Congress is scrambling to find a solution to the enhanced Affordable Care Act subsidies that expire at the end of the year. Without action, premiums are set to rise sharply for millions of Americans, creating a major health care cliff as 2026 approaches.

Congressional reporters Sandhya Raman (CQ Roll Call) and Robert King (Politico) join hosts Mark Masselli and Margaret Flinter to help make sense of the fast-moving negotiations and what is likely to happen next.

King captures the mood inside Congress as competing proposals circulate without leadership support. As he explains, “But right now, there has not been any indication from Speaker Johnson that he is going to be advocating for any of the compromise legislation that is being discussed in the House.”

Raman looks ahead to the broader forces that will shape the policy debate over the next year. She says, “I think affordability and the forms of that will be a big thing, whether or not we get any sort of deal on ACA or some of the other things that have been in the mix. Congress has been very interested in PBM reform and things like that to bring down health costs. So I think going into next year, regardless of what happens in the next couple weeks, that will be definitely something big to watch here.”

Together, their insights offer a timely look at why the subsidy cliff is proving so hard to solve, why the Senate’s competing plans are unlikely to pass, and how issues like abortion coverage and health savings account proposals are adding new complications to an already crowded landscape.

They also share their predictions for the top health care story of 2026, including the trends they believe will shape the year ahead for patients, providers, and policymakers.

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The doctor who once led the Centers for Disease Control and Prevention sees trouble ahead:

1. There’s been a significant decrease in people taking the COVID and flu vaccines
2. Europe is experiencing the worst flu season in years (an early indicator of problems in the U.S.)
3. CDC data show that Influenza infections are growing or likely growing in 41 states

“It’s not good…what we have seen from Europe is a very early and very severe flu season, something that could mean more hospitalizations.”

Dr. Tom Frieden says confusing vaccine guidance, limited access and weakened public health systems are contributing to fewer shots in arms. He also shares insights from his new book, “The Formula for Better Health: How to Save Millions of Lives—Including Your Own.” He explains his “See, Believe, Create” formula for building a healthier future and his broader call for a public health system that listens to communities and makes vaccination easier. Dr. Frieden now leads Resolve to Save Lives, which works to close the gap between proven, life-saving solutions and the people who need them around the world.

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Leading nutritionist Marion Nestle, Ph.D., has a sobering message as we get ready for Thanksgiving: America’s food system delivers twice the calories we need while wasting 40%. “Thanksgiving provides five times the calories we need,” she points out. Her advice? “It is a week in which you just have to do the best you can.”

But once we've cleared the dishes after Thursday’s meal, Nestle offers practical advice for people trying to make healthy, budget-conscious choices as food prices continue to rise.

“If there is anything that is a superfood, it is a bean. If you want to save money on food, you have to cook.”

Nestle discusses the dramatic changes in our food system over the last 20 years, the growing influence of social media on what we buy and eat, and the rise of ultra-processed foods. She joins hosts Mark Masselli and Margaret Flinter to discuss her new book, “What to Eat Now,” an updated and expanded guide to navigating today’s food landscape.

Watch the full interview now.

Nestle’s earlier appearance on Conversations on Health Care is also available, where she discussed artificial food dyes, food industry marketing and the need for a food system that puts public health first.

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People around the world are living longer and healthier lives because of an innovative idea that became a global force for change. On this episode of Conversations on Health Care, hosts Mark Masselli and Margaret Flinter welcome back Dr. Sanjeev Arora, founder of Project ECHO, an approach that has already improved care for more than 200 million patients worldwide.

Project ECHO was born from one question Dr. Arora asked himself more than 20 years ago: How do we make sure no patient is left behind because they cannot reach a specialist? What began as a hepatitis C initiative in New Mexico is now used for more than 70 complex conditions across over 200 countries and territories.

In this new interview, Dr. Arora reflects on what inspired him, what surprised him, and what he believes is possible next. He explains how primary care providers became force multipliers for specialty expertise, how Project ECHO expanded through COVID-19, and why community health centers continue to lead the way in democratizing knowledge.

“If we are willing to democratize our expertise and work together as interconnected providers, we can rapidly improve the U.S. health care system,” Dr. Arora said.

He also shares why the ECHO model boosts the resilience and joy of primary care teams, improves outcomes for underserved populations, and has transformed mental health care in India, where one psychiatrist may serve hundreds of thousands of patients.

“I know this work is making a difference in the community and in the world,” he said.

Listen to the full interview to hear Dr. Arora’s reflections on scaling impact, building health care communities, and the hope he carries for the next chapter of Project ECHO.

This episode also marks a meaningful return. Dr. Arora first appeared on Conversations on Health Care in 2011, shortly after Project ECHO was recognized as a disruptive innovation in global health. You can revisit that early conversation, here.

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What if health care for moms and babies came with a cash prescription for them?

In this Conversations on Health Care episode, hosts Mark Masselli and Margaret Flinter welcome back Dr. Mona Hanna, the Flint pediatrician whose research exposed the city’s water crisis and sparked a national reckoning on environmental justice.

Now, Dr. Hanna returns to share powerful results from Rx Kids, the nation’s first community-wide prenatal and infant cash prescription program. By providing unconditional financial support to pregnant women and new mothers, Rx Kids is improving maternal health, reducing infant deaths, and strengthening emotional well-being for families across Michigan.

“This is about investing in people’s humanity,” says Dr. Hanna. “When we provide the resources parents need to care for their babies, we create healthier families and stronger communities.”

Dr. Hanna explains how this simple but transformative idea, grounded in science, dignity, and love, has already reached more than 3,600 families in 11 Michigan communities and distributed $15 million in direct support. She also highlights how advocates can bring this program to their community.

Listen to the full interview.

You can also revisit Dr. Hanna’s earlier appearance on the program, where she discussed her pivotal role in uncovering the Flint lead water crisis and creating the Pediatric Public Health Initiative.

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Intimate partner violence affects more women in the United States than breast cancer and diabetes combined. Health care providers can be a lifeline for survivors, yet many still struggle to know how to talk about it or where to begin.

In this Conversations on Health Care episode, hosts Mark Masselli and Margaret Flinter speak with Virginia Duplessis, associate director at Futures Without Violence and director of the National Health Resource Center on Domestic Violence. Duplessis shares how health care professionals can take practical, compassionate steps to identify, prevent and respond to domestic violence.

“Violence is not an inevitable part of the human experience. We all have a unique and important role to play,” says Duplessis.

Her work helps providers use trauma-informed care to start conversations with all patients about relationship safety and well-being. Through Health Partners on IPV + Exploitation, Futures Without Violence is building partnerships that make these conversations part of routine care.

Duplessis also highlights how prevention can begin early, from school-based programs like Coaching Boys into Men. Pregnancy and postpartum care also give providers more opportunities to build trust and spot warning signs.

“We want every patient to leave feeling supported, listened to and connected to information about what’s available in the community if they choose to seek help,” she says.

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Food insecurity could soon worsen for millions of families and result in devastating health outcomes. American Academy of Family Physicians CEO Shawn Martin joins hosts Mark Masselli and Margaret Flinter to discuss how the government shutdown is putting the Supplemental Nutrition Assistance Program (SNAP) in jeopardy. Beginning on Saturday, Nov. 1, food assistance could end for up to 22 million recipients.

Martin and his 128,000 members are calling for bipartisan action to reopen the government and protect families from unnecessary harm.

“We must put the well-being of families first. Food insecurity is not a political issue—it’s a health issue, and every delay in action deepens the harm to our most vulnerable communities."

In this powerful conversation, Martin explores how hunger is showing up in exam rooms, the growing pressure on emergency food banks, and what policymakers must do to prevent a widening public health crisis.

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A recent report from the Centers for Disease Control and Prevention found that several Southeastern states continue to report the highest rates of late-pregnancy fetal death in the country. This is the kind of research that energizes Nurse-Family Partnership supporters to build on their mission to positively impact and transform the lives of first-time moms and their babies through a proven home visiting model.

The NFP model connects specially trained nurses with first-time mothers from early in pregnancy through the child’s second birthday.

Sharon Sprinkle, co-director of the partnership’s nursing practice, and Jenny Harper, its government affairs director, discuss with hosts Mark Masselli and Margaret Flinter the nonprofit’s founding, funding and how expectant moms can sign up.

Sprinkle says too often pregnant women say their concerns were “minimized or totally dismissed, when, in fact, if they were listened to, the outcome would have been better.

Originally broadcast June 5, 2024.

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