Would A Federal Shutdown Delay Health Care Exchanges?

Sep 24, 2013
Originally published on September 30, 2013 6:27 am

Well, it's almost Oct. 1, the day of a threatened government shutdown and the day state health insurance exchanges are scheduled to begin operations.

Those are the online marketplaces created by the Affordable Care Act where people can compare health plans and sign up for coverage.

Would closing down the government delay the opening of the health exchanges?

Probably not. And there are a few reasons why. First of all, in quite a few states and the District of Columbia, the exchanges aren't being run by the federal government; they're being run by the states themselves.

Yes, a lot of money came from the federal government to create the exchanges, but it has already been spent. At this point, the exchanges in those places don't depend on the status of the federal budget.

"We already have our funding, and we're ready to open as scheduled on Oct. 1," said Richard Sorian, spokesman for the DC Health Link, the exchange in Washington, D.C. "No effect on any of the people eligible; they can come and start shopping for health insurance."

But the other exchanges are being run in whole or part by the federal government, right? Won't they be affected if the federal government has to shut down?

That's what you might think. But, in fact, it's probably not the case. And this is where it gets a bit technical. When the government has to shut down because Congress fails to provide appropriations, only some parts have to close. And those are the things funded by annual appropriations. But the health law was mostly funded with what's called mandatory spending, which is different from annual appropriations. Mandatory programs — which include things like Medicare and Social Security — aren't affected by a government shutdown like the one we're potentially looking at.

But there are parts of the health law that were funded by annual appropriations, right?

Yes, that's true. But the administration has pretty much spent all the money that was appropriated to implement the law, and has been asking Congress for more money for two years now. Congress has been saying no. In the interim, the Department of Health and Human Services has been finding various accounts from which to draw funds to pay the people who are implementing the law. So HHS has basically insulated itself from a government shutdown, because most of those accounts wouldn't be affected.

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Transcript

MELISSA BLOCK, HOST:

October 1st, the day of that threatened government shutdown, is also the day that state health insurance exchanges are scheduled to open for business. Those are the online marketplaces where people can compare health plans and sign up under the Affordable Care Act. So here's the question: If the government does shut down, what effect would that have on the rollout of the health law? NPR health policy correspondent Julie Rovner joins us here in the studio to try to explain. Hey, Julie.

JULIE ROVNER, BYLINE: Hey, Melissa.

BLOCK: So would closing down the government delay the opening of these health exchanges that we're talking about?

ROVNER: Well, probably not. There's actually a couple of reasons why. First, in 18 states and the District of Columbia, the exchanges aren't even being run by the federal government. They are being run by the states themselves. A lot of the money did come from the federal government to create the exchanges, but that money has already been spent. So they don't even have to worry about the status of the federal budget. Here's Richard Sorian. He's spokesman for DC Health Link, the exchange in Washington, D.C.

RICHARD SORIAN: We already have our funding, and we're ready to open as scheduled on October 1st. No effect on any of the people eligible. They can come and they start shopping for health insurance.

BLOCK: OK. So no effect at least here in the District of Columbia. But what about the exchanges in other states that are being run by the federal government, either in part or in full? Wouldn't they be affected if the federal government shuts down?

ROVNER: Well, that's what you'd think. But in fact, it's probably not the case. And this gets a little bit technical. When the government has to shut down because Congress fails to provide appropriations, only some parts of the government have to close. Those are things that are funded by something called annual appropriations. But the health law was mostly funded with what's called mandatory spending, which is different from those annual appropriations. Now, mandatory programs, which includes things like Medicare and Social Security, aren't affected by a government shutdown like the one that we're potentially looking at here.

BLOCK: OK. I think a keyword in there, Julie, was mostly funded with mandatory spending. But does that mean that some was funded with annual appropriations and those would be affected?

ROVNER: Well, some of the - yes. Some of the health law was funded by appropriations. But the administration's pretty much spent all of the money that was appropriated to implement the law. In fact, they've been asking Congress for more money for two years now, and Congress has been saying no. So what's happened in the interim is the Department of Health and Human Services has been finding various accounts where it's been drawing funds to pay the people who are implementing the law. So HHS has basically insulated itself from a government shutdown because most of those accounts wouldn't be affected.

BLOCK: So bottom line, Julie, does this mean that if the government does shut down, there won't be any effect on the health law rollout?

ROVNER: Well, I'm not sure I'd go that far. It's not clear that every single person involved in this enormous rollout would be able to come to work if there's a government shutdown. And HHS was counting, for example, on having lots of extra IT people around to deal with what's expected to be inevitable computer glitches that are likely to pop up as people try to get these brand-new software programs to work and to talk to each other. But in general, the people I've been talking to, both at HHS and at the White House, say they're still feeling pretty confident that whatever happens, they'll be ready to open on time next Tuesday, and people can begin signing up for coverage.

BLOCK: OK. NPR's health policy correspondent Julie Rovner. Julie, thanks.

ROVNER: You're welcome. Transcript provided by NPR, Copyright NPR.