Following days of Congressional back-and-forth, the federal government shut down early in the morning on Tuesday, Oct. 1, 2013, only hours after the health insurance exchange mandated by President Barack Obama’s Patient Protection and Affordable Care Act took effect. The stalemate in Congress that led to the shutdown involved Democrats in the Senate once again rejecting the ACA-killing spending plan offered by the Republican-based House.
In an effort to repeal the healthcare reform law, Republicans forced what CNN called an “unnecessary budget crisis,” creating a broiling frustration in Washington D.C. However, the shutdown itself hasn’t stopped the ACA from going through or the health insurance exchange marketplaces from opening.
According to The New York Times, federal facilities across the country have been barricaded and padlocked for the shutdown – the first in 17 years. Approximately 800,000 federal employees are bracing to discover whether they will be furloughed. Many of them in the healthcare industry wonder what the federal shutdown will do to health IT and other government services, even if the ACA is continuing largely unhindered: Will the healthcare industry suffer financially? What about mental health EHR services or behavioral health funding?
Answers are coming slowly, but federal contingency plans are in place to steer the industry through a shutdown.
HHS and ONC shutter windows and prepare for a long hiatus
According to Government Health IT, for most federal offices the official word is: “Orderly phase-down and suspension of operations.” A memorandum from U.S. Office of Management and Budget director Sylvia Burwell circulated among agency heads, detailing this and further contingency plans.
The U.S. Department of Health and Human Services is expected to furlough 52 percent of its staff, according to its already published plans. This includes approximately 40,000 employees who will vary across agencies and offices within HHS. Employee-intensive and grant-making agencies, such as the Agency for Healthcare Research and Quality or the Substance Abuse and Mental Health Service Administration, will be significantly destaffed.
Amid the beginnings of new Meaningful Use stage 3, which begins in October 2013 for hospitals and January for independent physician practices, the Office of the National Coordinator for Health Information Technology was hit particularly hard, reported Government Health IT. ONC houses 184 workers, but following the shutdown only four of them will remain in order to handle the suspension of operations. Many of these operations have come to be seen as essential in the new era of health reform: EHR standards and interoperability, privacy and security policy, clinical quality measure development and the agency’s Certified Health IT Product List.
CMS continues, carrying the ACA
The news source reported that the Centers for Medicare and Medicaid Services will continue to operate, albeit with a staff cut. One of CMS’ primary roles during the shutdown will be to keep the majority of the ACA active, particularly the health insurance exchanges that opened Oct. 1. Furthermore, Medicare reimbursements will not be disrupted in the time being, ensuring the relative financial stability of the healthcare industry in the short-term.
In her memo, Burwell expressed a sense of urgency for settling on a budget, lest government agencies run into trouble further down the road:
“We urge Congress to act quickly to pass a Continuing Resolution to provide a short-term bridge that ensures sufficient time to pass a budget for the remainder of the fiscal year and to restore the operation of critical public programs that will be impacted by a lapse in appropriations,” she wrote.
The importance of the ACA to mental illness
The Republican attempt to repeal the ACA has left more than just Congressional Democrats rankled. The new law, which was signed in March 2010, is aiming to increase health insurance coverage to a large portion of the population that has gone uninsured previously – including many individuals living with mental illness.
According to the National Alliance on Mental Illness, this law will allow those living with mental health conditions access to services and treatments that had previously been denied or not included in past insurance coverage.
Once the government is up and running again, agencies such as ONC and HHS can return to the task of improving healthcare reform and health information technology. Not only will the ACA widen the breadth of individuals with mental illness able to secure treatment, but advances in health IT, like behavioral health software, will allow for unprecedented treatment and patient outcomes.
The next stages
According to CNN, following the House’s fourth spending plan with anti-ACA amendments sent to the Senate post-shutdown, the mood was sour in Congress. The Democrats are currently insisting that the House pass a different spending measure, one without any ACA amendments. In the House, this plan is supported by both the Democratic minority and enough moderate Republicans to potentially overcome the anti-ACA lawmakers, according to CNN.