Federal agencies Jan. 19 began issuing shutdown orders, as a continuing resolution (H.J.Res 125) approved by the House Jan. 18, stalled in the Senate hours before funding for federal operations was scheduled to lapse.
According to the contingency plan issued by the Department of Health and Human Services, the department would furlough approximately half of its employees in the event of a shutdown, primarily retaining federal staff with clinical care or service responsibilities. For example, operations such as caring for patients at the National Institutes of Health (NIH) Clinical Center would continue, though NIH would not admit new patients unless deemed “medically necessary” or take actions on grant applications or awards.
Senate Democrats and some Republicans have indicated that they will vote against the House-passed continuing resolution (CR), which would extend funding until Feb. 16, because it does not include immigration-related provisions, including a solution for individuals with Deferred Action for Childhood Arrivals (DACA) status, or revised discretionary spending caps.
Republican leaders argue that the four-week CR is necessary to allow negotiators additional time to finalize a deal on outstanding issues, while Democrats note that the CR would represent the fourth consecutive stopgap that has not produced results.
With lawmakers at an impasse, President Trump reportedly met with Senate Minority Leader Chuck Schumer (D-N.Y.) midday Jan. 19, though neither party shared details of the discussion. Meanwhile, the House concluded its legislative business for the week but advised lawmakers “to remain flexible” with the expectation of additional procedural votes if the Senate modifies the House-passed measure.
In addition to extending the current continuing resolution (P.L. 115-56) past its Jan. 19 expiration with some non-health related anomalies, the package also includes additional provisions to extend funding for the Children's Health Insurance Program (CHIP) through FY 2023, and suspend certain health-related taxes.
The bill does not include language to delay the Medicaid disproportionate share hospital (DSH) payment cuts. The DSH cuts, which total $43 billion through FY 2025, are scheduled to go into effect this year. The House previously passed a two year delay of these cuts for FYs 2018 and 2019 as part of its CHIP extension bill, the Championing Healthy Kids Act.
The AAMC signed on to two community letters sent to both the House and Senate urging the inclusion of a two-year delay of the Medicaid DSH cuts. The letters also call for straight extensions of the Medicare-dependent hospital and enhanced low-volume adjustment programs.