Ryan Long spent years on the Hill as a health care aide for lawmakers including former Speaker Kevin McCarthy. Now he's joined Paragon Health Institute as director of congressional relations and senior research fellow.

• Long spoke with Victoria about the year ahead for health and the legislative outlook. The remarks have been edited for length and clarity.

Why join Paragon now?

I was up on the Hill at the inception of Paragon. So I saw the type of team they built, and a lot of people I respected, and [had] done a lot of great work and a lot of great research on free market health care policy.

• And so when there was an opportunity … it just felt like the right fit at the right time.… 2025 is going to be a really busy year in health care policy and having an ability to hopefully be engaged in that part of the process. I thought, one, it would be fun, but two, it's important.

Why is 2025 going to be a big year in health care?

It's something that the Hill has talked about, the need to empower patients and get a more patient-centric health care system.… And I think anytime you have a new administration come in, whether it's Republican or Democrat administration, there's a window to try to get policies advanced.

• This incoming administration has indicated that they want to be forward leaning when it comes to health care policy.
• With a trifecta in the House and the Senate and administration, there's a lot of opportunity to pass things that have been discussed for a while that have not made it to the finish line for one reason or another.

What specific policies do you think will pop up?

In terms of what's going to be on the agenda, that's not necessarily our prerogative to set. That's really going to be up to the leadership in the House and Senate and the administration. So I guess that's somewhat of a TBD.

How did you get into health care policy?

Like a lot of people, it was just sort of the opportunity. My first job on the Hill was for Charlie Norwood from Georgia, who was a dentist on Energy and Commerce. I was just an LC for him, but it was when we were doing Patients' Bill of Rights, which he was very involved in.

• That sort of led to an opportunity to go work for Joe Barton when he needed a health care staffer, and I had been working for a member who was steeped in health care. So that was sort of how I got my start.

What's the biggest challenge working in the speaker's office?

Depending on the margin with 220 to 230 different opinions … it's trying to find the sweet spot after listening to all the various factions within the conference. Enough to get consensus to move a product.

• The committees are the people that are going to be developing the product, but ultimately, you have to work with them. You have to work with the different members and caucuses to find something that can pass. Sometimes that's easy and sometimes it's not.

What's the area you're most passionate about?

Going back to when I first started on Energy and Commerce, I was the FDA counsel. So that will always be a passion of mine, to ensure that we have a regulatory system that accepts innovation and doesn't stifle new technologies coming to market, because I think those are so important for patients.

• But you know, the longer that I've done it, the more I've become interested in identifying and eliminating federal policies that distort the health care market and needlessly increase federal spending.

An HHS inspector general's report raises new concerns with the FDA's accelerated approval process, which has received increased scrutiny in recent Congresses, Peter reports.

Why it matters: Concerns over the expedited pathway stem in large part from the agency's controversial approval of the Alzheimer's drug Aduhelm. The new report examines whether there are similar concerns with other drugs given fast-track reviews to fill unmet needs.

Driving the news: The IG identified three out of 24 accelerated drug approvals reviewed that raised concerns, suggesting that problems do not permeate all the approvals, but that there are still issues to be addressed.

• Those three drugs are Biogen's Aduhelm, Sarepta's Exondys 51 for Duchenne muscular dystrophy and Covis' Makena for preterm birth.
• The concerns raised include approving the drugs despite concerns from FDA advisory committees or agency reviewers, and not properly documenting meetings with manufacturers of the drugs.
• Aduhelm and Makena were subsequently pulled from the market.

What's next: Congress passed new legislation aimed at reforming the process at the end of 2022.

• Part of that legislation established a council within the FDA to review the accelerated approval process.
• The IG recommends that FDA define specific factors that would require the council to get involved in a drug's approval.
• It also says FDA should take steps to ensure that meetings with drug company sponsors are properly documented.

The bottom line: The IG report states that oversight is important because "there is risk that an accelerated approval drug will not ultimately provide a clinical benefit for patients, necessitating safeguards and transparency in FDA decision making."

Congressional Medicare advisers are recommending that lawmakers increase doctors' Medicare payments for next year, Maya Goldman reports.

Why it matters: Congress doesn't have to act on the recommendations. But the calls from MedPAC could add pressure in a growing campaign to get Congress to change the way Medicare pays physicians.

State of play: Congress should enact policies that increase doctors' Medicare payments an average of 5.7% for primary care clinicians and 2.5% for other clinicians in 2026, MedPAC voted on Thursday.

• The change would increase Medicare spending between $10 billion and $25 billion over five years, MedPAC estimates.

What they're saying: "The Medicare payment system is broken. MedPAC has come up with a thoughtful response that heads in the right direction," Bruce Scott, president of the American Medical Association, said in a statement.

• "Congress must prioritize Medicare reform this year. The status quo is unsustainable and unhealthy for our country."

For acute care hospitals, MedPAC voted to recommend that Congress increase Medicare base payments 1% above the amount specified in current law.

• Congress should also add $4 billion to the pool for payments to safety-net hospitals and change the way it distributes the safety-net payments.

MedPAC will also recommend a 3% decrease in Medicare payments for nursing homes and a 7% decrease for both home health and inpatient rehabilitation providers.

• The commission estimates that each of these proposals would save from $10 billion to $25 billion over five years, which could make up for the cost of increasing physician and hospital payments.

1. Medicaid pain: Cuts to federal Medicaid spending will force more tough choices for states that already are consumed with fiscal challenges, Maya reports.
2. Patient data: New companies have emerged to buy the data from hospitals and sell it to those wanting to train AI or do research. More from Stat.
3. Nicotine pouches: The FDA cleared the popular Zyn product to stay on the market, saying it was a safer alternative for adult cigarette smokers. More from WSJ.