Hospital leaders, patient groups and others are speaking out about the potential of upheaval as the partial government shutdown moves into day 34.
The shutdown is affecting healthcare in many ways, including stalled food inspections, people not being able to afford care and premiums and the possibility of Americans not receiving prompt tax credits that help pay their health insurance.
Dozens of health groups sent a letter to President Donald Trump calling for the president and Congress to reopen government immediately to "minimize any further impact on the public's health and wellbeing."
The government shutdown has impeded many federal agencies, including Homeland Security, National Parks and the National Transportation Safety Board. There have been stories of federal employees struggling to make ends meet, long security line waits at airports, air traffic controllers going without pay and non-reversible damage to park lands.
Although HHS is largely funded, health programs have also been affected.
Dozens of health organizations, including the Association of American Medical Colleges, New York City Health + Hospitals and National Alliance on Mental Illness, warned in a letter to the president last week that that basic health protections are being endangered. The FDA isn't working on new drug and device applications, which could delay "life-saving innovations," they said.
"A prolonged shutdown will continue to put the health and safety of the nation’s residents at risk. It is vital that Congress and the President work to reopen the government as soon as possible to minimize the effects of the impasse," the groups wrote.
The shutdown could also hurt payer and provider bottom lines and harm patient health. If furloughed employees can't afford their bills, health systems and payers may see a hit to their bottom lines and potentially diminished patient health if they delay necessary care.
The National Association of Insurance Commissioners is asking insurers to work with federal workers who are facing financial hardships during the shutdown. That includes people who aren't able to pay their insurance premiums promptly.
"The NAIC encourages insurance companies to exercise judicious efforts to assist these policyholders and work with them to make sure that their insurance policy does not lapse," the group said in a statement. "Affected policyholders who are unable to make timely premium payments due to the federal government shutdown should contact their insurance company as soon as possible."
These issues could be exacerbated as the shutdown is happening in the middle of flu season.
CDC estimates that as of January 12, there have been up to 9.6 million illnesses, 4.6 million medical visits, and 114,000 hospitalizations related to #flu.— CDC (@CDCgov) January 23, 2019
Stay alert for symptoms and know what to do if you or a family member gets sick with flu. https://t.co/DZokDxvnws pic.twitter.com/NzVTmVZGAX
Another area affected by the shutdown is rural hospitals. Rep. Ben Ray Lujan, D-N. M., on Wednesday spoke out about the Department of Agriculture not providing a needed loan to Pecos Valley Medical Center because of the shutdown.
On Twitter, Lujan asked Perdue and the Department of Agriculture "protect the federal investment so that the construction can continue."
The USDA provided a much needed loan to Pecos Valley Medical Center to expand their services. Because of the #TrumpShutdown construction has stopped. I'm asking @SecretarySonny and @USDA to protect the federal investment so that the construction can continue. https://t.co/6utmMpo3RY— Ben Ray Lujan (@repbenraylujan) January 23, 2019
Beyond those issues, there's also the potential problem of the IRS delaying the processing of tax credits to help people pay for health insurance premiums in Affordable Care Act exchange plans.
Although not expected to pass, lawmakers are voting on two proposals to get the government open later Thursday — one supported by Democrats and one by Republicans.
There is no clear avenue at the moment to resolve the impasse, but there is at least activity again on Capitol Hill to try to end the longest shutdown in U.S. history.