TrustWorks On Call: Camelot This Is Not

Behind the Headlines

Unpacking the forces driving healthcare's biggest stories.

1. RFK Jr. reshuffles leadership as FDA blocks vaccine review.

Last Thursday, in order “to accelerate adoption” of the Make America Healthy Again (MAHA) agenda, Health Secretary Robert F. Kennedy Jr. announced several leadership changes at the Department of Health and Human Services (HHS): Chris Klomp, the current Medicare director, will become chief counselor at HHS and oversee operations; John Brooks, Kyle Diamantas, and Grace Graham have been elevated to senior counselors advising Secretary Kennedy.
Earlier last week, Moderna shared that the Food and Drug Administration (FDA) will not consider approving its mRNA flu shot because its Phase 3 trial used a traditional flu vaccine as its comparator; the FDA letter, signed by prominent agency official Dr. Vinay Prasad, did not cite any specific safety or efficacy concerns.

TrustWorks Take: Reportedly, Secretary Kennedy is pivoting his agency’s focus away from his unpopular vaccine policies and toward his more-popular healthy eating campaign. The reshuffle reads like a bid to shore up voter support for the midterms. A survey of competitive districts last fall found that over 90 percent of voters believe the government should do more to regulate ultra-processed foods, whereas only 20 percent of voters support the removal of established childhood vaccine recommendations. The leadership changes, which have created a cabinet-style inner circle of Kennedy advisers, are likely intended to steer the ship of state in this new food-focused direction.

However, the FDA rejecting Moderna’s mRNA vaccine on unprecedented grounds (the FDA approved Moderna’s Phase 3 trial plan, only to refuse to review its results) proves the adage that personnel is policy. Dr. Vinay Prasad, who replaced Dr. Peter Marks after he resigned last May as leader of the FDA’s Center for Biologics Evaluation and Research, is a known critic of the COVID mRNA vaccine. Unless Secretary Kennedy, who largely shares the same beliefs on vaccines, replaces him, the development of mRNA vaccines will continue to be suppressed, even if the inner circle of HHS leadership tries to pivot their messaging focus elsewhere. As Moderna’s CEO delicately stated, this decision “does not further our shared goal of enhancing America's leadership in developing innovative medicines,” and will hold back a technology showing promise not just for infectious disease but cancer treatments as well.

2. Judge blocks federal cuts to public health in blue states.

Last Thursday, a federal judge in Illinois ordered a 14-day pause to allow the courts to decide on the Trump administration’s plan to rescind $600M of public health funding from four states led by Democratic governments: California, Colorado, Illinois, and Minnesota.
On February 9, the Trump administration announced the planned grant terminations, arguing the awards no longer align with updated CDC priorities; in response, the states sued, alleging the cuts were retaliatory and driven by "political animus" rather than program performance.
The judge ruled broadly that the states showed a likelihood of success and risk of irreparable harm, and that Trump administration could not terminate grants “based on undisclosed political priorities;” two thirds of the funding was dedicated to California’s public health system, with many of the grants focused on HIV and sexually transmitted infections, as well as promoting the health of underserved communities.

TrustWorks Take: In a similar move to our first story, the Trump administration is attempting to unilaterally unwind funds awarded under the prior administration to reflect a new set of priorities. These abrupt about-faces are a disaster for strategic business planning and emblematic of how the Trump administration’s preoccupations with combatting “wokeness” can get in the way of business-friendly policies. For healthcare organizations in these targeted states, even those not directly receiving these funds can still benefit from the preventative and complimentary care that these grants sponsor. The rescission of these grants would destabilize planning, staffing, and prevention infrastructure that health systems and community providers quietly rely on.

Targeting only blue states also underscores the capricious and cynical nature of the Trump administration’s actions. Are people living with HIV in blue states less deserving of support services than those living in purple and red states? (No, but their votes matter less.) Nor are these cuts limited to healthcare: another lawsuit has put $10B of childcare cuts to blue states on hold, as was an effort to freeze federal food assistance just in Minnesota. These haphazard efforts to combat wasteful spending have not amounted to significant fiscal savings, either, as projections of the federal deficit have increased since the second Trump term began.

3. CMS proposes significant changes to ACA regulation.

Last week, the Centers for Medicare and Medicaid Services (CMS) issued its proposed 2027 “Notice of Benefits and Payment Parameters,” which sets the standards for the Affordable Care Act (ACA) exchanges.
The 2027 Payment Notice, which is expected to receive thousands of public comments before finalizing this spring, seeks to expand catastrophic coverage plans, including raising their out-of-pocket caps, plan durations, and eligibility waivers; allow non-network plans, which pay providers a set amount for services and leave patients potentially making up the difference, to become qualified health plans on the exchanges; and impose a variety of other recordkeeping, reporting, and marketing requirements or restrictions.

TrustWorks Take: Early data show ACA exchange enrollment has dropped by over 1M people this year, due largely to the expiration of enhanced subsidies. These proposed changes to the ACA are the Trump administration’s response to Americans’ mounting concerns over healthcare affordability. Instead of subsidizing care, this approach relies on deregulation to allow people to choose plans that are cheaper upfront, albeit with increased risks of significant out-of-pocket expenses on the back end.

On its face, more options (when properly labeled and honestly marketed) should help consumers find the plan that is right for them. However, too many people switching to low-premium, high-cost-exposure plans could undermine the insurance market through adverse selection. There is also a flurry of intense industry lobbying and public commenting that is sure to take place before the rule is finalized, meaning anything in the proposed notice is subject to change.

Beyond the Whiteboard

Visualizing key trends from the healthcare industry

Only Healthcare is Hiring
According to the Bureau of Labor Statistics January jobs report posted last week, of the 130k net jobs the US economy added January, an astounding 124K of those jobs came from the healthcare and social assistance industry. (To illustrate net jobs: last month, construction added 33K jobs, but the government lost 42K, for a net loss of 9K jobs.) Zooming out further, the healthcare and social assistance industry employs 1.6M more people than it did in January 2024; on net, the rest of the economy employs 28K fewer people. The healthcare subsectors with the largest job increases—social assistance, which involves direct care work with minimal specific training, and ambulatory health care services, which employs millions of medical secretaries and assistants alongside higher-licensed staff—are expected to continue growing as the population ages and healthcare shifts outpatient. They also have less exposure to AI automation, which alongside the effect of tariffs, is thought to be a primary contributor to the sluggish job market. AI is already far more capable of writing business reports (and newsletters) than it ever will be at changing diapers and bedsheets. Those tasks will remain safely within human hands for the foreseeable future.

Dialing In

Sharing insights from our work with clients

Moving Locum Tenens Forward
Late last year, our TrustWorks team facilitated a locum tenens summit, hosted by Hallmark Health Care Solutions, a workforce technology vendor. The event brought agencies and health systems into the same room to discuss candidly what is working, what is not, and what it would take to improve our system for distributing temporary physician placements. From that day, I am convinced that to achieve its full potential, the industry has three fundamental challenges it needs to tackle: accelerating time to value, improving fee transparency, and identifying credible performance metrics, especially for comparing locum providers to employed staff. The reason we settled on these three issues is that resolving them should create win-win scenarios for health systems and agencies, who can otherwise feel opposed to each other.

The best part of the event may have been seeing that oppositional, “No, your side’s problem is…” thinking subside in real time. For example, addressing fee transparency simply meant having an adult conversation about what is being paid for. The conversation was mildly tense to begin with, but I could see shoulders relaxing and guards dropping as health system and agency representatives exchanged points and found agreement. Health systems want to forecast and have comfort in costs, and agencies want justify pricing based on service level and outcomes. Those goals are not at odds, but they are not served by the current system.

For more on this topic, check out Hallmark’s blog series on Fixing Locum Tenens, which featured my writing in Part 1.

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Camelot This Is Not