Premier’s Breakthroughs25: Soumi Saha Maps the Future of U.S. Healthcare Policy
At Premier’s Breakthroughs25 Conference, held in 2025, Soumi Saha—Senior Vice President of Government Affairs at Premier—delivered one of the most closely followed sessions of the event. Her presentation examined the current and future trajectory of healthcare policy in the United States, unpacking how 2025 is unfolding compared with expectations entering the year. With a candid lens on the intersection of politics and healthcare, Saha highlighted the key pressures shaping providers, patients, and policymakers alike, and laid out Premier’s advocacy priorities in response.
Her analysis made clear that this is a defining moment for healthcare policy—where political shifts, fiscal pressures, and industry demands converge to create both challenges and opportunities. Below are the major themes and takeaways from her presentation.
Hospitals and Nursing Homes Under Intensified Scrutiny
One of the clearest messages from Saha’s presentation was that healthcare providers—once hailed as “heroes” during the pandemic—are now under unprecedented policy and financial scrutiny. Premier had predicted at last year’s Breakthroughs that hospitals, nursing homes, and other providers would face heightened oversight regardless of the outcome of the 2024 elections. That forecast has proven accurate.
In 2025, a series of federal policy moves has increased transparency and reporting requirements, continued downward pressure on reimbursement rates, expanded site-neutral payment policies, and even included clawbacks of 340B drug discount funds. The collective impact is significant: Washington is signaling that there is no political mandate to rescue healthcare providers from financial strain.
Instead, providers must prepare to adapt and innovate under tougher oversight and shrinking margins. Premier, for its part, remains focused on equipping members with tools, data, and advocacy strategies to help them navigate this environment while sustaining high-quality care delivery.
Medicaid Reforms: Preparing for the Long Game
Saha highlighted that the recently enacted One Big Beautiful Bill Act (OBBBA) is poised to reshape Medicaid over the next decade, with provisions expected to reduce federal Medicaid spending by $1 trillion. While many of these changes will be phased in, the ripple effects are already becoming clear.
Cuts to federal support will likely increase the number of uninsured patients, while reductions in provider taxes are expected to weaken states’ ability to raise funds for healthcare programs. Post-Chevron legal rulings may also curtail states’ flexibility in managing Medicaid waivers, further limiting options.
Premier is working to influence implementation of OBBBA provisions and mitigate harmful cuts. However, Saha emphasized that healthcare providers must begin planning now for reduced revenue streams and shifting payer dynamics.
Medicare and ACA: Unexpected Shifts
Heading into 2024, the expectation was that Medicare and the Affordable Care Act (ACA) would remain largely untouched. Candidate Trump had pledged not to dismantle them, signaling a continuation of the status quo. Yet OBBBA has introduced sweeping changes that few predicted.
Key provisions include:
- A 2.5% payment increase for physicians under the Medicare Physician Fee Schedule in 2026.
- Elimination of enhanced federal matching funds for new Medicaid expansion states.
- Work requirements and cost-sharing mandates for Medicaid beneficiaries.
- Potential Medicare cuts under the Statutory PAYGO Act beginning in 2026.
- Expiration of enhanced ACA premium subsidies at the end of 2025.
For providers, this landscape means ongoing exposure to financial risk via sequestration cuts and site-neutral payment expansions. Premier is responding by pushing for multi-year reimbursement relief, improved CMS data to capture labor costs, and protection of key hospital support programs.
Medicare Advantage: Growth Meets Guardrails
Enrollment in Medicare Advantage (MA) continues to rise, but with growth has come new scrutiny. Policymakers are zeroing in on the financial practices of MA plans, especially around denials and delays that hinder patient care and strain provider finances.
Premier has been at the forefront of advocacy in this area—conducting surveys, submitting formal recommendations to CMS, and raising national awareness. These efforts have helped drive progress, including:
- CMS policies limiting retroactive denials and mandating automation in prior authorization.
- Insurers covering nearly 80% of Americans pledging to overhaul prior authorization.
- National media attention spotlighting patient and provider frustrations.
Premier continues to push for legislative reforms such as the Prompt and Fair Pay Act, the Improving Seniors’ Timely Access to Care Act, and the Reducing Medically Unnecessary Delays in Care Act—all aimed at improving accountability and ensuring timely patient care.
Deregulation and Federal Agency Restructuring
As predicted, a second Trump Administration has brought aggressive deregulation. Federal health agencies including CMS, FDA, NIH, and CDC have faced deep workforce reductions, restructuring, and a “10-for-1” regulation rollback initiative.
Saha underscored that while deregulation can reduce provider burdens, it also risks destabilizing critical oversight functions. Premier is actively engaging with policymakers to ensure reforms reduce red tape without compromising patient safety or care quality.
Value-Based Care: Marching Forward
Despite political shifts, the move from fee-for-service to value-based care continues to accelerate. CMS has rolled out its “Innovation Center Strategy to Make America Healthy Again,” emphasizing prevention, transparency, competition, and accountability.
However, the Trump Administration’s approach leans toward rapid deployment, mandatory participation, and cost-centered definitions of value. Providers may find themselves struggling to keep up with fast-moving, mandatory models that don’t always align with clinical realities.
Premier is advocating for tailored models, renewed provider incentives, and a holistic approach that spans acute, post-acute, and community-based care settings.
Supply Chain Resiliency: Policy Meets Practice
Healthcare supply chain resiliency remains a bipartisan priority, framed as a matter of national security. The Trump Administration has leaned heavily on tariffs and trade policy, though inconsistent implementation has created uncertainty for providers and manufacturers.
Premier is promoting a more measured strategy—proposing that tariff revenues be reinvested in programs that bolster supply stability, and advocating for targeted trade policies. Key legislative efforts supported by Premier include:
- The Medical Supply Chain Resiliency Act.
- The ONSHORE Manufacturing Act of 2025.
- The STOCK Healthcare Supplies Act of 2025.
Drug Pricing Reform: A Top-Tier Priority
As expected, drug pricing remains a central issue. The Trump Administration has revived the “Most Favored Nation” pricing model, tying U.S. drug prices to the lowest paid internationally, while also modifying the Inflation Reduction Act (IRA) to expand exemptions and adjust negotiation timelines.
Premier supports reforms that create transparency, deter anti-competitive behavior, and enable outcomes-based contracting to improve patient access.
Technology, Cybersecurity, and the Patient Experience
One of the most pressing challenges identified by Saha is the lag between healthcare technology adoption and federal regulatory action. While providers are embracing digital transformation, federal policy has not kept pace.
Premier is calling for:
- Interoperable and standardized patient data.
- An end to vendor-driven data blocking.
- Digital tools that enhance, not replace, the patient-provider relationship.
- Stronger federal investment in cybersecurity infrastructure.
Environmental Sustainability and Health Equity
Federal momentum on sustainability has slowed, with the HHS Climate Pledge de-emphasized and clean energy provisions rolled back. Still, Premier is working to ensure providers have resources to reduce their carbon footprint, prepare for climate-related disruptions, and address social determinants of health.
In parallel, Premier remains committed to advancing health equity, despite shifting federal priorities. Efforts focus on rural health support, standardized socio-demographic data collection, and expanded participation in alternative payment models for safety-net providers.
Maternal Health: A Nuanced Policy Landscape
Maternal health policy has largely shifted to the states, though the Trump Administration has supported certain initiatives, including Premier’s Perinatal Improvement Collaborative. The collaborative uses data-driven strategies to reduce disparities in maternal and infant outcomes.
Saha shared her own birthing experience, underscoring Premier’s commitment to ensuring every mother and child has access to patient-centered, evidence-based care.
