The Senate on Oct. 20 again voted against reopening the federal government, marking the 11th failed attempt to pass a House-approved funding measure. The move extends the shutdown into its 20th day — now the third-longest in modern U.S. history — with mounting consequences for the healthcare sector, including rising insurance premiums, stalled federal programs, delayed paychecks and growing data blind spots amid virus season.
ACA subsidies remain a sticking point
Enhanced ACA subsidies remain central to the impasse. During an Oct. 19 appearance on Face the Nation, Sen. Mark Kelly, D-Ariz., said the shutdown could end this week if Republicans agree to negotiations around extending the tax credits. “We should be able to wrap this up this week, if they will sit down and have a negotiation with us,” he said.
“The President has spent one hour negotiating this issue with leadership in Congress. That’s it; one hour,” Mr. Kelly said. “They need to get in a room and stay in a room until we can hash this out. The president has said he wants to fix this [ACA] premium thing and he wants the government open. That’s what we want.”
The tax credits have helped make ACA marketplace coverage more affordable for millions of Americans. Without congressional action, premiums are set to spike on Nov. 1, with some payers already requesting double-digit hikes. The Urban Institute projects that 4.8 million people would lose coverage if the subsidies lapse, with rural and safety-net hospitals absorbing much of the impact.
The effects are already being felt. Several states — including California, New York and Maryland — have already posted sharp increases in 2026 ACA premiums, according to The New York Times. KFF estimates the average subsidized premium could rise 93% without congressional intervention. In Mississippi, for example, 99% of ACA enrollees currently receive enhanced subsidies, making it particularly vulnerable to fallout.
While Democrats continue to push for an extension of the credits before reopening the government, Republicans — including Senate Majority Leader John Thune — have said they are only willing to discuss the issue after the shutdown ends.
“We are happy to have the conversation about the unaffordability of Obamacare and how to address it, but not while the government is being held hostage,” Mr. Thune wrote in an Oct. 20 post on X. “Open the government. Open the discussions.”
Disruptions ripple across healthcare programs
Hospital leaders are also warning about the consequences of stalled federal programs. Telehealth flexibilities expired Oct. 1, prompting uncertainty about Medicare reimbursement for virtual care and hospital-at-home models. About 30% of hospitals have halted Medicare telehealth services, and many have discharged or transferred hospital-at-home patients to traditional facilities as reimbursement expired. The American Telemedicine Association has described the situation as a “climate of confusion and hesitation,” with hospitals providing care at financial risk, and is hoping that Congress eventually acts retroactively.
Some medical institutions are also experiencing direct operational strain. Effective Oct. 1, HHS furloughed about 32,000 of its more than 79,000 employees. While some CDC layoffs have been reversed, job cuts have disrupted everything from vaccine distribution to disease surveillance. States including Washington and Georgia are reporting critical data gaps in flu and wastewater dashboards just as respiratory virus season begins.
Meanwhile, osteopathic medical schools — many of which operate on razor-tun margins in rural areas — face mounting uncertainty. These schools rely heavily on federal programs to fund training and research. Without clarity from Congress, efforts to expand residency programs and maintain clinical sites are being shelved.
As the shutdown approaches a fourth week, the absence of a clear resolution is straining federal operations and beginning to reshape the broader healthcare landscape.
