The Healthcare Policy Podcast ® Produced by David Introcaso

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/.


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To begin my 14th year of podcasting, my 335th interview is with John Abraham, Professor of Thermal Science and Fluid Mechanics at the University of St. Thomas. Prof. Abraham joins me for a fifth time or for a fifth consecutive year to discuss ocean warming in 2025 and the increasingly frightening consequences thereof.
Last Friday, Prof Abraham along with 54 research colleagues published in “Advances in Atmospheric Sciences” the article, “Ocean Heat Content Sets Another Record in 2025.” Their research found that in 2025 oceans absorbed 23 zetajoules (n followed by 21 zeros) of heat (30% more than in ’2024), a finding consistent with the fact that nearly every year since the start of the millennium has sent a new ocean heat record. In turn, the authors note long-term ocean heat accumulation contributed to extreme climate-related events in 2025 that included increasingly intense tropical cyclones, hurricanes and typhoons, heavier downpours (e.g., in late October Central Vietnam received 5.5 feet of rain in 24 hours), greater flooding, landslides, wildfires, longer marine heatwaves, increasingly decimated sea life, ice sheet loss and sea level rise that in sum impacted billions around the world. As I noted in previous years, ocean surface temps are now warming 40 times faster than 40 years ago. Because ocean heat content plays a fundamental role in the Earth’s energy, water and carbon cycles, warming ocean temperatures disrupt marine life that substantially threaten the availability of food we eat and the oxygen we breathe.
Abraham and colleagues’ article, “Ocean Heat Content Sets Another Record in 2025,” is at: https://link.springer.com/article/10.1007/s00376-026-5876-0.


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