A doctor in Buffalo wants to be able to help more opioid addicts, but the government shutdown stands in his way.
Landlords worry about losing the rent subsidies that help nearly 20,000 low-income families afford a place to live.
In Buffalo and beyond, businesses find themselves unable to get the government-backed business loans they expected.
And in Geneseo, a farmer expects to miss out on nearly $45,000 in income the government had promised him to compensate for his losses from President Trump's trade war with China.
Those are just some of the increasingly wide-ranging effects of the three-week-old shutdown that is now the nation's longest ever.
The federal operations that people see on a daily basis — the mail delivery people, the customs agents at the Peace Bridge, the Transportation Security Administration agents at the Buffalo Niagara International Airport — continue to work every day, even though Customs and TSA agents are among the essential federal personnel working without pay during the shutdown.
But behind the scenes, in a number of unexpected ways, the shutdown is putting a crimp in everything from health care to daily business operations.
Here's a survey of what's happening as the shutdown's impact stretches from city to country:
A doctor, hamstrung
Dr. Anthony Martinez of Buffalo sees the ravages of the opioid crisis on a daily basis. And he's been able to help 95 of his patients by prescribing suboxone, a drug that helps wean addicts off opioids.
But that's a daunting number to Martinez. The federal government mandates that doctors prescribe to suboxone to no more than 100 patients unless they apply for a waiver that can allow them to give the drug to up to 275 people.
Martinez has applied for such a waiver, but with the Substance Abuse and Mental Health Services Administration shut down, his application is going nowhere. So he expects to meet his quota of 100 suboxone patients next week — and to not be able to help others who need the drug after that.
"This sheds a light on the fact that the shutdown is not just about the government, but that it has the potential to be a public health problem," said Martinez, an associate professor of medicine at the University at Buffalo who practices at Erie County Medical Center.
The opioid epidemic has been a public health problem for years, but Martinez fears the shutdown could make it worse in Buffalo and nationwide. After all, other doctors elsewhere are likely faced with the same cap and the same situation.
"We have precious few slots available and a large wait list of patients waiting on treatment," said Martinez, who noted that Buffalo experienced nine overdoses and three opioid deaths last weekend alone. "This shutdown has now reached Americans waiting on therapy and is a literal life-and-death situation for some."
A pending housing crisis
Thousands of apartments across Buffalo don't really look like government housing, but in effect, they are. They're part of the Department of Housing and Urban Development's Section 8 housing program, which subsidizes rent for low-income residents in many properties.
Now, though, the department known as HUD is shut down — and the Section 8 program, which serves more than 20,000 families in Erie and Niagara counties, is in danger of being starved of funds.
That's a huge concern to Michael Riegel, president of Belmont Housing Resources for WNY, which works with landlords who manage nearly 7,000 properties.
"We're set through February, but if no money comes in for March, we're in serious trouble," Riegel said. "In that case, the landlords won't get their federal share of the rent. So they could end up evicting tenants or charging them the whole rent."
Section 8 housing tenants couldn't afford that, obviously, which is why such a prolonged shutdown could even prompt an increase in homelessness.
And it's not just tenants who live in Section 8 housing who have to worry, either. Gillian Brown, executive director of the Buffalo Municipal Housing Authority, said his agency would have to start dipping into its reserves if the shutdown continues and the agency doesn't get its regular federal subsidy by March.
What's more, maintenance problems have plagued some Buffalo housing projects — and HUD housing inspectors have been on furlough since before Christmas. Brown noted that the inspector general auditors who were examining the agency haven't been seen since before Christmas, either.
Business loans blocked
For decades, entrepreneurs have turned to their local lenders — and to the Small Business Administration's loan guarantee programs — for help.
But because of the shutdown, that government help has disappeared. And that means businesses aren't getting the money they need to get going.
At M&T Bank — the region's largest small business lender — 25 SBA-backed loans, worth a total of $4.3 million, remain in limbo in Western New York.
"They cannot be processed until the shutdown ends," said Eric Feldstein, the head of M&T's business banking division.
Similarly, the Bank of Akron — an active business lender to the east of Buffalo — reports 10 loans in limbo.
Officials at both banks said they are working with customers to to try to devise lending packages that can go forward without the SBA guarantee, which greatly reduces the risks that local lenders face.
"We're trying to restructure deals to eliminate any wait," said Tony Delmonte, president and CEO of the Bank of Akron.
But lenders can only do so much without government backing for the riskier loans. That's why Rep. Nydia M. Velazquez, a Bronx Democrat who chairs the House Small Business Committee, wrote to SBA Administrator Linda McMahon Friday demanding answers about how the shutdown is affecting small business lending.
Among businesspeople seeking help from the SBA, "the level of anxiety is unprecedented," Velazquez told The Washington Post.
The shutdown is the second government-inflicted blow to Brad Macauley's soybean and dairy farm in Geneseo.
First came Trump's trade war with China, which the president started with a round of tariffs on Chinese exports last year. China quickly retaliated with a set of tariffs of its own, including levies on soybeans: Macauley's cash crop.
China's purchase of American-grown soybeans quickly plummeted, costing Macauley's farm and soybean farms nationwide a huge chunk of their business. Hoping to ease the pain, the Trump administration set up an $11 billion cash assistance program for soybean growers.
Macauley expected to get a $99,000 federal payment. He got the first half of that money a few months ago, but the second half is now suspended, along with most of the Department of Agriculture's operations.
"That money would definitely help, without a doubt," said Macauley, who employs about 11 on his 1,000-acre farm.
Money is tight not only because of the loss of the soybean trade with China, but also because of falling milk prices, he noted.
But he sounded more concerned about the tariffs Trump imposed than the loss of the government help he expected before the shutdown.
"We'd rather have trade, not aid," Macauley said. "When you put restrictions on capitalism, it's just not capitalism anymore."