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Shutdown Day 27 and the Bleak Path Ahead
The shutdown continues but the to do list grows with SNAP relief, ACA subsidy extensions, 340B reforms, and agency staffing all poised to shift
Happy Monday! Week four opens with a continuous government shutdown and a health docket that is getting heavier. The Senate returns without a funding vote scheduled, and agencies are running on contingency. Behind the scenes, lawmakers are sketching post re-open moves.
In this week’s Nimitz Health:
Federal News: Shutdown operations, SNAP in jeopardy, ACA plans, CDC layoffs stalled, 340B talks
State & Industry News: Health companies flock to K street, GLP 1 coverage pressures in Medicaid
WHO’S HAVING EVENTS THIS WEEK?
Blue Star: Senate Event
Wednesday, October 29th
*Senate HELP: “The Future of Biotech: Maintaining U.S. Competitiveness and Delivering Lifesaving Cures to Patients” at 10am. Watch here.
Thursday, October 30th
*Senate HELP: “Nomination of Casey Means to be Medical Director in the Regular Corps of the Public Health Service and Surgeon General of the Public Health Service” at 11am. Watch here.
*Will be covered by Nimitz Health. Please email [email protected] if you would like a readout of any other hearings.
NEWS DRIVING THE WEEK
Federal News
It is day 27 of the shutdown. The Senate returns with no vote scheduled on the House bill that failed for a twelfth time last week. Federal workers missed their first full paycheck at the end of last week and the largest federal employee union is urging passage of a clean continuing resolution. USDA says federal food aid will not go out on November 1 and warned that the well has run dry for SNAP, which more than 40 million Americans use to help buy food. Agencies are leaning on contingency plans while grants, contracting, and rulemaking timelines slip. Live government shutdown updates are here.
Even as floor action stalls, Republicans are mapping a post reopen path for the expiring ACA subsidies. Leaders have floated a limited extension paired with guardrails such as an income cap, minimum out of pocket premiums, and potential grandfathering of current enrollees, with conservatives also pushing to tighten auto enrollment rules. Some discussions include moving a package under suspension in the House and pairing with priorities like HSAs or association plans, which would likely require explicit support from President Trump.
Pressure from the middle is rising. Thirteen swing district House Republicans urged Speaker Johnson to be ready with an extension plan as soon as the government reopens, warning that the December 31 cliff collides with open enrollment and insurer filings. Early ideas include minimum premiums and an income cap, with moderates framing a lapse as both a coverage and political risk.
Agency operations remain under pressure. A federal judge’s temporary order is shielding hundreds of union workers at CDC from layoffs, and HHS has narrowed the remaining cuts with December 8 as the target effective date. The Senate HELP Committee is set to question Surgeon General nominee Dr. Casey Means on October 30, with ethics divestments and business ties expected to draw scrutiny. That hearing will be streamed here.
On other policy tracks, a bipartisan Senate group continues work on a 340B reform bill. The effort centers on a clearer patient definition, contract pharmacy rules, transparency, and oversight, with members noting the program’s rapid growth and ongoing disputes between hospitals and manufacturers.
State & Industry News
K Street is running hot. Insurers, hospitals, and drugmakers increased third-quarter spending as clients push for an ACA subsidy extension and position for a potential year-end package that could touch PBM policy, telehealth flexibilities, and site neutral ideas. Companies are preparing for multiple scenarios given the shutdown and the narrow calendar.
More specifically, Novo Nordisk is lobbying to keep Medicaid coverage for Wegovy as several states report surging costs and move to curb access. California plans to end coverage in 2026 while North Carolina already cut coverage and Connecticut is narrowing eligibility. Pennsylvania is weighing stricter limits as spending rises. The outcome will influence payer formularies, state budgets, and manufacturer pricing strategy.
FOR FUN
One of Emily’s mentors, Tami Jackson Buckner, recently opened Jackson’s Pantry in honor of her son who died unexpectedly in 2023. Jackson's Pantry serves the entire DMV.
Due to the recent federal government shutdown, Jackson's Pantry is in immediate need of non-perishable food items and paper and baby products. If you are able to help, please consider donating items such as canned goods, dry pasta, rice, toilet paper, diapers, and paper towels. Every little bit helps and is greatly appreciated! You can send/deliver your tax-deductible items directly to:
Jackson’s Pantry │ C/O - NCCF │ 6301 Greentree Rd │ Bethesda, MD 20817
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