The Roadmap to the Republican Letter: How Puerto Rico Built the Case, PRFAA Built the Coalition, and Dr. Greg Murphy Led 13 Republicans to Challenge the CMS Formula for Puerto Rico

So imagine running the single most successful

hospital network in America.

Like you are literally outperforming 99% of the country

on well, basically every conceivable quality metric.

Right, your readmissions are down,

your chronic care is world-class.

Exactly, patient satisfaction is just off the charts.

And the federal government's reward

for this unprecedented excellence

is to just aggressively slash your funding

by 40% compared to some mediocre hospital

a few hundred miles away.

Which sounds completely absurd.

It sounds made up, right?

But that isn't a hypothetical scenario.

Right now in American healthcare,

excellence is being actively penalized

by this broken math equation.

It really is a phenomenal contradiction.

I mean, you're looking at a scenario

where the statutory formula

that's meant to sustain healthcare delivery

is essentially cannibalizing the best performing market

in the entire nation.

And that is exactly what we were unpacking today.

And you know, if you're listening to this

and you live in Florida or Arizona or Texas,

you might initially think,

well, this is just an isolated territorial issue.

Oh, but it is not.

No, it is not.

Just wait until you hear how this exact same

mathematical trap is coming

for your state's Medicare Advantage program.

So today you are joining us for a deep dive

into the strategy behind a really fascinating dossier.

Yeah, the dossier is titled

Puerto Rico Built the Case, PRFAA Built the Coalition.

Right.

We're looking at how this localized healthcare ecosystem

built a highly sophisticated political machine

to basically force Washington to fix a fatal flaw

in its own operating logic.

And we have some incredible source material here

to guide us through this.

We really do.

We've got Governor Jennifer Gonzalez-Colin's

February 2026 letter

to HHS Secretary Robert F. Kennedy, Jr.,

an official memorandum of understanding

from the island's provider network,

and this pivotal August 2026 letter

from 13 House Republicans.

And I think it's important to establish right up front,

this isn't just a story about lobbying dollars

or, you know, generic advocacy.

Right.

If we connect this to the bigger picture,

it is a masterclass in institutional warfare.

It's about leveraging a massive contradiction

between the CMS star ratings.

Which is the government's own quality assessment tool.

Exactly, the government's own tool.

And contrasting that with the flawed

actuarial methodology that actually dictates the payments.

Okay, let's unpack this

and start right there with the quality data.

Because if I'm a skeptical observer,

my first thought is, okay,

every state thinks their doctors are the best.

Sure, everyone claims they have the best care.

Right.

But we aren't talking about anecdotal quality here.

We are talking about hard CMS star ratings.

And getting five stars

on a Medicare Advantage prescription drug contract

and MAPD contract is notoriously brutal.

It is incredibly difficult.

You miss a few decimal points on your HEDES measures

or say your pharmacy adherence metrics

and bam, you drop down to 4.5.

It's unforgiving.

Very.

It requires a vertically integrated,

highly coordinated care model.

And the data from Puerto Rico is just staggering.

I mean, 99% of their MA beneficiaries

are enrolled in contracts rated 4.5 stars or higher.

99%.

99%.

Which is already crazy.

But the five star numbers are what really,

like they just break the brain.

81% of all Puerto Rico MA beneficiaries

are in five star contracts.

And to put that in perspective for the listener,

when you look at the macro national landscape,

there are roughly 820,000 members enrolled

in five star MAPD contracts across the entire United States.

Out of that national total,

Puerto Rico accounts for 547,600 of them.

Wait, that's two thirds.

Two thirds.

Puerto Rico represents 66.7% of all national enrollment

in five star Medicare Advantage contracts.

That is insane.

It really is.

Three of the 18 five star contracts

in the entire nation are on this one island.

Wow.

Yeah.

MCS contract H577, MMM H4003, and H4004.

And that MCS contract is actually the single largest

in America with over 332,000 members.

So they hold over 40% of the national five star

enrollment in just that one contract.

Exactly.

So they have completely objectively mastered

the CMS quality parameters.

They have.

Which makes the benchmark reality so incredibly jarring.

I mean, for 2026, the average benchmark for Puerto Rico

is just $730 per member per month.

Well, the national average is $1,246.

Okay, stop right there.

$730 versus $1,246.

We are talking about a $500 monthly deficit per patient.

Every single month.

Over a year.

That is $6,000 less per senior.

I mean, how does a healthcare system

absorb a six grand per patient hit

and still deliver five star care?

It requires immense strain on the local providers,

which we'll get into.

But wait, if I'm a CMS actuary

looking at this spreadsheet,

why isn't someone just hit a manual override?

Like in statistical modeling,

you can normalize for anomalies.

You'd think so, yeah.

Right, so why couldn't they just adjust the math

instead of waiting for a massive political coalition

to force their hand?

Well, because CMS actuaries are bound by section 1853

of the Social Security Act.

The statute.

Right, they can't just invent a new payment tier

because they feel like it

or because the data looks weird.

They have to follow the statutory formula

and that formula ties MA rates

directly to fee-for-service or FFS per capita costs

in that specific geographic area.

Meaning they're legally forced

to look at the traditional Medicare baseline.

Exactly.

But here is where the math completely detaches from reality.

The dossier calls this the success paradox.

The success paradox.

Yeah, so Puerto Rico's MA market is incredibly dense.

Over 670,000 seniors are in MA.

Which is like what, 96% of the Medicare

eligible population on the island?

Yes, roughly 96%.

Leaving a residual fee-for-service population

of only about 29,000 people.

So just 3%.

Just 3% of beneficiaries.

Okay, so let me see if I have this right.

Imagine trying to figure out the average grocery budget

for a town of 100,000 people.

And 96% of the town shops

at this hyper-efficient bulk discount Costco.

But your federal formula mandates

that you can only calculate the town's entire grocery budget

by analyzing the spending habits

of the 3% of people who exclusively buy their food

at a gas station at 2 in the morning.

That is actually a brilliant way to look at it.

It's an inherently corrupted data pool.

You are projecting the complex care costs

of over 670,000 seniors

based on a highly irregular 29,000-person sample size.

And that sample size doesn't reflect the norm at all.

Not at all.

The composition of that 29,000-person sample

is highly atypical.

It disproportionately includes individuals

with alternative coverage like veterans using the VA system

or dual-eligible with highly-fractured claims data.

So they aren't even using

the fee-for-service system in a standard way.

Exactly.

Their FFS claims profile doesn't remotely resemble

the actual morbidity or utilization rates

of the broader senior population.

So because the statutory formula relies

on this corrupted low-utilization baseline,

the FFS cost estimates systemically understate

the true cost of delivering care.

Which is why the MA benchmarks are 41%

below the national average

and frankly 20% below even the U.S. Virgin Islands.

Wow.

So they are getting punished literally

because they were too successful

at enrolling seniors into managed care.

That's the paradox.

The better MA performs, the more the FFS pool shrinks.

And the more distorted the data gets.

Right.

And then the lower the benchmark drops.

It is basically an actuarial death spiral.

And this is why the dossier frames this

as Puerto Rico as Medicare's future.

Yes.

What's fascinating here is that the mainland

is trending exactly in this direction.

Right.

If you are sitting in a highly saturated MA market

right now like parts of Florida

or Southern California or Arizona,

your fee for service pool is shrinking

every single open enrollment period.

It is.

Eventually, those states are gonna hit

the exact same mathematical singularity Puerto Rico

just hit where the FFS sample size becomes way too small

to generate a statistically valid benchmark.

Puerto Rico is the canary in the coal mine.

They just hit the extreme end of the curve

a decade before the mainland.

But recognizing that you are the canary

doesn't actually get you out of the coal mine.

No, it does not.

Knowing the math is broken is easy.

Fixing it in Washington is a nightmare.

Exactly.

And this is where Governor Jennifer Gonzales

Colin steps in.

Yeah.

Because you can't just walk into HHS and say,

hey, the formula is unfair.

Right, that gets you nowhere.

You have to engineer a highly specific,

legally viable off-ramp.

And that's exactly what she did.

The governor didn't just draft a grievance,

she drafted a blueprint.

When you analyze her February 25th,

2026 letter to Secretary Kennedy,

the strategic restraint is what really stands out.

Right, because she doesn't ask for full parity.

She doesn't go in demanding,

give us the $1,246 national average tomorrow.

No, because full parity requires

a legislative overhaul.

Right.

It requires an act of Congress,

an impossibly high CBO score,

and just years of committee battles.

So instead, she asked for an administrative fix

under existing statutory authority.

Which is so much smarter politically.

It is, she explicitly requested

a national Medicare Advantage benchmark floor of 0.70.

Meaning no jurisdiction can fall below

70% of the national average.

Exactly.

And she asked for that to begin

in the 2028 rate cycle.

And she anchors that request to the US Virgin Islands,

which is currently operating around that 70% mark anyway.

It's just brilliant.

It really is.

She's essentially telling CMS,

look, you already have the administrative president

right next door.

Just apply this 0.70 floor to us.

It aligns Puerto Rico more closely with national norms

without disproportionately blowing up federal spending.

It stops the bleeding,

it stabilizes the provider networks,

and it does so without triggering

a massive fiscal panic on Capitol Hill.

And you really have to factor in the messenger here.

I mean, Governor Gonzales Cologne

isn't some outsider trying to figure out how DC works.

Not at all.

She spent eight years

as Puerto Rico's resident commissioner.

She was a House Republican.

She knows the cadence, the pressure points,

the legislative staff architecture of these offices.

She has the relationship.

She has deep, established Republican relationships.

When she calls a House Republican,

she isn't a territorial governor asking for a handout.

She's a former colleague pointing out a technical flaw

in a federal program.

That unparalleled access and credibility is huge.

But I mean, even with her relationships

and her highly targeted 0.70 request,

a letter is just a piece of paper.

You need an institutional engine

to actually drive this through the bureaucracy.

You need a machine that operates daily.

And that was PRFAA,

the Puerto Rico Federal Affairs Administration.

I really want to dig into the operational mechanics here

because we always hear the term coalition building,

but it usually just means putting 50 logos on a PDF

and calling it a day.

Yeah, that's standard DC stuff.

Right, but PRFAA did something completely different.

Executive Director Gabriela Bafeli

and Deputy Director Natalia Gandia

essentially built a localized state department

combined with a tactical lobbying firm.

Because they had a highly complex ecosystem to manage.

The private healthcare sector in Puerto Rico,

the hospitals, the IPAs, the health plans,

the community pharmacies, they aren't new to this.

No, they've been dealing with this for a long time.

Over 15 years,

they've been fighting this funding disparity

for over 15 years.

So they have immense institutional memory

and massive amounts of localized data.

But raw data is heavy and it's hard to move.

Exactly, PRFAA's job was to act as the operational bridge.

They channeled all of that localized energy

from the private sector

into a single unified laser beam

aimed directly at the 0.704 request.

So what does that actually look like on the ground in DC?

Because I imagine it's not just setting up

a few cocktail hours and handing out pamphlets.

Far from it, it is a grueling logistical grind.

You're talking about Bafeli and Gandia

coordinating rolling fly-ins.

They are constantly looking at the congressional calendar.

They are sequencing the Hill visits.

They are prepping the private sector leaders

before they ever set foot

in a Rayburn office building suite.

They're essentially casting the meetings.

Precisely, it's incredibly tactical.

If they secure a meeting with a mainland representative

who has a strong voting record on small business issues,

PRFAA doesn't send the hospital CEO.

Oh, they send the independent pharmacy owner.

Exactly.

And if the representative sits on a committee

dealing with institutional health care resilience,

well, then they send the hospital administrators.

That is so smart.

They match the exact endpoint of the health care supply chain

to the specific political interest of the lawmaker.

And they back it up

with constant relentless follow-up,

the rapid debriefs in the hallway

right after the meeting,

the technical support for the legislative assistance,

the signature tracking for the eventual August letter.

They kept the entire private sector perfectly aligned

with the governor's strategy.

Total alignment, no rogue requests, no mixed messaging.

Just, we have five-star quality.

We have a 41% funding deficit

and we need the 0.70 floor in 2028.

But the true genius of PRFAA strategy

wasn't just in the DC office, that's right.

It was getting the lawmakers out of DC

and putting them on the ground in Puerto Rico.

Yes.

Because I understand getting politicians into a room,

but how do you actually show them a formula

failing in real time?

Like a hospital tour usually just involves

shaking hands with administrators,

looking at an MRI machine and taking a photo.

Yeah, the classic photo op.

Right.

So why did these specific visits

actually move the needle

for deeply skeptical Republicans?

By exposing them to the actual operating system.

This wasn't a standard PR tour.

The internal dossier maps this out

as a four-doors strategy.

Okay, four doors.

They didn't just show them

the glossy administrative suite.

They walked them through the harsh economic reality

of the supply chain.

Let's look at this sequence,

starting with the macro view.

The policy and chamber door?

Right.

This was with Luís Luigi Pizarro

at the Puerto Rico Chamber of Commerce Health

and Insurance Conferences.

Okay, so that's the big picture.

Exactly.

This is where you establish the systemic stakes.

You put the lawmakers in a room

with the island's economic leadership

to show that this $730 MA benchmark

isn't just an insurance issue.

It's a massive overarching economic drag.

Because it impacts employment

and capital investment

and the broader tax base.

Exactly.

Okay, so they established the macro,

then they take them through the second door,

the hospital door,

with Dr. Leo Valentin

at Professional Hospital of Guainabbo.

And here, the theoretical deficit

becomes totally tangible.

When you are underfunded

by $500 per patient per month,

what does that actually look like

on a hospital floor?

It looks like an inability

to match mainland nursing salaries.

Right, which leads to a brutal brain drain.

It looks like delayed capital expenditures

for surgical equipment.

Lawmakers got to see

that the hospital isn't just complaining

about profit margins.

They're literally fighting

to maintain institutional delivery

under a crushing financial handicap.

Wow.

And then we move to the third door,

which is fascinating

because it deals with the actual mechanics of MA care,

the physician and IPA door.

This was with Dr. Huaco Vargas

at Varmed Health Center.

And this is where the five-star metric

is actually achieved.

Oh, this is the ground level.

Right.

Lawmakers got to see firsthand

how independent practice associations or IPAs

utilize capitation

and heavily coordinated care models

to manage chronically ill populations.

So they saw the aggressive preventative care.

Yes.

And the complex referral management

that keeps readmissions so low.

They saw why the quality is so high,

but they also saw

how the underlying funding starvation

severely restricts the resources

those primary care doctors have

to actually manage that patient load.

Precisely.

It made the contradiction real.

But it's the fourth door

that really seemed to break

through the partisan resistance,

the pharmacy door.

Elliot Pacheco at Súper Farmacia

Isla Verde.

I love this part

because everybody understands a local pharmacy.

You walk into a community pharmacy

and you immediately grasp the retail economics.

Exactly.

This wasn't some corporate boardroom.

Lawmakers were standing in a community pharmacy

looking at the exact cash flow constraints.

They were seeing the acquisition costs

of specialty medications,

the predatory DIR fees,

the immense squeeze from PBMs.

Yes.

When the federal MA benchmark

is severely depressed,

the downstream reimbursement rates

for the pharmacy are razor thin

or often completely underwater.

So the pharmacist is literally asking

if I dispense this insulin to this senior,

will I lose money on the transaction?

And when a conservative lawmaker

sees a small business owner

and independent pharmacist

facing an existential threat

because of a flawed federal algorithm,

it fundamentally changes

their political calculus.

It's not abstract anymore.

Not at all.

Which perfectly sets up the centerpiece

of this entire coalition.

The white whale of their advocacy strategy,

Representative Greg Murphy.

His conversion is the defining political achievement

of this entire campaign.

Because if you look at the landscape

in early 2024,

Greg Murphy is the absolute last guy

you would expect to lead a coalition

defending Medicare Advantage funding.

The absolute last.

In March 2024, he goes on the record,

completely unvarnished,

saying he is, quote,

personally not a fan of MA.

He basically suggests the program

needs to be abolished and restarted from scratch.

Which raises an important question, right.

Why would PRFAA and the governor

waste their time on one of the most outspoken critics

of national Medicare Advantage abuses?

Seriously.

If I'm running this campaign,

I'm looking for members who already love MA.

Why target the guy trying to burn it down?

Because of his background.

Representative Murphy is a physician.

Ah, right.

He understands clinical reality

versus administrative bloat.

His deep skepticism of MA wasn't arbitrary.

It was rooted in highly valid criticisms

of the massive national carriers.

He was frustrated by the aggressive prior authorizations,

the systemic denial of care.

Exactly.

The aggressive coding intensity

and the massive profit margins of national insurers

at the expense of actual patient care.

Which, to be fair, are the exact things

most people hate about the corporatization of healthcare.

Right.

But in April 2025, Murphy takes the trip.

He speaks alongside Luigi Pizarro

at the chamber conference.

He goes to professional hospital Guainabo

with Dr. Valentin.

He sees the IPA model

ad-varmed with Dr. Vargas.

And he stands in Super Formatia, Ayla Verde,

talking directly with Elliot Pacheco

and other independent pharmacy owners.

He goes through the four doors.

And because he's a doctor,

he isn't just looking at the spreadsheets.

He is looking at the clinical pathways.

He recognizes immediately

that Puerto Rico's MA market is structurally different

from the mainland corporate models he despises.

It is deeply integrated.

It relies heavily on local independent providers.

And it is actually delivering

on the promise of managed care,

which is evidenced by the 81% five-star enrollment.

So he realizes that by starting

the funding formula in Puerto Rico,

the federal government isn't punishing

the national corporate executives in their high-rises.

It is actively crushing Dr. Valentin,

Dr. Vargas, and Elliot Pacheco.

It is punishing the exact local providers

Murphy wants to protect.

Which leads directly to this watershed moment

in July 2025.

During a congressional hearing,

while still being highly critical

of national MA carriers,

Murphy explicitly carves out Puerto Rico.

He points to their system and says,

quote, they do it right.

They do it right.

That forward sentence is the holy grail for PRFAA.

It unlocked the entire Republican policy frame.

So Murphy proved that you can hold

two thoughts simultaneously.

You can demand intense accountability from insurers,

demand massive PBM reform and fight fraud,

while also demanding that the federal government

provide an adequate baseline of funding

to protect local providers and patient choice.

Right, he separated the conduct of bad actors

from the underlying payment methodology.

Exactly.

We'll be very precise here.

Murphy didn't wake up one morning

and invent the 0.70 benchmark floor.

Oh no, not at all.

He didn't build the actuarial case.

PRFAA, the governor and the private sector

spent years building the engine,

refining the fuel and mapping the destination.

Murphy was the key turning the ignition.

He provided the uniquely credible validation.

Yeah, when the guy who hates MA

tells the rest of the Republican caucus,

actually we need to protect MA funding

in this specific jurisdiction.

Everyone else stops and listens.

It gives them permission to support it.

But one guy, even a highly credible one,

isn't a coalition.

You don't move the HHS secretary

or the CMS actuaries with one signature.

No, you need numbers.

So PRFAA leverages Murphy's conversion

and starts bringing in different facets

of the GOP conference.

Let's look at representative Buddy Carter from Georgia

because he brings an entirely different

microscopic lens to this problem.

Carter is fascinating because he isn't looking

at this primarily through the physician lens, like Murphy.

He is looking at it through the retail pharmacy lens.

Right.

Carter owned an independent pharmacy for 32 years.

He is arguably the most aggressive critic

of PBMs in Congress.

So when PRFAA gets Carter down to Puerto Rico

in April, 2026, they know exactly

which door matters most for him.

They take him straight to Super Formatia,

Isla Verde, to meet with Elia Pacheco.

And it's not a politician talking to an constituent.

It's an owner talking to an owner.

They speak the exact same highly technical language

of dispensing fees, clawbacks, and working capital.

Carter intrinsically understands

that when the federal benchmark drops to $730,

the PBMs don't absorb that loss.

Oh, of course not.

They push the pain downstream

to the independent pharmacist.

So Carter signs onto the coalition

and he brings this massive credibility

regarding small business protection and PBM reform.

The argument is just getting wider and wider.

Then you look at someone like

Representative Gus Bilorakis from Florida.

Why is he so critical?

Continuity and deep historical ties.

Okay.

Bilorakis had a documented legislative partnership

with Governor Gonzales Cologne on territorial health care

that predates Hurricane Maria.

Wow, so he goes way back.

He represents the institutional memory

of Puerto Rico's health care struggles.

And he brought this fascinating symbolic element

to the fight with the Roberto Clemente statue bill

in August, 2026.

It's a brilliant piece of legislative signaling.

Now the dossier acknowledges

that a statue doesn't change actuarial policy,

but rhetorically it perfectly frames

Puerto Rico's entire argument.

The Clemente statue is about recognizing excellence,

service, and high performance

despite overwhelming adversity.

Right, they aren't coming to Washington

with their hands out saying,

we are failing, please bail us out.

Exactly.

They're coming to Washington saying,

we are the best in the country.

We are delivering five star results

under a benchmark that would completely bankrupt

a mainland hospital, reward the excellence.

And that framing appeals immensely

to the merit-based philosophy of the Republican conference,

which is why you see the coalition expand to 14 members

by the August 3, 2026 letter.

It's an incredibly diverse group too.

You have Brian Fitzpatrick from Pennsylvania

bringing continuity on the physician migration crisis.

Don Bacon from Nebraska.

And why does Nebraska care?

Right, why Nebraska?

Because Bacon realizes that

as MA penetration climbs in the Midwest,

this exact FFS data corruption

is gonna hit his state eventually.

He sees the future.

You also have the territorial perspective

from Amua Amada Ridewagon of American Samoa

and James Moylan from Guam.

Plus the Florida heavyweights, right?

Oh.

Carlos Kimenez, Maria Elvira Salazar,

Mario Diaz Ballart.

Who deeply understand the senior care demographic

and the Puerto Rican migration link.

And then you have members like Pete Sessions,

Mike Kelly, Riley Moore and Claudia Tenney.

14 Republicans all signing on

to Governor Gonzalez-Colon's exact request,

establish a 70% national minimum MA benchmark floor

beginning in 2028.

I mean, it is a massive political victory.

It is, but as any seasoned DC operative will tell you,

a political victory is just the prerequisite

for the actual administrative war.

Right, because you can have the letter,

you can have the governor,

you can have the 14 members.

But Greg Murphy doesn't write the code

for the CMS payment algorithms.

No, he does not.

The fight isn't over.

What are the next steps?

Do they just sit back and wait for HHS to cut the check?

Not even close.

The pressure campaign now has to transition

into the labyrinth of administrative rulemaking.

The immediate next steps require the governor,

PRFAA and the private sector

to sustain intense technical engagement

with HHS, CMS, congressional leadership,

relevant committees and the White House.

They have to convince the actuaries.

Crucially, yes.

The career officials in the CMS office of the actuary,

the people in the basement who actually calculate

the geographic practice cost index and those FFS baseline.

The ones actually doing the math.

Right, PRFAA has to prove to them

not only that the math is broken,

but that CMS possesses the explicit legal authority

likely through section 1876A of the Social Security Act

or similar adjustment levers to implement the 0.70 floor

without requiring new legislation.

So it shifts from a political argument

to a deeply technical, legal and statistical argument.

Completely.

They have to keep the 14-member coalition engaged,

keep the private sector aligned,

and guide this all the way to the 2028 rate announcement.

It requires just relentless vigilance.

It really does.

Okay, we have covered an immense amount of ground today,

from the math of the CMSR ratings

to the granular logistics of congressional fly-ins.

Let's pull this all together.

Puerto Rico built the case.

They had the decades of localized private sector knowledge

and the undeniable 81% five-star quality data.

And Governor Gonzales Cologne took that raw data

and engineered a highly specific

legally viable policy objective,

the 0.70 benchmark floor.

And PRFAA built the coalition.

They managed the logistical ground game,

channeled the private sector

through the four doors of exposure,

and strategically deployed that reality to lawmakers.

Greg Murphy provided the essential credibility

by proving you can fight national corporate abuses

while still defending local private sector delivery.

And the 14 Republicans provided the political mass necessary

to force the administration's hand,

which brings us to the ultimate

unavoidable conclusion of this entire deep dive.

The contradiction that Washington can no longer ignore.

Puerto Rico has already delivered the quality.

99% in 4.5 stars or higher, 81% in five stars.

They are dominating the CMS quality metrics.

And Washington has consistently delivered the underfunding,

a $730 benchmark against a $1,246 national average.

In a purely merit-based system,

especially under a Republican administration

that claims to reward performance,

efficiency and results,

those two outcomes simply cannot logically coexist.

They are mutually exclusive concepts.

If the federal government's own quality assessment system

declares that Puerto Rico is operating

at the absolute pinnacle of healthcare excellence,

while its own actuarial payment methodology

leaves the island starved near the absolute bottom,

well, the problem is not the providers.

No, the problem is the formula.

You could hold the massive insurers accountable.

You can and must aggressively reform the PBMs.

You can fight fraud and protect patient choice.

But ultimately, you have to fix the formula.

Because of a system that claims to value

and reward quality continuously punishes

the one jurisdiction delivering

the highest quality in the nation,

that system loses all intellectual

and functional credibility.

I'm gonna leave you with a final thought to chew on.

We started off talking about excellence

being penalized by a math equation.

If the federal government can look at a market

that achieves 81% five-star enrollment,

look at a local hospital struggling to retain nurses,

look at an independent pharmacist wondering

if they can afford to dispense insulin.

Well, I mean, and then decide to starve

that entire ecosystem of 41% of its funding

simply because an outdated corrupted fee

for service sample dictates it.

What does they actually say about how our government

defines the word value in healthcare?

Are we paying for actual human excellence?

Or are we just paying for the math

to look clean on a bureaucrat's spreadsheet?

Think about that next time you look

at your own healthcare bill.