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Multitude of health programs with Sept. 30 deadlines

Illustration of a red cross scribbled on a calendar.

Illustration: Shoshana Gordon/Axios

Appropriations drama and the shutdown threat may be gripping the Hill. But Sept. 30 also marks the deadline for renewing a multitude of health programs due to sunset at the end of the fiscal year without congressional action.

  • We've got a look at which of these expirations are most urgent and likely in need of stopgap extensions, and which could be punted to later — or at least sustained through the appropriations process.
  • Community health centers and DSH payments are two of the more pressing items that could need short-term extensions on a CR.

Community health centers

Extending funding for health centers that serve more than 31 million people has long had bipartisan support. While none would immediately shut down on Oct. 1, backers argue they need the assurance of funding to keep workers and provide continuity.

  • Joe Dunn, senior vice president at the National Association of Community Health Centers, said their 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, or Sens. Bernie Sanders and Roger Marshall's more ambitious increase, will win out.

DSH cuts

  • Staving off scheduled cuts to 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 this 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.

PAHPA reauthorization

PAHPA reauthorization has been held up by partisan disagreements in the House around whether or not to use the legislation as a vehicle to address drug shortages.

  • If PAHPA isn't reauthorized by the end of the month, pandemic preparedness efforts can still be funded through appropriations. 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.
  • There's also a measure that was included in a Senate reauthorization plan, but not in the House, that would reauthorize the FDA's medical countermeasure priority review voucher program, an industry priority.

PEPFAR reauthorization

The PEPFAR program that invests in the global HIV/AIDS response is now embroiled in battles around abortion that are playing out in the House. Some Republicans are alleging that PEPFAR 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 Congress' and multiple administrations," said Kates. "It also might send a message to partner countries that we're not so supportive of PEPFAR and weaken our partnerships there."


The range of programs aimed at fighting the opioid epidemic originally passed in 2018 and are up for reauthorization. The House Energy and Commerce Committee has advanced a bipartisan bill, but Sen. Bill Cassidy 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."
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