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Health Team

How a partial government shutdown could affect your health: 'It's narrow'

Posted December 21, 2018 12:51 p.m. EST

— With a holiday government shutdown looming in the United States, there could be an impact not just on government workers but on you and public health -- but that impact is expected to be small.

At midnight Friday, funding is set to expire for several key federal agencies, including the Departments of Homeland Security, Justice, Interior, State and Housing and Urban Development.

There's no guarantee that lawmakers can come up with a plan that President Donald Trump will support to extend the rapidly approaching deadline. Meanwhile, a partial government shutdown appears to be likely.

An administration official told CNN that "If a lapse in appropriations were to take place, a majority of [Homeland Security] activities would continue. For instance, those protecting our borders with the customs and Border Patrol will continue to do so.

"Additionally, activities that are supported by multi-year funding, such as [the Federal Emergency Management Agency's] Disaster Relief Fund, will continue operations."

The Department of Health and Human Services referred questions to its contingency plan.

The plan says that "HHS' contingency plans for agency operations in the absence of appropriations for Agriculture and Interior would lead to retaining approximately 24,927 staff and furloughing 7,997 staff as of day two of a near-term funding hiatus. Put another way, more than 76% of HHS employees would be retained and 24% would be furloughed."

Since most of the agency's operating divisions were funded through fiscal year 2019 by the Labor, Health and Human Services, and Education appropriation -- which represents about 60% of staff overall -- the contingency plans would be for only the divisions and programs funded through the Agriculture and Interior appropriations, according to the department.

Emergency responses and high-risk recalls to continue

From a health perspective, the impact is expected to be minimal, said Art Caplan, a professor and founding head of the division of bioethics at NYU Langone Health in New York.

After all, if a shutdown were to take place, it would be limited in scope because lawmakers have funded roughly 75% of the federal government through September.

"It's serious, but it's narrow, because it's only a partial shutdown," Caplan said, adding that for the general public, worrying would be pointless.

"If there's a shutdown for a few days, the biggest concern will be the impact on the families of the workers who are going to be furloughed," said Dr. Irwin Redlener, director of Columbia University's National Center for Disaster Preparedness and a professor in the university's Mailman School of Public Health.

"In the short term, I'm not very worried much about the public health impact, but 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," he said.

For the Department of Health and Human Services, among the activities that would continue are Indian Health Service clinics, response efforts from the Agency for Toxic Substances and Disease Registry and specific activities under the Food and Drug Administration, including responding to emergencies and managing high-risk recalls.

In the case of a recall or outbreak, "FDA inspection is at the core of both finding out about those things, but more importantly, tracing them, triggering state agencies and other groups to figure out how extensive is the outbreak, and where did it start and how can it be stopped," Caplan said. "Having FDA off the food beat is always very dangerous."

Caplan added that the Environmental Protection Agency also plays a key role in coordinating disaster responses to chemical spills and other toxic accidents. The EPA has a contingency plan in place in the event of a shutdown.

'We'll get through this'

Health and Human Services activities that would not continue include the majority of funding to Tribes and Urban Indian Health Programs, some grant awards under the National Institutes of Health, some resources from the Agency for Toxic Substances and Disease Registry that are not related to protecting lives and limiting the spread of disease, and some routine regulatory and compliance activities under the FDA, including routine establishment inspections and ongoing research work.

When it comes to the National Institutes of Health, "I don't think we're going to see much in terms of impact of the research component here because grants that have already been made won't be affected. But evaluation of new research proposals may be delayed during the shutdown, though I'm not sure how consequential that is," Redlener said.

"NIH also has a very sizable health service for people who have not been successfully treated with conventional modalities and are on research protocols, often as a last ditch effort to be cured -- and that's obviously very meaningful," he said. "Patients already in the system will continue to get care during a shutdown. But NIH will likely stop admitting new patients for the duration of the shutdown."

All in all, "otherwise, from a public health point of view, we'll get through this," he said.