Rep. Matt Gaetz (R-FL) and different members of the right-wing Home Freedom Caucus may drive a federal authorities shutdown Oct. 1. The Nationwide Institutes of Well being and the Facilities for Illness Management and prevention can be affected.
Chip Somodevilla/Getty Photos
cover caption
toggle caption
Chip Somodevilla/Getty Photos
Rep. Matt Gaetz (R-FL) and different members of the right-wing Home Freedom Caucus may drive a federal authorities shutdown Oct. 1. The Nationwide Institutes of Well being and the Facilities for Illness Management and prevention can be affected.
Chip Somodevilla/Getty Photos
For the primary time since 2019, congressional gridlock is poised to not less than quickly shut down massive components of the federal authorities — together with many well being applications.
If it occurs, some authorities features would cease fully and a few partly, whereas others would not be instantly affected — together with Medicare, Medicaid, and well being plans bought beneath the Reasonably priced Care Act. However a shutdown would complicate the lives of everybody who interacts with any federal well being program, in addition to the individuals who work on the companies administering them.
Listed here are 5 issues to know concerning the potential affect to well being applications:
1. Not all federal well being spending is similar.
“Necessary” spending applications, like Medicare, have everlasting funding and do not want Congress to behave periodically to maintain them operating. However the Division of Well being and Human Companies is stuffed with “discretionary” applications — together with on the Nationwide Institutes of Well being, Facilities for Illness Management and Prevention, group well being facilities, and HIV/AIDS initiatives — that should be particularly funded by Congress via annual appropriations payments.
The appropriations payments (there are 12 of them, every protecting varied departments and companies) are purported to be handed by each chambers of Congress and signed by the president earlier than the beginning of the federal fiscal 12 months, Oct. 1. This virtually by no means occurs. In actual fact, in response to the Pew Analysis Heart, Congress has handed all of the appropriations payments in time for the beginning of the fiscal 12 months solely 4 instances for the reason that fashionable funds course of was adopted within the Nineteen Seventies; the final time was in 1997.
Congress often retains the lights on for the federal government by passing short-term funding payments, generally known as “persevering with resolutions,” or CRs, till lawmakers can resolve their variations on longer-term spending.
This 12 months, nonetheless, a handful of conservative Republicans within the Home have mentioned they will not vote for any CR, in an try to drive deeper spending cuts than these agreed to this spring in a bipartisan invoice to boost the nation’s borrowing authority. Home Speaker Kevin McCarthy and his allies may be part of with Democrats to maintain the federal government operating, however that will virtually actually value McCarthy his speakership. A number of of the rebellious conservatives are already threatening to drive a vote to oust him.
2. The Biden Administration decides what stays open.
The White Home Workplace of Administration and Finances is liable for drawing up contingency plans in case of a authorities shutdown and publishes one for every federal division. The plan for Well being and Human Companies estimates that 42 p.c of its workers can be furloughed in a shutdown and 58 p.c retained.
The overall rule is that two varieties of actions might proceed absent annual spending authority from Congress. One is actions wanted “for security of human life or the safety of property.” At HHS, that would come with caring for sufferers on the hospital on the campus of the Nationwide Institutes of Well being — although new sufferers typically wouldn’t be admitted — in addition to the company’s laboratory animals, and CDC investigations of illness outbreaks.
Different actions which will proceed are these with funding sources that are not depending on annual appropriations. Medicare and Social Safety, for instance, are entitlements funded by taxes and premiums. Drug approvals on the Meals and Drug Administration are largely funded by consumer charges paid by drugmakers, so approvals in course of can proceed however there are questions on whether or not new approval processes may begin.
Additionally unaffected are applications which were funded upfront by Congress. For instance, the Indian Well being Service is already funded via the 2024 fiscal 12 months.
3. What occurs to enrollment in Medicare and Reasonably priced Care Act plans?
It is determined by how lengthy the shutdown lasts. Within the brief time period, obligatory spending applications can be principally, however not fully, unaffected by a authorities shutdown. Advantages would proceed beneath applications like Medicare, Medicaid, and the Reasonably priced Care Act, and medical doctors and hospitals may proceed to submit payments and receives a commission. However federal workers not thought of “important” can be furloughed.
Meaning preliminary Medicare enrollment may very well be quickly stopped. In keeping with the Committee for a Accountable Federal Finances, an unbiased group that tracks federal spending, through the 1995-96 federal shutdown, “greater than 10,000 Medicare candidates had been quickly turned away every single day of the shutdown.”
A shutdown should not a lot have an effect on Medicare’s annual open enrollment interval, which begins Oct. 15 and permits present beneficiaries to hitch or change non-public Medicare Benefit or prescription drug plans. That is as a result of a lot of the funding to assist seniors and different beneficiaries select or change Medicare well being plans has already been allotted.
Rebecca Kinney, who runs the HHS workplace that oversees the federal program that counsels Medicare beneficiaries about their myriad selections, mentioned Friday that funding for each the 1-800-MEDICARE hotline and federally funded state counseling companies has already been distributed for this 12 months, so neither can be affected, not less than within the brief run.
The identical is true for Reasonably priced Care Act plans, which open for enrollment on Nov. 1. The HHS contingency paperwork say the Facilities for Medicare & Medicaid Companies, which oversees the federal well being alternate, HealthCare.gov, “will proceed Federal Change actions, similar to eligibility verification,” utilizing charges paid by insurers left over from the earlier 12 months.
Nonetheless, about half of CMS workers can be furloughed in a shutdown. That might complicate a whole lot of different actions there, beginning with drug value negotiations set to start Oct. 1. HHS Secretary Xavier Becerra instructed reporters on the White Home final week {that a} shutdown would probably push again the timeline for negotiations.
A shutdown would additionally threaten HHS oversight of the Medicaid “unwinding” course of, as states reevaluate the eligibility of these enrolled in this system for low-income individuals. State staff can be unaffected, in response to the Georgetown College Heart for Kids and Households, so eligibility evaluations will proceed regardless. However due to federal furloughs, “technical help to assist states handle unwinding issues and undertake mitigation methods may stop,” wrote the middle’s Kelly Whitener and Edwin Park. “Efforts to find out if there are additional renewal processes which are out of compliance with federal necessities may very well be restricted or ended.”
4. What if the shutdown is extended?
Extra applications may very well be affected. For instance, the HHS shutdown contingency doc says that “CMS can have enough funding for Medicaid to fund the primary quarter” of fiscal 12 months 2024. The federal government has by no means been shut down lengthy sufficient to know what would occur after that. The 2013 shutdown, which included HHS, lasted simply over two weeks. A lot of the company wasn’t affected by the 2018-19 shutdown as a result of its annual appropriations invoice had already been signed into regulation. (The FDA is funded beneath the appropriations invoice that covers the Agriculture Division quite than the one which funds HHS.)
5. Do federal workers receives a commission throughout a shutdown?
It relies upon. Workers whose applications are funded proceed to work and be paid. These thought of “important” however whose applications are usually not funded would proceed to work, however they would not receives a commission till after the shutdown ends. A 2019 regulation now requires federal staff to get again pay when funding resumes, which was not all the time the case. Nonetheless, federal contractors, together with those that work in meals service or upkeep jobs, don’t have any such assure.
KFF Well being Information, previously generally known as Kaiser Well being Information (KHN), is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working applications at KFF — the unbiased supply for well being coverage analysis, polling, and journalism.
