In observance of Passover, there will be no Digest the next two weeks. The Digest will return on Monday, April 28^th.

WHITE HOUSE:

The White House focused this week on the President’s tariffs (which are wreaking havoc with the markets), issuing an Executive Order to end price-gouging for live entertainment tickets, and establishing the “United States Investment Accelerator”, with the goal of encouraging more investment in American manufacturing facilities for semiconductors. One item of indirect interest:

• • The White House’s Office of National Drug Control Policy (ONDCP) released a new list of the Administration’s priorities as it relates to dealing with overdoses and illicit drugs. Two of the priorities focus on treatment and how to create more sustainable long-term treatment plans. Especially if you have facilities that deal with drug rehabs or other treatment programs, this is something to monitor. The full plan is available here (PDF).

CONGRESS:

And back we go to the House… Late on Friday night, the Senate adopted their own version of the budget blueprint needed for Reconciliation, despite losing the vote of Maine Senator Susan Collins, who voted no because of the threat to Medicaid. The Senate version comes with significantly lower target numbers than the House version, which has led multiple conservative House members to already publily oppose the Senate version. Trying to reassure his Members (and, frankly, explain what comes next in the complicated, byzantine Reconciliation process) House Speaker Mike Johnson sent a letter to his members (available here as a PDF) to point out that everything that’s happening right now is simply step 1. The real work begins once the House and Senate agree on a blueprint and the relevant committees can start hammering out real numbers. The House is planning to get a final vote done this week, although passage as currently constituted is far from certain. Regardless, the Reconciliation drama continues for now. Elsewhere in the political world:

• • Speaker Johnson suffered a defeat on the House floor last week when several Republicans joined with Democrats to defeat a rule that would have barred proxy voting. The fight was led by (former) House Freedom Caucus member Rep. Anna Paulina Luna, who was pushing for proxy voting for new mothers. The relevance for us is that the House can’t proceed with other votes (like on Reconciliation) until this gets resolved. It does look the Speaker is making progress on that front.

• • With so much economic turmoil resulting from the tariffs, several members of Congress are starting to make noise about taking back the emergency power that the President is using to implement the tariffs. While still symbolic at this point, members of the House are also joining the effort. Despite the mounting pressure, no one wants to be seen as unsupportive of the President’s policies.

• • An important priority for Republicans in high-tax states, like NY, NJ and CA, is the $10K cap on SALT (State & Local taxes) that was introduced in the 2017 tax cuts discussion. One early version of the tax bill would lift the cap to $25K, although that doesn’t appear to be enough for several swing Republicans. For those who want more information on SALT, the CRS issued a report breaking it down.

• • As expected, Republicans won two special elections to replace Congressional members nominated for Administration posts, although by lower margins than expected. Meanwhile, Democrats won the hotly contested Supreme Court seat in Wisconsin. Here’s one take on what it all means.

• • One very useful CRS report from the week: With FMAP being in the news (although not seen as a likely target for Medicaid cuts), the CRS broke down what FMAP is, how’s it’s calculated, and a breakdown of FMAP rates by state. You can access a copy here.

AGENCIES:

Late on Friday, CMS released the 2026 Medicare Advantage final rule. The final rule will be published to the Federal Register on April 15^th, but for those so inclined you can access a pre-release copy of the relatively svelte 438 page final rule here (PDF). A good summary can be found here. The final removes two key parts of the original proposed rule:

• • The rule no longer requires plans to cover weight loss drugs.

• • They also removed the guardrails that were put into place on the usage of AI, although the rule acknowledges that CMS is still working on figuring out the right way to regulate AI’s usage in healthcare.

The 2026 SNF payment rule remains at the White House’s Office of Management and Budget (OMB), pending final review.

As the chaos continues at HHS, with more layoffs followed by reinstatements, they laid out the vision for a more lean, focused agency. The layoffs have affected several hotlines that the public uses and portend a more stressed, short-staffed agency.

Dr. Oz was confirmed to lead CMS.

Although the DOJ filed a brief in support of the Biden Era nursing home mandate, it’s important to note that it’s standard practice for the DOJ to support Administration actions until they are officially rescinded.

FROM THE NOTEBOOK:

• • The Kaiser Family Foundation explored the role that immigrants play in the long-term care direct workforce.

• • While the first Trump Administration made hospital price transparency a major priority, it’s still not clear that it’s actually helped bring consumer spending down.

• • For the first time in years, Florida is starting to push back on the Governor’s priorities.

• • Even as the federal government continues to explore cutting Medicaid, red states continue to keep pursuing Medicaid expansion, with Montana extending the state’s participation in the program.

• • The state of Alabama released a report from a state task force that showed nearly 25% of state agencies are using generative AI. The full report is available here (PDF).