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Checking in on Make America Healthy Again, pt. 2: MAHA and the future of preventive care

Last week, we published an update on the Make America Healthy Again initiative: what its agenda looks like as of April 2025 and how the Trump administration has approached its most high-profile ambition—embracing a more cautious approach to vaccines—thus far. Today, we're back to take a closer look at the rest of the agenda; namely, MAHA and the future of preventive care, and how the current administration is looking to remake the U.S.'s approach to lifestyle modification and healthy eating.

(If you haven't read part 1 and want to catch up on that first, you can find that post here.)

MAHA and the future of preventive care: How the current administration is approaching primary care

HHS Secretary Robert F. Kennedy Jr. has long been known for his focus on environmental activism and criticism of the industrial agricultural industry. During (and since) his 2024 presidential campaign, he has increasingly tied those long-standing interest areas to the problem of growing chronic disease burden within the U.S., advocating for greater focus on disease prevention and critiquing the country's current approach to primary care.

We'll get to how he would like to shift the primary care framework in just a moment, but before we do that, let's stock of the system as it stands today. What is the state of primary care as of early 2025?

Reality check: The state of (U.S.) primary care in 2025

That the state of primary care in the U.S. leaves something to be desired (and may only be worsening with time) is something of an accepted conventional wisdom within the healthcare industry.

But we never like to accept things at face value. So, we dug in. What do the numbers actually show? How is primary care doing in 2025—and are things getting better or worse?

As it turns out, the answer is not a straightforward one; it very much depends on exactly how you define and measure success.


For example: if you look at how much the federal government spends on research dedicated to primary care, investment is increasing in sheer amount of dollars spent. But it's flat if you measure it by percentage of total research projects devoted to primary care.

Similarly, the number of primary care residents per 100,000 people has increased across the past 10 to 15 years—but the proportion of new physicians entering primary care relative to other specialties has declined. (By the way, if you're wondering how both of these things can be true, it's because growth in non-primary care specialty slots has far outpaced the growth in primary care residency slots. And a good number of primary care residents eventually end up pivoting to other specialties. In fact, the percentage of new physicians entering primary care is at a decade low).

Something that becomes very clear when examining these trends is that it matters immensely whether you look at these metrics solely through the lens of primary care physicians, or broaden your focus to include other clinicians such as nurse practitioners, physicians assistants, and OB/GYN providers as well. Focusing solely on primary care physicians paints a far more negative picture (declining spending and declining supply) than a broader definition that includes other types of clinicians.

It is also clear that the U.S. tends to lag behind other high-income countries by most primary care assessment measures.

This is true whether measured as a share of total healthcare spending, or by various access measures (e.g. the share of adults who report having a primary care physician, especially a long-standing relationship—i.e. five years or longer—with said physician). The U.S. also has a large gap between specialist and primary care physician income, with some sources suggesting the U.S. has the single largest gap and others suggesting that it's near, but not quite at, the top of the list.

How the MAHA team would like to remake primary care

That gap—between specialty and primary care reimbursement—is exactly where RFK Jr. would like to focus his efforts. On the 2024 campaign trail, he suggested that one way to reduce chronic disease burden would be through greater investment in primary care—and he argued that physician payment in the U.S. has skewed toward specialists because of the heavy influence of specialty physicians in the process of setting Medicare reimbursement.

Here's how the process works today (in admittedly overly simplistic terms). The American Medical Association includes a sub-committee called the RVS Update Committee (RUC) comprising 32 volunteer physicians. The RUC meets three times a year to come up with a set of recommendations regarding physician payment updates. They send these recommendations to CMS, which is ultimately responsible for reviewing and finalizing any payment updates on an annual basis. CMS is not required to accept the RUC'c recommendations, but data would suggest alignment about 70% of the time.

RFK Jr. is not the first to voice skepticism about the apparent level of influence that physicians have over setting their own pay; policymakers on both sides of the aisle have flagged this as an area of potential concern. And RFK Jr. has suggested that diminishing the role of the RUC and enhancing CMS's authority over the payment process would not only resolve a potential conflict of interest, but also ultimately lead to higher levels of reimbursement for primary care.

Such a move would undoubtedly generate significant backlash from industry groups, so it remains to be seen whether this proposal will ultimately move forward or not. It's also not clear that RFK Jr. could make such a change unilaterally—at the very least, it would likely require regulatory rulemaking, and would likely invite congressional scrutiny. And even if the administration were to secure congressional support, past efforts to reform or limit the authority of the RUC in Congress have stalled amid lobbying efforts from the AMA and specialty physician groups (by contrast, the American Academy of Family Physicians has long criticized the RUC—but has limited lobbying power compared to its specialty-focused brethren).

That said, the MAHA goal of reducing chronic disease burden through better preventive healthcare doesn't stop at emphasizing a greater focus on primary care—RFK Jr. would like to move even further upstream to focus on nutrition policy and healthy eating.

MAHA and the future of preventive care: Food policy, nutrition, and healthy eating

RFK Jr. has long been a vocal critic of industrial agriculture—and so, despite the fact that his position as HHS Secretary doesn't grant him authority over the Department of Agriculture, he has moved quickly to solidify food policy as a core priority early into his leadership tenure. And his oversight of the FDA does give him significant purview and influence over issues related to food safety, labeling, and processing; nutrition standards; and public health campaigns and regulatory frameworks related to nutrition.

That said, inflecting significant change on this front will not be easy, especially given the immense lobbying power of the food industry, and the consdierable costs and operational complexities associated with many of RFK Jr.'s ambitions.

This is an area, however, where RFK Jr.'s proposals have relatively broad public support, and where his ambitions largely align with the existing public health framework.

Overall, we expect more movement on actions related to transparency. Actual hard-edged limitations on food additives or ultra-processed foods (e.g., removing them from schools), will be more likely to generate significant pushback from the food industry, and more difficult to execute on given the associated costs.

RFK Jr.'s ultimate goal in shifting food policy is to dramatically improve U.S. health status—i.e., decrease dependence on pharmaceutical treatments, lower levels of food sensitivities/allergies, and reduce rates of chronic disease—ambitions which would have drastic implications for the healthcare industry in terms of utilization and spending patterns.

But given the uphill battle that many of these policies face—in addition to the fact that food policy is only one step toward actually encouraging lifestyle modification (something that any healthcare expert knows is far easier said than done)—we expect the impact to the healthcare industry to be nominal in the short term. Increased awareness around nutrition/healthy eating and the importance of weight management could drive increased demand for nutrition-related services. In fact, the industry is already seeing an uptick in demand for these types of services alongside growing demand for GLP-1s. As more patients approach their providers to have conversations about GLP-1s, it has increased demand for weight management services more generally alongside increased uptake of those drugs.

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