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January 22, 2018

Shutdown Monday: What's happening (and isn't) today at CDC, FDA, and more

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    Senators over the weekend failed to come to an agreement on legislation to end a government shutdown that began Saturday, the Wall Street Journal reports.

    In a state of reform: Profiles of state-level health care transformation

    Senate Majority Leader Mitch McConnell (R-Ky.) has scheduled a procedural vote for noon Monday to advance a temporary spending bill to reopen the government and fund it through Feb. 8. However, the bill's prospects are unclear.

    Government shuts down

    The Senate in a 50-49 vote Friday rejected a House-approved short-term continuing resolution (H.J. Res 125) that would have funded the federal government for an additional four weeks, reauthorized federal CHIP funding for six years, and delayed the Affordable Care Act's (ACA) taxes on medical devices, health insurance, and high-cost employer-sponsored health plans. The bill needed 60 votes to pass in the Senate.

    According to the New York Times, 44 Senate Democrats voted against the bill, in part because it did not provide protection for individuals whose immigration status in the United States would be jeopardized by the Trump administration's plans to end the Deferred Action for Childhood Arrivals (DACA) program March 5. Five Senate Republicans also voted no.

    White House spokesperson Sarah Huckabee Sanders said President Trump will not negotiate on DACA as part of talks to reopen the government.

    What a shutdown means for health care

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

    HHS staffers were told not to work over the weekend but were required to report to work Monday morning to begin "orderly shutdown" processes. The process takes about four hours and entails a range of tasks, such as reassigning work, setting out-of-office emails, and disposing of perishable food, according to Politico's "Pulse."

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

    However, HHS said certain activities will continue. For example, Medicare will continue to provide coverage, and states will continue to receive federal payments for Medicaid. HHS said that during the shutdown:

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

    HHS also said CMS will maintain staff to continue making CHIP payments to eligible states from the agency's reserve fund. However, without a full CHIP reauthorization, the program will not be fully funded. The Medicaid and CHIP Payment and Access Commission, which advises Congress, said 27 states and Washington, D.C., will have depleted their CHIP funding by the end of March.

    Meanwhile, the Health Resources Services Administration on Friday sent an email to community health centers that might have generated confusion over their funding, according to "Pulse." The email said the centers may face a funding lapse. However, according to Dan Hawkins, policy director at the Alliance of Community Health Centers, the email was routine, and the centers should still be funded through March under existing legislation.

    Where things stand

    While Democrats and Republicans remain divided on several issues, the most contentious point is the future of DACA, the Los Angeles Times reports.

    A bipartisan group of senators had worked over the weekend to reach a compromise, but a deal presented to McConnell late Sunday was not brought to a vote, according to the Times. The proposal would have funded the government through Feb. 8 and required lawmakers to take up immigration legislation if a deal was not reached before the funding expires.

    Any proposal that differs from the House-passed continuing resolution would need to go to the House for a final vote before it could head to Trump for his signature. According to GOP lawmakers, the House would likely pass a three-week spending bill if it passed in the Senate.

    Meanwhile, Trump on Sunday urged Senate Republicans to invoke the so-called "nuclear option" and change the Senate rules so that the spending bill can pass on a simple majority vote.

    Senate Republicans have opposed doing so in the past, and McConnell on Sunday said he supports the rules as they are (Peterson et al., Wall Street Journal, 1/21; Mascaro, Los Angeles Times, 1/21; Fandos/Kaplan, New York Times, 1/21; Fram et al., AP/Sacramento Bee, 1/22; Frieden, MedPage Today, 1/21; Firth, MedPage Today, 1/20; Luthi, Modern Healthcare, 1/20; Weinstock/Luthi, Modern Healthcare, 1/20; Kaiser Health News, 1/19; Diamond, "Pulse," Politico, 1/22; Collins, USA Today, 1/21; Lee/Simon New York Times, 1/19).

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