The Players

The future of medicine depends on a complicated relationship among several entities working to influence the direction of health care policy. In this edition, we’ll highlight some of these key players.

They’re policymakers working on legislation that will shape the industry for a long time; government agencies writing rules and overseeing the sector; and industry and advocacy groups pushing for policy that works in their favor.

These players have to contend with the chaotic first few months of the second Trump administration, which has sent both promising and concerning signals to the sprawling health care industry:

– Congress is working to cut billions of dollars from Medicaid through the reconciliation process.

– The White House and Department of Government Efficiency have frozen billions of dollars more in funding for drug development, research and clinical trials.

– Health and Human Services Secretary Robert F. Kennedy Jr. is upending the federal government’s approach to vaccines, health and safety protocols, pesticides and more.

Many of the sector’s advocates are focused on threats to federal funding for health care research. 

“We have a huge emphasis and priority on federal research funding given, right now, that there’s a lot of movement to cut federal funding throughout the government,” said Mark Fleury, a policy principal at the American Cancer Society Cancer Action Network. 

“We’re in an era where our biological understanding of cancer has really allowed us to take off with drug development, and that’s really been thanks to long-standing commitment to federal research,” Fleury added. 

It’s unclear what that commitment will look like through the rest of the Trump administration. 

In the meantime, advocates are pushing the government to embrace innovations in artificial intelligence and ease barriers for health care-focused startups and novel drug developments.

Here are some of the key players:

Sen. Bill Cassidy (R-La.) 

The chair of the Senate Health, Education, Labor and Pensions Committee, whom we recently interviewed, plays a crucial role in crafting the health agenda for Senate Republicans.

With key Trump nominations out of the way, Cassidy has turned to longstanding priorities like reforming the National Institutes of Health, including the release of a white paper in May calling for a top-down review of the agency’s functions and transparency. 

Sen. Patty Murray (D-Wash.)

The longtime Washington Democrat has positioned herself as a critical backstop against the Trump administration’s crackdown on research funding. As the top Democrat on the Senate Appropriations Committee, Murray blasted the White House for taking a “wrecking ball to our biomedical research enterprise” during an April hearing. 

Murray has also worked alongside Appropriations Committee Chair Susan Collins (R-Maine) to decry the White House’s proposed cuts to medical research.

Rep. Brett Guthrie (R-Ky.) 

As chair of the House Energy and Commerce Committee, Guthrie played a key role in negotiations around the GOP’s hunt for federal savings during the reconciliation process. That culminated in changes to Medicaid that the Congressional Budget Office estimates will cost 8.6 million Americans their insurance coverage. 

Guthrie has plenty of policy priorities, too, having expressed concern over “significant consolidation” among pharmacy benefit managers. 

The Kentucky Republican has also pushed for increased transparency at the NIH and is among several lawmakers seeking changes to the Inflation Reduction Act that would extend the time period “small molecule” drugs can be on the market before they’re eligible for Medicare price negotiations.

Rep. Frank Pallone (D-N.J.) 

The top Democrat on the House Energy and Commerce Committee has had his hands full responding to the Republican effort to cut Medicaid funding in reconciliation. 

Pallone guided Democrats through a 26-hour markup protesting the changes in mid-May. As the former chair of the panel, Pallone led efforts in 2022 to modernize and strengthen the FDA’s approval process for drugs on an accelerated review timetable. 

The New Jersey Democrat also helped create the Advanced Research Projects Agency for Health (ARPA-H) to help fund medical breakthroughs.

The Advanced Research Projects Agency for Health

Created in 2022 and designed to model the Defense Advanced Research Projects Agency (DARPA), ARPA-H funds high-risk, high-reward medical research. In the years since, the independent organization has pursued interventions in osteoarthritis, precision cancer surgery and various forms of immunotherapy. ARPA-H has been held up as a model of cutting regulatory red tape.

Centers for Medicare & Medicaid Services

The heart of the federal government’s administrative approach to Medicare and Medicaid coverage isn’t the most nimble federal office. But since 2023, CMS has been testing new ways to accelerate novel approaches to coverage and reimbursement, including pilot programs to test “value-based” primary care in rural areas. 

The CMS has also taken on newfound economic clout with its ability to negotiate drug prices.  

National Venture Capital Association 

The nation’s venture capitalists have a real stake in health care policy, particularly for drug development. Ashlyn Roberts, vice president of government affairs at the NVCA, said the sector is positioned to help innovations survive the transition from lab work to the real world.

“There’s this big chunk of time when the discovery gets spun out and iterated on for years and years, anywhere from between five to 11 or 12 years,” Roberts told us. “A lot of our folks really provide the highest risk capital in that long time horizon to develop these innovations and make them into products.”

– Brendan Pedersen