MAHA Turns One

A year into the job, HHS Secretary RFK Jr. has mostly let Big Medicine off easy.

Credit: iStock/hapabapa

By Emma Freer, Sr. Policy Analyst for Healthcare

Last Friday marked one year since the Senate narrowly confirmed Robert F. Kennedy Jr. as secretary of the U.S. Department of Health and Human Services (HHS). In office, he has proven to be a chaotic leader, shrinking the agency he leads while declaring war against seed oils, Tylenol, and, most notoriously and irresponsibly, vaccines.

This scattershot approach has overshadowed certain elements of Kennedy’s Make America Healthy Again (MAHA) agenda that impact Big Medicine, the vertically-integrated healthcare conglomerates that exploit conflicts of interest to drive costs up, quality down, and independent providers out of business. So far, Kennedy has presided over two reforms intended to rein in these conglomerates, but he has also championed many more that either preserve or exacerbate these conflicts.

This post is intended as a look at Kennedy’s first year in office – the good, the bad, and the ugly – viewed through an antimonopoly lens.

The Good

In recent months, Kennedy’s HHS has proposed, continued or been tapped to implement policies that lower healthcare costs by mitigating or eliminating the role of Big Medicine.

In January 2026, Medicare proposed to raise federal payments to private Medicare Advantage insurers by less than 0.1% in 2027, far short of both last year’s 5.1% increase and Wall Street’s expectations. While not final – final rates are not announced till early April – it’s an encouraging start. For years, organizations like AELP have pointed out that Medicare Advantage, initiated to save money, has done no such thing, in large part because the private Big Medicine insurers that participate in it inflate bills, even as they skimp on treatment. Medicare Advantage insurers charge taxpayers 14% more per patient – or $76 billion annually – compared with traditional Medicare, despite similar patient populations and coverage criteria across the two programs. They also deny prior authorization requests and claims at much higher rates, robbing older Americans of medically necessary care. There are further allegations of billing fraud and bribery schemes.

In addition, in November 2025, Medicare announced that it had negotiated lower prices for 15 additional high-cost prescription drugs, which will take effect on Jan. 1, 2027, and are projected to save $12 billion compared with annual spending on those same drugs in 2024. This is a continuation of a Biden-era initiative in the 2022 Inflation Reduction Act, and it was not clear for a time whether the Trump administration would continue it. While widely popular, many Republicans in Congress vehemently oppose any government negotiations to bring down the price of prescription drugs, no matter how much their constituents benefit.

That said, the Medicare Drug Negotiation Program is an incremental approach, and one targeted at older Americans. If Kennedy is serious about lowering prescription drug costs for everyone, he must rein in the Big Medicine corruption – namely, private pharmacy benefit managers (PBMs) that are vertically integrated with insurers and pharmacies – that is driving the high cost of pharmaceuticals. So far, however, he has failed to act, leaving it to Congress and others in the Trump administration – including the Department of Labor and Federal Trade Commission – to enact or propose long-awaited PBM reforms, some of which HHS will be responsible for implementing.

The Bad

HHS has also frequently ceded its regulatory authority to Big Medicine, trusting these conglomerates to put Americans’ interests above their own, despite decades of evidence to the contrary.

Since May 2025, HHS has leveraged the threat of future pharmaceutical tariffs to strike one-off deals with brand-name drug manufacturers to offer discounted cash prices, now available on the TrumpRx website. These deals hinge on manufacturers’ voluntary participation and consumers’ forfeiting existing insurance benefits, sometimes at great cost. Although certain drug prices may be lower on TrumpRx, these deals do nothing to address the cost drivers, including Big Medicine conglomerates that combine insurers, PBMs, and pharmacies under one parent company; PBMs’ rebate-based business model; and Big Pharma patent abuse.

Last spring, Kennedy announced a similarly unenforceable “pledge” by private Big Medicine insurers to reduce their self-imposed prior authorization requirements, which prevent patients from accessing care and physicians from exercising their clinical judgment. Although insurers committed to reductions by January of this year, there is little evidence of progress.

At the same time, HHS also enlisted Big Medicine to expand prior authorization in traditional Medicare, despite bipartisan opposition. Unlike private Medicare Advantage insurers, traditional Medicare has traditionally used prior authorization sparingly, streamlining patients’ access to care and easing providers’ administrative burdens.

The Ugly

Then there is the One Big Beautiful Bill Act, which slashed federal Medicaid funding and ended Affordable Care Act health plan premium subsidies to fund tax breaks for the richest Americans. The July 2025 law has proven ruinous for safety-net hospitals, which disproportionately rely on Medicaid reimbursements to stay afloat. Indeed, some have already closed, citing the cuts, and others are sure to follow or else be acquired by Big Medicine conglomerates, increasing their monopoly power. As a result, Americans will suffer, finding themselves stranded in either a care desert or at a corporate-owned entity that charges more for worse-quality care.

Nonetheless, Kennedy touted the law – which included a $50 billion rural health fund – as “the biggest infusion of federal dollars into rural health care in American history.” Of course, this claim conveniently ignored the facts that the fund was only included to secure the votes of Republican lawmakers from rural districts, offsets just a sliver of the overall cuts, and is being administered by Kennedy, at least in part, according to how faithful state applicants are to his MAHA agenda.

Conclusion

One year in, Kennedy’s actions underscore the need for structural legislative reforms that rein in Big Medicine, regardless of who sits in the White House or HHS headquarters. Just last week, Sens. Elizabeth Warren (D-MA) and Josh Hawley (R-MO) introduced the bipartisan Break Up Big Medicine Act, which would prohibit insurers and other middlemen, including PBMs, from owning or controlling medical providers. This bill would build on Kennedy’s better policy choices – to stop raising federal payments to Medicare Advantage insurers and keep negotiating lower Medicare drug prices with Big Pharma – while ensuring a more aggressive overall stance toward Big Medicine. This is the only way to make the U.S. healthcare system healthy again.