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WHITE HOUSE:

As the new Administration enters its third week, and the Executive Orders continue to fly fast and furious, it’s hard to overstate how many actions they’re taken that represent a significant shift from the previous administration. From foreign policy to educational goals to reversing diversity initiatives, the Administration has issued more than 80 EO’s in the past 18 days! Let’s highlight a few that are poised to have an outsized impact:

• Deregulation: After making deregulation a central feature of the first Administration with a 2-1 repeal to enactment goal, they’re significantly upping the game this time with a 10-1 effort. The full text of the EO is here.

• Tariffs: In an effort to stem the flow of illegal drugs the President announced tariffs on Mexico, Canada & China. While those for Mexico & Canada are currently on hold, the tariffs for China went into effect on Tuesday with China announcing retaliatory tariffs. Although they amended the EO earlier yesterday to allow the $800 de minimis exemption to continue, there’s a real concern that this can have a significant financial impact on healthcare related items. To that end, the American Hospital Association sent a letter urging a carveout for medications and medical devices. It’s also a significant challenge for healthcare supplies.

• FEMA: Following up on the perceived lackluster federal response to last year’s hurricanes and the devastating wildfires from earlier this year, this EO is designed to take a long look at FEMA and the role it plays in the response. As FEMA is the epicenter for federal funding in the wake of natural disasters, and the massive impacts those disasters have had on SNF’s, this is another important agency trend to keep an eye on.

• Funding Freeze: While it happened last week, the federal funding freeze that impacted grants and other federal programs remains caught up in litigation, and reports continue that many states are having difficulty accessing federal funds. Although Medicaid was not included in the freeze, the uncertainty that remains in the wake of the freeze highlights the real-world impact that the Administration’s diligent efforts to limit the federal government may have.

With so much happening via the Administration, a few useful tools to keep track of it all:

• Executive Action: A simple tracker from CNN with links to all the different actions the White House have issued.

• Executive Action with comments: The law firm Gibson Dunn created a tracker with context and a summary of each action.

• Litigation: As to be expected with the fast and furious pace of executive actions, the lawsuits are piling up. This site tracks all the different cases that have been filed.

CONGRESS:

As the White House continues it blistering pace on administrative actions, Congress continues to move at a more…. deliberate pace. Despite the looming March 14^th deadlineto fund the government, there has been little progress on striking a deal. With Democrats unhappy with the way the Administration has gone after USAID amid the lack of a Congressional Republican response, and the razor-thin GOP majority necessitating some Democratic buy-in, Democrats will have some leverage, although whether a government shutdown helps or hurt is an open question.

In the other funding battle, talks on the party-line Reconciliation bill continue. With a growing wish list and a need to find revenue, there’s a real concern that Medicaid cuts might be on the table. For now, it appears that the main target is the expansion population and not the core Medicaid beneficiaries, although that can change as they search for deeper cuts. On Friday, Senate Republicans released a budget resolution that is less ambitious (i.e. costly) than the House’s effort. The Senate version, released by Senator Lindsey Graham, focuses only on security and would leave the thornier tax issues to later this year. Despite the Senate proposal, House Speaker Johnson remains focused on producing one big bill by next week. The political math gets tougher with each passing day, but for now, it’s a waiting game. Elsewhere in the political world:

• Although Congress typically serves as a check on an Administration, for now, this Congress is giving the President a lot of leeway.

• Despite serious questions about the legality of the Administration’s buyout offer, more than 60,000 federal employees have accepted it.

• Following the funding freeze, Governing did a deep dive into just how dependent state budgets are on federal dollars, with nearly a third of state’s revenues coming from the feds.

• Is it ever too early to think about elections? The Cook Report released their first look at the 18 toss up races in the House for 2026.

AGENCIES:

As the federal agency communications freeze continues indefinitely (including star ratings data) past the originally scheduled end date, the only ”agency” making any noise right now is DOGE. Despite internal discontent, Democratic pushback, and multiple lawsuits, Elon Musk’s DOGE continues it work to reshape the federal government. After targeting USAID, the agency is now focused on the Consumer Financial Protection Bureau. CMS itself posted a notice that they are collaborating with DOGE. Adding to the noise, there’s reporting that the White House is preparing another Executive Order that would fire “thousands of employees” at HHS. For now, Musk’s efforts continue with the President’s approval.

FROM THE NOTEBOOK:

• Recognizing the potential threat to their own budgets, state governors are establishing DOGE-like programs at the state level to get ahead of potential cuts.

• As state legislative sessions continue, NCSL looked at some of the legislation dealing with prescription drugs.

• With Medicaid spending a key topic of conversation in the DC funding discussions, the Kaiser Family Foundation explored Medicaid trends in three distinct areas: 1) work requirements for those eligible; 2) seniors, and 3) the five largest Managed Medicaid plans.

• Optimism about the future of Medicaid is coming from an unlikely source: Molina Healthcare thinks that real cuts are unlikely.

• JAMA did an analysis of the many preventative measures issued in SNF’s during Covid and found that few had clear evidence that they were effective…

• As the Administration continues its efforts to revamp the federal government, efforts are underway to preserve government data even if the agency scrubs it.