Trump himself, during an interview last month in which YouTube influencer Theo Von described the healthcare system as rigged against the American people, called hospital and insurance lobbyists opposed to his competition and transparency efforts "bad people."
The source of antipathy to big healthcare conglomerates is growing anger at the healthcare system across the political spectrum, said Niko Lusiani, director of corporate power at the left-leaning Roosevelt Forward, which is the advocacy affiliate of the Roosevelt Institute, a think tank.
"There's a groundswell of frustration and anger about the fact that we've given the economy over to large incumbent corporations to decide for their own interests how the rules are going to be made in the economy," Lusiani said. "I think you're going to see either administration responding to that widespread concern with corporate consolidation, including the healthcare sector."
In Congress, such issues have become more bipartisan, with some conservative Republicans joining Democrats on a string of bills aimed at curtailing consolidation. That could well end up extending to the White House, Lusiani said.
Of course, antitrust agencies and policies do not just turn on a dime, and analysts noted that much would stay the same in the near term. While Khan's three-year term expires Sept. 25, she will likely stay on until the Senate confirms the next president's chosen successor. And the FTC itself is a bipartisan panel that employs aides who have been pursuing similar tacks for decades.
"While there may be some differences from an overall policy perspective, generally the staff at the antitrust enforcement agencies have been fairly consistent in reviewing and challenging potential transactions," Epstein Becker Green attorneys Anjana Patel and Patricia Wagner wrote in an email.
Chris Pope, a senior fellow the right-leaning Manhattan Institute, suspects the healthcare sector probably would see little difference, regardless of growing complaints, largely because he views concerns about consolidation as overblown.
"My sense is that antitrust intervention will end up being less than promised because the monopoly problem in healthcare is often exaggerated, because it is a comfortable political scapegoat," Pope said. "Antitrust is easy to propose as a solution in the abstract, but where monopoly power is a problem in healthcare, it's often because regulations have deliberately sought to foster it," he said, pointing to government efforts to stabilize insurance markets as an example.
Still, who the president is will make a difference.
Patel and Wagner expect a Harris administration would carry on much as the Biden administration, and cited examples such as Biden's 2021 executive order on competition that instructed the Justice Department and the FTC to overhaul M&A guidelines, as well as a specific emphasis on the effects of hospital mergers. They also noted the Biden White House's concern over imbalances in equity that arise after mergers, particularly in underserved and rural communities.
"Based on what we’ve seen to date, we would anticipate a Harris administration would take a similar approach," Patel and Wagner wrote.
The attorneys were less certain of specific approaches a Trump administration would take, but they noted there is more support in his party than there used to be for more vigorous antitrust enforcement.
"Some Republicans now have concerns that excessive consolidation could harm consumers, drive up prices and reduce the quality of care, which runs counter to the free-market principles many Republicans support," Patel and Wagner wrote. "This has led to a willingness among some Republicans to consider more robust antitrust policies as a way to ensure fair competition and prevent the concentration of too much power in the hands of a few large corporations."
Lusiani suggested the healthcare industry might be better off with a continuation of stricter Biden policies over volatilty under Trump, even if the bigger players don't like what Biden does and Harris would keep doing.
"If you're a business in the healthcare sector, it's more certain, it's more predictable," Lusiani said.
"A Trump administration wouldn't be scared to use the power of government in preventing, blocking or rescinding merger support," Lusiani said. "However, from what I can tell from the Trump campaign, it will be much more based around a more personal, more vengeful, more vindictive and company-specific targeted kind of approach."
Either way, Lusiani expects Harris and Trump are listening to rising populist dissatisfaction with large healthcare companies, and that those companies could also respond.
"It is going to be — no matter what — into the future, a different operating environment," Lusiani said. "No question, it's within the capacity of the healthcare sector to adjust and just play by a basic set of rules around fair competition."
