The shutdown of the federal government that began Oct. 1 continues as Republican and Democratic members of Congress remain at odds on the annual appropriations bill that funds the government.
House Republicans passed a short-term measure that sustains funding for federal agencies and programs at last year's levels through Nov. 21. Most Senate Democrats oppose the measure, in part because it doesn't extend the enhanced premium tax credits (EPTCs) for people who get health insurance through the federal marketplace, which was set up under the Affordable Care Act. Those credits lapse at the end of the year.
KFF, a nonpartisan health policy research group, says most of the 24 million Americans who get health insurance through the marketplace are eligible for the credits.
Catholic Health World spoke to Lucas Swanepoel, CHA's senior director of government relations, about the shutdown. His responses have been edited for length and clarity.
The shutdown is now in its third week. Is it having any effects on health care?
Absolutely. One of the things we've seen immediately as we got into the shutdown was uncertainty around access to telehealth and hospital-at-home programs and funding for critical health and community programs, such as the National Health Services Corps (which sends workers into underserved areas). Those programs have been in jeopardy over the last few weeks as part of the government shutdown.
This is only the beginning of the impacts that we're going to see. Now as the shutdown reaches into its fourth week, cuts in programs such as the Supplemental Nutrition Assistance Program, WIC and Head Start are going to become a reality for families. In addition, as we begin open enrollment, people are beginning to see the impact of failing to extend the EPTCs on the cost of coverage.
Are Catholic and other nonprofit hospitals vulnerable amid the shutdown?
I think all hospitals are impacted, and more fundamentally, it's the patients and people we serve that are impacted. When people start to look at the possibility of SNAP going away, or rising health insurance premiums, they start to get nervous and are afraid of what is going to be available for them in the coming months. Particularly for those currently addressing a health issue or facing a medical emergency, they worry that they're going to be in jeopardy moving forward.
What are your concerns if the shutdown continues?
The biggest concern is that these cuts and these changes that have already started to impact health care across the country will begin to deepen. As programs are being closed and things like SNAP and the Women, Infants and Children program lose funding, millions of Americans who rely on them will be disproportionately impacted. Hospitals continue to serve people regardless of the shutdown, but the ability for people to meet their own personal needs is only going to get worse.
Democrats have made the expanded ACA subsidies their focus in the negotiations. How important are those subsidies?
In our letter to Congress back in late July, it was a major priority for CHA to make sure the premium tax credits were extended. We would have loved to have seen this get done earlier this year. Now we're getting close to enrollment season, which starts on Nov. 1, when people are going to see dramatic increases to their premiums. So it's a top priority for CHA that this gets done as part of the government funding bill or on its own path — we don't really have a strong opinion. The biggest thing is that it needs to get done now.
The subsidies were in place during the COVID pandemic and were meant to have a limited lifetime. Should they at some point sunset?
Many of the subsidies and enhanced premium tax credits were established by the American Rescue Plan to close the gaps in coverage that we knew existed. That is, that some people made a little bit too much money for Medicaid, lived in a state that did not expand Medicaid or didn't have employer-sponsored coverage. These individuals were left in a persistent coverage gap. The premium assistance has made dramatic improvements in closing this gap and expanding coverage across the country.
I think the benefits of closing the coverage gap is one lesson learned from the COVID response that worked and it's worth looking to continue to make sure that we don't lose that progress.
As you mentioned, telehealth coverage is also under threat as this shutdown continues. Can you elaborate on how that is a concern for CHA and its members?
Sure, the telehealth flexibilities are another example of a COVID response that was initially temporary but has demonstrated incredible impact for extending health care access and coverage. When the COVID crisis was expanding back in 2020 and patients were having a hard time accessing coverage, President Donald Trump and his administration created a number of flexibilities that allowed telehealth under the Medicare program to be used in ways that were not possible before. Those flexibilities have been extended year after year, and they were part of the Sept. 30 appropriations deadline. However, because they weren't extended, they are also impacted by the government shutdown, and a number of Medicare recipients who used telehealth to access health care now must either find a way to go in person or find another way to get access to care. We continue to advocate for these flexibilities to be made permanent so that they are not subject to the annual congressional deadlines.
The failure to pass a continuing budget resolution could cut off SNAP benefits. Would that loss affect the health of those recipients?
Absolutely. As we know, nutrition is one of the leading drivers and upstream causes of ill health. When people don't have enough to eat or turn to cheaper, less healthy ways to get enough calories, it makes them less healthy and less able to thrive in their communities.
Aside from the shutdown, what else is happening in Washington that you are closely watching?
In addition to all the negotiations around the shutdown and the advanced premium tax credits, the reality is that a lot of other stuff still needs to get done. We still need to look at what happens with the implementation of HR 1, "The One Big Beautiful Bill," in the coming weeks and months. For example, the deadline for states to submit their application for the Rural Health Transformation Program is Nov. 5, and time is of the essence if we are going to set up programs and mitigate the harm of the Medicaid cuts in the bill.
In addition to addressing things like the tax credits and making sure telehealth is extended, there are a number of bipartisan programs that have been sidelined. For example, working with Congress to expand palliative care programs, strengthen maternal health programs, and bolster our health workforce are all issues that have not gotten the attention that they deserve over the last few weeks and months.
Read CHA's statement on the government shutdown.