As of Monday at midnight, the deadline to agree upon a Continuing Resolution (CR) passed and the federal government officially shutdown. Let’s review how Congress arrived at the first government shutdown in 17 years and what the impact will be for health centers.
As predicted, on Friday, the Senate voted to amend the House-passed version of the Continuing Resolution (CR), changing the end date of the CR from December 15th to November 15th and striking the language defunding the Affordable Care Act (ACA). This defunding would have resulted in a massive loss of funding for health centers, leading to the closure of health centers, lost health care capacity, and a loss of jobs in local communities.
The Senate-amended CR was then sent back to the House for consideration. On Sunday, the House amended the Senate-passed CR to include language delaying implementation of the Affordable Care Act for one year, repealing the tax on medical devices under the ACA, and changing back the expiration date of the CR to December 15th. This text related to the delay of the ACA would have frozen the Health Center Fund at the Fiscal Year (FY) 2013 level of $3.1 billion and not allowed any additional funding to be distributed from the Health Center Fund in future years. This bill was then sent back the Senate.
On Monday afternoon, the Senate voted to remove all of House amendments to the CR including the expiration date reverting it back to November 15th. This bill, or “clean CR,” which is the same as the original bill the Senate sent over to the House on Friday, was sent back to the House again.
While House Leadership contemplated their next move, Minority Leader Nancy Pelosi offered a “healthy number of Democratic votes” to Majority Leader John Boehner for a “clean multi-month CR”, but her offer was not taken up. Instead, the House amended the CR again on Monday afternoon to include a one-year delay of the ACA’s individual mandate and a provision eliminating employer-sponsored health subsidies for Members of Congress and their staff. This version of the CR was sent back over to the Senate and once again, the Senate amended it to remove the House’s ACA-related provisions and sent it back as a “clean” extension of federal funding until December 15th.
As Congress inched toward the midnight deadline, House leadership floated the idea to Majority Leader Harry Reid to appoint a Conference Committee to work out the differences between the two chambers. Senator Reid stated he would only agree to a Conference Committee if the House would pass a “multi-week” funding bill with no provisions related to the Affordable Care Act- a “clean” CR which they have repeatedly sent back to the House. House leadership would not agree to fund the government, even temporarily, without any limitations on the ACA. At 1am, after the government had already shutdown, the House proceeded to vote on a motion to go to conference with the Senate. This was swiftly rejected by the Senate this morning and at this time the government will remain shut down until an agreement is made on the CR.
How would a shutdown impact health centers? The information as we have it:
- With a shutdown of limited duration, most CHCs should be able to access their grant funds through the Payment Management System and funds should be available.
- It is our understanding, however, that not all health centers may be able to access funding through the Payment Management System, exceptions include:
– those with drawdown requests/restrictive terms and conditions that trigger one of the Payment Management System edit checks and/or the drawdown limit controls may not be able to access funds.
- The Bureau of Primary Health Care’s Outreach and Enrollment (O/E) Team will be available to support outreach and enrollment supplemental funding activities. Contact the O/E Team at firstname.lastname@example.org.
- Some HRSA employees will be furloughed resulting in a slow response to inquiries from the field.
NACHC asks health centers that experience a grave threat to their immediate operations as a result of payment delays and PCAs who become aware of these situations to contact Julie Schmidt at jschmidt@NACHC.COM.
For more information on HHS’ contingency plan for agency operations during a government shutdown, click here.
How does Congress resolve this showdown over the CR? Senate Majority Leader Harry Reid and President Obama have continually said they will reject all efforts to delay, defund, or rescind the ACA and House Majority Leader Boehner is still insisting on concessions regarding the ACA. With both sides in their respective corners at the moment, a path forward remains unclear. We will continue to post updates on Congressional action regarding the CR or from HRSA as soon as we receive them.