First time since late in 2019 the gridlock in Congress is set to stop major portions that of federal administrationincluding many health care programs.
If the shutdown happens, certain government functions could be shut down completely and others only partially, while other functions would not be affected immediately -for instance, Medicare, Medicaid and health plans in the Affordable Care Act. However, a shutdown could affect the lives of all who is involved in any federal health program as well as those employed by the organizations that manage them.
Here are five things you need to be aware of regarding the possible effects on programs for health:
1. There are many different federal health expenditures, but not every one is exactly the exact.
“Mandatory” expenditure programs such as Medicare have a long-term funding source and don’t require Congress to take action on a regular basis to ensure they’re running. However, there are other programs, like the Department of Health and Human Services is brimming with “discretionary” programs such as the National Institutes of Health, Centers for Disease Control and Prevention and community health centers, and HIV/AIDS initiatives that need to be specifically supported by Congress by appropriations bills each year.
The bills for appropriations (there is twelve each one covering different offices and departments) are expected to be ratified in both houses of Congress and then signed by the president prior to beginning of the fiscal year in October. 1. It’s almost never the case. According to Pew Research Center, Congress has approved all bills for appropriations in time for the beginning of this fiscal year just 4 times since the modern budget procedure was implemented in the 1970s. The most recent time was 1997.
Congress generally ensures that the lights are on for the government making short-term funding bills also known as “continuing resolutions” (CRs), until the lawmakers are able to find a solution to their differences over longer-term spending.
This year, however some moderate Republicans within the House have stated that they will not support any CR as a way to impose more drastic cuts to spending than the ones that were agreed to this spring in an agreement between the two parties to increase the country’s borrowing power. House Speaker Kevin McCarthy and his allies may join forces with Democrats to maintain the functioning of the government however, it would almost surely cost McCarthy his position as speaker. Some of the conservatives who have resisted are already in the process of threatening to force the vote to remove McCarthy from office.
2. The Biden administration decides on what is open.
The White House Office of Management and Budget is in charge of creating contingency plans for an unplanned shutdown of the government and has one published for every federal department. In the case of Health and Human Services estimates that 42 percent of its employees would be laid off in the event of an event of shutdown and 58 percent are retained.
The standard is that two kinds of activities could continue indefinitely without annual funding authority from Congress. The first is those that are required “for security of life and safety or for the protection of property.” For HHS this would mean providing care for patients in the hospital located on its campus at the National Institutes of Health -although new patients typically are not admitted to the hospital -and also the lab animals at HHS and CDC studies of outbreaks of disease.
Other programs that could be carried on are those that have funding sources that don’t depend on annual budgets. Medicare or Social Security, for example are entitlements that are funded by premiums and taxes. The approval process for drugs at the Food and Drug Administration are mostly funded by user fees made by drug manufacturers, therefore approvals that are currently in process may continue however there are concerns about how new approvals could begin.
Unaffected are the programs that are already funded by Congress. For instance The Indian Health Service is already fully funded until the fiscal year.
3. What happens to enrolling for Medicare or Affordable Care Act plans?
It’s dependent on the length of time that the shutdown will last. In the short run the mandatory spending programs would remain mostly however not entirely not affected by a shutdown of the government. Benefits would be maintained under programs such as Medicare, Medicaid and the Affordable Care Act, and hospitals and doctors would continue to file invoices and be paid. However, federal employees who are not considered “essential” could be reassigned to furloughs.
This means that the it is possible that initial Medicare enrollment may be suspended temporarily. In the words of Committee for a Responsible Federal Budget, an independent organization that monitors federal spending during the 1995-96 shut-down “more than 10,000 Medicare applicants were turned away throughout the shut-down.”
The shutdown won’t have much impact on the annual open enrollment period for Medicare that begins on October. 15 and permits current beneficiaries to enroll in or switch the private Medicare Advantage plans or other prescription drugs. This is because a large portion of funds to assist elderly and other beneficiaries pick or switch Medicare health plans has already been allocated.
Rebecca Kinney, who runs the HHS office responsible for the federal program that advises Medicare beneficiaries on their numerous options, announced Friday that the funding for the hotline 1-800-MEDICARE and the state counseling agencies funded by federal funds is already distributed this year, which means neither of them will not be affected in the the very least in the short-term.
This is also true for Affordable Care Act plans, which are open for enrollment November. 1. The HHS contingency plans state that they will Centers for Medicare & Medicaid Services who is responsible for the health exchange in the federal government, HealthCare.gov, “will continue Federal Exchange activities, such as eligibility verification” with the help of fees paid by insurers that are left unpaid from prior years.
But, roughly half of CMS staff could be sacked during the event of a shut down. This could impact a variety of other tasks there beginning with the negotiations on drug prices set to start in October. 1. HHS Secretary Xavier Becerra told reporters at the White House last week that the shutdown could delay the timeframe for talks.
The shutdown also could affect HHS supervision over monitoring of Medicaid “unwinding” method in states that reevaluate the eligibility of people in the program that caters to those with low incomes. State employees will not be affected as per the Georgetown University Center for Children and Families and assessments of eligibility will continue in the same manner. Due to the federal furloughs “technical assistance to assist states deal with unwinding issues and implement mitigation strategies could be cut off,” wrote the center’s Kelly Whitener and Edwin Park. “Efforts to find out if there is a need for other renewal processes not in conformity with federal requirements might be curtailed or stopped.”
4. What happens if the shutdown long?
There are other programs that could be affected. For instance the HHS document on the shutdown contingency states the “CMS will have enough funding for Medicaid to finance in the initial quarter” of the fiscal year 2024. The federal government has not been shut down for long enough to know what could take place after the shutdown. In 2013, the shutdown that also included HHS was just over two weeks. The majority of the agency was not affected by the shutdown in 2018-19 because its annual appropriations legislation was already signed into law. (The FDA is funded under the appropriations bill which covers those of the Agriculture Department rather than the one which provides funding to HHS.)
5. Are federal employees paid during the shutdown?
It depends. People who have programs funded will continue to work and get paid. People who are deemed “essential” however, who’s programs are not funded will be able to continue working however they won’t be paid until the shutdown has ended. A new law in 2019 stipulates that federal workers must be paid back as funding resumes however, this was not always the situation. However federal contractors, such as those employed in maintenance or food service jobs, do not have this security.
KFF Health News which was previously named Kaiser Health News (KHN) is a national newsroom which produces in-depth reporting on health-related issues. It is also one of the main operating programs of KFF — an non-profit source of research on health policies, surveys and journalism.
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