The House passed a sweeping tax-and-spending cuts bill Thursday that would dramatically reshape the healthcare system by slashing more than $1 trillion from Medicaid and other programs. The majority Republican lower chamber voted 215-214 to approve the One Big Beautiful Bill Act of 2025 just before 7:00 am after an all-night floor debate. Attention now shifts the GOP-led Senate, which has not commenced public debate on its tax measure. Congress is scheduled to begin a recess Friday and will return to Washington on June 2. These are the key healthcare provisions from the One Big Beautiful Bill Act that may impact CHCs and the patients they serve:
Medicaid
- Establishes work requirements for adult enrollees who don’t have disabilities or dependents that would begin no later than Dec. 31, 2026, and directs the Health and Human Services Department to issue guidance to states on this policy by the end of this year. Beneficiaries would have to document at least 80 hours a month of work or other qualifying activity, such as volunteering. The CBO estimated this would reduce spending by $280 billion based on an earlier iteration that wouldn’t have taken force until 2029.
- Suspends a 2024 Centers for Medicare and Medicaid Services regulation designed to ease enrollment in Medicaid, the Children’s Health Insurance Program and the Basic Health Program. Federal spending would be $82 billion lower under this policy.
- Requires eligibility redeterminations every six months for adults covered under the ACA Medicaid expansion. This would cut spending by $53 billion.
- Mandates cost-sharing up to $35 for services provided to Medicaid expansion enrollees with incomes above the federal poverty level, which is $15,650 for a single person. That is projected to reduce spending by $13 billion.
- Limits retroactive provider reimbursements for newly enrolled Medicaid recipients to one month instead of three. That is projected to save $6 billion.
- Reduces federal Medicaid funding to states that use their own money to cover undocumented immigrants through Medicaid. This would cut spending by $11 billion.
Health Insurance Exchanges
- Institutes stricter eligibility and income verifications for exchange customers and requires new checks for low-income enrollees with zero-premium plans. This would save $101 billion.
- Shortens open enrollment period by one month.
- Ends permanent special enrollment opportunity for people with incomes up to 150% of poverty and bars federal and state exchanges from establishing special enrollment periods linked to income.
- Bans gender-affirming care as an Essential Health Benefit under the ACA as well as Medicaid and CHIP coverage of these services. This would reduce spending by $830 million.
Pharmacy Benefit Managers
- Requires greater transparency for PBMs in Medicare Advantage and Medicare Part D.
- Bans spread pricing, a practice under which a PBM charges more for a medicine than the price it secured from the drug company. This would save $3 billion.
NACHC and PACHC are analyzing the bill. Questions? Contact Eric Kiehl, PACHC Director, Policy and Partnership