93. We Do Need Accountability: Not All Big Beautiful Bill Cuts Were Bad Policy

Notwithstanding my opposition to most of what is in the One Big Beautiful Bill, not everything in it was bad policy. After all, we do need accountability in government programs.   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 not every healthcare reduction in the One Big Beautiful Bill was unreasonable. We do need accountability in government programs.   Key Takeaways:  I have taken the position that most of the reductions to healthcare in the One Big Beautiful Bill Act (OBBBA) were simply bad policy. As a former state budget director and management secretary, I do believe in accountability of government healthcare programs. Areas I see in the OBBBA that promote accountability include certain provider tax reforms, some state directed payment changes, and verification of eligibility reforms. Democrats support universal access but have rarely asked if their policies do or do not promote accountability, real reform, efficiency in the system, and creating cost-effective coverage options. Their unfettered policy positions ignite massive spending growth to the detriment of long-term stability of the system as a whole. Case Study 1: Democrats passed a series of cost-sharing reductions on Part D, largely to score political points in the 2024 election. The changes have destabilized the standalone Part D program, leading to premium and cost-sharing hikes, benefit reductions, and less choice and access. Case Study 2: Democrats also fostered huge opportunities for Exchange enrollment fraud because enhanced premium subsidies became so generous and eligibility and enrollment so liberal. This led to phantom enrollees. The number of Exchange individual market enrollees with no medical claims more than tripled from 2021 to 2024. The percentage of individual market enrollees with no claims jumped from fewer than 20 percent in 2021 to 35 percent in 2024—an increase of nearly 80 percent in three years. Democrats ignore such issues in favor of expansive and unaccountable healthcare. The GOP has become so suspicious of healthcare expansion due to the lack of accountability. Unless we solve this issue, healthcare reform in Congress will be a long way off.   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