Gregg's Top Three Health Policy Articles

While there are lots of health policy issues, everything is being overshadowed by the likelihood of a government shutdown. This week, I added a section entitled “Shutdown Primer” to explore the implications to health programs. If you can only read three things about health policy this week, I suggest...

The Top Three

KFF Health News: What Happens To Health Programs If The Federal Government Shuts Down? For the first time since 2019, congressional gridlock is poised to at least temporarily shut down big parts of the federal government — including many health programs. If it happens, some government functions would stop completely and some in part, while others wouldn’t be immediately affected — including Medicare, Medicaid, and health plans sold under the Affordable Care Act. But a shutdown could complicate the lives of everyone who interacts with any federal health program, as well as the people who work at the agencies administering them. (Rovner, 9/27)

Politico: CBO: Center Tasked With Saving Medicare Money Falls Short The agency tasked with lowering Medicare costs by changing how physicians and hospitals are paid is on pace to increase spending by more than $1 billion through 2030. The Congressional Budget Office released an updated estimate Thursday that shows the Center for Medicare and Medicaid Innovation, created under Obamacare to test new ways to pay for health care, will increase federal spending by $1.3 billion from 2021 to 2030. From 2011 through 2020, the center increased spending by $5.4 billion. (King, 9/28)

The Washington Post: Medicaid Rolls Are Being Cut. Few Are Finding Refuge In ACA Plans As states prepared to end a pandemic-era promise earlier this year that everyone on Medicaid could keep their health coverage, the Biden administration sought to quell fears that millions of people would become newly uninsured. A policy favorite of the president’s — Affordable Care Act insurance marketplaces — would offer a haven for people losing Medicaid because their incomes had grown too high to qualify, his aides pledged. (Goldstein, 9/28)

Shutdown Primer

The Hill: House GOP To Consider Stopgap To To Avert Shutdown That Includes Deep Spending Cuts House Republicans on early Friday rolled out their new plan for a short-term spending bill that would stave off a government shutdown. The plan, dubbed the Spending Reduction and Border Security Act, would extend funding through the end of October, but impose across the board cuts of about 30 percent – with exemptions for national defense, the Departments of Veterans Affairs and Homeland Security, and for funding designated disaster relief. (Folley and Brooks, 9/29)

The Washington Post: How A Government Shutdown Would Affect Medicare, Medicaid Benefits A government shutdown could wreak havoc on many federally funded programs if lawmakers cannot negotiate a spending deal by the Saturday deadline, including potential disruptions to some services provided by the Centers for Medicare & Medicaid Services. Medicare benefits will not be affected, and Medicaid has full funding for the next three months. While the agency is partially shielded from the impending tumult, it will retain fewer than half of its employees — many unpaid — until a shutdown ends, according to the updated Health and Human Services contingency plan released Thursday. (Malhi, 9/26)

MedPage Today: With Shutdown Likely, Policy Experts Weigh Health Risks Unless Congress acts to pass a spending package on or before September 30, the federal government is hurtling toward a shutdown. How will that affect federal healthcare programs? Stakeholders and policy experts, including former government officials, shared with MedPage Today their forecasts around which health programs and personnel might be most impacted by a shutdown and the kinds of ripple effects patients, providers, and consumers broadly should anticipate. (Firth, 9/28)

The Hill: How A Shutdown Would Impact Key Health Care Programs The federal government is staring down a shutdown as a handful of ultra-conservative House Republicans remain opposed to a short-term agreement to keep the government funded. The current spending laws expire at 11:59 p.m. Sept. 30. Without a deal by that night, funding will lapse and many government functions, including some health care programs, will temporarily stop. Here’s how a shutdown will, and won’t, impact health agencies and services. (Weixel, 9/28)

NPR: How A Government Shutdown Would Impact Safety-Net Clinics For Most Vulnerable Community health centers across the country are anxiously watching the budget impasse in Congress. Some 1,400 clinics depend on federal funds to serve the most vulnerable patients, and any interruptions in their funding will only add to the financial pressures they already face. These federally-qualified health centers, or FQHCs, are often located in low-income or rural communities. They deliver care on a sliding-fee scale and are mandated to serve everyone regardless of a patient's ability to pay. For millions of Americans, these clinics are the only way they can access primary care. (Boden, 9/29)

The Washington Post's Health 202: What A Government Shutdown Means For Health Care When it comes to health policy, a short shutdown wouldn’t affect major programs like Medicare, Medicaid and Obamacare’s federal insurance marketplace. Research into developing vaccines and therapeutics would continue as would the federal health department’s response to covid-19, while the Food and Drug Administration could still support drug and medical device reviews. But a funding hiatus would still impact federal workers and some programs. Roughly 42 percent of staff at the Department of Health and Human Services would be furloughed on the second day of a shutdown, according to a new HHS contingency plan quietly updated Thursday. (Roubein, 9/25)

Modern Healthcare: Government Shutdown Threat Risks HHS Programs, Staffing A government shutdown could thrust healthcare providers into unpredictable and uncharted territory, even though vast portions of the federal healthcare apparatus, including Medicare and Medicaid, are immune from annual budget showdowns in Congress. According to President Joe Biden's proposed budget for fiscal 2024, which begins Sunday, 91% of Health and Human Services Department spending is categorized as mandatory, not as discretionary spending that is subject to yearly appropriations bills or periodic reauthorizations. (McAuliff, 9/26)

For a Deeper Dive...

Axios: Second Republican Debate Reveals Subtle Shifts On Health Policy Republican candidates during the second GOP presidential debate Wednesday night offered some unconventionally tough talk about the health care industry, even if they failed to offer substantive policy answers. (Owens, 9/28)

Politico: House Republicans Introduce National Ban On Abortion Pills Rep. Andy Ogles (R-Tenn.), flanked by leaders of anti-abortion groups, introduced a bill Thursday that would ban abortion pills nationwide. “Banning these dangerous drugs for the purpose of chemical abortion is an important step in protecting life,” he told reporters. “We have a duty to uphold the sanctity of life.” The new bill, which has 13 Republican co-sponsors as of Thursday, comes on the 23rd anniversary of the FDA approving the abortion drug mifepristone for terminating a pregnancy in the first 10 weeks. In recent years, the pills have become the most common method of abortion nationwide. (Miranda Ollstein, 9/28)

Stat: Senate Starts Talks On Medicare Solvency The Senate Budget Committee started what could become a bipartisan effort to extend Medicare’s solvency for seniors and people with disabilities. The fund for Medicare’s hospital benefit is scheduled to run dry by 2031, according to Medicare trustees. However, Budget Committee members in both parties said they expect that the government would borrow money to cover benefits once the fund runs out, adding to a deficit that is already well more than $1 trillion annually. (Wilkerson, 9/27)

Modern Healthcare: Hospitals, Health Systems Facing Credit Rating Downgrades Dozens of hospitals and health systems have faced credit rating downgrades this year as the industry continues to wrestle with a challenging operating environment. As of the end of August, more than 60 hospitals and health systems have been downgraded by at least one of the three largest credit rating agencies. ... Reports from the agencies often cited operating losses stemming from labor shortages and high costs plus dwindling liquidity, high debt-to-cash ratios and/or possible default on debt agreements as reasons for the downgrades. (Hudson, 9/28)

Stat: CFPB Takes On Medical Debt. Here's What Could Be Next The dramatic impact of medical debt on credit scores may soon be a thing of the past. On Thursday, the White House announced a plan outlined by the Consumer Financial Protection Bureau (CFPB) to eliminate medical debt from credit reports. The move — which follows an earlier decision from the three main credit bureaus to eliminate paid medical debt, medical debt that’s less than a year old, and medical debt balances lower than $500 from credit reports — could affect the tens of millions in the U.S. who have unpaid medical bills. (Merelli, 9/22)

Axios San Francisco: Kaiser Permanente Workers Authorize Strike In San Francisco Bay Area A group of 2,500 Bay Area Kaiser Permanente health care workers voted this week voted to authorize a strike amid ongoing concerns about short staffing and unfair labor practices. The workers, part of OPEIU Local 29, are prepared to strike if the coalition of unions they belong to can't reach a contract agreement by the end of this month. (Dickey and Murphy, 9/22)

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For the Visual Among Us...

A few years ago I started a weekly e-mail for friends and colleagues who want to keep up on major federal health policy developments but did not have time to plod through all the minutiae--they were busy doing important things like running organizations and taking care of patients! Much to my surprise, it became pretty popular. I have now converted to a weekly newsletter format so you can manage your own subscription preferences and forward to others that might be interested.

These summaries represent my judgement on health policy issues that may not on the front pages, but are relevant to clinicians, administrators, and educators. I monitor many news sources and clipping services to identify content for this newsletter and I try hard to be as factual, balanced, and non-partisan as possible. While the articles are written by others (with credit attributed), the choice of what to include is entirely mine. If you are interested in receiving a daily summary of health policy news, you might consider signing up for the KHN Morning Briefing. If you enjoy podcasts, I suggest What the Health? and Tradeoffs.

-Gregg S. Margolis, PhD