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The Keckley Report

The 5 Emergent Issues for Boards in Trump-DOGE Healthcare

By April 6, 2025No Comments

This was a week for healthcare that’s unprecedented in modern history:

  • A new CMS administrator: cardiothoracic surgeon and TV’s Dr. Oz won Senate confirmation by a party-line vote of 53-45. He’s pledged a top-down review of it programs vowing special attention to Medicaid and Medicare Advantage.
  • An HHS re-org: A massive cut of the federal healthcare workforce as Robert F. Kennedy Jr. issued 10,000 pink slips for HHS employees cutting across all its agencies and departments in tandem with a 35% reduction in outside contracting and reorganization under the new Administration for a Healthy America.
  • Tarriff-induced market shock: An international trade war commenced in reaction to the administration’s tariff policy sending the stock markets down 10%. A second announcement about additional “reciprocal” is anticipated this week.
  • Budget angst: The GOP-led Senate passed its FY26-FY35 federal budget proposal in the wee hours Saturday morning setting the stage for negotiations with the GOP-led House with major differences in the two including cuts to Medicaid and others.

Taken together, these set the stage for prioritizing activities in every department and program under HHS (Medicaid, CHIP, Medicare, FDA, CMS, NIH et al) and the budgetary constraints all face.

None of these is a surprise. Since the Trump inauguration January 20, a shake-up in federal government has been promised and last week’s actions show it’s serious.  Polls show a majority of Americans distrust the federal government, Congress, the media and the health system, so disruption is expected. But the nation’s divided about solutions, and healthcare is no exception.  

It’s clear why HHS is a priority for the Trump administration: it’s the largest employer in the economy (21 million), it’s almost 18% of the country’s entire GDP and a major source of the public discontent about its performance. Changes align well with the Trump-Kennedy pledges to Make America Great (and Healthy) Again.

As implementation proceeds, court challenges mount by opponents and budget negotiations commence, every healthcare C suite and Board—payers, providers, suppliers, advisors– should anticipate added scrutiny in five areas: each requires specifics about how they’re defined and measured, how they’re implemented by the organization and how consumers and households are impacted.

  1. Fraud, Waste and Abuse (FWA): The public believes healthcare has become ‘big business’ rife with fraudulent activities aka misrepresentation/deception that bolster profits illegally, wasteful spending aka willful misuse/overuse of resources unnecessarily and abuses aka willful non-adherence to evidence-based business/clinical practices that contribute to suboptimal outcomes. Most Boards have limited exposure to policies and procedures that address FWA. Most assume organizational compliance is effective if lawsuits are minimal and reputation risk is protected. The availability of social media coupled with AI tools and whistleblower protections mean FWA will be a bigger problem for Boards and management.
  2. Price Transparency: The President’s 2019 Hospital Price Transparency Executive Order (EO 13877)) has not achieved its intended purpose: to enable consumers to know what a service might cost them in advance of a choice and stimulate competition between hospitals. The updated February 25, 2025 directive essentially added stipulations to make prices understandable to consumers and stiffened non-compliance penalties for hospitals. Tools that enable consumers to easily and accurately compare prices across institutions is the focus: for most organizations, minimal effort to achieve compliance has been the operative response. More and better tools based on accurate, current and easily comparable searches will be required.
  3. Affordability: 4 in 10 U.S. households have an unpaid medical bill; 1 in 10 say they’re avoiding care they need due to their personal finances. These are primarily adults and their kids from lower-income households—the same population most adversely impacted by tariffs on goods and escalating housing costs. Affordability is not taken seriously by the health care industry: providers blame regulators and drug costs; insurers blame hospitals and drug companies and consumers blame everyone. Policies that enable optimal affordability begin with reasonable pricing, then support services that enable appropriate payment. Notably, revenue cycle management policies and procedures, including the business practices of outsourced services, must be an expanded focus for Boards.
  4. Workforce Wellbeing including Physicians: The healthcare workforce, especially those in hospitals, nursing homes and home health, are despondent. In these settings, compensation and wage increases for upper-middle and senior executives outpace theirs’s lending to internal tension and, in some cases, compromised patient safety. Physicians are likewise unhappy: scheduled Medicare reimbursement increases have not been realized for 5 years and challenges from insurers to their clinical judgement are mounting. The healthcare workforce is under enormous pressure, especially those who work in provider settings. Traditional approaches to workforce resilience, benefits and compensation are only a start: long-term strategies borrowed from other industries are needed. And Board recognition of workforce dynamics should be intensified.
  5. Funding: Access to capital is mission critical in healthcare: For investor-owned organizations, access is defined by SEC restrictions and shareholder access in addition to debt. For not-for-profits, philanthropy, partnerships with private equity and debt are the basics. All face added scrutiny as regulators determine the veracity of charity care and community benefit reporting, justification for prices and non-operating income, business relationships and more. Capital budgeting in healthcare will inevitably face added regulation: the process will require new models and deliberate planning by Boards and management teams.

The events of last week portend more pressure on healthcare Boards and management to execute. In these 5 areas, each organization should revisit current policies and strategies and refresh where appropriate. And each organization should evaluate current relationships with trade groups with whom advocacy efforts are coordinated to assure they’re responsive to the realities of healthcare in the Trump-DOGE era.

It’s a new day in U.S. healthcare.

Paul

Sections in this Report

  • Quotables
  • Corporate
  • Courts
  • Economy
  • Hospitals
  • Insurers
  • Physicians
  • Polling
  • Population Health
  • Regulators

Resources in addition to citations below

 

Quotables

RFK on HHS job cuts: “This is a difficult moment for all of us at HHS. Our hearts go out to those who have lost their jobs. But the reality is clear: what we’ve been doing isn’t working. Despite spending $1.9 trillion in annual costs, Americans are getting sicker every year. In the past four years alone, the agency’s budget has grown by 38% — yet outcomes continue to decline,”

Kennedy post on X April 1.

David Liu on gene editing innovation, regulatory threat: “The science of gene editing and its ability to improve and save the lives of patients has never been better. That’s part of the irony of seeing the gene editing industry under so much pressure. There’s a real divergence.

Some of it has to do with the tenor of people’s perception about biotech, about science in general, about uncertainties associated with government, with leadership in our country. Peter Marks’ departure — his forced resignation from the FDA — is bad for patients, bad for biotechnology and bad for science.”

Q&A: David Liu talks about science under pressure, teases “disease-agnostic” gene editing

Jerome H. Powell, the chair of the Federal Reserve on tariffs impact: “While uncertainty remains elevated, it is now becoming clear that the tariff increases will be significantly larger than expected, The same is likely to be true of the economic effects, which will include higher inflation and slower growth.. While tariffs are highly likely to generate at least a temporary rise in inflation, it is also possible that the effects could be more persistent.”

Federal Reserve Economic Outlook Chair Jerome H. Powell speech at the Society for Advancing Business Editing and Writing Annual Conference, Arlington, Virginia April 4, 2025 www.federalreserve.gov

Mark Cuban on system transparency: “It’s one of the most opaque marketplaces and industries on the planet, and that makes absolutely no sense. And when you get regulatory capture and scale capture that’s dominated by just a few players, like the, the medication businesses, it opens the door wide open for new players who aren’t so greedy and that’s us.

But the way it is right now with no transparency? Like if it was up to me, I wouldn’t be worried about pricing transparency from providers. I’d be worried about cost transparency from providers…

But if we forced hospitals to open up their general ledgers, then, oh my God, think about the change! Because then you know what the margins are. And they might say, ‘well, it’s competitive. We can’t disclose all this stuff.’ But we’re not talking about practice. We’re talking about healthcare, and trying to align interest of the patients and change the game. If somebody’s out there buying hospitals and they start publishing their costs of everything, people get to see and can start analyzing it, and then you get some wisdom from the crowd. Healthcare can change.”

Blake Madden  Fireside Chat | Talking Healthcare Shop with Mark Cuban Hospitalogy April 4, 2025 https://boardroom.hospitalogy.com

Modern Healthcare on Trump Healthcare: “President Donald Trump has rapidly and significantly shaken up the federal healthcare infrastructure, putting providers on unsteady footing.

Hospitals, health systems and other providers are struggling to maintain business as usual amid a cavalcade of executive actions, including a huge restructuring the Health and Human Services Department commenced under Secretary Robert F. Kennedy Jr. last week. The new administration has upended longstanding practices, means of communications with regulators, rulemaking procedures and bureaucratic chain of command, leaving healthcare providers uncertain about how to adapt.

Health systems have paused construction projects. Medical facilities are scrambling to acquire critical supplies as costs balloon under steep new tariffs. Hospitals are preparing to pare back services that don’t generate profits, such as and labor and delivery units. Medical schools and universities are laying off employees as they confront a deluge of funding cuts. Lobbyists worry mass layoffs at federal agencies will bring critical functions to a halt.

The Trump administration has narrowed opportunities for the private sector to weigh in on rulemaking, pulled funding from research institutions and instituted an aggressive immigration enforcement operation that has reached inside hospitals. The administration has canceled advisory meetings, wiped swathes of health data from federal websites, slashed the federal workforce, frozen approved funding, backed congressional efforts to eliminate billions in healthcare spending, and limited new regulations.

The communications freeze is already having a concrete impact in at least one area, LeadingAge said in a statement. CMS is supposed to redistribute the fines it collects from rule-breaking skilled nursing facilities to support nursing home programs, but it can’t because federal workers are forbidden to talk to their state counterparts, according to the trade association.”

Healthcare sector shaken as Trump stirs havoc in D.C. Modern Healthcare March 31, 2025 https://www.modernhealthcare.com/politics-policy/federal-restructuring-staffing-tariffs-grants

Arnold Ventures on Senate budget reconciliation use of “current baseline” to calculate savings: “The Senate budget resolution is an abdication of fiscal responsibility. It does not just open the door to a current policy baseline – it invites in a flood of new spending and phony budgeting. The precedents being set are reckless, and the damage to America’s economic foundation would be lasting.

“There is a credible, pro-growth path to permanent tax relief that aligns with the president’s goals and avoids blowing a hole in the deficit. This resolution rejects that path entirely. If the House were to rubber stamp this irresponsible approach, it would all but end any serious chance of enacting fiscally responsible tax reform this Congress.”

Arnold Ventures Reacts to Senate Budget Committee’s Irresponsible Proposal to Use Current Policy Baseline In Reconciliation Process April 2, 2025 https://www.arnoldventures.org/newsroom/arnold-ventures-reacts-to-senate-budget-committees-irresponsible-proposal-to-use-current-policy-baseline-in-reconciliation-process

WSJ on RFK: “Robert F. Kennedy Jr. has been secretary of Health and Human Services for all of six weeks, but he’s already vindicating his critics. First, he downplayed a measles outbreak in Texas. Then he reportedly hired a trial-lawyer ally to work on a government study of the link between vaccines and autism. Now he has pushed out a top Food and Drug Administration official because he helped accelerate approval of the Covid vaccines.

Some Senate Republicans hoped that other Trump HHS appointees—e.g., FDA Commissioner Marty Makary and National Institutes of Health Director Jay Bhattacharya—would keep Mr. Kennedy in check. It isn’t working out that way. NIH is now requiring grants or contracts involving mRNA technology to be reported to Mr. Kennedy’s office. The mRNA platform helped to develop Covid vaccines, and it has shown potential to treat and prevent other diseases including cancer. MedPAC to counter the incessant crying from the hospital lobby that hospitals and health systems are going broke. Guess what? They’re not.

RFK Jr. Is Already Vindicating His Critics: Shrinking HHS makes sense, but giving power to antivaccine crusader David Geier doesn’t. WSJ March 30, 2025 https://www.wsj.com/opinion/rfk-jr-david-geier-vaccines-autism-hhs-cdc-health-trump-administration-policy-184c242f?mod=itp_wsj,djemITP_h

Milbank on Year End spending cuts: “The Congressional Budget Office estimated last year that a 10-year extension from 2025 to 2034 would cost $335 billion, starting around $25 billion per year. No encouraging signs have appeared from White House, Senate, or House leaders whose top priority is finding major budget savings to pay for their planned tax cuts estimated at $4.5 trillion.

In that effort, Republicans are looking for major Medicaid reductions in the range of $800-900 billion over 10 years. Health access advocates are more worried about damage to Medicaid than to the ACA exchanges. For Medicaid, the challenge is to stop Congress from taking action that would hurt any of the program’s 72 million enrollees. For the ACA subsidies, the challenge is to get Congress and the White House to act affirmatively. If the subsidy enhancements expire on December 31, 2025, tax cut bill writers will achieve no savings because lower costs from the subsidy expiration are already baked into the federal budget status quo.

Over 24 million Americans have grown accustomed to enhanced subsidies. They are primarily lower-middle and middle-income Americans. The highest concentrations are in states that refuse to expand Medicaid as permitted by the ACA—including Texas and Florida. These Americans will wake up to this unpleasant surprise in the fall and feel the full effects early in 2026, a pivotal and high stakes mid-term election year. To those who will face staggering premium increases, Republicans’ responsibility will be undeniable.”

The ACA’s New Year’s Eve Cliff | Milbank Memorial Fund

Hal Andrews on price controls: “The long-term deleterious impact of Federal price controls is abundantly evident, which led me to declare in 2017 that the U.S. healthcare system operates in what game theorists refer to as a negative-sum game.

The combination of the Federal government’s implementation of price controls on healthcare providers over the last 40 years and a shrinking percentage of commercially insured patients in the U.S. health economy have created what economists call a “doom loop” for hospitals and physicians, “a situation in which one negative economic condition creates a second negative condition, which in turn creates a third negative condition or reinforces the first, resulting in a downward spiral”

Hal Andrews Counterpoint “No Good Deed Goes Unpunished, Healthcare Edition: Part II: The Doom Loop of Price Caps: Past, Present and Future” March 23, 2025 https://www.trillianthealth.com/part-ii-the-doom-loop-of-price-caps-past-present-and-future

 

Corporate News

  • Duke Health has completed its $284 million acquisition of a North Carolina hospital from Community Health Systems.  Duke took over operations of the Mooresville, North Carolina-based Lake Norman Regional Medical Center and its related businesses from Community Health Systems on April 1. The health system has renamed the 123-bed facility as the Duke Health Lake Norman Hospital.
  • Morgan Health is adding a ninth company to its portfolio with an equity investment in Venteur. Morgan, which is part of J.P. Morgan Chase, is participating in a $20 million investment round led by Informed Ventures and American Family Ventures. CEO Dan Mendelson declined to say how much Morgan is contributing to the round.
  • Novant Health, with MedQuest Associates, has signed an agreement to acquire 18 OrthoCarolina imaging centers in the Carolinas. The deal, which closed March 31, involves 13 locations in the Charlotte region in North Carolina, three locations in the Winston-Salem region in North Carolina and two locations in South Carolina. MedQuest, which is owned by Novant, will manage day-to-day operations at the sites, according to a Tuesday news release.
  • Digital health company Apree Health is reviving its Castlight Health brand and has tapped Jonathan Porter as CEO to lead the effort.  Apree Health formed as part of a January 2022 mergerbetween healthcare navigation-focused Castlight Health and primary care provider Vera Whole Health in an estimated $370 million deal. Porter, previously Apree’s chief product officer, will oversee the company’s effort to reestablish the Castlight Health brand and complement its Vera Whole Health offering.  Porter succeeds Donald Trigg as CEO, who took helm of the company following the merger of Castlight and Vera Whole Health. The leadership transition to Porter began in January.
  • CVS Asserts DOJ’s Opioid Prescription Suit Lacks Facts CVS Pharmacy Inc. has told a Rhode Island federal judge that most of the U.S. Department of Justice’s claims that it knowingly filed invalid prescriptions for opioids should be tossed, saying the agency failed to adequately allege the company willfully put profits over safety.
  • 23andMe files for bankruptcy. Shares plummeted after the announcement, a stunning fall for the buzzy health technology company that more than 15 million consumers have used to gain new insight into their lineage and health risks. The 23andMe site went down as customers struggled to delete their data.
  • OpenAI yesterday closed what amounts to the largest private tech funding round on record, according to CNBC News(March 31, Field, Rooney). Including the fresh capital, the $40 billion financing values the ChatGPT maker at $300 billion. It’s almost triple the amount previously raised by a private tech company, reports PitchBook, and puts OpenAI behind only SpaceX at $350 billion and even with TikTok parent ByteDance among the world’s most richly valued private companies. Japan’s SoftBank is leading the round with $30 billion and is joined by a syndicate of other backers, including core investor Microsoft..

Federal spending cuts: advisory services: The Big Four firm is one of the federal government’s 10 highest-paid consultancies, which have come under scrutiny amid the White House’s push to cut waste and improve efficiency. The list includes Accenture, Booz Allen Hamilton, IBM, and General Dynamics.

  • Deloitte: 127 contracts, $371.8 million.
  • Booz Allen Hamilton: 61 contracts, $207.1 million.
  • Guidehouse: 49 contracts, $128.7 million.
  • Accenture: 30 contracts, $240.2 million.
  • General Dynamics: 16 contracts, $202.7 million.
  • IBM: 10 contracts, $34.3 million.
  • Leidos: seven contracts, $78.5 million.
  • CGI Federal: seven contracts, $465,000.
  • Science Applications International Corp.: five contracts, $7.5 million.

Deloitte is the biggest loser so far in DOGE’s consulting crackdown Business Insider April 4, 2025 https://www.businessinsider.com/deloitte-doge-consulting-crackdown-contracts-cuts-big-four-2025

 

Courts

Last week’s major decisions:

  • SCOTUS: The Supreme Court ruled in favor of the Food and Drug Administration (FDA) by supporting its refusal to approve flavored e-cigarettes. The court dismissed an appeals court decision that claimed the FDA had unlawfully altered the rules during proceedings to decide whether to approve several such products.
  • RI Judge Hits Pause on Billions in Health Grant Funding Cuts A Rhode Island federal judge on Thursday barred the Trump administration from moving forward, for now, with the termination of billions of dollars in grants including $11B in public health funding.
  • On March 28, 2025, Colorado’s federal district court dismissed a challenge filed by Amgen against Colorado’s Prescription Drug Affordability Board (PDAB). Amgen filed a lawsuit in March of 2024, arguing that the establishment of Colorado’s PDAB and its actions were unconstitutional. The district court dismissed the case, finding that Amgen lacked standing and. Amgen did not effectively establish that the company’s profits would be reduced, citing “counterintuitive pricing behavior” across the pharmaceutical supply chain and the inability to predict an upper payment limit.

 

Economy

State spending targets expanding: “Nine states set targets for cost growth. Massachusetts was the first to establish a benchmark in 2012, and Oregon, Rhode Island, Connecticut, Delaware, Vermont, New Jersey, Washington and California followed.

States including Minnesota and Indiana have taken the first steps toward a cost growth benchmark by setting up offices of healthcare affordability and task forces that compile data, analysis and policy recommendations.”

PK note: Methodologies for setting ceilings is a work on process since blending commercial, Medicare and Medicaid rates is problematic, and enforcement is a second challenge in states considering commissions. Massachusetts is watched most closely since its commission issued its first report in 2022.

Healthcare cost growth targets see mixed results at state levels | Modern Healthcare

Gallagher on Exec Comp: Executive pay up 5.3% (Russell 3000) and up 5.8% (S&P 500) 2024 to 2025; 53% from 2022-2025

Gallagher: CEO and Executive Compensation Trends 2024-2025 Edition https://www.ajg.com/-/media/files/gallagher/us/2024/ceo-and-executive-compensation-trends-2024-2025

Economic Research Institute Report: Merit-based compensation trends in 2024: ERI surveyed officials from 327 organizations between October 7 and November 11, 2024. Highlights:

  • 88% of organizations have a merit-based pay policy/strategy tied to individual and organizational performance considerations. 83% adjust the awards annually.
  • “On average, organizations reported that they reward All Employees at a rate of 2.8%, Non-exempt employees at a rate of 3.4%, Professional employees at 2.7%, and Executives at a rate of 4.2%.
  • The number of organizations that reported planned increases for non-exempt employees has decreased by approximately 44%, front-line employees by 36%, exempt employees by 41%, executives by nearly 36%, and board members by about 13%.”

Economic Research Institute MERIT INCREASES, THE CHANGING ECONOMY, AND REMOTE WORK FALL 2024 https://downloads.erieri.com/pdf/Merit_Increases

BLS Jobs Report: “Total nonfarm payroll employment rose by 228,000 in March, and the unemployment rate changed little at 4.2%…. Job gains occurred in health care, in social assistance, and in transportation and warehousing. Employment also increased in retail trade, partially reflecting the return of workers from a strike. Federal government employment declined.

Health care added 54,000 jobs in March, in line with the average monthly gain of 52,000 over the prior 12 months. Over the month, employment continued to trend up in ambulatory health care services (+20,000), hospitals (+17,000), and nursing and residential care facilities (+17,000).

Among the major worker groups, the unemployment rates for adult men (3.8 percent), adult women (3.7%), teenagers (13.7 percent), Whites (3.7%), Blacks (6.2%), Asians (3.5%), and Hispanics (5.1%showed little or no change in March.

Total nonfarm payroll employment rose by 228,000 in March, higher than the average monthly gain of 158,000 over the prior 12 months. In March, job gains occurred in health care, in social assistance, and in transportation and warehousing. Employment also increased in retail trade, partially reflecting the return of workers from a strike. Federal government employment declined.

Healthcare workforce: undocumented workers:  Based on the Current Population Survey (CPS) from March 2024, there were over 20 million individuals making up the workforce across formal and informal healthcare settings nationwide, of whom an estimated 16.7 million were U.S.-born citizens, 2.3 million naturalized citizens, nearly 700,000 documented noncitizens, and over 366,500 undocumented immigrants.

THE EMPLOYMENT SITUATION — MARCH 2025 April 4, 2025 https://www.bls.gov/news.release/empsit.nr0.htm

JP Morgan on recession risk: “A global recession is more likely to happen than not this year, thanks to Wednesday’s tariff broadside from the U.S.

That’s the opinion of JPMorgan analysts who raised their forecast to 60% Thursday. That’s up from 40% before President Trump’s Wednesday afternoon announcements sent markets tumbling.

The administration’s plans will likely amount to a 20-percentage point increase in U.S. tariff rates, the firm said. The last increase that large, in 1968, was followed by recession, economists led by Bruce Kasman said.

Analysts said retaliatory tariffs by other countries, weakening business sentiment in the U.S. and supply chain disruptions will make things worse. Jeep maker Stellantis has already halted production at its auto assembly factories in Mexico and Canada.

A scenario where the U.S. enters a recession but the rest of the world is spared is also possible, the firm said, but less likely.”

Note: On March 28, JPM raised its recession risk to 40% from 25%.

JPMorgan Raises Recession Risk to 60%; JP Morgan March 28, 2025

The Budget Lab: Where We Stand: The Fiscal, Economic, and Distributional Effects of All U.S. Tariffs Enacted in 2025 Through April 2: “The April 2nd action is the equivalent of a rise in the effective US tariff rate of 11 ½ percentage points. The average effective US tariff rate after incorporating all 2025 tariffs is now 22 ½%, the highest since 1909.

The price level from all 2025 tariffs rises by 2.3% in the short-run, the equivalent of an average per household consumer loss of $3,800 in 2024$. Annual losses for households at the bottom of the income distribution are $1,700.

The price level from the April 2nd announcement alone rises by 1.3% in the short run, the equivalent of an average per household consumer loss of $2,100 in 2024$. Annual losses for households at the bottom of the income distribution are $980 under the April 2nd policy alone.

Both the April 2nd tariffs alone and all 2025 tariffs together disproportionately affect clothing and textiles, with apparel prices rising 17% under all tariffs.

US real GDP growth is -0.5pp lower in 2025 from the April 2nd announcement and -0.9pp lower from all 2025 tariffs. In the long-run, the US economy is persistently -0.4 and -0.6% smaller respectively, the equivalent of $100 billion and $180 billion annually in 2024$.

The April 2nd announcement raises $1.4 trillion over 2026-35 conventionally-scored, and $366 billion less if dynamic revenue effects are taken into account. All tariffs to date in 2025 raise $3.1 trillion, including the effect of retaliation to date, with $582 billion in negative dynamic revenue effects.

The Budget Lab at Yale

 

Hospitals

KFF on hospital price transparency: ”Trump’s 2025 order is also a symbol of how little progress the country has made since he issued a similar directive nearly six years ago. Consumers find it only partially useful, and the quality of the information is spotty…. What followed was, to consumer advocacy groups, a disappointment. Hospitals and insurers posted on websites voluminous, complex, and confusing data about their prices. The information has been a challenge for even experts in health care pricing to navigate, let alone consumers. Some members of Congress filed legislation to put the force of law behind price transparency requirements; those bills died. And President Joe Biden’s administration was criticized for not more stringently enforcing the regulations, with one consumer advocacy group even buying a Super Bowl ad featuring the rapper Fat Joe alleging that “hospitals and insurers hide their prices.”

Trump’s new order, signed in February, said that hospitals and health plans “were not adequately held to account when their price transparency data was incomplete or not even posted at all.”

‘Zombie’ Rates and Other Inconsistencies: Meanwhile, independent researchers have found numerous problems with the quality of price data both hospitals and health insurers do share with consumers.

How Much Will That Surgery Cost? 🤷 Hospital Prices Remain Largely Unhelpful. – KFF Health News

Study: association of social risk factors and hospital use:  “In this cohort study of US adults in a health care system, 25.4% and 10.3% of patients experienced an ED visit and hospitalization, respectively. Adults reporting social risk were significantly more likely to visit the ED (21%), but social risk was not associated with hospitalizations. The association between elevated social risk and increased ED visits warrants future evaluation to determine if addressing these risks changes acute care utilization.”

Social Risk and Acute Health Care Utilization Among Insured Adults JAMA Netw Open April 1, 2025;8(4):e254253. doi:10.1001/jamanetworkopen.2025.4253

Study: Association of agency nursing and patient safety in hospitals: “This quality improvement study of 70 US hospitals conducted from 2019 to 2022 found that agency nurse hours were significantly associated with negative outcomes for pressure ulcers and perioperative hemorrhage or hematoma. Exceeding breakpoint thresholds was associated with a 6.44% increase in pressure ulcers for agency nurse hours and a 2.09% increase for overtime hours; the average use exceeded these thresholds by 140.0% for agency nurse hours and by 63.6% for overtime.

These findings suggest that excessive use of overtime and agency nurse hours is associated with increased rates of pressure ulcers; future nurse staffing and patient safety research should consider disaggregating overtime and agency nurse hours from overall staffing measures so that hospitals can create their own breakpoint analyses to optimize patient safety.”

Increased Utilization of Overtime and Agency Nurses and Patient Safety JAMA Netw Open April 2, 2025;8(4):e252875. doi:10.1001/jamanetworkopen.2025.2875

Strata: Hospital finances in February: Per Strata analysis of financial data from 1600 hospitals for February 2025:

Health system operating margins were flat at 1% month over month while individual hospitals reported overall a 1.4%month-over-month operating margin drop. Compared to February 2024, hospitals reported a 1.4% increase in operating margins. The median EBITDA margin dropped 1.2% month over month.

  • Regions: South: +2.4% Northeast: +2%, Midwest: +1.2%, West: -0.5%

Total expenses dropped nearly 5% month over month, but were up 4.2%year over year. Total expenses per adjusted discharge was up 4.6%year over year. Labor expenses grew 2.2 % over the last year, but were down 7.1%month over month. Purchased services increased the most year over year, at 8.7%. Supply expenses were up 6.7%and drug expenses jumped 5.4 % the last year.

  • Regions: West: +5.5%, Northeast: +5.3%, South: +4%, Midwest: +3.9

 www.StrataDecision.com

Insurers

Marketplace enrollment: ACA Marketplace enrollment reached a record-high for a fourth year in a row, totaling 24.3 million people in 2025. Much of this growth can be attributed to the enhanced subsidies first made available by the American Rescue Plan Act (ARPA) in 2021 and later extended through the end of 2025 by the Inflation Reduction Act (IRA). Since 2020, enrollment in the Marketplaces has more than doubled, growing by 12.9M (a 113% increase) from 11.4M to 24.3M.

Enrollment Growth in the ACA Marketplaces | KFF

Senate Finance Report on MA Marketing: Per the Senate Finance Committee report, Medicare Advantage insurers are spending an increasing amount on fees and commissions paid to brokers

The report states that Medicare Advantage plans “increasingly rely” on third-party marketing organizations and lead generators to drive enrollment. Spending on agent and broker fees increased from $2.4 billion in 2018 to $6.9 billion in 2023, according to the report. The report recommended several policies to reform Medicare Advantage sales and marketing, including prohibiting Medicare Advantage plans from paying for platforms that limit which plans an agent or broker sees when meeting with enrollees.

Pushing Medicare Advantage on Seniors: Unraveling the Complex Network of Marketing Middlemen – 3.24.25.docx March 2025

Physicians

Primary care: Percentage of US Population Without a Usual Source of Care (USC), 2017-2022

Year Children without a USC Adults without a USC
2017 6.9% 24.4%
2018 9.0% 27.4%
2019 10.8% 29.0%
2020 10.3% 27.1%
2021 13.6% 28.7%
2022 12.4% 30.9%

Milbank Memorial Fund, The Health of US Primary Care: 2025 Scorecard Report — The Cost of Neglect, February 2025

Survey: Resident opinions about unionization: Per a survey of 1235 resident physicians responding to questions about unionization:

  • 20% reported working in unionized hospitals;
  • among nonunionized resident physicians, 63% reported an intention to vote to unionize, and less than 10% reported an intention to vote against unionization.
  • Pay and work hours were the most cited factors informing unionization decisions.

Resident Physician Intentions Regarding Unionization JAMA Netw Open. April 3, 2025;8(4):e253106. doi:10.1001/jamanetworkopen.2025.3106

 

Polling

Gallup-West Health poll: “The percentage of U.S. adults who have recently been unable to afford or access quality healthcare has reached 11% — equivalent to nearly 29 million people — its highest level since 2021, according to new findings from the West Health-Gallup Healthcare Indices Study, which classifies these individuals as “Cost Desperate.”

The most notable increases since 2021 have occurred among Hispanic adults (up eight percentage points to 18%), Black adults (up five points to 14%,) and the lowest-income households, earning under $24,000 per year (up 11 points to 25%). Meanwhile, there has been no meaningful change in the proportion of White adults or middle- to high-income earners facing the same level of struggle. As a result, disparities in access to healthcare based on race, ethnicity and income are also at their highest point since surveying began.”

In U.S., Inability to Pay for Care, Medicine Hits New High

 

Population Health

Study: suicide and living arrangements: this cohort study of 3 764 279 adults, living alone with depression or anxiety was associated with a significantly higher risk of suicide, particularly among middle-aged individuals (aged 40 to 64 years) and men.

Suicide Risk and Living Alone With Depression or Anxiety JAMA Netw Open March 26,. 2025;8(3):e251227. doi:10.1001/jamanetworkopen.2025.1227

Deloitte: Consumer Healthcare (CHC) in 2030: According to a report published by Deloitte in September 2024, Accelerating the future: The rise of a dynamic consumer health market. Highlight: drivers that will shape CHCs in 2030:

  • Trust central to the relationship of a consumer and the CHCs with which people connect
  • Technology and digital transformation underpinning personalization which will bolster the next iteration of retail pharmacies
  • Nutrition companies “putting health first,” in Deloitte’s words
  • Virtual assistants embedded with GenAI that will support consumers’ journeys, and,
  • Segment focuses that are informed by individuals’ data along with local contexts and regulatory compliance — Deloitte points to AgeTech and FemTech as examples of specific market penetration opportunities.

Accelerating the future: The rise of a dynamic consumer health market.

 

Regulators

HHS Secretary Robert F. Kennedy Jr. announced a proposed reorganization for the department — which, counting those who already left the agency, amounts to about a 25% cut in workforce. The planned “Administration for a Healthy America” will collapse several existing HHS agencies into one.

HHS: Obesity drugs coverage in Medicare: Tackling America’s obesity rate has been a focus of the Trump administration’s “Make America Healthy Again” movement, and health agency appointees have put an emphasis on healthier eating and lifestyle choices.

HHS Secretary Robert F. Kennedy Jr. has expressed skepticism of popular GLP-1 weight loss drugs in the past. He said during his Senate confirmation hearing in January that “the class of drugs are miracle drugs,” but added that they could be costly for the government and that “they have all kinds of bad side effects.

A Federal Register notice on Friday said the administration does “not intend to finalize” the anti-obesity drug coverage provisions from the proposed rule. It remains unclear whether the Trump administration is still considering expanding coverage.

Trump administration leaves obesity coverage expansion out of new Medicare rule April 4, 2025 https://endpts.com/trump-administration-leaves-obesity-coverage-expansion-out-of-new-medicare-rule

FDA: Vaccine regulation: “Food and Drug Administration Commissioner Marty Makary signed off on the ouster of top vaccine official Peter Marks shortly after being quietly sworn in as the agency’s new leader late last week, four people familiar with the matter told POLITICO. The forced removal was Makary’s first major act as commissioner and sent a powerful signal to a stunned Washington that was already anxious about the role vaccine skepticism would play under Secretary Robert F. Kennedy Jr.’s Health and Human Services Department. Makary and Kennedy had previously agreed to push out Marks, who led the FDA’s vaccine division for more than eight years, as part of a broader overhaul of HHS leadership.

Politico: New FDA Commissioner Agreed to Oust Top Vaccine Regulator After Private Swearing-In

HHS: The Secretary’s Advisory Committee on Human Research Protections is an 11-member panel of volunteers with expertise in bioethics and regulatory affairs that typically meets three times a year to provide recommendations to HHS’ Office for Human Research Protections.

OHRP has oversight of more than 13,000 institutions in the U.S. and internationally that conduct human subjects research supported by HHS.

Last Wednesday, the Department of Justice urged a federal judge not to toss out its long-running fraud case against UnitedHealth Group that alleges the company illegally collected billions of dollars from the Medicare Advantage program. The arguments from the DOJ amount to a last stand in the high-profile whistleblower case that it joined in 2017. The agency had until April 2 to respond to a special master’s recommendation from March, which said the DOJ lacked evidence to prove UnitedHealth illegally withheld at least $2 billion in overpayments from taxpayers.

DOJ asks judge to move forward UnitedHealth Medicare fraud case | STAT

 

 

 

 

 

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