Tariffs

Tariffs / en Sat, 14 Jun 2025 23:06:04 -0500 Thu, 29 May 25 14:42:56 -0500 Two federal courts block tariffs imposed under emergency law /news/headline/2025-05-29-two-federal-courts-block-tariffs-imposed-under-emergency-law The U.S. Court of International Trade May 28 <a href="https://www.cit.uscourts.gov/sites/cit/files/25-66.pdf" target="_blank">blocked</a> a series of tariffs issued by the Trump administration under the International Emergency Economic Powers Act, a law granting the president authority to regulate various economic transactions following the declaration of a national emergency. The enjoined tariffs include the 10% universal tariffs for all countries and reciprocal tariffs on certain countries with which the U.S. has high trade deficits that were announced April 2. The court order also blocks tariffs imposed on Canada, Mexico and China in February that were based on concerns about illicit fentanyl trafficking. Tariffs imposed under other authorities such as Section 232 tariffs on steel and aluminum imports remain in place and were not impacted by yesterday’s ruling.The Trump administration immediately filed a <a href="https://storage.courtlistener.com/recap/gov.uscourts.cafc.23106/gov.uscourts.cafc.23106.7.0.pdf" target="_blank">notice</a> in the U.S. Court of Appeals for the Federal Circuit indicating that it will appeal this decision. The appeals court May 29 granted a temporary stay pending the appeal.A second federal district court May 29 also <a href="https://storage.courtlistener.com/recap/gov.uscourts.dcd.279804/gov.uscourts.dcd.279804.37.0_3.pdf" target="_blank">found</a> the Trump administration’s tariffs to be unlawful. The U.S. District Court for the District of Columbia held that IEEPA does not address tariffs at all and therefore does not grant the president the authority to impose such levies. The court issued a preliminary injunction against all tariffs imposed under the IEEPA. The administration is also expected to appeal this decision. Thu, 29 May 2025 14:42:56 -0500 Tariffs Chair File: Leadership Dialogue — Tariffs and Health Care with Brian Pomper and Akin Demehin /news/chairpersons-file/2025-05-27-chair-file-leadership-dialogue-tariffs-and-health-care-brian-pomper-and-akin-demehin We are all closely watching changing tariff policy as it raises serious considerations for the medical products, devices and pharmaceuticals supply chain. Our ability to deliver safe, effective care to our patients relies on having essential supplies available.In this Leadership Dialogue, I am joined by Brian Pomper, a partner specializing in international trade policy at Akin Gump Strauss Hauer &amp; Feld, and Akin Demehin, vice president of quality and safety policy at the AHA. We discuss tariffs and their potential implications on the health care supply chain.You’ll hear Brian talk about current tariff agreements*, a brief history of U.S. tariffs and what could prompt a change in some current tariffs. Akin dives into how the AHA is working to secure tariff exemptions for medical devices and pharmaceutical products. He encourages all of us to share stories about the steps our teams go through to access supplies and deliver care, what that means to patients and how it impacts our hospitals and health systems.I hope you find our conversation insightful and strategic. Look for future conversations with health care, business and community leaders on making health better as part of the Chair File in 2025.* Note that this conversation was recorded on May 15, 2025.<a href="https://www.youtube.com/watch?v=TGXdfXOSJlA"><img src="/sites/default/files/inline-images/leadership-dialogue-freese-decker-pomper-demehin-watch-900x400-5-27-2025.jpg" data-entity-uuid="696806eb-1aaf-4869-a12b-71ad0b1e428b" data-entity-type="file" alt="May 27th Leadership Dialogue Watch video banner" width="900" height="400"></a><hr>&nbsp;<div></div><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript &nbsp; </h2> </summary> 00:00:01:04 - 00:00:32:24 Tom Haederle Welcome to Advancing Health. Most experts agree that less reliance on foreign made medical and pharmaceutical products would be a good thing for U.S. health care. But experts also agree it's going to take some time to increase control over our supply chain. In today's podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board Chair of the �� Association, we hear from two experts about the potential impact of the Trump administration's trade tariffs on our supply chain and what they could mean for patients and providers. 00:00:32:27 - 00:00:39:28 Tom Haederle This podcast was recorded on May 15th. 00:00:40:00 - 00:01:04:17 Tina Freese Decker Hello, and thank you so much for joining us today. I'm Tina Freese Decker, president and CEO of Corewell Health and board chair for the �� Association. This month, we are diving into a topic that is top of mind for all of our leaders, not just in health care. It's tariffs. As our nation watches the changing tariff policy play out for those in the hospital field, there are serious considerations as it relates to our supply chain. 00:01:04:19 - 00:01:31:00 Tina Freese Decker Every day at Corewell Health and I'm sure at every hospital health system across our country, we use a wide array of products, devices and pharmaceuticals to deliver safe and effective care to our communities. The lives of the people we serve often depend on these items being readily available, making a robust health care supply chain critical. While the field shares the administration's long term goal of strengthening the domestic supply chain for essential medical and pharmaceutical products, 00:01:31:03 - 00:01:57:00 Tina Freese Decker we know that achieving this goal will require significant time. In the short term, there is concern that tariffs could inadvertently disrupt that availability of these essential care delivery products, increase the complexity of delivering patient care, and significantly raise hospital costs. So today, I'm joined by two guests who will help us better understand the current environment as it relates to tariffs and the potential implications to health care supply chain. 00:01:57:02 - 00:02:06:12 Tina Freese Decker Brian Pomper is a partner at Akin Gump Strauss Hauer and Feld, a D.C. based law firm, and he specializes in international trade policy. Welcome, Brian. 00:02:06:19 - 00:02:07:05 Brian Pomper, JD Thanks for having me. 00:02:07:20 - 00:02:24:28 Tina Freese Decker Before joining Akin Gump, Brian formerly served as the chief international trade counsel to the Senate Finance Committee, where he advised of all aspects of the committee's international trade and economic agenda. So we'll get into some of your expertise today. And we are also joined by Akin Demehin. Welcome, Akin. 00:02:25:05 - 00:02:26:03 Akin Demehin Thank you Tina. 00:02:26:05 - 00:02:54:05 Tina Freese Decker Akin is AHA's vice president for quality and safety policy. He leads public policy analysis, development and advocacy efforts related to quality, patient safety and workforce on behalf of the �� Association. He also leads a regulatory policy development efforts related to the health care workforce. So thank you so much for joining us today. There's so many ups and downs, so many negotiations about what's happening with tariffs. 00:02:54:08 - 00:03:00:20 Tina Freese Decker So Brian, I'm going to start with you. Can you tell us where we are today about what's happening for tariffs. 00:03:00:22 - 00:03:29:23 Brian Pomper, JD Sure thing. Well there's a couple different avenues that the administration has taken on its trade and tariff plan, I'd say. The first I'd just talk about the giant reciprocal tariff regime that the president announced on Liberation Day, as he calls it, on April 2nd. On April 2nd, he announced that he would be imposing 10% tariffs on every country in the world and higher tariffs on 57 of those countries on April 9th. 00:03:29:23 - 00:03:53:27 Brian Pomper, JD And so the 10% tariffs went into effect April 5th and then April 9th - for about a few hours - you had much higher tariffs on those 57 countries. The bond market and the stock market reacted quite negatively at the time. And so he decided he would pause those higher tariffs on the 57 countries for 90 days to allow for negotiations. 00:03:53:27 - 00:04:18:21 Brian Pomper, JD He said at the time it was because the bond market had gotten, in his words, yippy. So they were watching what was happening in the broader market. Concerned about where the market was trending, decided to pause this enterprise to allow for these kind of bilateral negotiations over the course of 90 days. And so that's where we are now. Where there are, really, one hears 18 to 20 countries that are in active negotiations with the administration. 00:04:18:21 - 00:04:38:22 Brian Pomper, JD There are many more that have proposed some degree of, measures they could take for their own economy. So there are really are dozens of countries that are engaged in negotiations with the United States during this 90 day period. There's been one announced agreement with the United Kingdom that was late last week or earlier this week. 00:04:38:24 - 00:04:58:07 Brian Pomper, JD I would just note that that agreement with the U.K., it's much less of an operational agreement and much more really of a kind of a scoping exercise in agreement to agree sometime in the future on certain matters. And so it's really just a little bit of an appetizer for what maybe these agreements might look like in the future. 00:04:58:07 - 00:05:22:03 Brian Pomper, JD And the hard part in even negotiating with the U.K. has yet to be done. There's a rumor that there's another agreement that should be announced here fairly soon, but I expect there will be a whole series of these kinds of announcements over the course of the next 90 days, until July 9th. I wouldn't expect the very high reciprocal tariffs on those 57 countries to snap back immediately into place on July 9th. 00:05:22:06 - 00:05:39:01 Brian Pomper, JD My expectation is that countries that are able to negotiate, as the U.K. did, will end up with a 10% tariff. They won't get their higher tariff. But even for those countries that have expressed a willingness to negotiate with the United States, I don't think that the higher tariffs will go into place. I think the president will extend the pause there. 00:05:39:08 - 00:06:05:14 Brian Pomper, JD So that's reciprocal tariffs. And then there are section 232 investigations. This is a mechanism whereby the president can ask the Department of Commerce to do an investigation into the national security impact of certain imports. And there has been, a variety of investigations that this president has, has undertaken and actually imposed tariffs on steel and aluminum and autos. All those tariffs are in place under the section 232 authority. 00:06:05:16 - 00:06:30:16 Brian Pomper, JD But there's also investigations into pharmaceuticals, into semiconductors, trucks, timber, lumber, copper, aerospace, potentially more coming down the pike. And so we're expecting those investigations to be announced here in the coming months. But we don't know exactly where the president will land yet. The premise of those investigations is supposed to be the national security impacts of those imports. 00:06:30:18 - 00:06:52:20 Brian Pomper, JD But really, the president seems to be using them as a cudgel to try to force companies to restore their manufacturing from overseas to the United States by tariffing the imports. He seems to like a tariff of 25%. That's the tariff that applies on steel, aluminum and autos. I think that's where we see him landing on some of these others. 00:06:52:23 - 00:07:26:13 Brian Pomper, JD And unlike the reciprocal tariffs where there's a lot of negotiation that's ongoing, the section 232 tariffs feel a lot stickier. They'll be a lot harder to get out from underneath them. And then of course there are the China tariffs. When the president announced the 34% reciprocal tariff for China. China retaliated and we ended up in a tit for tat retaliation that ended up really with, 145% base tariff on imports into the United States from China and 125% tariff from US exports to China. 00:07:26:15 - 00:07:46:12 Brian Pomper, JD That really was like an economic blockade. And both economies really needed to lower those and in fact, they did agree. The United States and China agreed to lower those tariffs. And so now the tariffs on products coming into China, the base tariff is 30% plus whatever additional tariffs might apply. And from the US side into China, it's 10%. 00:07:46:15 - 00:08:02:28 Tina Freese Decker I was just recently reading a book, history book and talked about tariffs. So can you share how tariffs have been handled differently compared in the past, how they are different today than they were used in past administrations or past years and strategies? 00:08:03:00 - 00:08:26:03 Brian Pomper, JD Yeah. Thank you. I love this question. Allows me to bring out my inner professor. So I would say for the first 150 years of American history, there was no topic that was more often and more frequently debated in Congress than what should be the level of the tariff. You had the incipient industrial industries in the North that wanted higher tariffs to protect their growing power up there. 0:08:26:05 - 00:08:49:15 Brian Pomper, JD And then you had growers in the South who wanted open export markets, and so they wanted low tariffs so that other countries don't go there. So there was this just constant negotiation. We ended in 1930 with something called the Smoot-Hawley tariff, which people may remember from their high school history class, as blamed for having deepened the Great Depression, I think widely perceived as a negative economic outcome. 00:08:49:17 - 00:09:10:10 Brian Pomper, JD And since 1930, what the Congress has really done is to delegate to the president quite a bit of authority over trade policy. This is why we have things like the section 232 investigation, where Congress has understood that well, you know, maybe it's not the best use of congressional time to negotiate on what the tariff on salmon imports should be. 00:09:10:13 - 00:09:33:18 Brian Pomper, JD You know, we're going to let the president kind of deal with that stuff. So we have for the last almost 100 years, had this kind of joint authority between Congress and the president where they would share this, this sort of responsibility. And I think there are those who will argue that that President Trump is using this authority in ways that hadn't been contemplated. 00:09:33:20 - 00:09:56:17 Brian Pomper, JD In particular, I would say, with a line of tariffs that I didn't talk about, which are these tariffs under the International Emergency Economic Powers Act that were imposed on Canada and Mexico, also on China. And actually, I should say IEEPA is the underlying authority the president used for this entire reciprocal tariff regime. It is a very aggressive use of this authority. 00:09:56:20 - 00:10:17:18 Brian Pomper, JD That that's unusual. The president is much more willing to push legal boundaries, of course, not just in tariffs, but we certainly see it in tariffs here. So much so it is currently being challenged in the courts. And it's really anybody's guess whether the courts are going to decide that he may have exceeded his authority under the IEEPA statute to him to impose these tariffs. 00:10:17:21 - 00:10:19:28 Tina Freese Decker And can you explain the IEEPA statute? 00:10:20:01 - 00:10:43:18 Brian Pomper, JD Sure. I'm happy to. So IEEPA stands for the International Emergency Economic Powers Act. It was passed in 1977 to allow the president to act quickly in cases of some sort of economic emergency. It's actually the basis for our entire export controls regime. It has never been used before to impose tariffs. President Trump is the first president to use it to impose tariffs. 00:10:43:21 - 00:11:08:13 Brian Pomper, JD There was a predecessor statute called the Trading With the Enemy Act, that President Nixon used to impose tariffs when we were in the process of going off of the gold standard, because there was a balance of payments crisis at the time. That was challenged in the courts, and the court at the time decided that was okay because the court decided, well, those tariffs that the president imposed were really in response to a true economic crisis. 00:11:08:13 - 00:11:32:19 Brian Pomper, JD There wasn't enough gold in Fort Knox to cover the number of dollars that were in circulation at the time. And those tariffs were imposed for a relatively short period. It was only four months. And it wasn't every country and every product. If you fast forward now to the successor statute, the IEEPA statute, which was written largely because the Trading With the Enemy Act...it was an awkward fit for some of these actions that President Nixon took. 0:11:32:21 - 00:11:59:07 Brian Pomper, JD Here you now have a president who has used IEEPA to impose tariffs on every country, every product, effectively forever. And so the question that the court in Yoshida, which is the case I'm talking about, the court in Yoshida decided the president in that case was not seeking to usurp the role of Congress, which is clearly given to Congress in the Constitution to control international economic relations, trade with foreign nations. 00:11:59:10 - 00:12:30:11 Brian Pomper, JD The president wasn't seeking to stand in the role of Congress in resetting tariffs, because it was only time limited and, you know, limited in coverage. Here it's a much different circumstance where you really do have the entirety of the harmonized tariff code that covers all of our trade with every country being reset through executive order. I do think that there are very strong legal arguments that will be made and are being made in court, literally right now as we speak, that the president exceeded his authority under 00:12:30:14 - 00:12:40:06 Brian Pomper, JD IEEPA. So it's not inconceivable in the next few weeks, you could see a court order that would invalidate the president's actions and really get rid of this entire reciprocal tariff regime. 00:12:40:08 - 00:13:04:03 Tina Freese Decker Thank you very much. That was an excellent summary, we really appreciate that. I'm going to switch to Akin. Akin, can you share an overview of concerns specific to hospitals as how it relates to the tariffs may impact access to pharmaceuticals, medical supplies, other needed devices, and do you think that there is going to be a concern about exasperate some of the shortages that we have experienced to date? 00:13:04:06 - 00:13:27:02 Akin Demehin Absolutely. I think the complexity that Brian was talking about in terms of how these tariffs are being rolled out is really needing the complexity of the health care supply chain. And the concern that we hear from members and that we really put front and center in our own advocacy efforts is what does this mean for the delivery of patient care? 00:13:27:04 - 00:13:54:21 Akin Demehin What does it mean for our caregivers in health care facilities? Hospitals and health systems are constantly weaving together both domestic and international sources for their drugs, for their medical devices, and for other critical supplies. And we know that even temporary disruptions to the flows of those goods can have significant impacts to how hospitals deliver care. Great example are cancer drugs. 00:13:54:24 - 00:14:20:02 Akin Demehin Many of those are manufactured in China or rely on a significant number of key starting materials that are manufactured in China or in other locations across the globe. The disruption from tariffs could potentially lead to disruptions in those carefully planned cancer treatments that really rely on careful scheduling. The same thing is true of things like cardiovascular medicines. 00:14:20:04 - 00:14:57:21 Akin Demehin As you raised at the outset, Tina, we certainly support ongoing efforts to onshore production and really strengthen the domestic supply chain. At the same time, even those medical goods and devices that are manufactured here in the U.S. often draw in content from abroad. Great example is an infusion pump, where even those infusion pumps are manufactured here in the US might have parts from 20 or more different countries, ranging from the aluminum that goes into manufacturing the pole to the computer chips to the plastics. 00:14:57:24 - 00:15:12:17 Akin Demehin All of that involves a considerable amount of complexity. And switching sourcing and offshoring production really is a long term effort. So we've really tried to elevate those concerns in our work around tariffs. 00:15:12:19 - 00:15:19:09 Tina Freese Decker So can you tell us what the �� Association is doing to secure exemptions for medical devices and pharmaceuticals? 00:15:19:11 - 00:15:56:23 Akin Demehin Sure. So early in the rollout of the tariffs from the administration - going back to early February - we actually sent a letter to the president outlining our concerns about the potential impacts of tariffs to the delivery of patient care, to our ability to provide things like personal protective equipment to frontline providers. And we've continued to follow that up with ongoing proactive dialogue with the administration to really focus on advocating for exemptions for pharmaceutical products and for medical devices. 00:15:56:25 - 00:16:27:12 Akin Demehin Bryan talked about the section 232 investigations. The administration has one ongoing for pharmaceutical products, and had an opportunity for the field to share feedback. And we share our concerns with the administration and continue to ask for exemptions. The other thing that we are trying to do is to really provide the hospital and health system perspective to policymakers, to the media, to the administration. 00:16:27:14 - 00:16:51:22 Akin Demehin We're in a bit of a unique position versus other kinds of fields where we are large consumers of the goods within the supply chain. Our ability to stockpile any of these supplies is often constrained by just the sheer availability of the supplies. The shelf life for things like pharmaceuticals is finite, so it's not necessarily something that you can just have hanging out on a shelf. 00:16:51:25 - 00:17:20:12 Akin Demehin There's space that you have to have in order to warehouse some of these materials. And the way that hospitals and health systems are reimbursed means that it's really our members that bear the costs of tariffs. Because our rates are set by government and by contracts in the private sector, the potential cost impacts of tariffs are ones that we really feel quite directly for our members. 00:17:20:14 - 00:17:33:17 Tina Freese Decker Akin, you answered all of my questions coming through there. That was fantastic, because those are all of the concerns that we have as members and what's going on. Brian, do you think that exemptions are likely knowing this administration? 00:17:33:19 - 00:17:54:18 Brian Pomper, JD An excellent question I get from many, many clients. And I would go back to what I mentioned earlier. My expectation is that the American economy is going to struggle a bit under the weight of all of the tariffs that the president has imposed in all these ways. And there are more tariffs coming under these section 232 investigations that are currently ongoing. 00:17:54:20 - 00:18:27:09 Brian Pomper, JD I think that many in Congress, especially on the Republican side, have expressed privately but not publicly concern about the president's strategy with respect to tariffs and how it might impact their constituents. But I think over time, the political and economic pressure is going to force some kind of adjustment in the administration. And I think the most logical pressure valve to be released for the administration is for them to reimpose some type of exclusion process, as we did have in the first administration. 00:18:27:09 - 00:18:33:15 Brian Pomper, JD So if I'm a betting person, yes, I think we will have some kind of exclusion process. 00:18:33:18 - 00:18:54:27 Tina Freese Decker We'll come back to see if you're right. And so to close out our conversation today, this has been really helpful, a great history lesson and understanding of what's going on. Brian and Akin, can you share with us what your advice would be for our members? What should we be thinking about doing, planning for, as we think about these tariffs and the impact that they have? 00:18:54:29 - 00:19:13:08 Brian Pomper, JD Yeah, I always tell clients if something is important to you, important to your bottom line, you need to be vocal about it, and you need to be telling people how these measures are going to impact you. It's hard to argue with the goal, or at least one of the goals the president has of increasing manufacturing employment in the United States. 00:19:13:08 - 00:19:34:21 Brian Pomper, JD Who doesn't want that? I think where there's debate is how best to achieve that. But I do think it's important for organizations like AHA to go talk to your members, talk to the people who focus on the policy issues, the policy areas that you deal with. Let them know how these tariffs are going to impact you, and ask them to weigh in on your behalf. 00:19:34:21 - 00:19:46:01 Brian Pomper, JD And just make sure that whatever the administration does, they try to maximize benefit while minimizing harm. So I would just say where there's an opportunity to engage, I encourage the AHA to do so. 00:19:46:04 - 00:19:50:13 Tina Freese Decker Maximize benefit and minimize harm. Great statement. Akin? 00:19:50:15 - 00:20:20:02 Akin Demehin You know, Brian's counsel here is extremely wise. I'll just build on it in a couple of ways. One of the things that I know hospitals and health systems are so good at doing is bridging that gap between data and story. And often it is those stories of what's happening on the ground, how the steps that you go through to access supplies to deliver care, how those are affected, and playing that out for what it means for patients. 00:20:20:04 - 00:20:49:15 Akin Demehin Those are the kinds of stories that I know policymakers respond to. It really makes the issue even more real for them. And as Brian alluded to, raising some of those concerns with policymakers and certainly reaching out to us here at AHA, we can always be strong advocates on your behalf when we have intel and stories, and other information from all of you to help make the case as best we can. 00:20:49:16 - 00:20:58:17 Akin Demehin So we want to stay connected as we possibly can with all of you going forward so that we can push for those exemptions for pharmaceuticals and medical devices. 00:20:58:19 - 00:21:23:02 Tina Freese Decker That's wonderful. And your example about the cancer drugs or the smart pump or MRI and how all of those pieces come together is one of those stories that we can talk about and how it impacts us. So Brian and Akin, thank you so much for your time today and sharing in your expertise. I know this is an evolving issue and the AHA will continue to monitor closely and advocate on behalf of our field. 00:21:23:04 - 00:21:29:13 Tina Freese Decker And thank you to everyone tuning in today. We'll be back next month for another Leadership Dialogue conversation. 00:21:29:15 - 00:21:37:26 Tom Haederle Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </details> </div> Tue, 27 May 2025 10:11:08 -0500 Tariffs Tariffs, Trade and the Health Care Supply Chain: What Leaders Need to Know /advancing-health-podcast/2025-05-27-tariffs-trade-and-health-care-supply-chain-what-leaders-need-know The uncertainty of tariffs could lead to challenging situations in America's health care landscape. In this Leadership Dialogue conversation, Tina Freese Decker, president and CEO of Corewell Health and 2025 AHA board chair, talks with Brian Pomper, partner at Akin Gump Strauss Hauer &amp; Feld, and Akin Demehin, vice president of quality and safety policy at the AHA, about the past and present state of U.S. tariff policy, how tariffs could impact hospital and health system operations, and ways health care leaders can engage as policy advocates. This podcast was recorded on May 15, 2025.<hr><div></div><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript &nbsp; </h2> </summary> 00:00:01:04 - 00:00:32:24 Tom Haederle Welcome to Advancing Health. Most experts agree that less reliance on foreign made medical and pharmaceutical products would be a good thing for U.S. health care. But experts also agree it's going to take some time to increase control over our supply chain. In today's podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board Chair of the �� Association, we hear from two experts about the potential impact of the Trump administration's trade tariffs on our supply chain and what they could mean for patients and providers. 00:00:32:27 - 00:00:39:28 Tom Haederle This podcast was recorded on May 15th. 00:00:40:00 - 00:01:04:17 Tina Freese Decker Hello, and thank you so much for joining us today. I'm Tina Freese Decker, president and CEO of Corewell Health and board chair for the �� Association. This month, we are diving into a topic that is top of mind for all of our leaders, not just in health care. It's tariffs. As our nation watches the changing tariff policy play out for those in the hospital field, there are serious considerations as it relates to our supply chain. 00:01:04:19 - 00:01:31:00 Tina Freese Decker Every day at Corewell Health and I'm sure at every hospital health system across our country, we use a wide array of products, devices and pharmaceuticals to deliver safe and effective care to our communities. The lives of the people we serve often depend on these items being readily available, making a robust health care supply chain critical. While the field shares the administration's long term goal of strengthening the domestic supply chain for essential medical and pharmaceutical products, 00:01:31:03 - 00:01:57:00 Tina Freese Decker we know that achieving this goal will require significant time. In the short term, there is concern that tariffs could inadvertently disrupt that availability of these essential care delivery products, increase the complexity of delivering patient care, and significantly raise hospital costs. So today, I'm joined by two guests who will help us better understand the current environment as it relates to tariffs and the potential implications to health care supply chain. 00:01:57:02 - 00:02:06:12 Tina Freese Decker Brian Pomper is a partner at Akin Gump Strauss Hauer and Feld, a D.C. based law firm, and he specializes in international trade policy. Welcome, Brian. 00:02:06:19 - 00:02:07:05 Brian Pomper, JD Thanks for having me. 00:02:07:20 - 00:02:24:28 Tina Freese Decker Before joining Akin Gump, Brian formerly served as the chief international trade counsel to the Senate Finance Committee, where he advised of all aspects of the committee's international trade and economic agenda. So we'll get into some of your expertise today. And we are also joined by Akin Demehin. Welcome, Akin. 00:02:25:05 - 00:02:26:03 Akin Demehin Thank you Tina. 00:02:26:05 - 00:02:54:05 Tina Freese Decker Akin is AHA's vice president for quality and safety policy. He leads public policy analysis, development and advocacy efforts related to quality, patient safety and workforce on behalf of the �� Association. He also leads a regulatory policy development efforts related to the health care workforce. So thank you so much for joining us today. There's so many ups and downs, so many negotiations about what's happening with tariffs. 00:02:54:08 - 00:03:00:20 Tina Freese Decker So Brian, I'm going to start with you. Can you tell us where we are today about what's happening for tariffs. 00:03:00:22 - 00:03:29:23 Brian Pomper, JD Sure thing. Well there's a couple different avenues that the administration has taken on its trade and tariff plan, I'd say. The first I'd just talk about the giant reciprocal tariff regime that the president announced on Liberation Day, as he calls it, on April 2nd. On April 2nd, he announced that he would be imposing 10% tariffs on every country in the world and higher tariffs on 57 of those countries on April 9th. 00:03:29:23 - 00:03:53:27 Brian Pomper, JD And so the 10% tariffs went into effect April 5th and then April 9th - for about a few hours - you had much higher tariffs on those 57 countries. The bond market and the stock market reacted quite negatively at the time. And so he decided he would pause those higher tariffs on the 57 countries for 90 days to allow for negotiations. 00:03:53:27 - 00:04:18:21 Brian Pomper, JD He said at the time it was because the bond market had gotten, in his words, yippy. So they were watching what was happening in the broader market. Concerned about where the market was trending, decided to pause this enterprise to allow for these kind of bilateral negotiations over the course of 90 days. And so that's where we are now. Where there are, really, one hears 18 to 20 countries that are in active negotiations with the administration. 00:04:18:21 - 00:04:38:22 Brian Pomper, JD There are many more that have proposed some degree of, measures they could take for their own economy. So there are really are dozens of countries that are engaged in negotiations with the United States during this 90 day period. There's been one announced agreement with the United Kingdom that was late last week or earlier this week. 00:04:38:24 - 00:04:58:07 Brian Pomper, JD I would just note that that agreement with the U.K., it's much less of an operational agreement and much more really of a kind of a scoping exercise in agreement to agree sometime in the future on certain matters. And so it's really just a little bit of an appetizer for what maybe these agreements might look like in the future. 00:04:58:07 - 00:05:22:03 Brian Pomper, JD And the hard part in even negotiating with the U.K. has yet to be done. There's a rumor that there's another agreement that should be announced here fairly soon, but I expect there will be a whole series of these kinds of announcements over the course of the next 90 days, until July 9th. I wouldn't expect the very high reciprocal tariffs on those 57 countries to snap back immediately into place on July 9th. 00:05:22:06 - 00:05:39:01 Brian Pomper, JD My expectation is that countries that are able to negotiate, as the U.K. did, will end up with a 10% tariff. They won't get their higher tariff. But even for those countries that have expressed a willingness to negotiate with the United States, I don't think that the higher tariffs will go into place. I think the president will extend the pause there. 00:05:39:08 - 00:06:05:14 Brian Pomper, JD So that's reciprocal tariffs. And then there are section 232 investigations. This is a mechanism whereby the president can ask the Department of Commerce to do an investigation into the national security impact of certain imports. And there has been, a variety of investigations that this president has, has undertaken and actually imposed tariffs on steel and aluminum and autos. All those tariffs are in place under the section 232 authority. 00:06:05:16 - 00:06:30:16 Brian Pomper, JD But there's also investigations into pharmaceuticals, into semiconductors, trucks, timber, lumber, copper, aerospace, potentially more coming down the pike. And so we're expecting those investigations to be announced here in the coming months. But we don't know exactly where the president will land yet. The premise of those investigations is supposed to be the national security impacts of those imports. 00:06:30:18 - 00:06:52:20 Brian Pomper, JD But really, the president seems to be using them as a cudgel to try to force companies to restore their manufacturing from overseas to the United States by tariffing the imports. He seems to like a tariff of 25%. That's the tariff that applies on steel, aluminum and autos. I think that's where we see him landing on some of these others. 00:06:52:23 - 00:07:26:13 Brian Pomper, JD And unlike the reciprocal tariffs where there's a lot of negotiation that's ongoing, the section 232 tariffs feel a lot stickier. They'll be a lot harder to get out from underneath them. And then of course there are the China tariffs. When the president announced the 34% reciprocal tariff for China. China retaliated and we ended up in a tit for tat retaliation that ended up really with, 145% base tariff on imports into the United States from China and 125% tariff from US exports to China. 00:07:26:15 - 00:07:46:12 Brian Pomper, JD That really was like an economic blockade. And both economies really needed to lower those and in fact, they did agree. The United States and China agreed to lower those tariffs. And so now the tariffs on products coming into China, the base tariff is 30% plus whatever additional tariffs might apply. And from the US side into China, it's 10%. 00:07:46:15 - 00:08:02:28 Tina Freese Decker I was just recently reading a book, history book and talked about tariffs. So can you share how tariffs have been handled differently compared in the past, how they are different today than they were used in past administrations or past years and strategies? 00:08:03:00 - 00:08:26:03 Brian Pomper, JD Yeah. Thank you. I love this question. Allows me to bring out my inner professor. So I would say for the first 150 years of American history, there was no topic that was more often and more frequently debated in Congress than what should be the level of the tariff. You had the incipient industrial industries in the North that wanted higher tariffs to protect their growing power up there. 0:08:26:05 - 00:08:49:15 Brian Pomper, JD And then you had growers in the South who wanted open export markets, and so they wanted low tariffs so that other countries don't go there. So there was this just constant negotiation. We ended in 1930 with something called the Smoot-Hawley tariff, which people may remember from their high school history class, as blamed for having deepened the Great Depression, I think widely perceived as a negative economic outcome. 00:08:49:17 - 00:09:10:10 Brian Pomper, JD And since 1930, what the Congress has really done is to delegate to the president quite a bit of authority over trade policy. This is why we have things like the section 232 investigation, where Congress has understood that well, you know, maybe it's not the best use of congressional time to negotiate on what the tariff on salmon imports should be. 00:09:10:13 - 00:09:33:18 Brian Pomper, JD You know, we're going to let the president kind of deal with that stuff. So we have for the last almost 100 years, had this kind of joint authority between Congress and the president where they would share this, this sort of responsibility. And I think there are those who will argue that that President Trump is using this authority in ways that hadn't been contemplated. 00:09:33:20 - 00:09:56:17 Brian Pomper, JD In particular, I would say, with a line of tariffs that I didn't talk about, which are these tariffs under the International Emergency Economic Powers Act that were imposed on Canada and Mexico, also on China. And actually, I should say IEEPA is the underlying authority the president used for this entire reciprocal tariff regime. It is a very aggressive use of this authority. 00:09:56:20 - 00:10:17:18 Brian Pomper, JD That that's unusual. The president is much more willing to push legal boundaries, of course, not just in tariffs, but we certainly see it in tariffs here. So much so it is currently being challenged in the courts. And it's really anybody's guess whether the courts are going to decide that he may have exceeded his authority under the IEEPA statute to him to impose these tariffs. 00:10:17:21 - 00:10:19:28 Tina Freese Decker And can you explain the IEEPA statute? 00:10:20:01 - 00:10:43:18 Brian Pomper, JD Sure. I'm happy to. So IEEPA stands for the International Emergency Economic Powers Act. It was passed in 1977 to allow the president to act quickly in cases of some sort of economic emergency. It's actually the basis for our entire export controls regime. It has never been used before to impose tariffs. President Trump is the first president to use it to impose tariffs. 00:10:43:21 - 00:11:08:13 Brian Pomper, JD There was a predecessor statute called the Trading With the Enemy Act, that President Nixon used to impose tariffs when we were in the process of going off of the gold standard, because there was a balance of payments crisis at the time. That was challenged in the courts, and the court at the time decided that was okay because the court decided, well, those tariffs that the president imposed were really in response to a true economic crisis. 00:11:08:13 - 00:11:32:19 Brian Pomper, JD There wasn't enough gold in Fort Knox to cover the number of dollars that were in circulation at the time. And those tariffs were imposed for a relatively short period. It was only four months. And it wasn't every country and every product. If you fast forward now to the successor statute, the IEEPA statute, which was written largely because the Trading With the Enemy Act...it was an awkward fit for some of these actions that President Nixon took. 0:11:32:21 - 00:11:59:07 Brian Pomper, JD Here you now have a president who has used IEEPA to impose tariffs on every country, every product, effectively forever. And so the question that the court in Yoshida, which is the case I'm talking about, the court in Yoshida decided the president in that case was not seeking to usurp the role of Congress, which is clearly given to Congress in the Constitution to control international economic relations, trade with foreign nations. 00:11:59:10 - 00:12:30:11 Brian Pomper, JD The president wasn't seeking to stand in the role of Congress in resetting tariffs, because it was only time limited and, you know, limited in coverage. Here it's a much different circumstance where you really do have the entirety of the harmonized tariff code that covers all of our trade with every country being reset through executive order. I do think that there are very strong legal arguments that will be made and are being made in court, literally right now as we speak, that the president exceeded his authority under 00:12:30:14 - 00:12:40:06 Brian Pomper, JD IEEPA. So it's not inconceivable in the next few weeks, you could see a court order that would invalidate the president's actions and really get rid of this entire reciprocal tariff regime. 00:12:40:08 - 00:13:04:03 Tina Freese Decker Thank you very much. That was an excellent summary, we really appreciate that. I'm going to switch to Akin. Akin, can you share an overview of concerns specific to hospitals as how it relates to the tariffs may impact access to pharmaceuticals, medical supplies, other needed devices, and do you think that there is going to be a concern about exasperate some of the shortages that we have experienced to date? 00:13:04:06 - 00:13:27:02 Akin Demehin Absolutely. I think the complexity that Brian was talking about in terms of how these tariffs are being rolled out is really needing the complexity of the health care supply chain. And the concern that we hear from members and that we really put front and center in our own advocacy efforts is what does this mean for the delivery of patient care? 00:13:27:04 - 00:13:54:21 Akin Demehin What does it mean for our caregivers in health care facilities? Hospitals and health systems are constantly weaving together both domestic and international sources for their drugs, for their medical devices, and for other critical supplies. And we know that even temporary disruptions to the flows of those goods can have significant impacts to how hospitals deliver care. Great example are cancer drugs. 00:13:54:24 - 00:14:20:02 Akin Demehin Many of those are manufactured in China or rely on a significant number of key starting materials that are manufactured in China or in other locations across the globe. The disruption from tariffs could potentially lead to disruptions in those carefully planned cancer treatments that really rely on careful scheduling. The same thing is true of things like cardiovascular medicines. 00:14:20:04 - 00:14:57:21 Akin Demehin As you raised at the outset, Tina, we certainly support ongoing efforts to onshore production and really strengthen the domestic supply chain. At the same time, even those medical goods and devices that are manufactured here in the U.S. often draw in content from abroad. Great example is an infusion pump, where even those infusion pumps are manufactured here in the US might have parts from 20 or more different countries, ranging from the aluminum that goes into manufacturing the pole to the computer chips to the plastics. 00:14:57:24 - 00:15:12:17 Akin Demehin All of that involves a considerable amount of complexity. And switching sourcing and offshoring production really is a long term effort. So we've really tried to elevate those concerns in our work around tariffs. 00:15:12:19 - 00:15:19:09 Tina Freese Decker So can you tell us what the �� Association is doing to secure exemptions for medical devices and pharmaceuticals? 00:15:19:11 - 00:15:56:23 Akin Demehin Sure. So early in the rollout of the tariffs from the administration - going back to early February - we actually sent a letter to the president outlining our concerns about the potential impacts of tariffs to the delivery of patient care, to our ability to provide things like personal protective equipment to frontline providers. And we've continued to follow that up with ongoing proactive dialogue with the administration to really focus on advocating for exemptions for pharmaceutical products and for medical devices. 00:15:56:25 - 00:16:27:12 Akin Demehin Bryan talked about the section 232 investigations. The administration has one ongoing for pharmaceutical products, and had an opportunity for the field to share feedback. And we share our concerns with the administration and continue to ask for exemptions. The other thing that we are trying to do is to really provide the hospital and health system perspective to policymakers, to the media, to the administration. 00:16:27:14 - 00:16:51:22 Akin Demehin We're in a bit of a unique position versus other kinds of fields where we are large consumers of the goods within the supply chain. Our ability to stockpile any of these supplies is often constrained by just the sheer availability of the supplies. The shelf life for things like pharmaceuticals is finite, so it's not necessarily something that you can just have hanging out on a shelf. 00:16:51:25 - 00:17:20:12 Akin Demehin There's space that you have to have in order to warehouse some of these materials. And the way that hospitals and health systems are reimbursed means that it's really our members that bear the costs of tariffs. Because our rates are set by government and by contracts in the private sector, the potential cost impacts of tariffs are ones that we really feel quite directly for our members. 00:17:20:14 - 00:17:33:17 Tina Freese Decker Akin, you answered all of my questions coming through there. That was fantastic, because those are all of the concerns that we have as members and what's going on. Brian, do you think that exemptions are likely knowing this administration? 00:17:33:19 - 00:17:54:18 Brian Pomper, JD An excellent question I get from many, many clients. And I would go back to what I mentioned earlier. My expectation is that the American economy is going to struggle a bit under the weight of all of the tariffs that the president has imposed in all these ways. And there are more tariffs coming under these section 232 investigations that are currently ongoing. 00:17:54:20 - 00:18:27:09 Brian Pomper, JD I think that many in Congress, especially on the Republican side, have expressed privately but not publicly concern about the president's strategy with respect to tariffs and how it might impact their constituents. But I think over time, the political and economic pressure is going to force some kind of adjustment in the administration. And I think the most logical pressure valve to be released for the administration is for them to reimpose some type of exclusion process, as we did have in the first administration. 00:18:27:09 - 00:18:33:15 Brian Pomper, JD So if I'm a betting person, yes, I think we will have some kind of exclusion process. 00:18:33:18 - 00:18:54:27 Tina Freese Decker We'll come back to see if you're right. And so to close out our conversation today, this has been really helpful, a great history lesson and understanding of what's going on. Brian and Akin, can you share with us what your advice would be for our members? What should we be thinking about doing, planning for, as we think about these tariffs and the impact that they have? 00:18:54:29 - 00:19:13:08 Brian Pomper, JD Yeah, I always tell clients if something is important to you, important to your bottom line, you need to be vocal about it, and you need to be telling people how these measures are going to impact you. It's hard to argue with the goal, or at least one of the goals the president has of increasing manufacturing employment in the United States. 00:19:13:08 - 00:19:34:21 Brian Pomper, JD Who doesn't want that? I think where there's debate is how best to achieve that. But I do think it's important for organizations like AHA to go talk to your members, talk to the people who focus on the policy issues, the policy areas that you deal with. Let them know how these tariffs are going to impact you, and ask them to weigh in on your behalf. 00:19:34:21 - 00:19:46:01 Brian Pomper, JD And just make sure that whatever the administration does, they try to maximize benefit while minimizing harm. So I would just say where there's an opportunity to engage, I encourage the AHA to do so. 00:19:46:04 - 00:19:50:13 Tina Freese Decker Maximize benefit and minimize harm. Great statement. Akin? 00:19:50:15 - 00:20:20:02 Akin Demehin You know, Brian's counsel here is extremely wise. I'll just build on it in a couple of ways. One of the things that I know hospitals and health systems are so good at doing is bridging that gap between data and story. And often it is those stories of what's happening on the ground, how the steps that you go through to access supplies to deliver care, how those are affected, and playing that out for what it means for patients. 00:20:20:04 - 00:20:49:15 Akin Demehin Those are the kinds of stories that I know policymakers respond to. It really makes the issue even more real for them. And as Brian alluded to, raising some of those concerns with policymakers and certainly reaching out to us here at AHA, we can always be strong advocates on your behalf when we have intel and stories, and other information from all of you to help make the case as best we can. 00:20:49:16 - 00:20:58:17 Akin Demehin So we want to stay connected as we possibly can with all of you going forward so that we can push for those exemptions for pharmaceuticals and medical devices. 00:20:58:19 - 00:21:23:02 Tina Freese Decker That's wonderful. And your example about the cancer drugs or the smart pump or MRI and how all of those pieces come together is one of those stories that we can talk about and how it impacts us. So Brian and Akin, thank you so much for your time today and sharing in your expertise. I know this is an evolving issue and the AHA will continue to monitor closely and advocate on behalf of our field. 00:21:23:04 - 00:21:29:13 Tina Freese Decker And thank you to everyone tuning in today. We'll be back next month for another Leadership Dialogue conversation. 00:21:29:15 - 00:21:37:26 Tom Haederle Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </details> </div> Tue, 27 May 2025 09:15:31 -0500 Tariffs Tariff Implications for American Health Care /news/chairpersons-file/2025-05-19-tariff-implications-american-health-care Most hospitals and health systems are the largest organizations in our communities, providing critical services needed by every one of our neighbors. We take care of our communities as best as possible — which means advocating for the support and resources we need.A series of tariffs recently implemented could have significant implications for health care. A large proportion of medical goods currently comes from international sources, including pharmaceuticals, medical devices and personal protective equipment, as well as other low-margin, high-use essentials like syringes, needles and blood pressure cuffs.Tariffs on these items could impact patient care by jeopardizing the availability of vital medications and essential health care devices. They also could raise costs for hospitals and heighten shortages and supply chain disruptions.We’ve already seen the impact of supply chain disruptions in the aftermath of Hurricane Helene. To continue providing the care our communities rely on, hospitals and health systems need exemptions to ensure access to essential imports.AHA President and CEO Rick Pollack has&nbsp;<a href="/lettercomment/2025-02-05-aha-urges-administration-grant-exceptions-tariffs-medications-and-medical-supplies" title="AHA comment letter">urged the administration</a> to provide tariff exemptions for medications and medical supplies.The AHA also&nbsp;<a href="/lettercomment/2025-05-06-aha-comments-commerce-department-investigation-pharmaceutical-imports" title="AHA response to a request for public comment">recently responded</a> to a request for public comment on the Department of Commerce’s Section 232 national security investigation on pharmaceuticals and pharmaceutical ingredient imports, urging the administration to maintain tariff exemptions to minimize inadvertent disruptions to patient care.We’ve seen the creativity, innovation and resiliency of our hospitals to deliver patient care during the pandemic and other challenging circumstances. Health care leaders can work toward evaluating their supply chains to look for alternate sources, even as we advocate on behalf of our patients.There also is an important opportunity to make the supply chain more resilient. AHA has <a href="/testimony/2025-05-14-aha-senate-statement-trade-critical-supply-chains" title="AHA Senate testimony">been working with Congress</a> to urge consideration of legislation that would support efforts to proactively map and assess the pharmaceutical, medical device and equipment supply chains.I will be talking with Brian Pomper, partner with Akin Gump Strauss Hauer &amp; Feld, and Akin Demehin, AHA’s vice president of quality and patient safety policy, for an upcoming Leadership Dialogue on tariffs. Join us to learn about the potential impact on health care and how leaders can prepare.Helping You Help Communities: Key AHA Resources<ul><li><a href="/lettercomment/2025-02-05-aha-urges-administration-grant-exceptions-tariffs-medications-and-medical-supplies">AHA Urges Administration to Grant Exceptions for Tariffs for Medications and Medical Supplies</a></li><li><a href="https://www.modernhealthcare.com/providers/aha-akin-demehin-tariffs-medical-devices" target="_blank">The steps the AHA is taking to exempt medical devices from tariffs — Modern Healthcare</a></li><li><a href="/system/files/media/file/2025/04/The-Cost-of-Caring-April-2025.pdf">The Cost of Caring: Challenges Facing America’s Hospitals in 2025</a></li><li><a href="/lettercomment/2025-05-06-aha-comments-commerce-department-investigation-pharmaceutical-imports">AHA Comments on Commerce Department Investigation of Pharmaceutical Imports</a></li></ul><hr><div></div> Mon, 19 May 2025 10:16:36 -0500 Tariffs AHA urges Department of Commerce to enact tariff exceptions for critical minerals used in medical devices /news/headline/2025-05-16-aha-urges-department-commerce-enact-tariff-exceptions-critical-minerals-used-medical-devices The AHA May 16 <a href="/lettercomment/2025-05-16-aha-responds-commerce-department-investigation-critical-minerals" target="_blank">urged</a> the Department of Commerce to consider tariff exceptions for critical minerals and derivative products used for medical purposes. Critical minerals have many medical uses, such as for magnetic resonance imaging, computerized tomography, positron emission tomography, radiopharmaceuticals and radiation therapy equipment. &nbsp; &nbsp; “Tariffs on critical minerals could have a particularly significant impact on complex medical devices that are higher cost and lower volume, in part due to requiring specialized parts and customization to meet the needs of health care providers,” the AHA wrote. “A recent survey found that 82% of health care experts expect tariff-related expenses to raise hospital costs by at least 15%, and 90% of supply chain professionals expect procurement disruptions. Given that hospital payments are set by government and private payer contracts, the costs would be borne by hospitals directly.”&nbsp; Fri, 16 May 2025 15:04:33 -0500 Tariffs AHA Responds to Commerce Department Investigation of Critical Minerals /lettercomment/2025-05-16-aha-responds-commerce-department-investigation-critical-minerals May 16, 2025Stephen Astle Director, Defense Industrial Base Division Office of Strategic Industries and Economic Security U.S. Department of Commerce 1401 Constitution Ave, NW Washington, DC 20230RE: Notice of Request for Public Comments on Section 232 National Security Investigation of Imports of Processed Critical Minerals and Derivative Products (XRIN 0694-XC124), April 25, 2025Dear Director Astle:&nbsp;On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) appreciates the opportunity to comment on the Department of Commerce’s request for public comment on its Section 232 national security investigation on processed critical minerals and derivative products. The investigation could form the basis for future tariffs or other trade restrictions on these products.Critical minerals — including certain rare earth materials — are essential to the manufacture and operation of many medical devices that hospitals and health systems use to diagnose and treat patients every day. For example, magnetic resonance imaging (MRI), computerized tomography (CT), positron emission tomography (PET), radiopharmaceuticals and radiation therapy equipment all require the ready availability of critical minerals to function as intended. A substantial proportion of the critical minerals used in medical devices and therapies are either extracted or processed internationally, even when the device or therapy is manufactured in the U.S.The AHA shares the administration’s long-term goal of securing reliable sources for critical minerals, including by strengthening domestic capabilities for mining and processing such minerals where possible. At the same time, achieving this goal will require a significant amount of time, given the logistical complexity and resources involved in shifting the supply chain for critical minerals. In the short term, we are concerned that tariffs on critical minerals used in health care — and any retaliatory action from the countries on which tariffs are imposed — could inadvertently disrupt the availability of critical diagnostic and treatment tools on which effective patient care relies. Tariffs and retaliatory actions from other nations also could significantly raise hospital costs.The AHA urges the administration to consider&nbsp;tariff exceptions for critical minerals and derivative products that are used for medical purposes.&nbsp;These exceptions could be coupled with continued engagement with multiple stakeholders —hospitals and health systems, device and drug manufacturers, mining and mineral processors and others — to explore approaches to making the supply chain for critical minerals used in medical devices and therapies more resilient and, when feasible, less dependent on international sources.Multiple minerals on the critical minerals list are essential to aiding diagnosis and delivering treatments, and are heavily dependent on international sources, especially China. For diagnostic imaging, gadolinium is a rare earth material used in contrast fluid, which improve MRI precision. Contrast fluid can help identify vascular aneurysms and blockages, spinal cord injuries and brain tumors. Lutetium, another rare earth material, is used to produce very high-resolution PET/CT scans that help physicians determine how aggressive a tumor is and inform treatment plans. The U.S. is 80% reliant on international sources for rare earth materials.i&nbsp;Lutetium along with yttrium are also critical components of radiopharmaceuticals that are used to help shrink certain kinds of tumors. All of the yttrium used in the U.S. is imported, with 93% of it coming from China.ii Tungsten is also an essential component used to make certain linear accelerators that deliver radiation therapy treatment, with over half of the U.S. supply coming from China.iii Tariffs on these and other critical minerals used in health care could lead to disruptions in the availability of these critical patient care tools.Lastly, the AHA is concerned about the potential for tariffs to raise the costs of delivering care to hospitals and health systems. Tariffs on critical minerals could have a particularly significant impact on complex medical devices that are higher cost and lower volume, in part due to requiring specialized parts and customization to meet the needs of health care providers. A recent survey found that 82% of health care experts expect tariff-related expenses to raise hospital costs by at least 15%, and 90% of supply chain professionals expect procurement disruptions.iv&nbsp;Given that hospital payments are set by government and private payer contracts, the costs would be borne by hospitals directly. As underscored by the AHA’s recent Cost of Caring report, such cost increases could further compound the broader financial headwinds challenging hospitals’ ability to provide care to patients and communities.vThank you for the opportunity to provide feedback on this notice. We welcome the opportunity to discuss with your team how to preserve access to medical devices and technologies that depend on critical minerals and ensure that hospitals can continue delivering safe and effective care.&nbsp;Please contact me if you have questions at <a href="mailto:ademehin@aha.org">ademehin@aha.org</a>.Sincerely,/s/Akinluwa (Akin) A. Demehin Vice President Quality and Safety Policy ______<div><div id="edn1">i United States Geologic Services (USGS) Mineral Commodities Summaries. <a href="https://pubs.usgs.gov/periodicals/mcs2025/mcs2025-rare-earths.pdf">https://pubs.usgs.gov/periodicals/mcs2025/mcs2025-rare-earths.pdf</a></div><div id="edn2">ii USGS Mineral Commodities Summaries. <a href="https://pubs.usgs.gov/periodicals/mcs2025/mcs2025-yttrium.pdf">https://pubs.usgs.gov/periodicals/mcs2025/mcs2025-yttrium.pdf</a></div><div id="edn3">iii USGS Mineral Commodities Summaries. <a href="https://pubs.usgs.gov/periodicals/mcs2025/mcs2025-tungsten.pdf">https://pubs.usgs.gov/periodicals/mcs2025/mcs2025-tungsten.pdf</a></div><div id="edn4">iv <a href="https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/">https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/</a></div><div id="edn5">v <a href="/costsofcaring">/costsofcaring</a>&nbsp;</div></div> Fri, 16 May 2025 11:55:19 -0500 Tariffs AHA urges Senate Finance Committee to strengthen supply chain /news/headline/2025-05-14-aha-urges-senate-finance-committee-strengthen-supply-chain The AHA May 14 <a href="/testimony/2025-05-14-aha-senate-statement-trade-critical-supply-chains">urged</a> the Senate Finance Committee to take steps to strengthen the supply chain for essential pharmaceutical and other medical products. In comments to the committee for a <a href="https://www.finance.senate.gov/hearings/trade-in-critical-supply-chains">hearing</a> on supply chains, the AHA called for tariff exceptions to continue for pharmaceuticals and pharmaceutical products and that additional exceptions be added for medical devices and other critical care supplies. &nbsp;&nbsp; &nbsp;&nbsp; “Mitigating supply chain challenges requires diversifying where raw materials are sourced and where products are manufactured,” the AHA wrote. “Imposing tariffs that limit the U.S.’s ability to acquire constituent parts or finished medical and pharmaceutical products from abroad will hinder supply chain resiliency.” &nbsp; &nbsp;&nbsp; The AHA also urged Congress to reintroduce the Mapping America’s Pharmaceutical Supply Act, legislation that would create a plan for the Food and Drug Administration and the Department of Defense to map the U.S. pharmaceutical supply chain, and the Pharmaceutical Supply Chain Risk Assessment Act, a bill that would require a comprehensive risk assessment of the pharmaceutical supply chain.&nbsp; Wed, 14 May 2025 16:04:51 -0500 Tariffs AHA Senate Statement on Trade in Critical Supply Chains /testimony/2025-05-14-aha-senate-statement-trade-critical-supply-chains Statementof the�� Associationfor theUnited States SenateCommittee on Finance“Trade in Critical Supply Chains”May 14, 2025On behalf of our nearly 5,000 member hospitals and health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — the �� Association (AHA) appreciates the opportunity to submit this statement for the record to the Senate Committee on Finance regarding the importance of trade in critical supply chains.<h2>Trade in Critical Supply Chains: Challenges</h2>The AHA believes it is necessary to strengthen the domestic supply chain for essential pharmaceutical and other medical products and recognizes the value of reducing reliance on international sources. We are also aware that achieving this goal will require significant time due to the logistical complexity and resources involved in reorienting medical and pharmaceutical supply chains.<h3>Access Disruption</h3>Each day in America’s hospitals and health systems, patients receive safe and effective care from provider teams using a wide array of pharmaceuticals and medical devices. Patients’ lives depend on the ready availability of drugs and devices to respond to emergent conditions like heart attacks and infections, and other critical illnesses like cancer and organ failure. The medical supply chains for pharmaceutical products and other medical devices are highly complex and require hospitals to draw on domestic and international sources. These supply chains are also prone to significant disruption from a wide range of factors, including transportation interruptions, natural disasters, raw materials shortages and production breakdowns.Despite ongoing efforts to bolster the domestic supply chain, international sources supply a significant proportion of essential medical goods. For example, nearly 70% of medical devices marketed in the U.S. are manufactured exclusively overseas<a href="#_ftn1" title="">1</a> In 2024 alone, the U.S. imported over $75 billion in medical devices and supplies, according to AHA analysis of Census Bureau data. These imports include many low-margin, high-use essentials in hospital settings necessary for patient care. Some of these devices are single-use, designed to protect patients from infection, such as single-use blood pressure cuffs, stethoscope covers and sterile drapes. Others are small devices used ubiquitously in hospitals, such as anesthesia instruments, cautery pencils, needles, syringes and pulse oximeters. Disruption in the availability of these devices would curtail hospitals’ ability to perform life-saving surgeries and keep patients safe from contagion, as well as hinder providers’ ability to effectively diagnose, monitor and treat patients.Many pharmaceuticals are also sourced from overseas. For example, U.S. providers import many cancer and cardiovascular medications, immunosuppressives, antibiotics and combination antibiotics. For many patients, even a temporary disruption in their access to these needed medications could put them at significant risk of harm, including death. Carefully planned chemotherapy treatments and antibiotic schedules are essential to giving patients the best chance of overcoming their diseases. Similarly, the provision of necessary cardiovascular medications must be continuous to preserve their cardiovascular health. As of the first quarter of 2025, there are 270 drugs on the active shortage list, including lingering shortages of intravenous (IV) fluids stemming from the impacts of Hurricane Helene on a large North Carolina production facility.2 A recent Government Accountability Office analysis also found that the duration of drug shortages has increased, with nearly 60% of drug shortages lasting two or more years in 2024, compared to only one-third of shortages lasting that long in 2019.3In addition to finished pharmaceutical products, the U.S. sources many raw ingredients internationally for pharmaceuticals. These raw ingredients are commonly known as active pharmaceutical ingredients (APIs) and are the most important components of any pharmaceutical manufacturer’s supply chain. The U.S. gets nearly 30% of its APIs from China, and according to a 2023 Department of Health and Human Services estimate, over 90% of generic sterile injectable drugs — including many chemotherapy treatments and antibiotics — depend on APIs from either India or China.4 This means that trade disruptions and other shortage events limit the ability of American drug manufacturers to produce critical drugs even here in the U.S.5<h3>Increased Costs</h3>Tariffs on medical imports could significantly raise costs for hospitals. A recent survey found that 82% of health care experts expect tariff-related expenses to raise hospital costs by at least 15% over the next six months, and 94% of health care administrators expect to delay equipment upgrades to manage financial strain.6 Tariffs also may force hospitals to seek new vendors — often at higher cost or with lower reliability. In fact, 90% of supply chain professionals expect procurement disruptions and other shortages.7&nbsp;An analysis published in 2019 estimated that drug shortages alone result in at least $359 million annually in additional labor costs to hospitals because of the need to find alternative drugs to provide to patients.8These increased costs come at a time when hospital expenses are already outpacing inflation and significantly outpacing reimbursement. In 2024, total hospital expenses grew 5.1%, far surpassing the overall inflation rate of 2.9%. Though expense growth has started to slow in 2025, it remains elevated — particularly in areas driven by labor and supply chain pressures. Persistent expense growth threatens hospitals’ solvency and ability to sustain comprehensive services in their communities.Despite escalating expenses, Medicare reimbursement continues to lag behind inflation — covering just 83 cents for every dollar spent by hospitals in 2023, resulting in over $100 billion in underpayments, according to AHA analysis of AHA Annual Survey data. From 2022 to 2024, general inflation rose by 14.1%, while Medicare net inpatient payment rates increased by only 5.1% — amounting to an effective payment cut over the past three years. The AHA estimates that this erosion in payment value due to inflation resulted in $8.4 billion in lost hospital revenue during that period, further straining hospitals’ ability to care for Medicare beneficiaries, who make up a large share of most hospitals’ patients. In total, hospitals absorbed $130 billion in underpayments from Medicare and Medicaid in 2023 alone. These shortfalls are worsening — growing on average 14% annually between 2019 and 2023.<h2>Trade in Critical Supply Chains: Solutions</h2>Maintaining and improving pharmaceutical and medical device supply chains is essential to preserving patient access to care, reducing health care costs, and protecting America’s interests. While AHA recognizes the many challenges associated with the medical supply chain, we are committed to identifying workable solutions that protect America’s interests and shore up the supply chain while avoiding access disruption and increased costs.<h3>Maintain Tariff Exceptions for Pharmaceuticals, Adopt Them for Medical Devices and Supplies</h3>AHA has urged the administration to maintain tariff exceptions for pharmaceuticals and pharmaceutical products and to adopt them for medical devices and other critical supplies to minimize inadvertent disruptions to patient care.9 It is especially critical to have these exceptions for products already in shortage, and for which production in countries subject to increased tariffs supplies a significant part of the U.S. market for that product. Mitigating supply chain challenges requires diversifying where raw materials are sourced and where products are manufactured. Imposing tariffs that limit the U.S.’s ability to acquire constituent parts or finished medical and pharmaceutical products from abroad will hinder supply chain resiliency. AHA requests that tariff exceptions continue for pharmaceuticals and pharmaceutical products and that additional exceptions be added for medical devices and other critical supplies needed to provide care.<h3>Pass Legislation that Strengthens Supply Chains</h3>A critical step in protecting America’s pharmaceutical and medical supply chains is understanding vulnerabilities from the beginning of production to the moment a drug is administered to a patient or a device is used to deliver care.In the 118th Congress, two bills were introduced in the Senate that would increase visibility into and understanding of the U.S. pharmaceutical supply chain, in particular. The Pharmaceutical Supply Chain Risk Assessment Act of 2023 would require a comprehensive risk assessment of the entire U.S. pharmaceutical supply chain. This overarching project will help provide critical information necessary to mitigate and prevent drug supply shortages. A disruption anywhere in the supply chain can create prolonged difficulties in pharmaceutical supply acquisition for providers, and avoiding these disruptions before they occur will benefit providers and the patients they serve.10The Mapping America’s Pharmaceutical Supply (MAPS) Act creates a plan for the Food and Drug Administration and the Department of Defense to map the U.S. pharmaceutical supply chain. The act also includes the use of data analytics to identify and predict supply chain vulnerabilities and other national security threats. With the information collected and analyzed through the MAPS Act, it will be possible to begin addressing weaknesses in the pharmaceutical supply chain.11 Building on the framework created under the MAPS Act, the Pharmaceutical Supply Chain Risk Assessment Act of 2023 would require a comprehensive risk assessment of the entire U.S. pharmaceutical supply chain. A disruption anywhere in the supply chain can create prolonged difficulties in pharmaceutical supply acquisition for providers, and avoiding these disruptions before they occur will benefit providers and the patients they serve.<a href="#_ftn2" title="">12</a>AHA urges reintroduction of the MAPS Act and the Pharmaceutical Supply Chain Risk Assessment Act in the 119th Congress. Supply chain vulnerabilities often only become apparent when the chain has been broken, as in the case of the IV fluid shortage that resulted from Hurricane Helene. Proactively mapping and assessing the pharmaceutical supply chain, as well as supply chains for other medical devices and equipment, is an important step to improving resiliency in U.S. supply chains and protecting patients’ access to care.<h2>Conclusion</h2>Strengthening supply chains for essential pharmaceutical and other medical products is necessary, and AHA recognizes the value of reducing reliance on international sources. Achieving this goal will require significant time and resources, given the complexity of medical and pharmaceutical supply chains, and the importance of supply chain diversity in addition to the reshoring goal, should not be underestimated. AHA appreciates the committee’s invitation to comment on this topic and looks forward to further collaboration in the future. __________<div><div id="ftn1"><a href="#_ftnref1" title="">1 </a><a class="ck-anchor" href="https://www.medicaldevice-network.com/analyst-comment/trump-tariffs-us-medical-device-market/" id="https://www.medicaldevice-network.com/analyst-comment/trump-tariffs-us-medical-device-market/">https://www.medicaldevice-network.com/analyst-comment/trump-tariffs-us-medical-device-market/</a> 2 <a class="ck-anchor" href="https://www.ashp.org/drug-shortages/shortage-resources/drug-shortages-statistics" id="https://www.ashp.org/drug-shortages/shortage-resources/drug-shortages-statistics">https://www.ashp.org/drug-shortages/shortage-resources/drug-shortages-statistics</a> 3 Drug Shortages: HHS Should Implement a Mechanism to Coordinate Its Activities GAO-25-107110. Apr. 09, 2025. Publicly Released: Apr 09, 2025. 4&nbsp;<a class="ck-anchor" href="https://aspe.hhs.gov/sites/default/files/documents/3a9df8acf50e7fda2e443f025d51d038/HHS-White-Paper-Preventing-Shortages-Supply-Chain-Vulnerabilities.pdf" id="https://aspe.hhs.gov/sites/default/files/documents/3a9df8acf50e7fda2e443f025d51d038/HHS-White-Paper-Preventing-Shortages-Supply-Chain-Vulnerabilities.pdf">https://aspe.hhs.gov/sites/default/files/documents/3a9df8acf50e7fda2e443f025d51d038/HHS-White-Paper-Preventing-Shortages-Supply-Chain-Vulnerabilities.pdf</a>&nbsp; 5 Neils Graham, Atlantic Council, April 19, 2023; The US is relying more on China for pharmaceuticals and vice versa. 6&nbsp;<a class="ck-anchor" href="https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/" id="https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/">https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/</a> 7&nbsp;<a class="ck-anchor" href="https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/" id="https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/">https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/</a> 8&nbsp;<a class="ck-anchor" href="https://wieck-vizient-production.s3.us-west-1.amazonaws.com/page-Brum/attachment/c9dba646f40b9b5def8032480ea51e1e85194129" target="_blank" title="(opens in a new window)" id="https://wieck-vizient-production.s3.us-west-amazonaws.com/page-Brum/attachment/c9dba646f40b9b5def8032480ea51e1e85194129">https://wieck-vizient-production.s3.us-west-amazonaws.com/page-Brum/attachment/c9dba646f40b9b5def8032480ea51e1e85194129</a> 9 <a class="ck-anchor" href="/lettercomment/2025-05-06-aha-comments-commerce-department-investigation-pharmaceutical-imports" id="/lettercomment/2025-05-06-aha-comments-commerce-department-investigation-pharmaceutical-imports">/lettercomment/2025-05-06-aha-comments-commerce-department-investigation-pharmaceutical-imports</a> 10 <a class="ck-anchor" href="/lettercomment/2023-08-10-aha-letter-support-pharmaceutical-supply-chain-risk-assessment-act-2023" id="/lettercomment/2023-08-10-aha-letter-support-pharmaceutical-supply-chain-risk-assessment-act-2023">/lettercomment/2023-08-10-aha-letter-support-pharmaceutical-supply-chain-risk-assessment-act-2023</a> 11&nbsp;<a class="ck-anchor" href="/lettercomment/2023-08-10-aha-letter-support-mapping-americas-pharmaceutical-supply-chain-or-maps-act-2023" id="/lettercomment/2023-08-10-aha-letter-support-mapping-americas-pharmaceutical-supply-chain-or-maps-act-2023">/lettercomment/2023-08-10-aha-letter-support-mapping-americas-pharmaceutical-supply-chain-or-maps-act-2023</a> 12&nbsp;<a href="/lettercomment/2023-08-10-aha-letter-support-pharmaceutical-supply-chain-risk-assessment-act-2023">/lettercomment/2023-08-10-aha-letter-support-pharmaceutical-supply-chain-risk-assessment-act-2023</a>&nbsp;</div></div> Wed, 14 May 2025 12:04:36 -0500 Tariffs U.S., China temporarily agree to reduce tariffs for 90 days /news/headline/2025-05-12-us-china-temporarily-agree-reduce-tariffs-90-days The U.S. and China reached a joint agreement to temporarily reduce tariffs for 90 days, the White House <a href="https://www.whitehouse.gov/fact-sheets/2025/05/fact-sheet-president-donald-j-trump-secures-a-historic-trade-win-for-the-united-states/">announced</a> May 12. Both countries will lower tariffs by 115% effective May 14. This will reduce U.S. tariffs on Chinese goods to 30% — a 10% baseline tariff and a 20% tariff imposed in February due to concerns about the movement of illicit fentanyl from China. The U.S. also will retain other tariffs applied to Chinese goods. These tariffs were adopted prior to April 2 and include Section 301, Section 232 and most favored nation tariffs.&nbsp; Mon, 12 May 2025 15:17:05 -0500 Tariffs Health-ISAC TLP Green Biweekly Geopolitical Watchlist Update May, 7, 2025 <div class="container row"><div class="row"><div class="col-md-8">Developments<ul><li>EU Makes International Call for Researchers</li><li>Russia and North Korea Build Bridge</li><li>EU Will Not Use Russian Fuels After the War</li><li>US-Ukraine Mineral Agreement</li><li>Largest Criminal Organizations in Brazil Resume Hostilities</li></ul>Geopolitical Deep Dives<ul><li><a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fhealth-isac.cyware.com%2Fwebapp%2Fuser%2Fdoc-library%2F7215bc47-c8b5-492d-b9d2-1e34051f97ef&amp;data=05%7C02%7Cdsamuels%40aha.org%7C30a9be673a1d4dfc343308dd8d980d4d%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638822406414168400%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=UjridxVQUnm2OJQLXlXoiiwVDHsHbdnSMdteVa%2F1QVk%3D&amp;reserved=0" target="_blank">Current</a>: Supply Chain Impacts of Heightened China-Taiwan Tensions</li><li><a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fhealth-isac.cyware.com%2Fwebapp%2Fuser%2Fdoc-library%2F124545e5-5de5-41ff-8409-055be1077aeb&amp;data=05%7C02%7Cdsamuels%40aha.org%7C30a9be673a1d4dfc343308dd8d980d4d%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638822406414190866%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=SVhnyR8x68NXk9aMvUSW1S92PtHNiCJ07bLfNtUIR2w%3D&amp;reserved=0" target="_blank">Previous</a>: Trade Impacts of Proposed Tariffs on the EU Pharmaceutical Sector</li></ul></div><div class="col-md-4"><div>For help with Cybersecurity and Risk Advisory Services exclusively for AHA members, contact:<h3><a href="/system/files/media/file/2020/11/AHA-Riggi-Senior-Advisor-for-Cyber-and-Risk-Bio-08102020.pdf">John Riggi</a></h3><h4>National Advisor for Cybersecurity and Risk, AHA</h4><h4><a href="mailto:jriggi@aha.org?subject=Cybersecurity and Risk Advisory Services Query">jriggi@aha.org</a></h4><h4>(O) <a href="tel:1-202-626-2272">+1 202 626 2272</a></h4><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2020/11/AHA-Riggi-Senior-Advisor-for-Cyber-and-Risk-Bio-08102020.pdf" target="_blank">More on John Riggi</a></div><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/guidesreports/2018-06-15-cybersecurity-and-risk-advisory-services" target="_blank">Learn more about AHA's Cybersecurity and Risk Advisory Services</a></div></div></div></div></div> Wed, 07 May 2025 14:54:48 -0500 Tariffs