Regulators and investors alike turned their attention back to health care as the president held a health-care summit Thursday. With agreement still a stretch, every twist and turn -- or signs that either side is changing its mind on any issue is being closely monitored for its potential long-term effect on the market.

Investors seemed somewhat indecisive, with the Nasdaq biotechnology index gaining ground, and the Amex biotechnology and pharmaceutical indexes on the decline. Amgen, Celgene (CELG), and Biogen Idec were all lower. Pharmas were mixed with Eli Lilly and Novartis advancing, but generic drug maker Teva losing ground.

As issues get hammered out, eyes will no doubt be on health insurers like Humana and Aetna -- both of which advanced Thursday. What else happened by the end of the day? Here's a look.

The Market Reaction

There was little progress made Thursday from the market s point of view, says Marc Pado, U.S. market strategist for Cantor Fitzgerald. Pretty much what the market had discounted going in is what it looks like is coming out, he says. The day was pretty much grandstanding. The big concern for health-care companies -- eliminating the public option.

The Doughnut Hole Provision

One of the issues that came up on Day One of the summit, and that concerned biotech investors was the so-called doughnut hole provision the gap in Medicare s medication coverage. Under Medicare law, once $2,000 has been spent on medication, the patient has to cover the next $3,500 out of pocket in order to return to coverage. Investors are curious as to who would foot the bill to close the gap, if that s deemed appropriate.

But this may be less of an issue, says Christopher Raymond, a biotech analyst for Robert Baird and Co. He says that biotechs are already sometimes covering the cost of the doughnut hole. Take Celgene as an example, says Raymond. They haven t completely delineated what sales, general and administrative spending has been, but it s been sizable. A lot of patients who run into the doughnut hole indirectly have that paid for by Celgene. Net-net, says Raymond, there may not be a lot of impact.

The Generic Drug Issue

Some regulators want to make it easier for generic medications to get to market as they strive to control costs. But making generics more available is easier said than done because of patent protections, says Raymond. No one in their right mind should develop [a drug] without having a pretty bulletproof patent protection that goes much longer than the horizon that everyone is talking about. While the legislation might be good for sentiment, it might be limited in effect, he says.