When Governments Shut Down: More Than Just Politics for Patients

On October 1st, 2025, the U.S. federal government entered a shutdown after Congress failed to pass the appropriation bills required to fund government operations for the new fiscal year [1]. The lockdown occurred due to a partisan disagreement in spending levels for foreign aid, and most crucially, the continuation of enhanced health-insurance subsidies under the Affordable Care Act (ACA). Republicans proposed short-term funding that kept most programs at 2025 levels but excluded or pared back the healthcare provisions that Democrats insisted upon, while Democrats pushed for extensions of pandemic-era subsidies and protections for vulnerable populations. The stalemate meant the federal government could not continue funding many programs that day, triggering widespread agency furloughs and operational shutdowns.

While public focus is on federal workers missing paychecks, the ripple effects of the shutdown on healthcare and medicine carry equally large consequences. The Centers for Disease Control and Prevention and the National Institutes of Health have faced massive staff furloughs, while research and clinical-trial infrastructure along with regulatory reviews are slowed [2]. Although essential entitlement programs like Medicare and Medicaid are funded separately and will continue operating, other parts of the healthcare system are vulnerable [3]. Hospitals and clinics that rely on federal grants or regulatory approvals face uncertain timelines and budgets. Additionally, hospitals warn that key programs like telehealth waivers, home-hospital care and provider-reimbursement policies are at risk if funding lapses. 

From the patient’s perspective, this is more than waiting for the government to restart: it means interrupted access, longer delays, and higher costs. For example, if research funding from the NIH or approvals from the FDA slow, this could delay the development of new treatments or devices which could translate into fewer and more expensive options for patients. Meanwhile, if subsidies under the ACA aren't extended due to the shutdown, millions risk losing affordable coverage or seeing their premiums rise, which raises the out-of-pocket burden and healthcare bills. For providers, clinics and hospitals who assist underserved populations or provide preventive care may face disruptions, jeopardizing care for those who are the most vulnerable. 

Patients are already feeling immediate ripples from the shutdown, especially those who rely on newer forms of care. For example, many hospitals and health systems report they can no longer schedule telehealth appointments for Medicare or Medicaid beneficiaries because the expanded telehealth provisions that were introduced during the pandemic expired on September 30 and have not yet been renewed by Congress [4]. Resulting in older adults, rural patients, and people with mobility limitations being forced to travel in-person or skip care altogether. It also means clinics and therapists say they may not receive reimbursements for virtual visits if the shutdown drags on, which can lead to canceling services. Moreover, the shutdown threatens the stability of insurance markets and subsidy programs, which has a downstream effect on patients. If Congress does not act and the subsidies expire, the CBO estimates 3.8 million fewer people will have health insurance because of the change while out-of-pocket insurance premiums will rise for about 20 million Americans in January 2026 [5]. 

At its core, the government shutdown occurred due to political disagreements on how healthcare spending should be approached. Republicans argue that restricting spending, including setting limits on subsidies, is necessary to curb deficits and ensure that federal healthcare commitments are sustainable in the long run. They believe that without tougher terms and conditions, healthcare funding becomes open-ended and less accountable. On the other hand, Democrats believe that protecting healthcare subsidies and research funding is essential for maintaining innovation and access. In all, the government shutdown highlights that when government funding stops, the hidden economy behind grants, regulatory oversight, and subsidies collapse, with that harm ultimately falling on the patients themselves. 

While politics play out in Washington, the real consequences are felt in the exam rooms and waiting rooms across the country. When research pauses, telehealth flexibilities expire, and federal agency staffing declines, what begins as a budget dispute becomes a public-health issue. The shutdown underscores that healthcare is not only clinical care: it is built on a foundation of policy, funding and infrastructure that is vulnerable to disruption. As the stalemate and political theater continues, it is important to remember who the costs truly fall on: the patients. 

Reviewed by: Ashley Gutierrez-Torres

Designed by: Sydney Berger

References:

[1] Who Is Missing Paychecks in the 2025 Shutdown—When and Where?  Bipartisan Policy Center. (2025, October 14), https://bipartisanpolicy.org/explainer/who-is-missing-paychecks-in-the-2025-shutdown-when-and-where/.

[2] Aboulenein, A. (2025, September 29). US government shutdown to furlough 41% of health agency workers. Reuters. https://www.reuters.com/legal/litigation/us-government-shutdown-furlough-41-health-agency-workers-2025-09-29/ .

[3] Morse, A. (2025, October 1). What a Federal Government “Shutdown” Means for PAs and Their Patients. American Academy of Physician Associates.     https://www.aapa.org/news-central/2025/10/what-a-federal-government-shutdown-means-for-pas-and-their-patients/. 

[4] Feldman, A. (2025, October 8). How The Shutdown Impacts Healthcare. Forbes. https://www.forbes.com/sites/innovationrx/2025/10/08/how-the-shutdown-impacts-healthcare/ .

[5] The health insurance subsidies behind the government shutdown. (2025, October 20). Harvard Kennedy School. https://www.hks.harvard.edu/faculty-research/policy-topics/health/health-insurance-subsidies-behind-government-shutdown.

Premium Aging: The Growing Cost of Nursing Home Care

About 0.4% of the entire population of the United States lives in nursing homes, making up one of the most high-risk medical groups in the country [1]. It is a common misconception that nursing homes are the best option for an elderly person with complex medical needs or dementia. While they are able to provide continuous care, the quality of the facilities is often poor, and many are understaffed and underfunded, causing them to crowd more patients into smaller rooms and spend less time with each individual resident. Many nursing homes and assisted living facilities in the United States are common breeding grounds for communicable diseases that put patients’ fragile immune systems at risk. To make matters worse, many high-end skilled nursing facilities won’t accept Medicaid coverage, creating a divide between those who can afford clean accommodations and high quality care and those who cannot. The transition itself can also be a detriment to an elderly person’s health, since it is often an abrupt and jarring change that may cause them to feel a loss of self and autonomy [2]. 

But nursing homes haven’t always been the only option. For centuries, people have lived in multigenerational households with parents, children, and grandparents all under the same roof, which allows elderly individuals to grow old peacefully in a familiar home, surrounded by family and friends who can provide the care and attention that they need. However, when independent societies like the United States put more emphasis on people owning their own homes away from family in the 1950s and 1960s, they started pushing the elderly out of family homes and into nursing homes [3]. Now, in the 2020s, multigenerational housing is on the rise again, as people feel the pressures of inflation and the cost of living crisis, and are turning to sharing homes with their extended family to save money on mortgages, rent, and nursing home fees. 

This idea is also the basis of the Medicaid-funded home and community-based care program that allows elderly people to live at home and retain their community connections while also being supported by a skilled medical team and receiving at-home care as needed. However, current budget cuts to Medicaid have left 700,000 on the waitlist for these home care programs and more people are being forced into nursing homes every day [4]. This problem is exacerbated by the flux of Americans returning to in-person work after the pandemic, with many opting to pay out of pocket for nursing home care for their loved ones, since they cannot take care of them any longer and the home-based care programs have decades-long waitlists. 

Additionally, many working-class Americans plan their finances under the assumption that they will be living at home for the majority of their elderly years, but many conditions, such as stroke or dementia, are difficult to predict and can have a very rapid onset. In one study, about 83% of adults reported that they would have great difficulty paying for the estimated cost of one year in a nursing home or one year of at-home assistance, which is between $60,000 and $100,000 [5]. This means that if these individuals needed the assistance of a nursing home, they would likely have to apply for Medicaid, which many higher-end nursing homes will not accept as payment, or rely on family or friends to partially fund their stay. The reality is that many elderly people are forced to enter overcrowded and underfunded nursing homes as a last resort either due to their financial situation or their family’s inability to care for them. The United States needs to amplify their Medicaid-funded home-assistance programs in order to provide the best quality geriatric care possible and allow elderly people to enjoy the final years of their lives with their family instead of being forced to live in a nursing home. 

Reviewed by: Ayan Jung

Designed by: Ariha Mehta

References: [1] Bakx, P., Wouterse, B., van Doorslaer, E., & Wong, A. (2020). Better off at home? Effects of nursing home eligibility on costs, hospitalizations and survival. Journal of Health Economics, 73(73), 102354. https://doi.org/10.1016/j.jhealeco.2020.102354.

[2] Grabowski, D. C., Chen, A., & Saliba, D. (2023). Paying for Nursing Home Quality: An Elusive But Important Goal. Journal of the American Geriatrics Society, 71(2), 342–348. https://doi.org/10.1111/jgs.18260.

[3] ​​Ruggles, S. (2007). The Decline of Intergenerational Coresidence in the United States, 1850 to 2000. American Sociological Review, 72(6), 964–989. https://doi.org/10.1177/000312240707200606.

[4] Stedman, N. (2025, July 2). How Medicaid Cuts Could Force Millions Into Nursing Homes. Penn LDI. https://ldi.upenn.edu/our-work/research-updates/how-medicaid-cuts-could-force-millions-into-nursing-homes/.

[5] Hamel, L., & Montero, A. (2023, November 14). The Affordability of Long-Term Care and Support Services: Findings from a KFF Survey | KFF. https://www.kff.org/health-costs/the-affordability-of-long-term-care-and-support-services/.

A Growing Monster: The Secrets Behind Increasing Pharmaceutical Prices

For every dollar spent in other countries, the United States spent 2.78 dollars on drugs in 2022 [1]. This ranged from being 172 percent of the prices in Mexico to 1028 percent of the prices in Turkey. Most concerningly, this gap is only continuing to increase. This not only impacts those who must pay out of pocket for medications, but also taxpayers and businesses that have to cover the cost of federally funded programs such as Medicaid and Medicare, therefore affecting the entire economy [2]. What is causing this disparity in drug prices in the US versus internationally?

The problem is not with general pharmaceutical drugs, but a specific classification of drugs. In the pharmaceutical industry, drugs are classified as either “brand-name” or “generic drugs”. While both are therapeutically equivalent, brand-name drugs are patented and are often more expensive to consumers. In the US, brand-name drugs make up 72% of prescription spending, yet only 10% of dispensed prescriptions [3]. This 10% of brand-name drugs results in the United States having high drug prices. In fact, US prices for generic drugs are only 67% of the prices of other countries, making them cheaper than other countries [1].

Upon the creation of a drug, pharmaceutical companies are given a period where they are the only ones allowed to sell and produce their drug. After this period, generic drugs can be created and sold by other companies. Historically, this period of exclusivity was to allow drug companies to reap the monetary profits to compensate for the research and development associated with the drug. However, the monster that is the pharmaceutical industry has grown increasingly greedy, opting to sell medications at the highest possible price.

Other than New Zealand, the US is the only country that allows pharmaceutical companies to advertise prescription drugs directly to consumers. While direct-to-consumer (DTC) marketing is supposed to make the public better informed, DTC advertising contributes to a whole array of problems, including higher prescription drug costs. Pharmaceutical DTC marketing spending increased from 11.9% to 32.0% of total spending from 1997 to 2016 [4]. This does not even include the money pharmaceutical companies use for marketing to health care professionals. Overall, this enormous increase in money being spent on forms of marketing is increasing the price of brand-name drugs.

While it is evident that there is a problem with the cost of prescription medication, the solution is not yet clear. In other countries, universal health insurance systems have shifted the burden of high drug costs to the government, causing many regulations in the pharmaceutical industry. Some forms of regulations include product-by-product price control (in France), limits on insurer reimbursement prices (in Germany and Sweden), and profit control (in the United Kingdom) [5]. This resulted in France, Germany, Sweden, and the United Kingdom experiencing minimal drug price fluctuation when adjusted for inflation from 1985 to 1991, whereas in the United States, pharmaceutical prices increased at an annual rate of twice the inflation rate during this period.

The problem of high prescription costs is a result of a lack of regulation and a set of unique circumstances that set the United States apart in an unfortunate way. The use of DTC advertising increases pharmaceutical companies' spending, and thus the price of medication. The lack of universal healthcare leads to high prescription costs becoming an individual consumer problem as opposed to a national problem. If no fundamental government change is made, the price of prescription medication will only continue to grow monstrously large. 

Reviewed by: Eva Samborski

Designed by: Jennifer Liu

References: [1] Mulcahy, A. W., Whaley, C. M., Gizaw, M., Schwam, D., Edenfield, N., & Becerra-Ornelas, A. U. (2021). International prescription drug price comparisons: Current empirical estimates and comparisons with previous studies (RR-2956-ASPEC). RAND Corporation. https://www.rand.org/pubs/research_reports/RR2956.html 

[2] Baker D. E. (2017). High Drug Prices: So Who Is to Blame?. Hospital pharmacy, 52(1), 5–6. https://doi.org/10.1310/hpj5201-5  

[3] Kesselheim, A. S., Avorn, J., & Sarpatwari, A. (2016). The high cost of prescription drugs in the United States: Origins and prospects for reform. JAMA, 316(8), 858–871. https://doi.org/10.1001/jama.2016.11237 

[4] Schwartz, L. M., & Woloshin, S. (2019). Medical Marketing in the United States, 1997-2016. JAMA, 321(1), 80–96. https://doi.org/10.1001/jama.2018.19320  

[5] Gross, D. J., Ratner, J., Perez, J., & Glavin, S. L. (1994). International pharmaceutical spending controls: France, Germany, Sweden, and the United Kingdom. Health care financing review, 15(3), 127–140.