Holly Buckley

Great. So a couple of things that jump out, and this year and last year were very different than prior years in that we had this quick emergence of state-level pre-transaction filing requirements.

So while you'd have the federal antitrust filing for transactions above a certain size, a number of states came out with laws that said if you're doing a transaction of either any size or any size above a certain pretty low threshold that involves healthcare or healthcare private equity, you need to file with the state before that transaction closes and have some level of

So while you'd have the federal antitrust filing for transactions above a certain size, a number of states came out with laws that said if you're doing a transaction of either any size or any size above a certain pretty low threshold that involves healthcare or healthcare private equity, you need to file with the state before that transaction closes and have some level of

review over that transaction. So some of the states with those laws are Washington, Oregon, California, Nevada, New Mexico, Minnesota, Illinois, Indiana, New York, Connecticut, and Massachusetts. And just in the last few weeks, at least six state legislatures have introduced bills to curtail or demand more information about healthcare transactions. So this is just a very rapidly moving area.

review over that transaction. So some of the states with those laws are Washington, Oregon, California, Nevada, New Mexico, Minnesota, Illinois, Indiana, New York, Connecticut, and Massachusetts. And just in the last few weeks, at least six state legislatures have introduced bills to curtail or demand more information about healthcare transactions. So this is just a very rapidly moving area.

And for anyone investing in health care businesses, it's critical to be on top of these because they can trip you up and they can also create slowdowns in your closing timelines.

And for anyone investing in health care businesses, it's critical to be on top of these because they can trip you up and they can also create slowdowns in your closing timelines.

Yeah, so some states are really, really tricky. So, for example, Oregon, I think, is maybe 180 day pre-closing notice. So there's certainly a lot of investors that will stay away from Oregon at this point. And the same is true of some other states. There are other states that, while they have requirements, the timelines are maybe not super long. They're not actually preventing deals from closing.

Yeah, so some states are really, really tricky. So, for example, Oregon, I think, is maybe 180 day pre-closing notice. So there's certainly a lot of investors that will stay away from Oregon at this point. And the same is true of some other states. There are other states that, while they have requirements, the timelines are maybe not super long. They're not actually preventing deals from closing.

It's more a matter of an additional step in the process, but we're not seeing regulators actually try to thwart deals. But I think it is creating some reluctance in certain states. You wouldn't be surprised that California is one of them, right? It's a difficult state, and And it's always been difficult. And some investors have an appetite and others don't.

It's more a matter of an additional step in the process, but we're not seeing regulators actually try to thwart deals. But I think it is creating some reluctance in certain states. You wouldn't be surprised that California is one of them, right? It's a difficult state, and And it's always been difficult. And some investors have an appetite and others don't.

So we will see this factor into decisions around where to invest and who's willing to invest.

So we will see this factor into decisions around where to invest and who's willing to invest.

Yeah, I think one other one I would touch on is we're seeing a lot of excitement and interest in post-acute care and kind of the movement to health care at home. We saw it last year too, and it's been around. I mean, this isn't a new thing, but we are seeing a lot of excitement and energy around it.

Yeah, I think one other one I would touch on is we're seeing a lot of excitement and interest in post-acute care and kind of the movement to health care at home. We saw it last year too, and it's been around. I mean, this isn't a new thing, but we are seeing a lot of excitement and energy around it.

And I think this would include things like home infusion, hospice, home health, skilled and unskilled. And I think with the new administration, we're likely to see less regulatory burdens. and oversight, which I think will help continue to accelerate investment in this space.

And I think this would include things like home infusion, hospice, home health, skilled and unskilled. And I think with the new administration, we're likely to see less regulatory burdens. and oversight, which I think will help continue to accelerate investment in this space.

So for example, maybe there'll be a repeal of the 80-20 rule, which requires 80% of Medicaid payments going to direct care workers. Also with maybe more flexibility around workers and more movement towards Medicare Advantage, we think that this area will continue to be pretty hot and we'll continue to see more transaction volume this year.

So for example, maybe there'll be a repeal of the 80-20 rule, which requires 80% of Medicaid payments going to direct care workers. Also with maybe more flexibility around workers and more movement towards Medicare Advantage, we think that this area will continue to be pretty hot and we'll continue to see more transaction volume this year.

So my prediction is there's going to be less, but not a lot less. I think Lena Kahn was, you know, an outlier. She was a lot more aggressive than we've seen in a very long time out of the FTC. But I think the FTC's priorities are somewhat bipartisan. And I think that there's still going to be a lot of desire to put pressure on private equity, private equity investments.