By Tim Henderson, Stateline.org

The federal government shutdown is forcing a reckoning for two remote health care programs because they automatically expired Oct. 1.

The telehealth and in-home hospital care programs were both temporary — but increasingly popular — options for Medicare recipients. They allowed doctors and hospitals to bill Medicare for telehealth appointments and in-home visits from nurses to provide care that is generally only available in hospitals.

The shutdown has prevented Congress from extending them.

More than 4 million Medicare beneficiaries used telehealth services in the first half of the year, according to Brown University’s Center for Advancing Health Policy through Research.

As of last fall, 366 hospitals had participated in the hospital-at-home program, serving 31,000 patients, according to a federal report. The program, officially called Acute Hospital Care at Home, allows patients who would otherwise be hospitalized to get inpatient care at home with a combination of nurse visits, monitoring equipment and remote doctor visits.

The programs have their roots in the pandemic, when doctors and hospitals wanted to keep patients safe from the risks of travel and hospital stays. Both are for Medicare recipients, generally people over 65 or who are disabled. But since many private insurers follow federal guidelines, some physicians have stopped booking telemedicine appointments for non-Medicare patients, rather than risk a change in insurance coverage.

Alexis Wynn, who is in her mid-30s and covered by private insurance through her employer, tried to switch an in-person doctor appointment in Pennsylvania to a video visit last week. The office told her that “all telemedicine is uncovered by insurance as of Oct. 1” — so she had to cancel the routine appointment.

“It was just a follow-up appointment to make sure the dosing of my medication was still accurate, nothing that was pertinent to being face-to-face,” Wynn said. Her health insurance company later told her it still covered telehealth visits.

There have been other reports of insurers turning down non-Medicare telehealth appointments, said Alexis Apple, director of federal affairs for the American Telemedicine Association, a trade group.

“It’s a misunderstanding,” Apple said. “I’m not really sure what’s happening, but it’s unfortunate and very scary. There’s so much uncertainty out there now, and we see insurance payers start to pull back.”

Both telehealth and home hospital services can be a lifeline for older people, especially in rural areas, where residents may struggle to travel long distances for health care in person.

“In rural America, it’s often telemedicine or no medicine at all,” said Dr. David Newman, chief medical officer of virtual care at Sanford Health in South Dakota, in a September statement supporting congressional action to make Medicare telehealth permanent. Bipartisan bills that would have allowed telehealth to continue stalled in committee earlier this year in the Senate and House.

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There’s an exception for telehealth rural residents — but only if they travel to a brick-and-mortar health care facility to get the remote health care service.

“The patients have to go to a clinic to receive that telehealth visit from a provider in a different location,” Apple said. “It kind of defeats the purpose.”

According to the Brown University report, California had the highest rate of Medicare telehealth usage in the first six months of this year, with 26% of beneficiaries using at least one telehealth appointment, followed by 23% in Massachusetts and 21% in Hawaii.

There’s no reason for non-Medicare insurers to stop covering any telehealth visits during the shutdown, and even most Medicare Advantage programs will continue to cover telehealth, according to Tina Stow, a spokesperson for AHIP, a health industry trade association.

Nevertheless, at least some health care centers are refusing to take new telehealth appointments or are converting existing ones to office visits.

“This is causing a lot of confusion. We are still working with our members who are insurers and providers to get a gauge on what folks are doing — because at this point reports we’ve seen seem to suggest it is company by company, provider by provider,” said Sean Brown, a spokesperson for the Health Leadership Council, representing CEOs of health care firms and insurers.

The hospital-at-home program serves a smaller number of patients but its pause has caused more disruption: The federal government required patients to be discharged from the program or transferred to a brick-and-mortar hospital by Oct.1.

The Minnesota-based Mayo Clinic had 30 patients in the program in Arizona, Florida and Wisconsin — all of whom either had to be released from the program or sent to brick-and-mortar hospitals. One of Mayo’s hospitals in Florida was already over capacity and had no room for transfers, according to reporting by Becker’s Hospital Review.

In Massachusetts, which requires commercial insurers to follow Medicare guidelines, all insured patients had to leave the program. Mass General Brigham, which operates many hospitals in the state, has rejiggered its plans to create more home care without relying on the hospital-at-home program, according to the Becker’s report.

Congress was unable to avert a shutdown by late September, and some individual providers and patients were caught unawares.

Nurses on social media discussed losing home-care jobs or being reassigned overnight when the hospital-at-home program closed Oct. 1. They worried about patients being taken away from children at home, or placed in hallway beds at overcrowded emergency rooms because of the abrupt change.

“Management scheduled a random call this morning with a super vague title. Then drop the bomb on us,” wrote one poster in Texas. “So no job. Perfect!”

In a direct message, the poster, who didn’t want their name used for fear of getting in trouble at their hospital, told Stateline, “This obviously wasn’t ideal for the patients. One of them had four children and now could no longer be home with them. Some didn’t even get to have a bed in the hospital because there were none available and had to stay in the ER in a hallway bed.”

Parkland Health System in Dallas started tapering off its hospital-at-home program in September because of the impending shutdown, and the last patients were discharged from the program by Sept. 30 without returning to the hospital, spokesperson Wendi Hawthorne said.

“We are hopeful that Congress will renew this innovative model of care in the future,” Hawthorne said.

Likewise, OSF Healthcare in Peoria, Illinois, had started to wind down its hospital-at-home program “to avoid needing to return multiple patients to a very crowded facility,” said Jennifer Junis, president of OSF OnCall, which handles home hospital care.

There were only three patients in the program Sept. 30, all of whom were ready to be discharged without returning to the hospital, Junis said. Since the program’s start in 2020, it has helped 980 patients with home care through OSF’s Saint Francis Medical Center in Peoria.

“It is unfortunate that we will not be able to benefit by treating qualifying patients at home, where they are most comfortable and recover faster,” Junis said. “Our digital hospital program has allowed us to free up beds for our sickest patients who need them most.”

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By JAMEY KEATEN and SETH BORENSTEIN, Associated Press

GENEVA (AP) — Heat-trapping carbon dioxide levels in the atmosphere jumped by the highest amount on record last year, soaring to a level not seen in human civilization and “turbo-charging” the Earth’s climate and causing more extreme weather, the United Nations weather agency said Wednesday.

The World Meteorological Organization said in its latest bulletin on greenhouse gases, an annual study released ahead of the U.N.’s annual climate conference, that C02 growth rates have now tripled since the 1960s, and reached levels not seen in at least 800,000 years.

Emissions from burning coal, oil and gas, alongside more wildfires, have helped fan a “vicious climate cycle,” and people and industries continue to spew heat-trapping gases while the planet’s oceans and forests lose their ability to absorb them, the WMO report said.

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The Geneva-based agency said the increase in the global average concentration of carbon dioxide from 2023 to 2024 amounted to the highest annual level of any one-year span since measurements began in 1957. Growth rates of CO2 have accelerated from an annual average increase of 2.4 parts per million per year in the decade from 2011 to 2020, to 3.5 ppm from 2023 to 2024, WMO said.

“The heat trapped by CO2 and other greenhouse gases is turbo-charging our climate and leading to more extreme weather,” said WMO Deputy Secretary-General Ko Barrett in a statement. “Reducing emissions is therefore essential not just for our climate but also for our economic security and community well-being.”

Climate Analytics CEO Bill Hare called the new data “alarming and worrying.”

Even though fossil fuel emissions were “relatively flat” last year, he said, the report appeared to show an accelerating increase of CO2 in the atmosphere, “signaling a positive feedback from burning forests and warming oceans driven by record global temperatures.”

“Let there be no mistake, this is a very clear warning sign that the world is heading into an extremely dangerous state — and this is driven by the continued expansion of fossil fuel development, globally,” Hare said. “I’m beginning to feel that this points to a slow-moving climate catastrophe unfolding in front of us.”

WMO called on policymakers to take more steps to help reduce emissions.

While several governments have been pushing for further use of hydrocarbons like coal, oil and gas for energy production, some businesses and local governments have been mobilizing to fight global warming.

Still, Hare said very few countries have made new climate commitments to come “anywhere near dealing with the gravity of the climate crisis.”

The increase in 2024 is setting the planet on track for more long-term temperature increase, WMO said. It noted that concentrations of methane and nitrous oxide — other greenhouse gases caused by human activity — have also hit record levels.

The report was bound to raise new doubts on the world’s ability to hit the goal laid out in the 2015 Paris climate accord of keeping the global average temperature increase to 1.5 degrees Celsius (2.7 degrees Fahrenheit) above pre-industrial times.

United Nations climate chief, Simon Stiell, has said the Earth is now on track for 3 degrees Celsius (5.4 Fahrenheit).

Meanwhile, the U.S. National Oceanic and Atmospheric Administration’s global data for this year through June reveals that carbon dioxide rates are still rising at one of the highest rates on record, yet not quite as high as from 2023 to 2024.

The agency’s monthly data for the long-running Hawaii monitoring location for 2025 through August also showed CO2 rates are still increasing, but not as much as between 2023-2024.

The Associated Press’ climate and environmental coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

San Mateo County social worker Aldo Quintero and his wife, Liza, make respectable salaries in their government jobs, but in a region with a median home price of $1.4 million and a county where the figure reaches $2.2 million, a home for the couple and their two kids in the community they serve was out of reach.

For years, Quintero commuted an hour-plus across the Bay from Hayward, and though they later found a small rental in the San Mateo County town of Belmont, their pay wasn’t enough for them to afford a home of their own.

“Even as I got raises and better-paying jobs, it’s like I couldn’t catch up to where prices were,” said Quintero, who earns $144,000 not including benefits.

Each year, the Quinteros entered a program sponsored by the county for its employees — a lottery awarding 20 loans of up to $100,000 toward the purchase of a home in San Mateo County. In 2023, they won. Along with the loan, they scraped together their savings plus money from their family to put in an offer of $780,000 for a two-bedroom, one-bath condo in Foster City, just a 10-minute drive from work and their children’s school.

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“We got used to these hour-long commutes, and now that we don’t have to do that, it’s such a privilege,” Quintero said. “We have so much more time to spend on other things.”

Employee housing stipends have long been a feature of high-paying jobs in the corporate world, but the middle-income workers educating children, repairing roads and working in hospitals often must look far from where they work to find a home they can afford to rent, let alone buy.

To give their employees a fighting chance in the housing market, some local governments, universities and hospitals are offering down payment assistance as an employee benefit. These loans can be an opportunity for social workers, city planners and teachers to put down roots in the communities where they work — rather than having to choose between punishing commutes from the exurbs or leaving the Bay Area altogether, to afford a home.

“Down payment assistance allows middle-income families to be part of the wealth building of the community,” said Julie Mahowald, CFO of Housing Trust Silicon Valley, a nonprofit that provides down payment assistance to low-income households in Alameda and Contra Costa County. “People aren’t as transient, they’re not driving as far, and they’re not coming to work exhausted.”

Aldo Quintero with his wife Liza and children Isabella, 10 and Mateo, 13, at their home in San Mateo, Calif., on Monday, April 7, 2025. Quintero is an employee of San Mateo County who was able to use the county’s help to afford a down payment on a home. (Jane Tyska/Bay Area News Group)

For those without access to a loan from the “Bank of Mom and Dad,” stocks to cash out or lottery winnings, it can take years to save up for a down payment in the Bay Area. For a traditional 20% down payment on a median-priced home of $1.4 million, a family would need $280,000, plus more for closing costs. Even with that, payments on a fixed-rate 30-year mortgage at the current average of 6.34% would still cost $6,800 a month, plus property taxes. By increasing the down payment amount, a mortgage can become somewhat more manageable.

For employers, helping their workers find stable housing is also a matter of retention. In San Mateo County, commute time is among the top reasons workers cite for leaving.

“It’s exponentially harder to find employees to move to this area because of the high cost of living — or even to commute, because of traffic,” said Mike Callagy, San Mateo County Executive. “As a large employer in the county, we have to be creative in finding ways to incentivize people to move here.”

Most loans come with low interest rates that need not be paid back until the property is sold or the employee leaves. Some down-payment programs are catered to certain types of employees. Educators in San Francisco can apply to get a loan of up to $500,000. Kaiser Permanente offers up to $250,000 to newly-hired physicians. And union-affiliated employees in Sonoma County can apply for up to $100,000 toward a home in the county.

Many Bay Area universities have long offered a housing stipend to incoming faculty, which functions as a sign-on bonus, rather than a loan. At UC Berkeley, new professors typically receive around $88,900, but can go up to $150,000 in special circumstances. At Stanford, professors are eligible for up to $200,000 in housing assistance, paid out over 12 years. The benefit does not need to be repaid, but it is taxed.

Some economic research has questioned whether homebuyer assistance, by just infusing more money into a housing market with tight supply, actually counterproductively increases housing prices. But Ben Harris, vice president of economic studies at the Brookings Institution, said that too few people are likely taking advantage of down payment assistance to significantly increase prices locally, and their impact is also diluted when the supply of homes increases.

“It’s not an either-or situation,” Harris said. “You can expand the supply of homes while also subsidizing the purchase of them.”

Some local governments are doing just that. This year, teachers began moving into a 135-unit rental complex built by the San Francisco Unified School District and Mercy Housing in the Outer Sunset, as well as a 110-unit teacher housing project, The Acacia, in Palo Alto.

For the Quinteros, though, homeownership has offered more stability than renting. They moved with their two young kids three times in the past decade — moves that were especially disruptive for their youngest daughter, who has autism.

“It’s really nice to have a place where she feels secure,” Quintero said, “and to know we’re not going to have to move to another home or school.”

By STAN CHOE, Associated Press Business Writer

NEW YORK (AP) — Stocks are climbing on Wednesday following strong profit reports from some of the world’s biggest names in banking and technology.

The S&P 500 rose 0.7%, coming off a roller-coaster day where it careened between a sharp loss and modest gain. The Dow Jones Industrial Average was up 226 points, or 0.5%, as of 9:35 a.m. Eastern time, and the Nasdaq composite was 0.9% higher.

Tech stocks helped lead the way thanks in part to a profit report from ASML, which is a major supplier to the semiconductor industry. The Dutch company said it expects its revenue for 2025 to be 15% above last year’s, while next year’s should be at least as high as this year’s.

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CEO Christophe Fouquet said, “We have seen continued positive momentum around investments in AI, and have also seen this extending to more customers.” That’s key when worries have been high that a bubble may be forming in artificial-intelligence technology, with too much investment flowing in akin to the 2000 dot-com frenzy.

Outside of ASML’s 5% rise in Amsterdam, Nvidia added 1.3% on Wall Street. Because Nvidia is the most valuable U.S. stock, it was the strongest single force lifting the S&P 500.

Also helping the market were several big banks. Bank of America climbed 4.6% after delivering a profit for the latest quarter that was stronger than analysts expected. CEO Brian Moynihan said every line of the bank’s business reported growth.

Morgan Stanley climbed 6.6% after likewise reporting a stronger profit than analysts expected.

They helped offset a 4.3% loss for PNC Financial, which reported a stronger-than-expected profit but also gave a forecast for upcoming earnings that some analysts said was below expectations.

Abbott Laboratories sank 2.9% after its revenue for the latest quarter finished just shy of analysts’ expectations.

Companies are under pressure to deliver strong reports after their stock prices broadly surged 35% from a low in April. To justify those gains, which critics say made their stock prices too expensive, companies will need to show they’re making much more in profit and will continue to do so.

Corporate profit reports are also under more scrutiny than usual as investors scour them for clues about the health of the U.S. economy. That’s because the U.S. government’s latest shutdown is delaying important updates on the economy, such as the report on inflation that was supposed to arrive Wednesday.

The lack of such reports is making the job more difficult for the Federal Reserve, which is trying to figure out whether high inflation or a slowing job market is the bigger problem for the economy currently.

It cut its main interest rate last month for the first time this year and indicated more may be on the way in hopes of giving the job market a boost. But too low interest rates can push inflation higher, and it’s been stubbornly stuck above the Fed’s 2% target.

Comments from the Fed’s chair, Jerome Powell, on Tuesday may have hinted that more cuts to rates may be coming. In the bond market, the yield on the 10-year Treasury edged down to 4.01% from 4.03% late Tuesday.

Also weighing on the market recently have been worries about escalating tensions between the United States and China. President Donald Trump has gone back and forth in his criticism of China, particularly about restrictions it’s placed on exports of rare earths, which are materials that are critical for the manufacturing of everything from consumer electronics to jet engines.

One big winner in financial markets because of all the uncertainty around the world has been gold, and it rose another 1.1% to top $4,200 per ounce. It’s up nearly 60% for the year so far as investors look to buy something that may offer some protection from trade wars, real military wars and the prospect of higher inflation coming because of mountains of debt being amassed by governments worldwide.

In stock markets abroad, indexes were mixed in Europe after a stronger finish in Asia.

South Korea’s Kospi jumped 2.7%, and France’s CAC 40 rose 2.1% for two of the world’s bigger moves.

AP Business Writers Matt Ott and Elaine Kurtenbach contributed.