President Donald Trump and congressional leaders from both parties exited a high-stakes negotiation meeting Monday afternoon with little optimism a deal could be struck before the end of the month to avoid a government shutdown.
"I think we’re heading to a shutdown because the Democrats won’t do the right thing," Vice President J.D. Vance told reporters after the meeting. "I hope they change their mind, but we’re going to see.”
Healthcare issues have been and continue to be a sticking point of the negotiations, with Democrats demanding an extension of Affordable Care Act (ACA) enhanced premiums set to run dry at the end of the year as well as protections against White House recissions of appropriated funding. Republicans have floated a seven-week stopgap bill to keep the government running, telling their colleagues across the aisle that the ACA subsidies can wait until later in the year.
Democrat leaders, however, say the issue needs to be addressed immediately as punting an ACA subsidy extension past Sept. 30 would lead insurers to notify potential enrollees of higher premiums ahead of the open enrollment season, in which notices begin circulating in October. They also pointed to promises from Republicans to address healthcare during an earlier funding faceoff earlier this year, which didn't materialize.
“On Oct. 1 they get these notices, and many of them by November have to make a decision whether to change their healthcare,” Senate Minority Leader Chuck Schumer of New York told reporters after the meeting. “…You can’t wait till January. You have to do that now.”
On potential progress, Schumer told reporters that Trump appeared more receptive to the issue than congressional Republican leaders, particularly when Schumer and House Minority Leader Hakeem Jeffries, also of New York, outlined multiplicative increases in premiums some enrollees would face.
“There was a real division," Schumer said, "because when we talked to the president about the problems in healthcare, … he was not aware that … tens of millions of Americans would pay huge increases in their healthcare bills because of the ACA [enhanced premiums] expiring in December. He was not aware that the real effect of that starts Oct. 1, not Dec. 31.”
“Now we know why [congressional Republicans] didn’t want him to meet with us,” Schumer said.
Vance and House Speaker Mike Johnson, R-Louis., pushed back on Democrats' claims that they had been excluded from negotiations until Monday. Vance, speaking to press, said their opening demand of “hundreds of billions of dollars to illegal aliens for their healthcare while Americans are struggling to pay for their healthcare” was an “absurd” nonstarter that made any discussions impossible. Of note, undocumented immigrants are unable to sign up for federally funded health coverage, which would not change under Democrats' proposals.
They asserted that Republicans are open to the broader task of legislating bipartisan healthcare fixes, but not while a shutdown looms.
"Every single thing that they accuse about being broken about American healthcare is policy Democrats have supported in the past decade," Vance said. "So if they want to talk about how to fix American healthcare policy, let’s do it. The speaker would love to do it, the Senate majority leader would love to do it. Let’s work on it together, but lets do it in the context of an open government that’s providing essential services to the American people. That’s all that we’re proposing to do, and the fact that they refuse to do that shows how unreasonable their position is."
Other funding streams for hospitals and regulatory waivers around telehealth and hospital-at-home programs are also set to lapse should no deal be made by Tuesday night.
White House preps agencies for mass layoffs if government shuts down: media reports
Updated Sept. 25 at 11 a.m. ET
The White House has directed agencies to consider slashing their staff permanently if Congress fails to fund the government by Oct. 1.
The White House Office of Management and Budget Director Russ Vought sent a notice to agency heads on Wednesday that prompted them to consider permanent reductions in force (RIF) if the government shuts down next week, Politico reported Wednesday. The notice to agencies says they can consider firing staff that oversee programs Trump does not agree with.
Congress has not been able to pass its annual appropriations bills yet this year to fund government operations and programs into fiscal year 2026. The legislature has also stalled on passing temporary funding – known as a continuing resolution – to keep the government open until November 21.
The OMB notice sent to agencies said they can consider permanently firing staff that oversee programs that meet three conditions: the program funding will lapse if the government shuts down, the program was not funded by Trump’s massive tax package passed in July, and the program does not align with the President’s priorities.
The Department of Health and Human Services has already lost roughly 20,000 employees since Trump came into office in January. While its not immediately clear which healthcare programs may lose staff if the government shutdown happens, the targets will be partisan in nature.
The reduction in force notices will go out in addition to furlough notices for employees if the government shuts down, according to the memo. When funding is eventually passed, the agencies should “revise their RIFs as needed to retain the minimal number of employees necessary to carry out statutory functions," the memo states.
Vought makes clear that Democrats are to blame for the impending government shutdown and any reductions in force that follow.
“Over the past 10 fiscal years, Congress has consistently passed Continuing Resolutions (CRs) on or by September 30 on a bipartisan basis,” the OMB notice said. “Unfortunately, congressional Democrats are signaling that they intend to break this bipartisan trend and shut down the government in the coming days over a series of insane demands, including $1 trillion in new spending.”
Republicans' stopgap bill fails in Senate, sets up shutdown on Oct. 1
Sept. 19
Republicans' stopgap funding package passed through the House but failed in the Senate, triggering in earnest a political standoff over healthcare policies like Affordable Care Act (ACA) subsidies and Medicaid cuts passed over the summer.
The bill introduced earlier this week (see that story below) would keep the lights on through Nov. 21 and included extensions to less contentious health industry priorities surrounding hospital funding and virtual care flexibilities. The ACA premium tax credits set to expire at the end of this year were not part of the package, with leading Republicans suggesting that the issue should be shelved until later this year.
Democrats, whose votes are needed for the stopgap to clear the Senate, declared the bill a no-go without the subsidies, rollbacks to the Medicaid eligibility and funding restrictions set into motion with the One Big, Beautiful Bill and broader blocks against funding clawbacks by the Trump administration.
Republicans' bill passed through the House on a 217-212 Friday morning vote but failed to clear the Senate's 60-vote threshold. Among the senators, votes were largely cast along party lines with the exceptions of Sen. John Fetterman, D-Penn., voting for and Sens. Rand Paul, R-Ky., and Lisa Murkowski, R-Alaska, voting against.
Another bill brought by Senate Democrats Wednesday night that included their priorities also failed in a 47-45 Friday vote where all present senators voted on party lines. Both chambers are scheduled to be on recess next week.
"Democrats can vote with Republicans on our clean, nonpartisan [continuing resolution] to fund the government and allow the Senate to complete additional bipartisan appropriations work," Senate Majority Leader John Thune, R-S.D., wrote in a Friday social media statement. "Or they can vote for their own partisan [continuing resolution] and move one step closer to a shutdown. The ball is in their court."
“The American people will look at what Republicans are doing, look at what Democrats are doing, and it will be clear that public sentiment will be on our side,” Senate Minority Leader Chuck Schumer of New York said Friday.
Republicans unveil 7-week stopgap with hospital funding, telehealth extensions—but no ACA premiums
Sept. 16
House Republicans have pulled back the curtain on a seven-week stopgap bill that includes extensions to key hospital funding programs and virtual care flexibilities.
The package comes about two weeks ahead of a potential government shutdown, and, if passed, would keep the wheels turning through Nov. 21.
Text of the bill, titled the Continuing Appropriations and Extensions Act, 2026, was released by the House Appropriations Committee and would need a simple majority from the full House but 60 votes in the Senate to pass. The House is expected to vote on the measure before the end of the week before leaving for a scheduled recess.
“Keeping our government open and working for the American people is not a partisan issue—and this clean, short-term funding extension reflects that,” Appropriations Committee Chairman Tom Cole, R-Okla., said in a statement. “As we continue advancing FY26 conference negotiations, this measure prevents the chaos of a shutdown and allows us to stay focused on restoring regular order.”
The short-term extension comes as congressional Democrats suggested they would not cooperate on a funding resolution that does not include greater healthcare funding, such as a rollback to some of the One Big Beautiful Bill Act’s Medicaid cuts or an extension to Affordable Care Act (ACA) subsidies set to expire at the end of this year—neither of which is included in Republicans’ stopgap.
What has made the cut are some other healthcare industry priorities that shared the government’s end-of-month deadline.
For hospitals, the stopgap includes extensions to the Low-volume Adjustment and Medicare-dependent Hospital programs, which provide additional payments to rural hospitals and others that see fewer patients. There’s also a delay to $8 billion-per-year Medicaid disproportionate share hospital cuts that would run over three years, a total of $24 billion in funds compensating more than 2,500 hospitals for the deficit between Medicaid payments and care costs.
The continuing resolution would also extend the Medicare telehealth flexibilities and the acute hospital care at home program. Both Medicare telehealth and hospital-at-home flexibilities are set to expire Oct. 1. This marks the third instance in the last year that Congress has aligned the virtual care programs to expire alongside the short-term government funding patches.
Though legislation has recently been introduced to extend Medicare telehealth flexibilities for two additional years and the hospital-at-home program for five years, Congress has continued to evade making a decision on whether to allow the flexibilities long-term.
Independent providers that offer telehealth services have been hit especially hard by the short-term telehealth extensions because of the uncertainty it creates for their patients and businesses.
Other items of note for healthcare are an extension of add-on payments for Medicare ground ambulance services as well as an extension funding community health centers, the National Health Service Corps and teaching health centers that operate Graduate Medical Education programs. The Medicare Improvement Fund, meanwhile, has its funding reduced from $1.8 billion to $664 million.
Not included in the extension is an industry-supported extension of ACA premium tax credits set to expire at the end of this year. Established during the COVID-19 pandemic, the healthcare marketplace subsidies reduced average annual premium payments by $705 per enrollee.
Allowing them to expire would hit enrollees with hundreds of dollars in additional premium payments, with at least 12 states seeing average annual premiums expected to increase by more than double. The Congressional Budget Office estimated expiration of the credits will result in 4.2 million more people becoming uninsured by 2034.
House Speaker Mike Johnson, R-La., during a Tuesday morning press conference, said the “unrelated” push to extend ACA enhanced premiums is “a December policy issue, not a September funding issue.”
The top Republican lawmaker also described some Democrats’ calls for a shutdown barring Medicaid cut rollbacks or ACA extensions as a partisan political move and “a big mistake.”
“In exchange for their vote to fund the government, some Democrats said they wanted Republicans to repeal our very popular and very effective reforms to the Medicaid program, where we cut fraud, waste and abuse and we ensured illegal aliens don’t receive tax benefits and we put able-bodied men back to work,” he told reporters. “They want us to wind that back—zero chance that we will do that because it’s the right thing to do.”
Senate Minority Leader Chuck Schumer, D-N.Y., and House Minority Leader Hakeem Jeffries, D-N.Y., said in a joint statement that their counterparts across the aisle are acting under President Donald Trump’s orders to “jam a partisan spending bill down the throats of the American people” without including Democrats’ input.
Whereas Johnson said talks between the parties’ appropriators are ongoing, the leading Democrats said Republicans “have REFUSED to even sit down at the table with Democrats.”
Republicans’ package, they said, “fails to meet the needs of the American people and does nothing to stop the looming healthcare crisis. At a time when families are already being squeezed by higher costs, Republicans refuse to stop Americans from facing double-digit hikes in their health insurance premiums.”
Outside of healthcare, the continuing resolution adds $58 million toward enhanced security for federal judges and executive branch officials as well as $30 million for congressional security, in response to concerns of elevated political violence following the shooting of political commentator Charlie Kirk.