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 recently began offering 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.
Government shutdown possible
As negotiations for FY26 grind to a halt, a funding lapse or government shutdown seems inevitable starting at midnight tonight. Congressional Republicans have called for a clean continuing resolution (CR) to keep the government open until November 21 to give appropriators time to negotiate full year packages. Democrats have called said that any agreement must include provisions that extend ACA subsidies and roll back impoundment cuts over the last few months. The Senate is expected to vote on different proposals, but Speaker Johnson has kept the House in recess and out of DC after passing their proposal. This funding impasse is fundamentally a conversation about how to create a bipartisan funding agreement when the Administration will choose to not spend money that it does not agree with and the Republican majorities have voted on a party-line recissions that roll back bipartisan laws.
The Department of Health and Human Services is planning on furloughing over 40 percent of staff in the event of the shutdown. Programs such as Medicare, Medicaid, the Affordable Care Act marketplace, and Food and Drug Administration drug approvals will continue as they rely on non-discretionary funds. NIH is expected to furlough 75 percent of its workforce and CDC will furlough 64 percent. These furloughs will be highly corrosive to public health efforts and the scientific enterprise. Of the remaining staff still at AHRQ, 90 percent will be furloughed. Researchers should not expect to receive any awards funded by discretionary funding sources during a shutdown or in the immediate aftermath.
Congress requests GAO investigate impoundments at AHRQ
The Government Accountability Office (GAO) has been formally asked to investigate whether the Administration illegally withheld congressionally appropriated funds at the Agency for Healthcare Research and Quality (AHRQ), following a Monday, September 22, request from the Committee on Energy and Commerce, Subcommittee on Health Ranking Member Diana DeGette (D-CO) and Congresswoman Doris Matsui (D-CA). This investigation would come after nearly six months in which AHRQ has been unable to fund new research grants—delaying critical studies that help improve patient safety, strengthen care delivery, and ensure Americans receive high-quality, high-value care – due to policy choices made by the Administration. You can read the letter sent to GAO here.
“Evidence saves lives,” said Dr. Aaron Carroll, president and CEO of AcademyHealth. “We are grateful for the leadership of Representatives DeGette and Matsui in standing up for the research that powers better health outcomes through rigorous evidence, just as Congress designed. When research funding is blocked, the progress that improves patient outcomes slows or stops altogether. This investigation is an important step toward restoring AHRQ’s ability to carry out the work Congress intended and the public needs.”
AHRQ released strategic priorities
AHRQ Director Roger Klein released an updated statement of priorities for the Agency. This strategic document was generated without public comment. It’s priorities include enhancing patient safety, preventing antibiotic resistance, optimizing telehealth utilization, treating Long COVID, and nutrition research. The strategy document is dismissive of what it calls “poorly measured” factors, such as systemic racism, while also calling for a focus only on the harms of gender affirming care. It also raises serious questions about the future of critical health services research: patient-centered care, health disparities research, and dissemination & implementation (D&I) science. AcademyHealth’s Chief Programs & Science Officer Elizabeth Cope discusses this strategy document and its implications here.
GAO investigates Medicaid work requirements in Georgia, finds bloated red tape
The Government Accountability Office examined administrative expenses for the Georgia Pathways to Coverage program, which is the state’s experiment in instituting work requirements to receive Medicaid benefits. The program was intended to expand health care to a group that the state had previously blocked from eligibility – adults under 65 years old who earned less than the federal poverty line. This demonstration project led to $54.2 million in administrative costs since 2021, compared to $26.1 million spent on health care costs. The federal government paid for 88%. The most recent state data shows that 9,175 of the nearly quarter-million low-income Georgians eligible for the program were enrolled as of Aug. 31. This program was the model for congressional Republicans reforming Medicaid in their July reconciliation law.
Parents raise the alarm about losing disability protections from cuts to Dept. of Education
Under federal law, public schools must provide children with disabilities a “free appropriate public education,” to give them the same opportunity to learn as other kids. However, the ability of students with disabilities to get these opportunities is at risk due to the Trump Administration attempting to eliminate the Department of Education, which has the authority to protect students from discrimination based on race, sex, religion, or disability. The Administration shuttered seven of the 12 regional offices of the agency’s Office for Civil Rights, leaving a skeleton staff to investigate thousands of complaints filed each year, according to attorneys and advocates for the disabled. Parents and advocacy groups say the closings leave local authorities to police themselves.
Change in grantmaking strategy allowing NIH to obligate budget before end of fiscal year
After a fiscal year marked by mass layoffs, funding freezes, and thousands of arbitrary grant terminations, the National Institutes of Health are expected to obligate all of the appropriated grant funding for FY25. NIH changed its grantmaking strategy in June to prioritize awarding more grants their entire multiyear budget up front instead of in annual installments. However, this means funding far fewer research programs, with the year ending with 3,000 fewer funded grants than in the previous year. This leaves research on everything from cancer to aging underfunded.
CDC announces rise in highly antibiotic-resistant bacteria
The Centers for Disease Control and Prevention announced that infections from NDM-CRE bacteria rose by more than 460 percent in the U.S. between 2019 and 2023. These infections are uniquely resistant to the strongest antibiotics available. As these antibiotic-resistant bacteria continue to spread, efforts to avoid their spread in health systems are being blocked by cuts at AHRQ that have broken the grantmaking processes that have put health care delivery research on indefinite pause.
What we’re reading
Health research funding saves lives and drives innovations and our economy. Azoulay et al wrote in Science on how they created a counterfactual where NIH was 40 percent smaller throughout its existence – a proposal made in the President’s Budget Request for FY24. They identified which grants fell in the bottom 40 percent of the funding priority queue from 1980-2007. They found that the majority of drugs approved in their research sample are linked to research that would be at risk in the smaller NIH. This research only looked at small-molecule drugs, so it is a just a window into the impacts.
As immigration enforcement escalates, concerns about what this means for health outcomes rises. Herring and Barnow published in Social Science and Medicine their study on the indirect effects of immigration enforcement among lawfully present older Hispanics. Using the Secure Communities immigration enforcement program in 2008, they found that there was a 16.9 percent decline in the probability of legally authorized Hispanic immigrants visiting a health care provider. The declines in utilization relate to chilling effects and fear of putting others at risk as the respondents are likely not at immediate risk of deportation. As the enforcement efforts continue to increase, active efforts are necessary to promote access to health care for all people.
Sundermann and Yaver wrote an op-ed in The Hill making the case that if President Trump were focused on health care spending, cutting AHRQ funding is the wrong choice. The Administration is proposing a steep cut to the Agency in addition to an over 80 percent cut in staffing. They point out that it is unclear how cutting such a historically effective yet tiny agency is useful for United States patients, economy, or public health.
A new study finds that patient deaths increase in hospitals after being acquired by private equity firms. Kannan et al wrote in the Annals of Internal Medicine that mortality among Medicare beneficiaries in emergency departments increased by 13 percent when compared with hospitals that were not acquired by private equity firms. Additionally, the acquired hospitals saw hospital-wide cuts in staff by over 11 percent and salary expenditures by almost 17 percent.