By Shefali Luthra JANUARY 3, 2019
There
seems to be no end in sight for the current partial government shutdown,
the third since the beginning of the Trump administration.
For the
vast majority of the federal government’s public health efforts, though, it’s
business as usual.
That’s
because Congress has already passed five of its major appropriations bills,
funding about three-fourths of the federal government, including the Department
of Health and Human Services and the Department of Veterans Affairs.
But seven bills are
outstanding — including those that fund the Interior, Agriculture and Justice
departments — and that puts the squeeze on some important health-related
initiatives.
The
shutdown itself is not about health policies. It’s the result of differences of
opinion between the administration and congressional Democrats regarding
Trump’s so-called border wall. But it’s far-reaching, nonetheless. Here’s where
things stand:
Funding
for “big-ticket” health programs is already in place, alleviating much of the
shutdown’s immediate potential impact.
Since
HHS funding is set through September, the flagship government health care
programs — think Obamacare, Medicare and Medicaid — are insulated.
That’s
also true of public health surveillance, like tracking the flu virus, a
responsibility of the Centers for Disease Control and Prevention. The National
Institutes of Health, which oversees major biomedical research, is also fine.
It’s a stark contrast to last January’s shutdown, which sent home about
half of HHS’ staff.
But
some other public health operations are vulnerable because of complicated
funding streams.
Although
the Food and Drug Administration falls under the HHS umbrella, it receives
significant funding for its food safety operations through the spending bill
for the Department of Agriculture, which is entirely caught up in the shutdown.
Last
year, that tallied an estimated $2.9 billion to
support among other things these FDA oversight efforts, which involve
everything from food recalls to routine facility inspections and cosmetics
regulation. Not having those dollars now means, according to the FDA contingency plan, that
about 40 percent of the agency — thousands of government workers — is furloughed.
The
FDA’s responsibilities for drug approval and oversight are funded by user fees
and are generally not affected. Regulation of tobacco products is also
continuing.
Health
services for Native Americans are also on hold.
Because Congress
has yet to approve funding for the Indian Health Service, which is run by HHS
but gets its money through the Department
of the Interior, IHS feels the full weight of the shutdown.
The only services that can continue are those that meet “immediate needs of the
patients, medical staff, and medical facilities,” according to the
shutdown contingency plan.
That
includes IHS-run clinics, which provide direct health care to tribes around
the country. These facilities are open, and many staffers are
reporting to work because they are deemed “excepted,” said Jennifer Buschik, an
agency spokeswoman. But they will not be paid until Congress and the
administration reach a deal.
Other
IHS programs are taking a more direct hit. For example, the agency has
suspended grants that support tribal health programs, as well as preventive
health clinics run by the Office of Urban Indian Health
Programs.
Public
health efforts by Homeland Security and the EPA face serious constraints.
The
Department of Homeland Security’s Office of Health Affairs assesses threats
posed by infectious diseases, pandemics and biological and chemical attacks. It
is supposed to be scaling back, according to the department’s shutdown contingency plan.
This office is just one component of the 204-person Countering Weapons of Mass
Destruction Office, which is retaining about 65 employees during the funding
gap.
Other
DHS health workers are likely to work without pay — for instance, health
inspectors at the border, said Peter Boogaard, who was an agency spokesman
under the Obama administration. According to DHS’ plan, the vast
majority of border patrol employees will continue working through the shutdown.
The
Environmental Protection Agency has also run out of funding. According to its contingency plan, it’s
keeping on more than 700 employees without pay, including those who work on
Superfund sites or other activities where the “threat to life or property is
imminent.” (More than 13,000 EPA workers have been furloughed.)
That
limits the agency’s capacity for activities including inspecting water that
people drink and regulating pesticides.
But
it’s not just regulation. The public health stakes are visceral — and
sometimes, frankly, pretty gross.
Just
look at the National Park Service,
which has halted restroom maintenance and trash service for lack of funding. On
Sunday, Yosemite National Park in California closed its campgrounds. On Wednesday,
Joshua Tree National Park, also in California, did the same.
Why?
Per a park service press release: “The park
is being forced to take this action for health and safety concerns as vault
toilets reach capacity.”
Shefali Luthra: ShefaliL@kff.org,
@Shefalil
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