The increasing possibility of a broad federal government shutdown is stirring concerns about its potential effects on oncology care, spanning clinical trial access, practitioner payments, and more.
A shutdown would see millions of federal employees furloughed, although it is still unclear which specific government services would continue to operate if a budget deal isn’t passed by both houses of Congress and signed by President Joe Biden by Oct. 1.
Claire Ernst, director of government affairs for the Medical Group Management Association, said providers may feel some effects. However, these are dependent on several factors, including the length of the shutdown. The longest government shutdown in recent history lasted 35 days between December 2018 and January 2019.
Because Medicare is considered a mandatory program with permanent funding that doesn’t require congressional action, it should continue to be funded and operate during a shutdown. “However, there may be implications for timely Medicare payments to providers, depending on the length of the shutdown,” Ernst said.
A delay in certain payments could lead to possible cash flow challenges for practices, said Nick Ferreyros, managing director of policy, advocacy, and communications at the Community Oncology Alliance (COA).
“The most important thing [is] going to local banks to prepare beforehand,” he said. “The thing that I heard most practices have to prepare for is preparing their finances if this turns into an extended thing, because they need to be able to weather the storm and know they'll eventually get paid.”
The U.S. Department of Health and Human Services estimates that 42% of employees would be furloughed in the event of a shutdown. The Centers for Medicare & Medicaid Services (CMS) has a contingency plan to furlough about half of its employees.
Upcoming drug price negotiations, which were set to begin Oct. 1, could also be delayed due to a potential shutdown and reduced CMS headcount. However, whether delays or disruptions to this process will occur is still unclear, Ferreyros said.
Another concern is the possible shutdown of the clinical trial portal. The National Institutes of Health could be forced to delay new clinical trials, the Biden Administration wrote in a recent statement. “New patients, many of whom are desperately waiting for a chance at new treatment through a clinical trial, will be turned away,” the document stated.
U.S. Food and Drug Administration approvals, which receive a significant amount of funding from pharmaceutical companies, may continue to proceed during a shutdown. The country is still facing shortages of crucial cancer drugs, including cisplatin and carboplatin. Whether work to alleviate these shortages would continue during a shutdown is uncertain. Factory inspectors may be unable to work, which could further delay efforts to address and mitigate the issue.
Ferreyros said that a government shutdown would also complicate other initiatives COA has been working to address, including reforms to the 340B program and pharmacy benefit manager operation and payment adjustments for inflation. He suggested that challenges faced by oncology practitioners and patients may take a backseat if Congress cannot reach a deal.
“The government shutdown is an unnecessary distraction to getting our priorities done,” Ferreyros said. “This is just disruptive, unnecessarily disruptive.”
