TrustWorks On Call: Back in the New Year Groove

Behind the Headlines

Unpacking the forces driving healthcare's biggest stories.

1. OpenAI introduces ChatGPT Health.

Last week, OpenAI announced ChatGPT Health, a new product built into ChatGPT that will track and analyze a user’s health data across integrated apps and chatbot conversations in order “to support, not replace, medical care.”
According to OpenAI, ChatGPT Health pairs these new health data integrations, including medical records and Apple Health data, with enhanced data protections and privacy safeguards, such as a firewall that separates chat histories and protects medical conversations from becoming training data.
ChatGPT Health is only available on a limited waitlist for now, but the product is expected to roll out fully in the coming months.

TrustWorks Take: If OpenAI is to be believed, 230M people globally are asking health-related questions to ChatGPT every week, meaning a dedicated product tailored to the sensitivities of healthcare data was an inevitability. There’s clear demand among consumers for AI agents to dispense personalized medical advice, whether it’s a supplement to or a replacement for seeing a physician. OpenAI is not the only company trying to meet this moment, as Anthropic announced its Claude for Healthcare product just this week.

We have many questions about how companies can responsibly meet this demand. First, can a company like OpenAI be trusted with your health data? It claims that your health conversations won’t be used to train other models, but it will certainly use your health data to iterate and improve on the ChatGPT Health product itself. How will OpenAI’s privacy policies change as it introduces more advertisements or seeks new revenue streams to become profitable? (OpenAI is currently losing billions on operations each year).

Next, how will ChatGPT Health handle mental health issues? Tragic anecdotes are starting to amount into a narrative that the complimentary, people-pleasing nature of AI chatbots is feeding dangerous delusions among at-risk people resulting in violence and self-harm. OpenAI continues to release new mental health safeguards, but research has shown that AI chatbots systematically violate standards of practice even when prompted to follow certain guidelines. As long as developers keep pushing (and consumers keep adopting) this technology faster than regulators can create effective guardrails, our policy and legal frameworks will be responses to tragedies we failed to prevent.

Finally, how will ChatGPT Health resolve the tension between its users wanting clear answers to their medical problems and “responsible” medicine demanding cautious conservatism? The more caveats it includes, the less users will like ChatGPT Health’s answers, but also the less liability OpenAI would face for when people inevitably do use the tool as a replacement for seeing the doctor (despite the repeated disclaimers in the press release). This tension will only grow as OpenAI introduces advertising and other revenue streams, which could degrade the consumer experience. We expect ChatGPT Health to be a compelling product with widespread appeal, but watching how it evolves will tell us a lot about the business viability of consumer-facing AI agents.

2. Congress revives fight over ACA subsidies.

Last Thursday, the House of Representatives voted 230-196 to extend the lapsed Affordable Care Act (ACA) enhanced subsidies for three years, with 17 Republicans joining all House Democrats in support of the bill.
This bill is not expected to pass the Senate, where a moderate caucus is still working on its own bipartisan solution, and President Trump suggested he may veto an extension bill if one made it to his desk.

TrustWorks Take: Congress begins the new year the same way it closed out last year, debating over several competing plans to extend or replace the ACA subsidies, none of which appear to have the votes to pass both the House and Senate. We can expect the rest of this midterm election year to look a lot like this, as both parties may focus more on getting the other side on the record voting against popular initiatives, like addressing healthcare affordability, rather than working together on bipartisan causes.

Congress also faces urgent deadlines to keep the government open, as most federal agencies are only funded through the end of January on a continuing resolution. Fresh off the heels of the longest government shutdown in US history last fall, neither party wants to trigger another shutdown, but Congress has less than three weeks to pass seven appropriations bills. With the Senate on recess next week and the House on recess the week after, averting a partial shutdown will be a close call.

3. RFK Jr. updates food pyramid, childhood vaccine schedule.

Last Wednesday, Health Secretary Robert F. Kennedy Jr. unveiled a new food pyramid that’s been turned upside down to encourage the consumption of protein, dairy, and healthy fats, along with fruits and vegetables, while discouraging excess consumption of highly processed carbohydrates; alcohol guidelines were relaxed from a specific limit per day to a general encouragement to “consume less.”
Earlier last week, the Centers for Disease Control and Prevention (CDC) announced changes to the schedule of vaccines recommended to American children, reducing the number of diseases kids should be inoculated against from 17 to 11.

TrustWorks Take: An election year usually means Congress won’t accomplish much in terms of health policy, but we can expect Secretary Kennedy’s Department of Health and Human Services to stay busy promulgating rules to “Make America Healthy Again.” These two actions to kick off the new year, a relatively innocuous albeit unscientific change to dietary guidelines and a severe blow to our vaccine recommendations that will leave more children exposed to disease, represent Secretary Kennedy’s two main preoccupations in office. In both cases, the net result of his agency’s actions is to further undermine trust in the public health consensus and contribute to the polarization of Americans’ health information diets. When federal guidance becomes polarized, clinicians inherit the confusion, as they too often lack the bandwidth for complex conversations and shared decision-making. Patients, left to make their own decisions on conflicting information, will inherit the risk.

Beyond the Whiteboard

Visualizing key trends from the healthcare industry

Rural Health Program Lacks Funds for Transformation

At the end of last year, the Trump administration announced the first year of awards for the Rural Health Transformation Program, doling out $10B of the program’s total $50B. The allocation formula guaranteed half the funds be evenly split between all states, and half the funds be awarded based on a state’s rurality and health needs, along with a state’s willingness to implement the “Make America Healthy Again” agenda. Because of this formula, the fewer rural residents a state has, the more dollars per rural resident it received. So, while Texas was given the most money for having the largest rural population, it only amounts to about $53 per rural resident in 2026. Rhode Island, on the other end of the spectrum, received one of the smallest awards, but (depending on how you calculate the rural population of such an urbanized state) it’s receiving thousands of dollars per rural resident. Even for the low-population, highly rural states like Alaska, Wyoming, and Montana that the program was successfully designed to favor, the funding amounts lack the scale to be transformative. The $50B pot over five years pales in comparison to the $137B estimated reduction in Medicaid spending on rural areas over the next ten years, both of which were scheduled by last summer’s budget reconciliation law. Rural healthcare is looking to stop the bleeding, and a one-time cash infusion paired with even deeper cuts will not be enough to recover, let alone transform.

Dialing In

Sharing insights from our work with clients

Deal Flow Picking Up Speed in 2026
Ending 2025 in NYC with a flurry of strategy-setting sessions, I had one of those weeks where the city’s networking functions came alive, making me believe in the heightened expectations being laid for 2026. Investor interactions seemed more purposeful, as multiple breakfast introductions turned into a dozen separate conversations by dinner with folks from PE, VC, and strategic investors. Everyone was hunting for healthcare opportunities to feed the 2026 capacity awaiting deployment, leaving me to wonder what’s different about now.

Some first-of-year follow-ups have convinced me that investors’ stores of dry powder, or excess capital, have been largely restored, but they’ve also learned some lessons from 2021-2022, when our zero-interest rate policy meant it didn’t cost much to make a bad bet. The 2021–2022 cycle funneled investment dollars into telehealth, digital front doors, subsidized growth, and mere rollups. When funding tightened, a lot of that speculation came down to earth.

I now see 2025 as a reset year, in which the first six months were marked by relative caution as we adjusted to Trump 2.0, and the second half saw an investment boom as the pro-business policies, AI advancements, and interest rate cuts took hold. We now head into 2026 with more clarity and direction. Interest rates are down and steadier, so underwriting doesn’t feel like guesswork. Liquidity means more than just relying on an IPO or straight sale, as investors have regained flexibility through sales to new secondary buyers, continuation funding, or refinancing, which keeps capital recycling. And of course, every funding conversation features AI, but less as the product itself, and more as fuel to supercharge their problem-solving pitch. One investor summed it nicely: 2025 was “Does it work,” and 2026 is looking like “How fast can it scale, and how much of the engine is AI driven?”

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