The recently enacted “Big Beautiful Bill Act,” signed into law on July 4, 2025, may not have been presented as a healthcare bill, but most anyone working in the industry would agree that it represents some of the most sweeping changes to federal healthcare policy in decades. Framed by its proponents as a necessary step toward eliminating waste, fraud, and abuse, the legislation has sparked widespread debate among healthcare providers, policy analysts, and advocacy groups who fear the deep cuts to Medicaid, Medicare, and the Affordable Care Act (ACA) will destabilize healthcare access for at-risk populations and further strain the healthcare organizations that serve them.
This blog post explores some of the potential consequences — both positive and negative — of the Big Beautiful Bill (Public Law 119-21), drawing from a range of sources and perspectives to present an impartial, high-level analysis. The legislation will continue to spark debate across the political spectrum, but healthcare organizations must now focus on understanding and adapting to the law’s practical implications.
Key Provisions Impacting Healthcare Access and Delivery
While the new law was framed primarily as a budget reconciliation measure to extend tax cuts and reduce federal spending, nearly a third of its provisions directly affect healthcare. Notable points include:
- New work requirements and eligibility restrictions for Medicaid and ACA Marketplace plans
- Statutory caps on state-directed payments in Medicaid managed care
- Reductions in provider tax benefits used by the states to fund Medicaid
- Reduced and restricted ACA premium tax credits
- Excludes previously eligible populations from enrolling in Medicaid
- Statutory PAYGO rules trigger reductions to Medicare reimbursements, though some physician reimbursements will increase temporarily
The Congressional Budget Office (CBO) projects that the above provisions (along with others in the new law) will result in over $1 trillion in federal healthcare spending cuts over the next decade. For healthcare leaders — whether in hospitals, health systems, or private practices — the law presents both challenges and opportunities that demand strategic foresight, particularly as it relates to the following areas:
1. Coverage Loss and Medicaid Restructuring: Preparing for Patient Churn
One of the most consequential aspects of the new law is its impact on Medicaid and ACA Marketplace coverage. The CBO estimates that more than 10 million Americans could lose coverage over the next decade due to new eligibility rules, work requirements, and the expiration of premium tax credits.
Proponents say the changes will protect and preserve the programs for the vulnerable populations they were designed to serve. Double enrollments, deceased people on the rolls, and non-working, able-bodied people receiving benefits are examples of the waste, fraud, and abuse cited by champions of the law. However, critics, such as Shannon Dowler, a family physician in Western North Carolina, fear many of her patients will lose coverage because they have jobs without pay stubs (such as farming) or due to administrative challenges. She shared her concerns with journalist Natalie Kitroeff in a recent episode of The New York Times’ “The Daily.”
“Well, not everyone in this country reads at a sixth-grade level or has access to broadband so that they can upload the form and put in the information they need to put in. Is it going to fall on us [the providers] to say, “Hey, have you done your work requirement form for the month?” or do we use our care managers to make sure that we’re doing outreach, and doing home visits, and taking devices to people so that they can do their digital upload of their timesheet or their pay stub? There are plenty of people who aren’t going to be able to do this on their own.”
Without intervention, providers can expect some portion of their Medicaid patients to lose coverage. Knowing the loss of coverage will keep patients from receiving the care they need (likely escalating the condition until it results in a visit to the ER, where they will receive uncompensated care), healthcare leaders must consider if and how they can encourage patients to stay enrolled and help them with documentation if needed.
Healthcare leaders should also be aware of the strain this puts on the individual providers. Seeing patients get sicker or die due to an inability to pay for treatment causes moral injury, a form of burnout that is increasingly causing physicians to leave the practice. Leaders must consider how the organization can support physicians through this process.
Takeaway: Healthcare leaders must consider if and how they will prioritize outreach and enrollment assistance, especially in Medicaid expansion states. Investments in eligibility verification technology and partnerships with community organizations may help mitigate churn.
2. Rural Health: Between Investment and Instability
The new law includes a $50 billion Rural Health Transformation Program, touted by the White House as a historic investment in underserved communities. The White House emphasizes that the new program promotes innovation and sustainability by allowing states to submit transformation plans tailored to local needs. Funds can be used for telehealth, workforce development, and alternative payment models, potentially modernizing rural care delivery.
However, critics argue that this funding does not come close to offsetting the broader cuts to Medicaid and ACA programs that disproportionately affect rural areas. In a passionate blog post for KevinMD, Dr. Holland Haynie, family physician and chief medical officer at Central Ozarks Medical Center in rural Missouri, warns that rural hospitals are facing a “slow-motion detonation” of their safety nets. He outlines what he predicts will be the practical impact of the law, explaining that patients who lose coverage will stop getting treatment, then wait until conditions are urgent and go to the emergency room, where the already financially strained organization will provide uncompensated care.
Haynie goes on to suggest that those uninsured patients won’t receive follow-up care or medication assistance, and this, coupled with the decreased SNAP benefits called for by the new law, will cause them to become sicker, poorer, and more isolated. The patients will suffer, yes, but he also indicates that rural hospitals may not survive — and the numbers validate his fears. Policy analysts at KFF estimate rural areas will lose $137 billion in Medicaid funding over 10 years — nearly triple the rural health fund’s allocation.
Takeaway: Financial viability may hinge on securing grants and adapting to new care models. While hospitals prepare for increased ER visits and delayed care due to coverage loss, rural health leaders should engage proactively with CMS to shape and submit transformation plans. Collaboration across state lines and with national advocacy groups may amplify their voice in funding decisions. Exploring partnerships with telehealth providers and community health centers could enhance sustainability.
3. Operational and Financial Pressures: Navigating the New Normal
Beyond decreased coverage and changes to rural health, the law introduces a host of operational changes that affect providers, payers, and healthcare organizations of all types. Providers must comply with new documentation and eligibility verification rules, and they can expect to field a high volume of questions from patients confused about their coverage (or lack thereof). All of this increases the administrative burden placed on physicians, which, of course, heightens stress and burnout among a workforce already stretched thin.
Financial pressures created by increased uncompensated care, lower Medicare reimbursements, and decreased Medicaid patient volume weigh on all levels of the organization. The bill is projected to reduce federal healthcare spending by $1 trillion through 2034. These cuts, according to an Advisory Board analysis, amount to a potential 18-point hit to operating margins for mid-sized systems, pushing many organizations into the red. (The Advisory Board report provides multiple scenarios with outcomes between 8 and 18 point decreases.) Organizations must find ways to adapt or close their doors.
Takeaway: Healthcare organizations should conduct financial modeling to assess margin impacts and explore cost-containment strategies. Investments in digital health, predictive analytics, and workforce development may help offset operational strain.
Looking Ahead: What Healthcare Leaders Should Watch
Healthcare organizations must prepare for a dynamic and uncertain future. Key areas to monitor include:
- Regulatory Implementation: CMS will release rules to enforce new payment caps and eligibility requirements.
- State-Level Responses: States may seek waivers or alternative funding mechanisms to mitigate the impact of federal cuts.
- Legal Challenges: Provisions affecting Planned Parenthood and other providers are already facing court battles.
- Patient Engagement: Providers will need to help patients navigate coverage changes and maintain continuity of care.
An Uncertain Future
The One Big Beautiful Bill Act is reshaping the healthcare landscape in profound ways. For some, it represents a long-overdue shift toward personal responsibility and streamlined spending. For others, it signals a retreat from public health commitments that have propped up vulnerable populations. While it offers new tools and funding streams for rural providers, its sweeping cuts to Medicaid and ACA programs raise serious concerns about access, equity, and sustainability.
Whether the new law ultimately strengthens or weakens the U.S. healthcare system will depend on how its provisions are implemented, how states respond, and how providers rise to meet the moment. Healthcare organizations and providers must adapt quickly — balancing innovation with advocacy — to ensure that patients continue to receive the care they need.
Advisory Board. “One Big Beautiful Bill Act: Understanding the healthcare impacts.” July 2025.
Congressional Budget Office. Estimated Budgetary Effects of Public Law 119-21… July 25, 2025.
Holland, Haynie. “The One Big Beautiful Bill and the Fragile Heart of Rural Healthcare.” KevinMD, 2025.
Houchin, Erin. “GOP Rep.: The Truth About the One Big Beautiful Bill—and What Democrats Don’t Want You to Know.” Newsweek, June 4, 2025.
Kitroeff, Natalie. “One Rural Doctor on the Cuts to Medicaid.” The Daily Podcast. New York Times, 2025.
Pollack, Rick. “AHA Statement on Senate Passage of One Big Beautiful Bill Act.” American Hospital Association, July 1, 2025.
“The One Big Beautiful Bill Act (OBBBA): A trillion-dollar turn in US health policy.” PwC, July 10, 2025.
Saunders, Heather, Alice Burns, and Zachary Levinson. “How Might the House-Passed Reconciliation Bill’s Medicaid Cuts Affect Rural Areas?” KFF, June 27, 2025.
White House. “One Big Beautiful Bill Act is a Historic Investment in Rural Healthcare.” July 25, 2025.
