How Does a Government Shutdown Affect Health Care and Advocacy?
Another government shutdown looms on February 8 as government funding passed to end the last shutdown, January 20−22, expires. A government shutdown begins when Congress has yet to approve the federal budget and results in the cessation of certain so-called nonessential day-to-day functions until a budget deal is reached. The recent shutdown lasted only three days, and its effects were negligible for most U.S. citizens as it largely occurred over a weekend. Essential programs related to national defense and security continue during a shutdown, and essential federal employees, such as military service people, must report to work without a guarantee of pay. Congress generally exercises its option to pass a law at the conclusion of a shutdown to retroactively pay these employees, in addition to nonessential staff who was furloughed.
Approximately half of the employees at the U.S. Department of Health and Human Services (HHS) are considered nonessential and are furloughed during shutdowns; thus, its impact is felt immediately at the agency. However, both Medicare and Medicaid continue to function. Medicare continues to reimburse providers, and the federal government continues to fund its portion of a state’s Medicaid system. In addition, the Centers for Medicare & Medicaid Services (CMS) provides official news and updates—including government shutdown-related news—through CMS MLN Connects.
Operational procedures are similarly affected on Capitol Hill, as only a small number of congressional staffers are considered essential and continue to work. For the American College of Surgeons (ACS) and other organizations, a shutdown affects our ability to communicate with congressional staff and members of Congress who are often tied up in budget negotiations. Although shorter shutdowns can be minimal disruptions, the effect of those extending for a longer period can be felt for weeks and months after funding is restored.
HPAG Meets to Consider 2018 Legislative and Health Policy Priorities
The American College of Surgeons (ACS) Health Policy and Advocacy Group (HPAG) met January 27−28 to discuss issues that the ACS Division of Advocacy and Health Policy is working on in 2018. The purpose of HPAG is to identify public policy issues and concerns affecting surgeons and patients, prioritize these issues and concerns, and make recommendations to the Board of Regents regarding where the ACS should focus its resources. During the meeting, members considered nearly 50 issues. Examples include, reducing administrative burdens and regulations, the Merit-based Incentive Payment System (MIPS), and efforts by outside entities to reduce Medicare payments to surgeons. Besides identifying priorities, HPAG helps determine if the College should take a proactive or reactive stance and whether issues are top-priority, low-priority, or should be monitored.
HPAG follows a process to be effective and does not automatically take a position when new issues arise. Development of issues advocacy involves the following:
- Review of existing principles
- Determination of a new policy or position
- Initiation of legislative and regulatory tactics
HPAG comprises a cross-section of the ACS membership to bring different perspectives to issues.
The College’s 2018 advocacy and health policy agenda will be determined in the February Board of Regents meeting.
ACS-Supported State Lobby Days in Full Swing
Since 2010, the American College of Surgeons (ACS) has sponsored a chapter lobby day grant program. ACS chapters may apply annually for a grant of up to $5,000 to host a lobby day at their state capitol to engage in grassroots advocacy and move forward the College’s state legislative agenda. Since 2017, one $15,000 grant is allocated each year to a chapter that has developed a session-long grassroots advocacy plan built off a lobby day.
The number of applications for lobby day grants increased significantly in 2018, and 23 chapters were awarded grants. In most cases, chapters plan to incorporate Stop the Bleed® training into their efforts to advocate for funding for bleeding control kits in public facilities and to raise awareness of other trauma system funding and development issues.
Since January 1, the Arizona, Florida, Kansas, Washington State, and Wisconsin chapters have hosted lobby days, which have included many successful Stop the Bleed training sessions for legislators, other government officials, and legislative staff.
For more information about the chapter lobby day grant program, contact firstname.lastname@example.org.