On May 22, the U.S. House of Representatives narrowly passed the President Donald Trump-backed “One Big Beautiful Bill” in a 215–214 vote, advancing a sweeping package of healthcare and fiscal reforms that could significantly affect Medicaid, Medicare, physician reimbursement and medical education.
While the legislation still faces an uncertain future in the Senate, several provisions could directly or indirectly influence the financial and operational landscape for ASCs, physicians and future healthcare providers.
Here are six key takeaways:
1. The bill fast-tracks work requirements for able-bodied Medicaid beneficiaries ages 18–64. Originally slated for 2029, the mandate now takes effect by Dec. 31, 2026, with states allowed to adopt it sooner.
2. According to a May 20 Congressional Budget Office analysis, the bill could slash up to $500 billion from Medicare over the next decade. It also includes steep Medicaid reductions. While states that haven’t expanded Medicaid would receive higher payments as an incentive, the broader effect could jeopardize funding for services critical to ASC and hospital-based care, particularly safety-net services.
3. Starting Jan. 1, 2027, ACA plans would no longer cover gender transition procedures.
4. The bill rebrands individual coverage health reimbursement arrangements (ICHRA) to Custom Health Option and Individual Care Expense (CHOICE) arrangements. This provision solidifies the 2019 regulations that now allow employers to use ICHRAs to help employees purchase individual coverage, as well as cover certain medical expenses, without violating group plan rules.
5. Several major healthcare organizations, including the American Hospital Association, America’s Essential Hospitals, and the Federation of American Hospitals, have condemned the bill’s funding cuts. Chip Kahn, CEO of FAH, warned it would be a “death knell to critical hospital services,” urging lawmakers to reconsider. While ASCs are not the central focus of the criticism, reduced hospital and Medicaid funding could lead to spillover effects on surgical case volumes and payer negotiations.
6. The bill proposes eliminating Grad PLUS loans for new borrowers beginning in 2026–2027 and capping federal graduate student loans at $150,000 — well below the average U.S. medical school debt of over $200,000. It would also exclude medical residency loan payments from Public Service Loan Forgiveness eligibility, potentially discouraging service in lower-paying specialties or underserved regions.
According to the Association of American Medical Colleges, these changes would undermine future physicians’ ability to afford medical education, potentially exacerbating workforce shortages, particularly in specialties that rely on PSLF to attract talent.
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