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President Donald Trump and congressional leaders from both parties exited a high-stakes negotiation meeting Monday afternoon with little optimism a deal could be struck before the end of the month to avoid a government shutdown. "I think we’re heading to a shutdown because the Democrats won’t do the right thing," Vice President J.D. Vance told reporters after the meeting. "I hope they change their mind, but we’re going to see.” Healthcare issues have and continue to be a sticking point of the negotiations, with Democrats demanding an extension of Affordable Care Act (ACA) enhanced premiums set to run dry at the end of the year as well as protections against White House recissions of appropriated funding. (Muoio and Beavins, 9/29)

With Congress at an impasse over federal spending, Republicans have emerged with a new and misleading talking point: Democrats are shutting down the government to fund free health care for unauthorized immigrants. It is a message repeated by Vice President JD Vance, the official X account of Senate Republicans and Speaker Mike Johnson. But the proposal does not provide free health care for unauthorized immigrants. Republicans may be referring to the law changing the eligibility requirements for certain immigrant groups. (Qiu, 9/29)

If a government shutdown wasn’t already exceedingly likely, President Donald Trump might have made it a near certainty Monday night. The president posted a vulgar AI-generated deepfake video to his Truth Social slamming the top Democratic leaders — Senate Minority Leader Chuck Schumer and House Minority Leader Hakeem Jeffries — just hours after he hosted the two for an Oval Office meeting. (Hill, 9/29)

The top Democrat on the tax-writing House Ways and Means Committee cracked open the door to negotiating income limits for recipients of health care subsidies set to expire at the end of the year. “I think the question of subsidies for people that are making half a million dollars — I mean, that should be subject to a discussion and negotiation as well, but that shouldn’t become the pretense for shutting down the government,” Rep. Richie Neal of Massachusetts said in a brief interview, though he stressed it’d be “premature” to get too far into the specifics. (Wu, 9/29)

Medicare beneficiaries stand to lose access to two key virtual care programs that the federal government has offered since the start of the pandemic if the government shuts down on Tuesday at midnight. The Medicare telehealth waivers and Acute Hospital at Home (AcHaH) programs are set to expire Oct. 1 unless Congress passes a short-term government funding bill to avert the crisis. (Beavins, 9/29)

Federal health agencies under Robert F. Kennedy Jr. would furlough more than 40% of their remaining workforce in a government shutdown, according to a contingency plan. Some 32,460 government health workers would be without work at least temporarily under the plan and could lose their jobs if Trump follows through on threats to fire those deemed nonessential in a funding lapse. (Goldman, 9/29)

In some parts of the federal government, there is an immediate impact. But not every federally funded initiative is at the mercy of Congress’s budgeting standoffs, and even some that are may be able to rely on cash reserves to get through a brief shutdown. Department to department, the impacts vary. The Postal Service, which is self-funded, and Social Security and Medicare benefits, which are considered “mandatory” spending, should keep on going. While most federal workers are likely to be furloughed, those designated as “excepted,” such as active-duty troops, air traffic controllers and federal law enforcement officers, stay on the job, even though they cannot be paid for that work until after the shutdown is over. (Demirjian, 9/30)