Secretary of Podcast Services
April 14, 2026
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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 show how MA is still plenty profitable, before Dialing In on the fantasy of universal shared decision-making. But first, the news, starting with a story involving our Health Secretary focusing his attention on what really matters: podcasting.
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Behind the Headlines
Unpacking the forces driving healthcare's biggest stories.
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1. Revised ACIP charter doubles down on vaccine skepticism.
- Last Thursday, the Trump administration published a new charter for the Advisory Committee on Immunization Practices (ACIP), which expands the scope of its committee members’ qualifications to include authorities on “serious vaccine injuries,” after a federal judge ruled last month that ACIP’s members lacked sufficient qualifications.
- The revised charter could be a first step toward restoring ACIP, as the committee’s decision-making authority has been placed on hold until it resolves its makeup in the eyes of federal court.
TrustWorks Take: The White House sees vaccine skepticism as a losing issue in the upcoming midterms, but its efforts to pump the brakes on anti-vaccine policies are facing resistance. Health Secretary Robert F. Kennedy Jr. and his allies have not given up their fight to use ACIP to reduce vaccine requirements. HHS has yet to appeal the court order that disrupted ACIP, but it may not need to. By changing the charter’s qualifications, Kennedy has more flexibility to bring back old members and appoint new ones ideologically aligned with him. Once the committee is reloaded, it could reissue the vaccine schedule policy changes the court order paused.
Secretary Kennedy also announced last week that he is launching a podcast focused on “telling the truth” about our healthcare system, “especially when it’s uncomfortable.” Whatever topics he chooses to focus on will be broadcasted in a decidedly unscientific medium, as podcasts have no peer review, fact checking, or obligation for balance. It is at the least strange, if not dangerous, for a sitting cabinet secretary to launch his own personal communication platform outside traditional government structures, playing into today’s polarized, personality-driven information bubbles.
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2. Proposed IPPS rule would raise hospital pay 2.4 percent.
- On Friday, the Centers for Medicare and Medicaid Services (CMS) issued its FY 2027 Hospital Inpatient Prospective Payment System (IPPS) proposed rule, headlined by a projected 2.4 percent payment boost.
- CMS also proposed reviving and expanding the Comprehensive Care for Joint Replacements (CJR) model, a mandatory program which ran from 2016 to 2024 and generated over $100M in net Medicare savings on joint replacement surgeries in hospitals.
TrustWorks Take: Last year, CMS proposed the same 2.4 percent IPPS pay raise before finalizing a 2.6 percent increase, so it seems reasonable to expect another minor upward revision this year. As the American Hospital Association (AHA) points out, this $1.9B net increase in hospital payments will be severely undermined by the impact of the uninsured rate rising due to federal spending cuts for public insurance programs. Unfortunately, hospitals should recognize that reducing federal spending on healthcare is the administration’s explicit goal.
The White House’s 2027 budget request, which is more of a wish list for the administration than a serious policy document, calls for a 12.5 percent funding cut to HHS for the same logic. As President Trump said earlier this month, “It’s not possible for us to take care of day care, Medicaid, Medicare, all these individual things,” at the federal level because “we have to take care of one thing: military protection.” Improving healthcare is not a priority for this administration, so modest rate bumps for Medicare payments and avoiding further cuts may be the best hospitals can hope for until there’s a change in leadership.
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3. Medical supply chains disrupted by Iran war.
- The Persian Gulf’s sea-shipping lanes and cargo airports, which transport important medicine and supplies globally, have reduced their activity by 90 percent and 79 percent respectively since the war with Iran began on February 28, 2026.
- For the US healthcare sector, these trade disruptions will primarily impact: cold-chain medicines, which are often moved by air cargo through the Gulf; the helium used in MRI machines, 30 percent of which is produced Qatar; medicines made from petrochemical precursors, such as ibuprofen; and overall energy prices from disruptions to oil and natural gas production and trade, which has a cascading inflationary effect on most goods globally.
TrustWorks Take: Even with the current ceasefire agreement, the Strait’s closure is being enforced by both Iranian and US blockade, with no indication that global trade flows will resume soon. As a general rule, these massive trade disruptions in the Middle East are more likely to produce price shocks than shortages for US industries and consumers. For providers, that means higher energy costs and more expensive pharmaceuticals and supplies, but also tighter household budgets from patients, who are already extremely worried about unaffordable healthcare costs, leading to reduced utilization.
Expect to see price hikes first for cold-chain medicines, like biologics and vaccines, because they usually rely on air travel, which is operating under reduced cargo capacity and increased fuel costs. Because sea freight moves slower, its trade disruptions take longer both to manifest and to resolve. For example, the US imports almost half of its generic drug supply from India, which relies on many ingredients from the Gulf. Should drug distributors burn through their standard 30-to-60-day buffer stock, common antibiotics and painkillers could spike in price, while the foreign manufacturers who make them on razor-thin margins could even go under.
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Beyond the Whiteboard
Visualizing key trends from the healthcare industry
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Rumors of the Demise of MA Profitability Greatly Exaggerated
When CMS proposed to keep Medicare Advantage (MA) payment rates essentially flat for 2027, it raised the possibility that the Trump administration was finally getting serious about its rhetoric of reining in private health insurers. Then the final rule came out last week with a 2.48 percent payment increase worth $13B to MA plans, by doing away with a significant risk adjustment change. Last year, MA enrollment growth slowed significantly, as payers exited markets and cut back on benefits, citing high utilization and adverse regulatory changes. What those headlines obscure is that, even as MA profitability declines, it still offers far better margins than any other insurance product. In 2024, gross margins per MA enrollee were about double that of the employer market. The gap may have narrowed slightly in 2025, but higher utilization was seen in commercial populations as well. Now, with two friendly rate increases recorded under Trump’s CMS, payers and their investors are breathing a sigh of relief. CMS Administrator Dr. Mehmet Oz said during his confirmation hearings that there would be a “new sheriff in town” for MA, but so far, neither the rules around MA payments nor their enforcement have seen much change.
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Dialing In
Sharing insights from our work with clients
The Utopia of Shared Decision-Making
I was seated next to a primary care physician at a recent medical staff dinner in Colorado, and our conversation turned to changes in vaccine policy. I asked if he had more patients hesitant to receive their recommended shots. “I caught a bit of the [Surgeon General Nominee] Casey Means confirmation hearings,” he mused. “The answer to everything from birth control to vaccines, is to have a conversation with your doctor, and we don’t have the ability to manage that.”
Shared decision-making is foundational in the MAHA policy sphere, ceding policy recommendations to a discussion between patients and their doctors. In an ideal world, all patients would have ready access to that support. But a third of Americans don’t have a primary care provider. Practice schedules are not designed to incorporate lengthy impromptu conversations: “Devoting time to do this the right way will make me half an hour late for the rest of my patients.” And in fee-for-service medicine, providers aren’t incentivized to devote the time.
Moreover, most doctors are not trained in shared decision-making strategies. The doctor-patient relationship is hierarchical by nature, and conversations about changing a patient’s firmly held beliefs can make them feel their intelligence is being questioned. One CMO described a technology solution they were looking to implement. Patients fill out a questionnaire about vaccine questions, and an AI-driven conversation explores their reasoning and identifies specific areas for doctors to address. “Patients are actually more open with the iPad than they are with us,” he shared. If shared-decision making is to supplant top-down clinical policy, systemic changes in training, practice operations, access and technology support are critical to making it a successful substitute.
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