Patients go without needed treatment after the government shutdown disrupts a telehealth program

MINOOKA, Ill. (AP) — Bill Swick has a rare degenerative brain disease that inhibits his mobility and speech. Instead of the hassle of traveling an hour to a clinic in downtown Chicago to visit a speech therapist, he has benefited from virtual appointments from the comfort of his home.

But Swick, 53, hasn’t had access to those appointments for the last month.

The federal government shutdown, now in its fifth week, halted funding for the Medicare telehealth program that pays his provider for her services. So, Swick and his wife are practicing old strategies rather than learning new skills to manage his growing difficulties with processing language, connecting words and pacing himself while speaking.

“It’s frustrating because we want to continue with his journey, with his progress,” 45-year-old Martha Swick, a caregiver for her husband since his diagnosis three years ago, said during an interview at their home in Minooka, Illinois. “I try to have all his therapy and everything organized for him, to make his day easier and smoother, and then everything has a hitch, and we have to stop and wait.”

Their experience has become common in recent weeks among the millions of patients with Medicare fee-for-service plans who count on pandemic-era telehealth waivers to attend medical appointments from home.

With Congress unable to agree on a deal to fund the government, the waivers have lapsed, even with support from Republicans and Democrats. As a result, medical providers are deciding whether they can continue offering telehealth services without the guarantee of reimbursement or whether they need to halt virtual visits altogether.

That’s left a patient population of mostly older adults with fewer options to seek specialists or get help when they can’t physically travel far from home.

Swick, whose corticobasal degeneration causes symptoms similar to Parkinson's disease, can’t feed or dress himself anymore and struggles with balance and walking. Add on the logistical nightmare of driving to the city in traffic, and in-person speech therapy appointments aren’t a worthwhile ordeal for him and his wife.

But missing even a few appointments can impede progress for patients with dementia and other degenerative conditions who depend on continuity of care, experts said.

It “feels like you’re taking a step back,” Swick said in the interview.

Before the COVID-19 pandemic, Medicare only paid for virtual medical appointments under narrow circumstances, including in designated rural areas and when patients logged in from eligible sites, like hospitals and clinics.

That changed in 2020, when Trump’s first administration dramatically expanded telehealth coverage in response to the public health emergency. Medicare started reimbursing a wide range of telehealth visits, stripping the geographic requirement, and allowing patients to take calls from their homes.

Congress has routinely extended the telehealth flexibilities and was poised to do so again before their Sept. 30 expiration. But when budget negotiations stalled and the government shut down Oct. 1, the vote never happened, leaving the program temporarily unfunded.

With more than 4 million Medicare fee-for-service beneficiaries using telehealth in the first half of 2025, according to Brown University’s School of Public Health, the pause has had a major impact on an already vulnerable population.

Swick’s speech therapy services are provided by the Chicago-area business Memory and Aphasia Care. Owner Becky Khayum said many of her clients are in different cities and states and sought her therapists out because they specialize in frontal temporal dementias.

“Now suddenly without telehealth services, they do not continue to have the support to participate in those activities that are so important to them,” Khayum said. “The risk is we could see social withdrawal; we could see depression and anxiety increased.”

Virtual visits can also be useful in different areas of medicine. Dr. Faraz Ghoddusi, a family medicine provider in Tigard, Oregon, said he uses telehealth to check in and help his patients manage their conditions, like diabetes and chronic lung disease. He said that in the current Medicare telehealth pause, one of his patients wasn’t having regular check-ins and ended up in the emergency room.

Susan Collins, 73, in Murrieta, California, said Medicare-reimbursed telehealth appointments were a “tremendous relief” to her when she was a full-time caregiver for her late husband, Leo. Before he died last year from progressive supranuclear palsy, a rare brain disorder, she struggled to lift him from his wheelchair in and out of the car for his in-person doctor visits 60 miles from their home.

“He was much safer at home,” Collins said, noting that telehealth was a useful resource when her husband needed a medication or symptom consultation but not a complete physical exam.

The latest guidance from the Centers for Medicare and Medicaid Services does not ban medical providers from providing telehealth services during the lapse – but it stops short of promising they’ll be reimbursed if they do.

In response, providers are deciding whether they can absorb the risk of continuing care without assurance that they’ll be paid for it when the government reopens.

Khayum in Illinois said she had to stop providing telehealth services to Medicare patients because her small business couldn’t handle the volatility of potentially losing out on payments. Ghoddusi, the family medicine provider, said his Oregon practice is honoring telehealth appointments made before Oct. 1 but not scheduling additional ones for Medicare patients until the funding is restored.

Genevieve Richardson, owner of a speech pathology business in Austin, Texas, has stopped providing telehealth services to her Medicare clients who are spread across the country. She has been referring them to outpatient clinics in their areas who can provide stopgap services in person.

Major hospitals are also grappling with whether to provide virtual care to Medicare patients. Dr. Helen Hughes, medical director of the Office of Telemedicine at Johns Hopkins Medicine, said the hospital initially continued the care, but paused scheduling more Medicare telehealth visits as of Oct. 16 as the shutdown continued.

She said the uncertainty surrounding the waivers has been “a total roller coaster.”

The government shutdown is in its fifth week with no clear end on the horizon. Meanwhile, Medicare telehealth flexibilities and a separate Medicare program offering patients hospital-level care at home both remain paused.

Mei Kwong, executive director of the Center for Connected Health Policy, said the simplest solution to renewing the telehealth waivers would be for Congress to vote separately on them.

The hands of federal health care administrators “are kind of tied,” she said. “So, you really do need Congress to act.”

But with lawmakers divided and looking for leverage, hopes for such action are low.

Martha Swick, practicing word exercises with her husband in their home on a recent morning, said if a solution isn’t found soon, “my resource collection is going to run out.”

“I’m just doing what I’m able to at home as a wife and a caregiver,” she said. “But eventually I’m really going to need those appointments to come back.”

Swenson reported from New York.

Martha Swick holds papers of study guide as she asked questions to her husband Bill Swick at their home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

Bill Swick walks down stairs to study with his wife Martha Swick at his home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

Martha Swick, left, and her husband Bill Swick look at a photo at their home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

Bill Swick, right, studies with his wife Martha Swick at their home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

Bill Swick, right, looks around while study with his wife Martha Swick at their home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

Bill Swick looks at his wife Martha Swick at their home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

Bill Swick, bottom hand, points as he studies with his wife Martha Swick at their home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

Martha Swick, left, and her husband Bill Swick look at each other at their home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

Bill Swick sits on the chair at his home in Minooka, Ill., Friday, Oct. 24, 2025. (AP Photo/Nam Y. Huh)

NEW YORK (AP) — It's only two weeks into the new year, and President Donald Trump has already claimed control of Venezuela, escalated threats to seize Greenland and flooded American streets with masked immigration agents.

And that's not even counting an unprecedented criminal investigation at the Federal Reserve, a cornerstone of the national economy that Trump wants to bend to his will.

Even for a president who thrives on chaos, Trump is generating a stunning level of turmoil as voters prepare to deliver their verdict on his leadership in the upcoming midterm elections that will determine control of Congress.

Each decision carries tremendous risks, from the possibility of an overseas quagmire to undermining the country's financial system, but Trump has barreled forward with a ferocity that has rattled even some of his Republican allies.

“The presidency has gone rogue,” said historian Joanne B. Freeman, a Yale University professor. She said it's something "we haven’t seen in this way before.”

Trump seems undeterred by the potential blowback. Although he doesn't always follow through, he seems intent on doubling and tripling down whenever possible.

“Right now I’m feeling pretty good," Trump said Tuesday in Detroit. His speech was ostensibly arranged to refocus attention on the economy, which the president claimed is surging despite lingering concerns about higher prices.

However, he couldn't resist lashing out at Jerome Powell, who leads the Federal Reserve and has resisted Trump's pressure to lower interest rates.

"That jerk will be gone soon,” Trump said.

Republican leaders have overwhelmingly rallied behind Trump throughout his turbulent second term. But new cracks began to appear this week immediately after Powell disclosed on Sunday that the Federal Reserve was facing a criminal investigation over his testimony about the central bank's building renovations.

Over the last year, the Justice Department has already pursued criminal charges against former FBI Director James Comey, New York Attorney General Letitia James and former national security adviser John Bolton, among other Trump adversaries.

But going after Powell, who helps set the nation's monetary policy, appeared to be a step too far for some conservatives. Fox Business host Maria Bartiromo, a fierce Trump defender, was unusually critical.

“It just feels like most on Wall Street do not want to see this kind of fight,” she said during her Monday show. “The president has very good points, certainly. But Wall Street doesn’t want to see this kind of investigation.”

The Federal Reserve plays a key role in the economy by calibrating interest rates, which Trump insists should be lower. However, reducing the institution's independence could backfire and cause borrowing costs to increase instead.

At the same time, Trump has decided to expand the United States' role in complicated foreign entanglements — a seeming departure from the “America First” foreign policy that he promised on the campaign trail.

No move was more significant than the U.S. military operation earlier this month to remove Venezuelan President Nicolás Maduro and his wife from his country. In the months leading up to the attack, Trump frequently insisted he was targeting Maduro because of his role in the drug trade. He has quickly pivoted to portraying the move as an economic opportunity for the U.S.

Trump has said the U.S. will start controlling the sale of some Venezuelan oil, and he declared that the South American nation will be run from Washington. He even posted a meme declaring himself the “acting president of Venezuela.”

Trump has also threatened the leadership of Cuba and Iran, while insisting that the U.S. will control Greenland “ one way or the other ” — a position that has raised questions about U.S. relations with European allies. Greenland belongs to Denmark, a NATO member.

“NATO becomes far more formidable and effective with Greenland in the hands of the UNITED STATES,” Trump wrote on social media on Wednesday morning. “Anything less than that is unacceptable.”

Meanwhile, Trump's immigration crackdown continues to spark confrontations in American cities. Some have turned deadly, such as when a federal agent shot Renee Good, a 37-year-old mother of three in Minneapolis.

Administration officials have said the U.S. Immigration and Customs Enforcement officer acted in self-defense, accusing Good of trying to hit him with her car. But that explanation has been widely disputed by local officials and others based on videos circulating online.

The incident came after Trump dispatched 2,000 immigration agents to Minnesota, responding to reports of fraud involving the state's Somali community.

On Tuesday, Trump said the administration was targeting “thousands of already convicted murderers, drug dealers and addicts, rapists, violent released and escaped prisoners, dangerous people from foreign mental institutions and insane asylums, and other deadly criminals too dangerous to even mention.”

The Trump administration's moves have created “chaos, confusion and uncertainty,” said Cleveland Mayor Justin Bibb, who leads the Democratic Mayors Association.

“There’s so much uncertainty across my city right now. The ICE raids in Minneapolis have really shocked the consciousness of many of my residents, and we’re trying to do everything we can to calm that concerns and quell those fears," Bibb said. “But people don’t feel like the world is getting better. People don’t feel like the economy is getting better.”

Voters across the nation will have their next chance to weigh in on Trump's leadership at the ballot box this November, when Republicans hope to retain control of Congress for the last two years of his presidency.

Democratic campaign officials in Washington are focused largely on the economy in their early political messaging. Most voters maintain a decidedly negative view on the issue, despite Trump's rosy assessment this week.

Just 37% of U.S. adults approved of how the president is handling the economy, according to a January poll from The Associated Press-NORC Center for Public Affairs Research. His economic approval, which was previously a strength, has been low throughout his second term.

“Donald Trump’s visit to Michigan puts a glaring, unflattering spotlight on how he and House Republicans have failed to address the affordability crisis," said Rep. Suzan DelBene, who leads the Democrats' House campaign arm.

But some activists are frustrated that their party's leadership isn't focusing more on Trump's unprecedented power grabs.

Ezra Levin, co-founder of the leading progressive protest group Indivisible, said he expects Trump's actions to get worse as his second and final term nears its conclusion.

“Folks at the end of last year who thought he would become a typical lame duck and limp toward a midterm loss have a framework for understanding this moment that is drastically outdated,” Levin said. “Authoritarians don’t willingly give up power. When weakened and cornered they lash out.”

Trump has repeatedly insisted he's only doing what voters elected him to do, and his allies in Washington remain overwhelmingly united behind him.

Republican National Committee spokesperson Kiersten Pels predicted that voters will reward the party this year.

“Voters elected President Trump to put American lives first — and that’s exactly what he’s doing," she said. "President Trump is making our country safer, and the American people will remember it in November.”

President Donald Trump speaks with reporters at Joint Base Andrews, Tuesday, Jan. 13, 2026, in Joint Base Andrews, Md. (AP Photo/Evan Vucci)