.

Podcast: DC EKG with Joe Grogan
Guest: Ben Ippolito

Sponsor: Survivors for Solutions
Producer: Stay on Course Studios
Executive Producer: John CZ Czwartacki, DC EKG Podcast