TrustWorks On Call: There’s a Doctor in the House

Behind the Headlines

Unpacking the forces driving healthcare's biggest stories.

1. Trump sets 100 percent pharma tariff, with many exceptions.

In a Truth Social post last Thursday, President Trump announced that starting October 1, brand-name pharmaceutical drugs will face a 100-percent tariff unless the company is building a plant to manufacture the drug domestically.
This tariff will not apply to generic drugs, which usually face no tariffs, or drugs covered by a recent trade deal with the European Union (EU), which are capped at 15 percent.
Over 40 percent of active ingredients for US brand-name drugs, which are used for only one in ten prescriptions, are made outside of the US or EU and could fall subject to the tariff.
The White House has also hinted at upcoming regulation which would aim to equalize the drug prices paid in the US and abroad, potentially by imposing price controls on drugmakers tied to the lowest prices paid by peer nations.

TrustWorks Take: Given the considerable exemptions, the headline looks scarier than the details, as most brand-name drugs are already manufactured in the US or EU. The United Kingdom’s AstraZeneca and Switzerland’s Roche and Novartis are the most notable companies threatened by the tariff, although AstraZeneca and Roche’s US factories recently under construction could spare them. Smaller drugmakers based in Asia or other parts of North America, who lack the capital to finance new US factories, face the greatest exposure, and the patients who rely on their relatively niche brand-name drugs could suffer from price increases and shortages. Trump’s negotiating tactics appear to be successfully reshoring some domestic manufacturing for pharmaceuticals, but these efforts could be counterproductive to the administration’s other goal of lowering drug prices. Heavily taxing smaller drugmakers and inducing larger drugmakers to spend more domestically on capital and labor could raise the cost of doing business for these companies, which ultimately gets passed onto consumers through higher premiums, cost-sharing, and out-of-pocket spending.

2. Doctors may be exempted from $100K H-1B visa applications.

After President Trump signed a proclamation earlier this month that H-1B visas, which allow educated immigrants to work “specialty occupations” domestically, would require an additional $100K application fee from employers, the American Medical Association and 54 other medical societies petitioned the administration to exempt all physicians, including those in non-clinical settings.
In a statement to Bloomberg News, a White House spokesperson clarified that “the proclamation allows for potential exemptions, which can include physicians and medical residents,” leaving it up to the Secretary of Homeland Security, Kristi Noem, to waive the application fee.
Current holders of H-1B visas and their employers will not be subject to this one-time fee.

TrustWorks Take: International medical graduates, most of whom need H-1B visas to work here, comprise 23 percent of the country’s licensed physicians, with outsized importance to the rural and underserved communities where it is hardest to recruit physicians. Unlike the big tech companies who also rely on H-1B visa workers, many health systems do not have the margins to absorb these new visa fees without workforce reductions and service cutbacks. (Maintaining 60 H-1B visas would cost about an additional $1M per year, going forward.) And unlike protectionist policies to boost domestic manufacturing, the US physician supply is not suppressed by international competition but rather by its own artificial limits on medical residency slots. It is therefore a relief to hear that physicians could be exempted from this policy, but we are still waiting for confirmation. Meanwhile, the uncertainty it has produced could still have a chilling effect on international physician recruitment. The US has benefited from its reputation as a place that welcomes the best and brightest from around the world to practice medicine, but new policies can quickly lead to a different reputation. Not only is the U.S. at risk of losing top research talent due to funding cuts, but we may now also lose critical medical expertise if visa barriers discourage physicians from practicing here.

3. White House promotes unproven autism-acetaminophen link.

At a White House Briefing last week featuring Health Secretary Robert F. Kennedy Jr. and Food and Drug Administration (FDA) Commissioner Marty Makary, President Trump advanced the claim that Tylenol’s active ingredient, acetaminophen, is an important root cause of autism, and that pregnant women should “tough it out,” and “fight like hell not to take [Tylenol].”
This week, President Trump posted that parents shouldn’t give Tylenol to their children “for virtually any reason” and recommended delays to the childhood vaccine schedule.
At the event last week, administration officials also announced $50M of federal research funding to investigate potential causes of autism, including vaccines; additionally, they approved leucovorin, traditionally used to treat chemotherapy side effects, as a treatment for children with autism and a folate deficiency.

TrustWorks Take: The President’s nearly unprecedented decision to dispense direct medical advice to the public (comparable perhaps only to his behavior during COVID, in his first term) would be concerning even if it didn’t contradict the scientific consensus that no causal link between acetaminophen and autism has been found. Tylenol remains one of the few safe options for pain relief during pregnancy, and avoiding its use could result in untreated fevers, migraines, or high blood pressure, all of which pose a greater risk of fetal harm than acetaminophen itself. And the dangers posed by this politicization of medical research go far beyond Tylenol usage in pregnancy. Instead of directly interpreting evidence, people tend to rely on trusted authorities to know what’s best for their health. The intrusion of partisan politics into personal healthcare decisions and regulatory health guidance is confusing, divisive, and a deterrent to effective care. However, most Americans still trust their personal doctor more than any other medical authority or politician, which puts physicians on the front lines of the battle to defend evidence-based healthcare.

Beyond the Whiteboard

Visualizing key trends from the healthcare industry

Consumers About to be Caught in Health Plan Crunch
During the upcoming open enrollment season for Medicare Advantage (MA), a record 28 percent of MA members are expected to switch plans, driven by payers cancelling unprofitable plans and paring back benefits. The loss of supplemental benefits is even inspiring some enrollees to leave MA for traditional Medicare, with MA’s share of Medicare enrollment projected to fall from 50 to 48 percent next year. The largest MA payers are pivoting from membership growth to margin control because rising medical costs and slowed federal reimbursement growth have taken the wind out of MA’s profitable sales. CVS-Aetna and Humana have led this charge since 2024, while payers like UnitedHealth Group (UHG) are playing catchup by promising to cut 600K members’ plans in 2026, after picking up too many members shed by Aetna and Humana in the year before. Although fewer plan options could be a problem for MA beneficiaries, the individuals and small businesses purchasing insurance on the Affordable Care Act exchanges are facing a catastrophe. Average premium increases of 18 percent are the result of higher utilization and medical costs hitting at the same time as the expiration of enhanced subsidies. For a family of four making $85K, the premiums they pay each month could go up by 94 percent, unless Congress acts to extend the enhanced subsidies. The expiration of these subsidies could cause 2.9M people to lose health insurance in 2026 alone, which is why Congressional Democrats have made it a top issue in ongoing budgetary negotiations to avoid a government shutdown. This crisis can still be avoided, but we are running out of time.

Dialing In

Sharing insights from our work with clients

Three Questions with Lisa Bielamowicz, MD

Given all the uncertainty, where do you advise people to focus?
Get unstuck! So many leaders look at the political and economic chaos and think it’s safest to enter a holding pattern. But it’s dangerous to stand still in a chaotic market because standing still means falling behind. We know the challenges of the health system business model, and we must keep moving to find the right efficiencies while also innovating. I’m reminded of a quote, “Chaos is a ladder”. A turbulent market can provide outsized opportunities for those organizations who remain focused and diligent.

What is the most difficult conversation you’ve facilitated with boards or C-suites in 2025?
For perhaps the first time ever, providers need to develop their own individual, unique strategy. Health systems often look to the external market for strategic direction. Think back over the past twenty or thirty years. In the early 2000s, we all competed by bringing the best clinical technology to the forefront. Remember the billboards for da Vinci robots on the side of the road? With the passage of the ACA, everyone launched an ACO and focused on value-based care. For the past several years, it’s been all about consumer and digital health. Now, there’s not a common identity that everyone is chasing. This makes strategy setting a lot harder. First, you have to understand your market position, strengths, weaknesses, ambitions, competitive environment. Then, you have to actually create something unique. It’s a lot harder.

What’s something that has you optimistic about healthcare in 2025?
When you ask consumers whom they trust to help them make important healthcare decisions, providers, from personal doctors and nurses to institutions like their local hospitals and health systems, are still at the top of the list. It’s a fantastic relationship to build from and deepen. But to be the kind of partner patients and customers are looking for, we need to be maximizing the value delivered: accessibility, affordability, and a seamless experience in every interaction, big or small. There’s tremendous opportunity to build long-term loyalty in a way that will be much more difficult for insurer or retailer to accomplish.

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There's a Doctor in the House