Health Care Matters | November 14
Federal Disruptions and Affordability Debates Shape the Post-Shutdown Landscape
The recent federal shutdown has ended with a "clean" continuing resolution that funds the government through January 30, 2026, setting up a potential repeat crisis in early 2026. Critically, the deal did not include an extension of the Affordable Care Act's enhanced premium tax credits, which expire at year's end, despite this being Democrats' primary demand during shutdown negotiations. Senior Trump administration officials, including CMS Administrator Dr. Mehmet Oz and the Domestic Policy Council, are now meeting privately to develop alternatives to the expiring ACA subsidies, with options including Health Savings Accounts, Flexible Savings Accounts, subsidizing out-of-pocket costs for low-income enrollees, and reducing cost-sharing through payments to insurers. The shutdown also created operational challenges as CMS furloughed employees, placed temporary holds on physician claims, and ended pandemic-era telehealth flexibilities. The Senate deal extends Medicare telehealth coverage and other health extenders only through January 30, meaning these issues will resurface when current funding expires. Read more here, here, and here.
Why It Matters
The health system faces compounded uncertainty from multiple directions. Senate Majority Leader John Thune promised a December vote on ACA subsidy extension, but there's no guarantee it will pass, and House Speaker Mike Johnson made no such commitment. This leaves insurers, providers, and 24 million marketplace enrollees in limbo during open enrollment. The short-term nature of the continuing resolution means Congress will face the same shutdown dynamics again in late January 2026, potentially during or immediately after the critical open enrollment period. This creates cascading planning challenges: health plans must finalize 2026 products without knowing final subsidy structures, providers face continued uncertainty about telehealth reimbursement beyond January, and CMS must process backlogged administrative functions while preparing for potential disruption again in weeks.
The White House is keenly aware of political vulnerabilities, with officials noting that health care was a decisive issue in the 2018 midterms and will be again in 2026. The administration's rush to develop subsidy alternatives reflects this pressure, but without congressional action or clear White House proposals, the market faces destabilizing uncertainty that could drive enrollment losses and premium spikes just as the 2026 midterm campaigns intensify. Providers and payers must navigate not only the immediate operational backlog from the shutdown but also plan for a compressed timeline where subsidy decisions, telehealth policy, and another potential funding lapse could all converge in the coming weeks.
Look for the Helpers: A Doula Network That's Saving Lives
A new Commonwealth Fund podcast highlights a community-based doula network that is improving maternal health outcomes by offering continuous, culturally attuned support throughout pregnancy, birth and the postpartum period. The episode follows doulas who provide home visits, care navigation and emotional support while helping clients advocate for themselves in clinical settings. By pairing trusted community members with evidence-based practices, this model is closing gaps in access, strengthening patient safety and saving lives in places where maternal mortality rates are highest. Listen here.
What We're Writing
Key Focus Areas in State Rural Health Transformation Program Initiatives
In our latest blog, we examine themes from 37 state applications to the Rural Health Transformation Program. Despite differences in geography and local context, states overwhelmingly focus on seven shared priorities: workforce development, telehealth, mobile care, chronic disease prevention, maternal and child health, payment reform, and infrastructure modernization. We also highlight our State Initiative Tracker, which captures where states are directing energy and where TA needs may emerge. Read the full blog post here.
What We Are Reading
Under Pressure: ACPT Pushing Down on 2024 and 2025 MSSP Starters
A recent Milliman analysis finds that the introduction of the Accountable Care Prospective Trend is lowering MSSP benchmarks for new ACOs, reducing projected savings by up to 3.3 percent for 2024 starters and 1.5 percent for 2025 starters. Read here.
UnitedHealth to Stop Covering Most Remote Patient Monitoring
Modern Healthcare reports that UnitedHealthcare will end most remote physiologic monitoring coverage for commercial and Medicare plans starting January 2026. Read here.
What We're Watching
Struggling Rural Hospitals Compete for Billions of Dollars in Federal Funding
A PBS News video explores how financially struggling rural hospitals are competing for newly released federal transformation funds, highlighting the stakes for communities at risk of losing essential health services. Watch here.
New Resource
Closing the Distance in Rural Primary Care
The Primary Care Collaborative has released a comprehensive report that analyzes workforce trends, care spending and practice models in rural settings, and presents five case studies along with policy recommendations to sustain and strengthen primary care in rural communities. Read the full report here.
