The longest government shutdown in United States history concluded on November 12. Yesterday, I wrote a post summarizing the process until resolution – https://rhislop3.com/congress-medicaid-subsidies-whats-next/
Despite the cessation of the shutdown, pivotal issues—most notably the future of enhanced premium tax credits under the Affordable Care Act (ACA), which remain a point of contention for Democratic policymakers—are yet to be resolved and will be addressed in December. The following points encapsulate the principal legislative outcomes, programmatic effects, and ongoing negotiations.
1. Interim Extension of Government Funding
President Donald Trump executed a resolution extending government funding through January 30, subsequent to a 222-209 vote in the House of Representatives. This legislative measure provides full fiscal year funding for the Department of Agriculture, Food and Drug Administration, and Department of Veterans Affairs. Remaining federal departments, including the Department of Health and Human Services (HHS), have been allocated funding only until the end of January.
2. Renewal of Medicare Telehealth and Acute Hospital Care at Home Programs
The aforementioned spending package reinstates both Medicare telehealth and acute hospital care at home programs, which had previously lapsed following the shutdown’s commencement on October 1. These initiatives are now funded through January 30, with provisions for retroactive compensation for services rendered during the waiver period. Notably, post-shutdown data indicates that 35% of hospital-at-home programs suspended care for traditional Medicare beneficiaries under the CMS waiver, 20% ceased services to non-waiver patients, and 23% transitioned select care to outpatient home settings.
Ninety-two percent of hospital-at-home programs were affected by the government shutdown, with more than half of healthcare organizations with programs permanently or temporarily shutting them down, a trade group found.
The federal government shutdown interrupted hospital at home, as the care model relied on a CMS waiver, that expired Sept. 30 with the shutdown. The waiver allowed health systems to bill Medicare for the service line. Over 400 hospitals across 39 states had programs that were impacted/affected.
Before the waiver expired, hospital-at-home programs admitted an average of 5.58 patients per day, a number that fell to 1.84 after the shutdown, a 67% drop in daily admissions, according to the Hospital at Home Users Group.
At the end of this post, I’ve provided a quick summary on the hospital-at-home program.
3. Deferred Vote on ACA Subsidy Extension
The Senate ratified the spending package on November 10, establishing terms for a mid-December vote regarding the extension of ACA enhanced premium tax credits—a matter of central importance for Democratic legislators. It should be noted, however, that Speaker of the House Mike Johnson did not participate in Senate negotiations and has not committed to facilitating a comparable vote in the House of Representatives, thereby leaving the resolution of this issue in abeyance.
4. Reinstatement and Compensation of Federal Employees
As part of the Senate-brokered agreement, the White House has guaranteed the reemployment of all federal personnel dismissed during the shutdown as a result of the administration’s reductions in force. Furthermore, the administration has pledged to provide retroactive pay to all federal employees for the duration of the shutdown period.
5. Restoration of Supplemental Nutrition Assistance Program (SNAP) Benefits
A White House budget office spokesperson confirmed that Supplemental Nutrition Assistance Program (SNAP) benefits, which had expired on November 1 and become subject to legal disputes concerning short-term funding, would be fully reinstated within hours following the reopening of government operations. Beneficiary accounts are to be replenished expeditiously.
Although the immediate effects of the government shutdown have been mitigated, several outstanding concerns—including the extension of ACA subsidies and appropriations for federal departments—await resolution in the forthcoming weeks. The recent legislative actions, restoration of critical health programs, rehiring of federal employees, and reinstatement of SNAP benefits represent significant progress; nevertheless, continued legislative engagement will be necessary to address remaining challenges.
(A Hospital at Home program provides acute, hospital-level medical care in a patient’s home, using a combination of in-person visits, remote monitoring, and telehealth. It is for patients who are sick enough to need hospitalization but stable enough to be cared for at home, often for conditions like pneumonia, heart failure, or infectious diseases. This model aims to improve patient outcomes and experience and can reduce costs and hospital strain – Hospital-at-Home | AHA)