July 22, 2025- The Trump Administration’s domestic agenda bill H.R. 1, known as the One Big Beautiful Bill Act (OBBBA), was signed into law on July 4 and has significant implications for healthcare in the United States, according to Premier.
In particular, providers are most concerned about the twin hits of Federal Medicaid spending cuts of $793 billion over a decade, plus $268 billion in reduced spending for Affordable Care Act (ACA) marketplace subsidies — totaling over $1 trillion in cuts. These reductions are expected to increase the number of uninsured patients, while reductions in provider taxes also limit states’ ability to raise revenues in support of healthcare programs.
Together, this combination will have financial consequences for hospitals, with success or failure in the new environment substantially contingent on how well providers can execute resiliency planning in the face of this coming storm. Though the bill’s provisions will not take effect immediately, with the earliest implementation timelines in late 2026, it is critical that healthcare providers prepare now.
While the bill introduces real challenges, it also creates a rare inflection point — a chance for healthcare leaders to convene, innovate and shape the future of care delivery.
What Providers Should Do: Embrace the Disruption, Lead the Transformation
Passage of OBBBA is not just a policy shift — it’s a call to action. What follows are near-term recommendations that providers can use to prepare for implementation in this new environment.
1. Tackle Total Margin Management
Healthcare providers must take immediate, data-driven steps to model financial impact and identify levers for value-driven performance.
2. Speed the Move to Value-Based Care Arrangements
The Medicaid and ACA cuts in OBBBA may leave hospitals with a higher share of uninsured and underinsured patients, meaning more care delivered with little or no fee-for-service (FFS) reimbursement. As a result, health systems should start to see value-based care not just as a choice, but as a survival strategy to avoid “death by a thousand cuts” in an increasingly restrictive payment landscape.
3. Deploy Technology to Optimize
In today’s resource-constrained healthcare environment, technology is no longer a nice-to-have — it’s a necessity. That’s where advanced technology, particularly AI, becomes critical.
4. Pursue Public Health Engagement
As health systems face growing pressure to improve outcomes while managing tighter margins, collaboration is rapidly becoming a financial imperative. Many health systems continue to build and operate community-facing programs that overlap significantly with services already provided by both payers and local health departments (LHDs). Such initiatives include maternal health outreach, immunizations, home visits and health education. While well-intentioned, this duplication is both costly and inefficient.
Continue Reading the 4 Key Strategies for turning disruption into opportunity from Premier HERE.