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As a Federal Government Shutdown Looms, Some Governmental Functions Left More Vulnerable Than Others

September 30, 2013
by Pamela Tabar and Mark Hagland
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A looming federal government shutdown appeared certain as of Monday evening

Thanks to our colleague, Pamela Tabar, Editor-in-Chief of our sister publication, Long-Term Living Magazine, for the bulk of reporting and writing of this report. Healthcare Informatics will continue to update its readers on this developing story.


Political stances hardened in the U.S. Senate Monday afternoon, Sep. 30, as a proposed amendment to bolster government funding by delaying the Affordable Care Act (ACA) was voted down 54-46. The amendment, passed by the House during a rare weekend session, was based on a GOP-led proposal to delay the implementation of the ACA by one year and repeal the medical device tax as a way to avert government shutdown, which was set to take effect at midnight on Tuesday, Oct. 1, should the Congress fail to pass a continuing resolution to keep the operations of the federal government going.

The Republican-led House of Representatives had voted late Saturday to approve the idea, 231-192, primarily along party lines. But Senate Majority Leader Harry Reid (D-Nev.) had vowed to kill the bill if it reached the Senate floor.

Prior to the House vote, the White House issued a veto threat, reiterating that President Obama would not sign any bill that would delay the ACA. “The only way we can do that is for everybody to sit down in good faith and without threatening to harm,” Obama said in a briefing today. “There can be no meaningful negotiations under a cloud of default.” After a second cycle of continuing resolution votes, in which the Democratic-controlled Senate rejected the House's continuing resolution and the House on Monday afternoon passed a second CR identical to the one passed on Saturday, the first federal government shutdown in 17 years (the last time the federal government shut down was in 1996) appeared to be a looming certainty.

Then, at about 4:00 P.M. eastern time, President Barack Obama appeared before reporters to condemn the House Republicans' refusal to submit for a vote a "clean CR," meaning a continuing resolution to fund the federal government's operations that does not include provisions removing funding from the ACA. "Of all the responsibilities the Constitution endows to Congress, two should be fairly simple: pass a budget, and pay America's bills. But if the United States Congress does not fulfill its responsibility to pass a budget today, much of the United States government will be forced to shut down tomorrow. And I want to be very clear about what that shutdown would mean, what will remain open and what will not." He went on to state that the ACA's funding is assured, and that the statewide health insurance exchanges would open on schedule on Tuesday, Oct. 1.

As the hours wind down towards the shutdown, federal officials noted that Social Security checks and Medicare payments are not involved in the current government shutdown risks, since those programs are not funded by the annual congressional appropriations at issue this week, noted the watchdog site The Hill.

Although a government shutdown could result in furlough of many agency workers, it won’t stop the healthcare insurance marketplaces, scheduled to roll out Oct. 1. The Centers for Medicare & Medicaid Services (CMS) “would continue large portions of ACA activities, including coordination between Medicaid and the Marketplace, as well as insurance rate reviews, and assessment of a portion of insurance premiums that are used on medical services,” noted a CMS memo outlining its contingency plans during a shutdown. “In the short term, the Medicare Program will continue largely without disruption during a lapse in appropriations.”

However, several key programs would be placed on hold if a government shutdown took place. Federal officials would be forced to determine who are essential employees and what are essential functions that cannot be interrupted. The CMS memo stated that:

  • CMS will be unable to fund fraud strike forces and would cut back on the number of surveys and recertifications due to reduced workforces.
  • The Office of the National Coordinator for Health Information Technology (ONC) will stop work on the Standards and Interoperability Framework and on policy development. What's more, a highly placed source within the federal government has told Healthcare Informatics that virtually all ONC operations would be affected.
  • The Centers for Disease Control and Prevention will not be able to fund its annual influenza program, including its national infection surveillance functions.