Key Policy Shifts Shaping Healthcare with Laura Dyrda

Summary

Becker’s Healthcare Podcast

Episode Title: Key Policy Shifts Shaping Healthcare with Laura Dyrda
Date: September 18, 2025
Host: Scott Becker
Guest: Laura Dyrda, Editor in Chief & Chief Content Officer

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Episode Overview

This episode dives deep into the major policy changes and legislative debates currently shaping the future of U.S. healthcare, with a focus on looming federal deadlines, pivotal healthcare programs, and the financial pressures facing hospitals and health systems. Laura Dyrda, Editor in Chief at Becker’s, outlines the critical issues on her radar, including government funding debates, the fate of ACA subsidies, telehealth flexibilities, HHS budget shifts, and potential changes to the 340B program. The discussion is candid and analytical, calling attention to the interconnectedness of healthcare funding and the operational realities faced by providers.

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Key Discussion Points & Insights

1. The September 30th Government Funding Deadline ([01:00]–[04:08])

• Context: An upcoming deadline for federal government funding puts hospitals and health systems on alert.
• Policy Stakes:
  • ACA Premium Tax Credits/Subsidies: Expanded during the pandemic, set to expire end of 2025.
    • Over 24 million currently enrolled in ACA plans, a majority reliant on financial help.
    • Without renewed subsidies, insurers warn of double-digit premium hikes in 2026, which could:
      • Push millions to delay care
      • Increase strain on emergency departments
      • Add billions in uncompensated hospital costs
    • The American Hospital Association projects a $28B loss for hospitals over the next decade if subsidies lapse.
• Congressional Debate:
  • House Republicans propose a short-term funding extension; Democrats insist on a healthcare-inclusive deal.

“If the subsidies disappear, insurers are already preparing for double-digit premium hikes in 2026 that could push millions to delay care, hit emergency departments harder, and add billions of dollars to uncompensated hospital costs.”
— Laura Dyrda ([01:36])

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2. Telehealth and “Hospital at Home” Policies ([02:20]–[03:10])

• COVID-Era Flexibilities: Two bipartisan bills in Congress could determine the fate of expanded Medicare telehealth coverage and the “Hospital at Home” program.
  • Over 300 hospitals now deliver at-home hospital-level care.
  • Policies on the table include temporary vs. permanent extension of these flexibilities.
  • Lack of congressional action could sunset these benefits this month.

“One proposal would extend them temporarily, another would make many of the flexibilities permanent so that telehealth, hospital at home could continue.”
— Laura Dyrda ([02:58])

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3. HHS Budget and Funding Shifts ([03:10]–[03:50])

• House Appropriations: Proposed 2026 HHS budget is $108B, a 6% cut from 2025.
  • Sharp CDC Reductions, Modest NIH Cuts
  • Expansion for Rural Health, Investment in Telehealth & Chronic Care Prevention
  • Hospitals are closely watching for impact on medical research, innovation, and operations.

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4. Contentious Reforms to the 340B Drug Discount Program ([03:50]–[05:15])

• HHS Pilot Proposal: Replace upfront drug savings with post-sale rebates.
  • Hospital groups argue this increases administrative strain and hurts safety-net providers.
  • Broad bipartisan pushback; lawmakers label the pilot “rushed and harmful.”
  • Outcome could reshape hospital finances for years.
  • Hospitals are contingency-planning for reduced 340B revenue and seeking alternative funding.

“HHS has floated a pilot that would replace upfront drug costs with post-sale rebates... Lawmakers from both parties have urged HHS to back off, calling the program and pilot rushed and harmful.”
— Laura Dyrda ([03:50])

“No, this concept on the rebate programs is really obviously feels a little insane...I always feel like I’m never going to get that rebate back...doing this at scale with the 340B program seems largely ridiculous or insane.”
— Scott Becker ([04:08])

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5. Broader Healthcare Funding & Hospital Margins ([05:15]–[06:47])

• Patchwork Funding Model: Hospitals rely on a mixture of programs (e.g., 340B, site-neutral payments) to remain solvent; removing any one creates systemic risk unless offset.
  • Site-neutral payments: The push for hospitals and outpatient centers to be paid the same is attractive on paper, but creates revenue gaps.
  • 22 hospital closures this year; over 70 more cutting jobs.
  • Trends not due solely to mismanagement—population needs and staff shortages play a major role.
• Stakeholder Advocacy: Hospital leaders are engaging legislators at all levels to highlight these impacts, especially for rural and community providers planning for higher patient volumes if funding is cut.

“On its face, [site neutrality] makes tremendous sense...But what people miss...is 340B is a very similar type of program...if you take one of these programs away, it's not right or wrong, but you have to fix it someplace else, because you can’t put hospitals underwater.”
— Scott Becker ([06:00])

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6. Legislative Uncertainty & Health System Planning ([07:32]–[08:50])

• Uncertainty Dominates: Hospitals face numerous “balls in the air” depending on Congressional deals and program renewals.
• What’s Ahead: Becker’s upcoming CEO/CFO roundtable in November to focus on these topics—how large, regional, rural, and community hospitals are planning for future growth amid ongoing disruption.

“There’s just a lot of uncertainty on how all of these trends will continue to play out, and especially given on the legislative front...can lawmakers find a way to ensure that these programs that are vital can continue to function in a meaningful way?” — Laura Dyrda ([07:32])

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Notable Quotes & Memorable Moments

• “If the subsidies disappear, insurers are already preparing for double-digit premium hikes...could push millions to delay care, hit emergency departments harder, and add billions of dollars to uncompensated hospital costs.”
  — Laura Dyrda ([01:36])
• “No, this concept on the rebate programs is really obviously feels a little insane...doing this at scale with the 340B program seems largely ridiculous or insane.”
  — Scott Becker ([04:08])
• “You can’t put hospitals underwater. I think we’ve seen this year, we’ve reported on 22 hospitals closing so far this year, another 70 hospitals or more cutting jobs...”
  — Scott Becker ([06:15])
• “We’re all kind of coming together to see what solutions are out there and what we can do together as partners in trying to make sure the healthcare system works better overall.”
  — Laura Dyrda ([08:45])

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Timestamps for Key Segments

| Time | Segment / Topic | |---------|------------------------------------------------------| | 01:00 | ACA subsidies, funding deadline, impact on hospitals | | 02:20 | Telehealth & Hospital at Home policy fate | | 03:10 | HHS budget, CDC, NIH, rural health investments | | 03:50 | 340B reforms, rebate pilot, legislative reaction | | 04:48 | Impact on rural hospitals, preparations for cuts | | 05:15 | Patchwork hospital funding, site-neutral payments | | 06:47 | Hospital closures, staff cuts, advocacy | | 07:32 | Legislative uncertainty, upcoming industry forums |

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Conclusion

The episode provides a clear-eyed look at the high-stakes policy battles underway in U.S. healthcare, the complex financial web that sustains hospitals, and the urgent need for legislative clarity to ensure continuity of care. Laura Dyrda and Scott Becker underscore both the granular operational concerns and the system-wide policy dynamics, making this a must-listen for those who need to understand where hospital financing and healthcare delivery could be heading next.

Transcript

[A]

Exciting things are happening at Beckers Healthcare Stay ahead of industry trends with the new Beckers CFO plus Revenue Cycle Podcast your go to source for insights from top healthcare finance leaders. Tune in wherever you get your podcasts and don't miss the 10th annual Health IT Digital Health RCM Conference happening September 30 to October 3, 2025 in Chicago. Join thousands of executives, engage with industry leaders and explore the future of healthcare innov. Learn more about our upcoming [e-mail] See you there.

[B]

This is Scott Becker with the Becker's Healthcare Podcast. We're joined today by Laura Dearda, Editor in Chief, Brilliant leader, also serves as Chief Content Officer, does a fantastic job. She joins us regularly to share stories that she's watching. Laura, let me tee it up and ask to turn it over to you. What are a couple of the stories that you're watching currently in healthcare?

[A]

Absolutely. Well, thank you so much Scott. I think right now we're looking at a very big deadline coming up here at the end of the month. It's the September 30th government funding deadline and why it matters so much for hospitals and health systems. House Republicans are preparing a short term measure to keep the government running through November 20, but Democrats have made it clear that they want to support a deal that includes health care provisions. So at the center of the debate is the future of the Affordable Care act premium tax credits and those subsidies first expanded during the pandemic are set to expire at the end of this year. So since their expansion, the ACA enrollment has really skyrocketed past 24 million people, with most participants receiving financial help. And if the subsidies disappear, insurers are already preparing for double digit premium hikes in 2026 that could push millions to delay care, hit emergency departments harder, and add billions of dollars to uncompensated hospital costs. The American Hospital association estimates hospitals could lose around $28 billion in spending over the next decade if the way at the same time, Congress is weighing other policies with long term consequences. There are two bipartisan bills that would decide the fate of pandemic era flexibilities Medicare, telehealth coverage, and the Hospital Home program. More than 300 hospitals are already delivering hospital level care in the patient's home. But without this congressional action, these programs could end this month. One proposal would extend them temporarily. Another would make many of the flexibilities permanent so that telehealth Health hospital at home could continue. So those are some really big things that we're watching today. And meanwhile, HHS is in the spot for his 2026 budget proposal too. The House Appropriations Committee has advanced a bill setting HHS funding at around $108 billion. A 6% cut from 2025 includes sharp reductions to the CDC and modest cuts for the National Institutes of Health. But it also boosts the rural health program and invests in prevention for telehealth and chronic care. So those again that hospitals and health systems are paying close attention to and how that impacts their operations, the funding and more for some of these medical breakthroughs. And then finally, we're also watching very closely the contentious debate around the 340B program. HHS has floated a pilot that would replace upfront drug costs with post sale rebates. And hospital groups argue that this would drive up costs for safety net providers already under strain. Lawmakers from both parties have urged HHS to back off, calling the program and pilot rushed and harmful. Whether the administration holds firm or backs down could reshape hospital finances for the years to come. And so at 340B we hear consistently from CEOs of hospitals and health systems is something that has been really beneficial for them. But they are planning for agencies if the program has changed and how they can continue with funding mechanisms outside of that program to keep their essential services flow.

[B]

No, this concept on the rebate programs is really obviously feels a little insane. It feels like when I go to Best Buy and I buy a washer and dryer and they tell me you pay the full price, 2,500 bucks or whatever you're paying for it or the refrigerator, but you're going to get a rebate back from the manufacturer for 500. I always feel like I'm never going to get that rebate back. And by the time I do so it's forever and it's always a hassle. And doing this at scale with the 340B program seems largely ridiculous or insane. I think that's how hospital executives and the AHA feels about that.

[A]

Yeah, absolutely. Absolutely. And you know, I'm hearing more and more from CEOs and CFOs, especially thinking about how they can really make this clear to their legislators, how they can talk through the impacts of what could happen if these programs are changed significantly as well as, you know, continued cuts to Medicaid follow through over the next couple of years. And so it's just been really a lot of focus on that type of connection in D.C. at the local and state level as well to try to ensure that hospitals and systems have the foundation that they need in order to continue providing services. And I do know, too, you know, a lot of hospitals, whether they're community hospitals or even more regional centers, have been planning and imagine that they'll need to be having bigger space and taking on additional patient volume because of these programs, you know, could really hit rural healthcare centers hard. And so they're already planning for that and just starting to make the adjustments needed to deal with the influx of patients.

[B]

One of the large challenges we have, of course, is a larger holistic problem that healthcare payments to health systems are this patchwork of things that help to keep hospital margins at least a little bit in the positive, at least for 60% of health systems right now. But you look at things like site neutrality, that hospitals shouldn't get paid any more than surgery centers get paid for. And of course, on its face, that makes tremendous sense, you know, and you would save billions if you moved site payments down to being the same payments to get in surgery centers for hospitals. But what people miss when they make that argument or make the. And the reason I mentioned it is 340B is a very similar type of program. On his face, it doesn't necessarily make sense in terms of a way to fund hospitals or make sure hospitals can make money or offset the cost of drugs, like in a vacuum. Some of these programs don't make necessarily sense, so they're easy to attack, but they all are part of a gestalt framework of how hospitals are able to make enough revenue to meet their expenses. And so what really happens is if you take one of these programs away, it's not right or wrong, but you have to fix it someplace else, because you can't put hospitals underwater. I think we've seen this year, We've reported on 22 hospitals closing so far this year, another 70 hospitals or more that are cutting jobs currently. You know, and it's, it's, it's not all because hospitals are not managing it well. It's just because we really deal with an exploding population and needs a shortage of staff in a very patchwork way of us all getting paid. So it is what it is. Laura, let me turn it back to you.

[A]

Yeah, no, absolutely. That's 100% what we're seeing and hearing across the board is just a lot of uncertainty on how all of these trends will continue to play out, and especially given on the legislative front. So many things up in the air and balls up in the air depending on whether Congress can work together and lawmakers can find a way to ensure that these programs that are vital to the care of communities and really important for hospitals and systems to stay up and running can continue to function in a meaningful way. We'll definitely be following that. Of course, any kind of extensions or other rules that come out around that over the next two or three months here, and especially leading into our CEO CFR Roundtable in November. A lot of our panels and discussions will be around these topics and how large health systems, as well as small rural and community hospitals are meeting these challenges and how their leaders are thinking about the future and still planning for growth in spite of all of this. So it'll be very interesting discussions, a lot going on and truly a place where we're all kind of coming together to see what solutions are out there and what we can do together as partners in trying to make sure the healthcare system works better overall.

[B]

Dora, thank you so much again for joining us on the Beckers Healthcare podcast. You're an extraordinary leader and I appreciate you joining us so much. Thank you very, very much.

[A]

Absolutely. Thanks so much, Scott.