What the government reopening means for healthcare

After a record-setting 43-day shutdown, the government reopened Nov. 13 with a law that includes a number of healthcare measures.

From the insurance subsidies at the center of the debate that kept the shutdown raging on to policies around telehealth and hospital-at-home care, healthcare has been front and center in Washington lately.

Healthcare Brew broke down the healthcare measures included in the stopgap funding law, which funds the government through Jan. 30.

ACA premium tax credits

A key factor in the government shutdown was a disagreement between Democrats and Republicans over expanding 2021 enhanced Affordable Care Act (ACA) premium subsidies.

Democrats wanted to extend the premium subsidies, which make ACA marketplace plans more affordable for people with incomes over 400% of the federal poverty line, while Republicans wanted to let them expire at the end of the year.

Democrats had vowed not to end the shutdown until Republicans agreed to an extension. However, the funding law doesn’t include one. Rather, Republicans promised to vote on extending the subsidies by Dec. 12, NBC News reported.

Without the subsidies, Cynthia Cox, VP and director of the Program on the ACA for KFF, said insurance premiums are expected to spike as much as 114% for the more than 24 million people enrolled in marketplace plans, NPR reported in October. Providers would likely also lose tens of billions in revenue, according to the nonprofit Robert Wood Johnson Foundation. And the Congressional Budget Office (CBO) estimated that nearly 4 million more people will be uninsured by 2035.

The CBO also estimated that extending subsidies would be expensive, costing the government $350 billion over 10 years.

Telehealth

Telehealth flexibilities that allowed more Medicare patients to be seen virtually lapsed on Oct. 1, but the new funding law temporarily extends them through the end of January.

Virtual visits have become a significant part of Medicare since the Covid-19 pandemic, with 25% of beneficiaries using telehealth in 2024, according to data from the Centers for Medicare and Medicaid Services.

The new law also gives back pay to clinicians who provided certain telehealth services during the shutdown, Axios reported.

However, telehealth visits dropped sharply during the shutdown. The percentage of Medicare fee-for-service visits done virtually fell by 24% from Oct. 1 to Oct. 17 compared to July through September, according to an analysis from Brown University’s Center for Advancing Health Policy Through Research.

And telehealth advocates aren’t satisfied with the short-term extension.

“Short-term, and even year-to-year, extensions are no longer sustainable for a care model that is now central to how America delivers healthcare,” Chris Adamec, executive director of the telehealth advocacy group Alliance for Connected Care, said in a statement shared with Healthcare Brew. “Telehealth is an integrated part of care delivery, and the current system needs to reflect that.”

Hospital at home

Congress also granted more flexibility to hospital-at-home services for Medicare patients during the pandemic. Those flexibilities expired on Sept. 30, but were extended through January with the funding law.

The Acute Hospital Care at Home program, created in November 2020, allowed hospitals with a waiver to be paid the same Medicare rate for providing certain types of care in the home as they would for providing the services in the hospital.

In response to the shutdown, health systems delayed starting or expanding hospital-at-home programs, according to Modern Healthcare. Stephen Dorner, chief of clinical operations and medical affairs for Mass General Brigham’s Healthcare at Home program, reportedly told the publication the temporary extension is only adding more uncertainty to the program’s future.

Other healthcare changes

A number of other healthcare measures were included in the government funding bill, including extending funding for community health centers, delaying payment cuts to Medicaid disproportionate share hospitals, and boosting funding to implement the No Surprises Act.

Plus, a provision was included that could make it easier for drug companies to apply to switch a drug from prescription-only to over the counter, Endpoints News reported.

The White House will also no longer look to Medicare to find room for about $500 billion in cuts as required under the One Big Beautiful Bill, according to Modern Healthcare—at least for now.