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 Timestamps0:55 Jackson's background and how he got into health policy3:39 Focus areas: Medicare, hospitals, drug pricing, PBMs, and 340B5:14 What the NHE report is showing6:14 Healthcare spending trajectory: $5.2T to $8.6T and why it matters8:00 Why health spending is not really optional10:11 Where the money goes: payer mix and per-enrollee costs12:23 Medicaid costs, provider taxes, and state financing tactics15:58 Medicare spending pressure and fiscal risk21:06 Misconception: coverage equals care26:18 Why provider payments keep rising after COVID demand and consolidation33:01 Rural care, consolidation, and rural emergency hospital models40:08 Drug pricing: retrospective versus prospective MFN approaches49:20 2026 outlook and closing thoughtsKey TopicsNational 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 policyAbout 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 GroganHost: Joe GroganGuest: Jackson HammondSponsor: Survivors for SolutionsExecutive Producer: John CZ Czwartacki, DC EKG Podcast