October 01, 2025
KFF Health News: Shutdown Halts Some Health Services as Political Risks Test Parties’ Resolve
Threats of a federal government shutdown have evolved from an October surprise into a recurring theme, with the stakes now higher than ever. Federal funding expired at midnight on October 1, following Congress’s failure to pass even a stopgap budget while negotiations continued.
The pressing question now is how long this deadlock will persist. Democrats and Republicans are at odds, with a presidential administration that has strayed from constitutional norms and frequently employs political intimidation and primary threats to achieve its goals. Given that Republicans hold only a slim majority in the Senate, any agreement will require bipartisan support.
The ramifications of a shutdown on public health systems and programs will extend far beyond Washington, D.C., halting nearly all nonessential federal functions, including critical public health operations.
As the clock ticked down on September 30, President Donald Trump renewed threats regarding mass firings of federal workers if Democrats did not comply with GOP demands. Concerns are mounting that such workforce reductions could further enable the administration to undermine federal operations, reducing the budget impasse to a complex game of chicken.
G. William Hoagland of the Bipartisan Policy Center described these threats to fire federal workers as “unprecedented.” He noted that the lack of negotiations between Capitol Hill Republicans and Democrats prior to the shutdown is also a first in his experience.
The stalemate primarily revolves around health coverage, with Democrats and Republicans clashing over the Affordable Care Act (ACA) and proposed Medicaid cuts. For Americans enrolled in ACA marketplace plans, government subsidies limit the percentage of household income they must allocate toward premiums. While lawmakers expanded these subsidies in 2021 and extended them through the end of 2025, the looming expiration of these enhancements could lead to increased costs and reduced eligibility for millions of enrollees.
Democrats are advocating for a further extension of these subsidies, but many GOP lawmakers resist, insisting that discussions should wait until after a budget deal is reached. Tensions have escalated, with both parties engaged in a fierce battle to assign blame for the government’s closure.
Senate Minority Leader Chuck Schumer stated on the Senate floor on September 30: “Republicans have chosen the losing side of the health care debate, because they’re trying to take away people’s health care; they’re going to let people’s premiums rise.” In contrast, Senate Majority Leader John Thune accused Democrats of attempting to “take government funding hostage.”
The longer the shutdown persists, the more severe the impacts will be. Community health centers may face closure as their federal funding dwindles. Additionally, long-term projects by the Federal Emergency Management Agency aimed at reducing future disaster damage will come to a halt. Rescue services at national parks that remain open will be limited, and the National Institutes of Health may not admit many new patients awaiting access to experimental treatments.
While entitlement programs like Medicaid and Medicare will continue, operations at the Indian Health Service will also be affected. Disease surveillance, support from the Centers for Disease Control and Prevention (CDC) to local and state health departments, and funding for various health programs will be hampered, according to federal health agencies’ contingency plans.
The Department of Health and Human Services (HHS) is expected to furlough about 40% of its workforce, which has already been reduced by approximately 20,000 positions under the Trump administration. An estimate from the Congressional Budget Office suggests that around 750,000 federal employees will be furloughed, resulting in back pay totaling about $400 million daily.
At HHS, research on the links between drug prices and the Inflation Reduction Act, a significant law enacted under former President Joe Biden, is expected to pause. Despite claims from FDA Commissioner Marty Makary that the FDA would remain largely unaffected, the agency will not accept new drug applications, and food safety efforts will be curtailed. Federal oversight of programs designed to assist hospitals in saving lives during environmental crises is also anticipated to cease.
Fewer federal staff will be available to assist Medicaid and Medicare enrollees, and CDC responses to public health inquiries will be suspended. The work of a federal vaccine injury program is also expected to come to a halt.
Congressional Democrats assert that the ACA subsidies must be renewed immediately, as enrollment for the Obama-era health program opens on November 1. Without the extended subsidies, health insurers are warning of double-digit premium increases for millions of enrollees.
House Democratic Leader Hakeem Jeffries has claimed that a “Republican-caused health care crisis” looms over Americans due to Trump’s new tax-and-spending bill, which imposes restrictions on Medicaid that are expected to displace millions. Republicans, on the other hand, have pushed for mass layoffs and funding cuts at the nation’s health department, leading to widespread confusion regarding vaccine access.
“We’re not going to simply go along to get along with a Republican bill that continues to gut the health care of everyday Americans,” Jeffries stated on September 29. “These people have been trying to repeal and displace people off the Affordable Care Act since 2010.”
Republicans have criticized Democrats for stalling funding over the subsidies, asserting that any agreement will require concessions. “If there were some extension of the existing policy, I think it would have to come with some reforms,” Thune remarked on September 26.
Such a deal may involve changes to the policy that caps what consumers pay for ACA marketplace plans at 8.5% of their income, regardless of earnings. It could also affect their ability to access plans with no premiums, an option that became more prevalent due to the enhanced subsidies.
Adding restrictions to the ACA subsidies is likely to decrease enrollment in the program, which had previously seen declines during the first Trump administration and only reached 20 million for the first time last year, largely due to the subsidies.
Several Republicans have shown interest in extending the subsidies, including a group of GOP representatives who proposed legislation to do so last month. Democrats may be banking on the timing of the shutdown to pressure their Republican counterparts into negotiations regarding the ACA subsidies.
In the days following the government’s closure, ACA enrollees are expected to receive notices from their health insurers about increased premiums. Insurers have indicated that the expiring subsidies will lead to significant premium hikes, as healthier and younger individuals are more likely to opt out of coverage when prices rise.
The White House has intensified its pressure campaign on Democrats, with press secretary Karoline Leavitt asserting on September 29 that Trump wants to keep the government operational. “Our most vulnerable in our society and our country will be impacted by a government shutdown,” she emphasized.
By Stephanie Armour, Julie Rovner, Amanda Seitz, Arielle Zionts, and Rachana Pradhan
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
