Here's how this shutdown is different

ACA tax credits are at the center of the government shutdown and the heart of Democrats' risky plan to win the fight over public opinion.

As in the past, this shutdown is over funding a policy that's important to the party voting against government funding. But there is a key difference this time: the policy in question has an immediate, direct impact on some voters. Past shutdowns were over such issues as border wall funding and the defunding of the ACA. There were no direct impacts to voters by leaving the status quo of those policies unchanged.

Democrats' key demand is extending enhanced tax credits that make premiums for ACA marketplace plans cheaper for many.

Democrats are betting that the public will pressure Republicans to extend the ACA credits when they see that premiums will more than double on average if the credits expire. Notices of those higher premiums started going out yesterday in some states ahead of the Nov. 1 start of marketplace enrollment for 2026.

"They're going to say, 'What's happening?'," Schumer said of voters receiving premium notices. "And we're going to be right there explaining to them, 'It's because the Republicans wouldn't negotiate with us.'"

But it's a quite a gamble for a pro-government party that typically avoids shutdowns. A lot will depend on the messaging war.

Republicans say they are confident that they can get enough Democrats to eventually vote for their bill to temporarily fund the government without the policies that Democrats are demanding. Two Democrats, and one independent who caucuses with Democrats, voted for the "clean" Republican continuing resolution Tuesday. Republicans need to peel off five more Democrats.

hhs

The shutdown's impact on HHS

Here's a rundown from Chelsea Cirruzzo: More than 32,000 HHS employees have been furloughed, and the Trump administration is warning of actual layoffs, though it's not clear whether HHS will be targeted. The CDC's communications have been impeded. The NIH is not admitting new patients to its clinical center. The FDA is not expected to accept new drug applications.

Essential programs will continue, including Medicare and Medicaid payments and disease surveillance by the CDC.

However, government services and functions could be slowed by the lack of employees. Read more.

hospitals

Shutdown hits hospital at home programs

Mario Aguilar spoke to executives about the strain that the shutdown puts on hospital at home programs, because the program's funding was set to be renewed in the government spending bill.

UMass Memorial Medical Center is one of many health systems that stopped admitting patients into its hospital at home program in the lead-up to the shutdown, straining its already overcrowded hospitals. Other health system execs told Mario that the uncertain funding situation makes them reluctant to invest in the hospital at home program, even though it could benefit patients and their facilities. Read more.

tariffs

Drug tariffs as price-bargaining tool

Trump said drugmakers would face 100% tariffs by yesterday if they didn't start building domestic facilities. But the tariffs have not taken effect, Daniel Payne writes. Instead, White House officials said the administration would "begin preparing" tariffs on companies that don't build in the U.S. or make a drug pricing agreement with the administration.

Commerce Secretary Howard Lutnick said Tuesday that he would let drug companies' negotiations with the administration "play out" before turning to the import taxes.

drug prices

Drug and pony show

Pfizer avoided tariffs for three years by agreeing to a deal to lower some U.S. drug prices to levels in other rich countries, which Trump touted at a White House press conference.

Elaine Chen dissected the deal.

Experts told Elaine they questioned whether Pfizer's deal will change the status quo much. They said many details are still unknown, such as what the most-favored nation prices will be and how the plans will be implemented.

Read more from Elaine and check out Matthew Herper's article on how Pfizer CEO Albert Bourla won over Trump and eased investor concerns.

vaccines

Poor kids can't get new Covid-19 shot

States can't order updated Covid-19 shots for low-income children because neither health secretary Robert F. Kennedy Jr. nor his deputy have signed off on recommendations by Kennedy's vaccine advisers on who should get the shots, Anil Oza and Chelsea report.

About half of American kids get free immunizations under the Vaccines for Children program. But the vaccines can't be shipped for that program without that sign off.

Children covered by private insurance can still get the vaccines, since insurers said they will cover the cost of the shot at least through next year. Read more.

More around STAT

Check out more exclusive coverage with a STAT+ subscription

Read premium in-depth biotech, pharma, policy, and life science coverage and analysis with all of our STAT+ articles.

What we're reading

First Opinion: Instead of work requirements, Medicaid should turn to employer incentives, STAT
Trump's USAID pause stranded lifesaving drugs. Children died waiting, The Washington Post
U.K. is urged to probe drugmakers for conspiring to scrap or halt investments amid pricing disputes, STAT
A small think tank's crusade against Obamacare is making some Republicans nervous, Politico