WHITE HOUSE:

The White House this week instituted new tariffs on Venezuelan oil, imported cars and automobile parts, exempted several federal agencies from collective bargaining requirements, and issuing a new executive order that strengthens citizenship verification requirements to participate in federal elections. Three items of interest for us:

• • In an effort to combat fraud and “modernize America’s bank account”, they issued a new Executive Order that will phase out the usage of any paper checks/payments by the federal government by September 30, 2025. Although this will, in theory, speed up disbursements and payments, for those that rely on paper checks there may be growing pains when the system gets implemented later this year.

• • They also issued an executive order that essentially requires any government payments to get clearance from the Treasury department, even from those agencies that historically have had the legal right to disburse funds.

• • The President sent a letter to the White House’s Office of Science and Technology Policy directing the office to identify how to accelerate the country’s role as a leader in emerging technologies. Although no new policies are spelled out in the letter, it signals that the White House is serious about bringing the deregulatory agenda to areas like artificial intelligence and quantum computing.

CONGRESS:

The discussions over Reconciliation are heating up in the Senate as they continue to seek a path forward. With time dwindling before the mid-April recess, Senate Majority Leader Thune told his members to expect a vote next week on the Senate’s version of the bill. Despite House pressure on the Senate, the next step in the process is up to the Senate. We’re not gonna get too wonky here, but the Senate is planning on structuring their version differently than the House’s, which they hope will give them wiggle room to avoid the political pitfalls that come with the House’s version that make such deep cuts to Medicaid. With news this week that the country might hit the debt ceiling earlier than expected, the Senate is on the hot seat. Elsewhere in DC:

• • Following a Democratic win in a deep-red state senate seat in Pennsylvania, the President pulled the nomination of Congresswoman Elise Stefanik. The move, intended to preserve the GOP’s narrow House majority, highlights the concerns that Republicans are having about the political environment.

• • Another early sign for the GOP? This week’s hotly contested election in Wisconsin for control of the state’s Supreme Court.

• • Despite growing discontent with the way he handled the government shutdown, there doesn’t appear to be a viable alternative to Senator Chuck Schumer to leading the Senate’s Democratic caucus.

• • Is Congress starting to grow a backbone? Two top Congressional appropriators sent a bipartisan letter (PDF) to the OMB highlighting their concerns with the way Congress has been sidelined in the appropriations conversations. This is the most public pushback yet from Congress, even as they make subtle moves that don’t always align with the Administration.

AGENCIES:

The BOI reporting requirements are officially done with the filing by FinCEN of an interim final rule removing the reporting requirements.

HHS announced that they’re “restructuring” as they eliminate nearly 10,000 full time employees and shutter regional offices. A more thorough breakdown of the office closures and how they want to structure the agency is available at the Federal Register.

The only agency that appears to have any profile these days, DOGE, led by Elon Musk, had their first interview this week. The interview came during a very rough week for the Social Security Administration following DOGE cuts. The interview led to solid insight into the process that DOGE is using as they enter each agency as well as who is part of DOGE’s team.

HHS announced more than $12 billion in cuts to federal grants to states.

FROM THE NOTEBOOK:

• • The Kaiser Family Foundation updated their guide to provider taxes with a breakdown of each’s state’s provider tax, an enormously helpful resource in understanding just how important provider taxes are to healthcare funding. They also explored the direct impact to state budgets and how they fund Medicaid. Should the cuts go through, it’s not gonna be pretty for state Governors that need to balance their budget…..

• • It’s not just direct healthcare spending that’s at risk. The deep cuts to Medicaid have an economic impact well beyond healthcare, with one estimate published this week showing that it would cost more than $100 billion in economic losses and thousands of job cuts. Another report this week estimates that healthcare employment is the largest industry by employment in the country.

• • CALPERS, one of the largest state pension funds, filed a lawsuit against United Healthcare for their MA practices.

• • Optum said they’re changing the way they reimburse pharmacies. Fierce Healthcare has a good summary.