The longest government shutdown in U.S. history came to an end on Nov. 12, when both the House and Senate voted for a continuing resolution signed by President Trump that will keep federal agencies open through Jan. 30, 2026. Eight members of the Senate Democratic Caucus broke ranks to vote for a deal that failed to win a renewal of subsidies for the Affordable Care Act, overcoming the 43-day congressional impasse. That means without further congressional action some 24 million Americans will likely see their health insurance premiums double or triple, beginning in 2026, with 5 million unable to afford health insurance coverage.
The federal budget passed by the Republican-controlled Congress and signed into law by Trump in July, cut more than $1 trillion to Medicaid and Medicare over the next decade. These largest cuts to healthcare programs in U.S. history won’t take effect until after the November 2026 midterm election.
The dramatic cutbacks in funding for health programs highlights a long running crisis that an increasing number of Americans view as a failure of our nation’s healthcare system. Between The Lines’ Scott Harris spoke with Dr. Diljeet Singh, president of Physicians for a National Health Program and a practicing gynecologic oncologist. Here she reviews the many failures of the U.S. for-profit healthcare system and her group’s advocacy for adoption of a universal, comprehensive single-payer national health insurance program.
DR. DILJEET SINGH: The ACA cuts that are coming are impacting mostly the states that did not expand Medicaid. And then there’s Medicaid cuts coming on top of that. And there’ve been several studies that have come out looking at what the impact of those changes will be. And I think the nicest study comes from a group of some collaborators at Yale and Penn that basically showed that this combination of Medicaid cuts and then lack of extension of the enhanced ACA premium tax credits—that combination is likely to lead to over 50,000 preventable deaths just from lack of insurance. For every million people who don’t have insurance, we think that there’s somewhere between 1,000-1,200 preventable deaths. We often think of like, “Oh, well, Medicaid cuts. That’s not going to impact me because I don’t personally have Medicaid, not realizing that so many rural hospitals, so many hospitals in smaller towns count on that Medicaid funding to keep their doors open.
So even people who don’t actually have Medicaid as their source of insurance have the strong potential to lose their local hospital. And we already have such dramatic maternity care deserts and just care deserts in general in rural areas. I’ll be honest, I think that there’s things that even those of us who think a lot about this aren’t foreseeing: the nursing home, the cuts to the regulation and assessment of nursing homes that will be cut in the same bill. That reconciliation bill very, very deliberately seemed to target healthcare access and seniors in rural areas, but across our country in multiple different settings.
SCOTT HARRIS: Dr. Singh, please summarize for our audience physicians for a National Health Program’s proposals for a single-payer universal and comprehensive health insurance coverage system that would cover all Americans. What are you proposing for our country in the midst of this crisis?
DR. DILJEET SINGH: We don’t actually need health care insurance. We just need health care. The health insurance industry essentially uses somewhere between 25 and 35 cents of every dollar to do nothing related to healthcare. It’s either a profit. There’s pure profit for them, something that goes to their shareholders, or it’s just kind of bureaucracy administration that’s been created by, “Well, if you have Aetna, this is approved” and if you have United Healthcare, “This is approved.” And so there’s layers and layers of bureaucracy at the individual physician office, at the hospital level and then at employers’ level. And then of course, these insurance industry calls it their administrative overhead, but it’s this created thing. And so I think that’s one piece that people don’t always perceive that if we just got back that—let’s just use a round number, 30 percent. If we just got back 30 percent of the whole healthcare budget in America, we could actually cover everybody.
And we could give everybody vision. We could give everybody dental. We could give everybody adequate mental health coverage. Things like hearing aids and etc., that managed to bankrupt people because it’s not part of their health care. All of those things could be included if we just took that money back. And there’s a lot of people who say, “Well, no, I’m worried if we have a socialized system, maybe we’ll have long wait times.”
Well, I’ll tell you, it doesn’t matter what city you live in, it takes a long time to get in to see a primary care doctor. There’s parts of the country where it takes weeks to months to get in to see specialists, and then there’s of parts of the countries where there aren’t even specialists, and I’m saying specialists, but there’s parts of the country where you can’t even see a gynecologist or an OB-GYN, because there’s not enough.
I think in America, we don’t realize that the rest of the world, including places that have a lot less money than us, have a lot better healthcare. And a lot better prevention in place and a lot more access to the things that can keep them healthy. So I think the big work that we need to do is we need to stand up as citizens of the country and demand that our legislators not give in to pressure from healthcare or Humana or Aetna and just say, “No, we think our people deserve access to healthcare.” We shouldn’t worry about how much does something cost. We should worry, “How effective is it?”
And so what I think we really deserve, we deserve high quality, trustworthy healthcare, period. I don’t even think affordable comes into it. The truth is cost-effective healthcare, all of those things are things we can do. But we have to start with high quality and the second demand: Be completely trustworthy that the people who are helping you make decisions are doing it for you, not because they’re worried about how much money the hospitals making or how much money an insurance company’s making.
