A large-scale reduction in the federal workforce has been an overarching focus of President Donald Trump’s administration in its early days, and the government’s health care apparatus has not been exempted.
The cuts have covered a wide range of departments, and so far have included the Centers for Disease Control, the National Institutes of Health, the U.S. Department of Veterans Affairs, the Food and Drug Administration and the U.S. Department of Health and Human Services.
Julius Hobson, a senior policy advisor at Polsinelli, said at a roundtable Feb. 18 that the cuts so far have been fairly significant and are likely to continue. He noted that some of it will be contested, but that it will take some time to see how it plays out.
But as the administration nears the end of its first month, roundtable participants said its changes haven’t been solely confined to workforce reductions.
“The ongoing process of medicare payment rules, that process is continuing, we don’t know what that’s going to look like as we go forward,” Hobson said.
The Medicare Fee-For Service Payment System Rules set the rates that the Medicare FFS program pays physicians, hospitals and other health care facilities, according to the Congressional Research Service. The CRS notes that most of the rules are updated annually through regulations. The Biden administration published its final rules in November 2025, and it included a nearly 3% cut in the Medicare physician payment schedule, according to the American Medical Association.
In addition to the Medicare payment rules, Hobson is watching the discussion about whether to get rid of the AMA/Specialty Society RVS Update Committee, which provides the Centers for Medicare & Medicaid Services with recommendations for the relative values of medical services for Medicare reimbursement.
He’s also wondering if the physician fee schedule process, which Medicare uses to pay enrolled health care providers, will be a target of a change in process, and whether current procedural terminology coding, which the AMA describes as a uniform language doctors and health care professionals use for coding medical services and procedures, would be continued.
“None of that is clear,” Hobson said.
The nation’s high court in its recent decisions has also impacted the legal health care landscape. Jennifer Evans, Polsinelli’s Denver office managing partner, said the ending of the Chevron deference was a really big deal in administrative law. She said that the ruling in that case offers another line of attack for someone to contest a rule that adversely affects them or that they find difficult to comply with.
She noted that for those in the health care world, the agency with a lot of rules of this kind is HHS.
“Lots of them are highly technical rules around coverage, around payment, around retaining funds that have already been paid to us,” Evans said. “It offers an opportunity to go in and address some of the underpinnings of how our health care system is put together through the rulemaking.”
“It offers health care providers in particular an opportunity to really go in and address concerns that they have with the way federal health care programs are being administered,” Evans added.
The end of Chevron isn’t the only U.S. Supreme Court case of the past year that Evans sees as providing more opportunity for administrative relief. She cited Corner Post, Inc. v. Board of Governors of the Federal Reserve System, which addressed a technical question around the timing of bringing a case to attack a rule.
“What Corner Post said was, ‘If you’re new to the industry, and you are being harmed by a rule, you can come in and ask for relief under that rule, even if the rule has been in place for years and years and years,’” Evans said. “And that really opens up that Loper Bright end of Chevron deference to attack a rule to a much larger group of folks who are impacted by a rule.”
“There’s even been talk of potentially redesigning a corporate structure for an entity that has been surviving or working under a rule format for a number of years, to say, ‘Hey, we still want to attack that rule, maybe we have a different entity or a different line of business that is newer to the system that can take advantage of this new Corner Post rule to attack a long standing rule that we find to be harmful to our business,’” Evans explained.
She said that these decisions give the health care industry a new approach to take a look at the rules that it’s finding hard to comply with.
The third case that Evans found important for health care was Securities and Exchange Commission v. Jarkesy. That case held that when the SEC sought civil penalties against a defendant, that the Seventh Amendment entitles that defendant to a jury trial.
“It really impacts the enforcement ability of agencies, and for health care, that’s specifically going to come down in HHS, HHS [Office of Inspector General], that has a lot of statutory authority to impose civil monetary penalties against health care providers and suppliers who aren’t following the rules,” Evans said.
She noted that it’s now an interesting consideration for entities facing these types of actions, as it’s an open question if the government will pursue them with the same rigor that it used to.
“That has a big impact on health care providers deciding how to structure their business, how to structure their work and also how to defend themselves when and if they do face enforcement activity,” Evans said.
Looking forward, Evans said that she’s watching the case of Braidwood Management, Inc. et al. v. Xavier Becerra et al.
“The Supreme Court is interested in hearing whether or not the United States Preventative [Services] Task Force can opine over which tests in health care are preventative, and as a result, which of those preventative tests can be furnished, or must be furnished by health insurance providers or carriers without out of pocket expenses,” Evans said.
Evans noted that it will be interesting to see what the high court has to say about the routine practice of the federal government seeking professional guidance from outside of the government to help decide what its policy should be.
“There’s a bunch of different things that could come up from that Supreme Court case that I think will all be mildly or extremely interesting, depending on where you sit,” Evans said.