There will be no Digest next week. We will return on Monday, February 10^th, when we’ll be at eCap. If you’re there, come say hi!

WHITE HOUSE:

What a busy first week for the new Administration! In his first week in office the President signed more than 50 official actions as either proactive executive orders or rescinding prior Administration actions. While many executive orders are performative in nature, they can represent a profound shift in federal policy. This is a good breakdown of how Executive Orders work and when they can be overturned. This is an ongoing updated list

of the many different actions the President is taking. For our purposes, let’s focus on a few that have the chance to be a real difference makers, either directly or indirectly, for us:

• • Immigration: The President declared a national emergency at the border, closed it, and is giving states more authority to deal with immigrants. The challenge, of course, is that immigrants play a vital role as caregivers and any limitation in legal pathways can exacerbate the workforce shortage.

• • Artificial Intelligence: While it doesn’t mention specific policies or actions, an Executive Order was issued to revoke the prior Administration’s actions on AI. The President also announced a $500 billion public-private partnership with OpenAI, among others, to spur investment in AI infrastructure. The announcement caused an internal rift when Elon Musk criticized the effort.

• • DOGE: Speaking of Musk, his new Department of Government Efficiency is starting to come to shape with an EO officially establishing it. It turns out that DOGE will repurpose an existing federal agency, the United States Digital Services agency, which cuts out a lot of the bureaucratic red tape involved in forming DOGE. This is a good breakdown on how the agency will work. One early target? The penny.

CONGRESS:

While the President is focused on federal policy, the hard work for Congress is underway. With practically no majority, GOP Speaker Johnson will likely need Democratic support to pass anything, which is going to complicate the politics involved. There are two major agenda items, both of which will involve funding fights:

• • Reconciliation: this is the big one that the GOP will attempt to use to enact significant parts of the President’s agenda, including an extension of many of the tax cuts passed during the first Trump Administration as well as border security. The challenge is figuring out how to pay for it. With an estimated cost of more than $4 trillion, Congress is looking under every couch cushion for spare change, including many programs that impact healthcare, like Medicaid and provider taxes. While mainly targeting the expansion population, these programs are popular and upending them can be very politically difficult. Reconciliation is going to be a major topic for the GOP retreat over the next few days, as Speaker Johnson would like to get the necessary procedural stepsdone by February.

• • Government Funding: Let’s not forget that the government is currently being funded by a short-term deal that expires March 14^th. Unlike Reconciliation, this is what Congress needs to pass to keep the government open and operating. The top four appropriators got together for a “four corners” meeting last week to begin the conversations, but as with all things funding, the political math to get something done is very challenging.

Elsewhere in the political world:

• • The Administration issued a pause on all public health agencies communications through at least February 1^st. A copy of the memo can be found here. McKnight’s explored the implications for the sector.

• • While the confirmation hearings on the Hill continue, here’s a look at some of the acting leaders for the agencies, while here’s background on the acting director for HHS.

• • Nearly 20 sitting lawmakers are thinking about leaving Congress to get involved in a gubernatorial race, potentially further shifting the political dynamic in DC.

• • Although one of the executive orders implemented a new governmentwide hiring freeze, the VA said that more than 300,000 health care positions are exempt. This is a good summary.

• • Senator Elizabeth Warren is trying to get in on DOGE as she sent Elon Musk a 21-page letter outlining 30 ideas for DOGE to limit government spending. Among the healthcare recommendations are going after MA plans and PBM’s. You can access a copy of the letter here (PDF).

AGENCIES:

With the healthcare agencies are mostly shut down at the moment in terms of their public facing efforts (as mentioned above), it’s a quiet week on the regulatory front. One note from the final week of the last Administration. They delayed the implementation of the new survey process until March 24^th. You can access a copy of the QSO here (PDF).

FROM THE NOTEBOOK:

• • In the final weeks of the last Administration, CMS picked another round of 15 drugs for the Medicare Drug Price Negotiation program. Following the announcement, the Kaiser Family Foundation updated their brief on the program.

• • We’ve tracked the state of Washington’s effort to roll out a long-term care insurance program. In November, voters supported it and now advocates are calling for ways to strengthen and expand the program.

• • Indiana is working on legislation that would limit the usage of AI for prior authorizations.

• • Fierce Healthcare did a deep dive into the healthcare implications of the first week of the new Administration.