Health programs amid shutdown
How the government’s partial shutdown affects the public’s well-being
What the federal government’s partial closures mean for the public’s well-being.
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 President Trump’s border wall plans. 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 impact for now.
Since funding for the Health and Human Services Department is set through September, the flagship government healthcare programs — think Obamacare, Medicare and Medicaid — are insulated.
That’s also true of public health surveillance, such as tracking the flu virus, done by 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 Health and Human Services staff.
But some other public health operations are vulnerable due to complicated funding streams.
Although the Food and Drug Administration falls under Health and Human Services, it receives significant funding for food safety operations through 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 things like food recalls, routine facility inspections and cosmetics regulation. Not having those dollars now means, according to the FDA contingency plan, that about 40% of the agency — thousands of government workers — is furloughed.
The FDA’s role in drug approval and oversight is funded by user fees and generally not affected. Regulation of tobacco products also continues.
Services for Native Americans are also on hold.
Because Congress has yet to approve funding for the Indian Health Service, which is run by Health and Human Services but gets its money through the Interior Department, the Indian Health Service 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 Indian Health Service-run clinics, which provide healthcare to tribes around the U.S. These facilities are open, and many staffers are working 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 Indian Health Service programs are taking a more direct hit. For example, the agency has suspended grants for 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.
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 one component of the 204-person Countering Weapons of Mass Destruction Office, which has about 65 employees during the funding gap.
Other Homeland Security health workers are likely to work without pay — for instance, health inspectors at the border, said Peter Boogaard, an agency spokesman in the Obama administration. According to the Homeland Security Department’s plan, the vast majority of Border Patrol employees will keep working through the shutdown.
The EPA 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 on 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 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 closed its campgrounds. On Wednesday, Joshua Tree National Park 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.”