THE PROGNOSIS

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:

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:

Paramedics were called Friday morning to Supreme Court Justice Sonia Sotomayor's apartment, where she was treated for low blood sugar.
Politico
MEDICAL MISSIVES
The Switch
The new humblebrag: ‘I’m not looking at my smartphone’
Geoffrey A. Fowler
INDUSTRY RX
The Switch
The new humblebrag: ‘I’m not looking at my smartphone’
Geoffrey A. Fowler
STATE SCAN
Health & Science
Kentucky’s governor foresees a more self-reliant state. But losing Medicaid, one woman says, is “not the way to get out of poverty.”
Amy Goldstein
OPIOID OPTICS
Arts and Entertainment
Tom Petty died of an accidental drug overdose, according to coroner's report
Marwa Eltagouri
REPRODUCTIVE WARS
The Trump administration is overturning Obama-era advisories aimed at preventing states from cutting Medicaid funding to Planned Parenthood.
Washington Examiner
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: