Federal Gov’t Shutdown Begins; ACA Implementation To Continue
Parts of the federal government began to shut down early Tuesday after lawmakers failed to bridge a gap over language that would defund the Affordable Care Act as part of a short-term continuing resolution package, the New York Times reports.
Congress in recent years routinely has passed short-term spending bills to keep the government funded. However, negotiations over a short-term CR that would keep the government funded for several months became tense between the House and Senate after House Republicans insisted on including provisions targeting the ACA in the spending bill.
The Senate and House spent Monday volleying spending measures back and forth in a series of legislative maneuvers.
First, the Senate voted 54-46 to strip a House-approved CR of provisions that would delay the ACA for one year and repeal the law's 2.3% medical device tax (Weisman/Peters, New York Times, 9/30).
In response, the House adjusted its strategy and voted 228-201 to approve an amended version of the Senate-approved spending bill that included measures that would delay by one year the law's individual mandate (Hook/Peterson, Wall Street Journal, 10/1). The bill also would have forced lawmakers and their staffs, the White House -- including President Obama and Vice President Joe Biden -- and political appointees to purchase health coverage through the exchanges without an employer contribution (Kasperowicz, "Floor Action Blog," The Hill, 9/30).
The measure immediately was rejected by the Senate, which again sent the House back a "clean" CR, devoid of any ACA measures (Wall Street Journal, 10/1).
In a final move, the House around 1 a.m. passed a proposal with similar ACA provisions, returning it to the Senate with a measure that would set up a special House-Senate committee to meet in the coming days to discuss the differences between the parties (Montgomery/Kane, Washington Post, 10/1).
The Senate voted 54-46 against that proposal on Tuesday morning, marking the fourth time that the chamber has rejected a House CR plan (Cassata, AP/ABC News, 10/1).
Prior to the vote, Senate Majority Leader Harry Reid (D-Nev.) said he would not enter negotiations with House Republicans until they agreed to reopen the government (Wall Street Journal, 10/1).
Meanwhile, President Obama on Monday night called House Speaker John Boehner (R-Ohio) to urge him to reconsider his position on the ACA. According to Boehner's office, the call lasted about 10 minutes (Washington Post, 10/1).
Lawmakers Raise Concerns
Throughout the back-and-forth on Monday, several Democrats -- and even some Republicans -- expressed frustration with the House GOP leadership's plan to push the U.S. government to close over the ACA, the New York Times reports.
In a speech on the Senate floor, Sen. Claire McCaskill (D-Mo.) said, "It's very hard from a distance to figure out who has lost their minds ... One party, the other party, all of us, the president" (Parker, New York Times, 9/30).
Meanwhile, Reid criticized the House GOP leaders, saying, "The responsibility for this Republican government shutdown will rest squarely on your shoulders."
Sen. John McCain (R-Ariz.) also criticized the House GOP's plan, saying that it "defies what the popular will is." He said, "I campaigned in 2012 all over this country for months: 'Repeal and replace Obamacare.' That was not the mandate of the voters." McCain added, "If they wanted to repeal Obamacare, the 2012 election would have been probably significantly different" (Washington Post, 10/1).
Meanwhile, Rep. Peter King (R- N.Y.) said, "It's just leading us into a dead end." He added, "The Democrats are going to reject it, and the government's going to shut down" (Parker, New York Times, 9/30).
What Happens After a Shutdown?
Shortly before midnight, the Office of Management and Budget issued orders for federal agencies to "execute plans for an orderly shutdown due to the absence of appropriations," the New York Times reports.
The government shutdown means that 800,000 federal workers will be furloughed and more than one million other employees will be asked to work without pay, affecting several facets of health care, while leaving other aspects untouched (Peter/Weisman, New York Times, 9/30).
- CDC will suspend its seasonal influenza program, reduce its outbreak detection efforts and stop helping states with infectious disease monitoring;
- CMS will suspend certain health care fraud and abuse detection efforts (California Healthline, 9/30);
- The Department of Agriculture will furlough 1,226 food safety and inspection workers, and more if the shutdown goes beyond two days;
- FDA will furlough 6,620 workers -- about 45% of its workforce -- forcing it to halt safety activities, including routine inspections, import monitoring and laboratory research needed to inform public health decisionmaking;
- HHS will furlough 40,512 of its 78,198 employees, with the vast majority coming from grant-making and employee-intensive agencies such as the Administration for Children and Families and the Substance Abuse and Mental Health Services Administration;
- NIH will furlough 13,698 workers and will not accept new clinical care patients or award new grants; and
- Veterans Affairs will furlough 14,224 workers, which will likely have an effect on benefit checks -- including disability claims -- and will prevent the VA appeals board from holding hearings (Washington Post, 9/30).
Several veterans groups are speaking out against the shutdown, which will threaten the VA's ability to process veterans' disability claims, the Washington Post reports. Tom Tarantino -- chief policy officer for Iraq and Afghanistan Veterans of America -- said that losing the payments could have a devastating effect on veterans, particularly those who are severely wounded and unable to work.
A spokesperson for Sen. Bernie Sanders (I-Vt.) -- chair of the Senate Committee on Veterans' Affairs -- said Sanders plans to introduce legislation Monday that would provide funding for the VA to continue issuing checks to veterans (Vogel, Washington Post, 9/30).
However, the shutdown will spare certain aspects of health care. For example, Medicare will continue to provide coverage, and states will continue to receive federal payments for Medicaid and CHIP. In addition:
- NIH will continue patient care for current clinical center patients;
- PEPFAR, CDC's Global AIDS program, and other similar programs will be funded;
- FDA will continue to some activities, including those in the Center for Tobacco Products (California Healthline, 9/30); and
- The Drug Enforcement Administration and the Bureau of Alcohol, Tobacco, Firearms and Explosives are exempt from the DOJ's 17,742 furloughed employees (Washington Post, 9/30).
ACA Implementation Continues
Although the federal government is partially shutting down because of the flap over the ACA, implementation of the law will continue as scheduled, The Hill's "Healthwatch" reports (Baker, "Healthwatch," The Hill, 9/30).
According to Politico, many parts of the ACA are considered mandatory spending -- such as federal subsidies to help individuals purchase coverage through the law's exchanges and Medicaid expansion funding -- and therefore are not subject to annual appropriations bills (Cunningham/Nather, Politico, 9/29).
A memo to HHS staffers also stated that those involved in the law's implementation will not be furloughed with other federal workers, including employees who are helping with "coordination between Medicaid and the [marketplace], as well as insurance rate reviews" (Schatz, "Washington Wire," Wall Street Journal, 9/30).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.