US shutdown enters fourth week

As the federal government shutdown enters its fourth week, pressure is mounting on the nation’s healthcare infrastructure. Paychecks have been halted for more than 1 million federal employees, critical agencies such as CMS are scrambling to maintain operations, and national disease surveillance efforts are beginning to fracture — just as the U.S. heads into the respiratory virus season.

Funding delays are now directly affecting large swaths of the healthcare workforce and related support systems. More than 1 million civilian federal employees and military personnel — including those at HHS and the Department of Veterans Affairs — have begun missing their paychecks.

The White House has suggested it may not provide back pay for furloughed federal workers, but the Internal Revenue Service has said it will be guaranteed, according to Axios. 

To fund the move, the agency is drawing on user fees collected from researchers accessing CMS data, with plans to reimburse the account once appropriations resume. The decision comes amid mounting pressure to stabilise key healthcare functions as disruptions and delays in telehealth reimbursement and hospital-at-home programs continue to ripple across the system.

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Source: Becker's Hospital Review, 27 October 2025