On November 12, the longest government shutdown in U.S. history came to an end as President Donald Trump signed a continuing resolution (CR) approved by both the U.S. House and U.S. Senate to reopen federal agencies and extend government operations through January 30, 2026.

While the CR renewed several expiring health programs including Medicare’s pandemic-era telehealth flexibilities and averted additional Medicare sequestration cuts, a provision to extend the Affordable Care Act (ACA) enhanced premium tax credits was not part of the bill – an omission that threatens the health care coverage of millions of Americans.

The deal includes a pledge from Senate Majority Leader John Thune to hold a vote on extending the enhanced premium tax credits in mid-December. However, House Speaker Mike Johnson has thus far refused to commit to a floor vote before the tax credits expire on December 31. In the meantime, House Democrats announced that they will attempt to use a procedural move known as a discharge petition to force a vote on a three-year extension of the ACA tax credits. The discharge petition requires 218 cosponsors, so the Democrats would need four Republican votes.

For Californians, the stakes could not be higher. The ACA premium tax credits have made obtaining coverage in the ACA marketplace affordable for millions of Californians. Covered California projects that, absent the extension of the tax credits, monthly premiums will increase 97% on average for nearly 1.7 million Californians enrolled in the state’s marketplace – increases that patients are already starting to see amid the ACA open enrollment period. As a result, as many as 400,000 Californians could soon be priced out of their health care coverage.

As the nation braces for the upcoming HR 1-related Medicaid cuts, the loss of these ACA tax credits would further destabilize our health system, exacerbate disparities, and place additional pressure on a health care system already stretched thin.

Health Programs and Medicare Physician Payment Relief

The legislation maintains government funding at current levels and renews several expiring health programs that were jeopardized by the shutdown – retroactive to October 1, 2025. It extends:

• National Health Service Corps
• Teaching Health Center Graduate Medical Education program
• Community health centers
• Hospital-at-Home initiative
• $8 billion for Disproportionate Share Hospitals

It also restores Medicare’s pandemic-era telehealth flexibilities retroactive to October 1, 2025 – ensuring continuity of care for patients who depend on virtual visits.

Importantly for physicians, the bill waives the statutory budget neutral “PAY-AS-YOU-GO” requirement to prevent an across-the-board 2% federal budget sequestration cut in 2026. Without that waiver, physician payments could have faced an additional 2% sequestration reduction in 2026, compounding the ongoing financial strain on medical practices.

ACA Premium Tax Credits Left Out

However, the agreement leaves one major health care issue unresolved: the fate of the enhanced Affordable Care Act premium tax credits that make marketplace coverage affordable for millions of Californians. The credits – first expanded under the American Rescue Plan and extended once under the Inflation Reduction Act – are set to expire unless Congress acts before the end of the year. Senate Republican Leader John Thune has pledged to hold a stand-alone vote to extend the subsidies in mid-December, but House leaders have so far resisted bringing the measure forward.

Without an extension, as many as 5 million Americans – including nearly 400,000 Californians – could lose ACA coverage entirely and, for millions more, basic coverage will become unaffordable.

What’s Next

For physicians and patients, the Continuing Resolution leaves long-term uncertainty. Federal agencies are poised to resume full operations on Thursday, November 13, and vital programs will be protected but only through January. And the absence of an ACA fix means millions could see premium hikes or lose coverage in 2026, threatening access to care and straining an already burdened safety net of hospitals and physicians.

“Ending the shutdown and restoring telehealth services is a necessary first step, but the real test will come next month,” said CMA President René Bravo, M.D. “Congress cannot claim victory while millions of Americans stand to lose their health coverage. Extending the ACA premium tax credits isn’t optional—it’s essential to protecting access to care and preventing the destabilization of our health system.”

CMA will continue to advocate on behalf of physicians and patients in urging the federal government to preserve access to affordable ACA health care coverage as the December vote approaches.