REFILL | Jackson Hammond on NHE, CMS Reform, and Making Insurance Almost Obsolete (Originally Aired: January 22, 2026)

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