As federal and state policy changes accelerate, legal departments inside health systems are taking on a more operational role. At Chicago-based Rush University System for Health, that shift has intensified over the past year as political and regulatory developments increasingly influence day-to-day decisions across the organization.
Carl Bergetz, chief legal officer and general counsel of Rush University System for Health, said the pace and breadth of change has required the legal function to stay closely connected to operations, communications and leadership. At the start of 2025 as President Donald Trump took office, Rush reactivated an interdisciplinary legal and government affairs work group that was first used during the COVID-19 pandemic. The group is led by the legal team but includes leaders from communications, finance, clinical services and operations.
“At the start of last year, with the new administration, we knew there’d be a lot of change, and I don’t think we anticipated it would be as much change and as quickly as it has been,” Mr. Bergetz said during an interview for an upcoming episode of the “Becker’s Healthcare Podcast.”
The group tracks executive orders, court opinions, legislative proposals and regulatory changes at the federal, state and local levels, then works with operational leaders to interpret how those developments affect Rush specifically. Government affairs reports through the legal department at Rush, a structure that helps ensure alignment between political developments, legal interpretation and compliance obligations.
“So much was driven in 2025 and continues to be by politics and government,” he said. “And given that healthcare is so heavily regulated, we always know that muscle needs to be in shape and staying fit and growing.”
Preparing for ICE
One of the most operationally sensitive issues Rush addressed last year involved U.S. Immigration and Customs Enforcement. After the Trump administration rescinded a prior executive order shielding hospitals and universities from immigration enforcement activity, Rush prepared for the possibility of ICE agents appearing on campus.
While Rush already had policies governing interactions with law enforcement, ICE presented new challenges for frontline staff, particularly clinicians who were not accustomed to dealing with immigration officials.
“With ICE, it was a little different because we hadn’t seen them as much before,” he said. “We also weren’t necessarily sure at the beginning of it what was the scope of their jurisdiction.”
ICE agents ultimately appeared at multiple Rush locations, including the downtown campus, Oak Park and Aurora. In most cases, the encounters involved detainees who required medical care. The legal team focused on ensuring staff understood the requirements around judicial warrants and how to respond appropriately.
“We had to make sure we were educating people on the need for a judicial warrant that was signed by a judge in this district, and that was very specific,” he said.
The situation also drew public attention, including protests and inquiries from local officials. Mr. Bergetz said training and preparation were critical in helping staff respond appropriately in high-pressure moments.
“No matter how well you write something down, until you train on it, and actually until you live it, it’s really hard to put into action when something emergent happens,” he said.
Rush has continued to debrief and refine its approach to prepare for future encounters.
“We want to make sure that we’re prepared for it,” Mr. Bergetz said. “And put ourselves in the best position possible to de-escalate, make sure that things aren’t getting out of hand, and job number one, taking care of the patients that need the care.”
Legislative funding changes
Rush used the same communication to communicate potential changes to the ACA and the Budget Reconciliation Act last year to avoid confusion. Mr. Bergetz expects the pace of change and pressure on hospitals to intensify, particularly as delayed federal budget decisions begin to take effect this year.
“Legal counsel is helping to provide counsel around an increasingly difficult time from a standpoint of margins, Medicaid and Medicare dollars being cut, and it is more difficult to obtain research dollars now,” he said. “We need a different sort of framework of thinking about how those research dollars can be granted, if at all.”
The health system is planning for more uninsured patients over the next few years and will need to provide additional support to the university for research and innovation.
“I view things as the default setting right now is uncertainty, and it’s our job to create some semblance of normalcy, but it’s really hard to do that when we’re not even sure if funding is going to be there for certain programs, even something as big as Medicaid,” said Mr. Bergetz. “There will be funding for it, but what is the scope? We are continuing forward with the work group to keep the energy level going to understand and make sense of what is happening in real time, and hopefully mitigate where the risks are arising. I see this continuing more of 2025 in 2026, and it will probably get more and more difficult.”
