When Governments Shut Down: More Than Just Politics for Patients

On October 1st, 2025, the U.S. federal government entered a shutdown after Congress failed to pass the appropriation bills required to fund government operations for the new fiscal year [1]. The lockdown occurred due to a partisan disagreement in spending levels for foreign aid, and most crucially, the continuation of enhanced health-insurance subsidies under the Affordable Care Act (ACA). Republicans proposed short-term funding that kept most programs at 2025 levels but excluded or pared back the healthcare provisions that Democrats insisted upon, while Democrats pushed for extensions of pandemic-era subsidies and protections for vulnerable populations. The stalemate meant the federal government could not continue funding many programs that day, triggering widespread agency furloughs and operational shutdowns.

While public focus is on federal workers missing paychecks, the ripple effects of the shutdown on healthcare and medicine carry equally large consequences. The Centers for Disease Control and Prevention and the National Institutes of Health have faced massive staff furloughs, while research and clinical-trial infrastructure along with regulatory reviews are slowed [2]. Although essential entitlement programs like Medicare and Medicaid are funded separately and will continue operating, other parts of the healthcare system are vulnerable [3]. Hospitals and clinics that rely on federal grants or regulatory approvals face uncertain timelines and budgets. Additionally, hospitals warn that key programs like telehealth waivers, home-hospital care and provider-reimbursement policies are at risk if funding lapses. 

From the patient’s perspective, this is more than waiting for the government to restart: it means interrupted access, longer delays, and higher costs. For example, if research funding from the NIH or approvals from the FDA slow, this could delay the development of new treatments or devices which could translate into fewer and more expensive options for patients. Meanwhile, if subsidies under the ACA aren't extended due to the shutdown, millions risk losing affordable coverage or seeing their premiums rise, which raises the out-of-pocket burden and healthcare bills. For providers, clinics and hospitals who assist underserved populations or provide preventive care may face disruptions, jeopardizing care for those who are the most vulnerable. 

Patients are already feeling immediate ripples from the shutdown, especially those who rely on newer forms of care. For example, many hospitals and health systems report they can no longer schedule telehealth appointments for Medicare or Medicaid beneficiaries because the expanded telehealth provisions that were introduced during the pandemic expired on September 30 and have not yet been renewed by Congress [4]. Resulting in older adults, rural patients, and people with mobility limitations being forced to travel in-person or skip care altogether. It also means clinics and therapists say they may not receive reimbursements for virtual visits if the shutdown drags on, which can lead to canceling services. Moreover, the shutdown threatens the stability of insurance markets and subsidy programs, which has a downstream effect on patients. If Congress does not act and the subsidies expire, the CBO estimates 3.8 million fewer people will have health insurance because of the change while out-of-pocket insurance premiums will rise for about 20 million Americans in January 2026 [5]. 

At its core, the government shutdown occurred due to political disagreements on how healthcare spending should be approached. Republicans argue that restricting spending, including setting limits on subsidies, is necessary to curb deficits and ensure that federal healthcare commitments are sustainable in the long run. They believe that without tougher terms and conditions, healthcare funding becomes open-ended and less accountable. On the other hand, Democrats believe that protecting healthcare subsidies and research funding is essential for maintaining innovation and access. In all, the government shutdown highlights that when government funding stops, the hidden economy behind grants, regulatory oversight, and subsidies collapse, with that harm ultimately falling on the patients themselves. 

While politics play out in Washington, the real consequences are felt in the exam rooms and waiting rooms across the country. When research pauses, telehealth flexibilities expire, and federal agency staffing declines, what begins as a budget dispute becomes a public-health issue. The shutdown underscores that healthcare is not only clinical care: it is built on a foundation of policy, funding and infrastructure that is vulnerable to disruption. As the stalemate and political theater continues, it is important to remember who the costs truly fall on: the patients. 

Reviewed by: Ashley Gutierrez-Torres

Designed by: Sydney Berger

References:

[1] Who Is Missing Paychecks in the 2025 Shutdown—When and Where?  Bipartisan Policy Center. (2025, October 14), https://bipartisanpolicy.org/explainer/who-is-missing-paychecks-in-the-2025-shutdown-when-and-where/.

[2] Aboulenein, A. (2025, September 29). US government shutdown to furlough 41% of health agency workers. Reuters. https://www.reuters.com/legal/litigation/us-government-shutdown-furlough-41-health-agency-workers-2025-09-29/ .

[3] Morse, A. (2025, October 1). What a Federal Government “Shutdown” Means for PAs and Their Patients. American Academy of Physician Associates.     https://www.aapa.org/news-central/2025/10/what-a-federal-government-shutdown-means-for-pas-and-their-patients/. 

[4] Feldman, A. (2025, October 8). How The Shutdown Impacts Healthcare. Forbes. https://www.forbes.com/sites/innovationrx/2025/10/08/how-the-shutdown-impacts-healthcare/ .

[5] The health insurance subsidies behind the government shutdown. (2025, October 20). Harvard Kennedy School. https://www.hks.harvard.edu/faculty-research/policy-topics/health/health-insurance-subsidies-behind-government-shutdown.