As the federal government shutdown enters its fourth week, pressure is mounting on the nation’s healthcare infrastructure. Paychecks have been halted for more than 1 million federal employees, critical agencies such as CMS are scrambling to maintain operations, and national disease surveillance efforts are beginning to fracture — just as the U.S. heads into the respiratory virus season.
Three things to know:
1. The federal government shutdown enters its fourth week and funding delays are now directly affecting large swaths of the healthcare workforce and related support systems. More than 1 million civilian federal employees and military personnel — including those at HHS and the Department of Veterans Affairs — have begun missing their paychecks, with the first wave occurring on Oct. 24 and more to follow by Oct. 30, according to a report by the Bipartisan Policy Center. If the shutdown stretches into December, an estimated 4.5 million paychecks totaling $21 billion in lost wages will be withheld.
2. The White House has suggested it may not provide back pay for furloughed federal workers, but the Internal Revenue Service has said it will be guaranteed, according to Axios. In a notable reversal, CMS recalled all furloughed employees on Oct. 27 to support Medicare and ACA Marketplace open enrollment efforts. Nearly half of the agency’s 7,700-person workforce had been furloughed since Oct. 1.
To fund the move, the agency is drawing on user fees collected from researchers accessing CMS data, with plans to reimburse the account once appropriations resume. The decision comes amid mounting pressure to stabilize key healthcare functions as disruptions and delays in telehealth reimbursement and hospital-at-home programs continue to ripple across the system.
3. In the 2024-25 respiratory virus season, the CDC confirmed 70 human cases of bird flu and one death during an outbreak spanning millions of poultry animals, dairy cows and wild birds. Last year marked the first time bird flu spread to humans.
This virus season has not recorded a human case so far, but the U.S. Department of Agriculture has confirmed increasing avian flu illnesses among commercial and backyard flocks, and wild birds, since the summer.
As the government shutdown crawls without an end in sight, national reporting on the 2025-26 virus season could see a hiccup. The CDC has paused its Morbidity & Mortality Weekly Report during the shutdown, prompting The New England Journal of Medicine and the Center for Infectious Disease Research and Policy at the University of Minnesota to develop a new publication on public health outbreaks and emerging diseases.
In May, HHS revoked funding for Moderna’s efforts to develop a human avian flu vaccine. This move, combined with the lack of federal oversight on bird flu, could hinder the nation’s response to another outbreak.
