Health Programs Threatened by Possible Government Shutdown

Alicia Ault

January 17, 2018

Unless Congress acts to avert a government shutdown by midnight January 19, federal agencies, including the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), may be forced to cease many of their important duties.

In the most recent government shutdown, which lasted 16 days in 2013, federal agencies had to furlough a large number of workers. The US Department of Health and Humans Services' (HHS) contingency plan for shutdowns indicates that it would send about half of its 80,000-person workforce home, keeping some for essential duties such as continuing oversight of clinical trials and caring for animals involved in research.

Each HHS agency would be affected differently. The contingency plan called for 55% of FDA staff to be kept on, for instance, 39% of CDC staff, and 38% of the workforce at the Centers for Medicare and Medicaid Services. In the 2013 shutdown, Medicare and Medicaid continued to process physician payments, but there were some delays.

And the CDC was forced to shut down its influenza surveillance. 

The current January 19 shutdown date was established by a short-term spending bill approved by Congress on December 22 and later signed by President Donald J. Trump. That continuing resolution (CR) was approved to give legislators more time to work out a plan to further extend the Children's Health Insurance Program (CHIP) and determine what to do about immigrants who have been protected under the Deferred Action for Childhood Arrivals (DACA) program, which the president ended in September. Trump gave Congress until March to come up with a legislative solution.

Under that spending plan, CHIP was given $2.85 billion in funds through March 31. But lawmakers have not come up with a permanent plan, and are also still arguing over what to do about DACA. Democrats are threatening to vote for a government shutdown if a compromise is not reached before legislators have to vote on a new CR.

Plan to Avert Shutdown

Republicans in the House have unveiled a plan that would keep the government in operation through February 16. It includes a 6-year extension for CHIP (through fiscal 2023). The new CR would also establish a 2-year delay for taxes on medical devices and a 1-year delay for so-called Cadillac insurance plans — both created by the Affordable Care Act.  

Physician organizations and others are warning that if CHIP is not extended, and soon, the consequences could be dire for the nine million children covered by the program.

A new report by the Georgetown University Health Policy Institute Center for Children and Families estimates that, without an extension, 23 states and Washington, DC, will have CHIP funding shortfalls this month.  

Michael Munger, MD, president of the American Academy of Family Physicians said in a statement that community health centers, the Teaching Health Center Graduate Medical Education program, and the National Health Service Corps are also in need of long-term funding to ensure access to care for all Americans.

"Children and low-income families must be able to see their doctors through CHIP and community health centers. Those centers, like all health care facilities across the country, must have trained physicians. The physician workforce must be built on stable residency training. These four programs are integral to the foundation for our health care system," he said.

Many lawmakers have argued in favor of giving CHIP a more stable base. "It's long past time we advance this vital extension — kids can't wait any longer," said Energy and Commerce Committee Chairman Greg Walden (R-OR) and Health Subcommittee Chairman Michael C. Burgess, MD (R-TX), in a statement.

"Without immediate action to fund CHIP, millions of low-income children will receive notices in the coming weeks that they might lose their health coverage. Such an outcome would cause needless fear and anxiety for families in our communities and all over the country," they said.

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