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January 19, 2018

The govt could shut down at midnight. Here's how that would affect health care.

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    Congress faces a midnight deadline to pass and have President Trump sign a short-term continuing resolution to avoid a federal shutdown that would, if implemented, have significant implications for public health programs, including those related to influenza and disease outbreak detection.

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    The House on Thursday voted 230-197 to pass a short-term continuing resolution (H.J. Res 125) that would fund the federal government for an additional four weeks, reauthorize federal CHIP funding for six years, and delay the Affordable Care Act's (ACA) taxes on medical devices, health insurance, and high-cost employer-sponsored health plans. However, the measure is expected to fail in the Senate, and a shutdown was looking "likely" as of Friday morning, Jake Sherman reports for Politico. Senate Majority Leader Mitch McConnell (R-Ky.) told members via email Thursday that he would keep the Senate in session over the weekend if the lawmakers could not reach an agreement and the shutdown takes effect.

    What a shutdown would mean for health care

    HHS on Friday released a contingency staffing plan for fiscal year 2018 in the event of a federal shutdown, which broadly resembles plans the department used during the last shutdown in 2013. HHS said a shutdown would lead it to furlough 50% of its 81,915 employees.

    As a result of the furloughs, HHS said some agencies would need to suspend certain activities, such as CDC's seasonal influenza program. In addition, HHS said:

    • The Health Resources and Services Administration would not make Children’s Hospital GME Program payments;
    • NIH would not admit new clinical care patients who were not critically ill or award new grants;
    • The Office of National Coordinator for Health IT would suspend efforts to improve interoperability and combat information blocking;
    • FDA would suspend most of its food safety, nutrition, and cosmetics activities, including routine onsite inspections and import inspections;
    • CDC would partially reduce its outbreak detection efforts and stop helping states with infectious disease monitoring;
    • The Indian Health Service (IHS) would suspend funding to tribes and Urban Indian health programs;
    • The Agency for Healthcare Research and Quality would not issue new grant and contract funds or monitor certain existing projects; and
    • Substance Abuse and Mental Health Services Administration (SAMHSA) would not issue new grant funding or monitor certain existing grants.

    However, HHS said in the event of a federal shutdown, certain activities would continue. For example, Medicare would continue to provide coverage, and states would continue to receive federal payments for Medicaid. HHS also said CMS would maintain staff to continue making CHIP payments to eligible states from the agency's reserve fund. However, without a full CHIP reauthorization, the program would not be fully funded. (The Georgetown University Health Policy Institute has estimated that "if Congress fails to approve long-term funding for CHIP in January, nearly 1.7 million children in separate CHIP programs in 21 states with shortfalls in March 2018 could lose coverage by the end of February 2018.")

    In addition, HHS said in a shutdown:

    • CMS would continue federal exchange activities, such as open enrollment eligibility verification;
    • FDA would continue some activities, including those in the Center for Tobacco Products;
    • IHS would continue to provide direct clinical health services and referrals;
    • NIH would continue patient care for current clinical center patients;
    • PEPFAR, CDC's Global AIDS program, and other similar programs would remain funded; and
    • SAMHSA's suicide prevention lifeline, disaster distress helpline, and similar programs would continue but without technical assistance or facilitation from the agency.

    Former public health officials said the 2013 shutdown, which lasted 16 days as Republicans tried unsuccessfully to force changes to the ACA, had wide-reaching consequences for health care, STAT News reports.

    For instance, Margaret Hamburg, who was FDA's commissioner at the time of the 2013 shutdown, said it "was a very challenging time," adding, "(It was) extremely disruptive to the critical, unique, and essential work of the FDA. … Important programs dramatically slowed or halted without the needed staff. Even for those essential time-urgent activities, available staff—professional and support—were stretched dangerously thin."

    Tom Frieden, who led the CDC during the 2013 government shutdown, said it "was this time in which that I felt I really couldn't do my job, as CDC director, of keeping Americans safe, because more than 8,500 of my staffers had been told to go home, and they do important things that protect Americans."

    (Everett et al., Politico, 1/18; DeBonis et al., "PowerPost," Washington Post, 1/18; Shesgreen/Collins, USA Today, 1/19; Andrews at el., Wall Street Journal, 1/19; Merhson, STAT News, 1/17; Fabian, The Hill, 1/18; Mershon/Swetlitz, STAT News, 1/19; HHS FY 2018 contingency plan, 1/19).

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