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How Americans’ Financial Health Is Faring In The “K-Shaped” Economy
Hey all, Jason here. Money20/20 is still two weeks away, but I’ve already started packing (not procrastinating for once!). My calendar is already filling up with various sessions I want to catch, meetings, and of course happy hours, dinners, and other side events. If you’ll be in Vegas and want to catch up, let me know by replying to this email, and we can try to find a time amidst the chaos of the Venetian. A big if not totally unexpected piece of news dropped on Friday: the Independent Community Bankers of America, a trade group that represents smaller U.S. banks, filed a lawsuit against the OCC and Comptroller Jonathan Gould, arguing that the regulator’s move to grant trust bank charters to firms seeking to use them to conduct substantial non-fiduciary activities exceeds the authorities granted to the OCC by Congress. I haven’t had time to fully digest the legal filing or speak to folks in my network about it, but you can expect to see coverage and analysis on it in next week’s newsletter. Subscribe or Support by Upgrading The NerdCon agenda just dropped. It’s stacked. Partner content: Nubank built an AI-first bank. Chime built its own banking core. Figure and Valon are rebuilding the mortgage stack. At NerdCon, you’ll hear from the people behind those bets: what they chose, what they learned, and what they’re still figuring out. The agenda is live, with leaders from Nubank, Chime, OpenAI, Remitly, Mercury, Figure, Valon and more. Follow the mainstage conversations, bring the problem your team is wrestling with to a hands-on workshop, or pull up a chair at a roundtable. Pick your quests. Meet us in San Diego, November 18–20. Fintech Business Weekly readers save 20% with code FBW20. Explore the Agenda Things To Know & Other Good Reads Federal Reserve Board finalizes changes to enhance the transparency and public accountability of its stress test and reduce volatility in its stress test-related capital requirements (Federal Reserve Board of Governors) FDIC Announces Conclusion of Independent Monitorship (FDIC) Modernizing Financial Regulation: Initial Observations from eSLR (Fed Vice Chair for Supervision Michelle Bowman) The Data Version of Godzilla versus Kong: FRED Takes on AI (Fed Governor Christopher Waller) Financing the AI buildout (Brookings) Q3’26: Rules for Banks but Not for Crypto (Fintech Takes Banking) The Inevitability of Local Stablecoins (Lombard Notes) Delusions of AI Governance: The Human-in-the-Loop Comfort Blanket (Fintech Snark Tank) Stripe agrees to acquire Parafin to expand revenue opportunities for platforms and help small businesses grow (Stripe) Listen: Fighting Fraud in the Age of AI, with SEON’s Tamas Kadar (Fintech Business Weekly) How Americans’ Financial Health Is Faring In The “K-Shaped” Economy If there is one overarching theme across the economy and politics in the U.S. at the moment, it’s “affordability.” The term is vague enough to encompass a panoply of factors shaping Americans’ day-to-day lives: rising costs for the hallmarks of being “middle class,” including healthcare, housing, childcare, and education, inflation and rising interest rates, and a job market with the specter of AI hovering over it. At the same time, policy shifts under the Trump administration have resulted in reduced subsidies to those who get health insurance under the Affordable Care Act and new restrictions on qualifying for Medicaid and SNAP, the impacts of which have yet to be fully felt. These factors are contributing to declining consumer confidence and general dissatisfaction with the economy, despite continuing GDP growth and stock market records. This divergence is encapsulated in the idea of the “K-shaped” economy, in which a small proportion of Americans have seen their wealth balloon, while the majority of American households struggle to preserve the lifestyle they have. Perhaps the greatest determinant of which branch of the “K” a household is on is whether their wealth and income are primarily derived from employment vs. from assets. Nearly two decades of low interest rates and, more recently, elevated rates of inflation have benefited asset owners, while those whose income is primarily or solely derived from labor have largely seen real purchasing power stagnate or decline. This is reflected in recent Bureau of Labor Statistics data showing that labor share of U.S. GDP — the fraction of economic output that accrues to workers as compensation in exchange for their labor — dropped to just 52.8% in Q2 2026, the lowest since the BLS began keeping records. In 1947, approximately 2/3rds of economic output accrued to workers; even as recently as 2001, labor’s share of GDP was 64.1%. Against this backdrop, we’ve seen the rise of more credit and credit-like products: cash advance apps, “no-fee” overdraft, earned wage access, and buy now pay later, which are often used as small-dollar short-term borrowing mechanisms to meet immediate consumption needs or pay other bills (eg utilities, cell phone, other debt payments). With the markers of a middle class existence and, increasingly, basic financial stability seemingly out of reach for many, it should be no surprise there’s been an increase in “financial nihilism,” something industry peers like Alex Johnson and Frank Rotman have discussed and analyzed the roots of. The explosion of gambling and gambling-adjacent products and services — often marketed under the guise of being an “investment” — is inextricably intertwined with the rise of financial nihilism. Crypto, sports betting, and, more recently, prediction markets offer an escape or even hope of sorts, like a contemporary, digital version of a scratch-off lottery ticket, while leaving the overwhelming number of people who use such products worse off. Share of Households That Are Financially “Vulnerable” Ticks Up The Financial Health Network’s 2026 Financial Health Pulse® report adds context on how American households are faring. (I linked to this report in last week’s newsletter, but wanted to take time to further unpack the data in the report this week.) The Financial Health Network publishes the report annually, providing insight into how Americans’ financial circumstances are changing over time. The 2026 report is derived from a survey fielded in April and May 2026. The report leverages survey responses to assess indicators of financial health across spending, saving, borrowing, and planning/protecting and to determine a zero to 100 “FinHealth” score. Those with scores between 0 and 39 are considered “Financially Vulnerable,” consumers with scores ranging between 40 and 79 are defined as “Financially Coping,” and those with scores of 80 to 100 are “Financially Healthy.” The report found that moderate improvements in 2025 were reversed, with the share of respondents considered financially “vulnerable” rebounding to 17%. The longitudinal data reflect the impact of pandemic-era programs, like expanded unemployment, cash stimulus payments, and pauses of federal student loan payments. The positive impacts of those programs, as reflected in the Financial Health Pulse reports, had largely disappeared by 2023. While pandemic-era inflation — to be fair, in part caused by the various support and stimulus measures — had come down from as high as 9% in 2022, it has rebounded since the start of Trump’s second term, with tariffs and energy market disruptions owing to the war in Iran pushing prices back up. Specific indicators in the survey that deteriorated from 2025 to 2026 include the share of respondents spending less than their income over the past 12 months, the share paying all bills on time over the past 12 months, the share that have a manageable amount or no debt, the share that are “moderately” or “very” confident their insurance is adequate to cover them in an emergency, and the share that “somewhat” or “strongly” agree that their household plans ahead financially. Unsurprisingly, lower- and moderate-income households are more likely to struggle to pay their bills on time and have any funds leftover to save. The share of low-income households whose income exceeded their spending dropped from 35% in 2025 to 31% in 2026, while the share of upper-income households whose income exceeded expenses remained unchanged at 63%. Households with student loans or revolving credit card debt reported having “a bit more” or “far more” debt than was manageable at rates far higher than those not carrying these types of debts. The share of those with student loan debt indicating their debt load was too high to manage increased from 50% in 2025 to 55% in 2026, while the share of those with revolving credit card debt saying the same ticked up from 51% in 2025 to 54% in 2026. Households that had student loans were markedly more likely to be financially “coping” or “vulnerable” vs. those without student loans. In 2026, 27% of households with student loans were considered financially vulnerable, a jump of 6% points vs. 2025. Households without student loans saw just a 1% point increase (not statistically significant) in those considered financially vulnerable. Households’ perception of the affordability of categories of goods and services paints a stark picture, with less than one-fourth considering higher education affordable, about a third deeming childcare affordable, and less than half viewing healthcare as affordable. Fintech Business Weekly is made possible by the generous support of paying subscribers — bringing you independent analysis of banking, fintech, and crypto without fear or favor. You can support my work by becoming a paying subscriber if you aren’t already. Paying subscribers enjoy: access to the entire archive of nearly six years of newsletters extended versions of the weekly newsletter, with additional content and analysis and (for founding member tier) quarterly personal 1:1 fintech Q&A / strategy calls with me, tapping into my unparalleled knowledge of the intersection of banking and fintech and experience working in the sector, including helping to launch Goldman Sachs’ retail bank Marcus Support Fintech Business Weekly You can also support Fintech Business Weekly by sponsoring a newsletter or podcast, putting you in front of 93,000+ of the most influential decision makers in banking, fintech, and crypto. Learn more about sponsor opportunities or request a media kit by dropping me an email. Democratic Senate Report Highlights How Iran Uses Tether to Evade U.S. Sanctions Iran uses stablecoins, specifically Tether, to evade sanctions, fund regional proxies, and to purchase military drones, a report released last week by the Senate Permanent Subcommittee on Investigations says. The report was authored by committee ranking member Senator Richard Blumenthal (D-CT) and the minority staff. Crypto and stablecoin proponents will often push back on criticism that criminals make use of these assets by arguing that, on an absolute dollar basis, far more illicit funds flow through traditional banking systems and payment rails than via crypto and stablecoins. And while that is likely true, it elides the reality presented in news story after news story: whether state actors — Russia, Iran, North Korea — or criminal groups, those looking to engage in illicit transactions increasingly favor stablecoins and, specifically, Tether (USDT). The report from the Senate Permanent Subcommittee on Investigations released last week adds context to how Iran uses Tether has a lynchpin in its shadow banking system. The report analyzed 846 wallets that have been sanctioned or targeted for seizure, finding that 84% of them transacted exclusively or primarily in Tether. The ability to create near limitless, anonymous wallets and to move funds effectively instantaneously and irreversibly have made crypto a favored financial mechanism for bad actors. Stablecoins solved key drawbacks of bitcoin, namely, the original cryptocurrency’s highly volatile value in dollars. And while Tether (the company) has the technical ability to “freeze” or destroy funds, the company is often limited and reactive in its approach to doing so, the Senate report argues. Tether, which is nominally based in crypto-friendly El Salvador, “has stated that its compliance with OFAC sanctions is ‘voluntary’ and that it follows ‘OFAC guidelines,’” the Senate report says. Owing to these favorable attributes, Tether “became a primary cryptocurrency for Iran, Hamas, Hizballah, and the Houthis beginning in 2023 and has expanded in scale since,” according to the report. Tether’s role in Iran’s shadow banking system, the report says, is enhanced by crypto exchanges like Bybit, Kyrrex, OKX, Gate, and Binance, and through “over the counter” exchanges and hawala networks. The consequences of these financial flows aren’t hypothetical. The Senate report links Tether as a funds transfer mechanism to Iranian proxies in the region, including Hizballah, the Houthis, and Hamas. Tether has also been used to make payments to secure components necessary to manufacture drones, the report says. The report concludes by arguing that “[s]tablecoin issuers with a significant nexus to the United States, particularly those that offer dollar-denominated stablecoins, should be subject to American sanctions law rather than being allowed to hide behind foreign jurisdictions.” Stablecoin issuers like Tether must be held accountable for repeated failures to prevent illicit finance and sanctions violations by law enforcement, the Department of Justice, the Securities and Exchange Commission, and OFAC, the report argues. [Paying Subscriber Exclusive] OUSD Goes Live, Make Your Own Neobank, U.S. Sanctions Russia’s A7 Network As “Transnational Criminal Organization” OpenUSD, the stablecoin issued by the Open Standard consortium that includes Stripe, Visa, Mastercard, core providers, crypto firms, and numerous banks, went live last week. Social commerce platform Whop raised eyebrows in fintech by offering creators on its platform the ability to launch their own neobanks, which the company describes as “great businesses that are easy to run,” in just 15 minutes. And OFAC and FinCEN target Russia’s “shadow banking” A7 Network — more on these stories after the paywall.
Georgia woman business owner arrested on fraud charges
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This is a condensed version of Business Insider Today, a newsletter that gives you a look at the week’s top stories. Sign up here to get the full Business Insider Today in your inbox every day for the top stories in markets, tech, and business.
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A leader of the Church of Jesus Christ of Latter-day Saints says an explosion in online prediction markets and sports betting is fostering greed among young people
Mormon leader decries explosion in sports gambling, prediction markets
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Mormon leader decries explosion in sports gambling, prediction markets
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Mormon Leader Decries Explosion in Sports Gambling, Prediction Markets
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Coastal forces shape building sciences practice
When Built Environments relocated to Wilmington, the firm’s partners weren’t looking for the lazy tranquility one hopes for when on vacation. Instead, they sought sultry heat. They wanted to understand whipping coastal winds and punishing precipitation – the kind that tropical storms produce. That’s because how materials degrade can reveal a lot about how they can be improved. “We specifically chose the Wilmington market because it does fall within Climate Zone 3A, which is a coastal warm-humid climate,” said Jarrett Davis, who joined Built Environments in 2023 to lead the company’s building science practice. “There’s not a lot of product research in that climate zone, but there are a lot of structures here that get weatherized pretty severely.” Built Environments has provided building science, material testing and code compliance consulting for 25 years, ever since principal materials scientist Steve Doggett founded the company in Minnesota. “There are very few manufacturers that understand fully how their own materials and products work, whereas we know their shortfalls and their benefits out in the real world on jobsites,” Doggett said. “That’s why the original Built Environments was formed, to make buildings better.” He said the 15-employee company is just as comfortable on a jobsite, retrofitting a high-end beachside property, for example, as it is recreating some of the coast’s most intense weather conditions in the great indoors. The company operates an A2LA-accredited ISO/IEC 17025 mechanical testing laboratory on Wright Street. The year-old facility has expanded Built Environments’ in-house capabilities, Doggett said. “We’re able to simulate that hurricane wind (and) rain and perform structural and impact testing on wall assemblies, roof assemblies and glazing assemblies,” he said. “There are certain requirements that those windows and doors need to meet as far as wind ratings and pressure ratings and things of that nature.” Standard Glass Co.-Glass Depots, of Wilmington, is currently testing a new glazing system using Built Environments’ stress testing, the partners said. One method involves what’s called a “large missile cannon.” “We take 8-foot two-by-fours, and we shoot them at assemblies, so they have to withstand that impact,” Davis said. “It’s pretty cool to see, I’m not going to lie.” In many cases, the lab can run a full, wall-scale test of a product in a matter of weeks or months, whereas “it might take midrange manufacturers years,” Doggett said. “We’re nimble. We can cut that time in half.” The lab also develops intellectual property. Doggett, for example, shares a patent with Sustant LLC, of Minnesota, on a fastener patch to increase the air and water tightness within building envelopes. “We have too many ideas and not enough time,” he said. But the partners noted that they or their fellow principals – of which the company has four total, including a principal engineer and a principal codes and standards expert – could be anywhere on a given day, including in the courtroom providing expert testimony in contentious insurance cases. “Let’s say there is a fire on a structure,” Davis said. “We can analyze all the specific materials within that assembly – an exterior wall or something like that – because there are loads that require certain heat release. And so, we can measure each one of those materials, if need be, to say if this was likely or not a code-approved assembly.” Despite what can be inferred in a lab, the partners said nothing beats learning from how materials change over time under real-world strain. Take, for instance, the curious case of the creaking condo. “We recently had a customer that came to us trying to assess a sound issue of a roof. It was making noises that no one could explain or account for. How do you tackle something like that?” Doggett asked rhetorically. “There’s really no generally agreed-upon methodologies.” The problem turned out to be a faulty installation of a commercial roof system. “The building in this particular case was not local,” he said. “In the initial installation, the commercial roofing contractor installed the wrong fasteners in the wrong locations into the deck, and essentially the solar radiation was causing the building to move quite substantially early in the morning when the sun initially hit that assembly after a quite cool evening, causing the threads on the fasteners to kind of jump within the material, within the metal.” Built Environments designed an effective repair methodology that was within budget, the partners said. “We get the bizarre,” Doggett said. “I will say that’s something that has stayed the same over 25 years.” The partners said they are hiring, and that Cape Fear Community College is one of their main recruiting grounds. Davis and Doggett look for talented people who can understand traditional methodologies yet are open to on-the-job training and new understandings, they said. After all, it’s not just weather that can ruin a building. “My favorite saying is,” Davis said, “‘What are the eight most expensive words in construction? That’s how my daddy used to do it.’”
Coastal forces shape building sciences practice
When Built Environments relocated to Wilmington, the firm’s partners weren’t looking for the lazy tranquility one hopes for when on vacation. Instead, they sought sultry heat. They wanted to understand whipping coastal winds and punishing precipitation – the kind that tropical storms produce. That’s because how materials degrade can reveal a lot about how they can be improved. “We specifically chose the Wilmington market because it does fall within Climate Zone 3A, which is a coastal warm-humid climate,” said Jarrett Davis, who joined Built Environments in 2023 to lead the company’s building science practice. “There’s not a lot of product research in that climate zone, but there are a lot of structures here that get weatherized pretty severely.” Built Environments has provided building science, material testing and code compliance consulting for 25 years, ever since principal materials scientist Steve Doggett founded the company in Minnesota. “There are very few manufacturers that understand fully how their own materials and products work, whereas we know their shortfalls and their benefits out in the real world on jobsites,” Doggett said. “That’s why the original Built Environments was formed, to make buildings better.” He said the 15-employee company is just as comfortable on a jobsite, retrofitting a high-end beachside property, for example, as it is recreating some of the coast’s most intense weather conditions in the great indoors. The company operates an A2LA-accredited ISO/IEC 17025 mechanical testing laboratory on Wright Street. The year-old facility has expanded Built Environments’ in-house capabilities, Doggett said. “We’re able to simulate that hurricane wind (and) rain and perform structural and impact testing on wall assemblies, roof assemblies and glazing assemblies,” he said. “There are certain requirements that those windows and doors need to meet as far as wind ratings and pressure ratings and things of that nature.” Standard Glass Co.-Glass Depots, of Wilmington, is currently testing a new glazing system using Built Environments’ stress testing, the partners said. One method involves what’s called a “large missile cannon.” “We take 8-foot two-by-fours, and we shoot them at assemblies, so they have to withstand that impact,” Davis said. “It’s pretty cool to see, I’m not going to lie.” In many cases, the lab can run a full, wall-scale test of a product in a matter of weeks or months, whereas “it might take midrange manufacturers years,” Doggett said. “We’re nimble. We can cut that time in half.” The lab also develops intellectual property. Doggett, for example, shares a patent with Sustant LLC, of Minnesota, on a fastener patch to increase the air and water tightness within building envelopes. “We have too many ideas and not enough time,” he said. But the partners noted that they or their fellow principals – of which the company has four total, including a principal engineer and a principal codes and standards expert – could be anywhere on a given day, including in the courtroom providing expert testimony in contentious insurance cases. “Let’s say there is a fire on a structure,” Davis said. “We can analyze all the specific materials within that assembly – an exterior wall or something like that – because there are loads that require certain heat release. And so, we can measure each one of those materials, if need be, to say if this was likely or not a code-approved assembly.” Despite what can be inferred in a lab, the partners said nothing beats learning from how materials change over time under real-world strain. Take, for instance, the curious case of the creaking condo. “We recently had a customer that came to us trying to assess a sound issue of a roof. It was making noises that no one could explain or account for. How do you tackle something like that?” Doggett asked rhetorically. “There’s really no generally agreed-upon methodologies.” The problem turned out to be a faulty installation of a commercial roof system. “The building in this particular case was not local,” he said. “In the initial installation, the commercial roofing contractor installed the wrong fasteners in the wrong locations into the deck, and essentially the solar radiation was causing the building to move quite substantially early in the morning when the sun initially hit that assembly after a quite cool evening, causing the threads on the fasteners to kind of jump within the material, within the metal.” Built Environments designed an effective repair methodology that was within budget, the partners said. “We get the bizarre,” Doggett said. “I will say that’s something that has stayed the same over 25 years.” The partners said they are hiring, and that Cape Fear Community College is one of their main recruiting grounds. Davis and Doggett look for talented people who can understand traditional methodologies yet are open to on-the-job training and new understandings, they said. After all, it’s not just weather that can ruin a building. “My favorite saying is,” Davis said, “‘What are the eight most expensive words in construction? That’s how my daddy used to do it.’”
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September Monthly Review: Health MCP Guy?
For all the time I spend talking about APIs and data exchange, this newsletter has had embarrassingly little interoperability of its own. It’s old-school SaaS, baby - UI or bust. Not all of that is my fault! Substack, for all its popularity, is (as mentioned before) really frustrating as my system of record. The primary user it optimizes towards is the reader, whose attention feeds the app, the Notes feed, and the recommendation network that Substack is actually selling. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe They’re falling into the same trap that Medium once sprinted into, albeit at a much more glacial speed. Younger generations may not remember (or never knew) it, but Medium once lured publications like The Ringer and Signal v. Noise onto its platform, only to lose them as it rebuilt itself around a paywall and an algorithmic feed. Substack’s original pitch circa 2020 was the antidote (you own your list), but every new feed feature chips away at it. I get it: writers are generic supply in the eyes of the Substack product team. Generic supply follows demand, so the consistent pressure on the PMs is to generate demand, which leads to every product cycle going toward discovery (Notes, recommendations, the app, live video). The end result lackluster author tools (laggy and broken analytics are truly crippling) all despite the premium price point. The archive is where it crosses from authorial gripes to actual reader impact, though. Across Substack and LinkedIn, I’ve published 1,218 posts and nearly 900,000 words since 2018. Substack’s native search can see only the 464 posts that live on Substack, and even there it’s woefully inadequate at surfacing relevant content (even for the guy who wrote it)! Readers have the same problem, writ large. Ask the Archive Fixing search (for both my readers and my own use) turned out to be extremely non-trivial, unfortunately: There’s no public API for readers to access content RSS exists for new content notification, but it only carries the 20 most recent posts and cuts paid ones off at the preview The only Substack MCP is an admin tool for analytics The export exists for authors, but it’s painfully awkward and slow. So I built something to work around that: the Health API Guy MCP. It’s a private MCP server holding the full text of everything I’ve written across Substack and LinkedIn. Add it to Claude or ChatGPT as a connector and you can ask things like: It pairs keyword search (for acronyms and case names, of which we have many) with semantic search. Every post is also labeled by topic, form, and court case, so you can pull a lawsuit’s (or multiple cases’) entire docket across Substack and LinkedIn in one query: Hail, Healthapiguyhydra This is also a bit of me eating my own cooking. I’ve spent the year arguing that headless healthcare is arriving and that developers want primitives over abstractions. Last week in Hail, Benihydra, I watched Salesforce plug its platform into Claude and bet that the records underneath outlive whatever interface sits on top: Salesforce must believe that the Hydra’s immortal head is the records, permissions, and business logic (in that they will survive whatever happens to the interface). It felt a bit hypocritical to keep my own archive behind a Substack search bar. The archive is the body. Substack is one head, and now whatever tool you might use is another. Will the EHRs follow my lead? Probably not imminently, but one can hope! Why Founding Members Only The MCP is available to Founding Member subscribers. A few reasons: It costs money and time to run. Hosting, the database, Clerk usage and AI compute for search and labeling are significant operational costs (that increase with usage). Substack gives me no way to automate access. There’s no API to check whether someone is a paid subscriber, so every user is manual operations for now. It’s a beta. We’ll need to improve things and parts will break. I’d rather they break for a small group of dedicated readers who will tell me about it. The Founding tier deserved a real benefit. Until now it was mostly a generous tip. Now it comes with something. If you’re already a Founding Member, reply to this email with the address you’d like provisioned. If you’re not and want in, upgrade here. Larger teams (such as companies) can get access too: group subscriptions at the Founding tier come with the group discount. The admin for the subscription can reply with the list of addresses to provision. Get 20% off a group subscription Pricing Founding membership is now a flat $200 a year, replacing the old suggested $150 that readers could adjust. Existing Founding Members will have access grandfathered in at their previous rate. Month in Review Articles Published Make Networks Dumb Again (Sep 11): AI is making old analog networks cheaper to use and flooding them with machine traffic in the process. A plea for agent-native rails with the intelligence at the endpoints, and for Washington to drag them to ubiquity. Interoperability, Unbuttoned (Sep 29): Interoperability is a series of workflows in a trenchcoat, and this post finally takes the trenchcoat off. A color-coded map shows which provider workflows went digital, which are fragmented, and which still run on fax. Video Content Antitrust’s System of Record Problem (Sep 3): The FTC’s investigation into Epic prompted a ninety-minute webinar, now posted with chapters and a smoothed transcript. We get into why market definition, missing B2B share data, and the SSNIP test leave antitrust poorly suited to systems of record, plus why information blocking may be doing more than any pending lawsuit. The Information Exchange: Cerner Milking Edition (Sep 18): This was so fucking fun. Ryan Tucker, Ryan Brickner, Brad Thorson, and I try an Around the Horn format, complete with points, penalties, and a mute button. We debate whether Oracle Health is dead, who would actually buy Cerner (IBM enters the chat), p(Doom), and why the front desk still hands you a clipboard. Regulatory Ask Not What Your Network Can Do (Sep 23): CDC’s RFI on public health data intermediaries lists use cases already served, unevenly, by eCR, lab reporting, IZ Gateway, and syndromic surveillance. The real opportunity sits in one question about AI: a network that can handle the next emergency without another interface project. Court cases Particle v. Epic: The Naughty Schoolteacher (Sep 4): After a summer-long vigil, the answer on Epic’s early summary judgment bid is two paragraphs and a remedial assignment. Particle advances to the next grade, and market definition gets another year of discovery. The Epic Discovery Files (Sep 8): Texas’s motions to compel arrive with a 251-page appendix of requests, objections, and meet-and-confer letters with Cravath. Inside: Epic using generative AI for document review, denied interoperability requests in scope, and Noerr-Pennington raised against lobbying discovery. Epic v. Health Gorilla: “Working as Designed” (Sep 9): Epic wants nothing to do with the data breach MDL, and explaining why puts fresh discovery on the public docket. The spiciest allegation: Health Gorilla told GuardDog to scrub its law firm business from its website instead of cutting off access. Veeva v. Epic: Legal Bypass Surgery (Sep 15): Veeva asks the Wisconsin Supreme Court to skip the Court of Appeals, while law professors and three policy groups line up as amici. Meanwhile, Epic’s lawyers apologize for another round of citation errors, including a quote that never existed. Texas v. Epic: Behind the Black Bars (Sep 17): The court portal served up Epic’s unredacted filings, revealing a $5 million document review budget and the AI workflow behind it. Also inside: the 200-plus company names Texas wants searched, and one very expensive Zoom invitation. OpenEvidence v. Doximity: Consequences Will Follow (Sep 25): OpenEvidence tells the court it will not comply with a discovery order, and its own lawyers at Quinn Emanuel say they won’t defend the choice. Add years of Slack reported unrecoverable, and Rule 37 sanctions come into view. Health Tech Keeps Choosing Violence (Sep 28): Doximity moves to end OpenEvidence’s case, Epic asks Texas to show its work, and a sleepy Audacious Inquiry patent fight sprouts antitrust and information blocking counterclaims. The main event is a long-sealed Cognizant v. Infosys ruling that hints where system of record antitrust claims can survive. EHRs One Verb for Oracle Health (Sep 14): Oracle’s earnings call quantifies every data center to the decimal point, while Oracle Health gets a single verb: “accelerate.” Panning the few healthcare mentions turns up an agentic care management system, a research-to-care ledger play, and the question of whether healthcare gets Larry’s patience. Epic’s Forretress Under Siege (Sep 30): Judy Faulkner tells a panel Epic paused hundreds of projects to harden its software and calls it a “shame,” while a spokesperson insists the roadmap hasn’t changed. Project Glasswing, a Pokémon-branded QAN sprint, and a trove of Jodel grievances reconcile the two Epics and preview the Jevons paradox coming for all software. Industry Analysis Scanning for a Network (Sep 1): Scan.com raises $220M to build the imaging network labs never got, speedrunning Zocdoc’s consumer-to-B2B pivot. Its wedge to network density may be the most American one available: personal injury litigation. The Front Desk Wants the Damn Whole Building (Sep 16): Hello Patient buys Converse Health, pushing its AI front desk into referrals, chart work, and prior auth. The copilot categories keep blurring, and your distribution partner is still your final boss. Cross-industry Comparisons A Different Patchwork Quilt (Sep 10): Healthcare loves to envy open banking, but the US version has no mandate, a toll booth at Chase, and data quality problems of its own. The grass isn’t greener; it’s another American patchwork quilt, and perhaps a worse one. Hail, Benihydra (Sep 21): Salesforce brings its platform into Claude, Slack, and its own agent, inviting the interfaces that might replace it. Cut off one head and more grow back, so long as the records underneath stay put. Living on A Trade Secret Prayer (Sep 22): Six credit unions are suing Fiserv, the Epic of core banking, by claiming their own member records as trade secrets. Banking has no Cures Act, so its lawyers reach for legal alchemy that healthcare has already tried. Other News None this month External Media Nabla Accelerate NYC: I kicked off fall conference season at Nabla’s Accelerate event in New York, where Delphine Groll opened by asking the room to picture the company it wants to become and the one it doesn’t. I liked her framework of bureaucracy, fear, and ego as the blockers. I also love vendor conferences/events in general - different vibe than industry biggies. Healthcare 101 with Nikhil Krishnan: I briefly guest lectured Out-Of-Pocket’s Healthcare 101 class. Appreciated Nikhil’s takeaways cover whether AI doctors can query HIEs, why healthcare’s data-liberation rules beat most industries’, and the hi-res graphic is in the comments. HCN: Epic Probed by the FTC: I joined the HCN guys to talk through the FTC’s investigation into Epic. Cedric’s new hairdo was an unexpected plot twist. The episode also covers MFN drug pricing, healthcare M&A and Eli Lilly’s acquisition streak. Fall Conferences: At eHealth Exchange’s Annual Meeting in Austin on Oct 27, I’ll moderate a panel on the tensions between AI, HIEs, and timely patient access with Jean Ross (Primary Record), Therasa Bell (Kno2), Byron Crowe (Doctronic), and Michael Marchant (Freenome). Here’s the rest of my schedule if you want to meet up: CommonWell (Redwood Shores, CA): Oct 13-14 Will be participating in a fun Jeopardy event Open@Epic (Madison, WI): Oct 20-23 Will be enjoying Verona, Willy Street, and other local adventures eHealth Exchange and Sequoia Project (Austin, TX): Oct 27-29 Yeehaw HLTH (Vegas): Nov 15-18 Groundhog Day, Venetian Edition RSNA (Chicago): Nov 30-Dec 2 See me at “Governing AI in Breast Imaging: What Health Systems Are Actually Doing” Digital Health Counsel 2026 AI Summit (Seattle): December 2-3 Will likely be speaking to a bunch of lawyers about information blocking Posts I Liked ChatGPT’s Epic integration: game changer or nothing burger?: Joshua Liu, MD offers five thoughts on OpenAI’s Epic launch, starting from the point that it rides the same open APIs available to anyone. He argues read-only access leaves ordering to Art and the ambient startups, and asks why HCA is piloting it alongside Commure. He’s sorta a must-follow at this point - consistently excellent, thought-provoking takes. Epic, Lilly, and the Discovery pass: Seth Chaney reads Epic’s first major Discovery deal (with Eli Lilly), as well as its revised developer terms on commercial displays, as the pipe finally opening between EHRs and pharma. Life sciences and health continue to collide. Scott Rossignol on EHR payer platforms and ePA fees: Scott argues the top ambulatory EHR vendors are turning the prior auth mandate into a per-member-per-year toll on payers, for an API whose operating cost has nothing to do with covered lives. His fix is two lines of regulatory text: put the CRD/DTR/PAS certification criteria in the Base EHR definition, and bring payer-facing ePA connectivity under § 170.404’s cost-based fee rules. It’s a good solution. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe
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KIII 3 News
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Sandhills Community College Small Business Center expands to Moore and Hoke Counties
Small Business Center Director, Laura Kinsman. Photo provided by: SCCSandhills Community College (SCC) is launching a redesigned Small Business Center model that expands no-cost entrepreneurial support across Moore and Hoke Counties. Rooted in the College’s commitment to strengthening small businesses and entrepreneurship as drivers of economic growth, the enhanced model is led by recently appointed Small Business Center Director, Laura Kinsman. The model also includes two new Senior Business Advisors who will provide trusted expertise, stronger community connections, and individualized guidance to entrepreneurs and business owners throughout the region.Kinsman brings a unique perspective to the director’s role as both a local business owner, operating in downtown Southern Pines, and a former Moore County educator. “Her combination of education, business ownership, leadership, and community involvement make her a great fit for the Small Business Center and the work we are continuing to build across Moore and Hoke counties,” said Taylor L. McCaskill, senior director of Workforce Development & Corporate Partnerships in a press release.Kinsman is an active member of the Southern Pines Business Association and has been connected to the Sandhills Small Business Center since the beginning of her entrepreneurial journey. She looks forward to building on that experience by strengthening the Center’s partnerships and expanding its connections throughout the community.She will lead the Center's efforts to support entrepreneurs and business owners throughout Moore and Hoke County and be the connector to the North Carolina Community College System Small Business Center Network operations. The Center offers no-cost, confidential one-on-one counseling, practical workshops, and connections to the resources and partners that help local businesses start, grow, and create jobs.A key part of this new approach, only offered at SCC, is a network of Senior Business Advisors, experienced professionals who will provide individualized guidance in areas such as business planning, finance, marketing, operations, growth strategy, and problem-solving. These advisors will serve as trusted partners to entrepreneurs and business owners, helping them turn ideas into action, overcome barriers, strengthen existing businesses, and pursue new opportunities. This one-on-one counseling is available at no cost, ensuring that high-quality business support is accessible to entrepreneurs at every stage.Senior Business Advisor for Hoke County, Kenna Parks. Photo provided by: SCCKenna Parks has been named the senior business advisor for Hoke County. She is a business professional, entrepreneur, and educator who brings a unique combination of academic training and real-world business experience. She earned her Master of Business Administration (MBA) in 2017 and has built her career around entrepreneurship, marketing, business development, and helping others turn ideas into sustainable opportunities.Senior Business Advisor for Moore County, Katrin Henderson. Photo provided by: SCCAs a military spouse, she has successfully launched and operated businesses across five states, giving her firsthand experience in adapting to diverse markets, building new customer bases and understanding the importance of global reach in today’s business environment. Over the last decade, her areas of focus include business planning, marketing strategy, branding, customer development, financial preparedness, operational planning and connecting entrepreneurs with educational programs and community resources.Parks brings an especially valuable perspective to business advising because she is an entrepreneur herself. She is the owner of Glamo Society Bridal & Formal Wear in Raeford, N.C., giving her firsthand experience with the realities of launching, operating, marketing and growing a small business. She understands that entrepreneurship extends far beyond developing a great idea; it requires strategy, financial awareness, adaptability, strong customer relationships, and consistent execution.Katrin Henderson will serve as the senior business advisor for Moore County. Thriving in hospitality and retail, Henderson has enjoyed positions in Food & Beverage Management and Retail Management in various fine dining and retail establishments in the area, before opening her own children's shop in 2015, in the Village of Pinehurst. She is a native of Moore County.Quickly immersing herself in this new world of small business ownership, Henderson joined various boards and committees, including President Elect of Pinehurst Business Partners and Event Chair for the Holly Arts & Crafts Festival. She also partnered with local organizations such as Moore County Economic Development and Moore County Chamber of Commerce and Sandhills Community College Small Business Center in events and educational opportunities. In 2026, Henderson sold her shop and now offers full-time support to both new and seasoned entrepreneurs through freelance consulting mentorship and the SCC Small Business Center program.The Small Business Center team is passionate about making business resources more accessible, and ensuring entrepreneurs know they do not have to navigate business ownership alone. Through their work with SCC, they are committed to building meaningful relationships with local businesses, community organizations, and industry partners while helping entrepreneurs move from idea to strategy, strategy to action, and action to sustainable growth.“Sandhills Community College believes deeply in the power of small business and entrepreneurship because strong local businesses create jobs, spark innovation, generate investment, and strengthen the communities we serve,” said McCaskill in press release. “Through this new Small Business Center model, Sandhills is building a stronger ecosystem where entrepreneurs can connect, grow, and thrive, while helping drive long-term economic vitality throughout our region.”To learn more about the Center's services or to schedule a consultation, please contact Kinsman directly at kinsmanl@sandhills.edu or 910-695-3938.