Katy Talento ran healthcare at the White House Domestic Policy Council and helped push through the price transparency executive order. Now she runs health plans for a living, including for the convent where she once lived as a nun.

She spends this episode on why a post-network world keeps hitting the same wall: the three-way contracts between carrier, TPA, and provider that make the network Plan A by force. She explains why she thinks those provisions violate the Sherman Act, what DOJ has started doing about it, and why the workarounds employers use today amount to an underground railroad rather than a functioning market.

We also cover the 2026 CAA and the DOL rule that together make PBMs fiduciaries and may do the same to TPAs, her four-part "school choice for healthcare" plan to scale cash pay nationally, and the AI upcoding wave she thinks is breaking stop-loss actuarial models right now.

If you've ever wondered why the obvious fix isn't available to you, this is the episode. Tune in.

"Nobody in the entire town understands employer-sponsored care. All the oxygen is on 20 million people on the ACA. But 180 million people over here, we're not doing any policy for." - Katy Talento

Thank you to our 2026 sponsors!

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Chapters:

(00:00:00) Intro
(00:01:05) From Epidemiologist to Capitol Hill
(00:05:37) The Nun Years and Her First Client
(00:10:50) Inside the Price Transparency Executive Order
(00:16:58) Why Washington Ignores 180 Million People
(00:20:33) What Transparency Data Can Actually Do Now
(00:25:55) The Plantation Contracts
(00:29:01) DOJ, the Sherman Act, and Anti-Competitive Provisions
(00:33:04) The CAA and the DOL Rule That Reset Fiduciary Duty
(00:39:16) Why the Big Three PBM Model Is Now Illegal
(00:46:53) RBP's Access Problem: The Nuns at NYU Langone
(00:54:54) The Holy Grail: One Cash Price
(00:57:46) School Choice for Healthcare
(01:13:43) AI Upcoding and Why Stop-Loss Models Broke
(01:21:15) Closing Thoughts: Tell Your Story

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