Podcast Summary:

The Clay Travis and Buck Sexton Show – "Wellness Unmasked: The Future of U.S. Healthcare: Fixing Home Care, Fraud, and Broken Policies"
Date: January 13, 2026
Host: Dr. Nicole Saphier (guest hosting)
Guest: Julian Hagman, CEO of Caring Professionals

Episode Overview

This episode tackles pressing challenges in the U.S. healthcare system, focusing on home care, fraud, policy failures, and the impacts of expiring Affordable Care Act (ACA) subsidies. Dr. Nicole Saphier interviews Julian Hagman, CEO of Caring Professionals, to explore how policy decisions affect patient care and what reforms are needed. The discussion ranges from structural problems in home care policy to the human side of aging in America, with real-world insights on fraud, funding, and outcomes.

Key Topics & Insights

1. The State of the U.S. Healthcare System

[02:03]

• Fragmentation & Segregation: Hagman describes New York's healthcare as "becoming more segregated" due to legislation, which fractures continuity of care, especially for the elderly and disabled ([03:41]).
• Monopolization & Loss of Choice: New York consolidated providers into a single, state-sanctioned monopoly for home care, limiting patient choice and increasing risk of institutionalization ([04:21]).

Notable Quote:
"They're really stripping apart the home and community based models to create fractured care across the spectrum." — Julian Hagman [03:41]

2. The Affordable Care Act, Subsidy Expiration, and Cost Pressures

[05:42]

• Subsidies Expiring: COVID-era enhanced ACA subsidies expired at the end of 2025, not extended into 2026.
• Impact: Millions may see premiums rise (“sticker shock”), affecting whether people can afford care ([06:34]), potentially leading to more ER visits and less preventive care ([07:34]).
• Comprehensive Mandates Drive Up Costs: Mandated coverage for comprehensive services, while well-intentioned, increases insurance premiums, reducing affordability for all ([07:34]).

Notable Quote:
"That's like saying your car insurance has to cover your oil changes or even your car washes… What's going to happen? Your insurance cost is going to go up" — Dr. Nicole Saphier [07:34]

3. The Case for Home Care

[09:01]

• Patient Preference: Most people, across political lines, prefer to remain at home as they age rather than move into institutions ([09:22]).
• Cost-Effectiveness and Better Outcomes: Investing in home support prevents costly hospitalizations, “a line item on the budget in the billions” ([09:22]).
• Structural Models: Home care can be provided via two routes ([12:02]):
  • Traditional provider-sent aides (vetted, trained, but with limits on care level).
  • Consumer Directed Personal Assistance Program (CDPAP): Patients pick trusted caregivers (family/friends), capable of higher-level tasks like administering medication.

Notable Quote:
"My whole philosophy is keep people in the home, keep people in community where they want to be." — Julian Hagman [09:01]

4. Balancing Care Quality, Skills, and Oversight

[17:16]

• Who Decides Level of Care & Skill?: A multi-step process starting with the primary care physician, followed by state assessment, managed care review, and a final provider assessment ensures appropriate care and safety ([17:46]).
• Training and Limitations: There's a strict delineation between what licensed and unlicensed caregivers can do; family/friends can perform higher-skill tasks if trained and assessed properly ([12:02]).

Notable Quote:
"There are checks and balances in place to ensure that nobody coming off the street can get into this program and, you know, be put at risk." — Julian Hagman [17:46]

5. Fraud in Home Care: The Minnesota Case and National Implications

[18:39]

• Minnesota Scandal: Fraud surfaced in both childcare and home care claims, leading to public outcry ([18:39]).
• New York’s Approach: Advocacy failed to prevent consolidation into one massive provider, ostensibly to combat fraud. Hagman argues the move invited new risks and removed choice, while lacking evidence for widespread fraud ([19:30],[23:13]).
• Political Power and Contracts: The winning provider (“Public Partnerships LLC”) secured a $60 billion contract, bypassing oversight, and opening the door for large unions to consolidate their influence (“the fourth branch of government” [25:15]).

Notable Quote:
"Now that this whole workforce is monopolized under one company, guess who's coming to knock at the door trying to get a piece of their pie? The 1199 SEIU." — Julian Hagman [24:42]

6. Future Threats: Budget Cuts and Policy Shortfalls

[26:00]

• With Subsidies Gone and Budgets Tight: Consumer-directed programs may “start going away…disappearing,” despite their effectiveness and cost savings ([26:14]).
• Waste in Consulting: States spend “hundreds of millions” on consultants rather than listening to providers who do the actual work ([26:14]).

Notable Quote:
"The providers would be able to help you more than a consultant… it's all from an office building somewhere or a Zoom meeting somewhere." — Julian Hagman [26:14]

7. Value-Based Care and Policy Failures

[27:27]

• Bundled Payments & Value-Based Care: Tied to ACA, these policies have not shown outcome improvements, but have increased system confusion and costs ([27:27]-[28:57]).
• Disconnect Between Policymakers and Providers: Providers are left out of the design and implementation of reforms that directly affect their work ([28:57]).

8. Advice for Policymakers

[28:57]

• Root Out Contract Waste: True fraud is in massive, opaque government contracts, not small-scale provider or consumer fraud ([29:27]).
• Top-Down Review Needed: Calls for federal and state officials to “inspect, review, and grade” all contracts, looking for real waste, abuse, and misplaced priorities ([29:27]).

Notable Quote:
"That's the real fraud, that's the real miscarriage of justice here. And it's not the mom who, you know, got twelve hundred dollars fraudulently, it's the company…paying some PAC somewhere, you know, a million dollars to get a hundred million dollar contracts." — Julian Hagman [29:27]

9. Human Impact and The Value of Home-Based Care

[34:59]

• Quality of Life: Staying at home leads to better physical, mental, and social health, especially when compared to institution-based care ([35:17]).
• Blue Zones as a Model: Societies with longest, healthiest lives keep elders at the heart of families and communities ([36:23]).
• Compensating Family Caregivers: Programs enabling families to be paid for home care help keep patients out of institutions and provide dignity ([36:23],[37:48]).

Notable Quote:
"It's really about staying engaged…when people sit in a nursing home or even at their own home and they don't have anybody to talk to…everything just starts sliding downhill." — Julian Hagman [37:48]

Memorable Moments & Quotes (with Timestamps)

• Home Care Fragmentation:
  "They're really stripping apart the home and community based models to create fractured care across the spectrum." — Julian Hagman [03:41]
• Loss of Choice:
  "Eliminating choice for the consumers and creating more of a risk for those individuals to be hospitalized..." — Julian Hagman [04:21]
• Insurance Cost Analogy:
  "That's like saying your car insurance has to cover your oil changes or even your car washes… what's going to happen? Your insurance cost is going to go up..." — Dr. Nicole Saphier [07:34]
• On Fraud and Monopolization:
  "I'm happy that that's public and that's out there. Where are these other cases of fraud?...They could never, you know, show me the receipts for any of this stuff." — Julian Hagman [21:46]
• True Nature of Waste:
  "That's the real fraud, that's the real miscarriage of justice here. And it's not the mom who, you know, got twelve hundred dollars fraudulently, it's the company…paying some PAC somewhere, you know, a million dollars to get a hundred million dollar contracts." — Julian Hagman [29:27]
• Why Home Care Matters:
  "The results, you know, in terms from the patient aspect of things…are best treated in the home." — Julian Hagman [35:17]
  "One of the big pillars to people living longer and healthier lives is that they are maintained as part of a community." — Dr. Nicole Saphier [36:23]

Timeline of Key Segments

| Timestamp | Segment/Topic | |-------------|-----------------------------------------------------------------------------| | 02:03 | Introduction to rising healthcare costs & system breakdown | | 03:41 | Fracturing and monopolization of home care | | 05:42 | The ACA, COVID-era subsidies, and the impact as they expire | | 09:01 | Advantages of in-home care and the structure of home care programs | | 12:02 | The Consumer Directed Personal Assistance Program (CDPAP) details | | 17:16 | Training, assessment, and oversight in home care | | 18:39 | Minnesota fraud scandal and parallels in New York | | 23:13 | Public Partnerships LLC single-provider contract in New York | | 25:15 | Unions’ role in new home care structure | | 26:00 | Threats to home care as budgets tighten | | 27:27 | Why value-based reforms have often failed | | 29:27 | Policy prescriptions and rooting out contract waste/fraud | | 34:59 | Personal and community value of home care, how patients/families benefit | | 36:23 | The “blue zones” and their lesson for community-based care | | 37:48 | How lack of engagement accelerates decline |

Conclusions & Takeaways

• Policy design and funding for home care are at a crossroads: With the end of ACA subsidies and ongoing consolidation, patient choice and cost-effective home care are threatened.
• Fraud and waste in the system require nuanced solutions: Attention must shift from frontline fraud to contract and systemic abuse at higher levels.
• Engaging providers in policy and contracting could yield better results: Providers have firsthand knowledge and are currently excluded from key policy decisions.
• Preserving and supporting home-based care must be a priority: Evidence and lived experience support its value for individuals, families, and communities—financially and for quality of life.