Editorial note: The Read on Washington is a monthly column on happenings in DC that affect the field of health services research. In addition, AcademyHealth offers ad hoc updates via the Situation Report series. The Situation Report can be found on our blog and is also emailed directly to our members. All of AcademyHealth’s advocacy work is supported by member dues.
The federal government remains shutdown with no end in sight
Due to a lapse in federal appropriations, a large swath of the federal government shutdown on October 1, and remains shutdown with no clear sign of progress. The shutdown was caused by Congress not passing appropriations bills or a continuing resolution before the new fiscal year began. There are several reasons why they were unable to come to an agreement. Congressional Republicans are calling for a clean extension of funding until November 21, while Congressional Democrats are calling for any legislation to include the ACA subsidies, a roll back of Medicaid cuts, and guardrails that ensure the lawful execution of the legislation by the Administration. At this time, there have been few if any negotiations on how to reopen the government, and the House of Representatives has been on recess for 85 of the last 97 calendar days. Shutdowns are somewhat rare, with only 15 since 1981, although this is the 3rd shutdown under the two Trump Administrations.
New wave of layoffs hit HHS, severely damaging NCHS, SAHMSA, CDC, and others
Nearly 1,700 HHS employees received layoff notices on October 10, despite the government shutdown. The government then backtracked and said that it mistakenly fired nearly half of this group, and had intended to fire approximately 1000 employees. The Administration’s move appeared to be politically motivated, and likely unlawful. A court order has paused the layoffs for litigation to proceed, however HHS has not confirmed that it will follow the court order. Notably this RIF is not actually caused by the shutdown, like the Administration initially claimed, but is instead part of the massive, planned, and likely unlawful reduction in the federal workforce the Administration has been pursuing since inauguration.
The Substance Abuse and Mental Health Services Administration (SAMHSA) lost 100 workers, which in addition to previous layoffs has brought the Agency down to less than half of the staff that it had. The National Center for Health Statistics (NCHS) also saw devastating cuts. AcademyHealth has warned Congress that these cuts could cause a “collapse in the nation’s health evidence infrastructure.” We continue to meet with congressional leaders to urge them to restore these federal agencies and ensure that each has the support and independence to promote better health outcomes for people across the country.
More than 400 anti-science bills have been introduced in statehouses
The Associated Press investigated anti-science legislation, and found that more than 420 bills that attack longstanding public health protections, like vaccines, milk safety, and fluoride, have been introduced in statehouses across the country, and around 30 of them have been enacted. They report that this has been directed by Trump Administration officials, who are directing activists to push anti-science legislation in the states to normalize fringe and conspiracy theories supported by Secretary Kennedy.
SNAP benefits will start ending on November 1
The Trump Administration has announced that it will not tap dedicated emergency funds to pay for federal nutrition programs due to the government shutdown, endangering benefits starting on November 1 for nearly 42 million Americans who rely on SNAP. In order to make the November deadline to utilize the emergency funding without interruption, the Trump Administration would have needed to start preparing for the processing of partial payments weeks ago, which it has not done. The loss of nutrition access will have detrimental implications for health outcomes for vulnerable populations.
Republicans still considering responses to ACA premium cliff
Congressional Republicans are heading towards the upcoming ACA enrollment period without a unified plan to address skyrocketing premium increases due to the expiration of subsidies. The extensions are a key component of the current government shutdown. Hill Republicans will need President Trump’s sign off to do anything with the Affordable Care Act subsidies, and they’re starting to run short on time. Most beneficiaries will see the jump in premiums starting on November 1.
Surgeon General nominee confirmation hearing set
Dr. Casey Means, President Trump’s second pick for Surgeon General, will have her confirmation hearing before the Senate Health, Education, Labor, and Pensions Committee on Thursday, Oct 30. She was nominated for the position in May due to her “impeccable MAHA” credentials according to the President. She is the co-founder of Levels, a health technology company that focuses on tracking health information through devices. Unlike previous Surgeon Generals, Means has no public health experience and is not a practicing doctor.
Congressional Republicans supporting Secretary Kennedy over medical professional groups
Secretary Kennedy has made no secret of his animosity towards many nonpartisan physician professional societies, deriding them as being controlled by pharma and “woke” activists. While these groups, such as the American Medical Association and American Academy of Pediatrics, were seen positively by both parties, many Republican Members have started attacking them and defending Secretary Kennedy’s criticisms. This could lead to a realignment where doctors are generally less influential in periods of Republican control and far more influential under Democratic leadership.
Bipartisan 340B reform possible
The Senate 340B Working Group may soon introduce a bipartisan bill to reform operational processes and covered entity practices that appear to be increasing costs in the discount drug program. The Government Accountability Office has testified that the 340B program lacks sufficient oversight to ensure that it is effectively supporting the efficient purchasing of outpatient drugs for low-income patients. Reforms being considered include increasing transparency around how revenue is generated and how it is spent.
What we’re reading
AI summary tools are everywhere, but how accurate are they? New research by the European Broadcasting Union and BBC found that AI assistants routinely misrepresent news content, regardless of language, territory, or AI platform. They found that 45 percent of all AI answers had a significant issue, 31 percent had serious sourcing problems, and 20 percent contained major accuracy issues.
Why can’t the President simply spend federal money on what is necessary, regardless of existing appropriations? Kogan writes in Lawfare about the laws, politics, and constitutional violations when President Trump did that to ensure that active duty military did not miss a paycheck this month by taking funding for research and development using it for salaries. By using money authorized and appropriated for one purpose and using it for another, Trump violated the Antideficiency Act (ADA) and Article I, Section 9 of the Constitution, as well as effectively cut Congress out of the power of the purse completely. There are important lessons for the research community to understand both the law and possible violations of it as budget turmoil continues.
A group of former members of the Advisory Committee on Immunization Practices (ACIP) conducted a rigorous analysis of how the handpicked Committee members undertook their September meeting. This analysis, published in Vaccine, found significant evidence-based concerns about that meeting, including: the lack of evidence behind the removal of choice for previously recommended vaccines; focus on theoretical harms relying on low-quality data; the lack of vaccine science and clinical practice expertise; and reduced transparency and independence. As federal gatherings of experts continued to be eliminated, it becomes more critical for practitioners and policymakers to have outside organizations fill the gap.rcent and salary expenditures by almost 17 percent.