Tom Church

I'm a Policy Fellow at the Hoover Institution at Stanford. I work on health care, entitlements, and the federal budget. Write me via email, or get new posts by subscribing on Substack.

New: We Know Price Setting Leads to Disaster, But We Still Do It Every Year in Medicare. CMS just released its newest centrally planned PFS and OPPS payment rates.

• Writing
• Research
• Podcasts
• Code

Writing

• We Know Price Setting Leads to Disaster, But We Still Do It Every Year in Medicare
• What is Next for Healthcare Policy After the 2026 Midterm Elections?
• How to Screw Up Any Industry
• Seven Policies to Reduce Medicare Spending and Shrink the Federal Deficit
• Medicare for All Fixes Coverage for the Few by Breaking It for Everyone Else

All 35 posts →

Research

• Reducing Premium Subsidies for High-Income Enrollees in Medicare Part B Hoover Institution, 2026 (PDF)
  Replacing Part B's five IRMAA premium tiers with a linear ramp would end the taxpayer subsidy at $250,000 of income for single seniors and $500,000 for couples. It raises $89 billion to $106 billion over ten years after behavioral responses and leaves premiums unchanged for about 90% of enrollees.
• Refocusing Medicare Reform on Its Cost to Taxpayers with Lanhee J. Chen, JAMA Health Forum, 2026
• Expanding Access to HSAs: A Path to More Healthcare Choices for ACA Enrollees with Daniel L. Heil and Lanhee J. Chen, Hoover Institution, 2025 (PDF)
  Many high-deductible ACA plans lose HSA eligibility because their out-of-pocket limits grow with premiums. A fix would open HSAs to about 945,000 more people for roughly $1.7 billion over ten years.
• The Choices for All Project: Healthcare Reforms for the Future with Lanhee J. Chen and Daniel L. Heil, Hoover Institution, 2023 (PDF)
  Five reforms that put prices and choices in front of patients, with chapter summaries and downloads.

All research →

Podcasts

584 Vetoes is a podcast about the federal budget that I host alongside Brian Miller. Listen on Apple, Spotify, or YouTube, or subscribe by RSS.

• Ep 15Health Insurance Covers Too Much (and Coverage Mandates Are Partly to Blame) with Jared Rhoads
• Ep 14The Lessons from Part D and Public-Private Partnerships for the Rest of Medicare with Eric Hargan
• Ep 13It’s Time for a Fiscal Commission to Fix the Debt w/Congressman Lloyd Smucker
• Ep 12Why Does Medicare Pay Different Prices for the Same Procedures? Site Neutral Payments w/Charlie Katebi

All 15 episodes →

Podcast appearances

• The Medicare Time Bomb: Can Washington Defuse It? Matters of Policy & Politics with Bill Whalen, Hoover Institution, Oct 9, 2026
• The Federal Budget: More Than Just Dollars and Cents Qualified Opinions with Veronique de Rugy, alongside Danny Heil, May 2, 2025
• The Fiscal Effects of a Public Option Area 45, Hoover Institution

From 2021 to 2024 I hosted The Libertarian, Hoover's weekly conversation with Richard Epstein, for 124 episodes.

Code

1. TGAP, the Total Government Assistance Project. How much does the federal government spend on each American, and through which channels? An open-source, person-level ledger of federal assistance. Public release coming.