The Trump administration has wasted no time reducing and reshaping the federal government. Comprising 27 percent of annual federal outlays, healthcare programs and services are an inevitable target for Department of Government Efficiency reforms and budgetary offsets. President Trump has said that entitlements such as Social Security, Medicare, and Medicaid should be protected, but Medicaid appears to be the most vulnerable to spending cuts. On the provider side (beyond a potential increase to the uninsured population), site-neutral payment reforms, uncompensated care cuts, and changes to the Medicare Physician Fee Schedule could further undermine care delivery businesses. Amid the federal government rolling back oversight and encouraging privatization, states will play an increasingly pivotal role, either by countering federal actions where possible or doubling down on deregulatory initiatives. One item in particular to look out for: state governments conditioning not-for-profit hospital tax breaks on compliance with price ceilings or other outcomes and factors.