EP469 (Part 1): The Impact on Plan Sponsors of Medicaid Cuts, With James Gelfand, JD

I was talking to Cora Opsahl the other day, and the topic of Medicaid came up—mostly how the current Medicaid goings-on will impact plan sponsors, if at all. But if so, what would a savvy plan sponsor be doing in this moment to not get caught flat-footed?

For a full transcript of this episode, click here.

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So, and I will admit there were martinis involved, there was speculation between Cora and I and hypotheses offered. But at one point, Cora said, you know, if you’re gonna talk about this on the podcast, who you really should be speaking with is James Gelfand, president and CEO of The ERISA Industry Committee, otherwise known as ERIC.

So, yeah … I’m good like this.

And today I am welcoming James Gelfand to the pod for this double episode. What is in store for you, you may be wondering, and why with a double episode? Well, let me put it to you straight. When I tracked down James Gelfand and we started chatting about the possible ways this show could go, James said, “Just as important as or maybe more important for plan sponsors than the Medicaid goings-on are what’s happening with Medicare site-neutral payments and also with updates to HSA (health savings account) legislation.”

And here we are with our two-part episode today. I briefly toyed with jamming it all into one show but then decided it would be, yeah, just a little too long.

You can let me know what you think, though, should you have commentary on this decision of mine to break it into two shows. James thought you could handle it all in one (just saying, by the way).

This first show will be the down-low on what’s happening with Medicaid cuts. And I’m so thankful to James for straightening out a lot of question marks for me.

For example, the “Cornhusker Kickback.” You familiar with this? I was not. But this Cornhusker Kickback kind of plays center stage role in the current Medicaid possibly cuts. So, yeah, listen to the show to get up to speed on that. And also James Gelfand’s opinion on how much and how proposed Medicaid cuts may impact employers in ways that may be more or less obvious.

For example, how many of an employer’s members are actually on Medicaid? Also, if states have to pay more for Medicaid, will they raise the corporate tax to cover their new Medicaid costs currently being funded by the federal government?

Another impact on plan sponsors, hospitals, who could very easily, and probably will, use this as a quite opportunistic reason (or as an excuse, depending on the hospital) to raise their prices. And that matters because 50%-ish of most plan sponsors’ spend these days is on hospitals.

Listen to the shows with (my goodness, there are many) Vivian Ho, PhD (EP466), most recently; Marilyn Bartlett, CPA, CGMA, CMA, CFM (EP450) also talked about the impact of hospital prices on plan spend. Cora Opsahl (EP452), of course.

Yeah, that’s a good trifecta for you there if you want a place to start. There’s an article, by the way, about the hospital/plan sponsor/Medicaid dynamic in Modern Healthcare the other day that quotes Shawn Gremminger and Elizabeth Mitchell, and both of them are quoted as saying, don’t even think about it, major consolidated hospitals. The title of the article is pretty blunt to that end. It’s called “Medicaid Cuts Cannot Increase Hospital Rates, Employers Warn.”

Big caveat I just want to throw in here is that the situation is fluid. This show with James Gelfand was recorded the first week of March 2025, and it represented what was going on at that time.

A lot of this conversation is great historical background information, however, which will be no matter what happens, it is extremely relevant, again, no matter how reality winds up unfolding. But yeah … lots of forces at play that could impact the outcomes here, so do check on the latest.

James Gelfand, as aforementioned, is president and CEO of The ERISA Industry Committee, otherwise known as ERIC. ERIC represents the largest self-insured employers advocating for comprehensive benefits and healthcare policies that impact millions of employees.

James Gelfand brings nearly two decades of experience in healthcare advocacy, having worked at the Chamber of Commerce and on Capitol Hill.

When you are done listening to this show, do queue up Part 2 of this particular double episode, where we talk site-neutral payments and honest billing practices there, and then also HSA reform.

Also mentioned in this episode are The ERISA Industry Committee; Cora Opsahl; Vivian Ho, PhD; Marilyn Bartlett, CPA, CGMA, CMA, CFM; Shawn Gremminger; Elizabeth Mitchell; and Al Lewis.

You can learn more at The ERISA Industry Committee and by following James on LinkedIn.

James Gelfand, JD, became president and CEO of The ERISA Industry Committee (ERIC) in April 2023, having previously served as its senior and then executive vice president for eight years. He was promoted to the position of president in June 2022.

James oversees all aspects of the association’s activities, which focus on programs that shape federal and state health and retirement benefit policies and that impact ERIC member companies’ ability to operate under federal ERISA protection from a patchwork of conflicting state and local laws. He has brought prominence to ERIC among federal and state lawmakers, thought leaders, and major companies in the United States and globally. James provides strategic leadership to ERIC’s legislative, regulatory, and legal advocacy; membership and partnerships; and communications and operations to achieve ERIC’s mission and implement the directives of ERIC’s board of directors.

James has been recognized as a top industry lobbyist by both the National Institute for Lobbying & Ethics and The Hill. Since 2018, he has served on the board of directors and executive committee of the Arlington, Virginia–based Maternal Mental Health Leadership Alliance (MMHLA). MMHLA is a nonpartisan, nonprofit organization dedicated to promoting the mental health of mothers in the United States, with a focus on national policy and health equity. MMHLA is a staunch advocate for improved mental healthcare during pregnancy and postpartum.

James earned his JD at George Washington University Law School in Washington, DC, and his undergraduate degrees in political science and legal studies at Northwestern University in Evanston, Illinois.

05:22 What’s happening with Medicaid cuts?

06:47 What are the four main things congress is actually looking at in cutting Medicaid?

09:12 What is the Cornhusker Kickback?

16:46 What should plan sponsors be doing right now to prepare for these potential Medicaid cuts?

20:04 What’s going to happen to hospitals with these proposed Medicaid cuts?

20:48 EP464 with Al Lewis.

23:41 How does hospital consolidation affect the potential future with these Medicaid cuts?

Recent past interviews:

Click a guest’s name for their latest RHV episode!

Matt McQuide, Stacey Richter (EP467), Vivian Ho, Chris Crawford (EP465), Al Lewis, Betsy Seals, Wendell Potter (Encore! EP384), Dr Scott Conard, Stacey Richter (INBW42), Chris Crawford (EP461)