By Simon F. Haeder
Major rifts over key health care issues are at the heart of the federal government shutdown that began at the stroke of midnight on Oct. 1, 2025.
This is not the first time political arguments over health care policy have instigated a government shutdown. In 2013, for example, the government shut down due to disputes over the Affordable Care Act.
This time around, the ACA continues to play a central role, with Democrats demanding, among other things, an extension of subsidies for ACA plan insurance premiums that are set to expire at the end of 2025. Democrats are also holding out to roll back cuts to the Medicaid program that President Donald Trump signed into law on July 4, as part of what he called his “One Big Beautiful Bill.”
Without a budget agreement in place, Trump ordered most federal agencies to wind down their nonessential activities. The shutdown will continue until Congress passes either a short-term or long-term funding bill and Trump signs it.
Government shutdowns are nothing new, but as a health policy expert, I worry this time around the impasse may have far-reaching effects on health care.
Even as Democrats stage their battle over access to health care, the shutdown itself could also make it harder for Americans to get the care they need. Meanwhile, Trump has threatened to use the crisis to permanently cut federal jobs on a mass scale, including ones in the health care sector, which could substantially reshape federal health agencies and their ability to protect Americans’ health.
The partisan health care divide
Historically, questions about how the government should support access to health care have long been a source of conflict between the two main political parties. The passage of the ACA in 2010 and its implementation have only intensified this friction.
In the lead-up to the current shutdown, Republicans needed Democratic votes in the Senate to pass a bill that would keep funding the government at existing levels at least until November.
In return for their support, Democrats sought several concessions. A major one was to extend subsidies for ACA insurance policy premiums, which were established during the COVID-19 pandemic. These subsidies addressed a shortcoming in the ACA by decreasing premiums for millions of Americans – and they played a crucial role in more than doubling enrollment in the ACA marketplaces.
Without this extension, ACA premiums are set to rise by more than 75% in 2026, and the Congressional Budget Office estimated that 4.2 million Americans would lose insurance. At least some Republicans seemed open to considering the ACA subsidies, particularly those from districts that were more moderate and that had large numbers of people enrolled in ACA plans. But many have objected to doing that as part of the budget process.
Democrats are also pushing to renegotiate some of the changes made to Medicaid in the budget bill. These include new work requirements that are a cornerstone of Republican demands, under which certain adults would have to work or engage in qualifying activities to maintain Medicaid benefits. Work requirements are set to take effect in 2027, but implementing them would lead to an estimated 5 million people losing their health insurance coverage.
Most contentiously, these rollbacks to Medicaid cuts would reverse restrictions that made immigrants who are generally present in the country legally, such as refugees and asylum-seekers, ineligible for Medicaid and ACA coverage. These restrictions, which were included in the budget bill, could lead to the loss of insurance for about 1.4 million lawfully present immigrants, the Congressional Budget Office has estimated.
Republicans have balked at these demands, taking particular issue with the prospect of restoring Medicaid benefits to immigrants. Some Republicans – and Trump himself – have misconstrued the Democrats’ position, saying they are seeking free health care for immigrants in the country illegally.
What kinds of health services might be affected?
Most obviously, large-scale staff reductions would interfere with a wide range of health-related services not considered essential during the shutdown. This includes everything from surveying and certifying nursing homes to assisting Medicaid and Medicare beneficiaries and overseeing contracts or extra payments to rural ambulance providers.
Tasos Katopodis/Getty Images Entertainment
Some seniors may face an immediate impact as two programs have now lost funding without a new budget in place. One expanded access for seniors to telehealth services. The other allowed people to receive services at home that are generally provided in a hospital.
Crucially, most seniors will continue to receive Social Security payments. However, providers might be hesitant to schedule patients covered by Medicare if the shutdown drags on over a long period of time. This is because payments to medical providers would likely be delayed.
What health services will continue to function?
The Centers for Medicare and Medicaid Services has indicated that there is enough funding for Medicaid, the government program that primarily provides health services to low-income Americans, to support the program through the end of the calendar year. If the shutdown lasts beyond that, states may have to decide whether to temporarily fund the program on their own or whether to reduce or delay provider payments. However, no previous shutdown has ever lasted more than 34 days.
Community health centers are generally expected to receive some funding, at least for now. These providers offer nonemergency medical services for about 34 million Americans each year. Many also provide important services across the nation’s schools. However, if the standoff continues for more than a few days, those centers may struggle to keep their doors open.
Health and Human Services has also indicated that it will use all available funding to maintain “minimal readiness for all hazards” and will maintain certain medical services, such as the Indian Health Service. The Veterans Health Administration will also stay open. One of the agencies most affected by previous layoffs, the Food and Drug Administration, has indicated that it would be exempt from further cuts.
A longer-term view
Ultimately, the severity of the shutdown’s effects on health care will depend on how long it lasts.
It will also depend on whether Trump makes good on his stated intention to use the shutdown as “an unprecedented opportunity” to reshape the federal bureaucracy. The White House announced plans for potential mass firings of workers, particularly those at “Democrat Agencies.”
Whether this threat is simply a bargaining tactic remains to be seen, and it’s unclear whether health-related workers and agencies are in the crosshairs. But given that previous layoffs specifically targeted health programs, more permanent reductions in programs that affect health care may be on the way.
Simon F. Haeder is Associate Professor of Public Health at The Ohio State University.
JimboXYZ says
While the subsidies may seem to lower premiums, it’s a bandaid for rising healthcare premiums. As healthcare premiums rise, so do the cost of procedures for the out of pocket costs. Simply put, it falsely inflates enrollment/membership numbers & nobody can afford to be sick to be treated. Those that are becoming unemployed won’t have healthcare, will either go without or deeper into debt to pay for their premiums. They wouldn’t be able to afford the OOP’s just the same for being unemployed. This is nothing more than the Federal Government subsidizing the healthcare insurers, rewarding the healthcare industry. Wonderful, we can’t afford healthcare but we can get a smoke & mirrors Covid vaccine that was most likely a trillion dollar effort to this point.
Wool over the conspiracy eyes sees no conspiracy says
I know those on the far right complaining that health care costs are going up more and more… they actually think the increase is from .. somehow.. ..Obama. Yes!!! I guess ’cause it IS called ‘Obama Care’, right? That conspiracy wool must be super thick! Enjoy the view! ;-)
DaleL says
Simon Haeder is missing a key point is the shutdown battle. It is that enough Republicans and also Trump cannot be trusted. Haeder wrote: “Some Republicans – and Trump himself – have misconstrued the Democrats’ position, saying they are seeking free health care for immigrants in the country illegally.” Misconstrued is such a mild word to describe flat out LIES. When the B.B.B. (Big Bloated Bill) passed, Republicans promised to protect health care costs. In fact, they have done the opposite.
PaulT says
Donald Trump has been trying to destroy Obamacare since 2017 and the Medicaid cuts in his ‘Big Ugly Bill’ are part and parcel of that aim. The fake claim by the administration about stopping immigrants stealing healthcare is nonsense and about as believable as Karoline Leavitt’s claim that Trump has a plan to improve healthcare ‘for everone’.
Face facts. Trump and his budget director, ex-Project 2025 author Russel Vought, wanted this shutdow so they could continue their program to punish Democratic strongholds by witholding already allocated funding whil abusing shutdown traditions by continuing to shrink the civil service as Congress watches in silence in complete abandonment of it’s constitutional duty.
You have to hand it to Trump though, or prhaps to his advisors Stephen Miller and Russel Vought. Between them they’ve managed to break America’s system of government checks and balances before the Founders’ experiment makes it to it’s 150th birthday. Though to be fair, Madison did predict that a corrupt and/or incompetent president could be the downfall of our Republic.
Pogo says
Deborah Coffey says
There is nothing American that Project 2025 won’t destroy for people. The MAGAs, and all the rest of us are being lied to, used up, and spit out by the entire Trump administration. The pain is just beginning. It will be severe. I couldn’t understand why Americans didn’t see that during Trump’s first term. He was just getting started. But apparently, a 34-count felon, an adjudicated rapist, a very likely pedophile (according to the victims), a six-time bankrupt loser, a tax fraud, a serial adulterer, got enough Americans to believe he’d be a good president. God save our country and all the people in it.
Deborah Coffey says
@ Jimbo XYZ
Jimbo, I know 3 MAGA couples that have Obamacare. They love it and they need it. Do you know any because it doesn’t sound like it from your comment.
Kennan says
I don’t wanna hear anyone on the right complain about anything related to healthcare.
The Republican Party conveniently forgets how Ted Cruz held Congress hostage for four days because he refused to negotiate with Barack Obama and Democrats on how to give 27 million Americans access to healthcare insurance. The affordable care act or” Obama care” as the right preferred to call it, was performativly demonized by Ted Cruz. When the president asked for feedback from the Republicans, he was met with nothing. No ideas. No interest. Not a care in the world for Americans, healthcare, and quite frankly, if you can’t afford it…… Your on your own. That was 2009, and we haven’t heard shit since then. Almost 20 years and still nothing. This is what you idiots voted for. Morons that would do this to the country. That country includes you!
Let me be frank. The affordable care act wasn’t perfect, but it attempted to give people access.
Listen, the”Two Party System” is an absolute failure. The polarization and the
“Blue, Red” gang filiation tactics leave all Americans in the cold.
This government shut down, needed to happen, Because the things being taken away Like healthcare, provisions, and let’s be honest, possibly Medicare??!? That won’t stand. This is about all Americans. Not left or right. Your food fight fucks all of us.
Two major differences between the parties: One: Republicans are the evil empire, they do things that hurt people. They are in the process of taking away people‘s civil rights, constitutional rights, and human rights. If that’s not a fact to you, you’re not paying attention.
Democrats: Wokeism, DEI, transgenders, Public schools, grooming, our children? Listen, I’m a liberal, And the lefts Over correction on things can be very annoying to me, but the things I previously mentioned at worst are just annoying. The things the right does actually affect people and hurt people and can get people killed.
It’s time to start thinking like Americans. Not Democrats or Republicans, but fucking Americans!
True, the Democratic Party is a party of status quo, pussies, but holy hell… republicans? There are none. This current administration is a full blown dictatorial autocracy poised to crash through the fascist door.
My glass is half empty. I hope this gets worked out, but many of you are just not paying attention. There is a plethora of things that the American people need to fight. To save our democracy and to save our country, or at least reimagined it in a way that makes our voices heard.
Oh, and by the way. Stop demonizing Democratic socialists like Zorhan Mamdani. We have plenty of social services that we use in this country right now. I’m not afraid to tell you that socialism is not bad.Socialism Is good and it works in many countries, is it better in some than others? Of course. The way we do. Capitalism is going to destroy this country faster than shit through a goose. Stop demonizing, and start thinking!
Weeeeeeehheww I’m exhausted.
Kennan says
Let me just reiterate, a few things. Number one.:
I am 150% behind transgender rights, DEI, and other things that I consider human rights. My attempt was to make a comparison of what the LEFT wants being an annoyance to the RIGHT , as opposed to what the right does which actually takes away civil, constitutional, and human rights. I feel I need to clarify that.. The two party system is still a failure, though.😊
PS. FREE PALESTINE 🇵🇸🇵🇸🇵🇸