TrustWorks On Call: Healthcare’s Naughty and Nice List

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The 2025 Healthcare "Naughty" List

Congress: For its action on Medicaid cuts and inaction on health insurance affordability.
Tariffs: For raising costs for patients and providers and creating mass strategic uncertainty.
Insurance costs: For their rapid growth, not just in the Affordable Care Act (ACA) exchange population, but for employer-sponsored insurance and Medicare coverage as well.
Measles: For their worst outbreak in over 30 years, totaling over 1,900 cases, 218 hospitalizations, and three deaths, setting up the US to lose elimination status next month.
Robert F. Kennedy, Jr.: For orchestrating the Make America Healthy Again agenda that undermines vaccines and discredits public health experts.

TrustWorks Take: This year saw the most Congressional attention on healthcare since the late Senator John McCain spared the ACA in 2017, and the results were not favorable. This summer’s One Big Beautiful Bill Act scheduled an unprecedented $1T of healthcare cuts over the next decade, and Congress followed that up by failing to extend the enhanced ACA subsidies. All told, an estimated 16M people could lose health insurance by 2034 because of the choices made by Congress this year. That'll get you on the naughty list.

Tariffs and insurance costs go hand-in-hand to end up on this side of the list, as insurers named the pricing impact of tariffs on pharmaceuticals as a common justification for requested rate increases this year. Even if most pharmaceuticals end up exempted from any tariff, the uncertainty alone drives up the cost of doing business for the entire sector. Insurance costs could probably make healthcare’s naughty list every year, but the addition of unnecessary trade restrictions and loss of federal subsidies puts them over the top.

Continuing the theme of national self-sabotage, the last two naughty listers are both responsible for the ongoing outbreak of measles across the country: the measles disease itself, which is caused by the Rubeola virus, and Health Secretary Robert F. Kennedy Jr., who has done more than anyone to mainstream anti-vaccine beliefs. To include a highly contagious, sometimes-deadly disease on healthcare’s naughty list is not surprising, but is extremely frustrating when we have a highly effective vaccine for it. The only thing more frustrating has been watching our Health Secretary realize his dream of destroying our vaccine infrastructure under the guise of restoring “public trust” and “safety.”

The 2025 Healthcare "Nice" List

Dr. Susan Monarez (on behalf of all the civil servants pressured out of government): For standing up for vaccines, public health, and evidence-based science at personal sacrifice.
Biomedical researchers: For breakthroughs on the likes of custom gene editing and xenotransplantation despite research funding cuts.
GLP-1 drugs: For delivering on their "wonder-drug" reputation, with new indications, better formulations, and lower prices.
Hospital-at-home programs: For exemplifying how good healthcare policy can spur health system innovation.
The Affordable Care Act: For holding strong, after so many challenges, as the focal point and high-water mark of all healthcare legislating.

TrustWorks Take: In a difficult year for scientists and civil servants, the federal workers who stuck to their beliefs at the cost of losing their jobs deserve extra commendation. Former Centers for Disease Control and Prevention (CDC) Director Dr. Susan Monarez, fired weeks after her Senate confirmation because she wouldn’t accept Secretary Kennedy's vaccine recommendations, became the most high-profile example of a civil servant standing up for science, but she’s joined by the other CDC officials who resigned after her, ousted top vaccine regulator at the Food and Drug Administration Dr. Peter Marks, and the over 1,000 current and former Department of Health and Human Services workers who called for Secretary Kennedy to resign. Especially for those who have struggled to find new employment, may their stockings be full this time of year.

Biomedical researchers have also inspired us this year, in spite of mass funding cuts to federal research grants. Thanks to federal support at every step of the way, a baby was treated for his life-threatening genetic disorder using a revolutionary CRISPR therapy, and he's enjoying a happy and healthy life eight months later. Elsewhere, a man in New England lived for six months with a kidney grown in a genetically modified pig, which is seen as a major step forward even though he returned to dialysis. The support of the US government, which has funded almost 90 percent of biomedical research grants in recent years, was essential for these breakthroughs to occur, and the withdrawal of US research funding could deprive us of untold future breakthroughs.

While the likes of pig-organ transplants and CRISPR therapies remain relatively niche, GLP-1 drugs solidified their place as healthcare’s latest miracle drugs. There’s still concern over their prices, which are driving up insurance premiums, but President Trump's GLP-1 pricing deals for tariff relief, robust competition between Eli Lilly and Novo Nordisk, and the introduction of new oral formulations should help improve affordability and access for these drugs.

Our final two nice listers exhibited impressive resilience. First, we want to commend the resilience of hospital-at-home programs, which were suspended during the government shutdown, as we discussed last month in a great interview with Dr. Taki Michaelidis, the medical director for UMass Memorial’s hospital-at-home program. But nothing matches the resilience of the defining healthcare legislation of our era, the Patient Protection and Affordable Care Act, which celebrated its 15th birthday in March. Labeled the “most challenged statute in American history” since at least 2020, the ACA survived another Supreme Court ruling this year, which upheld the preventive services requirement. The ACA took some hits with the massive Medicaid cuts and the expiration of enhanced subsidies, but it remains the focal point for all healthcare policymaking and a reminder that things used to be worse.

Beyond the Whiteboard

Visualizing key trends from the healthcare industry

“Nice” Reasons for Hope in Healthcare
Although nothing compares to the operational challenges of 2020 as COVID swept the nation, 2025 was as difficult a year for healthcare strategy as any in recent memory. Nearly every organization we work with put their big decisions on hold for the first half of the year, as we watched the Trump administration reshape the federal government, impose and revise massive trade restrictions, and slash federal healthcare spending. Since then, the second half of the year has felt like a mad scramble to prep for an oncoming hurricane, as we can see the consequences of cutting Medicaid, ACA funding, and research grants on the horizon, but for now the air is still relatively calm and dry. The one good thing about living in such cloudy times is the presence of so many silver linings. Vaccines are under attack, but public health officials are standing up for them. Research grants are being cancelled, but we’re still finding new and amazing ways to save patients’ lives. Congress can’t agree on much of anything with healthcare, except that hospital-at-home programs are working and worth extending. Focusing on the small victories doesn’t make our big problems go away, but it does make them more bearable.

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Sharing insights from our work with clients

Twelve Days of (Healthcare) Christmas
On the twelfth day of Christmas
My healthcare system gave to me
Twelve AI apps for labor savings
Eleven startups seeking funding
Ten ASCs a-opening
Nine rural hospitals closing
Eight PE platforms growing
Seven MA plans disbanding
Six nurses striking
Five vac-cines
Four tariff changes
Three telehealth extensions
Two board retreats
And less patients in the ED

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