Takeaway: The White House rolled out a load of EOs, none of which were too surprising; HCA is getting into PPE; and ARK does not like ILMN

Editor's Note: This is a complimentary research note published by Healthcare Policy analyst Emily Evans. CLICK HERE to get COVID-19 analysis and alerts from our research team and access our related webcasts.

Healthcare Policy Moves |  Executive Orders Abound But $HCA Waits Not - 01.27.2020 coronavirus cartoon  6

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As the vaccine deployment ramps, the new Biden administration's goal of 100 million vaccines in 100 days seems a bit modest.

A bigger question for the White House is why normally resouce rich states like California are struggling with administration (36% of delivered doses) while poorer states with limited tax bases like Tennessee (51% of delivered doses) are performing well.

Healthcare Policy Moves |  Executive Orders Abound But $HCA Waits Not - 20200122Chart of the Week

This week was all about the inauguration. While we are partial to all the pomp and parties that usual go along with the installation of a new president, Wednesday's events were quite well done, all things considered.

The rest of the week was dedicated to rolling out Executive Orders and other immediate actions President Biden has been previewing for several months. 

  • COVID Response. Thursday, President Biden released his National Strategy for the COVID-19 Response and Pandemic Preparedness Plan. The plan is what you would have expected and very similar to what the transition had promised. It lays at seven goals. The most important of those is a plan to have 100 million vaccinations in the first 100 days. The deployment program was well underway by Wednesday, causing some to suggest the new goal should be 200 million instead. Other important aspects of the plan call for using the Defense Production Act to accelerate vaccine production and more and better data collection and dissemination on testing, hospitalization and vaccines as well as increased survelliance through genetic sequencing. ($ILMN). The plan also calls for a mask mandate on federal property among other places. What the plan does not, and really cannot, do is alter the state-federal partnership of the COVID-19 response. The president has called for paying for National Guard involvement in vaccine deployment, something that has worked well in Tennessee and West Virginia.
  • Rule-A-Rama. The White House issued a directive to halt release of any rules for publication in the Federal Register until a Biden appointed/desgnated agency head can review. The regulatory freeze also calls for any rule sent to the Office of the Federal Register but unpublished to be recalled and subject to review by Biden appointed/designated agency representatives. Rules that have been published in the Federal Register - and these include the Most Favored Nation Rule, the Drug Rebate Rule and the Part D protected class rule - may have implementation delayed for 60 days subject to the judgement of the agency. During the 60-day delay, the White House has asked the agencies to consider another 30-day comment period. If no major issues are raised during the comment period, the rules will be finalized. If the proposal is controversial, the OMB Director will determine next steps.
  • Testing for All. Another Executive Order aims to expand testing and in doing so require insurers to reimburse even in the absence of symptoms. Current regulations from June require it only in the case of symptomatic individuals. The asks the Treasury, Labor and HHS Departments to clarify group health plans' (read: employer-based) obligation to cover COVID-19 testing. The ACLA, which is dominated by members $LH and $DGX, cheered the move for the obvious reason. Secondarily, the Biden administration is going to probably lean on employers much harder to help with COVID response and containment. A second EO calls on OSHA to consider emergency regulations on PPE and probably testing and vaccinations. Employer involvement in health care, long considered on the way out, is making a comeback, which makes $ONEM an attractive solution for some. $WMT and $AMZN Care are other employer-based models.
  • HHS, CMS and FDA Appointments. While the White House waits on confirmations, which is slow going given the power-sharing stand-off in the Senate, acting heads have been appointed at HHS, CMS and the FDA. Norris Cochran, Assistant Secretary for Budget, will stand in as acting HHS Secretary, as he did in January and February of 2017. Liz Richter, Deputy Director of the Medicare Center will step into Seema Verma's shoes. Finally, and most debated, Janet Woodcock will take the acting role at FDA. Woodcock has been at the FDA since Ronald Reagan was president, which naturally means loads of people have strong opinions about her. She was credited with pushing through approval of $SRPT's drug for Duchenne muscular dystrophy, despite weak evidence of effectiveness. If Woodcock is appointed as Commissioner, look for progressives to take issue with her "partner of Pharma" view of regulatory enforcement.

Not waiting on the federal government, $HCA announced this week it would be investing in the production of PPE through its Mission Fund which was created out of its acquisition of Mission Health in western North Carolina. Developing a dependable supply chain joins HCA's investments in labor through its acquisition of a nursing school and the support for the new Belmont School of Medicine at Belmont University in Nashville. The move also signals an important shift toward on-shoring and near-shoring of materials critical to the health care infrastructure. Expect more of it. Worth a look at how $PINC and others will respond as well.


News is that ARK had some unkind things to say about $ILMN, all of which may be true. However, it is worth remembering that the federal government is pouring gazillions of dollars into genetic research, not just at NIH but also the Dept of Energy, at the new Agro-Defense facility and at labs across the US.

With a pandemic pressing, adopting new technologiy seems like a stretch, at least in the near term. That said, $PACB will make things interesting.

Healthcare Policy Moves |  Executive Orders Abound But $HCA Waits Not - tweet of the week 01222020

Upcoming Events

The Realities of a 50-50 Senate. Wednesday, January 27th @12:30PM  -  I am pleased to be joined next week by Chris Jacobs of Juniper Research Group. Chris is both knowledgeable about the procedures that define these possibilities for health legislation in the 117th Congress and the laws themselves. Chris's experience on the Republican side of the aisle also offers important insight into how the minority - just barely - will position itself on health policy.