October 3, 2025
House Majority Leader Mike Johnson just announced that the House is not going to be in session next week as the federal government shutdown continues. Obviously House and Senate leaders will continue to discuss a continuing budget resolution deal, but it’s mostly posturing and blaming at this point, and this is usually the case with a politically-motivated shutdown that does nothing but add to the already high levels of chaos and dysfunction while average Americans suffer the consequences.
Summary: The federal government entered a shutdown at midnight on Wednesday. Democrats had pushed for an Oct. 31 extension of current funding levels, while Republicans supported a Nov. 21 plan. Neither plan ultimately won the 60 votes needed to pass the Senate, and Republican leaders said yesterday that it is unlikely that senators will be in the Capitol voting over the weekend, meaning the shutdown will likely continue into next week. Some members of Congress are still working to complete a deal, but so far it seems little progress has been made.
As it relates to telehealth, a reminder that because congressional action was not taken before Oct. 1, Medicare telehealth flexibilities that needed a statutory extension have expired. See the Department of Health and Human Services (HHS) webpage for a list of Medicare telehealth flexibilities. The Centers for Medicare and Medicaid Services (CMS) on Oct. 2 sent out a bulletin stating in part, “Absent Congressional action, beginning Oct. 1, 2025, many of the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 public health emergency will take effect again for services that are not behavioral and mental health services.”
While most behavioral health telehealth services are unaffected, one expiring flexibility that will impact many behavioral health providers and patients is the six-month in-person prerequisite for receiving telemental health services, which will now resume. As a precondition for receiving mental health telehealth services, a patient must have had an in-person appointment with a physician or practitioner within the prior six months. Established patients who began treatment while the waiver was in effect who are currently receiving behavioral health services via telehealth do not need to have an in-person visit within six months of the Sept. 30 expiration date. Additionally, when a beneficiary has a substance use disorder diagnosis or co-occurring mental health and substance use disorder diagnoses, the telehealth service is not subject to the in-person requirement.
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| House will stay out of session next week as Senate works to solve shutdown |
| By Meredith Lee Hill | 10/03/2025 03:49 PM EDT, Politico |
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The House won’t return to session next week as Speaker Mike Johnson had previously indicated, according to a notice made during Friday’s pro forma session. The move came after the Senate voted a fourth time Friday to reject a House-passed continuing resolution that would break the ongoing government shutdown. Johnson and House GOP leaders have argued that measure, which would extend federal funding through Nov. 21, is the only viable path out of the standoff. The extended recess also stands to delay the swearing-in of Rep-elect. Adelita Grijalva (D-Ariz.), who is expected to be the final required signature on a discharge petition for a bill forcing Justice Department disclosure of files related to the late sex offender Jeffrey Epstein. “Johnson and House Republicans care more about protecting the Epstein files than protecting the American people,” Senate Minority Leader Chuck Schumer said after the schedule announcement Friday. |
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Politico, 10/3 at 3:30:
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The government shutdown will go into a second week. Senators rejected another opportunity Friday to reopen agencies and are now out of session until Monday, when leadership is expected to force a fifth vote on a House-passed proposal to fund the government through Nov. 21. The stalemate comes as the fallout from the shutdown is growing: White House budget director Russ Vought announced Friday he was targeting funding in Illinois, another largely Democratic state, following cuts made earlier in the week to infrastructure projects in New York. The administration is also on the precipice of enacting its widely telegraphed plans to carry out mass firings of federal employees. So far, however, congressional leaders and the White House are locked in a cold war, with no sign that, left to their own devices, they would be able to find a way to reopen the government anytime soon. Senate Majority Leader John Thune played down the chances of a rumored meeting Friday with Minority Leader Chuck Schumer, saying he didn’t think it would be productive unless the top Senate Democrat is ready to declare a detente. “I don’t think there’s at this point a lot to negotiate, and I think at this point a lot of the more productive conversations are happening outside of the leader’s office,” Thune said Friday. That was a reference to a bipartisan group of rank-and-file senators that has been talking for days about finding a path out of the shutdown. But while those conversations are ongoing, involved GOP senators said Friday, they don’t believe enough Democrats are ready to break ranks with party leadership to support the House-passed stopgap bill. “I’m not optimistic that we have the numbers at this stage of the game, but it really depends on if any of our colleagues want to get to yes,” said Sen. Mike Rounds (R-S.D.). Sen. Jeanne Shaheen of New Hampshire, a key player on the Democratic side, said only, “We’re talking.” She was spotted huddling with some of her GOP counterparts, including Appropriations Chair Susan Collins (R-Maine), around the Senate Friday. Schumer, in a Friday floor speech, showed no signs of backing down, saying that Congress needs to “act now” on extending health insurance subsidies that are set to expire at the end of the year. Democrats warn that Congress can’t wait past Nov. 1 to extend the subsidies because open enrollment for Affordable Care Act plans will start before then. “We’re ready to work on a path forward to lower health care costs for the American people and fund the government,” Schumer said. Rounds agreed that any ACA deal needs to be “done by about Nov. 1” but suggested that Democrats were in a self-defeating position by refusing to reopen the government and allow negotiations to proceed. “Their time is running out as well,” he said. Therein lies the chicken-and-egg nature of the stalemate: Democrats are demanding a deal on the insurance subsidies to reopen the government, while Republicans insist there can be no deal so long as the government is closed. Thune and Speaker Mike Johnson held a joint new conference on Friday morning to reiterate that message. “Open the government. Open the discussions,” said Thune’s top spokesperson, Ryan Wrasse, in an X post Friday. Republicans, instead, are hoping that they can peel off enough Democratic senators to support the GOP-led funding bill by offering them something short of an ACA deal attached to the stopgap spending measure. Ideas being tossed around the bipartisan group include seeking commitments on moving full-year appropriations bills once the government reopens. They’ve also talked about reaching an understanding about how the ACA negotiations could work — again, only once the government is open. Democrats have also raised their desire to block any White House efforts to claw back already-approved funding for the length of the stopgap bill. But the talks remain unsettled, and no additional Democrats broke ranks Friday to vote for the House-passed stopgap. The GOP bill failed 54-44, falling short of the 60 votes needed to move forward. Sens. Angus King (I-Maine), Catherine Cortez Masto (D-Nev.) and John Fetterman (D-Pa.) voted for the GOP bill, while Sen. Rand Paul (R-Ky.) voted against it — same as a Wednesday vote taken just hours after the shutdown began. Republicans also rejected a Democratic proposal for the fifth time, in a 52-46 vote. That bill would link funding the government through the end of October to various Democratic health care priorities, including an extension of the ACA subsidies and a rollback of some provisions in the GOP megabill enacted this summer. |
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CMS: Shutdown Will Not Affect RHTP Application Deadline |
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During a Sept. 30 webinar, CMS staff said the Nov. 5 application deadline for states to apply for the $50 billion Rural Health Transformation Program (RHTP) would not be pushed back (subscription required) as a result of the shutdown. “The Office of Rural Health Transformation work is funded through mandatory appropriations, so all of our ongoing staff and work will continue at the Center for Medicaid and CHIP Services, regardless of if there is a shutdown,” Alina Czekai, director of the office. She added that 27 states had submitted letters of intent. |
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RWJF Report Shows $32B Revenue Loss for Providers if ACA Enhanced Premiums Expire
On September 25th, the Robert Wood Johnson Foundation published a report on the effects of allowing the Affordable Care Act’s enhanced premium tax credits to expire at the end of 2025. This is one of the primary reasons the federal government is shut down – the fight over renewing these tax credits with Senate Dems insisting a Continuing Budget Resolution bill must include an extension of these tax credits that were first implemented under Obamacare.
The report projects that if the enhanced tax credits expire, an estimated 7.3 million people will lose subsidized coverage and 4.8 million will become uninsured. In addition, RWJF projects $32.1 billion in lost provider revenue and a $7.7 billion increase in uncompensated care in 2026. Overall, spending would be reduced by $14.2 billion on hospital services, by $5.1 billion on physician services, by $5.8 billion on prescription drugs, and by $6.9 billion on other services. The added burden of uncompensated care would fall more sharply on non-expansion states.
The report is available here: https://www.
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From today’s online Modern Healthcare edition:
By
Michael McAuliff
October 03, 2025 05:00 AM
Amid shutdown, poll finds overwhelming support for ACA subsidies |
Survey results released Friday show broad-based and strong support for maintaining enhanced subsidies for health insurance exchange plans, which Democrats have made the focal point of their standoff with Republicans over government funding.
According to a poll from the health policy research institution KFF, 78% of respondents favor keeping the subsidies in place.
A majority of Republicans and core supporters of President Donald Trump back extending the subsidies. The survey found that 59% of Republicans want them extended, as do 57% of “Make America Great Again” Republicans.
Unless Trump and the Republican congressional majority agree to renew the policy before the end of this year, financial assistance will revert to the lower level originally conceived in the Affordable Care Act of 2010.
The survey ran Sept. 23-29, just before the federal government shut down Oct. 1 over a partisan dispute over spending and other matters.
This snapshot of public opinion helps explain the rhetoric each side has deployed in the lead-up to the shutdown and the days since.
The GOP needs at least a few Democratic votes to advance a spending bill, but the minority party has refused to support a short-term funding bill that would have kept the government in operation for the first seven weeks of fiscal 2026.
Instead, Democrats are using the shutdown face-off as an opportunity to draw attention to the GOP’s health policy agenda, which includes the $1.1 trillion in cuts to Medicaid and the exchanges that are a central component of the tax law Trump enacted in July.
Democrats demand a permanent extension of the enhanced exchange subsidies and a rollback of the Medicaid and exchange cuts as a condition for backing legislation to fund the government.
Democrats have repeatedly accused GOP leaders of refusing to negotiate with them to avoid dramatic spikes in health insurance costs.
According to a separate KFF analysis, net premiums after subsidies are set to spike an average of 114% to $1,904 next year. Twenty-two million people are projected to see higher premiums.
Trump and congressional Republicans have chosen to focus their arguments on spending and immigration, often making claims that stretch or disregard the facts.
House Speaker Mike Johnson (R-La.) argued that Democrats’ true agenda is providing health benefits to undocumented immigrants, an assertion Trump has also made.
“They have made a decision that they would rather give taxpayer-funded benefits to illegal aliens than to keep the doors open for the American people to keep vital services,” Johnson said at a news conference Thursday.
Federal law has long forbidden unlawfully present migrants from accessing federal benefits and includes significant limitations for legal immigrants. Trump’s tax law toughend those restrictions.
Republicans have also attempted to cast Democrats as enemies of rural America, saying their plans would take away the $50 billion Rural Health Transformation Program included in the tax law.
“They want to remove the rural hospital fund the Republicans fought so hard to put into the ‘One Big Beautiful Bill,’” Johnson said. “A lot of those rural hospitals are in red states.”
Republicans conceived of the fund as a way to mitigate the effects of the tax law’s healthcare cuts on hospitals in rural areas. Repealing the healthcare cuts, as Democrats propose, would also eliminate the rural hospital fund.
According to KFF estimates, rural providers will lose $137 billion over 10 years because of the tax law’s healthcare cuts.
Despite the top line survey findings showing support for extending the tax credits, the Republican position has some political advantages.
When respondents were told extending enhanced tax credits would require significant spending, 63% said they would be concerned.
Another challenge for Democrats is that most people don’t know the tax credits are running out: 61% of respondents said they had heard “a little” or “nothing at all” about it.
Awareness may increase soon because the open enrollment period begins Nov. 1 and Democrats are likely to continue pressing the point.
The health insurance industry and an alliance of healthcare providers is ramping up advertising and lobbying campaigns appealing for Congress to extend the subsidies.
A handful of Senate Republicans have expressed openness to a deal on the subsidies, including Thom Tillis (N.C.), Dr. Bill Cassidy (La.) and Mike Rounds (S.D.), but insist Democrats should wait until after the government is funded.
GOP leaders remain steadfast that Democrats must support the stopgap spending bill as written. Congress will be back in session on Monday.