Hello, and welcome back to TrustWorks On Call—here’s our healthcare business and strategy 411 for the week. If you enjoy our work, please consider forwarding it along to a friend and encouraging them to subscribe!
This week, we’re changing up our approach a bit. To commemorate the second Trump administration’s 100th day in office, our news section is devoted to a high-level roundup of the healthcare policy changes we’ve seen since January. It’s been a busy 100 days, to say the least! Following our news analysis, we’re staying on theme by looking at the consequences of blanket tariffs and reflecting on how providers should approach policy engagement in a time like this.
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Behind the Headlines
Unpacking the forces driving healthcare's biggest stories
How healthcare fared through 100 days of Trump, round two.
- Today, Tuesday April 29, 2025, marks President Donald Trump’s 100th day of his second term in office, during which he has issued 142 executive orders, a new record for a president’s first 100 days.
- One of the most impactful executive orders, “Implementing The President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative,” triggered a restructuring of the Department of Health & Human Services (HHS) that involves downsizing its workforce from 82K to 62K full-time employees, including:
- 2.4K jobs lost at the Centers for Disease Control and Prevention (CDC).
- 3.5K jobs lost at the Food and Drug Administration (FDA).
- 1.2K jobs lost at the National Institutes of Health (NIH).
- 300 jobs lost at the Centers for Medicare & Medicaid Services (CMS).
- About 10K workers across agencies taking voluntary buyouts or early retirements.
- Another pillar of Trump’s efficiency initiative has been to freeze or cancel over a thousand federal grants funding healthcare delivery and biomedical research; the collective scale and fiscal savings of these cancelled grants are difficult to assess, but notable examples include:
- Rescinding more than $11B of CDC grants to state and local public health authorities authorized for COVID relief (currently paused by the courts).
- Scaling back new NIH grants by at least $2.3B since the beginning of the year, a 28 percent contraction that particularly targeted research relating to HIV/AIDS, trans health, COVID, and climate.
- Trump imposed a 10 percent tariff on all imported goods and a reciprocal tariff on select countries proportional to their trade imbalance on his campaign promise to raise tariffs across the board; while the reciprocal tariff is currently paused except for China, Trump’s trade policies have rattled markets and threatened healthcare supply chains (for more on tariffs, see our graphic below).
- Congressional budget negotiations are ongoing, in which healthcare funding levels, especially for Medicaid, are expected to be contentious and pivotal.
- The House passed a budget resolution instructing its Energy & Commerce Committee, which oversees Medicaid, to cut $880B over a decade; however, Trump recently stated he would veto a bill that cut Medicaid or social security spending.
- A leaked draft of the White House’s budget request included a $41B cut to HHS’s discretionary funding, 34 percent of its annual budget.
TrustWorks Take: The above list is far from exhaustive, but it captures the Trump administration’s genuinely impressive and expeditious commitment to reshaping the federal government and its role in healthcare services. Thermostatic changes between administrations are to be expected, especially in today’s highly polarized political environment, and this opportunity to slash spending is the Republicans’ reward for winning trifecta control in Washington. However, it is easier to tear down administrative capacity than to build it back up. The mass exodus of federal workers and the mass cancellation of grant-funded programs represent an immense loss of institutional knowledge that can’t easily be unwound and reconstituted by a new administration. Even if elections continue to swing back and forth, the loss of a bipartisan consensus on whether the government should fund scientific research, public health, and rural healthcare will be felt regardless of which party is in charge.
The federal government is not free of waste, fraud, and abuse, but everyone in the healthcare industry knows that any genuine inquisition against fraud would include Medicare Advantage, which the Trump administration just scheduled for a generous pay bump. Instead, they’re cancelling project grants because of words like “bias” or “female.” The impacts of these workforce and research cuts—the loss of biomedical innovation, the lack of safety and efficacy reviews, the undermining of vaccines and public health—will only be fully felt in the long-term, in ways that are too complex to ever be traced back to a single source. However, political consequences don’t have to wait for policy outcomes. Trump voters strongly oppose Medicaid cuts, which is likely why Trump said he would veto any such bill. Once Republicans come to an agreement on a passable budget, voters may not like what they see, but it’ll be too late to undo much of the damage.
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Beyond the Whiteboard
Visualizing key trends from the healthcare industry
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Tariffs Risk Upending Care Delivery on Every Level
Trump’s tariff policies have the potential to be the most impactful aspect of his transformative agenda. In typical Trump fashion, they’re a contradictory combination of good policy and negotiating posture, to be imposed, paused, and redoubled at will. As the details of specific tariff policies for certain goods or countries are liable to change at any moment, our graphic this week instead captures the general economic consequences for providers of blanket tariffs, such as the minimum 10 percent tariff currently in effect for all countries.
The first and most obvious impact of this tariff is higher drug, medical device, and supply costs, which together amount to roughly $250B of US imports annually. Who absorbs these costs is complicated by the long-term, fixed-price nature of healthcare contracts, but the market will readjust via occasional shortages, margin hits along the supply and care delivery chains, and higher prices for patients. Economists say those ingredients are a recipe for stagflation, which is the root of the secondary problem for providers. Inflation calls for higher interest rates, which makes debt more expensive, and strategic planning goes on pause when you can’t price future goods, so capital projects are put on hold. Before long, corporate struggles will translate to a pullback in consumer spending, including on healthcare. Providers, who have recently been enjoying robust care volumes, don’t want to find out if healthcare is still “recession-proof,” nor do their (increasingly cost-exposed) patients, but care avoidance would likely increase. The only potential advantage of tariffs comes in the quaternary tier (not pictured), in which domestic manufacturing delivers us a more secure supply chain in the face of crisis. Somehow. In the Distant Future. It could be a difficult present until then.
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Dialing In
Sharing insights from our work with clients
Policy Engagement Is No Longer Optional—It’s a Strategic Imperative
With the torrent of policy news—tariffs, funding cuts, civil service layoffs—growing by the week under this administration, I’ve heard mounting frustrations and worries voiced by even the most committedly nonpartisan of my clients and colleagues. Catching up the other day with a health system CEO in a southern state, we debated what his system can do to petition for relief and protection via his state’s elected officials. Rather than discussing politics, we focused on how to effectively engage with lawmakers to build relationships and strategic influence.
First, develop a clear, data-driven story. Know your impact—how many people you employ, the economic footprint of your operations, the lives touched through your clinical and community programs (i.e., the impact of your absence). When you can communicate the cost of inaction, the value of care delivered, and the return on investment for public dollars, policymakers take notice.
Equally important are internal mobilization and external coordination. Your board members, physicians, nurses, and staff are among the most trusted messengers in healthcare, so equip them to tell your story. At the same time, aligning with your state hospital association, national trade groups like the American Hospital Association, and issue-based coalitions gives your voice greater strength. But don’t stop at signing on to someone else’s agenda—be in the room where that agenda is set.
Perhaps most critically, the most forward-looking organizations aren’t just defending against bad policies—they’re proposing good ones. They’re putting forward ideas on workforce development, behavioral health access, and care transformation that solve real problems for real people.
In today’s healthcare environment, where reimbursement, regulation, workforce pipelines, and even licensure frameworks are in flux, policy engagement has become nothing short of a strategic imperative. Whether you’re a rural critical access hospital or a multi-state system, decisions made by policymakers will define your future. When the policy landscape shifts, it’s not just your bottom line at risk—it’s your mission, your workforce, and the health of the communities you serve. To stay silent is not an expression of neutrality but rather of consent.
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