The 24-days-and-counting US government shutdown is wreaking plenty of havoc, but one of the many consequences that hasn’t been in the news as much (there is just too much competing havoc to report) is the expiration of Medicare telemedicine coverage. This is a provision that has been in place since Covid times, when it was part of the Public Health Emergency (PHE) stopgap legislation that expanded access to care during the pandemic. It allowed for those on Medicare to access care virtually and in some cases, in their home.
These waivers were never made permanent, but were extended several times as they had become built in to the care continuum for many patients and providers, particularly the elderly and those with disabilities. It turned out that telehealth worked well and was efficient on both sides under many circumstances, with half of Medicare enrollees opting to use telehealth services. However, these allowances faced another funding cliff on September 30, 2025, and this time they expired without being renewed— then the government shut down.
There are plenty of other government programs - and more importantly, people who benefit from them - that are suffering with shutdown. Federal workers going without pay, hungry families going without SNAP benefits, the list goes on. I highlight this one today because it disproportionately impacts caregivers, but also risks completely disappearing since the cliff came and went the day the shutdown began - a shutdown that is Democrats’ last ditch attempt to salvage our health care safety net overall. The telehealth provision could be renewed when the government is up and running again - but will it, under a government that just stripped nearly $1 Trillion in Medicaid?
Most of us are now dependent upon the convenience and efficiency of telemedicine options when possible. Those of us with private health insurance will likely continue to benefit from them. But those on Medicare already disproportionately struggle to get to the doctor due to physical limitations or lack of transportation. For many seniors and disabled folks, telehealth options make the difference between getting care or not, or waiting until an emergency and ending up in the ER instead.
In short, telemedicine increases care compliance for those who need it most. Care compliance improves health outcomes. And better compliance and outcomes further reduce costs. A similar situation plays out for medicaid and medicare cuts overall: lower insurance coverage in the population as a whole means more expensive premiums for those who are covered (since there are less paying into the pool). Lower insurance coverage also means lower uptake of preventative health, which means a sicker population and more ER use (and higher costs) down the road.
It’s not unlike return to office mandates - they create negative impacts on productivity and employee satisfaction, and clearly disproportionately harmful for women, caregivers, and people with disabilities. We are already seeing that one play out in real time, as women’s participation in the labor force has taken a measurable downturn in 2025 with RTO mandates.
Speaking of women exiting the workforce, new research suggests that the Tradwife trend isn’t about a fond remembrance of women’s relegation to the home, but a response to the exhaustion of chasing an unattainable duality. Much of this stems from women’s role as default caregivers in an environment of increasing childcare costs and expectations, while still being expected to work like those other responsibilities don’t exist. Josie Cox writes in the Persistent:
“While the tradwife movement might look like a nostalgic return to the 1950s, it actually indicates something more sinister: a cry for help and a sign of women’s collective exhaustion….For many, it represents an escape from relentless work demands, high childcare costs, and a culture that still expects employees to be ‘ideal workers’ without family responsibilities”
Yep, that tracks. Women still can’t “have it all.” At least not without equity and support, and a healthy dose of redefining what “having it all” means in the first place.
Did you see the recent Caregiver’s Survival Guide from NPR? They collected advice from readers who are caregivers, organized into six different categories.
Lastly, and on a positive note: Iceland is celebrating 50 years since the “Day Iceland Stood Still” - the first Women’s Strike in 1975, in which 90% of women walked out of their jobs and homes to draw attention to unequal pay and rights. It has been credited for the country’s progress in closing the gender gap, where today it sits at the top of gender equity rankings worldwide. Change is inevitable; and positive change is possible - if we work for it.
It’s rough out there, but don’t give up. Do see if your elderly neighbor needs a ride to the doctor. And keep protesting!
Psssst… I just started a lil’ Gen Xandwich account on Instagram if you want to follow along there.
As always, thanks for being here.