In this edition of AcademyHealth’s Situation Report, we examine the reopening of the federal government after a record-breaking shutdown, as Congress debates ACA tax credits and abortion coverage. At the same time, new data showing ongoing closures of rural maternity units highlights persistent challenges in access to maternal care. Together, these developments underscore the importance of evidence-based research to guide policy and practice, and the critical role of health service researchers in monitoring impacts on care delivery and informing solutions.
In today’s issue:
- Next Steps for Researchers as Government Reopens
- Senate Republicans Seek Abortion Restrictions in Exchange for ACA Tax Credit Extension
- Policy Proposal Raises Concerns About ACA Market Stability
- MAHA Summit Draws Senior HHS Officials, Biotech Industry Leaders
- Rural Hospital Maternity Unit Closures Rise in 2025
Next Steps for Researchers as Government Reopens
On the 43rd day of the record-breaking government shutdown, the House passed a Republican-backed bill to fund the government through January and re-open the government. The bill passed 222 to 209 with two Republicans and six Democrats voting opposite of their parties. Trump signed the bill Wednesday night. Given none of the Democratic demands related to health care were met, House Democrats plan to push an ACA subsidy-related discharge petition. Although some House Republicans are in support of a one-year extension of ACA subsidies, the petition would require 218 signatures to force a House vote.
As the government reopens, researchers should be prepared to take related actions. For any protentional missed communications, deadlines, or system updates, researchers should reconnect with their federal program officers and grant specialists to confirm important updates and changes. Researchers should also consider checking submission deadlines and reporting schedules to determine if there have been any changes as extensions are not automatic. Additionally, it is important that researchers and their organizations coordinate the resuming of drawdowns in their payment management systems and review active grant terms and period of performance. If there have been any lost working days due to the shutdown, it is important that researchers record the impact of lost working hours for future potential requests for non-cost extensions. Lastly, researchers should connect with subrecipients and contractors where applicable to make sure they are fully read in on any changes or impacts and up to date on how all parties will move forward as the re-opening unfolds.
Senate Republicans Seek Abortion Restrictions in Exchange for ACA Tax Credit Extension
Senate Republicans are open to negotiating a one-year extension of the Affordable Care Act (ACA) tax credits at the center of the government shutdown, but only if Democrats agree to restrict abortion access under insurance plans. Majority Leader John Thune has suggested revisiting the Hyde Amendment provisions, which currently bar federal funds from being used for abortion except in specific circumstances. Opponents of additional restrictions argue that such changes could limit coverage options under state or private plans. States may provide coverage for abortion through other funding sources, such as private or state funds. Twenty-five states prohibit coverage for abortion on all ACA marketplaces and twelve states require abortion to be covered in ACA marketplace plans. For health services researchers, these discussions highlight ongoing policy tensions between insurance design, state variation, and access to comprehensive reproductive care — all areas where evidence can inform the impact of potential policy changes.
Policy Proposal Raises Concerns About ACA Market Stability
As Congress prepares to debate extending the enhanced ACA subsidies, experts suspect that conservative lawmakers’ idea to not extend the enhanced subsidies, but route cash to consumers, is intended to undermine the ACA. While this plan would offer consumers cash to help them purchase plans, experts note that healthier people would likely opt for cheaper plans with skimpier coverage outside of the ACA marketplaces that don’t have to comply with ACA consumer protections, often called “junk plans.” These plans, which include short-term plans, association health plans, health care sharing ministries, or fixed indemnity plans, frequently include medical underwriting or don’t cover preexisting conditions. By removing healthy individuals from the broader ACA pool, a larger proportion of the pool will be sicker people who need more and costlier care. These raising costs for insurers could cause them to raise premiums and the cost of care, or even exit the ACA marketplace, causing a “death spiral.”
The risk is not just to the ACA marketplaces themselves, but also to Americans who purchase one of these “junk plans” – if they have a sudden unforeseen medical emergency, their needed care may not be covered. The American Hospital Association notes that relying on plans with inadequate benefits leads to surprise gaps in coverage and can drive medical debt. It is unclear whether there is enough time to formalize this plan for 2026. Health services researchers should continue to educate policymakers on the importance of the ACA marketplaces on everyday Americans’ health coverage, and the risks associated with “junk plans.”
MAHA Summit Draws Senior HHS Officials, Biotech Industry Leaders
Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. was joined by industry executives, health activists, and top health officials at a MAHA event on Wednesday. The agenda featured a number of federal health officials with significant authority including- namely, Medicare Director Chris Klomp, FDA Commissioner Marty Makary, HHS Deputy Secretary and CDC Director Jim O’Neill, CMS Administrator Mehmet Oz,Vice President JD Vance, and David Sacks, who was appointed as the White House artificial intelligence (AI) expert. CRISPR Therapeutics CEO Sam Kulkarni, biotech entrepreneur Alexis Borisy, and Regeneron science chief and co-founder George Yancopoulos were also featured as panelists speaking on ways to advance American biotechnology. Attendees were able to participate in “exclusive networking” with leaders.
The event was not open to the press, and details about policy discussions have not been made public. Given the participation of senior health officials and industry leaders, the meeting raises important questions about how information from such convenings is shared. Attendees discussed high-priority topics in the field with MAHA and industry leaders ranging from AI in health care, developments in biotechnology, food as medicine, and the fate of the NIH and FDA. Health services researchers should call for greater transparency amongst the field by advocating that discussions from the conference be shared with the public.
Rural Hospital Maternity Closures Rise in 2025
A recent report from the Center for Healthcare Quality and Payment Reform (CHQPR) finds that rural hospitals are increasingly closing or planning to close their labor and delivery (L&D) units. In 2025 alone, there have been 27 completed or planned closures, bringing the total of closed L&D units since the end of 2020 up to 116. As a result, only 41 percent of rural-classified hospitals currently deliver babies, with 13 percent of those hospitals at risk due to sustained negative margins. The loss of local maternity services forces many pregnant women residing in rural areas to travel over 30 minutes, and more often over 50 minutes, to the nearest facility. CHQPR warns that long trips to alternative hospitals increase the risk of maternal and infant complications. The policy group identifies two strategies to improve rural maternity: strengthening the rural L&D workforce and boosting rural hospital’s financial security. To combat staffing shortages, CHQPR recommends recruitment and training efforts specifically focused on rural care delivery and increased access to remote specialty support to reduce the number of hours rural clinicians are expected to be on call. Secondly, CHQPR recommends rural employers and states push commercial payers toward reimbursement levels that fully cover the breadth of maternity care services.
For health services researchers, closures in rural L&D units highlight critical gaps in financing, workforce capacity, and access to care. This trend signals an urgent need to understand how different payment policies, innovative staffing models, and systems incentives can be implemented to shape maternal care in low-volume, rural settings. Generating timely, actionable evidence to inform sustainable rural maternal care models and policy solutions is critical to prevent further erosion of these essential services.
Previous Editions
This is the latest in a series of Situation Report updates from AcademyHealth. You can find prior issues here.
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