(As of November 1, 2025) The path to reopening the federal government remains unclear as it hit the one-month mark, leaving hundreds of thousands of federal workers without pay and no clear path to a resolution.
A short-term spending bill was approved by the House on September 16 and was intended to prevent the government shutdown by temporarily funding programs through November 21. However, Senate Democrats halted the process, and Congress has been at a standstill ever since.
At the heart of the standoff is a dispute over the Affordable Care Act’s (ACA) advanced premium tax credits, which are set to expire at the end of 2025. Democrats insist that any spending bill must include an extension of the subsidies, while Republican leaders maintain that reopening the government must come first. The ACA marketplace enrollment period began November 1, and there will be steep premium hikes without the enhanced subsidies.
Behind the scenes, Republicans are exploring ways to tie an extension of the tax credits to other health policy priorities. Meanwhile, some Senators are trying to mitigate the effects of the shutdown on select groups and services, such as federal workers or active-duty military, but those provisions are unlikely to pass as both sides fear losing leverage in the standoff.
The good news for physicians is that the Centers for Medicare & Medicaid Services (CMS) has instructed the Medicare Administrate Contractors (MACs) to process claims dated after October 1. This means physicians should continue to be paid for most services.
One exception is telehealth services. CMS has directed all MACs to continue to temporarily hold claims for some telehealth services (i.e., those that CMS cannot confirm are definitively for behavioral and mental health services). While most other claims will be processed, it is unclear if operations and speed of the processing will be affected by the furloughs.
There is another program that could significantly impact the negotiations and possibly force lawmakers to reach an agreement – The Supplemental Nutrition Assistance Program (SNAP). More than 40 million people rely on SNAP, and it ran out of money on November 1. The U.S. Department of Agriculture, which oversees the program, stated it cannot tap into emergency funds to keep those benefits going. At least 25 states are planning to cut off these benefits that support low-income families. However, on October 31, a federal judge ordered the Administration to release billions in SNAP contingency funds, adding a new layer of complexity to an already fluid situation. The impact of this ruling and how it will be implemented remains uncertain, making the timeline and pressure on lawmakers to act even more unpredictable.
Combined with the increased ACA premiums and other program cuts, lawmakers may start to feel enough pressure that they are forced to reach an agreement and reopen the government. The Academy will continue to monitor the situation and keep our members up to date on important developments.
