President Donald Trump on Nov. 12 signed a resolution to fund the government through Jan. 30, ending the longest government shutdown in U.S. history, and spine surgeons have their eyes on the next steps.
The spending package extends Medicare telehealth, and HHS will be funded through the end of January. A Senate vote to extend ACA subsidies is slated to take place in mid-December.
Spine surgeons shared their thoughts about what’s ahead.
Note: Responses were lightly edited for clarity.
Question: What’s your initial reaction to the end of this shutdown, and what do you want to see come out of it?
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I’m grateful that the shutdown is over and that we can get back to the business of, hopefully reforming healthcare. The game of political chicken is getting really old, and we need to be able to have a reasonable budget, and we need to stop using people as pawns in politics. It’s unfortunate that we set a new record with this, and SNAP benefits should have never been at risk at all.
In regards to the ACA premiums expiring, I think while some may want it, we don’t have another system in place to help mitigate premium raises. People’s premiums going up 20% or even 30% could be catastrophic for them, and I think if we really want to lower costs in healthcare, we have to mandate that the large insurers get broken up, and that comes from enforcement of existing anti-competition laws. The Federal Trade Commission has to start doing its job. We also have to stop the exemption of hospital systems from being tax havens and also create smaller systems from these huge systems. The bloat of healthcare is on the shoulders of the rise of the administrative class in healthcare, and until that gets addressed, we will never see decreases in the cost of care. We’ll keep spending a large percentage of our GDP on it.
Lastly, I think we need to have a reasonable plan for the future, how to fund Medicare and how to pay for care. That comes from getting rid of administrative bloat, and it does not require cutting the reimbursements of doctors. As we’ve seen with this administration and every one since the Affordable Care Act was placed, we’ve seen nothing but cuts. And to be honest, we’ve seen nothing but 25 years worth of cuts. So if you’re not going to pay for patient care and instead put money toward administrative costs and bloat, you’ll never see a decrease in cost from cutting the reimbursements to physicians. In fact, the only thing you’ll see is more consolidation, more doctors closing their practices or selling out to large hospital conglomerates, decreasing competition, increasing cost. Until we do what needs to be done, we will not ever save any money on healthcare. And unfortunately that has repeated itself every year for the past 15 years, and the lack of transparency of the Affordable Care Act, especially these past two or three years, and the most recent meeting behind closed doors with no physician stakeholders in attendance, really speaks to how willing the administration is to be transparent, and they need to work on that.
Katherine Wagner, MD. Ventura (Calif.) Neurosurgery: I hope the government realizes two things: we need to maintain the subsidies for now, and we need to let Medicare patients use telehealth for routine visits.
Vijay Yanamadala, MD. Hartford (Conn.) Healthcare: The shutdown’s end provides some relief, but the ongoing uncertainty around healthcare policy makes long-term planning challenging for both providers and patients. Healthcare delivery requires sustained investment in infrastructure, workforce, and care coordination — all of which become difficult when policy foundations keep shifting. This affects everything from staffing decisions to program development.
From a clinical perspective, coverage stability matters significantly. When patients have consistent access to insurance, they’re more likely to pursue timely, appropriate care — including conservative treatments like physical therapy, medication management, and lifestyle interventions — rather than delaying until problems become more acute and complex. The enhanced premium tax credits have expanded coverage for millions of Americans, but their temporary nature creates uncertainty for patients trying to plan their healthcare and finances.
What I’d like to see:
1. Predictable policy frameworks that allow patients and providers to plan effectively beyond the next budget cycle.
2. Bipartisan solutions that balance expanding access to care with fiscal responsibility and sustainability.
3. Focus on value and outcomes rather than volume of services, regardless of the specific policy mechanism used to achieve it.
3. Data-driven decision-making that evaluates what’s actually working for patient health and system efficiency.
4. Healthcare works best when there’s stability and clear direction. Whatever path forward emerges in December, I hope it prioritizes patient access to evidence-based care while respecting legitimate concerns on both sides of the aisle about costs, government role and long-term sustainability.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): My initial reactions are one of redundancy and then curiosity. Yet further investigation and focus drew more attention to the political positioning and intent. On one hand, the national debt and its enormity becomes a centerpiece of continuance and concern, while public assistance also becomes an issue. With recent disclosure of CMS revealing the billions of dollars historically funding non-citizenry, the concerns become more germane. Allocation and overspending is the normalcy in our nation’s political culture, and both questioning and reaction don’t seem unwarranted. Political leveraging as a means to impose denigration and damage, when third-party hardship results is nothing less than shameful. Hopefully, someone learns from the longevity of this last episode and realizes the money tree is fantastical.
