On November 12, 2025, President Trump signed into law a legislative package to end the longest government shutdown in United States history, and with it comes several implications for today’s medical practices. In this article, we’ll summarize key aspects and omissions of the legislation that may directly impact physicians in the coming year.

Without additional Congressional action, the enhanced premium tax credits that have helped many Americans pay for Affordable Care Act health insurance plans for 4 years will disappear. This means on average, subsidized enrollees will pay more than twice their current premium amount, according to an analysis by the healthcare research nonprofit KFF.

If the enhanced premium tax credits expire, many insurance enrollees may drop coverage or switch to other plans, which could affect payer mix, patient volumes, and bad-debt risk for practices.

If Congress does step in and act to extend the enhanced premium tax credits, federal and state marketplaces will have to adjust the plans they’ve made available for consumers, though this could take weeks. In some cases, people may have already decided not to purchase insurance at all. 

“They just might react and say this is too expensive for me, I can’t afford this anymore,” Cynthia Cox, a vice president and director of KFF’s ACA program, told PBS.org. “There’s no guarantee that you can get that person to come back and shop again.”

What does the potential expiration of enhanced premium tax credits mean for medical practices? It could lead to a potential increase in bad debt and other patient collection challenges. Financial counseling and proactive outreach to boost financial literacy will be very important as patients face personal financial challenges.

The new law extends key telehealth provisions, but only until January 30, 2026, creating another "telehealth cliff" unless Congress acts again. These provisions include short-term extensions for:

In a recent press release, the American Telemedicine Association (ATA) voiced its concerns about the short-term extension. 

“We appreciate that this legislation includes critical bipartisan telehealth policies, but such a short-term extension for services this essential remains concerning,” said Kyle Zebley, executive director, ATA Action, and senior vice president, public policy, the ATA. He continued, “We call on Congress and the administration to now move toward a permanent fix — or at least a multi-year extension — to restore stability and predictability for millions of patients and the providers who rely on telehealth every day. We cannot end up back in the same position in January, staring down another avoidable lapse driven by partisanship or process. Patients and providers deserve certainty, not recurring cliffs.”

In the meantime, billing teams should plan ahead to ensure their workflows, documentation, systems that hinge on home-originating site, audio-only telehealth, expanded practitioner eligibility, etc., are aligned for now, but with the caveat of horizon-planning. If telehealth extensions are not passed, the business model may need to revert.

Some good news? Healthcare providers may soon see payments for Medicare telehealth visits that haven’t been paid during the stoppage, InsideHealthPolicy reported Nov. 10. Telehealth claims would be paid retroactively to October 1, 2025, and claims reimbursed at a lower rate because of geographic rule changes would likely be reprocessed.

Most federal agencies, including CMS and the contractors that process Medicare claims, will receive funding through January 30, 2026. This means Medicare claims, prior authorization decisions, and appeals can resume normally.

With this funding, practices avoid potentially delayed Medicare payments and burdensome operational workarounds.

The new law provides short-term federal funding through January 30, 2026, for:

These funding extensions are critical for medical practices in safety-net and rural settings. Without these health extenders, many rural practices wouldn’t be able to maintain operations, staff their clinics, or ensure access to hospital and specialty services.

While the longest government shutdown has finally reached an end, a new phase of uncertainty remains for medical practices. For example, it’s not clear when Congress will hold a vote dedicated solely to making telehealth flexibilities permanent, though a bill was recently introduced in the House to extend flexibilities through 2027.

A vote regarding enhanced premium tax credits will occur no later than the second week of December.

In the meantime, practices should take the following revenue cycle management steps: 

Medical practices must prepare for 2 scenarios: one in which enhanced premium tax credits and telehealth flexibilities are extended and one in which these credits and extensions expire. Building operational contingencies will be paramount.

See how Tebra's practice management platform can help you navigate policy changes and maintain stable revenue. Schedule your free, personalized demo today.