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I work in the digital healthcare business — helping healthcare organizations build systems that talk to each other, share data, and ideally reduce friction for both patients and care teams. I’ve also spent time working on digital front doors—the slick, app-like experiences many hospitals and other providers now use to engage patients. These solutions are effective, but they’re not too cheap, both in licensing costs and the services required to put them together.
Recently, I’ve been thinking about what happens to all of this infrastructure—the APIs, middleware, and patient portals—when the funding starts to disappear. The signals are there: pressure on Medicaid, Medicare, VA services, and public health agencies is rising. In previous posts, I’ve explored the downstream risks (The Big Beautiful Bill, Can We Automate Our Way Out, The Cost of Early Death). But it’s clear that interoperability itself may also be in the crosshairs. What Interoperability Meant—And Why It Might Be Changing Interoperability has been around for a while, but was supercharged about 15 years ago with the HITECH Act (Health Information Technology for Economic and Clinical Health). The Office of the National Coordinator for Health Information Technology (ONC) define interoperability across four levels:
These definitions assume continued growth and investment—backed by Meaningful Use, Cures Act mandates, and adoption of EHRs. However, if federal reimbursement begin to shrink, this framework may no longer hold up. Digital Front Doors—What Happens When the Budget Gets Tight? Digital front doors, including mobile apps, chatbots, appointment engines, and patient access APIs, are not free. In fact, a 2023 Chilmark Research report noted that digital front door initiatives often exceed $500K in upfront investment for midsize systems—not including maintenance and integration costs (Chilmark Research, 2023). If funding goes away, some possible outcomes may be:
This is not theoretical--state-level Medicaid agencies have already pulled back on HIE access in some cases (KFF, 2024). Have We Engineered Ourselves Into a Privacy Trap? Modern interoperability assumes real-time, cross-entity data sharing. The Trusted Exchange Framework and Common Agreement (TEFCA) is supposed to enable this while protecting consent and governance (ONC TEFCA Overview, 2024). But things have gotten messier.
Interoperability doesn’t inherently weaken privacy, poor implementation and deregulation can. What Happens When the Money Dries Up? If proposed federal cuts materialize, the interoperability ecosystem will feel it in three key ways:
We should expect increased demand for cloud-native integration platforms, Pay-as-you-go API solutions, and simplified FHIR middleware that minimizes custom development. How We As Consultants, Product Teams, and Strategists Can Respond For Consultants & Integrators:
Where the Market Is Shifting This took some research on my part, but it looks like a number companies are well-positioned for what’s next:
Final Thought: Strategy Over Nostalgia Interoperability isn’t collapsing—but it looks like it is evolving. Consultants, technologists, and product leaders will need to adjust expectations, revise architectures, and help clients prioritize privacy and value over perfection. This new era we are in is marked by constrained budgets, decentralization, and (not always strategic) tradeoffs. We are going to have to build things differently. Sources & Citations
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“The Big Beautiful Bill”: What’s Really in It, What’s Likely to Pass, and What It Tells Us5/26/2025 We don’t talk much about TV or sports at my house. Our dinner table is usually a mash-up of topics like: my eldest son's running commentary on AI and the moral arc of video games, my youngest son’s digital dispatches from his post-college trek across Japan (equal parts neon and existential), and my wife and I debating backsplash options for our long-overdue kitchen remodel.
Lately, however there’s been a new contender for conversational dominance: the Big Beautiful Bill. And since I’m the resident Political Scientist in my home, it’s apparently my job to explain what it is, what it does, and whether we should actually be worried. So here it is—a plainspoken breakdown of what this bill proposes, what might realistically get passed, and what kind of government it seems designed to shape. Spoiler: it’s not all that beautiful. A Fiscal Grab Bag Disguised as Reform At its core, the bill is a budget reconciliation measure laced with permanent policy changes. It includes:
Some of the provisions—like the denial of Medicaid for undocumented immigrants—are not new. They already exist in federal policy and administrative practice. So why include them again? The answer appears to be less about legislative necessity and more about symbolic politics. These reassertions serve as red meat for the administration’s supporters, offering visible victories in areas already shaped by precedent. It’s less about changing the law and more about broadcasting allegiance to a specific worldview. It is, as one pundit described, a “smorgasbord of ideological victories” dressed in fiscal packaging. Will It Pass? The Senate is the firewall—at least that is how things were envisioned by our founding fathers, who masterminded the "Great American Experiment" between 1760s and 1787. Under the more recent (1985) Byrd Rule, provisions related strictly to federal revenue and spending can pass through the budget reconciliation process with a simple majority (51 votes, including the Vice President as tiebreaker). That’s how the Trump Administration hopes to push through the financial and tax sections of the bill (CRS, 2024). However, the more radical judicial and social policy tomfoolery—like limits on court contempt powers or structural changes to loan forgiveness—are not budgetary in nature. These typically require 60 votes to overcome a filibuster and proceed to a vote. This distinction is crucial, because it means the bill, as written, almost certainly cannot pass. Unless those policy provisions are stripped out or diluted significantly, the bill would face strong opposition in the Senate. Moderate Republicans and Democrats alike have signaled resistance, particularly to cuts in disaster relief, SNAP, and veterans’ programs—many of which remain popular with constituents across all party lines. What’s At Stake Healthcare, in particular, is already on the chopping block. As I discussed in an earlier post (How Sick Will America Get?), the bill could roll back many protections under Medicaid expansion, erode HHS oversight authority, and prioritize short-term cost savings over long-term population health outcomes. These aren’t just policy tweaks—they’re foundational shifts that would limit access and reduce public accountability. On top of that, proposed cuts to FEMA disaster preparedness and VA care would have direct consequences. In an age of climate-driven emergencies and an aging veteran population, these cuts are not only deeply unpopular—they’re dangerous. Does The Administration Care? That’s the cynical but unavoidable question. The bill reflects a time-tested pattern: legislate in a way that shifts wealth and influence toward those that already have it, while weakening safeguards that protect the rest of us. The court reforms, in particular, are not about reducing bureaucracy—they’re about reducing oversight. Enriching loyalists through tax codes, deregulation, and public-private mechanisms appears to be the through-line. Whether through expanded tax shelters or privatized education and health services, the bill rewards aligned actors while dismantling public-facing institutions. Conclusion: What’s Real, What’s Rhetoric It’s unlikely this bill passes in its current form. The Senate will almost certainly strip out or stall the most controversial items, particularly those unrelated to the federal budget. Yet the danger lies in what can still get through via reconciliation—and what it signals about governance should a second Trump term come to pass. It’s not just about what’s in the bill. It’s about what kind of country this bill envisions—and who it leaves behind. Sources & Citations Lately, I’ve been reading a lot in the news about staffing and service cuts at hospitals and clinics. What struck me wasn’t just the headlines—it’s that this feels increasingly personal. My wife works as a practitioner in a rural, federally funded health clinic. I’ve watched firsthand how under-resourcing affects care, staff morale, and ultimately, patient outcomes. At the same time, I’m seeing stories about states refusing to expand Medicaid, even as their hospitals struggle to stay open. And across the industry, there's rising chatter that maybe we can just automate our way through this.
As someone who works in digital health, AI platforms, and go-to-market strategy, I understand the appeal. But I also know it’s not that simple. What’s Causing These Cuts? Financial pressure in healthcare isn’t new, but it’s deepening. Cuts to Medicare and Medicaid funding are placing real strain on provider organizations. In 2025 alone, Medicare saw a 2.83% payment cut—the fifth year in a row this has happened—while a proposed $880 billion reduction in Medicaid could result in more than 13 million Americans losing coverage by 2034 (The Guardian, AMA). The challenge may soon grow deeper: the latest federal budget proposal includes further cuts to Medicaid and related safety-net programs, which would likely accelerate service reductions and make sustainable solutions even harder to achieve. In my view, this isn’t just a budget issue. It’s systemic. We’ve created a model that underfunds essential services and expects innovation to fill the gap without investing in the infrastructure that makes it sustainable. Layer on rising costs, workforce shortages, and aging populations, and it’s no surprise that many organizations—especially rural or safety-net clinics—are being forced to scale back staff or shut down entire categories of service. Can AI Help? Yes—but With Limits There’s no denying that AI, machine learning, and automation can streamline tasks. In Medicaid programs, for example, AI has been used to assist with eligibility determination and to predict patient risks and outcomes (arXiv). Care planning, coordination, and documentation are all ripe for tools that reduce manual overhead. But this can’t be a swap-out strategy. CMS has already issued guidance that AI should support, not replace, human decision-making in coverage and clinical determinations (Norton Rose Fulbright). We’ve also seen lawsuits and compliance reviews over the misuse of algorithms to deny care (Maynard Nexsen). So yes, AI can help—but only if implemented ethically, with transparency, and as a tool to extend, not replace, human care. So What Can We Actually Do? Here’s what I think is realistic—ground-level actions that make a difference: 🏥 At the Policy and Grassroots Level:
This isn’t about “saving jobs for the sake of jobs.” It’s about making sure patients don’t suffer because a system tried to cut corners where it couldn’t afford to. So... Is This a Real Problem? In short: yes. If we don’t address it, we’re not just risking operational inefficiency—we’re risking community health. Automation alone won’t fix it. We need better policy, better tools, and more collaboration between clinicians, technologists, and administrators who are willing to tackle this head-on. We’re not making a mountain out of a molehill. The mountain has a name now. Sources
Let’s be real: this was supposed to be a blog post.
I sat down thinking I’d write a few hundred words about some proposed changes to the VA, Medicare, and Medicaid systems—just a quick post to highlight a few concerns. But the deeper I dug, the more it became clear: this isn’t a blog entry. It’s a white paper. Why? Because what’s happening isn’t simple. What’s being sold as “streamlining” or “cost efficiency” is, in practice, a restructuring of how care is delivered to veterans, seniors, and low-income Americans. These systems aren’t perfect, but they’re foundational—and when you start chipping away at them without a plan that puts outcomes first, people suffer. Medicare Advantage plans are costing more while denying more. Medicaid redetermination is booting millions off coverage for paperwork reasons. And VA services are being diverted to private providers who aren’t always equipped to treat veteran-specific trauma. These aren’t abstract issues—they have real human consequences. So yeah, the blog became a paper. It’s detailed, sourced, and longer than your average lunch-break read. But if you work in healthcare, policy, or even just vote, this affects you too. One thing about being unemployed - it allows you more time to read and think. In recent months, I’ve started to notice a troubling trend—and based on my research, I don't think I am the only one. Public health policy in the U.S. seems to be shifting away from long-term wellbeing and toward something harder to name, but easier to feel: neglect, erosion, and a quiet normalization of early death. That may sound alarmist. I don’t intend it to be. I’m not promoting conspiracies. But as someone who has worked in and around healthcare technology and policy for years—and someone who cares deeply about what happens to people in this country—I’ve learned to recognize patterns. And this one’s hard to ignore. We’re watching funding cuts and strategic retreats from the very programs designed to keep people healthy before crisis hits. The CDC’s influence has been systematically diminished. COVID booster approvals are now facing new hurdles under current HHS leadership. Chronic disease prevention programs—especially for diabetes and cardiovascular health—are being quietly deprioritized. We’ve even seen federal food assistance programs scaled back, despite mounting evidence that food insecurity is one of the strongest predictors of poor health outcomes. Much of this is happening in plain sight. Some is buried in committee decisions or drowned out by bigger headlines. But the result is the same: less access, less protection, and a slow unspooling of the public health safety net that generations fought to build. I’ve done my research. In 2023, the CDC’s budget for public health preparedness was cut by over $400 million. The Center for Budget and Policy Priorities reports that more than 16 million people lost Medicaid coverage in the last 18 months—many due to administrative red tape, not changes in eligibility. Under the current administration, the trend has accelerated: career scientists have been sidelined, longstanding sources of public health data and analysis have been defunded or eliminated, and entire branches of preparedness infrastructure are being stripped of resources. States continue to be encouraged to prioritize short-term cost savings over long-term investments in health equity and disease prevention. This isn’t just about policy nuance. This is about lives. And I can’t help but wonder: is this really about “saving money,” or is something deeper at play? Could the withdrawal from public health be part of a broader strategy—conscious or not—to reduce long-term entitlement obligations like Social Security, Medicare, and Medicaid? After all, dead people don’t draw benefits. Or is this more ideological—a reflection of a government that no longer sees public health as its responsibility? I don’t pretend to have the answers. But after watching this space for decades, I know when something doesn’t add up. It wouldn’t be the first time. Public health has always been vulnerable to political cycles and budget cuts. But today’s retreat feels different—not just cyclical, but ideological. When Johns Hopkins reports that 45% of U.S. adults have hypertension, and The Lancet shows that American life expectancy now lags peer countries by nearly six years, the problem isn’t abstract. It’s measurable. It’s visible. And it’s here. We don’t need fear-mongering. We need accountability. We need leadership that values prevention, access, and dignity. The more we undermine public health, the more we normalize early death. That’s not a policy I can support. Source I Used and Related Readings
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AuthorAxel Newe is a strategic partnerships and GTM leader with a background in healthcare, SaaS, and digital transformation. He’s also a Navy veteran, cyclist, and lifelong problem solver. Lately, he’s been writing not just from the field and the road—but from the gut—on democracy, civic engagement, and current events (minus the rage memes). This blog is where clarity meets commentary, one honest post at a time. ArchivesCategories
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