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How does a government shutdown affect the way we Innovate? 

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How does a government shutdown affect the way we Innovate? 

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In this NASA handout, the SpaceX Falcon 9 rocket, with the Dragon spacecraft on board, launches at Kennedy Space Center in Cape Canaveral, Florida, on June 3, 2017. - Bill Ingalls/NASA via Getty Images

The federal government is back open today after a shutdown that lasted just three days. But the budget impasse is not over - this could all start again in about three weeks, when the short-term spending bill expires.

And that uncertainty puts strain on science and tech agencies like the National Institutes of Health, NASA, the Centers for Disease Control and Prevention, and the National Oceanic and Atmospheric Administration.

It even hurts private-public partnerships. During this weekend's shutdown, SpaceX had to delay a test fire of its newest rocket.

What are the long-term effects of government uncertainty on a country's ability to innovate? Marketplace Tech host Molly Wood talks with Nicol Turner-Lee, a fellow at the Center for Technology Innovation at the Brookings Institution. Below is an edited transcript of their conversation.

Molly Wood: How does uncertainty affect innovation?

Nicol Turner-Lee: When you look at innovation, we're not going deeper under the surface of what impact the shutdown will actually have on current projects that are really pushing out science, technology, biomedical engineering - areas that require research and development, where people are going to be able invest, if projects are going to be able to continue. We've already heard with the SpaceX program that they cannot launch the new Falcon project without the U.S. Air Force personnel being available to help them with that.

Wood: Yeah. So what happens if the government reopens this week, it shuts down again in three weeks? The SpaceX launch as just one example: Will they hold off on that until they see whether there's a deal again in February?

Turner-Lee: I mean, our hope is that they won't, right? Because innovation moves at the speed of light, and light moves very quickly. We can't often calculate how long it's actually going to take. People have, for months, planned for conferences that they're going to go to. You've got papers that have to come out. We're in the middle of a flu epidemic. I can't tell you what's going to happen with this off-on mentality that we're sort of putting in front of these government agencies. But it may not be pretty when we're trying to recover the losses.

Wood: Then what about private partnerships? As these budget cuts have been proposed, as deregulation has been proposed, there's been sort of a shifting of the burden to private industry and a sense that public-private partnerships can continue to drive innovation forward. What happens if one side doesn't hold up the deal?

Turner-Lee: I don't know. I don't think I would want all of my R&D dependent on private-sector partnerships for a public-interest cause. We really have to sit back and say: The government shutdown means a lot to the continuous nature of our society, and what people have come to expect when it comes to innovation, when it comes to general efficiency, when it comes to our everyday lives. I was here for 2013. It wasn't a pretty sight. We lost a lot of money. All these plans - there are cities that are dependent on the funding that's coming out of government to create more innovative cities and smart services. They can't do that, either.

Wood: As America tries to maintain its leadership in the innovation economy, what does it mean long term when our government just isn't functioning very well?

Turner-Lee: We've got to come up with a very specific plan to maintain some consistency in our government and to understand the co-dependence of all of these actors in the type of society that we have built and we want to continue to build. This is not an on-and-off switch for those things that are important to the creation of ideas and the circulation of the ideas marketplace. And I think that's the part that we keep missing. That keeps becoming pawned in this whole debate.

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How does a government shutdown affect our ability to innovate?

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The federal government is back open today after a shutdown that lasted just three days. But the budget impasse is not over - this could all start again in about three weeks, when the short-term spending bill expires.

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A shutdown could be particularly troubling for the CDC because of the deadly flu season. The last time the government shutdown in 2013, the CDC had trouble collecting data about the flu because of furloughs.

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How the Government Shutdown will affect Influenza across the U.S.

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How the Government Shutdown will affect Influenza across the U.S.

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The shutdown of the U.S. government has raised concern about worsening an already dangerous flu season. As of now, the Center for Disease Control and Prevention will be continuing its "immediate response" to the flu season, including its influenza surveillance programs.

At first, the CDC was planning to temporarily shut the flu program, STAT reported Friday. That sounded bad-after all, this winter has brought a moderately severe flu season, with a relatively ineffective vaccine, a particularly dangerous strain and widespread illness across the country. And while the agency will "report out critical information needed [...] to track, prevent and treat the disease,"according to a Health and Human Services statement, there's no indication of what that information is.

The shutdown won't worsen the severity of flu season, this year or next year, unless the government shutdown lasts into spring. Though the CDC is crucial for flu surveillance efforts, state and local health labs actually do the majority of the heavy lifting.

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"CDC doesn't really collect original front-line data. It comes from local and state health departments," Dr. Tim Jones, state epidemiologist for the Tennessee Department of Health, told Newsweek. Those departments send data to the CDC, which creates a map of the national picture.

That collecting is on hold during the shutdown, so we won't have an up-to-date and accurate national picture until the shutdown ends. "But where diseases are occurring and actually affecting people, nothing is going to stop," said Jones.

But the shutdown could impact flu season in other ways. Former CDC director Tom Frieden told the Washington Post that during the 2013 shutdown, samples waiting to be tested began piling up. The CDC also works with manufacturers to deal with shortages of antiviral drugs, which has happened in some areas this season. The current CDC contingency plan does not specifically indicate if either of these activities will be affected.

Flu testing is also tied in with federal funding. Although most public health departments can test for influenza on their own, some of the most detailed analyses -like the exact strains circulating or whether or not the virus is susceptible-are done by labs with CDC contracts. If the shutdown continues further into flu season, we could miss information showing that the viral strains were changing, explained Dr. David Hooper, chief of the infection control unit at Massachusetts General Hospital.

If the strain mutates to the point where the vaccine might be even less effective, doctors might prescribe antiviral medication more aggressively, Hooper said. That would be especially true for people who are more likely to have serious or even deadly complications from the infection.

A very long-lasting government shutdown could also affect the development of next year's flu vaccine. The Food and Drug Administration's advisory committee for vaccines typically meets around March to begin the process of selecting strains to include in the vaccine for next year's flu season. No date for the 2018 meeting has been set yet. Data from the World Health Organization as well as the CDC from the previous year's flu season is typically presented at these meetings.

If the shutdown resolves by Monday afternoon, when a Senate vote on a temporary spending bill is expected, then the effect should be minimal. "Now, if it goes into June, it's a different story," Jones said. But for now, "people don't need to panic or really even worry."

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How the government shutdown will affect flu season across the U.S.

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The shutdown of the U.S. government has raised concern about worsening an already dangerous flu season. As of now, the Center for Disease Control and Prevention will be continuing its "immediate response" to the flu season, including its influenza surveillance programs. At first, the CDC was planning to temporarily shut the flu program, STAT reported Friday.

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The biggest effect of a government shutdown on health care would be a mass of furloughs. “50% of HHS employees would be on furlough, and 50% would be retained,” writes HHS. The groups that would be most affected by a shutdown are the ones that have the most employees and rely the most on grants, including the Administration for Children and Families (ACF), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Administration for Community Living (ACL), and the Agency for Healthcare Research and Quality (AHRQ).
http://fortune.com/2018/01/19/government-shutdown-healthcare/

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How the shutdown will affect specific organizations in relation to health

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How the shutdown will affect specific organizations in relation to health

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https://www.nbcnews.com/health/health-news/how-government-shutdown-might-affect-your-health-n839516

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The 2013 shutdown cost the federal government $2 billion in furloughed employee salaries, and 120,000 fewer private sector jobs were created than would have been otherwise. Hundreds of patients were prevented from enrolling in clinical trials at the National Institutes of Health, and almost $4 billion in tax refunds were delayed.

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What happen's when the Government Shutdowns and how does it affect Social Security and disability benefits 

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What happen's when the Government Shutdowns and how does it affect Social Security and disability benefits 

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Spencer Platt/Getty Images

The federal government entered into a partial shutdown at midnight Saturday.

In the event of a shutdown, Social Security and disability checks still go out.

While core functions would not be affected, some Social Security Administration employees would be placed on furlough and minor services would be frozen.

The federal government entered into a partial shutdown at midnight Saturday, which could cause widespread adjustments for a slew of government programs.

All essential services will continue during a shutdown, such as public safety operations and Medicare payments.

Additionally, the shutdown should have little effect on Social Security checks. According to the Social Security Administration's shutdown contingency plan, released in December, most core programs and benefits would continue in the event of a shutdown.

"Funding for the programs under Titles II, XVI, and XVIII of the Social Security Act will continue, even in the event of a lapse in appropriations," the plan says.

A shutdown only affects funds annually appropriated by Congress, not funding that is sustained long-term. The Social Security trust fund is paid for through a combination of taxes and long-term investments.

Other core functions like disability claims or appeals over benefits would continue to function.

For the military and veterans, VA disability payments, Surivior Benefits Plan payments, and retiree payments would all be made becuase those funds also come from non-annual approriations.

While checks still go out, some aspects of the Social Security Administration would get hit during a shutdown. Many employees would be placed on furlough, meaning they couldn't work and would not receive pay for the duration of the shutdown. (In past shutdowns, Congress has passed legislation to back-pay employees placed on furlough.)

Additionally, some functions like benefit verification and issuing Social Security cards would cease.

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Here's what happens to Social Security and disability benefits during a government shutdown

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The federal government entered into a partial shutdown at midnight Saturday. In the event of a shutdown, Social Security and disability checks still go out. While core functions would not be affected, some Social Security Administration employees would be placed on furlough and minor services would be frozen.

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http://www.newsweek.com/government-shutdown-congress-senate-787186

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The first government shutdown was in 1976, when President Ford was in office. It had lasted from September 30th to October 11th. The second government shutdown occurred the following year while President Jimmy Carter was in office. It also began on September 30th, but it lasted until October 13th. There have been 5 total shutdowns with Jimmy Carter in office and 8 total shutdowns with Ronald Reagan in office. As of now, there have been a total of 18 government shutdowns in the history of the United States.

https://www.vox.com/policy-and-politics/2018/1/19/16905584/government-shutdown-history-clinton-obama-explained

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Why the government shut down, what a government shutdown is and past government shutdowns

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Why the government shut down, what a government shutdown is and past government shutdowns

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https://www.vox.com/2018/1/22/16918686/government-shutdown-why-what

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How the government shutdown debacle looked to the rest of the world

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How the government shutdown debacle looked to the rest of the world

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https://www.vox.com/world/2018/1/22/16919166/government-shutdown-2018-global

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https://www.cnn.com/2018/01/22/politics/government-shutdown-federal-monuments/

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"As a reminder, there are federal workers who "are still awaiting financial compensation for damages sustained during the 2013 government shutdown." https://t.co/ehC7EWTtT3

And there's your fun shutdown fact of the day.

— Shawna Thomas (@Shawna) January 20, 2018

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The National Institutes of Health can’t enroll new patients in clinical trials or take action on grant applications.

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The National Institutes of Health can’t enroll new patients in clinical trials or take action on grant applications.

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During the last shutdown, NIH turned away about 200 patients each week from its clinical research center since nearly three-fourths of its staff was furloughed. The center can only admit new patients with cases NIH Director Francis Collins deems “medically necessary.”
https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/01/22/the-health-202-how-the-government-shutdown-could-affect-your-health-care-or-not/5a625a1030fb0469e884025b/?utm_term=.3ddcae3ed25d

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Who are the victims/ are affected by government shutdown?

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Who are the victims/ are affected by government shutdown?

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Will I continue to receive my Social Security and SSI checks?

During a government shutdown, recipients will continue to receive their Social Security and SSI checks. However, a shutdown suspends the issuance of Social Security cards. On a typical day, approximately 60,000 Americans apply for Social Security cards, which they may need to be able to start a job, take out a loan, open a bank account, or conduct other financial transactions. During a shutdown, no Social Security cards are issued.

Will my mail still arrive?

Yes. The approximately 500,000 Postal Service employees are exempt from furlough because the Postal Service is self-funded.

Will I still be able to visit the national parks and monuments?

During the 2013 16-day shutdown, national parks, national monuments, and the Smithsonian museums were closed. However, the Trump Administration has announced that it will work to keep national parks "as accessible as possible" in the event of a shutdown. Officials have said that the anticipated plan is to keep many national parks open for hiking, wildlife watching, snowshoeing and cross-country skiing. Open-air parks and monuments in Washington, D.C. will remain open. However, other services that require National Park Service staff, including campgrounds and concessions, will be closed.

How will the shutdown affect FEMA natural disaster clean-up efforts?

It's unclear how ongoing FEMA recovery efforts in Texas, Florida, California, Puerto Rico, and the Virgin Islands from recent hurricanes and wildfires will be impacted. FEMA staff would still respond to emergencies, but the Trump Administration has not clarified how many workers, if any, would continue with long-term projects.

What is the impact on veterans' services?

During a government shutdown, all VA medical facilities and clinics will remain fully operational. However, VA call centers and hotlines cease to function, and Veterans Benefits Administration public contact services are not available. In addition, the 2013 16-day shutdown stopped progress in reducing veterans' disability claims backlog, which had previously been progressing at a rate of almost 20,000 claims per week. In addition, during the 2013 16-day shutdown, many veterans lost access to vocational rehabilitation and education counseling services.

What is the impact on U.S. military personnel?

The Defense Department issued guidance today saying that in the event of a shutdown, "Military personnel on active duty, including reserve component personnel on federal active duty, will continue to report for duty and carry out assigned duties." Regarding their pay, the Washington Post reports, "There would be no gap in their pay unless the shutdown lasted past February 1, and otherwise they would continue on the job without getting paid until the shutdown ended or until Congress and the President agreed to cover their costs before it ended. The last time the government shut down, in 2013, the military remained on the job and legislation to pay service members during the shutdown was signed by President Obama."

What is the impact on small businesses?

A shutdown halts federal loans to small businesses. During a shutdown, the Small Business Adminisitration stops approving applications for small businesses to obtain loans and loan guarantees, typically $1 billion per month. During the 2013 16-day shutdown, the SBA was unable to process about 700 applications for $140 million in small business loans.

What is the impact on federal housing loans?

During a shutdown, the Federal Housing Administration stops approving applications for housing loans. During the 2013 16-day shutdown, the FHA delayed processing over 500 applications for loans to develop, rehabilitate, or refinance around 80,000 units of multifamily rental housing.

What is the impact on medical research?

During a shutdown, NIH shuts down most medical research taking place on its campus in Maryland, prevents the enrollment of patients in NIH Clinical Center studies, and stops reviewing medical research grant applications and making or renewing research grants.

What is the impact on the Centers for Disease Control?

During a shutdown, CDC has to greatly curtail its activities to conduct flu season surveillance and monitoring, promote immunization, support state and local health departments, and update disease treatment and prevention recommendations.

What is the impact on food safety activities?

During a shutdown, the FDA is unable to support the majority of its food safety activities. The 2013 16-day shutdown sharply curtailed critical FDA food safety inspections of domestic and international food facilities.

Which federal employees keep working during a government shutdown?

When there is a government shutdown, federal agencies are required to classify their employees as either "essential" or "non-essential." The employees classified as "essential" continue to work during the shutdown. However, the employees classified as "non-essential" are put on unpaid furlough. In the 2013 16-day shutdown, about 800,000 of the 2.1 million civilian federal employees in the executive branch were classified as "non-essential" and furloughed.

Do furloughed federal employees get back pay?

That is up to the Congress and White House. The precedent has been that furloughed employees are later paid, through enactment of legislation. For example, that was done in the most recent shutdown in 2013.

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Questions and Answers about the Impact of a Government Shutdown

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Will I continue to receive my Social Security and SSI checks? During a government shutdown, recipients will continue to receive their Social Security and SSI checks. However, a shutdown suspends the issuance of Social Security cards.

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What the government shutdown means for the health of Americans

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What the government shutdown means for the health of Americans

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The shutdown does affect the Department of Health and Human Services, where 50 percent of all public employees will be sent home on furlough, or without pay. The remaining workers are considered essential to protect life and property.

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The federal government shut down this weekend, as Congress failed to pass a stopgap spending measure. Many may wonder what this means for the nation's public health battles against threats like the flu and the opioid crisis.

In a shutdown, contingency plans allow the federal government to meet most short-term health care needs. Most American hospitals are privately run. Public hospitals are, with very few exceptions, run by state and local governments, which aren't directly affected. No one will be turned away at the emergency room because of the shutdown.

There are, however, plenty of federally funded programs and a few medical facilities that are immediately affected. The federal government will also likely take longer to respond to emerging health crises, as nonessential personnel are sent home.

Patient care

Most federal funding for direct patient care is appropriated separately from the budget negotiations causing the shutdown. So Medicare and Medicaid will be largely unaffected, for example.

There's also a separate appropriation to sustain medical care for veterans. This has been in place since the 2013 shutdown, which caused Congress to change the way it funds veteran care.

The shutdown does affect the Department of Health and Human Services, where 50 percent of all public employees will be sent home on furlough, or without pay. The remaining workers are considered essential to protect life and property.

HHS provides direct patient care only in a few cases, but Indian Health Services - the agency charged with providing clinical care for 2.2 million American Indians and Alaskan Natives - is under its purview. Thankfully, there will be no disruptions in those services, because nearly every IHS employee is considered essential.

The National Health Institute Clinical Center provides medical services, primarily for patients participating in medical studies funded by the federal government. Patients already admitted will continue to receive care, but there will be no new clinical study admissions during the shutdown.

This is one of the few places where the shutdown could result in fatalities. Many patients only participate in medical studies when conventional medicine has failed. It's possible that some would-be patients, who would have received potentially lifesaving medical care, will die without these lifesaving treatments. That probability increases with the duration of the shutdown.

Public health

Much of the federal funding for public health helps local and state authorities preempt and mitigate threats.

The Centers for Disease Control and Prevention supports local and state authorities in disease outbreaks and coordinates national level efforts to counter them. The urgent response to disease outbreaks, like the this year's record-breaking flu, will continue without disruption.

However, federal investigations of new disease outbreaks - which are crucial to countering diseases before they become widespread in multiple states - will be substantially slower during the shutdown. It will also take longer for the CDC to disseminate crucial national public health information to hospitals and doctors, who often depend on this data to administer appropriate care at local levels.

The federal government also ensures the safety and well-being of Americans through food inspections, which keep contaminated meats, eggs, grains and other foodstuffs from making it to the consumer. Many of these inspections will continue without disruption.

Brain drain

While the law mandates that the essential personnel who protect life and property must remain at work, these government workers will not receive pay during the shutdown.

By law, essential personnel have to be reimbursed for their lost earnings once the government resumes full operations. But, in the short run, it changes how government workers can spend money and take care of their families. The government workers who were furloughed are not guaranteed any pay for the period they were locked out.

The public health sector, more so than many other aspects of the federal government, depends on highly educated and skilled employees with advanced degrees, such as medical doctors and researchers. Although government workers often make higher wages than they could in the private sector, that isn't true for those who are most skilled. Many public servants in public health take pay cuts to work for the federal government.

Friday's government shutdown is the second in just five years. With the disruption to the livelihoods of more than a million federal employees, it's understandable that some employees may seek employment in the private sector instead, leaving the federal government less capable in the future.

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What the government shutdown means for the health of Americans

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The federal government shut down this weekend, as Congress failed to pass a stopgap spending measure. Many may wonder what this means for the nation's public health battles against threats like the flu and the opioid crisis. In a shutdown, contingency plans allow the federal government to meet most short-term health care needs.

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What are the consequences of the government shutting down

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What are the consequences of the government shutting down

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If Congress fails to come to an agreement, the government shutdown that officially began at 12:01 a.m. Saturday would continue indefinitely. Hundreds of thousands of federal workers would be furloughed, affecting a wide range of government programs.

Share of Employees Who Would Stay Home

Critical services that protect "human life or property," like air traffic control, and programs like the United States Postal Service that have alternate funding sources would continue.

Here are the outlooks for major federal agencies and some consequences of the last government shutdown, which lasted for 16 days in October 2013:

Housing and Urban Development

Most of the nearly 8,000 employees would be furloughed, but the agency would continue essential services like emergency housing for the homeless and new loan endorsements for single family homes.

Loans to develop or rehabilitate rental units went unprocessed.

Environmental Protection Agency

Most of its nearly 14,500 employees would be furloughed, according to the agency's contingency plan. On Friday, however, the agency's administrator, Scott Pruitt, said that E.P.A. has sufficient resources to operate through next week even if government financing expired and that all employees should plan on working next week.

Inspections at about 1,200 water, hazardous waste and chemical sites were halted.

Evaluations of potential health impacts of new industrial chemicals were discontinued.

Reviews of pesticides for adverse effects on health and the environment were stopped.

Most of the department's nearly 4,000 employees would be furloughed. Other than financial aid support, most of the department's activities would come to a halt.

Of the department's nearly 48,000 employees, 90 percent would be furloughed. Work would stall across a wide swath of scientific and economic agencies, including the National Oceanic Atmospheric Administration, the Census Bureau and the International Trade Administration, while activities like fisheries management, patent processing and climate observation would continue.

Important monthly reports on trade, retail sales and construction were not released.

Some technology exports were delayed.

More than 80 percent of its 15,000 or so employees would be furloughed. Most of the department would be closed, but unemployment compensation would continue.

Some 1,400 inspections to prevent workplace fatalities were delayed.

Investigations to enforce workplace protections were delayed.

Monthly employment and price reports were not released.

More than three-quarters of the roughly 70,000 employees would be furloughed. Unlike with previous shutdowns, national parks would remain open, but some services that require staffing, like campgrounds and full-service restrooms, would not operate. Smithsonian museums and the National Zoo would be closed beginning on Monday.

Drilling permit applications were not processed.

National parks and the Smithsonian closed.

Data on natural disasters could not be gathered.

More than half of the 88,000 or so employees would be furloughed. The Internal Revenue Service would exempt more employees from being furloughed than it normally would during a shutdown because it is tax filing season.

There was a much larger furlough of 80 percent of employees.

Export certificates for alcohol were not issued.

The I.R.S. could not verify data for private-sector lenders.

Tax refunds were delayed.

Implementation of financial sanctions against countries like Iran and Syria were hampered.

Health and Human Services

Half of its nearly 82,000 employees would be furloughed, including a vast majority of staff members at agencies that provide grants. Agencies with a substantial direct service component, like the Indian Health Service, would remain mostly open. Medicare would operate " largely without disruption," according to the Health and Human Services contingency plan, and health care exchange activities would continue.

Approval of medical devices and drugs was delayed.

Flu season surveillance and monitoring were cut back.

New patients were prevented from enrolling in clinical studies.

Head Start programs temporarily closed their centers.

Food safety inspections were delayed.

The furlough would apply only to about half of the department's 740,000 civilian workers, but military personnel also would not be paid unless Congress voted to pay them (it did in 2013).

Contracts with small businesses dropped by almost one-third.

Thousands of hours were spent developing and implementing contingency plans and restarting full operations.

Less than half of its 55,000 or so employees would be furloughed, leaving operations like air traffic control and hazardous material safety inspections largely intact.

Aircraft purchases and deliveries were delayed.

The United States Merchant Marine Academy closed for nearly three weeks. The latest guidance said that the academy would now remain open in a shutdown.

More than 80 percent of the department's 115,000 employees would be allowed to work through a shutdown because they have national security, law enforcement and criminal justice responsibilities.

Social Security Administration

Social Security recipients would continue to receive their benefits. Most of the agency's 63,000 employees would continue to work.

A small share of the department's 241,000 employees would be furloughed, including those who perform planning, research, policy, regulatory and training activities. Nearly all Customs and Border Protection; Immigration and Customs Enforcement; and Transportation Security Administration employees would remain at work.

Nearly 96 percent of the agency's roughly 377,000 employees would continue to work. V.A. hospitals would remain open but functions like education assistance and case appeals would be delayed.

Progress in reducing the backlog of disability claims stalled.

Support for military service members who were transitioning to civilian life was delayed.

The department has not released estimates for how many employees would be furloughed. According to a memo, passport services would continue, though passport offices in federal buildings affected by the shutdown could be closed.

Current furlough data for the agency was not immediately available, but 69 percent of workers were furloughed in 2013.

National Nuclear Security Administration labs and plants and also nuclear cleanup sites likely lost weeks of productivity.

Nutrition programs including food stamps (SNAP) and the program for women and children (WIC) would continue. Current furlough data for the agency was not immediately available.

There were delayed home loan program decisions for low-income families.

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housing and urban development department

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What Will Happen if the Government Remains Shut Down

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If Congress fails to come to an agreement, the government shutdown that officially began at 12:01 a.m. Saturday would continue indefinitely. Hundreds of thousands of federal workers would be furloughed, affecting a wide range of government programs. Share of Employees Who Would Stay Home Critical services that protect "human life or property," like air traffic control, and programs like the United States Postal Service that have alternate funding sources would continue.

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the CDC is saying it will be suspending its flu tracking program. That’s bad timing because given the country is at the height of a particularly bad flu season.

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How the government impacts military families services

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How the government impacts military families services

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https://www.military.com/spousebuzz/2018/01/20/how-government-shutdown-impacts-military-family-services.htmlhttps://www.military.com/spousebuzz/2018/01/20/how-government-shutdown-impacts-military-family-services.html

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is starting to send 63 percent of its 13,600 employees home. Which is going to be affecting Americans especially since it is flu season, this will affect if Americans an be tested or not.

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Other ways the government shutdown affects an individual

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Other ways the government shutdown affects an individual

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If an individual is buying a home, there can be a delay in closing on that home. Mortgage approvals will be on hold by the Federal Housing Administration.

https://www.usatoday.com/story/news/politics/2018/01/19/open-closed-heres-how-government-shutdown-could-impact-you/1048155001/

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https://www.nbcnews.com/health/health-news/how-government-shutdown-might-affect-your-health-n839516
https://www.nbcnews.com/health/health-news/how-government-shutdown-might-affect-your-health-n839516

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Several agencies such as the US Department of Health and Human Services will send thousands of workers home as a contingency plan.

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As the U.S. government shuts down, nearly 41,000 employees in various U.S. federal health agencies will be furloughed , triggering potential delays in medical care services and payments to medical care providers, a U.S. Department of Health and Human Services contingency plan shows.

Congress and the Donald Trump White House Friday night were unable to agree on a short-term spending bill, putting in motion contingency plans that are expected to lead to furloughing more than 40,000 workers in various agencies under the U.S. Department of Health and Human Services.

"Put another way, 50% of HHS employees would be on furlough, and 50% would be retained," HHS' fiscal 2018 ''Contingency Staffing Plan for Operations in the Absence of Enacted Annual Appropriations" says.

U.S. agencies that will be impacted by the shutdown include the Food and Drug Administration, the National Institutes of Health, the Centers for Disease Control & Prevention and the Indian Health Service.

"Contingency plans for agency operations in the absence of appropriations would lead to furloughing 40,959 staff and retaining 40,956 staff as of day two of a near-term funding hiatus," HHS said in its contingency document, which was updated Friday.

The U.S. Senate had to pass a short-term spending bill by midnight Friday to avoid a government shutdown but Senators were unable to do so. The U.S. House of Representatives earlier this week approved a short-term funding bill. Negotiations continued Saturday.

Aside from routine funding of the government, Congress is considering longer term funding of the Children's Health Insurance Program, which provides healthcare coverage to 9 million children of low-income families. The fact that the program known as CHIP hasn't already been renewed as it has ever five years since it was created in 1997 is baffling healthcare providers.

"This carries real consequences for children and families, especially those who rely on vital nutrition, housing and health care assistance, many of whose lives were affected by the last federal government shut down," said American Academy of Pediatrics president Dr. Colleen Kraft.

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Government Shutdown To Furlough 41,000 U.S. Health Workers

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As the U.S. government shuts down, nearly 41,000 employees in various U.S. federal health agencies will be furloughed , triggering potential delays in medical care services and payments to medical care providers, a U.S. Department of Health and Human Services contingency plan shows.

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What are programs, etc. that will be affected by the Government Shut down?

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What are programs, etc. that will be affected by the Government Shut down?

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Social Security and Medicare; Social safety net programs; The US Postal Service; National parks, museums, libraries, and zoo; The IRS; Veterans hospitals; Military; Health Agencies; regulatory agencies; courts; Federal prisons and border control

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The federal government shutdown is under way in earnest.

After Congress tried and failed to reach a deal over the weekend, huge swathes of the federal government have suspended operations and furloughed employees until a government funding bill is passed.

Not everything is affected. Post offices are still open and mail delivery continues. Social Security checks will still go out, as will veterans' pensions and survivor benefits. And the Trump administration is encouraging agencies to remain open if they're funded outside the annual appropriations process - so the Energy Department, for example, will remain open.

But many other functions are suspended. The Internal Revenue Service can process returns, for example, but it can't issue refunds.

Here's what we know so far about how the shutdown is affecting various agencies and services. A full list of contingency plans for federally funded agencies can be found here.

Social Security and Medicare

Social Security: As a "program written into law," the Social Security Administration will ensure checks keep going out. However, the agency might not have (and in the past has not had) enough staff to do things like answer phone calls or help recipients who need to change addresses. Disability payments will also continue as normal.

Medicare: Medicare is unaffected, according to the Department of Health and Human Services.

Social safety net programs

Payments for the TANF (Temporary Assistance for Needy Families) program will continue to go out.

Medicaid is unaffected in the short term, as states have funding through the second quarter of 2018.

A portion of Head Start Programs receive funding on the first of every month, meaning the impact of a shutdown will only be felt if it lasts until February 1. During the 2013 shutdown, federally funded Head Start preschools in six states closed their doors, impacting 6,300 low-income kids, according to a White House report.

Food stamps and subsidized lunches are unaffected for now, but the US Department of Agriculture announced that funding will run out by the end of February or early March, if Congress doesn't reach a deal to reopen the government. Food stamps and other federal nutritional programs are considered mandatory programs, but still require Congress to renew the funding every year.

The US Postal Service

Post offices will remain open and postal workers will continue delivering mail, as the postal service is funded by independent sources of revenue.

National parks, museums, libraries, and zoo

About two-thirds of national parks remain open, but with reduced services. Gift shop clerks aren't working; restrooms aren't being maintained, and trash isn't being collected. Access could change without notice, and some parks aren't open at all.

Smithsonian museums are still open Monday, but it's not clear what's going to happen after that.

The Library of Congress has been closed since Saturday.

The IRS

Veterans hospitals

The military

The military falls under the "essential to national security" umbrella, along with Border Patrol agents and TSA screeners, and so military personnel still report to work.

Members of the military are paid twice a month, so pay won't be delayed unless the shutdown lasts beyond February 1.

Health agencies

The National Institutes of Health cannot accept new patients for clinical research and answer hotline calls about medical questions. Patients currently in NIH hospitals will still be cared for.

Indian Health Services clinics will continue to provide health care.

The Centers for Disease Control and Prevention has a significantly reduced capacity to respond to outbreak investigations, process lab samples, and maintain its 24/7 emergency operations center, but it continues its work on flu surveillance, the administration official said Friday.

TheFood and Drug Administration can't conduct nonessential routine inspections or certain lab research; 42 percent of its workers are furloughed.

Regulatory agencies

Certain financial regulators, including the Securities and Exchange Commission and the US Commodity Future Trading Commission, have sent the majority of their staff home. While corporations will still be able to file documents, nobody will be around to look at them.

The Environmental Protection Agency said in a letter to staff Friday that its operations will continue as normal through next week, even though its shutdown contingency plan calls for furloughing about 95 percent of employees. Other agencies conducting research on climate change, however, will not be open during the shutdown.

The Consumer Financial Protection Bureau, which is not funded through the annual appropriations process, will remain open.

The courts

According to a memo from the director of the administrative office of the US courts, James C. Duff, the judiciary will not shut down, and all employees will be expected to return to work as normal on Monday.

The judiciaryhas enough money to continue paid operations for approximately the next three weeks, or until February 9, 2018.

This is a noted contrast to the 2013 shutdown, when the federal courts were already limping along on limited funds. That time, the judiciary ended up experiencing broad disruptions, including delays in bankruptcy and Social Security cases, condensed criminal calendars, cuts in building maintenance, and uncertainty over juror payments.

Air traffic control

The air traffic controllers responsible for making sure planes land and take off safely, as well as TSA agents, will continue work as normal. However, they won't be paid until the government reopens.

Federal prisons and border control

These employees also fall under the "public safety" category, and workers are exempt from furloughs as a result.

Washington, DC

During the 2013 shutdown, then-Mayor Vincent C. Gray was forced to dip into budget reserves and designate every one of the city's employees as "essential" in order to keep the city up and running. Since then, however, Congress has given DC more budget autonomy, insulating it from the effects of a shutdown by allowing it to spend more of its budget as it sees fit.

"Our budget has a degree of separation from the Congress that it did not have at the time of the last shutdown," Kevin Donahue, deputy mayor for public safety and justice, told the Washington Post in response to the threat of a shutdown this past April. "We believe, in the event of a shutdown, that there will be no effect on city services, nor will we need to take the extraordinary step of declaring all employees essential."

Only federal landmarks and smaller, federally controlled parks in the city will go without trash collection. In 2013, the district ended up picking up the slack after an accumulation of garbage and rats prompted a rapid response.

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What's affected - and what's not - by the government shutdown

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The federal government shutdown is under way in earnest. After Congress tried and failed to reach a deal over the weekend, huge swathes of the federal government have suspended operations and furloughed employees until a government funding bill is passed. Not everything is affected. Post offices are still open and mail delivery continues.

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In response to a government shutdown, the Health and Human Services would furlough (send home until further notice) about half of its employees, almost 41,000 people.

Additionally, states would be able to continue their flu research, but wouldn’t be able to send it to the CDC for testing because the CDC would suspend their flu-tracking program until the government opened back up.

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A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts said Friday.

In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

Here are some federal services and programs consumers might be wondering about:

Centers for Disease Control and Prevention

According to the HHS plan, the CDC will suspend its flu-tracking program. That's bad timing, given the country is at the height of a particularly bad flu season, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. Without the CDC's updates, doctors could have a harder time diagnosing and treating patients quickly, he said.

Although states will still track flu cases, "they won't be able to call CDC to verify samples or seek their expertise," said Dr. Thomas Frieden, who was the director of the agency during the 2013 government shutdown.

A government shutdown will also affect the CDC's involvement in key decisions about next year's flu vaccine, which are scheduled to be made in coming weeks, said Dr. Arnold Monto, a professor of global public health at the University of Michigan.

Related: Congress, pointing fingers amid shutdown stalemate, returns to work

Beyond the flu, the CDC will provide only "minimal support" to programs that investigate infectious-disease outbreaks. The Atlanta-based agency's ability to test suspicious pathogens and maintain its 24-hour emergency operations center will be "significantly reduced," according to the plan.

That could prevent the CDC from identifying clusters of symptoms and disease "that are the earliest indicators of outbreaks," Frieden said.

National Institutes of Health

Although the NIH will continue to treat patients at its clinical center in Bethesda, Md., the agency will not enroll new patients in clinical trials - which many people with life-threatening illnesses see as their last hope.

Beneficiaries will be largely unaffected by a shutdown, especially if it is short. Patients will continue to receive their insurance coverage, and Medicare will continue to process reimbursement payments to medical providers. But those checks could be delayed if the shutdown is prolonged.

Medicaid

States already have their funding for Medicaid through the second quarter, so no shortfall in coverage for enrollees or payments to providers is expected. Enrolling new Medicaid applicants is a state function, so that process should not be affected.

States also handle much of the Children's Health Insurance Program (CHIP), which provides coverage for lower-income children whose families earn too much to qualify for Medicaid. But federal funding for CHIP is running dry - its regular authorization expired on Oct. 1, and Congress has not agreed on a long-term funding solution. Federal officials announced Friday that the staff necessary to make payments to states running low on funds will continue to work during a shutdown.

Community health centers

According to the HHS plan, the Health Resources and Services Administration will continue to operate the nation's 1,400 community health centers - clinics that serve about 27 million low-income people, providing preventive care, dentistry and other basic services. It will also continue the Maternal, Infant and Early Childhood Home Visiting Program, which targets low-income and at-risk families with house calls and lessons for healthy parenting. That program served about 160,000 families in fiscal year 2016.

But even those programs may not be at full speed. Funding for community health centers and the home visiting program was not renewed last fall - a casualty of Congress' fight over the CHIP reauthorization - so, they are operating on left-over funds.

Related: Government shutdown 2018: What's open and what's closed?

ACA premium subsidies

The shutdown will not affect some of the most politically charged health care programs, including ones created by the Affordable Care Act. Subsidies for people who get their health insurance through healthcare.gov or state marketplaces will not be affected, according to HHS.

Veterans Affairs

Staffing for the Department of Veterans Affairs will remain largely intact. "Even in the event that there is a shutdown, 95.5 percent of VA employees would come to work, and most aspects of VA's operations would not be impacted," said department press secretary Curtis Cashour in an email.

More than 99 percent of employees of the Veterans Health Administration, which runs the health care system, will continue working, according to the department's contingency plan.

However, the Veterans Benefits Administration, responsible for overseeing benefits such as life insurance and disability checks, will face larger cutbacks. Over a third of its employees face furlough under a government shutdown.

Food and Drug Administration

In the short term, the crucial activities that protect consumers will get done, said Jill Hartzler Warner, who was the associate commissioner for special medical programs at the FDA during the 2013 shutdown.

Programs that are critical for the public safety will continue, as will positions paid for by user fees, including work under the Center for Tobacco Products, according to the HHS plan.

The hundreds of staff members who conduct sample analysis and review entry of products into the U.S. will continue to work. However, routine inspections and laboratory research will cease.

Warner, who left the agency in March 2017 and now works as an industry consultant, said grants for rare-disease drug development were determined in 2013 to not be necessary and were postponed.

Nutrition services for seniors

The Administration for Community Living will not be able to fund federal senior nutrition programs during any shutdown, according to HHS officials. But it was not immediately clear how quickly clients would be affected.

A shutdown could delay federal reimbursements to independent Meals on Wheels programs, which serve more than 2.4 million seniors nationwide, according to Colleen Psomas, a spokeswoman for Meals on Wheels America. That could force programs to expand waiting lists for meals, reduce meals or delivery days, or suspend service, she said.

The magnitude of the effect could vary by the length of the shutdown and any final allocation. Some programs, however, could weather a shutdown, staffers said. In Portland, Ore., Meals on Wheel People spokeswoman Julie Piper Finley said meal delivery there will not be suspended. That agency receives about 35 percent of its funding through the Older Americans Act, but raises the rest of the money, ensuring that services are not disrupted.

Meanwhile, services connected to food and nutrition services for other needy populations are likely to keep operating with state partners who have funding through February and, in some cases, March, according to a Department of Agriculture spokesperson. Those programs include the Supplemental Nutrition Assistance Program, the Child Nutrition Programs and the Special Supplemental Nutrition Program for Women, Infants and Children.

Food safety

The FDA's food safety programs will cease, according to the HHS plan, but inspections conducted by Agriculture's Food Safety and Inspection Service (FSIS) will continue.

Meat and poultry inspections are "such a critical, essential task, and the meat and poultry inspection acts require that inspectors be present continuously," otherwise processing plants would have to close, said Brian Ronholm, former head of FSIS who now works for the law firm Arent Fox.

Ronholm added that many FSIS employees are "career folks" who have worked there through previous government shutdowns. "There was a lot of built-in knowledge of how to function during the [2013] shutdown," he said, adding that this expertise would help the agency if there is another shutdown.

This story was contributed by Kaiser Health News, a national health policy news service that is an editorially independent part of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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How the government shutdown might affect your health

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A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts said Friday. In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

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The last time the government shut down was in October 2013 for 16 days in a showdown over Obamacare funding. That time around, about 850,000 federal workers, or about 40 percent of all federal nonmilitary employees, received furloughs.

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The United States federal government shut down at 12:01 am on Saturday as Republicans and Democrats remain in a standoff over the spending bill. But how will the shutdown end? Essentially, Congress has to reach a deal on a spending bill, which it hasn't yet been able to do.

The government has officially shut down 18 times since the modern process that Congress uses to pass budget and spending bills took effect in 1976 - although this is the first time it's happened under single-party control. The shutdown doesn't mean all governmental operations cease entirely, but instead " nonessential " activities do. Which means the mail will keep coming, and Social Security checks will go out. But passport processing applications will come to a halt, and most federal employees will be furloughed.

"Congress would have to pass either another continuing resolution or permanent appropriations bill, and then funding is restored and workers are brought back," Columbia University political science professor Greg Wawro told me. "Assume non-essential workers are furloughed, offices close, communications go out and then, basically, they just reverse the process."

As Vox's Tara Golshan and Dylan Scott recently explained, there are multiple avenues for legislative action:

That means Congress can 1) pass the appropriations bills, likely in an omnibus, which just crams together 11 appropriations bills into one spending package; 2) pass a "continuing resolution" (CR), which would fund the government at its current levels, basically buying more time to negotiate the actual appropriations bills (this is what Congress has done since last October); or 3) pass a "CRomnibus," which is a combination of the two, extending the deadline on certain more contentious appropriations - like for the Department of Homeland Security - and passing a spending bill on the rest.

Lawmakers are negotiating into the weekend in hopes of striking a deal to get the government up and running again, though it's hard to tell at this point when they'll reach an agreement or how they might negotiate to one. And once they do, getting moving again could be complicated.

A lot will depend on how long the government is shut down

"It certainly depends on how long it's down," said Wendy Parmet, director of Northeastern University's Center for Health Policy and Law. "If they're down over the weekend, it's not such a big deal. If they're down for a long time, things back up, and then it's a bigger process and a more complicated one."

During shutdowns, federal employees are divided into "essential" and "nonessential" groups. Nonessential personnel receive furloughs, meaning they're off work until the shutdown is resolved and stop receiving paychecks. Essential workers have to go to work anyway, but they're not paid for it.

The last time the government shut down was in October 2013 for 16 days in a showdown over Obamacare funding. That time around, about 850,000 federal workers, or about 40 percent of all federal nonmilitary employees, received furloughs.

Generally, furloughed and non-furloughed workers alike are paid retroactively to cover their salaries during a shutdown. But that could take a while, and there are no guarantees. More than 25,000 federal employees are still awaiting financial compensation for damages sustained during the 2013 shutdown.

As a reminder, there are federal workers who "are still awaiting financial compensation for damages sustained during the 2013 government shutdown." https://t.co/ehC7EWTtT3

And there's your fun shutdown fact of the day.
- Shawna Thomas (@Shawna) January 20, 2018

Moreover, it's not just full-time federal employees who are affected - it's potentially thousands of contractors as well. TheOffice of Management and Budget's guidance varies on what types of contractors are and are not required to keep working - whether their work is necessary for health or safety, whether their supervisors will be working, whether they've been paid in advance, according to the Washington Post. An OMB assessment found that the 2013 resulted in 10,000 stop work orders for contracts and numerous temporary layoffs, and payment delays "forced contractors to temporarily lay off employees and imposed particular financial hardship on small businesses with less ability to absorb losses and put off payments of their own."

Broadly, some of those most affected by the shutdown are the most vulnerable - kids in the Head Start program, military families, janitors, security guards, and other low-wage federal contractors.

"If it's a weekend, I don't think it's an enormous mess," Parmet told me. "If it's two weeks, it starts becoming a real problem to real people."

A government shutdown is bad for the economy (obviously)

While a government shutdown won't have devastating effects on the economy, it's not good either. And some of what's lost during a shutdown simply can't be recovered.

According to an analysis from the Obama White House, the 2013 shutdown cost the federal government $2 billion in furloughed employee salaries, and 120,000 fewer private sector jobs were created than would have been otherwise. Hundreds of patients were prevented from enrolling in clinical trials at the National Institutes of Health, and almost $4 billion in tax refunds were delayed.

According to analysts at research firm S&P Global, the current shutdown could cost the economy about $6.5 billion per week, or about 0.2 percent of the United States' fourth quarter 2017 gross domestic product.

"It hurts the economy and the many people who are directly or indirectly reliant on the government for their livelihoods," said Mark Hamrick, senior economic analyst at consumer financial services company Bankrate, in an email. "With most Americans unable to muster sufficient savings to pay for an unexpected $1,000 expense, this shutdown can only do further damage."

Eventually Congress will reach a deal, but partisan brinksmanship isn't going to end

Republicans and Democrats will eventually strike a deal to fund the government. Federal workers will go back to work and get paid, passports will start processing, trash pickup at national parks will resume. But the partisanship that got us here in the first place - and the supposedly deal-making president's inability to make a deal - will continue.

"There has not been a strong move toward bipartisanship on this, and this is the way that Congress has been operating for the past several years," Wawro said. Democrats passed the Affordable Care Act on party lines; Republicans had the recent tax bill. "It's just become standard operating procedure. And the issue for Republicans is that Congress is not united enough in order to provide the votes to keep things open."

Five Republicans voted against a House-passed spending bill on Friday. Demands from ultra-conservatives in the House and President Donald Trump's antagonistic antics, particularly on immigration, have jammed things up further.

"This is a symptom of hyper-polarization, norm-breaking dysfunctionality," Parmet said. "I don't know how we put Humpty Dumpty back together again."

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The United States federal government shut down at 12:01 am on Saturday as Republicans and Democrats remain in a standoff over the spending bill. But how will the shutdown end? Essentially, Congress has to reach a deal on a spending bill, which it hasn't yet been able to do.

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Considering the shut down within the flu season can be a tremendous harm to the health of individuals who are having the flu. Having the problem of flu the states would not be able to call the CDC and let them verify samples or do anything.

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Considering the shut down within the flu season can be a tremendous harm to the health of individuals who are having the flu. Having the problem of flu the states would not be able to call the

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Department of Health and Human Services is Furloughing over half of the employees.

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The Food and Drug Administration is expected to retain about 58 percent of its staff. During the 2013 shutdown, FDA inspectors gave up their work phones and couldn't check emails. Because FDA inspectors only audit facilities, food production continued in 2013.

U.S. Department of Agriculture meat inspectors, however, must be present in every meat-processing facility nationwide. During the last shutdown, USDA inspectors continued to work.

The National Institutes of Health will keep around 23 percent of its staff on duty. Although patients currently receiving experimental care will remain in these programs, new patients will not be able to enroll in experimental programs.

Anthony Fauci, the NIH's infectious disease chief, said the shutdown means chaos for scientific researchers. "It's a scramble," Fauci told the Associated Press. "You can't push the pause button on an experiment when you inject an animal with a particular substance to see what the response is and then you have to go home for a week."

The Veterans Health Administration is already funded through the 2018 fiscal year, so VA hospitals will remain open. The agency's public affairs office said 95.5 percent of VA employees will come to work.

Still, community health centers face major problems, as money to those programs suffered a major cut in the current budget. Their funding is one of several reasons Democrats have refused to vote in favor of a resolution that would have kept the government open.

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The shutdown means trouble for government health agencies

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The Food and Drug Administration is expected to retain about 58 percent of its staff. During the 2013 shutdown, FDA inspectors gave up their work phones and couldn't check emails. Because FDA inspectors only audit facilities, food production continued in 2013. U.S. Department of Agriculture meat inspectors, however, must be present in every meat-processing facility nationwide.

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The government's shutdown effect on Tax Returns and Refunds

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The government's shutdown effect on Tax Returns and Refunds

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https://www.vox.com/policy-and-politics/2018/1/22/16919050/government-shutdown-tax-returns-refunds

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Tricare still provides care but there are some problems

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Tricare still provides care but there are some problems

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https://federalnewsradio.com/government-shutdown/2018/01/tricare-still-providing-services-despite-shutdown-but-there-may-be-some-difficulties/

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First, you need 60 votes to end debate on the bill, and second, you need 51 votes to pass it. So Republicans, who have 51 senators, need at least nine Democrats in order to start debate on the bill.

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Here's how a shutdown would affect your pay and benefits

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Here's how a shutdown would affect your pay and benefits

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https://federalnewsradio.com/government-shutdown/2018/01/heres-how-a-shutdown-would-affect-your-pay-and-benefits/

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Considering all of the cases of the flu, what happens now? The CDC is technically shut down, are they still investigating?

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FORT WORTH (CBSDFW.COM) - The government remains shut down on Monday morning after the U.S. Senate failed to reach a spending bill deal on Friday night. But there is optimism on Capitol Hill. Majority leader Mitch McConnell presented a plan Sunday night that would restore government funding for three weeks.

A vote on that measure will be held at 11:00 a.m. on Monday.

Meanwhile, the country is also trying to get a handle on one of the most severe flu seasons in recent history. Officials with the Centers for Disease Control and Prevention are still tracking cases of the flu, and stated that they will continue to do so despite the government shutdown.

However, it is likely that the CDC will be short-staffed while tracking the country's flu cases. According to Time magazine, 63 percent of the CDC's employees will be furloughed during the government shutdown. That comes out to a total of about 8,500 people that the CDC will be without.

MedStar has released some local flu statistics. There have been 389 total cases this month in the Metroplex. Of those, 71 of the patients were in the 50-59 age range. About six cases were reported each day in December. That number has jumped to about 19 cases each day in January.

Tarrant County is seeing some of the highest numbers of patients with primary or secondary flu-like symptoms.

Dallas County has reported 40 flu-related deaths so far this season. According to the most recent numbers from Dallas County Health and Human Services, the 39th patient was an 81-year-old resident from Dallas while the most recent was a 17-year-old resident from Dallas. Both died after complications from the flu, and had high-risk health conditions.

More From CBS Dallas / Fort Worth

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CDC Continues To Track Flu Cases During Government Shutdown

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FORT WORTH (CBSDFW.COM) - The government remains shut down on Monday morning after the U.S. Senate failed to reach a spending bill deal on Friday night. But there is optimism on Capitol Hill. Majority leader Mitch McConnell presented a plan Sunday night that would restore government funding for three weeks.

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How the government shutdown will affect the response time for the flu outbreak. 

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How the government shutdown will affect the response time for the flu outbreak. 

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The CDC says its “immediate response to urgent disease outbreaks, including seasonal influenza” will continue. This includes collecting data reported by states, hospitals and others. But a CDC representative said response could be issued at a slower rate than usual. Former CDC director Tom Frieden, who led the agency during the 2013 shutdown, said the shutdown means a slower response to changes in the flu virus and less preparation among doctors to provide rapid treatment.
https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/01/22/the-health-202-how-the-government-shutdown-could-affect-your-health-care-or-not/5a625a1030fb0469e884025b/?utm_term=.3ddcae3ed25d

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A government shutdown will have far reaching effects for public health. Including the nation’s response to the current difficult flu season. It will also disrupt some federally supported health services

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How the Government shutdown affects healthcare

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How the Government shutdown affects healthcare

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http://fortune.com/2018/01/19/government-shutdown-healthcare/

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The logicistic about the goverment shut down ? 

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The logicistic about the goverment shut down ? 

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Updated at 8:10 a.m. ET
Hundreds of thousands of federal employees will either be sent home or have been told to not show up to work at all on Monday, as furloughs due to the government shutdown that began Friday night start to affect workers around the country.

Senate Majority Leader Mitch McConnell, R-Ky., gave a foreboding warning from the Senate floor on Sunday.

"The shutdown is going to get a lot worse tomorrow," he warned. "A lot worse."

Republicans are insisting the shutdown is less "weaponized" than the last time this happened, in 2013 under then-President Barack Obama, but it's still sure to have a broad effect across the country and get worse the longer it goes.

"Essential services" will continue, and essential workers will remain on the job, albeit without pay.

But there will be a lot of federal workers - thousands - who will see a change.

Every federal agency has a specific contingency plan, in the case of a loss of funding, and you can look through them all here. In 2013, about 800,000 of the 2.1 million civilian federal employees were furloughed in 2013, according to The Washington Post.

In the Department of Agriculture's Farm Service Agency, for example, which employed 10,944 people as of last September, just 62 people are considered completely exempt from furlough.

The agency's plan then lays out a schedule for an additional tapering of labor: All employees are called to work for the first half of the first day of a shutdown, and then over the next 20 days, the plan dwindles the workforce down to 120 by the second half of the first day, and all the way down to seven people by day 20.

Here's how the shutdown will affect some key aspects of the government:
Military
Guidance from the Defense Department issued on Friday said military personnel will continue working, and military operations in places like Afghanistan would continue.

"There would be no gap in their pay unless the shutdown lasted past Feb. 1, and otherwise they would continue on the job without getting paid until the shutdown ended or until Congress and the president agreed to cover their costs before it ended," according to The Washington Post fact checker, who debunked President Trump's numerous claims that the military would be hit the hardest in the event of a government shutdown.
Veterans Affairs
Of the VA's 377,000 employees, more than 335,000 are expected to continue working. After a scare about veterans not getting the care they needed during the last shutdown, the Veterans Health Administration has been getting its funding appropriated in advance.
Social Security
Social Security checks will continue to go out, and most of the Social Security Administration's staff are exempt from the furloughs.
Postal Service
Postal delivery will be unaffected by the shutdown as the Postal Service operates on its own revenue stream. Post offices will also remain open.
The Justice Department
The Justice Department says criminal litigation will go on without interruption. The office of special counsel Robert Mueller, who is investigating Russian interference in the 2016 election and potential ties to the Trump campaign, will also be unimpeded.
Education
In the Department of Education, the contingency plan calls for more than 90 percent of its total 3,912 person staff to be furloughed during the first week of a shutdown, and a total of "not more than 6 percent of the total staff to be called back to work during a longer interruption."
Housing and Urban Development
The Department of Housing and Urban Development employs about 7,800 people. About 300 of them are considered exempt from furloughs, according to its contingency plan. It will continue to provide essential services like housing the homeless and providing emergency services to people with AIDS.

National Parks
One of the most visible symbols of that 2013 shutdown was gated off national parks. That won't be happening this year.

Most national parks, recreation areas, and monuments are staying open during the shutdown, but as NPR's Nathan Rott reported over the weekend, many rangers and staffers won't be on duty.

"There's absolutely a frustration [among park rangers]," Rott said on NPR's Weekend All Things Considered. "By keeping the parks open, the Department of Interior is basically saying that we can do this whole national park thing without you guys. And in reality, they don't think that's going to work."

Most landmarks, such as Independence Hall, which houses the Liberty Bell in Philadelphia, will be closed.

But one of America's most famous monuments, the Statue of Liberty, will reopen Monday after the state of New York agreed to temporarily pick up the tab for operating the park.

New York State will reopen the Statue of Liberty and Ellis Island tomorrow. We will not stand by as this symbol of freedom and opportunity goes dark. pic.twitter.com/8g6dnsZmU7
- Archive: Governor Andrew Cuomo (@NYGovCuomo) January 22, 2018

Arizona Gov. Doug Ducey has vowed to keep the Grand Canyon open as well. "The Grand Canyon will not close on our watch. Period," said Ducey said in a statement. "If Washington, D.C. won't function, Arizona will."
EPA
The environmental Protection Agency has enough funding on hand to remain open through the coming week, according to a memo from administrator Scott Pruitt. All EPA employees are expected to come to work on Monday.
Homeland Security
The Department of Homeland Security says nearly 90 percent of its personnel are considered essential staff and will continue to perform their duties.

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The Thorny Logistics Of A Government Shutdown

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The partial federal shutdown that went into effect at midnight on Friday has a broad impact, from closing Independence Hall to furloughs at the Department of Education.

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Medicare and Medicaid will still be funded while the government is shut down. But nutrition programs will be shut down along with the slowing of the response to the flu. Funding for medical trials will also be stopped.

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Stopgap Bill that ends government shutdown passes congress.

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Stopgap Bill that ends government shutdown passes congress.

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Congress had to pass a stopgap bill to keep the government funded because temporary government funding would've run out at midnight on Friday and the House and Senate had to pass a temporary extension to avoid a partial shutdown

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In addition to keeping the government operating until Feb. 8, the bill would extend the popular Children's Health Insurance Program for another six years.

Senate votes to end shutdown.

The Senate voted 81-18 on Monday to end the three-day-old government shutdown, with Democrats joining Republicans to fund the government through February 8 in exchange for a promise from Republican leaders to address the fate of young, undocumented immigrants known as Dreamers.

"In a few hours, the government will reopen," said Senator Chuck Schumer of New York, the Democratic leader. "We have a lot to do."

The House must still vote on the measure later Monday afternoon or evening, but final passage is a formality. The bill also funds the popular Children's Health Insurance Program for six years and delays or suspends a handful of tax increases that were to help pay for insurance coverage under the Affordable Care Act.

After a weekend of partisan finger-pointing - in which Democrats branded the shutdown the "Trump Shutdown," after President Trump, and Republicans branded it the "Schumer shutdown" - Monday's vote offered Republicans and Democrats a way out of an ugly impasse that threatened to cause political harm to both parties.

Mr. Schumer, speaking on the Senate floor, announced that he and Senator Mitch McConnell of Kentucky, the Republican leader, had "come to an arrangement" to adopt the three-week spending measure while continuing to negotiate a "global agreement" that would include the fate of the dreamers, undocumented immigrants brought to the country as children.

Monday's vote came after a frantic weekend of work by a bipartisan group of more than 20 senators, who on Sunday night were discussing a plan in which the government would stay open through early February, coupled with a promise from Mr. McConnell to allow a vote on a measure to protect the Dreamers from deportation.

Mr. McConnell pledged Monday morning that he would permit a "free and open debate" on immigration next month if the issue had not been resolved by then. But his promise was not enough for many Democrats, and on Monday morning, moderate Senate Democrats were still pressing for more in exchange for their votes to end the shutdown.

By noon, just before the first vote to end debate on the spending bill, the moderate Democrats were predicting passage.

"We're going to vote to reopen the government," Senator Mark Warner of Virginia, a Democrat whose state is home to thousands of federal workers, told reporters. Mr. Warner said there was now a "path clear on how we're going to get a full-year budget and we got a path clear on how we're going to start an immigration debate."

Senator Angus King of Maine, an independent who caucuses with Democrats, said he was a "strong" yes.

"I said before trust but verify," he said of Mr. McConnell. "He made this commitment publicly in the Senate floor. He was much more specific than he was last night. And frankly I think this is an important opportunity for him to demonstrate that he will carry through."
- Sheryl Gay Stolberg

Trump: the Democrats "have come to their senses."

"I am pleased that Democrats in Congress have come to their senses and are now willing to fund our great military, border patrol, first responders, and insurance for vulnerable children. As I have always said, once the Government is funded, my Administration will work toward solving the problem of very unfair illegal immigration. We will make a long-term deal on immigration if, and only if, it is good for our country." - Statement released by the White House

White House insists Trump was part of the deal-making.

Sarah Huckabee Sanders, the White House press secretary, insisted that the deal that the Senatevoted on was not "drastically different" than what was discussed on Friday between the president and Mr. Schumer.

Despite what was characterized by both parties as Mr. Trump's invisibility this weekend, Ms. Sanders still insisted that he was responsible for making a deal happen.

"What the president did clearly worked," she said, calling the numbers more in Mr. Trump's favor "than in Senator Schumer's favor."

"The president stayed firm, Republicans stayed firm and Democrats Ithink realized that they had to move past that piece of legislation" in order to discuss immigration going forward, Ms. Sanders said.

But she declined to clarify precisely what the parameters of an immigration deal would look like. She dodged several questions about how many of the so-called dreamers might be eligible for what she called a "permanent solution" to their legal status, or how it might be put into effect, or when deportations of DACA recipients might begin.

"They say they want to negotiate so much so that they were willing to shut down the government," Ms. Sanders said of Democrats in response to a specific question about when deportations would start.

She dodged a question about whether Mr. Trump had a role in dictating a web ad his campaign released over the weekend that said Democrats would be "complicit" in murders committed by undocumented immigrants. But she anticipated a full restoration of federal services by Tuesday morning.

White House official Marc Short credited the president with impacting the tide turning by calling into the House Freedom Caucus meeting on Thursday. He then - mostly - held to a script that his aides prescribed that blamed Democrats. The White House consistently said they believed Democrats in red states would be forced to come around.

But aides at the White House, many of whom had never lived through a shut down before, were unsure how to spend their time. A group of press aides considered sending volunteers to the Mall to clean up after the women's rally on Saturday to highlight that the govenrment was shut, but they scuttled the plan when they found out that the Washington D.C. police were already doing it.

"Put this mess behind us."

Mr. McConnell said on Monday morning that the Senate would move ahead with a scheduled procedural vote at noon on a proposal to fund the government through Feb. 8, and he urged his colleagues to put an end to the shutdown.

"Every day we spend arguing about keeping the lights on is another day we cannot spend negotiating DACA or defense spending or any of our other shared priorities," Mr. McConnell said, referring to Deferred Action for Childhood Arrivals, the program put in place by the Obama administration that shields young undocumented immigrants from deportation.

Mr. McConnell reiterated a pledge he offered on Sunday night that he intended for the Senate to take up immigration legislation in February if the issue has not been resolved by then. A major question as senators seek to end the shutdown is what kind of commitment Mr. McConnell is willing to make regarding the consideration of legislation for the young immigrants, a central issue in the current impasse.

On Monday, Mr. McConnell pledged that the Senate's immigration debate would have "a level playing field at the outset and an amendment process that is fair to all sides."

"The very first step is ending the government shutdown," he said.
- Thomas Kaplan
Democrats wanted more than McConnell's word.

Moderate Senate Democrats Monday morning had sought a firmer commitment from Mr. McConnell that the Senate would move to address the fate of hundreds of thousands of young undocumented immigrants, known as Dreamers, in the coming weeks.

The Democrats were part of a bipartisan group of more than 20 senators working throughout the weekend to forge a compromise to reopen the government. Mr. McConnell signaled Sunday night that he was listening to their demands, saying from the Senate floor that he intended to move ahead with immigration legislation in February if the issue had not been resolved by then.

But on Monday, Democrats wanted more in exchange for the votes to end the shutdown.

"Well I think the first thing he needs to do is strengthen his statement from last night," said Senator Angus King of Maine, an independent who votes with the Democrats. " 'I intend.' I would much rather he say, 'I commit' or 'I will move.'"

As senators from the group shuffled in and out of leadership offices, Senator Jeff Flake, Republican of Arizona and another member of the group, expressed optimism that such a public statement by Mr. McConnell would be enough to win over enough Democrats to vote to end the shutdown. Some Democrats called on Mr. McConnell to delay a procedural vote schedule for noon.

The crux issue, it seemed, was whether the majority leader could be trusted to keep his word. Democrats have not forgiven Mr. McConnell for blocking the Supreme Court nomination of Merrick Garland for almost a year pending the election of a Republican to the White House. And Mr. McConnell's promises to Republican Senators Flake and Susan Collins of Maine for votes on health care and immigration in exchange for their support of the tax cut have yet to materialize.

How much of the issue is that mistrust?

"Uh, most of it," said Senator Joseph Manchin III, Democrat of West Virginia.
- Nicholas Fandos
Liberal activists weren't ready to relent.

A broad array of liberal advocacy groups - including unions and immigrants' rights activists - stepped up pressure on Democrats not to accede on Monday to any deal that does not include protections for the young undocumented immigrants known as Dreamers.

The advocates made clear that they do not trust Mr. McConnell.

"To anyone considering such a move, let me clear, promises won't protect anyone from deportation, because delay means deportation for us," said Greisa Martinez Rosas, advocacy director for America's Voice, an immigrant rights group.

Moderate Senate Democrats on Monday were seeking a firmer commitment from Mr. McConnell. But the groups remained skeptical. Vanita Gutpta, the president and chief executive officer of the Leadership Conference on Civil Rights, harked back to Democrats' vote on Friday to block a spending bill that would have kept the government open, without protecting the Dreamers.

"We've made it clear that the broad progressive movement is unified in saying the Democrats stood strong on Friday, they absolutely need to continue to do so," Ms. Gupta said. She added, "Simply put a dream deferred right now is a dream denied for hundreds of thousands in our country."

The Sierra Club's executive director, Michael Brune, was blunt: "Everyone in the Senate should have learned the lesson Senators Flake and Collins learned: you can't trust Mitch McConnell. His promises are empty from the start."
- Sheryl Gay Stolberg
The White House comment line had an attitude.

On Monday morning, a telephone call to the White House comment line reminded callers that the federal government was shutdown and offered the Trump administration's explanation for why: "Unfortunately, we cannot answer your call today because congressional Democrats are holding government funding for our troops and other national security priorities hostage to an unrelated immigration debate," a recording said. "Due to this obstruction the government is shut down."

Setting aside the partisan nature of the call, its message was only half true, if that. Most of the government is functioning, at least for now. The Environmental Protection Agency and the Federal Communications Commission say they have enough money in the pipeline to operate normally. The White House ordered the National Parks to stay open, depriving the media of the most obvious signs of dysfunction.

Even Robert S. Mueller III, the special counsel investigating Russia's intervention in the 2016 election and any possible collusion with the Trump campaign, is still in action. He has declared his investigators "essential employees."

But was the recording legal? Norm Eisen, who served as the top ethics lawyer during Barack Obama's first term in the White House and is now on the board of the liberal Citizens for Responsibility and Ethics in Washington, said the message probably did not violate the Hatch Act, the statute that bars most executive branch employees from engaging in political activity. It certainly does run contrary to its policy, and therefore "would have been inconceivable in any other administration, of either party."

"This telephone message falls in the very thin, gray area where this White House lives, which is quite a bit north of definitely wrong, but just south, or on the borderline, of illegal," Mr. Eisen said.

He said it violated the longstanding norm observed by presidents in both parties that the White House staff, particularly nonpartisan career employees such as the person likely to have recorded the message, is there to serve all Americans, not just those who voted for him.

But the recording would be unlikely to generate a formal complaint, Mr. Eisen said, because no specific political candidate was mentioned. The White House changed the message as the Senate headed toward a deal.
- Eileen Sullivan and Julie Hirschfeld Davis
White House shows signs it's on the offense.

After a weekend of relative silence from the White House, Raj Shah, a White House spokesman, appeared on CNN to defend President Trump, who had been publicly criticized as disengaged on the negotiations and unduly influenced by his senior advisers.

"We're happy with how the president engaged," Mr. Shah said, before shifting blame to the Democrats. "It was them that were holding back funding for our military, our troops, our border patrol agents and our first responders."

Mr. Shah also defended a president who has been publicly accused by lawmakers in his own party of deferring to Stephen Miller, the adviser who is ideologically behind much of the White House's restrictive immigration agenda.

"Those charges are frankly ridiculous, and they're a little insulting," Mr. Shah said. "The views that the president is endorsing are his and his alone."

Mr. Trump, a president prone to hit back against his critics in real time, remained relatively restrained on Monday, except to accuse Democrats of being cowed by activists who want a fast decision on the fate of the Dreamers.

Democrats have shut down our government in the interests of their far left base. They don't want to do it but are powerless!
- Donald J. Trump (@realDonaldTrump) Jan. 22, 2018

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Congress Passes Stopgap Bill to End Government Shutdown

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In addition to keeping the government operating until Feb. 8, the bill would extend the popular Children's Health Insurance Program for another six years. Senate votes to end shutdown. The Senate voted 81-18 on Monday to end the three-day-old government shutdown, with Democrats joining Republicans to fund the government through February 8 in exchange for a promise from Republican leaders to address the fate of young, undocumented immigrants known as Dreamers.

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Are tax returns affected by this as well ?

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Medical facilities on base for hospitals and dental care clinics will stay open. However, inpatient care and primary care operations are canceled.

https://www.military.com/daily-news/2018/01/18/how-government-shutdown-would-impact-pay-benefits.html

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How the shutdown could affect our health and not only health care

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How the shutdown could affect our health and not only health care

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A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts said Friday.

In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

Here are some federal services and programs consumers might be wondering about:

Centers for Disease Control and Prevention

According to the HHS plan, the CDC will suspend its flu-tracking program. That's bad timing, given the country is at the height of a particularly bad flu season, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. Without the CDC's updates, doctors could have a harder time diagnosing and treating patients quickly, he said.

Although states will still track flu cases, "they won't be able to call CDC to verify samples or seek their expertise," said Dr. Thomas Frieden, who was the director of the agency during the 2013 government shutdown.

A government shutdown will also affect the CDC's involvement in key decisions about next year's flu vaccine, which are scheduled to be made in coming weeks, said Dr. Arnold Monto, a professor of global public health at the University of Michigan.

Related: Congress, pointing fingers amid shutdown stalemate, returns to work

Beyond the flu, the CDC will provide only "minimal support" to programs that investigate infectious-disease outbreaks. The Atlanta-based agency's ability to test suspicious pathogens and maintain its 24-hour emergency operations center will be "significantly reduced," according to the plan.

That could prevent the CDC from identifying clusters of symptoms and disease "that are the earliest indicators of outbreaks," Frieden said.

National Institutes of Health

Although the NIH will continue to treat patients at its clinical center in Bethesda, Md., the agency will not enroll new patients in clinical trials - which many people with life-threatening illnesses see as their last hope.

Beneficiaries will be largely unaffected by a shutdown, especially if it is short. Patients will continue to receive their insurance coverage, and Medicare will continue to process reimbursement payments to medical providers. But those checks could be delayed if the shutdown is prolonged.

Medicaid

States already have their funding for Medicaid through the second quarter, so no shortfall in coverage for enrollees or payments to providers is expected. Enrolling new Medicaid applicants is a state function, so that process should not be affected.

States also handle much of the Children's Health Insurance Program (CHIP), which provides coverage for lower-income children whose families earn too much to qualify for Medicaid. But federal funding for CHIP is running dry - its regular authorization expired on Oct. 1, and Congress has not agreed on a long-term funding solution. Federal officials announced Friday that the staff necessary to make payments to states running low on funds will continue to work during a shutdown.

Community health centers

According to the HHS plan, the Health Resources and Services Administration will continue to operate the nation's 1,400 community health centers - clinics that serve about 27 million low-income people, providing preventive care, dentistry and other basic services. It will also continue the Maternal, Infant and Early Childhood Home Visiting Program, which targets low-income and at-risk families with house calls and lessons for healthy parenting. That program served about 160,000 families in fiscal year 2016.

But even those programs may not be at full speed. Funding for community health centers and the home visiting program was not renewed last fall - a casualty of Congress' fight over the CHIP reauthorization - so, they are operating on left-over funds.

Related: Government shutdown 2018: What's open and what's closed?

ACA premium subsidies

The shutdown will not affect some of the most politically charged health care programs, including ones created by the Affordable Care Act. Subsidies for people who get their health insurance through healthcare.gov or state marketplaces will not be affected, according to HHS.

Veterans Affairs

Staffing for the Department of Veterans Affairs will remain largely intact. "Even in the event that there is a shutdown, 95.5 percent of VA employees would come to work, and most aspects of VA's operations would not be impacted," said department press secretary Curtis Cashour in an email.

More than 99 percent of employees of the Veterans Health Administration, which runs the health care system, will continue working, according to the department's contingency plan.

However, the Veterans Benefits Administration, responsible for overseeing benefits such as life insurance and disability checks, will face larger cutbacks. Over a third of its employees face furlough under a government shutdown.

Food and Drug Administration

In the short term, the crucial activities that protect consumers will get done, said Jill Hartzler Warner, who was the associate commissioner for special medical programs at the FDA during the 2013 shutdown.

Programs that are critical for the public safety will continue, as will positions paid for by user fees, including work under the Center for Tobacco Products, according to the HHS plan.

The hundreds of staff members who conduct sample analysis and review entry of products into the U.S. will continue to work. However, routine inspections and laboratory research will cease.

Warner, who left the agency in March 2017 and now works as an industry consultant, said grants for rare-disease drug development were determined in 2013 to not be necessary and were postponed.

Nutrition services for seniors

The Administration for Community Living will not be able to fund federal senior nutrition programs during any shutdown, according to HHS officials. But it was not immediately clear how quickly clients would be affected.

A shutdown could delay federal reimbursements to independent Meals on Wheels programs, which serve more than 2.4 million seniors nationwide, according to Colleen Psomas, a spokeswoman for Meals on Wheels America. That could force programs to expand waiting lists for meals, reduce meals or delivery days, or suspend service, she said.

The magnitude of the effect could vary by the length of the shutdown and any final allocation. Some programs, however, could weather a shutdown, staffers said. In Portland, Ore., Meals on Wheel People spokeswoman Julie Piper Finley said meal delivery there will not be suspended. That agency receives about 35 percent of its funding through the Older Americans Act, but raises the rest of the money, ensuring that services are not disrupted.

Meanwhile, services connected to food and nutrition services for other needy populations are likely to keep operating with state partners who have funding through February and, in some cases, March, according to a Department of Agriculture spokesperson. Those programs include the Supplemental Nutrition Assistance Program, the Child Nutrition Programs and the Special Supplemental Nutrition Program for Women, Infants and Children.

Food safety

The FDA's food safety programs will cease, according to the HHS plan, but inspections conducted by Agriculture's Food Safety and Inspection Service (FSIS) will continue.

Meat and poultry inspections are "such a critical, essential task, and the meat and poultry inspection acts require that inspectors be present continuously," otherwise processing plants would have to close, said Brian Ronholm, former head of FSIS who now works for the law firm Arent Fox.

Ronholm added that many FSIS employees are "career folks" who have worked there through previous government shutdowns. "There was a lot of built-in knowledge of how to function during the [2013] shutdown," he said, adding that this expertise would help the agency if there is another shutdown.

This story was contributed by Kaiser Health News, a national health policy news service that is an editorially independent part of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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How the government shutdown might affect your health

# data[].attributes.attachment_link.description
A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts said Friday. In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

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Health Programs Threatened by Possible Government Shutdown

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Health Programs Threatened by Possible Government Shutdown

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http://www.medscape.com/viewarticle/891463

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Due to the shutdown, many programs that run on government grants, like substance abuse and suicide prevention programs, are faced with the problem of not having any staff/funding.

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what is affected in a government shutdown

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what agenices are affected by government shutdown

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Here's What Would Happen to U.S. Health Care If the Government Shuts Down

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An impending government shutdown would affect healthcare in many ways, hitting agencies like the CDC, the FDA, and others.

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Lesser-Known Effects of a Government Shutdown:

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Lesser-Known Effects of a Government Shutdown:

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http://www.cnn.com/2018/01/21/politics/unexpected-effects-government-shutdown/index.html

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Three Lessons for the Next Government Shutdown

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Three Lessons for the Next Government Shutdown

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https://www.bostonglobe.com/news/politics/2018/01/23/lessons-for-next-government-shutdown/sDtRvNcV4e9Qf1sTMFbUeJ/story.html

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The Centers for Disease Control and Prevention would have a tough time supporting its annual seasonal influenza program, among other programs. Reduced staffing and worker furloughs might be needed.

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So the government shut down at 12:01 a.m. EST on Saturday after lawmakers unsuccessfully brokered a plan to continue government funding into next week.

But how will various branches and agencies of the federal government respond? Below, a primer of what to expect:

Some history

There have been 12 shutdowns since 1981, ranging in duration from a single day to 21 days, according to the Congressional Research Service. The last shutdown happened in 2013 and lasted 16 days.

Nearly 800,000 federal employees were out of work without pay. In addition, more than a million other working employees had their paychecks delayed. On day five of the shutdown, Congress voted to give the furloughed government employees retroactive pay.

Meanwhile, some members of Congress kept collecting their paychecks, while others voluntarily gave up their checks. According to estimates by the financial services company Standards & Poor's, the last government shutdown cost America $24 billion, or $1.5 billion a day.

Congress still gets paid

It's the ultimate paradox. Salaries for members of the House and Senate are written into permanent law. That's why politicians get paid even in the event that congress can't agree on a bill to fund the government.

"Due to their constitutional responsibilities and a permanent appropriation for congressional pay, Members of Congress are not subject to furlough. Additionally, Article I, Section 6, of the Constitution states that Members of Congress 'shall receive a Compensation for their Services, to be ascertained by Law, and paid out of the Treasury of the United States,' and the 27th Amendment states, 'No law, varying the compensation for the services of the Senators and Representatives, shall take effect, until an election of Representatives shall have intervened.'"

What happens to the military?

Deputy Secretary of Defense Patrick Shanahan issued guidance to top Department of Defense heads, including service secretaries, under secretaries of defense, and commanders of combatant commands, on Friday that outlines how the department functions in the absence of government funds.

The department lists "excepted" activities that it considers essential services during a government shutdown. At the top of that list is national security.

U.S. military options around the world continue unaffected, including the war in Afghanistan and ongoing operations in Iraq and Syria. All active duty (and reserve components on federal active duty) continue to work during a shutdown. Civilian personnel with the Department of the Defense who are deemed essential to "excepted" activities will also continue to work. However, both groups would not be paid until after the shutdown ends.

Bill Clark/CQ Roll Call via AP

Non-essential Department of Defense civilian employees will be furloughed. During the 2013 shutdown, 400,000 of the department's 800,000 civilian workers were furloughed without pay, though they were later repaid after the shutdown.

Government contracts that were fully funded prior to the shutdown will continue, but new contracts (including renewals or extensions) will be halted.

Additionally, families will not receive the $100,000 death benefit provided for fallen service members. That money can cover funeral costs and family travel. It also helps to bridge the sudden halt of once-regular paychecks that the deceased was receiving -- paychecks that end immediately after the individual is killed.

During the 2013 shutdown, Congress worked to mitigate the shutdown's effects on the Department of Defense by passing a bill allowing for the death benefits to continue. Another bill allowed service members and "essential" Department of Defense civilian personnel to be exempt from the pay freeze.

Out of 114,647 employees, 95,102 are excepted from furlough, representing 83 percent of DOJ employees. Most of these exempt employees, 72,242, are necessary to protect life and property.

Criminal litigation will continue without interruption, but civil litigation will be curtailed or postponed as long as safety of human life or protection of property are not impacted. Administrative services will curtailed and maintained only to the extent needed to support operations. Training will largely be cancelled.

What happens to the special counsel's Russia investigation?

The Special Counsel's work will continue, as it is funded through a permanent indefinite appropriation. The Special Counsel's Office is funded with a permanent indefinite appropriation and all direct employees are excepted positions because their funding is not dependent upon an appropriations that require renewal.

The U.S. District Court in Washington, DC, would have roughly three weeks of budgetary pad, meaning they can keep the lights on and doors open.

What happens at the State Department? Passport services?

The State Department provided guidance to its employees on Friday in advance of a potential shutdown.

Starting Monday, the agency will furlough non-essential personnel and require them not to work or even use their government-issued laptops or cell phones - although they could come in for four hours to finish any required work and prepare for when the shutdown ends.

Because some U.S. missions overseas are open Sunday to Thursday, those missions would move into restricted operations starting Sunday.

State Department spokesperson Heather Nauert said Thursday that the agency will do its best to "minimize the impact on the American people," including passport and visa services. According to the agency's internal guidance, "Consular operations domestically and abroad will remain 100% operational as long as there are sufficient fees to support operations" and except if housed in a different government building that is forced to close.

It's the secretary's office that reviews the available options and will make a decision, but they have no numbers yet on possible furloughs or anything.

Jacquelyn Martin/AP Photo

"We're not going to get all excited about what may or may not happen. We will have contingency plans that we put in place and we will adhere to those," she said. But one area that won't be touched: "We will not pull back on areas of national security or staff security."

Tillerson is scheduled to travel to Europe next week, and the agency is still working to determine whether or not he would go, with one State Department official saying they were still awaiting guidance from Office of Management and Budget. Nauert said Thursday that Tillerson will follow all the necessary regulations very carefully, but won't make any decisions until necessary.

The Under Secretary of State for Management normally handles the contingency plans for a shutdown, but because that role is still vacant under the Trump administration, William Todd, the acting Director of Human Resources, sent out the agency's guidance instead.

Tillerson himself was asked about a shutdown during a photo-op with the Jordanian Foreign Minister and said the agency is ready, but hoping there isn't a shutdown.

"We're ready if that's what happens. We hope not. We hope not, but we're ready."

What happens to the Supreme Court?

In the event of a lapse of appropriations, the Supreme Court will continue to conduct its normal operations, and the Court building will be open to the public during its usual hours. The Court will rely on non-appropriated funds, as it has in the past, to maintain operations through the duration of short-term lapses of appropriations.

What happens at other agencies?

Staffing at most agencies will be cut to just a fraction of normal levels across federal government agencies.

Consumer Product Safety Commission: The number of employees goes from 550 to 22. Investigations generally come to a halt. It continues to implement the most critical of recalls.

National Transportation Safety Board: Employees go from 405 to 22. Most investigations cannot be launched or continued during shutdown. However, if a major transportation accident occurs, it will be investigated.

Department of Education: Employees go from 4,000 to 250, more than 150 of those are from the student financial aid office... so already-awarded grants and loans can continue as normal.

Department of Homeland Security: Staffing would go down from 232,860 to 201,700. There will still be normal security at airports, train stations, etc...

FEMA will retain more than 12,000 of its 15,000 employees. But in October of 2013, the agency's administrative support reportedly suffered (IT, HR, etc...)

US Postal Service: You'll still get your mail.

Department of Transportation: Air Traffic Controllers keep directing flights. FAA, FRA, FTA and other agency investigations generally come to a halt unless they pose an imminent threat.

Social Security: Will continue to issue checks.

EPA: Employees were told to go to work next week in the event of a shutdown. Administrator Scott Pruitt said in an email that the EPA has "sufficient resources" to stay open for a limited amount of time.

USDA: Meat, egg, and dairy inspections continue. Food stamps are still available but could run out of money. Food inspections of processed and imported food conducted by the FDA would be suspended.

Customer service at many of these agencies, including Medicare and Medicaid could be impacted due to furloughed employees.

What happens at Department of Health and Human Services

The Centers for Disease Control and Prevention would have a tough time supporting its annual seasonal influenza program, among other programs. Reduced staffing and worker furloughs might be needed.

Neither CDC nor the Office of Management and Budget would elaborate when asked by ABC News.

What happens to NASA?

NASA says critical work continues - which would need to be identified. The space station is at the top of the list since there are people living in orbit.

We're testing a power source that could provide safe, efficient energy for future crewed missions to the Moon, Mars & beyond. The system may be essential for day-to-day mission needs, like lighting, water & oxygen, as well as fuel for the journey home: https://t.co/vRYuKr4iqn pic.twitter.com/kLzwrvhl5Z
- NASA (@NASA) January 19, 2018

Mission Control would continue to operate 24/7 with a critical needs staff.

However, there would be no more astronauts tweets, because they can't actually tweet on their own - someone on the ground needs to push it out for them. They would assess various missions and see how far along they are in development - first up is the GOLD launch - which measures what happens when space weather from above meets terrestrial weather from below - but its launching from French Guiana so that helps. NASA space station management will be talking about two spacewalks coming up at the end of the month - to do critical work to maintain the space station Canadian robotic arm. The spacewalks would proceed but NASA won't be televising them so if you don't get a direct NASA wired feed you won't know anything (we get those feeds here at out office at Johnson Space Center).

What happens to National Parks?

In a break from previous shutdowns, the administration has said that national parks will be accessible if the government shuts down this weekend, perhaps in an attempt to avoid the striking images of veterans being turned away from war memorials that we saw during previous shutdowns. Roads, trails, and memorials will be open but parks will not collect entrance fees and will not be staffed for basic work like picking up trash, staffing visitors centers, or issuing permits. Campgrounds will be closed.

According to the National Park Service contingency plan only 3,300 employees are deemed essential out of almost 25,000, 650 of which are Park Police. If the Park thinks areas of the park are not safe without guides the area can be closed but they cannot bring on additional staff to enforce the closure. Individual parks will have their own plans to determine what areas will be open.

What happens to the Smithsonian museums and the National Zoo?

In the event of a federal government shutdown Friday night, the Smithsonian museums and its National Zoo will remain open for the weekend. The museums and the National Zoo will be closed beginning Monday, Jan. 22. The Smithsonian also has two museums in New York City that will be closed - the Cooper Hewitt Design Museum and Heye Center, a branch of the National Museum of the American Indian.

The National Zoo live-animal cameras, including the panda cam, will not be broadcasting. All the animals will continue to be fed and cared for at the National Zoo. A shutdown will not affect the Zoo's commitment to the safety of staff and the standard excellence in animal care.

ABC News' Lucien Bruggeman, Jeff Cook, Jack Date, Erin Dooley, Stephanie Ebbs, Conor Finnegan, Luis Martinez, Elizabeth McLaughlin, Gina Sunseri, Audrey Taylor, Trish Turner and Kelsey Walsh contributed to this story.

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Here's how a government shutdown could affect you

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So the government shut down at 12:01 a.m. EST on Saturday after lawmakers unsuccessfully brokered a plan to continue government funding into next week. But how will various branches and agencies of the federal government respond? Below, a primer of what to expect: Some history There have been 12...

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How the Government shutdown is going to affect Public Health

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How the Government shutdown is going to affect Public Health

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A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts say.

In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

Here are some federal services and programs consumers might be wondering about:

CENTERS FOR DISEASE CONTROL AND PREVENTION

According to the HHS plan, the CDC will suspend its flu-tracking program. That's bad timing, given the country is at the height of a particularly bad flu season, said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. Without the CDC's updates, doctors could have a harder time diagnosing and treating patients quickly, he said.

Although states will still track flu cases, "they won't be able to call CDC to verify samples or seek their expertise," said Thomas Frieden, who was the director of the agency during the 2013 government shutdown.

A government shutdown will also affect the CDC's involvement in key decisions about next year's flu vaccine, which are scheduled to be made in coming weeks, said Arnold Monto, a professor of global public health at the University of Michigan.

Beyond the flu, the CDC will provide only "minimal support" to programs that investigate infectious-disease outbreaks. The Atlanta-based agency's ability to test suspicious pathogens and maintain its 24-hour emergency operations center will be "significantly reduced," according to the plan.

That could prevent the CDC from identifying clusters of symptoms and disease "that are the earliest indicators of outbreaks," Frieden said.

NATIONAL INSTITUTES OF HEALTH

Although the NIH will continue to treat patients at its clinical center in Bethesda, Md., the agency will not enroll new patients in clinical trials - which many people with life-threatening illnesses see as their last hope.

MEDICARE

Beneficiaries will be largely unaffected by a shutdown, especially if it is short. Patients will continue to receive their insurance coverage, and Medicare will continue to process reimbursement payments to medical providers. But those checks could be delayed if the shutdown is prolonged.

MEDICAID

States already have their funding for Medicaid through the second quarter, so no shortfall in coverage for enrollees or payments to providers is expected. Enrolling new Medicaid applicants is a state function, so that process should not be affected.

States also handle much of the Children's Health Insurance Program (CHIP), which provides coverage for lower-income children whose families earn too much to qualify for Medicaid. But federal funding for CHIP is running dry - its regular authorization expired on Oct. 1, and Congress has not agreed on a long-term funding solution. Federal officials announced Friday that the staff necessary to make payments to states running low on funds will continue to work during a shutdown.

COMMUNITY HEALTH CENTERS

According to the HHS plan, the Health Resources and Services Administration will continue to operate the nation's 1,400 community health centers - clinics that serve about 27 million low-income people, providing preventive care, dentistry and other basic services. It will also continue the Maternal, Infant and Early Childhood Home Visiting Program, which targets low-income and at-risk families with house calls and lessons for healthy parenting. That program served about 160,000 families in fiscal year 2016.

But even those programs may not be at full speed. Funding for community health centers and the home visiting program was not renewed last fall - a casualty of Congress' fight over the CHIP reauthorization - so, they are operating on left-over funds.

ACA PREMIUM SUBSIDIES

The shutdown will not affect some of the most politically charged health care programs, including ones created by the Affordable Care Act. Subsidies for people who get their health insurance through healthcare.gov or state marketplaces will not be affected, according to HHS.

VETERANS AFFAIRS

Staffing for the Department of Veterans Affairs will remain largely intact. "Even in the event that there is a shutdown, 95.5% of VA employees would come to work, and most aspects of VA's operations would not be impacted," said department press secretary Curtis Cashour in an email.

More than 99% of employees of the Veterans Health Administration, which runs the health care system, will continue working, according to the department's contingency plan.

However, the Veterans Benefits Administration, responsible for overseeing benefits such as life insurance and disability checks, will face larger cutbacks. Over a third of its employees face furlough under a government shutdown.

More: Government shutdown 2018 enters day 3: Will it end Monday?

More: The government shutdown: What we know now and what happens next

More: To end government shutdown, Trump suggests Senate use 'nuclear option'

FOOD AND DRUG ADMINISTRATION

In the short term, the crucial activities that protect consumers will get done, said Jill Hartzler Warner, who was the associate commissioner for special medical programs at the FDA during the 2013 shutdown.

Programs that are critical for the public safety will continue, as will positions paid for by user fees, including work under the Center for Tobacco Products, according to the HHS plan.

The hundreds of staff members who conduct sample analysis and review entry of products into the U.S. will continue to work. However, routine inspections and laboratory research will cease.

Warner, who left the agency in March 2017 and now works as an industry consultant, said grants for rare-disease drug development were determined in 2013 to not be necessary and were postponed.

NUTRITION SERVICES FOR SENIORS

The Administration for Community Living will not be able to fund federal senior nutrition programs during any shutdown, according to HHS officials. But it was not immediately clear how quickly clients would be affected.

A shutdown could delay federal reimbursements to independent Meals on Wheels programs, which serve more than 2.4 million seniors nationwide, according to Colleen Psomas, a spokeswoman for Meals on Wheels America. That could force programs to expand waiting lists for meals, reduce meals or delivery days or suspend service, she said.

The magnitude of the effect could vary by the length of the shutdown and any final allocation. Some programs, however, could weather a shutdown, staffers said. In Portland, Ore., Meals on Wheel People spokeswoman Julie Piper Finley said meal delivery there will not be suspended. That agency receives about 35% of its funding through the Older Americans Act but raises the rest of the money, ensuring that services are not disrupted.

Meanwhile, services connected to food and nutrition services for other needy populations are likely to keep operating with state partners who have funding through February and, in some cases, March, according to a Department of Agriculture spokesperson. Those programs include the Supplemental Nutrition Assistance Program, the Child Nutrition Programs and the Special Supplemental Nutrition Program for Women, Infants and Children.

FOOD SAFETY

The FDA's food safety programs will cease, according to the HHS plan, but inspections conducted by Agriculture's Food Safety and Inspection Service (FSIS) will continue.

Meat and poultry inspections are "such a critical, essential task, and the meat and poultry inspection acts require that inspectors be present continuously," otherwise processing plants would have to close, said Brian Ronholm, former head of FSIS who now works for the law firm Arent Fox.

Ronholm added that many FSIS employees are "career folks" who have worked there through previous government shutdowns. "There was a lot of built-in knowledge of how to function during the (2013) shutdown," he said, adding that this expertise would help the agency if there is another shutdown.
Staff writers JoNel Aleccia, Julie Appleby, Carmen Heredia Rodriguez, Shefali Luthra, Jordan Rau, Stephanie Stapleton, Liz Szabo, Sarah Jane Tribble and Lydia Zuraw contributed to this report. Kaiser Health News, a non-profit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.
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Government shutdown: How it could affect your health

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CLOSE A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts say. In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

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What does a federal government shutdown mean?

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What does a federal government shutdown mean?

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When Congress can’t pass some kind of appropriations bill before a spending deadline, the government shuts down, and many “nonessential” government activities suddenly cease.

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Congress has missed a government shutdown deadline.

The House and Senate had until midnight on Friday, January 19, to pass a spending bill before the federal government ran out of money and closed its doors.

Despite controlling every lever of government, Republicans are somehow faced with the possibility that they can't get the votes together to keep the government open.

It's been more than four years since the last government shutdown, but after copious experience with shutdowns, especially during the protracted budget standoffs of the Clinton and Obama presidencies, we have a good sense of what will happen to the federal government.

What a government "shutdown" looks like

When Congress can't pass some kind of appropriations bill before a spending deadline, the government shuts down, and many "nonessential" government activities suddenly cease.

It's not unusual for Congress to go to the brink of shutdown; it happened as recently as this past fall, when President Trump threatened a shutdown in a bid to get funding for a border wall.

The government has officially shut down 18 times since the modern process that Congress uses to pass budget and spending bills took effect in 1976. The first six of those didn't actually affect the functioning of government at all. It wasn't until a set of opinions issued by Attorney General Benjamin Civiletti in 1980 and '81 that the government started to treat "spending gaps" - periods when Congress has failed to allocate funds for the ongoing functions of government - as necessitating the full or partial shutdown of government agencies.

But from the Reagan years onward, any period in which Congress failed to pass funding measures has meant that major chunks of the government stop operating. Which parts differ from shutdown to shutdown, but it generally excludes essential services without which the economy would grind to a halt and people would die.

During shutdowns, federal employees are divided into "essential" and "nonessential" groups (the official wording was changed to "excepted" and "non-excepted" in 1995 to avoid hurting people's feelings). Nonessential personnel receive furloughs: They're off work until the shutdown is resolved and stop receiving paychecks.

In the October 2013 shutdown, about 850,000 federal workers received furloughs, or about 40 percent of all federal nonmilitary employees. After shutdowns, furloughed workers almost always receive retroactive payments covering their salaries during the shutdown. Essential workers also see their pay withheld - but they have to work anyway.

Who is exempted, and not exempted

Despite President Trump's tendency to point to the military as the biggest victim of a potential shutdown, it's not - the military is, of course, generally considered "essential" to the functioning of the US government.

And just as law enforcement agents have become the domestic mirror image of soldiers in conservative identity politics, they're also considered essential employees across all government agencies. Air traffic control, federal prisons, and Social Security and other benefit payments also generally keep functioning as normal during shutdowns.

But many other government functions are curtailed. In the 2013 shutdown, the effects of the furloughs and other shutdowns in government activity included:

Tax refunds totaling almost $4 billion were delayed.

The Women, Infants, and Children nutrition program went unfunded.

Federal research activities at the National Institutes of Health (which lost about three-quarters of its employees), the National Science Foundation (which lost 98 percent of its workforce), and the Centers for Disease Control and Prevention (which lost two-thirds) shut down nearly entirely; the CDC scaled back its monitoring of disease outbreaks.

Environmental Protection Agency inspections halted at 1,200 locations.

The Food and Drug Administration delayed approval of drugs and medical devices.

The national parks shut down, resulting in $500 million in lost consumer spending from tourism.

Reviews of veterans' disability applications slowed to a halt, with nearly 20,000 applications per week not being evaluated.

In total, the Office of Management and Budget estimated that the shutdown cut GDP growth in the fourth quarter of 2013 by 0.2 to 0.6 points, and resulted in 120,000 fewer jobs.

So while shutdowns don't result in seniors going without their retirement checks, or the military closing up shop, or airplanes crashing into each other in the sky, they do cause massive disruption in the lives of hundreds of thousands of workers and their families, and grind a lot of government agencies to a halt.

Immigration agencies are slowed down

The exception for law enforcement means that the overwhelming majority of Border Patrol, customs officers, and Immigration and Customs Enforcement agents will remain on duty through a shutdown - and that the Trump administration's stepped-up enforcement of immigration laws, including greater arrests of immigrants without criminal records, is as essential as anything else.

But it isn't in itself essential to facilitate legal immigration to the US. US Citizenship and Immigration Services will largely be unaffected by the shutdown simply because it doesn't get its money from Congress; it's funded by the fees it charges applicants. But companies seeking work visas for their employees might run into trouble, because the Department of Labor office that needs to approve their petition would be closed.

Overseas, consular offices, while they could stay open over a brief shutdown by running off fee money, could end up being closed if the shutdown is prolonged - making it impossible for people in those countries to get approved to come to the US until the government reopened.

And while the US Refugee Admissions Program isn't technically subject to shutdown, the Obama administration stopped bringing refugees to the US during the 2013 shutdown anyway, because of the anticipated difficulty getting Social Security cards and other vital resources to refugees once they arrived in the United States. Feeding refugees is considered an essential function of the State Department, but resettling them permanently isn't on the same level.

That's an appropriate balance if you think the parts of the US government that exist to punish lawbreakers are more essential to day-to-day operations than the parts that allow people to follow the laws. But that is, itself, a skewed view of what's most important about the government - and about who can afford to wait for days or weeks while a shutdown is resolved in Washington.

A government that provides routine inspections and generates information isn't "essential"

Not all "law enforcement" or security efforts are created equal under shutdown plans, of course, and regulatory agencies are generally given short shrift.

Drug Enforcement Administration and Bureau of Alcohol, Tobacco, and Firearms field offices are exempt from shutdowns; many Food and Drug Administration officials working on investigations, however, are not. The TSA is fully exempt, but the Centers for Disease Control and Prevention had to furlough a large fraction of its staff. Civil litigation efforts at the Department of Justice (including antitrust investigations) would cease; the Occupational Safety and Health Administration and the Mine Health and Safety Administration would be, temporarily, all but gutted.

In a way, all of these are either security or law enforcement functions of government. But the "essential" government doesn't think that every official whose job is to check compliance with the laws is an essential one - even if those laws could, in theory, be protecting people from health and safety hazards.

At OSHA, the FDA, and the Mine Health and Safety Administration, for example, what gets shut down are "routine" inspections and investigations. Emergency efforts - mines near collapse, large-scale food or drug recalls - can proceed or be initiated, but the day-to-day compliance efforts that are supposed to prevent those emergencies from happening can't.

For progressives who see consumer protection as an important function of the federal government, this is arbitrary, even insulting (though partisans can take some glee in knowing that the Consumer Financial Protection Bureau itself is unaffected by shutdown). For libertarians and business-minded conservatives who see overregulation and red tape as a serious chilling effect on entrepreneurship in America, it's an (admittedly extreme) version of the regulatory state they'd like to see to begin with.

And then there are the parts of the government dedicated primarily to the production of knowledge - a function that's been underappreciated in the past, but that has come to the fore as worries have spread that the Trump administration is neglecting it. At the Environmental Protection Agency, where administrator Scott Pruitt is openly contemptuous of employees and where some employees have all but started smuggling out data before it gets destroyed, the overwhelming majority of staff would be furloughed.

The Bureau of Labor Statistics would stop releasing reports, as would the Bureau of Justice Statistics. Work at the US Census Bureau, which is already behind in preparations for the 2020 census, would grind to a halt.

These are things that people who care about "good government" care about. They're not, for the most part, high priorities for people who care about "small government."

This might explain why, as a shutdown looms, the burden is often perceived from the outside to be on Democrats to avoid it - not just because they're the ones, in this case, refusing to vote for a bill that keeps the government open for another few weeks but doesn't provide a permanent solution for Deferred Action for Childhood Arrivals (DACA) recipients, but because they're the ones who believe most firmly that these "nonessential" government functions really are essential.

Government is made of people

But given all this, it's important to remember: Not even the most radical small-government ideologue in Congress ever prefers shutting down the government to keeping it open on their terms. That's because when a shutdown actually happens, it calls attention to the fact that government is made of people - and that those people are both more interdependent on each other (even the "nonessential" ones) and less politicized than the functions they represent.

Even "essential" employees at FEMA or the US Border Patrol, for example, suffer setbacks in morale and job function when they don't have any support staff to help them, because the field agents are "essential" but support staff is not. The military may itself be deemed essential, but delays in paychecks, and the inability to request leave, can grind down service members and their families.

The same is true on the other side: Americans who interact with the government for benefits. Older middle-class Americans might be better off than those living in poverty under a shutdown, because Social Security and Medicare are exempt (not congressionally appropriated) while Temporary Assistance for Needy Families may not - but if they lose their Social Security cards, they won't be able to get new ones issued.

And even Americans who dislike the idea of federal land ownership still go to national parks and monuments - which is why there was such a fuss over the closure of war memorials during the 2013 shutdown, and why the Trump administration is reportedly trying to find a way to keep parks open this time.

It's a broad truth of American politics that people may not like "government" in the abstract, but they like the particular ways government benefits them. Shutdowns bring that dynamic to the fore: They force people to reckon with the fact that while concepts like "cutting the fat" and "waste, fraud, and abuse" are broadly appealing, agreeing on what counts as fat or waste is much harder.

And it makes apparent that living in uncertainty day to day isn't actually a way to go about one's life, whether one is a government employee or someone whose life is in a government employee's hands.

The government that survives a shutdown is a government that is much more hobbled in some respects than others, but it isn't the government anyone wants.

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What a federal government shutdown actually means

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Congress has missed a government shutdown deadline. The House and Senate had until midnight on Friday, January 19, to pass a spending bill before the federal government ran out of money and closed its doors. Despite controlling every lever of government, Republicans are somehow faced with the possibility that they can't get the votes together to keep the government open.

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https://www.cnn.com/2018/01/22/politics/senate-shutdown-vote-congress/index.htmlhttps://www.cnn.com/2018/01/22/politics/senate-shutdown-vote-congress/index.html

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Would president Trump have to sign the bill into action ?
If not would the senate just put into action ?

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http://fortune.com/2018/01/19/government-shutdown-healthcare/
http://fortune.com/2018/01/19/government-shutdown-healthcare/

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The Food and Drug Administration is expected to retain about 58 percent of its staff. During the 2013 shutdown, FDA inspectors gave up their work phones and couldn't check emails. Because FDA inspectors only audit facilities, food production continued in 2013.

U.S. Department of Agriculture meat inspectors, however, must be present in every meat-processing facility nationwide. During the last shutdown, USDA inspectors continued to work.

The National Institutes of Health will keep around 23 percent of its staff on duty. Although patients currently receiving experimental care will remain in these programs, new patients will not be able to enroll in experimental programs.

Anthony Fauci, the NIH's infectious disease chief, said the shutdown means chaos for scientific researchers. "It's a scramble," Fauci told the Associated Press. "You can't push the pause button on an experiment when you inject an animal with a particular substance to see what the response is and then you have to go home for a week."

The Veterans Health Administration is already funded through the 2018 fiscal year, so VA hospitals will remain open. The agency's public affairs office said 95.5 percent of VA employees will come to work.

Still, community health centers face major problems, as money to those programs suffered a major cut in the current budget. Their funding is one of several reasons Democrats have refused to vote in favor of a resolution that would have kept the government open.

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The shutdown means trouble for government health agencies

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The Food and Drug Administration is expected to retain about 58 percent of its staff. During the 2013 shutdown, FDA inspectors gave up their work phones and couldn't check emails. Because FDA inspectors only audit facilities, food production continued in 2013. U.S. Department of Agriculture meat inspectors, however, must be present in every meat-processing facility nationwide.

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The government shut down will lead to a lot of administrations losing funding...

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The government shut down will lead to a lot of administrations losing funding...

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"The groups that would be most affected by a shutdown are the ones that have the most employees and rely the most on grants, including the Administration for Children and Families (ACF), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Administration for Community Living (ACL), and the Agency for Healthcare Research and Quality (AHRQ)"
These groups provide a lot of help for different healthcare issues such as suicide prevention and also children's healthcare.

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In the middle of this horrible flu season, would the shutting down of the government negatively affect how many people contract the flu?

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How does the government shutdown affect healthcare?

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How does the government shutdown affect healthcare?

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CDC will suspend its flu-tracking program.

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A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts said Friday.

In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

Here are some federal services and programs consumers might be wondering about:

Centers for Disease Control and Prevention

According to the HHS plan, the CDC will suspend its flu-tracking program. That's bad timing, given the country is at the height of a particularly bad flu season, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. Without the CDC's updates, doctors could have a harder time diagnosing and treating patients quickly, he said.

Although states will still track flu cases, "they won't be able to call CDC to verify samples or seek their expertise," said Dr. Thomas Frieden, who was the director of the agency during the 2013 government shutdown.

A government shutdown will also affect the CDC's involvement in key decisions about next year's flu vaccine, which are scheduled to be made in coming weeks, said Dr. Arnold Monto, a professor of global public health at the University of Michigan.

Related: Congress, pointing fingers amid shutdown stalemate, returns to work

Beyond the flu, the CDC will provide only "minimal support" to programs that investigate infectious-disease outbreaks. The Atlanta-based agency's ability to test suspicious pathogens and maintain its 24-hour emergency operations center will be "significantly reduced," according to the plan.

That could prevent the CDC from identifying clusters of symptoms and disease "that are the earliest indicators of outbreaks," Frieden said.

National Institutes of Health

Although the NIH will continue to treat patients at its clinical center in Bethesda, Md., the agency will not enroll new patients in clinical trials - which many people with life-threatening illnesses see as their last hope.

Beneficiaries will be largely unaffected by a shutdown, especially if it is short. Patients will continue to receive their insurance coverage, and Medicare will continue to process reimbursement payments to medical providers. But those checks could be delayed if the shutdown is prolonged.

Medicaid

States already have their funding for Medicaid through the second quarter, so no shortfall in coverage for enrollees or payments to providers is expected. Enrolling new Medicaid applicants is a state function, so that process should not be affected.

States also handle much of the Children's Health Insurance Program (CHIP), which provides coverage for lower-income children whose families earn too much to qualify for Medicaid. But federal funding for CHIP is running dry - its regular authorization expired on Oct. 1, and Congress has not agreed on a long-term funding solution. Federal officials announced Friday that the staff necessary to make payments to states running low on funds will continue to work during a shutdown.

Community health centers

According to the HHS plan, the Health Resources and Services Administration will continue to operate the nation's 1,400 community health centers - clinics that serve about 27 million low-income people, providing preventive care, dentistry and other basic services. It will also continue the Maternal, Infant and Early Childhood Home Visiting Program, which targets low-income and at-risk families with house calls and lessons for healthy parenting. That program served about 160,000 families in fiscal year 2016.

But even those programs may not be at full speed. Funding for community health centers and the home visiting program was not renewed last fall - a casualty of Congress' fight over the CHIP reauthorization - so, they are operating on left-over funds.

Related: Government shutdown 2018: What's open and what's closed?

ACA premium subsidies

The shutdown will not affect some of the most politically charged health care programs, including ones created by the Affordable Care Act. Subsidies for people who get their health insurance through healthcare.gov or state marketplaces will not be affected, according to HHS.

Veterans Affairs

Staffing for the Department of Veterans Affairs will remain largely intact. "Even in the event that there is a shutdown, 95.5 percent of VA employees would come to work, and most aspects of VA's operations would not be impacted," said department press secretary Curtis Cashour in an email.

More than 99 percent of employees of the Veterans Health Administration, which runs the health care system, will continue working, according to the department's contingency plan.

However, the Veterans Benefits Administration, responsible for overseeing benefits such as life insurance and disability checks, will face larger cutbacks. Over a third of its employees face furlough under a government shutdown.

Food and Drug Administration

In the short term, the crucial activities that protect consumers will get done, said Jill Hartzler Warner, who was the associate commissioner for special medical programs at the FDA during the 2013 shutdown.

Programs that are critical for the public safety will continue, as will positions paid for by user fees, including work under the Center for Tobacco Products, according to the HHS plan.

The hundreds of staff members who conduct sample analysis and review entry of products into the U.S. will continue to work. However, routine inspections and laboratory research will cease.

Warner, who left the agency in March 2017 and now works as an industry consultant, said grants for rare-disease drug development were determined in 2013 to not be necessary and were postponed.

Nutrition services for seniors

The Administration for Community Living will not be able to fund federal senior nutrition programs during any shutdown, according to HHS officials. But it was not immediately clear how quickly clients would be affected.

A shutdown could delay federal reimbursements to independent Meals on Wheels programs, which serve more than 2.4 million seniors nationwide, according to Colleen Psomas, a spokeswoman for Meals on Wheels America. That could force programs to expand waiting lists for meals, reduce meals or delivery days, or suspend service, she said.

The magnitude of the effect could vary by the length of the shutdown and any final allocation. Some programs, however, could weather a shutdown, staffers said. In Portland, Ore., Meals on Wheel People spokeswoman Julie Piper Finley said meal delivery there will not be suspended. That agency receives about 35 percent of its funding through the Older Americans Act, but raises the rest of the money, ensuring that services are not disrupted.

Meanwhile, services connected to food and nutrition services for other needy populations are likely to keep operating with state partners who have funding through February and, in some cases, March, according to a Department of Agriculture spokesperson. Those programs include the Supplemental Nutrition Assistance Program, the Child Nutrition Programs and the Special Supplemental Nutrition Program for Women, Infants and Children.

Food safety

The FDA's food safety programs will cease, according to the HHS plan, but inspections conducted by Agriculture's Food Safety and Inspection Service (FSIS) will continue.

Meat and poultry inspections are "such a critical, essential task, and the meat and poultry inspection acts require that inspectors be present continuously," otherwise processing plants would have to close, said Brian Ronholm, former head of FSIS who now works for the law firm Arent Fox.

Ronholm added that many FSIS employees are "career folks" who have worked there through previous government shutdowns. "There was a lot of built-in knowledge of how to function during the [2013] shutdown," he said, adding that this expertise would help the agency if there is another shutdown.

This story was contributed by Kaiser Health News, a national health policy news service that is an editorially independent part of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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How the government shutdown might affect your health

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A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts said Friday. In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

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How the government shut down can affect the CDC, the flu, and your healthcare

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How the government shut down can affect the CDC, the flu, and your healthcare

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A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts say.

In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

Here are some federal services and programs consumers might be wondering about:

CENTERS FOR DISEASE CONTROL AND PREVENTION

According to the HHS plan, the CDC will suspend its flu-tracking program. That's bad timing, given the country is at the height of a particularly bad flu season, said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. Without the CDC's updates, doctors could have a harder time diagnosing and treating patients quickly, he said.

Although states will still track flu cases, "they won't be able to call CDC to verify samples or seek their expertise," said Thomas Frieden, who was the director of the agency during the 2013 government shutdown.

A government shutdown will also affect the CDC's involvement in key decisions about next year's flu vaccine, which are scheduled to be made in coming weeks, said Arnold Monto, a professor of global public health at the University of Michigan.

Beyond the flu, the CDC will provide only "minimal support" to programs that investigate infectious-disease outbreaks. The Atlanta-based agency's ability to test suspicious pathogens and maintain its 24-hour emergency operations center will be "significantly reduced," according to the plan.

That could prevent the CDC from identifying clusters of symptoms and disease "that are the earliest indicators of outbreaks," Frieden said.

NATIONAL INSTITUTES OF HEALTH

Although the NIH will continue to treat patients at its clinical center in Bethesda, Md., the agency will not enroll new patients in clinical trials - which many people with life-threatening illnesses see as their last hope.

MEDICARE

Beneficiaries will be largely unaffected by a shutdown, especially if it is short. Patients will continue to receive their insurance coverage, and Medicare will continue to process reimbursement payments to medical providers. But those checks could be delayed if the shutdown is prolonged.

MEDICAID

States already have their funding for Medicaid through the second quarter, so no shortfall in coverage for enrollees or payments to providers is expected. Enrolling new Medicaid applicants is a state function, so that process should not be affected.

States also handle much of the Children's Health Insurance Program (CHIP), which provides coverage for lower-income children whose families earn too much to qualify for Medicaid. But federal funding for CHIP is running dry - its regular authorization expired on Oct. 1, and Congress has not agreed on a long-term funding solution. Federal officials announced Friday that the staff necessary to make payments to states running low on funds will continue to work during a shutdown.

COMMUNITY HEALTH CENTERS

According to the HHS plan, the Health Resources and Services Administration will continue to operate the nation's 1,400 community health centers - clinics that serve about 27 million low-income people, providing preventive care, dentistry and other basic services. It will also continue the Maternal, Infant and Early Childhood Home Visiting Program, which targets low-income and at-risk families with house calls and lessons for healthy parenting. That program served about 160,000 families in fiscal year 2016.

But even those programs may not be at full speed. Funding for community health centers and the home visiting program was not renewed last fall - a casualty of Congress' fight over the CHIP reauthorization - so, they are operating on left-over funds.

ACA PREMIUM SUBSIDIES

The shutdown will not affect some of the most politically charged health care programs, including ones created by the Affordable Care Act. Subsidies for people who get their health insurance through healthcare.gov or state marketplaces will not be affected, according to HHS.

VETERANS AFFAIRS

Staffing for the Department of Veterans Affairs will remain largely intact. "Even in the event that there is a shutdown, 95.5% of VA employees would come to work, and most aspects of VA's operations would not be impacted," said department press secretary Curtis Cashour in an email.

More than 99% of employees of the Veterans Health Administration, which runs the health care system, will continue working, according to the department's contingency plan.

However, the Veterans Benefits Administration, responsible for overseeing benefits such as life insurance and disability checks, will face larger cutbacks. Over a third of its employees face furlough under a government shutdown.

More: Government shutdown 2018 enters day 3: Will it end Monday?

More: The government shutdown: What we know now and what happens next

More: To end government shutdown, Trump suggests Senate use 'nuclear option'

FOOD AND DRUG ADMINISTRATION

In the short term, the crucial activities that protect consumers will get done, said Jill Hartzler Warner, who was the associate commissioner for special medical programs at the FDA during the 2013 shutdown.

Programs that are critical for the public safety will continue, as will positions paid for by user fees, including work under the Center for Tobacco Products, according to the HHS plan.

The hundreds of staff members who conduct sample analysis and review entry of products into the U.S. will continue to work. However, routine inspections and laboratory research will cease.

Warner, who left the agency in March 2017 and now works as an industry consultant, said grants for rare-disease drug development were determined in 2013 to not be necessary and were postponed.

NUTRITION SERVICES FOR SENIORS

The Administration for Community Living will not be able to fund federal senior nutrition programs during any shutdown, according to HHS officials. But it was not immediately clear how quickly clients would be affected.

A shutdown could delay federal reimbursements to independent Meals on Wheels programs, which serve more than 2.4 million seniors nationwide, according to Colleen Psomas, a spokeswoman for Meals on Wheels America. That could force programs to expand waiting lists for meals, reduce meals or delivery days or suspend service, she said.

The magnitude of the effect could vary by the length of the shutdown and any final allocation. Some programs, however, could weather a shutdown, staffers said. In Portland, Ore., Meals on Wheel People spokeswoman Julie Piper Finley said meal delivery there will not be suspended. That agency receives about 35% of its funding through the Older Americans Act but raises the rest of the money, ensuring that services are not disrupted.

Meanwhile, services connected to food and nutrition services for other needy populations are likely to keep operating with state partners who have funding through February and, in some cases, March, according to a Department of Agriculture spokesperson. Those programs include the Supplemental Nutrition Assistance Program, the Child Nutrition Programs and the Special Supplemental Nutrition Program for Women, Infants and Children.

FOOD SAFETY

The FDA's food safety programs will cease, according to the HHS plan, but inspections conducted by Agriculture's Food Safety and Inspection Service (FSIS) will continue.

Meat and poultry inspections are "such a critical, essential task, and the meat and poultry inspection acts require that inspectors be present continuously," otherwise processing plants would have to close, said Brian Ronholm, former head of FSIS who now works for the law firm Arent Fox.

Ronholm added that many FSIS employees are "career folks" who have worked there through previous government shutdowns. "There was a lot of built-in knowledge of how to function during the (2013) shutdown," he said, adding that this expertise would help the agency if there is another shutdown.
Staff writers JoNel Aleccia, Julie Appleby, Carmen Heredia Rodriguez, Shefali Luthra, Jordan Rau, Stephanie Stapleton, Liz Szabo, Sarah Jane Tribble and Lydia Zuraw contributed to this report. Kaiser Health News, a non-profit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.
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Government shutdown: How it could affect your health

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CLOSE A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts say. In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

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This Article talks about how The CHIP won in the government shutdown but how the community health centers did not

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Congress has finally hauled the health insurance program for low-income kids to dry land, but community health centers are still out at sea.

After an unprecedented 114-day funding lapse, lawmakers voted yesterday to reauthorize the Children's Health Insurance Program for another six years as part of the spending bill to reopen the government. But while we certainly applaud lawmakers for meeting their CHIP deadline a mere four months after the fact, let's not forget that Congress has only really done half the job here.

Funding for the nation's community health centers, which serve one out of every dozen Americans, also technically expired Sept. 30. These centers, which provide a range of services to the low-income population, would lose $3.6 billion this year without renewal by Congress.

It was definitely a surprise that lawmakers allowed the bipartisan CHIP program to go so long without renewal - especially because Democrats and Republicans both typically praise the program and have repeatedly voted overwhelmingly to fund it. But it's even more shocking to some health-care advocates that Congress has permitted community health center funding to lapse this long.

After all, long-term CHIP funding has run out before (although Congress patched the program with short-term fixes), but community health centers haven't faced the same dilemma. In fact, Republicans would have beefed up community health center funding in their health-care bills last summer by diverting Medicaid dollars from Planned Parenthood clinics.

The word on Capitol Hill is that Congress will tackle funding for community health centers in the next spending bill it takes up three weeks from now. Lawmakers agreed yesterday to fund the government through Feb. 8 after Senate Majority Leader Mitch McConnell (R-Ky.) said he would address the status of young immigrants called "dreamers" who were brought to this country illegally as children, my colleagues Sean Sullivan, Ed O'Keefe and Elise Viebeck report. But with few details of what that plan might look like, health-center advocates remain worried.

"I am genuinely shocked at how hard it has been to get community health center funding extended," Eliot Fishman, senior director of health policy at Families USA, told me. "That has been completely uncontroversial for very good reason for a long time."

The National Association of Community Health Centers:

We still need a health center funding cliff fix, help us spread the word https://t.co/Gein8I57lU #fqhc #fixthecliff #valuechcs https://t.co/P2sIgt9Sx9
- NACHC (@NACHC) January 22, 2018
NACHC Senior Vice President Dan Hawkins said he's "very disappointed" and warned that some of the health centers his group represents have started reducing services - including opioid treatment and prenatal care - because of the uncertainty they face.
"While we have supported and are very pleased that CHIP relief is included, the failure to do the same for health centers leaves them increasingly anxious that many more will face a loss of clinical health professionals, who are seeking other more stable work options, and some are facing closure of their clinic facilities because they cannot sign longer-term lease agreements," Hawkins said. "This will only get worse if relief is not forthcoming very soon."

Sen. Bernie Sanders (I-Vt.) pointed to the lack of community health center funding as a reason he voted against yesterday's spending bill. "We're talking about 27 million Americans who will find it harder and harder to get their health care through community health centers because that program has not yet been reauthorized," Sanders said on the Senate floor.

But for right now, there's some cause to celebrate. For at least half a decade, The Health 202 won't have to write again about reauthorizing CHIP.

More importantly, states that cover about 9 million poor children and pregnant moms through the mostly federally funded program won't need to prepare notices of coverage cancellation or try to scrape together enough state funds to keep going. As of last week, nine states had issued some kind of notification that diminishing funds were threatening the program.

Sen. Sheldon Whitehouse (D-R.I.):

The shutdown ends! We fund CHIP. We get a vote on DACA--the first Floor vote for Democrats since the election (not counting sham budget reconciliation). Negotiations accelerated on funding bill and debt limit ahead.
- Sheldon Whitehouse (@SenWhitehouse) January 22, 2018

The GOP strategy to use CHIP as leverage in spending negotiations worked - sort of. Republicans arm-twisted Democrats into reopening the government for three weeks without giving in to their demands for legal protections for young undocumented immigrants. Yet the spending bill lasts only until Feb. 8. At that point, both parties will have to return to the negotiating table - and Republicans will no longer have CHIP funding in their back pocket.

Some judged it a pretty good deal for Dems. Bloomberg's Joe Weisenthal:

Dems got 6 years of CHIP funding in exchange for only keeping the government open 3 more weeks.
- Joe Weisenthal (@TheStalwart) January 22, 2018

Economist Paul Krugman:

So as I understand it, Dems gave Trump 3 weeks in return for promise of a vote on DACA; also got 6 years of CHIP funding. I understand the concerns of immigration activists, but this doesn't sound like a surrender, unless I'm missing something
- Paul Krugman (@paulkrugman) January 22, 2018

HuffPost's Matt Fuller:

Setting yourself up for a better argument in three weeks - while giving up none of your leverage, funding CHIP, and ending a government shutdown - is a pretty good cave tbh.
- Matt Fuller (@MEPFuller) January 22, 2018

Slate's Jordan Weissmann:

I'm confused.

Dems get CHIP renewal and the promise of a DACA vote in return for a 3-week CR.

If the vote doesn't happen, or Paul Ryan refuses to play ball, they can shut down the gov. again.

Why is this a bad deal? Seems close to a clean CHIP vote.
- Jordan Weissmann (@JHWeissmann) January 22, 2018

Democratic Coalition co-founder Scott Dworkin:

Democrats won multiple battles:

-We got CHIP funded
-We reopened the Gov't
-We got a commitment from the GOP that we get a DACA vote in the next few weeks
-If they are lying then the Gov't shuts down again before DACA expires

GOP caved, GOP lost big time

It's time #TrumpResign
- Scott Dworkin (@funder) January 22, 2018

But some argued Democrats still got the short end of the stick. Daily Caller's Benny Johnson:

Dems shutdown the government for 3 days.
Here's what they got:

* Messaging win for Trump
* Full Schumer surrender to McConnell
* Cave to GOP demands (filibuster, DACA)
* Pointless messaging war with military, CHIP funding
* Demoralization of their base

Bravo guys.
- Benny (@bennyjohnson) January 22, 2018
AHH, OOF and OUCH
AHH: Vermont has become the ninth state in the nation allowing recreational use of pot, but the first to approve it legislatively. Yesterday, the state's Republican Gov. Phil Scott signed a bill legalizing the possession and consumption of marijuana for recreational use, The Post's Christopher Ingraham and Tauhid Chappell report. But unlike the other eight states allowing recreational use of pot, Vermont's law doesn't allow for a commercial marijuana industry to be established there.

"Individuals may possess up to an ounce of marijuana for personal consumption and grow up to six plants, but buying and selling the drug remains prohibited," Christopher and Tauhid write. "Public health experts say the lack of a commercial market could be a good thing...While marijuana is generally regarded as less harmful than other drugs such as alcohol or opioids, its use does bring a number of health risks...Opponents of legalization have contended that the commercialization of marijuana will lead to more widespread use of the drug and hence be harmful to public health."

OOF: A bit of confusing regulatory language may have led drug companies to incorrectly classify drugs, leading to charges by federal authorities and watchdogs that they stiffed Medicaid millions of dollars, Stat News reports. Companies have to give Medicaid a 23 percent discount for "innovator" (typically branded) drugs and a 13 percent discount for non-innovator (typically generic) drugs. Yet those categories don't perfectly match up to the branded and generic categories, meaning it's not always been clear which drugs fit into which category.

Companies say for the most part, they've correctly classified their drugs, Ike Swetlitz writes. But last month, the Health and Human Services inspector general issued a report saying drugmakers could have avoided more than a billion dollars in discounts by pricing some generic drugs like brand-name drugs. In August, the company Mylan paid a $465 million settlement and agreed to a review of its pricing practices to resolve claims it overcharged Medicaid for its EpiPen.

The alleged errors may not be industry's fault. "At the heart of the issue, legal experts say, is an arcane bit of regulatory language - a single ambiguous word written by Congress and poorly clarified by Medicaid's overseers in the decades since," Ike writes. "I think there's an ambiguity in terms of the original Medicaid legislation, in terms of how it defined innovator versus non-innovator," MIT professor Ernst Berndt told Ike.

OUCH: Oregon vastly expanded Medicaid under the Affordable Care Act to the point where just 5 percent of residents remain uninsured. But as the federal government is now set to reduce Medicaid payments, Oregon needs help paying for that expanded coverage. Today, Oregon residents vote in a special election on whether to approve a new "0.7 percent tax on some hospitals and a 1.5 percent tax on the gross health insurance premiums collected by insurers and on managed care organizations," the Associated Press reports. The tax would raise between $210 million and $320 million over the next two years to help cover more than 350,000 low-income Oregonians added to Medicaid since 2014.

When Oregon expanded Medicaid coverage in 2014 (as have 32 other states plus D.C.), the federal government initially covered the full cost of the new enrollees. But last year, that match dropped to 95 percent, and will decrease further to 90 percent in 2020.

As of Monday afternoon, Oregon Public Broadcasting reported turnout appeared to be low but was leaning Democratic. "The latest ballot return numbers from the Oregon Election Department showed that Democrats have cast about 94,000 more ballots than Republicans," OPB's Jeff Mapes reported. "That's an encouraging sign for supporters of the measure to impose taxes on hospitals and insurers as a way to help pay for Medicaid."
HEALTH ON THE HILL
--Besides funding CHIP, there are a couple other big health-care policies included in the three-week spending deal Congress passed yesterday -- namely, a delay of a trio of industry taxes under the ACA. The law's 2.3 percent medical device tax won a two-year delay; its so-called "Cadillac tax," a 40 percent levy on high-cost employer insurance, was put in hold until 2022; and the health insurance tax (known to industry as "HIT") got a one-year reprieve next year. The New York Times gives a good explanation here of the impact of the taxes and the effects of delaying them.

--House Majority Whip Steve Scalise was discharged from the hospital yesterday morning just in time for the vote on reopening the government. The Louisiana Republican was recovering from a follow-up surgery at MedStar Washington Hospital Center, per his office, after he was shot last year at a practice for the congressional baseball game.

--What are government shutdowns all about, anyway? One answer is "branding" for lawmakers, The Post's Fred Barbash writes in a fascinating piece looking at why Congress decides to shut down the government even though polls show voters oppose the heavy-handed tactis. There have been four true government shutdowns in modern times, including the latest one. The 16-day-shutdown back in 2013, which centered around Obamacare, is a prime example of how conservative Republicans from places where the ACA was unpopular used the shutdown to highlight their diehard opposition to the ACA.

Remember how Sen. Ted Cruz (R-Tex.) read "Green Eggs and Ham" to his daughters on C-SPAN while holding the Senate floor for 24 hours? Cruz's obstruction "helped make the otherwise obscure freshman a national figure, loathed and ridiculed by many but lionized by the most fervent opponents of the ACA," Fred writes. "It turned him into a plausible, albeit ultimately unsuccessful, contender for the 2016 presidential nomination."

Cruz's take on the 2018 version? He t old reporters Monday that he "consistently opposed shutdowns. In 2013, I said we shouldn't shut the government." Ummm, that's not really the case.

-- Recall those dual bills to stabilize the Obamacare marketplaces by giving insurers more funding? Yes, the ones that got so much media coverage last fall. They're not included in the three-week spending bill Congress passed yesterday, but lobbyists and aides say they're still potentially alive.

That's also the line from Sen. Susan Collins (R-Maine), a top Republican who hinged her vote for the tax overhaul on passing these measures (and is co-sponsoring one of them). Collins said negotiations with the House on the cost-sharing reductions bill from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) are "going very well," per the Washington Examiner. She also stressed that passing the measures right now isn't crucial. "We do have a little time here," she said.
--A few more good reads from The Post and beyond: MEDICAL MISSIVES INDUSTRY RX OPIOID OPTICS REPRODUCTIVE WARS DAYBOOK Today

The Senate Health, Education, Labor and Pensions Committee is scheduled to hold a hearing on "Facing 21st Century Public Health Threats: Our Nation's Preparedness and Response Capabilities, Part 2."

The National Institutes of Health is scheduled to hold a meeting of the National Heart, Lung, and Blood Institute's Sickle Cell Disease Advisory Committee for presentations and discussion of programs.

The National Institutes of Health is scheduled to hold a meeting of the National Institute of Nursing Research to discuss program policies and issues.

The Advisory Board holds a web conference on BPCI Advanced.

Coming Up

The Families USA Health Action Conference begins on Wednesday.

The Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations is scheduled to hold a hearing on combatting the opioid crisis on Thursday.

The National Institutes of Health is scheduled to hold a meeting of the National Advisory Mental Health Council on Thursday.

The Medicaid and CHIP Payment and Access Commission holds its January meeting starting on Thursday.

Locust Street Group hosts an event on "Aging in Rural America: The Growing Crisis, a Movement for Change" with remarks from Sen. Chuck Grassley (R-Iowa) on Thursday.

SUGAR RUSH
Why women could sway the 2018 midterms:

Senators relieved after vote to end shutdown:

A woman battling cancer is surprised with every puppy from an animal shelter:

Seth Meyers takes a closer look at the Women's March and the government shutdown:

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Analysis | The Health 202: CHIP won in the government shutdown. But community health centers did not.

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Congress has finally hauled the health insurance program for low-income kids to dry land, but community health centers are still out at sea. After an unprecedented 114-day funding lapse, lawmakers voted yesterday to reauthorize the Children's Health Insurance Program for another six years as part of the spending bill to reopen the government.

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How the government shutdown affects medical care. 

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How the government shutdown affects medical care. 

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https://www.nbcnews.com/health/health-news/how-government-shutdown-might-affect-your-health-n839516

This article talks about the effects this government shutdown has on the health care field. It talks about how to CDC must stop their flu prevention program. It talks about the effects of the government shut down has on medicare and medicaid.

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What is affected and what is not (in health care)

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What is affected and what is not (in health care)

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The government shutdown isn't over Obamacare this time. But depending on how long it lasts, there will be ripple effects on health care as the Department of Health and Human Services sees half its workers furloughed.
Happy third day of the shutdown. The impasse on Capitol Hill continues, as Democrats refuse to budge on their demands for legal protections for young immigrants and Republicans seem unwilling to move in their direction, my tireless colleagues Robert Costa, Erica Werner, Mike DeBonis and Sean Sullivan report. After a bipartisan group of moderate senators failed to produce a compromise yesterday, buy Senate Majority Leader Mitch McConnell (R-Ky.) plans to hold a vote at about noon anyway. There was some hope building yesterday for a deal to fund the government for three weeks with a guarantee by McConnell to consider immigration legislation after that if there has been no agreement before then. But it doesn't look like we're there yet.

The effects of the shutdown were relatively limited over the weekend, but now that the workweek is starting, hundreds of thousands of workers will stay home and key federal agencies will be affected. "Federal contractors will see payments delayed, and the Internal Revenue Service will slow its preparations for the coming tax season," my colleagues writes.

Trump, who to his aides relief it seems, has remained relatively quiet during the shutdown so far. Nonetheless, the president took to Twitter this morning to blame Democrats:

The Democrats are turning down services and security for citizens in favor of services and security for non-citizens. Not good!
- Donald J. Trump (@realDonaldTrump) January 22, 2018

Democrats have shut down our government in the interests of their far left base. They don't want to do it but are powerless!
- Donald J. Trump (@realDonaldTrump) January 22, 2018

But the effects of a shutdown -- especially if it continues -- on the federal workforce, and Americans by extension, are real.

Granted, because so much of what HHS does is considered "essential," a smaller proportion of its workers are furloughed during a shutdown compared to other agencies. About 41,000 of HHS' 82,148 employees will still come to work today, according to these helpful visuals from The Post's Darla Cameron and Lisa Rein. There are five other federal agencies - Justice, Homeland Security, Veterans Affairs, Defense and Transportation - where at least half of employees are similarly considered essential.

On Friday, HHS updated its last shutdown contingency plan - issued in the fall of 2013 when the government shut down for more than two weeks as Sen. Ted Cruz (R-Tex.) demanded to defund the Affordable Care Act - with a new version. Per that document, here are five top things the agency keeps doing while the government is shuttered - and five services it halts.
Services that continue:
1. States keep getting their Medicaid payments. Federal funding for the health insurance program for the low-income population is secure through the end of June, according to the contingency plan. And because states oversee enrollment, Americans should be able to continue signing up for the program without hiccups.

2. Seniors can keep seeing the doctor. As with Medicaid, Medicare has funding sources that don't depend on Congress passing annual spending bills. Beneficiaries shouldn't much feel the effects of a shutdown, unless it is prolonged. Medicare will continue to reimburse medical providers, so coverage should continue without interruption.

3. Premium subsidies continue for Obamacare enrollees, and the marketplaces remain open for those qualifying to sign up off-season. Like Medicare and Medicaid benefits, marketplace subsidies are considered mandatory spending. And the Centers for Medicare and Medicaid Services can use leftover fees paid by health insurers to keep verifying eligibility so enrollments can continue.

4. The Food and Drug Administration continues drug reviews. That's because these reviews are paid for by fees from the pharmaceutical industry. Staffers who analyze and review medicines entering the United States would also be considered essential, according to HHS.

5. The nation's 1,400 community health centers stay open. These clinics - which provide preventive care and dental services to about 27 million low-income Americans - also enjoy mandatory spending status. But they're threatened by an underlying problem: The program has needed reauthorization by Congress since last fall, and it's unclear whether lawmakers will include that in a spending bill reopening the government.
Services that stop or slow:
1. The FDA's food-safety inspection program hits pause. "FDA will be unable to support the majority of its food safety, nutrition and cosmetics activities," the HHS contingency plan says. The exception is meat and poultry inspections carried out by the Agriculture Department's Food Safety and Inspection Service.

2. The National Institutes of Health can't enroll new patients in clinical trials or take action on grant applications. During the last shutdown, NIH turned away about 200 patients each week from its clinical research center since nearly three-fourths of its staff was furloughed. The center can only admit new patients with cases NIH Director Francis Collins deems "medically necessary."

3. No new mental health or social services grant awards and less monitoring of existing grants. The HHS departments most involved in issuing grants to health-care providers around the country would be particularly affected by the shutdown because more of their employees are furloughed. This includes the Substance Abuse and Mental Health Services Administration and the Administration for Children and Families.

4. Payments for senior nutrition programs stop. The shutdown would halt funding for federal senior nutrition programs funded through the Administration for Community Living, and would delay federal reimbursements to privately run programs such as Meals on Wheels (which services more than 2.4 million seniors across the country). But the severity of the impact on such programs depends on how long the shutdown lasts.

5. Response to this year's deadly flu outbreak could be slowed. The CDC says its "immediate response to urgent disease outbreaks, including seasonal influenza" will continue. This includes collecting data reported by states, hospitals and others. But a CDC representative told BuzzFeed News the reports could be issued at a slower rate than usual. Former CDC director Tom Frieden, who led the agency during the 2013 shutdown, told NPR the shutdown means a slower response to changes in the flu virus and less preparation among doctors to provide rapid treatment.
AHH, OOF and OUCH
AHH: A government shutdown comes at an especially inopportune time for flu season, which is particularly deadly this year per the latest data released Friday, The Post's Lena H. Sun reports. During the second week of January, more people sought care for flulike illnesses than at any comparable period in nearly a decade and 10 children died, bringing the total number of pediatric deaths this flu season to 30. More than 8,900 people have been hospitalized since the season started Oct. 1.

"The flu activity indicators are notable for the sheer volume and intensity of flu that is taking place in most of the country at the same time," Lena writes. "A federal government shutdown could complicate CDC's ability to know, in real time, whether flu cases are continuing to increase."

About 63 percent of CDC employees are furloughed, according to HHS's contingency plan. While state labs will continue to operate and monitor flu activity, test specimens and send that information to the federal agency, there may not be enough CDC epidemiologists to monitor the data and compile it, Lena reports. Additionally, there are spot shortages of prescription antiviral drugs and it's unclear whether the agency personnel working on that will be able to stay on duty during a shutdown.

OOF: In the state President Trump called a "drug-infested den" - New Hampshire - the opioid crisis is something of an obsession, the New York Times's Katharine Q. Seelye reports. New Hampshire is tied with Ohio for the state with the second-highest rate of drug overdose deaths per capita (West Virginia is first), and 53 percent of adults there say drugs are the biggest problem.

It's surprising when you consider New Hampshire's demographics. "Unlike West Virginia, New Hampshire is relatively prosperous, which makes an opioid crisis here seem all the more jarring," Katharine writes. "This state has the highest median household income in the country, ranks low in unemployment and crime, and often lands at or near the top of lists of the best states in which to live."

So why is the state's opioid problem so bad? Researchers say one big reason is the proximity to an abundant drug supply in neighboring Massachusetts and its drug distribution networks; another is the state's limited spending on addiction services. In addition, doctors in New Hampshire have long prescribed opioids at almost twice the national rate.

"This is a kind of perfect storm," Lisa Marsch, a professor of psychiatry and health policy at Dartmouth's Geisel School of Medicine, told the Times. "We have highly available, highly potent opioids in New Hampshire. And highly limited resources to reduce the risk."

OUCH: And over in neighboring Massachusetts, there's a spirited debate over the idea of "supervised injection sites" as another way to reduce overdose deaths, the AP reports. These sites are safe spaces where drug users can shoot up under the supervision of trained staff. While the Massachusetts Medical Society and the Massachusetts Hospital Association back the idea, Gov. Charlie Baker (R) is among the skeptics who don't see such sites as leading to treatment.

"As far as the data I've seen is concerned, it has not demonstrated any legitimate success in creating a pathway to treatment," Baker said at a public hearing last week. "The harm reduction argument I think is a much better one, but I'm kind of a hard sell on that one."

"In a report released last year, the medical society found supervised injection sites can reduce overdose mortality and increase access to drug treatment. Much of the research is based on two sites in Canada and Australia," Steve Leblanc writes. "The report called for the creation of a pilot supervised injection facility program in Massachusetts. The group said the state should seek an exemption from federal drug laws to pursue the pilot program and consider partnering with other states."
TRUMP TEMPERATURE
- The Trump administration may be no more willing to put more restrictions on food stamps than was the Obama administration. Although momentum is building for a ban on the purchase of candy and soda with food stamps, the Agriculture Department last week denied a request from Maine that would have placed such restrictions on its food stamp program, The Post's Caitlin Dewey reports. Now, supporters of such bans are trying to parse the meaning of the rejection.

"In its application to USDA, Maine said it would evaluate the ban's impact on soda and candy purchases but did not propose any specific monitoring of health effects," Caitlin writes. "It is not clear if USDA rejected the request because of this kind of omission or because the administration more generally opposes junk food bans."

"When considering waiver requests, USDA focuses on moving people into self-sufficient lives, protecting the integrity of the program, and improving customer service," the agency said in a statement. "We don't want to be in the business of picking winners and losers among food products in the marketplace, or in passing judgment about the relative benefits of individual food products."

--About that 24-year-old in a top Trump administration role: Taylor Weyeneth, who was appointed to a top position in the White House's drug policy office at age 23, was previously dismissed from a job at a law firm for repeatedly missing work, The Post's Robert O'Harrow Jr. reports. Weyeneth worked as a legal assistant at the New York firm O'Dwyer & Bernstien while in college, but he was "discharged" in August 2015 for being a no-show.

Brian O'Dwyer, a partner at the firm, said he hired Weyeneth in part because both men were involved in the same fraternity. He told Robert the team was "very disappointed in what happened" and that Weyeneth "just didn't show."

"In a résumé initially submitted to the government, Weyeneth said he worked at the firm until April 2016," Robert writes. "When an FBI official called as part of a background check in January 2017, the firm said Weyeneth had left eight months earlier than the résumé indicated...an administration official previously said that Weyeneth revised his résumé to correct 'errors.'" In a revised résumé, Weyeneth said he worked at the law firm from November 2014 to August 2015.

Since Robert first reported on the young appointee's rapid ascent to a top White House post, several Democratic lawmakers have expressed concern about Weyeneth and about other unfilled drug policy roles in the administration. The concern comes as Trump, who has pledged to allocate government resources toward the opioid crisis, still has not named a permanent director for his drug policy office.

"You have claimed that the opioid epidemic is a top priority for your administration, but the personnel you have staffing these key agencies - and the lack of nominees to head them - is cause for deep concern," ten lawmakers, including Sens. Maggie Hassan (D-N.H.) and Dianne Feinstein (D-Calif.), recently wrote to the president.
AGENCY ALERT
- Our colleague Tory Newmyer, who writes The Finance 202, is staking out the World Economic Forum meeting in Davos, Switzerland this week. We noticed FDA Commissioner Scott Gottlieb is among the top Trump appointees who are on the guest list. The president is also expected to attend. Sign up to receive updates from Davos in The Finance 202 here.
HEALTH ON THE HILL
--Top Senate Finance Committee Democrat Ron Wyden (Ore.) wants an investigation into whether Seema Verma, who heads the Centers for Medicare and Medicaid Services, violated ethics rules in handling Medicaid waiver requests from states she used to work with privately. Verma formerly consulted for Kentucky, Arkansas, Iowa and other states seeking permission from the federal government to enact changes to their Medicaid programs.

Wyden asked HHS's general counsel, in a letter last week, to open an ethics investigation into the matter, questioning whether she had recused herself (as she'd promised) from being involved in waiver requests with states with whom she formerly contracted.

"Administrator Verma's commitment to recuse herself from work with former clients appears to have fallen short of the mark thus far, which is extremely concerning given that many of her former clients have sought, or plan to seek, waivers to impose unprecedented work requirements in state Medicaid programs," he wrote.
--A few more good reads from The Post and beyond: MEDICAL MISSIVES INDUSTRY RX STATE SCAN OPIOID OPTICS REPRODUCTIVE WARS DAYBOOK Today

The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, hold the "National Drug and Alcohol Chat Day" web chat event.

The Alliance of Community Health Plans holds a briefing on "The Value of Medicare Advantage."

The Alliance for Strong Families and Communities, and the American Public Human Services Association host a webinar.

Coming Up

The Senate Health, Education, Labor and Pensions Committee is scheduled to hold a hearing on "Facing 21st Century Public Health Threats: Our Nation's Preparedness and Response Capabilities, Part 2" on Tuesday.

The National Institutes of Health is scheduled to hold a meeting of the National Heart, Lung, and Blood Institute's Sickle Cell Disease Advisory Committee for presentations and discussion of programs on Tuesday.

The National Institutes of Health is scheduled to hold a meeting of the National Institute of Nursing Research to discuss program policies and issues on Tuesday.

The Advisory Board holds a web conference on BPCI Advanced on Tuesday.

The Families USA Health Action Conference begins on Wednesday.

The Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations is scheduled to hold a hearing on combatting the opioid crisis on Thursday.

The National Institutes of Health is scheduled to hold a meeting of the National Advisory Mental Health Council on Thursday.

The Medicaid and CHIP Payment and Access Commission holds its January meeting starting on Thursday.

SUGAR RUSH
House Minority leader Nancy Pelosi (D-Calif.) said the military would be paid during the government shutdown:

Activists protest around the globe during the a second annual Women's March:

Saturday Night Live takes on White House doctor Navy Rear Adm. Ronny L. Jackson's report on President Trump's health:

The Daily Show with Trevor Noah on Trump's first year as president:

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Analysis | The Health 202: How the government shutdown could affect your health care (or not)

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The government shutdown isn't over Obamacare this time. But depending on how long it lasts, there will be ripple effects on health care as the Department of Health and Human Services sees half its workers furloughed. Happy third day of the shutdown.

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Services that will continue even after government shutdown. 

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Services that will continue even after government shutdown. 

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1. States keep getting their Medicaid payments. Federal funding for the health insurance program for the low-income population is secure through the end of June, according to the contingency plan. And because states oversee enrollment, Americans should be able to continue signing up for the program without hiccups.

2. Seniors can keep seeing the doctor. As with Medicaid, Medicare has funding sources that don’t depend on Congress passing annual spending bills. Beneficiaries shouldn’t much feel the effects of a shutdown, unless it is prolonged. Medicare will continue to reimburse medical providers, so coverage should continue without interruption.

3. Premium subsidies continue for Obamacare enrollees, and the marketplaces remain open for those qualifying to sign up off-season. Like Medicare and Medicaid benefits, marketplace subsidies are considered mandatory spending. And the Centers for Medicare and Medicaid Services can use leftover fees paid by health insurers to keep verifying eligibility so enrollments can continue.

4. The Food and Drug Administration continues drug reviews. That’s because these reviews are paid for by fees from the pharmaceutical industry. Staffers who analyze and review medicines entering the United States would also be considered essential, according to HHS.

5. The nation’s 1,400 community health centers stay open. These clinics — which provide preventive care and dental services to about 27 million low-income Americans — also enjoy mandatory spending status. But they’re threatened by an underlying problem: The program has needed reauthorization by Congress since last fall, and it’s unclear whether lawmakers will include that in a spending bill reopening the government.
https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/01/22/the-health-202-how-the-government-shutdown-could-affect-your-health-care-or-not/5a625a1030fb0469e884025b/?utm_term=.3ddcae3ed25d

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The Breakdown of Who is/Who isn't Affected

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The Breakdown of Who is/Who isn't Affected

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https://www.npr.org/2018/01/22/579552110/the-thorny-logistics-of-a-government-shutdown

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Childrens Health Insurance and why CHIP is still unfunded

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Childrens Health Insurance and why CHIP is still unfunded

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https://www.vox.com/policy-and-politics/2018/1/18/16901526/congress-chip-crisis

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What is the point of a government shutdown? Is that a bad thing?

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What is the point of a government shutdown? Is that a bad thing?

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Who would be affected the most by the government shutdown?

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Who would be affected the most by the government shutdown?

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The groups that would be most affected by a shutdown are the ones that rely on grants, such as Substance Abuse and Mental Health Services Administration (SAMHSA) and Agency for Healthcare Research and Quality (AHRQ)

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THE BIG IDEA: The Resistance will struggle when it tries to replicate the tactics of the tea party movement. The left learned with its failed shutdown gambit that it cannot beat President Trump by copying the same playbook that the right used against Bill Clinton and Barack Obama.

Many Republicans think the federal government isn't just a problem, but a leviathan that needs to be slew. Democrats, in contrast, believe that government is a force for good, and party leaders see it as their solemn duty to deliver services. They see themselves as "afflicted," as Hillary Clinton likes to say, "with the responsibility gene."

That's partly why it took Republicans two weeks to cave when they shut down the federal government in 2013, but Democrats could only hold out for two full days when they tried it. Their ploy failed as vulnerable incumbents and pillars of the party's governing wing got cold feet, forcing leaders to blink.

The doomed-to-fail strategy was reminiscent of Air America, the radio channel that was created by the left during the George W. Bush era to try to out-Rush-Limbaugh Rush Limbaugh. Not only can that not be done, it wasn't really what the base wanted. They hated Bush, but lefties also temperamentally yearn for inclusion, civility and dialogue.

One of the reasons that the Obama alumni who host Pod Save America have become so popular in the progressive world is that they did not try to mimic Fox or Breitbart when they launched their show. They came up with a new model.
-- As government employees head back to work, here are six additional takeaways: 1. Senate Democrats do not really trust Mitch McConnell. They just needed an excuse to cave.
In exchange for reopening the government through Feb. 8, the majority leader promised that the Senate will consider the status of "dreamers," the undocumented immigrants who were brought to this country illegally as children.

"The agreement ... merely set the parameters of a debate and did not specify the substance of any potential legislation, leaving the fate of the immigration issue just as unclear as before. But the deal was enough for 33 Senate Democrats, who joined 48 Republicans to break an impasse," Sean Sullivan, Ed O'Keefe and Elise Viebeck report. "McConnell delivered a carefully worded speech on the Senate floor, saying it was his 'intention' to address the dreamer issue, whether in the next spending bill or thereafter. He did not offer a specific promise to protect dreamers, and he suggested that he would offer nothing if the government shut down again, but he said he would follow an evenhanded process."

"He did not make a commitment," said Sen. Kamala Harris (D-Calif.), one of 16 Democrats who voted against the bill.

The Majority Leader's comments fell far short of the ironclad guarantee I needed to support a stopgap spending bill. I refuse to put the lives of nearly 700,000 young people in the hands of someone who has repeatedly gone back on his word.
- Kamala Harris (@SenKamalaHarris) January 22, 2018

The freshman was one of several potential presidential candidates who opposed the "compromise," including Elizabeth Warren (Mass.), Cory Booker (N.J.), Kirsten Gillibrand (N.Y.), Chris Murphy (Conn.) and Bernie Sanders (Vt.). (See how every member voted here.)

But Senate Minority Leader Charles Schumer (D-N.Y.) made clear that he is more concerned about his members who are on the ballot this November than the 2020 wannabes. Senators like Joe Donnelly (D-Ind.) warned him loudly during a caucus meeting on Monday morning that the political cost of the shutdown was rapidly escalating for them back home.

"Voters in Florida, Michigan, Ohio, Pennsylvania and Wisconsin were getting Republican robo-calls saying Democrats had 'prioritized illegal immigrants over American citizens,'" Robert Costa, Erica Werner and Karen Tumulty report. "Polls consistently show that a large majority of the public is sympathetic to the plight of the hundreds of thousands of (dreamers) ... But what the Democratic senators were sensing was something else that shows up in the polls: Most voters do not want to see the government shut down over immigration. And the causes that are articles of faith with the Democrats' liberal and ethnically diverse base can alienate many voters in conservative, largely white battleground states. After the Democrats' huddle, Schumer went to the floor and relented."
2. Moderates flexed their muscles.
"The number of ideological moderates in the Senate can be counted on one hand, but the 25 who hatched the compromise were the temperamental moderates," writes Dana Milbank. "And, for once, moderation prevailed."

A group of about two dozen senators began meeting late last week in the office of Sen. Susan Collins (R-Maine) to try brokering a deal that would avert a shutdown, and they kept talking after it began. "To try and keep the peace, Collins wouldn't let any senator in the room talk unless they were holding a 'talking stick' - which a senator in the room described as a 'ceremonial Native American stick' that Collins owned," Politico reports. "At one point, Sen. Lamar Alexander of Tennessee forcefully tossed the stick toward Sen. Mark Warner of Virginia after Warner interrupted him, nearly shattering a glass elephant belonging to Collins, according to two people briefed on the throw. After that incident, Collins suggested using a small rubber ball, and Alexander also brought his own basketball 'because it'd be safer than a stick,' an aide said."
3. Many House conservatives remain determined to pigeonhole any DACA fix that could pass the Senate.
The deal that reopened the government did nothing to ensure the House will act on a bill that the Senate passes, and conservatives aligned with the Freedom Caucus predicted that the bipartisan proposals currently being considered would be dead on arrival in their chamber.

In 2013, the Senate passed comprehensive immigration reform. The House never even took it up, and any prospect that it would be considered died when House Majority Leader Eric Cantor lost his primary to Dave Brat in Virginia.

"Just like the Gang of Eight bill didn't pass in the House, this idea is not going to pass in the House. That's when they're going to realize that they're going to have to move a little bit to our side," said Rep. Raúl Labrador (R-Idaho).

"House Republicans, meanwhile, are entertaining much more restrictive legislation that would grant legal status only to those who applied for and received DACA protections," Mike DeBonis reports. "In addition, the bill sponsored by Reps. Bob Goodlatte (R-Va.), Michael McCaul (R-Tex.), Martha McSally (R-Ariz.) and Labrador would reduce the number of authorized legal immigrants by roughly 25 percent - about 260,000 a year - while also authorizing border-wall construction, funding 10,000 new Border Patrol and immigration enforcement officers, and mandating employers use the federal 'E-Verify' system to screen employees for immigration status. The legislation also would crack down on 'sanctuary cities' that do not cooperate with federal immigration authorities.

"Any one of those provisions represents a deal-killer for Democrats - as well as for many Republicans," DeBonis notes. "House GOP leaders have been skeptical that they can build enough support among Republicans alone, but the bill's sponsors and House Majority Whip Steve Scalise (R-La.) have launched an effort to get more members on board in hopes of staging a vote before the March deadline. Bipartisan talks among House members have produced a bill sponsored by Reps. Will Hurd (R-Tex.) and Pete Aguilar (D-Calif.) that would take a much narrower approach to protecting dreamers and could ultimately get Democrats on board. But under pressure from their conservative ranks, House Republican leaders have shown little enthusiasm for the bill."
4. This dynamic will put Paul Ryan between a rock (the establishment) and a hard place (the grass roots).
As a congressman, he agitated for a bipartisan immigration deal. To become speaker, he pledged that he'd only bring an immigration bill to the floor if a majority of GOP lawmakers would vote for it. That's the so-called Hastert Rule.

For now, he's trying to thread the needle. "We don't want to kick kids out," he said on Fox News yesterday. "But ... we don't want to say to people in other countries, 'Oh, get yourself to America illegally because sooner or later you will get legalized.' We need to make sure that we control immigration."

House leaders said they're still acting as if the deadline to deal with DACA is March 6, which is when Trump announced last year that he would end the program.

A former spokesman for the Obama Justice Department argues that Democrats will benefit politically if House Republicans block a DACA fix that passes the Senate:

I don't think people analyzing the politics of this have considered how bad the situation will be for the GOP if the Senate passes a DACA bill, the House doesn't, and deportations start in the months before the midterms.
- Matthew Miller (@matthewamiller) January 22, 2018
5. McConnell won the messaging war because Trump (mostly) stayed out of his way.
Keeping the president as contained as possible and largely hidden from view deprived Democrats of the boogeyman they expected when they decided to force the shutdown.

As negotiations stalled Friday night, McConnell called Trump and told him he should prepare for a shutdown. "Trump, ever eager for a deal, responded by asking who else he should call and suggested he dial Democrats or try [Schumer] again," Ashley Parker and Josh Dawsey report. "But McConnell urged the president to sit tight and make the Democrats come to them ... Trump paused, agreed, and then offered McConnell his highest praise: 'You are a good negotiator.' ... Over the weekend, aides like [Mick] Mulvaney, [John] Kelly and [Marc] Short warned Trump to stay out of the fight and let it play out on Capitol Hill. ... McConnell and [Ryan] also believed that the Democrats were in a politically tricky position, and called Trump multiple times to ensure he remained locked into the approach ... Trump told advisers on several occasions he was listening - even if his instincts were to do otherwise ...

"Frank Sharry, the executive director of America's Voice, a pro-immigration group, said the Democratic strategy - to have Schumer coax Trump into a bipartisan deal, which the president would then sell to reluctant congressional Republicans - failed when Trump receded from public view and negotiations. Schumer tried to lure Trump back to the table with public comments but failed, aides said ...

"Whether the White House can secure an immigration deal - and stave off a longer shutdown - remains unclear," Parker and Dawsey write. "Trump huddled with hard-line Republicans and moderate Democrats at the White House on Monday but offered few specifics on what he wanted. He remains flexible on policy and an unreliable negotiator, and several aides said privately the next test would be harder than this one."

"What's been difficult is dealing with the White House and not knowing where the president is," Sen. Jeff Flake (R-Ariz.) said yesterday. "I don't think it will change."
6. Dreamers (who can't vote) feel betrayed, but Latinos (who can) will probably still turn out for Democrats anyway because of how much they hate Trump:
Alida Garcia is the director of coalitions and policy for FWD.us, the pro-immigration group funded by tech executives like Mark Zuckerberg. She was deputy director of national Latino outreach for Obama's reelection campaign and has worked on a bunch of Democratic campaigns. Yesterday she left the Democratic Party:

I'm leaving the Democratic Party today.

They're complicit w/ every single young person living in fear. Every pain Latino & immigrant families feel from here out is 100% due to @TheDemocrats not fully embracing us as American. Implicit racism is equally as harmful. I'm done. pic.twitter.com/4mrNaz6rO6
- Alida Garcia (@leedsgarcia) January 22, 2018

There was lots of grumbling in this vein on social media, including from a veteran of Bernie's presidential campaign who has been organizing dreamer protests:

If I could vote, I would have done the same a while ago. Whats about to happen in Senate is exactly what has been happening on immigration with Dems for decades. Just let it sink in. After this please never ask me why I don't trust them. No spine to stand up to racism in the GOP. https://t.co/K4Gk32f2nL
- Erika Andiola - #NoDreamNoDeal (@ErikaAndiola) January 22, 2018

David Weigel, who closely follows Latinos and the professional left for us, rounds up a lot of angry statements from the usual suspects, including the Working Families Party, the Indivisible Project, Justice Democrats, CREDO Action and the Progressive Change Campaign Committee. But he's skeptical that these jabs will mean long-term term damage to the party:

"The progressive movement's most pugnacious groups have swung and missed before; in Virginia, infamously, the Howard Dean-founded group Democracy for America denounced now-Gov. Ralph Northam (D-Va.) for a 'racist' statement that he would oppose sanctuary status if any of the state's cities tried to implement it. Latino turnout surged regardless, powering Northam to a nine-point victory and sweeping 14 new Democratic legislators into the state's House of Delegates ...

"Democrats believe that the anger and cries of betrayal would have been worse had the party not fought the continuing resolution at all. One senator predicted that any deal short of a 'clean Dream Act' - i.e., the deal that Democrats thought they had before the infamous 's - hole' meeting at the White House - was going to stoke a certain amount of anger in the base. Rep. Luis V. Gutiérrez (D-Ill.), perhaps the fiercest advocate for dreamers in the House, caught a glimpse of that anger after suggesting that funding (or partially funding) a wall on the U.S.-Mexico border would be worth it if that meant a path for the Dream Act. ... After denouncing the way Democrats handled negotiations, by Monday afternoon most of the outraged groups were urging activists to pile on the pressure."

-- A new cliff now looms in 16 days. In addition to immigration, both parties and both chambers still need to hash out a deal on military and domestic spending.
HOW IT'S PLAYING: -- This morning's clips are brutal for Senate Democrats, especially Schumer. The mainstream media coverage is portraying them, almost universally, as weak-kneed and hapless. They're getting mocked on the right and hammered even harder from left-leaning outlets. -- From the MSM:

Los Angeles Times: "Analysts say Russian Twitter accounts promoted Republican talking points during government shutdown."

New York Times: "Hoping for a Bargain in a Swift Surrender: Senate Democrats believe they are limiting damage from a political miscalculation by surrendering, but doing so has drawn a fierce backlash from the left."

Politico: "Schumer's shutdown performance sparks unrest in his ranks. The Democratic leader confronts the most serious cracks in the unity he's tried to foster since he took the reins of his conference last year."

Reuters: "Schumer keeps eye on November."

The Hill: "2020 Democrats vote against Schumer deal."

Wall Street Journal: "Centrist Senators Outflanked Party Leadership to End Shutdown."

The New Yorker: "In the end, it took two weeks for Washington to agree on how it will fund the government for the next three weeks."

Minneapolis Star Tribune: "Congress opts for another Band-Aid."

ABC: "... Immigration debate continues."

CNN: "Progressives fume..."

Time: "The Shutdown Ended Because Democrats Lost Their Spine."

Daily Beast: "Dems Fold on This Shutdown, but the Next One Could Be Worse. ... If the majority leader breaks his promise, all hell will break loose."

Miami Herald: "Bill Nelson votes to reopen the federal government without an immigration deal."

McClatchy story running in the Charlotte Observer: "'None of it matters' - top operatives shrug off shutdown fallout in 2018 vote."

The Atlantic: "Democrats Relent."

Fortune: "Democrats ... Blinked."

Yahoo News: "Shutdown fizzles..."

-- On the right:

Fox News: "Trump lauds 'big win.'"

National Review: "Democrats Learn the Hard Way that Americans Don't Like Government Shutdowns."

Breitbart: "Surrender: Dems' Schumer Shutdown Cave Endangers Leftists, Emboldens GOP for 2018 Elections."

The Drudge Report banner headline is: "THEY'RE BACK."

Washington Examiner: "'Stupidest damn thing I've ever seen': Democrats miscalculate..."

Weekly Standard: "Trump ... signals willingness to get DACA deal."

-- On the left:

MSNBC: "Schumer's rare double-buckle on the shutdown infuriates Democrats..."

HuffPost: "Dreamers Feel Betrayed After Senate Democrats Break Their Promises."

Vox: "Democrats didn't cave on the shutdown."

Talking Points Memo: "'It's Morally Reprehensible': Liberals Livid With Senate Dems..."

Mother Jones: "Ban Government Shutdowns? Maybe We Actually Need More of Them."

Slate: "The Democrats Are Losers. Democrats in Congress fail, again, to deliver for an active, energized base."

WAPO TEAM COVERAGE:

Style's Ben Terris sets the scene: "The Senate gathered to reopen the government, and boy did everyone have a great time."

The Fix's Amber Phillips says congressional Republicans, Trump and moderates are "the winners," and Democrats, dreamers and future spending deals were "the losers."

The brinkmanship is making government work less attractive for many civil servants. From the local desk's Arelis R. Hernández, Steve Hendrix and John Woodrow Cox: "Errick King, a federal employee for 30 years, thinks he knows exactly what lawmakers will do next: more of the same. Congress has not balanced a budget in years, and King doesn't expect them to come February. That has left the father of three feeling so hopeless that he has considered changing his family's lifestyle, including skipping the after-church meals out on Sunday afternoons and nixing the weekly bowling games they so enjoy. The relentless instability, he said, is leading career employees to retire early and abandon agencies, leaving them increasingly thin on institutional knowledge. 'People are fed up,' said King, an IT specialist with the Bureau of the Fiscal Service in Hyattsville, Md. 'I think it hurts the government overall because you are losing that knowledge and skill. We are reliant on that to provide quality service.'"

-- The Post's opinion page:

The Editorial Board praises the senators who worked to end the impasse: "From here, that core group of moderate, dealmaking lawmakers should feel empowered. The broad middle in both houses of Congress should no longer wait for direction from a chaotic White House or spineless congressional leadership. They may discover that they have more in common with members of the other party also interested in competent, responsive government than they do with the ideologues in their own camp."

Catherine Rampell: "Blame McConnell and Ryan for the shutdown."

Marc Thiessen: "Democrats just got rolled. They can blame Barack Obama."

Carter Eskew: "Schumer's strategic retreat..."

Jennifer Rubin: "It is unlikely to matter by the midterms. Especially during the Trump era, the sheer volume of news cycles between now and then should make this a distant memory. (If you recall, the GOP staged and lost a government shutdown in 2013, and then won big in 2014.)"

Listen to James's quick summary of today's Big Idea and the headlines you need to know to start your day:

Subscribe to The Daily 202's Big Idea on
Amazon Echo, Google Home, Apple Podcasts and other podcast players.

WHILE YOU WERE SLEEPING:
-- " FBI Director Christopher A. Wray has been resisting pressure from Attorney General Jeff Sessions to replace the bureau's deputy director, Andrew McCabe, a frequent target of criticism from President Trump," Devlin Barrett and Philip Rucker report, citing people familiar with the matter. "The tension over McCabe and other high-level FBI officials who served during James B. Comey's tenure has reached the White House, where counsel Donald McGahn has sought to mediate the issue ... As Sessions tried to push Wray to make personnel changes, Wray conveyed his frustration to the attorney general ... Sessions then discussed the matter with McGahn, who advised him to ease off, which he did ..."

"Axios was first to report the Session-Wray dispute on Monday evening, indicating that Wray had threatened to resign if Sessions did not stop pressuring him to fire McCabe. But several people familiar with the dynamic told The Post that they were not aware of Wray making such an explicit threat. Firing McCabe could be problematic because he has limited civil service protections as a government employee. Such a move, in the aftermath of public criticism from the president and others, could prompt litigation."
-- The former FBI director appeared to react overnight:

Good to read reports of people standing up for what they believe in. "The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy" - MLK
- James Comey (@Comey) January 23, 2018

-- A tsunami warning was issued and soon after lifted for the northern Pacific Coast after an undersea earthquake with an approximate magnitude of 8.2 struck near Alaska. Fred Barbash and Brian Murphy report: "There were no reports of significant ocean surges after the expected time the first effects could reach Alaskan shores. Later, The National Weather Service in Juneau said the warning was lifted from the Washington border, British Columbia and up to Alaska's Hinchinbrook Entrance, a seaway southeast of Anchorage. An advisory remained in effect to the west, including Kodiak. ... At its height, a warning was in effect for more than 3,000 miles of coastal zones north of the Washington border: British Columbia and Alaska's entire southern shoreline including the Aleutian Islands."

GET SMART FAST: ​​

1. Thousands of families are being evacuated from the Philippine's Albany province as the country's most active volcano, Mount Mayon, inches closer to what could be a major eruption. (Kristine Phillips)

2. Five people remain missing following a gas explosion at an Oklahoma drilling rig. The local sheriff's office declined to say whether anyone was killed but noted that more than 20 employees were present at the time of the explosion. (Kristine Phillips)

3. The Navy's brand new, $440 million warship - hailed as a fast, agile platform capable of battling a bevy of advanced coastal threats - has been trapped in ice since Christmas Eve in Canadian waters. (Amy B Wang)

4. Hawaii's governor explained his delayed response after the false missile alert: He forgot his Twitter password. Gov. David Ige (D) waited 17 minutes to tweet, "There is NO missile threat." He explained after his state of the state address, "I have to confess that I don't know my Twitter account logons and the passwords, so certainly that's one of the changes that I've made." (Travis M. Andrews)

5. The House Ethics Committee launched an investigation into sexual misconduct allegations against Rep. Patrick Meehan. The Pennsylvania Republican requested the inquiry after reports he used public funds to settle a sexual harassment complaint from a former staffer. (Mike DeBonis)

6. Three top members of the USA Gymnastics board resigned as more than 140 women have now alleged abuse by the organization's former physician, Larry Nassar, who is awaiting sentencing on charges of child pornography and molestation. (Cindy Boren)

7. USA Gymnastics also suspended former U.S. women's coach John Geddert, pending an investigation into his ties to Nassar. Geddert coached women's gymnastics during the 2012 London Olympics and has operated two gyms that employed Nassar. (ESPN)

8. Pope Francis apologized for defending Juan Barros, a controversial Chilean bishop accused of covering up sexual abuse, even as he continued to describe him as a victim of "slander." Francis set off a firestorm last week, generating backlash from his own top adviser on clerical sex abuse. (Sarah Pulliam Bailey)

9. A man in Michigan was arrested for threatening to "gun the f - kin' CNN cast down." Brandon Griesemer is accused of making 22 phone calls to CNN's public contact number, four of which resulted in threats. (Kyle Swenson)

10. A Cuban boy with a 10-pound, basketball-sized facial tumor died last week, just days after a team of doctors removed the life-threatening growth from his face. The boy was originally brought to U.S. doctors by missionaries in Cuba after doctors on the island refused to perform the risky operation. (Cleve R. Wootson Jr.)

11. Neil Diamond announced he has Parkinson's disease. The legendary songwriter said he would retire from touring as a result of the diagnosis. (Travis M. Andrews)

12. Delta is tightening its policy allowing "emotional support" animals on its planes after they caused a surge of "incidents," such as biting or defecating midflight. Delta said it flew some 250,000 emotional support animals last year, an increase of 150 percent from 2015. (Karin Brulliard)

13. Ousted "Today" show host Matt Lauer has been kicked out of his family home in the Hamptons. Page Six reports that Lauer's wife, Annette Roque, is likely to file for divorce soon.

BACKLASH TO TRUMP TARIFFS: -- Trump imposed new tariffs on solar panels and washing machines on Monday, two unilateral actions that could signal the start of a broader trade war.
The 30 percent tariff on solar cells will gradually decline to half that figure over a four-year period. From David J. Lynch: "The Suniva-SolarWorld request for protection was opposed by much of the domestic U.S. solar industry. Tariffs make solar panels more expensive, and thus discourage their use, according to the Solar Energy Industries Association. The trade association said the tariffs would cause 23,000 installers, engineers and project managers to lose their jobs this year as billions of dollars in planned investment evaporates. ... Up to one third of the 260,000 Americans currently employed in the industry are at risk because of the tariffs over the longer term, the group said."

"In the case of washing machines, Trump acted in response to a petition from Whirlpool, which complained about low-cost competition from rivals Samsung and LG," Lynch writes. "The first 1.2 million washing machines imported each year will face a 20 percent tariff, with additional imports facing a 50 percent tax. Under Monday's announcement, parts also will be hit with a 50 percent tariff."

-- Tellingly, only some GOP lawmakers put out statements objecting to the latest round of protectionism. Sen. Ben Sasse (R-Neb.) was one of them: "Here's something Republicans used to understand: Tariffs are taxes on families. Moms and dads shopping on a budget for a new washing machine will pay for this - not big companies. You don't fix eight years of bad energy policy with bad trade policy."

-- Trump's decision will hurt South Carolina, even though the Palmetto State delivered bigly for him in the 2016 primaries. "Samsung recently opened a home appliance plant in Newberry, S.C., and affiliates with the manufacturing giant say tariffs could make it difficult for the new operation to stay viable," McClatchyDC's Emma Dumain reports. "It has opened for business and hired more than 600 people with plans to employ as many as 1,000 by 2020. The company has also been working to forge research partnerships with Clemson University and the University of South Carolina. Rep. Ralph Norman, R-S.C., who represents Newberry, [said] Samsung president's had told him this decision would 'not bode well' for the company."

A spokesman for South Carolina Gov. Henry McMaster (R) - who has spent several months heavily lobbying Trump's administration for leniency in the trade cases - said the governor was "obviously disappointed" by Trump's decision.

-- Samsung called the Trump administration's decision "a great loss for American consumers and workers": "This tariff is a tax on every consumer who wants to buy a washing machine. Everyone will pay more, with fewer choices."
NATIVISM WATCH:
-- ICE authorities detained Polish doctor and green-card holder Lukasz Niec last week - opening the Michigan father and husband, who has lived in the United States for nearly 40 years and doesn't even speak Polish - to possible deportation. Samantha Schmidt reports: "According to his 'notice to appear' from [DHS], Niec's detention stems from two misdemeanor convictions from 26 years ago. In January 1992, Niec was convicted of malicious destruction of property under $100. In April of that year, he was convicted of receiving and concealing stolen property[.] ... Both of the offenses took place when he was a teenager. [Under] previous administrations, immigration authorities have often let low-level offenders off the hook, prioritizing the deportations of violent criminals. ... But the Trump administration has issued sweeping new guidelines expanding the range of immigrants that count as high priority for deportation, including low-level offenders, and those with no criminal record - regardless of how long they have lived in the country."

-- Before Trump's controversial voting commission was disbanded, it paid to buy Texas election data flagging voters with Hispanic surnames. Spencer S. Hsu and John Wagner report: "In buying nearly 50 million records from the state with the nation's second-largest Hispanic population, a researcher for [Trump's panel] checked a box on two Texas public voter data request forms explicitly asking for the 'Hispanic surname flag notation,' to be included in information sent to the voting commission[.] . . . Texas since 1983 has identified voters with a Hispanic name to mail bilingual election notices in Spanish and English as required by state and federal laws, said [a spokesman] for Texas Secretary of State Rolando Pablos (R). White House and Texas officials said the state's voter data was never delivered because a lawsuit brought by Texas voting rights advocates after the request last year temporarily stopped any data handoff."
THERE'S A BEAR IN THE WOODS:
-- The fiancee of former Trump campaign adviser George Papadopoulos said he is the "John Dean" of the Russia investigation - comparing him to Nixon's former White House counsel who became a key witness after pleading guilty to his role in the Watergate scandal. Rosalind S. Helderman reports: "'George is very loyal. And he is on the right side of history,' added [Simona Mangiante.] ... Mangiante said she was advised by Papadopoulos's lawyers not to answer specific questions about his activities during the 2016 presidential campaign or what he has told the FBI. But she indicated in an interview that she believes he ultimately will emerge as more than a bit player in the Russia probe - and that his decision to cooperate after he was arrested getting [in July] was a key turning point."

"Without offering specifics, Mangiante said there is much more that has not yet been told publicly about Papadopoulos' 10 months as an informal national security adviser to Trump and his interactions with a London-based professor [who claimed to have 'dirt' on Hillary Clinton]." "There's a lot to come," she said. "He was the first one to break a hole on all of this."

-- Jared Kushner's father, Charles Kushner, dismissed concerns about how the Russia investigations may probe the finances of the family business. Michael Kranish reports: "In his first interview since his son entered the White House, Charles Kushner said the company has no concerns about the investigations and dismissed suggestions that his son's work with Trump has made it harder to obtain financing for the family's many real estate projects. ... Kushner said he has been given no indication that the firm is being investigated by [Robert Mueller.]"

-- Trump is slated to tap billionaire financier Stephen Feinberg to lead his Intelligence Advisory Board group, which serves as the president's personal resource on intelligence matters. Its members are tasked with reviewing everything from bioweapons to intelligence failures. Foreign Policy's Jenna McLaughlin reports: "Feinberg is the CEO of private investment firm Cerberus Capital Management, which owns the private security firm DynCorp International. Over the past summer, Feinberg and Blackwater founder Erik Prince both pitched plans for a private military force in Afghanistan to the White House. Prince had also suggested creating a 'viceroy' to oversee U.S. operations in Afghanistan - a position that Feinberg was reportedly angling to fill. Trump instead went with a more traditional military plan. ... Feinberg does not have experience in government, but he donated nearly $1 million to a pro-Trump PAC five days before the election, and his name has repeatedly surfaced as a candidate for various national security and military roles during Trump's first year in office."

-- Attorney General Jeff Sessions pledged to "leave no stone unturned" in investigating why the FBI did not retain text messages between senior officials accused of political bias in the Russia probe. Sari Horwitz reports: "Sessions said late Monday that he has spoken to Inspector General Michael E. Horowitz about the missing text messages and that 'a review is already underway to ascertain what occurred' and determine whether the missing text messages can be recovered."

-- Ecuador's president described Julian Assange's presence in the country's London embassy, where the WikiLeaks founder has resided for over five years, as "more than a nuisance." President Lenín Moreno also called Assange an "inherited problem," as Moreno's predecessor approved the hacker's political asylum, rankling the United Kingdom and United States. (Amanda Erickson)
PALACE INTRIGUE:
-- A watchdog group filed a complaint against Trump's campaign over its reported payout to Stormy Daniels, saying the $130,000 in hush money allegedly given to the adult film star may have violated campaign finance laws. Mark Berman reports: "In a pair of federal complaints, Common Cause, a nonprofit government watchdog group, argued that the settlement amounted to an unreported in-kind contribution to Trump's campaign. The group called on the [DOJ] and [FEC] to investigate. This settlement should have been considered a campaign expense 'because the funds were paid for the purpose of influencing the 2016 presidential general election,' Paul S. Ryan, a campaign finance expert at the group, said in a letter addressed to [Jeff Sessions and Rod Rosenstein]. The pair of complaints filed by Common Cause said that the source of the $130,000 payment remains unknown, but they added that regardless of where it originated - even 'if Donald J. Trump provided the funds' - the money was aimed at affecting the election and then never reported."

-- Is John Kelly on the outs? Vanity Fair's Gabriel Sherman reports that Trump has discussed choosing a successor to his chief of staff in recent days -- and has tasked Ivanka Trump with searching for Kelly's possible replacement. "'Ivanka is the most worried about it. She's trying to figure who replaces Kelly,' a person who's spoken with her said. Kelly's departure likely isn't imminent ... [But] the prospect of a Trump-Kelly rupture became more probable as news of their clashes over immigration leaked. Last week, Kelly reportedly infuriated Trump when he told Fox News that Trump had 'evolved' on his position to build a southern border wall. Kelly further catalyzed Trump's ire when he told Democratic lawmakers that Trump was 'uninformed' when he made his [campaign promise of a border wall]. ... Trump has increasingly been chafing at the media narrative that he needs Kelly to instill discipline on his freewheeling management style. In recent days, Trump has fumed to friends that Kelly acts like he's running the government while Trump tweets and watches television. 'I've got another nut job here who thinks he's running things,' Trump told one friend, according to a Republican briefed on the call."
WITH AN EYE TOWARD TRUMP, THE GLOBAL ELITE GATHER IN DAVOS:
-- As this year's annual World Economic Forum in Davos kicks off today, its attendees are pretty happy with their situation, powered by a strong global economy. Yet even the top 1 percent are concerned about the political fallout of "excessive inequality." Heather Long reports: "Stock markets are at record highs, corporate taxes in the United States and United Kingdom are falling, and every major economy is growing. [Still], there is growing unease among the world's millionaires and billionaires that this current gilded age could soon be cut short by the rise of populism and the deepening inequality fueling it. ... Such anxieties that the global economic surge could be too good to last are manifest in the official theme for this year's Swiss gathering: how to come together in a 'fractured world."

-- CEO optimism is also at a record high, according to a new survey. The Finance 202's Tory Newmyer reports from Davos: "And while the cheer has spread to executives in every corner of the world, North American CEOs lead the pack. It's the only region where business leaders expect their own companies' fortunes to keep pace with the broader trend lines. The sentiment amounts to a Trump-style thumbs-up of sorts for the president's economic agenda - at least as far as CEOs are concerned - and a shrug in the direction of his hawkish trade rhetoric and chaotic style." Sign up for Tory's newsletter here.
-- Meanwhile, Trump is expected to bring his "America First" rhetoric to the gathering of global elites later this week now that the government shutdown is over.
-- In a change of plans, the first lady will no longer be accompanying Trump to Davos, however. CNN's Kate Bennett reports: "East Wing communications director Stephanie Grisham confirmed to CNN that the first lady's decision to forgo the trip was based on 'scheduling and logistical issues.' A week ago, Grisham told CNN the first lady would be attending the annual meeting of influential financial leaders and business titans in a show of support for her husband, who intends to give remarks during his visit. ... Melania Trump has not made a public statement since January 12, when news of a possible payoff from her husband's lawyer to porn star Stormy Daniels to cover up an alleged affair was first reported by The Wall Street Journal."
THE ROAD TO 2018:
-- The Pennsylvania Supreme Court struck down the state's congressional map, ruling the Republican-drawn districts were unconstitutionally gerrymandered. The decision is a big win for Democrats, forcing lawmakers to approve a replacement map ahead of the November elections. Amber Phillips reports: "Less partisan congressional districts could give Democrats a chance this November to win back as many as half a dozen seats that had been lost to them over the past decade. It could also give the party a major boost in its quest to take back the House of Representatives[.] ... Pennsylvania Republicans cried foul and said they would try to appeal the decision to the U.S. Supreme Court."

-- Republican strategists hope focusing on the benefits of the GOP tax plan will allow them to avoid a blue wave in November. Michael Scherer and Karen Tumulty report: "GOP leaders and their allies plan to talk up job growth, highlight the soaring stock market and, most of all, convince voters that the tax-cut legislation that stands as their only major accomplishment is bringing back the good times. The effort represents an all-hands deployment by top Republican officials and their allies, with extensive travel in the coming months to key districts by Trump, Vice President Pence and Cabinet officials, as well as White House aides Ivanka Trump and Kellyanne Conway, to sell the tax overhaul."

-- Georgia Democrats believe they have a chance to flip the governor's mansion this year. Politico's Daniel Strauss writes: "The party has two major candidates with a lot in common: Stacey Abrams and Stacey Evans are both veterans of the Georgia state House. Both are running as unapologetic liberals who see a path to victory guided by tapping into black voters, whom they see as an electoral sleeping giant - and courting suburban whites who usually vote Republican but are repelled by President Donald Trump."

-- Despite his pending retrial on federal corruption charges, Sen. Bob Menendez (D-N.J.) insists he'll run for reelection and is currently backed by his state's Democratic leadership. Politico's Matt Friedman reports: "The biggest [practical consideration] is a precedent set in 2002, when Democratic Sen. Bob Torricelli - damaged by his own scandal involving gifts from a campaign contributor - dropped his reelection bid. In October of that year, the state Supreme Court allowed Democrats to swap Torricelli's name on the ballot with that of former Sen. Frank Lautenberg, who regretted his decision to retire two years earlier. Lautenberg won the election over Doug Forrester, a wealthy businessman and former small town mayor, by 10 points."
PENCE'S MIDDLE EAST ADVENTURE:
-- Mike Pence announced before Israel's parliament that the United States will relocate its embassy from Tel Aviv to Jerusalem in 2019, accelerating the timeline for the move. Jenna Johnson, Loveday Morris and Carol Morello report: "[On Monday], Pence looked notably more at ease than during earlier meetings in Egypt and Jordan, where he has been forced to defend the controversial decision[.] ... 'Jerusalem is Israel's capital - and, as such, [Trump] has directed the State Department to immediately begin preparations to move the United States embassy from Tel Aviv to Jerusalem,' Pence said to applause."

-- Pence also defended Trump's comments regarding "shithole" countries, telling the AP in an interview that he "knows the president's heart": "[Pence said] Trump is determined to implement a merit-based system that encourages immigration by those who will 'contribute to a growing American economy and thriving communities' and one that does not take into account the immigrants' 'race or creed.'" He also refused to respond to reports of Trump's alleged affair with an adult film star, dismissing them as "baseless allegations."
SOCIAL MEDIA SPEED READ:
Sen. Roger Wicker (R-Miss.) had this moment on the Senate floor caught on a hot mic:

Heard on a hot mic...

During the Senate CR vote, Sen. Wicker said, "I thought you were going to say this was one of the most beautiful girls. What about these others?" to either another senator or a male page about female pages. pic.twitter.com/ZTHxOVvK1F
- Amelia Frappolli (@AmeliaFrappolli) January 23, 2018

The resolution of the shutdown - and the political costs of it - dominated social media. From an adviser to Paul Ryan:

Signing the bill to end the stupid shutdown.

- 30 - pic.twitter.com/IPD8nkwQYn
- Brendan Buck (@BrendanBuck) January 22, 2018

The White House shared this picture of Trump signing the short-term spending measure:

Tonight, President Donald J. Trump signs H.R. 195 - Federal Register Printing Savings Act of 2017, including Extension of Continuing Appropriations Act, 2018, in the Treaty Room at the White House. pic.twitter.com/2ws5dsTa3M
- Dan Scavino Jr. (@Scavino45) January 23, 2018

Trump took a victory lap:

Big win for Republicans as Democrats cave on Shutdown. Now I want a big win for everyone, including Republicans, Democrats and DACA, but especially for our Great Military and Border Security. Should be able to get there. See you at the negotiating table!
- Donald J. Trump (@realDonaldTrump) January 23, 2018

Even Crazy Jim Acosta of Fake News CNN agrees: "Trump World and WH sources dancing in end zone: Trump wins again...Schumer and Dems caved...gambled and lost." Thank you for your honesty Jim!
- Donald J. Trump (@realDonaldTrump) January 23, 2018

Sen. Ted Cruz (R-Tex.) raised eyebrows with this quote:

.@SenTedCruz : "I have consistently opposed shut downs"
- Andrew Rafferty (@AndrewNBCNews) January 22, 2018

A former senior aide to John Boehner, and veteran of the presidential campaigns of Mitt Romney and Jeb Bush, bristled:

If God made an asterisk large enough for this statement, could even He lift it? https://t.co/4pyn6YFpSK
- Michael Steel (@michael_steel) January 22, 2018

Sen. Kamala Harris (D-Calif.) doesn't trust Mitch McConnell:

🔥Kamala Harris on McConnell: "I don't believe he made any commitment whatsoever and I think it would be foolhardy to believe he made a commitment."
Cc: Democratic leadership
- Tal Kopan (@TalKopan) January 22, 2018

From Politico's senior congressional scribe:

How do Dems get win on CHIP when 144 House Dems & 16 Senate Dems voted against CHIP funding? No, this was a loss for Dems, no way to spin this one otherwise https://t.co/YDQUi7EwXD
- John Bresnahan (@BresPolitico) January 22, 2018

From a Fox News analyst:

I doubted it was possible, but Dems have actually lost a shutdown fight. Schumer has agreed to end the filibuster in exchange for practically nothing. Make no mistake: Schumer & Dems caved. What a political fiasco.
- Brit Hume (@brithume) January 22, 2018

From the Boston Globe's deputy Washington bureau chief:

Democrats have managed to accede to Republican demands, demoralize their energized base, give a disengaged president a win, and look like they held a meaningless three day government shutdown - all at once.
- Matt Viser (@mviser) January 22, 2018

From a former Obama administration official:

The homepage of @nytimes right now. Posted without comment. pic.twitter.com/sH01pjl76q
- Kenneth Baer (@KennethBaer) January 23, 2018

From a former spokesman for both Hillary Clinton and Chuck Schumer:

Schumer took the heat in Dec when mods did not want to make any stand on DACA
He's taking the heat today as the same mods decided two days was enough to hold out
That comes with being Leader. Amid total one-party control, there's still no one I trust more to see this fight thru
- Brian Fallon (@brianefallon) January 22, 2018

Conservative pundit Ann Coulter mocked Sen. Lindsey Graham (R-S.C.) for his views on DACA:

Any responsible immigration bill must include a path to ex-citizenship for Lindsey Graham.
- Ann Coulter (@AnnCoulter) January 22, 2018

From a Washington Examiner correspondent:

So for all of @LindseyGrahamSC's cultivation of @realDonaldTrump,
White House is now referring to him as supporting "amnesty" & "open borders."
- David M. Drucker (@DavidMDrucker) January 22, 2018

The White House defended its position on immigration:

White House spokesman Hogan Gidley: Sens. Lindsey Graham and Dick Durbin were "dishonest" about their immigration plan https://t.co/tbHxeGKlXQ pic.twitter.com/jcXXLfPZcz
- CNN Politics (@CNNPolitics) January 23, 2018

From the communications director for Sen. Dick Durbin (D-Ill.):

I don't know who "J. Hogan Gidley" is or how many Scaramuccis he's been at the White House for, but his word doesn't stack up that well against Senators Graham or Durbin. https://t.co/VLhyEsGpA3
- Ben Marter (@BenMarter) January 23, 2018

Trump criticized the FBI for not retaining texts between senior officials accused of political bias:

In one of the biggest stories in a long time, the FBI now says it is missing five months worth of lovers Strzok-Page texts, perhaps 50,000, and all in prime time. Wow!
- Donald J. Trump (@realDonaldTrump) January 23, 2018

From the president's son:

The FBI/govt "loss of texts" revelations are crazy. How often can they lose seemingly critical info before Americans realize it's all a big scam? Lerner, Clinton, FBI etc...

Imagine if I tried that???

Why the different standard for them?
- Donald Trump Jr. (@DonaldJTrumpJr) January 22, 2018

A House Republican suggested the texts were not truly lost:

Color me skeptical that the Strzok-Page texts are actually "lost". I'd predict they are a million times more likely to fall under the categories of "revealing" & "damaging" instead of "lost". In this order, what's needed is transparency, accountability, & regaining public trust.
- Lee Zeldin (@RepLeeZeldin) January 22, 2018

Sen. Jeff Flake provided on update on his fellow Arizona Republican:

Just got off the phone with @SenJohnMcCain. He is sounding good and is pleased that the senate has voted to reopen the federal government.
- Jeff Flake (@JeffFlake) January 22, 2018

Some powerful Republicans gathered at John Cornyn's house last night for a dinner to fete Neil Gorsuch:

I enjoyed having dinner tonight at the home of Senator John Cornyn and his wife Sandy with our newest Supreme Court Justice, Neil Gorsuch, Transportation Secretary Chao and a few of my other Senate colleagues to talk about important issues facing our country.
- Sen. Lamar Alexander (@SenAlexander) January 23, 2018

Mike Bloomberg slammed the new tariffs on solar panels:

Taxing solar panels up to 30% will destroy U.S. jobs, raise Americans' electric bills and hurt our environment. Congress should stand up for American workers and consumers and overturn the administration's harmful decision. https://t.co/TBdgQ1LluV
- Mike Bloomberg (@MikeBloomberg) January 23, 2018

And the Super Bowl trash-talking has already begun. From a House Democrat:

Hey @joekennedy - when the Eagles pull off yet another upset win and beat the evil empire (aka your Patriots) I just want you to know I will not totally rub in our victory since we're friends. You're welcome. #FlyEaglesFly
- US Rep Brendan Boyle (@RepBrendanBoyle) January 23, 2018
GOOD READS FROM ELSEWHERE:
-- Politico Magazine, "Tony Perkins: Trump Gets 'a Mulligan' on Life, Stormy Daniels," by Edward-Isaac Dovere: "[Conservative evangelical leaders] embrace Trump the policymaker, says Family Research Council president Tony Perkins, despite being uneasy about Trump as a man. ... 'We kind of gave him - "All right, you get a mulligan. You get a do-over here,"' Perkins [said.] Weigh a paid-off porn star against being the first president to address the March for Life, and a lot of evangelical leaders insist they can still walk away happy."

-- New York Times, "Wary, Weary or Both, Southern Lawmakers Tone Down Culture Wars," by Alan Binder: "A combination of fear, fatigue and legislative mathematics appear to be behind the shift. Many people believe that states have grown wary of provoking a pronounced corporate backlash like the one North Carolina experienced in 2016. Others sense little appetite among lawmakers for another year of battles over divisive social issues, noting that few of the faces in the legislatures have changed since the previous conflagrations."

-- BuzzFeed News, "Inside The Fight For The Soul Of Kaspersky Lab," by Ilya Zhegulev: "[T]he decline in fortunes of Kaspersky Lab was the result of an internal struggle for control that pitted allies of the Russian secret service against 'tech-savvy' staff and Western investors. The managers within destroy everything the company has built outside Russia."Kaspersky Lab, like [alleged former KGB officer Igor Chekunov], with ties to Russia's security agencies won that battle. But in so doing, they threaten to

-- New York Times, "Naomi Parker Fraley, the Real Rosie the Riveter, Dies at 96," by Margalit Fox: "Unsung for seven decades, the real Rosie the Riveter was a California waitress named Naomi Parker Fraley. Over the years, a welter of American women have been identified as the model for Rosie, the war worker of 1940s popular culture who became a feminist touchstone in the late 20th century. Mrs. Fraley, who died on Saturday, at 96, in Longview, Wash., staked the most legitimate claim of all. But because her claim was eclipsed by another woman's, she went unrecognized for more than 70 years."

"NASA pulled this astronaut from a space station crew. Her brother blames racism," from Sarah Kaplan : "NASA astronaut Jeanette Epps, who was slated to become the first black crew member to live on board the International Space Station, was unexpectedly pulled from her June flight. ... Epps, who has a PhD in aerospace engineering, was selected as a NASA astronaut in 2009 after seven years of working for the CIA. [NASA] did not give an explanation for the crew change. But Epps's brother blamed racism at the space agency. 'My sister ... has been fighting against oppressive racism and misogynist in NASA and now they are holding her back and allowing a Caucasian Astronaut to take her place!' Henry Epps wrote in a Facebook post[.] Epps said that she did not have a medical condition or family problem that would have prevented her from participating in the mission and that her overseas training in Russia and Kazakhstan had been successful."

HOT ON THE RIGHT:

"Kid Rock sends $122K from fake campaign to voter group," from : "Kid Rock last month donated $122,000 of the money raised by selling merchandise promoting 'Kid Rock for US Senate' - his fake political campaign - to a voter-registration organization affiliated with the College Republicans, his publicist said. Kid Rock ... for more than three months last year teased a Republican run for Senate against incumbent Democratic U.S. Sen. Debbie Stabenow of Lansing but later revealed it was a publicity stunt amid the launch of his latest album and tour. Instead, the money raised went to CRNC Action, an affiliate of the College Republicans that did voter-registration work last summer at his concerts, said Kid Rock publicist Jay Jones. Ted Dooley, the president of CRNC Action, confirmed that a donation of about $122,000 was made in early December."

DAYBOOK:
Trump will sign "Section 201 actions" this afternoon.

Pence will return to Washington from Israel later tonight.

QUOTE OF THE DAY:

Sen. John Kennedy (R-La.) summarized Congress's handling of the shutdown: "I think most Americans are wondering how some folks up here made it through the birth canal." ( )

NEWS YOU CAN USE IF YOU LIVE IN D.C.:
-- Washingtonians will see more warm weather and possible thunderstorms today. The Capital Weather Gang forecasts: "Scattered showers and thunderstorms this morning continue to just about midday. Some of these storms could contain heavy downpours and gusty winds that impair commuting visibility. ... Highs reach the mid- to upper-60s during the midday hours before temperatures slide into the 50s later in the afternoon as skies turn partly sunny."

-- The Wizards lost to the Mavericks 98-75. ( Candace Buckner)

-- Lt. Gov. Justin Fairfax, Virginia's only black statewide officeholder currently, protested a state Senate tribute to Stonewall Jackson. Laura Vozzella reports: "After Sen. Emmett W. Hanger Jr. (R-Augusta) called on the Senate to adjourn for the day in honor of Jackson, whose birthday was Sunday, Fairfax (D) moved from his spot as presiding officer to a bench normally occupied by Senate pages . . . Fairfax described his protest as a 'personal decision' based, in part, on his family history. Tucked in his jacket pocket when he was sworn in as lieutenant governor on Jan. 13 was the manumission document that freed his enslaved ancestors in 1798."

-- Maryland Gov. Larry Hogan (R) is offering $5 billion in incentives to lure Amazon's second headquarters to Montgomery County. Robert McCartney and Ovetta Wiggins report: "[Hogan] will offer more than $3 billion in tax breaks and grants and about $2 billion in transportation upgrades[.] ... It appears to be the second-most generous set of inducements among the 20 locations on Amazon's shortlist. ... Maryland's package, which Hogan will make public Monday morning, will require legislative approval and would dwarf any previous economic development offering in the state's history."
VIDEOS OF THE DAY:
Seth Meyers had some mixed feelings about the end of the shutdown:

Jimmy Kimmel mocked Trump's response to the Women's March:

Team USA unveiled its uniforms for the 2018 Winter Olympics:

Rex Tillerson visited the new U.S. embassy in London after Trump canceled his own appearance:

A teenager testified that Michigan State was still billing her mother for appointments she had with sports doctor and accused pedophile Larry Nassar:

And a woman in California battling cancer lived out her dream of being "showered" with puppies:

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Analysis | The Daily 202: Seven takeaways from the failed Democratic government shutdown

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THE BIG IDEA: The Resistance will struggle when it tries to replicate the tactics of the tea party movement. The left learned with its failed shutdown gambit that it cannot beat President Trump by copying the same playbook that the right used against Bill Clinton and Barack Obama.

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FDA will have its food safety and inspection programs slowed down by the shut down

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Here's What Would Happen to U.S. Health Care if the Government Shuts Down

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Here's What Would Happen to U.S. Health Care if the Government Shuts Down

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http://fortune.com/2018/01/19/government-shutdown-healthcare/

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http://www.newsweek.com/what-chip-what-know-about-child-healthcare-program-held-hostage-government-786635

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CDC stops its flu-tracking plan in the midst of flu season due to government shutdown

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CDC stops its flu-tracking plan in the midst of flu season due to government shutdown

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CLOSE

A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts say.

In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

Here are some federal services and programs consumers might be wondering about:

CENTERS FOR DISEASE CONTROL AND PREVENTION

According to the HHS plan, the CDC will suspend its flu-tracking program. That's bad timing, given the country is at the height of a particularly bad flu season, said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. Without the CDC's updates, doctors could have a harder time diagnosing and treating patients quickly, he said.

Although states will still track flu cases, "they won't be able to call CDC to verify samples or seek their expertise," said Thomas Frieden, who was the director of the agency during the 2013 government shutdown.

A government shutdown will also affect the CDC's involvement in key decisions about next year's flu vaccine, which are scheduled to be made in coming weeks, said Arnold Monto, a professor of global public health at the University of Michigan.

Beyond the flu, the CDC will provide only "minimal support" to programs that investigate infectious-disease outbreaks. The Atlanta-based agency's ability to test suspicious pathogens and maintain its 24-hour emergency operations center will be "significantly reduced," according to the plan.

That could prevent the CDC from identifying clusters of symptoms and disease "that are the earliest indicators of outbreaks," Frieden said.

NATIONAL INSTITUTES OF HEALTH

Although the NIH will continue to treat patients at its clinical center in Bethesda, Md., the agency will not enroll new patients in clinical trials - which many people with life-threatening illnesses see as their last hope.

MEDICARE

Beneficiaries will be largely unaffected by a shutdown, especially if it is short. Patients will continue to receive their insurance coverage, and Medicare will continue to process reimbursement payments to medical providers. But those checks could be delayed if the shutdown is prolonged.

MEDICAID

States already have their funding for Medicaid through the second quarter, so no shortfall in coverage for enrollees or payments to providers is expected. Enrolling new Medicaid applicants is a state function, so that process should not be affected.

States also handle much of the Children's Health Insurance Program (CHIP), which provides coverage for lower-income children whose families earn too much to qualify for Medicaid. But federal funding for CHIP is running dry - its regular authorization expired on Oct. 1, and Congress has not agreed on a long-term funding solution. Federal officials announced Friday that the staff necessary to make payments to states running low on funds will continue to work during a shutdown.

COMMUNITY HEALTH CENTERS

According to the HHS plan, the Health Resources and Services Administration will continue to operate the nation's 1,400 community health centers - clinics that serve about 27 million low-income people, providing preventive care, dentistry and other basic services. It will also continue the Maternal, Infant and Early Childhood Home Visiting Program, which targets low-income and at-risk families with house calls and lessons for healthy parenting. That program served about 160,000 families in fiscal year 2016.

But even those programs may not be at full speed. Funding for community health centers and the home visiting program was not renewed last fall - a casualty of Congress' fight over the CHIP reauthorization - so, they are operating on left-over funds.

ACA PREMIUM SUBSIDIES

The shutdown will not affect some of the most politically charged health care programs, including ones created by the Affordable Care Act. Subsidies for people who get their health insurance through healthcare.gov or state marketplaces will not be affected, according to HHS.

VETERANS AFFAIRS

Staffing for the Department of Veterans Affairs will remain largely intact. "Even in the event that there is a shutdown, 95.5% of VA employees would come to work, and most aspects of VA's operations would not be impacted," said department press secretary Curtis Cashour in an email.

More than 99% of employees of the Veterans Health Administration, which runs the health care system, will continue working, according to the department's contingency plan.

However, the Veterans Benefits Administration, responsible for overseeing benefits such as life insurance and disability checks, will face larger cutbacks. Over a third of its employees face furlough under a government shutdown.

More: Government shutdown 2018 enters day 3: Will it end Monday?

More: The government shutdown: What we know now and what happens next

More: To end government shutdown, Trump suggests Senate use 'nuclear option'

FOOD AND DRUG ADMINISTRATION

In the short term, the crucial activities that protect consumers will get done, said Jill Hartzler Warner, who was the associate commissioner for special medical programs at the FDA during the 2013 shutdown.

Programs that are critical for the public safety will continue, as will positions paid for by user fees, including work under the Center for Tobacco Products, according to the HHS plan.

The hundreds of staff members who conduct sample analysis and review entry of products into the U.S. will continue to work. However, routine inspections and laboratory research will cease.

Warner, who left the agency in March 2017 and now works as an industry consultant, said grants for rare-disease drug development were determined in 2013 to not be necessary and were postponed.

NUTRITION SERVICES FOR SENIORS

The Administration for Community Living will not be able to fund federal senior nutrition programs during any shutdown, according to HHS officials. But it was not immediately clear how quickly clients would be affected.

A shutdown could delay federal reimbursements to independent Meals on Wheels programs, which serve more than 2.4 million seniors nationwide, according to Colleen Psomas, a spokeswoman for Meals on Wheels America. That could force programs to expand waiting lists for meals, reduce meals or delivery days or suspend service, she said.

The magnitude of the effect could vary by the length of the shutdown and any final allocation. Some programs, however, could weather a shutdown, staffers said. In Portland, Ore., Meals on Wheel People spokeswoman Julie Piper Finley said meal delivery there will not be suspended. That agency receives about 35% of its funding through the Older Americans Act but raises the rest of the money, ensuring that services are not disrupted.

Meanwhile, services connected to food and nutrition services for other needy populations are likely to keep operating with state partners who have funding through February and, in some cases, March, according to a Department of Agriculture spokesperson. Those programs include the Supplemental Nutrition Assistance Program, the Child Nutrition Programs and the Special Supplemental Nutrition Program for Women, Infants and Children.

FOOD SAFETY

The FDA's food safety programs will cease, according to the HHS plan, but inspections conducted by Agriculture's Food Safety and Inspection Service (FSIS) will continue.

Meat and poultry inspections are "such a critical, essential task, and the meat and poultry inspection acts require that inspectors be present continuously," otherwise processing plants would have to close, said Brian Ronholm, former head of FSIS who now works for the law firm Arent Fox.

Ronholm added that many FSIS employees are "career folks" who have worked there through previous government shutdowns. "There was a lot of built-in knowledge of how to function during the (2013) shutdown," he said, adding that this expertise would help the agency if there is another shutdown.
Staff writers JoNel Aleccia, Julie Appleby, Carmen Heredia Rodriguez, Shefali Luthra, Jordan Rau, Stephanie Stapleton, Liz Szabo, Sarah Jane Tribble and Lydia Zuraw contributed to this report. Kaiser Health News, a non-profit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.
CLOSE

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Government shutdown: How it could affect your health

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CLOSE A government shutdown will have far-reaching effects for public health, including the nation's response to the current, difficult flu season. It will also disrupt some federally supported health services, experts say. In all, the Department of Health and Human Services will send home - or furlough - about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

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CDC is not going to be tracking flu anymore, and we are at the peak of flu season.

https://www.nbcnews.com/health/health-news/how-government-shutdown-might-affect-your-health-n839516

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The healthcare that would be most affected by a government shutdown would be the groups that has more employees and relies more often on grant such as the administration of children's and families, substance abuse and mental health service administration, Administration for community living. These organizations corresponds to the needs of individuals and if they get affected by the shutdown then so wil the individuals.

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Health centers did not "win" in the government shut down

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Health centers did not "win" in the government shut down

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Congress has finally hauled the health insurance program for low-income kids to dry land, but community health centers are still out at sea.

After an unprecedented 114-day funding lapse, lawmakers voted yesterday to reauthorize the Children's Health Insurance Program for another six years as part of the spending bill to reopen the government. But while we certainly applaud lawmakers for meeting their CHIP deadline a mere four months after the fact, let's not forget that Congress has only really done half the job here.

Funding for the nation's community health centers, which serve one out of every dozen Americans, also technically expired Sept. 30. These centers, which provide a range of services to the low-income population, would lose $3.6 billion this year without renewal by Congress.

It was definitely a surprise that lawmakers allowed the bipartisan CHIP program to go so long without renewal - especially because Democrats and Republicans both typically praise the program and have repeatedly voted overwhelmingly to fund it. But it's even more shocking to some health-care advocates that Congress has permitted community health center funding to lapse this long.

After all, long-term CHIP funding has run out before (although Congress patched the program with short-term fixes), but community health centers haven't faced the same dilemma. In fact, Republicans would have beefed up community health center funding in their health-care bills last summer by diverting Medicaid dollars from Planned Parenthood clinics.

The word on Capitol Hill is that Congress will tackle funding for community health centers in the next spending bill it takes up three weeks from now. Lawmakers agreed yesterday to fund the government through Feb. 8 after Senate Majority Leader Mitch McConnell (R-Ky.) said he would address the status of young immigrants called "dreamers" who were brought to this country illegally as children, my colleagues Sean Sullivan, Ed O'Keefe and Elise Viebeck report. But with few details of what that plan might look like, health-center advocates remain worried.

"I am genuinely shocked at how hard it has been to get community health center funding extended," Eliot Fishman, senior director of health policy at Families USA, told me. "That has been completely uncontroversial for very good reason for a long time."

The National Association of Community Health Centers:

We still need a health center funding cliff fix, help us spread the word https://t.co/Gein8I57lU #fqhc #fixthecliff #valuechcs https://t.co/P2sIgt9Sx9
- NACHC (@NACHC) January 22, 2018
NACHC Senior Vice President Dan Hawkins said he's "very disappointed" and warned that some of the health centers his group represents have started reducing services - including opioid treatment and prenatal care - because of the uncertainty they face.
"While we have supported and are very pleased that CHIP relief is included, the failure to do the same for health centers leaves them increasingly anxious that many more will face a loss of clinical health professionals, who are seeking other more stable work options, and some are facing closure of their clinic facilities because they cannot sign longer-term lease agreements," Hawkins said. "This will only get worse if relief is not forthcoming very soon."

Sen. Bernie Sanders (I-Vt.) pointed to the lack of community health center funding as a reason he voted against yesterday's spending bill. "We're talking about 27 million Americans who will find it harder and harder to get their health care through community health centers because that program has not yet been reauthorized," Sanders said on the Senate floor.

But for right now, there's some cause to celebrate. For at least half a decade, The Health 202 won't have to write again about reauthorizing CHIP.

More importantly, states that cover about 9 million poor children and pregnant moms through the mostly federally funded program won't need to prepare notices of coverage cancellation or try to scrape together enough state funds to keep going. As of last week, nine states had issued some kind of notification that diminishing funds were threatening the program.

Sen. Sheldon Whitehouse (D-R.I.):

The shutdown ends! We fund CHIP. We get a vote on DACA--the first Floor vote for Democrats since the election (not counting sham budget reconciliation). Negotiations accelerated on funding bill and debt limit ahead.
- Sheldon Whitehouse (@SenWhitehouse) January 22, 2018

The GOP strategy to use CHIP as leverage in spending negotiations worked - sort of. Republicans arm-twisted Democrats into reopening the government for three weeks without giving in to their demands for legal protections for young undocumented immigrants. Yet the spending bill lasts only until Feb. 8. At that point, both parties will have to return to the negotiating table - and Republicans will no longer have CHIP funding in their back pocket.

Some judged it a pretty good deal for Dems. Bloomberg's Joe Weisenthal:

Dems got 6 years of CHIP funding in exchange for only keeping the government open 3 more weeks.
- Joe Weisenthal (@TheStalwart) January 22, 2018

Economist Paul Krugman:

So as I understand it, Dems gave Trump 3 weeks in return for promise of a vote on DACA; also got 6 years of CHIP funding. I understand the concerns of immigration activists, but this doesn't sound like a surrender, unless I'm missing something
- Paul Krugman (@paulkrugman) January 22, 2018

HuffPost's Matt Fuller:

Setting yourself up for a better argument in three weeks - while giving up none of your leverage, funding CHIP, and ending a government shutdown - is a pretty good cave tbh.
- Matt Fuller (@MEPFuller) January 22, 2018

Slate's Jordan Weissmann:

I'm confused.

Dems get CHIP renewal and the promise of a DACA vote in return for a 3-week CR.

If the vote doesn't happen, or Paul Ryan refuses to play ball, they can shut down the gov. again.

Why is this a bad deal? Seems close to a clean CHIP vote.
- Jordan Weissmann (@JHWeissmann) January 22, 2018

Democratic Coalition co-founder Scott Dworkin:

Democrats won multiple battles:

-We got CHIP funded
-We reopened the Gov't
-We got a commitment from the GOP that we get a DACA vote in the next few weeks
-If they are lying then the Gov't shuts down again before DACA expires

GOP caved, GOP lost big time

It's time #TrumpResign
- Scott Dworkin (@funder) January 22, 2018

But some argued Democrats still got the short end of the stick. Daily Caller's Benny Johnson:

Dems shutdown the government for 3 days.
Here's what they got:

* Messaging win for Trump
* Full Schumer surrender to McConnell
* Cave to GOP demands (filibuster, DACA)
* Pointless messaging war with military, CHIP funding
* Demoralization of their base

Bravo guys.
- Benny (@bennyjohnson) January 22, 2018
AHH, OOF and OUCH
AHH: Vermont has become the ninth state in the nation allowing recreational use of pot, but the first to approve it legislatively. Yesterday, the state's Republican Gov. Phil Scott signed a bill legalizing the possession and consumption of marijuana for recreational use, The Post's Christopher Ingraham and Tauhid Chappell report. But unlike the other eight states allowing recreational use of pot, Vermont's law doesn't allow for a commercial marijuana industry to be established there.

"Individuals may possess up to an ounce of marijuana for personal consumption and grow up to six plants, but buying and selling the drug remains prohibited," Christopher and Tauhid write. "Public health experts say the lack of a commercial market could be a good thing...While marijuana is generally regarded as less harmful than other drugs such as alcohol or opioids, its use does bring a number of health risks...Opponents of legalization have contended that the commercialization of marijuana will lead to more widespread use of the drug and hence be harmful to public health."

OOF: A bit of confusing regulatory language may have led drug companies to incorrectly classify drugs, leading to charges by federal authorities and watchdogs that they stiffed Medicaid millions of dollars, Stat News reports. Companies have to give Medicaid a 23 percent discount for "innovator" (typically branded) drugs and a 13 percent discount for non-innovator (typically generic) drugs. Yet those categories don't perfectly match up to the branded and generic categories, meaning it's not always been clear which drugs fit into which category.

Companies say for the most part, they've correctly classified their drugs, Ike Swetlitz writes. But last month, the Health and Human Services inspector general issued a report saying drugmakers could have avoided more than a billion dollars in discounts by pricing some generic drugs like brand-name drugs. In August, the company Mylan paid a $465 million settlement and agreed to a review of its pricing practices to resolve claims it overcharged Medicaid for its EpiPen.

The alleged errors may not be industry's fault. "At the heart of the issue, legal experts say, is an arcane bit of regulatory language - a single ambiguous word written by Congress and poorly clarified by Medicaid's overseers in the decades since," Ike writes. "I think there's an ambiguity in terms of the original Medicaid legislation, in terms of how it defined innovator versus non-innovator," MIT professor Ernst Berndt told Ike.

OUCH: Oregon vastly expanded Medicaid under the Affordable Care Act to the point where just 5 percent of residents remain uninsured. But as the federal government is now set to reduce Medicaid payments, Oregon needs help paying for that expanded coverage. Today, Oregon residents vote in a special election on whether to approve a new "0.7 percent tax on some hospitals and a 1.5 percent tax on the gross health insurance premiums collected by insurers and on managed care organizations," the Associated Press reports. The tax would raise between $210 million and $320 million over the next two years to help cover more than 350,000 low-income Oregonians added to Medicaid since 2014.

When Oregon expanded Medicaid coverage in 2014 (as have 32 other states plus D.C.), the federal government initially covered the full cost of the new enrollees. But last year, that match dropped to 95 percent, and will decrease further to 90 percent in 2020.

As of Monday afternoon, Oregon Public Broadcasting reported turnout appeared to be low but was leaning Democratic. "The latest ballot return numbers from the Oregon Election Department showed that Democrats have cast about 94,000 more ballots than Republicans," OPB's Jeff Mapes reported. "That's an encouraging sign for supporters of the measure to impose taxes on hospitals and insurers as a way to help pay for Medicaid."
HEALTH ON THE HILL
--Besides funding CHIP, there are a couple other big health-care policies included in the three-week spending deal Congress passed yesterday -- namely, a delay of a trio of industry taxes under the ACA. The law's 2.3 percent medical device tax won a two-year delay; its so-called "Cadillac tax," a 40 percent levy on high-cost employer insurance, was put in hold until 2022; and the health insurance tax (known to industry as "HIT") got a one-year reprieve next year. The New York Times gives a good explanation here of the impact of the taxes and the effects of delaying them.

--House Majority Whip Steve Scalise was discharged from the hospital yesterday morning just in time for the vote on reopening the government. The Louisiana Republican was recovering from a follow-up surgery at MedStar Washington Hospital Center, per his office, after he was shot last year at a practice for the congressional baseball game.

--What are government shutdowns all about, anyway? One answer is "branding" for lawmakers, The Post's Fred Barbash writes in a fascinating piece looking at why Congress decides to shut down the government even though polls show voters oppose the heavy-handed tactis. There have been four true government shutdowns in modern times, including the latest one. The 16-day-shutdown back in 2013, which centered around Obamacare, is a prime example of how conservative Republicans from places where the ACA was unpopular used the shutdown to highlight their diehard opposition to the ACA.

Remember how Sen. Ted Cruz (R-Tex.) read "Green Eggs and Ham" to his daughters on C-SPAN while holding the Senate floor for 24 hours? Cruz's obstruction "helped make the otherwise obscure freshman a national figure, loathed and ridiculed by many but lionized by the most fervent opponents of the ACA," Fred writes. "It turned him into a plausible, albeit ultimately unsuccessful, contender for the 2016 presidential nomination."

Cruz's take on the 2018 version? He t old reporters Monday that he "consistently opposed shutdowns. In 2013, I said we shouldn't shut the government." Ummm, that's not really the case.

-- Recall those dual bills to stabilize the Obamacare marketplaces by giving insurers more funding? Yes, the ones that got so much media coverage last fall. They're not included in the three-week spending bill Congress passed yesterday, but lobbyists and aides say they're still potentially alive.

That's also the line from Sen. Susan Collins (R-Maine), a top Republican who hinged her vote for the tax overhaul on passing these measures (and is co-sponsoring one of them). Collins said negotiations with the House on the cost-sharing reductions bill from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) are "going very well," per the Washington Examiner. She also stressed that passing the measures right now isn't crucial. "We do have a little time here," she said.
--A few more good reads from The Post and beyond: MEDICAL MISSIVES INDUSTRY RX OPIOID OPTICS REPRODUCTIVE WARS DAYBOOK Today

The Senate Health, Education, Labor and Pensions Committee is scheduled to hold a hearing on "Facing 21st Century Public Health Threats: Our Nation's Preparedness and Response Capabilities, Part 2."

The National Institutes of Health is scheduled to hold a meeting of the National Heart, Lung, and Blood Institute's Sickle Cell Disease Advisory Committee for presentations and discussion of programs.

The National Institutes of Health is scheduled to hold a meeting of the National Institute of Nursing Research to discuss program policies and issues.

The Advisory Board holds a web conference on BPCI Advanced.

Coming Up

The Families USA Health Action Conference begins on Wednesday.

The Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations is scheduled to hold a hearing on combatting the opioid crisis on Thursday.

The National Institutes of Health is scheduled to hold a meeting of the National Advisory Mental Health Council on Thursday.

The Medicaid and CHIP Payment and Access Commission holds its January meeting starting on Thursday.

Locust Street Group hosts an event on "Aging in Rural America: The Growing Crisis, a Movement for Change" with remarks from Sen. Chuck Grassley (R-Iowa) on Thursday.

SUGAR RUSH
Why women could sway the 2018 midterms:

Senators relieved after vote to end shutdown:

A woman battling cancer is surprised with every puppy from an animal shelter:

Seth Meyers takes a closer look at the Women's March and the government shutdown:

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Analysis | The Health 202: CHIP won in the government shutdown. But community health centers did not.

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Congress has finally hauled the health insurance program for low-income kids to dry land, but community health centers are still out at sea. After an unprecedented 114-day funding lapse, lawmakers voted yesterday to reauthorize the Children's Health Insurance Program for another six years as part of the spending bill to reopen the government.

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Negative Loop (It hurt's the government)

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Negative Loop (It hurt's the government)

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I think the government shut down is going to hurt the government in the long run. As military personal, firefighters and alike are not paid they become dependent on whatever money they have saved, once that finishes they depend on welfare which makes the government lose money. Some military personal and alike can also become homeless and become addicted to drugs to find happiness. The way this affects medical care is doctors have to deal with a lot more uninsured homeless people who may be overdosing or dealing with other problems related to being homeless.

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THE BIG IDEA: The Resistance will struggle when it tries to replicate the tactics of the tea party movement. The left learned with its failed shutdown gambit that it cannot beat President Trump by copying the same playbook that the right used against Bill Clinton and Barack Obama.

Many Republicans think the federal government isn't just a problem, but a leviathan that needs to be slew. Democrats, in contrast, believe that government is a force for good, and party leaders see it as their solemn duty to deliver services. They see themselves as "afflicted," as Hillary Clinton likes to say, "with the responsibility gene."

That's partly why it took Republicans two weeks to cave when they shut down the federal government in 2013, but Democrats could only hold out for two full days when they tried it. Their ploy failed as vulnerable incumbents and pillars of the party's governing wing got cold feet, forcing leaders to blink.

The doomed-to-fail strategy was reminiscent of Air America, the radio channel that was created by the left during the George W. Bush era to try to out-Rush-Limbaugh Rush Limbaugh. Not only can that not be done, it wasn't really what the base wanted. They hated Bush, but lefties also temperamentally yearn for inclusion, civility and dialogue.

One of the reasons that the Obama alumni who host Pod Save America have become so popular in the progressive world is that they did not try to mimic Fox or Breitbart when they launched their show. They came up with a new model.
-- As government employees head back to work, here are six additional takeaways: 1. Senate Democrats do not really trust Mitch McConnell. They just needed an excuse to cave.
In exchange for reopening the government through Feb. 8, the majority leader promised that the Senate will consider the status of "dreamers," the undocumented immigrants who were brought to this country illegally as children.

"The agreement ... merely set the parameters of a debate and did not specify the substance of any potential legislation, leaving the fate of the immigration issue just as unclear as before. But the deal was enough for 33 Senate Democrats, who joined 48 Republicans to break an impasse," Sean Sullivan, Ed O'Keefe and Elise Viebeck report. "McConnell delivered a carefully worded speech on the Senate floor, saying it was his 'intention' to address the dreamer issue, whether in the next spending bill or thereafter. He did not offer a specific promise to protect dreamers, and he suggested that he would offer nothing if the government shut down again, but he said he would follow an evenhanded process."

"He did not make a commitment," said Sen. Kamala Harris (D-Calif.), one of 16 Democrats who voted against the bill.

The Majority Leader's comments fell far short of the ironclad guarantee I needed to support a stopgap spending bill. I refuse to put the lives of nearly 700,000 young people in the hands of someone who has repeatedly gone back on his word.
- Kamala Harris (@SenKamalaHarris) January 22, 2018

The freshman was one of several potential presidential candidates who opposed the "compromise," including Elizabeth Warren (Mass.), Cory Booker (N.J.), Kirsten Gillibrand (N.Y.), Chris Murphy (Conn.) and Bernie Sanders (Vt.). (See how every member voted here.)

But Senate Minority Leader Charles Schumer (D-N.Y.) made clear that he is more concerned about his members who are on the ballot this November than the 2020 wannabes. Senators like Joe Donnelly (D-Ind.) warned him loudly during a caucus meeting on Monday morning that the political cost of the shutdown was rapidly escalating for them back home.

"Voters in Florida, Michigan, Ohio, Pennsylvania and Wisconsin were getting Republican robo-calls saying Democrats had 'prioritized illegal immigrants over American citizens,'" Robert Costa, Erica Werner and Karen Tumulty report. "Polls consistently show that a large majority of the public is sympathetic to the plight of the hundreds of thousands of (dreamers) ... But what the Democratic senators were sensing was something else that shows up in the polls: Most voters do not want to see the government shut down over immigration. And the causes that are articles of faith with the Democrats' liberal and ethnically diverse base can alienate many voters in conservative, largely white battleground states. After the Democrats' huddle, Schumer went to the floor and relented."
2. Moderates flexed their muscles.
"The number of ideological moderates in the Senate can be counted on one hand, but the 25 who hatched the compromise were the temperamental moderates," writes Dana Milbank. "And, for once, moderation prevailed."

A group of about two dozen senators began meeting late last week in the office of Sen. Susan Collins (R-Maine) to try brokering a deal that would avert a shutdown, and they kept talking after it began. "To try and keep the peace, Collins wouldn't let any senator in the room talk unless they were holding a 'talking stick' - which a senator in the room described as a 'ceremonial Native American stick' that Collins owned," Politico reports. "At one point, Sen. Lamar Alexander of Tennessee forcefully tossed the stick toward Sen. Mark Warner of Virginia after Warner interrupted him, nearly shattering a glass elephant belonging to Collins, according to two people briefed on the throw. After that incident, Collins suggested using a small rubber ball, and Alexander also brought his own basketball 'because it'd be safer than a stick,' an aide said."
3. Many House conservatives remain determined to pigeonhole any DACA fix that could pass the Senate.
The deal that reopened the government did nothing to ensure the House will act on a bill that the Senate passes, and conservatives aligned with the Freedom Caucus predicted that the bipartisan proposals currently being considered would be dead on arrival in their chamber.

In 2013, the Senate passed comprehensive immigration reform. The House never even took it up, and any prospect that it would be considered died when House Majority Leader Eric Cantor lost his primary to Dave Brat in Virginia.

"Just like the Gang of Eight bill didn't pass in the House, this idea is not going to pass in the House. That's when they're going to realize that they're going to have to move a little bit to our side," said Rep. Raúl Labrador (R-Idaho).

"House Republicans, meanwhile, are entertaining much more restrictive legislation that would grant legal status only to those who applied for and received DACA protections," Mike DeBonis reports. "In addition, the bill sponsored by Reps. Bob Goodlatte (R-Va.), Michael McCaul (R-Tex.), Martha McSally (R-Ariz.) and Labrador would reduce the number of authorized legal immigrants by roughly 25 percent - about 260,000 a year - while also authorizing border-wall construction, funding 10,000 new Border Patrol and immigration enforcement officers, and mandating employers use the federal 'E-Verify' system to screen employees for immigration status. The legislation also would crack down on 'sanctuary cities' that do not cooperate with federal immigration authorities.

"Any one of those provisions represents a deal-killer for Democrats - as well as for many Republicans," DeBonis notes. "House GOP leaders have been skeptical that they can build enough support among Republicans alone, but the bill's sponsors and House Majority Whip Steve Scalise (R-La.) have launched an effort to get more members on board in hopes of staging a vote before the March deadline. Bipartisan talks among House members have produced a bill sponsored by Reps. Will Hurd (R-Tex.) and Pete Aguilar (D-Calif.) that would take a much narrower approach to protecting dreamers and could ultimately get Democrats on board. But under pressure from their conservative ranks, House Republican leaders have shown little enthusiasm for the bill."
4. This dynamic will put Paul Ryan between a rock (the establishment) and a hard place (the grass roots).
As a congressman, he agitated for a bipartisan immigration deal. To become speaker, he pledged that he'd only bring an immigration bill to the floor if a majority of GOP lawmakers would vote for it. That's the so-called Hastert Rule.

For now, he's trying to thread the needle. "We don't want to kick kids out," he said on Fox News yesterday. "But ... we don't want to say to people in other countries, 'Oh, get yourself to America illegally because sooner or later you will get legalized.' We need to make sure that we control immigration."

House leaders said they're still acting as if the deadline to deal with DACA is March 6, which is when Trump announced last year that he would end the program.

A former spokesman for the Obama Justice Department argues that Democrats will benefit politically if House Republicans block a DACA fix that passes the Senate:

I don't think people analyzing the politics of this have considered how bad the situation will be for the GOP if the Senate passes a DACA bill, the House doesn't, and deportations start in the months before the midterms.
- Matthew Miller (@matthewamiller) January 22, 2018
5. McConnell won the messaging war because Trump (mostly) stayed out of his way.
Keeping the president as contained as possible and largely hidden from view deprived Democrats of the boogeyman they expected when they decided to force the shutdown.

As negotiations stalled Friday night, McConnell called Trump and told him he should prepare for a shutdown. "Trump, ever eager for a deal, responded by asking who else he should call and suggested he dial Democrats or try [Schumer] again," Ashley Parker and Josh Dawsey report. "But McConnell urged the president to sit tight and make the Democrats come to them ... Trump paused, agreed, and then offered McConnell his highest praise: 'You are a good negotiator.' ... Over the weekend, aides like [Mick] Mulvaney, [John] Kelly and [Marc] Short warned Trump to stay out of the fight and let it play out on Capitol Hill. ... McConnell and [Ryan] also believed that the Democrats were in a politically tricky position, and called Trump multiple times to ensure he remained locked into the approach ... Trump told advisers on several occasions he was listening - even if his instincts were to do otherwise ...

"Frank Sharry, the executive director of America's Voice, a pro-immigration group, said the Democratic strategy - to have Schumer coax Trump into a bipartisan deal, which the president would then sell to reluctant congressional Republicans - failed when Trump receded from public view and negotiations. Schumer tried to lure Trump back to the table with public comments but failed, aides said ...

"Whether the White House can secure an immigration deal - and stave off a longer shutdown - remains unclear," Parker and Dawsey write. "Trump huddled with hard-line Republicans and moderate Democrats at the White House on Monday but offered few specifics on what he wanted. He remains flexible on policy and an unreliable negotiator, and several aides said privately the next test would be harder than this one."

"What's been difficult is dealing with the White House and not knowing where the president is," Sen. Jeff Flake (R-Ariz.) said yesterday. "I don't think it will change."
6. Dreamers (who can't vote) feel betrayed, but Latinos (who can) will probably still turn out for Democrats anyway because of how much they hate Trump:
Alida Garcia is the director of coalitions and policy for FWD.us, the pro-immigration group funded by tech executives like Mark Zuckerberg. She was deputy director of national Latino outreach for Obama's reelection campaign and has worked on a bunch of Democratic campaigns. Yesterday she left the Democratic Party:

I'm leaving the Democratic Party today.

They're complicit w/ every single young person living in fear. Every pain Latino & immigrant families feel from here out is 100% due to @TheDemocrats not fully embracing us as American. Implicit racism is equally as harmful. I'm done. pic.twitter.com/4mrNaz6rO6
- Alida Garcia (@leedsgarcia) January 22, 2018

There was lots of grumbling in this vein on social media, including from a veteran of Bernie's presidential campaign who has been organizing dreamer protests:

If I could vote, I would have done the same a while ago. Whats about to happen in Senate is exactly what has been happening on immigration with Dems for decades. Just let it sink in. After this please never ask me why I don't trust them. No spine to stand up to racism in the GOP. https://t.co/K4Gk32f2nL
- Erika Andiola - #NoDreamNoDeal (@ErikaAndiola) January 22, 2018

David Weigel, who closely follows Latinos and the professional left for us, rounds up a lot of angry statements from the usual suspects, including the Working Families Party, the Indivisible Project, Justice Democrats, CREDO Action and the Progressive Change Campaign Committee. But he's skeptical that these jabs will mean long-term term damage to the party:

"The progressive movement's most pugnacious groups have swung and missed before; in Virginia, infamously, the Howard Dean-founded group Democracy for America denounced now-Gov. Ralph Northam (D-Va.) for a 'racist' statement that he would oppose sanctuary status if any of the state's cities tried to implement it. Latino turnout surged regardless, powering Northam to a nine-point victory and sweeping 14 new Democratic legislators into the state's House of Delegates ...

"Democrats believe that the anger and cries of betrayal would have been worse had the party not fought the continuing resolution at all. One senator predicted that any deal short of a 'clean Dream Act' - i.e., the deal that Democrats thought they had before the infamous 's - hole' meeting at the White House - was going to stoke a certain amount of anger in the base. Rep. Luis V. Gutiérrez (D-Ill.), perhaps the fiercest advocate for dreamers in the House, caught a glimpse of that anger after suggesting that funding (or partially funding) a wall on the U.S.-Mexico border would be worth it if that meant a path for the Dream Act. ... After denouncing the way Democrats handled negotiations, by Monday afternoon most of the outraged groups were urging activists to pile on the pressure."

-- A new cliff now looms in 16 days. In addition to immigration, both parties and both chambers still need to hash out a deal on military and domestic spending.
HOW IT'S PLAYING: -- This morning's clips are brutal for Senate Democrats, especially Schumer. The mainstream media coverage is portraying them, almost universally, as weak-kneed and hapless. They're getting mocked on the right and hammered even harder from left-leaning outlets. -- From the MSM:

Los Angeles Times: "Analysts say Russian Twitter accounts promoted Republican talking points during government shutdown."

New York Times: "Hoping for a Bargain in a Swift Surrender: Senate Democrats believe they are limiting damage from a political miscalculation by surrendering, but doing so has drawn a fierce backlash from the left."

Politico: "Schumer's shutdown performance sparks unrest in his ranks. The Democratic leader confronts the most serious cracks in the unity he's tried to foster since he took the reins of his conference last year."

Reuters: "Schumer keeps eye on November."

The Hill: "2020 Democrats vote against Schumer deal."

Wall Street Journal: "Centrist Senators Outflanked Party Leadership to End Shutdown."

The New Yorker: "In the end, it took two weeks for Washington to agree on how it will fund the government for the next three weeks."

Minneapolis Star Tribune: "Congress opts for another Band-Aid."

ABC: "... Immigration debate continues."

CNN: "Progressives fume..."

Time: "The Shutdown Ended Because Democrats Lost Their Spine."

Daily Beast: "Dems Fold on This Shutdown, but the Next One Could Be Worse. ... If the majority leader breaks his promise, all hell will break loose."

Miami Herald: "Bill Nelson votes to reopen the federal government without an immigration deal."

McClatchy story running in the Charlotte Observer: "'None of it matters' - top operatives shrug off shutdown fallout in 2018 vote."

The Atlantic: "Democrats Relent."

Fortune: "Democrats ... Blinked."

Yahoo News: "Shutdown fizzles..."

-- On the right:

Fox News: "Trump lauds 'big win.'"

National Review: "Democrats Learn the Hard Way that Americans Don't Like Government Shutdowns."

Breitbart: "Surrender: Dems' Schumer Shutdown Cave Endangers Leftists, Emboldens GOP for 2018 Elections."

The Drudge Report banner headline is: "THEY'RE BACK."

Washington Examiner: "'Stupidest damn thing I've ever seen': Democrats miscalculate..."

Weekly Standard: "Trump ... signals willingness to get DACA deal."

-- On the left:

MSNBC: "Schumer's rare double-buckle on the shutdown infuriates Democrats..."

HuffPost: "Dreamers Feel Betrayed After Senate Democrats Break Their Promises."

Vox: "Democrats didn't cave on the shutdown."

Talking Points Memo: "'It's Morally Reprehensible': Liberals Livid With Senate Dems..."

Mother Jones: "Ban Government Shutdowns? Maybe We Actually Need More of Them."

Slate: "The Democrats Are Losers. Democrats in Congress fail, again, to deliver for an active, energized base."

WAPO TEAM COVERAGE:

Style's Ben Terris sets the scene: "The Senate gathered to reopen the government, and boy did everyone have a great time."

The Fix's Amber Phillips says congressional Republicans, Trump and moderates are "the winners," and Democrats, dreamers and future spending deals were "the losers."

The brinkmanship is making government work less attractive for many civil servants. From the local desk's Arelis R. Hernández, Steve Hendrix and John Woodrow Cox: "Errick King, a federal employee for 30 years, thinks he knows exactly what lawmakers will do next: more of the same. Congress has not balanced a budget in years, and King doesn't expect them to come February. That has left the father of three feeling so hopeless that he has considered changing his family's lifestyle, including skipping the after-church meals out on Sunday afternoons and nixing the weekly bowling games they so enjoy. The relentless instability, he said, is leading career employees to retire early and abandon agencies, leaving them increasingly thin on institutional knowledge. 'People are fed up,' said King, an IT specialist with the Bureau of the Fiscal Service in Hyattsville, Md. 'I think it hurts the government overall because you are losing that knowledge and skill. We are reliant on that to provide quality service.'"

-- The Post's opinion page:

The Editorial Board praises the senators who worked to end the impasse: "From here, that core group of moderate, dealmaking lawmakers should feel empowered. The broad middle in both houses of Congress should no longer wait for direction from a chaotic White House or spineless congressional leadership. They may discover that they have more in common with members of the other party also interested in competent, responsive government than they do with the ideologues in their own camp."

Catherine Rampell: "Blame McConnell and Ryan for the shutdown."

Marc Thiessen: "Democrats just got rolled. They can blame Barack Obama."

Carter Eskew: "Schumer's strategic retreat..."

Jennifer Rubin: "It is unlikely to matter by the midterms. Especially during the Trump era, the sheer volume of news cycles between now and then should make this a distant memory. (If you recall, the GOP staged and lost a government shutdown in 2013, and then won big in 2014.)"

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WHILE YOU WERE SLEEPING:
-- " FBI Director Christopher A. Wray has been resisting pressure from Attorney General Jeff Sessions to replace the bureau's deputy director, Andrew McCabe, a frequent target of criticism from President Trump," Devlin Barrett and Philip Rucker report, citing people familiar with the matter. "The tension over McCabe and other high-level FBI officials who served during James B. Comey's tenure has reached the White House, where counsel Donald McGahn has sought to mediate the issue ... As Sessions tried to push Wray to make personnel changes, Wray conveyed his frustration to the attorney general ... Sessions then discussed the matter with McGahn, who advised him to ease off, which he did ..."

"Axios was first to report the Session-Wray dispute on Monday evening, indicating that Wray had threatened to resign if Sessions did not stop pressuring him to fire McCabe. But several people familiar with the dynamic told The Post that they were not aware of Wray making such an explicit threat. Firing McCabe could be problematic because he has limited civil service protections as a government employee. Such a move, in the aftermath of public criticism from the president and others, could prompt litigation."
-- The former FBI director appeared to react overnight:

Good to read reports of people standing up for what they believe in. "The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy" - MLK
- James Comey (@Comey) January 23, 2018

-- A tsunami warning was issued and soon after lifted for the northern Pacific Coast after an undersea earthquake with an approximate magnitude of 8.2 struck near Alaska. Fred Barbash and Brian Murphy report: "There were no reports of significant ocean surges after the expected time the first effects could reach Alaskan shores. Later, The National Weather Service in Juneau said the warning was lifted from the Washington border, British Columbia and up to Alaska's Hinchinbrook Entrance, a seaway southeast of Anchorage. An advisory remained in effect to the west, including Kodiak. ... At its height, a warning was in effect for more than 3,000 miles of coastal zones north of the Washington border: British Columbia and Alaska's entire southern shoreline including the Aleutian Islands."

GET SMART FAST: ​​

1. Thousands of families are being evacuated from the Philippine's Albany province as the country's most active volcano, Mount Mayon, inches closer to what could be a major eruption. (Kristine Phillips)

2. Five people remain missing following a gas explosion at an Oklahoma drilling rig. The local sheriff's office declined to say whether anyone was killed but noted that more than 20 employees were present at the time of the explosion. (Kristine Phillips)

3. The Navy's brand new, $440 million warship - hailed as a fast, agile platform capable of battling a bevy of advanced coastal threats - has been trapped in ice since Christmas Eve in Canadian waters. (Amy B Wang)

4. Hawaii's governor explained his delayed response after the false missile alert: He forgot his Twitter password. Gov. David Ige (D) waited 17 minutes to tweet, "There is NO missile threat." He explained after his state of the state address, "I have to confess that I don't know my Twitter account logons and the passwords, so certainly that's one of the changes that I've made." (Travis M. Andrews)

5. The House Ethics Committee launched an investigation into sexual misconduct allegations against Rep. Patrick Meehan. The Pennsylvania Republican requested the inquiry after reports he used public funds to settle a sexual harassment complaint from a former staffer. (Mike DeBonis)

6. Three top members of the USA Gymnastics board resigned as more than 140 women have now alleged abuse by the organization's former physician, Larry Nassar, who is awaiting sentencing on charges of child pornography and molestation. (Cindy Boren)

7. USA Gymnastics also suspended former U.S. women's coach John Geddert, pending an investigation into his ties to Nassar. Geddert coached women's gymnastics during the 2012 London Olympics and has operated two gyms that employed Nassar. (ESPN)

8. Pope Francis apologized for defending Juan Barros, a controversial Chilean bishop accused of covering up sexual abuse, even as he continued to describe him as a victim of "slander." Francis set off a firestorm last week, generating backlash from his own top adviser on clerical sex abuse. (Sarah Pulliam Bailey)

9. A man in Michigan was arrested for threatening to "gun the f - kin' CNN cast down." Brandon Griesemer is accused of making 22 phone calls to CNN's public contact number, four of which resulted in threats. (Kyle Swenson)

10. A Cuban boy with a 10-pound, basketball-sized facial tumor died last week, just days after a team of doctors removed the life-threatening growth from his face. The boy was originally brought to U.S. doctors by missionaries in Cuba after doctors on the island refused to perform the risky operation. (Cleve R. Wootson Jr.)

11. Neil Diamond announced he has Parkinson's disease. The legendary songwriter said he would retire from touring as a result of the diagnosis. (Travis M. Andrews)

12. Delta is tightening its policy allowing "emotional support" animals on its planes after they caused a surge of "incidents," such as biting or defecating midflight. Delta said it flew some 250,000 emotional support animals last year, an increase of 150 percent from 2015. (Karin Brulliard)

13. Ousted "Today" show host Matt Lauer has been kicked out of his family home in the Hamptons. Page Six reports that Lauer's wife, Annette Roque, is likely to file for divorce soon.

BACKLASH TO TRUMP TARIFFS: -- Trump imposed new tariffs on solar panels and washing machines on Monday, two unilateral actions that could signal the start of a broader trade war.
The 30 percent tariff on solar cells will gradually decline to half that figure over a four-year period. From David J. Lynch: "The Suniva-SolarWorld request for protection was opposed by much of the domestic U.S. solar industry. Tariffs make solar panels more expensive, and thus discourage their use, according to the Solar Energy Industries Association. The trade association said the tariffs would cause 23,000 installers, engineers and project managers to lose their jobs this year as billions of dollars in planned investment evaporates. ... Up to one third of the 260,000 Americans currently employed in the industry are at risk because of the tariffs over the longer term, the group said."

"In the case of washing machines, Trump acted in response to a petition from Whirlpool, which complained about low-cost competition from rivals Samsung and LG," Lynch writes. "The first 1.2 million washing machines imported each year will face a 20 percent tariff, with additional imports facing a 50 percent tax. Under Monday's announcement, parts also will be hit with a 50 percent tariff."

-- Tellingly, only some GOP lawmakers put out statements objecting to the latest round of protectionism. Sen. Ben Sasse (R-Neb.) was one of them: "Here's something Republicans used to understand: Tariffs are taxes on families. Moms and dads shopping on a budget for a new washing machine will pay for this - not big companies. You don't fix eight years of bad energy policy with bad trade policy."

-- Trump's decision will hurt South Carolina, even though the Palmetto State delivered bigly for him in the 2016 primaries. "Samsung recently opened a home appliance plant in Newberry, S.C., and affiliates with the manufacturing giant say tariffs could make it difficult for the new operation to stay viable," McClatchyDC's Emma Dumain reports. "It has opened for business and hired more than 600 people with plans to employ as many as 1,000 by 2020. The company has also been working to forge research partnerships with Clemson University and the University of South Carolina. Rep. Ralph Norman, R-S.C., who represents Newberry, [said] Samsung president's had told him this decision would 'not bode well' for the company."

A spokesman for South Carolina Gov. Henry McMaster (R) - who has spent several months heavily lobbying Trump's administration for leniency in the trade cases - said the governor was "obviously disappointed" by Trump's decision.

-- Samsung called the Trump administration's decision "a great loss for American consumers and workers": "This tariff is a tax on every consumer who wants to buy a washing machine. Everyone will pay more, with fewer choices."
NATIVISM WATCH:
-- ICE authorities detained Polish doctor and green-card holder Lukasz Niec last week - opening the Michigan father and husband, who has lived in the United States for nearly 40 years and doesn't even speak Polish - to possible deportation. Samantha Schmidt reports: "According to his 'notice to appear' from [DHS], Niec's detention stems from two misdemeanor convictions from 26 years ago. In January 1992, Niec was convicted of malicious destruction of property under $100. In April of that year, he was convicted of receiving and concealing stolen property[.] ... Both of the offenses took place when he was a teenager. [Under] previous administrations, immigration authorities have often let low-level offenders off the hook, prioritizing the deportations of violent criminals. ... But the Trump administration has issued sweeping new guidelines expanding the range of immigrants that count as high priority for deportation, including low-level offenders, and those with no criminal record - regardless of how long they have lived in the country."

-- Before Trump's controversial voting commission was disbanded, it paid to buy Texas election data flagging voters with Hispanic surnames. Spencer S. Hsu and John Wagner report: "In buying nearly 50 million records from the state with the nation's second-largest Hispanic population, a researcher for [Trump's panel] checked a box on two Texas public voter data request forms explicitly asking for the 'Hispanic surname flag notation,' to be included in information sent to the voting commission[.] . . . Texas since 1983 has identified voters with a Hispanic name to mail bilingual election notices in Spanish and English as required by state and federal laws, said [a spokesman] for Texas Secretary of State Rolando Pablos (R). White House and Texas officials said the state's voter data was never delivered because a lawsuit brought by Texas voting rights advocates after the request last year temporarily stopped any data handoff."
THERE'S A BEAR IN THE WOODS:
-- The fiancee of former Trump campaign adviser George Papadopoulos said he is the "John Dean" of the Russia investigation - comparing him to Nixon's former White House counsel who became a key witness after pleading guilty to his role in the Watergate scandal. Rosalind S. Helderman reports: "'George is very loyal. And he is on the right side of history,' added [Simona Mangiante.] ... Mangiante said she was advised by Papadopoulos's lawyers not to answer specific questions about his activities during the 2016 presidential campaign or what he has told the FBI. But she indicated in an interview that she believes he ultimately will emerge as more than a bit player in the Russia probe - and that his decision to cooperate after he was arrested getting [in July] was a key turning point."

"Without offering specifics, Mangiante said there is much more that has not yet been told publicly about Papadopoulos' 10 months as an informal national security adviser to Trump and his interactions with a London-based professor [who claimed to have 'dirt' on Hillary Clinton]." "There's a lot to come," she said. "He was the first one to break a hole on all of this."

-- Jared Kushner's father, Charles Kushner, dismissed concerns about how the Russia investigations may probe the finances of the family business. Michael Kranish reports: "In his first interview since his son entered the White House, Charles Kushner said the company has no concerns about the investigations and dismissed suggestions that his son's work with Trump has made it harder to obtain financing for the family's many real estate projects. ... Kushner said he has been given no indication that the firm is being investigated by [Robert Mueller.]"

-- Trump is slated to tap billionaire financier Stephen Feinberg to lead his Intelligence Advisory Board group, which serves as the president's personal resource on intelligence matters. Its members are tasked with reviewing everything from bioweapons to intelligence failures. Foreign Policy's Jenna McLaughlin reports: "Feinberg is the CEO of private investment firm Cerberus Capital Management, which owns the private security firm DynCorp International. Over the past summer, Feinberg and Blackwater founder Erik Prince both pitched plans for a private military force in Afghanistan to the White House. Prince had also suggested creating a 'viceroy' to oversee U.S. operations in Afghanistan - a position that Feinberg was reportedly angling to fill. Trump instead went with a more traditional military plan. ... Feinberg does not have experience in government, but he donated nearly $1 million to a pro-Trump PAC five days before the election, and his name has repeatedly surfaced as a candidate for various national security and military roles during Trump's first year in office."

-- Attorney General Jeff Sessions pledged to "leave no stone unturned" in investigating why the FBI did not retain text messages between senior officials accused of political bias in the Russia probe. Sari Horwitz reports: "Sessions said late Monday that he has spoken to Inspector General Michael E. Horowitz about the missing text messages and that 'a review is already underway to ascertain what occurred' and determine whether the missing text messages can be recovered."

-- Ecuador's president described Julian Assange's presence in the country's London embassy, where the WikiLeaks founder has resided for over five years, as "more than a nuisance." President Lenín Moreno also called Assange an "inherited problem," as Moreno's predecessor approved the hacker's political asylum, rankling the United Kingdom and United States. (Amanda Erickson)
PALACE INTRIGUE:
-- A watchdog group filed a complaint against Trump's campaign over its reported payout to Stormy Daniels, saying the $130,000 in hush money allegedly given to the adult film star may have violated campaign finance laws. Mark Berman reports: "In a pair of federal complaints, Common Cause, a nonprofit government watchdog group, argued that the settlement amounted to an unreported in-kind contribution to Trump's campaign. The group called on the [DOJ] and [FEC] to investigate. This settlement should have been considered a campaign expense 'because the funds were paid for the purpose of influencing the 2016 presidential general election,' Paul S. Ryan, a campaign finance expert at the group, said in a letter addressed to [Jeff Sessions and Rod Rosenstein]. The pair of complaints filed by Common Cause said that the source of the $130,000 payment remains unknown, but they added that regardless of where it originated - even 'if Donald J. Trump provided the funds' - the money was aimed at affecting the election and then never reported."

-- Is John Kelly on the outs? Vanity Fair's Gabriel Sherman reports that Trump has discussed choosing a successor to his chief of staff in recent days -- and has tasked Ivanka Trump with searching for Kelly's possible replacement. "'Ivanka is the most worried about it. She's trying to figure who replaces Kelly,' a person who's spoken with her said. Kelly's departure likely isn't imminent ... [But] the prospect of a Trump-Kelly rupture became more probable as news of their clashes over immigration leaked. Last week, Kelly reportedly infuriated Trump when he told Fox News that Trump had 'evolved' on his position to build a southern border wall. Kelly further catalyzed Trump's ire when he told Democratic lawmakers that Trump was 'uninformed' when he made his [campaign promise of a border wall]. ... Trump has increasingly been chafing at the media narrative that he needs Kelly to instill discipline on his freewheeling management style. In recent days, Trump has fumed to friends that Kelly acts like he's running the government while Trump tweets and watches television. 'I've got another nut job here who thinks he's running things,' Trump told one friend, according to a Republican briefed on the call."
WITH AN EYE TOWARD TRUMP, THE GLOBAL ELITE GATHER IN DAVOS:
-- As this year's annual World Economic Forum in Davos kicks off today, its attendees are pretty happy with their situation, powered by a strong global economy. Yet even the top 1 percent are concerned about the political fallout of "excessive inequality." Heather Long reports: "Stock markets are at record highs, corporate taxes in the United States and United Kingdom are falling, and every major economy is growing. [Still], there is growing unease among the world's millionaires and billionaires that this current gilded age could soon be cut short by the rise of populism and the deepening inequality fueling it. ... Such anxieties that the global economic surge could be too good to last are manifest in the official theme for this year's Swiss gathering: how to come together in a 'fractured world."

-- CEO optimism is also at a record high, according to a new survey. The Finance 202's Tory Newmyer reports from Davos: "And while the cheer has spread to executives in every corner of the world, North American CEOs lead the pack. It's the only region where business leaders expect their own companies' fortunes to keep pace with the broader trend lines. The sentiment amounts to a Trump-style thumbs-up of sorts for the president's economic agenda - at least as far as CEOs are concerned - and a shrug in the direction of his hawkish trade rhetoric and chaotic style." Sign up for Tory's newsletter here.
-- Meanwhile, Trump is expected to bring his "America First" rhetoric to the gathering of global elites later this week now that the government shutdown is over.
-- In a change of plans, the first lady will no longer be accompanying Trump to Davos, however. CNN's Kate Bennett reports: "East Wing communications director Stephanie Grisham confirmed to CNN that the first lady's decision to forgo the trip was based on 'scheduling and logistical issues.' A week ago, Grisham told CNN the first lady would be attending the annual meeting of influential financial leaders and business titans in a show of support for her husband, who intends to give remarks during his visit. ... Melania Trump has not made a public statement since January 12, when news of a possible payoff from her husband's lawyer to porn star Stormy Daniels to cover up an alleged affair was first reported by The Wall Street Journal."
THE ROAD TO 2018:
-- The Pennsylvania Supreme Court struck down the state's congressional map, ruling the Republican-drawn districts were unconstitutionally gerrymandered. The decision is a big win for Democrats, forcing lawmakers to approve a replacement map ahead of the November elections. Amber Phillips reports: "Less partisan congressional districts could give Democrats a chance this November to win back as many as half a dozen seats that had been lost to them over the past decade. It could also give the party a major boost in its quest to take back the House of Representatives[.] ... Pennsylvania Republicans cried foul and said they would try to appeal the decision to the U.S. Supreme Court."

-- Republican strategists hope focusing on the benefits of the GOP tax plan will allow them to avoid a blue wave in November. Michael Scherer and Karen Tumulty report: "GOP leaders and their allies plan to talk up job growth, highlight the soaring stock market and, most of all, convince voters that the tax-cut legislation that stands as their only major accomplishment is bringing back the good times. The effort represents an all-hands deployment by top Republican officials and their allies, with extensive travel in the coming months to key districts by Trump, Vice President Pence and Cabinet officials, as well as White House aides Ivanka Trump and Kellyanne Conway, to sell the tax overhaul."

-- Georgia Democrats believe they have a chance to flip the governor's mansion this year. Politico's Daniel Strauss writes: "The party has two major candidates with a lot in common: Stacey Abrams and Stacey Evans are both veterans of the Georgia state House. Both are running as unapologetic liberals who see a path to victory guided by tapping into black voters, whom they see as an electoral sleeping giant - and courting suburban whites who usually vote Republican but are repelled by President Donald Trump."

-- Despite his pending retrial on federal corruption charges, Sen. Bob Menendez (D-N.J.) insists he'll run for reelection and is currently backed by his state's Democratic leadership. Politico's Matt Friedman reports: "The biggest [practical consideration] is a precedent set in 2002, when Democratic Sen. Bob Torricelli - damaged by his own scandal involving gifts from a campaign contributor - dropped his reelection bid. In October of that year, the state Supreme Court allowed Democrats to swap Torricelli's name on the ballot with that of former Sen. Frank Lautenberg, who regretted his decision to retire two years earlier. Lautenberg won the election over Doug Forrester, a wealthy businessman and former small town mayor, by 10 points."
PENCE'S MIDDLE EAST ADVENTURE:
-- Mike Pence announced before Israel's parliament that the United States will relocate its embassy from Tel Aviv to Jerusalem in 2019, accelerating the timeline for the move. Jenna Johnson, Loveday Morris and Carol Morello report: "[On Monday], Pence looked notably more at ease than during earlier meetings in Egypt and Jordan, where he has been forced to defend the controversial decision[.] ... 'Jerusalem is Israel's capital - and, as such, [Trump] has directed the State Department to immediately begin preparations to move the United States embassy from Tel Aviv to Jerusalem,' Pence said to applause."

-- Pence also defended Trump's comments regarding "shithole" countries, telling the AP in an interview that he "knows the president's heart": "[Pence said] Trump is determined to implement a merit-based system that encourages immigration by those who will 'contribute to a growing American economy and thriving communities' and one that does not take into account the immigrants' 'race or creed.'" He also refused to respond to reports of Trump's alleged affair with an adult film star, dismissing them as "baseless allegations."
SOCIAL MEDIA SPEED READ:
Sen. Roger Wicker (R-Miss.) had this moment on the Senate floor caught on a hot mic:

Heard on a hot mic...

During the Senate CR vote, Sen. Wicker said, "I thought you were going to say this was one of the most beautiful girls. What about these others?" to either another senator or a male page about female pages. pic.twitter.com/ZTHxOVvK1F
- Amelia Frappolli (@AmeliaFrappolli) January 23, 2018

The resolution of the shutdown - and the political costs of it - dominated social media. From an adviser to Paul Ryan:

Signing the bill to end the stupid shutdown.

- 30 - pic.twitter.com/IPD8nkwQYn
- Brendan Buck (@BrendanBuck) January 22, 2018

The White House shared this picture of Trump signing the short-term spending measure:

Tonight, President Donald J. Trump signs H.R. 195 - Federal Register Printing Savings Act of 2017, including Extension of Continuing Appropriations Act, 2018, in the Treaty Room at the White House. pic.twitter.com/2ws5dsTa3M
- Dan Scavino Jr. (@Scavino45) January 23, 2018

Trump took a victory lap:

Big win for Republicans as Democrats cave on Shutdown. Now I want a big win for everyone, including Republicans, Democrats and DACA, but especially for our Great Military and Border Security. Should be able to get there. See you at the negotiating table!
- Donald J. Trump (@realDonaldTrump) January 23, 2018

Even Crazy Jim Acosta of Fake News CNN agrees: "Trump World and WH sources dancing in end zone: Trump wins again...Schumer and Dems caved...gambled and lost." Thank you for your honesty Jim!
- Donald J. Trump (@realDonaldTrump) January 23, 2018

Sen. Ted Cruz (R-Tex.) raised eyebrows with this quote:

.@SenTedCruz : "I have consistently opposed shut downs"
- Andrew Rafferty (@AndrewNBCNews) January 22, 2018

A former senior aide to John Boehner, and veteran of the presidential campaigns of Mitt Romney and Jeb Bush, bristled:

If God made an asterisk large enough for this statement, could even He lift it? https://t.co/4pyn6YFpSK
- Michael Steel (@michael_steel) January 22, 2018

Sen. Kamala Harris (D-Calif.) doesn't trust Mitch McConnell:

🔥Kamala Harris on McConnell: "I don't believe he made any commitment whatsoever and I think it would be foolhardy to believe he made a commitment."
Cc: Democratic leadership
- Tal Kopan (@TalKopan) January 22, 2018

From Politico's senior congressional scribe:

How do Dems get win on CHIP when 144 House Dems & 16 Senate Dems voted against CHIP funding? No, this was a loss for Dems, no way to spin this one otherwise https://t.co/YDQUi7EwXD
- John Bresnahan (@BresPolitico) January 22, 2018

From a Fox News analyst:

I doubted it was possible, but Dems have actually lost a shutdown fight. Schumer has agreed to end the filibuster in exchange for practically nothing. Make no mistake: Schumer & Dems caved. What a political fiasco.
- Brit Hume (@brithume) January 22, 2018

From the Boston Globe's deputy Washington bureau chief:

Democrats have managed to accede to Republican demands, demoralize their energized base, give a disengaged president a win, and look like they held a meaningless three day government shutdown - all at once.
- Matt Viser (@mviser) January 22, 2018

From a former Obama administration official:

The homepage of @nytimes right now. Posted without comment. pic.twitter.com/sH01pjl76q
- Kenneth Baer (@KennethBaer) January 23, 2018

From a former spokesman for both Hillary Clinton and Chuck Schumer:

Schumer took the heat in Dec when mods did not want to make any stand on DACA
He's taking the heat today as the same mods decided two days was enough to hold out
That comes with being Leader. Amid total one-party control, there's still no one I trust more to see this fight thru
- Brian Fallon (@brianefallon) January 22, 2018

Conservative pundit Ann Coulter mocked Sen. Lindsey Graham (R-S.C.) for his views on DACA:

Any responsible immigration bill must include a path to ex-citizenship for Lindsey Graham.
- Ann Coulter (@AnnCoulter) January 22, 2018

From a Washington Examiner correspondent:

So for all of @LindseyGrahamSC's cultivation of @realDonaldTrump,
White House is now referring to him as supporting "amnesty" & "open borders."
- David M. Drucker (@DavidMDrucker) January 22, 2018

The White House defended its position on immigration:

White House spokesman Hogan Gidley: Sens. Lindsey Graham and Dick Durbin were "dishonest" about their immigration plan https://t.co/tbHxeGKlXQ pic.twitter.com/jcXXLfPZcz
- CNN Politics (@CNNPolitics) January 23, 2018

From the communications director for Sen. Dick Durbin (D-Ill.):

I don't know who "J. Hogan Gidley" is or how many Scaramuccis he's been at the White House for, but his word doesn't stack up that well against Senators Graham or Durbin. https://t.co/VLhyEsGpA3
- Ben Marter (@BenMarter) January 23, 2018

Trump criticized the FBI for not retaining texts between senior officials accused of political bias:

In one of the biggest stories in a long time, the FBI now says it is missing five months worth of lovers Strzok-Page texts, perhaps 50,000, and all in prime time. Wow!
- Donald J. Trump (@realDonaldTrump) January 23, 2018

From the president's son:

The FBI/govt "loss of texts" revelations are crazy. How often can they lose seemingly critical info before Americans realize it's all a big scam? Lerner, Clinton, FBI etc...

Imagine if I tried that???

Why the different standard for them?
- Donald Trump Jr. (@DonaldJTrumpJr) January 22, 2018

A House Republican suggested the texts were not truly lost:

Color me skeptical that the Strzok-Page texts are actually "lost". I'd predict they are a million times more likely to fall under the categories of "revealing" & "damaging" instead of "lost". In this order, what's needed is transparency, accountability, & regaining public trust.
- Lee Zeldin (@RepLeeZeldin) January 22, 2018

Sen. Jeff Flake provided on update on his fellow Arizona Republican:

Just got off the phone with @SenJohnMcCain. He is sounding good and is pleased that the senate has voted to reopen the federal government.
- Jeff Flake (@JeffFlake) January 22, 2018

Some powerful Republicans gathered at John Cornyn's house last night for a dinner to fete Neil Gorsuch:

I enjoyed having dinner tonight at the home of Senator John Cornyn and his wife Sandy with our newest Supreme Court Justice, Neil Gorsuch, Transportation Secretary Chao and a few of my other Senate colleagues to talk about important issues facing our country.
- Sen. Lamar Alexander (@SenAlexander) January 23, 2018

Mike Bloomberg slammed the new tariffs on solar panels:

Taxing solar panels up to 30% will destroy U.S. jobs, raise Americans' electric bills and hurt our environment. Congress should stand up for American workers and consumers and overturn the administration's harmful decision. https://t.co/TBdgQ1LluV
- Mike Bloomberg (@MikeBloomberg) January 23, 2018

And the Super Bowl trash-talking has already begun. From a House Democrat:

Hey @joekennedy - when the Eagles pull off yet another upset win and beat the evil empire (aka your Patriots) I just want you to know I will not totally rub in our victory since we're friends. You're welcome. #FlyEaglesFly
- US Rep Brendan Boyle (@RepBrendanBoyle) January 23, 2018
GOOD READS FROM ELSEWHERE:
-- Politico Magazine, "Tony Perkins: Trump Gets 'a Mulligan' on Life, Stormy Daniels," by Edward-Isaac Dovere: "[Conservative evangelical leaders] embrace Trump the policymaker, says Family Research Council president Tony Perkins, despite being uneasy about Trump as a man. ... 'We kind of gave him - "All right, you get a mulligan. You get a do-over here,"' Perkins [said.] Weigh a paid-off porn star against being the first president to address the March for Life, and a lot of evangelical leaders insist they can still walk away happy."

-- New York Times, "Wary, Weary or Both, Southern Lawmakers Tone Down Culture Wars," by Alan Binder: "A combination of fear, fatigue and legislative mathematics appear to be behind the shift. Many people believe that states have grown wary of provoking a pronounced corporate backlash like the one North Carolina experienced in 2016. Others sense little appetite among lawmakers for another year of battles over divisive social issues, noting that few of the faces in the legislatures have changed since the previous conflagrations."

-- BuzzFeed News, "Inside The Fight For The Soul Of Kaspersky Lab," by Ilya Zhegulev: "[T]he decline in fortunes of Kaspersky Lab was the result of an internal struggle for control that pitted allies of the Russian secret service against 'tech-savvy' staff and Western investors. The managers within destroy everything the company has built outside Russia."Kaspersky Lab, like [alleged former KGB officer Igor Chekunov], with ties to Russia's security agencies won that battle. But in so doing, they threaten to

-- New York Times, "Naomi Parker Fraley, the Real Rosie the Riveter, Dies at 96," by Margalit Fox: "Unsung for seven decades, the real Rosie the Riveter was a California waitress named Naomi Parker Fraley. Over the years, a welter of American women have been identified as the model for Rosie, the war worker of 1940s popular culture who became a feminist touchstone in the late 20th century. Mrs. Fraley, who died on Saturday, at 96, in Longview, Wash., staked the most legitimate claim of all. But because her claim was eclipsed by another woman's, she went unrecognized for more than 70 years."

"NASA pulled this astronaut from a space station crew. Her brother blames racism," from Sarah Kaplan : "NASA astronaut Jeanette Epps, who was slated to become the first black crew member to live on board the International Space Station, was unexpectedly pulled from her June flight. ... Epps, who has a PhD in aerospace engineering, was selected as a NASA astronaut in 2009 after seven years of working for the CIA. [NASA] did not give an explanation for the crew change. But Epps's brother blamed racism at the space agency. 'My sister ... has been fighting against oppressive racism and misogynist in NASA and now they are holding her back and allowing a Caucasian Astronaut to take her place!' Henry Epps wrote in a Facebook post[.] Epps said that she did not have a medical condition or family problem that would have prevented her from participating in the mission and that her overseas training in Russia and Kazakhstan had been successful."

HOT ON THE RIGHT:

"Kid Rock sends $122K from fake campaign to voter group," from : "Kid Rock last month donated $122,000 of the money raised by selling merchandise promoting 'Kid Rock for US Senate' - his fake political campaign - to a voter-registration organization affiliated with the College Republicans, his publicist said. Kid Rock ... for more than three months last year teased a Republican run for Senate against incumbent Democratic U.S. Sen. Debbie Stabenow of Lansing but later revealed it was a publicity stunt amid the launch of his latest album and tour. Instead, the money raised went to CRNC Action, an affiliate of the College Republicans that did voter-registration work last summer at his concerts, said Kid Rock publicist Jay Jones. Ted Dooley, the president of CRNC Action, confirmed that a donation of about $122,000 was made in early December."

DAYBOOK:
Trump will sign "Section 201 actions" this afternoon.

Pence will return to Washington from Israel later tonight.

QUOTE OF THE DAY:

Sen. John Kennedy (R-La.) summarized Congress's handling of the shutdown: "I think most Americans are wondering how some folks up here made it through the birth canal." ( )

NEWS YOU CAN USE IF YOU LIVE IN D.C.:
-- Washingtonians will see more warm weather and possible thunderstorms today. The Capital Weather Gang forecasts: "Scattered showers and thunderstorms this morning continue to just about midday. Some of these storms could contain heavy downpours and gusty winds that impair commuting visibility. ... Highs reach the mid- to upper-60s during the midday hours before temperatures slide into the 50s later in the afternoon as skies turn partly sunny."

-- The Wizards lost to the Mavericks 98-75. ( Candace Buckner)

-- Lt. Gov. Justin Fairfax, Virginia's only black statewide officeholder currently, protested a state Senate tribute to Stonewall Jackson. Laura Vozzella reports: "After Sen. Emmett W. Hanger Jr. (R-Augusta) called on the Senate to adjourn for the day in honor of Jackson, whose birthday was Sunday, Fairfax (D) moved from his spot as presiding officer to a bench normally occupied by Senate pages . . . Fairfax described his protest as a 'personal decision' based, in part, on his family history. Tucked in his jacket pocket when he was sworn in as lieutenant governor on Jan. 13 was the manumission document that freed his enslaved ancestors in 1798."

-- Maryland Gov. Larry Hogan (R) is offering $5 billion in incentives to lure Amazon's second headquarters to Montgomery County. Robert McCartney and Ovetta Wiggins report: "[Hogan] will offer more than $3 billion in tax breaks and grants and about $2 billion in transportation upgrades[.] ... It appears to be the second-most generous set of inducements among the 20 locations on Amazon's shortlist. ... Maryland's package, which Hogan will make public Monday morning, will require legislative approval and would dwarf any previous economic development offering in the state's history."
VIDEOS OF THE DAY:
Seth Meyers had some mixed feelings about the end of the shutdown:

Jimmy Kimmel mocked Trump's response to the Women's March:

Team USA unveiled its uniforms for the 2018 Winter Olympics:

Rex Tillerson visited the new U.S. embassy in London after Trump canceled his own appearance:

A teenager testified that Michigan State was still billing her mother for appointments she had with sports doctor and accused pedophile Larry Nassar:

And a woman in California battling cancer lived out her dream of being "showered" with puppies:

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Analysis | The Daily 202: Seven takeaways from the failed Democratic government shutdown

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THE BIG IDEA: The Resistance will struggle when it tries to replicate the tactics of the tea party movement. The left learned with its failed shutdown gambit that it cannot beat President Trump by copying the same playbook that the right used against Bill Clinton and Barack Obama.

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A breakdown of what happens to certain healthcare systems when the government shuts down

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A breakdown of what happens to certain healthcare systems when the government shuts down

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This article explains how a government shutdown affects the NIH, CDC, FDA, and other organizations dedicated to keeping US citizens healthy

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what is affected in a government shutdown

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what agenices are affected by government shutdown

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Here's What Would Happen to U.S. Health Care If the Government Shuts Down

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An impending government shutdown would affect healthcare in many ways, hitting agencies like the CDC, the FDA, and others.

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Regardless of the government shutdown:
"States keep getting their Medicaid payments"
"The Food and Drug Administration continues drug reviews."
... and much more. Refer to the link below

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/01/22/the-health-202-how-the-government-shutdown-could-affect-your-health-care-or-not/5a625a1030fb0469e884025b/?utm_term=.6efd5671dfda

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Government shutdown affects government health agencies

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Government shutdown affects government health agencies

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https://www.cnbc.com/2018/01/20/the-government-shutdown-means-chaos-for-government-health-agencies-.html

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The Department of Veterans Affairs - which runs more than 150 hospitals across the country - will remain open and largely unaffected by the federal government shutdown.

Certain claims processing departments of the VA may experience a slowdown. But its core functions - providing health care services to an estimated 9 million American veterans - are largely exempted from federal rules that require "nonessential" services to scale back or shut entirely.

The VA's official shutdown plan notes that 96 percent of its 377,000 employees will continue to work through a government shutdown. That's a significantly higher share than most other federal employees. Only 5 percent of Department of Education employees continue to work through a shutdown, for example, and 50 percent of Health and Human Services workers.

VA hospitals and clinics will remain open in the midst of a government shutdown, with patients able to keep their appointments or seek help in case of an emergency.

The reason the VA continues to operate normally has to do with the criteria the government uses to decide which functions are "essential" during a shutdown. Those criteria instruct agencies to keep running programs that are necessary to protect human life and property.

The VA's role administering medical care means it easily fits into the category of protecting human life.

There are, however, some smaller functions of the VA that did slow down during the last government shutdown in 2013. The agency stopped processing disability claims during that 16-day closure. A federal report estimated that this "stalled weekly progress in reducing the backlog of veterans' disability claims, which was previously being reduced at a rate of almost 20,000 claims per week."

The same report found that certain call lines, meant to help veterans better understand their benefits, closed during the shutdown.

"Services that help veterans understand their benefits - including the education call center, hotlines, and all regional offices outreach activities - were closed to the public during the shutdown, and many veterans lost access to vocational rehabilitation and education counseling services," the Office of Management and Budget report said.

Read more of Vox's 2018 government shutdown coverage here.

Was this article helpful?

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Why VA hospitals stay open during a government shutdown

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The Department of Veterans Affairs - which runs more than 150 hospitals across the country - will remain open and largely unaffected by the federal government shutdown. Certain claims processing departments of the VA may experience a slowdown.

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https://www.nbcnews.com/health/health-news/how-government-shutdown-might-affect-your-health-n839516

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How has the government shutdown affected the society?

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How has the government shutdown affected the society?

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https://www.vox.com/2018/1/22/16920124/government-shutdown-2018-winners-losers

The article discusses the federal government shutdown that is going to have another showdown on February 8th. It talks about how the CHIPs funding crisis was resolved by a six year extension, and the Children's Health Insurance Program now do not have to worry.

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CDC would have to lay off some of their key staff members during an intense flu season.

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How or how not the government could affect health care

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How or how not the government could affect health care

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https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/01/22/the-health-202-how-the-government-shutdown-could-affect-your-health-care-or-not/5a625a1030fb0469e884025b/?utm_term=.2d119fc2f46c

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The response to this year's flu season may be slowed due to the shutdown because there may not be enough epidemiologists and doctors to regulate and monitor the constant changes.

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The government shutdown isn't over Obamacare this time. But depending on how long it lasts, there will be ripple effects on health care as the Department of Health and Human Services sees half its workers furloughed.
Happy third day of the shutdown. The impasse on Capitol Hill continues, as Democrats refuse to budge on their demands for legal protections for young immigrants and Republicans seem unwilling to move in their direction, my tireless colleagues Robert Costa, Erica Werner, Mike DeBonis and Sean Sullivan report. After a bipartisan group of moderate senators failed to produce a compromise yesterday, buy Senate Majority Leader Mitch McConnell (R-Ky.) plans to hold a vote at about noon anyway. There was some hope building yesterday for a deal to fund the government for three weeks with a guarantee by McConnell to consider immigration legislation after that if there has been no agreement before then. But it doesn't look like we're there yet.

The effects of the shutdown were relatively limited over the weekend, but now that the workweek is starting, hundreds of thousands of workers will stay home and key federal agencies will be affected. "Federal contractors will see payments delayed, and the Internal Revenue Service will slow its preparations for the coming tax season," my colleagues writes.

Trump, who to his aides relief it seems, has remained relatively quiet during the shutdown so far. Nonetheless, the president took to Twitter this morning to blame Democrats:

The Democrats are turning down services and security for citizens in favor of services and security for non-citizens. Not good!
- Donald J. Trump (@realDonaldTrump) January 22, 2018

Democrats have shut down our government in the interests of their far left base. They don't want to do it but are powerless!
- Donald J. Trump (@realDonaldTrump) January 22, 2018

But the effects of a shutdown -- especially if it continues -- on the federal workforce, and Americans by extension, are real.

Granted, because so much of what HHS does is considered "essential," a smaller proportion of its workers are furloughed during a shutdown compared to other agencies. About 41,000 of HHS' 82,148 employees will still come to work today, according to these helpful visuals from The Post's Darla Cameron and Lisa Rein. There are five other federal agencies - Justice, Homeland Security, Veterans Affairs, Defense and Transportation - where at least half of employees are similarly considered essential.

On Friday, HHS updated its last shutdown contingency plan - issued in the fall of 2013 when the government shut down for more than two weeks as Sen. Ted Cruz (R-Tex.) demanded to defund the Affordable Care Act - with a new version. Per that document, here are five top things the agency keeps doing while the government is shuttered - and five services it halts.
Services that continue:
1. States keep getting their Medicaid payments. Federal funding for the health insurance program for the low-income population is secure through the end of June, according to the contingency plan. And because states oversee enrollment, Americans should be able to continue signing up for the program without hiccups.

2. Seniors can keep seeing the doctor. As with Medicaid, Medicare has funding sources that don't depend on Congress passing annual spending bills. Beneficiaries shouldn't much feel the effects of a shutdown, unless it is prolonged. Medicare will continue to reimburse medical providers, so coverage should continue without interruption.

3. Premium subsidies continue for Obamacare enrollees, and the marketplaces remain open for those qualifying to sign up off-season. Like Medicare and Medicaid benefits, marketplace subsidies are considered mandatory spending. And the Centers for Medicare and Medicaid Services can use leftover fees paid by health insurers to keep verifying eligibility so enrollments can continue.

4. The Food and Drug Administration continues drug reviews. That's because these reviews are paid for by fees from the pharmaceutical industry. Staffers who analyze and review medicines entering the United States would also be considered essential, according to HHS.

5. The nation's 1,400 community health centers stay open. These clinics - which provide preventive care and dental services to about 27 million low-income Americans - also enjoy mandatory spending status. But they're threatened by an underlying problem: The program has needed reauthorization by Congress since last fall, and it's unclear whether lawmakers will include that in a spending bill reopening the government.
Services that stop or slow:
1. The FDA's food-safety inspection program hits pause. "FDA will be unable to support the majority of its food safety, nutrition and cosmetics activities," the HHS contingency plan says. The exception is meat and poultry inspections carried out by the Agriculture Department's Food Safety and Inspection Service.

2. The National Institutes of Health can't enroll new patients in clinical trials or take action on grant applications. During the last shutdown, NIH turned away about 200 patients each week from its clinical research center since nearly three-fourths of its staff was furloughed. The center can only admit new patients with cases NIH Director Francis Collins deems "medically necessary."

3. No new mental health or social services grant awards and less monitoring of existing grants. The HHS departments most involved in issuing grants to health-care providers around the country would be particularly affected by the shutdown because more of their employees are furloughed. This includes the Substance Abuse and Mental Health Services Administration and the Administration for Children and Families.

4. Payments for senior nutrition programs stop. The shutdown would halt funding for federal senior nutrition programs funded through the Administration for Community Living, and would delay federal reimbursements to privately run programs such as Meals on Wheels (which services more than 2.4 million seniors across the country). But the severity of the impact on such programs depends on how long the shutdown lasts.

5. Response to this year's deadly flu outbreak could be slowed. The CDC says its "immediate response to urgent disease outbreaks, including seasonal influenza" will continue. This includes collecting data reported by states, hospitals and others. But a CDC representative told BuzzFeed News the reports could be issued at a slower rate than usual. Former CDC director Tom Frieden, who led the agency during the 2013 shutdown, told NPR the shutdown means a slower response to changes in the flu virus and less preparation among doctors to provide rapid treatment.
AHH, OOF and OUCH
AHH: A government shutdown comes at an especially inopportune time for flu season, which is particularly deadly this year per the latest data released Friday, The Post's Lena H. Sun reports. During the second week of January, more people sought care for flulike illnesses than at any comparable period in nearly a decade and 10 children died, bringing the total number of pediatric deaths this flu season to 30. More than 8,900 people have been hospitalized since the season started Oct. 1.

"The flu activity indicators are notable for the sheer volume and intensity of flu that is taking place in most of the country at the same time," Lena writes. "A federal government shutdown could complicate CDC's ability to know, in real time, whether flu cases are continuing to increase."

About 63 percent of CDC employees are furloughed, according to HHS's contingency plan. While state labs will continue to operate and monitor flu activity, test specimens and send that information to the federal agency, there may not be enough CDC epidemiologists to monitor the data and compile it, Lena reports. Additionally, there are spot shortages of prescription antiviral drugs and it's unclear whether the agency personnel working on that will be able to stay on duty during a shutdown.

OOF: In the state President Trump called a "drug-infested den" - New Hampshire - the opioid crisis is something of an obsession, the New York Times's Katharine Q. Seelye reports. New Hampshire is tied with Ohio for the state with the second-highest rate of drug overdose deaths per capita (West Virginia is first), and 53 percent of adults there say drugs are the biggest problem.

It's surprising when you consider New Hampshire's demographics. "Unlike West Virginia, New Hampshire is relatively prosperous, which makes an opioid crisis here seem all the more jarring," Katharine writes. "This state has the highest median household income in the country, ranks low in unemployment and crime, and often lands at or near the top of lists of the best states in which to live."

So why is the state's opioid problem so bad? Researchers say one big reason is the proximity to an abundant drug supply in neighboring Massachusetts and its drug distribution networks; another is the state's limited spending on addiction services. In addition, doctors in New Hampshire have long prescribed opioids at almost twice the national rate.

"This is a kind of perfect storm," Lisa Marsch, a professor of psychiatry and health policy at Dartmouth's Geisel School of Medicine, told the Times. "We have highly available, highly potent opioids in New Hampshire. And highly limited resources to reduce the risk."

OUCH: And over in neighboring Massachusetts, there's a spirited debate over the idea of "supervised injection sites" as another way to reduce overdose deaths, the AP reports. These sites are safe spaces where drug users can shoot up under the supervision of trained staff. While the Massachusetts Medical Society and the Massachusetts Hospital Association back the idea, Gov. Charlie Baker (R) is among the skeptics who don't see such sites as leading to treatment.

"As far as the data I've seen is concerned, it has not demonstrated any legitimate success in creating a pathway to treatment," Baker said at a public hearing last week. "The harm reduction argument I think is a much better one, but I'm kind of a hard sell on that one."

"In a report released last year, the medical society found supervised injection sites can reduce overdose mortality and increase access to drug treatment. Much of the research is based on two sites in Canada and Australia," Steve Leblanc writes. "The report called for the creation of a pilot supervised injection facility program in Massachusetts. The group said the state should seek an exemption from federal drug laws to pursue the pilot program and consider partnering with other states."
TRUMP TEMPERATURE
- The Trump administration may be no more willing to put more restrictions on food stamps than was the Obama administration. Although momentum is building for a ban on the purchase of candy and soda with food stamps, the Agriculture Department last week denied a request from Maine that would have placed such restrictions on its food stamp program, The Post's Caitlin Dewey reports. Now, supporters of such bans are trying to parse the meaning of the rejection.

"In its application to USDA, Maine said it would evaluate the ban's impact on soda and candy purchases but did not propose any specific monitoring of health effects," Caitlin writes. "It is not clear if USDA rejected the request because of this kind of omission or because the administration more generally opposes junk food bans."

"When considering waiver requests, USDA focuses on moving people into self-sufficient lives, protecting the integrity of the program, and improving customer service," the agency said in a statement. "We don't want to be in the business of picking winners and losers among food products in the marketplace, or in passing judgment about the relative benefits of individual food products."

--About that 24-year-old in a top Trump administration role: Taylor Weyeneth, who was appointed to a top position in the White House's drug policy office at age 23, was previously dismissed from a job at a law firm for repeatedly missing work, The Post's Robert O'Harrow Jr. reports. Weyeneth worked as a legal assistant at the New York firm O'Dwyer & Bernstien while in college, but he was "discharged" in August 2015 for being a no-show.

Brian O'Dwyer, a partner at the firm, said he hired Weyeneth in part because both men were involved in the same fraternity. He told Robert the team was "very disappointed in what happened" and that Weyeneth "just didn't show."

"In a résumé initially submitted to the government, Weyeneth said he worked at the firm until April 2016," Robert writes. "When an FBI official called as part of a background check in January 2017, the firm said Weyeneth had left eight months earlier than the résumé indicated...an administration official previously said that Weyeneth revised his résumé to correct 'errors.'" In a revised résumé, Weyeneth said he worked at the law firm from November 2014 to August 2015.

Since Robert first reported on the young appointee's rapid ascent to a top White House post, several Democratic lawmakers have expressed concern about Weyeneth and about other unfilled drug policy roles in the administration. The concern comes as Trump, who has pledged to allocate government resources toward the opioid crisis, still has not named a permanent director for his drug policy office.

"You have claimed that the opioid epidemic is a top priority for your administration, but the personnel you have staffing these key agencies - and the lack of nominees to head them - is cause for deep concern," ten lawmakers, including Sens. Maggie Hassan (D-N.H.) and Dianne Feinstein (D-Calif.), recently wrote to the president.
AGENCY ALERT
- Our colleague Tory Newmyer, who writes The Finance 202, is staking out the World Economic Forum meeting in Davos, Switzerland this week. We noticed FDA Commissioner Scott Gottlieb is among the top Trump appointees who are on the guest list. The president is also expected to attend. Sign up to receive updates from Davos in The Finance 202 here.
HEALTH ON THE HILL
--Top Senate Finance Committee Democrat Ron Wyden (Ore.) wants an investigation into whether Seema Verma, who heads the Centers for Medicare and Medicaid Services, violated ethics rules in handling Medicaid waiver requests from states she used to work with privately. Verma formerly consulted for Kentucky, Arkansas, Iowa and other states seeking permission from the federal government to enact changes to their Medicaid programs.

Wyden asked HHS's general counsel, in a letter last week, to open an ethics investigation into the matter, questioning whether she had recused herself (as she'd promised) from being involved in waiver requests with states with whom she formerly contracted.

"Administrator Verma's commitment to recuse herself from work with former clients appears to have fallen short of the mark thus far, which is extremely concerning given that many of her former clients have sought, or plan to seek, waivers to impose unprecedented work requirements in state Medicaid programs," he wrote.
--A few more good reads from The Post and beyond: MEDICAL MISSIVES INDUSTRY RX STATE SCAN OPIOID OPTICS REPRODUCTIVE WARS DAYBOOK Today

The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, hold the "National Drug and Alcohol Chat Day" web chat event.

The Alliance of Community Health Plans holds a briefing on "The Value of Medicare Advantage."

The Alliance for Strong Families and Communities, and the American Public Human Services Association host a webinar.

Coming Up

The Senate Health, Education, Labor and Pensions Committee is scheduled to hold a hearing on "Facing 21st Century Public Health Threats: Our Nation's Preparedness and Response Capabilities, Part 2" on Tuesday.

The National Institutes of Health is scheduled to hold a meeting of the National Heart, Lung, and Blood Institute's Sickle Cell Disease Advisory Committee for presentations and discussion of programs on Tuesday.

The National Institutes of Health is scheduled to hold a meeting of the National Institute of Nursing Research to discuss program policies and issues on Tuesday.

The Advisory Board holds a web conference on BPCI Advanced on Tuesday.

The Families USA Health Action Conference begins on Wednesday.

The Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations is scheduled to hold a hearing on combatting the opioid crisis on Thursday.

The National Institutes of Health is scheduled to hold a meeting of the National Advisory Mental Health Council on Thursday.

The Medicaid and CHIP Payment and Access Commission holds its January meeting starting on Thursday.

SUGAR RUSH
House Minority leader Nancy Pelosi (D-Calif.) said the military would be paid during the government shutdown:

Activists protest around the globe during the a second annual Women's March:

Saturday Night Live takes on White House doctor Navy Rear Adm. Ronny L. Jackson's report on President Trump's health:

The Daily Show with Trevor Noah on Trump's first year as president:

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Analysis | The Health 202: How the government shutdown could affect your health care (or not)

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The government shutdown isn't over Obamacare this time. But depending on how long it lasts, there will be ripple effects on health care as the Department of Health and Human Services sees half its workers furloughed. Happy third day of the shutdown.

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The government shutdown isn't over Obamacare this time. But depending on how long it lasts, there will be ripple effects on health care as the Department of Health and Human Services sees half its workers furloughed.
Happy third day of the shutdown. The impasse on Capitol Hill continues, as Democrats refuse to budge on their demands for legal protections for young immigrants and Republicans seem unwilling to move in their direction, my tireless colleagues Robert Costa, Erica Werner, Mike DeBonis and Sean Sullivan report. After a bipartisan group of moderate senators failed to produce a compromise yesterday, buy Senate Majority Leader Mitch McConnell (R-Ky.) plans to hold a vote at about noon anyway. There was some hope building yesterday for a deal to fund the government for three weeks with a guarantee by McConnell to consider immigration legislation after that if there has been no agreement before then. But it doesn't look like we're there yet.

The effects of the shutdown were relatively limited over the weekend, but now that the workweek is starting, hundreds of thousands of workers will stay home and key federal agencies will be affected. "Federal contractors will see payments delayed, and the Internal Revenue Service will slow its preparations for the coming tax season," my colleagues writes.

Trump, who to his aides relief it seems, has remained relatively quiet during the shutdown so far. Nonetheless, the president took to Twitter this morning to blame Democrats:

The Democrats are turning down services and security for citizens in favor of services and security for non-citizens. Not good!
- Donald J. Trump (@realDonaldTrump) January 22, 2018

Democrats have shut down our government in the interests of their far left base. They don't want to do it but are powerless!
- Donald J. Trump (@realDonaldTrump) January 22, 2018

But the effects of a shutdown -- especially if it continues -- on the federal workforce, and Americans by extension, are real.

Granted, because so much of what HHS does is considered "essential," a smaller proportion of its workers are furloughed during a shutdown compared to other agencies. About 41,000 of HHS' 82,148 employees will still come to work today, according to these helpful visuals from The Post's Darla Cameron and Lisa Rein. There are five other federal agencies - Justice, Homeland Security, Veterans Affairs, Defense and Transportation - where at least half of employees are similarly considered essential.

On Friday, HHS updated its last shutdown contingency plan - issued in the fall of 2013 when the government shut down for more than two weeks as Sen. Ted Cruz (R-Tex.) demanded to defund the Affordable Care Act - with a new version. Per that document, here are five top things the agency keeps doing while the government is shuttered - and five services it halts.
Services that continue:
1. States keep getting their Medicaid payments. Federal funding for the health insurance program for the low-income population is secure through the end of June, according to the contingency plan. And because states oversee enrollment, Americans should be able to continue signing up for the program without hiccups.

2. Seniors can keep seeing the doctor. As with Medicaid, Medicare has funding sources that don't depend on Congress passing annual spending bills. Beneficiaries shouldn't much feel the effects of a shutdown, unless it is prolonged. Medicare will continue to reimburse medical providers, so coverage should continue without interruption.

3. Premium subsidies continue for Obamacare enrollees, and the marketplaces remain open for those qualifying to sign up off-season. Like Medicare and Medicaid benefits, marketplace subsidies are considered mandatory spending. And the Centers for Medicare and Medicaid Services can use leftover fees paid by health insurers to keep verifying eligibility so enrollments can continue.

4. The Food and Drug Administration continues drug reviews. That's because these reviews are paid for by fees from the pharmaceutical industry. Staffers who analyze and review medicines entering the United States would also be considered essential, according to HHS.

5. The nation's 1,400 community health centers stay open. These clinics - which provide preventive care and dental services to about 27 million low-income Americans - also enjoy mandatory spending status. But they're threatened by an underlying problem: The program has needed reauthorization by Congress since last fall, and it's unclear whether lawmakers will include that in a spending bill reopening the government.
Services that stop or slow:
1. The FDA's food-safety inspection program hits pause. "FDA will be unable to support the majority of its food safety, nutrition and cosmetics activities," the HHS contingency plan says. The exception is meat and poultry inspections carried out by the Agriculture Department's Food Safety and Inspection Service.

2. The National Institutes of Health can't enroll new patients in clinical trials or take action on grant applications. During the last shutdown, NIH turned away about 200 patients each week from its clinical research center since nearly three-fourths of its staff was furloughed. The center can only admit new patients with cases NIH Director Francis Collins deems "medically necessary."

3. No new mental health or social services grant awards and less monitoring of existing grants. The HHS departments most involved in issuing grants to health-care providers around the country would be particularly affected by the shutdown because more of their employees are furloughed. This includes the Substance Abuse and Mental Health Services Administration and the Administration for Children and Families.

4. Payments for senior nutrition programs stop. The shutdown would halt funding for federal senior nutrition programs funded through the Administration for Community Living, and would delay federal reimbursements to privately run programs such as Meals on Wheels (which services more than 2.4 million seniors across the country). But the severity of the impact on such programs depends on how long the shutdown lasts.

5. Response to this year's deadly flu outbreak could be slowed. The CDC says its "immediate response to urgent disease outbreaks, including seasonal influenza" will continue. This includes collecting data reported by states, hospitals and others. But a CDC representative told BuzzFeed News the reports could be issued at a slower rate than usual. Former CDC director Tom Frieden, who led the agency during the 2013 shutdown, told NPR the shutdown means a slower response to changes in the flu virus and less preparation among doctors to provide rapid treatment.
AHH, OOF and OUCH
AHH: A government shutdown comes at an especially inopportune time for flu season, which is particularly deadly this year per the latest data released Friday, The Post's Lena H. Sun reports. During the second week of January, more people sought care for flulike illnesses than at any comparable period in nearly a decade and 10 children died, bringing the total number of pediatric deaths this flu season to 30. More than 8,900 people have been hospitalized since the season started Oct. 1.

"The flu activity indicators are notable for the sheer volume and intensity of flu that is taking place in most of the country at the same time," Lena writes. "A federal government shutdown could complicate CDC's ability to know, in real time, whether flu cases are continuing to increase."

About 63 percent of CDC employees are furloughed, according to HHS's contingency plan. While state labs will continue to operate and monitor flu activity, test specimens and send that information to the federal agency, there may not be enough CDC epidemiologists to monitor the data and compile it, Lena reports. Additionally, there are spot shortages of prescription antiviral drugs and it's unclear whether the agency personnel working on that will be able to stay on duty during a shutdown.

OOF: In the state President Trump called a "drug-infested den" - New Hampshire - the opioid crisis is something of an obsession, the New York Times's Katharine Q. Seelye reports. New Hampshire is tied with Ohio for the state with the second-highest rate of drug overdose deaths per capita (West Virginia is first), and 53 percent of adults there say drugs are the biggest problem.

It's surprising when you consider New Hampshire's demographics. "Unlike West Virginia, New Hampshire is relatively prosperous, which makes an opioid crisis here seem all the more jarring," Katharine writes. "This state has the highest median household income in the country, ranks low in unemployment and crime, and often lands at or near the top of lists of the best states in which to live."

So why is the state's opioid problem so bad? Researchers say one big reason is the proximity to an abundant drug supply in neighboring Massachusetts and its drug distribution networks; another is the state's limited spending on addiction services. In addition, doctors in New Hampshire have long prescribed opioids at almost twice the national rate.

"This is a kind of perfect storm," Lisa Marsch, a professor of psychiatry and health policy at Dartmouth's Geisel School of Medicine, told the Times. "We have highly available, highly potent opioids in New Hampshire. And highly limited resources to reduce the risk."

OUCH: And over in neighboring Massachusetts, there's a spirited debate over the idea of "supervised injection sites" as another way to reduce overdose deaths, the AP reports. These sites are safe spaces where drug users can shoot up under the supervision of trained staff. While the Massachusetts Medical Society and the Massachusetts Hospital Association back the idea, Gov. Charlie Baker (R) is among the skeptics who don't see such sites as leading to treatment.

"As far as the data I've seen is concerned, it has not demonstrated any legitimate success in creating a pathway to treatment," Baker said at a public hearing last week. "The harm reduction argument I think is a much better one, but I'm kind of a hard sell on that one."

"In a report released last year, the medical society found supervised injection sites can reduce overdose mortality and increase access to drug treatment. Much of the research is based on two sites in Canada and Australia," Steve Leblanc writes. "The report called for the creation of a pilot supervised injection facility program in Massachusetts. The group said the state should seek an exemption from federal drug laws to pursue the pilot program and consider partnering with other states."
TRUMP TEMPERATURE
- The Trump administration may be no more willing to put more restrictions on food stamps than was the Obama administration. Although momentum is building for a ban on the purchase of candy and soda with food stamps, the Agriculture Department last week denied a request from Maine that would have placed such restrictions on its food stamp program, The Post's Caitlin Dewey reports. Now, supporters of such bans are trying to parse the meaning of the rejection.

"In its application to USDA, Maine said it would evaluate the ban's impact on soda and candy purchases but did not propose any specific monitoring of health effects," Caitlin writes. "It is not clear if USDA rejected the request because of this kind of omission or because the administration more generally opposes junk food bans."

"When considering waiver requests, USDA focuses on moving people into self-sufficient lives, protecting the integrity of the program, and improving customer service," the agency said in a statement. "We don't want to be in the business of picking winners and losers among food products in the marketplace, or in passing judgment about the relative benefits of individual food products."

--About that 24-year-old in a top Trump administration role: Taylor Weyeneth, who was appointed to a top position in the White House's drug policy office at age 23, was previously dismissed from a job at a law firm for repeatedly missing work, The Post's Robert O'Harrow Jr. reports. Weyeneth worked as a legal assistant at the New York firm O'Dwyer & Bernstien while in college, but he was "discharged" in August 2015 for being a no-show.

Brian O'Dwyer, a partner at the firm, said he hired Weyeneth in part because both men were involved in the same fraternity. He told Robert the team was "very disappointed in what happened" and that Weyeneth "just didn't show."

"In a résumé initially submitted to the government, Weyeneth said he worked at the firm until April 2016," Robert writes. "When an FBI official called as part of a background check in January 2017, the firm said Weyeneth had left eight months earlier than the résumé indicated...an administration official previously said that Weyeneth revised his résumé to correct 'errors.'" In a revised résumé, Weyeneth said he worked at the law firm from November 2014 to August 2015.

Since Robert first reported on the young appointee's rapid ascent to a top White House post, several Democratic lawmakers have expressed concern about Weyeneth and about other unfilled drug policy roles in the administration. The concern comes as Trump, who has pledged to allocate government resources toward the opioid crisis, still has not named a permanent director for his drug policy office.

"You have claimed that the opioid epidemic is a top priority for your administration, but the personnel you have staffing these key agencies - and the lack of nominees to head them - is cause for deep concern," ten lawmakers, including Sens. Maggie Hassan (D-N.H.) and Dianne Feinstein (D-Calif.), recently wrote to the president.
AGENCY ALERT
- Our colleague Tory Newmyer, who writes The Finance 202, is staking out the World Economic Forum meeting in Davos, Switzerland this week. We noticed FDA Commissioner Scott Gottlieb is among the top Trump appointees who are on the guest list. The president is also expected to attend. Sign up to receive updates from Davos in The Finance 202 here.
HEALTH ON THE HILL
--Top Senate Finance Committee Democrat Ron Wyden (Ore.) wants an investigation into whether Seema Verma, who heads the Centers for Medicare and Medicaid Services, violated ethics rules in handling Medicaid waiver requests from states she used to work with privately. Verma formerly consulted for Kentucky, Arkansas, Iowa and other states seeking permission from the federal government to enact changes to their Medicaid programs.

Wyden asked HHS's general counsel, in a letter last week, to open an ethics investigation into the matter, questioning whether she had recused herself (as she'd promised) from being involved in waiver requests with states with whom she formerly contracted.

"Administrator Verma's commitment to recuse herself from work with former clients appears to have fallen short of the mark thus far, which is extremely concerning given that many of her former clients have sought, or plan to seek, waivers to impose unprecedented work requirements in state Medicaid programs," he wrote.
--A few more good reads from The Post and beyond: MEDICAL MISSIVES INDUSTRY RX STATE SCAN OPIOID OPTICS REPRODUCTIVE WARS DAYBOOK Today

The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, hold the "National Drug and Alcohol Chat Day" web chat event.

The Alliance of Community Health Plans holds a briefing on "The Value of Medicare Advantage."

The Alliance for Strong Families and Communities, and the American Public Human Services Association host a webinar.

Coming Up

The Senate Health, Education, Labor and Pensions Committee is scheduled to hold a hearing on "Facing 21st Century Public Health Threats: Our Nation's Preparedness and Response Capabilities, Part 2" on Tuesday.

The National Institutes of Health is scheduled to hold a meeting of the National Heart, Lung, and Blood Institute's Sickle Cell Disease Advisory Committee for presentations and discussion of programs on Tuesday.

The National Institutes of Health is scheduled to hold a meeting of the National Institute of Nursing Research to discuss program policies and issues on Tuesday.

The Advisory Board holds a web conference on BPCI Advanced on Tuesday.

The Families USA Health Action Conference begins on Wednesday.

The Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations is scheduled to hold a hearing on combatting the opioid crisis on Thursday.

The National Institutes of Health is scheduled to hold a meeting of the National Advisory Mental Health Council on Thursday.

The Medicaid and CHIP Payment and Access Commission holds its January meeting starting on Thursday.

SUGAR RUSH
House Minority leader Nancy Pelosi (D-Calif.) said the military would be paid during the government shutdown:

Activists protest around the globe during the a second annual Women's March:

Saturday Night Live takes on White House doctor Navy Rear Adm. Ronny L. Jackson's report on President Trump's health:

The Daily Show with Trevor Noah on Trump's first year as president:

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Analysis | The Health 202: How the government shutdown could affect your health care (or not)

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The government shutdown isn't over Obamacare this time. But depending on how long it lasts, there will be ripple effects on health care as the Department of Health and Human Services sees half its workers furloughed. Happy third day of the shutdown.

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Who is affected by the Government shutdown?

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Who is affected by the Government shutdown?

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Employees considered essential will be required to report to work where as employees that are not will be prevented.

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Thousands of government workers are unsure whether or not they will be heading to work on Monday amid uncertainty about how long a government shutdown will last.

Uncertainty is the byproduct of a government shutdown, with its impact often hard to predict. However, clues exist in the last shutdown, which was in 2013.

Key services will continue, and many agencies plan to use carryover funds to remain open for several days. But each day the shutdown lasts adds to the pressure on agencies, government employees and civilian contractors, as well as Americans who rely on various federal services.

Employees considered "essential" will still be required to report to work should the shutdown continue, while those in positions deemed "nonessential" will be barred from coming in.

The White House on Friday pledged to minimize the effects of the shutdown on the American people, with one official noting that the administration has urged government agencies "to do as much as they can" within the law to maintain operations.

The push for departments and agencies to utilize existing funding to remain open suggests the Trump administration is hedging its bets that lawmakers can reach a deal and avoid a shutdown the length of one in 2013, which lasted 16 days.

Each federal agency has a contingency plan for a shutdown that is written with help from the White House's Office of Management and Budget. But the impact of the shutdown, which began at midnight when the Senate failed to pass a short-term spending bill, is likely to trickle down gradually as agencies work to mitigate the effects.

About half of the Department of Health and Human Services will be placed on furlough. Beneficiaries of programs like Medicare, Social Security and Medicaid will still receive services. The Food and Drug Administration, however, will take a hit, as it will have to halt activities like food safety inspections. The Centers for Disease Control and Prevention will continue "immediate response work" on influenza, according to White House budget chief Mick Mulvaney John (Mick) Michael Mulvaney Overnight Finance: Lawmakers see shutdown odds rising | Trump calls for looser rules for bank loans | Consumer bureau moves to revise payday lending rule | Trump warns China on trade deficit Overnight Regulation: Dems claim 50 votes in Senate to block net neutrality repeal | Consumer bureau takes first step to revising payday lending rule | Trump wants to loosen rules on bank loans | Pentagon, FDA to speed up military drug approvals Consumer bureau takes first step to revising payday lending rule MORE .

The National Park Service (NPS) will keep parks open, unlike in 2013, though much of its staff will not report to work. Services such as trash pickup and restroom cleaning will be halted, according to the NPS contingency plan for a shutdown.

Cybersecurity will remain a priority during the shutdown, as the government will continue to protect information technology systems, Mulvaney said Saturday at a press conference.

The Environmental Protection Agency will largely stay open during the government's closure, and the Labor Department will resume mine safety inspections.

Military personnel will be required to show up for work, but will not receive pay for as long as the shutdown lasts. Families of slain military members will experience a halt to death benefits as a result of the shutdown.

Transportation Security Administration (TSA) personnel will continue operations, meaning travelers will see both TSA employees and canines operating in airports. The Federal Aviation Administration's (FAA) management of air traffic control will also continue. Flight delays are not expected and much of the FAA's safety inspections will continue.

The government closure, a result of Congress's failed negotiations over a spending bill the last several weeks, has sparked both intraparty battles and fights between Democrats and Republicans.

The two parties have each tried to cast blame on the other for the shutdown, with the Republican National Committee invoking the hashtag #SchumerShutdown, referring to Senate Minority Leader Charles Schumer President Trump Donald John Trump Dems flip Wisconsin state Senate seat Sessions: 'We should be like Canada' in how we take in immigrants GOP rep: 'Sheet metal and garbage' everywhere in Haiti MORE is to blame for the closure, which follows failed talks over immigration and health-care funding. Charles (Chuck) Ellis Schumer Democrats will need to explain if they shut government down over illegal immigration White House: Trump remarks didn't derail shutdown talks Schumer defends Durbin after GOP senator questions account of Trump meeting MORE (D-N.Y.). Democrats say

What happens next depends on whether lawmakers reach a deal, as members of both the House and Senate have remained in Washington, D.C., to work toward an agreement to open the government.

Leaders in opposing parties on Saturday appear to be at odds over a short-term resolution to fund the government. Both chambers returned to Capitol Hill on Saturday afternoon to work toward a solution.

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Who is affected by the government shutdown?

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Thousands of government workers are unsure whether or not they will be heading to work on Monday amid uncertainty about how long a government shutdown will last. Uncertainty is the byproduct of a government shutdown, with its impact often hard to predict. However, clues exist in the last shutdown, which was in 2013.

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https://www.washingtonpost.com/news/the-fix/wp/2018/01/22/winners-and-losers-of-the-government-shutdown/?utm_term=.e6db80bb15e1

This article talks about the different people who are affected by this government shut down and how the different parties are fighting against issues. It talks about who is responsible for such a shutdown and everyone, especially the democrats who lost the shutdown are dealing with this situation.

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How can the government shutdown affect healthcare as a whole? 

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How can the government shutdown affect healthcare as a whole? 

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Certain services continue, such as states getting their medicaid payments, the FDA continues drug reviews, the nation's community health centers stay open, etc.; however, other services such as the  FDA's food safety inspection program is halted, the NIH can't enroll new patients in clinical trials,  response to this year's flu outbreak will be slowed down, etc.

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The government shutdown isn't over Obamacare this time. But depending on how long it lasts, there will be ripple effects on health care as the Department of Health and Human Services sees half its workers furloughed.
Happy third day of the shutdown. The impasse on Capitol Hill continues, as Democrats refuse to budge on their demands for legal protections for young immigrants and Republicans seem unwilling to move in their direction, my tireless colleagues Robert Costa, Erica Werner, Mike DeBonis and Sean Sullivan report. After a bipartisan group of moderate senators failed to produce a compromise yesterday, buy Senate Majority Leader Mitch McConnell (R-Ky.) plans to hold a vote at about noon anyway. There was some hope building yesterday for a deal to fund the government for three weeks with a guarantee by McConnell to consider immigration legislation after that if there has been no agreement before then. But it doesn't look like we're there yet.

The effects of the shutdown were relatively limited over the weekend, but now that the workweek is starting, hundreds of thousands of workers will stay home and key federal agencies will be affected. "Federal contractors will see payments delayed, and the Internal Revenue Service will slow its preparations for the coming tax season," my colleagues writes.

Trump, who to his aides relief it seems, has remained relatively quiet during the shutdown so far. Nonetheless, the president took to Twitter this morning to blame Democrats:

The Democrats are turning down services and security for citizens in favor of services and security for non-citizens. Not good!
- Donald J. Trump (@realDonaldTrump) January 22, 2018

Democrats have shut down our government in the interests of their far left base. They don't want to do it but are powerless!
- Donald J. Trump (@realDonaldTrump) January 22, 2018

But the effects of a shutdown -- especially if it continues -- on the federal workforce, and Americans by extension, are real.

Granted, because so much of what HHS does is considered "essential," a smaller proportion of its workers are furloughed during a shutdown compared to other agencies. About 41,000 of HHS' 82,148 employees will still come to work today, according to these helpful visuals from The Post's Darla Cameron and Lisa Rein. There are five other federal agencies - Justice, Homeland Security, Veterans Affairs, Defense and Transportation - where at least half of employees are similarly considered essential.

On Friday, HHS updated its last shutdown contingency plan - issued in the fall of 2013 when the government shut down for more than two weeks as Sen. Ted Cruz (R-Tex.) demanded to defund the Affordable Care Act - with a new version. Per that document, here are five top things the agency keeps doing while the government is shuttered - and five services it halts.
Services that continue:
1. States keep getting their Medicaid payments. Federal funding for the health insurance program for the low-income population is secure through the end of June, according to the contingency plan. And because states oversee enrollment, Americans should be able to continue signing up for the program without hiccups.

2. Seniors can keep seeing the doctor. As with Medicaid, Medicare has funding sources that don't depend on Congress passing annual spending bills. Beneficiaries shouldn't much feel the effects of a shutdown, unless it is prolonged. Medicare will continue to reimburse medical providers, so coverage should continue without interruption.

3. Premium subsidies continue for Obamacare enrollees, and the marketplaces remain open for those qualifying to sign up off-season. Like Medicare and Medicaid benefits, marketplace subsidies are considered mandatory spending. And the Centers for Medicare and Medicaid Services can use leftover fees paid by health insurers to keep verifying eligibility so enrollments can continue.

4. The Food and Drug Administration continues drug reviews. That's because these reviews are paid for by fees from the pharmaceutical industry. Staffers who analyze and review medicines entering the United States would also be considered essential, according to HHS.

5. The nation's 1,400 community health centers stay open. These clinics - which provide preventive care and dental services to about 27 million low-income Americans - also enjoy mandatory spending status. But they're threatened by an underlying problem: The program has needed reauthorization by Congress since last fall, and it's unclear whether lawmakers will include that in a spending bill reopening the government.
Services that stop or slow:
1. The FDA's food-safety inspection program hits pause. "FDA will be unable to support the majority of its food safety, nutrition and cosmetics activities," the HHS contingency plan says. The exception is meat and poultry inspections carried out by the Agriculture Department's Food Safety and Inspection Service.

2. The National Institutes of Health can't enroll new patients in clinical trials or take action on grant applications. During the last shutdown, NIH turned away about 200 patients each week from its clinical research center since nearly three-fourths of its staff was furloughed. The center can only admit new patients with cases NIH Director Francis Collins deems "medically necessary."

3. No new mental health or social services grant awards and less monitoring of existing grants. The HHS departments most involved in issuing grants to health-care providers around the country would be particularly affected by the shutdown because more of their employees are furloughed. This includes the Substance Abuse and Mental Health Services Administration and the Administration for Children and Families.

4. Payments for senior nutrition programs stop. The shutdown would halt funding for federal senior nutrition programs funded through the Administration for Community Living, and would delay federal reimbursements to privately run programs such as Meals on Wheels (which services more than 2.4 million seniors across the country). But the severity of the impact on such programs depends on how long the shutdown lasts.

5. Response to this year's deadly flu outbreak could be slowed. The CDC says its "immediate response to urgent disease outbreaks, including seasonal influenza" will continue. This includes collecting data reported by states, hospitals and others. But a CDC representative told BuzzFeed News the reports could be issued at a slower rate than usual. Former CDC director Tom Frieden, who led the agency during the 2013 shutdown, told NPR the shutdown means a slower response to changes in the flu virus and less preparation among doctors to provide rapid treatment.
AHH, OOF and OUCH
AHH: A government shutdown comes at an especially inopportune time for flu season, which is particularly deadly this year per the latest data released Friday, The Post's Lena H. Sun reports. During the second week of January, more people sought care for flulike illnesses than at any comparable period in nearly a decade and 10 children died, bringing the total number of pediatric deaths this flu season to 30. More than 8,900 people have been hospitalized since the season started Oct. 1.

"The flu activity indicators are notable for the sheer volume and intensity of flu that is taking place in most of the country at the same time," Lena writes. "A federal government shutdown could complicate CDC's ability to know, in real time, whether flu cases are continuing to increase."

About 63 percent of CDC employees are furloughed, according to HHS's contingency plan. While state labs will continue to operate and monitor flu activity, test specimens and send that information to the federal agency, there may not be enough CDC epidemiologists to monitor the data and compile it, Lena reports. Additionally, there are spot shortages of prescription antiviral drugs and it's unclear whether the agency personnel working on that will be able to stay on duty during a shutdown.

OOF: In the state President Trump called a "drug-infested den" - New Hampshire - the opioid crisis is something of an obsession, the New York Times's Katharine Q. Seelye reports. New Hampshire is tied with Ohio for the state with the second-highest rate of drug overdose deaths per capita (West Virginia is first), and 53 percent of adults there say drugs are the biggest problem.

It's surprising when you consider New Hampshire's demographics. "Unlike West Virginia, New Hampshire is relatively prosperous, which makes an opioid crisis here seem all the more jarring," Katharine writes. "This state has the highest median household income in the country, ranks low in unemployment and crime, and often lands at or near the top of lists of the best states in which to live."

So why is the state's opioid problem so bad? Researchers say one big reason is the proximity to an abundant drug supply in neighboring Massachusetts and its drug distribution networks; another is the state's limited spending on addiction services. In addition, doctors in New Hampshire have long prescribed opioids at almost twice the national rate.

"This is a kind of perfect storm," Lisa Marsch, a professor of psychiatry and health policy at Dartmouth's Geisel School of Medicine, told the Times. "We have highly available, highly potent opioids in New Hampshire. And highly limited resources to reduce the risk."

OUCH: And over in neighboring Massachusetts, there's a spirited debate over the idea of "supervised injection sites" as another way to reduce overdose deaths, the AP reports. These sites are safe spaces where drug users can shoot up under the supervision of trained staff. While the Massachusetts Medical Society and the Massachusetts Hospital Association back the idea, Gov. Charlie Baker (R) is among the skeptics who don't see such sites as leading to treatment.

"As far as the data I've seen is concerned, it has not demonstrated any legitimate success in creating a pathway to treatment," Baker said at a public hearing last week. "The harm reduction argument I think is a much better one, but I'm kind of a hard sell on that one."

"In a report released last year, the medical society found supervised injection sites can reduce overdose mortality and increase access to drug treatment. Much of the research is based on two sites in Canada and Australia," Steve Leblanc writes. "The report called for the creation of a pilot supervised injection facility program in Massachusetts. The group said the state should seek an exemption from federal drug laws to pursue the pilot program and consider partnering with other states."
TRUMP TEMPERATURE
- The Trump administration may be no more willing to put more restrictions on food stamps than was the Obama administration. Although momentum is building for a ban on the purchase of candy and soda with food stamps, the Agriculture Department last week denied a request from Maine that would have placed such restrictions on its food stamp program, The Post's Caitlin Dewey reports. Now, supporters of such bans are trying to parse the meaning of the rejection.

"In its application to USDA, Maine said it would evaluate the ban's impact on soda and candy purchases but did not propose any specific monitoring of health effects," Caitlin writes. "It is not clear if USDA rejected the request because of this kind of omission or because the administration more generally opposes junk food bans."

"When considering waiver requests, USDA focuses on moving people into self-sufficient lives, protecting the integrity of the program, and improving customer service," the agency said in a statement. "We don't want to be in the business of picking winners and losers among food products in the marketplace, or in passing judgment about the relative benefits of individual food products."

--About that 24-year-old in a top Trump administration role: Taylor Weyeneth, who was appointed to a top position in the White House's drug policy office at age 23, was previously dismissed from a job at a law firm for repeatedly missing work, The Post's Robert O'Harrow Jr. reports. Weyeneth worked as a legal assistant at the New York firm O'Dwyer & Bernstien while in college, but he was "discharged" in August 2015 for being a no-show.

Brian O'Dwyer, a partner at the firm, said he hired Weyeneth in part because both men were involved in the same fraternity. He told Robert the team was "very disappointed in what happened" and that Weyeneth "just didn't show."

"In a résumé initially submitted to the government, Weyeneth said he worked at the firm until April 2016," Robert writes. "When an FBI official called as part of a background check in January 2017, the firm said Weyeneth had left eight months earlier than the résumé indicated...an administration official previously said that Weyeneth revised his résumé to correct 'errors.'" In a revised résumé, Weyeneth said he worked at the law firm from November 2014 to August 2015.

Since Robert first reported on the young appointee's rapid ascent to a top White House post, several Democratic lawmakers have expressed concern about Weyeneth and about other unfilled drug policy roles in the administration. The concern comes as Trump, who has pledged to allocate government resources toward the opioid crisis, still has not named a permanent director for his drug policy office.

"You have claimed that the opioid epidemic is a top priority for your administration, but the personnel you have staffing these key agencies - and the lack of nominees to head them - is cause for deep concern," ten lawmakers, including Sens. Maggie Hassan (D-N.H.) and Dianne Feinstein (D-Calif.), recently wrote to the president.
AGENCY ALERT
- Our colleague Tory Newmyer, who writes The Finance 202, is staking out the World Economic Forum meeting in Davos, Switzerland this week. We noticed FDA Commissioner Scott Gottlieb is among the top Trump appointees who are on the guest list. The president is also expected to attend. Sign up to receive updates from Davos in The Finance 202 here.
HEALTH ON THE HILL
--Top Senate Finance Committee Democrat Ron Wyden (Ore.) wants an investigation into whether Seema Verma, who heads the Centers for Medicare and Medicaid Services, violated ethics rules in handling Medicaid waiver requests from states she used to work with privately. Verma formerly consulted for Kentucky, Arkansas, Iowa and other states seeking permission from the federal government to enact changes to their Medicaid programs.

Wyden asked HHS's general counsel, in a letter last week, to open an ethics investigation into the matter, questioning whether she had recused herself (as she'd promised) from being involved in waiver requests with states with whom she formerly contracted.

"Administrator Verma's commitment to recuse herself from work with former clients appears to have fallen short of the mark thus far, which is extremely concerning given that many of her former clients have sought, or plan to seek, waivers to impose unprecedented work requirements in state Medicaid programs," he wrote.
--A few more good reads from The Post and beyond: MEDICAL MISSIVES INDUSTRY RX STATE SCAN OPIOID OPTICS REPRODUCTIVE WARS DAYBOOK Today

The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, hold the "National Drug and Alcohol Chat Day" web chat event.

The Alliance of Community Health Plans holds a briefing on "The Value of Medicare Advantage."

The Alliance for Strong Families and Communities, and the American Public Human Services Association host a webinar.

Coming Up

The Senate Health, Education, Labor and Pensions Committee is scheduled to hold a hearing on "Facing 21st Century Public Health Threats: Our Nation's Preparedness and Response Capabilities, Part 2" on Tuesday.

The National Institutes of Health is scheduled to hold a meeting of the National Heart, Lung, and Blood Institute's Sickle Cell Disease Advisory Committee for presentations and discussion of programs on Tuesday.

The National Institutes of Health is scheduled to hold a meeting of the National Institute of Nursing Research to discuss program policies and issues on Tuesday.

The Advisory Board holds a web conference on BPCI Advanced on Tuesday.

The Families USA Health Action Conference begins on Wednesday.

The Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations is scheduled to hold a hearing on combatting the opioid crisis on Thursday.

The National Institutes of Health is scheduled to hold a meeting of the National Advisory Mental Health Council on Thursday.

The Medicaid and CHIP Payment and Access Commission holds its January meeting starting on Thursday.

SUGAR RUSH
House Minority leader Nancy Pelosi (D-Calif.) said the military would be paid during the government shutdown:

Activists protest around the globe during the a second annual Women's March:

Saturday Night Live takes on White House doctor Navy Rear Adm. Ronny L. Jackson's report on President Trump's health:

The Daily Show with Trevor Noah on Trump's first year as president:

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Analysis | The Health 202: How the government shutdown could affect your health care (or not)

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The government shutdown isn't over Obamacare this time. But depending on how long it lasts, there will be ripple effects on health care as the Department of Health and Human Services sees half its workers furloughed. Happy third day of the shutdown.

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It's down to the wire for President Trump and Republican lawmakers to come up with a plan for the thousands of young, undocumented immigrants living in the U.S.

Earlier in January, Trump held a publicized, bipartisan meeting with lawmakers to discuss continuing protections for those who fell under the Deferred Action for Childhood Arrivals (DACA) program and broader immigration reform.

But Trump recently tweeted that DACA is "probably dead because the Democrats don't really want it."

The Trump administration officially announced its plan to phase out DACA - which provides a level of amnesty to certain undocumented immigrants, many of whom came to the U.S. as children - with a six-month delay for recipients in 2017.

A federal judge temporarily blocked the administration's decision to halt the program as lawsuits play out in court. U.S. District Judge William Alsup said lawyers in favor of DACA clearly demonstrated that young immigrants "were likely to suffer serious, irreparable harm" without court action.

What is the DACA program?

The DACA program was formed through executive order by former President Barack Obama in 2012 and allowed certain people, called Dreamers, who came to the U.S. illegally as minors to be protected from immediate deportation. Recipients were able to request "consideration of deferred action" for a period of two years, which is subject to renewal.

"Deferred action is a use of prosecutorial discretion to defer removal action against an individual for a certain period of time," U.S. Citizenship and Immigration Services stated. "Deferred action does not provide lawful status."

Individuals were able to request DACA status if they were under the age of 31 on June 15, 2012, came to the U.S. before turning 16 and continuously lived in the country since June 15, 2007.

Individuals also had to have a high school diploma, GED certification, been honorably discharged from the military or still be in school. Recipients could not have a criminal record.

It did not provide "legal status."

How many people are affected by DACA?

Nearly 800,000 undocumented youth are under the program's umbrella.

Thousands of people could lose their jobs if the DACA program is rescinded permanently, according to a study by the left-leaning think tank, the Center for American Progress.

Daniel Garza, president of the conservative immigration nonprofit Libre Initiative, told Fox News that DACA offers a "reprieve from a life of uncertainty for innocent kids who didn't break the law."

"It's rather disappointing to think they could return to a state of anxiety and fear," he said.

Why did the Trump administration dismantle it?

During the presidential campaign, Trump referred to DACA as "illegal amnesty." However, he seemingly signaled that he had softened his stance on the program last year when he told the Associated Press that DACA recipients could "rest easy."

Then-Acting Homeland Security Secretary Elaine Duke said in September 2017 that DACA would be phased out for current recipients, and no new requests would be granted.

Republicans - and some Democrats - opposed Obama's order from the start as a perceived overreach of executive power.

"The point here is ... the president does not have the authority to waive immigration law, nor does he have the authority to create it out of thin air," Rep. Steve King, R-Iowa, said at the time.

King has remained a stalwart Republican against the program; he suggested in August that DACA recipients should turn their parents in to federal immigration authorities.

Obama spoke out on social media after the Trump administration's announcement, stating that it's "self-defeating ... and it is cruel" to end the DACA program, and questioned the motive behind the decision.

One thing to consider: the decision to end DACA could toss a wrench into Trump's other immigration plans, including securing the border wall, Capitol Hill aides told the Washington Examiner.

Do any DACA recipients serve in the military?

Despite some rumors circulating online to the contrary, Dreamers were eligible to serve in the U.S. military since 2014 when the Pentagon adopted a policy to allow a certain amount of undocumented immigrants to join.

In the fiscal year 2016, 359 DACA recipients had enlisted in the Army - which is the only branch to accept immigrants of this category.

A Department of Defense official said in April 2017 that the military would continue to accept noncitizen recruits, but it is unclear if that will continue to be the case.
The Associated Press contributed to this report.
Kaitlyn Schallhorn is a Reporter for Fox News. Follow her on Twitter @K_Schallhorn.

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What is DACA and why is the Trump administration ending it?

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It's down to the wire for President Trump and Republican lawmakers to come up with a plan for the thousands of young, undocumented immigrants living in the U.S. Earlier in January, Trump held a publicized, bipartisan meeting with lawmakers to discuss continuing protections for those who fell under the Deferred Action for Childhood Arrivals (DACA) program and broader immigration reform.