As Government Shuts Down, Exchanges “Open”
Yesterday’s government shutdown coincides with the much anticipated debut of the Affordable Care Act’s (ACA) health insurance exchanges. But while consumers across the country were immediately met with error messages blocking enrollment, the shaky start had little do with the budget standoff.
Around midnight, the Office of Management and Budget released a statement instructing federal agencies to “execute plans for an orderly shutdown due to the absence of appropriations.” Simultaneously, exchanges across the country were gearing up to go live—providing many Americans their first opportunity to interface with the sweeping law. Early reports of delays, however, can’t be attributed to the current impasse in Washington. As the Congressional Research Service (CRS) noted in a memo released in late July, ACA implementation will continue despite the shutdown.
Significantly, CRS noted, “[i]t appears that substantial ACA implementation might continue during a lapse in annual appropriations that resulted in a temporary government shutdown…the federal government will be able to rely on sources of funding other than annual discretionary appropriations to support implementation activities, including multiple-year and no-year discretionary funds still available for obligation as well as mandatory funds.”
More specifically, state and federal exchanges will continue operations during a shutdown— “[O]ther sources of funding besides annual discretionary appropriations are available in FY2014 and beyond to support exchange operations…the HHS Secretary  is using funding from ACA and other sources to establish federally facilitated exchanges and related information technology.”
Though states grappling with the federal health law have long faced uncertainties with implementation, the shutdown will have little short-term impact on key provisions taking effect. What states should take note of, however, is the political climate in Washington, and implications for long-term funding of the law’s numerous provisions, including “guaranteed funding” for Medicaid expansion.