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

DC EKG

In this episode of DC EKG, Joe Grogan interviews Jackson Hammond, a senior policy analyst at Paragon Health Institute, about his work on Medicare, drug pricing, hospital reform, and the potential for

Key takeaways

• National health expenditures are growing rapidly, projected to reach $8.6 trillion by 2033—over 20% of GDP.
• The healthcare system is inefficient, with hospitals receiving disproportionate funding despite not being the primary innovators.

Main topics

• National Health Expenditures (NHE) report trends
• Medicare reform and drug pricing policy

Notable quotes

"We are always increasingly spending hundreds of billions more every year. In 2024, the estimate is $5.2 trillion. Estimated for 2025, $5.6 trillion."

Conclusion

Despite troubling trend lines in healthcare spending, Jackson Hammond remains optimistic about the future of health

Transcript preview

Speaker 1 (0:00) This refill episode was recorded in January 2026. At the time of recording, Jackson Hammond was a senior policy analyst at Paragon Health Institute focused on health spending, CMS policy, and reforms centered on choice, competition, and patient-centered care. This is DCEKG, exploring the intersection of politics and healthcare by diagnosing Washington and prescribing solutions. We take a deep dive into the legislation, regulation, and innovation impacting policymakers, providers, and patients. Now, America's health policy expert, Joe Grogan. Speaker 2 (0:40) Welcome back to DCEKG, the most informative healthcare podcast that focuses on Washington, D.C. policy issues. I'm Joe Grogan, the host, and today we're joined by Jackson Hammond. Jackson is one of these young Turks who get on my nerves and reminds me how old I am every time I talk to him. And he clearly has a high energy level. So Jackson, thanks so much for joining. Speaker 3 (1:07) Of course, Joe. Thanks for having me on. Look, you're doing better than me in the hair department, at least. Speaker 2 (1:12) So let's talk a little bit about your role. You're a big shot at Paragon Health Institute, the most important new think tank in Washington, D.C. In healthcare policy, I'd say Paragon is now the most important think tank. And as far as number of references or impact, I think 2025. had a huge impact, bigger than anybody else's. And coincidentally, I happen to be chairman of the board and only got to know you for the past few years. So Jackson, let's start with you. How did you get involved in healthcare policy? Speaker 3 (1:48) Well, I started 2017. I wanted to do trade and criminal justice when I became a young Senate Legislative Correspondent, a junior staffer there. And I got assigned to the health care portfolio. And I got mentored there, though, by a great woman named Jamie Light, who's no longer with Todd, but she was Todd Young's longtime health care advisor. Speaker 3 (2:12) That and the mentorship, as well as it was right around the time, it was 2017, repeal and replace was big action. Everything was happening all at once. And healthcare was a really cool topic to be in. And I got to meet with a lot of people as well, patient groups, providers, et cetera. And you really learn how much that healthcare matters in a way to people that. Tax policy doesn't, not to attack tax policy or anything, it's very difficult. But, you know, my tax policy friends will point out when I go, man, I can't, I could never do tax policy. It's so hard. They're like, no one cries on you in tax policy meetings. And so it means something. And it really kind of imbued me with this sense of like, this isn't that really matters to people a whole lot in a way that I hadn't considered before. You know, I know healthcare is important. Doing that, I kept trying to get deeper and deeper into the policy. I went to the House for a year. I went to the Republican Governors Association. uh as a policy advisor uh in healthcare during the pandemic uh which is an incredible time to do healthcare policy in the states by the way march 25th 2020 was when i started Speaker 2 (3:14) oh right and then uh after a year there i joined think tank land Speaker 3 (3:19) american action forum i was there for just under three years doing Speaker 2 (3:23) a Speaker 3 (3:23) healthcare policy all the time then i through the and i have to give them a shout out the health reformers academy which is headed by Josh Archambault, formerly of Cicero. It was a great group of folks who I met there along the way, including Elman Aminarek, Tanner Aleph. But through that, I got connected to Paragon and I got noticed. And Brian approached me and was like, hey, we'd like to bring you on. And I was like, absolutely. This is where all the magic's happening right now. Speaker 2 (3:55) Cool. So in health care, what health care policy, what topics are you focused on most or do you care about most passionately? Speaker 3 (4:05) Right now, at Perion, my big focus is Medicare and drug pricing. I think in those, those encompass a lot of the health care system, spending over a trillion dollars every year on health care. And we'll get into that later on Medicare specifically, rather. Hospital reform policy in general really gets me going. I have found over the years, there's no good guys in healthcare. I'll put it that way. I think everyone has their problems as part of this sector. But for me, it's the hospital industry where you're not the doctor, you're not making the medicine. Somehow you're getting most of the money. It never ever sat right with me. And you've got nonprofit institutions acting like for-profit actors and they're chasing after. indigent patients with debt collectors who would otherwise qualify for their charity care programs but they're hidden from that there's just a lot of things in that that really gas me up um as well i so i don't want to get too into it but uh the on top of that uh kind of part of drug pricing pbm issues as well i got into that because my old boss at american action forum laura hobbs steered me down that road and what used to be a thing I would avoid all the time, drug pricing in general, PBMs as well, was something I got really into. And it's now one of the things I've known for riding well. And of course, 340B. Speaker 2 (5:31) 340B, yeah, the gift that keeps on giving. It's interesting you said, I don't know any young conservative policy person who goes to DC to do healthcare policy. They all end up wanting to do something else. And then they kind of fall into health care for whatever reason. And then they find themselves intellectually intrigued, having the ability to run a portfolio that others are not interested in. And then you can have an impact. So it's not an unfamiliar story to encounter somebody smart like yourself who's more interested in other subjects on the right and then realizes how cool it is. So what national health expenditures? report came out in, I want to say this summer, June, correct? June, July timeframe. You did a lot of digging into this. Well, first of all, what is the NHE report? What does it tell us about the state of the country? Speaker 3 (6:31) It's not good. I've never seen one of these that has ever been a good news. We are always increasingly spending hundreds of billions more every year. In 2024, the estimate is $5.2 trillion. Estimated for 2025, $5.6 trillion. We've grown in a year $400 billion in extra spending on health care. Speaker 2 (6:56) That's dollars shifting from one hand to another. So that encompasses. Medicare, Medicaid, commercial, private pay, but everything. Speaker 3 (7:05) Oh, yeah. That's everything from business to business stuff between insurers and PBMs and other TPAs. All the government spending you could possibly imagine. Everyone's personal expenditures. All of that's included in Speaker 2 (7:17) there. So we're spending 5.2. We're projected to spend 5.6. 5 Speaker 3 (7:22) .2. Yeah, 5.6 this year, 2025. It gets up to 8.6. trillion dollars by 2033 8.6 trillion which Speaker 2 (7:35) is like tomorrow 2033 is like tomorrow i Speaker 3 (7:38) i keep blinking and all of a sudden we're at the next crisis level uh for the medicare trust fund or for the next spending cliff all of this and it is right around the corner everyone it's it's hard to Speaker 3 (7:55) overstate how much of a burden this is. That is in 2033, that will be over 20 % of GDP for the U S currently we're already at a little over 18 % right now in 2023, it was 17.6%. And we are, it is escalating constantly, but Speaker 2 (8:17) here's the thing. And this is, this is a. a little bit of a provocative statement, but who cares, honestly? I mean, if American people are rich and they want to spend money on health, why not let them spend money on healthcare as opposed to video games or as opposed to amusement parks or movies? What do I care if... my neighbor is going to get i i don't know if plastic surgery is included i would imagine plastic surgery is a national health so if they want to go get their eyes done or something else or they want to go to um go to the physician to have something looked at what do i care Speaker 3 (9:00) I think it's not necessarily a question of like, should people be doing X amount if they're voluntarily getting procedures, if they're willing to spend extra money on, you know, premium care or some sort of concierge health service. I don't think that's the problem. The issue is that for the vast majority of people, these are not like, oh, I feel like spending more on health care today. The amount we're spending every year is a direct sign that people. more and more are spending more of their money on health care, where they would almost assuredly rather spend on other things, rent, mortgage, their kids, any sort of various mundane or fun luxury item, anything else. I think very few people go, oh, goody, I get to pay a hospital bill. And these expenditures are also signs not just that people are spending more, but the reason they're spending more is because prices are going up constantly. Premiums go up for insurance. Prices go up for hospital care. Prices are going up for at least out-of-pocket prices. Now we can get to that on the drug pricing side, but out-of-pocket prices are going up for drugs for the vast majority of people. And so we're seeing people spending more money where they otherwise would almost assuredly allocate it to something else if they had the option. Speaker 2 (10:14) That's fair enough. Yeah, I don't think people are, as a general rule, would like spending as much as they want. And we're not getting any healthier. Right. With all these expenditures. Oh, Speaker 3 (10:24) no, no, no. We are getting sicker by the day. Yeah. Speaker 2 (10:27) So what is the what when you peer behind the numbers and the top line numbers are pretty horrific? What does it tell you about the payer mix or more people accessing care through Medicaid, for instance, than they were five years ago? Are there fewer people covered by commercial? Where is all this money going? I mean, we hear a lot about drug companies are sucking up all this cash. but who's getting the bulk of the money? And when you look at it, Jackson, what are you drawing out of this data? Speaker 3 (10:59) A lot of it is coming from growth that we're seeing in Medicare expenditures. I think the part of the issue that some of this is a little intractable is that we just have a constantly growing Medicare population. We are probably at peak boomer entry into Medicare, but the issue is that the boomers also had kids roughly at or above replacement level of the population. So it's not like it's going down. There's not like a bubble. that came and then it's going to go back down to like pre-boomer levels of Medicare. We're just going to see it kind of stay at that, if not grow slightly every year from there. I think that's probably the biggest issue you're seeing, for example, the per enrollee spending. So private health insurance is the majority of the spending. That's 1.7 or the plurality of the spending, 1.7 trillion in 2025. When Speaker 2 (11:51) you say private health insurance, are you talking about? Me through my employer, you through your employer, Speaker 3 (11:57) ACA, any plan that you're paying for a premium out of pocket that is not Medicare, Medicare Advantage or Medicaid. That includes the government health care benefits as well. So if you're in the does not count for TRICARE or the VA, but it does include like if you're in a union or if you're a public employee for a state or something like that. counts as private insurance, which is questionable if that should really count as private insurance because that's so heavily subsidized by the taxpayer. Speaker 2 (12:27) Well, yeah, we'll give it to them. Okay. So your number one trend line, your number one takeaway is the increase in expenditure just for the cost of private