President Trump speaks to reporters in the rose garden

Shutdown Fever: How Washington’s Standstill Impacts Health

While Federal Employees Health Benefits (FEHB) coverage will continue during the shutdown, with 800,000 federal employees going without paychecks, there are a range of fears looming in terms of health, for federal workers specifically, as well as for public health more generally.

Kaiser Health News recently reported the story of Joseph Daskalakis, a federally employed air traffic controller in Minnesota whose son was born on New Years Eve, about 10 weeks earlier than expected. The very premature baby was taken to a specialized neonatal intensive care unit (NICU) in a hospital outside of the father’s insurer’s network. Ordinarily, he would be able to file paperwork and switch insurers. But this isn’t possible during the shutdown. And while Mr. Daskalakis’ insurer and the Office of Personnel Management’s (OPM, which oversees federal health benefits programs) website have indicated that his requested change of carriers to have that hospital in his network would be effective retroactively, his family still received an initial bill of $6,000, with more charges likely yet to come. And as long as the shutdown lasts, none of those federal employees can add spouses or newborns to existing plans or change insurers in the case of unexpected circumstances.

Uncertainty surrounding medications during the shutdown can also present incredibly difficult decisions for federal workers, as it already has for Mallory Lorge, an employee of the U.S. Fish and Wildlife Service. Lorge is diabetic and began rationing her insulin because “‘the thought of having more debt was scarier than the thought of dying’ in her sleep.” Lorge went an entire weekend without using her insulin pump, experiencing skyrocketing blood sugar levels, but knowing she couldn’t afford the copay if she needed more insulin.

And because premiums for dental, vision, and long-term care insurance programs are generally deducted from employees’ pay and sent to carriers, these carriers may start billing workers directly if the shutdown extends beyond two or three pay periods. Because payroll deductions to cover these premiums will cease, OPM has advised enrollees to make these payments on a timely basis to ensure coverage continuation.

In addition to implications for federal employees’ insurance coverage, some areas of public health have already been hit by the shutdown, while others face looming troubles depending on how long it extends.

A CNN article from December 21, the eve of the shutdown, anticipated its effects on public health. Given that about 75 percent of the federal government had been funded through September, the implications weren’t too alarming to everyone. Art Caplan, a professor and the founding head of the Division of Medical Ethics at NYU Langone Health in New York City, for example, expected a minimal impact from a health perspective. But while the short term forecast didn’t seem too concerning to some, “every day that passes presents a new threat that something will happen that could have been prevented if the government was functioning at full throttle,” said Dr. Irwin Redlener, the director of the National Center for Disaster Preparedness at Columbia University and a professor in the Mailman School of Public Health.

Some Congress members have expressed concern that the shutdown could harm those who have purchased coverage under the Affordable Care Act. These Congressmen fear that because the Internal Revenue Service (IRS) and the U.S. Treasury Department are largely unfunded, this could delay payments of “advanced premium tax credits” (APTCs) for people who need those tax credits to pay their premiums. On January 14, Democrats in the Senate and House of Representatives wrote a letter to Steven Mnuchin, Secretary of the U.S. Department of the Treasury, and Alex Azar, Secretary of the U.S. Department of Health and Human Services, explaining their concerns for those receiving health insurance in the private health insurance market. The letter urged the Secretaries and their agencies “to ensure consumers are not faced with insurmountable premium costs or loss of coverage as a result of this unnecessary shutdown.” Health insurance companies, however, do not anticipate impacts of the shutdown to spread beyond those Obamacare enrollees who failed to file a tax return timely.

Public interest organizations are adding to the pressure as well. On January 17, the Trust for America’s Health wrote a letter, with 280 organizations signing on, to President Trump and Congress requesting that the shutdown end.

According to John Auerbach, Trust for America’s Health’s President and CEO:

[t]he goal is to indicate an unintended consequence of the government shutdown is putting the health of the population at risk and in particular putting some of the people whose living conditions make them quite vulnerable [at risk of] preventable illnesses, preventable injuries and preventable deaths.

Recipients of public benefits could be especially hard hit as the shutdown drags on. In New York City, for example, Mayor Bill de Blasio stated, “[w]e’re literally watching as our federal government starts to starve its people.” De Blasio warned that if the shutdown extends into March, it would impose $500 million costs on the city each month, and he stated that the first and worst impacts would be felt by the 1.6 million people in New York City receiving Supplemental Nutrition Assistance Program (SNAP) benefits.

Food safety is another area of concern. The U.S. Food and Drug Administration stopped conducting inspections of high-risk foods  as a result of the shutdown. On January 14, the FDA announced that these would restart, but with the workers conducting these inspections mostly doing so unpaid. A long-term solution, however, is uncertain.

 

Rebecca Freidman is a 2018-2019 Petrie-Flom Center Student Fellow. 

 

Image: Washington, D.C., January 4 2019: President Donald Trump, speaks to the media in the Rose Garden at the White House after meeting with Democrats to discuss the ongoing partial government shutdown. Via Shutterstock.
Rebecca Friedman

Rebecca Friedman

Rebecca Friedman graduated from Harvard Law School in 2019. Prior to becoming a Student Fellow, she participated in the Health Law and Policy Clinic with HLS' Center for Health Law and Policy Innovation. At the time she completed her Fellowship, Rebecca planned to work at Charlotte Center for Legal Advocacy in Charlotte, North Carolina as an Equal Justice Works Fellow sponsored by Kilpatrick, Townsend & Stockton LLP. There, Rebecca will provide direct representation to Medicaid beneficiaries experiencing legal challenges as North Carolina transforms its Medicaid system to managed care, and will work to ensure that Medicaid beneficiaries facing legal issues as a result of social determinants of health receive appropriate support. As a Petrie Flom Center Student Fellow, Rebecca studied the potential for Medicaid to cover doula services and analyzed how racial and socioeconomic disparities in prenatal care and childbirth could be mitigated as a result. The current title of Rebecca’s paper is “The Feasibility and Potential Impact of Broader Medicaid Coverage of Doula Services on Racial and Socioeconomic Disparities in Birth Outcomes.”

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