All eyes were on New York this week, as President Donald Trump took the podium at the United Nations and threatened war with North Korea. Back in Washington, the House was on recess and the Senate scrambled to find 50 Republican votes to pass their back-from-the-dead health care bill, an effort likely to come up short once again after Sen. John McCain announced his opposition on Friday afternoon.

More quietly, the Trump administration continues to target Obama-era environmental and workplace rules and forge ahead to implement a new conservative agenda. Perhaps most notably, the administration offered a sign this week that it might test a major Medicare reform long championed by House Speaker Paul Ryan. Here’s how Trump changed policy this week:

1. Trump administration hints at big Medicare experiments

The Center for Medicaid and Medicare Innovation, created in 2010 by Obamacare, can spend $1 billion a year on innovative ideas to reduce Medicare costs. Under Obama, the agency piloted a number of ideas, such as reducing Medicare payments for cancer drugs and changing how the government pays for hip surgery. Republicans complained of executive overreach and tried to scale back the agency’s powers, but now that Trump is in the White House, the GOP is looking to turn the agency to its advantage.

This week, the Trump administration took the first step toward reforming CMMI when it released a nine-page notice asking for comments on a “new direction” for the agency. The notice is just a preliminary move—it doesn’t actually change any policy right now—but it sends a clear message about how Tom Price, secretary of Health and Human Services, and Seema Verma, director of Centers for Medicare and Medicaid Services, intend to use the agency. The notice emphasizes the need for a more “market-based” direction, saying consumers should be empowered “to drive change in the health system through their choices.” The notice doesn’t specify any policy changes but the language may signal that Price and Verma want to test Medicare premium support, an idea long favored by Ryan and Price. Instead of paying for health care, premium support would change Medicare into an insurance subsidy that recipients would use to purchase private insurance. The idea is extremely controversial and loathed by Democrats.

A few days after the election, Price and Ryan suggested that transitioning Medicare to a premium support system would be on the agenda for the Republican Congress. Almost a year later, Republicans have struggled to repeal and replace Obamacare, much less undertake a comprehensive Medicare reform. But even if premium support isn’t on the table right now, Price and Verma could lay the groundwork for it through CMMI.

2. Labor Department delays a rule on cancer-causing silica dust

In March 2016, the Department of Labor issued a regulation lowering the workplace exposure standard for silica, a mineral that can cause lung cancer when ground into dust and inhaled. The final rule was heralded by workplace advocates as long overdue—it took more than four decades to finalize—and was set to be enforced on June 23.

But in April, the Department of Labor announced it was delaying enforcement of the rule for three months until September 23. Technically, that date still stands. But this week, the agency issued a memo, saying that as long as employers show they have made a “good faith effort” to comply with the rule, the agency will give them a pass for any violations in the next 30 days. In other words, the silica rule is effectively delayed another month. The delay is a victory for industry groups, but it is likely to be short-lived: Unlike with some other rules, the Labor Department does not appear to be delaying the enforcement date of the silica rule to give itself additional time to repeal or rewrite it.

3. Trump issues new executive order on North Korea

Trump spent much of his time at the United Nations this week addressing North Korea’s nuclear program, vowing to “totally destroy” the country if necessary and discussing the topic in almost every meeting with foreign leaders. With each successive nuclear test, Washington tries to ratchet up pressure on Pyongyang, issuing new sanctions and pressuring China to cut off trade with North Korea.

So it was this week when Trump announced an executive order that attempts to further cut off North Korea from the world. The sanctions are a step beyond anything that the U.S. has imposed on Pyongyang in the past, drawing praise from former Obama administration officials. The order allows the Treasury Department to sanction any individual who operates in major North Korean industries like textiles and manufacturing; who owns or operates North Korean ports; who imports or exports significant goods, services or technology to or from North Korea; or who generates revenue for the government. It also prohibits any foreign-owned aircraft or vessel from coming to the U.S. within 180 days of visiting North Korea.

4. EPA delays its formaldehyde rule, again

On Dec. 12, the Environmental Protection Bureau issued a rule on formaldehyde emissions for certain wood products, one of the last significant rules issued by the EPA during the Obama administration. The rule was set to take effect on Feb. 27, but Trump already delayed that date twice: first to March 21 and later until May 22. At that point, the rule took effect.

But this week, the EPA announced that it was effectively delaying the formaldehyde rule another year by extending the rule’s compliance deadlines. In other words, even though the rule took effect, companies don’t yet actually have to comply with different pieces of the rule until sometime in the future. In some cases, the new compliance deadline is far in the future—in one case, not until 2024.

5. A smaller move on immigration—and a big one coming soon

This week, the Department of Homeland Security made one small move on immigration—and there are reports that a big policy change is coming soon.

First, DHS extended a special immigration status for Sudanese and South Sudanese nationals that had been set to expire later this year. The status, known as Temporary Protected Status, allows foreign nationals whose home country is hit by a war or natural disaster to temporarily live and work in the U.S. Sudanese nationals can now stay until November 2018, while South Sudanese nationals can stay until May 2019. It’s a sign that despite Trump’s immigration crackdown, DHS isn’t just deporting all foreign nationals without considering their individual circumstances.

Be that as it may, there’s more change afoot. The Trump administration is reportedly preparing to impose tighter vetting procedures on a broad list of countries, a replacement for Trump’s travel ban, which attempted to block people from seven Muslim-majority countries from entering the United States. The ban, which has been tied up in the courts, expires on September 24, so the Trump administration had to make a decision. Expect more on the new vetting program in the coming days.

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