WASHINGTON — With a midnight Tuesday deadline looming, President Donald Trump and congressional leaders are scrambling to avoid a government shutdown that could disrupt federal services and jeopardize critical health care programs.
Trump is meeting top lawmakers at the White House on Monday afternoon, but it remains unclear whether the talks will bridge sharp partisan divides. At issue is whether expiring health benefits, including Affordable Care Act subsidies, Medicaid funding, and telehealth flexibilities, should be extended as part of a short-term spending deal.
Health Care at the Center of the Standoff
Democrats insist that any agreement to extend government funding must also preserve health programs that millions of Americans rely on. Without action, ACA premium tax credits will expire at year’s end, raising costs for roughly 24 million enrollees. Because open enrollment begins November 1, Democrats warn that higher premiums shown in pre-calculated rate quotes could discourage people from signing up for coverage.
House Minority Leader Hakeem Jeffries (D-N.Y.) labeled the situation a “five-alarm fire,” pointing to looming cuts in Medicaid, Medicare, medical research, and vaccine programs. “What we will not do is support a partisan Republican spending bill that continues to gut the health care of the American people,” Jeffries told reporters. “This is a five-alarm fire in terms of the Republican-caused health care crisis. And that’s why Democrats are determined to turn things around.”
Republicans, meanwhile, argue that health care and government funding should be addressed separately. Senate GOP Leader John Thune (R-S.D.) cautioned against “major decisions made in haste” and said a temporary funding extension should come first.
What’s at Risk for Patients and Providers
Several health care provisions tied to temporary resolutions are set to lapse, including:
- Community Health Center Fund, which provides approximately 70% of federal funding for community clinics.
- Medicare telehealth flexibilities, allowing broader use of virtual visits, audio-only care, and expanded provider eligibility.
- Special diabetes programs and rural hospital payment boosts.
- FDA’s Over-the-Counter Drug User Fee Program and funding for implementing the No Surprises Act.
Hospitals, clinics, and insurers warn that uncertainty could quickly ripple through the system, with some programs halting immediately if funding dries up.
Potential Fallout
Essential services, such as hospital-based care, Social Security payments, and TSA screenings, would continue, although many federal health employees could be furloughed, potentially delaying new enrollments or claims processing. Previous shutdowns have resulted in billions of dollars in lost economic output and disruptions to patient care, but this round could be more severe. The Trump administration has signaled that it might use the lapse to pursue permanent federal workforce cuts, potentially deepening the long-term impacts.
High Stakes for Both Parties
Republicans passed a House bill to fund the government through November 21, but it failed in the Senate. Democrats countered with a shorter extension paired with health care provisions, which Republicans rejected.
With $1.7 trillion in discretionary spending, approximately a quarter of the $7 trillion federal budget, at stake, both sides are maneuvering not just over immediate funding but also the framing of health care ahead of the 2026 midterms.
Shutdowns are not new to Washington; there have been 14 since 1981, most of which have been short-lived. But the 2018-19 lapse stretched 35 days, the longest in U.S. history. Health leaders fear that another prolonged fight now would not only strain the economy but also weaken public health protections when millions depend on them.
