Jeff and Jay discuss the history of ACA as well as current issues in health insurance and how career civil servants adapt to changes in administrations and policies. This video was recorded at Medicarians 2025 annual conference in Las Vegas and released on their site May 28.

Excerpt

Jay Weintraub: Welcome to Medicarians Live, I am joined by Jeff Grant. Jeff, thank you so much for being here. For 29 years, it’s probably not fair to say for all 29 years since ACA wasn’t around back then, but you know, I have started to call you as of five seconds ago in my head, Mr. Healthcare Dot Gov. But for those that don’t know you, please introduce yourself.

Jeff Grant: I joined CMS in a very different era, where we had 36 million Medicare beneficiaries and 35 million of them were in fee for service Medicare. And health plans was this little niche part of CMS that hardly anybody paid attention to or talked about, and it was a very small group of people that managed them. And then I was there to watch MA blossom, first Medicare Plus Choice and then Medicare Advantage, and they added in the prescription drug benefit. And now you have tens of millions of people in coverage from health plans, and MA is now the majority of coverage. And then I stayed through the Part D implementation, running payments, and when we got done reconciling the first year of part D, I left and went out into consulting on risk adjustment, Part D payment, enrollment, that kind of thing. Did that for a couple years. And then they passed this thing called the ACA. And incidentally, I had gone into CMS in 1993 to do Clinton self-care reform, which never happened. So they passed AVA and I got a phone call saying “Hey, they’ve got the exact same payment programs you have in Part D, would you like to come implement them for ACA?”