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.