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