What is the budget process?
The federal government’s budget is made up of 12 appropriation bills. After analyzing the President’s proposed annual budget, 12 House and Senate Appropriations Subcommittees draft and propose their appropriation bills. 

The House and the Senate must agree on the 12 appropriation bills by the end of the fiscal year, September 30. (In this case, we’re going into Fiscal Year (FY) 2026.) If they cannot come to an agreement, Congress must pass a continuing resolution or we go into a government shutdown on October 1st.

What’s on the line?
Trump’s Big Ugly Murder Bill (the tax and spending bill signed into law in July 2025) will have devastating impacts on healthcare access. It cuts federal healthcare spending by $1 trillion and will leave up to 15 million people uninsured. The bill drastically changes eligibility and access to Medicaid and the Affordable Care Act (ACA). Upcoming Medicaid changes include an 80-hour monthly work requirement, cost-sharing, and reduced retroactive eligibility. Upcoming ACA changes include allowing the enhanced premium tax credit to expire, which would cause 22 million people’s insurance premiums to skyrocket by 93%, on average.

In light of the Big Ugly Murder Bill changes on the horizon, the FY 2026 appropriations bill is a critical battleground to ensure access to care. Unfortunately, the proposed US House Labor-Health and Human Services (LHHS) subcommittee appropriations 

bill cuts almost $2 billion dollars in federal HIV programming. The proposed bill threatens to end Center for Disease Control (CDC) HIV prevention funding and cut Ryan White Funding by over 20%, including eliminating all of Ryan White Parts C, D, and F. If the House LHHS bill passes, it will accelerate the dismantling of  healthcare in this nation and prove detrimental for our most vulnerable communities.

Where are we now?

Congress must pass a continuing resolution by September 30 or we will have a government shutdown. House Republicans proposed extending government funding until November 21, 2025. Senate Democrats, on the other hand, are fighting to make the premium tax credits permanent and address some of the impacts of the Big Ugly Murder Bill. As negotiations continue, access to abortion may be a critical issue. While Democrats seek to reach a compromise to extend the premium tax credits, which expire on December 31, 2025, Republican lawmakers are pushing to include an anti-abortion Hyde Amendment rider into any possible legislative compromise. If Republicans succeed, there will be increased administrative burdens for access to abortion care.


What to expect IF a government shutdown occurs

A shutdown will have little immediate impact on programs such as Medicare, Medicaid, and Social Security. However, there will be substantial impact on other programs and federal employees.

For more information, please reference PWN’s September 2023 MPU and the Congressional Progressive Caucus Center’s shutdown explainer.

Contact your congresspeople to let them know that HIV funding is non-negotiable and that the proposed cuts in the LHHS appropriation bill are unacceptable. We need every federal lawmaker to stand up for our healthcare.

• Contact your representatives using these call scripts, email scripts and email tools!
  • #CUTSKill: Tell Congress to Reject the deadly $2 Billion in cuts to HIV Programs (Save HIV Funding)
  • Protect HIV Prevention, Care, Housing, and Research! (5 calls)
  • Tell Congress: Protect Enhanced Premium Tax Credits (AIDS United)

• Win: Honesty Bishop won her lawsuit against the Missouri Department of Corrections (MDOC).  Missouri will change its HIV policy that mandates solitary confinement for people who are incarcerated and living with HIV. Bishop, a Black trans woman, spent six years in solitary confinement because of her HIV status. Unfortunately, Bishop is no longer alive to witness this win, but her family hopes this will prevent similar treatment for incarcerated people living with HIV, including trans people living with HIV.

• The House Republican’s proposed appropriation bills include riders, policy changes slipped into budget bills, that are anti-trans and anti-LGBTQ+. As the budget process continues to heat up, the Trump Administration remains adamant that they will not compromise on these provisions. 

Congress must ensure that any prevention of a government shutdown does not hinge on passing anti-trans or anti-LGBTQ+ policies. As we organize we must speak out to name and center trans lives in our calls to action!

• On the horizon: In October, the Supreme Court will hear the case Chiles v. Colorado which concerns the legal right of states to regulate conversion "therapy" as a medical treatment. If Colorado wins, state governments will remain free to legally regulate medical and mental health care to protect minors from dangerous conversion "therapy" practices.

• The Trump regime released the strategic priority areas for federal agencies that implement HIV care and prevention, including the CDC, SAMHSA, and HRSA. As was written by the AIDS United Public Policy Council, “The contents of these agency priorities documents further demonstrate that this Administration's actions are consistently in direct conflict with what is actually needed to achieve better health outcomes in our country. Instead of working to address existing issues within our healthcare systems, this Administration has prioritized targeting and inflicting harm on the most vulnerable in our communities.” Read the full statement here.
• The Food and Drug Administration’s (FDA) updated COVID-19 shots restricts the vaccine to people who are over the age of 65 and people with underlying health conditions. Changes in federal vaccine recommendations creates uncertainty on where vaccines will be available and if insurance will cover it. In response to the growing uncertainty, state governments are taking action to ensure access to the COVID-19 shot.
• The Department of State released its new “America First Global Health” strategic document. The U.S. will shift away from providing aid to nonprofits and non-government organizations and instead partner directly with other governments. HIV/AIDS advocates fear that the global response will fail to include a holistic approach to HIV response.

• The U.S First Circuit Court of Appeals ruled to allow the defunding of Planned Parenthood. As a result, the Trump Administration can prevent Medicaid funds from being used at Planned Parenthood clinics for non-abortion services such as testing, screenings, and contraception. Without Medicaid reimbursements, one of Planned Parenthood’s largest public funders, Planned Parenthood must seek additional funds to keep clinics open and services accessible. To support Planned Parenthood and advance sexual and reproductive health care and rights, contact your members of congress and urge them to support and co-sponsor the Restoring Essential Health Care Act.
• Texas bill HB7, set to go into effect in December 2026, gives private citizens the right to bring a civil lawsuit against anyone who provides medication abortion available to a Texan. The risk of litigation will prevent many telehealth medical providers from mailing abortion medication to Texas further restricting access to abortion in the state.
• Due to the freeze on foreign aid, $9.7 million dollars' worth of birth control currently held in a warehouse in Belgium is set to be destroyed. Most of the products were meant for the Democratic Republic of Congo, Kenya, Tanzania, Zambia, and Mali. If the birth control is destroyed, it could lead to 362,000 unintended pregnancies, 161,000 unplanned births, 110,000 unsafe abortions, and 718 preventable material deaths. Over 70 organizations (including PWN) sent a letter to Secretary of State Marco Rubio to advocate against the destruction.

• Win: The Colorado legislature passed Senate Bill 25B2 which allows Colorado to use state money to fund Medicaid reimbursements for reproductive health care providers, such as Planned Parenthood, who the Trump Administration excluded from receiving federal Medicaid funds.

• A judge granted a temporary restraining order preventing the Trump Administration from collecting personal information about Supplemental Nutrition Assistance Program (SNAP) recipients in 21 states. The Trump Administration claims the information is needed to prevent “fraud”, yet a coalition of 21 state Attorney Generals sued based on data privacy and immigration enforcement concerns.
• A new study by the National Bureau of Economic Research tracked the impact of the 2013 Texas abortion ban. The study found a link between abortion restrictions and increased economic harm that demonstrates barriers to abortion access led to economic vulnerability. 

• The Supreme Court’s decision in Noem v. Vasquez-Perdomo allows roving patrols by federal immigration officers in Los Angeles to use race-based profiling to stop individuals.
• President Trump authorized sending national guard troops into Memphis and Portland as the administration pushes the boundary of executive branch power. For more information on what to do if the Trump regime deploys the National Guard in your state, see this resource by Movement Law Labs.
• A Georgia judge dismissed all the RICO charges against “Stop Cop City” defendants. Many defendants no longer face years in prison for misdemeanor charges, which is a win for the Stop Cop City movement. 

• The Department of Justice (DOJ) continues to demand states provide election related voter information. Requests for confidential voter information raises concerns about security and data privacy rights. Check out the Brennan Center’s Tracker to see if your state received a DOJ voter information request.

• Post-2020 census congressional and legislative maps continue to face legal challenges for violating the constitution’s Equal Protection Clause of the 14th and 5th amendment that prohibits racial gerrymandering.  Check out the Brennan Center’s Redistricting Litigation Roundup to see if your state’s map has been challenged.