Managed Care Under the Microscope: Medicare Advantage Overreach and Its Ripple Effects

Today, more than half of Medicare-eligible beneficiaries—nearly 35 million Americans—are enrolled in Medicare Advantage (MA) plans. These plans promise efficiency and added benefits compared to traditional Medicare, but a growing trend of MA payment delays and care denials is fueling concerns about insurer overreach.What’s behind this surge in MA overreach, and what does it mean for providers and patients?Brad Gingerich, Vice President at Ensemble Health Partners, joins this episode to unpack the incentives driving these behaviors, the impact on care delivery, and the solutions that could restore accountability and transparency. With years of experience helping hospital systems navigate managed care and revenue cycle challenges, Brad is the perfect guide through this complex and urgent issue.Guest Bio:Brad Gingerich is a healthcare executive with 15+ years leading managed care and revenue cycle operations for multihospital systems. He develops payer strategies and negotiates agreements — from fee-for-service to complex shared savings and population management — that balance provider priorities, strengthen payer partnerships and deliver organizational value. As a data-driven executive, he brings deep skills in analytics, contract modeling and financial forecasting, and is a recognized speaker and thought leader in healthcare finance.

Today, we are at the high-water mark of health coverage in America. More Americans than ever before benefit from the peace of mind that health insurance affords, with over 90 percent of Americans covered through private insurance, Medicare, Medicaid, or the exchanges. With recently passed legislation and Administration actions that target Medicaid and implement new rules for marketplace enrollees, these coverage levels are set to decline. This sets us up for a new challenge: what is our path forward for making health coverage accessible for those who need it, and how do we keep coverage affordable for those who have it?Larry Levitt, KFF’s Executive Vice President for health policy, joins this episode of Hospitals in Focus to discuss this challenge, and the solutions available to policymakers. Larry is a veteran policy expert steeped in knowledge of Medicare, Medicaid, and the health care marketplace who understands just how central health coverage is to Americans’ health. Guest Bio:Larry Levitt is the executive vice president for health policy, overseeing KFF’s policy work on Medicare, Medicaid, the health care marketplace, the Affordable Care Act, racial equity, women’s health, and global health. He previously was editor-in-chief of kaisernetwork.org, which was KFF’s online health policy news and information service and directed KFF’s communications.Prior to joining KFF, Levitt served as a senior health policy adviser to the White House and the Department of Health and Human Services, working on the development of the Clinton Administration’s Health Security Act and other health policy initiatives. Earlier, he was the special assistant for health policy with California Insurance Commissioner John Garamendi, a medical economist with Kaiser Permanente, and served in a number of positions in Massachusetts state government.Levitt holds a bachelor’s degree in economics from the University of California, Berkeley, and a master’s degree in public policy from the Kennedy School of Government at Harvard University.

Recently passed Medicaid cuts are estimated to increase the number of uninsured by over 10 million. That number climbs to over 16 million when you factor in the upcoming expiration of the enhanced premium tax credits that enable hardworking Americans to afford to purchase their own health insurance from the exchanges.Hospitals serve every patient who walks through their doors, regardless of their insurance or lack-thereof. These cuts will impact their ability to keep the lights on and reduce patients’ access to care – all of which has damaging effects on the surrounding community. On today’s episode, Donald Baker, Regional President for Ardent Health’s Texas Region, takes us inside the UT Health East Texas hospital system. Donald explains just how damaging recently passed health care cuts, and the possible elimination of the enhanced premium tax credits, could be not just on patient care, but on the health and economic wellbeing of the entire East Texas community. Guest Bio: Regional President, Ardent Health’s – Texas Region (Lone Star)Donald Baker serves as Regional President for Ardent Health’s Texas Region, known as the Lone Star Region. In this role, he oversees strategy development and operations for hospitals and health services in comprehensive delivery networks across Amarillo, Harker Heights, and East Texas, driving strategic growth, clinical excellence, and community-focused care.Previously, Mr. Baker served as Chief Operating Officer and Chief Financial Officer for UT Health East Texas, where he led a comprehensive network that included nine hospitals, an academic medical center, regional rehabilitation facilities, freestanding emergency centers, more than 90 physician clinics, and a full continuum of outpatient and in-home healthcare services. Under his leadership, the system operated the region’s only Level 1 trauma center and maintained a robust emergency transport network with over 65 ambulances and four helicopters, serving a 40-county region with nearly 8,000 employees.Before joining UT Health East Texas in 2020, Mr. Baker spent more than two decades with Hillcrest HealthCare System in Oklahoma, including 10 years as Market CFO. There, he supported seven hospitals, over 95 clinic locations, and 7,000 employees. His expertise spans managed care contracting, FP&A, financial operations, and executive leadership at large academic medical centers.Mr. Baker currently serves on the Texas Hospital Association Board of Directors, the HOSPAC Board, and the Tyler Economic Development Council Board of Directors. He holds a bachelor’s degree in accounting from Langston University and is a Certified Public Accountant (CPA).

With the passage of the One Big Beautiful Bill Act, Congress has taken a major step toward reshaping large parts of the nation’s health care coverage, through cuts, restrictions, and regulatory changes. The new law’s most consequential provisions, like work requirements and provider-related cuts, are not going into effect until 2027 and 2028, leaving room for uncertainty and political recalibration.  On this episode of Hospitals in Focus, Chip Kahn is joined by Jim Capretta - senior fellow at the American Enterprise Institute and senior adviser with the Bipartisan Policy Center – to discuss what the future of health care access and coverage looks like in light of the current political and policy climate.  Key topics include:  The health provisions included in the OBBBA, the likelihood they take effect, and their anticipated impacts if they are.  The future of the individual market and Medicaid. The Americans who may be caught in the middle of coverage losses.  The path forward on health policy.  Guest bio: Jim Capretta is a senior fellow at the American Enterprise Institute where he studies health care and entitlement policy. He is also a senior adviser with the Bipartisan Policy Center. He previously served in senior positions at the Office of Management and Budget and on the staffs of two congressional committees. He has an MA in public policy studies from Duke University and BA in government from the University of Notre Dame. He is the author of US Health Policy and Market Reforms: An Introduction, published by AEI in 2022. 

The One Big Beautiful Bill Act, which was signed into law on July 4, 2025, includes significant changes to Medicaid and the insurance exchange marketplaces that are expected to leave millions of Americans uninsured and significantly reduce resources available to fund care. In addition to the sweeping changes coming to health care, the enhanced premium changes that help hardworking Americans afford to buy their own health coverage from the exchanges are set to expire at the end of the year, which could leave as many as 5 million more Americans uninsured and lead to premiums skyrocketing for millions more. These impacts add insult to injury on 24/7 hospital care that is already stretched thin.In this episode, Chip Kahn welcomes Dr. Fred Blavin, a senior fellow at the Urban Institute, to explore Urban’s studies on how the OBBBA and the expiration of the enhanced tax credits could exacerbate challenges facing uninsured Americans and add to the uncompensated care hospitals will have to shoulder in the years ahead. Key topics include: The health measures included in the “One Big Beautiful Bill Act”The impacts the expiration of the enhanced premium tax credits would have on America’s uninsured rate and the health systems who provide all patients with critical care. The need for Congress to keep affordable access to coverage available and extend the tax credits. Studies relevant to the conversation: The Urban Institute: “Rural Hospital Revenue Could Drop by $87 Billion over 10 Years Because of the Reconciliation Bill and Expiring Enhanced Tax Credits”The Urban Institute: “State-Level Estimates of Health Care Spending and Uncompensated Care Changes under the Reconciliation Bill and Expiration of Enhanced Subsidies”Guest Bio: Dr. Fred Blavin is a Senior Fellow and leads the Low-Income Coverage, Access, and Affordability Practice Area in the Urban Institute’s Health Policy Division, where he specializes in health economics and policy research. He has extensive experience leading the design and the evaluation of state and federal policies related to medical debt, health care reform, Medicaid, income and benefits, and health information technology. His research incorporates diverse topics including medical debt and affordability, hospital finances, provider consolidation, health care spending and prices, and how public policy choices affect consumers, providers, and health insurance markets. He is an author of over 80 policy reports and 30 peer-reviewed articles in a variety of economic, policy, and medical journals. Dr. Blavin’s research has been featured in numerous local and national media outlets, such as the New York Times, USA Today, Wall Street Journal, Washington Post, Marketplace, Forbes, CBS News, and Kaiser Health News.

Medicaid provides critical care for over 72 million Americans—from children and pregnant women to individuals with disabilities, and seniors. It’s also a lifeline for the facilities that care for them, including hospitals and long-term care providers. In this episode, Chip Kahn welcomes Clifton Porter Jr., President and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), to explore the critical role long-term care providers play in the health care continuum—and how Congress’s Medicaid cuts threaten patients’ access to care in hospitals and in post-acute long term care settings.  Key topics include: AHCA/NCAL’s mission and who they serve; How hospitals and long-term care providers work together to support patients; Why Medicaid cuts jeopardize care; and,  What policymakers need to consider to protect access and quality of care  Guest Bio Clifton (Clif) Porter is the President & CEO at AHCA/NCAL.  Porter has been serving the needs of seniors in the long term care field for over 30 years, beginning his career as an administrator in training at a skilled nursing facility in 1989, serving as an administrator of several skilled nursing centers from 1990 through 1998, and capping his operational experience as a regional director of operations for a large-urban market from 1998 through 2004. Porter then accepted the challenge of leading HCR ManorCare’s Government Relations Department from 2004 to 2013 as its Vice President of Government Relations and served on various state healthcare association boards from 2004 to 2013. Today, Porter leads AHCA/NCAL’s national advocacy efforts, championing policies that protect high-quality care and strengthen the long-term care workforce. With his experience, he understands the devastating impacts that Medicaid cuts would have on residents and providers and is determined to ensure critical funding is preserved.  Porter holds a Bachelor of Science degree from the Virginia Commonwealth University School of Medicine in Healthcare Management. You can learn more about the devastating impacts Medicaid cuts will have on nursing homes from our provider survey: www.ahcancal.org/providersurvey To learn more about AHCA/NCAL’s advocacy efforts visit www.ahcancal.org. You can also find us at: Facebook, X, LinkedIn and YouTube. 

As Congress focuses on budget reconciliation and debates over Medicaid dominate the headlines, another major shift in health coverage continues quietly but powerfully—the explosive growth of Medicare Advantage (MA). Now covering more than half of all Medicare beneficiaries, MA plans are transforming the health care landscape in ways that can no longer be ignored.In this episode, Chip Kahn sits down with Molly Turco, a former CMS senior policy advisor and health policy expert at her firm MTT Strategies, to dig into the rise of Medicare Advantage, the challenges it presents for hospitals and patients, and what commonsense policy is needed to ensure the program delivers on its promises.Key topics include: Medicare Advantage by the numbers particularly in rural markets;MA Plans bring added benefits for the consumer but at a cost, including financial warning signs and long-term sustainability;  Hospital and provider obstacles, including prior authorization, observation care, and claim denials; and, Bipartisan policy shifts focusing on transparency and plan practices.Guest Bio: Molly T. Turco is a Medicare policy expert with over 15 years of experience shaping national healthcare strategy. Molly has dedicated her career to helping healthcare work better for people. She recently launched MTT Strategies, where she provides strategic and policy consulting services with a focus on Medicare Advantage and Medicare Part D. She previously served as Senior Policy Advisor for Medicare Advantage and Part D at the Center for Medicare at the Centers for Medicare & Medicaid Services (CMS), where she helped lead major initiatives to improve transparency, payment accuracy, and consumer protections in Medicare Advantage and Part D — including reforms under the Inflation Reduction Act. Prior to her work at CMS, Molly led Medicare policy efforts at the Blue Cross Blue Shield Association and the Better Medicare Alliance. She also brings experience as an investor consultant and public health researcher. Molly holds a BA from Middlebury College and a Master of Public Health from the Dartmouth Institute for Health Policy & Clinical Practice. She lives in Washington, D.C., with frequent trips to her home state of Vermont.

Medicaid is making headlines on Capitol Hill, and the debate is about more than just crunching numbers—it’s about people. This joint federal-state Medicaid program is a lifeline for millions of Americans, including children, seniors, people with disabilities, veterans, and low-income adults. From primary care to nursing home services, Medicaid provides critical coverage and support. But today, policy proposals under consideration in Washington could put that care at risk. In this episode, host Chip Kahn is joined by Medicaid policy expert Matt Salo, founder and CEO of Salo Health Strategies and former founding executive director of the National Association of Medicaid Directors. Matt brings decades of experience navigating the intersection of Medicaid and the practical implications of policy changes. Together, Matt and Chip dive into the policy cuts on the table and examine what they mean for patients in communities across the country.Key topics include: Medicaid’s design as a complex but critical program;What’s on the table in Washington from per-capita caps to block grants; and,The “waste, fraud, and abuse” narrative and downstream effects. Guest Bio: Matt Salo is the founder and CEO of Salo Health Strategies, a boutique healthcare consulting firm in the Washington DC area that specializes in strategic advice, health care policy, Medicaid market development and relationship building across 56 states and US territories. The firm capitalizes on decades of experience working with state and federal government officials as well as the full spectrum of Medicaid and broader health care stakeholders ranging from health plans, providers, pharmaceutical companies, foundations, and consumer groups. Matt is the founding Executive Director of the National Association of Medicaid Directors (NAMD), having started the association in February 2011, and he worked in that role until he stepped down in August 2022. The organization represents the state government leaders responsible for administering the Medicaid program. NAMD was established as a permanent community for state leaders to share best practices, and worked to develop technical assistance, invest in leadership development, and formulate a strong unified voice in communication with Congress, the Administration, and other key national stakeholders. He built the organization from an initial staff of one to a full-time complement of ten staff and an operating budget of more than $3 million. Matt formerly spent 12 years at the National Governors Association, where he worked on the Governors’ health care and human services reform agendas. His major accomplishments included getting legislation passed that guaranteed state control of the entire $250 Billion tobacco Master Settlement Agreement, which resulted in Forbes Magazine naming NGA one of the nation’s top ten most influential lobbying organizations. He also worked to get legislative approval of more than $100 billion in state fiscal relief during the Great Recession; and in bringing bipartisan groups of Governors together on multiple occasions to reach agreement on Medicaid reform proposals, ultimately serving as the backbone for the Deficit Reduction Act of 2007. Matt was a substitute teacher for two years in the Alexandria City public school system before joining the DC health policy world. He holds a BA in Eastern Religious Studies from the University of Virginia, and is still trying to find ways to explain how that got him to where he is today. Matt is a nationally recognized expert in Medicaid, state government, health care reform, federalism, long term care. He was recently named by Washingtonian Magazine as one of the 500 most influential people in Washington DC. He is a member of the National Academy of Social Insurance (NASI), and was recently recognized by the National Academy of State Health Policy as its 2022 Academy Award Winner for a lifetime of contributions to health policy. 

“Hospitals in Focus” takes a high-level look at how Americans really feel about two  cornerstones of health coverage in our country: Medicaid and the enhanced premium tax  credits available through the individual marketplace. Joining Chip Kahn on this episode is Bob Ward, a partner at polling firm Fabrizio Ward,  whose team recently conducted two national surveys examining public opinion on these  programs. The findings might surprise you—voters from across the political spectrum,  including MAGA Republicans, swing voters, and Democrats, overwhelmingly support  Medicaid and premium tax credits, even as partisan debates on potential cuts and the  extension of the enhanced tax credits continue in Washington. Key topics include: • Understanding the demographics and makeup of voters; • How views on Medicaid and the enhanced tax credits break traditional party lines; • What the data reveals about coverage concerns; and, • How lawmakers can better align with what Americans actually want. References:  Medicaid Attitudes Poll Memo for Modern Medicaid Alliance BAF Economy & Tax Poll for Building America’s Future Guest Bio:  Bob Ward is a partner of Fabrizio Ward, a public affairs polling firm he co-founded with  Tony Fabrizio, lead pollster for President Donald Trump. Ward is a veteran political pollster,  having worked for Republican candidates at all levels of government. Internationally his  political work extends to elections and NGOs in Europe, Asia, and Africa. He provides  political polling and election insights for a range of advocacy groups.  Ward has over 30 years of public and stakeholder opinion research experience,  specializing in public affairs research, corporate image, reputation, and issues  management. His counsel and research have guided a wide range of client engagements  including public affairs campaigns designed to influence policy makers, product liability crises, high profile litigation, long-term reputation measurement and management, to  message development supporting everything from rebranding universities, launching  advocacy groups, and product roll-outs. 

Medicaid, together with the Children’s Health Insurance Program (CHIP), forms the backbone of pediatric care in the United States — providing nearly 40 million children with access to routine checkups to life-saving hospital services. But that care is at risk. Congress is considering cuts to Medicaid funding, which could have devastating consequences for kids and the specialized hospitals that serve them.In this episode, Chip Kahn is joined by Matthew Cook, President and CEO of the Children’s Hospital Association. With decades of leadership experience on the floors of children’s hospitals and now serving as a national advocate, Matt offers powerful stories into what’s at stake if Medicaid is scaled back — and why protecting it is critical for the health and future of America’s children.Key topics include:The scope of Medicaid’s support for children’s health;The role of children’s hospitals in providing pediatric care;Unique challenges facing children’s hospitals;What proposed Medicaid cuts could mean for access, treatment delays, and pediatric services; and,What lawmakers need to understand beyond balancing the budget.Guest Bio:  Matthew Cook is President and CEO of Children’s Hospital Association (CHA), representing over 200 children’s hospitals and health systems as the leading national advocates for children’s health.   Cook is an established health care industry executive with decades of unparalleled leadership which includes leadership roles at children’s hospitals and maternal health programs. Cook also previously served as a member of CHA’s Board of Trustees and Public Policy Committees.  Prior to joining CHA, Cook served as president of UCSF Benioff Children's Hospitals and senior vice president of Children’s Services at UCSF Health, where he oversaw strategic direction, operations, and clinical services for all pediatric services in both Oakland and San Francisco, as well as serving on the UCSF Health leadership team.   Cook previously served as president of Riley Children’s Health and chief strategy officer for Indiana University Health and served as executive vice president of strategic planning and business development at Children's Hospital of Philadelphia. Cook was also a principal at the Chartis Group, a health care consulting firm based in Chicago.  Cook earned a Master of Business Administration from New York University and graduated cum laude with a Bachelor of Science in Economics from The Wharton School of the University of Pennsylvania.