While Democrats and Republicans in Congress try to agree on a budget, much of the federal government has shut down because of a lack of funds. The impasse will affect the healthcare sector, although essential services will remain in place.
The insurance exchanges, designed for people to shop for individual health insurance policies as established by the Affordable Care Act, opened for business Oct. 1 as planned. However, the Department of Health and Human Services planned to furlough 40,512 staff across its various agencies, or 52% of its total workforce.
The effect on some of the agencies for as long as the shutdown remains in place, according to an HHS contingency document:
Centers for Medicare & Medicaid Services: CMS plans to continue large portions of ACA-related activities, including coordination between Medicaid and the exchanges. In the short term, according to HHS, Medicare will continue largely without disruption during a lapse in appropriations.” That means providers will continue to receive reimbursement as they normally would.
However, fewer recertification and initial surveys for Medicare and Medicaid providers would be completed, putting beneficiaries at risk of quality-of-care deficiencies, according to HHS.
CDC: The agency plans to continue public health activities to stymie imminent health threats to U.S. citizens domestically and abroad. But for the duration of the government shutdown, the CDC would be unable to support the annual seasonal influenza program, outbreak detection and linking across state boundaries using genetic and molecular analysis, continuous updating of disease treatment and prevention recommendations (such as HIV,TB, STDs, hepatitis), and technical assistance, analysis and support to state and local partners for infectious disease surveillance.
Food and Drug Administration: The FDA plans to continue select vital activities, including maintaining critical consumer protection to handle emergencies, high-risk recalls, civil and criminal investigations, import entry review and other critical public health issues.
The agency will be unable to support the majority of its food safety, nutrition and cosmetics activities. It also will have to cease safety activities such as routine establishment inspections, some compliance and enforcement activities, monitoring of imports, notification programs (such as food contact substances, infant formula), and the majority of the laboratory research necessary to inform public health decision-making.
Health Resources and Services Administration: HRSA will continue activities funded through sources other than annual appropriations: community health centers, the National Health Service Corps and the Maternal Infant and Child Health Home Visiting Program. Additionally, HRSA would continue the National Practitioner Databanks and Hansens Disease program.
Substance Abuse and Mental Health Services Administration: SAMHSA will continue programs such as the disaster distress help-line, treatment locator, treatment referral line and suicide prevention lifeline using available grant balances.
Agency for Healthcare Research and Quality: The agency will be unable to fund new grants and contracts related to health services research initiatives, including research on improving patient safety and reducing healthcare-associated infections.
National Institutes of Health: The agency will continue patient care for current NIH clinical center patients, minimal support for ongoing protocols, animal care services to protect the health of NIH animals and minimal staff to safeguard NIH facilities and infrastructure. The agency will not admit new patients unless deemed medically necessary by the NIH director or initiate new protocols.