Cause and Effect: Understanding Federal Delays

The Trump Administration has put a hold on a federal program designed to increase oversight of hospice care, which receives over $25 billion annually from Medicare. This pause is meant to root out and eliminate fraud and waste and address fraudulent billing and improper patient enrollments.

The program, initiated during the Biden administration, required noncompliant hospices to take corrective action or face expulsion from Medicare. The pause amounts to a win for the hospice industry, which said the Biden plan would penalize well-meaning operators without identifying underperforming ones.

Also, agencies must undertake a sweeping legal review by identifying regulations that—in the context of this administration’s views—are unconstitutional or “raise serious constitutional difficulties;” are based on “unlawful delegations of legislative power;” implicate issues of social, political, or economic significance that are not clearly authorized by statute; or are inconsistent with “the best reading” of the agency’s statutory authority. With this directive, President Trump is requiring agencies—in consultation with DOGE, the U.S. Office of Management and Budget (OMB), and the Department of Justice (DOJ)—to identify rules that current leaders believe raise constitutional questions or administrative law issues. This includes identifying rules that could implicate the major questions doctrine, the nondelegation doctrine, and recent Supreme Court decisions such as Loper Bright.

It is not clear how the U.S. Department of Health & Human Services (HHS) and other key health care agencies will approach this directive. But this process likely puts many health care rules in the crosshairs. In addition to the prospect of litigation by outside parties (as was predicted after Loper Bright), many current health care rules could be targeted by those entrusted with enforcing existing requirements and implementing major health care programs like Medicare, Medicaid, and the Patient Protection and Affordable Care Act (ACA). Indeed, the executive order explicitly directs agencies to, where appropriate, deprioritize enforcement of rules that it believes are potentially unlawful, which could lead to the termination of civil or criminal enforcement efforts and the use of additional enforcement discretion.

Agencies must conduct a policy review by identifying regulations that—based on this administration’s views—impose significant costs on private parties that are not outweighed by benefits to the public; impede technological innovation, infrastructure development, disaster response, inflation reduction, research and development, economic development, energy production, land use, or foreign policy objectives; impose undue burdens on small business; or impede private enterprise and entrepreneurship. Trump administration leaders are expected to use this process to identify ACA or Medicaid rules that, for instance, it believes do not benefit the public or impose significant burdens on private industry.

This approach appears to be consistent with that of the first Trump administration and the deregulatory efforts discussed above.

In other news, Dr. Mehmet Oz was confirmed April 3, 2025, which surprised me. I just didn’t know that the HHS Secretary was confirmed so much later then the President was confirmed. The confirmation of a Cabinet Secretary — like the HHH Secretary—is a process that follows the presidential inauguration. The president is sworn in on January 20, but Cabinet nominees require Senate confirmation, which can take weeks or even months.

Nomination happens soon after inauguration (sometimes even before).

Senate hearings and confirmation votes depend on committee scheduling, political negotiations, and background vetting.

April 3 confirmation, like with former HHS Secretary Alex Azar (in 2018) or Xavier Becerra (in 2021), isn’t abnormal.

So… is there no HHS Secretary until April?

Technically yes, but practically no.

There’s always someone in charge — even if not the Senate-confirmed Secretary.

During that time: an Acting Secretary is appointed — usually a senior career official or someone from the prior administration who’s willing to stay during the transition.