The Healthcare Policy Podcast ® Produced by David Introcaso

Listeners are all well aware US healthcare is increasingly unaffordable. Among other stats nearly 50% of Americas are either uninsured, at 8% or 27 million, or underinsured, at 41% or 120 million. Upwards of 4.8 million Americans are expected to drop their ACA coverage; the average commercial family plan comes w/a $6,800 annual premium and 42% of Americans are now enrolled in high-deductible commercial health plans. As a result 36% of all adults now skip or postpone medical care. Though I’ve likely previously cited, the Noble Prize-winning Princeton economist Angus Deaton concluded in 2020, the US healthcare industry,
“is a cancer at the heart of the economy, one that has widely metastasized, bringing down wages, destroying good jobs and making it harder and harder for state and federal governments to afford what their constituents need. Public purpose and wellbeing of ordinary people are being subordinated to the private gain of the already well off. None of this would be possible without acquiescence – and sometimes enthusiastic participation – of the politicians who are supposed to act in the interest of the public.”


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Over the past 12 years the Affordable Care Act (ACA) has reduced the total number of uninsured Americans and low-income individuals more specifically by over 50% and by over 66% for young adults. In 2025 the ACA insured a record breaking 45 million Americans: 24 million through the federal and state exchanges; and, 21 million via the ACA’s expansion of the Medicaid program. Having been under nearly continual attack by Republicans, the proposed 2027 ACA rule, announced February 9th (with comments due March 13), was highly anticipated. Within a week after it was announced, Professor Keith and her colleague Matthew Fielder authored three lengthy essays unpacking numerous proposed rule provisions. Top of line the authors noted the proposed, if finalized, will decrease marketplace enrollment by 2 million in 2027 (marketplace enrollment is already down this year by one million due to the Congress’s refusal or failure to extend COVID-era enhanced premium tax credits) and will increase ACA-related reporting & record keeping by approximately $1.34 billion every year.
The first of three Health Affairs’ Forefront essays by Katie Keith and Matthew Fielder is at: https://www.healthaffairs.org/content/forefront/hhs-proposes-sweeping-changes-2027-marketplace-plans-part-1
The second is at: https://www.healthaffairs.org/content/forefront/hhs-proposes-sweeping-changes-2027-marketplace-plans-part-2
The third is at: https://www.healthaffairs.org/content/forefront/hhs-proposes-sweeping-changes-2027-marketplace-plans-part-3
The proposed rule is at: https://www.govinfo.gov/content/pkg/FR-2026-02-11/pdf/2026-02769.pdf
CMS’ related press release is at: https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-payment-parameters-2027-proposed-rule



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Podcast listeners are aware US healthcare, the largest industry in the world’s largest economy, consumes- and wastes a massive amount of carbon-based energy made painfully evident by the fact annual greenhouse gas emissions account for over 600 million metric tons of carbon dioxide equivalents. Healthcare’s extraordinary or excessive energy consumption means it is a high entropy producer, one that is s responsible for a great deal of (literally) unaccounted for waste, termed more formally negative externalities. What this means in sum is the US healthcare industry works directly against itself. For example, the annual social costs of just three industry greenhouse gas emissions are has high as more than total annual Medicare and Medicaid spending, or ~ $2 trillion. For this reasons and others entropic philosophy as a root metaphor can explain our infatuation with modern entropic nihilism and can offer or a way out of or overcoming it.
Prof. Mussett’s 2022 work, “Entropic Philosophy, Chaos, Breakdown and Creation,” is at: https://www.bloomsbury.com/us/entropic-philosophy-9781538165188/.
Drew Dalton’s related Aeon essay published last August and discussed here, “Reality is Evil,” is at: https://aeon.co/essays/philosophers-must-reckon-with-the-meaning-of-thermodynamics.


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Listeners may recall I interviewed Ms. Smith early last March because the Trump administration immediately abandoned a decades old policy that forbade immigration enforcement at “protected [or sensitive] areas” that include healthcare facilities. Now a year later, ICE contingents have been sent to over 15 cities including of course Minneapolis. Beyond ICE arrest operations resulting in gunshot wounds, blunt force and psychological trauma and a constellation of subsequent health harms via arrest and detention, ICE agents have been appearing moreover in community health center and hospital ED waiting rooms, accessing facility medical examination rooms and pursuing Medicaid and other patient record resources. As a result, patients are effectively being “ICE-d Out of healthcare.” A recent Kaiser survey found, e.g., 14% of lawfully present immigrants, 8% of naturalized citizens and 48% of undocumented immigrant adults said they or a family member have avoided seeking medical care this year. In turn, healthcare providers are in sum left to determine how they can meet their professional responsibilities to effectively render timely care while managing or deescalating intimidation and avoiding possible obstruction charges.
The recently published JAMA article, “Patients Are Getting ICE-d Out of Health Care” is at: https://jamanetwork.com/journals/jama/fullarticle/2845182.
The recently published Stateline article, “Health care workers want ICE Out of Hospitals, and Blue States Are Responding,” is at: https://stateline.org/2026/02/09/health-care-workers-want-ice-out-of-hospitals-and-blue-states-are-responding/.


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Over the past few weeks the Trump administration has significantly upped its game to eliminate greenhouse gas regulations that protect human and global health. The Sabin Center on Climate Change Law’s “Climate Backtracker” database presently identifies over 320-related administrative and regulatory actions that in sum undermine the EPA’s mission to protect human health and the environment. Most recently, the US has withdrawn from the United Nations Framework Convention on Climate Change (UNFCCC) and 65 other related international organizations, rescinded National Environmental Protection Act’s (NEPA) implementing regulations and moved to roll back automotive fuel efficiency standards by nearly 33%. Concerning the Clean Air Act, initially passed in 1963, the EPA is expected to soon finalize a 2025 proposed rule to rescind its Endangerment Finding that provides the legal basis for the agency to regulate six greenhouse gasses and recently announced the agency is no longer estimating the monetary value of lives saved in establishing the limits of two major air pollutants: ozone; and, fine particulate matter frequently noted as PM 2.5.
The Columbia University Sabin Center “Climate Backtracker” database is at: https://climate.law.columbia.edu/content/climate-backtracker.
Information on Resources for the Future is at: .https://www.rff.org/.
Dr. Hubbell’s bio is at: https://www.rff.org/people/bryan-hubbell/.


This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com