Advancing Health Podcast Summary

Episode Title: Inside Washington: The Government Shutdown and Pending 2025 Legislative Outlook
Date: October 15, 2025
Host: Tina Friesdecker (President & CEO, Corewell Health; AHA 2025 Board Chair)
Guest: Stacy Hughes (Executive VP, Government Relations and Public Policy, American Hospital Association)

Episode Overview

This episode offers a timely dialogue between Tina Friesdecker and Stacy Hughes, unpacking the impacts of the federal government shutdown initiated on October 1, 2025, and exploring what hospitals and health systems can expect on the legislative front for the remainder of the year. Hughes shares updates on key policy issues such as the fate of enhanced premium tax credits (EPTCs), telehealth authorization, pharmacy benefit manager (PBM) reform, Medicare Advantage, immigration-related workforce concerns, tariffs on medical supplies, and the importance of advocacy in influencing outcomes during uncertain times.

Key Discussion Points & Insights

1. The 2025 Federal Government Shutdown

• Nature and Uniqueness of the Shutdown

  • This is a complete, full government shutdown, unlike past shutdowns (such as 2018-2019), which were partial and left essential departments funded.
    "The last shutdown in 2018 and 19... was just a partial and HHS was funded. Department of Defense was funded. This is 100% shutdown of the full government." — Stacy Hughes [01:36]
  • The shutdown is fundamentally different due to its connection with political leverage around extending premium tax credits (EPTCs).
  • Key payroll cutoff dates for government and congressional employees loom as potential pressure points to end the impasse.
  • The President’s trip to Israel and current news cycles further complicate the timeline for resolution. "It's a test of political stamina, you know, which party can withstand the things we just talked about." — Stacy Hughes [03:45]

• Impact on Patients and Healthcare Services

  • The expiration of telehealth and "hospital at home" waivers directly impacts real patients (with ~1,200 affected across 419 hospitals in the past month alone). "We feel it a little bit more than we normally would, acutely in terms of some of these programs... but it is real life implications." — Stacy Hughes [04:02]

2. Enhanced Premium Tax Credits (EPTCs) and Their Importance

• Consequences if Not Extended

  • If EPTCs expire at the end of the year, 5 million more people may go uninsured. Losing subsidies could mean 10 million fewer people with coverage—a substantial setback for healthcare access. "If those were to expire, you'd see at least another 5 million individuals that would go from insured to uninsured status... 19 or 20 million people will see some reduction in their actual subsidy to pay for their premiums." — Stacy Hughes [04:56]

• Impact on Hospitals

  • The fiscal health of hospitals is at stake, with an estimated $28 billion loss over the next decade if EPTCs are not preserved. "It will just create more people who are uninsured that will come through our doors..." — Stacy Hughes [05:34]

3. Prospects for Comprehensive Healthcare Legislation

• Policy Issues Now and On the Horizon
  • PBM reforms and changes to Medicare Advantage (MA) are priorities with bipartisan support, but political acrimony over the shutdown has all but halted progress. "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." — Stacy Hughes [06:36]
  • Upcoming opportunities for legislative movement could arise in December or may be pushed into next year.

4. Other Key Legislative Issues Being Tracked

• Immigration and H1B Visa Fees

  • New $100,000 fee for H1B visa sponsorship threatens healthcare workforce capacity. AHA is lobbying for exemptions for healthcare professionals. "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." — Stacy Hughes [08:17]

• Tariffs and Supply Chain Security

  • Continued concern over tariffs (including threats on medical devices) and their impact on supply chains and PPE access.

• Rulemaking Season

  • Ongoing engagement with agencies on statutory rules, including those around price transparency, 340B, and rebate models, despite the government shutdown.

5. Advice for Hospital Leaders & Advocates

• Staying Engaged is Crucial
  • Persist in advocacy efforts and share the human impact of policy and coverage gaps with lawmakers. "I just think it's engage, engage, engage, engage. And I think that... everyone appreciates being able to hear our story and telling it well and telling it well with data with real life consequences." — Stacy Hughes [10:36]
  • Tell positive stories about hospital innovation and efficiencies to balance advocacy strategies.

Notable Quotes & Memorable Moments

• On Shutdown’s Tangible Impact:

  "We feel it a little bit more than we normally would, acutely in terms of some of these programs... it is real life implications."
  — Stacy Hughes [04:02]

• On the EPTCs Cliff:

  "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."
  — Stacy Hughes [05:14]

• On Effective Advocacy:

  "Just don't take your foot off the pedal on that. The whole field really rose up in a way to tell Congress and the executive branch about the impact of the Medicaid cuts... And also make sure we're telling our story, where we're innovating, where we're creating efficiencies..."
  — Stacy Hughes [10:36]

Key Timestamps

• 00:40 — Introduction by Tina Friesdecker and preview of urgent topics
• 01:36 — Stacy Hughes distinguishes this shutdown from previous ones
• 03:53 — Discussion on impacts to federal workers, public services, and political repercussions
• 04:02 — Real-world effects on patients: telehealth and hospital-at-home expirations
• 04:56 — Deep dive into the enhanced premium tax credits cliff
• 06:36 — Prospects for PBM/MA reform and December’s legislative window
• 08:17 — Policy updates: immigration/H1B, tariffs, statutory rulemaking, 340B
• 10:36 — Hughes encourages robust engagement and positive storytelling

Final Takeaway

This episode offers a sobering look at the current policy environment for hospitals amid a full federal government shutdown, highlighting the urgency of maintaining insurance coverage, the precariousness of ongoing reforms, and the need for constant, constructive advocacy. The stakes for patients and providers are high, making engagement with policymakers and effective storytelling all the more essential as 2025’s legislative battles unfold.