Hamas Agrees to Trump Plan, Shutdown Day 4, Medicaid Cuts

Hamas says yes to President Trump's ceasefire proposal, but still wants to negotiate some conditions.

Israel said it's ready to implement the plan.

Trump has told Israel to stop the bombing in Gaza.

I'm Scott Simon.

And I'm Aisha Roscoe with Up First from NPR News.

It's day four of a government shutdown.

The Democrats refused to budge in a Senate vote yesterday.

They want Congress to increase health care benefits.

Medicaid Medicaid covers health care for many people with low incomes, kids and adults.

Three in five nursing home residents in the U.S.

also rely on Medicaid.

And they may be some of the first to feel the pain as states slash the programs.

We'll hear from some people who are directly affected.

So stay with us.

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Hamas says it's ready to release all remaining hostages in Gaza, living and dead.

The militant group said yesterday it accepted President Trump's ceasefire proposal, but still wants to negotiate some of the conditions.

And Pierre's Emily Fang joins us now from Tel Aviv.

Emily, thanks for being with us.

Hey, Scott, it's a pleasure.

It seems like it could be a serious step toward actually ending the two-year war.

Is it what's in play?

What's in the play?

Yes, you're right.

It is.

You have Israel, you have Hamas, you have major Arab countries like Qatar and Egypt, and then, of course, the U.S., who proposed this current formulation, all signing on to the basic principles of this plan to end the war.

Now, the basic outline of this plan is not a new one.

Hamas has said it's going to return all hostages living and dead within 72 hours.

Then Israel is supposed to stop its war in Gaza.

And then Israel, the U.S., and Arab countries, working with Palestinian leaders, figure out a day after plan to govern and rebuild the enclave.

What is new is there's been so much pressure mounting on all sides, and that has created this potential breakthrough.

And a person briefed by an Israeli official told NPR today that Israel's military has been ordered to reduce their activity in Gaza to, quote, a minimum and only for defensive actions.

But no ceasefire yet, right?

No.

And in fact, NPR Zaniz Baba, who is in Gaza, and he's been there for the entirety of this war, says there was still shelling that continued overnight.

There were at least three strikes this morning.

Israel's military said Gaza City, which is the strip's most populous urban center, is still off limits.

And remember, this week it had given Palestinians there a last chance to flee, saying that anyone who remained would be considered a militant.

And I want to sound a note of caution.

There is still a chance that this proposal falls apart.

And Emily,

Hamas has come back and said they accept the first phase, but officials with Hamas have said they need more details on the exact timetable and process for how and when Israeli forces would withdraw from Gaza and when Israel would let more food and aid in.

And then there's the big question of who governs Gaza.

Under the American plan, an international board of experts that would be headed by President Trump and includes the former British Prime Minister Tony Blair would initially run the enclave.

And Hamas would have no role at all.

But let's listen to this interview that Osama Hamdan, a senior Hamas official, gave to Al Jazeera last night.

So Hamdan says here, Hamas will not accept the affairs of Gaza to be run by a non-Palestinian party.

And then he went on in this interview to say Hamas is fundamental to resolving issues facing any future Palestinian state, and that all clashes with U.S.

and Israeli assertions that Hamas would have no presence and that its fighters should leave Gaza.

Earlier this week, another Hamas official, named Mohamed Nazal, also told Al Jazeera the group is not reviewing this American plan with a, quote, black or white mindset.

So they very much see this proposal as a work in progress and not a final agreement.

And the question is now whether the U.S.

and Israel can accept or perhaps even ignore for now these proposed revisions from Hamas and move forward to at least the first step to get the hostages back ASAP.

And how's Hamas' response being received in Israel?

You know, there's cautious optimism.

Israel's main opposition leader says he backs the proposal as well.

Many of the families of the hostages have been lobbying for an end to the war for months so they can release the hostages and get them back.

They've lent their support to this first phase of the proposal, but there's so much distrust, including a word that Hamas is stalling for time.

Officials with the group are saying in order to exhume some of the hostages' bodies, they need maybe more than the three days that have been allocated to retrieve these people's bodies in a war zone.

Emily Fang and Tel Aviv, thanks so much.

Thanks, Scott.

It's day four of a government shutdown.

And since Tuesday, the Senate has taken up the same votes to fund the government temporarily by continuing resolutions.

They still don't have the votes, but is there an agreement even on the distant horizon?

And Pure Congressional correspondent Barbara Sprunt joins us.

Thanks for being with with us.

Hey, thank you.

The Senate yesterday failed once more to advance competing plans to extend federal funding and end the shutdown.

How are those plans different again?

Well, one is a GOP plan that has already passed the House.

It would fund the government through November 21st.

And then there's a Democratic counterproposal as well.

That would fund the government through October, and it includes an extension of health care tax credits that were boosted up during the pandemic.

Those are on track to expire at the end of the year.

Now, Republicans have said they'll negotiate on that point, but only after the government is funded.

And even then, Senate Majority Leader John Thune has said it would not be a simple process.

We can't make commitments or promises on the COVID subsidies because that's not something that we can guarantee that they're the votes there to do.

There were a few Democrats who did support the Republican proposal this week.

Has there been any more movement or are the numbers tightening?

No, they are not.

It has been the same as that first vote where we saw two Democratic senators and one Independent joining Republicans.

In fact, there's been so little movement on any kind of negotiation between the two parties that the Senate isn't even expected to stay over the weekend and do more votes.

Here's Foon yesterday when asked about the possibility of weekend work.

Hopefully over the weekend, they'll have a chance to think about it.

Maybe some of these conversations start to result in something to where we can start moving some votes and actually get this thing passed.

The impasse is essentially this.

Because the Senate needs Democrats to reach that 60-vote threshold to pass this kind of bill, Democrats, who of course have very little power as the party in the minority, say that demanding that there be some kind of negotiations between the two parties is appropriate.

Unsurprisingly, Republicans do not share that view.

They say Democrats are holding the American people hostage via this shutdown.

Of course, in the meantime, the White House is proceeding with plans to cut programs and spending,

often it seems, in areas with lots of Democratic voters.

What is the argument they make here?

Well, this is very much in line with the administration's thesis when it comes to its role in cutting programs and government workers.

Items on the chopping block include some transportation projects in New York, the home state of both the House and Senate Democratic leaders.

Press Secretary Caroline Levitt told our colleague Steve Inskeep yesterday that the administration views that as minority leader Chuck Schumer's fault.

They can't show up to work right now.

So that project is currently temporarily halted because of Chuck Schumer's shutdown.

So Chuck Schumer did that to himself.

He did that to his constituents in New York.

And how do Democrats respond?

Well, Democrats have called this an intimidation tactic.

They've blasted a plan from the White House's budget arm to fire federal workers instead of temporarily furloughing them, which is usually what happens in a shutdown.

Independent Senator Bernie Sanders of Vermont said he thinks that plan will backfire.

And the idea that you have a president who says, hey, your state voted against me, we're going to cut funding for you.

That is not only illegal, not only outrageous, it is unconstitutional.

So, Democrats like Sanders insist these cuts are illegal, but it's an open question right now.

There are several active lawsuits challenging the administration's cuts to congressionally approved spending.

And here's Barbara Sprunch.

Thanks so much for all your reporting.

Thank you, Scott.

We're in a federal government shutdown over Affordable Care Act tax credits.

Meanwhile, state governments are beginning to make cuts to their Medicaid programs.

That's the public health insurance that covers more than 70 million Americans.

Those cuts are likely to continue regardless of how the shutdown ends.

We're now joined by Bram Sable-Smith, reporter with our partner KFF Health News.

Thanks for joining us.

Happy to be here.

For those who might not be familiar with the benefit, can you briefly tell us what Medicaid usually pays for?

So Medicaid is a joint program between the feds and the states.

We usually think of it as covering adults and kids with lower incomes, but it also pays for longer-term services like in-home care for people with disabilities and also nursing home care.

Three in five nursing home residents in the U.S.

rely on Medicaid.

So it's a large program.

It typically makes up around 19% of the spending from any given state's general fund.

And many states are facing budget shortfalls and they're looking to slash their Medicaid programs to make due.

These programs are pretty tightly funded to start with, right?

So, I mean, what is there to slash?

Right.

Well, so far this year, two states have forced every medical provider that accepts Medicaid to take a pay cut.

So Idaho announced a 4% across the board pay cut in September.

And most recently, North Carolina on Wednesday cut pay by at least 3%.

Primary care got an 8% cut, and specialty care saw a 10% cut.

That sounds like a lot.

I mean, what effect do those pay cuts have on people's access to health care?

Well, when you cut payments to doctors and to nurses and to physical therapists, they become less likely to accept patients that have Medicaid coverage.

Okay.

So is that already happening in states that cut payments?

Yes, it is.

I spoke recently to Alessandra Fabrello.

She lives in Chapel Hill, North Carolina, and she's a medical caregiver for her son, Isidore, who's now 18.

He experienced a rare brain condition as a baby that kills brain tissue, and he's needed round-the-clock care ever since.

He struggles to survive every single day.

It is almost impossible to explain what it takes to keep a child alive who should be dead.

Medicaid is supposed to pay for him to get that care at home.

Otherwise, he'd have to live in a hospital.

But even before this rate cut, Alessandra said it's been extremely difficult finding in-home medical providers who take Medicaid.

Take physical therapy, for example.

He doesn't receive any therapy.

He qualifies for therapy, but he doesn't receive any in-home therapy because we cannot find providers because of the reimbursement rate as it is.

Medicaid already paid way less than private insurance, so not many providers take it.

And now with these new cuts, even more providers are dropping out.

And for the past year, North Carolina's Medicaid program paid Alessandra herself to take care of Isidor.

It's her main source of income.

And now she's facing a pay cut too.

Are we going to see cuts like this in other states across the country?

Well, we don't know yet what other states plan to do, but these cuts in North Carolina and in Idaho really could be an indication of things to come elsewhere.

There's sort of a perfect storm brewing right now.

State budgets are getting squeezed.

Medicaid costs are going up.

Some states are cutting taxes.

Federal COVID relief dollars that states were using to patch budget holes in the past fully dried up this year.

And of course, President Trump's signature budget legislation is going to cut federal spending on Medicaid by almost $1 trillion over the next decade.

States will have to make that up or cut services.

These provider pay cuts are an example of how states will begin to manage those shortfalls.

Well, we will continue monitoring the situation, as I'm sure you will too.

That's Bram Sable-Smith.

He's a reporter with our partner, KFF Health News.

Thanks so much for your reporting.

Thanks for having me.

And that's up first.

For Saturday, October 4th, 2025, I'm Scott Simon.

And I'm Aisha Roscoe.

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