A year after the Trump administration pledged to harness Medicaid's vast purchasing power to lower drug prices for tens of millions of Americans, the promise remains largely unrealized — its terms undefined, its participants uncommitted, its leverage unexercised. The initiative, which drew on the logic that large buyers can demand better prices, has stalled in the space between announcement and implementation, where policy intentions so often quietly dissolve. What was framed as a straightforward application of market power has revealed, instead, the deep structural complexity of governing a f