After Congress failed to pass a funding bill, the government shut down early Wednesday morning, which has significant implications for healthcare, including the future of telehealth flexibilities and Affordable Care Act (ACA) coverage.
The shutdown has sparked strong backlash from the healthcare community. Patient advocacy group Families USA, for example, criticized Congressional leaders for not extending the ACA’s enhanced premium tax credits.
These enhanced subsidies (which are set to expire at the end of the year) were introduced in 2021 and lowered monthly premiums for those who buy coverage on the marketplaces. The subsidies are a key sticking point between Democrats and Republicans, with Democrats calling for an extension, while Republicans say negotiations should happen after the funding is approved.
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“We shouldn’t need a shutdown to prevent a massive spike in health insurance premiums. After an election on affordability, Republican leaders are betraying their own voters with their willingness to shut down the government to avoid extending tax credits that help more than 20 million working-class Americans afford health care,” said Anthony Wright, executive director of Families USA. “When Republicans in Congress passed huge, permanent tax credits for billionaires and big corporations this summer, they blocked multiple attempts and amendments to similarly extend the tax credits that help working families pay their health insurance premiums.”
According to KFF, if the enhanced subsidies expire, out-of-pocket premium payments would increase by 114%, from $888 on average in 2025 to $1,904 in 2026.
Another key issue with the shutdown is the expiration of the Medicare telehealth flexibilities, which expired on Tuesday and will remain expired unless Congress includes them in the next funding bill. The flexibilities introduced during the Covid-19 pandemic broadened Medicare eligibility for virtual care, which had previously been limited to patients in rural areas and required them to be at an approved originating site, such as a hospital or physician’s office. Now that the flexibilities have expired, Medicare telehealth coverage will return to its pre-pandemic requirements.
The American Telemedicine Association is calling for Trump and Congress to restore these flexibilities and retroactively reimburse providers still offering telehealth services during the shutdown.
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“Most providers and hospital systems are taking calculated risks to continue care during this time, but long-term continuity depends on action by our telehealth champions in Washington to restore these flexibilities and ensure retroactive reimbursement,” said Kyle Zebley, executive director of ATA Action and senior vice president of public policy at the ATA, in a statement. “Medicare patients woke up this morning without telehealth coverage for the first time since the pandemic, five years ago. Our healthcare services are regressing, falling woefully short for millions of patients in need.”
An executive for a brain health company also expressed concern over the uncertainty of Medicare telehealth flexibilities.
“Most likely telehealth benefits will be extended, but we are getting a lot of questions both from our employees and patients on where they stand,” said Dr. Julius Bruch, co-founder and CEO of Isaac Health. “In an area like dementia care, where there are already so few neurologists, and not nearly enough to care for the aging population, telehealth works wonders to increase access, and the potential of this going away could be detrimental for not only patients with dementia, but for their caregivers, and other loved ones.”
Another industry follower is worried about how the shutdown will affect those who depend on government-funded programs, such as the Supplemental Nutrition Assistance Program (SNAP).
“If this shutdown lasts more than a month, which is a possibility given the last shutdown was 34 days, those experiencing food insecurity across the country may see a lapse in SNAP benefits, as government funding for the program will only last about a month. We risk creating more non-medical barriers to health, like lack of access to food or transportation to doctor appointments, which can account for up to 80% of a person’s health,” said Cindy Jordan, CEO and co-founder of Pyx Health, an engagement company.
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