Why Reshoring, State-Level Growth, and Tariffs are Reshaping Medtech M&A Value

One of the most interesting panel discussions at the 19th Florida Medical Device Symposium last month examined the medtech manufacturing economy’s health. Perspective came from John Ray (Florida Medical Manufacturers Consortium executive director), Michael Gregory (deputy chief economist/managing director, BMO Capital Markets), and yours truly (Dave Sheppard). The discussion ranged from Florida’s macroeconomic trajectory to the specific dynamics shaping medical manufacturing in the Sunshine State, the United States, and globally. A clear theme emerged from the panelists’ perspectives: U.S. medtech manufacturing is undergoing a structural realignment, and that shift is producing measurable impacts on company valuations. 

The implications are immediate, particularly for those considering a future liquidity event. The factors driving the realignment—reshoring momentum, state-level manufacturing growth, tariff-driven supply chain restructuring, and the steady incorporation of artificial intelligence (AI) on the factory floor—are precisely the factors strategic acquirers and private equity sponsors are currently weighing as they evaluate U.S.-based manufacturing targets. 

The View From Florida Medtech Manufacturing’s Front Lines

FMMC convenes the leadership of Florida’s medical manufacturing community—OEMs, contract manufacturers, suppliers, and the economic development organizations that support them. Industry folks attend FMMC’s annual event to gain actionable insight about the industry’s general health and direction. The economic health co-panelists brought distinctly complementary perspectives to the discussion: Ray spoke from the vantage point of an association that monitors Florida’s medtech growth at a highly granular level, while Gregory reviewed U.S. and global macro trends—gross domestic product (GDP), employment, capital flows, and trade policy.

Sheppard then connected those macro and association-level signals to the developments occurring within corporate C-Suites and deal rooms. The strongest takeaway from the discussion was that buyers who set valuations for small and mid-market medtech companies are closely monitoring production geography and its vulnerability (or resilience) to evolving trade policies, supply chain flexibility, and regional manufacturing capability.

Inside the Data Driving State-Level Medtech Manufacturing Growth

Depending on the source, Florida currently ranks as the nation’s second-largest medical device manufacturing production state—a remarkable position considering the state historically was associated mostly with tourism, agriculture, and aerospace. 

The underlying medtech ecosystem spans more than 2,200 life sciences establishments distributed across four distinct regions: Tampa for device manufacturing and corporate headquarters; Miami for international connectivity to Latin American markets; Jacksonville for logistics and major OEM presence (Johnson & Johnson Vision, Medtronic’s ENT division); and Orlando for diversified manufacturing along with research partnerships. Florida’s overall manufacturing GDP grew 67.8% from $43.5 billion in 2014 to $73 billion in 2022, thanks in part to medical device production.

Florida is not the only state seeing this kind of momentum, though. Indiana continues to dominate orthopedics, Minnesota remains a cardiovascular and diagnostics powerhouse, and Pennsylvania, Texas, and the Carolinas are all attracting medtech manufacturing investment. The state-level manufacturing map is being redrawn in real time and acquirers are tracking it to determine the ways in which state policies, talent pool depth, and logistics infrastructure will impact the long-term viability of the new vistas.

The Reshoring and Near-Shoring Tailwind is Real and Quantifiable

Reshoring and near-shoring have been discussed in industry circles for the better part of a decade, but the data have shifted decisively. Approximately 244,000 U.S. manufacturing jobs were announced through reshoring and foreign direct investment in 2024, with medical and pharmaceutical manufacturing comprising roughly 14% of that total. 

This is relevant to the M&A market in two ways. First, a U.S. medtech manufacturer with credible, automation-enabled domestic capacity is now scarcer and more strategically valuable than it was three years ago. Second, acquirers are increasingly underwriting the resilience of a target’s manufacturing footprint as part of the valuation model—as a quantifiable factor, with explicit assumptions about geopolitical risk, tariff exposure, and supply chain redundancy.

Tariffs as a Catalyst

Rather than focusing on how tariffs act as a headwind for medtech manufacturing, the panel noted the current tariff environment is actually accelerating a structural shift toward U.S. medical device production.

Since broad tariff measures were implemented last year, U.S. based medical devices and component companies that built their cost structure around low-duty or duty-free imports from China, the European Union, and other regions are now reassessing their individual supplier relationships as well as their entire manufacturing geography. As discussed in previous C-Suite columns, the macro supply chain trend among international medtech players to “manufacture in the region for the region” still exists globally.

Firms that already have meaningful U.S. capacity, particularly in states like Florida that actively recruit medtech investment with long-term incentive structures, are positioned to attract work that was previously sourced offshore. Some Florida counties have approved incentive packages that translate to $10,000 to $40,000 per job or 10% to 30% of total capital investment for qualifying medtech expansions. The lack of state income tax is an inducement, too.

Acquirers know this. Inside deal rooms this year, the questions about U.S. manufacturing capacity, state-level incentives, and tariff exposure are no longer abstract—they are line items in the diligence model.

Why U.S.-Based Manufacturers Command Renewed Strategic Interest

MedWorld Advisors’ guiding principle is Value = Strategic Fit + Timing. The current environment makes both halves of that equation especially relevant for U.S.-based medical device manufacturers.

On the strategic fit side, acquirers are actively seeking targets whose manufacturing footprint complements a reshoring or near-shoring strategy they are already executing. On the timing side, the window for owners to monetize this positioning is being shaped by competing forces that include tariff duration, the pace of competitor reshoring announcements, and the buildout of new domestic capacity by major OEMs that will eventually saturate certain segments.

Consequently, small and mid-market medtech manufacturers should focus on several areas as they prepare for these conversations.

• Quantify the U.S. capacity advantage. Acquirers want specifics: percentage of U.S. production performed, percentage of revenue derived from U.S.-manufactured products, and the labor and capital flexibility available to absorb additional work. Vague claims about domestic capability are no longer sufficient; the diligence process is sharper than it was even a year ago.
• Document the company’s reshoring or near-shoring story. Even if a reshoring initiative has not formally been executed, operational decisions over the past three years—supplier diversification, dual-sourcing arrangements, and regional inventory positioning—are part of a credible narrative. Capture and articulate it before entering a sale process.
• Map the state-level positioning. Acquirers increasingly evaluate the policy environment, talent pool, and incentive landscape of the states where facilities are located. A company with a manufacturing footprint in a high-growth state backed by strong long-term incentives should make that a central part of its enterprise value narrative. Conversely, organizations should strategically address its decision to locate in a state with rising operating costs or workforce constraints. MedWorld Advisors receives buyer mandates that specifically exclude California, New York, and Massachusetts as deal options because industry capital is frustrated with the red tape in those states.
• Engage in valuation conversations early with M&A advisors. Whether the plan is to exit in one, three, or five years (or longer), contact an M&A advisor “early and often” to discuss potential enterprise value (EV) today and what helpful activities might ensure improved EV upon exit timing.

The Manufacturing Floor Reality

No discussion of the state of medtech manufacturing in 2026 can be complete without addressing AI, and it was discussed on the panel for the same reason. For U.S.-based manufacturers considering capitalizing on the reshoring tailwind, AI-enabled operational excellence is increasingly the differentiator between a credible domestic capacity story and a generic one.

The Bottom Line 

The conversation at FMMC mirrored some of the discussions taking place in deal rooms this year. The U.S. medtech manufacturing landscape is being reshaped by forces that are simultaneously creating risk for unprepared companies and opportunity for positioned ones. State-level growth stories like Florida’s, the reshoring and near-shoring tailwind, the changing tariff environment, and the steady advance of AI on the factory floor are not separate trends. They are facets of the same realignment, and they are converging in ways that will determine the medtech firms that will command premium valuations over the next three to five years.

The medtech industry has generally always rewarded companies that invest ahead of the market. The U.S. manufacturing renaissance is one of those inflection points. For those positioned to capture it, the conversations with acquirers are going to be among the most consequential of the next several years. Now is the time to make sure your story is ready.

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Florence Joffroy-Black, CM&AA, and Dave Sheppard, CM&AA, are managing partners at MedWorld Advisors, a global M&A advisory firm serving the medical technology and life-science industries. Florence can be reached at [email protected]. Dave can be reached at [email protected].