WHITE HOUSE:

Over the last two weeks, the White House focused on an Executive Order limiting the scope of the Department of Education, working to expand American mineral production, bringing manufacturing back to America, continuing to unwind the prior Administration’s Executive actions (the Executive Order with the full list is here), working to create a new strategy to better empower states and localities to navigate emergency preparedness, continuing the effort to reduce the federal bureaucracy, and looking to better share information across federal agencies. 2 items of interest to us:

• • The President issued a public proclamation that the White House will “protect” Social Security, Medicare, and Medicaid. While the proclamation has no force of law, and it doesn’t automatically protect against the wonky provider tax conversations that are happening in Congress as part of the Reconciliation effort, it provides hope the White House understands the damage that cutting Medicaid would have on the American public and the states.

• • The President signed an Executive Order that looks to consolidate government procurement into one centralized agency, under the auspices of the GSA. In theory, especially for those who do business with the federal government, this should make it easier to navigate the arcane government procurement process and make it easier for vendors and the public to track business.

CONGRESS:

As expected, Congress passed a Continuing Resolution that will fund the government through September 30^th. Unexpectedly though, the CR passed with nearly no Democratic support in the House. After initially saying he won’t support the bill, Senate Democratic Leader Schumer ultimately led the vote in support of the CR, averting a government shutdown. The flipflop has led to serious questions about Schumer’s ability to continue to lead the party and left Democrats in disarray as they search for a path forward against a unified GOP. With the conversation shifting back to Reconciliation, which continues to stall in the Senate, it’s go time in DC if they want to get Reconciliation moving by April. Elsewhere in DC:

• • The latest on reconciliation? Get ready to wonk out! With the difference between the House and Senate versions coming out to nearly $2 trillion, the Senate GOP wants to use a strategy called the “current policy baseline” to bring the cost down. For our purposes, it would essentially revise the estimated cost of the bill down significantly, which would limit the amount of cuts needed for it to pass. As expected, opinions on the tool differ if you’re a Democrat or Republican, but these are the nuances that can make all the political difference in the world. Having said that, even some Republican members are balking at the cost of the bill.

• • Get ready for yet another round of tariffs as the White House announced that they’ll release a new set of retaliatory tariffs on April 2^nd .

• • With the White House basically muscling the Continuing Resolution through, and Reconciliation essentially being handled by House Speaker Mike Johnson and Senate President John Thune, the traditional role of Congressional Appropriators are in danger of being set to the side.

• • An important state-level race for a seat on the Wisconsin Supreme Court is an early test for Democrats as they search for messaging in the Trump era.

• • We’ve discussed at length how Congressional members continue to get older. An important read from Politico on how one Congresswoman disappeared for weeks, only to be found later living with dementia, and the folks in DC didn’t notice.

• • The Congressional Research Service is a non-partisan advisory group that provides background and information to members of Congress on different relevant topics. They recently modernized their system and made it easier to access. Two reports from the past two weeks of interest:

• • A guide to non-citizen eligibility for Medicaid.

• • An update on the legal challenges to the recent federal buyout offers.

AGENCIES:

An important update from the IRS on how to handle ERC claims and tax returns.

CMS announced that they had signed agreements with the manufacturers of the 15 drugs selected for the second round of drug pricing negotiations.

CMS announced that they are ending several innovation model programs early as they seek to better align the organization’s goals with the Administration’s new policies.

At his confirmation hearing to lead CMS, Dr. Mehmet Oz said that he wants to take a close look at Medicare Advantage plans and acknowledged that the government often pays MA more for worse outcomes than they do traditional Medicare.

The OIG at HHS found that state survey agencies need more guidance from CMS on how to properly survey SNF’s for emergency preparedness, finding that surveyors are often lack the expertise necessary to properly survey facilities. The full report is here (PDF) and the summary is here (PDF).

The OIG at HHS released an audit of Medicare Administrative Contractors and found that they did not “consistently meet” federal requirements for cost reporting. The full report is here (PDF) and the summary is here (PDF).

In at least one area, HHS is continuing the efforts of the prior administration: continuing the legal fight against 340B rebates.

The Social Security Administration announced that beneficiaries will no longer be able to make changes over the phone, but will have to visit in person to make changes to their direct deposits.

A facility in Missouri won a TRO against HHS preventing the termination of the program from Medicare.

FROM THE NOTEBOOK:

• • A very helpful guide from the Kaiser Family Foundation breaking down Medicaid enrollment by Congressional district.

• • They also provided a helpful context to the ongoing debate in DC regarding reconciliation, highlighting the fact that most states simply cannot afford to replace federal cuts for Medicaid. Additionally, they released a guide to trying to define the terms for what actually would constitute “fraud, waste, and abuse” in Medicaid and Medicare.

• • It’s not official policy, but a very influential think tank with ties to the Administration released a new white paper pushing for a policy that was discussed during the first Trump Administration to keep drug prices down: global reference pricing, which would tie what Americans pay for drugs to what foreign countries pay. Axios has a good summary.

• • Pennsylvania is thinking deeply about how the state funds long-term care and if there’s a better way to do it. One way? Maybe it’s time to eliminate the “Budget Adjustment Factor” (PDF). Thanks to PHCA for taking the time to explain the wonky inner workings of Medicaid.

• • Idaho passed a law that will add work requirements and privatize Medicaid.

• • A new report found that more than 5 million adults would lose access to Medicaid benefits if work requirements were enacted.

• • California’s Medicaid program is facing a significant shortfall and the Governor is asking the Legislature for an immediate infusion of $2.8 billion.

• • A close look at Indiana’s UPL program from the Indy Star.

• • For now, it looks updates to the Special Focus Facility list remain on hold.