A government shutdown could harm the U.S. medical system, even affecting Medicare payments to physicians
Oct. 6, 2023 (ACP) — While Congress averted a government shutdown on a temporary basis, the American College of Physicians is urging the nation's leaders to resolve their differences before the stopgap period ends on Nov. 17.
A government shutdown would harm the nation's medical system in a variety of ways, warned David Pugach, J.D., ACP vice president for governmental affairs and public policy. Many federal health programs would be impacted, he said, which could potentially affect Medicare payments to physicians if a shutdown lasts for an extended period. Federal programs like Medicare, Medicaid and Social Security will continue during a shutdown. “Claims are paid during a shutdown, but a prolonged shutdown could affect Medicare Administrative Contractor staffing, which could impact the processing of payments,” Pugach said.
In late September, the votes needed to pass even a short-term spending bill were elusive and appeared likely to doom the nation to a shutdown as of Oct. 1, the beginning of the federal fiscal year. But a coalition of Democrats and some Republicans reached temporary appropriations deal in the House. The Senate signed on, and President Biden signed legislation that funds the government through Nov. 17.
If there is a shutdown at that point, the medical system will take a hit on a variety of fronts, according to Pugach. “A shutdown occurs when there is a lapse in appropriations,” he explained. “The appropriations process is the legislation enacted into law each year that funds the operations of federal agencies, including the range of programs that provide resources to states and local governments, as well as universities, hospitals and other nongovernmental organizations.”
State and local programs that rely on federal funding would not be able to obtain new funding during a shutdown, he said, adding that “the extent to which physicians and their patients are directly impacted by a federal government shutdown depends on how long a shutdown lasts.”
The U.S. Department of Health and Human Services expects to furlough more than 40 percent of its workforce under a shutdown, meaning “that many requests for assistance or technical support will go unanswered during a shutdown,” Pugach said.
The Centers for Medicare and Medicaid Services also could halt many of its efforts to provide support to state Medicaid programs to help mitigate the potential impact of redeterminations on program enrollees, Pugach noted.
“The federal health insurance exchange would remain open, although limited staff would be available to assist people or address technical issues,” he explained. “If a shutdown were to extend into an open enrollment period, it could have a greater impact on people navigating the exchange.”
A shutdown could have many other effects: Enrollment of new patients in clinical trials being conducted at the National Institutes of Health will be uncertain, and new grant awards for research projects would be delayed. Additionally, National Institutes of Health and Centers for Disease Control and Prevention advisory committees would not be able to meet.
“Under a prolonged shutdown, funding for safety net assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants and Children (WIC), would likely run out of funding,” Pugach noted.
Rulemaking could also be delayed.
ACP will advocate for a resolution that will avert a shutdown and fund the government for the entire fiscal year through Sept. 30, 2024. As for the larger budget picture, “ACP will fight for our funding priorities and pursue opportunities to leverage appropriations legislation as a vehicle to support physician payment,” Pugach said.
“With so many competing issues, it is critical that members of Congress hear from people in their communities,” Pugach added. “As physicians, ACP members are uniquely positioned to convey the real-world impact of policies to their lawmakers and explain why a legislative solution is necessary. This is one of the reasons we provide ACP members with easy ways to send advocacy messages to their lawmakers through our Legislative Action Center.”
He added that “it is also important for people to know that multiple contacts with legislators on a single issue are usually needed. Every email and phone call helps. The more a lawmaker hears from constituents on an issue, the more likely they are to prioritize it.”