Government shutdown stalls healthcare access, freezes Medicare telehealth, hospital-at-home services

Editor's Note

A federal shutdown has halted critical healthcare programs, disrupted Medicare telehealth and hospital-at-home coverage, and escalated partisan conflict over the Affordable Care Act (ACA) and Medicaid, multiple outlets report, including HealthLeaders October 1 and KFF Health News. The budget impasse reportedly is leaving both patients and providers in limbo, with Democrats and Republicans trading blame while vital services are suspended.

At the center of the stalemate is the ACA. Democrats are pushing to extend expanded subsidies that cap household spending on ACA marketplace premiums, set to expire at year’s end. Without renewal, millions face higher premiums and reduced eligibility for assistance, with insurers already warning of steep hikes. Republicans insist any extension must follow a broader budget deal and may include reforms such as altering income caps or no-premium plan availability. The timing is particularly consequential as ACA open enrollment begins November 1.

The shutdown’s reach extends beyond insurance. The Department of Health and Human Services expects to furlough about 40% of its workforce, while the CDC’s disease surveillance and response to state health departments are paused. New drug applications are on hold at the FDA, food safety oversight is scaled back, and research on drug pricing under the Inflation Reduction Act has stopped. At the National Institutes of Health, some patients awaiting experimental treatments cannot be admitted, and certain federal health safety programs have been suspended. Community health centers also face funding risks if the closure drags on.

Medicare telehealth flexibilities and the Acute Care Hospital at Home program, both widely used since the pandemic, expired on September 30 when their funding lapsed, Axios October 1 reports. As a result, hospitals had to discharge patients from at-home care programs or transfer them back into inpatient units, straining facilities already under pressure. Providers can technically continue delivering telehealth services, but Medicare will not reimburse them during the shutdown unless Congress later authorizes retroactive payment. While rural telehealth coverage tied to in-clinic visits remains intact, many systems are cutting off seniors’ access or holding claims in the hope of future reimbursement.

Both programs enjoy bipartisan support, but permanent funding carries steep costs, and their renewal has become entangled in the broader budget fight. Democrats refused to back Republican funding proposals that extended telehealth but did not preserve ACA subsidies, while GOP leaders accused Democrats of jeopardizing care for political leverage.

With 750,000 federal employees furloughed and essential health services suspended, the longer the standoff continues, the deeper the disruptions for patients, providers, and public health infrastructure.