On Nov. 12, President Trump signed legislation to restore funding to the federal government, ending the longest shutdown in American history. While this provided immediate relief for households and businesses, the agreement may be short-lived.

The continuing resolution passed by Congress includes only a few appropriations bills, leaving several politically contentious topics unaddressed, including healthcare. These remaining issues must be resolved before the new funding deadline of Jan. 31, 2026, to avoid another government shutdown.

One of the most contentious issues is whether to extend enhanced Affordable Care Act (ACA) subsidies that expire at the end of the year. Partisan and bipartisan legislation to extend the enhanced ACA subsidies fully or partially has been proposed. However, as of the time of this writing, no proposals have been able to gain a majority of votes in the House and the 60 votes necessary in the Senate to pass.

The debate about extending the enhanced ACA subsidies is not the only concern. Congress is actively working on the remaining appropriations bills, but many of the same roadblocks that prevented passage before the shutdown remain — for example, earmarks, specific funding levels, and inclusion of unrelated policy priorities. Without progress soon, the likelihood of another stopgap funding bill and another shutdown increases.

The off-year elections revealed notable shifts from 2024, when most precincts trended right. This year's results — including in gubernatorial elections in New Jersey and Virginia — show precincts trending left, even in areas won by President Trump in 2024.

This has energized Democrats, who perceive momentum to push their priorities during the interim before the next funding deadline. Republicans, on the other hand, feel they “won” the shutdown standoff, although polling suggests many Americans blame them for the shutdown.

The upshot is continued gridlock and political tension, with the upcoming midterm elections looming in the background. Polling and recent election trends suggest Democrats could gain seats in both chambers of Congress, although Republicans are expected to retain control of the Senate.

These results would align with historical norms. In the last 23 midterm elections, the president’s party has gained seats in the House just three times and in the Senate just seven times, according to the American Presidency Project at the University of California, Santa Barbara.

Redistricting adds further complexity. In August, Texas enacted a new electoral map that improves the election changes for Republicans. The U.S. District Court for the Western District of Texas later ruled that revised map is unconstitutional, but the Supreme Court on Dec. 4 stayed the lower court’s ruling, allowing for the new map to be used during the midterms. Meanwhile, in November, California voters approved a new map that improves the election chances for some vulnerable Democrats, while creating openings for moderates. Other Republican-led states have either considered or passed new maps, with mixed results.

Healthcare policy remains one of the most divisive issues in politics. The shutdown amplified concerns about changes to Medicaid, Medicare, and ACA subsidies, issues that have been in the spotlight since the debates leading up to the passage of the One Big Beautiful Bill Act this summer.

Hospitals, long-term care facilities, and clinic operators are closely monitoring developments, concerned about the financial implications of reduced federal support. Democrats remain committed to defending ACA funding, while Republicans continue to craft alternative proposals that would result in major reforms. Whether reduced funding could accelerate facility closures or drive further private equity consolidation remains an open question.

These dynamics underscore the need for strategic planning among healthcare organizations as legislative and regulatory shifts loom.

Even as healthcare dominates the agenda, other regulatory topics remain in play.

Digital asset regulation has emerged as a notable area of bipartisan interest. A recent Senate Agriculture Committee draft on digital asset market structure reflects incremental progress, but significant questions remain, particularly around jurisdictional clarity for the Securities and Exchange Commission (SEC) and the Commodity Futures Trading Commission.

This effort signals that even amid fiscal brinkmanship, lawmakers can advance targeted legislation. Still, broader priorities will dominate the agenda, limiting bandwidth for niche issues.

A key economic concern is tariffs. The Supreme Court is reviewing the legality of tariffs imposed by President Trump under IEEPA. If invalidated, the ruling could require the repayment of billions collected thus far, unless the court specifies otherwise. The administration is expected to resist broad refunds absent explicit judicial direction.

Should the Supreme Court invalidate the IEEPA levies, it does not end the debate around tariffs, as the administration may be able to reimpose them under different legal frameworks. Regardless of the court’s ruling, businesses should prepare for tariffs to remain a policy tool used by future administrations of both parties.

Federal and state policymakers continue to work on a regulatory framework for AI. Concern about a patchwork of state regulations has led some federal lawmakers, including some in the Trump administration, to back a moratorium on state AI regulation as the process to develop uniform federal rules continues.

Finally, the cannabis industry is anxiously awaiting a final determination from federal regulators on whether to the drug will be rescheduled. Reports indicate a decision is likely to come soon.