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Advancing Health
Inside Washington: The Government Shutdown and Pending 2025 Legislative Outlook
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- [00:01]
A
Welcome to advancing health changes and challenges. That pretty well sums up the state of American health care in the last quarter of 2025. In this month's Leadership Dialogue podcast, hosted by Tina Fries decker, president and CEO of Corewell Health and the 2025 board chair of the American Hospital association, we get a briefing From Stacy Hughes, AHA's executive vice president of government relations and Public policy, on the outlook for ending the government shutdown that began October 1st, and insights on what's expected on the legislative front for the remainder of the year and an update on a host of issues important to the field.
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B
Thank you everyone for joining us today. I'm Tina Friesdecker, President and CEO of corewell Health and the board chair for the American Hospital Association. I did my first leadership dialogue with Stacy Hughes and there have been so many new changes and challenges, opportunities, development since January that I felt that it was the right time to bring Stacy back for an update. I can't wait to hear your insights, Stacy, on all that is playing out in Washington, D.C. and how the American Hospital association is continuing to advance this work on behalf of our field. So you and I have had lots of conversations over the past year. I am so grateful for your expertise and just understanding what it feels like, what it's about and what we should be doing as we go forward. So let's start with what is top of mind for many of us, the current federal government shutdown. Can you give us a sense of how this government shutdown is the same or different from previous times? What do you think is going to happen?
- [01:36]
C
I'm so grateful that you invited me and it's so fun to talk to you always and appreciate your leadership through all these different events this year for sure hitting in the Q4, which is nice, but still a lot of challenges. So yeah, to your point, the shutdown, what is different? One, it's a full shutdown. The last shutdown in 2018 and 19, Tina, was just a partial and HHS was funded. Department of Defense was funded. This is 100% shutdown of the full government. And so that's really different. I think. Second, one of the reasons the government is shut down, which I know we'll talk more about, is the concern Democrats have in wanting to use this opportunity to have leverage to get Republicans to support extending the EPTCs. I'd say that's a second difference in that this is going to play out in real time, you know, as we're speaking now and 21 days from now during this shutdown or maybe it reopens, people are going to get their notices about their premium subsidies and what they. Those that have gone away during this time. So you've got sort of this dramatic dynamic that Democrats are kind of banking on so that people, everyday, Americans, understand what a shutdown is. So for those two reasons, it's very different. I will say a lot of people will ask me, how will it end? And really nobody knows. I'll just add a few more facts about kind of this particular shutdown in terms of where we are. They've got about five payroll periods that are going to be coming up that are important. One I think has been highly reported, which is the active military PayCheck stops on October 15th. The second full government, federal government employee paycheck stops between the 20th and 31st. Senate employees stop the 20th, you know, go down the line. October 31st, the House employees stop receiving their paycheck. So those. That's kind of a. An important mashup right there in terms of will that be impactful. They are moving money around to try to protect the WIC program that pro. That funding is also expired. So there could be some action forcing events. I will say the President is going to be in Israel this weekend, rightly so, for an important ceasefire. And that's going to really occupy the new cycle till Tuesday. So I think we get back here Tuesday and we're kind of still stymie Tina. So I don't know how this ends, but both sides feel like they're doing well. And I think frankly, starting Tuesday, it's a test of political stamina, you know, which party can withstand the things we just talked about.
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B
Right. And it's challenging because all of those impact people. That's right, American people, the federal workers and so on. And so it's what's the way to get unstuck from that for sure.
- [04:02]
C
And I think for us, you know, because it is the Department of hhs, we also have some things that are affecting real patients. In particular the telehealth pieces. As you know, that program expired September 30th when the CR was unsuccessful. And so did hospital at home. And, you know, that does affect real lives. And there's about, according to CMS, there were about 1200 patients that were in the system during that month between about 419 hospitals. And those patients almost all had to be moved under the fact that the program was no longer authorized. So we feel it a little bit more than we normally would, acutely in terms of some of these programs, not in the mandatory side but it is, it is real life implications.
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B
True. So you mentioned this before. One of the sticking points is the enhanced premium tax credits, which, you know, expire at the end of the year. Why is extending those tax credits so important for hospitals and our members people? And what do you think is going to happen with those?
- [04:56]
C
Yeah, boy, that's, that's a great question. A couple things. Some certainly we just came off the OBBA debate, right. And that already includes scoring estimates that up to 10 million people will be displaced from coverage over the next 10 years. If you were to lose the enhanced subsidies, which were part of President Biden's inflation Reduction act as well as his American Rescue plan, if those were to expire, you'd see at least another 5 million individuals that would go from insured to uninsured status. But in addition, under the four years of these enhanced subsidies, about 10 million people have come on the rolls and it's a substantial part of their ability to afford their care. 19 or 20 million people will see some reduction in their actual subsidy to pay for their premiums. And even if you get some of it, some people said even just a $12 differential could be the choice of staying covered or not covered. So that's number one. It will just create more people who are uninsured that will come through our doors. But importantly, also in terms of our own fiscal health, you know, we would estimate that's about a $28 billion loss of our ability to continue to provide services over the next 10 years. So it's very real to hospitals in terms of what it would mean to our overall day to day ability to serve patients.
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B
Right. And it is impacting in communities where we have payers offering the products and some not offering the products. So it's a very dynamic time happening on the ground, but then also what will happen in D.C. so thanks for that update. There are some more things from a comprehensive healthcare package that come together, such as structural changes to how pharmacy benefit managers operate or changes to Medicare Advantage. What do you think is going to be put together in that sort of comprehensive package?
- [06:37]
C
Let's talk about the Hill first. I guess I'd say that's where the PBM reform really does lie. And there's probably a combination of MA with regulatory and hil. But right now it's so acrimonious. Tina, I think while there is a lot of bipartisan support for both of those, I think that until they resolve this issue, it is going to be very difficult to restart those bipartisan conversations. And frankly, the longer this goes on, I think the more it will spoil the waters for those kind of conversations in terms of is there an opportunity in December? We would hope so. As you know, there was some significant proposals, ones that you mentioned that were left on the cutting room floor last December when we had the healthcare, you know, end of year package and some other priorities on community health centers, ma, as you mentioned. So I think there's an opportunity, but it may actually bleed into next year. It's going to be solely dependent on the appropriations process. And once we open the government back up and there's a bipartisan solution for that, the question is how long. Right. Is it a bipartisan solution? Just till next March. And normally our priorities and those types of priorities tend to travel just the length of the amount of time at the continuing resolution. So I'm not so sure when we'll be at that point of having more permanent PBM reform or MA reform. But the good news is I think the commitment to those are high. So we'll see if they revisit it. But I think they'll pick up where they left off once we can get appropriations settled.
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B
Okay, so you talked a little bit about December. I know the American Hospital association has a full end of the year list of priority items. What are some of those other key issues that your team is tracking? And you know, immigration, H1B visa exemptions, maybe one, some of those. What are you thinking about that that we should be mindful of.
- [08:18]
C
There's no shortage of issues and it's real diverse. You know, I'll start with immigration. You know, I think everyone saw tension around the President's proclamation a couple weeks ago around adding a hundred thousand dollar fee going forward, the companies who are sponsoring H1B visa applicants and so on that one, we're looking and working very hard with the administration to try to seek exemption for health care workers. And that would be every. Every clinical aspect. Right. It would be lab technicians, physicians, nurses. You know, we are probably only 4.2% or 5% of the total of H1B visas. So we're hopeful with the demonstrated workforce shortages that exist, that we have a good chance of leaning on the administration to be thoughtful about their exemption process for healthcare workers. That's number one tariffs. I think you mentioned to me that continues to be an area of concern. You know, we've engaged very significantly with some of the other stakeholders, obviously avamed and some of the other organizations. But for us, you know, a significant part of our ppe, which the President has now threatened a tariff on medical devices, which he's just renewed a threat about an investigation about foreign national security around tariffs. All of those really impact our domestic supply chain, our ability to access products. So those two are, you know, I wouldn't say left field, but they continue to occupy a lot of our bandwidth and trying to get some remedies for those two issues. Not to mention we're in that statutory rulemaking season. You know, we're in the part of this, of the rulemaking process. Our comments have been submitted, but the government shut down, but the statutory rules still need to be addressed and worked on. This is when we spend our time with all the agency leaders, both political and career, and make our case coming off of our submitted comments in the field. Comments so a lot of challenges there, including some proposals on price transparency, obviously 340B. 340B. Obviously, separate from the rule, there's the rebate model. So a lot is going to occupy our time and trying to influence these next two or three months for the year.
- [10:12]
B
TINA so Stacy, my final question for you is, you know, you've been in this field for a long time. You know the players, you know the process. What advice can you give to our members as, as we're hearing about it, navigating through it, trying to be active with our government relations teams and legislative leaders and administrative leaders. What advice can you give to us that we should be doing?
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C
I just think it's engaged, engage, engage, engage. And I think that, you know, while it's a new group of single party leaders that are in town, I think everyone appreciates being able to hear our story and telling it well and telling it well with data with real life consequences. And so I think just don't take your foot off the pedal on that. You know, the whole field really rose up in a way to tell Congress and the executive branch about the impact of the Medicaid cuts that were being considered. And I think we got to continue to do that as we try to mitigate some of these issues and also make sure we're telling our story, where we're innovating, where we're creating efficiencies, what we're doing that is helpful in chronic disease. You know, we have a positive story to tell as well. And I think you'll find some, some people are really interested in what we can be doing to help improve health care.
- [11:19]
B
I think that's a great reminder, Stacy, of all the positive stories that we have. I was just rounding in one of our hospitals and am so impressed by what is happening there's so many things that are happening to improve patient care that many people, including our legislative leaders, need to understand and recognize and know that they impact that our ability to provide that. So thank you so much, Stacy, for your time today, for all of the work that you and your team do on behalf of our field. And thank you so much for finding the time to listen to us. We'll be back next month for another leadership dialogue conversation.
- [11:51]
C
Thank you, Tina. Appreciate your time.
- [11:54]
A
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