REFILL | Ryan Long on 340B Drug Pricing, Enhanced ACA Tax Credits, and Medicare Part D (Originally Aired: September 24, 2025)

Joe Grogan sits down with Ryan Long, healthcare policy expert and senior research fellow at Paragon, to discuss three critical healthcare policy issues facing Congress. First, the Congressional Budget Office's landmark analysis of the 340B drug pricing program, which revealed the program increases federal spending, drives up premiums, and channels most benefits to wealthy hospitals rather than those serving low-income patients. Second, the enhanced premium tax credits set to expire at the end of 2025, which have been plagued by fraud and fraudulent enrollment. Long explains how unscrupulous brokers have exploited the system, enrolling people without their knowledge, with billions in improper payments going to insurance companies. Third, the Inflation Reduction Act's devastating impact on Medicare Part D, including premium increases from thirty to sixty dollars monthly, coinsurance replacing copays, and seniors paying higher out-of-pocket costs despite the legislation's promise to lower drug costs.

Key Timestamps

1:20 Welcome to DC EKG and introduction of Ryan Long 2:15 Congressional Budget Office analysis of 340B program 4:06 Why CBO conducted the 340B study 4:25 How 340B increases federal spending and premiums 4:58 Studies showing 340B drives higher-cost drug utilization 5:30 Will CBO analysis lead to legislative reform efforts 6:15 Program expansion from 90 to 2,600 participating hospitals 8:06 Timeline for 340B reform legislation 10:43 340B program growth from two billion to sixty-six billion annually 11:52 Why insurance companies support limiting 340B 12:20 Enhanced premium tax credits and ACA credits expiring 14:22 Difference between baseline and enhanced ACA credits 16:34 Zero-dollar plans and fraud mechanisms 18:19 Broker fraud and fraudulent enrollment schemes 21:09 How fraudulent brokers exploit free plans and commission structure 22:53 Paragon study showing four times over-enrollment in Florida 25:30 Misleading polling about ACA credits expiring 28:18 Groups pushing misleading messaging on enhanced credits 29:31 Political dynamics and Republican position on credits 33:17 Government shutdown politics and Democrat strategy 36:09 Elevance exiting standalone Medicare Part D plans 38:03 Migration from Part D to Medicare Advantage due to IRA 39:15 How IRA's out-of-pocket cap restructuring increased premiums 40:34 Coinsurance replacing copays and cost shift to seniors 42:20 IRA using fictitious list price to calculate negotiated savings 44:47 Multiple factors causing Medicare Part D premium increases

Key Topics 340B program, Congressional Budget Office, drug pricing, hospital consolidation, enhanced premium tax credits, ACA fraud, fraudulent enrollment, broker fraud, government subsidies, Medicare Part D, out-of-pocket costs, coinsurance, Inflation Reduction Act, pharmaceutical pricing, program integrity

About the Guest (at time of recording, September 2025) Ryan Long is a Senior Research Fellow at the Paragon Health Institute and affiliated with the USC Schaefer Center for Health Policy and Economics. He is a healthcare policy expert with extensive experience on Capitol Hill, including service as a staffer on the House Energy and Commerce Committee and chief health policy advisor to Speaker Kevin McCarthy. Long specializes in healthcare reform, pharmaceutical pricing policy, Medicare and Medicaid issues, and legislative strategy.

Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Ryan Long

Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast