In this "REFILL" episode, Joe Grogan sits down with Jackson Hammond from Paragon Health Institute to unpack what the latest CMS National Health Expenditure data says about where U.S. healthcare is headed. They break down spending trends from $5.2 trillion to projections of $8.6 trillion, explaining what changed, what didn't, and what it means for affordability, Medicare, Medicaid, and long-run fiscal pressure. The conversation connects spending outlook to Jackson's work on CMS Innovation Center reform and debates whether CMMI is bending the cost curve or adding bureaucracy without accountability. Jackson argues we should aim for healthcare so affordable you barely need insurance, exploring how choice and competition could reshape the system.

Key Timestamps

0:55 Jackson's background and how he got into health policy

3:39 Focus areas: Medicare, hospitals, drug pricing, PBMs, and 340B

5:14 What the NHE report is showing

6:14 Healthcare spending trajectory: $5.2T to $8.6T and why it matters

8:00 Why health spending is not really optional

10:11 Where the money goes: payer mix and per-enrollee costs

12:23 Medicaid costs, provider taxes, and state financing tactics

15:58 Medicare spending pressure and fiscal risk

21:06 Misconception: coverage equals care

26:18 Why provider payments keep rising after COVID demand and consolidation

33:01 Rural care, consolidation, and rural emergency hospital models

40:08 Drug pricing: retrospective versus prospective MFN approaches

49:20 2026 outlook and closing thoughts

Key Topics

National Health Expenditure, healthcare spending, CMS reform, CMS Innovation Center, Medicare spending, Medicaid costs, hospital consolidation, rural healthcare, drug pricing, PBMs, 340B program, provider payments, patient-centered care, healthcare affordability, choice and competition, fiscal policy

About the Guest (at time of recording, January 2026)

Jackson Hammond is a Senior Policy Analyst at the Paragon Health Institute focused on health spending, CMS policy, and reforms centered on choice, competition, and patient-centered care. He authors Paragon's Paragon Prognosis analyses and has written extensively on CMS Innovation Center reform and strategies for making healthcare more affordable through competitive market approaches.

Podcast: DC EKG with Joe Grogan

Host: Joe Grogan

Guest: Jackson Hammond

Sponsor: Survivors for Solutions

Executive Producer: John CZ Czwartacki, DC EKG Podcast