President Donald Trump is poised to sign the One Big Beautiful Bill Act as early as July 4, after the Republican-led Congress agreed upon its contents July 3.
The final bill impacts healthcare and health insurance coverage in a variety of ways:
- Temporary 2.5% bump in Medicaid Physician Fee Schedule for exceptional circumstances next year.
- Restricts ACA premium tax credit eligibility
- Limits the ACA special enrollment period, unless enrollees meet certain criteria
- Restricts state-directed payments and provider taxes for hospitals
- Requires states to establish Medicaid work requirements as early as January 2027
- Increased oversight of the Medicaid provide taxes
- $50 billion over five years for the Rural Health Transformation program
The Congressional Budget Office estimates the bill will lower Medicaid spending by around $1 trillion but leave around 11.8 million more people uninsured over the next nine years. The shift would have a large financial impact on hospitals, which will then affect ASCs and physician practices.
“I am worried about what happens to Medicaid,” said Paul Bruning, DHA, division administrator for hand in sports medicine at Duke University in Durham, N.C., during a session at the Becker’s Spine, Orthopedic and Pain Management-Driven ASC Conference in June. “When you’re looking at large hospitals that are even struggling, where are the patients going to go? They’re coming to us and we’re going to be struggling, and that’s all going to be uncompensated care. How are we going to be able to provide that care?”
Physicians may see ASCs as their best option to treat patients in a lower-cost setting. The removal of certain more complex procedures from the inpatient-only list allows for a broader scope of surgeries.
“Physicians are going to be wanting to move those cases to potentially a lower cost, lower friction point of care,” said Dr. Bruning. “ASCs can provide that.”
Physician organizations have been critical of the bill since it was announced and continue to sound the alarm.
“Today is a sad and unnecessarily harmful day for patients and healthcare across the country, and its impact will reverberate for years,” said Bobby Mukkamala, MD, president of the American Medical Association. “Care will be less accessible and patients may simply forego seeing their physician because the lifelines of Medicaid and CHIP are severed.”
Dr. Mukkamala also said the bill could make it harder for patients to access care and the ripple effect would mean treatable illnesses “turn into life-threatening or costly chronic conditions.”
“That is disappointing, maddening and unacceptable,” he said.
Medical Group Management Association’s Anders Gilberg, senior vice president of government affairs, said the bill’s passage “paints a grim future for America’s physician practices” because so many Americans stand to lose coverage. The MGMA supports healthcare reform, but not the Medicaid coverage changes.
“Make no mistake, these beneficiaries are not going anywhere,” said Mr. Gilberg. “They will still find care in our U.S. healthcare system. Only now, under OBBA, medical groups and hospitals will be left picking up the enormous tab.”
Physicians and medical groups in rural areas will be hit the hardest, as their financial burdens are already immense and a large swath of the patient population will become uncompensated care. The one-year Medicaid conversion factor update isn’t enough to ease the burden, Mr. Gilberg said.
“Practices are still dealing with the detrimental consequences of this year’s 2.87% cut, and a future one-year adjustment fails to provide long-term financial stability for practices,” he said. “If the administration’s commitment is to make America healthy, it must work with Congress to ensure both practices and physicians have the wherewithal to continue providing healthcare for all Americans.”
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