The recent government shutdown, the longest in American history, dominated national headlines for its impact on the lives of 800,000 federal workers and their families. The shutdown’s effects made waves across the nation, extending beyond furloughed workers to government contractors, small businesses and all Americans who depend on a functioning government, whether that is to travel safely by air, get a loan or receive a tax refund. With the threat of another government shutdown looming, it is important to remember what is at stake. The shutdown not only withheld the paychecks of hundreds of thousands of federal employees, but also jeopardized the health and wellbeing of thousands of individuals with complex health and social needs. It also left a lasting impact on the overall health of the nation.

In some cases, the impact on health was due to a loss of health care services. Many major health programs were unaffected by the shutdown, but for those that were the impact was severe.  Health services for Native Americans were deeply impacted. In some areas, the lapse in funding for Indian Health Services caused clinics serving indigenous people to face the possibility of suspending services.

Furloughed federal workers also saw direct impacts on their access to health care due to missed paychecks. Some workers rationed their prescriptions until they could be paid again, while others were unable to get proper treatment or complete diagnostic testing. Delaying treatment and rationing medication could leave a lasting impact on an individual’s health beyond the shutdown.

The impact of the shutdown for people with complex health and social needs extended beyond the loss of health care. As we know, services the doctor’s office or the hospital provide are not the only driver of health. Social and economic factors, such as housing and food, are also important drivers of health and in this regard, the impacts of the shutdown were profound.

Funding for several Department of Housing and Urban Development (HUD) programs either lapsed or expired, which imperiled more than 70,000 low-income renters. Affected programs included Section 8 Project-Based Rental Assistance (which allows low-income families, seniors and individuals with disabilities to afford housing in the private market), Section 202 Housing for the Elderly (which subsidizes supportive housing for low-income seniors), disaster relief funding and rural housing assistance. Lapses in government contracts with private property owners meant that many individuals faced having to cover the subsidized portion of their rent out of pocket and forgo other necessities, or risk eviction and possible homelessness.

Shelters that served individuals experiencing homelessness lost federal funding (particularly domestic violence shelters since Congress didn’t reauthorize funding for the Violence Against Women Act prior to the shutdown) and were forced to consider cutting staff or tapping into emergency reserves in order to make sure services continued without interruption. With frigid winter temperatures occurring throughout January, forcing individuals to sleep outdoors could have resulted in illness, injury or even death.

Food assistance is another critical support for low-income families and older adults, and the shutdown jeopardized the Supplemental Nutrition Assistance Program (SNAP), the Supplemental Nutrition Program for Women, Infants and Children (WIC), as well as the school lunch program that serves 22 million children. Funding for SNAP and WIC were set to run out if the shutdown had continued into March. These programs are vital for fighting food insecurity, particularly among families with children and low-income seniors. The shutdown risked nutrition assistance for over 40 million people nationwide (approximately 1 in 8 people in the United States)

The extended government shutdown shined a spotlight on the important role government plays in providing services that meet the basic needs of millions of Americans, especially those with complex health and social needs, and the impact these unmet needs have on the health of our nation. We hope policymakers will remember the very human costs that come with shutting down the federal government, and stop using federal funding deadlines as a lever for resolving policy differences.