Big Cuts, Big Shifts: What the One Big Beautiful Bill Really Means for HealthCare

Katie Barone
Aug 7
3 min read

Originally published by HealthCorum

The healthcare implications of the One Big Beautiful Bill Act (H.R. 1), signed into law this month, have rightfully dominated headlines with sweeping changes to funding, coverage, and delivery. The Congressional Budget Office projects these changes will leave 17 million more Americans uninsured by 2034, challenging payers, health systems, and employers.

The key healthcare implications of H.R. 1 are:

Medicaid Funding Cut: Reduces federal Medicaid spending by $1 trillion over 10 years (Section 10101).
Expanded Medicaid Work Requirements (Section 10102).
Medicaid Cost-Sharing: Imposes copays up to $35 for certain services for enrollees with incomes 100–138% of the federal poverty level (Section 10103).
Medicaid Eligibility Verification: Tightens rules with address checks and reduced retroactive coverage (Section 10104).
Provider Tax Reduction: Lowers state provider tax cap from 6% to 3.5% by 2032 (Section 10105).
Rural Health Funding: Allocates $50 billion over 2026–2030 for rural hospitals (Section 10106).
ACA Premium Tax Credits: Allows enhanced credits to expire in 2025 (Section 10201).
ACA Enrollment Restrictions: Shortens Marketplace open enrollment period and eliminates special enrollment periods (Sections 10202–10203).
ACA Verification: Codifies stricter eligibility checks for Marketplace enrollees (Section 10204).
Silver Loading Ban: Prohibits silver loading, potentially raising Marketplace premiums (Section 10205).
Medicare Savings Programs: Blocks rules expanding access to cost-sharing support until 2034 (Section 10301).
Telehealth Expansion: Permanently allows High-Deductible Health Plans to cover telehealth pre-deductible (Section 71306).
Medical Innovation: Provides tax breaks for U.S.-based medical technology and pharmaceutical R&D (Section 71401).

With the significant cuts to government programs, these changes will shift volume into commercial plans and continue to push the cost burden onto employers and self-insured individuals. Building efficient networks and referral systems to accommodate these shifting populations and cost constraints will be more important than ever.

Medicaid’s Leaner Landscape:

The $1 trillion Medicaid cut, increased copays and tightened eligibility requirements squeeze providers and may make already cost-conscious patients less likely to seek care until situations are urgent. Payers and health systems must target providers already serving Medicaid patients, especially the highest performers who deliver quality care cost-effectively. Identifying these high-value partners, presents a win-win to networks looking to ensure adequate and high-quality coverage and Medicaid- heavy providers who may be worried about volume and revenue cuts. Target these providers for inclusion in networks and incentivize them for their high-quality, cost-efficient care.

Telehealth’s Continued Role:

The telehealth safe harbor cements virtual care as a core delivery model. However, not all providers excel at telehealth, and inappropriate use can still raise costs. Additionally, telehealth implemented without necessary interoperability and patient record sharing can lead to inefficient or redundant care, and hybrid care continues to pose administrative and incentive challenges.

Curated networks with telehealth-proficient providers and strong and utilized referral networks to brick-and-mortar practices can ensure the cost and efficiency promises of telehealth are met.

Rural Healthcare’s Narrow Window

The $50 billion Rural Health Transformation Program supports rural hospitals, but it’s dwarfed by Medicaid cuts. High-performing providers in rural areas, especially those serving Medicaid patients, must be identified to secure funding and be prioritized for the value they are delivering. Data and insights like HealthCorum’s facility and provider scores that measure cost, quality, and appropriateness can highlight these providers, while interoperable data ensures accurate benchmarking against urban peers, informing funding and network decisions.

Uninsured Surge: Redesigning Networks and Referrals

An estimated increase of 17 million to the uninsured population by 2034 will not only increase uncompensated care costs, but will also steer volume to commercial plans and put continued pressure on employers. Curated networks and strong referral systems can steer patients to high-value providers who already manage populations cost-effectively.

The bottom line:

Government program cuts, telehealth expansion, rural funding, and coverage losses will not only shift volumes into commercial and employer sponsored plans, but add additional cost concerns and bring new urgency to waste reduction efforts. By building curated networks, strengthening referral systems, and leveraging interoperable data, healthcare organizations can successfully offset these cost and access challenges.

HealthCorum’s holistic provider scoring supports this shift by identifying high-value providers to ensure quality care in a constrained landscape.