John Arnold is an Enron executive-turned-hedge fund billionaire-turned-philanthropist who has taken a great interest in the healthcare debate, specifically on issues related to Medicare, Medicaid, drug prices, and the role hospitals play in increasing medical costs.

Arnold’s interest is so strong that he bankrolls players at every point in the generation and dissemination of information related to healthcare.

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He funds the academics who produce research on the topic. He funds the publications and academic conferences where that research is presented. He even funds organizations that lobby the government on healthcare policy using the very information produced by the entities he funds.

In June 2024, for example, Families USA, an organization Arnold funds, penned a letter to senior Biden administration officials, which, among other things, argued that hospital consolidation was to blame for rising healthcare costs. In doing so, Families USA cited an article published in Health Affairs, a journal funded by Arnold, which itself cited research that Arnold provided the financial backing for.

This instance serves as a microcosm of how Arnold’s network of health nonprofit organizations functions. Arnold Ventures, his primary philanthropy, funds research on a topic that is of interest to it, such as the role of hospitals in rising medical costs. That research is then published in a journal that also happens to be funded by Arnold. And finally, the published research is presented to policymakers by a think tank that Arnold funds.

Though such a characterization could be seen as verging on conspiratorial, Arnold Ventures practically admits to it.

According to an Arnold Ventures document hosted online by AcademyHealth, the organization’s “funding strategy” is to support “research to identify and highlight the drivers of the problem and to generate evidence about what works,” then to fund “policy development to translate evidence into actionable solutions,” with backing for “technical assistance and advocacy to provide timely, on-the-ground support to policymakers and other stakeholders” to follow, and finally to bankroll “visibility and communications to amplify evidence-based policy solutions.”

AcademyHealth, perhaps fittingly, is a healthcare research professional association that is financially supported by Arnold Ventures and promotes research funded by the philanthropy.

Critics of the Arnold network, speaking with the Washington Examiner, bemoaned how these kinds of circular citations might serve to artificially inflate the prominence of a given view within academic or policymaking discussions.

“I find it concerning when an organization funds researchers, venues, and conferences that promote and create a virtuous circle of ideas that appear independent when they often are not,” American Enterprise Institute fellow Brian Miller told the Washington Examiner. “I think it’s bad for the country. It promotes a circular discussion.”

Miller is also a commissioner of the Medicare Payment Advisory Commission, an independent legislative branch agency that advises Congress on Medicare issues.

“That’s an ideal arrangement for those interested in controlling the public’s access to healthcare, a lousy one for taxpayers,” Public Health Reform Alliance communications director Cara Kingan told the Washington Examiner. “A single, well-funded anti-free market organization that can pay for research, and fund the outlets that publish it and activist groups that publicize it, has amplified its voice by at least three times. That’s bolstered when like-minded administration appointees invite Arnold or allied personnel to informally consult on policy. Arnold provides the deliberative inputs, has the access to help shape the process, and isn’t answerable to the people it’s ultimately affecting.”

Arnold Ventures, of course, sees things differently.

“Arnold Ventures is committed to stopping fraud, waste, and abuse to create a more sustainable and fiscally responsible healthcare system,” a spokeswoman for the philanthropy told the Washington Examiner. “In pursuit of that mission, we award grants to well-respected and experienced researchers and analysts who approach the work from multiple perspectives. Because our grantees are leading thinkers in the marketplace of ideas, their work is often cited by one another and used by policymakers across the political spectrum.”

Arnold’s philanthropic empire has three primary components: Arnold Ventures, a limited liability company that forgoes charitable tax-exemption in exchange for avoiding financial disclosures; the Laura and John Arnold Foundation, which is a traditional 501(c)(3); and Action Now Initiative, his politically oriented nonprofit group.

Arnold has been characterized by conservative journalists as a liberal, with some going as far as to dub him the “new George Soros” over his funding of left-of-center criminal reform efforts and advocacy for “equity” in healthcare.

“I would see them as a liberal philanthropy given their strong support for price regulation and price caps at the state and federal level for drugs and hospital costs,” Miller told the Washington Examiner. “Price regulation is not a market-based policy.”

Allies of the billionaire, however, have been quick to deny that label, pointing to his bipartisan donation record and his network’s efforts to work across the aisle.

Regardless, Arnold throws around a lot of money, and with money comes influence.

Critics of Arnold charge that his interest in healthcare could be spurred by a financial stake in the sector. However, because he is not required to disclose his portfolio, there is no public evidence of this. Those close to him say he gives away far too much to net a profit from his philanthropy and point toward his pledge to donate the majority of his wealth. In Arnold’s telling, he is merely trying to create a world where healthcare costs less and disparities in access are reduced.

Academic research often forms the foundation of policy discussions in Washington. It is cited in committee hearings, populates briefings published by think tanks, attracts media attention, and is pored over by government staffers. Arnold spends millions of dollars to support healthcare research, and the results of that research often align with his organization’s positions.

The Laura and John Arnold Foundation’s most recent tax filings, which cover grants made in 2023, show that the organization spent nearly $20 million sponsoring dozens of healthcare-related research initiatives that year — not an unusual sum compared to past tax forms.

Following the Arnold network’s generous funding, studies that support its policy preferences have flooded academic journals.

Arnold’s network, for instance, generally blames hospitals for the high cost of healthcare. Studies funded by the network, meanwhile, have found that hospital prices lead to job losses outside the health sector, analyzed regulation comments to expose the influence of hospitals over policymaking, cited the power of hospitals over markets as a driver of higher costs, and uncovered that hospitals are largely not in compliance with federal transparency requirements — largely reflecting the views of their patron billionaire.

Some of these studies cite other studies funded by the Arnold network to support their conclusions, which is a recurring theme across research and publications funded by Arnold Ventures and its affiliated grantmakers.

In one such instance, a paper published in Health Affairs titled “Beyond The Bill: The Hidden Economic Toll Of High Commercial Provider Prices,” which disclosed funding from Arnold Ventures, cited a working paper published by the National Bureau of Economic Research, which was also funded by Arnold Ventures, to support the claim that “when local hospital prices increase, firms outside the healthcare sector respond by cutting jobs.”

Tax forms show that, in addition to funding research, Arnold also funds the media where research is published and the academic conferences where it is presented, further evidencing the billionaire’s influence at every level of the healthcare policy discussion.

Health Affairs, a peer-reviewed health and healthcare policy journal, lists Arnold Ventures among its funders. Tax documents show that the Arnold network provides the journal, which is one of the most prestigious and widely read in its field, with over $300,000 per year. In addition to funding the publication generally, it also provides support for specific projects, such as its solicitation of research related to Medicare-Medicaid integration, and a series of pieces, for instance, on the role hospitals play in driving healthcare costs.

Similar to Arnold-funded studies citing one another, articles published in Health Affairs often cite research that was funded by the Arnold network.

Health Affairs also cites and, in turn, is cited by other healthcare-related media ventures that the Arnold network funds.

Trade Offs, a popular trade publication and podcast dealing in healthcare policy, also counts Arnold Ventures among its patrons. It is not unusual for pieces published by Trade Offs to cite materials published in Health Affairs or materials directly funded by the Arnold network.

Arnold has also expanded into legacy media, occasionally paying for sponsored articles in Politico.

Healthcare think tanks, which serve as a sort of middle ground between academic institutions and media operations, also count on the Arnold network for support. Among the most notable organizations fitting this description are the National Academy for State Health Policy, Families USA, and Third Way.

These organizations differ from the media and research operations funded by Arnold in that they directly put pressure on the government to enact certain policies, as Families USA did in June 2024.

Arnold and his philanthropic empire are far from the only players in the healthcare debate that fund a wide array of interconnected groups. Perhaps the most famous example of this is the Pharmaceutical Research and Manufacturers of America, better known as PhRMA, and the broader pharmaceutical industry. The drug industry and its allied trade groups fund myriad organizations that promote their interests at the state and national levels.

These pharma-funded organizations often form coalitions with one another to support policies favorable to the drug industry. Critics have charged that financial backing from drugmakers allows these groups to be great in number and cause some policies to appear to have broader support than they really do. Many of the organizations, however, claim that funding from the pharmaceutical industry doesn’t influence what they choose to advocate for or against.

Sometimes, however, links to the industry can border on clandestine. In February, for instance, the Washington Examiner uncovered that a pharmaceutical-linked research nonprofit organization concealed its financial links to the industry while placing research extensively in high-prestige publications such as the New York Times, Wall Street Journal, and Reuters.

DONORS WERE GIVEN SECRET ROLE IN SHAPING MEDICARE POLICY IN BIDEN YEARS, DOCUMENTS REVEAL

Like the pharmaceutical industry, Arnold enjoys considerable direct access to the policymaking process. Arnold, who donates to causes on both sides of the aisle, has contributed close to $6.7 million to various political committees since 2016.

During the Biden administration, staffers working for Arnold Ventures were in direct contact with senior staffers at the Centers for Medicare & Medicaid Services, according to documents exclusively obtained by the Washington Examiner. This access went all the way to the top, with then-CMS Director Meena Seshamani personally approaching the healthcare team at Arnold Ventures via email to get its input on Medicare Advantage risk adjustment, a key policy change.