Robert Thornton received personalized hospital care for COVID-19 and pneumonia in his Belvidere, Ill., home in 2024 as part of a Medicare in-home care program that expired October 1. (Photo courtesy of OSF Healthcare)

The federal government shutdown is forcing a reckoning for two remote health care programs because they automatically expired Oct. 1.

The telehealth and in-home hospital care programs were both temporary — but increasingly popular — options for Medicare recipients. They allowed doctors and hospitals to bill Medicare for telehealth appointments and in-home visits from nurses to provide care that is generally only available in hospitals.

The shutdown has prevented Congress from extending them.

More than 4 million Medicare beneficiaries used telehealth services in the first half of the year, according to Brown University’s Center for Advancing Health Policy through Research.

As of last fall, 366 hospitals had participated in the hospital-at-home program, serving 31,000 patients, according to a federal report. The program, officially called Acute Hospital Care at Home, allows patients who would otherwise be hospitalized to get inpatient care at home with a combination of nurse visits, monitoring equipment and remote doctor visits.

The programs have their roots in the pandemic, when doctors and hospitals wanted to keep patients safe from the risks of travel and hospital stays. Both are for Medicare recipients, generally people over 65 or who are disabled. But since many private insurers follow federal guidelines, some physicians have stopped booking telemedicine appointments for non-Medicare patients, rather than risk a change in insurance coverage.

Alexis Wynn, who is in her mid-30s and covered by private insurance through her employer, tried to switch an in-person doctor appointment in Pennsylvania to a video visit last week. The office told her that “all telemedicine is uncovered by insurance as of Oct. 1” — so she had to cancel the routine appointment.

“It was just a follow-up appointment  to make sure the dosing of my medication was still accurate, nothing that was pertinent to being face-to-face,” Wynn said. Her health insurance company later told her it still covered telehealth visits.

There have been other reports of insurers turning down non-Medicare telehealth appointments, said Alexis Apple, director of federal affairs for the American Telemedicine Association, a trade group.

“It’s a misunderstanding,” Apple said. “I’m not really sure what’s happening, but it’s unfortunate and very scary. There’s so much uncertainty out there now, and we see insurance payers start to pull back.”

Both telehealth and home hospital services can be a lifeline for older people, especially in rural areas, where residents may struggle to travel long distances for health care in person.

“In rural America, it’s often telemedicine or no medicine at all,” said Dr. David Newman, chief medical officer of virtual care at Sanford Health in South Dakota, in a September statement supporting congressional action to make Medicare telehealth permanent. Bipartisan bills that would have allowed telehealth to continue stalled in committee earlier this year in the Senate and House.

There’s an exception for telehealth rural residents — but only if they travel to a brick-and-mortar health care facility to get the remote health care service.

“The patients have to go to a clinic to receive that telehealth visit from a provider in a different location,” Apple said. “It kind of defeats the purpose.”

According to the Brown University report, California had the highest rate of Medicare telehealth usage in the first six months of this year, with 26% of beneficiaries using at least one telehealth appointment, followed by 23% in Massachusetts and 21% in Hawaii.

There’s no reason for non-Medicare insurers to stop covering any telehealth visits during the shutdown, and even most Medicare Advantage programs will continue to cover telehealth, according to Tina Stow, a spokesperson for AHIP, a health industry trade association.

Nevertheless, at least some health care centers are refusing to take new telehealth appointments or are converting existing ones to office visits.

“This is causing a lot of confusion. We are still working with our members who are insurers and providers to get a gauge on what folks are doing — because at this point reports we’ve seen seem to suggest it is company by company, provider by provider,” said Sean Brown, a spokesperson for the Health Leadership Council, representing CEOs of health care firms and insurers.

The hospital-at-home program serves a smaller number of patients but its pause has caused more disruption: The federal government required patients to be discharged from the program or transferred to a brick-and-mortar hospital by Oct.1.

The Minnesota-based Mayo Clinic had 30 patients in the program in Arizona, Florida and Wisconsin — all of whom either had to be released from the program or sent to brick-and-mortar hospitals. One of Mayo’s hospitals in Florida was already over capacity and had no room for transfers, according to reporting by Becker’s Hospital Review.

In Massachusetts, which requires commercial insurers to follow Medicare guidelines, all insured patients had to leave the program. Mass General Brigham, which operates many hospitals in the state, has rejiggered its plans to create more home care without relying on the hospital-at-home program, according to the Becker’s report.

Congress was unable to avert a shutdown by late September, and some individual providers and patients were caught unawares.

Nurses on social media discussed losing home-care jobs or being reassigned overnight when the hospital-at-home program closed Oct. 1. They worried about patients being taken away from children at home, or placed in hallway beds at overcrowded emergency rooms because of the abrupt change.

“Management scheduled a random call this morning with a super vague title. Then drop the bomb on us,” wrote one poster in Texas. “So no job. Perfect!”

In a direct message, the poster, who didn’t want their name used for fear of getting in trouble at their hospital, told Stateline, “This obviously wasn’t ideal for the patients. One of them had four children and now could no longer be home with them. Some didn’t even get to have a bed in the hospital because there were none available and had to stay in the ER in a hallway bed.”

Parkland Health System in Dallas started tapering off its hospital-at-home program in September because of the impending shutdown, and the last patients were discharged from the program by Sept. 30 without returning to the hospital, spokesperson Wendi Hawthorne said.

“We are hopeful that Congress will renew this innovative model of care in the future,” Hawthorne said.

Likewise, OSF Healthcare in Peoria, Illinois, had started to wind down its hospital-at-home program “to avoid needing to return multiple patients to a very crowded facility,” said Jennifer Junis, president of OSF OnCall, which handles home hospital care.

There were only three patients in the program Sept. 30, all of whom were ready to be discharged without returning to the hospital, Junis said. Since the program’s start in 2020, it has helped 980 patients with home care through OSF’s Saint Francis Medical Center in Peoria.

“It is unfortunate that we will not be able to benefit by treating qualifying patients at home, where they are most comfortable and recover faster,” Junis said. “Our digital hospital program has allowed us to free up beds for our sickest patients who need them most.”

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

President Donald Trump speaks during a Cabinet meeting at the White House on Oct. 9, 2025 in Washington, D.C. (Photo by Anna Moneymaker/Getty Images)

WASHINGTON — President Donald Trump said Thursday he’s prepared to cancel funding approved by Congress that he believes is going toward programs supported by Democrats, though he didn’t share any additional details during a Cabinet meeting. 

“We’ll be cutting some very popular Democratic programs that aren’t popular with Republicans,” he said. “They wanted to do this, so we’ll give them a little taste of their own medicine.” 

Meanwhile, on day nine of the government shutdown, members of the U.S. Senate for the seventh time failed to advance either a Democratic or Republican stopgap spending bill, and House Speaker Mike Johnson said partisan tensions in his chamber are so intense he is reluctant to bring members back until a resolution is found. 

“This gets personal. Emotions are high. People are upset. I’m upset,” Johnson told reporters at a morning press conference.

Layoffs, denial of back pay also threatened

Trump has signaled throughout the shutdown he wants to unilaterally cancel funding approved by Congress, lay off federal workers by the thousands and may try to reinterpret a 2019 law that requires back pay for furloughed federal employees after the funding lapse ends. 

He has yet to give any real details on those plans or say exactly when he’ll try to take those steps, which would likely result in additional lawsuits. 

Trump said during the hour-long public portion of the Cabinet meeting that Office of Management and Budget Director Russ Vought would be able to share more details, but Vought never spoke and Trump didn’t call on him. 

“The shutdown has been, you know, pretty damaging. I mean, not yet, because it’s early. But it gets a little bit worse as it goes along,” Trump said. “And we’ll be making cuts that will be permanent and we’re only going to cut Democrat programs. I hate to tell you. I guess that makes sense, but we’re only cutting Democratic programs. But we’re going to start that and we have Russell, who can talk to you about it if he wants to.”

The president is generally required to faithfully execute the laws that Congress approves, including the government funding bills. 

The White House budget office has frozen or canceled funding several times this year without going to lawmakers for approval, which is required under a 1970s law. 

That has led to a slew of lawsuits and the Government Accountability Office repeatedly citing the administration for illegally impounding funds. 

No progress on votes

On Capitol Hill, lawmakers remained deadlocked over how to advance a stopgap bill to fund the government for a few weeks. 

The Senate voted 54-45 on the House-passed bill that would fund federal programs through Nov. 21 and 47-50 on Democrats’ counterproposal that would provide spending authority through Oct. 31 and make substantial changes to health care policy. 

The tally for the seventh vote to advance those two proposals wasn’t much different from the previous ones. Nevada Sen. Catherine Cortez Masto and Pennsylvania Sen. John Fetterman, both Democrats, as well as Maine independent Sen. Angus King voted with Republicans to advance their bill. Kentucky GOP Sen. Rand Paul voted no.

Legislation needs the support of at least 60 senators to advance under that chamber’s legislative filibuster rule. 

The vote came shortly after Speaker Johnson, R-La., made disparaging remarks about Senate Democratic Leader Chuck Schumer during his press conference, with the two increasingly blaming each other for the funding impasse.  

“There is one thing that Chuck Schumer cares about more than anything else and that is his Senate seat,” Johnson said. “The guy has been in Congress for 44 years. He doesn’t know how to live life outside this building and so he will do anything to make sure that he keeps that seat.”

Johnson, asked about the increasing tensions between Republicans and Democrats over the funding lapse and health care policy, said it is likely better to keep lawmakers in that chamber separated until a resolution is reached. 

“I’m a very patient man, but I am very angry right now because this is dangerous stuff,” Johnson said. “And so, is it better for them, probably, to be physically separated right now? Yeah, it probably is, frankly. 

“I wish that weren’t the case. But we do have to turn the volume down. The best way to turn the volume down is to turn the lights back on and get the government open for the people.”

Shutdown pay for members of the military 

Johnson reiterated that he does not intend to bring the House back from an extended recess to vote on a stand-alone bill to provide on-time paychecks to military members during the shutdown. 

Johnson stuck to his position that the best way to ensure pay for U.S. troops is for Democrats to pass the GOP stopgap spending bill, despite Trump breaking with Johnson on that particular issue. 

Trump, asked Wednesday about the upcoming Oct. 15 payday for military members, said “that probably will happen” and that the “military is always going to be taken care of.”

But, Johnson said during his Thursday press conference the only way out is through the Republican stopgap bill that remains stalled in the Senate. 

“We have already voted to pay the troops. We did it three weeks ago. We put that bill on the floor, and the Republicans voted to pay the troops, TSA agents, border patrol, air traffic control and everybody else,” Johnson said. “So coming back here and doing it and having a duplicative vote to do the same thing they already did would accomplish nothing.”

Schumer, D-N.Y., said during a floor speech the shutdown will not end until after Republicans and Democrats find a way to extend tax credits for people who buy their health insurance from the Affordable Care Act Marketplace past the end of the year. 

Schumer also rebuked Johnson for the House schedule, which has only had members in Washington, D.C., for 12 days since the end of July. 

“If you’re someone who works two jobs or weekends or overtime to make ends meet, what on Earth are you supposed to think when House Republicans can’t even be bothered to show up to reopen the government?” Schumer said. 

New England senators initiate talks

Senate Appropriations Chairwoman Susan Collins, R-Maine, said she has been speaking with New Hampshire Democratic Sen. Jeanne Shaheen about possible solutions to the impasse. 

“I have been in very close contact with Sen. Shaheen, who is very constructive, and is trying to find a path forward,” Collins said.  

“The ACA issue is important to a lot of us, not just to Democrats,” she added. “The tax subsidies were enhanced during COVID. They do need to be reformed, but they do need to be extended as well. They expire at the end of the year. We need to open up government today before more harm is done, before people in the military don’t have their paychecks.”

 Ariana Figueroa and Shauneen Miranda contributed to this report. 

Health and Human Services Secretary Robert F. Kennedy Jr., joined by President Donald Trump, delivers an announcement on “significant medical and scientific findings for America’s children” in the Roosevelt Room of the White House on Sept. 22, 2025 in Washington, D.C. Federal health officials suggested a link between the use of acetaminophen during pregnancy as a risk for autism, although many health agencies have noted inconclusive results in the research. (Photo by Andrew Harnik/Getty Images)

WASHINGTON — A majority of Americans disapprove of Health and Human Services Secretary Robert F. Kennedy Jr.’s job performance and the federal government’s evolving vaccine policy, according to a poll released Thursday by the nonpartisan health organization KFF.

In addition, the vast majority of those surveyed have heard the unproven claims made by President Donald Trump, Kennedy and others in late September that taking acetaminophen, also known as Tylenol, during pregnancy could be one possible environmental factor in a child later being diagnosed with autism.

A total of 77% of the people KFF polled said they knew of the statements, though whether people believe the claims, which have yet to be established by the medical community, varied.

Only 4% of those surveyed said it is “definitely true” that taking Tylenol during pregnancy increases the risk of the child developing autism, and 35% said the claim is “definitely false.” Thirty percent said it is “probably true” and 30% said it is “probably false.”

Combined, 65% said it’s either probably or definitely false to say that taking acetaminophen during pregnancy increases the chance of a child developing autism, a complex disorder that experts believe is the result of both genetic and environmental factors.

When broken down by political party, 86% of Democrats, 67% of independents and 43% of Republicans said the claims were either probably or definitely false.

The survey shows 59% somewhat or strongly disapprove of how Kennedy is handling his new role at the top of the country’s public health infrastructure.

The level of support changes considerably depending on political party affiliation, with 86% of Democrats, 64% of independents and 26% of Republicans disapproving.

A slightly higher number, 62%, either somewhat or strongly disapprove of the United States’ vaccine policy.A similar trend emerged when those polled were broken up by political parties. Eighty-eight percent of Democrats, 67% of independents and 31% of Republicans somewhat or strongly disapproved of vaccine policy.

The survey shows a declining share of Americans have faith in the Centers for Disease Control and Prevention to provide trusted information about vaccines, compared with previous KFF polls in September 2023 and earlier this year.

A total of 63% of respondents two years ago trusted the CDC on vaccines, but that has declined to 50%.

Democrats’ faith in the CDC’s vaccine recommendations has dropped from 88% two years ago to 64%, independents have gone from 61% to 47% and Republicans have remained relatively steady, only going from 40% to 39%.

Across political parties, a person’s own doctor as well as the American Academy of Pediatrics and the American Medical Association remain broadly trusted for vaccine information.Eighty-three percent said they trust their doctor or health care provider, 69% believed information from the American Academy of Pediatrics and 64% had faith in the AMA.

The poll of 1,334 adults took place from Sept. 23 to Sept. 29 and had a margin of error of plus or minus 3 percentage points for the full survey. Questions broken down by a person’s political ideology had a margin of error of plus or minus 6 percentage points.

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U.S. Rep. Mark Pocan (D-Black Earth) speaks about impending insurance price increases due to the sunset of enhance subsidies for health insurance policies purchased at HealthCare.gov. (Photo by Erik Gunn/Wisconsin Examiner)

Sometime in the next 10 days, Wisconsin residents will see directly what the stakes are in the ongoing standoff in Washington over the federal shutdown, U.S. Rep. Mark Pocan (D-Black Earth) said Wednesday.

That’s when people who buy health insurance through the federal HealthCare.gov marketplace under the Affordable Care Act (ACA) will find out their likely premiums for 2026.

“In the next probably 10 days, we’re going to have a lot more information,” Pocan said at a press conference in the state Capitol along with small business owners and state lawmakers. “Health care is going to start getting very expensive for everyone beyond what it costs now — but for some people it’s going to be so cost prohibitive that they’re going to actually wind up losing their health insurance.”

Most Democrats in the U.S. Senate have refused to vote to advance a Republican continuing resolution to keep the federal government funded and have said they won’t do so if Republicans won’t negotiate with them on the bill.

In demanding changes to the stopgap spending bill, Democrats have focused on enhanced premium tax credits that provide subsidies for most people who buy health insurance on the federal marketplace.

The enhanced subsidies, enacted in 2021 and extended in 2022, will expire at the end of this year, driving up the premium cost for health insurance policies sold on the marketplace.

Pocan said that with the premiums on ACA policies going up and losing the additional subsidies, “a couple 60 years old making $85,000 in my district could see somewhere between a $16,000 and $17,000 increase next year in their premiums.” The projections are the product of KFF, the independent health research, policy and news organization.

Macy Buhler owns a child care center. She said her own health insurance comes through her husband’s job, but some of her employees have relied on the ACA and HealthCare.gov to buy insurance. With the possibility that they won’t be able to afford those plans any more, she said, she’s been inquiring with insurance companies about their potential options.

“I’m doing the best I can,” Buhler said. “But when people don’t see that this is going to affect our workforce, it frustrates me. It will absolutely affect our workforce. It will absolutely affect families who are middle class and lower. It will affect our farmers.”

Kyle LaFond, who  owns a custom manufacturing business, said he and his team of eight employees have relied on the ACA for health insurance.

“The ACA really leveled the playing field in terms of being able to provide coverage,” LaFond said.

Among his employees, the projected increases for health insurance will range from $2,000 to about $12,000. “For a growing family, those price hikes are almost insurmountable. It’s unconscionable,” La Fond said.

With the increased subsidies expiring, “I might lose some good people,” he added. “So I’m talking about the future of my business.”

Democrats tried to make extending the subsidies part of the tax- and spending-cut megabill that President Donald Trump signed in July, but the procedure Republicans used to pass that legislation allowed them to move it through the process without Democratic votes.

Pocan said the Democrats are not willing to trust the Republican majority to  negotiate on the ACA subsidies if the Democrats first agree on the GOP bill and simply reopen the government.

Previous deals in December and in March on stopgap spending bills fell apart, he said. “Then Donald Trump did recissions, which are against the law, and started taking away funding that we did. Article 1 of the Constitution gives the power of the purse to Congress and he took it away. So they get all of that.”

Pocan said the recurring Republican claim that Democrats are holding out “because they want to give hundreds of billions of dollars of health benefits to illegal aliens — PolitiFact gave that an outright false.”

Pocan refrained from using a barnyard epithet for the claim. “Manure is what it is,” he said, glancing around at the ornately decorated Assembly parlor. “It’s a pretty room. I got to talk pretty.”

But, he said, “by federal law, not one dime can go directly to someone who’s an undocumented person — I’m going to use that terminology — from Medicare, Medicaid, or the Affordable Care Act. So, nothing. So, it’s not true.”

Public awareness about the shutdown could be lagging. Pocan said his office had 85 calls last week about the shutdown.

By contrast, in the last nine months, his office has taken 14,435 calls about health care. “So this is something that people really care about.”

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U.S. Senate Minority Leader Chuck Schumer, D-N.Y., speaks with reporters in the U.S Senate press gallery on Wednesday, Oct. 8, 2025. (Photo by Jennifer Shutt/States Newsroom)

This report has been updated.

WASHINGTON — Congress has just one week to break the stalemate and fund the government before active duty military members miss their first paycheck of the shutdown. 

That would be followed later in the month by absent wages for federal civilian employees and the staffers who work for lawmakers — benchmarks that would traditionally increase pressure on Democrats and Republicans to negotiate a deal.

But both sides remained dug in Wednesday, as the Senate failed to pass Republicans’ short-term government funding bill for the sixth time and Democrats were unable to get the support needed to advance their counterproposal. 

The 54-45 vote on the GOP bill and the 47-52 vote on Democrats’ legislation didn’t reach the 60 votes needed to advance under Senate rules.

Nevada Sen. Catherine Cortez Masto and Pennsylvania Sen. John Fetterman, both Democrats, as well as Maine independent Sen. Angus King voted with Republicans to advance their multi-week funding bill. Kentucky GOP Sen. Rand Paul voted no.

The shutdown began on Oct. 1, the start of the federal government’s 2026 fiscal year.

Trump warms up to idea of separate bill on military pay

Speaker Mike Johnson, R-La., rejected the idea of voting on a stand-alone bill to provide paychecks to active duty military members during the shutdown, saying that if Democrats wanted to ensure salaries for federal workers, they should vote to advance the stopgap spending bill. 

“They live with that vote. They made that decision. The House is done,” Johnson said at a morning press conference. “The ball is now in the Senate’s court. It does us no good to be here dithering on show votes. We did it. We sent the product over.”

Trump, speaking from the White House later in the afternoon, broke with GOP leaders in Congress on passing a stand-alone bill to provide pay for military members during the shutdown. 

“Yeah, that probably will happen. We don’t have to worry about it yet. That’s a long time,” Trump said. “You know what one week is for me? An eternity. One week for me is a long time. We’ll take care of it. Our military is always going to be taken care of.”

Johnson also appeared to fully reject an idea floated by the Trump administration not to provide back pay for furloughed federal employees, which is required by a 2019 law. 

“It’s my understanding that the law is that they would be paid. There is some other legal analysis that’s floating around. I haven’t yet had time to dig into and read that,” Johnson said. “But it has always been the case, it is tradition and I think it is statutory law that federal employees be paid. And that’s my position. I think they should be.”

Trump muddied the waters on that issue during his afternoon appearance, blaming Democrats for how his administration plans to handle back pay for furloughed federal workers. 

“We’re going to see. Most of them are going to get back pay and we’re going to try to make sure of that,” Trump said. “But some of them are being hurt very badly by the Democrats and they therefore won’t qualify.”

The shutdown will likely only end after congressional leaders begin talking with each other about core policy issues, including how to address enhanced tax credits for people who buy their own health insurance from the Affordable Care Act Marketplace. The credits are set to expire at the end of the year, spurring huge increases in health insurance costs.

Democrats say a deal must be reached before they’ll vote to advance the GOP stopgap spending bill that would fund the government through Nov. 21. Republican leaders maintain they won’t negotiate until after Democrats vote to open the government.

‘You can’t take the federal government hostage’

Senate Majority Leader John Thune, R-S.D., said he and other GOP lawmakers are willing to talk with Democrats about the tax credits, but only after the government reopens. 

“They have other issues that they want to bring up, which I said before we’re happy to discuss, and yes, there are some things that I think there’s interest on both sides in trying to address when it comes to health care in this country,” Thune said. “But you can’t take the federal government hostage and expect to have a reasonable conversation on those issues.”

Thune said the stopgap funding bill is needed to give both chambers more time to work out a final agreement on the dozen full-year government funding bills, which were supposed to become law by the start of the fiscal year.

“What this does is provide a short-term extension in order for all that to happen,” he said. “That’s all that we’re talking about.”

Senate Minority Leader Chuck Schumer, D-N.Y., said Republicans are divided on health care issues and want to avoid a public debate over the Affordable Care Act tax credits. 

Schumer then read part of a social media post by Georgia Republican Rep. Marjorie Taylor Greene in which she said she was “absolutely disgusted” that health premiums will double by the end of the year without action.

“More Republicans should listen to her because, on this issue, she’s right on the money,” Schumer said. “Meanwhile, Democrats’ position hasn’t changed. We urge our Republican colleagues to join us in a serious negotiation to reopen the government and extend ACA premiums.”

Trump threats

The shutdown’s ramifications will continue to get worse the longer lawmakers remain intransigent, especially given President Donald Trump’s efforts to differentiate this funding lapse from those in the past.

Trump has said he’ll lay off federal workers by the thousands, cancel funding approved by Congress for projects in Democratic regions of the country and may not provide back pay for the hundreds of thousands of furloughed federal employees.

Trump and administration officials have been vague about when and how they’d implement layoffs, but a federal judge hearing arguments in a suit brought by a federal employee labor union has ordered government attorneys to file a brief later this week detailing its plans and its timeline.  

Northern District of California Judge Susan Illston has given the Trump administration until the end of Friday to share details of any planned or in-progress Reduction in Force plans, “including the earliest date that those RIF notices will go out.”

Illston, who was nominated by former President Bill Clinton, also told the Trump administration to detail what agencies anticipate implementing layoffs and how many employees that would impact. 

Illston set Oct. 16 for oral arguments between the American Federation of Government Employees and federal government attorneys over AFGE’s request for a temporary restraining order to block the Trump administration from implementing layoffs during the shutdown.

Murkowski reports informal talks

Alaska Republican Sen. Lisa Murkowski, part of a bipartisan group that has begun informal talks, said during a brief interview Wednesday that the government must reopen before real steps can be taken on the ACA tax credits. 

“I think the leadership has made very, very clear that the way to open up the government is, let’s pass a bill that will allow us to open up the government, and then there’s a lot of good conversations that can go on,” Murkowski said. “It doesn’t mean that we wait until then to start conversations, and that’s what we’re doing. We’re talking but we’re talking outside of the range of your microphones.”

She said, “There are not a lot of guarantees around this place, are there?” when asked by a reporter whether Republicans could provide Democrats with assurances on floor votes on ACA tax credit extensions if they vote for the stopgap spending bill. 

North Carolina GOP Sen. Thom Tillis said he expects the shutdown to last for at least a couple more weeks and urged Democratic senators to vote to reopen the government. 

“Go take a look at the list of Democrats who are either not running for reelection or not up until ‘28 or ‘30,” Tillis said. “There are plenty of them to walk the plank like I have multiple times to get the government funded and then the discussions start.”

Oklahoma Republican Sen. Markwayne Mullin said that talks between Democrats and Republicans are “stalled” but “we’re having conversations with everybody.” 

South Dakota GOP Sen. Mike Rounds said that lawmakers have had bipartisan “visits” though no real conversations. 

“There’s no framework,” Rounds said. “There’s just a matter of a clarification about how important it is to get the shutdown over with. And once we get that shutdown over with, we’ll go back to bipartisan work in the Senate.”

Ariana Figueroa contributed to this report.

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We found no documentation confirming a Sept. 29 statement by U.S. Sen. Ron Johnson, R-Wis., that 6 million people unknowingly received health insurance through the Affordable Care Act.

Johnson cited a report by Paragon Health Institute, a think tank aligned with the Trump administration. 

The report produced an estimate, not a count, claiming 6.4 million people were fraudulently enrolled in Obamacare. It said they were not income-eligible, including millions who “appear to be enrolled without their knowledge.”

The methodology was faulted by Blue Cross Blue Shield, the National Association of Benefits and Insurance Professionals and the American Hospital Association. 

Paragon stood by its work.

Fraud is much more common among brokers misappropriating patients’ identities than by patients, said KFF Obamacare program director Cynthia Cox and Justin Giovannelli of Georgetown University’s Center on Health Insurance Reforms.

Consumers are cautioned about offers to enroll them in Obamacare.

This fact brief is responsive to conversations such as this one.

Sources

• U.S. Sen. Ron Johnson: Email
• Paragon Health Institute: The Greater Obamacare Enrollment Fraud: The Fraud Got Much Worse in 2025
• Politico: The think tank driving health policy on Capitol Hill — and dividing Republicans
• Washington Post: As GOP eyes ACA cuts, a conservative group highlights rampant fraud
• Paragon Health Institute: Answering the Critics: How Paragon Discovered Enrollment Fraud in the ACA Exchanges
• Blue Cross Blue Shield: The facts about the individual marketplace
• National Association of Benefits and Insurance Professionals: Facts Over Fear: NABIP Rebukes Paragon’s Misleading ACA Claims
• American Hospital Association: Setting the Record Straight: Separating Fact from Fiction on Health Insurance Marketplace Fraud
• U.S. Department of Health and Human Services: Consumer Fraud in the Health Insurance Marketplace

Do 6 million people receive Obamacare health insurance without knowing it? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Dr. Lauren VanDeHey speaks at a press conference on Tuesday in favor of legislation to require insurers to cover infertility treatment. (Photo by Erik Gunn/Wisconsin Examiner)

Treatments for infertility can cost tens of thousands of dollars, leaving some couples to borrow huge sums to cover the expense and others to decide against having children at all.

Lawmakers are circulating a draft bill to change that by requiring health insurers in Wisconsin to cover infertility procedures. If the measure is enacted, Wisconsin would join 22 states and the District of Columbia in providing some form of coverage for fertility treatments, according to advocates.

“Infertility is a medical issue,” said state Rep. Jodi Emerson (D-Eau Claire) at a Capitol press conference Tuesday. “And like any other health condition, it deserves the medical treatment to be affordable and accessible. Yet right now, too many individuals and couples are forced to choose between financial stability and the chance to start a family. That’s a choice no one should ever have to make.”

Emerson is the lead Assembly author of the proposal, along with Sen. Kelda Roys (D-Madison), the lead Senate author.

Roys described infertility as a deep source of disappointment for many couples who want to have children. “One of the things that it shouldn’t do, though, is bankrupt you,” she said. “Everyone should be able to access treatment for health conditions and diseases like infertility without regard for the type of insurance you have.”

Dr. Bala Bhagavath, an infertility specialist based in Madison, told reporters that he previously practiced in New York and Rhode Island, where state laws mandate coverage for infertility treatments. Relocating to Wisconsin “has been a rude awakening,” he said.

“Although some patients get coverage for diagnosis of their condition, most pay out of pocket for both diagnosis as well as treatment,” Bhagavath said. “It’s quite common for patients to take out loans and second mortgages so that they can build a family. I’ve had patients taking a second job or moving south of the border to Illinois as they would get insurance coverage for infertility treatment.”

Dr. Lauren VanDeHey, a medical resident in obstetrics and gynecology, said that as a cancer survivor she underwent a procedure to preserve embryos to avoid the risk of damage from chemotherapy and radiation. She was able to get free medication and the cost of some of her in vitro fertilization services discounted, but is still faced with a $17,000 bill she and her husband  will have to pay off over the next several years, she said.

“I am fortunate I will be able to pay these debts off when I complete my medical training,” she said. “For others, taking on this expense is simply not an option. Support for this bill needs to be a bipartisan effort because cancer and infertility can affect anyone.”

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President Donald Trump speaks to the media in the Oval Office at the White House on Sept. 2, 2025 in Washington, D.C. (Photo by Alex Wong/Getty Images)

WASHINGTON — President Donald Trump sent mixed messages Monday about whether he would negotiate a deal with Democrats to extend the enhanced tax credits for people who get their health insurance from the Affordable Care Act Marketplace, one of the main issues that led to the government shutdown. 

His comments came shortly before the Senate deadlocked for a fifth time on short-term government funding bills, voting 45-50 on Democrats’ proposal and 52-42 on a House-passed Republican stopgap spending bill. Both needed at least 60 votes to advance.

Nevada Sen. Catherine Cortez Masto and Pennsylvania Sen. John Fetterman, both Democrats, as well as Maine independent Sen. Angus King voted with Republicans to advance their multi-week funding bill. Kentucky GOP Sen. Rand Paul voted no.

Trump said during a press conference “some very good things could happen with respect to health care” and that “if we made the right deal, I’d make a deal, sure,” before sharply criticizing the 2010 health care law, also called Obamacare. 

“That’s the problem with Obamacare. The subsidies are so much — billions and billions of dollars is being wasted,” Trump said. “And we could have much better health care than we have right now. And we’re talking to them. I’m not saying that’s going to happen.”

Trump centered much of his 2016 campaign for the presidency around repealing and replacing the health care law, but Republicans were unable to do so with unified control of government during the first half of his first term.  

After Democrats swept in the 2020 elections, they enhanced the tax credits for people who buy their health insurance through the ACA Marketplace in a coronavirus relief law. Those enhanced subsidies are set to expire at the end of December. 

Democratic leaders for weeks have called on Republicans to negotiate a bipartisan agreement to extend those enhanced tax credits ahead of open enrollment beginning on Nov. 1. 

That didn’t happen and Democrats have largely voted against advancing a stopgap spending bill written by Republicans that was needed to fund the government past the end of September. 

‘On another planet’

Senate Minority Leader Chuck Schumer, D-N.Y., said during a floor speech shortly before Trump spoke from the Oval Office that the president and GOP leaders seem “to be on another planet.”

“Instead of trying to solve this shutdown crisis, Donald Trump spent the weekend golfing and posting memes and deepfakes on the internet,” Schumer said. “He seems to think this shutdown is some big joke. He’s wrong.”

Schumer released a statement following Trump’s press conference, saying the two sides aren’t negotiating, despite the president saying “we are speaking with the Democrats.” 

“For months, Democrats have been calling on Donald Trump and Congressional Republicans to come to the table and work with us to deliver lower costs and better healthcare for the American people,” Schumer wrote. “If President Trump and Republicans are finally ready to sit down and get something done on healthcare for American families, Democrats will be there — ready to make it happen.”

Speaker Mike Johnson, R-La., said during a morning press conference he will only negotiate with Democrats on the enhanced ACA Marketplace tax credits after the shutdown ends. 

But Johnson did indicate he believes the expiring expansion likely needs a resolution before open enrollment begins next month.

“They’ve been saying that some of the insurance companies will be sending out notices in early November. The last time I checked, it’s Oct. 6. We have the entire month of October,” Johnson said. “We’ll stay here around the clock to work through all these things, but we have to get government open again to do it.”

Discussion about passing bills

The House has been in recess since mid-September and Johnson has refused to bring representatives back until after the Senate approves a bill to reopen the government. 

Johnson revealed during the press conference that he had a “fruitful conversation” a few days ago with Senate Appropriations Committee ranking member Patty Murray, D-Wash., about the annual government funding process, which lawmakers were supposed to complete by the start of the fiscal year on Oct. 1.

Johnson said he gave Murray assurances that he would hold floor votes on the final bipartisan versions of the dozen full-year bills after the Democrats and Republicans in charge of each subcommittee worked out an agreement.

“I’m ready to go,” Johnson said. “But we’ve got to open government up so that they can move to that next level, so that the conference committee can get that work done. That is small-d democracy at its best; you get Rs and Ds, everybody in the room, and they hash it out, and whatever that final product is, we will move through the process.”

The House has passed three of the full-year government funding bills along party-line votes and the Senate has approved three with a broadly bipartisan vote. 

Congress’ failure to approve all of the bills on time, combined with its inability to approve a stopgap spending bill to keep funding on autopilot while lawmakers work out a final full-year agreement, is why a shutdown began.

Dems say bipartisan talks needed to end shutdown

Murray posted later in the day on social media that bipartisan talks between the congressional leaders are the best option to end the shutdown.

“I’ll reiterate now what I told @SpeakerJohnson: the only path forward begins with him & @LeaderJohnThune talking with Leaders Schumer & Jeffries,” Murray wrote. “Premium hikes are going out THIS MONTH. We need a deal that reopens the government & stops premiums from doubling.”

White House press secretary Karoline Leavitt said during an afternoon briefing before Trump spoke that he “is definitely committed to fixing and improving our health care system,” though she declined to say if he supports extending the enhanced ACA tax credits as they exist. 

Leavitt also opted not to fully answer questions about when the administration will begin laying off federal workers by the thousands, saying the White House budget office continues to consult with Cabinet secretaries to determine which workers may lose their jobs. 

“We’ll see how the vote goes tonight,” Leavitt said, referring to the Senate’s Monday evening vote on the stopgap spending bills. 

Rural air service, air traffic controllers

Transportation Secretary Sean Duffy said during a press conference at Newark Liberty International Airport in New Jersey that the shutdown means there are only a few days left of funding for the Essential Air Service program, which provides federal “subsidies to airlines to service” rural communities. 

“That money runs out this Sunday, so there are many small communities across the country that will now no longer have the resources to make sure they have air service in their community,” Duffy said.  

Alaska will be the most affected by that particular funding lapse, he said. 

Duffy said there has been a “slight” increase in the number of air traffic controllers calling out sick during the shutdown but added it hadn’t caused any safety challenges yet. That will all change if transportation officials feel the staffing isn’t adequate for the number of flights. 

“If we see there are issues in the tower that are affecting the controllers’ ability to effectively control the airspace, we’ll reduce the rate and you’ll see more delays or you might see a cancellation,” Duffy said. “I’m willing to do that before we’re willing to risk anyone’s life in the air.”

Duffy, a former Republican congressman from Wisconsin, said he had spoken earlier in the day with air traffic controllers who were thinking about taking on jobs at ride-sharing companies to pay the bills, since they will not be paid until after the shutdown ends. 

He said the effects of the funding lapse, including air traffic controllers worrying how they’ll make ends meet, are problematic, especially if they’re distracted by it while on shift or exhausted from working other jobs.  

“I don’t want them finding a second job to pay the bills,” Duffy said. “I want them to get paid for the work they’re doing today, keeping our planes in the air and our skies safe.”

Duffy also reiterated the Transportation Security Administration, or TSA, which screens people entering airports, is housed within the Department of Homeland Security, not DOT. 

 Shauneen Miranda contributed to this report. 

The U.S. Supreme Court on Tuesday is scheduled to hear oral arguments in a case that could impact state laws around the country that ban “conversion therapy,” a controversial counseling practice for LGBTQ+ youth. (Photo by Anna Moneymaker/Getty Images)

The U.S. Supreme Court on Tuesday is scheduled to hear oral arguments in a case that could reverse or solidify state laws across the country that ban a controversial counseling practice for LGBTQ+ youth.

The case challenges a 2019 Colorado law that bans “conversion therapy” for children and teens. Conversion therapy is a catchall term for efforts to change the sexual orientation or gender identity of LGBTQ+ people. Sometimes called “reparative therapy,” it can range from talk therapy and religious counseling to electrical shocks, pain-inducing aversion therapy and physical isolation. The therapy has been widely discredited by medical groups.

More than half of states — including some led by Republicans — have banned or restricted the practice for children and teens since California became the first to do so in 2012, according to the Movement Advancement Project, a left-leaning nonprofit research organization that tracks LGBTQ+-related laws and policies.

In recent years, however, Republicans in several states have worked to reverse bans, with some success. A poll in June by Data for Progress, a liberal think tank, found that although less than half of Republican voters, 43%, support or strongly support conversion therapy, more than half — 56% — said the Supreme Court ought to allow states to ban it.

A decision in the Colorado case, expected next year, could have far-reaching ramifications for dozens of other states.

“I think we’re all really worried about the implications,” said Cliff Rosky, a professor of law at the University of Utah. Rosky helped draft Utah’s 2023 law prohibiting licensed professionals from practicing conversion therapy on LGBTQ+ youth. That measure unanimously passed the Republican-controlled legislature.

“We certainly hope the court will uphold the right of states to regulate the behavior of therapists that it licenses and protect children from a lethal public health threat,” he told Stateline.

The impact on other states’ laws would depend on the scope of the high court’s ruling. But most of those laws are similar to Colorado’s, Rosky said.

“Certainly, a broad ruling against Colorado’s law would jeopardize the constitutionality of all the other laws.”

In Chiles v. Salazar, a licensed counselor in Colorado Springs, Kaley Chiles, sued state officials in 2022 over a law that bars licensed mental health professionals from conducting conversion therapy on clients under 18. She argues the law violates her First Amendment right to free speech and interferes with her ability to practice counseling in a way that aligns with her religious convictions. Chiles is represented by conservative religious law firm Alliance Defending Freedom.

“The government has no business censoring private conversations between clients and counselors,” Jim Campbell, chief legal counsel for Alliance Defending Freedom, said in a news release when the group filed its opening brief in June. “Colorado’s law harms these young people by depriving them of caring and compassionate conversations with a counselor who helps them pursue the goals they desire.”

Colorado Attorney General Phil Weiser, a Democrat, said in an August news conference that the law doesn’t prohibit a provider from sharing information or viewpoints with a patient, and that therapists are still allowed to talk with patients about conversion practices offered by religious groups.

But he called conversion therapy a “substandard, discredited practice.” Conversion therapy has been denounced by major medical organizations including the American Medical Association, the American Psychological Association, the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.

“This practice has been used in the past to try to force patients to change their sexual orientation or their gender identity,” Weiser said. “The science, however, says that this practice is harmful. It doesn’t work.

“Regardless of how it’s performed, there can be real harms from this practice. And those harms can include depression, self-hatred, loss of faith, even suicide.”

The key question in the case is whether Colorado’s law regulates professional standards of conduct and speech, or whether it attempts to regulate the right to free speech, said Marie-Amélie George, a legal historian who has published extensively on LGBTQ+ rights and is a professor of law at Wake Forest University School of Law.

“What is really interesting about these laws is that most licensed health professionals don’t offer conversion therapy because professional associations across the board have condemned it as extremely harmful,” George told Stateline. After the mainstream mental health community disavowed efforts to change people’s sexual orientation by the late 1980s, conversion therapy “became primarily the province of religious and lay ministers,” she said.

State laws like Colorado’s don’t restrict clergy and lay ministers from engaging in conversion therapy, she said. They address only the small subset of state-licensed mental health professionals who wish to use it.

In August, attorneys general in 20 states and the District of Columbia filed an amicus brief supporting Colorado’s law. They argue the First Amendment doesn’t shield mental health practices from regulation when the state deems them dangerous or ineffective, and that states have a long and established history of regulating professional standards of care.

Colorado isn’t the only recent battleground over conversion therapy, as conservative majorities in the courts, state legislatures and at the federal level have opened the door for Republican lawmakers and conservative Christian groups to reinstate the practice.

Earlier this year, Kentucky’s Republican-controlled legislature passed a bill canceling Democratic Gov. Andy Beshear’s 2024 executive order that banned conversion therapy for minors. Beshear promptly vetoed the bill, but the legislature overrode his veto in March.

In April, a coalition of Republican attorneys general from 11 states, led by Iowa and South Carolina, appealed a January decision by a U.S. district court judge to uphold a 2023 Michigan law that’s similar to Colorado’s. It prohibits mental health professionals from trying to alter a minor’s sexual orientation or gender identity. The case began when Catholic Charities of three Michigan counties filed a lawsuit targeting Michigan’s law in 2024 on behalf of a licensed therapist.

In July, a Virginia court partially struck down the state’s 2020 ban on conversion therapy for minors. Republican lawmakers in Michigan introduced a bill in July to repeal their state’s ban, while Missouri’s Republican attorney general sued to overturn local conversion therapy bans.

From the mid-1990s until the mid-2010s, LGBTQ+ rights advocates won a lot of cases before the U.S. Supreme Court, said George, the Wake Forest professor.

“But in the years since, the Supreme Court has been more hostile to LGBTQ+ rights claims,” she said. “I think, with the political environment of the court, it will be interesting to see what they do given how they have treated other LGBTQ+ rights cases in recent years.

“States are extremely similar in the laws they have enacted, so the decision in this case will probably affect all of the conversion therapy bans in this country.”

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

The CDC says people age 65 and older should talk to their doctor about COVID 19 vaccines. (Photo by George Frey/Getty Images)

The Centers for Disease Control and Prevention on Monday updated its adult and child immunization schedules to to recommend COVID-19 shots for people 65 and older after they consult with their health care providers.

The CDC also is recommending in its updated immunization schedules that toddlers receive the chickenpox vaccines as a standalone immunization rather than in combination with measles, mumps, and rubella (MMR) shot.

The CDC announced what it called the return to “individual-based decision-making to COVID-19 vaccinations” in a press release on its website Monday morning.

The immunization schedules adopt recent recommendations by the Advisory Committee on Immunization Practices (ACIP), which has been overhauled by Health Secretary Robert F. Kennedy Jr., who fired  all 17 former members of the vaccine panel earlier this year and replaced them with his own appointees.

RFK Jr. fired everyone on a key vaccine panel. Here’s who he replaced them with.

“Informed consent is back,” said Acting Director of the CDC and Deputy Secretary of Health and Human Services Jim O’Neill. “CDC’s 2022 blanket recommendation for perpetual COVID-19 boosters deterred health care providers from talking about the risks and benefits of vaccination for the individual patient or parent. That changes today,” he continued.

“I commend the doctors and public health experts of ACIP for educating Americans about important vaccine safety signals. I also thank President Trump for his leadership in making sure we protect children from unintended side effects during routine immunization.”

According to the CDC press release, individual-based decision-making “means that the clinical decision to vaccinate should be based on patient characteristics that, unlike age, are difficult to incorporate in recommendations, including risk factors for the underlying disease as well as characteristics of the vaccine itself and the best available evidence of who might benefit from vaccination.

“Individual-based-decision-making,” the release continues,” allows for immunization coverage through all payment mechanisms including entitlement programs such as the Medicare, Medicaid, Children’s Health Insurance Program, and the Vaccines for Children Program, as well as insurance plans regulated by the Affordable Care Act.”

Vaccines greatly reduce rates of death and disease around the world. The American Academy of Pediatrics, American Academy of Family Practitioners, American College of Obstetricians and Gynecologists, American Medical Association, American Nurses Association, American Pharmacists Association, National Academy of Medicine, and World Health Organization endorse the use of vaccines.

The health insurance trade group AHIP issued a statement last month saying health plans would continue to cover all ACIP-recommended vaccinations, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026.

Health insurance group says vaccines in Florida still a covered benefit

The Florida Board of Pharmacy met briefly last month to affirm that Florida patients don’t need a prescription from their physician before receiving a vaccine. That’s because Florida law authorizes certain pharmacists who work in collaboration with physicians to administer vaccines.

Chickenpox

Meanwhile, the “new recommendation of standalone chickenpox vaccination for toddlers through age three follows evidence presented to ACIP by the CDC Immunization Safety Office’s that healthy 12–23 months old toddlers have increased risk of febrile seizure” from the combined chickenpox-MMR vaccine compared to those given immunization for chickenpox separately.

“The combination vaccine doubles the risk of febrile seizures without conferring additional protection from varicella compared to standalone vaccination,” the CDC statement says. Febrile seizures are brought on by high fevers.

An Afghan refugee caresses her 9-day-old infant inside the pediatric ward of a medical treatment facility in 2021 at Joint Base McGuire-Dix-Lakehurst, N.J. Refugees are among the lawfully present noncitizens facing the loss of federally funded health care coverage. (Photo by Barbara Davidson/Pool/Getty Images)

An estimated 1.4 million immigrants who are in the country legally but are not citizens stand to lose their government-subsidized health care coverage under the sweeping tax and spending bill President Donald Trump signed into law this summer, according to estimates from the nonpartisan Congressional Budget Office.

The One Big Beautiful Bill Act cuts federal spending on Medicaid, the joint federal-state health insurance program for low-income people. It also places new eligibility restrictions on lawfully present immigrants, including refugees and asylees, who are enrolled in a variety of government-subsidized health programs: Medicaid, the Children’s Health Insurance Program (CHIP), Medicare and Affordable Care Act marketplaces.

Immigrants who are in the country illegally have long been ineligible for federally funded health coverage.

But seven states — California, Colorado, Illinois, Minnesota, New York, Oregon and Washington — plus the District of Columbia have extended state-funded coverage to some income-eligible noncitizen adults regardless of their immigration status. Fourteen states plus the district provide state-funded coverage to noncitizen children whether they are here legally or not.

The new restrictions in the One Big Beautiful Bill Act, combined with other Trump policies limiting public benefits for immigrants, put those states in a financial bind. With less federal money to provide health benefits to immigrants who are here legally, states will be hard-pressed to maintain their programs that offer coverage to all immigrants, regardless of their legal status.

“We’re taking a giant step backwards from that public health and preventive health measure by excluding more people and draining federal resources from states that need it,” said Tanya Broder, a senior counsel specializing in immigrant health policy at the National Immigration Law Center, an advocacy group.

“And the result will be that our health — individually, as families and as communities — will be in jeopardy, and the health care infrastructure that serves all of us will also be compromised,” Broder said.

Already, some states that had offered health coverage aid to all immigrants — regardless of status — have been pulling back.

To help close a $12 billion deficit, California Democratic Gov. Gavin Newsom in June signed a state budget that bars immigrants who are here illegally from enrolling in the state’s Medicaid program, known as Medi-Cal. Current enrollees between the ages of 19 and 59 will have to pay a new $30 monthly premium beginning in 2027. In July 2026, the state will eliminate dental care for noncitizens.

Illinois in July ended its state-funded health coverage program for all immigrants ages 42 to 64. The state still operates a state-funded plan for residents 65 and older regardless of immigration status, but enrollment has been paused. And Minnesota also plans to exclude adult immigrants who are here illegally from a program that used to provide coverage regardless of immigration status.

New York is in an especially tough spot, since its state constitution prohibits discrimination against lawfully present immigrants in providing public benefits.

“States have had some type of leeway to fund resources for migrant communities if they want to,” said Medha Makhlouf, a law professor and the founding director of the Medical-Legal Partnership Clinic at Penn State Dickinson Law who studies immigrants’ access to health care. “But now this [federal] law makes it difficult for them to do that.”

Making it less attractive to stay

Jessica Vaughan, director of policy studies at the Center for Immigration Studies, a nonprofit group that backs stricter immigration policies, said these efforts are part of both Trump’s larger anti-immigration stance and “Congress’ interest in getting rid of any incentive or benefit for people who are in the country illegally.”

“It’s a way of making it less attractive for people to stay here illegally, right?” Vaughan said. “They’re trying to give people reasons to leave rather than reasons to stay.”

As noncitizens who are here legally lose access to federally funded benefits, the demand for state-funded coverage is “likely to increase,” Drishti Pillai, director of immigrant health policy at KFF, a health policy research group, told Stateline.

“However, at the same time, states are facing increasing budget pressures, especially with the Medicaid cuts,” Pillai said. “So it’s almost a double whammy, where there will likely be increased demand for state-funded coverage programs, but also states will have fewer resources to cover people.”

Makhlouf said the Trump administration’s policy changes reflect a broader strategy of stripping public benefits from marginalized and poor communities.

“Everyone who cares about access to health care needs to pay attention to what’s happening to immigrants,” she said. “When it becomes normalized to be able to sacrifice certain people’s humanity or their vulnerability, or to minimize their contributions to society, and say, ‘You don’t deserve access to health care,’ then that can be turned on to any group.”

Under Trump’s domestic policy law, California expects to lose at least $28.4 billion in federal Medicaid funding, according to Newsom’s office.

On the California Senate floor June 27, Democratic state Sen. María Elena Durazo expressed her sorrow at the state’s decision to deny coverage to immigrants.

“I can’t express how much joy I felt when we expanded basic health care,” Durazo said. “Today, that joy that I was so happy about, that joy has turned into pain, that joy has turned into shame.”

Democratic Senate Pro Tem Mike McGuire, however, said the state had little choice.

“We are a state of immigrants, 10.6 million strong. And we will never turn our backs on those who are part of the heart of the largest economy in the United States of America,” McGuire said during the debate. “So we’ve had to make some tough decisions. I know we’re not going to please everyone.”

Obligated in New York

One state, New York, is particularly in a bind, because its constitution requires it to provide coverage to lawfully present noncitizens.

Roxana, 27, has been living in the U.S. under the Deferred Action for Childhood Arrivals program, known as DACA, since she was 8 years old and is using her first name only out of fear she will be targeted. At the end of 2019, she experienced a range of debilitating symptoms, including pelvic pain and chronic fatigue, and discovered a noncancerous lump on her breast.

“Chronic illness has impacted my career trajectory with a lot of fatigue and chronic pain,” said Roxana, who lives in the Bronx, New York.

Roxana cannot get federally funded Medicaid. But she qualified for state-funded public health coverage in New York. A 2001 court case, Aliessa v. Novello, requires the state to offer publicly funded health coverage to all lawfully present residents under the state constitution. So, she could afford to go to the doctor, where she learned that she had a hormonal condition called polycystic ovary syndrome, or PCOS, and she was able to get the lump removed.

New York mostly picked up the tab for immigrants and other lawfully residing immigrants until 2016, when it launched coverage it called the Essential Plan under the 2010 Affordable Care Act, also known as Obamacare. Under the ACA, the plan has no deductibles or monthly premiums for patients, and the federal government has picked up almost the entire cost — 90% — of the plan, a huge economic relief for the state.

Now, New York faces an annual loss of $13.5 billion in federal Medicaid and Affordable Care Act funds. Additionally, the phasing out of premium tax credits for noncitizens under Trump’s law would lead to a loss of $7.5 billion in annual funding to the state’s Essential Plan, which covers 1.7 million New Yorkers.

“These are billions of dollars that are being taken away and out of New York’s delivery system,” Amir Bassiri, director of Medicaid at the New York State Department of Health, said at a United Hospital Fund conference on July 30.

It’s unclear whether and how the state will afford to cover people like Roxana, even though it’s required under the state’s constitution. Like other immigrants, she is terrified that in the face of cuts and shrinking safety net access for noncitizens, she will lose continuous health care coverage and that her condition will get worse.

“My PCOS symptoms have just been getting worse over the years. I really want to try my best with the health access that I have to get it under control.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Hope Broussard, 20, sought care at a Planned Parenthood in Washington in 2023 when her IUD became lodged in her cervix and the clinics in her hometown of Sandpoint, Idaho, weren’t able to help. She now lives in Pullman, Washington. (Photo by Geoff Crimmins for States Newsroom)

Fifth in a five-part series. 

Hope Broussard’s intrauterine device should have brought relief from her severe periods. But at 17, it started causing debilitating pain.

At the Sandpoint, Idaho, clinic where the device was implanted, providers suspected it was embedded in her uterine wall, but lacked the ultrasound equipment to make a diagnosis.

Homeless with no insurance after her mother kicked her out, Broussard couldn’t enroll in Medicaid as a minor without a parent’s involvement. The women’s clinics in Sandpoint couldn’t help. Hospital bills were out of the question.

“The only people that were able to help me were Planned Parenthood,” Broussard said.

She sought care across the border in Washington, at the Spokane Planned Parenthood, where an ultrasound showed the IUD was coiled around her cervix. A specialist carefully removed it in a follow-up appointment and she paid $20 for everything because it was all she could afford.

“It really was my saving grace at the time,” said Broussard, who moved from Idaho to Pullman, Washington, in part because of that experience of being unable to access health care locally. “I have no idea what I would’ve done if I didn’t have that option available to me.”

Broussard is one of more than 2 million people nationwide who used Planned Parenthood for health care between 2023 and 2024, according to the national organization’s annual report. But how many people will be able to afford and access care is changing after a new federal provision prohibits some organizations that provide abortions from receiving Medicaid payments for at least a year. Nationally, Planned Parenthood estimates it could lose $700 million from Title X and Medicaid cuts, forcing affiliates to close some clinics, curtail services and stop accepting Medicaid patients.

Many Republican lawmakers and anti-abortion groups celebrated the provision passed by Congress in July that essentially targeted Planned Parenthood clinics nationwide for “defunding” because abortion care is part of clinical services in many states where access is mostly legal. Federal Medicaid dollars cannot be used to pay for abortions except in limited circumstances, and abortion care makes up a small percentage of overall care provided by clinics. Still, conservatives argue the mere association with any such clinics is equivalent to funding all abortion. 

“Planned Parenthood’s desperate ploy for our tax dollars only underscores why the One Big Beautiful Bill is such a historic win,” said Susan B. Anthony Pro-Life America President Marjorie Dannenfelser in a July statement. “It halted, for the first time, over half a billion taxpayer dollars from propping up the corrupt abortion industry.”

Democratic-led states are in troubleshooting mode 

In response, elected officials in some Democratic-led states, including Washington, Hawaii, Colorado and Massachusetts have publicly pledged to backfill the funding needed to allow Planned Parenthood clinics to keep accepting Medicaid and other low-income patients. In July, Washington Gov. Bob Ferguson committed to filling the $11 million gap Planned Parenthood expected to see.

Many states don’t begin their legislative sessions until January, so some of the plans aren’t official yet and still need to make it through the legislative process or the details of allocation are still in progress. That means clinics either have to absorb the costs for now with the promise of reimbursement, or change their payment options and services for the time being. For example Hawaii is moving to sliding-scale fees for some Medicaid patients, and in Maine, a major independent clinic is making changes to its services. 

Idaho’s border with Washington and Oregon is a point of contention among lawmakers across state lines, where the political views could hardly be more polarized between the hard-line conservatives in Idaho and progressive politics in the other two states. But for the people who need abortion care, or even a basic ultrasound, like Broussard, clinics in places like Spokane and Ontario, Oregon, are some of the last options available. 

Oregon lawmakers are also brainstorming ways that the state can provide reimbursement to Planned Parenthood for lost funding. Clinics across the state billed Medicaid nearly $17 million for services in 2024, according to the Oregon Capital Chronicle. 

Courtney Normand, the Washington state director for Planned Parenthood Alliance Advocates, said this latest move from Congress is adding to challenges from the first Trump administration when there were other cuts, along with health care system pressures from the COVID-19 pandemic, and the impact of increasing patient volumes after the U.S. Supreme Court’s Dobbs decision that upended federal abortion rights protections.

“It feels like the hits have just kept on coming in Washington, and that’s why access, affordability and stable funding is our key concern,” Normand said. 

Brita Lund, the health center manager at a Planned Parenthood in Seattle, worries about having to turn away patients if the federal Medicaid cuts and other strains on the health care system become too much to bear. She already feels like she spends too much time grilling a patient about their personal details at an appointment so the staff can find a way to get the treatment paid for by a specific pocket of funding. 

“Who is going to help these people if we’re not going to help them? I want someone to give me that answer,” Lund said. “It literally keeps me up at night.” 

While Washington state is known for being one of the most openly accessible for sexual and reproductive health, a budget crisis led legislators to cut 55% of the funding to the Abortion Access Project, about $8.5 million. Normand said it’s hard to know exactly why legislators made the decision, but some regretted it and are trying to find a solution for the upcoming session. Ferguson pledged to restore the funding as well. 

‘I know the state is supportive, it’s just about what their capacity is’

In Hawaii, Title X cuts from the Trump administration earlier this year amounted to about $2.1 million, said Jen Wilbur, Hawaii state director for Planned Parenthood Alliance Advocates. The state legislature acted quickly in April to approve a new $6 million family planning fund to offset that loss over the next two years, with $3 million specifically allocated to Planned Parenthood clinics. What the funding program will look like exactly is still to be determined, Wilbur said. The needs vary by island, and an assessment of what those needs are is underway.  

Hawaii has trended slightly more conservative than other blue states in recent elections, Wilbur said, but support from lawmakers still feels strong. She and other advocates are trying to game plan in the event that the federal government restricts access to mifepristone through the mail, which would severely affect access for the islands. 

But Wilbur worries about the long-term sustainability of the funding in a small state that already has many challenges with high cost of living, difficulty retaining providers and navigating the unknown. 

“We don’t even know how many more cuts are coming, so is any state really going to be able to sustain this going forward? I don’t know,” Wilbur said. “I know the state is supportive, it’s just about what their capacity is.” 

Short-term state fixes in Maine, Massachusetts 

New England, considered a hub for abortion access and low-cost reproductive health services, has been especially impacted by the federal Medicaid rule. It affects not only Planned Parenthood affiliates, but also two nonprofit health networks that offer wide-ranging health services primarily to Medicaid patients: Health Imperatives in Massachusetts and Maine Family Planning, which, like Planned Parenthood, has sued over the new policy. 

Maine’s legislature this summer appropriated about $6 million for family planning funding, to go to organizations like Planned Parenthood of Northern New England and Maine Family Planning, the largest reproductive health provider in the state with 18 clinics compared to Planned Parenthood’s four. But as Maine Morning Star reports, the temporary relief does not fully meet both organizations’ deficits, and Maine Family Planning this week announced it will end primary care services in Ellsworth, Houlton and Presque Isle at the end of October.

Still, both Maine Family Planning and Planned Parenthood of Northern New England say they will continue to see Medicaid patients free of charge for reproductive health and family planning services. 

Massachusetts Democratic Gov. Maura Healey also announced the state would deliver $2 million to Planned Parenthood League of Massachusetts, which is one of the co-plaintiffs in Planned Parenthood’s lawsuit against the federal government.

“We want the people of Massachusetts to know that if you need reproductive health care services, you should continue to seek this care,” Healey said in a news release. 

Massachusetts has been a leader in policy promoting access to reproductive health including abortions, which is legal in the state up to 24 weeks of pregnancy with exceptions for significant fetal abnormalities and the pregnant person’s health.  

But access to broad reproductive health care even in a city like Boston remains limited, especially for people living in poverty, said Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts.

Lee told States Newsroom that making a primary care or OB-GYN appointment in the Boston area can mean having to wait 60 days, while Planned Parenthoods typically have same-day appointments. She noted that the communities with the least access to low-cost reproductive health services are concentrated in central and western Massachusetts, where Planned Parenthood has three clinics.

Lee said she is grateful for the $2 million in state funding, which she calls “short-term relief.” Because Medicaid funding represented about a quarter of her organization’s revenue, Lee said it is like a business losing its biggest customer. Her goal now is to figure out how the affiliate can sustain long term. She said they are brainstorming other revenue streams like offering vasectomies.

“We have gotten really good at contingency planning,” Lee said. “But it would be great to have a business model that is sustainable, that can withstand all of these attacks, and not have to worry about it. That would be a dream.”

The affiliate’s website notes that patients can no longer use their MassHealth or Medicaid Managed plans for care at Planned Parenthood clinics but says they are still seeing “all patients.”

Health Imperatives, which operates seven clinics in southern Massachusetts, is also looking at operations.

Health Imperatives CEO Julia Kehoe said the $19 million nonprofit serves about 23,000 people annually and offers social and psychiatric services to vulnerable populations. About 40% of what Health Imperatives does is offer low-cost sexual and reproductive health services for about 10,000 patients annually, Kehoe said. For now, they are continuing to see the same amount of patients and are working with the state government for funding help. 

But she said the organization is also looking at private funding because they are determined to continue seeing Massachusetts’ poorest residents, many of whom experience food insecurity in places like Nantucket, which is one of the nation’s wealthiest towns but where the main safety net for those who are not wealthy is a single Health Imperatives clinic. 

“I would never, ever make the decision to not see Medicaid patients,” Kehoe said. “We exist to provide services to people who fall through the cracks of mainstream systems of care. So we’re going to prioritize people who are on Medicaid or people who don’t have insurance. What I would do is, rather than further health disparities and wealth disparities in one of the most expensive states in the country, I would have fewer clinics.”

Correction: This article has been corrected to reflect that elected officials in Maine have not yet pledged to support family planning clinics with backfilled funding. The state passed a bill last session that provided family planning funding that was already needed before the congressional bill cut Medicaid funding.

Senate Minority Leader Chuck Schumer of New York speaks to reporters at a press conference at the U.S. Capitol during the third day of a federal government shutdown, on Friday, Oct. 3, 2025. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — An agreement to reopen the federal government was nowhere in sight Friday after U.S. Senate Democrats and Republicans failed Friday, for the fourth time, to move on a deal and House Speaker Mike Johnson announced he won’t bring his members back until the middle of the month.

Two Senate votes to advance funding bills flopped, as expected, as Senate Democrats remained almost unanimous in demanding Republicans extend health care subsidies amid steep insurance premium increases. 

Republicans maintain they will not negotiate until the government reopens.

At the center of the argument are two separate government funding bills. One is a 91-page House-passed Republican bill that would keep the government open until Nov. 21.

The other is a 68-page Democrat counterproposal that aims to provide funding through October while restoring and permanently extending certain federal health funding and subsidies.

Republicans once again failed, 54-44, to gain enough Democratic support to reach the 60 votes needed — though Democratic Sens. Catherine Cortez Masto of Nevada and John Fetterman of Pennsylvania joined the GOP, as did Maine’s Sen. Angus King, an independent. Republican Sen. Rand Paul of Kentucky voted no. 

The Democrats’ plan also fell short in a 46-52 vote.

“It’s always wrong to shut the government down,” Fetterman said outside the Senate chamber after voting yes on both bills. “Why do this s–t?” 

Sens. Chris Coons, a Delaware Democrat, and Jerry Moran, a Kansas Republican, did not vote on either bill.

The Senate will not return to work until Monday, when two more votes on the same bills are planned.

Johnson said after the votes that the House will stay in recess until Oct. 14, which means the government shutdown could last until at least then, if not longer, if Democrats in the Senate continue their resistance to the House bill.

Nonstop messaging

Republican and Democratic leaders spent another day on Capitol Hill hammering their shutdown messages. 

At a morning press conference in the middle of the Capitol’s grand Statuary Hall, Johnson and Senate Majority Leader John Thune doubled down on their claim that Democrats are blocking government funding over a policy that Republicans say would provide health care to immigrants without legal status. 

“We challenge them to tell us why they’re not trying to give illegal aliens health care again when they put it in their own bill,” Johnson said, pointing to a poster of highlighted language from the Democrats’ proposal.

Democrats’ plan includes language reversing the GOP’s roughly $1 trillion in Medicaid cuts that President Donald Trump signed into law as part of a tax and spending cuts package on July 4. 

Johnson hailed a nonpartisan Congressional Budget Office finding in August that the new law would result in about 1.4 million immigrants losing health coverage. 

“That’s exactly what we promised, and that’s what’s gonna be achieved,” the Louisiana Republican said.

The populations slated to lose the coverage comprise lawfully present immigrants, including refugees and asylees, according to analysis by the nonprofit health policy research organization KFF. 

Longstanding federal policy prohibits immigrants without legal status in the U.S. from receiving government-funded health care. 

Health care premium hikes

At their own set of afternoon press conferences, Democratic leaders slammed what they described as a “Republican health care crisis.”

House Minority Leader Hakeem Jeffries pointed to a poster showing health care premium increases for 2026 plans in Georgia, Idaho and Virginia.

“The crisis is having real impact on working-class Americans right now,” the New York Democrat said.

Jeffries questioned why Republicans extended numerous tax cuts in their July budget reconciliation law, otherwise known as the “one big beautiful bill,” but could not “be bothered” to extend the premium enhanced tax credits for people who buy health insurance on the Affordable Care Act marketplace.

“Republicans spent all year focused on their one big, ugly bill so they could permanently extend massive tax breaks for the wealthy,” Jeffries said.

Senate Minority Leader Chuck Schumer also came armed with a set of posters to his snap briefing after the funding bill failed yet again. 

One showed a PolitiFact graphic arrow pointing to “FALSE” under the question of whether Democrats were threatening a government shutdown over health care for immigrants without legal status.

“They thought they could bludgeon us and threaten us and scare us. It ain’t working, because my caucus and Democrats are adamant that we must protect the health care of the American people,” Schumer said.

Sen. Brian Schatz of Hawaii said of the news of the House members not returning next week: “There is not a clearer illustration of their lack of seriousness in terms of reopening the government and solving the health care crisis.”  

‘It shifts the authority to the executive’

Johnson dismissed the Democrats’ fight over health care as “a political talking point.”

When asked about the Trump administration’s threats to permanently lay off thousands of federal workers and cancel funding for projects in blue states, Johnson said “when Congress decides to turn off the lights, shut the government down, it shifts the authority to the executive.”

“The president takes no pleasure in this, but if Chuck Schumer is gonna give Donald Trump the opportunity to determine what the priorities are, he’s gonna exercise that opportunity, and that’s where we are,” Johnson said.

When pressed by a reporter about the memes the White House has posted online in recent days, Johnson responded, “what they’re trying to have fun with, trying to make light of, is the absurdity of the Democrats’ position.” 

On Tuesday the White House posted an AI deepfake video that depicted Jeffries in a sombrero and mustache as mariachi music played while Schumer talks in a fake voice about duping people who do not speak English. 

The U.S. Capitol on the evening of Tuesday, Sept. 30, 2025, just hours before a federal government shutdown. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — The vast majority of Americans, including Republicans and those who identify as strong supporters of President Donald Trump, want Congress to renew the enhanced tax credits for people who buy their health insurance from the Affordable Care Act Marketplace, according to a poll released Friday. 

More than 78% of people surveyed by the nonpartisan health organization KFF in late September said they want lawmakers to keep the enhanced credits. Their extension has become a major linchpin in debate about the government shutdown. 

When broken down by political party, 92% of Democrats, 82% of independents and 59% of Republicans supported renewing the credits.

Within the Republican Party, 57% of people who identified as supporting Trump’s Make America Great Again policies and 70% of GOP voters who identified as non-MAGA supporters want to see the tax credits extended, according to the poll.  

Spending bill held up over tax credit debate

The ACA tax credit expansion was created by Democrats in a coronavirus relief bill approved during the Biden administration and set to expire at the end of the year. 

Democrats have repeatedly called on Republicans to negotiate an extension of the enhanced tax credits and have held up a stopgap spending bill to force those talks to happen now, rather than later in the year. 

Speaker Mike Johnson, R-La., said Thursday the discussion should happen during the next few months and that GOP lawmakers will press for “major reform.” 

“That’s not a simple issue. That’s going to take weeks to deliberate and discuss and debate, but that’s the beauty of the process. We have three months to do that. That is not an issue for today,” Johnson said. “Today the only issue is whether they’re going to vote to keep the government operating for the people.”

Democrats strongly disagree, saying a bipartisan accord must be struck before the open enrollment period for ACA plans begins on Nov. 1, when consumers will see large cost increases for next year. 

“We can’t accept an empty promise, which is, ‘Oh, we’ll deal with this later,’” Sen. Patty Murray, D-Wash., said on a call with reporters Thursday. “The fact is that this crisis is in front of us now. People are getting this month their premium increases if the Senate does not act.”

Murray said she finds it “ironic” that Republican leaders are saying they’ll negotiate with Democrats on health care once the government reopens after they “refused to negotiate with us during that entire time when government was open.”

The House voted mostly along party lines in mid-September to approve a seven-week stopgap spending bill that has since stalled in the Senate, leading to the shutdown.

The upper chamber, where major legislation needs at least 60 votes to advance, is set to vote again Friday to try to advance Republicans’ short-term government funding bill, though it’s unlikely to move forward amid the stalemate.  

Many of those polled knew little about shutdown debate 

The KFF poll looked at public knowledge and understanding about the enhanced tax credits for ACA Marketplace health insurance plans, finding 61% of respondents knew nothing or only a little about the issue. 

Another 32% of those surveyed said they know some about the policy debate and 7% said they know a lot. 

The poll of 1,334 adults took place Sept. 23 to Sept. 29 and has a margin of error of plus or minus 3 percentage points for a full survey. Each political affiliation question has a margin of error of plus or minus 6 percentage points.

The government shutdown began on Oct. 1, just after the poll wrapped. 

Concern about the ramifications of letting the enhanced tax credits expire fluctuated when KFF asked the question in different ways, though those who said they were “very concerned” never dipped below a majority. 

Fifty-six percent were very concerned and 30% were somewhat concerned when told “health insurance would be unaffordable for many people who buy their own coverage” if the enhanced tax credits weren’t extended. 

The number of people who would be very or somewhat concerned was high among Republicans, 78%, and MAGA supporters, 76%. 

Respondents who were very concerned rose to 60% when told “about 4 million people will lose their health insurance coverage” if they do not keep receiving the enhanced credits. An additional 26% said they were somewhat concerned and 10% said they were not too concerned, with the rest of those polled saying they were not concerned at all. 

When broken down by political party, the number of people very or somewhat concerned remained high, with 76% of Republicans and 73% of MAGA supporters citing worry. 

Small business staff, self-employed people

Fifty-one percent of those polled said they were very concerned when told “millions of people who work at small businesses or who are self-employed would be directly impacted as many of them rely on the ACA marketplace.”

Another 33% said they were somewhat concerned, 11% said they were not too concerned and the remainder said they were not concerned at all. 

Seventy-five percent of Republicans and 72% of MAGA supporters responded they would be very or somewhat concerned when asked that question. 

The poll showed that Congress extending the enhanced tax credits as they exist now comes with some trepidation about the price tag. 

When asked how concerned people would be if they heard “it would require significant federal spending that would be largely paid for by taxpayers,” 27% said they would be very concerned, 36% somewhat concerned, 28% not too concerned and 8% not at all concerned. 

Forty-one percent of Republicans said they would be very concerned, with another 41% responding they would be somewhat concerned. An additional 15% said they would be not too concerned with the rest saying they were not concerned at all.

Sarah Elgatian is a graduate student in rural Iowa, who like about 16 million women of reproductive age, uses Medicaid insurance and at times has relied on Planned Parenthood for routine gynecological treatment for infections and birth control, both in person and through its growing telehealth program. (Photo by Todd Welvaert for States Newsroom)

Fourth in a five-part series.

Sarah Elgatian was in too much pain to feel awkward. 

That morning in 2019, she was hunched over her toilet, feeling what she described as a “weird burning nausea,” abdominal pain and other symptoms. She remembered the Planned Parenthood telehealth ad she’d seen recently. Elgatian downloaded the app, and within a couple hours from her bathroom, she was video chatting with a health provider. She recalled that the doctor could tell she had a urinary tract infection just by looking at her face.

“They were like, yeah, those are textbook symptoms, and you are cringing,” said Elgatian, 35, who lives on the outskirts of Davenport, Iowa, where the nearest pharmacy is at least a 20-minute drive. But luckily, Elgatian’s spouse was able to get the antibiotics the Planned Parenthood provider prescribed, and with it, relief. “That was really scary, just because, if you’ve ever had a UTI, when they’re bad, they’re so bad.”

Elgatian, like about 16 million women of reproductive age, has Medicaid, the federal and state medical insurance program for people with low incomes, and therefore limited options when it comes to reproductive health. With even fewer options in rural Iowa, Elgatian, who is a graduate student, said at times she has relied on Planned Parenthood for routine gynecological treatment for infections and birth control, both in person and through its growing telehealth program.

Now that a new rule has eliminated hundreds of millions in Medicaid reimbursements to Planned Parenthood, reproductive health providers have turned to telehealth as part of the solution to offer low-cost health services due to reductions in clinic staff and services, or closures.  

Telemedicine gained momentum in the wake of the COVID-19 pandemic and the increasing health care deserts around the country. In the reproductive health space, it has expanded in the last few years, as the overturn of Roe v. Wade and the resulting policies prompted the closure of many physical clinics. By the end of 2024, 1 in 4 abortions was provided via telehealth, according to the Society of Family Planning, though there are ongoing efforts at the federal and state level to prohibit telehealth abortions.

“We’ve — overall as a trend — seen more patients taking advantage of telehealth, and I think it’s a combination of factors, particularly in rural areas where access to care can be very, very limited,” said Ruth Richardson, president and CEO of Planned Parenthood North Central States, which covers Iowa, Minnesota, Nebraska, North Dakota (which has no physical clinics) and South Dakota, and recently closed eight clinics after the Trump administration froze their federal family planning Title X grant funding. “That is something that we’ve seen as a trend even before the Medicaid defund occurred.”

At the same time, providers and advocates warn that telehealth — the virtual delivery of care using technology from video conferencing, phone- or computer-based apps, to text messaging — still leaves a huge gap in reproductive health care access, especially for patients without reliable Internet or who don’t have the financial resources necessary to participate, like a debit or credit card. Much of the care cannot be delivered virtually, such as treating certain STIs, intrauterine device insertion, performing vasectomies and procedural abortions, which are optional in the first trimester and necessary later in pregnancy.

“There’s a lot of people for whom telemedicine is not an option, and so I think it’s really important to note that it’s not a quick fix,” said Amy Hagstrom Miller, president and CEO of Whole Woman’s Health, which manages five physical clinics in Maryland, Minnesota, New Mexico, and Virginia that specialize in abortion and offer some gynecology services. It also has a virtual care practice in 10 states that offers primarily medication abortion. “It’s not the only fix, right? It’s got to be both and so that people truly have choice.”

Turning to telehealth 

In 2023, one-third of Iowa’s counties were considered maternal health deserts, according to the March of Dimes. That number will likely increase in the nonprofit’s next report. Earlier this year, Planned Parenthood North Central States shrunk its physical presence in Iowa from six to two clinics. The affiliate, Richardson said, stands to lose $11 million from the latest federal Medicaid change, after having served about 27,000 people on Medicaid — about one-third of their total patients — in 2024. 

Richardson said the affiliate’s health centers will continue to serve patients regardless of their insurance status and will work with them to understand their payment options. She said she is expecting their telehealth program to keep growing, especially after shuttering clinics in more rural areas like Bemidji, Minnesota. 

In the past year, the North Central States affiliate reported it saw 4,204 patients during 8,241 visits on the Planned Parenthood Direct app, a 12.9% increase in virtual care visits, and about 5% of the 87,631 total patients seen. Services offered during telehealth visits include birth control counseling and prescriptions, UTI treatment, gender-affirming care, emergency contraception and the abortion pill. Newer virtual care services were launched this past year, related to menopause, sexual wellness and early pregnancy complications.

Planned Parenthood has increased its telehealth presence across the nation in the last two years. Planned Parenthood Direct, launched about a decade ago and expanded nationally in 2019, provides both text-based and video-based care, and accepts Medicaid in some states.

Separately, Planned Parenthood affiliates run virtual health centers, which have expanded to more than 50 nationwide, said a Planned Parenthood Federation of America spokesperson. According to Planned Parenthood’s 2023-2024 annual report, patients booked more than 47,000 appointments through virtual health centers in the last fiscal year, and, on average, virtual health center patients are accessing care more than two days sooner than in-person appointments. Across all telehealth platforms, there were 142,000 appointments made, the spokesperson said. 

In Michigan the most popular Planned Parenthood clinic has no real walls or windows. The virtual clinic launched in 2023, and now sees the highest number of patients compared to the state’s 10 physical health centers, said Ashlea Phenicie, the chief external affairs officer at Planned Parenthood of Michigan, which in April closed three clinics in underserved areas and consolidated two health centers in Ann Arbor because of Title X cuts. 

Phenicie said Michigan’s virtual clinic is always more than 100% booked and offers evening and weekend appointments.

“I think that not only is it filling a need in communities where we don’t have brick-and-mortar health centers, but for many patients, this is how they prefer to access care,” Phenicie said. “It’s convenient. A lot of our patients will do it on their lunch break or, you know, before school or between work and picking up their kids. It lets them fit their health care into their everyday lives. It can also provide a degree of privacy and security. There’s no protesters who walk by when you’re visiting a telehealth provider or getting birth control through the PPDirect app.” 

In a new study in the journal Contraception, researchers from the Guttmacher Institute found that while many publicly funded family planning clinics offer some services via telehealth, Planned Parenthood clinics offer telehealth most frequently, and offer a wider variety of services. The researchers, who surveyed nearly 500 publicly supported family planning clinics, wrote that many health departments and federally qualified health centers need more support and infrastructure to implement telehealth, especially for contraceptive care. They noted that while the benefits of telehealth include convenience, low cost, and improved patient outcomes, difficulties include loss of patient-provider rapport, technology and workflow issues, and regulatory barriers.

And they warned: “If telehealth is implemented inequitably, it may deepen existing disparities.”

Barriers 

Research is still limited when it comes to telehealth delivery of broad reproductive health services. A 2023 study by researchers at Oregon Health & Science University found evidence suggesting telehealth care for intimate partner violence and contraceptive care can produce “equivalent clinical and patient-reported outcomes as in-person care.”

But many reproductive health care advocates and researchers agree that telehealth will likely not be enough to fill the gap left by closing physical clinics, and that there remain many barriers to accessing telehealth generally, related to age, language, financial resources, digital literacy, and access to technology and internet.

In 2023, the National Telecommunications and Information Administration reported that roughly 12% of people lived in households with no internet connection, while a National Digital Inclusion Alliance analysis of 2022 data showed that 24% of households lacked a home internet connection.

Last month the Journal of Medical Internet Research published a study examining telehealth usage patterns of nearly 10,000 adults in rural California that found people who are older, speak Spanish or rely on public insurance struggle the most to access virtual care. The researchers reported that rural health disparities are often more pronounced among rural populations of color, who make up about 20% of rural U.S. residents.

For Elgatian, her occasional use of telehealth has not erased her need for affordable in-person reproductive health care, something she’s currently worried is about to change in Iowa following the new Medicaid rule. In a pinch, her fail-safe — at least until recently — had been Planned Parenthood, the closest being more than an hour away in Iowa City, followed by just one other in-state option: the Des Moines clinic nearly three hours away. But it was the latter clinic that Elgatian was closest to while driving through last year and suddenly bleeding vaginally. It turned out to be related to uterine polyps and her IUD, something she likely wouldn’t have discovered via telehealth.

“I don’t yet know, personally, how this will pan out for me, but it seems likely that there will be a time when I will struggle to find care without being able to use Planned Parenthood,” she said.

Efforts to expand and improve telehealth

Since its founding four years ago, telehealth provider Hey Jane, which is not affected by the government’s new Medicaid exclusion, has provided care to more than 100,000 people and expanded beyond medication abortion to provide birth control, emergency contraception, treatment for vaginal infections, herpes, and UTIs, according to co-founder Kiki Freedman. Hey Jane operates in the District of Columbia and 22 states (California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Rhode Island, Vermont, Virginia and Washington). It recently became a Medicaid provider for people in Illinois. 

Freedman said their services are offered on a sliding fee scale. And she said the platform allows patients to text with clinicians, which is popular with patients.

“They could be on their couch, watching a movie with their partner by their side, or whomever they need, and then just be chatting with us,” Freedman said. “That’s not something that you could get if you receive care in person and take the medication home with you, and then don’t have those ongoing touch points.”

Freedman said that Hey Jane has already seen an influx in patients since Congress passed the federal tax and spending cut bill and more clinics have closed, and that they are working on becoming Medicaid providers in more states — something that can be challenging for telehealth businesses without a physical facility. 

“We’ve continued to grow really fast over the past several years, and have just been hiring a lot and doing a lot of work on sort of our technical automation so that we can continue to meet the demand that has been rising,” Freedman said. “These acute events, like these terrible clinic closures, have definitely exacerbated that.”

Coming Friday: Democratic-led states try to backfill funding losses.

Correction: This article has been corrected to reflect that the mobile Planned Parenthood Direct app provides both text-based and video-based care.

A sign on the entrance to the U.S. National Arboretum says it is closed due to the federal government shut down on Oct.  1, 2025 in Washington, D.C. (Photo by Kevin Dietsch/Getty Images)

WASHINGTON — The first federal government shutdown in seven years has left hundreds of thousands of workers furloughed and members of the public struggling to understand what’s open, what’s closed and what might be delayed.

States Newsroom’s Washington, D.C. Bureau scoured agency plans published by the Trump administration and the courts, and produced this guide to help you understand what’s going on:

Agriculture Department 

The USDA plans to furlough about half, 42,300, of its nearly 86,000 employees, though workers at several programs for farm communities and rural areas will keep working without pay.

Operations will continue on some farm loans, certain natural resource and conservation programs, essential food safety operations related to public health and wildland firefighting activities. 

Agriculture Department employees working on animal and plant health emergency programs — including African swine fever, highly pathogenic avian influenza, exotic fruit flies, new world screwworm and rabies — are exempt from furloughs.  

But dozens of USDA programs addressing everything from disaster assistance processing to trade negotiations to long-term research on animal diseases will cease until Congress reaches a funding deal. 

Employees working on those programs will be furloughed until the government is once again funded, but both working and non-working federal employees in all agencies are required to receive back pay under the law. 

Agencies housed within the USDA have varying levels of furloughs. The Food and Nutrition Service, Office of the Inspector General and Natural Resources Conservation Service are among those with higher numbers of furloughed workers.

Commerce Department

The Department of Commerce will retain just over 19% of its nearly 43,000 employees during the shutdown, and most will have to stay on without pay, as outlined in its government funding lapse plan. 

The department oversees a wide range of federal government activities — weather forecasting, issuing patents and trademarks, regulating fisheries, enforcing export laws, managing government-owned and -controlled spectrum frequencies, and collecting demographics and other population data.

Notably, the department houses the National Oceanic and Atmospheric Administration, and will continue providing “weather, water and climate observations, prediction, forecasting, warning and related support.” But research activities will largely stop.

The U.S. Census Bureau, also part of the department, will cease most operations, including providing monthly economic indicators and updated data about disaster-impacted areas. Certain preparations for the 2030 Census will stop, as will any data collection for the American Community Survey.

Funding outside of annual appropriations may keep some U.S. Patent and Trademark Office units open, but the timelines will be variable, according to the department. When funding runs out, the office will continue “a bare minimum set of activities necessary to protect against the actual loss of intellectual property (IP) rights.”

Defense Department 

The Defense Department’s contingency plan calls for the nearly 2.1 million military personnel to keep working as normal and says 406,500 of its roughly 741,000 civilian employees will work without pay, while the others will be furloughed.  

The plan says the Defense Department believes operations to secure the U.S. southern border, Middle East operations, Golden Dome for America defense system, depot maintenance, shipbuilding and critical munitions are the “highest priorities” in the event of a shutdown. 

Medical and dental services, including private sector care under the TRICARE health care program, would largely continue at the Defense Department, though “(e)lective surgery and other routine/elective procedures in DoW medical and dental facilities are generally not excepted activities, unless the deferral or delay of such procedures would impact personnel readiness or deployability.”

Education Department 

The Department of Education said it would furlough roughly 95% of employees outside its federal student aid unit. 

The agency will continue disbursing Federal Direct Loans as well as Pell Grants, which help low-income students pay for college. 

Borrowers still have to make payments toward their student loan debt during the shutdown. 

Title I and Individuals with Disabilities Education Act, or IDEA, grant funding would continue to be available as usual, according to the department. Title I provides funding for low-income school districts, while IDEA guarantees a free public education for students with disabilities. 

But the agency is ceasing several operations, including any new grantmaking activities. Still, the department said the majority of its grant programs “typically make awards over the summer and therefore there would be limited impact on the Department’s grantmaking.”

The agency’s Office for Civil Rights also has to pause investigations of any civil rights complaints. 

Energy Department 

The Energy Department will furlough a little over 8,100 of its 13,800 federal workers – nearly 60% of its workforce, according to its contingency plan. 

The National Nuclear Security Administration would continue maintenance and safeguarding of nuclear weapons. 

Some programs, like the medical isotope program, will require DOE to “produce additional isotopes in order to protect human life.” 

“The need to do this will depend on the length of the lapse and the stockpile of individual isotopes,” according to DOE. 

Certain programs are self-funded, such as the Bonneville Power Administration, which provides hydropower in the Columbia River Basin of the Pacific Northwest.

Environmental Protection Agency 

EPA, according to its contingency plan, will have the biggest percentage of federal employees furloughed. Nearly 90% of its workforce, or 13,400 out of 15,000, will be furloughed. 

Only agency activities that revolve around protecting human life, such as monitoring some Superfund sites and responding to emergency environmental disasters, will continue. 

Some EPA functions that will halt include issuing of new grants, publishing new research, pausing of cleanup of Superfund sites that don’t pose an imminent threat to human life, enforcement inspections and issuing of permits.

Health and Human Services Department 

The department, one of the larger ones within the executive branch that houses many of the country’s best-known public health agencies, has furloughed about 32,500 of its nearly 80,000 employees, according to its contingency plan.

Many of HHS’ activities fall under the life and property or even the national security exceptions during a funding lapse, though dozens of programs will still be affected.

HHS officials plan to ensure “minimal readiness” at the Administration for Strategic Preparedness and Response for “all hazards, including pandemic flu and hurricane responses.”

Certain employees at the Centers for Disease Control and Prevention will keep working, albeit without pay, to monitor for any disease outbreaks. But the contingency plan says the CDC’s “communication to the American public about health-related information will be hampered.”

The Centers for Medicare and Medicaid Services plans to keep 3,300, or about 53%, of its employees during the shutdown in order to keep running core programs.

Since many of the country’s major health care programs are funded outside of the annual government funding process, they shouldn’t be affected by the shutdown, even though the employees who run the programs often rely on full-year or stopgap spending bills for their salaries.

CMS’ contingency plan says “the Medicare Program will continue during a lapse in appropriations” and that it has “sufficient funding for Medicaid to fund the first quarter of FY 2026,” which includes October, November and December.  

Additionally, it “will maintain the staff necessary to make payments to eligible states for the Children’s Health Insurance Program (CHIP).”

Department of Housing and Urban Development 

The Department of Housing and Urban Development’s website opens with a message that reads: “The Radical Left in Congress shut down the government. HUD will use available resources to help Americans in need.”

The department says the majority of its annual grant programs, including those that provide for emergency housing for people experiencing homelessness and people living with HIV/AIDS, “continue to operate in States and local communities across the country when such grant funding has already been obligated.” 

The agency also said many of its programs “addressing imminent threats to the health and welfare of HUD tenants and children will continue where such grant funding has already been obligated before the lapse occurs.”  

For as long as the funding remains available, “monthly subsidy programs such as the public housing operating subsidies, housing choice voucher subsidies, and multifamily assistance contracts will continue to operate,” according to the department.  

However, the agency said nearly all of its “fair housing activities” will halt during the shutdown. 

Internal Revenue Service 

The Internal Revenue Service will continue normal operations using supplemental funding enacted under the Democrats’ 2022 budget reconciliation law, known as the Inflation Reduction Act.

The IRS will retain its 74,299 employees, according to the latest available shutdown contingency plan. 

The Trump administration has shrunk the IRS significantly this year, down from its roughly 95,000 employees, and has turned over the agency’s top leadership six times.

The agency processes about 180 million income tax returns each year.

The body that independently oversees the IRS will not operate at full capacity during the shutdown. Only 40% of employees in the department’s Treasury Inspector General for Tax Administration will remain on, with a small fraction required to stay without pay if necessary, according to the agency’s plan.

As of Thursday afternoon Eastern time, the home page for that agency, tigta.gov, was blank except for the message “Due to a lack of apportionment of funds, this website is currently unavailable.”

Interior Department

A little more than half of the federal workforce for the Interior Department will be furloughed – 31,000 out of 58,600 employees – according to its contingency plan.

Some services within the agency will continue, such as the Bureau of Indian Affairs’ wildland fire management, but programs that provide social services to foster children and residential adults will pause.

As for national parks, the trails, open memorials and overlooks will generally remain open. The National Park Service will retain minimal staff to allow for visitors. But general maintenance, trash pick-up and educational programs, will cease during the shutdown. 

Hunters or people seeking access to public lands will not be able to have their permits processed by U.S. Fish and Wildlife Services. 

Justice Department

The Justice Department will keep a majority of its federal workers during the shutdown, according to its contingency plan. Out of roughly 110,000 employees, nearly 13,000 will be furloughed. 

Because the judicial branch will continue to function, the Justice Department will retain most of its attorneys for criminal and civil litigation. Federal law enforcement agencies and their agents will continue to work, such as the FBI, Drug Enforcement Administration and Bureau of Alcohol, Tobacco, Firearms and Explosives. 

A shutdown typically means that immigration cases would be rescheduled and courts not located in an Immigration and Customs Enforcement detention center will be shut down. But the Trump administration has prioritized the Executive Office for Immigration Review, housed within the Department of Justice, as essential. 

The contingency plan points to the president’s national emergency, “citing the threat to the national security and economy of the United States caused by illegal migration.”

Labor Department 

More than 75% of the Department of Labor’s employees will be furloughed, according to the agency’s contingency plan. 

Several units will come to a halt, such as the Bureau of Labor Statistics, Veterans’ Employment and Training Service, Office of Federal Contract Compliance Programs, Office of Disability Employment Policy, Women’s Bureau, Office of Administrative Law Judges, Administrative Review Board, and Benefits Review Board, as well as the Employees’ Compensation Appeals Board.

The agency said it will continue to support states and other agencies when it comes to administering and paying unemployment insurance benefits. 

The department notes that “unless excepted or exempt, agencies’ technical assistance, compliance assistance, regulatory, policy, research, advisories, responding to inquiries, most oversight, hearing preparation, and cooperative activities will cease.”

Job Corps centers that house students “will remain in operation while funds remain available,” and “federal oversight of those centers related to safety and property will continue,” per the department. 

Homeland Security Department 

Homeland Security will retain most of its workforce without pay. About 14,000 employees will be furloughed among its nearly 272,000 workforce, according to its contingency plan. 

That means ports of entry will remain open for inspections from Customs and Border Protection, but there could be delays in paperwork at U.S. borders. 

Most federal workers responsible for security at airports across the country – more than 61,000 Transportation Security Administration employees – would be required to work without pay. 

Another agency within DHS that will remain most of its workforce is the Federal Emergency Management Agency, or FEMA. About 21,000 employees out of 24,000 will continue to work. 

The office involved in departmental oversight, the Office of Inspector General, will pause its work on reports and investigations. 

And the Trump administration’s aggressive immigration crackdown will continue, with nearly all employees from Immigration and Customs Enforcement considered non-exempt, about 19,600 out of 21,000.

Several agencies within the Department of Homeland Security will remain running because they are fee-based, such as U.S. Citizenship and Immigration Services. Some visa programs within USCIS are tied to appropriations funding, so those programs will be suspended. 

That includes E-Verify, which verifies immigration status; visas for foreign doctors; and visas for non-minister religious workers. 

State Department 

A little more than half the employees in the State Department will be furloughed, about 16,600 out of its nearly 27,000-employee workforce, according to its contingency plan.

Because visa and passport services are fee-funded, they will likely not be impacted. Consular operations will be affected and diplomatic visas will only be issued in “life or death” emergencies.

Social Security Administration 

The program for America’s seniors and some people with disabilities is largely funded outside of the annual government spending process, which makes it mostly exempt from shutdowns. 

One big caveat is that the federal workers who administer the program are paid through one of the 12 congressional appropriations bills, which can cause issues during a funding lapse. 

SSA’s contingency plan says it will furlough about 6,200 of its nearly 52,000 employees until the government is fully operational again. 

The agency plans to continue “accurate and timely payment of benefits” as well as taking applications, requests for appeal, issuing and replacing Social Security cards and fraud prevention activities, among others. 

The SSA during the lapse will not conduct certain activities, including benefits verification, replacement of Medicare cards, or addressing overpayments processing during the funding lapse. 

Transportation Department

Slightly more than 11,000 of the department’s nearly 45,000 employees will be furloughed for the remainder of the government shutdown, but its leaders plan to keep several activities essential for the traveling public going during a shutdown, according to its contingency plan.

Air traffic control services and hiring, hazardous materials safety inspections, airport inspections and much more will continue, though many activities will cease. 

Some agencies within the Transportation Department will see little impact on their staffing, even though workers will not be paid until the shutdown ends. 

For example, no one at the Federal Highway Administration, the Federal Motor Carrier Safety Administration, the National Highway Traffic Safety Administration, the Federal Transit Administration, or the Great Lakes St. Lawrence Seaway Development Corporation will be furloughed. 

Treasury Department 

The department has individual contingency plans for its various components, including departmental offices, the Alcohol and Tobacco Tax and Trade Bureau, the Bureau of the Fiscal Service, the Financial Crimes Enforcement Network, the Internal Revenue Service, the Office of the Inspector General and the Treasury Inspector General for Tax Administration.

Treasury officials expect to keep about 1,850 of its more than 2,700 employees working in the departmental offices without pay during the shutdown, in part to “support the president” with “market and economic updates, economic policy options and recommendations, including those related to national security incidents.”

The Office of Inspector General, which oversees officials’ actions for waste, fraud and abuse, will keep about 30 of its roughly 150 employees working throughout the shutdown and furlough the rest. 

Department of Veterans Affairs

Large parts of the Department of Veterans Affairs, including the processing and payout of benefits, are funded outside of the annual appropriations process and will continue through the shutdown.

The department projects 97% of its staff will continue to work, and most will be paid, according to its latest publicly available shutdown contingency plan. 

Health care will continue uninterrupted at VA medical centers and outpatient clinics, and vets will still receive benefits, including compensation, pension, education and housing.

Veterans suicide prevention and homelessness programs will remain in operation, and the Veterans Crisis Line will continue to answer calls. The crisis line can be reached by dialing 988 followed by pressing 1, or by texting 838255.

The MyVA411 and PACT Act call centers will operate “as necessary to prevent disruption to mandatory VA benefit programs,” according to the department’s guide.

The National Cemetery Administration will continue to inter veterans and eligible family members, as well as schedule burials, determine eligibility and process headstone applications. However, headstone and marker installation and groundskeeping will cease, and the application assistance unit call center will be closed.

All Transition Assistance Programs, including career and financial counseling, are suspended, and the GI Bill hotline is not taking calls. 

The department’s whistleblower program is also not accepting or investigating complaints. 

Executive Office of the President

The first Trump administration posted a contingency plan in March 2018, though it doesn’t appear there is a current one and the White House did not respond to a request from States Newsroom about how it’s implementing the shutdown. 

The earlier three-page plan said the president planned to place “1068 of the 1759 EOP staff in furlough status (“Non-Excepted Staff’), while an estimated 691 EOP staff would continue to report to duty.”

President Donald Trump continues to be paid during a shutdown, as are members of Congress, under the law.

Judicial branch 

The Supreme Court will remain functioning during the shutdown, as well as the federal courts. 

By using court fees, the judiciary branch can continue with paid operations until Oct. 17, according to the Administrative Office of the U.S. Courts. Most proceedings and deadlines set in cases will continue, but if Department of Justice attorneys representing the executive branch are furloughed, then those cases will be rescheduled. 

Supreme Court judges and federal judges will continue to be paid due to Article III of the U.S. Constitution that specifies judge’s compensation “shall not be diminished” during their term. 

A nurse holds a vial of COVID-19 vaccine and syringe. (Getty Images)

Wisconsin clinics and hospitals are stepping up the rollout of the newest version of the COVID-19 vaccination.

UW Health started offering the new edition vaccine to patients Wednesday and will start scheduling COVID-19 shots beginning Monday.

The Madison-based hospital and clinic system previously began giving the vaccine to people older than 65, considered the highest-risk population for the respiratory infection, according to Dr. Jim Conway, an infectious disease specialist and medical director for the UW Health immunization program.

The 2025-26 version of the vaccine is “built around the most current, circulating strains of COVID that are out there,” Conway said in an interview Wednesday. “As we all learned during the entire pandemic, these strains are mutating constantly, and so they’re constantly changing . . . You try to keep up with what’s the most prevalent.”

Major pharmacy chains typically get the first available allotments of the vaccine and have already, Conway said. In the meantime, UW Health and other health systems have been preparing to offer the shot and preparing their scheduling systems.

The vaccine’s components are developed following discussions among health experts for the World Health Organization and other agencies, Conway said. Both the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) take part in those discussions.

In the weeks leading up to Sept. 19, when the CDC’s Advisory Committee on Immunization Practice (ACIP) opened its most recent meeting, public health professionals were apprehensive that the body might limit access to the COVID-19 vaccine.

Robert F. Kennedy Jr., secretary of the Department of Health and Human Services, has a long history of embracing unfounded claims critical of vaccines. Kennedy replaced the members of the ACIP with people viewed as skeptics of vaccination. Susan Monarez, appointed CDC director earlier this year by President Donald Trump, testified at a congressional hearing in September that Kennedy fired her for refusing to agree to his demand that she endorse ACIP’s recommendations without reviewing them.

Ahead of ACIP’s meeting, “we were all really nervous,” Conway said. Medical professional groups emphasized their endorsement of the COVID-19 shot to counter messaging from Kennedy and other HHS officials that appeared to cast doubt on the vaccine.

“Our professional societies make recommendations every year, but this year we really leaned into making sure people were aware of those and really were promoting those as … evidence-based, data driven,” he said.

When ACIP met just two days after Monarez’s testimony, the panel left in place the CDC’s recommendation for COVID-19 vaccinations from the age of six months to 64. While the panel’s recommendation highlighted concerns about risk, ACIP rejected a proposal to require a prescription for the shot.

“It’s actually in some ways reassuring that even people that may come across as skeptics and doubters at some level as they were repopulating the ACIP — even they couldn’t be swayed from how clear the evidence and the data is that these vaccines are really valuable and really safe,” Conway said. “It was a very pleasant surprise.”

Wisconsin Gov. Tony Evers issued an executive order to ensure COVID-19 vaccine access and the state Department of Health Services followed up with a health order that functions as a statewide prescription for the shot. The Office of the Commissioner of Insurance also issued guidance that insurance companies in Wisconsin are expected to cover the vaccine without requiring a patient co-pay.

Conway said with those actions insurers began announcing in the last week their coverage plans, which set the stage for providers to set up their vaccine programs.

The first objective of a vaccine is “to prevent you from getting serious disease,” Conway said, so patients don’t have to go to a doctor, “or aren’t getting admitted to the hospital or aren’t getting in the ICU [intensive care unit] or aren’t going on a ventilator or, God forbid, aren’t dying. That’s the ultimate goal, and that’s what the vaccines are really very good at.”

If the shot prevents a person from getting sick from the virus at all, that’s a bonus,  “but we know that that’s never completely possible with these kinds of respiratory viruses,” he added. “But we know that even if you get ill, you’re much more likely to have a very, very mild case.”

Vaccination also helps prevent the spread of disease as it reduces the amount of virus infected people are shedding, Conway said. That can reduce the chances that others will be exposed to the virus, helping to protect people whose immune systems are suppressed due to age or an underlying medical condition.

With enough people vaccinated, that allows  community immunity — “what used to be called herd immunity” — to develop, Conway said. That reduces the risk of outbreaks, “but it also starts to protect the really vulnerable parts of your population.”

The vaccine’s availability came as good news Wednesday to Patricia Fisher, a graduate student and the mother of a six-month-old. Fisher was disappointed this week when the vaccine wasn’t available at her baby’s check-up.

“It’s not just about my baby,” said Fisher,  who is enrolled in a sociology Ph.D. program at the University of Wisconsin. “The community is safer if more people are vaccinated.”

Fisher has a master’s degree in public health. While her own research focuses on food systems, climate change and health, she said she’s learned enough about population health outcomes to make her alarmed at the prevalence of anti-vaccine attitudes.

“I find it really, really frightening how anti-vaccine some people are, and that people are particularly worried about [vaccines for] COVID, flu and RSV [respiratory syncytial virus],” Fisher said. “COVID is a very clear and present threat to infant health and so it’s very worrying to me.”

Between the national upsurge in measles that has surfaced in Wisconsin, surges in pertussis (whooping cough) in the last couple of years, influenza and COVID-19, “there’s a lot of threats out there,” she said. “I just didn’t think that infectious disease would be the thing about parenting that would be the most stressful, but it definitely is.”

On Wednesday she made an appointment for her child’s COVID-19 shot in mid-October. “I’m thrilled it’s going to be available,” she said.

Conway said the flood of both information and misinformation about the vaccine can overwhelm people. “Sometimes the natural human response is to just hunker down and do nothing,” he said.

He counsels patience and keeping messaging simple: pointing to the decades of data on the safety and effectiveness of vaccines along with the number of professional medical organizations that have made recommendations on the basis of scientific evidence.

“I think people should understand that there’s an opportunity here to protect themselves and their families from these really potentially very unpredictable diseases that can devastate individuals, families and communities,” Conway said.

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Jess Deis, a nurse practitioner and nurse midwife in Kentucky and Indiana, learned she had cervical cancer after she qualified for Medicaid insurance in 2014. (Sarah Ladd/Kentucky Lantern)

Third in a five-part series.

It had been a decade since Jess Deis’ last women’s wellness exam when Kentucky expanded Medicaid and she finally qualified for the state insurance program.

Physicians recommend a cervical cancer screening — also referred to as a Pap smear, which is a swab of the cervix — as part of a wellness exam once every three to five years for women between the ages of 21 and 65. Deis, 43, was in her last semester of nursing school in 2014 when the test came back with abnormal results. Her doctor ordered additional testing.

“Then I got a call on a Sunday evening from a physician letting me know I had cervical cancer and I needed to see a specialist,” Deis said.

Cervical cancer is one of few cancers that has a known path of prevention after the approval of the first HPV vaccine in 2006. But that also means it falls at the intersection of three cultural issues that are facing strong political opposition — broad access to low-cost or free reproductive health care, access to vaccines for children, and sex education.

Kentucky had the highest cervical cancer incidence rate in the country between 2015 and 2019, according to medical research, and a mortality rate twice as high as the rest of the country. The state tied with West Virginia for the second-highest rate of 9.7 cases per 100,000 residents between 2017 and 2021. Oklahoma topped the list for that five-year period with 10.2 cases per 100,000, according to the National Cancer Institute.

Deis delayed the surgery to remove her uterus until after graduation, and later became a certified nurse practitioner. Now she provides Pap smears to patients multiple times a day at Planned Parenthood clinics in Kentucky and Indiana and other care via telehealth. She recently helped a patient who hadn’t been seen for a screening in 15 years discover she had advanced cervical cancer.

She is troubled by what could happen in the wake of the new Medicaid rule passed by Congress and signed by President Donald Trump in July that barred nearly all Planned Parenthood affiliates from receiving Medicaid reimbursements because some clinics in the nonprofit network provide abortions. Kentucky and Indiana both have abortion bans, but still have Planned Parenthood clinics to provide other reproductive health care.

“I don’t just worry; I know that there’s going to be more folks with stories like mine, but without the happy ending,” Deis said.

‘What we’re really talking about is our daughters getting cervical cancer’

The American Cancer Society recently reported the number of early cervical cancer cases has declined sharply among young people since the vaccine’s introduction nearly 20 years ago. But vaccine adoption rates for children are low in the states where rates are highest — about one-third of boys and girls between the ages of 13 and 17 were vaccinated in Mississippi as of 2020.

The vaccine is most effective when given before engaging in any kind of sexual activity for the first time, because it can prevent the sexually transmitted strains of HPV that present the highest risk of cervical cancer. More than 98% of cervical cancer cases are caused by HPV, and a 2024 study from the Journal of the National Cancer Institute found zero cases of cervical cancer in Scottish women born between 1988 and 1996 who were fully vaccinated against HPV between the ages of 12 and 13.

“We could make (cervical cancer) an eradicated disease,” said Dr. Emily Boevers, an Iowa OB-GYN. “But everything is falling apart at the same time.”

Boevers said limitations on Medicaid coverage and the loss of Title X family planning funding will make screenings and vaccines less accessible for the populations that need them the most, even if clinics don’t close as a result. But it will take years to see the consequences of these changes, she said, because it takes about 15 years on average for HPV to become cancer. 

“So what we’re really talking about is our daughters getting cervical cancer,” she said. 

Kentucky’s legislature acknowledged the importance of HPV vaccines as recently as 2019, when representatives passed bipartisan House Resolution 80, which encouraged females and males between the ages of 9 and 26 to get the HPV vaccine and everyone to “become more knowledgeable of the benefits of the vaccine.” Only four legislators voted against it.

But today, the U.S. Department of Health and Human Services is led by Secretary Robert F. Kennedy Jr., who has made false statements about the HPV vaccine’s safety and effectiveness and played a leading role in organizing a mass lawsuit against one of the vaccine’s manufacturers, Merck. The Associated Press reported the judge dismissed more than 120 claims of injuries from Gardasil, the name of one HPV vaccine, because of a lack of evidence. 

“Secretary Kennedy supports renewing the focus on the doctor-patient relationship and encourages individuals to discuss any personal medical decisions, including vaccines, with their healthcare provider,” a Health and Human Services spokesperson wrote to States Newsroom in September. “The American people voted for transparency, accountability, and the restoration of their decision-making power, and that is exactly what HHS is delivering.”

The response did not clarify whether Kennedy still thinks the vaccine is unsafe and what basis there is for that claim. 

Dr. Linda Eckert, a University of Washington School of Medicine professor and practicing OB-GYN, has an extensive background in immunizations and cervical cancer prevention. She served as a liaison for the American College of Obstetricians and Gynecologists to the CDC’s Advisory Committee on Immunization Practices until 2024. Members of the committee were recently dismissed by Kennedy’s agency and replaced by new members, several of whom have reportedly expressed anti-vaccine views. Eckert said the group had plans in motion to present to the ACIP in June a case for administering the HPV vaccine at the earliest age of 9 before it was disbanded. 

Although Black and Hispanic women are affected by cervical cancer at disproportionate rates because of systemic inequities, Eckert said the fastest rising group experiencing late-stage cancer is white women in the Southeast. But she added that Alabama was the first state in the country that launched a targeted campaign to eliminate cervical cancer. 

Treatment for the cancer once it develops can also be difficult to obtain, Eckert said. It can be expensive and require many follow-up visits, and usually leads to infertility either through hysterectomy or invasive radiation treatments. 

“It is a really devastating disease to treat,” Eckert said. “Even if you live, you are permanently changed.”

Recent study showed zero cases of cervical cancer after HPV vaccine 

Dr. Aisha Mays, founder and CEO of a Dream Youth Clinic in Oakland, California, said the services her clinic offers to young people for free includes most of the same services that Planned Parenthood clinics provide, including the HPV vaccine.

“That’s the work of Planned Parenthood and clinics like mine that are encouraging and doing regular Pap smear screenings and vaccines, and having really clear conversations with young people around the importance of these procedures,” Mays said.

The recent turn against vaccines by some segments of the public and members of President Donald Trump’s cabinet who doubt their effectiveness and baselessly claim that they cause injury and developmental issues like autism has made the promotion of HPV vaccines more difficult for Mays. Overwhelming evidence, including from the Centers for Disease Control and Prevention, shows that they are safe and effective.  

The vaccine can also protect against genital warts, anal cancer and oropharyngeal cancer, Mays said. There are about 40 strains of HPV in total that are known to infect the genitals, and more that can attach to certain patches of skin. Most people who have sex will come in contact with one or more of the strains by the time they reach their mid-20s or early 30s.

Mays’ clinic is largely funded by state and local grants, but it received more than $100,000 in federal funding for a sexual health education program through the U.S. Department of Health and Human Services’ Office of Population Affairs. It was a nationally distributed podcast hosted by adolescents, Mays said, and they chose topics to talk about related to sexual health, including HPV.

The program’s grant was one of many that have been cancelled under the Trump administration. An objective laid out in Project 2025, the blueprint document for the next Republican presidency written by conservative advocacy group the Heritage Foundation, was to ensure no subgrantees of sex education programs were promoting abortion or “high-risk sexual behavior” among adolescents. It also stated that any programming should not be used to “promote sex.”

HHS also terminated funding for one of California’s sexual health programs in August over the state’s refusal to remove references in the programming related to gender, including the idea that biological sex and gender identity are distinct concepts. Another directive of Project 2025 was to make sure biological sex is never conflated with gender identity or sexual orientation.

States with high rates of cervical cancer have low density of physicians

States with the lowest incidences of cervical cancer, including Massachusetts, New Hampshire, Connecticut and Minnesota, also have the highest density of physicians per capita. According to the Association of American Medical Colleges’ state physician workforce data, Massachusetts has the highest number of physicians per 100,000 people, and Oklahoma ranks in the bottom three.

Kentucky is in the bottom 15, and so is Indiana, where Marissa Brown works as a Planned Parenthood health center manager in Bloomington. Brown described her clinic as “an oasis in a desert” because there are few options for gynecological care in the area, and even fewer for obstetrics. Brown said they routinely see patients from rural areas two or more hours away, and many of them are coming for wellness exams that include cancer screenings.

Indiana used to have 38 Planned Parenthood clinics, but through 15 years of funding cuts and targeted anti-abortion legislation, the organization closed 21 of them between 2002 and 2017. In the years since then, another seven shut down to consolidate services. Many of them did not provide abortions.

“We hear a lot about patients coming in who can’t get into their gynecologist for four to 12 weeks,” Brown said. “We can do that in a few days to two weeks, and we have walk-in appointments too.”

Health Imperatives, a nonprofit network of seven community health clinics in southern Massachusetts, can no longer bill for Medicaid because they provide medication abortions and received about $800,000 in reimbursements for other services in 2023, like Planned Parenthood. One of Health Imperatives’ clinics is in Martha’s Vineyard, whose working-class residents have to work three to four jobs just to afford to live on the affluent island, said Julia Kehoe, the organization’s president and CEO.

More than a decade ago, she said she noticed a pattern: Their patients would come in for an annual gynecological exam, receive an abnormal cervical cancer screening, but not follow up, because the closest available specialist would require expensive travel off the island. Kehoe said that once their Martha’s Vineyard clinic purchased a colposcopy machine, from privately raised funds, in 2012, they started diagnosing some of their regular patients with now-advanced cancer.

“In the first year that we did colposcopies, we found four individuals who had stage three or four cancer, who we luckily were then able to connect up to Boston for critical care,” she said. “But if we had had that capacity earlier … we would have caught it earlier.”

States Newsroom reproductive rights reporter Sofia Resnick contributed to this report.

Coming Thursday: Telemedicine could help narrow the care gap in rural communities.

Stephanie Johnson, whose husband died after living with Parkinson's Disease for 13 years, speaks at a news conference Wednesday, Oct. 1, about legislation to create a state Parkinson's registry. (Photo by Erik Gunn/Wisconsin Examiner)

A bipartisan group of Wisconsin lawmakers announced legislation Wednesday to  create a statewide registry for Parkinson’s Disease.

Parkinson’s, a neurological condition that is characterized by tremors, but also by a variety of other symptoms, has been increasing disproportionately, according to Dr. Brian Nagle, a movement disorder specialist.

“It’s the second most common neurological disease after Alzheimer’s disease, but it’s the fastest growing,” Nagle said in an interview Wednesday.

The speed with which Parkinson’s diagnoses are increasing is outpacing the aging of the population, “which suggests that it’s not just due to our population getting older, but that there may be some sort of risk factor that is causing it to grow more rapidly,” Nagle said.

A statewide registry of Parkinson’s patients could help provide clues about factors, such as environmental conditions, that may be at the root of the illness, he said.

State Sen. Rachael Cabral-Guevara (R-Fox Crossing) and state Rep. Lisa Subeck (D-Madison) began circulating a draft bill Wednesday to create the proposed state registry.

“Right now, when patients and their doctors are looking for answers, we struggle a little bit,” said Cabral-Guevara, who is a nurse practitioner, at a press conference to announce the legislation.

“We simply don’t have the data that we need,” she said. “We don’t know who is infected. Where the disease is hitting the hardest. Are there environmental factors that impact this, that cause this, that make it progress even faster? That lack of the clear picture of this is a barrier.”

The legislation was the brainchild of Stephanie Johnson, director of the Parkinson’s Disease Alliance of Wisconsin. Johnson told reporters Wednesday that her husband, Rick, was diagnosed with Parkinson’s 15 years ago when he was 61. After living with the illness for 13 years, he died in December 2023.

“I think we typically think of Parkinson’s as tremors or shuffling,” Johnson said, “but Rick had dangerously low blood pressure that would cause him to pass out. He had cognitive changes that made it very, very challenging for him to communicate. And he had visual hallucinations and many other non-motor symptoms.”

Johnson said she was also diagnosed with Parkinson’s three months after her husband’s death — a finding that astonished her. Then she learned that in the neighborhood where they had previously lived for 20 years, they were two of six residents who developed Parkinson’s disease, she said.

“And I thought, this can’t be a coincidence,” Johnson said, “And I wondered, is this a disease cluster? I didn’t know.”

“We don’t have a systematic way of tracking the incidence and prevalence of Parkinson’s in Wisconsin,” Johnson said.

The proposed legislation is aimed at filling that gap. The bill’s authors have named it in memory of Johnson’s husband at her request.

Fourteen U.S. states have some form of registry for Parkinson’s Disease, with some tracking other conditions as well, according to the Michael J. Fox foundation, a national research nonprofit named for the TV actor who was diagnosed with Parkinson’s disease when he was 30.

The draft legislation calls for the establishment of a registry at the Department of Population Health Sciences at the University of Wisconsin-Madison School of Medicine and Public Health. The registry would include a website with annual reports on the incidence and prevalence of Parkinson’s Disease in Wisconsin.

Health care providers would file information with the directory about patients they treat for Parkinson’s or closely related conditions. If patients don’t consent for their information to be shared, the incidence would be reported and nothing else, according to the bill.

Parkinson’s Disease is the subject of “a lot of mysteries,” Subeck said. “The reality is we are not going to get closer to curing Parkinson’s unless we do the research, unless we collect the data, and unless we enable that data to be used in meaningful ways.”

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The U.S. Capitol on the evening of Tuesday, Sept. 30, 2025, just hours before a federal government shutdown. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — U.S. Senate Democrats and Republicans remained at a stalemate Wednesday as government offices closed and hundreds of thousands of federal workers faced furloughs on the first day of a government shutdown that showed no sign of ending.

Proposals from each side of the aisle to fund and reopen the government failed again during morning Senate votes, mirroring the same vote breakdowns as Tuesday evening, when lawmakers could not reach a deal hours before the government ran out of money.

The nonpartisan Congressional Budget Office projected up to 750,000 federal workers could be furloughed, leading to a $400 million per day impact on the economy.

Locked in their positions, Republicans failed to pick up enough Democrats to reach the 60 votes needed to advance their plan to fund the government until Nov. 21. 

Senators will break Thursday to observe Yom Kippur but will return Friday to again vote on the funding proposals.

Democratic Sens. Catherine Cortez Masto of Nevada and John Fetterman of Pennsylvania, along with independent Angus King of Maine, again joined Republicans in the 55-45 vote for the House-passed stopgap spending bill. GOP Sen. Rand Paul of Kentucky voted no.

Democrats also failed to find support to move forward their bill to fund the government through Oct. 31, roll back GOP cuts on Medicaid and permanently extend subsidies that tie the cost of Affordable  Care Act health insurance premiums to an enrollee’s income level. 

The Democrats failed to advance their plan in a party-line 47-53 vote. King, who caucuses with Democrats, voted in favor.

Shutdown tied to health care tax credits

Senate and House Democrats say they will not support a GOP path to reopen the government unless Republicans agree to negotiate on rising health care costs. 

House Minority Leader Hakeem Jeffries said at a press conference that Democrats are “ready to sit down with anyone at any time and at any place in order now to reopen the government, to enact a spending agreement that meets the needs of the American people and to address the devastating Republican health care crisis that has caused extraordinary harm on people all across the country.”

The New York Democrat pointed to harms in “rural America, working class America, urban America, small-town America, the heartland of America and Black and brown communities throughout America.” 

Democratic leaders blitzed Capitol Hill with their message on health care, holding press conferences and attending an evening rally Tuesday on the lawn outside the U.S. House. 

They pointed to new data published this week showing annual insurance premiums could double on average in 2026 if the subsidies expire at year’s end, according to an analysis from the nonprofit health policy research organization KFF. 

Open enrollment for next year’s ACA health insurance plans opens Nov. 1 in most states, and Oct. 15 in Idaho.

Uptake of ACA health insurance plans has more than doubled to over 24 million, up from 11 million, since the introduction of the subsidies in 2021, according to KFF. 

During their own budget reconciliation deal in 2022, Democrats extended the insurance premium tax credits until the end of 2025. The majority of ACA enrollees currently rely on the credits.

Democrats also want assurances that the White House and Senate Republicans will not cancel any more funds that have already been approved by Congress, as was the case this year when the administration and GOP lawmakers stripped funding for medical research, foreign aid and public broadcasting, among other areas.

‘This can all end today’

GOP leaders in the House and Senate continued to blame Senate Democrats for the government shutdown at the expense of furloughed federal workers and Americans who rely on their services. 

At a Wednesday morning press conference, House Speaker Mike Johnson said “troops and border patrol agents will have to go to work, but they’ll be working without pay.”

Johnson also claimed at the press conference that veterans benefits would stop. The claim is false, as Veterans Administration medical care will continue uninterrupted and vets will also continue to receive benefits, including compensation, pension, education and housing.

“As we speak here this morning, there are hundreds of thousands of federal workers who are getting their furlough notices. Nearly half of our civilian workforce is being sent home — these are hard-working Americans who work for our federal government,” the Louisiana Republican said, flanked by fellow GOP leaders on the Upper West Terrace of the U.S. Capitol overlooking the National Mall. 

Johnson decided in late September the House will be out until Oct. 6, canceling this week’s votes. 

The speaker said he will bring House members back next week, even if the government is still shut down.

“They would be here this week, except that we did our work — we passed the bill almost two weeks ago out of the House, sent it to the Senate,” Johnson said. “The ball is literally in (Senate Minority Leader) Chuck Schumer’s court, so he determines that.” 

Senate Majority Leader John Thune said “this can all end today” and “needs to end today.”

The South Dakota Republican said the funding lapse can cease when Senate Democrats vote for the GOP’s “clean” short-term funding bill. 

“We will continue to work together with our House counterparts, with the president of the United States, to get this government open again on behalf of the American people,” Thune said. 

Bipartisan deal and Trump

Virginia Democratic Sen. Tim Kaine said later in the day that a bipartisan group huddled on the floor during votes to talk about a possible path forward on “health care fixes” and ensuring that if a bipartisan deal is brokered, the Trump administration will stick to it. 

Republican senators, he said, could give Democrats assurances they won’t vote for any more rescissions requests from the White House, which ask Congress to cancel already approved government spending. But other issues, like laying off federal workers by the hundreds or thousands, have to be a promise from the president. 

“If I find a deal, should Congress have to follow it? Yes. Should the president have to follow it? Yes. Well, what if the president won’t follow it? Oh, yeah, you got a problem,” Kaine said. “So you know, rescission, impoundment, those are Senate words. But a deal is a deal — people get that.”

Kaine also emphasized that it’s not a “clean” stopgap funding bill if the Trump administration unilaterally cancels some of the spending. 

“In the past, we voted for clean (continuing resolutions), but the president has shown that he’ll take the money back,” Kaine said, referring to the technical name for a short-term funding bill. “I mean, just in Virginia, canceling $400 million to our public health, $40 million economic projects just pulled off the table, firing more Virginians than any president. 

“So we just want you to agree, if we do a deal, then you’ll honor the deal,” Kaine said. “It’s not that much to ask.”

‘People are suffering’

North Carolina Republican Sen. Thom Tillis said he doesn’t expect the shutdown will have long-term ramifications for senators’ ability to negotiate bipartisan deals — a necessity in the upper chamber, which has a 60-vote threshold to advance legislation. 

“It’s all transactional,” Tillis said. “I think there’s going to be opportunities for some bipartisan work, but none of that happens, you can’t even really consider it when you’re in a shutdown posture.”

Cortez Masto, who voted to advance Republicans’ seven-week stopgap bill, said the GOP “created this crisis” on health care and “need to address it.”

“They have no moral standing — no moral standing —- to say that this is all on the Democrats. They are in control. They’ve created this crisis,” Cortez Masto said. “People are suffering and they need to come to the table.” 

Missouri Republican Sen. Josh Hawley, who was sworn in for the first time during the last shutdown, said he worries about longer-term effects. 

“My concern is it’s going to poison the well on negotiations going forward on a lot of things,” Hawley said. “I can’t speak for anybody but myself, but I would just say that these tactics are very destructive. And it’s destructive, not just for relationships, but for real people.”

Ariana Figueroa contributed to this report.