HHS shutdown: what work would continue in health agencies

Efforts by health agencies to tackle the Covid-19 pandemic would likely continue in the event of a government shutdown, but other key work including enrolling patients in clinical trials, drug and disease surveillance and rule making, could stop.

Thursday is the deadline to fund the federal government and avoid a shutdown. The House and Senate will likely have to pass a short-term spending bill that will need to be enacted by 11:59 p.m. ET.

The impending shutdown comes as more than 2,000 people die from Covid-19 every day and hospitals in pandemic hotspots consider rationing care. Organizations with public safety functions must assess each activity they conduct to determine whether it has a source of funding or falls under an emergency exception that would allow it to continue.

But even when “critical activities” are allowed to continue during a shutdown, “it is actually very difficult to do” these activities because many workers are on leave or off duty, Joshua Sharfstein, associate dean for practice of public health and community engagement at the Johns Hopkins Bloomberg School of Public Health, told reporters.

“There are a lot of things that maybe aren’t critical and immediate, but they keep things from becoming critical and immediate,” said Sharfstein, former deputy in the Food and Drug Administration. For example, the CDC was prepared to suspend influenza surveillance during a previous government shutdown, he said.

The Department of Health and Human Services would be able to retain a higher percentage of staff compared to 2018, when the last shutdown occurred. In 2018, the department put about half of its staff on leave, or 40,845 employees. This year it would be leave about 43%, or about 36,536 people. The HHS has about 3,000 more employees than three years ago.

The HHS contingency plan, however, is not clear on what types of workers will be put on leave and instead focuses on work that will continue. Here is an overview:

  • The Food and drug administration would continue to authorize vaccines, therapeutics and diagnostics, including Covid-19 vaccines for school-aged children. The agency would also be able to continue any work funded by user fees, including the regulation and review of drugs, biologics and medical devices. However, if the shutdown is extended, the agency could miss out on user fees that fund this work.
  • The Centers for Disaster Control and Prevention would continue to address the immediate ongoing epidemics, including the Ebola outbreak in the Democratic Republic of the Congo. The agency would also collect and report data used to track, prevent and treat disease. CDC laboratories and the 24/7 emergency operations center would remain open.
  • The National Institutes of Health would maintain its support for priority research and development on Covid-19. Additional funding from Covid-19 bills previously passed by Congress can be used to fund some of this work. The NIH would maintain lean operations – about 25% of its staff or 4,500 people – to care for patients in its clinical center and care for animals and cell lines.
  • The Medicare and Medicaid Service Centers operations related to the pandemic were funded by the Coronavirus Aid, Relief, and Economic Security Act and will not be affected by a shutdown. The agency will continue to support the Medicare program and has enough money to fund Medicaid until the first quarter of fiscal 2022. The agency will also continue its efforts to prevent fraud and abuse and the activities of the Center for Medicare & Medicaid Innovation. Some maintenance work for the Federal Insurance Exchange, including verifying eligibility, would be funded by user fees.

Here’s what the job would stop if there was a disruption in government funding:

  • High-stakes work of the FDA, including policy-making functions and most oversight inspections regarding compliance and safety, would shut down in the event of a shutdown.
  • Any less immediate monitoring by the CDC could be suspended, potentially slowing responses to emerging diseases.
  • The NIH is expected to put about 75% of its staff on leave, a backlash that would exacerbate existing setbacks. The NIH has already lost or delayed at least $ 16 billion in research due to the pandemic. Work to enroll new patients in clinical trials, labs and plans to build the $ 6.5 billion biomedical incubator proposed by President Joe Biden, dubbed the Advanced Research Projects Agency for the health, would be suspended.
  • The shutdown could delay the CMS released several important regulations, including the final 2022 Medicare Physician Fee Schedule rule, which determines how much physicians, surgeons, and other specialists are paid.

—With help from Alex Ruoff

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