AHLA's Speaking of Health Law

Key Health Law Developments From 2024 and What to Expect in 2025

• American Health Law Association

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Judith Waltz, Partner, Foley & Lardner LLP, Dionne Lomax, Managing Director of Antitrust and Trade Regulation, Affiliated Monitors, Inc., and Dee Anna Hays, Shareholder, Ogletree Deakins, discuss some of the key health law developments in 2024 and what to expect in 2025. They cover a wide range of legislative, regulatory, and judicial issues but mainly focus on Medicare and Medicaid, antitrust, and labor and employment. Waltz, Lomax, and Hays are editors of AHLA’s bestselling title, Federal Health Care Laws and Regulations, which contains a brand-new 2024 supplement.

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Speaker 1:

<silence>

Speaker 2:

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Speaker 3:

So, hello and welcome to our podcast this morning, the , the three of us today. My name is Judy Waltz . We also have Dion and Deanna here who will introduce themselves in just a second. Um, are here because of our involvement with the A HLA Federal Healthcare Law Regulations, I'm gonna hold up one of the , um, hopefully you can see it. My camera seems to not be cooperating anyway. It is, it is at the moment a four volume set plus a supplement. And this has the , um, not every single one of the federal healthcare laws and regulations, but it is an excellent , um, version printed copy . It also comes in digital. So the three of us were sub-editors , um, or co-editors, I think was the term that HLA used. The main editor for this version was someone named Bill Horton, who unfortunately died during the process. He was , um, very much beloved by HLA and all of us who, who worked with him. And so his name is on the cover. Um, and this version is in purple, but that's how the three of us came together. So what we are going to do today, first to introduce ourselves and then talk about our , um, substantive areas. So my name again is Judy Waltz . I'm based in the San Francisco office, which of Foley and Lardner , which if any of you can see , um, my Zoom background here. This is , uh, a , uh, picture taken from my office , um, showing Alcatraz , um, or whether today is not quite as good as <laugh> as it was when I took this picture. But it is just a , a lovely view. I am chair of Foley's Healthcare Practice. We have about 60 healthcare lawyers across the country. My personal background is that before I came to Foley, which was 26 years ago now, I was , um, assistant Regional council with the Department of Health and Human Services in San Francisco. So my entire career has revolved around the federal healthcare programs and , um, that's what I'm gonna talk about later today. So, Dionne , do you wanna introduce yourself and tell us ? Sure.

Speaker 4:

Yeah , sure. Thanks, Judy. Um , hello everyone. I'm Dionne Lomax and , um, I'm the Managing Director of Antitrust and Trait Regulation at Affiliated Monitors Inc. However, I'm also a law professor. I teach business law at , um, the RUM School of Business at Boston University. I teach in the undergraduate program, but I also teach in the online MBA program where I teach regulatory risk management. So that's fun . And I also have a courtesy appointment at BU Law where I occasionally will teach a healthcare antitrust course. So, so happy to be here. But , but before all of that, I was a partner at two , um, national law firms where I exclusively practiced in the healthcare antitrust area. And prior to that, I was a trial attorney at the US Department of Justice Antitrust Divisions Healthcare Task Force .

Speaker 3:

Thank you, Dionne . And Deanna, how about you?

Speaker 5:

Hello, everyone. I am Deanna Hayes. I am a shareholder or partner attorney at Ogletree Deacons Tampa office. So , um, also have a nice view. Unfortunately, you can't see it in the video screen , um, but it's nice. I , I know in December it's quite cold in some other places, and Dion said she had some snow this morning, so definitely don't have that here in Florida. So I have been involved with a HLA for many years and really value the organization. I think it produces great content and great networking opportunities. I am board certified in Labor and Employment Law by the Florida Bar. It's all I've done for my career , um, was with a different firm before joining O Ogletree and now co-chair Ogletree Multi-State Advice and Counseling Practice group. And I'm active in our healthcare industry group as well. Glad to be here.

Speaker 3:

So Dion , I think we were going to go with you first telling us about developments in antitrust.

Speaker 4:

Mm-hmm <affirmative> . Yes. Okay. Um, I will try to make this brief, although there has been a lot happening, but before I even get into the enforcement issues, what I really wanna highlight is that there have been some very significant policy changes at the federal agencies that I think really have been shaping enforcement trends and will continue to shape enforcement. Trends to note have been essentially the withdrawal of a number of longstanding guidelines. Of course, that started last year, but the most recent was literally hot off the press just last week. The DLJ and FTC rescinded the antitrust guidelines for collaborations among competitors. Now, that's significant because those guidelines have been out there since 2000 <laugh> . And so similar to what we heard from the agencies last year when they withdrew the healthcare guidelines, the agencies have pretty much said, look, you know, we don't think, given the healthcare, well just not, well, of course we're talking about healthcare, but generally speaking, given the different current market dynamics, we don't think that these guidelines as they exist today, are really reliable for businesses to be able to use as they assess their collaborative activ activities. Now, of course, businesses are like, well, wait a minute. There , there were pro-competitive examples in there. There were safety zones that were helpful, but the agency say, Hey, look, you've got statutes you can look at, you've got ongoing case law. And so we think that, you know, obviously we're gonna be looking at things and analyzing things on a case by case basis, and the business community should do the same. So that's number one. But number two, you also had back in, I wanna say may you had the formation of the Department of Justices healthcare Monopolies and Collusion Task Force . Now, it still remains a bit murky and unclear exactly what they're going to be investigating, but one thing is for sure about that task force is that it is, I think, designed to get at , uh, and , and look at these more and more integrated healthcare platforms. And so this task force has economists and healthcare care industry participants, and of course lawyers and data scientists. And so, you know, it remains to be seen exactly what their activities will be, but, but everyone's kind taking a wait and see approach beyond that. Of course, on the heels of that, you also have what I thought was pretty interesting, the development and the launch of healthy competition.gov, which is a public facing portal, I think designed to be the eyes and ears of the agency as different things are happening in the healthcare community. Um, trying to leverage a little bit more of that input from the, from the public to see if they can, I think, find out about especially roll up transactions and things of that nature sooner rather than later. And then we also have the proposed changes to the Hart Scott Rodino Act , um, which are being touted as some of the most significant changes since the inception of the act of 1976, really trying to mandate more significant disclosures of things like what's the deal purpose and, and what are the various corporate relationships that exist at these different entities. Really trying to, again, once again, I think this is trying to get at what we see what's happening with private equity, especially private equity in the healthcare area. They're asking, Hey, you know, what, prior acquisitions have taken place over the last 10 years. So those are some very significant policy changes, developments that I think that are gonna have ramifications for years to come. Now let me tell you just a few, three or four major enforcement actions that have happened over the past year. One, of course, most recently is the Department of Justice filed a lawsuit to block and challenge UnitedHealthcare's $3.3 billion acquisition of AIM Diocese , which is an entity that would bring together, which is a home health and hospice entity. So the DOJ is concerned, of course, about consolidation in that area to the detriment of consumers. You also, of course, have what I think is just a continuation of the Federal Trade Commission's focus on pharmacy benefit managers looking and analyzing pharma pharmaceutical supply chains and pricing practices. And so of course, the three largest PBMs, Caremark, express Scripts and OptumRx have been sued with allegations that they are engaging in anti-competitive rebate practices that inflated the cost of insulin. You also had a , uh, hospital merger that was walked away from, I should say , um, Novin Health abandoned its acquisition of two North Carolina hospitals from community health systems , um, after the fourth Circuit court of appeals, granted the FTCs request for preliminary injunction, and then even on the private side, you had back in May , uh, three, health systems suing MultiPlan, claiming that this repricing tools that they're using and the algorithms that they use for these repricing tools essentially is giving MultiPlan the ability to collude on price with other health insurers. I'll stop there and let you all talk about your areas

Speaker 5:

<laugh> .

Speaker 4:

So Deanna,

Speaker 5:

I think you're next. So , uh, like Deion said, we've had a lot of activity in the labor and employment space over the past year, and things may continue to change because anytime we have a shift in political administration, there tends to be a shift in labor and employment issues because it seems that the parties have different enforcement priorities that come out with rulemaking. Um, so the two kind of really key areas, I would say over the past year that many employers have been watching, particularly those in healthcare, have been the FTCs rule , potentially banning non-compete agreements, and then also the Department of Labor's rule that would have raised the minimum salary threshold for exempt employees. So both of those rules are currently blocked, but are also pending appeal. So taking them piece by piece here . So what the FTCs non-compete would have done it , it noncompete rule would essentially have prohibited employers from having that type of agreement. And it was unclear how far that might extend into other types of restrictive covenants, like non-solicitation clauses as well. Um, the agency had basically just issued guidance saying anything that would effectively be a non-compete , um, in effect they would treat as such, even if it's called a non-solicitation or non-disclosure, if there's no way that that employee could then work for a competitor because of that restrictive covenant. There were actually three different cases challenging that FTC role . There was one in Texas, it seems like that is the forum of choice when it comes to challenging government regulations as district court in Texas. So we had a Texas case, and that was , um, Ryan, LLC versus the Federal Trade Commission. Um , we had , um, another case in the middle district of Florida, which is in my neighborhood. It was properties of the villages versus the Federal Trade Commission, and then yet another case in Pennsylvania, a TS Tree Services, LLC versus the Federal Trade Commission. Now, the Pennsylvania case is a case where the judge declined to grant a preliminary injunction saying that it thought that the FTC had acted within its authority and ultimately a TS tree service did not pursue the injunction in that case, probably because the other two cases were pending in the Texas case. First we had a preliminary injunction that applied only to the state of Texas, and now we have a nationwide injunction that is in place. And similarly, we have the same thing in Florida, right? So the FTC has appealed both cases, probably hoping that there could potentially be a split and we would end up in the Supreme Court. So that is something that might happen. However, it's not clear how , uh, president Trump's administration will approach these lawsuits. They may decide to , um, drop the appeals or enter into some type of settlement agreements that would include withdrawing the rule in its current form. So definitely something to continue watching for employers. And really this is an area where the states aren't waiting for the federal government to come up with its own restriction. Um , more and more we're seeing states have very specific rules about whether or not non-competes are allowed in the first place. And we have several states that have an outright prohibition when it comes to non-compete provisions . Uh , California, which Judy May be <laugh> familiar with because that's her home state also , uh, Minnesota, Nebraska and North Dakota and Oklahoma, there are many other states that requires some type of additional consideration beyond the employment relationship to make that type of agreement binding. And then another, a good amount of states have compensation related requirements where an employee has to make a minimum salary or , um, pay rate before you could have an effective non-compete agreement with that employee. So, as a best practice or takeaway, if you haven't looked at your non-compete agreement template in a while, or really all of your restrictive covenants, when it comes to non-solicitation, non-disclosure, it's a good time to do that and know that one size really does not fit all. So what you have in Florida probably won't work in California , uh, or Massachusetts. So something to be on the lookout for , um, with the DOL overtime rule. So what this rule would have done is raise the minimum salary threshold for exempt employees, and it would have done it in two steps. So the first step actually did go into effect. It was on July 1st that raised the minimum salary , um, to 43,888, and then January one that was set to raise to 58,656. So significant increases there. Um , we had a , a nationwide injunction of that rule as well. And the DOL appealed at the very end of November on November 26. And that case is called Texas versus Department of Labor, if you're tracking that one. Um, so this is another one that's interesting because the whole rule has essentially been invalidated, and the court found that the agency exceeded its authority in setting those minimums and also in building in an automatic increase to those amounts every three years. It's really hard to walk that back. As you may know practically, if you're an employer, if you already raised salaries with that July 1st deadline. Um, but you know, perhaps you decided to make some of those folks non-exempt rather than raising salaries and keeping them , um, as exempt employees, then you could feasibly put them back as exempt employees provided that they meet the job duties test . And that's really what this court said at the end of the day, is that the agency made it all about pay and really completely ignored the job duties test , which are the core component of whether or not an employee should be treated as exempt. And quickly. This is another area where we've seen states, again, not wait for the federal government to raise the threshold. We have , uh, several states, Alaska, California, Colorado, Maine, New York, and Washington that currently have higher minimum salary levels for exempt employees than the current federal level. So if you're in one of those states, you still have to follow those rules despite the, the federal injunction and ban. And we think that this is something that probably is going to be a trend in other states as well, if we don't have a rule that becomes effective, that raises the, the bar nationwide. So another area to continue watching.

Speaker 3:

Thank you, Deanna. So this is Judy again. For those of you who are , who don't have the advantage of seeing us on camera , um, I'm going to talk about the federal healthcare programs and the changes that came about this year and, and some trends. So one of the things I was thinking about last night was to go back and look at what new things were rolled out. And this is one of the things that we do as part of our review of these , um, of these federal healthcare law and regulations , um, books. And , and I always focus on the new provisions. There are always tweaks to every, not to every, but to the statutes and to the regulations. You know, one provision has changed or something is added, but the ones that I focused on were the new ones, and they, there really were not , were not very many new things that came out of this , um, last Congress or even with respect to regulations. So with respect to Congress, and we all know how Congress was functioning, there was only one completely new provision that came that was added in the last year. And that was , um, 42 USC 1396 W eight , which you could email me if you really were really interested. That deals with collection and reporting of comprehensive data for specific populations. So about as non, non-controversial as one could imagine data collection. So that was the only one in terms of regulations. Um, the regulations of course would be , uh, usually about a year or sometimes more , um, after the enabling statutes. And even here though, the new programs or new , um, completely new provisions were limited. Um, there was a whole section , um, actually two sections. 'cause one had to do with payment set up for the , um, new billing , um, requirements, not requirements, but the , the authorities , um, for MFTs and mhc, which personally I think is just a huge deal for , um, access for people with mental health issues, particularly in California. Uh , we have a lot of MFTs and MHC who can now provide , um, care to Medicare beneficiaries. Uh , lymph lymphedema compression. <laugh> also finally made it through, is it home? IVIG . Um, and then there were some significant changes to provider enrollment. Um, those were not completely new, but, but some , um, new things like a stay of enrollment. If you've got your paperwork , um, you , you don't have your paperwork adequately , um, pulled together to convince the contractors . So that is a , a very much a , a change in favor of , of , um, providers and suppliers in terms of where things are going or where things were headed. <laugh> as of last year, right now, I think it's very hard to say where things are headed. <laugh> after the inauguration, we're gonna have to, to wait and see. Medicare Advantage seems to be coming , um, a bigger and bigger focus of everyone. Um, the Medicare Advantage now, now cares for more than 50% of the Medicare population. Um, there was a, a very big rule that came out a year ago that's now kicking in , um, that has changes with respect to broker compensation, with respect to coverage rules, with respect to prior authorizations and many other things that will drastically change how those , um, programs are, are administered. Other things that have come up on the horizon. And again, we'll see how these, whether they survive into the new administration and how they, how they evolve, I'm sure they will at least evolve. We'll see whether they survive. Um, there's regulation on laboratory developed tests coming out of the FDA laboratory developed tests are exactly what they say. They're developed by one single laboratory. Um, there are a lot of advantages to LDTs, but the FDA has flipped back and forth over the years about how to regulate, and now has some final regulations out that will kick in , um, in a few years down the line. So time to, to revise them. There's also a continuing focus on private equity investment in healthcare. And that , um, we'll see how that plays out in the new administration. That one , uh, well that my own thoughts on , on that one. And there were also some long awaited changes to the overpayment refund , um, rule. So even if there wasn't as much regulatory change as has been the case in some prior years, there were some big, big cases, <laugh> that probably will upend , um, enforcement and all sorts of things about, about not only these new regulations have come out, but ones that have been in existence for a while . So the biggest one, of course, was Loper Bright , which overturned the deference , um, that had previously been given. It was called Chevron deference, but it , um, the doctrine applied a level of deference to agency actions that now is no longer , uh, required. We'll see how this plays out there. There seem to be two considerable considerably different views on this. One is mine, like it's just gonna cause a lot of chaos <laugh> at , at all levels. Um, there are other people are saying, you know, wait and see, it may not be so bad. It may not have have much of any impact at all. Chevron had kind of passed its prime, so to speak. So we'll see how all that plays out. I think personally it's going to result just in a lot more work for the agency, which means a lot more delay. And that , um, and we'll see how that one plays out. There were a couple others that, that came outta the Supreme Court just a couple days after Loper Bright to one was called esy , and no one that I know knows how to actually pronounce that name. So <laugh> JARAs is my Indiana accent and, and apologies if, if it's way off, but that's, that's my pronunciation, and I can't find anyone who actually knows. So what this case did is to say that , um, that under the SEC regulations, which allowed , uh, for an administrative hearing, that there was also a constitutional right to a jury trial <laugh> . And so this person darky , um, opposed his, his A LJ hearing and the court upheld the constitutional right for , um, for a jury trial. So I work a lot with OIG and with CMS , um, administrative appeals, and we'll see how, how this plays out here. I think some of the, the provisions from HHS could fall under the darky , um, approach. Others, I think hopefully would not, but again, I think it's gonna be a lot of delay and a lot of confusion in how, in how things play out. And there was a third case that came outta the Supreme Court. It was a big week , uh, for that , this one was called Corner Post . And this has to do with the statute of limitations and when an injury , uh, comes up. So even though in Loper Bright , the court said it was not going to apply this retroactively, so it wouldn't uphold every case that had ever been decided on the basis of a Chevron , um, defense. Um, here the injury <laugh> is, is the determinative factor in, in deciding the start of the statute of limitations. So instead of, let's say six years after the enactment of a particular provision, it would be six years after someone was injured by that particular , um, provision that was enacted. So we'll see how that one , um, plays out too. That also seems to me like it's like a revisit of, of , um, prior cases despite what the court said in, in Loper Bright . And then one more <laugh>. This one is out of Florida. Um, and it's called Z-Z-Z-A-F-I-R-O-V . Um , this actually was handled by my firm, I'm very proud of, of them , um, out of our Tampa office, by the way. So, so what it concludes is that the FCA is unconstitutional. This was a case that the, the , um, government had not intervened in. It was being pursued by a relator. And to oversimplify, the court basically concluded that the , uh, the delegation to the relator to pursue an action like this was beyond constitutional delegation authority . In other words, it gave the relator too much power for a government , um, authority. And so it was , uh, determined to be unconstitutional. The government has already said it plans to appeal this, and so we'll see how , um, how this plays out. But obviously it could, <laugh> could have significant implications if it's, if it's not overturned , um, on appeal,

Speaker 4:

That is huge. When I saw that, when I saw that on your outline, I was like, wait, what? <laugh>

Speaker 3:

I know it's crazy, huh ? I mean , it is . Yeah .

Speaker 4:

Can I follow up on, it's something that both of you guys mentioned, and I , and I should , um, discuss this a little bit too, in this whole private equity issue. And the , the another kind of notable thing , even though the case was filed before this year, is there was a development, I know, Deanna, you were talking about activities in the States and the state of Texas. So , uh, you may recall that the Federal Trade Commission sued a private equity firm named Walsh Carson, as well as its portfolio company, the , um, US anesthesia partners for, you know , essentially all of these roll up kind of stealth acquisitions. There's also some allegations of market allocation against US anesthesia partners. But one, the notable development this year was that the, the , uh, there's a court in Texas that di that dismissed Welsh Carson, the private equity firm from that lawsuit. And essentially what the court said was, look, private equity firms are not liable for the actions of their portfolio companies under Section 13 B . And , and the way that the court got there was to say, wait a minute, Welsh Car Carson is a minority non-controlling investor. And the judge basically said, Hey, look, this is a little bit too much of a novel interpretation to say that we're gonna expand the scope of the FTCs enforcement to potentially expose minority non-controlling investors to liability based on the actions of their portfolio companies. And so, even though the case is ongoing with the portfolio company, it , you know, it, it , it, it , that was a pretty notable action. And then the other thing, speaking of the actions of State attorneys general, there was a group or coalition of about 11 attorneys general that sent a letter to the federal agencies to express some concerns about private equity's role in healthcare and , and concerns about OB obviously, you know, quality of care and all of those types of things, but really advocating for greater transparency, which in part, like I said before, I do think that some of the new HSR rules in terms of what parties have to submit to the federal agencies before they close their transactions, you know, those of course transactions that are HSR reportable I do think gets at some of that. But the state coalition really advocated for greater transparency, but also working more closely with the federal agencies in on certain m and a investigations and things of that nature, which is not anything that is new. You, you know, even when I was at the agency, that the states routinely will work along with the federal antitrust authorities on investigations and things of that nature. At the state level, though, I would say that the states are trying to, even though a number of states don't have their own quote unquote HSR pre-merger notification statute, what they are doing is starting to roll out similar statutes. So for example, this earlier this year, it became effective July 1st. The state of Indiana now has a requirement that 90 days prior to closing healthcare providers, insurers, health HMOs, insurance administrators, those in the healthcare field have to submit their transactions to the, in Indiana , um, attorney's general's office for review. California, of course, was already doing this, but you also have , um, Pennsylvania has now a proposed bill along those lines as well. And there , there are other states that are doing things that are similar.

Speaker 5:

That's really interesting. And it's definitely something that we're seeing in other areas of labor and employment as well. You know, many states and localities have their own, you know, paid sick leave requirements or their own family medical leave requirements. So that's another area that employers have to continue to watch. And interestingly enough, this year we also saw some developments in the workplace. Uh , so can't talk to workplace safety and health realm. Uh , we had osha, the Federal Administrative Agency that governs , um, safety and health in the workplace issue, a proposed rule for heat illness prevention. And that's the first rule of its kind. There's never been a specific standard with respect to heat at the federal level. And before OSHA has looked to enforce violations under its general duty clause, which is something that applies to all employers , um, that says all employers have a duty to keep employees safe from known and recognized hazards in the workplace. And I found that , um, knocking on wood here for everyone listening <laugh> , but not a lot of healthcare organizations have had to deal with OSHA on a frequent basis. That wasn't until covid , right. I think Covid changed things, and we had osha, you know, doing more inspections in the healthcare space under the guise of this general duty clause. Um, so while not all healthcare employers might not have to worry about heat illness prevention, there is another component that's been on OSHA's radar for a long time with respect to workplace violence and will OSHA issue some type of workplace violence standard, either as a whole for general industry or just specific to healthcare employers. So that's something else to continue watching. And, and in the meantime, states have really jumped into the arena in both of these areas. And now we have California, Colorado, Maryland, Minnesota, Nevada, Oregon and Washington that have their own standards for indoor and or outdoor heat illness prevention. And then we have California and New York now that have broad workplace violence prevention requirements in Texas. You have to post a specific notice about how to , um, issue complaints to the state regarding workplace violence. And then there are about a dozen states that have roles that are specific to healthcare when it comes to workplace violence. So that's another good area, you know, when you're doing your annual policy review to say, Hey, what are we doing when it comes to workplace violence prevention and he illness prevention, if that applies.

Speaker 3:

So I have been through mandatory training on avoiding workplace violence here in California. So it wasn't healthcare related , it was, I don't know , <laugh> because we work in California, we, we all had to had to take that training. So let me just follow up on Dion's talk about , um, private equity. The Medicare program has been working very hard to surface the ownership and control , um, of healthcare entities that, that have private equity investors. I think they have not figured out what to do with that information. And so right now they're requiring disclosure, but then there's not really an action , um, that can be taken. The , um, preambles to the regulations have included some very , um, almost defamatory, you can't say defamatory because they, they all cite to other sources, but they include a lot of discussion about, about various publications that indicate that there's a higher rate of, you know, one thing and another in PE owned , um, or controlled facilities. And you have to imagine that some action will come of this. I think they just haven't figured out legally what they can do beyond requiring , um, disclosure. So we will see, I know that that many of our clients have some PE investment at one level or another. Sometimes that , you know, way far up and having to disclose this has been , um, ha has been a quite a burden <laugh> for them , and one that hasn't gone over very well. So it would not surprise me if the next administration begins to back off , um, from that. But right now you can even look up, for example, deficiencies , um, in skilled nursing facilities by whether they're for-profit or profit. It is really kind of interesting how much data is available. Um, but you know, it's, at the end of the day it's kind of like, so what if you can't do anything except hold them , uh, potentially, I guess, hold them responsible like any other investor, but it's a little oblique as to what the consequences could be. Well,

Speaker 4:

You know, and , and no , I , I agree with you. I think on the private equity front , um, there they might not be as much intense scrutiny mm-hmm <affirmative> . Um, be because, you know, I know that there have been some, especially like FTC commissioners that have been maybe a little bit critical of the agency being so focused on these roll-up strategies. But that being said, I do think when you think about some of the changes to the HSR statute that I talked about, you know, those changes were those proposed with bipartisan support. And some of those changes are at least geared at getting the information into the agency's hands so that they can determine whether or not there's a problem. So I, you know, while the next administration might not be as dogmatic and focused on going after private equity for antitrust purposes, I do think that there's still some mechanisms that will remain in place that that will help them get the information that they need so that if there is a particular situation that is having an anti-competitive effect in the market, they can challenge it. Uh , on the, on the pharma side, I do think that high drug prices remain a bipartisan concern. So I don't see those cases in the next administration really going anywhere. I think they'll continue to be prosecuted heavily. I also think that, you know , in Republican administrations healthcare antitrust seems to still be important in a focus. Now, I will say, you know , the d the nominee for the DOJ antitrust division, Gail Slater is probably will have a little bit more of an emphasis on big tech. That that doesn't mean that, you know , so , so , so some of the focus might shift a little bit more to big tech. Well, there's already a focus and so that will remain. But , um, I , it's , it is not to say that I think that healthcare and not trust enforcement is going to decrease at all. I think if it increases anywhere, it will be more so at the state level.

Speaker 3:

Any last comments?

Speaker 4:

No, I think I , I , I would just like to say I, I , um, I think HLA for having us do this, I think that , uh, it's gonna be interesting to, to to see how things develop in all of these areas going forward in the next administration. So I'm kind of excited to, as an academic, I'm kind of excited to see how it all shakes out <laugh> ,

Speaker 3:

And I'm thinking it's gonna be as crazy as the years after the Affordable Care Act and then during the PHE for, for us, I think this is , is gonna be a wild time. Lots of changes.

Speaker 5:

I would agree with that on the labor and employment side as well. I think we'll see some shifts in strategy at all of the major agencies in this space, including the wage and hour division at DOL , the EEOC , osha, and of course the NLRB, which is a very political agency. Um, so it's definitely something that employers should be paying attention to, particularly if you're in multiple states, because again, we may see more rules and cases that are significant at the state and local level if we don't see these fraud , uh, sweeping federal rules. So I think it's gonna be really important just to stay on top of your annual policy reviews as a best practice to make sure that you're in compliance. Thank you for having me.

Speaker 3:

Yeah. So I wanna thank Deanna , uh, so Deanna Hayes, in case you didn't write down her name at the beginning, Dionne Lomax. And my name is Judy Waltz and thank you for having us for this. And , um, thank you.

Speaker 2:

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