Blogged Arteries

Opinion and Commentary from TMA

A Dozen Ways the Shutdown is Affecting Health Care

(Legislature, Public Health, U.S. Congress) Permanent link   All Posts

Fontenotes_Shutdown

This is an exceprt of a post originally published on Sarah Fontenot’s website.  

As other industries are struggling through the partial government shutdown, it would be easy to feel positive about health care. Funding for both Health and Human Services (HHS) and the Department of Veteran Affairs (VA) are secure due to appropriation bills that predate the current crisis. VA benefits, Medicare, Medicaid and the Affordable Care Act (also known as Obamacare) are — at least at face value — protected. 

The Centers for Disease Control and Prevention (CDC) is up and running, the National Institutes of Health (NIH) continues to oversee biomedical research, and Food and Drug Administration (FDA) responsibility for drug approval is not affected.

But that is not the whole story.

The shutdown is impacting — even risking — the health of countless Americans. Protections and processes all of us rely on are on hold. Innovations and developments in science, policy, and the law are being delayed or subverted.

Starting with the most important examples — people who are directly affected — here are 12 ways this shutdown is doing damage in the realm of health care.

1. Some Federal Workers are Losing Their Health Benefits  

The 800,000 employees at shut down federal agencies who fall under the Federal Employees Health Benefits (FEHB) program are not at risk of losing their health care insurance. But they could start to receive bills for their dental, vision, and long-term care coverage if the crisis continues. 

The federal employees most in jeopardy are those working under contracts not eligible for the FEHB program. Not only are contract workers potentially not going to get paid when the shutdown ends, they lost their health care benefits at midnight on Dec. 22. A poignant story highlighted by NBC News and the New York Post covers a young woman from the Interior Department now rationing her insulin because she cannot afford the cost.

2. Many Native Americans are Going Without Health Services  

The Indian Health Service — run by HHS but funded through the Department of the Interior — is directly affected by the shutdown. Native American tribes have already missed millions of dollars in essential services; only health care that meets the "immediate needs of the patients, medical staff, and medical facilities" are included in the department’s shutdown plan. Some clinics serving Native Americans have closed already; others are expected to cease services by the end of this week. 

3. Some People Eligible for ACA Subsidies May Have Their Applications Delayed  

Many (if not most) people who purchase insurance on the Affordable Care Act (ACA) Exchanges (or “Marketplaces”) receive a subsidy from the government to help them afford health care coverage. Applications for subsidies may require an Internal Revenue Service (IRS) review in some circumstances, such as when applicants lose their job, a baby has been born, or the person involved filed for an extension on paying income taxes or signed up for insurance outside of the open enrollment window.

With 90 percent of IRS workers out of the office, these applications are now delayed — and the patients involved could lose their insurance entirely if they can’t pay the full premium while they are waiting. (As a bonus, the IRS Call Center is closed so these people can’t get information on what they should do.). Democratic senators andrepresentatives sent a letter Monday to HHS and Treasury asking for protection from unexpected premium costs due to the shutdown.

4. People Who Receive SNAP Benefits (Food Stamps) Have Another Month of Coverage  

The United States Department of Agriculture, Food and Nutrition Service (FNS) released funds to each state to provide February Supplemental Nutrition Assistance Program (SNAP) benefits two days before the shutdown. This means people who receive SNAP (food stamps) must ration their benefits to last two months; it is unclear if there will be any further assistance if the shutdown continues into March.

People who were in the process of applying for food stamps when the shutdown began may have to go without until the reopening of the government. Although the SNAP program is administered through the states, “FNS does not guarantee eligible applicants will receive food stamp benefits while the partial federal shutdown is in effect,” St. Louis Public Radio wrote.

5. Food Safety Issues May Affect Public Health  

Food safety is a basic component of public health, and it is now threatened by the interruption of routine food safety inspections. However, the day after FDA Commissioner Scott Gottlieb confirmed the cessation of food control efforts, the FDA announced that “high-risk” inspections, including infant formula, shellfish, and prepared salads and sandwiches, will resume with the return of 150 furloughed (but still unpaid) people next week.

6. Industry Developments Are Affected by Government Regulators’ Lack of Funding  

The Antitrust Division of the Justice Department asked the U.S. District Court in Washington, D.C., last week to suspend review of the $70 billion CVS-Aetna merger due to lack of resources. The judge told them to keep working.

This “mega-merger” is a highly publicized case — and the judge’s opinion presumably reflects that. Undoubtedly there are lesser-known business dealings and corporate plans that cannot come to fruition while the necessary federal agencies are unavailable to serve their role.

7. The Safety of Drinking Water is Threatened  

After what is happening in Flint, Mich., water safety is top-of-mind for all health care providers, but with more than 13,000 workers furloughed, the Environmental Protection Agency does not have enough staffing to inspect drinking water adequately.

8. State 1332 Waivers for Innovations in Marketplaces are on Hold  

IRS evaluation of the financial impact of proposed innovations is a central component in a state’s process to obtain a 1332 waiver, but because the IRS is currently crippled (see above) that agency can’t work with HHS to evaluate state initiatives to revamp their ACA marketplaces, a chief focus of conservative efforts to alter the ACA.

9. The Appeal of the Texas Decision Striking Down the ACA is on Pause  

The federal court system has survived the shutdown by conserving resources as best as possible (although a closure could happen as early as next week), but the shutdown has still impacted the most prominent court case in health care today: the Texas lawsuit decided in December declaring the entire ACA invalid. On Jan. 11, the 5th Circuit Court of Appeals in New Orleans issued a stay in the appeal of that decision until the government reopens.

10. The FDA is Open — but New Drug Treatments may be Delayed  

The FDA, as a branch of HHS, is up and running, but even so, some pending new drug treatments (including those for multiple sclerosis, depression, and diabetes) may be delayed if the shutdown continues, as the agency cannot process the application fees paid by drug manufacturers during the shutdown. Funds available at FDA are expected to be exhausted before March. 

11. It is Increasingly Difficult to Hire Researchers at the FDA  

In 2016, the passage of the 21st Century Cures Law (Pub. L. 114-255) was “designed to help accelerate medical product development and bring innovations and advances to patients who need them faster and more efficiently.” Part of that directive was to accelerate hiring scientists (and increase their pay) at the FDA. However, as recently reported by Bloomberg, the shutdown is making it difficult to entice the best minds away from the private market — to reinforce the argument that the government is “a good place to work.”

 

12. Activities of Homeland Security Related to Health are at Peril  

The division of the Department of Homeland Security that monitors threats related to infectious diseases, pandemics, and biological and chemical attacks (the Office of Health Affairs) is scaled back throughout the shutdown. Of the 204 people who typically address these threats as well as others in the Countering Weapons of Mass Destruction Office, only 65 remain active.

Other Homeland Security employees who will continue to work without pay include border health inspectors and members of the border patrol.

This shutdown is a world of pain for all of us. But for many, it is an actual threat to life (such as living without insulin).

2019 will be a year of political battles over the future of the American health care system on both a federal and state level. The Trump Administration will (presumably) continue to erode protections provided in the ACA, and the December case ruling the entire ACA unconstitutional will continue to wind its way toward a newly constituted conservative U.S. Supreme Court. The ying and yang of “Medicare for All” and “Free Market Health Care” will be the debate of the year. All of that, and much more, will be the subject of future Fontenotes.

But until our government fully reopens — those debates all seem irrelevant — if not irreverent.

 


Leave a comment
Name *
Email *
Homepage
Comment