Sep 18, 2023 - Health

Health programs could be stranded by government shutdown

Illustration of a stethoscope draped over the dome of the US Capitol building.

Illustration: Gabriella Turrisi/Axios

The threat of a government shutdown is hanging over Capitol Hill. But so is the realization that gridlock could claim an array of health programs that are due to sunset at the end of the month without congressional action.

Who's affected: Key health interests potentially have billions of dollars of funding on the line, from community health centers that serve 31 million people to hospitals that provide charity care. Opioid abuse programs and federal preparedness for another pandemic could also be affected.

  • But there's still some wiggle room to keep efforts from stopping when the calendar flips to the new fiscal year. Help could come in the form of a stopgap funding measure or whenever Congress gets back to drafting fiscal 2024 spending bills.

Here are the programs that need to be renewed listed roughly in the order lobbyists and interest groups say they should be addressed:

Community health centers

The Community Health Center Fund that provides about 70% of federal funding for health centers is due to expire Sept. 30. About 300 grantees have relied on its funding since 2015, and backers say they need the assurance of continued funding to keep workers and provide continuity of care.

  • Joe Dunn, senior vice president at the National Association of Community Health Centers, said their members' workers "have a lot of different options" for employment, and that a lapse in funding would be "a signal to the workforce that there's instability and uncertainty."
  • For a long-term reauthorization, there is still a question of whether the House's approach, with a modest increase to $4.4 billion per year through 2025, or a more ambitious plan from Sens. Bernie Sanders (I-Vt.) and Roger Marshall (R-Kan.) that calls for $5.8 billion annually for three years, will win out.

DSH cuts

Staving off scheduled cuts to Medicaid disproportionate share hospital (DSH) payments that offset uncompensated care is a recurring priority for hospitals, and a CR could also include some short-term relief here.

  • America's Essential Hospitals warned in a letter to Congress late last week of an $8 billion cut that would begin Oct. 1. "These cuts would undermine America's health care safety net and significantly reduce our hospitals' ability to provide lifesaving services to the communities you represent," the hospitals wrote.

Pandemic preparedness

Reauthorization of the Pandemic and All Hazards Preparedness Act has been held up by partisan disagreements in the House around whether to use the legislation as a vehicle to also address drug shortages.

  • If PAHPA isn't reauthorized by the end of the month, pandemic preparedness efforts can still be funded through the annual appropriations cycle. The bigger deal, though, is that there are some provisions within PAHPA that do have expiration dates and would need to be extended.
  • There are two provisions related to a FOIA and antitrust exemptions that could sunset. That would have an impact on what medical countermeasure companies are willing to share due to intellectual property concerns, said one PAHPA lobbyist.

PEPFAR reauthorization

The President's Emergency Plan for AIDS Relief, or PEPFAR, invests in the global HIV/AIDS response but is now embroiled in battles around abortion that are playing out in the House.

  • Some Republicans are alleging that the widely praised program, launched during the George W. Bush administration, provides funds to organizations that provide abortions, while Democrats are insisting that is not the case and that current statutory restrictions prevent that from happening.
  • If PEPFAR isn't authorized, it can still continue to operate as long as funds are still appropriated for it, just as with PAHPA. But there are also seven provisions within PEPFAR that would sunset at the end of FY2023 and would need to be extended. They mostly include how HIV funds are allocated and a cap on how much the U.S. can contribute to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
  • The impact of not reauthorizing PEPFAR or doing a shorter-term reauthorization (it's usually renewed in five-year increments) is largely symbolic, said Jen Kates, director of the Global Health and HIV Policy Program at KFF.
  • "If it's not reauthorized that would be a significant departure, since it's had widespread bipartisan support among multiple Congresses and multiple administrations," said Kates.

Opioid funding

A range of programs aimed at fighting the opioid epidemic that Congress passed in 2018 are up for reauthorization. The House Energy and Commerce Committee has advanced a bipartisan bill, but Sen. Bill Cassidy (R-La.) has raised alarm that the Senate process is behind.

  • "The opioid and mental health crises are tearing families apart," Cassidy said in July. "This legislation ensures programs supporting our most vulnerable Americans do not lapse and can reach all communities."

A version of this story was published first on Axios Pro. Get news like this by subscribing

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