Dr. Erkan Hassan

Monthly Writings

Evaluations and reviews of the latest in the field.

The 4 Major Areas of Healthcare Impact of the Big Beautiful Bill Act

After reading this article, you will be able to realize the immediate and long-term negative clinical and financial complexities of the new law on healthcare.

SUMMARY:

  • Major rollbacks to Medicaid and the Affordable Care Act subsidies are the main targets of the Bill

  • Millions will lose insurance coverage

  • A financial strain will be placed on all states, hospitals, and providers as they lose Medicaid revenue

  • The full impact will not be known for years

COMMON PAIN POINTS

  • Significant reductions in reimbursement

  • Millions of uninsured patients needing uncompensated care

  • Limiting health services, care delays, longer wait times (especially in ED)

REVIEW

  • The Bill decreases Medicaid payments to:

    • States by $863 Billion over 10 years

    • Hospitals by $321 Billion over 10 years

    • Physicians by $81 billion

    • Prescription payments by $191 Billion

  • The changes will result in an estimated  loss of insurance in 11.8 to 16 million individuals

  • The Bill will shift the cost of care from the federal government to providers and local governments.

    • Translates into more uninsured patients, more uncompensated care, and more medical debt.

    • The Congressional Budget Office estimates the Bill will add $3.3 trillion to the national deficit.

    • Medicaid funding changes are not scheduled to take effect until 2028.

    • Work requirements are to begin no later than December 2026.

    • Two rules are delayed until 2035:

      • Reduced barriers to enrollment in the Medicare Savings Program (MSPs), which help low-income Medicare participants with Medicare premiums

      • Streamline application and enrollment in Medicaid

  • The Work Requirement

    • Accelerated into 2026

    • Medicaid participants aged 19-64, who are childless, without disabilities, and parents of children over age 14, must work, volunteer, or attend school at least 80 hours per month, unless they qualify for exemption.

  • The impact of the Bill:

    • Estimates range from 11.8 to 16 million people will lose health insurance by 2034

    • Severely restricts how states pay for their share of Medicaid costs

    • Creates several new bureaucratic hurdles

    • Rural hospitals are heavily dependent on Medicaid revenue.

    • Estimated rural hospitals will lose $50.4 billion in 10 years and 1.8 million rural residents will lose coverage.

Savvy Approaches

  • Doing nothing will doom you to failure

  • Operational changes are not sufficient to solve these problems.

    • ED Wait times and overcrowding will worsen

    • Rural hospitals with already thin margins will be under greater financial pressure

    • Safety net hospitals will provide an increased level of uncompensated care

  • Larger strategies are needed to address the uncompensated care provided.

  • Requires a multifaceted approach

  • Innovation and analytics

  • Goals are to:

    • Improved care delivery mechanisms

    • Control expenses

    • Increase efficiency - Lower cost sites of care

    • Maximize profitable service lines

    • Decreased prices of basic services

    • Revenue cycle management – identify underpayments

  • Since costs are being shifted to states, their options are:

    • Raise taxes

    • Eliminate other services

    • Make deeper cuts into the state run Medicare program

CONCLUSIONS:

  • Elimination of the Affordable Care Act premium subsidies with financial loss to providers and loss of insurance coverage to 5 million individuals

  • Up to 16 million individuals will lose insurance coverage, particularly low-income individuals.

  • Cost shifting to individuals

  • Largest impact on safety net hospitals, rural hospitals, children's hospitals, and community health centers

  • Full impact will not be known for years

  • To be successful, must start addressing possible solutions now.

Get started with one of the following “NO” responses:

1. No obligation initial consultation - let’s have a brief chat

OR

2. No Thanks, I’ll go it alone

Erkan Hassan