Episode #26 Deep Dive – Candid with Kander: VA Cuts, GOP Shutdown, and What’s at Risk
A deep dive into this week's episode of Paging America
Impact of the government shutdown on health care and the nexus with the “Authoritarian Project”
The Washington Post: We asked 1,000 Americans who they blame for the shutdown. Here’s what they said.
By a 17-percentage-point margin, the poll finds more saying Trump and Republicans are responsible for the partial government shutdown than Democrats in Congress. [...]
Congressional Democrats have demanded an extension of federal subsidies that reduce the cost of health insurance plans through the Affordable Care Act, which will expire at the end of 2025.
The Post poll finds 71 percent of Americans say federal health insurance subsidies should be extended, while 29 percent say they should end as scheduled. A 95 percent majority of Democrats and 80 percent of independents support extending health insurance subsidies, but support drops to 38 percent among Republicans. A 62 percent majority of Republicans say they should end as scheduled. [...]
About three-quarters of Democrats (76 percent) and 55 percent of independents want Democrats in Congress to demand the extension of insurance subsidies even if it extends the shutdown.
Community health centers and telehealth, in particular, are going to take a big hit with the government shutdown.
Via MedPage Today:
Some parts of the healthcare system will not be affected by a shutdown; Medicare and Medicaid will keep operating, and enrollees in those programs will continue to be able to see their doctors and get their claims paid. However, there are other areas of healthcare that will start to be affected, experts say. [...]
Community health centers will be among those feeling the pinch, according to Carole Johnson, former administrator of the Health Resources and Services Administration (HRSA) during the Biden administration. “It’s a particularly challenging time for health centers, which are already grappling with almost $1 trillion coming out of Medicaid” and when some of their previously appropriated funding also hasn’t been disbursed yet, Johnson, now a senior fellow at the Century Foundation in Washington, said in a phone call. [...]
Faced with all of these actual and potential cuts, the country’s 1,400 health centers “are going to have to make business decisions based on available resources,” she said, adding that the centers’ 15,000 sites serve about 30 million people annually. [...]
Additionally, if a shutdown continues for several weeks, “it could affect the Medicare annual enrollment period for Medicare Advantage plans and Part D Prescription Drug Plans that start on October 15.
If the failure to extend the pandemic-era expansion of the ACA subsidies goes through the end of the year, millions face losing their health insurance:
The extra marketplace subsidies gave the average customer $700 more dollars annually for their premium, according to KFF, a nonpartisan health policy organization. That meant many families with low incomes could get a plan for free and many middle-income families qualified for subsidies for the first time.
Going back to the original subsidies would be disastrous, Democrats and health plans say, because they just weren’t sufficient. [...]
Letting the subsidy enhancement expire would have little effect on the lowest-income earners in the marketplaces… But analysts say it will cause price shocks for just about everyone else. And those price hikes would come just as Republicans seek to retain their House and Senate majorities. Twelve House Republicans, many of them in vulnerable seats, have signed onto a bipartisan bill by Rep. Jen Kiggans (R-Virginia) to extend the subsidies for another year.
For example, a couple earning $30,000 would go from paying nothing for their annual premium to spending $1,107 for a mid-range insurance plan, according to a KFF analysis. A single person making $35,000 would have to pay $2,615, up from $1,033.
Nearly 4 million fewer people will be enrolled in the marketplaces a decade from now if the subsidies end, according to the nonpartisan Congressional Budget Office. Many of those losses may be among relatively healthier people who, weighing the costs and benefits of coverage, will decide to go without. That would leave behind a sicker pool of people buying insurance, causing premiums to rise. Insurers selling plans through Affordable Care Act marketplaces have cited that likelihood in proposing double-digit premium hikes for 2026.
In other words, health insurance will get more expensive for everyone because the pool of covered patients will overall be unhealthier.
The HHS states in its plan that it expects 32,460 employees to be furloughed during the shutdown, while retaining 79,717 employees. Roughly 15,000 retained employees will be kept on to perform activities required or implied to be necessary by law.
Ultimately, the department estimates that 41 percent of its total staff will be furloughed.
As part of the shutdown, Congress missed the deadline on extending COVID-era telehealth programs for Medicare beneficiaries, meaning previous restrictions will go back into place until lawmakers pass some sort of budget measure, according to the Centers for Medicare & Medicaid Services (CMS). [...]
Before the COVID-19 pandemic, there were tighter restrictions on who could get telehealth services covered by Medicare; for the most part, virtual healthcare appointments were reserved for beneficiaries living in rural areas or care facilities, or those working with certain types of providers.
While some of these changes were permanent, others continued to rely on temporary waivers to operate. Some of these temporary allowances included the ability to use telehealth services from anywhere without geographic restrictions, have appointments in audio-only formats and receive mental health and behavioral healthcare virtually without regular in-person appointments.
During the shutdown, these services, which expired on Sept. 30, will no longer be available to Medicare recipients. Patients can no longer receive telehealth from home unless they meet specific criteria; telehealth flexibility will again be limited to rural areas; audio-only visits will no longer be reimbursed for most services; and physical therapists, occupational therapists, speech-language pathologists and audiologists will be excluded from telehealth reimbursement.
Finally, from the American Journal of Managed Care:
The shutdown immediately threatens the stability of Medicare’s expanded telehealth authority... Many emergency rules allowing virtual visits during the pandemic could be suspended if funding lapses persist. This would most impact rural and mobility‑limited patients who rely on telehealth for specialist care. Programs that support hospital‑at‑home or home‑based services also face uncertainty, as waivers may expire without congressional action.
Such disruptions could force providers to limit virtual care offerings or shift patients back to in‑person visits, which could delay care and add costs. Seniors and patients with chronic conditions stand to be most affected. For providers, reimbursement uncertainty could impact staffing, technology investments, and program sustainability.
Shield laws
Shield laws are statutes that provide legal protection to individuals, most notably journalists and healthcare providers, by allowing them to withhold certain information or identities from legal proceedings, investigations, or government action. Reproductive health shield laws protect patients and providers from out-of-state legal consequences for actions taken within the shielding state’s jurisdiction.
States around the country are passing shield laws to protect abortion providers from actions by other states. For example, an important shield law in California was just signed into law. Via POLITICO:
California will allow doctors to anonymously mail abortion drugs after Gavin Newsom signed legislation Friday designed to shield health care providers and their patients from legal threats or disciplinary action.
The measure, the latest effort by Democrats here to safeguard abortion access, would also keep abortion drugs like mifepristone available even if the FDA revokes its approval.
NOTE: Doctors aren’t actually prescribing abortion pills “anonymously” as many media outlets are describing it. The law simply says identifying information does not have to appear on the packaging and the information could only be seen through a subpoena.
The shield laws are necessary given recent actions by Louisiana where the Attorney General there is going after TWO physicians in other states for prescribing mifepristone. Via Jessica Valenti at ABORTION, EVERY DAY, “Both cases have been brought by Louisiana Attorney General Liz Murrill, who’s been leading the anti-abortion movement’s charge to equate abortion pills with ‘coercion’ and abuse.” One of the two physicians is also the target of a Texas lawsuit.
The “coercion and abuse” excuse is getting used more and more often because nobody thinks coerced abortions are okay. Another example of this being used comes from Katie Daniel, director of legal affairs at the anti-abortion Susan B. Anthony Pro-Life America. Daniel said of the legal case against New York abortion provider Dr. Margaret Carpenter: “This case exposes how mail-order abortion drugs are fueling an epidemic of coercion.”
Links for a deeper dive on Episode #26
Jason Kander’s website is JasonKander.com
You can find the Majority 54 podcast HERE
You can find the American Rescue Project HERE
You can find the Veterans Community Project HERE
The Washington Post: We asked 1,000 Americans who they blame for the shutdown. Here’s what they said.
MedPage Today: If Government Shuts Down, Federal Health Programs Would Feel the Pinch
The Washington Post: Shutdown fight over Obamacare highlights drawback of health care law
The Hill: How a shutdown will impact health agencies and Social Security
USA Today: Millions of seniors could lose access to telehealth and in-home care during shutdown
Alexandria Ocasio-Cortez and Bernie Sanders explaining the impact of the shutdown on health care is HERE
JD Vance lying about the cause of the shutdown is HERE and HERE
American Journal of Managed Care: Government Shutdown Could Disrupt Health Care Access
POLITICO: California doctors can now prescribe abortion anonymously
ABORTION, EVERY DAY: Louisiana Issued Arrest Warrant for ANOTHER Abortion Provider