One Month In: How the Government Shut Down is Impacting Access to Health Care

As of the publication of this article, the U.S. federal government has been shut down for an entire month, marking a prolonged disruption with wide-ranging consequences. The effects of this closure are being felt across multiple levels of government and society, from federal employees who remain furloughed or working without pay, to state agencies that depend on federal funding and guidance to operate essential programs. One of the most immediate impacts is the suspension of the Supplemental Nutrition Assistance Program (SNAP) benefits. Many states have announced that beginning November 1, they will halt SNAP benefits due to the lack of federal funding, leaving millions of low-income families at risk of food insecurity.  

Within the health policy arena, the shutdown has effectively stalled operations at the Center for Medicare and Medicaid Services (CMS). As a result, states are unable to receive timely reviews of Medicaid waiver applications, amendments, and other critical policy documents. This delay hampers states’ ability to implement or modify programs that serve vulnerable populations. States are also navigating the complex Rural Health Transformation Program application within minimal federal engagement and technical assistance due to the shutdown, with the application deadline looming early next month. The lack of federal partnership during this time may hinder states’ ability to submit competitive proposals, potentially jeopardizing access to much-needed funding for rural health system innovation.  

While much focus has appropriately been given to the impacts of the shut-down, the debate over the enhanced advance premium tax credits (APTCs), which is at the center of the logjam, also has significant implications for access to health insurance and healthcare services. The APTCs were established through the Affordable Care Act to provide subsidies for lower-income families to purchase insurance through the Marketplaces. They were subsequently enhanced (to provide access to more individuals and a higher subsidy level) through the American Rescue Plan Act (ARPA). Those enhanced APTCs were later extended under the Inflation Reduction Act (IRA).  While the base APTCs do not have an end date, the enhanced APTCs are set to expire at the end of 2025 unless reauthorized. Without any prior action to reauthorize them, they have become embroiled in the shutdown debate. 

Loss of the enhanced APTCs would most directly impact the individuals who rely on them for access to affordable health insurance. However, state Section 1332 Waivers will also feel an impact given that the “pass-through funding” (from federal savings resulting from the waiver) that states rely on is often tied to APTCs.