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.

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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.

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.

A patient goes to a physical therapy session at Lake Charles Memorial Hospital in Lake Charles, La. Without congressional action, more than 7 million people who buy their health insurance on Affordable Care Act marketplaces will pay much higher premiums next year. (Photo by Mario Tama/Getty Images)

Without congressional action, more than 7 million people who buy their health insurance on Affordable Care Act marketplaces would pay much higher premiums next year. Close to 5 million of them wouldn’t be able to absorb the price hike – nor would they be able to afford to buy coverage anywhere else, according to a new analysis.

The study by the Urban Institute, a left-leaning research organization, estimates that in eight states (Georgia, Louisiana, Mississippi, Oregon, South Carolina, Tennessee, Texas, and West Virginia) the number of people buying subsidized insurance from the marketplace would drop by at least half. Non-Hispanic Black people, non-Hispanic white people, and young adults would see the largest increases in the number of insured.

Enrollment in marketplace coverage surged from 11.4 million people in 2020 to 24.3 million this year, largely because of enhanced federal subsidies first made available by the American Rescue Plan Act in 2021 and later extended through the end of 2025 by the Inflation Reduction Act.

Unless Congress extends the subsidies, they will expire at the end of this year.

The Urban Institute projects that in 2026, the average premium paid by individuals or households with incomes below 250% of the federal poverty level (250% of the federal poverty level is $39,125 for an individual) would be $919, up from $169. Premiums would more than double, from $1,171 to $2,455, for people with incomes from 250% to 400% of the federal poverty level. And they would nearly double, from $4,436 to $8,471, for people with incomes above 400% of the federal poverty level.

Jessica Banthin, a senior fellow at the Urban Institute, said in an interview that the expiration of the tax credits would leave millions without access to any affordable health care options. She also noted that it likely would raise the cost of insurance for those who do remain on the marketplaces.

“People who are sicker will make the effort or find the money to stay enrolled,” Banthin said. “People who are healthier are more likely to leave the marketplace and either find another source of coverage or stay uninsured — they’re more likely to risk it.”

“And so what that means is the people remaining in the marketplace are a little bit sicker on average than they were before, and that means the risk pool is more costly, and premiums go up across the board.”

Last week, Democratic governors from 18 states sent a letter to congressional leaders of both parties, urging them to extend the subsidies.

“The timing couldn’t be more urgent. Insurers are already setting 2026 rates. If Congress acts quickly, states can lock in lower premiums and spare families a wave of sticker shock this fall,” the letter said. “If not, the damage will be felt for years.”

Congressional Republicans recognize the political peril in allowing the credits to expire less than a year before the midterm elections. Earlier this month, 10 GOP representatives introduced legislation that would extend the subsidies for one year. Senate Majority Leader John Thune, a South Dakota Republican, told reporters last week that GOP leaders are open to addressing the issue of the expiring credits but not until later this year.

U.S. Sen. Tammy Baldwin | Photo by Shauneen Miranda/States Newsroom

WASHINGTON — A trio of Senate Democrats urged Republican lawmakers at a Tuesday press conference to extend and make permanent the enhanced Affordable Care Act tax credits set to expire at the end of 2025.  

Senate Minority Leader Chuck Schumer of New York, along with Sens. Tammy Baldwin of Wisconsin and Jeanne Shaheen of New Hampshire, warned that the expiration of these credits would lead to “skyrocketing” costs for millions of enrollees unless the GOP-controlled Congress takes action. 

The credits are used by people who buy their own health insurance through the Affordable Care Act Marketplace.

Stopgap spending bill

The extension is among congressional Democrats’ broader health care demands in order to back any stopgap funding bill to avert a government shutdown before the next fiscal year begins Oct. 1. 

House GOP leadership did not negotiate with Democrats on the seven-week stopgap funding bill released on Tuesday.

Schumer, alongside House Minority Leader Hakeem Jeffries of New York, said in a joint statement Tuesday that “the House Republican-only spending bill fails to meet the needs of the American people and does nothing to stop the looming healthcare crisis.” 

They added that “at a time when families are already being squeezed by higher costs, Republicans refuse to stop Americans from facing double-digit hikes in their health insurance premiums.” 

At the press conference, Baldwin called for legislation she and Shaheen introduced earlier this year that would make the enhanced premium tax credits permanent to be included in the stopgap government funding bill. 

“Time is of the essence — families and businesses are planning for next year, and we need to get this done,” Baldwin said. “The only question is whether Republicans will join us and stand for lower costs for families or not.” 

Shaheen said that “as we near the deadline for government funding, I hope that our colleagues here in Congress will join us, that they will act to extend these tax credits and to keep health insurance affordable for millions of Americans.” 

Premiums expected to soar without action

The enhanced premium tax credits, established by Democrats in 2021 as part of a massive COVID-19 relief package, were extended in 2022 through the Inflation Reduction Act. They are set to expire at the end of 2025.

Premiums, on average, for enrollees would soar by more than 75% if the credits expire, according to the nonpartisan health research organization KFF. 

House Speaker Mike Johnson, R-La., said Tuesday at a press conference that “Republicans have concerns” about the credits because they have no income cap and certain high-income people can qualify for them. He also said Congress has until the end of the year to decide what to do.

At the Democrats’ press conference, Schumer said President Donald Trump “has taken a meat ax to our health care system,” adding that “it’s vicious, it’s cruel, it’s mean” and pointing to some of the repercussions of the GOP’s mega tax and spending cut law on Medicaid recipients. 

Meanwhile, open enrollment begins in November, meaning Congress would have to act before the end of the calendar year to avoid premium spikes.  

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There are not tens of millions of unauthorized immigrants in the U.S. receiving federal health care benefits.

The unauthorized population reached a record 14 million in 2023, according to an August 2025 research estimate. 

Unauthorized immigrants are not eligible to enroll in federally funded health coverage. 

That includes Medicaid (low-income people), Medicare (age 65 and over) and the Children’s Health Insurance Program (CHIP). And they aren’t eligible to buy coverage through the Affordable Care Act (Obamacare) marketplaces.

Federal Medicaid can reimburse hospitals for providing emergency care to unauthorized immigrants, but that is not coverage for individuals.

Vice President JD Vance said Aug. 28 in La Crosse, Wisconsin, that health care benefits can’t be sustained “if you allow tens of millions of people” into the U.S. without authorization “and give them those benefits.”

White House spokespersons did not return requests for comment.

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

Sources

• Pew Research Center: U.S. Unauthorized Immigrant Population Reached a Record 14 Million in 2023
• Congressional Research Service: Noncitizens’ Access to Health Care
• Migration Policy Institute: Immigrants’ Eligibility for U.S. Public Benefits: A Primer
• KFF: Key Facts on Health Coverage of Immigrants
• Migration Policy Institute: Immigrants and the Use of Public Benefits in the United States
• HealthCare.gov: Health coverage for immigrants
• KFF: 5 Key Facts About Immigrants and Medicaid
• Right Side Broadcasting Network: Vice President JD Vance Delivers Remarks in La Crosse, WI – 8/28/25

Do tens of millions of unauthorized immigrants receive federal health benefits? 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.