Bob Herman covers health insurance, government programs, hospitals, physicians, and other providers — reporting on how money influences those businesses and shapes what we all pay for care. He is also the author of the Health Care Inc. newsletter. You can reach Bob on Signal at bobjherman.09.

President Trump and his health leaders have repeatedly directed their ire toward health insurance companies, painting them as fat cats that need to be reined in.

But almost every major decision Trump officials have made since reclaiming the White House has benefitted insurers and their bottom lines. The most recent action — finalizing higher payments to Medicare Advantage plans in 2027 — will funnel an extra $13 billion toward the industry while abandoning a reform that would have led to more accurate, and lower, payments. 

“It really does seem like the rhetoric is going one way, and now these actions seem very industry-friendly,” said Neil Patil, a senior fellow and Medicare policy expert at Georgetown University’s Center on Health Insurance Reform.