Well, it’s what we’ve all been waiting for…
In a late-night move last Wednesday, Nov. 12, President Trump signed the Continuing Appropriations Act (CAA) of 2026 into law, officially ending what had become the longest federal government shutdown in U.S. history.
The legislation, passed after weeks of tense negotiations, funds the federal government through Jan. 30, 2026, reverses layoffs that occurred after Oct. 1, and secures funding for key agencies for the remainder of the fiscal year.
Let’s dive into some of the key implications of the bill’s passage – as well as what was (and was not) included in the spending package.
The CAA delivers relief across several sectors, with healthcare emerging as a major focus. Among its notable provisions is a $14 million funding boost for implementation of the No Surprises Act (NSA), likely aimed at improving the government’s Independent Dispute Resolution (IDR) online portal. This overhaul was first proposed in a 2023 Centers for Medicare & Medicaid Services (CMS) rule, and the Trump Administration expects a final rule on these improvements to be published later this month.
Another critical measure retroactively extends Medicare telehealth flexibilities to cover services provided during the shutdown. Many Medicare beneficiaries were unable to access telehealth during the shutdown, while providers were forced to halt new virtual visits or assume financial risk, creating significant care gaps. Although the extension is welcome, having enjoyed bipartisan support since before the expiration, it’s a stopgap, lasting only until Jan. 30 of next year, when Congress will need to act again to prevent further disruption.
The CAA also restores funding for community health centers and increases Medicare ambulance payments, both of which expired at the end of September. These provisions, however, share the same short-term time frame, expiring at the end of January.
Of course, notably absent from the CAA is an extension of the Patient Protection and Affordable Care Act’s (PPACA’s) enhanced premium tax credits (PTCs), which help millions of consumers afford healthcare coverage, but expire at year’s end.
GOP leaders have pledged to hold a vote on extending the tax subsidies next month, but insiders suggest that the measure faces steep hurdles in the Senate and is unlikely to advance in the House. This omission has sparked concern among healthcare advocates and small businesses, as roughly one in five employees who work in small businesses rely on PPACA coverage.
Debate during the shutdown over the tax credits underscores broader ideological divides in Congress. During a recent hearing, Republican lawmakers argued that PPACA subsidies inflate costs and degrade coverage quality.
Meanwhile, President Trump floated an alternative approach last week: redirecting funds used for the subsidies directly to consumers, allowing them to choose their own healthcare rather than funneling money to what he called “money-sucking insurance companies.” Industry leaders, however, countered that health plans operate on razor-thin margins, with profits below 1 percent.
Experts warn that eliminating the subsidies without a viable replacement could trigger a “death spiral” in PPACA marketplaces, driving premiums higher and destabilizing coverage. Still, the Administration appears open to compromise, suggesting a willingness to explore options such as cost-sharing reductions and health savings accounts to soften the impact.
Regardless, the coming weeks will be pivotal. Committees in both chambers of Congress are already scheduling hearings on healthcare costs and care coordination, signaling that reform efforts will likely remain front and center. Bipartisan legislation to extend the premium tax credits for at least two years has also been introduced, though its prospects are currently uncertain.
For now, the 2026 CAA buys lawmakers time, but only temporarily. Without a long-term spending solution, we could be in exactly the same place as we just were: with a government shutdown, complete with expiring telehealth waivers, long lines at airports, and all the rest, at the end of January.
Stay tuned, because the next couple months should be very enlightening.
