The federal government shutdown that began at midnight on October 1, 2025, has significant implications for the U.S. health care system. Political disagreements over key health care policies, particularly related to the Affordable Care Act (ACA), have fueled this shutdown, which bears similarities to previous shutdowns, including the one in 2013.
Disputes center around the extension of subsidies for ACA insurance premiums, which are set to expire at the end of 2025. The Democratic Party is advocating for the continuation of these subsidies, as well as pushing to reverse cuts to the Medicaid program enacted under former President Donald Trump in July 2025. Without a budget agreement, federal agencies have been directed to suspend nonessential activities, leading to a potential crisis in health care access across the nation.
The ACA has long been a flashpoint in American politics, with the law’s enactment in 2010 intensifying partisan tensions. In the lead-up to the shutdown, negotiations faltered when Republicans required Democratic support in the Senate to pass a temporary funding bill, which would have maintained government operations at current levels. In exchange, Democrats sought concessions, particularly the extension of ACA subsidies that successfully reduced insurance premiums for millions of Americans during the COVID-19 pandemic.
The loss of these subsidies could lead to a staggering increase in premiums, with estimates suggesting a rise of over 75% in 2026, potentially resulting in 4.2 million Americans losing their health insurance. Some moderate Republicans have expressed willingness to discuss these subsidies, especially in districts with high ACA enrollment numbers, but many resist tying these discussions to the budget negotiations.
Another contentious issue involves changes to Medicaid, particularly new work requirements that could see approximately 5 million people losing their health insurance coverage starting in 2027. Additionally, proposed rollbacks would impact lawfully present immigrants, making it more difficult for them to access both Medicaid and ACA coverage. The Congressional Budget Office estimates that around 1.4 million immigrants could face loss of insurance due to these changes.
The ramifications of the shutdown extend beyond political negotiations. Health-related services that are not deemed essential may face significant disruptions. This includes critical activities such as certifying nursing homes and administering support for Medicaid and Medicare beneficiaries. Seniors may experience immediate effects, as funding for programs that expanded access to telehealth services and in-home care has ceased without a new budget.
While the Centers for Medicare and Medicaid Services has indicated that funding for Medicaid can last until the end of the calendar year, a prolonged shutdown could force states to make difficult decisions regarding program funding. Historically, no shutdown has exceeded 34 days, but if this one drags on, community health centers, which serve approximately 34 million Americans annually, could struggle to maintain operations.
The Department of Health and Human Services has committed to using its available funding to ensure minimal readiness for health emergencies, while key services like the Indian Health Service and the Veterans Health Administration will remain operational. The Food and Drug Administration has also reported that it would not face immediate cuts.
Ultimately, the impact of this government shutdown on health care will depend on its duration and the administration’s willingness to use the situation as an opportunity to enforce significant staffing cuts within federal health agencies. As the situation evolves, the potential for widespread changes to health care access remains a pressing concern for millions of Americans.
