photo credit: Courtesy of carieinnovations.org

The Oct. 1 2025 federal government shutdown is now in its second day, and one of the biggest sticking points is healthcare.

Specifically, whether to keep expanded subsidies for people buying insurance through the Affordable Care Act.

Congress is fighting over whether to keep giving extra help to people buying insurance through Obamacare. Democrats want to keep the bigger subsidies so coverage stays affordable. Republicans say it’s too expensive, or want to deal with it separately from other budget items.

While Congress debates, the effects are already being felt in Sonoma County.

Petaluma Health Center CEO Pedro Toledo said Medicare and Medi-Cal, which pay for healthcare for low-income people, are still up and running.

But for low-income individuals who can’t come in physically, telehealth coverage is on pause.

"We're not getting, we won't get paid on those visits," said Toledo. "Potentially, we may never get paid on those visits."

Toledo said across all Petaluma Health Center sites in Point Reyes, West Marin, Petaluma, and Marina Park,10% of are visits online.

The healthcare center is continuing to provide that care, hoping Congress will restore telehealth billing and offer retroactive payments. For now, about 100 visits a day are simply unpaid.

"It just seems unconscionable to me," Toledo said, "given the demographic that we serve, especially our homebound patients in rural communities and many of these disabled individuals, to not provide a service that is allowing them to stay at home and be able to, oftentimes keeps them out of the emergency room and or worse."

Toledo said he's hoping the shutdown lasts only days. But that he and the center's administrative team are evaluating weekly to see what remains possible on their end.

"We operate on a small margin," Toledo told KRCB News. "We're a nonprofit, right? We're not here to make money. We're here to ensure that everyone has access to health care."