January 24, 2019

Shutdown, Day 34: Health groups raise alarms as FDA furloughs more staff

Daily Briefing

    Health care groups have raised the alarm about the ongoing partial government shutdown's potential health ramifications, and now the shutdown has affected funding for at least one rural hospital.

    Cheat sheet: Understand the health impacts of the government shutdown

    About the shutdown—and efforts to end it

    The shutdown occurred after members of the 115th Congress and President Trump failed to reach an agreement on a short-term spending bill to extend funding for seven federal departments, FDA, and other federal agencies, including the Indian Health Service, by the Dec. 22, 2018, deadline.

    Trump earlier this month met with leaders of the 116th Congress to negotiate a plan to fund the federal government and end the partial shutdown, but they did not reach such a deal. Trump during the meeting said he would end the partial shutdown if federal lawmakers agreed to fund the border wall, but House Speaker Nancy Pelosi (D-Calif.) said she would not support such funding, even if it meant the partial shutdown would end.

    Since convening Jan. 3, the Democratic-controlled House has passed seven separate spending measures to reopen some or all of the departments and agencies affected by the shutdown, but none have included funding for the border wall. For example, the House approved a bill (HR 265) to fund the Department of Agriculture (USDA), which includes funding for FDA and would end the partial shutdown at the agency, but the bill stalled in the Senate. Senate Majority Leader Mitch McConnell (R-Ky.) has said the Senate will not consider any spending bills that Trump will not sign, meaning Democrats likely must first reach an agreement with Trump on border wall funding.

    The House last week introduced two more bills intended to reopen federal departments and agencies affected by the shutdown. The House considered one of the measures (H.J. Res. 27), which would have provided funding through Feb. 1, but it did not garner enough votes for approval. The House is scheduled to consider the other measure (H.J. Res. 28), which would provide stop-gap funding through Feb. 28, this week.

    Senate Republicans on Monday unveiled a $354.5 billion spending package to end the shutdown that includes funding for a border wall. The Senate is scheduled to vote on the measure Thursday, but it is unlikely to advance because Democrats have said they will not support it, Roll Call reports.

    Health groups express concerns as FDA furloughs more staff

    In a letter sent Tuesday to Trump and congressional leaders, a coalition of more than 40 patient and health industry groups, led by Friends of Cancer Research, "raise[d] alarm at the continued government shutdown—particularly its impact on [FDA]." The groups wrote, "While we applaud [FDA] Commissioner [Scott] Gottlieb, FDA leadership, and 'essential staff' for truly heroic work to keep many aspects of its mission functioning, we fear that this continued shutdown not only puts the current health and safety of Americans at risk, but has begun to put future scientific discovery and innovation in jeopardy."

    The letter followed warnings from hundreds of health care groups about the shutdown's "long-lasting health consequences." The groups cautioned that furloughed workers "simply cannot maintain their health without stable housing, food, and medical care."

    According to CQ News, Gottlieb this week said FDA is furloughing about 350 out of a total of 550 inspectors. Gottlieb said FDA is continuing to inspect high-risk food processing facilities but, according to CQ News, the agency is not inspecting lower-risk facilities, issuing public warning letters to facilities in violation of FDA rules, or issuing guidance and rules related to food production.

    Separately, the medical device lobbying group AdvaMed on Tuesday announced it is holding a conference call to discuss the effect the shutdown is having on FDA's medical device review process.

    Shutdown could affect ACA subsidies

    IRS also is affected by the current shutdown, which has the potential to affect coverage purchased through the Affordable Care Act's exchanges, Forbes reports.

    IRS, which has furloughed 90% of its employees, calculates U.S. residents' eligibility for subsidies available to help them purchase exchange plans and works with HHS to review states' requests to alter their exchange markets.

    Congressional Democrats in a letter sent last week to the secretaries of HHS and the Department of the Treasury wrote, "[W]e are concerned … some taxpayers will face an unexpected spike in premiums for their health care coverage due to delayed" subsidy payments. The lawmakers urged the secretaries "to ensure consumers are not faced with insurmountable premium costs or loss of coverage as a result of this unnecessary shutdown."

    USDA suspends funding to at least one rural hospital

    Meanwhile, USDA has suspended funding to at least one rural hospital because of the shutdown, Modern Healthcare reports.

    According to Modern Healthcare, New Mexico-based Pecos Valley Medical Center received a $3.2 million low-interest rural development loan from USDA to finance a 9,000-square-foot expansion, which the hospital hoped would allow it to provide all its services at one facility. However, USDA has paused the financing because of the shutdown.

    Pecos Valley Medical Center CEO Kevin Norris said contractors working on the project might suspend their work if the hospital does not receive the USDA funding. "If they shut down, they will pull equipment and workers from the site. So when they do come back it will add cost to the project—it would be substantial for us, and we're not a huge clinic so we can't absorb this," Norris said.

    Rep. Ben Ray Luján (D-N.M) in a letter sent to USDA Secretary Sonny Perdue has asked the department to immediately resume the funding  (Roubein, "Pulse," Politico, 1/23; Luthi, Modern Healthcare, 1/22; Siddons, CQ News, 1/22 [subscription required]; Shutt, Roll Call, 1/22; Cowan, Reuters, 1/23; Japsen, Forbes, 1/20).

    New cheat sheet: The health impacts of the government shutdown

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    Since 1981, when then-Attorney General Benjamin Civiletti decided that a failure to pass new funding bills should result in a cessation of government functioning, there have been 14 complete or partial government shutdowns. Health care has been deeply embroiled in the debates causing them. Indeed, the longest recent shutdown, which lasted 16 days in 2013, was the result of a contentious dispute over the Affordable Care Act.

    While providers generally shouldn’t expect major changes in their day-to-day operations due to a lapse in government funding, they should be aware of the significant indirect implications on the health care system.

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