Children's Vaccine Defense
December 9, 2025
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Welcome to TrustWorks On Call, here with your 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 go Beyond the Whiteboard to illustrate how the healthcare lobby’s spending compares to other industries, and we’re Dialing In on what autonomous vehicles can teach us about AI adoption. But first, the news, leading off with a story about exactly what we feared would happen under the leadership of a man who used his nonprofit, Children’s Health Defense, to push vaccine skepticism for decades: |
Behind the Headlines
Unpacking the forces driving healthcare's biggest stories.
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1. ACIP ends hepatitis B vaccine recommendation for newborns.
- Last Friday, the Advisory Committee on Immunization Practices (ACIP) voted 8-3 to no longer recommend that all newborns receive hepatitis B vaccines; instead, mothers who test negative for hepatitis B should consult their healthcare provider on whether to vaccinate their newborn against the disease.
- ACIP now suggests that parents without hepatitis B wait at least two months to administer the first dose of the hepatitis B vaccine to their child, instead of within 24 hours after birth, and that antibody tests should be used to help determine whether the second dose is needed.
- The recommendation to vaccinate, within 12 hours of delivery, the children of mothers testing positive for hepatitis B remains unchanged.
TrustWorks Take: Ever since Health Secretary Robert F. Kennedy Jr. fired and replaced every member of ACIP with hand-picked vaccine skeptics in June, a rollback of the childhood vaccine schedule has felt inevitable. In September, ACIP dipped its toes into these waters by ending its recommendation of the combination measles, mumps, rubella, and varicella/chickenpox (MMRV) vaccine, favoring instead the separate MMR and varicella vaccines, which are more common anyway. After punting on the hepatitis B schedule last time, the committee has now replaced its recommendation, which had stood for 35 years and proved itself to be effective and safe, with an arbitrary and evidence-free standard that leaves newborns unprotected for the first two months of their life. Infants infected with hepatitis B have a 90 percent chance of contracting the chronic form of the disease, and a quarter of them will go on to die prematurely because of it. Instituting universal hepatitis B vaccinations reduced the number of US children contracting the disease each year from 18K to under 1K.
Under Secretary Kennedy’s leadership, which culminates his 20-year career of opposing vaccines, more changes to the childhood immunization schedule are inevitable. This hepatitis B decision is not expected to impact insurance coverage, but future recommendation changes might. Many state and local vaccine policies, such as those governing schools and private insurers, are tied to ACIP's recommendations, and ACIP decides which vaccines poor children can get for free. Some states may have to change their laws if they want to unlink their policies from ACIP’s recommendations. Even where formal policies don’t change, the loss of public trust in vaccines and public health authorities will do their own damage. Federal policy tilting away from evidence and toward ideology leaves clinicians, payers, public health agencies, and patients in confusion as they respond to the instability.
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2. House passes five-year extension for hospital-at-home waiver.
- Last week, the House of Representative voted unanimously to extend the Medicare Acute Hospital Care at Home waiver program until September 30, 2030, after the waiver program was allowed to expire during the 43-day government shutdown.
- The bill still needs approval from the Senate, where it enjoys bipartisan support but does not yet have a voted scheduled; the bill must be signed into law before January 30, 2026 in order to avoid the hospital-at-home waiver expiring again.
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TrustWorks Take: Health systems, telemedicine groups, and all the other stakeholders involved in hospital-at-home care finally got what they’ve been asking for in a five-year extension (caveat on the Senate voting the bill through in time). Prior to this, the longest extension of the Medicare waiver had been for two years, back in 2022, which has presented challenges given that the process of setting up a hospital-at-home program can take upwards of a year. Despite this, over 400 hospitals were participating in the program prior to the government shutdown, and many others are expected to launch their own programs now that they have the regulatory certainty needed to secure multi-year contracts and capital. Going forward, hospital-at-home should no longer be considered a pilot project, but rather an operating-model decision.
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3. Congress scrambles on subsidy replacement plan.
- According to the latest reporting, Congress's response to the expiration of the Affordable Care Act (ACA) enhanced subsidies has taken the form of at least three competing plans: a “clean” three-year extension backed by Democrats, an unreleased plan to fund health savings accounts (HSAs) endorsed by House Republican leadership, and another unreleased plan currently being drafted by more moderate members of each caucus that could involve a diminished subsidy extension.
- Senate Majority Leader John Thune (R, SD) has promised Senate Democrats a vote on the clean extension this Thursday, but its prospects of passing are very low; the other plans are expected to receive votes before the year is over and the subsidies officially expire, but the details behind each plan are still unclear.
TrustWorks Take: There’s very little hope left for an extension of the enhanced subsidies into 2026, and even if a miracle passed through Congress, the complications of applying the subsidies this late into open enrollment would negate many of their benefits. Instead, Congress will either do something superficial to help healthcare affordability on the margins, like expanding funding for HSAs, or it will do nothing to help the millions of Americans facing skyrocketing healthcare costs. In response to the subsidies expiring, one in four ACA enrollees expect to go without health insurance, while others will try to cut back on healthcare services and other household spending.
Moderate House Republicans are leading the charge for doing something, anything to take home to their constituents in anticipation of affordability being a deciding factor in next year’s midterm elections. It will be a very tight needle to thread, crafting legislation that is bipartisan enough to win 60 votes in the Senate while appealing to a majority of the Republican-controlled House. President Trump’s endorsement could become the difference-maker for any hopeful bill, but so far his only directive has been to “give money directly to the people,” which leaves room for interpretation. |
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Beyond the Whiteboard
Visualizing key trends from the healthcare industry
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More Dollars than Results for the Healthcare Lobby
Healthcare policy has occupied center stage on Capitol Hill at many points this year, and the money spent by healthcare companies and interest groups on lobbying reflects that. According to OpenSecrets, corporate contributors representing pharmaceuticals, providers, and health insurers spent nearly $700M in the first nine months of 2025 to influence the direction of health policy in Washington, upping last year's spending through that point by over 15 percent. The healthcare products (i.e. pharmaceuticals) and healthcare services (i.e. providers) lobbies are only surpassed by energy and natural resources lobby (think Big Oil) in spending this year. Although the health insurers’ lobby may seem small in comparison, Blue Cross Blue Shield ($21M) and UnitedHealth Group ($10M) were two of the highest-spending companies in any industry.
All this money begs the question, what is it buying? Setting aside questions of potential corruption, it’s hard to map the money spent on healthcare lobbying this year to favorable policy. Hospitals were uniformly opposed to the $1T of Medicaid cuts in this summer’s budget reconciliation package, and yet it passed. Providers and payers alike would prefer to see the ACA enhanced subsidies extended, but they are unlikely to get their wish. One explanation for the diminishing influence of the healthcare lobby could be rising partisanship. For hospitals, their pitch as vital employers serving district needs are losing their power, as members of Congress focus more on national headlines and party directives.
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Dialing In
Sharing insights from our work with clients
From AI Drivers to AI Doctors?
I was thinking about the clinical applications of healthcare AI while reading a recent New York Times piece highlighting safety data from Waymo’s autonomous vehicles (AVs). Across 100-million miles of sample size, Waymo’s AVs experienced 91 percent fewer severe crashes and 80 percent fewer injury-related crashes compared with human drivers on the same roads. If a clinical treatment produced that level of benefit, we’d stop the trial early and adopt it system-wide, but the problem is that we are instinctually much less tolerant of machine errors compared to mistakes made by humans. The consequences of human error (23 deaths per 100-million miles driven) we accept as the cost of driving compared to the relatively rare instances of AV error (2 deaths per 100-million miles driven) is just one example, as this dynamic also plays out in healthcare.
The most AI-forward groups I work with have been happy to outsource administrative tasks to AI assistants, but they’ve guarded their tasks of clinical judgment much more carefully. As one physician told me, “If I make a mistake, I can explain why. If a machine makes a mistake, no one wants to hear the explanation.” This fear of machine failure means the boldest advances in clinical AI will likely come from outside our health system, particularly lower-income countries with much less access to specialist physicians. As with driving, it may feel like our clinical practices are working just fine, only for a new way of doing things to emerge and save lives on a staggering scale.
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