Managed Care Outlook 2025

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The change in control of the White House and the Senate that will take place later this month is expected to bring major shifts in federal antitrust enforcement. Commentators predict that the new administration will be more friendly to mergers but perhaps just as focused on reining in dominant tech companies as the Biden administration has been. Where does health care fall? The record of the first Trump administration and an active private plaintiffs’ bar suggest that managed care companies should continue to take active steps to mitigate antitrust risk and monitor key case developments in 2025 and beyond.

At the outset of the Trump-Pence administration, the Departments of Health and Human Services, Treasury, and Labor and the Federal Trade Commission issued a joint report titled Reforming America’s Healthcare System Through Choice and Competition. That report proposed managing health care costs by removing regulations and promoting competition, including through “vigorous” antitrust enforcement to prevent the accumulation of market power, particularly by health care providers. This is consistent with an evergreen approach to health care enforcement that persists across administrations and may set the tone for the Trump-Vance approach to enforcement.

Key takeaways
  • Antitrust agencies will likely continue focusing enforcement resources on dominant market players despite the U.S. government switchover
  • The Trump-Pence health care report emphasized competition and antitrust enforcement to manage health care costs, suggesting vigorous health care antitrust enforcement will persist in the new administration
  • Information transfers among affiliated entities, out-of-network reimbursement calculators, and use of market power to steer self-referrals have been investigated
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