Our Mission
“For too long, efforts to reform the healthcare system have been fragmented, with one organization focused on insurance rules, another on Medicaid, and others on PBMs, pharmaceuticals, or hospital consolidation. The Center for Healthcare Affordability exists to connect the dots.”
“We're building the most comprehensive, provision-by-provision picture of how the ACA distorted incentives, drove up costs, narrowed choices, and empowered entrenched interests. Just as important, we're providing lawmakers and everyday Americans a clear set of limited government prescriptions that put patients back in charge.”
— Ryan McGowan, CEO, Institute for Legislative Analysis
The Center for Healthcare Affordability has assembled one of the most expansive bodies of research on the ACA’s architecture and how its individual provisions have reshaped healthcare. From that foundation, we identified the top five greatest challenges to healthcare affordability, then tasked a team of healthcare policy experts with tracing each problem back to its real causes. For every challenge, our policy framework provides a clear diagnosis and a practical set of prescriptions lawmakers can enact to reduce harm, restore competition, and protect patients.
Healthcare is arguably the most complex policy field in America. It is heavily regulated, intensely lobbied, and deliberately opaque, making it difficult for everyday Americans to understand what is happening, who benefits, and what reforms would actually improve care. While many organizations have produced valuable work, most have been forced by scale and specialization to operate in silos, focusing on a single area such as Medicaid, insurance regulation, pharmaceuticals, PBMs, or provider consolidation. Our Center fills what has been missing: a comprehensive, evidence-driven framework that connects these issues into a coherent picture of cause and effect.
To make that possible, our team built a detailed policy index that breaks down the ACA provision by provision and maps how the law’s incentives interact across the system. This approach allows policymakers and citizens to see what fragmented analysis often misses: how a “fix” in one lane can worsen outcomes in another, and how complexity creates opportunities for entrenched interests to extract value at the expense of patients and taxpayers.
Our reform agenda is designed to solve the greatest healthcare affordability challenges and move healthcare toward lower costs, higher-quality care, and greater innovation by applying limited government and free-market principles wherever possible. To separate serious reformers from those protecting the status quo, the Center has also launched the Healthcare Affordability Index: the most in-depth analysis of lawmaker healthcare voting to date, powered by the Institute for Legislative Analysis. Americans deserve to know whether their elected officials are advancing patient-centered, limited government reforms or doubling down on a system that keeps getting more expensive, more consolidated, and less accountable.
Leadership Team
The leaders guiding national reforms in healthcare
Ryan McGowan
Chief Executive Officer, Institute for Legislative Analysis
As CEO, Ryan McGowan leads the Institute for Legislative Analysis and oversees all financial and organizational operations. Prior to ILA, Ryan held the top finance position at the American Conservative Union where he served for over 6 years. Before joining the ACU, Ryan worked in the private and public accounting sectors, as well as management consulting where he assisted his clients in the areas of IPO readiness, mergers and acquisitions, revenue recognition, and audit readiness.
Emily Hargan
Senior Fellow, The Center for Healthcare Affordability
As Senior Fellow of The Center for Healthcare Affordability, Emily Duke Hargan leverages nearly 30 years of experience in government affairs and policy. Hargan also serves as Managing Principal of The Hargan Group, where she works alongside her husband, The Honorable Eric D. Hargan, former HHS Deputy Secretary, in advising top leaders in business, public policy and government.
Research Team
The policy experts and analysts driving our research initiatives
Fred McGrath
President & Executive Director, Institute for Legislative Analysis
Fred McGrath serves as ILA's President, overseeing the organization's policy, research and scorecard operations. He previously served as the Director of the Center for Legislative Accountability at the American Conservative Union (CPAC), where he spent a decade leading the creation of the nation's first and only legislative scorecard program covering all 8,000 federal and state lawmakers.
Francis Finnegan
Vice President & Database Manager, Institute for Legislative Analysis
Francis Finnegan directs the ILA's data and analytics operations. During his decade of service at the American Conservative Union he served in multiple capacities including Data Director, Python Developer and Legislative Analyst. An expert in SQL and Python programming, he constructed ACU's database of 16,000 lawmaker profiles, 19,000 bills and 1.7 million votes.
Bryan Axler
Director of Policy Analysis, Institute for Legislative Analysis
Bryan Axler serves as the ILA's Director of Policy Analysis where he plays a critical role in managing the review of policy and legislative procedure across the scorecard creation process. He holds a J.D. from Penn State Law and earned his Bachelor's in Business Administration from Kennesaw State University.
Zoe Reese
Director of Legislative Research, Institute for Legislative Analysis
Zoe Reese serves as the ILA's Director of Legislative Research and directs the research processes for ILA's congressional and 50 state scorecards. She is responsible for managing the organization's review of the over 105,000 bills introduced across the nation annually.
Cari Fike
Senior Legislative Consultant, Institute for Legislative Analysis
Cari Fike serves as a Senior Legislative Consultant for ILA. She graduated from the University of Alabama School of Law and spent the last 10 years in the halls of Congress serving in various roles, including Legislative Director and Deputy Chief of Staff for Rep. Gary Palmer, Chief of Staff for Rep. Mary Miller, and Executive Director for the House Republican Policy Committee.