This is a developing story. Last updated at 5:30 p.m. ET.
A government shutdown appeared likely on Monday afternoon, after the Senate rejected a House proposal to continue funding the government—but at the cost of delaying the Affordable Care Act.
The House on Sunday had passed an amended Senate-approved continuing resolution (CR), which included measures intended to derail and defund the ACA. However, Senate and White House leaders have held firm in their resistance to the plan, leading to a stalemate and a probable shutdown at midnight on Tuesday.
However, most ACA-related provisions are expected to be protected in the event of a shutdown, and the much-awaited health insurance exchanges are slated to launch as scheduled.
Previous ACA repeal efforts
House defunds the ACA—for the 40th time
33rd time's a charm? House again votes to repeal ACA
House votes to repeal health reform. What now?
Republican-led House initially acts to change, delay ACA measures
House lawmakers first voted 248-174 to include language that would repeal the ACA's 2.3% medical device tax, which was included as a revenue generator to help pay for the law. Lawmakers then voted 231-192 to delay the law's individual mandate and health insurance exchanges by one year. The measure also would allow employers and health care providers to opt out of mandatory contraception coverage under the ACA.
Under a conscience clause included in the GOP's measure, insurers and others also would be able to avoid providing abortion coverage if such coverage conflicts with their religious or moral beliefs.
After Senate draws hard line, both sides volley again
In a 54-46 vote, the Senate on Monday afternoon quickly rejected the new House-approved CR and sent the chamber back a "clean" budget bill, devoid of any provisions targeting the ACA.
However, the House rapidly drew up a new bill that "raise[s] the stakes," CNN reports, by including an amendment that would disqualify the White House, members of Congress, and their staffs from receiving an employer contribution for health coverage.
"[The] marketplaces will be open for business on Tuesday no matter what—even if there’s a government shutdown. That’s a done deal."
- President Obama
Senate leaders say they aren't prepared to give any ground. According to Senate Majority Leader Harry Reid, "our negotiation is over with."
"You know with a bully you cannot let them slap you around because they slap you around today, they slap you five or six times tomorrow," Reid added, according to the New York Times. "We are not going to be bullied."
White House officials also have stressed that President Obama would veto the House bill in the unlikely event it made it to his desk.
What happens after a shutdown?
One of the most significant questions has centered around implementation of the health reform law. However, HHS's plan for a shutdown states that "CMS would continue large portions of ACA activities."
The shutdown would have a significant effect on the government's health care operations, with some areas temporarily shut down and others proceeding as usual.
- Staffing: HHS would furlough 40,512 of its 78,198 employees;
- Disease monitoring: CDC would suspend its seasonal influenza program, reduce its outbreak detection efforts, and stop helping states with infectious disease monitoring;
- Fraud and abuse control: CMS would suspend certain health care fraud and abuse detection efforts, such as its high-profile strike force;
- Ongoing safety efforts: FDA would halt some activities, including routine inspections, import monitoring and laboratory research needed to inform public health decision making; and
- Routine oversight: Medicare and Medicaid providers would complete fewer recertification and entry surveys, which CMS says could put "beneficiaries at risk of quality of care deficiencies."
- Health insurance exchanges: President Obama in a speech on Friday said that the new state insurance exchanges are a "done deal" and would open on Tuesday as scheduled regardless of a federal shutdown;
- Public health insurance programs: Medicare would continue to provide coverage, and states would continue to receive federal payments for Medicaid and CHIP; and
- Clinical trials: NIH would continue patient care for current clinical center patients.
Sources: Peters/Weisman, New York Times, 9/29; Weisman/Peters, New York Times, 9/28; Espo, AP/Boston Globe, 9/28; Krauskopf, Reuters, 9/27; Bunis, CQ HealthBeat, 9/27 [subscription required].