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 — 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.

Donna Powell, 66, a resident of Austin, Texas, who is temporarily living in the nation's capital, holds a sign at the "Healthcare Over Billionaires" rally hosted by Fair Share America and nearly three dozen other advocacy organizations outside the U.S. Capitol on Tuesday, Sept. 30, 2025, hours before federal government funding ran out at midnight. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — A large crowd gathered on Capitol Hill Tuesday hours before a federal government shutdown to protest rising health care costs — the crux of Democrats’ stand against approving a temporary Republican funding bill.

More than a dozen Democratic lawmakers joined activists and people who shared stories of rising health insurance premium costs at the “Healthcare Over Billionaires” rally hosted by the advocacy group Fair Share America, along with nearly three dozen labor unions, political advocacy groups and other organizations. 

Senate Democrats again on Tuesday blocked Republicans’ temporary government funding bill, citing the expiration of Affordable Care Act enhanced premium tax credits that since 2021 have lowered health insurance costs tied to an enrollee’s income. 

The standoff means a federal government shutdown will begin after midnight Tuesday.

Tony Gonzales, of Indiana County, Pennsylvania, told the crowd he worries how losing the premium tax credits will affect his family’s finances as he continues treatment for thymic carcinoma, a rare cancer he was diagnosed with two years ago.

“I need these subsidies. If the rich and the Republicans can go out there and have money for tax cuts, to buy another yacht, to go out in space, why can’t I at least have health care to address my needs, my wife’s needs, and maintain a lifestyle that we deserve as an American family?” said Gonzales.

Sen. Amy Klobuchar of Minnesota said her constituents are “standing on a health insurance cliff right now” and she will not support a Republican funding proposal until GOP lawmakers agree to extend the health insurance subsidies.

“When I hear them say, ‘oh, we’ll look at this in December, we’ll look at this in January.’ This is not a December thing. This is not a January thing. This is a now thing,” she said.

Open enrollment for health care plans begins Nov. 1 in most states, except Idaho, where it begins Oct. 15.

Annual insurance premiums could double on average in 2026 if the subsidies expire at year’s end, according to an analysis published Tuesday by the nonprofit health policy research organization KFF.

The enhanced premium tax credits were extended through 2025 under the Democrat-led budget reconciliation law in 2022, otherwise known as the Inflation Reduction Act.

Participation in Affordable Care Act health insurance exchanges has more than doubled to over 24 million, up from 11 million, since the introduction of the tax credits, which the majority of enrollees receive, according to KFF. 

Congressional Hispanic Caucus Chair Adriano Espaillat, a New York Democrat, speaks at a press conference outside the U.S. Capitol in Washington, D.C., on Sept. 30, 2025. (Photo by Shauneen Miranda/States Newsroom)

WASHINGTON — A group of Democratic caucus leaders on Tuesday blasted a vulgar deepfake of Senate Minority Leader Chuck Schumer and House Minority Leader Hakeem Jeffries posted by President Donald Trump on social media. 

The chairs of the Congressional Hispanic Caucus, Congressional Black Caucus, Congressional Asian Pacific American Caucus, Democratic Women’s Caucus, New Democrat Coalition, Congressional Progressive Caucus and Congressional Equality Caucus also refused to back down on their health care demands as the federal government barrels toward a shutdown.

The GOP and Democratic lawmakers are in a deadlock, and funding is set to run out by midnight Tuesday, when the new fiscal year begins.

“We won’t vote for anything that doesn’t restore the cuts to Medicaid and doesn’t protect people that will be paying higher premiums,” Congressional Hispanic Caucus Chair Adriano Espaillat said at a press conference outside the U.S. Capitol, referring to Medicaid reductions made in the “big, beautiful” law enacted by Republicans earlier this year.

The New York Democrat said “we won’t mess around with Americans’ health care — people that are sick that deserve to have a first-quality health care system providing assistance to them in one of the most serious periods of their lives.” 

While Republicans want a “clean” stopgap funding bill to keep the government open, Democrats are calling for the extension of enhanced Affordable Care Act tax credits set to expire at the end of 2025 and the reversal of sweeping health care changes brought by the GOP’s mega tax and spending cuts law, including the massive funding cuts to Medicaid. 

‘Racist meme’ by Trump slammed

Trump posted the deepfake on his social media platform Truth Social just hours after his White House meeting with Schumer, Jeffries, Senate Majority Leader John Thune of South Dakota and House Speaker Mike Johnson of Louisiana, which failed to yield any funding deal. The Congressional Budget Office estimated Tuesday that some 750,000 federal employees could be furloughed if the government shuts down. 

The 35-second video appears to be AI-generated and uses the setting of Schumer and Jeffries, both New York Democrats, speaking to reporters outside the White House after their meeting with Trump. 

The fake video shows Jeffries with a sombrero and mustache and Schumer ranting that “if we give all these illegal aliens free health care, we might be able to get them on our side so they can vote for us.” 

Espaillat of the Congressional Hispanic Caucus described the video as “insulting,” saying it shows Trump is “out of touch with the health care challenges of the American people.” 

The New York Democrat said “with your health care on the line, all he could do is put out this deepfake racist meme — not funny at all, not for any of us here, particularly for people that are ill and fighting for their lives that need health care.” 

Democratic Women’s Caucus Chair Teresa Leger Fernández also blasted the video, saying “that’s not how you get to a deal.” Instead, the New Mexico Democrat said Trump’s decision to post it “looks like a little 6-year-old having a temper tantrum.” 

‘Bigotry will get you nowhere’

Congressional Black Caucus Chair Yvette Clarke, a New York Democrat, said “the juvenile behavior coming out of the White House should not be dignified by any American.”   

Clarke noted that her caucus “will not support a partisan spending bill that slashes health care, guts federal jobs and raises costs, all while targeting the very communities that keep this country running.” 

In a social media post Monday responding to the fabricated video, Schumer said “if you think your shutdown is a joke, it just proves what we all know: You can’t negotiate. You can only throw tantrums.” 

Jeffries also responded to Trump on social media Monday, saying “bigotry will get you nowhere” and “we are NOT backing down.” 

Rep. Mark Pocan and Sen. Tammy Baldwin | Collage of screenshots via Zoom

Last time the government was on the brink of a shutdown, Democratic leaders rushed to negotiate with Republicans and reached a deal to keep federal agencies open and basic services flowing. Now that deal is about to expire and there seems to be little appetite for compromise in Washington. 

President Donald Trump has directed Republicans “don’t even bother dealing with” Democrats, and the House rammed through a near-party-line resolution to keep the government open that ignored Democratic demands and had no Democratic input at all. 

“We’re not sure how serious they are about actually trying to have something done by September 30,” Wisconsin Democratic U.S. Rep. Mark Pocan, who sits on the House Appropriations Committee, told reporters in his Madison office Wednesday. Trump had just canceled a meeting with Democratic leaders of the House and Senate, and the House isn’t even in session during the last days of September, as the shutdown clock winds down. 

Still, House Minority Leader Hakeem Jeffries (D-NY) called the Democratic caucus back anyway, “so I’ll be flying Monday out to Washington,” Pocan said.  “Hopefully they’ll decide we’ve got work to do. But you know, this is something where we don’t run the House or the Senate or the White House.” In other words, if the government shuts down, it’s the Republicans’ fault. Republicans, who don’t appear worried about a shutdown, say the opposite, rolling their eyes at Democrats’ demands that a stopgap government funding bill must reverse Medicaid cuts and extend Affordable Care Act premium tax credits, which are set to expire at the end of the year and without which an estimated 5 million Americans will no longer be able to afford any health insurance at all.

A shutdown means hardship for people who depend on government services and could harm the whole economy, “But at the same time,” Pocan said, “we’re trying to fight for people who lost their health care and other things from what we call the Big, Ugly Law.”

Pocan cited data from the nonpartisan health research organization KFF on likely health insurance premium hikes in Wisconsin if the ACA tax credits are not extended. A KFF calculator estimates premium increases for families of different sizes and income levels in every state. A family of four earning $130,000 per year in Wisconsin could see premiums jump by as much as $1,588 per month or $19,081 per year, according to the calculator.

Nationwide, premiums will soar by more than 75% if the credits expire, according to KFF.

Wisconsin Sen. Tammy Baldwin has called for legislation she introduced earlier this year to make the enhanced premium tax credits permanent to be included in any stopgap bill to avert a shutdown.

In a joint statement, Democratic leaders of the House and Senate criticized House Republicans for ignoring their pleas to address the expiring ACA tax credits, writing, “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.” 

The sudden jump in health insurance premiums, combined with high costs for consumer goods because of Trump’s tariffs, will hit voters just ahead of the midterm elections, which take place right after the ACA tax credits are set to expire. Politics alone should make the idea of forestalling the sudden cliff appealing. But this is no ordinary Republican party. Back in their districts, ducking in-person meetings with constituents, members of Congress who voted for the Big Beautiful Bill Act to slash health care, food assistance and federal agencies that serve their constituents are still in lockstep with Trump. No wonder they don’t care if the entire government grinds to a halt.

A shutdown will be bad. But what Trump and the Republicans have in store for Americans is worse. 

More than the effects of a shutdown, said Pocan, “I’m far more concerned about what they just did to people that we need to try to fix, and if they’re not willing to have those conversations with us — that’s a big problem.”

GET THE MORNING HEADLINES.

SUBSCRIBE

Elementary school students arrive for the first day of school in September in Minnesota. About 3 in 4 children nationwide relied on government-subsidized health care, and 2 in 5 experience disruptions in health coverage during their childhood, according to a study by researchers at the Harvard T.H. Chan School of Public Health. (Photo by Stephen Maturen/Getty Images)

A majority of children in the United States rely on Medicaid or the Children’s Health Insurance Program at some point by their 18th birthday, and many experience periods of coverage loss, according to a study published Wednesday in the journal JAMA.

By their 18th birthday, about 3 in 4 children nationwide relied on Medicaid, CHIP (which subsidizes health care for children and pregnant women in families that earn too much for Medicaid), or the subsidized insurance marketplaces established through the 2010 Affordable Care Act — or experienced a period during their childhood without health insurance, the study found.

Researchers from the Harvard T.H. Chan School of Public Health conducted estimates based on analyses of national data from 2015 to 2019, looking at cumulative coverage rates over the course of childhood. 

The study comes as states grapple with federal Medicaid cuts under President Donald Trump’s One Big Beautiful Bill Act. The tax and spending law will reduce Medicaid funding by $1 trillion and cut enrollment by 10 million to 15 million people over the next decade, according to projections by the Congressional Budget Office.

About 42% of children suffered a period of losing health coverage at any point in time by their 18th birthday, the Harvard researchers found, and 61% had at some point enrolled in Medicaid or CHIP. About 78.5% were at some point enrolled in employment-based insurance.

Rates of children who lost insurance coverage were higher in states that hadn’t expanded Medicaid income eligibility under the Affordable Care Act, often known as Obamacare. Roughly 59% of children in non-expansion states had periods without any insurance coverage — compared with 36% in expansion states. Overall, about 2 in 5 children experienced periods without health insurance, the study found.

And states with the strictest income thresholds saw the highest share of kids losing coverage who previously were covered by Medicaid or CHIP at birth.

“Upcoming changes to Medicaid could affect a significant portion of children and worsen already substantial insurance gaps,” senior author Nicolas Menzies, an  associate professor of global health and faculty member in the school’s Center for Health Decision Science, said in a statement. 

“We’re particularly worried about explicit loss of public insurance eligibility for noncitizen children; spillover effects through parental Medicaid coverage losses due to work requirements and more eligibility checks; and state-level cuts to Medicaid.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.