Sometimes it feels like Groundhog Day in Washington, even in the summer. Republicans had yet another high-stakes week of healthcare negotiations. Meanwhile, a trip to Paris wasn’t enough for President Donald Trump to escape the snowballing Russia scandal, which has now ensnared his son, Donald Trump Jr., who apparently met with a Russian lawyer during the campaign to discuss potential dirt on Hillary Clinton.

Despite stagnation on Capitol Hill—the Senate hasn’t even held a roll-call vote on legislation since June 15—Trump’s policy agenda has not stagnated. From immigration to healthcare to trade, political appointees have settled in and are beginning to leave the administration’s mark on the government.

Here’s week six of The Agenda’s series on how Trump is changing policy, while most people’s eyes are elsewhere:

1. Foreign entrepreneurs not welcome

Trump’s overhaul of U.S. immigration policy hit a new target this week: foreign-born entrepreneurs.

In 2016, President Barack Obama passed a rule to allow foreign-born entrepreneurs to remain in the U.S. while they build new companies. The so-called startup visa was a linchpin in Obama’s effort to encourage innovative foreigners to remain the U.S. as long as they were creating jobs for Americans; it was a top priority for many technology companies and venture capitalists. It was supposed to go into effect on July 17.

This week, the Department of Homeland Security pushed it back, delaying the effective date until March, 2018. The agency also said it will propose another regulation to repeal the original rule, which relies on the government’s parole authority to allow foreigners to temporarily stay in the United States even if they don’t meet the requirements for a visa. This all has its roots in Trump’s executive order on immigration, signed in January, that directed the government to limit its use of parole to only a case-by-case basis. That provision didn’t make headlines, but many immigration experts saw it as a signal that Trump was planning to kill the startup visa—and this week’s move confirms that that is the case.

2. A Korean trade war brewing?

Trump’s favorite targets on target on trade are well-known: China, Mexico and Germany. But there’s another country—an important U.S. ally—that often is a frequent target of Trump’s ire: South Korea.

This week, U.S. Trade Representative Robert Lighthizer took the first formal step to combatting Korea’s perceived trade infractions when he formally requested the two sides enter into discussions to consider changes to the five-year-old U.S.-South Korea trade agreement, which was signed under George W. Bush and approved by Congress in 2011. In a one-page letter to his Korean counterpart, Lighthizer specifically wrote that the Trump administration was determined to reverse the U.S.’s $28 billion bilateral trade deficit, a top goal for Trump, who brought up Korea’s trade policies as recently as Thursday in an interview with reporters on the plane ride to Paris.

The stakes are high: Both the U.S. and South Korea are seeking a strategy to block North Korea’s nuclear weapons program, a difficult issue that has already created some tension between the longtime allies. Any trade disputes would only hurt the U.S.-Korea relationship.

3. A milestone for Obamacare

As the Republican healthcare reform stands on a knife’s edge on Capitol Hill, states can’t just wait and see how those efforts end up; they need to take immediate steps to stabilize their health insurance markets—and they have a powerful tool to do so.

A so-called Section 1332 innovation waiver, for its section of the Affordable Care Act, allows states to opt out of many Obamacare regulations within the basic parameters of the law. This week, the Centers for Medicare and Medicaid Services approved its first waiver, to Alaska, which wants to set up a reinsurance program to help insurers that end up with a disproportionate number of high-cost enrollees. The program is intended to moderate premium increases and prevent its individual insurance market from collapsing. CMS will provide $323 million from 2018 to 2022, and estimates that Alaska’s plan will reduce premiums by 20 percent in 2018. The agency had previously signaled support for the waiver, so Tuesday’s announcement wasn’t a surprise. But it still marked a milestone for the law.

The ACA puts strict rules around when and how states can waive Obamacare requirements but that could change if Senate Republicans reach a compromise on their health reform: Under their bill, states could receive approval for waivers much easily—with less oversight, and more freedom to spend money as they see fit.

4. The rollback of Obama’s environmental legacy continues

While the Clean Power Plan and the Paris deal garnered most of the headlines, Obama’s environmental legacy touched all corners of the government, from offshore drilling leases to energy efficiency policies. But under Trump, a new environmental regime is underway, quickly reversing those policies.

This week brought two such efforts. First, on Tuesday, the Environmental Protection Agency announced that it was accepting comments on its proposal to rescind a ban on mining in Alaska’s Pebble Mine. Under Obama, the EPA refused to issue permits for gold and copper mining in Pebble and instead officially restricted mining in the area. The decision was the subject of a fierce legal battle, with developers arguing that the EPA’s determination violated the law and environmentalists arguing that pollution from the mining would threaten a nearby wild salmon fishery, the world’s largest. In May, the EPA, under Administrator Scott Pruitt, announced a deal with the owner of the Pebble Mine to withdraw an ongoing lawsuit, repeal the mining restrictions and allow Pebble a fair process to apply for a permit. Tuesday’s move is the first step in implementing that agreement and allowing drilling in Pebble.

On Thursday, the Interior Department announced its first oil and gas lease sale since Trump took office, offering 75.9 million acres in the Gulf of Mexico—more than the agency offered in the Gulf of Mexico during all of 2016, in part due to a lack of demand. Secretary Ryan Zinke also announced that he was lowering royalty rates—the government’s share of the take—on shallow-water leases, an effort to encourage oil companies to drill despite the fact that oil prices remain depressed. The lease sale is scheduled for August 16.

5. A move to lower drug prices

As prescription drug prices have climbed higher and higher, Americans have become angrier and angrier at drug companies and the government’s inability to rein in the price hikes. Trump has said the issue is a top priority for his administration, but he has made few real policy changes on it so far.

That changed on Thursday when the Department of Health and Human Services released two major new rules setting 2018 payment rates and policies for hospital outpatient departments and ambulatory surgical centers. If it sounds complicated, that’s because it is: The proposed rules run almost 1,500 pages in total. But experts immediately focused on a reform to the prices that the government will pay certain doctors and hospitals for prescription drugs.

The change relates to the 340B discount drug program, which was created in 1992 and requires drug manufacturers to offer outpatient drugs at a heavy discount—around 22.5 percent on average—to hospitals and doctors that serve a large share of low-income patients. Under last year’s payment schedule, CMS reimbursed hospitals for 340B drugs by about 6 percent above their average sales price. The new proposal would reimburse hospitals for such drugs at 22.5 percent below their average sales price, effectively negating the discount. CMS says that this reform will lower out-of-pocket costs for patients, ensuring that the 340B program is actually benefiting Medicare patients and not just goosing the bottom line of 340B hospitals and doctors.

The Trump administration heavily promoted the changes, even sending out a statement from Trump touting the reforms. But hospitals warned that the changes would hurt patients’ access to care by threatening the financial health of 340B hospitals. The payment rates aren’t final, and the agency is accepting comments on it. Expect a major fight to come.

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