The House still could pass the Senate's “clean” continuing resolution, which would then move to the president for his signature and restart government operations. If House members choose to amend the Senate-passed bill again, it would still require Senate consideration.
President Barack Obama said Tuesday morning that the shutdown is not about deficits or budgets, but instead is about Republican's “ideological crusade” to roll back efforts to provide health insurance to those who need it. The president reiterated that he will not give into “reckless demands” by some members of the Republican Party.
“As I've said before, the irony House Republicans have to contend with is they shut down whole parts of the government, but the Affordable Care Act is still open for business,” the president said in the White House Rose Garden, flanked by HHS Secretary Kathleen Sebelius and a group of Americans with healthcare issues whom he said will benefit from the Affordable Care Act. Later, he promised he would not negotiate “over Congress' responsibility to pay bills it has already racked up,” signaling that House Republicans can expect resistance if they continue their fight to dismantle the Affordable Care Act when the country hits the debt ceiling in a few weeks and must extend its borrowing authority.
In addition to open enrollment on the state health insurance exchanges, other key healthcare functions that rely on mandatory funding will continue. For instance, the CMS on Tuesday released a brief notice that said during the time that the “partial government shutdown is in effect,” Medicare Administrative Contractors will continue to perform all functions that relate to Medicare fee-for-service claims processing and payment.
But because the shutdown is based on continuing appropriations, it's likely to have significant, negative consequences on programs and services that rely on discretionary spending. That includes funding for key activities such as biomedical and clinical research at the National Institutes of Health and the seasonal influenza program at the Centers for Disease Control and Prevention, which an HHS contingency plan said the CDC won't be able to support.
“We are on the edge of entering cold and flu season,” said Ilisa Halpern Paul, managing government relations director at Drinker Biddle & Reath in Washington, who added that the elderly and very young are at higher risk of getting the flu. “For the CDC to not engage at this time, we could see outbreaks of the flu where we wouldn't have had it.”
Similarly, the CDC's efforts to help serve as support for state and local health departments will be compromised, said Dr. Georges Benjamin, executive director of the American Public Health Association. Benjamin noted that the CDC is still managing its emergency operations center at a “skeletal level,” so the Atlanta-based agency would be able to report a terrorist attack. But if there is, say, a food-borne illness outbreak in Mississippi, the first responders in the area would not be able to rely on the CDC for backup. He's also concerned about the effect on clinical research.
“If you're working in a lab, hopefully, you had an orderly shutdown of your lab, but critical research experiments don't get done,” Benjamin said. “If you're growing cultures, they don't wait because the government shuts down. You have to start those all over again. It's a nightmare for research.”
Halpern Paul echoed that sentiment, saying the National Institutes of Health Clinical Center will see existing patients, but it's unclear if the agency will be able to process new patients. Biomedical and clinical research need funding consistency, she said, and can't be turned on and off like a light switch. The challenge is that no one knows—or can speculate—how two days or two weeks of a government shutdown could affect particular research endeavors, particularly if scientists are on the brink of discovery. As she put it, a critical nonevent is very hard to prove.
“That could be the difference between a cure and years of more suffering,” Halpern Paul said. “That is where I get worried. For a lot of policymakers, the impact of their actions is going to be hard to see in the near term, and have long-term, adverse consequences.”
Meanwhile, Halpern Paul, Benjamin and Dr. Atul Grover, chief public policy officer at the Association of American Medical Colleges, all said that there isn't likely to be much disruption in the first day or two of a shutdown, which Benjamin likened to the first day of a snowstorm. But a more extended period could start to make things much more difficult for providers and patients.
According to Grover, a bigger concern for the nation's academic medical centers is continuation of the budget sequestration cuts, which have significantly reduced Medicare payments to providers in 2013. Academic medical centers rely on grants, but they also rely on essential clinical revenue for their work. In the past year, Grover said, the nation's medical schools saw a $1 billion reduction in NIH funding. On top of that, they faced a $1.5 billion reduction in Medicare funding—both in hospital reimbursement and practice plan management.
“All of this has really been the culmination of a very bad year in our ability to support these missions,” Grover said. “That's going to get worse if lawmakers don't resolve the government shutdown and if they don't try to alleviate the sequester cuts.”
Follow Jessica Zigmond on Twitter: @MHjzigmond
