Norton CEO: Calling health care “unaffordable” could drive patients away

This is a preview of the November 13 edition of Access Health—Tap here to get this newsletter delivered straight to your inbox.

Good morning. I spent the weekend in Arizona, soaking up the sun that I’ll dearly miss during the next few months of Chicago winter. I always feel lucky when I’m sitting by the pool with a spicy margarita in hand, but I felt especially lucky (and a little bit guilty) knowing that thousands of Americans had their flights cancelled due to the ongoing government shutdown.  

I’m writing this on Wednesday evening, day 43 of the federal impasse—the longest in history. By the time you’re reading this on Thursday morning, it could be over. For the first time since September 19, our representatives are in the House right now to debate a funding deal that would end this whole ordeal. Frequent flyers, rejoice.  

But while we’ll all be happy to see federal workers receive their paychecks and public institutions get back on their feet, health care stakeholders can’t relax just yet.  

The proposed deal to end the federal shutdown offers hospital and health system executives a moment of stability. Many spent the past month-and-some-change bracing for cascading delays in Medicare payments, stalled CMS guidance, FDA review backlogs and potential contractor pullbacks. Regulatory functions that had slowed or paused outright—Medicaid waiver processing, telehealth program extensions, quality reporting reviews—can resume. Federal partners, from CMS regional offices to FDA field staff, can begin working through their inboxes again (I wish I could send them all a spicy margarita). 

In summary, the administrative turbulence would ease if a deal were achieved. But it’s still a partial victory.  

The shutdown deal very deliberately did not resolve one of the most significant patient-market risks in more than a decade: the expiration of enhanced Affordable Care Act (ACA) premium tax credits. Roughly 24 million Americans are insured through the ACA marketplaces, and the vast majority of them rely on those subsidies that sharply reduce premiums, capping costs at roughly 8.5 percent of income for many enrollees.  

Countless projections have warned that if Congress fails to extend these subsidies before December 31, premiums could more than double. One analysis from KFF estimates average premium increases of roughly 114 percent, or more than $1,000 per enrollee, in 2026. The Congressional Budget Office projects up to 4.2 million people could become uninsured if the expanded credits lapse. 

For hospitals, the downstream consequences of that scenario are substantial. Systems already navigating tighter margins, rising labor costs and Medicaid churn would face an influx of un- or under-insured patients. In turn, those patients would be more likely to delay primary and specialty care and rely disproportionately on emergency departments, where many of them would present sicker. Uncompensated care burdens would rise, payer-mix ratios would shift unfavorably and community-benefit obligations would intensify. Safety-net hospitals and rural systems would be especially vulnerable. 

As the government votes to resume operations (and the health care funding saga continues), here are three priorities that I’m hearing are on health system leaders’ to-do lists:  

• Confirm federal reporting timelines are back on track; 

• Assess operational backlogs caused by the hiatus;  

• And—this is an important one—model the financial and patient-volume impact of an ACA subsidy cliff. Congress is expected to take up the subsidies in mid-December, but an extension isn’t guaranteed. 

More than the shutdown itself, this looming decision may shape your patient/payer mix—and your margins—through 2026 and beyond. Let me know how you’re thinking and feeling about all of this; you can reach me at a.kayser@newsweek.com.  

In Other News

Major health care headlines from the week

• Beginning Saturday, CMS will start sending hospitals their initial pricing targets and quality scores for 2026 under the new Transforming Episode Accountability Model (TEAM).  
  • The stakes are high. Starting January 1, 2026, one in four hospitals that perform high-spend surgical episodes for Medicare patients will be mandated to participate. Hospitals that fail to meet CMS’ cost and quality benchmarks could face tens of millions of dollars in downside risk, including repayment penalties. 
  • For hospital leaders, this week’s notifications represent the first concrete signal of how their organization will be evaluated—and how much financial exposure they may need to plan for ahead of the model’s go-live. 
  • One analysis from the American College of Surgeons estimates that approximately 741 acute care hospitals in 188 markets will be required to assume financial risk under TEAM.  
    
• CMS has launched a new payment model—the GENEROUS Medicaid Model—aimed at lowering prescription drug spending and improving medication access for Medicaid beneficiaries.  
  • Beginning in 2026, participating states will be able to purchase selected drugs at “most-favored-nation” prices, aligning U.S. Medicaid drug costs with those paid in peer countries. Federal officials frame this as a major step to curb Medicaid drug spending, which climbed to over $100 billion in 2024 ($60 billion after rebates), and to protect program sustainability as utilization and specialty-drug costs rise. 
  • Under GENEROUS, CMS will negotiate drug prices directly with manufacturers and establish uniform coverage criteria that participating states can adopt. A Request for Applications for manufacturers is expected this fall, and states may begin submitting letters of intent.  
  • The model follows a recent executive order directing the alignment of U.S. and international drug prices and coincides with separate administration deals that lower costs for select Eli Lilly and Novo Nordisk drugs.  
  • Click here to read the full scoop from Newsweek’s Lauren Giella.  
    
• Two weeks ago, this newsletter covered states’ efforts to reduce private equity’s influence in health care. If you’re interested in learning more, The American Medical Association has released a new report outlining five approaches that states are taking to curb corporate influence in the industry. Click here to give it a read.  
  
• Don’t forget: Newsweek will host a live webinar, “Traveler to Teammate: Becoming a Hospital Where Nurses Choose to Stay,” next Wednesday, November 19, at 2 p.m. Eastern.  
  • My colleague Aman Kidwai will host the discussion with Dr. Regina Foley (Chief Nursing Executive and Chief Clinical Transformation and Integration Officer, Hackensack Meridian Health), David Rutherford (Senior Advisor, HR Transformation, OhioHealth) and Dr. Vikas Sinai (President of the Lown Institute). 
  • Learn more and register for free here. I hope to see you there! 

Pulse Check

Executive perspectives on key industry issues

For this week’s Pulse Check, I spoke with Russ Cox, president and CEO of Norton Healthcare based in Louisville, Kentucky.  

Cox didn’t take a traditional path to the helm. He entered the workforce as a middle school teacher and considered going to law school—even taking the LSAT—before deciding to use his educational skills in human resources. He spent his first 16 years in health care climbing the HR ranks at Humana before transitioning to the not-for-profit side of the industry, which brings us to his role today.  

Our conversation covered good news, like the health system’s recent capital investments, and bad news, like what has disappointed him lately in industry conversations. Find a portion of our interview below.  

Editor’s Note: Responses have been lightly edited for length and clarity. 

Russ, the Norton West Louisville Hospital is celebrating its one-year anniversary in November. It’s a historic investment, as the first hospital built west of 9^th Street in Louisville in 150 years. Tell me what you’ve learned during the hospital’s first year—anything that might be helpful to other health systems who are addressing access gaps in their own communities?  

Right off the bat, you can’t listen enough. You know, I was pretty set on the fact that I didn’t want us to build a “new old” hospital as Norton West Louisville Hospital, because it’s so easy for us in health care to take what we believe has worked for all these years from a design perspective, from a services perspective, and just superimpose it [and say,] “We’ll do it here.” I really thought it was important before we ever put the first pencil on an easel for design that we went out in the community and asked questions and listened to what people had to say about what they would like to see. What are the things they would like to see from a design perspective? What services would they like to see? How would they like to feel when they came into this facility? And what about the facility might make them feel that way? 

So my [first piece of] advice would be, make sure that that you commit to listening. Make sure that you don’t just make it perfunctory box-checking. Like, we had four meetings, we listened to the community. Get in churches, get in community centers, get in schools, anytime that you can get in a place where people are already gathering, no matter where it is, have conversations. Make them structured, ask questions.  

Thank goodness we did, because so much of what they told us, we incorporated into the design and into the functioning processes of the facility. And I like to think we got most of it right. I think we continue to perfect it as the community evolves, change it as it needs to be changed. But I also believe that the community accepted this facility much more expediently based on the fact that we did go ask questions and listen. I don’t think in the underserved areas of any community, trust in health care is really very high. As a matter of fact, I know it’s not. So one of my concerns right off the bat was, what can we do to begin the process of building trust? It’s going to take a long time to build trust, but what do we do on the front end so that we can get things right and start the process of dialogue, as opposed to us telling you what you’re going to get?  

The second [piece of advice] from me is, it’s so easy for us in health care to get caught up in people telling us why it won’t work. And there’s a million reasons that you could give [as] to why Norton West Louisville Hospital [wouldn’t work].  

As a leader, you are truly committed to doing the right thing. And I know most of us think we are, especially in the not-for-profit side. We’re all committed to doing the right thing, but you need to have a conviction that you do believe that there is a right to a level playing field as it relates to access to health care, and you have to understand that your return on investment is a bigger picture than just the financial if what you’re trying to do is to build trust, to change access, to get to a place where we can take costs down in health care through prevention. 

So many solutions to underserved areas have been brought on wheels or mobile vans, but they weren’t permanent. There wasn’t a feeling of permanency. [So] there was a lot of doubt that we would finish this project, that we would do it.  

But once there was the understanding of permanency, we began to be able to have different conversations. Now we’re just a year in there, so I’m not professing to you that mission is completed. It’s not. But our first steps were the right ones, and for the right reasons. We had a board of trustees that endorsed this project wholeheartedly, and that’s an important thing. We spent a lot of time talking about the “whys,” the importance of the hospital.  

I will also tell you it’s equally as important to communicate with your existing employees and providers while you’re doing this, because the culture of your organization is very important to supporting this effort. So my advice to people would be, talk about this within your organization just as much as you talk about it outside of your organization. I wanted people to know exactly what we were doing, what we were thinking. Our folks, from marketing and communications, did a great job of being intentional about giving opportunities for our own employees at their site of service to weigh in and talk about this and hear what we were doing. I felt that we had good energy [amongst] the entire 23,000 employees. It was just 300 that were going to be working at this facility, but we had the energy and the exponential power of 23,000 people who believed this was a good thing. 

New construction projects continue to be a priority for Norton—you’re currently in listening sessions for the design and construction of the second pediatric hospital in Kentucky. What are you hearing most consistently from patients, families and community members, and how is that impacting your strategic plan for the hospital? 

Let’s just start with this one: The overwhelming desire is, whenever possible, I want my child to be able to get their care as close to home as possible. And we agree, 1,000 percent—everything that we see says that healing works best closer to home. It disrupts the family less, the cost stays down. But [parents] always finish [by saying], when I need that higher, more specialized level of care, I want to know that it’s within 100 miles.  

That’s a big reminder for us. Let’s have clinics. Let’s have pediatric offices. Let’s have some diagnostics in all of these communities, and let’s work with the communities in a way that makes sense, so that we can build that trust again and build that relationship. But they’re clearly telling us through this process that their preference is as close to home as possible, which is intuitive, [it’s] what we thought.  

But the other part of it is, [patients are saying] we’re willing to go wherever we think the best expertise and the most support for us is. This is one of the things we should have known, that we’re using going forward.  

[Something else] that current parent population is saying to us is, I want the ability to have frictionless service when I come here, because I want to spend all of my time focused on the healing of my child. I don’t want to worry about where I park. I don’t want to worry about where I can go to get some exercise. I don’t want to worry about the fact that I feel like I need some mental health [care] myself as a parent.  

One of the reasons we’re so excited about having 152 continuous acres [for the new pediatric hospital] is that all of this can be dedicated to the care of the pediatric patient, the child and the family. We can use this acreage to build whatever we want. As we hear these things, we’re going to be able to piece together, what are the things that support the patient, and what are the things that support [their caregivers]? 

I get really excited thinking about some of these. For instance, QR codes. Think about arriving on this campus and parking your car using a QR code, getting in an autonomous car and being taken to the exact location of where your appointment is; walking in the door and using that same QR code to be directed to the office; having used that same QR code to register and do everything you needed to do in preparation [for the appointment]. There has been no friction on your journey. We knew you were coming, and we made this easy for you.  

Now, don’t hear that we’re not going to have friendly people along the way, because that is an important thing. People do rely on having human beings around. But my point is, what we’re hearing is, do all the administrative things that cause me nightmares—like asking my kid’s birthday 17 times while I’m there—get all that done. Don’t make me have to worry about where I’m supposed to go, how I’m supposed to get there, what I’m supposed to do.  

We’re listening and saying, OK, we need to design mechanisms and structures where we take all that friction out. And the only thing you have to worry about, if you’re a parent of that child, is them. In some of the listening sessions, [people say,] use my time efficiently. Time is a very valuable asset. So if there are things that can be done appropriately virtually,  make sure that you’re utilizing those. Because I would much rather be able to deal with this in that way, if I can and not have to take my time to come there.  

Is there anything you feel like we aren’t talking about enough in the health care industry that deserves more attention?  

Gosh, there are a lot of things. What disappoints me most is that there’s a lot of narrative out there about the health care system that I think is not altogether right, it’s not well-founded, and it’s not really fair, in some cases.  It is what it is, but I’ll just give you an example.  

Not for private health care institutions are given the blessing of not having to pay taxes, and in return for that, there’s an expectation that we provide a community benefit. And one of those planks of community benefit is charity care. It really bothers me that that there’s a lot of people who are not talking enough about that fact.  

We have a financial assistance program available for people that is very inclusive. I believe the last time I looked, a family of four can [receive] up to $130,000. All their health care and all their physician costs would be paid for [by the] community benefit that we have here. 

When we [hosted listening sessions for] Norton West Louisville Hospital, one of the things we heard over and over again was the awkward moment in registration where the question came up about how you [will pay for care], do you have [insurance] coverage? And many people told us, that’s an embarrassing question. I’m not even going to come to the hospital because I don’t want to deal with that. And we decided early on that that wasn’t acceptable.  

So we put together a way that that people and families could apply for this financial assistance so that when it came time that they did need it, we avoided the awkward conversation. What we have hoped to accomplish with that is getting people to a place where they then trusted health care a little bit, where they weren’t going to have to deal with the awkward conversation and where they weren’t going to wait [for financial assistance]. Everything that we do in health care is made worse by the wait. If we discover something [is a problem], the sooner we can get it, the more likely it is that we can make a difference.  

I think we’re not talking about it enough that every not-for-profit health care institution has a policy similar, probably not [exactly like ours], but similar. And when people talk about “health care is not affordable,” I get a little chagrin. We all need to do our best to manage costs, and we all need to work to keep the cost down. But I think it deters people who need health care from coming in and getting health care because of that conversation, especially in light of the fact that we have opportunities of financial assistance for people who don’t have financial resources to pay for care.  

But you never hear that part. I think we all can talk about it a lot more.  

C-Suite Shuffles

Where health care leaders are coming and going

• The Joint Commission has named two new leaders to its C-suite.  
  • This week, the accrediting body selected Dr. Arjun Srinivasan as its deputy chief medical officer. He has spent more than 25 years with the Centers for Disease Control and Prevention (CDC), most recently serving as deputy director of its Division of Healthcare Quality Promotion.  
  • And last week, Dr. James Merlino became the Joint Commission’s new chief operating officer. He has worked as the organization’s chief innovation officer since August 2023.
    
• Novant Health, the integrated health system in North and South Carolina, also tapped two executives this week.  
  • CJ Atkinson was named senior vice president of physician enterprise operations and network development, after previously serving as deputy chief physician executive for Novant Health Enterprises. In his new role, he’ll work to deliver seamless care across the organization’s acute, primary care and specialty arms.  
  • Bill Schiff will be the health system’s senior vice president and chief payor strategy officer: an upgraded title that builds on his experience as Novant’s chief payor officer and chief operating officer of Novant Health Enterprises Management Services, Newsweek’s Lauren Giella reports.  
    
• CommonSpirit has snagged a Providence executive to guide it through policy changes.  
  • Jacquelyn Bombard, the longtime chief federal affairs officer at West Coast-based Providence, is now system senior vice president of government affairs at Chicago-based CommonSpirit.  

Executive Edge

How health care execs are managing their own health

On Tuesday, I spoke with Dr. Maria Ansari, co-CEO of The Permanente Federation (Kaiser Permanente’s medical group consortium). She’s also the primary CEO of three of the eight medical groups in the Federation: the Mid-Atlantic Permanente Medical Group, the Permanente Medical Group in Northern California and the Northwest Permanente Medical Group in Oregon and part of Washington.  

Needless to say, she has her hands full. She oversees about 12,000 physicians caring for 6 million patients—and I’m excited to bring you more of her insights in next week’s Pulse Check.  

But today, I wanted to share a snippet of our conversation, which centered on improving care for the 65+ population, and promoting longevity and healthy aging. Ansari told me that she’s focused on “helping people live their best life” —so I asked her how she lives out those evidence-based practices to live her own best life. Here’s what she said.  

Editor’s Note: Responses have been lightly edited for length and clarity.  

• “When you look at how to live a really long, healthy life, one of the big things is strength training and physical activity. We sometimes discount some of the really basic things that are proven time and time again, and staying active [is one of them]. 
   
•  “I look at our older patients, and [for] some of them, their muscle strength is weak, and they fall and they can’t get up. We all know that when you break your hip, that’s kind of a downward spiral.  
   
• “And so really, I’ve been working a lot on core strengthening, doing a lot of, like, getting up from the floor and squats and [other] core strengthening exercises. 
   
• “I like to think of [Kaiser Permanente] as a blue zone, because our mortality rates are significantly lower wherever we serve. And I really do think it’s because of the major investment and in the things that we know to prolong life: vaccines, smoking cessation, exercise, blood pressure control and chronic disease management. I think when you do those things, you will live a longer, healthier life.” 

CEO Circle

Insights from health care thought leaders around the world

Before you go, check out our video interview and Q&A with Dr. Majid Al Fayyadh, CEO of King Faisal Specialist Hospital and Research Centre in Saudi Arabia, and a member of Newsweek’s CEO Circle. He has guided his hospital through significant transformations to align with Saudi Vision 2030, a Kingdom-wide commitment to building a thriving economy and supporting national innovation. Click here to hear what’s new in Saudi Arabia—and why its hospitals are claiming more spots on our World’s Best Smart Hospitals ranking.   

This is a preview of the November 13 edition of Access Health—Tap here to get this newsletter delivered straight to your inbox.