“It takes 10 times as long to put yourself back together as it does to fall apart.” This may be what the Trump administration official and federal government shutdown power broker Russ Vought is saying to Democratic leaders to get them to negotiate, but it is actually a quote from the movie The Hunger Games. It seems appropriate right now to invoke a movie about a high-stakes competition orchestrated by government leaders that is ultimately about a power play. Plus, The Hunger Games plot is a lot easier to understand than the plot of a new movie Splitsville, where the main character copes with his wife’s admission of infidelity and request for divorce by ruining Dakota Johnson’s happy, open marriage. See? Confusing. But these are confusing times, even for health policy, as I explain in the One Thoughtful Paragraph.
Other head-shaking, confusing news this week:
- Medicare telehealth flexibilities have expired, as Congress did not renew them before October 1, 2025. CMS issued a memo affirming these flexibilities have ended and instructing Medicare Administrative Contractors (MACs) to place a temporary 10-day hold on telehealth claims. Medicare beneficiaries must now be located in specific health care facilities to attend telehealth appointments. Audio-only visits are also not permitted, and patients receiving mental health treatments must have periodic in-person visits. More here.
- As of October 1, 2025, all Medicare patients receiving hospital care at home must be discharged to a hospital immediately. At-home hospital-level care programs operating outside of the waiver—including those under managed care arrangements or commercial contracts—may continue, but some health systems (e.g., Mass General Brigham and Hackensack Meridian Health) started phasing out their hospital-at-home patients in anticipation of a shutdown.
- The Cybersecurity Information Sharing Act expired on October 1, 2025, coinciding with the federal government shutdown. The law provided protections for the private sector to facilitate data sharing and reporting on cybersecurity issues.
“This is normal, right? People go through this in the first year of marriage?” Kyle Marvin’s character asks Dakota Johnson’s character in the movie Splitsville. She shakes her head and admits: “No.” And, no – people do not typically go through a government shutdown during the first year of a new administration. It is also disorienting to have an administration tout its “partnership with innovative private sector companies” as it did in July when Big Tech companies gathered during the Make Health Tech Great Again event, but, only two months later, hear the administration say that Big Tech, major health systems, and government officials coming together to establish guardrails for health AI tools is the wrong way to do things. This feels like one of those movies where there are scene-stealing supporting actors outshining the rest of the big-time principal cast. Still, the plot of this movie is clear: a group of super-smart IT nerds and government power brokers must try to come together to apply promising, but scary, new technologies to a health care system in order to ensure the survival of all Americans. For this movie to have a happy ending, everyone needs to stop trying to grab the spotlight and just collaborate on finding solutions that work. A cautionary quote from The Hunger Games: “Destroying things is much easier than making them.”
