
2025 U.S. Health System Executive Survey: Regulatory Priorities and Planned Actions Post-OBBBA
- Article
Each year, L.E.K. Consulting surveys hundreds of hospital and health system executives to understand their outlook for the year ahead, their strategic priorities and the specific actions their systems plan to take over the coming (approximately) three years. This year, L.E.K. fielded this annual survey in late July and early August 2025, just weeks after the passage of the One Big Beautiful Bill Act (OBBBA), providing a unique view into the policy changes executives are most concerned about — and how hospitals are responding to these and other potential regulatory changes (see Figure 1).
Executives are most concerned about Medicaid and Affordable Care Act (ACA) changes passed in the OBBBA, 340B reform, and tariffs. The results are clear: More than half of the respondents believe that the impact of each of these policy changes on their organizations will be significant (see Figure 2).
One key area of concern for respondents is the expected decline in Medicaid and ACA marketplace enrollment. The resulting increase in uninsured patients could drive higher levels of uncompensated care and decreased patient volumes for elective services. Decreased Medicaid volume also poses a direct threat to 340B eligibility.
Survey respondents are already taking steps to respond. Executives highlighted three areas of focus (see Figure 3):
The 340B program is a critical source of support for a majority of U.S. health systems, contributing to the ability of providers to sustain access and invest in care across rural, community and urban settings. The Trump administration is already piloting a rebate program (as opposed to the up-front discounts that are the normal 340B mechanism) and has begun initial steps toward reducing reimbursement for 340B-purchased drugs. Additionally, legislative proposals under discussion would further tighten eligibility, limit contract pharmacy use and reduce the scope of covered outpatient drugs.
In response, hospitals are already acting (see Figure 4):
Another pressing issue for hospitals is the impact of tariffs. While tariffs are not targeted at medical products specifically, many critical supplies and pieces of equipment are sourced from countries subject to these trade measures — leaving hospitals exposed to rising costs and ongoing uncertainty about future duties.
Hospitals are adjusting their supply chain strategies to mitigate tariff impacts (see Figure 5):
It is clear that hospitals are not waiting on the sidelines. Leaders are actively scenario-planning, restructuring supply chains, tightening compliance and seeking partnerships to protect margins and sustain care delivery.
We work with provider organizations to respond to these pressures with structured strategies. Our teams help executives assess regulatory risks and their financial implications, drive cost improvements, transform operational performance and make disciplined decisions on capital deployment and partnership strategies to support both near-term stability and long-term sustainability.
If you are interested in discussing how L.E.K. can support your organization in navigating these challenges, please reach out to us.